Search Results (899)

Objectives: To evaluate perinatal, obstetric, and early functional outcomes following totally percutaneous fetoscopic repair of open spina bifida (OSB) using the skin-over-biocellulose for antenatal fetoscopic repair (SAFER) technique. Methods: This retrospective cohort study included all fetuses who underwent totally percutaneous fetoscopic repair of OSB at a single tertiary referral center between September 2018 and March 2026. Eligibility was based on predefined clinical criteria. Data on maternal, fetal, operative, and neonatal outcomes were collected. The primary outcomes included perinatal and obstetric results, need for cerebrospinal fluid (CSF) diversion within the first year of life, and early functional outcomes, including motor improvement and ambulation. Exploratory analyses were performed to assess associations between procedural factors and obstetric outcomes. Results: Twenty-two fetuses underwent fetoscopic repair. The procedure was completed in 95% of cases. Median gestational age at surgery was 28.2 weeks. Preterm prelabor rupture of membranes (PPROM) occurred in 68% of cases, and the median gestational age at delivery was 32.7 weeks. All fetuses were live-born, with no neonatal deaths. Maternal outcomes were favorable, with no maternal mortality and no ICU admissions. Vaginal delivery was achieved in 50% of cases, with no uterine rupture or dehiscence. The rate of CSF diversion within the first year was 31.8%. Reversal of hindbrain herniation was observed in 95% of cases. A motor improvement of ≥2 levels was achieved in 68% of patients, with no cases of functional deterioration. Community ambulation at ≥24 months was observed in 53% of cases with available follow-up. Conclusions: Totally percutaneous fetoscopic repair of OSB using the SAFER technique was associated with favorable perinatal, obstetric, and early functional outcomes in this single-center cohort. The high incidence of PPROM and subsequent preterm delivery remains an obstetrical challenge. Maternal safety profile, including the preservation of uterine integrity for vaginal delivery, and the early neurological benefits were encouraging. Our results support the feasibility of this approach and highlight the absolute necessity of multidisciplinary expertise and structured training. Full article

Background: Data on assisted reproductive technology (ART) outcomes among Roma women are virtually absent from the literature, despite Roma being the largest and most socioeconomically marginalized ethnic minority in Europe. This study provides the first structured evaluation of IVF/ICSI outcomes among Roma women at a tertiary fertility center. Methods: A retrospective observational cohort study was conducted at the Clinic for Gynecology and Obstetrics, University Clinical Center Niš, Serbia (May 2010–September 2015). Roma (n = 88) and non-Roma women (n = 1197) undergoing IVF/ICSI were compared on baseline clinical, hormonal, and embryological parameters. Primary and secondary outcomes were clinical pregnancy and live birth, respectively. Multivariable logistic regression, propensity score matching (1:4, by age and AMH), first-cycle sensitivity analysis, and a machine learning pipeline (logistic regression, random forest, XGBoost) with SHAP interpretability analysis were applied. Results: Roma women were significantly younger (31.9 ± 4.0 vs. 34.5 ± 4.7 years; p < 0.001) and had a more favorable ovarian reserve profile (AMH 3.78 vs. 2.90 ng/mL; p = 0.004; FSH 6.87 vs. 8.23 IU/L; p < 0.001), yet had a markedly longer duration of infertility (9.3 vs. 6.3 years; p < 0.001). Clinical pregnancy rates (48.9% vs. 41.3%; p = 0.179) and live birth rates (28.4% vs. 30.9%; p = 0.720) were comparable between groups. In multivariable logistic regression and propensity score-matched analyses, Roma ethnicity was not an independent predictor of either outcome. XGBoost SHAP analysis ranked Roma ethnicity last (11th of 11) in feature importance for both clinical pregnancy (mean |SHAP| = 0.033) and live birth (mean |SHAP| = 0.009). The dominant predictors were the number of embryos transferred, AMH, and age. Only 88 Roma women accessed ART over the decade-long study period, indicating profound underutilization of fertility services. Conclusions: No independent association was detected between Roma ethnicity and IVF/ICSI outcomes within the statistical power afforded by the Roma subgroup (n = 88). An exploratory first-cycle live birth signal (adjusted OR = 0.478; 95% CI 0.249–0.920; p = 0.027), not replicated in primary or propensity-matched analyses, is interpreted as hypothesis-generating. The extreme underutilization of ART services among Roma women remains the most clinically salient observation and a priority for targeted public health intervention. Full article

