Search Results (432)

The impact of prenatal exposure to trace metal mixtures on children’s neurodevelopment remains debated. Many studies treat all trace metals as a single entity, overlooking the distinct biological roles of essential and toxic metals. This approach may highlight overall exposure but fails to capture their differential effects on neurodevelopment. This study aims to examine the associations between prenatal exposure to essential and toxic metals and children’s cognitive development, focusing on their independent effects. A cohort of 201 mother–infant pairs was analyzed. Maternal urinary metal levels were measured at 12 weeks of gestation, and children’s neurodevelopment was assessed at 4 years using the Wechsler Preschool and Primary Scale of Intelligence and the Developmental Neuropsychological Assessment. Generalized Additive Models (GAM), Restricted Cubic Spline (RCS), and Weighted Quantile Sum (WQS) regression were applied. GAM identified non-linear associations between essential metals (manganese and molybdenum) and cognitive outcomes, including verbal comprehension index (VCI), working memory index, full-scale IQ, and general ability index, which were confirmed by RCS. No non-linear relationships were observed for toxic metals. WQS showed negative associations between toxic metals and VCI (b = −1.07), processing speed index (b = −0.98), vocabulary acquisition index (b = −1.25), and verbal fluency (b = −0.23), mainly driven by cadmium (Cd) and antimony (Sb). Essential metal mixtures were not associated with cognitive outcomes. Prenatal exposure to toxic metals negatively affects children’s cognitive and neuropsychological development. Reducing maternal exposure during pregnancy is essential for protecting offspring development. Full article

The medical condition of pregnancy-associated breast cancer (PABC) requires oncologists to determine the best way to protect both the mother and the fetus during cancer treatment. The safety profile of taxanes, including paclitaxel and docetaxel, in the second and third trimesters of pregnancy remains unclear despite well-established anthracycline-based regimens (e.g., doxorubicin). High-risk breast cancer subtypes such as triple negative breast cancer (TNBC) and human epidermal growth factor receptor (HER2)-positive disease require taxane chemotherapy as standard treatment in nonpregnant patients. Objective: This paper aims to gather available data about the safety, timing and fetal outcomes related to taxane chemotherapy during PABC, focusing on pharmacological and clinical guidance. Methods: A targeted literature review of PubMed and Scopus databases was performed to identify case series, cohort studies, and clinical guidelines addressing taxane use during pregnancy. This was not conducted as a formal systematic review or meta-analysis, but as a comprehensive narrative synthesis of available data. Results: The pharmacological properties of paclitaxel and docetaxel limit their placental transfer. Paclitaxel has not been associated with increased congenital anomalies; however, the long-term developmental data remain limited. Similarly, docetaxel administration shows no increase in major malformations. The most common approach used in PABC is to administer anthracyclines first and taxanes after 16–18 weeks’ gestation. The adverse effects experienced by pregnant patients match those experienced by nonpregnant patients. Conclusions: Taxanes can be used with caution after the first trimester in patients with PABC, especially in high-risk cases following anthracycline treatment. The absence of randomized trials combined with limited developmental data highlight the need for more standardized treatment approaches, aligning with current guideline recommendations. Full article

Background/Purpose: Reproductive health and fertility outcomes are essential but often overlooked aspects of occupational well-being. Organizational dysfunction, demanding workloads, and limited workplace accommodations may negatively affect fertility, while supportive policies and inclusive cultures can mitigate risks. This review aimed to map current evidence on these relationships and their economic consequences. Methodology/Approach: A scoping review was conducted using the PCC (Population–Concept–Context) framework. Systematic searches across multiple databases identified 30 eligible studies, including quantitative, qualitative, and mixed-method designs, spanning different sectors and international contexts. Findings: Four main domains emerged: shift work and circadian disruption, organizational stress and burnout, workplace flexibility and accommodations, and fertility-related policies and organizational support. Hazardous working conditions, long hours, and psychosocial stressors were consistently associated with impaired fertility, reduced fecundability, and pregnancy complications. Conversely, flexible scheduling, fertility benefits, and supportive organizational cultures were linked to improved well-being, retention, and productivity. Originality/Value: This review integrates evidence across occupational health, organizational psychology, and labor economics, offering a comprehensive overview of workplace influences on reproductive health. It highlights gaps in equity and representation—particularly for men, LGBTQ+ employees, and workers in precarious jobs—and calls for longitudinal, interdisciplinary, and intervention-based studies to inform effective workplace policies. Full article

