Search Results (254)

Objectives: To primarily determine the effect of a previous cesarean section on Doppler studies of the uterine artery, umbilical artery, and umbilical vein. Patients and Methods: This prospective study was conducted on singleton pregnancies between 18 and 22 weeks of gestation, including both women with and without a previous cesarean section. Doppler studies of the uterine artery, umbilical artery, and umbilical vein indices were performed during mid-trimester fetal ultrasound scans. Doppler indices and pregnancy outcomes were compared between the two groups. Results: A total of 351 pregnancies, including 74 women with a previous cesarean section and 277 women with an unscarred uterus, underwent Doppler studies. The uterine artery pulsatility index (PI) and resistance index (RI) were significantly higher in women with a previous cesarean section (p < 0.001). Moreover, both univariate and multivariate analyses demonstrated that a previous cesarean section was significantly associated with an increase in uterine artery PI, RI, and the rate of abnormal uterine artery PI, defined as values above the 95th percentile (p = 0.034). Other Doppler study results, as well as pregnancy outcomes, were comparable between the two groups. Conclusions: Pregnant women with a previous cesarean section have significantly higher uterine artery resistance, and a higher rate of abnormal uterine artery PI during mid-pregnancy. Therefore, a cesarean section may be detrimental to uterine arterial health. However, no significant adverse clinical outcomes were observed. Full article

Introduction: Gestational physiology is characterized by an expansion of plasma volume and an elevation in cardiac output. Given the scarcity of existing data on pregnancy-related left atrial (LA) volumetric and functional features, this study aims to define LA volumes, volume-based functional properties and strains in healthy subjects during mid-term pregnancy. Methods: The present study comprised 19 healthy women in mid-term pregnancy (mean age: 30.5 ± 2.7 years, weight: 81.7 ± 14.0 kg, height: 166.9 ± 5.7 cm) without any symptoms, known diseases or other conditions, which could affect the results. Their results were compared to those of 43 healthy non-pregnant women (mean age: 28.6 ± 4.9 years, weight: 59.9 ± 8.5 kg, height: 167.8 ± 7.6 cm). All participants underwent comprehensive two-dimensional Doppler echocardiography with three-dimensional speckle-tracking echocardiography (3DSTE). Results: Thicker interventricular septum, increased left ventricular ejection fraction and impaired early and late transmitral flow velocities could be detected in healthy pregnant subjects as compared to those of non-pregnant individuals. End-systolic maximum LA volume was increased with elevated stroke volume and emptying fraction. While early diastolic LA volume was preserved with elevated stroke volume and emptying fraction, late diastolic LA volume, stroke volume and emptying fraction remained unchanged. However, indexed LA volumes did not differ between the groups. Among end-systolic peak global LA strains, only LA longitudinal strain (LS) was increased, while all others remained unchanged. Among regional strains, basal, midatrial and superior LA circumferential strain (CS) and LA-LS were increased except for basal LA-CS, which was impaired. Among late diastolic LA strains at atrial contraction, none of them showed any significant changes in healthy pregnant subjects compared with those of non-pregnant women. Conclusions: With a detailed 3DSTE study, elevated end-systolic LA volume and preserved diastolic LA volumes, together with enhanced end-systolic LA reservoir and early diastolic LA conduit functional properties, could be detected with features of preserved late diastolic booster pump function in healthy women during mid-term pregnancy (second trimester). When comparing indexed LA volumes, no significant difference could be confirmed between the pregnant and non-pregnant groups. This suggests that the increased end-systolic LA volume may be an adaptation to increased body weight. Full article

