Search Results (134)

Background: Gestational diabetes mellitus (GDM) is associated with metabolic disturbance and subclinical cardiovascular changes during pregnancy and after birth. Optimal glycaemic control remains challenging for many patients despite existing management strategies. Ursodeoxycholic acid (UDCA) has shown potential metabolic effects, including enhanced insulin sensitivity and anti-inflammatory effects. Previously, we demonstrated that UDCA improves glycaemic control in women achieving higher circulating UDCA concentrations; however, its effect on maternal cardiac function remains unknown. The objective was to evaluate whether treatment with UDCA compared with placebo is associated with differences in maternal cardiac function in pregnancies complicated by GDM. Methods: In this randomized, placebo-controlled trial, 113 women with GDM were recruited, with 56 allocated to UDCA and 57 to placebo (IMIB-GU-2019-02, registration date: 17 June 2020; first participant enrolled: 3 March 2021). After measurement of maternal blood UDCA levels, 43 participants in the treatment group with levels ≥ 0.5 μmol/L were included in a per-protocol analysis. Participants had cardiac assessments at baseline, in the late third trimester (36 weeks) and postpartum. Detailed left ventricular systolic and diastolic functional indices were assessed using conventional pulse and tissue Doppler indices as well as strain imaging. Right ventricular systolic function was also assessed. Results: Baseline maternal characteristics and cardiac functional indices were comparable between the UDCA and placebo groups. In the third trimester, women treated with UDCA showed more negative left atrial strain during atrial contraction (LASct_AC) compared with placebo (p = 0.016), while no significant between-group differences were observed in conventional left ventricular systolic or diastolic parameters. In the postpartum period, UDCA treatment was associated with higher left atrial reservoir function, reflected by increased LASr_ED (p = 0.041) and LASr_AC (p = 0.036), as well as more negative left atrial conduit strain at end-diastole (LAScd_ED; p = 0.043). No consistent differences were observed in left ventricular systolic function, haemodynamic indices, or right ventricular functional parameters between the two groups. Conclusions: These findings are associated with small and time-dependent differences in reducing atrial dysfunction and improving cardiac efficiency during late pregnancy and postpartum. However, given the lack of long-term follow-up, further research is needed to determine the long-term cardiovascular relevance of UDCA in this population. Full article

This article examines the maternal healthcare experiences of ten Brazilian women during Portugal’s obstetric crisis, focusing on access, use, and quality of care throughout the perinatal and childbirth periods. Using a qualitative approach based on semi-structured interviews, this study explores women’s perceptions of the adequacy and quality of maternal healthcare, contributing to a deeper understanding of their experiences within the Portuguese health system. Thematic analysis revealed persistent barriers to accessing services, linked to limited knowledge of the healthcare system, lack of awareness of legal rights, discrimination, and other structural obstacles. Participants expressed dissatisfaction with the clarity and quality of information provided by healthcare professionals, their communication skills, and the limited access to specialized care. They also described feeling undervalued by healthcare providers and reported an absence of emotional and psychosocial support during pregnancy, childbirth, and the postpartum period. Accounts of disrespectful and abusive practices highlight the vulnerability of migrant women. This study underscores the urgent need to recognize and address migrant women’s needs. Beyond access, policies should promote equity, cultural responsiveness, and intercultural dialogue to ensure respectful, person-centered maternal care. Full article