The global prevalence of infertility has reached critical levels, making it one of the most pressing issues in modern society. Assisted reproductive technologies (ARTs), particularly in vitro fertilization (IVF), are the primary treatment methods for infertility. However, even under optimal conditions, the pregnancy rate per IVF cycle does not exceed 40%, while the live birth rate remains around 30%. A key unresolved challenge in ART is impaired endometrial receptivity (ER), which significantly contributes to repeated implantation failure (RIF). Advances in molecular and genetic diagnostics have revealed that gynecological conditions associated with infertility, such as chronic endometritis, uterine fibroids, polycystic ovary syndrome (PCOS), and tuboperitoneal factor infertility, are often linked to epigenetic alterations. Specifically, abnormal hypermethylation of the promoter regions of the HOXA10 and HOXA11 genes has been observed in women of reproductive age with these conditions. Such epigenetic dysregulation negatively impacts ER and is associated with infertility. The methylation status of HOXA10 and HOXA11 may serve as a potential diagnostic marker for evaluating and treating infertility. These markers can be assessed using available molecular genetic techniques, including real-time PCR. A promising therapeutic approach to improve ER involves the use of epigallocatechin-3-gallate and indole-3-carbinol, which have been shown to demethylate and restore the expression of HOXA10 and HOXA11. Epigenetic regulation holds significant potential for enhancing the effectiveness of ART programs, offering new avenues for addressing infertility and improving reproductive outcomes. This review consolidates the current body of knowledge regarding the epigenetic regulation of endometrial receptivity. It outlines fundamental scientific data on epigenetic mechanisms and discusses contemporary diagnostic and pharmacological intervention strategies. Full article

This study investigated the impact of maternal psychological factors—specifically anxiety and depression—on breastfeeding outcomes in women with high-risk and low-risk pregnancies. A total of 157 postpartum women were assessed using the State-Trait Anxiety Inventory (STAI) and the Edinburgh Postnatal Depression Scale (EPDS) at multiple time points: 3–4 days, 3 months, and 6 months postpartum. Breastfeeding duration and exclusivity were the primary outcomes. Correlation analyses showed significant negative associations between STAI scores and breastfeeding duration in both groups, with stronger effects in the low-risk group (e.g., r = −0.546, p < 0.001 at 3 months). Similarly, EPDS scores were inversely correlated with breastfeeding duration, particularly at 3 and 6 months postpartum (r = −0.272, p < 0.001 and r = −0.248, p = 0.001, respectively, in the high-risk group). Logistic regression identified EPDS scores at 3 months (p = 0.046, Exp(B) = 0.844) and STAI scores at 3–4 days postpartum (p = 0.006, Exp(B) = 0.861) as significant predictors of early breastfeeding cessation. The model explained 64.9% of the variance in the low-risk group. These findings highlight the significant influence of postpartum anxiety and depressive symptoms on breastfeeding outcomes and suggest that early screening and support for these specific psychological factors may enhance breastfeeding duration and exclusivity, particularly after high-risk pregnancies. Full article

