Search Results (3,752)

Background/Objectives: This study describes the process of harmonising data from food consumption screeners (FCSs) and food frequency questionnaires (FFQs) in pregnant women, highlighting challenges and strategies. Methods: It is a methodological, descriptive study on the harmonisation of individual food intake data. The data were divided into two datasets: FCS and FFQ. FCS responses were categorised as “never/almost never”, “1–4 days per week”, and “≥5 days per week”. FFQ data were harmonised by deriving variables in grams per day. Outliers were identified using z-scores for total harmonised caloric intake exceeding ±2 standard deviations. The distribution and heterogeneity of the derived variables were assessed using multilevel models. Results: Data were drawn from 12 studies conducted in Brazil, part of the Brazilian Maternal and Child Nutrition Consortium (BMCNC). The sample included pregnant women aged 18 years or older, at any stage of pregnancy. The final harmonised datasets comprised eight studies (n = 5484) with FCS data and four studies (n = 1759) with FFQ data. Most food categories in the FCS dataset had comparable frequencies across studies, with differences observed for natural juices, soft drinks, and sweetened beverages. In the FFQ data, the largest variations in daily consumption were found for leafy vegetables, sweetened beverages, and soft drinks. Heterogeneity ranged from less than 0.01% for beans (FCS) to 15.5% for fruits and natural juices (FFQ). Conclusions: By enabling standardised analyses across diverse Brazilian populations, the harmonised BMCNC datasets provide a valuable resource for investigating nutritional inequities and supporting future research to improve maternal and child nutrition. Full article

Temperament has been associated with reproductive success in beef cattle, with excitable animals often exhibiting reduced fertility. This study evaluated whether acclimating heifers to human handling during an ovulation synchronization protocol improves temperament and pregnancy rates to timed artificial insemination (TAI). A total of 622 Bos taurus yearling beef heifers across five locations and two breeding seasons (eight herd-year observations) were stratified according to reproductive maturity and temperament and were assigned to either acclimation (TRT; n = 307) or control (CTRL; n = 315). Acclimated heifers were moved through handling facilities without restraint prior to each protocol event (days 0, 7, and 10). Temperament was assessed using chute score (CS) and exit velocity (EV), and plasma cortisol was measured in a subset of animals. Acclimated heifers had lower CS on days 7 and 10 (p = 0.011 and p = 0.010, respectively) and greater pregnancy rates to TAI compared with control heifers (54.5% vs. 45.2%; p = 0.018). Exit velocity and cortisol concentrations did not differ between treatments (p ≥ 0.13). These results indicate that acclimation during handling events can improve behavioral responses and pregnancy rates to TAI with modest additional handling time (a mean of 17 s per heifer; no more than 18 min per location/day), providing a practical and scalable strategy for beef producers. Full article

Background and Objectives: Appendectomy during pregnancy is associated with preterm birth, but downstream neonatal outcomes, neonatal intensive care resource use, and caregiver-reported psychological symptom burden remain insufficiently characterized. We aimed to compare neonatal infection rates, NICU resource utilization, and caregiver psychosocial outcomes between preterm infants born after maternal appendectomy during pregnancy and preterm controls frequency-matched by gestational-age strata without antecedent non-obstetric surgery. Methods: In this single-center prospective cohort study (March 2023–December 2025), 121 preterm infants were enrolled: 54 born after maternal appendectomy during pregnancy (31 laparoscopic, 23 open) and 67 non-surgical preterm controls. Neonatal outcomes included culture-confirmed infection, death, or major neonatal morbidity, and neonatal intensive care resource metrics. Caregiver outcomes were assessed near discharge using the 36-Item Short Form Survey, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7 scale, and Hospital Anxiety and Depression Scale. Group comparisons used normality-guided parametric or non-parametric tests and multivariable logistic regression; subgroup and mediation analyses were exploratory. Mediation analyses explored indirect pathways. Results: Culture-confirmed infection was numerically more frequent in appendectomy-group neonates than in controls (35.2% versus 20.9%; p = 0.078), but this difference was not statistically significant. NICU length of stay was significantly longer (47.3 ± 14.8 vs. 41.2 ± 12.6 days; p = 0.014), and caregiver Patient Health Questionnaire-9 depressive symptom scores were higher (12.4 ± 4.3 vs. 9.6 ± 3.8; p < 0.001). Open appendectomy and negative histopathology subgroups showed the strongest adverse signals. Exploratory mediation analysis suggested that a substantial portion of the appendectomy-caregiver depression association statistically co-varied with prolonged hospitalization (Sobel p = 0.008); this exploratory pathway analysis does not establish a causal mediation pathway. Conclusions: Preterm infants born after maternal appendectomy during pregnancy showed non-significant numerical increases in infection outcomes, significantly higher neonatal intensive care resource use, and higher caregiver-reported psychological symptom scores compared with non-surgical preterm controls, with open surgery and negative appendectomy representing clinically complex subgroups with less favorable exploratory signals. Full article