Introduction. Pregnancy is characterized by a significant expansion of plasma volume and an increase in cardiac output, necessitating structural and functional adaptations of the cardiac chambers, including the right atrium (RA). To evaluate these changes, three-dimensional (3D) speckle-tracking echocardiography (STE) was used as a validated and sophisticated modality for the concurrent assessment of RA volumetric and functional alterations. This study aimed to characterize RA volumes, volume-based functional indices, and strain parameters in healthy women during mid-gestation, compared with a cohort of non-pregnant controls. Methods. This retrospective cohort analysis included 20 healthy, asymptomatic women in their second trimester (mean age: 29.9 ± 3.0 years; weight: 81.2 ± 14.2 kg; height: 166.9 ± 5.8 cm; body surface area [BSA]: 1.95 ± 0.17 m²). The control group consisted of 30 age-matched healthy non-pregnant women (mean age: 29.9 ± 4.1 years; weight: 58.7 ± 6.5 kg; height: 166.0 ± 5.4 cm; BSA: 1.68 ± 0.11 m²). All subjects underwent comprehensive two-dimensional Doppler echocardiography and 3DSTE. Results. Early and late diastolic RA volumes were significantly reduced, despite preserved end-systolic RA volume. Pregnant subjects exhibited reduced active RA stroke volume and increased passive RA emptying fraction, while all other parameters remained comparable between the groups. No significant differences were observed between groups in end-systolic peak RA global or mean segmental strains, nor in RA strains measured during atrial contraction. However, end-systolic peak regional RA strain analysis revealed decreased basal RA circumferential strain (CS) and increased superior RA-CS in pregnant participants compared with controls. Furthermore, during late diastole (at atrial contraction), superior RA-CS, RA-3D strain, and RA-area strain were significantly higher in healthy pregnant subjects than in controls. Conclusions. Substantial regional changes in RA function were detected by 3DSTE, likely reflecting adaptation to pregnancy-induced plasma volume expansion, and resulting in significant RA volumetric changes. Full article

Objective: To investigate whether gestational diabetes mellitus (GDM), including insulin-treated GDM, affects cerebroplacental ratio (CPR) values in monochorionic diamniotic (MCDA) twin pregnancies. Methods: This retrospective single-center cohort study included a total of 262 MCDA twin pregnancies managed at a tertiary referral center, comprising pregnancies without GDM (n = 120), with diet-controlled GDM (n = 80), and with insulin-treated GDM (n = 62). Doppler ultrasound examinations were performed at three gestational time points between 24 and 36 weeks of gestation. CPR, umbilical artery pulsatility index (UA-PI), and middle cerebral artery pulsatility index (MCA-PI) were compared longitudinally between groups. Doppler indices were compared between groups without adjustment for baseline differences such as BMI and parity Results: Maternal body mass index was significantly higher in pregnancies complicated by GDM, particularly in those requiring insulin therapy (p < 0.001). Estimated fetal weight was higher in the insulin-treated GDM group at mid-gestation (28–32 weeks; p = 0.01). However, CPR values remained within normal ranges throughout all screening points across all three groups. No relevant differences in UA-PI, MCA-PI, gestational age at delivery, Apgar scores, or umbilical cord pH were observed between groups. Conclusions: In MCDA twin pregnancies, gestational diabetes—regardless of insulin treatment—does not appear to significantly influence cerebroplacental ratio values throughout gestation. No statistically significant differences in CPR values were observed between groups. No statistically significant differences in CPR values were detected between groups. However, given the exploratory design and lack of adjustment for confounders, subtle effects cannot be excluded. The clinical utility of CPR in this population requires further investigation. Full article

The timing and nature of gestational stress can alter offspring immune function and hypothalamic–pituitary–adrenal (HPA) axis regulation, yet the role of maternal stress history remains poorly understood. This study evaluated the effects of prenatal stress, maternal stress history, and repeated stress exposure on immune and stress reactivity in prenatally stressed (PS) gilts across two farrowings. Eleven PS second-parity sows (197.27 ± 19.22 kg) were sampled at multiple timepoints and compared with their maternally stressed (MS) dams. During the second pregnancy, PS sows received the same maternal treatment as their dams: placebo (CON) or hydrocortisone acetate (HCA) administered twice daily for 21 days during mid (M; d 51–72) or late (L; d 81–102) gestation. Data were analyzed using mixed models with repeated measures in SAS (Version 9.4). During the first pregnancy, PS gilts in the L-HCA group exhibited higher lymphocyte proliferation indices and plasma cortisol concentrations than MS dams (p < 0.05). In the second pregnancy, dehydroepiandrosterone sulfate concentrations were lower in PS sows in the M-HCA group than the CON sows (p < 0.05). Overall, cortisol concentrations were lower in PS sows than PS gilts (p < 0.05), suggesting that maternal stress history modifies physiological responses to gestational stress, though this interpretation is constrained by the small sample size. Full article