Background: Sexual health is a fundamental pillar of well-being during the perinatal period. However, many studies suffer from scoring bias associated with zero values by failing to distinguish between women who are sexually inactive and those with physiological dysfunction. This study aimed to identify the distinct sociodemographic and psychological determinants of sexual inactivity versus sexual dysfunction quality in a Romanian perinatal cohort. Methods: An observational, cross-sectional study was conducted with 100 women (52% sexually active, 48% inactive). Participants were evaluated using the Female Sexual Function Index (FSFI), Patient Health Questionnaire-9 (PHQ-9), RSES (Rosenberg Self-Esteem Scale), and Generalized Anxiety Disorder-7 (GAD-7). Data were analyzed using binary logistic regression for activity status and multiple linear regression for functional quality. Results: Among sexually active women, 84.6% met the clinical criteria for sexual dysfunction (median FSFI = 21.6). Binary logistic regression revealed that self-esteem (RSES) was the sole independent predictor of sexual activity status (aOR = 1.144; 95% CI: 1.028–1.217, p = 0.016). Conversely, multiple linear regression showed that depression (PHQ-9) was the only significant independent predictor of functional quality (B = −0.73, p = 0.006). Maternal age, residence, and obstetric history did not significantly predict either outcome. Conclusions: Based on the findings of our preliminary, exploratory study, we propose a conceptual interpretation, framing perinatal sexuality as a potential two-stage process, where self-esteem appears to serve as a primary behavioral barrier for the resumption of intimacy, while depression serves as the primary disruptor of functional quality. Clinical interventions may benefit from moving beyond physical recovery to include psychological screening for body image and mood disorders to restore sexual quality of life. Full article

Background/Objectives: Health outcome determinants affecting Human Papillomavirus (HPV) vaccination among the adult female population are scarce in Spain. This study aimed to describe the health outcomes and determinants of HPV vaccination in women 18–65 years attending lower genital tract outpatient clinics across regions of Spain. Methods: This was a cross-sectional, multicenter, non-interventional, descriptive, and comparative nationwide study. Sociodemographic characteristics and health outcomes included obstetric, gynecological and HPV vaccination antecedents, together with patient-reported outcomes related to HPV infection. Statistical analysis included multivariate logistic regression models. Results: Among 2004 adult women recruited, 1907 (95.2%) were eligible for analysis. Vaccine uptake was 48.8%; 81.6% among women who were ever HPV positive (adjusted OR = 2.16 [95% CI: 1.59–2.93], p < 0.001), but 65.9% among women with an active infection, which acted as a negative factor for vaccination (OR = 0.63 [0.45–0.87], p = 0.005), as did increasing age (OR = 0.92 [0.90–0.93], p < 0.001); the higher the age, the lower the adjusted likelihood of being vaccinated. HPV knowledge and adequate physician-provided information were weakly associated with vaccination likelihood. A history of conization (OR = 7.48 [5.34–10.47], p < 0.001), use of contraception (OR = 1.49 [1.13–1.96], p = 0.004), infection with high-risk or unknown-risk HPV genotypes (OR = 1.86 [1.23–2.82], p = 0.003 and OR = 1.68 [1.17–2.42], p = 0.006, respectively), and Spanish nationality (OR = 2.46 [1.68–3.61], p < 0.001) were identified as factors associated with a higher vaccination likelihood. Conclusions: This study found that HPV vaccination uptake is improvable. Previous HPV infection favored vaccination; however, active infection and increasing age acted against vaccination. HPV knowledge and adequate healthcare professional information appeared to favor vaccination, along with, most notably, a history of cervical surgery (conization), contraceptive use, or infection with high-risk or unknown-risk HPV genotypes. Spanish women had a higher likelihood of receiving HPV vaccination than foreign residents. Full article