Background: Gestational diabetes mellitus (GDM) affects between 1% and 14% of pregnancies worldwide. Major risk factors include advanced maternal age, excess adiposity, family history of type 2 diabetes, and unhealthy dietary habits. In Mexico, evidence on the association between dietary patterns and GDM remains scarce, particularly in socioeconomically vulnerable populations with limited access to specialized nutrition services. This study aimed to evaluate the association between dietary patterns and the presence of GDM in pregnant women attending the outpatient obstetrics clinic of a teaching public hospital in Guadalajara, México. Methods: We conducted a case–control study including 169 pregnant women: 71 with GDM confirmed by the ADA one-step 75 g oral glucose tolerance test OGTT criteria and 98 without GDM based on a negative OGTT, recruited consecutively from the same clinic during the same period. Dietary intake was assessed using a culturally adapted and validated Food Frequency Questionnaire. Dietary patterns were identified through Principal Component Analysis, and associations were examined using logistic regression adjusted for maternal age, pregestational BMI, and family history of type 2 diabetes. Results: Women with GDM had higher maternal age, greater pregestational BMI, and more frequent family history of type 2 diabetes compared with controls. Three dietary patterns were identified: Western, Healthy, and Dairy/Refined. High adherence to the Western pattern was inversely associated with GDM (aOR = 0.36; 95% CI: 0.16–0.78; p = 0.010); however, this finding most likely reflects post-diagnosis dietary modifications rather than a protective effect, while maternal age remained the strongest risk factor (OR = 1.09; 95% CI: 1.03–1.16; p = 0.002). The Healthy pattern (aOR = 1.25; 95% CI: 0.55–2.82; p = 0.593) and the Dairy/Refined pattern (aOR = 0.80; 95% CI: 0.39–1.66; p = 0.554) were not significantly associated with GDM in the adjusted model. Conclusions: GDM was associated with older maternal age, higher pregestational BMI, and family history of T2DM. The inverse association with the Western pattern may reflect post-diagnosis dietary changes rather than a protective effect. Due to the retrospective design, causal inference is not possible, highlighting the need for longitudinal studies. Full article

Efficient reproductive management in mares relies on the accurate assessment of periovulatory status; however, routine ultrasonographic parameters cannot fully reflect underlying reproductive competence. The aim of this study was to evaluate hormonal (estradiol), inflammatory (IL-6), and clinical (follicle size, uterine edema, age, parity) biomarkers in relation to pregnancy outcome in mares and to assess whether these parameters may provide additional information alongside routine transrectal ultrasonographic evaluation. A total of 31 mares were examined. Estradiol concentration, follicle size, uterine edema score, and interleukin-6 (IL-6) concentration were assessed 24 h prior to insemination. Pregnancy outcomes were determined 14 days post ovulation. Statistical analysis included non-parametric tests and correlation analysis. Estradiol concentrations were significantly higher in pregnant compared to non-pregnant mares (p = 0.004). A moderate positive correlation was observed between mare age and estradiol concentration (Spearman’s rho = 0.599, p < 0.01), although age itself was not associated with pregnancy outcome. Stratified analysis confirmed higher estradiol concentrations in pregnant mares within both age groups, with statistical significance observed in younger mares (p = 0.003). No significant associations were found for uterine edema score, follicle size (continuous), or IL-6 concentration. These findings indicate that among the evaluated parameters, estradiol concentration at insemination showed the strongest association with subsequent pregnancy status and may provide additional information about periovulatory reproductive status. Although estradiol concentrations varied with age, its association with fertility was not solely explained by age-related differences. Rather than serving as a stand-alone predictor, peri-insemination estradiol was associated with pregnancy outcome and may provide additional information about periovulatory reproductive status. However, due to the relatively small sample size and observational design, these findings should be interpreted cautiously. Full article