Background: The definitions and approaches used to diagnose gestational diabetes (GD) are varied. The two-step approach recommended by the American College of Obstetricians and Gynecologists (ACOG) combines the sensitivity of a glucose challenge test (GCT) with the specificity of a 3-hour oral glucose tolerance test (OGTT). We investigated if minor modification of the two-step procedure can provide improved detection of GD by identifying a risk group of pregnant women with high risk of GD. Methods: We conducted a prospective cohort study of pregnant women enrolled early during pregnancy and followed till delivery. All participants underwent the ACOG-recommended two-step procedure for GD diagnosis. Based on GCT and OGTT results, the participants were divided into four risk groups (RGs): GCT-negative (RG0), GCT-positive but OGTT normal (RG1), single abnormal value on OGTT or raised HbA1c (RG2) and diagnosed GD (RG3). Baseline evaluation included dietary history (24 hour recall) and physical activity. A series of multivariable logistic regression analyses were conducted to estimate the odds of maternal and fetal outcomes. Results: A total of 1041 pregnant women were included in the study, of whom 16 (1.6%) were diagnosed as GD. Our two-step approach identified 48 (4.6%) women as GD, while RG2, RG1 and RG0 comprised 75 (7.2%), 218 (20.9%) and 700 (67.2%), respectively. Compared to RG0, RG2 showed a higher likelihood of antepartum complications [odds ratio and 95% confidence interval 2.38 (1.16–4.15)], any adverse outcome without [2.04 (1.17–3.55)] or with cesarean section [2.09 (1.21–3.61)] and primary cesarean section [1.68 (1.01–2.81)] after adjustment for potential confounders. RG2 was also significantly associated with pregnancy-induced hypertension, meconium-stained amniotic fluid and premature rupture of membranes. Conclusions: In the study participants, we identified a subgroup (RG2) at high risk of GD with perinatal outcomes showing profile consistent with that of GD. Full article

Background/Objectives: Alcohol and smoking during pregnancy may be associated with several complications, but the underlying mechanism is still unclear. The aim of this study was to evaluate the role of oxidative stress induced by smoking and alcohol during pregnancy and their effects on fetal and neonatal outcomes. Material and methods: We considered pregnant women at term. Validated questionnaires were used to investigate smoking and alcohol habits. Ultrasound was performed to evaluate fetal weight, amniotic fluid index, and maternal-fetal Doppler velocimetry. At the time of delivery, we collected a tuft of maternal hair, maternal venous blood, and cord blood. In these samplings we determined in phase I nicotine, cotinine, and ethyl glucuronide on the maternal keratin matrix with the gas chromatography-mass spectrometry technique. In phase II, the Free Oxygen Radicals Test (FORT) and Free Oxygen Radical Defense (FORD) test were used to assess circulating reactive oxygen species (ROS). Results: 119 pregnant patients were enrolled (n = 62 for smoking and n = 57 for alcohol). Twenty-six patients (42%) out of 62 were active smokers. Three patients (5%) out of 57 were alcoholic consumers. Mean neonatal weight and mean placental weight were significantly lower for active smokers (p = 0.0001). The neonatal weight was in the 1st–2nd percentile for all alcohol abusers. Considering two subgroups (n = 10 non-smokers and n = 10 smokers) for ROS determination, a statistically significant higher oxidative stress in the blood of smoking patients was evidenced (p < 0.0001). In cord blood the differences were not statistically significant (p = 0.2216). Conclusions: Fetal growth restriction was present in the group of active smokers and in patients with alcohol abuse. Oxidative stress was higher in smoking patients than in non-smokers. However, in cord blood, FORT was negative in all cases, suggesting a protective mechanism in utero. Given the limited sample size, the results obtained are preliminary and require future studies. Full article

Background/Objectives: The success of artificial reproductive technologies (ARTs) depends on different factors, such as patient-specific reproductive features, ovarian response to stimulation, oocyte and embryo quality, and endometrial receptivity. This study aimed to evaluate their association with oocyte yield, fertilization, endometrial thickness, and pregnancy outcomes. Methods: A prospective clinical study included 128 women undergoing IVF/ICSI. Baseline hormone levels (E2, P4, FSH, LH, AMH) were assessed prior to stimulation. E2 levels were monitored during stimulation, and P4 was measured on the day of oocyte retrieval. Patients were grouped based on P4 levels (<2 ng/mL vs. ≥2 ng/mL). IVF outcomes and endometrial characteristics were statistically analyzed. Results: Lower P4 levels (<2 ng/mL) on the day of oocyte retrieval were significantly associated with higher fertilization rates (p < 0.003), more fertilized oocytes (p < 0.001), and increased pregnancy rates (p < 0.001). Elevated P4 (≥2 ng/mL) correlated with a higher frequency of thin endometrium (<7 mm, p < 0.007). E2 levels on the hCG trigger day correlated positively with the number of retrieved and mature oocytes and fertilization outcomes (p < 0.05). Patients who achieved pregnancy had lower P4 and BMI, and higher E2, AMH, and endometrial thickness. ROC identified a P4 threshold of 1.99 ng/mL with moderate predictive value. Conclusions: Elevated progesterone levels on the day of oocyte retrieval negatively impact fertilization and pregnancy outcomes, likely due to impaired endometrial receptivity. Combined assessment of P4, E2, AMH, and endometrial thickness may enhance embryo transfer planning and improve IVF success rates. Full article