Background: Iodine deficiency during pregnancy remains a leading cause of preventable neurodevelopmental impairment worldwide, yet quantitative characterization of the dose–response relationship between maternal iodine status and child neurodevelopment is lacking. Methods: A systematic search of PubMed, Embase, the Cochrane Library, and Web of Science was conducted for prospective cohort studies published up to February 2026 reporting associations between maternal iodine status and child neurodevelopmental outcomes across at least three exposure categories. All continuous effect estimates were converted to standardized mean differences (Hedges’ g) to permit pooling across heterogeneous assessment instruments, and meta-analyses were stratified by neurodevelopmental domain (cognitive, language, motor, behavior, academic). A two-stage dose–response meta-analysis was used to characterize non-linearity. Risk of bias was evaluated using the Newcastle–Ottawa Scale (NOS). Results: Ten prospective cohort publications corresponding to eight independent cohorts were included. After converting all continuous effect estimates to standardized mean differences (Hedges’ g) and consolidating the three overlapping MoBa publications into a single cohort, the pooled analysis revealed a significant negative association between suboptimal maternal iodine status and child neurodevelopmental performance (Hedges’ g = −0.13, 95% CI: −0.20 to −0.06, p < 0.001; I² = 95.2%). Domain-stratified analysis identified cognitive outcomes as most consistently affected (g = −0.22, 95% CI: −0.30 to −0.14; I² = 37.5%), followed by motor (g = −0.17; I² = 0%) and language outcomes (g = −0.16; I² = 92.5%), with between-domain heterogeneity explaining 38.6% of the total variance (p = 0.012). Binary outcome analysis confirmed increased odds of adverse neurodevelopmental outcomes (OR = 1.19, 95% CI: 1.03 to 1.39, p = 0.026). Subgroup analysis by iodine exposure indicator showed directionally consistent negative effects across dietary intake (g = −0.11), UIC (g = −0.11) and UI/Cr (g = −0.28), with no significant between-subgroup difference (p = 0.237). Exploratory dose–response modeling on the Hedges’ g scale suggested that neurodevelopmental performance in the fitted curves approached its maximum within a mid-range of dietary iodine intake (approximately 150–300 µg/d); however, the quadratic non-linearity terms did not reach statistical significance after cohort consolidation (p = 0.612 for dietary intake; p = 0.436 for UI/Cr), and these findings should therefore be interpreted as exploratory. Conclusions: Suboptimal maternal iodine status during pregnancy was associated with modest decrements in child neurodevelopmental performance, with exploratory dose–response analyses suggesting that the fitted curves approached their maximum within a mid-range of dietary iodine intake. Although statistical evidence for quadratic non-linearity was attenuated after consolidating overlapping cohorts, the directional pattern across indicators remained consistent with an inverted U-shaped relationship, supporting maintenance of adequate but not excessive iodine nutrition during pregnancy. Full article