Background and Objectives: Maternal nutrition during pregnancy has been associated with fetal development and long-term health trajectories through mechanisms potentially involving epigenetic and metabolic programming. However, the molecular mediators linking dietary quality to fetal biochemical profiles remain poorly characterized. This exploratory pilot study aimed to investigate associations between maternal nutritional adequacy and the amniotic-fluid metabolomic profile during the second trimester. Materials and Methods: In this prospective study, AF samples from 41 pregnant women undergoing second-trimester amniocentesis were analyzed using gas chromatography–mass spectrometry (GC-MS). Nutritional status was assessed via the FIGO Nutrition Checklist. Subjects were divided into two groups based on dietary adequacy (FIGO Score >5 vs. ≤5). Multivariate analysis (PLS-DA, VIP scores, volcano plots) and pathway enrichment were performed to identify discriminatory metabolites. Results: Exploratory metabolomic analysis suggested differences between the two nutritional groups. Several candidate metabolites, including stearic acid, lactic acid, proline, and scyllo-inositol, contributed to the observed differences between groups. These features may provide preliminary hypotheses regarding energy-, amino acid-, and lipid-related biochemical pathways. Conclusions: Maternal dietary quality was associated with differences in the amniotic-fluid metabolomic profile. These preliminary findings support further investigation of amniotic-fluid metabolomics as a potential tool for studying the fetal biochemical environment. Full article

Background/Objectives: Vaginal microbiota is relevant to pregnancy, but evidence on neonatal anthropometry is mainly molecular and focused on pre-term birth. This study evaluated whether microscopy-based vaginal lactobacillary dominance in late pregnancy is associated with neonatal anthropometric measures after accounting for maternal and gestational determinants. Methods: This prospective observational study included 144 mother–newborn pairs recruited at a tertiary hospital in Romania between February and August 2025. Gram-stained smears were assessed for lactobacillary dominance, leukocyte density, and candidiasis; a composite vaginal indicator was derived. Outcomes were birth weight, length, and head circumference. Associations were assessed using correlation, adjusted regression, hierarchical models, and sensitivity analyses. Results: Lactobacillary dominance was not associated with birth weight or length in bivariate analyses, but correlated weakly with head circumference (ρ = 0.186, p = 0.025). In adjusted models, it was nominally associated with higher birth weight (B = 133.5 g, p = 0.043) and larger head circumference (B = 0.47 cm, p = 0.034), but not birth length; these associations did not remain significant after multiple-testing correction. Incremental explanatory contribution was modest (ΔR² = 0.022 and 0.025), and associations attenuated after socioeconomic adjustment. Leukocyte density and candidiasis were not associated with outcomes; intermediate versus balanced vaginal status was associated with lower birth weight and head circumference in exploratory analyses. Conclusions: Routine microscopy-based lactobacillary dominance showed modest nominal associations with birth weight and head circumference, limited incremental explanatory value, and no robustness after multiplicity correction. These findings suggest a context-dependent association with limited clinical relevance. Full article

Background/Objectives: Maternal nutrition and physical activity are modifiable behaviours relevant to pregnancy outcomes, but higher activity may coexist with both favourable and unfavourable dietary patterns. This study examined associations between pregnancy physical activity, individualised fruit–vegetable adequacy, energy-dense, nutrient-poor (EDNP) food and beverage intake, and preterm birth. Methods: This cross-sectional study included 1048 postpartum women with singleton live births recruited consecutively at a tertiary maternity hospital in Romania. Physical activity during the last three months of pregnancy was assessed using the Pregnancy Physical Activity Questionnaire and categorised into quartiles of total MET-hours/week. Dietary intake was assessed using an adapted food frequency questionnaire. Fruit–vegetable adequacy was evaluated against individualised recommendations, and EDNP intake was summarised using a composite score derived from fast food, sweets, chocolate, and sugar-sweetened beverages. Preterm birth was defined as delivery before 37 completed weeks of gestation. Results: Preterm birth occurred in 118 cases (11.3%). Higher physical activity categories showed greater fruit–vegetable intake and adequacy, but also higher EDNP intake. After adjustment for maternal age, pregestational BMI, parity, education, and income, physical activity category remained associated with all modelled dietary outcomes. Category 4 had higher odds of fruit–vegetable adequacy than category 1 (OR 2.24, 95% CI 1.55–3.24). In diet-informed models, category 3 had the lowest odds of preterm birth (OR 0.38, 95% CI 0.21–0.68). Conclusions: Total physical activity during pregnancy was associated with a complex dietary profile rather than a uniformly favourable lifestyle pattern. The lowest odds of preterm birth were observed in the third activity category, suggesting a non-linear association. Full article