Background. Gestational diabetes mellitus (GDM) induces maternal hyperglycemia, which may alter fetal cardiac structure and function, increasing short- and long-term cardiovascular risks. Purpose. To systematically review the evidence on the fetal cardiac structural and functional effects of GDM, to explore the diagnostic role of novel imaging and biochemical biomarkers, and to summarize the long-term cardiovascular complications associated with GDM. Materials and Methods. A systematic search of PubMed, Scopus, and Cochrane Library was conducted according to the PRISMA guidelines. All studies comparing cardiac outcomes in GDM and non-GDM pregnancies were included. Data on myocardial hypertrophy, diastolic and systolic function, imaging modalities, and biomarkers were extracted and qualitatively synthesized. Results. A total of twelve eligible studies were identified. Fetal cardiac hypertrophy and diastolic and early systolic dysfunction are common among GDM pregnancies and can be detected by dual-gate Doppler and speckle-tracking echocardiography. Abnormalities are observed in indices such as the myocardial performance index, E/A, E/e′ ratios, and global longitudinal and circumferential strain in fetuses and may persist in the neonatal period. Alterations may be more pronounced for the right ventricle compared to the left. Septal hypertrophy is associated with elevated umbilical cord pro-brain natriuretic peptide. The risk of early-onset cardiovascular disease in the progeny of diabetic mothers is 29% higher, as evidenced by population-based cohort data. Conclusions. GDM is linked to fetal cardiac remodeling and an increased long-term cardiovascular risk. Early detection and customized interventions to reduce adverse outcomes may be achieved by integrating advanced echocardiographic techniques and biomarkers into prenatal surveillance. Full article

Background/Objectives: Obstetric violence (OV) is a violation of women’s human rights during reproductive processes. Despite being the subject of debate among healthcare professionals, increasingly recognized, and legislated against in some countries, OV continues to be reproduced and normalized during training. The objective of this study was to determine the perception of OV among health sciences students and gynaecology and obstetrics residents. Methods: A cross-sectional observational study was conducted with 304 health sciences students and gynaecology and obstetrics residents in Spain. An online questionnaire was distributed that gathered information on sociodemographic variables and clinical experience and included the validated PercOV-S instrument. Descriptive and bivariate analyses were performed to explore associations between variables. Results: The overall perception of OV was moderately high (mean 3.93/5), with higher scores for visible or protocolized forms (4.27/5) than for invisible or subtle forms (2.87/5). Being a woman, being a midwifery resident, or having had personal experiences with pregnancy or childbirth increased sensitivity to OV. Clinical exposure in obstetrics and gynaecology services increased both awareness and the likelihood of witnessing OV. Twenty-eight percent of students reported having observed OV, and twenty percent reported emotional distress, even considering dropping out. Conclusions: Despite the recognition of OV, repeated exposure during training can promote its normalization. The results of this study highlight the need for safe, reflective training environments that mainstream feminist perspectives, sexual rights, and the detection of subtle forms of OV. Full article

Background: Retinal dystrophies are often challenging to diagnose. At early stages, they may resemble benign retinal pigment epithelium alterations and drusen present in otherwise healthy individuals. With the increased incidence of autoimmunity-related disorders and new treatments for retinal dystrophies on the horizon, thorough investigations and making the correct diagnosis in time are particularly important for these patients. Case report: A 44-year-old myopic female was admitted to the Ophthalmology Department with a 3-week history of painless blurred vision in her right eye. Fundoscopic examination revealed the presence of optic disc edema in this eye with pigmentary and atrophic changes in the macular regions of both eyes. She had no prior ophthalmic history nor systemic comorbidities known at the time. Marked hyperglycemia and renal angiomyolipoma were discovered subsequently. Ultimately, a diagnosis of Maternally Inherited Diabetes and Deafness was made. Discussion and Conclusion: Maternally Inherited Diabetes and Deafness is a rare mitochondrial disorder that should be considered in the differential diagnosis of retinal dystrophies, particularly due to multi-organ syndromes they can occur with, requiring collaborative medical care of several specialists. Integrating the findings and comparing them with other online sources facilitates clinical differential and treatment selection, eventually promoting faster accurate diagnosis of patients. It is especially important because of a long waiting time for results of genetic testing, while ophthalmic pathology can be the first sign of the disease. Full article