Pregnancy involves major cardiovascular adaptations, yet its long-term impact on maternal brain health remains poorly understood. The American Heart Association’s Life’s Simple 7 (LS7) and Life’s Essential 8 (LE8) are validated tools to assess cardiovascular and brain health, but their use in obstetric populations is limited. Following PRISMA-ScR guidelines, we searched three databases (2010–2024) for studies assessing ≥ 1 LS7/LE8 component during pregnancy with mid- or later-life cognitive or dementia outcomes; narrative synthesis and meta-analyses were conducted where feasible. Of 3940 screened abstracts, 30 studies met the inclusion criteria. Most examined hypertensive disorders of pregnancy (HDP), few assessed diabetes independently, and none evaluated the full LS7/LE8 construct. Meta-analyses showed that HDP was associated with increased risk of all-cause dementia (HR 1.34; 95% CI 1.11–1.62) and vascular dementia (HR 1.76; 95% CI 1.03–3.00; n = 3 studies), but not Alzheimer’s disease (HR 1.22; 95% CI 0.96–1.56). Although LS7/LE8 are established frameworks for cardiovascular and brain health, their application during pregnancy remains limited. Integrating LE8 into obstetric care may enable earlier identification of individuals at risk for later-life cognitive decline and inform strategies to promote maternal brain health across the lifespan. Full article

Systemic lupus erythematosus (SLE) is an autoimmune disease that predominantly affects women of childbearing age, and active disease during pregnancy is associated with increased maternal and fetal morbidity. Belimumab is an effective biologic therapy for active SLE; however, its use during pregnancy has long been limited by the scarcity of safety data. Recent evidence and updated international recommendations suggest that belimumab may be considered in selected cases when required to maintain maternal disease control. We report the case of a woman with SLE who experienced three consecutive pregnancies with live births between 2019 and 2024 while receiving belimumab, allowing an intra-individual comparison of different exposure strategies. During the first pregnancy, belimumab was discontinued at conception and was followed by a disease flare in late pregnancy and postpartum. In the second and third pregnancies, belimumab was continued until gestational week 20 following shared decision-making with the patient; nevertheless, disease flares occurred during the third trimester of both pregnancies. All pregnancies resulted in live births at term, with no congenital anomalies, placental insufficiency, or fetal growth restriction. One neonate from the third pregnancy developed early-onset neonatal sepsis and meningitis, which resolved completely after antibiotic treatment. All children are currently growing and developing normally. This case supports a risk-adapted approach to belimumab use during pregnancy. In selected women with SLE at high risk of disease reactivation, continuation of belimumab until mid-gestation may contribute to improved maternal disease control without evident adverse fetal outcomes. Full article

Pregnancy in dairy cattle is characterized by marked metabolic adaptations that may influence oxidative balance. In this study, oxidative stress markers and thiol–disulfide homeostasis were evaluated in transported and non-transported Holstein heifers during the last trimester of gestation. Clinically healthy 2-year-old heifers were divided into transported pregnant (n = 21) and non-transported pregnant (n = 9) groups. Blood samples were collected from the jugular vein approximately 90 days (3 months) after the mid-gestation transport event. These samples were analyzed for total antioxidant capacity (TAC), total oxidant status (TOS), oxidative stress index (OSI), malondialdehyde (MDA), native thiol (NTL), total thiol (TTL), and disulfide levels. Total oxidant status and oxidative stress index values were significantly higher in the non-transported group (p < 0.05). However, no significant differences were observed between groups in total antioxidant capacity, malondialdehyde, or thiol–disulfide parameters (p > 0.05). These findings suggest that metabolic adaptations specific to late gestation may influence systemic oxidant levels independently of transport exposure. Under the conditions of this study, transport did not induce a marked redox imbalance in pregnant Holstein heifers. Full article

The slaughter of pregnant pigs raises legal, ethical, and animal welfare concerns in pig production. Relevant information for this overview was compiled from research identified through searches of PubMed, Web of Science, and Google Scholar using defined combinations of search terms related to pregnancy, slaughter of sows, fetal age, gestational stage, and prevalence. No lower time limit for publication year was predefined; publications published up to 2025 were considered. Regulations vary widely between countries, with some specifying clear restrictions for animals in late gestation, while many provide no stage-specific limits. Reasons for culling include economic pressures, management practices such as unrecognized pregnancies and mixed-sex housing, and health or welfare issues. In Europe, the prevalence of sows being pregnant at slaughter ranges from 1.5% to 13%, with most fetuses being in the first or second trimester and a small proportion in the final trimester. In Africa, prevalence is higher and more variable, ranging from 9% to 36.14%, with a larger share of fetuses in mid to late gestation. Data from America is limited, reporting prevalences between 5.9% and 13.5%. The comparability of prevalence estimates is limited due to high heterogeneity and differences in study design. Fetal age can be assessed using metric or non-metric methods, applied either postmortem or in vivo (for example, ultrasonography). Variations in study design, methodology, and population characteristics restrict direct comparability. For legal enforcement and veterinary inspection, reliable fetal age assessment is important, and updated fetometric reference values could contribute to a more consistent interpretation of fetal age. Full article