Background: Pregnancy is a vital period during which maternal nutrition profoundly influences both maternal health and fetal development. Carotenoids, predominantly found in fruits and vegetables, are bioactive compounds that enhance antioxidant defenses and facilitate vitamin A metabolism throughout pregnancy. However, assessing carotenoids intake presents challenges due to the lack of dietary assessment tools capable of quantifying individual carotenoids, coupled with limited data from populations in Eastern Europe. Methods: A cross-sectional study involving 621 pregnant women in Romania was conducted to estimate dietary carotenoids intake and investigate associations with dietary patterns and overall diet quality. Dietary data were obtained using the EPIC Food Frequency Questionnaire (EPIC-FFQ), adapted for Romanian populations. A dedicated carotenoid estimation model was developed utilizing the USDA Carotenoid Database. Principal component analysis (PCA) was employed to identify dietary patterns, and diet quality was evaluated using the Diet Quality Index during Pregnancy (DQI-P). Results: The findings revealed significant individual variability. The median intake was highest for β-carotene (2464 μg), and lycopene (1664 μg), followed by lutein and zeaxanthin (908 μg), α-carotene (615 μg), and β-cryptoxanthin (121 μg). The Vegetable-meal pattern exhibited the strongest positive correlation with carotenoids intake, whereas the Energy-dense pattern was primarily associated with vitamin E and tocopherols/tocotrienols, and the Mixed pattern with vitamins A and D. Higher DQI-P scores were consistently correlated with increased carotenoids consumption. Conclusions: Overall, maternal carotenoids intake during pregnancy was frequently insufficient and showed considerable variation among women. A diet rich in vegetables and higher overall diet quality were associated with elevated carotenoids intake levels. These findings enhance the understanding of dietary carotenoids intake among pregnant women in Eastern Europe. Full article

Background/Objectives: Minipuberty represents the second phase of physiological activation of the reproductive axis and may play a role in postnatal genital development. Its course has been shown to be affected by untreated or inadequately treated maternal hypothyroidism. The aim of the present study was to investigate minipuberty in the sons of women with euthyroid autoimmune thyroiditis during pregnancy. Methods: This prospective matched cohort study included three groups of apparently healthy infant boys. Two groups comprised the male offspring of levothyroxine-naive, euthyroid women with autoimmune thyroiditis: one group was unsupplemented, and the other received vitamin D and selenium supplementation. The control group consisted of boys born to healthy women. Salivary concentrations of testosterone, androstenedione, DHEA-S, estradiol, and progesterone, along with urinary FSH and LH levels, were assessed longitudinally over the first 12 months of life. These hormonal measurements were evaluated in relation to genital development, including testicular volume and penile length, which were recorded at each study visit. Results: Compared with the offspring of healthy mothers, sons of women with autoimmune thyroiditis who did not receive supplementation exhibited lower concentrations of LH and testosterone, without a distinct peak, while the duration of hormone detectability did not differ between the groups. These hormonal alterations were accompanied by reduced penile length, with no differences observed in testicular volume. This group also exhibited lower DHEA-S concentrations, whereas levels of other hormones were comparable. In contrast, in the group receiving vitamin D and selenium supplementation, the dynamics of hormonal changes and genital organ growth did not differ from those observed in the control group. LH concentrations were inversely correlated with thyroid peroxidase antibody titers, which were lower in the supplemented group. Conclusions: The findings indicate an altered course of minipuberty in the sons of women with euthyroid autoimmune thyroiditis during pregnancy and suggest a potential benefit of exogenous vitamin D and selenium supplementation in this population. Full article