Background: Fetal growth restriction (FGR) is associated with increased perinatal morbidity and mortality, yet optimal intrapartum management remains debated. The contraction stress test (CST) has been proposed as a tool to assess fetal tolerance to labor, but its prognostic value in FGR pregnancies is unclear. This study aimed to evaluate the utility of CST in predicting perinatal outcomes among term fetuses with FGR and to compare these outcomes with those of small-for-gestational-age (SGA) fetuses. Methods: We conducted a retrospective cohort study of term singleton deliveries at a tertiary care center over a two-year period. FGR was defined as birthweight below the 3rd percentile or, prenatally, below the 10th percentile with abnormal Doppler findings. SGA fetuses were defined as birthweights between the 3rd and 10th percentiles. Participants were stratified into the following three groups: (1) FGR with a negative CST result, (2) FGR without CST, and (3) SGA without FGR. The primary outcome was the rate of emergency cesarean delivery. Secondary outcomes included a composite of neonatal adverse events (Apgar score < 7 at 5 min, umbilical cord pH < 7.1, NICU admission, prolonged neonatal hospitalization, intubation, or intraventricular hemorrhage) and a combined metric of neonatal and maternal adverse events. Results: A total of 1688 term singleton pregnancies were included in this analysis, comprising 33 cases of FGR with negative CST results, 275 cases of FGR without CST, and 1123 cases classified as SGA. Emergency cesarean delivery rates were comparable between FGR with negative CST (15.2%) and FGR without CST (14.9%), both were significantly higher than in the SGA group (9.7%, p = 0.025). Composite neonatal adverse events did not differ significantly between the FGR groups (21.2% vs. 24.7%) but were more frequent than in the SGA group (8.1%, p < 0.001). Similarly, the incidence of combined neonatal and maternal adverse events was not different between the FGR groups (30.3% vs. 33.5%) yet exceeded that of the SGA group (15.1%, p < 0.001). Conclusions: In this cohort, a negative CST performed prior to labor induction did not reduce the risk of adverse maternal or neonatal outcomes in pregnancies complicated by FGR. These findings indicate that routine use of CST may offer limited prognostic benefit in the evaluation of term FGR, highlighting the necessity for further studies to establish evidence-based surveillance and management strategies for this high-risk group. Full article

Introduction: Globally, approximately 53 million children under the age of five live with some form of developmental disability. Exposure to heavy metals has been identified in the literature as a contributing factor in the etiology of neurodevelopmental disorders, however it usually is understudied. Even at low concentrations, these toxicants pose a risk to neurodevelopment, when affecting children early as in the prenatal period. This study aims to systematically review the literature on the associations between exposure to toxic heavy metals and neurodevelopmental outcomes in children. Method: The review was registered at the International Prospective Register of Systematic Review-PROSPERO, under number CRD420250653229 and searches were conducted in the PubMed, Scopus, Web of Science, EMBASE, Lilacs and PsycInfo databases. Results: A total of 68 articles were included, comprising 48 longitudinal studies and 20 cross-sectional studies, published between 2006 and 2025, with a combined sample of 215,195 individuals from 23 countries. Lead was the most consistently investigated metal, appearing in 75% of the studies, followed by mercury, cadmium, and arsenic. Most findings referred to prenatal exposure. Cognitive and motor outcomes were predominantly affected by exposure to Pb and Hg, while behavioral outcomes showed negative associations mainly with Pb and As. Conclusions: The majority of the studies analyzed indicated adverse effects resulting from exposure to heavy metals during pregnancy, especially in the early months, highlighting the vulnerability of the developing brain. Full article