Objective: Isolated gestational proteinuria (IGP) has traditionally been considered a benign condition; however, emerging evidence suggests that it may represent an early stage in the spectrum of preeclampsia. This study aimed to evaluate clinical and laboratory predictors of progression from IGP to preeclampsia. Methods: This retrospective cohort study included pregnant women diagnosed with proteinuria ≥ 300 mg/day after 20 weeks of gestation between January 2023 and December 2024. After applying predefined exclusion criteria, 319 women with isolated gestational proteinuria (IGP) were included and stratified according to progression to preeclampsia (n = 42, 17.8%). Baseline clinical and laboratory parameters were compared between groups. Multivariable logistic regression analysis was performed to identify independent predictors of progression, and receiver operating characteristic (ROC) curve analysis was used to evaluate the discriminative performance of significant variables. Results: Preeclampsia developed in 17.8% of women with IGP. In multivariable analysis, higher maternal body mass index (aOR 1.085, p = 0.028) and earlier gestational age at diagnosis (aOR 0.883, p = 0.011) were identified as independent predictors of progression. Although neutrophil count and systemic inflammatory indices were elevated in univariate analyses, they did not retain independent predictive value after adjustment. Conclusions: In pregnancies complicated by isolated gestational proteinuria, clinical parameters appear to be more informative than inflammatory and renal markers for predicting progression to preeclampsia. Laboratory-derived indices offer limited additional value and should be interpreted cautiously in risk assessment. Full article

Alpha-fetoprotein (AFP) is a glycoprotein primarily produced by the fetal liver and yolk sac during development. It is a multifaceted biomarker with significant applications in the prenatal screening of congenital abnormalities, cancer, and other disorders. The level of AFP in maternal blood may indicate several obstetric concerns and complications during pregnancy. Atypical AFP levels are commonly utilized as a biomarker for detecting fetal anomalies, placental complications, and other pregnancy-related issues. These findings raise concerns regarding the effectiveness of screening maternal serum alpha-fetoprotein (MS-AFP) as a primary indicator of pregnancy problems and underscore the need for further investigation into the functional role of AFP throughout pregnancy. The measurement of MS-AFP has been utilized for the past four decades. It is anticipated that MS-AFP measurement will continue to be utilized as a component of integrated or sequential tests for chromosomal abnormalities and may serve as a prognostic indicator for adverse obstetric outcomes. Critically, whether AFP functions solely as a passive marker or plays active biological roles in pregnancy physiology and pathology remains unresolved, necessitating additional mechanistic investigation and discourse. This review consolidates critical data from numerous studies on AFP, focusing specifically on its diagnostic and prognostic applications for congenital abnormalities and problems during pregnancy. This review also identifies key research gaps regarding the functional biology of AFP, particularly whether AFP functions as a passive biomarker or an active participant in the pathophysiology of adverse pregnancy outcomes. Full article

Background/Objectives: The COVID-19 pandemic has raised concerns about maternal mental health, particularly among women infected during pregnancy. This study aimed to examine longitudinal changes in depressive and anxiety symptoms and subjective distress among pregnant women in Slovakia with confirmed SARS-CoV-2 infection and to explore the role of obstetric complications and vaccination status in these trajectories. Methods: In this retrospective longitudinal study, women with SARS-CoV-2 infection during pregnancy were assessed at three time points: during infection, six weeks postpartum, and one year postpartum (11 March 2020–5 May 2023). Depressive symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS; cut-off ≥ 11), anxiety symptoms were measured using the EPDS-3A subscale (cut-off ≥ 5), and subjective distress was measured using visual analogue scales (VAS). A repeated-measures ANCOVA design was used to evaluate within-subject changes over time while adjusting for vaccination status and pregnancy complications. Results: Of 1184 contacted women, 170 provided complete data. The proportion of women exceeding the EPDS cut-off decreased from 27.6% during infection to 17.6% at six weeks postpartum and 4.7% at one year postpartum. Anxiety symptoms showed a similar pattern, declining from 27.6% during infection to 20.6% at six weeks postpartum and 7.6% at one year postpartum. Repeated-measures analyses confirmed significant time effects across psychological outcomes, with symptom levels decreasing over the postpartum year. Post-infection obstetric complications were associated with higher subjective distress at selected time points. Conclusions: Psychological symptoms were highest during the acute infection period and declined significantly over time. These findings support the importance of timely mental health screening during pregnancy affected by COVID-19, while suggesting that, in many women, psychological distress may decrease across the postpartum year. Full article