Apical periodontitis is a common inflammatory oral condition and a major cause of endodontic treatment need. The present retrospective clinical study aimed to evaluate the frequency, distribution, and radiographic healing of teeth diagnosed with apical periodontitis following primary endodontic treatment or nonsurgical retreatment within a specific patient cohort. Consecutive patients presenting for endodontic treatment at the study clinic between 2020 and 2021 were screened for inclusion. Eligible cases were those in which patients provided written informed consent, presented with periapical inflammatory pathology, and underwent conservative endodontic treatment. Exclusion criteria were incomplete data, non-functional or non-restorable teeth, third molars, pregnancy, probing depth ≥ 4 mm, radiographic bone loss, pathologic tooth mobility due to attachment loss, periodontal involvement of the lesion, and primary dentition. A total of 277 teeth, all diagnosed with apical periodontitis at baseline, were included. Some patients contributed more than one tooth. All treatments were performed by a single operator according to a standardized clinical protocol, including uniform diagnostic criteria, chemo-mechanical preparation, irrigation regimen, obturation technique, and radiographic follow-up at 12 and 24 months. Periapical healing was assessed radiographically using the Periapical Index (PAI). Within this cohort, elderly patients significantly represented the largest proportion of those treated (p < 0.001). Maxillary teeth also comprised a significantly higher proportion of cases than mandibular teeth (55.2% vs. 44.8%). The mean initial PAI score was 3.37 ± 0.9 points, with a median of 3 points, and the final score was 1.31 ± 0.93 points, with a median of 1 point. Radiographic healing was observed in 56.68% of cases at 12 months and in 84.84% of cases at 24 months. Primary endodontic treatment and nonsurgical retreatment of teeth with apical periodontitis in this selected patient population were associated with substantial radiographic improvement over a 24-month follow-up period. These findings support the value of standardized endodontic management and longitudinal radiographic monitoring. Full article

Gestational diabetes mellitus (GDM), as one of the most common metabolic disorders occurring during pregnancy, represents a significant public health concern due to its rising prevalence and the numerous complications that can affect both the mother and the foetus. In recent years, there has been growing interest in the use of omics technologies, such as metabolomics and proteomics, in research on the pathogenesis and early detection of GDM. The aim of this paper was to summarise the current knowledge on metabolomic and proteomic changes observed in women with GDM and to assess the potential usefulness of these methods in identifying biomarkers of the disease. The narrative review was conducted in accordance with the PRISMA 2020 statement, using PubMed and Web of Science until 23 December 2025. The studies analysed show that GDM is associated with abnormalities in the metabolism of lipids, amino acids, carbohydrates and metabolites associated with the gut microbiota. The most commonly observed changes included: elevated levels of branched-chain amino acids, free fatty acids and purine metabolites, as well as changes in the metabolism of phospholipids and acylcarnitines. Multi-omics studies also indicate significant changes in plasma protein and lipid profiles. The data collected suggest that omics technologies may be a promising tool for identifying early biomarkers of GDM and for developing our understanding of the pathophysiological mechanisms of this condition. Nevertheless, further studies involving larger and more diverse patient populations are needed to confirm their diagnostic and clinical value. Full article