Background/Objectives: Adolescent pregnancies are associated with negative outcomes of health and social and economic consequences for both the mother and child. The aim of this audit was to determine the incidence of gynaecological complications and adverse social determinants of health affecting pregnant women less than 20 years old at the time of delivery in Stoke-on-Trent, with the goal of improving local and national trust guidelines. Methods: A retrospective case note review was conducted using electronic databases. Subjects had to be under the age of 20 years old at the time of delivery at our local tertiary hospital from January 2020 to December 2022. Results: Four hundred and seventy-three women met the inclusion criteria. The median age was 18 years old (range: 13–19 years). Most women delivered at term (mean 38⁺³), were primigravida (76%), and underwent spontaneous delivery (43%). Both our induction rate of 28.2% and caesarean section rate of 18.4% were below the national averages. Complications of post-partum haemorrhage and low birth weights exceeded the national averages, with third- to fourth-degree perineal tears just below the national incidence rate of 2.9%. Negative social determinants of health included smoking, mental illness, and low breastfeeding rates. Our mean 3-year breastfeeding rate was 24.3%. Conclusions: This single-centre audit at a large tertiary hospital has demonstrated that women under the age of 20 years old in socially deprived areas of the UK are more likely to experience negative gynaecological and social outcomes from their pregnancies compared to areas of low deprivation within the UK. Full article

Tuberculosis remains a serious infectious disease that causes over 1.3 million deaths annually. Following the COVID-19 pandemic, the global incidence of tuberculosis has increased to 10.8 million cases. Pregnant women represent a particularly vulnerable population requiring tailored approaches to the prevention, diagnosis, and treatment of tuberculosis. SARS-CoV-2 infection may have impacted existing clinical protocols. Implementing updated methods of tuberculosis prevention, diagnosis, and treatment in pregnant women could help reduce adverse maternal and fetal outcomes. The aim of this review was to explore potential modifications in tuberculosis management among pregnant women in the post-COVID-19 era, including co-infection with SARS-CoV-2. Methods: A review was conducted, incorporating a systematic literature search across major international databases, including Medline, PubMed, Web of Science, Scopus, and Google Scholar. The search covered publications released between December 2019 and September 2024 and used targeted keywords such as “COVID-19” OR “SARS-CoV-2”, “tuberculosis” OR “TB” OR “latent tuberculosis infection” OR “pulmonary tuberculosis”, and “pregnancy” OR “pregnant women”. Results: Pregnant women living with HIV are at increased risk of developing tuberculosis, which can negatively affect both maternal and perinatal outcomes. Screening for tuberculosis is recommended for all HIV-positive pregnant women, even in the absence of clinical symptoms. Notably, immunological testing before and during pregnancy facilitates the timely and safe detection of tuberculosis infection, enabling preventive and therapeutic interventions during any stage of gestation and the early postpartum period, for the benefit of both mother and child. Drug–drug interactions play a significant role in tuberculosis management, both among anti-tuberculosis agents and with medications for comorbid conditions. Current knowledge of the pharmacokinetics and pharmacodynamics of antituberculosis agents, coupled with therapeutic drug monitoring, supports the development of individualized and effective treatment regimens, which are particularly critical for pregnant patients. Recommendations for managing tuberculosis in pregnant women after COVID-19 infection include measuring D-dimer levels, performing echocardiography, and consulting cardiologists to prevent treatment-related complications. Conclusions: Pregnant women represent a distinct subgroup of tuberculosis patients requiring individualized management. Changes observed in tuberculosis progression and treatment responses in pregnant women before and after SARS-CoV-2 infection should inform therapeutic choices, especially in cases of drug-resistant tuberculosis treated with bedaquiline. COVID-19 has been associated with increased cardiovascular risk, which may heighten the likelihood of adverse drug reactions in this population, especially given the limited therapeutic options. Further research is required to assess the long-term outcomes of latent tuberculosis infection in pregnant women and to evaluate the safety and efficacy of novel regimens for drug-resistant TB during pregnancy. Full article