Postpartum hemorrhage (PPH) is a high-stakes obstetric emergency in which delayed recognition and inadequate structured management may result in severe maternal morbidity. Medical students have limited exposure to such scenarios during clinical rotations, raising concerns regarding preparedness for emergency obstetric care. Simulation-based training has been proposed to address this situation; however, its impact on emergency-specific performance, confidence calibration, and determinants of skill acquisition remains incompletely understood. Methods: A single-group prospective pre–post-educational intervention study was conducted among sixth-year medical students following an obstetrics and gynecology rotation. Participants completed a structured high-fidelity simulation module focused on PPH management. Outcomes included an objective composite performance score and self-assessed emergency confidence. Results: A total of 215 students were included. Simulation-based training resulted in substantial improvements in PPH composite performance (scaled 0–1: 0.34 ± 0.20 to 0.67 ± 0.23; p < 0.001; Cohen’s dz = 1.38). Conclusions: Structured simulation-based PPH training markedly enhances emergency management performance among final-year medical students. Learning gains are primarily determined by baseline competence, while motivational responses are influenced by perceived realism, supporting the integration of structured emergency simulation into undergraduate curricula. Full article

Background: Micro- and nano-plastics (MNPs) are pervasive environmental contaminants that accumulate in various tissues, including the placenta. Experimental and clinical studies suggest potential cytotoxic, oxidative, and inflammatory effects that may lead to placental dysfunction and adverse obstetric outcomes. However, high-quality evidence on the clinical relevance of MNPs exposure during pregnancy remains scarce, underscoring the need for systematic evaluation of their impact on maternal and fetal health. Methods: The databases PubMed, ScienceDirect, CENTRAL, Embase, MDPI and Google Scholar were searched for studies published up to September 2025 investigating the relationship between MNPs and obstetric outcomes. Results: Twelve studies were included in this review, with half employing an observational design in human subjects and the other half using experimental studies in murine models. Although the available evidence is limited, there are studies reporting the association between MNPs exposure and premature birth, low birth weight, intrauterine growth restriction, and miscarriage. The most prevalent polymer detected was polyethylene, and the most commonly used MNPs detection techniques were Raman microspectroscopy, digital microscopy, Fourier Transform Infrared, and Pyrolysis gas chromatography-mass spectrometry. Conclusions: This systematic review summarizes current limited insights on the potential effects of MNPs on obstetric outcomes, highlighting possible associations with low gestational age, low birth weight, intrauterine growth restriction, and miscarriage. Findings do not allow causal inference due to heterogeneity in study design, exposure assessment, contamination control, and analytical methodologies. Full article

Background: During the COVID pandemic increased rates of intensive care unit (ICU) admission, mechanical ventilation, caesarean delivery, and preterm birth among women with SARS-CoV-2 infection in pregnancy were recorded. Purpose: This study describes the clinical course and perinatal outcomes of pregnant women with COVID-19 across pre- and post-vaccination periods. Methods: This study included all pregnant women with confirmed SARS-CoV-2 infection who subsequently delivered at the University General Hospital of Larissa between March 2020 and May 2023. Demographics, comorbidities, gestational age at infection and at delivery, COVID-19 symptoms, need for hospitalization, obstetric complications, mode of delivery, and neonatal outcomes were documented. An assessment of ischemia-modified albumin (IMA) was performed in a subset of women. Results: A total of 327 women (including 14 twin gestations) were recorded. Most women experienced mild disease while a minority required hospital admission, or intensive care (1.8 and 0.3% for the studied population, respectively). Fever and upper respiratory symptoms predominated, while radiologic evidence of pneumonia was rare. Overall preterm birth (<37 weeks) occurred in 13% of pregnancies and caesarean section in about two thirds of deliveries. Neonatal outcomes were favorable, with low rates of neonatal intensive care unit (NICU) admission and no early neonatal deaths. IMA values were higher during acute infection and declined towards recovery. Conclusion: Pregnant women with COVID-19 in Central Greece had predominantly mild clinical courses and excellent perinatal outcomes. IMA may represent a biologically plausible marker of disease activity, but further studies are needed. Full article