Background/Objective: Human milk is an irreplaceable source of nutrition and is essential for the infant’s growth and development right after birth and for early life stage survival. This study aims to characterize and compare the metabolite profiles of colostrum and transitional and mature milk using an untargeted GC-MS approach. Additionally, it explores potential correlations between the identified metabolites and maternal nutritional factors. Methods: This was a longitudinal, prospective, and observational study. We included human milk samples from 113 Mexican women who practiced exclusive breastfeeding. Partial least squares-discriminant analysis (PLS-DA) was performed to assess differences among lactation stages. Metabolites showing significant variation across lactation stages were further analyzed using Friedman tests with post hoc Wilcoxon tests and Bonferroni correction. Correlations with maternal anthropometric measures were evaluated. Results: Twenty-three metabolites were identified, including amino acids and derivatives, sugars, fatty acids, and energetic metabolites. Alanine and creatinine levels decreased during lactation, while aspartate, serine, and valine levels increased. Rhamnose level was higher in colostrum, whereas decanoic, dodecanoic, and tetradecanoic acid levels increased over time, and that of 11,14-eicosadienoic acid decreased. Lactic acid levels declined across stages. Negative correlations were found between several amino acids and maternal anthropometric variables, while glyceric acid, rhamnose and lactic acid correlated positively. Conclusions: Human milk metabolomic profiles display distinct, stage-specific variations shaped by maternal characteristics, reflecting the dynamic physiological and nutritional demands of the developing infant Full article

Globally, women continue to die from pregnancy-related conditions that could be prevented through ensuring timely access to emergency obstetric care and facility-based deliveries supervised by skilled birth attendants. However, many women are reluctant to deliver in maternity healthcare facilities due to the widespread disrespect and abuse that patients have reportedly received. Respectful maternity care has been identified amongst the possible solutions. This study explored perceptions of respectful maternity care and the enabling conditions of a multidisciplinary group of maternity healthcare providers working at a busy, specialised public mother and child regional hospital in Gauteng, South Africa. An explorative, descriptive, and contextual study design with a phenomenological perspective was adopted. Semi-structured interviews were conducted with each of the 30 purposefully selected study participants. The interviews were digitally recorded, professionally transcribed, and analysed using Tesch’s Constant Comparison method. Two main categories, namely (1) healthcare providers’ perceptions of respectful maternity care and (2) enabling conditions for its practice emerged, encompassing seven themes: women-centred care, provision of high-quality care, preservation and promotion of women’s rights, creating an enabling environment for the practice of RMC, in-service training, accountability of healthcare providers for their actions, and community involvement. The perceptions of the study participants regarding respectful maternity care align with global standards; however, successful implementation requires the establishment of enabling conditions. Full article

Healthcare access is a fundamental human right, yet barriers often negatively impact health, particularly in developing countries like Pakistan, where maternal mortality remains a crisis. This study aimed to identify factors influencing healthcare access barriers among married women aged 15–49 years using spatial analysis. Methods: Data were drawn from the 2017-18 Pakistan Demographic and Health Survey (PDHS), which included an unweighted sample of 8127 women. Healthcare access barriers were identified as the outcome variable. Results: A spatial analysis using ArcGIS 10.7.1 and SaTScan identified clustered distributions, with concentration areas identified in Gilgit Baltistan, Khyber Pakhtunkhwa (KPK), Federally Administered Tribal Areas (FATA), Punjab, and Balochistan. SaTScan highlighted primary clusters in FATA, Southern KPK, Northern Balochistan, and Eastern Punjab. Geographically Weighted Regression identified women who had five or more living children, respondents who did not have four or more antenatal care (ANC) visits, respondents who experienced a lower income (wealth index), respondents who did not participate in decision-making, respondents with a primary education, and respondents who accepted domestic violence as the significant predictors of healthcare access barriers. Conclusions: To improve women’s healthcare access, integrated policy interventions are needed, addressing socioeconomic disparities, strengthening national health policies, empowering women, and expanding healthcare accessibility. Strengthening health insurance and economic empowerment is crucial for achieving Sustainable Development Goals. Full article