This study addresses the challenge of the difficult identification of organ structures in the standard sections of fetal abdominal ultrasounds. A deep learning-based multi-task model named SEG-FAUSP was developed to segment the core anatomical structures of seven key fetal abdominal ultrasound sections. We collected fetal abdominal ultrasound images from pregnant women in the mid-pregnancy period (18–24 weeks) using various mainstream ultrasound devices, and professional physicians annotated key anatomical structures (e.g., umbilical veins, gastric bubbles, spine) in the images. Based on an improved deep learning framework, the model accurately segments and locates the target organ structures through a parallel dual-branch semantic segmentation network, which avoids the over-reliance on large-scale pre-trained data in traditional methods. Experimental results show that the model achieves excellent performance in anatomical structure segmentation, with the intersection over union of the bladder and gastric bubble both reaching above 0.84; its segmentation accuracy for complex structures such as the inferior vena cava is also significantly superior to the baseline model. As an end-to-end model, it simplifies the clinical interpretation process of fetal abdominal ultrasound, reduces the risk of missed diagnoses caused by unclear organ identification, provides an efficient auxiliary tool for prenatal screening in grassroots medical institutions, and is of great significance for improving the quality of newborns. Full article

Background/Objectives: In pregnancy, beta-cell function is of interest since not only insulin resistance but also beta-cell dysfunction is common, especially when gestational diabetes mellitus (GDM) occurs. Typically, model-based beta-cell function is assessed with (at least) five-sample oral glucose tolerance test (OGTT). The aim of this study was to investigate whether the clinically common three-sample OGTT is sufficient for model-based beta-cell function assessment in pregnancy. Methods: We studied a group of pregnant women undergoing a 2 h five-sample OGTT with glucose, insulin, and C-peptide measurement at early and/or mid-pregnancy, for a total of 152 OGTTs. The five-sample OGTT was used for model-based beta-cell function assessment, yielding three beta-cell function parameters, i.e., glucose sensitivity (GSENS), potentiation factor ratio (PFR), and rate sensitivity (RSENS). GSENS, PFR, and RSENS assessment was repeated with the three-sample OGTT (at 0, 60, 120 min) and related values were compared to those from the five-sample OGTT (reference). Results: We found that, for GSENS, regression and Bland–Altman analyses showed satisfactory results (conditional and marginal R² values: 0.56 and 0.75, p < 0.0001, and limits of agreement containing 94.2% of samples). Moreover, five-sample and three-sample OGTT GSENS versions were fully consistent in patient subgroup analyses. Results for PFR were less satisfactory but acceptable, whereas those for RSENS were not reliable. Conclusions: The three-sample OGTT is acceptable for model-based beta-cell function assessment in pregnancy, although not for all parameters. Our methodology may be used to explore the effect of time sample reduction in other in-silico models. Full article