Background: Pregnancy presents unique immunological and obstetrical challenges for women with Common Variable Immune Deficiency (CVID). No standardized guidelines currently exist to guide pregnancy management, as CVID is a rare diagnosis, with pregnancy outcomes limited to case reports and case series. Establishing a structured approach to care is important to optimize maternal and fetal outcomes. Methods: A narrative review of the literature with a structured search was performed to detail pregnancy outcomes in CVID and management strategies. A 10-year retrospective chart review of women with CVID who became pregnant while receiving care at the McGill University Health Centre between January 2015 and January 2025 was conducted to add to the existing clinical data. Results: Pregnancy outcomes were improved through pre-conception planning, regular serum Immunoglobulin G (IgG) monitoring, trimester-based immunoglobulin replacement dose adjustments, proactive management of autoimmune or infectious complications, and multidisciplinary care. Subcutaneous immunoglobulin may offer better flexibility and stability of IgG levels. Conclusions: In the available observational literature and our institutional experience, many patients with CVID have carried pregnancies to term with favorable maternal and neonatal outcomes when managed with IgRT and multidisciplinary coordination. We outline a stepwise multidisciplinary framework for clinicians caring for women with CVID who are planning or undergoing pregnancy, and we identify gaps in knowledge for future studies. Full article

Objective: To evaluate the association of salivary progesterone and estradiol levels and the progesterone-to-estradiol ratio (P4/E2 ratio) in early pregnancy with threatened miscarriage and pregnancy outcome. Methods: This single-center prospective cohort study was conducted at the Department of Obstetrics and Gynecology, Ankara Atatürk Sanatorium Training and Research Hospital, between 10 January 2025 and 10 January 2026. Primigravid women with a confirmed live intrauterine pregnancy were included. Saliva samples were collected at 6–7 and 8–9 weeks of gestation; in pregnancies remaining viable to 12 weeks, salivary estradiol was also measured at week 12. Progesterone and estradiol levels were measured by immunoassay, and the P4/E2 ratio was calculated. Participants were classified as healthy ongoing pregnancies to 12 weeks (n = 102), threatened miscarriage with viability preserved to 12 weeks after progesterone treatment (n = 63), and miscarriage (n = 29). Group comparisons were performed using the Kruskal–Wallis test, one-way ANOVA, Mann–Whitney U test, and paired-samples t-test, as appropriate. Results: At both 6–7 and 8–9 weeks, progesterone, estradiol, and the P4/E2 ratio differed significantly among groups. Values were highest in uncomplicated ongoing pregnancies, lowest in pregnancies ending in miscarriage, and generally intermediate in progesterone-treated threatened miscarriage with preserved viability. The progesterone-to-estradiol ratio increased significantly from 6–7 to 8–9 weeks in uncomplicated ongoing pregnancies (p = 0.005), whereas no significant longitudinal change was observed in the threatened miscarriage group. Among pregnancies viable at 12 weeks, estradiol levels at week 12 remained significantly lower in women with prior vaginal bleeding (p < 0.001). Conclusions: Salivary progesterone, estradiol, and the progesterone-to-estradiol ratio were significantly associated with early pregnancy outcome in this prospective cohort. These findings suggest that salivary hormonal assessment may provide a non-invasive adjunct for characterizing early hormonal patterns in threatened miscarriage; however, it should not be interpreted as a stand-alone prognostic tool without further validation in larger cohorts. Full article

Pre-eclampsia, a major obstetric syndrome with an estimated global incidence of 2–8% of all pregnancies, ranks among the foremost causes of adverse maternal and perinatal outcomes worldwide. The Systemic Immune-Inflammation Index (SII)—derived as the product of platelet and neutrophil counts divided by the lymphocyte count—is a composite hematological parameter first established in oncological research that simultaneously captures neutrophil activation, lymphocyte dysfunction, and platelet alterations—three immunohematological disturbances implicated in pre-eclampsia pathophysiology. This narrative review synthesizes the current evidence regarding SII in pre-eclampsia, examining the biological rationale, clinical study findings, comparative performance against established inflammatory biomarkers, practical advantages, and limitations. A comprehensive literature search encompassing PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar was conducted, covering all available records up to January 2026. The available data reveal substantial heterogeneity in both the direction of association (elevated versus paradoxically decreased SII in pre-eclampsia) and diagnostic performance across populations. While some studies report significantly elevated first-trimester SII values in women who subsequently develop pre-eclampsia, others demonstrate lower values or no significant predictive capacity. The only available meta-analysis reported non-significant pooled results for the pre-eclampsia-specific subgroup. Although SII’s derivation from routine complete blood count testing presents the advantages of cost-effectiveness and universal accessibility, methodological limitations—including retrospective study designs, the absence of standardized thresholds, the inconsistent discriminatory performance, and the conflicting directionality of association—preclude clinical implementation at present. Integration within multiparametric prediction models may optimize SII’s clinical utility. Future research should prioritize prospective validation studies across diverse populations, mechanistic investigations, and randomized controlled trials to establish evidence-based clinical translation. Full article