Background: Pulmonary hypertension (PH) in newborns is a rare but serious condition and potentially life-threatening disorder, often initially confused with congenital heart disease due to overlapping echocardiographic findings in the late third trimester. Evidence on prenatal predictors of postnatal PH is limited. We aimed to describe detailed third-trimester echocardiographic findings associated with postnatal PH in infants with prenatally suspected CoA based on a retrospective case series. Methods: We reviewed 18 years of fetal echocardiography (2004–2022) in a tertiary maternal–fetal–neonatal center. We identified fetuses with suspected coarctation of the aorta (CoA) in late gestation who were delivered at term (≥37 weeks) and had prolonged neonatal hospitalization (>10 days) without cardiac surgery or catheterization. Z-scores for cardiac dimensions were calculated. All examinations were performed by experienced fetal cardiologists. Postnatal evaluations confirmed PH based on echocardiographic and clinical findings. Results: Among 19,836 fetuses examined, 138 were prenatally suspected of CoA. In 70 cases, this diagnosis was not confirmed postnatally (false positives). Of these, eight infants (0.04% of the total cohort) developed postnatal PH. Postnatally, all eight neonates required intensive care. Prenatal features included ventricular/atrial disproportion (7/8), cardiomegaly (8/8), main pulmonary artery dilatation (10.2 ± 2.2 mm; Z-score +2.7 ± 1.3), tricuspid regurgitation (8/8), pulmonary regurgitation (4/8), and interventricular septal hypertrophy (>4.5 mm in 5/8). Postnatal evaluations confirmed PH based on echocardiographic criteria (elevated right ventricular pressure, septal flattening/bowing, right ventricular dilation or dysfunction, and abnormal shunt direction) combined with clinical compromise. All infants received prostaglandin E1 (PGE1) initially; none required extracorporeal membrane oxygenation-ECMO. Three died, while five survived with medical management (oxygen, inhaled nitric oxide, sildenafil). Conclusions: Specific functional abnormalities on late third-trimester echocardiography may indicate impaired pulmonary vascular adaptation and predict postnatal PH, particularly in cases initially suspected of CoA. Recognition and awareness of these findings can guide delivery planning, neonatal surveillance, and timely intervention. Prospective multicenter studies are needed to validate these associations and refine prenatal screening protocols. Full article

Background/Objectives: Respectful maternity care involves privacy, dignity, and informed choice within the process of delivery as stipulated by the World Health Organization (WHO). Informed consent is a cornerstone of patient-centered care, representing not just a formal document, but an ongoing ethical and clinical process through which women are offered objective, understandable information to support autonomous, informed decision-making. Methods: This narrative review critically examines the literature on informed consent in maternity care, with particular attention to both obstetric-led and midwifery-led models of care. In addition to identifying institutional, cultural, and systemic obstacles to its successful implementation, the review examines the definition and application of informed consent in perinatal settings and evaluates its effects on women’s autonomy and satisfaction with care. Results: Important conclusions emphasize that improving women’s experiences and minimizing needless interventions require active decision-making participation, a positive provider–patient relationship, and ongoing support from medical professionals. However, significant gaps persist between legal mandates and actual practice due to provider attitudes, systemic constraints, and sociocultural influences. Women’s experiences of consent can be more effectively understood through the use of instruments such as the Mothers’ Respect (MOR) Index and the Mothers’ Autonomy in Decision Making (MADM) Scale. Conclusions: To promote genuinely informed and considerate maternity care, this review emphasizes the necessity of legislative reform and improved provider education in order to close the gap between policy and practice. Full article