Background: Frozen embryo transfer (FET) use in assisted reproductive technology (ART) has increased globally, with multiple reviews linking FET—particularly medicated cycles—to higher risks of obstetric complications including hypertensive disorders of pregnancy (HDP). Given that HDP is a sex-specific risk factor for future cardiovascular disease (CVD), this study aimed to assess acute cardiovascular changes in medicated versus natural modified FET cycles. Methods: This was a prospective observational cohort study at a fertility centre in London. Patients were recruited from May 2021 to March 2022. Maternal demographics including age, body mass index, smoking status, ethnicity and parity were recorded. Cardiovascular parameters including blood pressure along with measures of left ventricular systolic and diastolic function, assessed by transthoracic echo, were analysed at baseline in the luteal phase of the preceding cycle and on the day of embryo transfer, in medicated and natural modified FET cycles. Repeat measures analysis of the cardiac variables for the two time points, comparing the two protocols after controlling for maternal demographics, was performed by linear mixed models. Results: Seventy-two healthy patients were included in the analysis; of those, 59 (82%) underwent the medicated protocol. For both protocols, after controlling for maternal demographic characteristics, the left atrial area significantly increased (p = 0.004) from baseline to embryo transfer with a mean difference of 0.98 (95% CI [0.33, 1.63]). When comparing the interaction between the protocols between the two time points, whilst no effect could be seen on haemodynamic variables or left ventricular diastolic/systolic function, medicated FET cycles were associated with a statistically significant improvement in mean average global longitudinal strain (GLS) (p = 0.024) with a mean difference of −2.24 (95% CI [−4.17, −0.31]), whereas natural modified cycles demonstrated a slight shift toward more positive strain values. Conclusions: In this cohort of healthy patients undergoing FET, both protocols were associated with a significant increase in left atrial area from baseline to embryo transfer possibly resulting from an increased preload due to progesterone administration. The improvement in left ventricular average GLS seen in medicated FET cycles may reflect protocol-related physiological effects, potentially mediated by sustained exogenous oestrogen exposure and its influence on vascular loading conditions and myocardial relaxation. Full article

Background/Objectives: Childhood vaccine refusal may negatively affect immunization programs in Türkiye, where regional clusters of hesitancy have emerged despite high national coverage. This study aimed to identify sociodemographic, behavioral, and vaccine confidence-related factors independently associated with childhood vaccine refusal in Konya, Türkiye. Methods: An unmatched case–control study was conducted between July and October 2025 in family health centers across Konya. Cases were parents who had refused at least one routine childhood vaccine (n = 406); controls were parents whose children had completed all routine vaccinations (n = 412). Data were collected through face-to-face interviews using a 47-item structured questionnaire and the Turkish version of the Vaccine Hesitancy Scale (VHS). Independent associations were assessed using multivariable logistic regression, with multicollinearity evaluated by variance inflation factors. Results: Maternal employment (aOR = 0.371, 95% CI: 0.218–0.633), parental COVID-19 vaccination (aOR = 0.131, 95% CI: 0.086–0.200), mother’s complete childhood immunization (aOR = 0.418, 95% CI: 0.262–0.667), tetanus vaccination during pregnancy (aOR = 0.259, 95% CI: 0.159–0.421), and neonatal vitamin K administration (aOR = 0.256, 95% CI: 0.132–0.497) were independently associated with lower refusal odds. Higher number of children (aOR = 1.281) and perceived vaccine-related adverse events in the social environment (aOR = 16.982, 95% CI: 9.914–29.089) increased refusal odds. VHS scores were significantly lower in the refusal group (22.2 ± 6.4 vs. 39.8 ± 6.5; p < 0.001), indicating greater hesitancy. Notably, 21.9% of refusing parents reported being advised by a healthcare professional not to vaccinate. Conclusions: Childhood vaccine refusal in Konya was associated with sociodemographic, behavioral, preventive health-related, and vaccine confidence-related factors. The findings suggest relatively reduced engagement with selected preventive health practices, greater reliance on non-professional information sources, and lower vaccine confidence among refusing parents. Interventions should focus on strengthening healthcare-professional communication, trust-building, transparent risk communication, and evidence-based social media strategies. Full article

Despite the years that have passed since the pandemic, data regarding the effects of mild SARS-CoV-2 infection and vaccination during pregnancy remain limited. The current study investigated the expression of molecules that may be involved in the placental immune response using real-time PCR and Western blot analysis in a well-characterized cohort of 118 placentas collected between the 37th and 40th week of gestation. Secreted mediators were assessed in the supernatant of placental cell cultures, and histological examinations of the placental tissue were performed. Significant differences in the expression levels of S100B, IL6, and CCL5 were observed in control versus vaccinated and previously infected women, as determined by PCR. Acute SARS-CoV-2 infection decreased the expression of p38 MAPK and Bcl-2 compared to control patients. The secretion of G-CSF, IFN-α2, IL-2, and CXCL8 (IL-8) increased in women who were infected during pregnancy and/or vaccinated. However, histological analysis revealed only minor differences between the groups. In conclusion, SARS-CoV-2 infection or vaccination during pregnancy induced a measurable placental immune response that remained below the threshold of histologically detectable tissue injury. Full article