Background: Oral dysbiosis during pregnancy has been associated with adverse outcomes, including preterm birth, premature rupture of membranes (PROM), and low birth weight, yet oral health remains an underappreciated component of routine prenatal care. Dental caries and gingival bleeding are frequently reported during pregnancy and may remain clinically relevant in the immediate postpartum period, but their relationship with specific oral pathogens in postpartum women has been insufficiently characterised, particularly in Eastern European populations. Methods: This exploratory cross-sectional, single-centre study included 60 postpartum women recruited consecutively at “Cuza-Vodă” Clinical Hospital of Obstetrics and Gynecology, Iași, Romania, between December 2025 and February 2026. All participants completed a structured questionnaire covering obstetric history, demographic characteristics, and oral hygiene behaviours and underwent a standardised clinical oral examination by two calibrated examiners. Before study initiation, the two examiners underwent a joint calibration session based on the predefined visual oral assessment criteria used in this study and agreed on uniform recording procedures for visible dental caries, self-reported gingival bleeding during brushing, tooth mobility, and overall oral status. Saliva samples were collected after delivery. Genomic DNA was extracted using a magnetic-bead protocol and analysed by Real-Time PCR using TaqMan-based assays to detect four oral pathogens: Porphyromonas gingivalis, Streptococcus mutans, Mycoplasma salivarium, and Fusobacterium nucleatum. Results: Most participants were primiparous (55.0%) and delivered at term (≥37 weeks of gestation; 78.3%). The prevalence of pathogen detection was: P. gingivalis 38.3% (23/60), S. mutans 70.0% (42/60), M. salivarium 71.7% (43/60), and F. nucleatum 100% (60/60). Poly-microbial carriage was common: 15.0% of participants carried all three variable pathogens simultaneously (S. mutans, M. salivarium, and P. gingivalis), and the most frequent two-pathogen combination was S. mutans + M. salivarium (30.0%). No statistically significant associations were identified between pathogen detection and clinical or obstetric variables, consistent with limited statistical power in this small convenience sample. Conclusions: This exploratory study provides the first salivary prevalence estimates for these four oral pathogens in postpartum women in Northeast Romania. The high prevalence of poly-microbial carriage, including the novel quantitative estimate for M. salivarium, provides an empirical foundation for power calculations and future confirmatory research integrating standardised periodontal assessment with pregnancy outcome data. Full article

Advances in prenatal diagnosis have improved the perinatal management of congenital heart disease (CHD). However postnatal comorbidities still persist due to multifactorial causes, which limits prenatal prediction of individual outcomes. Oxidative stress (OS), particularly lipid peroxidation, has been suggested to play a role in the development and progression of CHD, with 8-iso-prostaglandin F₂α (8-iso-PGF₂α) serving as a biomarker of oxidative injury. This prospective case–control study aimed to evaluate OS in fetuses with isolated major CHD by comparing amniotic fluid (AF) 8-iso-PGF₂α concentrations with controls. A total of 123 fetuses (83 CHD, 40 controls) were included at a tertiary CHD referral center. CHD cases were subclassified according to anatomical type and expected fetal brain perfusion under placental circulation. Controls were gestational age-matched pregnancies undergoing amniocentesis for indications unlikely to affect OS. All pregnant women underwent standardized fetal biometry, Doppler assessment, and detailed echocardiography. AF samples were obtained by amniocentesis and analyzed for free 8-iso-PGF₂α using a competitive ELISA, with values normalized to creatinine. Clinical, obstetric, and Doppler characteristics were comparable between groups. CHD fetuses showed significantly higher AF 8-iso-PGF₂α concentrations than controls (2849 ± 1377 vs. 2088 ± 1087 ng/mg Cr, p = < 0.001), and remained significant after adjustment for GA, smoking status, diabetes and maternal age and body mass index (BMI). No consistent differences were observed across anatomical or hemodynamic CHD subgroups. These findings provide the first intrauterine evidence of increased lipid peroxidation in fetuses with CHD as reflected by elevated amniotic fluid 8-iso-PGF₂α concentrations. Full article