Background and Clinical Significance: Gliomas diagnosed during pregnancy are rare, and there are no established guidelines for their management. Effective treatment requires a multidisciplinary approach to balance maternal health and pregnancy preservation. Case Presentation: We here present a case of rapidly progressing glioma in a 33-year-old pregnant woman. The patient initially presented with a generalized tonic–clonic seizure at 21 weeks’ gestation. Imaging revealed a tumor in the right cerebral lobe, involving both cortical and subcortical structures, while magnetic resonance spectroscopy suggested a low-grade glioma. The patient remained clinically stable for two months but then developed severe headaches; MRI showed a worsening mass effect. At 34 weeks’ gestation, an emergency and premature caesarean section was performed under general anesthesia. The patient then underwent a craniotomy for maximal tumor resection, which was histologically and molecularly diagnosed as IDH wild-type glioblastoma (GB). Using qPCR, we found that the GB tissue showed upregulated expression of genes involved in cell structure (GFAP, VIM) and immune response (SSP1, TSPO), as well as increased expression of genes related to potential hormone response (AR, CYP19A1, ESR1, GPER1). After surgery, the patient showed resistance to Stupp protocol therapy, which was substituted with lomustine and bevacizumab combination therapy. Conclusions: This case illustrates that glioma may progress rapidly during pregnancy, but a favorable obstetric outcome is achievable. Management of similar cases should respect both the need for timely treatment and the patient’s informed decision. Full article

Background/Objectives: Conduct Disorder (CD) involves persistent behavior violating societal norms and others’ rights. A subgroup of adolescents with CD exhibits callous–unemotional (CU) traits, which are linked to severe antisocial behavior and poorer long-term outcomes. Research suggests parenting plays an important role in the development of CU traits. However, few studies have explored the role of maternal and paternal parenting practices mediating the link between CU traits and violence within the same study. Methods: This study included 222 adolescents with Conduct Disorder (M_age = 15.7, 68% male) and examined whether perceived parental warmth and hostility, measured using the Quality of Parental Relationships, mediated the association between callous–unemotional (CU) traits and youth involvement in violent crime and gun violence, assessed via the Violent Crime Assessment and Gun Violence Questionnaire. Results: Double mediation models showed that only maternal hostility mediated the link between CU traits and violence, while maternal warmth and paternal parenting practices did not. Conclusions: Findings emphasize the role of maternal hostility in exacerbating violence, including gun violence, among adolescents with CD and CU traits. Full article

Background: Among patients with congenital heart disease, particularly those with a history of undergoing the Fontan operation, pregnancy presents a significant maternal–fetal risk, especially when complicated by severe valvular dysfunction. Lung reperfusion syndrome (LRS) is a rare but life-threatening complication occurring following valve intervention. Multidisciplinary management, including by Cardio-Obstetrics teams, is essential for optimizing outcomes in such high-risk cases. Methods: We present the case of a 37-year-old pregnant patient with previously repaired tetralogy of Fallot (via the Fontan procedure) who presented at 24 weeks gestation with worsening severe pulmonary stenosis and right-ventricular dysfunction. The patient had been lost to cardiac follow-up for over a decade. She experienced recurrent arrhythmias, including supraventricular and non-sustained ventricular tachycardia, prompting hospital admission. A multidisciplinary team recommended transcatheter pulmonic valve replacement (TPVR), performed at 28 weeks’ gestation. Results: Post-TPVR, the patient developed acute hypoxia and hypotension, consistent with Lung Reperfusion Syndrome, necessitating intensive cardiopulmonary support. Despite initial stabilization, progressive maternal respiratory failure and fetal compromise led to an emergent cesarean delivery. The neonate’s neonatal intensive care unit (NICU) course was complicated by spontaneous intestinal perforation, while the mother required intensive care unit (ICU)-level care and a bronchoscopy due to new pulmonary findings. She was extubated and discharged in stable condition on postoperative day five. Conclusions: This case underscores the complexity of managing severe congenital heart disease and valve pathology during pregnancy. Lung reperfusion syndrome should be recognized as a potential complication following TPVR, particularly in pregnant patients with Fontan physiology. Early involvement of a multidisciplinary Cardio-Obstetrics team and structured peripartum planning are critical to improving both maternal and neonatal outcomes. Full article