Background: Although there is substantial research into individual nutrients during pregnancy, such as folate, iron, and vitamin D, little is known about the impact of mixtures of essential nutrients. We investigated the associations between mixtures of maternal essential minerals and vitamin concentrations and child cognition and executive functions at age 7. Methods: Data from 348 mother–child pairs in the Growing up in Singapore Towards Healthy Outcomes birth cohort with both plasma nutrient and neurodevelopmental outcome data were used. Gestational fasting plasma samples between 26 and 28 weeks of gestation were analyzed for 10 essential minerals and 12 B and D vitamers. Child cognition and executive functions at 7 years were assessed using the Wechsler Abbreviated Scale of Intelligence 2nd Edition (WASI-II) [n = 331] and the Behavior Rating Inventory of Executive Function 2nd Edition (BRIEF-2) [n = 348], respectively. Generalized weighted quantile sum regression (gWQS) was used to investigate the associations between nutrient mixtures and child cognitive executive function scores. Single-nutrient analysis using covariate-adjusted multivariable regressions was performed as a sensitivity analysis. Results: A one-quartile increase in the positively weighted nutrient mixture index was associated with higher block design T-scores (β = 2.17, 95% CI: 0.03, 4.31). Additionally, the negatively weighted mixture was associated with lower block design (β = −2.25, 95% CI: −4.92, 0.41, p = 0.02) and perceptual reasoning (β = −1.94, 95% CI: −5.17, 1.29, p = 0.04) scores in boys only. We found no association between the nutrient mixture and BRIEF-2 subscale T-scores. Conclusions: In this study, we found that a positively weighted nutrient mixture index of maternal gestational minerals and vitamins was associated with a greater ability in children to analyze and understand abstract visual items. Full article

Preeclampsia (PE), fetal growth restriction (FGR), and gestational diabetes mellitus (GDM) complicate approximately 15–20% of pregnancies and represent major contributors to perinatal morbidity, mortality, and long-term cardiovascular risk in offspring. Increasing evidence from longitudinal cohort studies indicates that adult cardiovascular disease, including hypertension, coronary artery disease, and stroke, may be programmed in utero through early alterations in fetal cardiac structure and function. Two-dimensional speckle-tracking echocardiography (2D-STE) has emerged as the most sensitive non-invasive technique for detecting subclinical myocardial deformation, often preceding abnormalities detected by conventional Doppler or biometric parameters. While numerous third-trimester studies have demonstrated impaired global longitudinal strain (GLS), altered ventricular geometry, and diastolic dysfunction in established disease, data from mid-gestation (18–28 weeks), the critical preclinical window, remain extremely limited. Therefore, this review aims to systematically synthesize the available evidence on fetal cardiac deformation parameters assessed by 2D-STE at mid-gestation in pregnancies that subsequently developed PE, FGR, or GDM, in order to identify the earliest detectable signatures of fetal cardiovascular programming and highlight key knowledge gaps that must be addressed prior to clinical implementation. Full article

Objectives: Global infertility rates are rapidly increasing. Assisted reproductive technologies combined with artificial intelligence are the next hope for overcoming infertility. In vitro fertilization (IVF) is gaining popularity owing to its increasing success rates. The success rate of IVF essentially depends on the assessment and inspection of blastocysts. Blastocysts can be segmented into several important compartments, and advanced and precise assessment of these compartments is strongly associated with successful pregnancies. However, currently, embryologists must manually analyze blastocysts, which is a time-consuming, subjective, and error-prone process. Several AI-based techniques, including segmentation, have been recently proposed to fill this gap. However, most existing methods rely only on raw grayscale intensity and do not perform well under challenging blastocyst image conditions, such as low contrast, similarity in textures, shape variability, and class imbalance. Methods: To overcome this limitation, we developed a novel and lightweight architecture, the microscopic multimodal interaction segmentation network (MiMics-Net), to accurately segment blastocyst components. MiMics-Net employs a multimodal blastocyst stem to decompose and process each frame into three modalities (photometric intensity, local textures, and directional orientation), followed by feature fusion to enhance segmentation performance. Moreover, MiMic dual-path grouped blocks have been designed, in which parallel-grouped convolutional paths are fused through point-wise convolutional layers to increase diverse learning. A lightweight refinement decoder is employed to refine and restore the spatial features while maintaining computational efficiency. Finally, semantic skip pathways are induced to transfer low- and mid-level spatial features after passing through the grouped and point-wise convolutional layers. Results/Conclusions: MiMics-Net was evaluated using a publicly available human blastocyst dataset and achieved a Jaccard index score of 87.9% while requiring only 0.65 million trainable parameters. Full article