Telomeres are protective DNA sequences located at chromosome ends, essential to maintaining genomic stability. This narrative review examines how maternal lifestyle factors during pregnancy influence fetal telomere length (TL). Positive associations have been identified between offspring’s TL and maternal consumption of nutrients such as vitamins C and D, folate, and magnesium. Additionally, adherence to a Mediterranean diet and regular physical activity during pregnancy are correlated with increased placental TL, supporting fetal genomic integrity. Conversely, maternal dietary patterns high in carbohydrates, fats, or alcohol, as well as exposure to triclosan and sleep-disordered breathing, negatively correlate with offspring’s TL. Maternal infections may also shorten TL through heightened inflammation and oxidative stress. However, evidence regarding the impact of other lifestyle factors—including maternal stress, smoking, caffeine intake, polyunsaturated fatty acid consumption, obesity, and sleep quality—remains inconsistent. Given that shorter telomere length has been associated with cardiovascular, pulmonary, and neurodegenerative diseases, as well as certain types of cancer, these findings highlight the vital importance of maternal health during pregnancy in order to prevent potential adverse effects on the fetus. Further studies are required to elucidate the precise timing, intensity, and interplay of these influences, enabling targeted prenatal interventions to enhance offspring health outcomes. Full article

HIV infection and hypertensive disorders of pregnancy (HDP), particularly preeclampsia (PE) with severe features, are leading causes of maternal mortality worldwide. This study investigates the role of asymmetric dimethylarginine (ADMA) and prostacyclin (PGI2) concentrations in endothelial impairment in normotensive pregnant versus PE women within an HIV endemic setting in KwaZulu-Natal Province, South Africa. The study population (n = 84) was grouped according to pregnancy type, i.e., normotensive (n = 42) and PE (n = 42), and further stratified by HIV status. Clinical factors were maternal age, weight, blood pressure (both systolic and diastolic) levels, and gestational age. Plasma concentrations of ADMA and PGI2 were measured using the enzyme-linked immunoassay (ELISA). Differences in outcomes were analyzed using the Mann–Whitney U and Kruskal–Wallis test together with Dunn’s multiple-comparison post hoc test. The non-parametric data were presented as medians and interquartile ranges. Gravidity, gestational age, and systolic and diastolic blood pressures were significantly different across the study groups where p < 0.05 was deemed significant. Furthermore, the concentration of ADMA was significantly elevated in PE HIV-positive vs. PE HIV-negative (p = 0.0174) groups. PGI2 did not show a significant difference in PE compared to normotensive pregnancies (p = 0.8826) but was significantly different across all groups (p = 0.0212). An increase in plasma ADMA levels was observed in the preeclampsia HIV-negative group compared to the normotensive HIV-negative group. This is linked to the role played by ADMA in endothelial impairment, a characteristic of PE development. PGI2 levels were decreased in PE compared to the normotensive group regardless of HIV status. These findings draw attention to the importance of endothelial indicators in pathogenesis and possibly early prediction of PE development. Full article

Chromosomal microarray analysis (CMA) was performed for 40 patients with B-ALL undergoing treatment according to the ALL-2016 protocol to investigate the copy number alterations (CNAs) and copy neutral loss of heterozygosity (cnLOH) associated with minimal residual disease (MRD)-positive remission. Aberrations involving over 20,000 genes were identified, and a random forest approach was applied to isolate a subset of genes whose CNAs and cnLOH are significantly associated with poor therapeutic response. We have assembled the triple matched healthy population data and used that data as a reference, but not as a matched control. We identified a recurrent cluster of cnLOH in the 19q13.2–19q13.31 region, significantly enriched in MRD-positive patients (70% vs. 47% in the reference group vs. 16% in MRD-negative patients). This region includes the pregnancy-specific glycoprotein (PSG) gene family and the oncogene ERF, suggesting a potential role in leukemic persistence and treatment resistance. Additionally, we observed significant deletions involving 7p22.3 and 16q13, often as part of large-scale losses affecting almost the entire chromosomes 7 and 16, indicative of global chromosomal instability. These findings highlight specific genomic regions potentially involved in therapy resistance and may contribute to improved risk stratification in B-ALL. Our findings emphasize the value of high-resolution CMA in diagnostics and risk stratification and suggest that PSG genes and other candidate genes could serve as biomarkers for predicting treatment outcomes. Full article