Background/Objectives: The pubic symphysis is formed by the fusion of the right and left pubic bones. The metrics, such as breadth, length, and depth, increase during pregnancy and can be measured and analyzed using standard sonography. Obstetricians require clear and consistent criteria for standard sonography evaluation. Methods: Sonographic examinations were performed on a cohort of 225 pregnant women, aged between 23 and 41 years, as part of a prospective observational study. The parameters measured included pubic symphysis entry middle width, intertubercular distance, pubic symphysis width, and pubic symphysis depth. Results: The width of the pubic symphysis exhibited the greatest consistency, measuring between 2.2 and 11.3 mm, whereas the depth displayed the highest variability, ranging from 5.4 to 22.6 mm. The measurements most correlated with fetal weight included pubic symphysis entry width (6.5 ± 3.4 mm; p ˂ 0.001), pubic symphysis width (6.4 ± 2.9 mm; p ˂ 0.001), and depth (14.8 ± 4.8 mm; p = 0.03). The intertubercular distance exhibited the strongest correlation with maternal age (15.1 ± 5.4 mm; p = 0.03). In contrast, pubic symphysis entry width (6.4 ± 3.3 mm; p = 0.02; 6.4 ± 3.4 mm; p ˂ 0.001) and pubic symphysis width (6.3 ± 2.6 mm; p = 0.01; 6.3 ± 2.6; p ˂ 0.001) demonstrated stronger associations with maternal weight and weight gained during pregnancy, respectively. In the singular pregnancy group, the width of the pubic symphysis exhibited significant correlations with fetal weight categories: under or equal to 1000 g (4.56 ± 1.5 mm; p = 0.02), 1001–2000 g (5.51 ± 2.6 mm; p = 0.02), and more than 3000 g (7.3 ± 3.9 mm; p = 0.02). Pubic symphysis entry width is significantly correlated with fetal weight in the range of 1001–2000 g (5.5 ± 3 mm; p = 0.02) and fetal weight exceeding 3000 g (7.4 ± 3.9 mm; p = 0.02). In singular pregnancies, statistically significant differences were noted in intertubercular distance (15.9 ± 7.2 mm vs. 13.4 ± 6.2 mm; p = 0.03) when comparing fetuses weighing 2000 g or less between nulliparous and multiparous women. Conclusions: Fetal and maternal weight were the primary parameters that were positively correlated with these measurements. The term ‘pubic symphysis entry’ is proposed to describe a trapezoidal space situated superior to the pubic symphysis disc, delineated by an imaginary line connecting the bilateral pubic tubercles. Full article

Background/Objectives: This study identifies barriers to maternal and child healthcare access in Afghanistan under the Taliban and proposes solutions using the WHO Health System Building Blocks Framework. Methods: Midwives and mothers were recruited via chain-referral sampling. After obtaining IRB and the participants’ informed consent, in-depth virtual interviews, guided by Social Cognitive Theory, were recorded, transcribed, and analyzed using content analysis in MAXQDA 2020. Results: Data analysis revealed four primary consequences of the political unrest in Afghanistan that have exacerbated barriers to accessing maternal and child healthcare: (a) Taliban-imposed restrictions on women’s education and mobility, reducing female healthcare providers and limiting mothers’ access to care; (b) increased poverty, preventing women from attending perinatal visits due to out-of-pocket costs; (c) the deterioration of healthcare services, including medicine shortages, weakened health financing due to donor withdrawals, lack of insurance, and poor governance; and (d) the increased perpetuation of misinformation and harmful practices, such as the use of clergymen for medical advice instead of doctors. Using the WHO Health Systems Framework, we recommend solutions that address issues in service delivery, health workforce, health information systems, access to essential medicines, financing, and governance. Conclusions: This is the first qualitative study capturing Afghan mothers’ and healthcare providers’ experiences under Taliban rule. Our findings can inform international efforts to advocate for women’s healthcare and education rights and guide global aid programs in strengthening Afghanistan’s healthcare system in alignment with Sustainable Development Goal 5. Full article