Search Results (646)

Legal definitions of human viability vary worldwide. Background/Objectives: The treatment of periviable newborns remains controversial and raises ethical concerns. However, currently, the World Health Organization (WHO) sets the lower limit of viability at 22 weeks of gestation or 500 g birth weight. The aim of our research was to determine the knowledge of healthcare practitioners in our country regarding this topic, as well as including a course after which we sought to evaluate whether their perceptions regarding the management of these cases changed. Methods: The recruitment of participants encompassed those who voluntarily took part in the survey, and 30 clinicians were included; they participated in a 30 h online course and completed a survey questionnaire before and after the course. Results: After Holm adjustment, we observed an improvement in participants’ perceptions regarding recommendations concerning a multidisciplinary approach, perinatal counseling (20.0% vs. 100.0%), ethical issues (16.7% vs. 93.3%), and awareness of national guidelines (36.7% vs. 100.0%). Moreover, they recognized the importance of including parental wishes in decision-making (Holm-adjusted p = 0.0469), but with clinicians having the final word in the decision. Other factors did not change, with practitioners having knowledge about the serious outcomes of newborns in such challenging situations. Conclusions: Ethically grounded strategies to guide the management of newborns at the limit of viability is of great importance, whereby gestational age is an insufficient parameter. A collaborative, multidisciplinary process is mandatory in order to ensure the best outcomes for the newborn. The value of continuing medical education should be acknowledged. Full article

Social media influences community social issues in varied ways, yet their effects on teenage pregnancy remain uncertain. The purpose of this study is to explore how social media and human experiences are entangled in shaping teenage pregnancy in the Capricorn district of South Africa. Bandura’s social learning theory was used to determine the interplay between observation, imitation, social media modelling, peers, and society’ influences on teenage pregnancy. This study used a qualitative approach, engaging 34 Non-Governmental Organisations through purposive and convenience sampling and small focus groups to achieve saturation, examining how digital technologies and human experiences influence teenage pregnancy in Africa. Data analysis followed the Naeem, Ozuem, Howell, and Ranfagni thematic analysis six-step process. Two themes emerged: pervasive influences and positive influences of social media. Five sub-themes emerged supporting the pervasive and positive influences, that is, normalisation of risky sexual behaviours and experimentation; peer pressure influences and cyberbullying; promotion of gender-based violence and vulnerability; provision of adequate sexual education; and the consequences and promotion of supporting networks. Social media both supports and harms adolescents, influencing teenage pregnancy through its educational value and risky behavioural modelling. Positive role models can reduce vulnerability, while insights from this study guide policymakers, communities, and researchers in addressing social media’s complex effects on teenage pregnancy. Full article

Background/Objectives: Gallbladder emptying is primarily regulated by postprandial cholecystokinin release. In proteinuric glomerular diseases, renal loss of peptide hormones, hormone-binding proteins, or related regulatory proteins may affect biliary motility. However, gallbladder function has not been adequately investigated in individuals with proteinuric glomerular disease. This study evaluated the association between proteinuria and gallbladder emptying in patients with preserved kidney function and biopsy-proven glomerular disease. Methods: This single-center ultrasonographic case–control study with prospective participant enrollment and data collection included 106 participants: 52 patients with biopsy-proven proteinuric glomerular disease and 54 healthy controls without proteinuria. The proteinuric patient group consisted of individuals diagnosed with primary glomerulonephritis or amyloid A (AA) amyloidosis. Acute kidney injury, estimated glomerular filtration rate <60 mL/min/1.73 m², cholelithiasis, liver disease, diabetes mellitus, previous upper gastrointestinal surgery, pregnancy, oral contraceptive use, and recent rapid weight loss were considered exclusion criteria. After an overnight fast of at least 8 h, fasting gallbladder volume was measured by ultrasonography and recorded as baseline volume (V0). Gallbladder volume was measured again 45 min after stimulation with a standardized 40 g chocolate meal and recorded as postprandial volume (V45). Gallbladder volume was calculated using the ellipsoid formula, and gallbladder ejection fraction (GBEF) was calculated as [(V0 − V45)/V0] × 100. GBEF <40% was used as a predefined clinical threshold for impaired gallbladder emptying. In the primary analysis, the association between proteinuria status and GBEF as a continuous outcome was evaluated using a multivariable linear regression model adjusted for age, sex, body mass index, and family history of gallstones. Impaired gallbladder emptying, operationally defined as GBEF <40% for the supportive secondary binary outcome, was examined using multivariable logistic regression model adjusted for the same covariates. Results: Compared with controls, proteinuric patients had significantly higher postprandial gallbladder volume at 45 min: 15,614.04 ± 9148.35 mm³ versus 10,346.89 ± 5254.17 mm³ (p = 0.0003). GBEF was significantly lower in the proteinuria group than in healthy controls: 41.76% ± 19.64 versus 53.10% ± 20.22; mean difference, −11.34 percentage points (95% confidence interval, −19.02 to −3.66; p = 0.0042). Impaired gallbladder emptying was more frequently observed in the proteinuria group: 48.1% versus 27.8% (p = 0.031). In unadjusted analysis, the presence of proteinuria was associated with a 2.41-fold increase in the odds of impaired gallbladder emptying. This association remained statistically significant after adjustment for age, sex, and body mass index: adjusted odds ratio, 2.95 (95% confidence interval, 1.17–7.47; p = 0.022). Among proteinuric patients, GBEF did not differ significantly according to nephrotic versus non-nephrotic proteinuria, serum albumin level, serum total protein level, or histopathological diagnostic subgroup. Conclusions: In individuals with preserved kidney function and biopsy-proven glomerular disease, proteinuria was associated with impaired postprandial gallbladder emptying, and this association persisted after multivariable adjustment. These findings suggest that gallbladder dysmotility may represent a potentially relevant functional feature of proteinuric kidney disease; however, its biological basis and clinical consequences remain to be established. Prospective studies incorporating cholecystokinin measurements, duration of proteinuria, and longitudinal clinical follow-up are needed to clarify these issues. Full article

Background/Objectives: Shared Care Planning (SCP) represents a collaborative decision-making process integrating advance care planning and shared decision-making to support ethically complex clinical pathways. Since 2016, the Clinical Ethics Consultation (CEC) service at the Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS (FPUG) in Rome has implemented SCP through the use of the Shared Document (SD) for healthcare ethics planning. This study aimed to describe the SD as an operational tool supporting SCP, focusing on its procedural characteristics, multidisciplinary dimension, and the ethical and contextual issues emerging during its implementation. Methods: This single-center, retrospective observational study analyzed digitized medical records of patients who underwent SCP through the drafting of one or more SDs between 2016 and 2024 at FPUG. Data were extracted from SDs and clinical records in accordance with the RECORD guidelines. Variables included processing time, number of meetings with the clinical ethics consultant (CEc), number of healthcare professionals and family members involved, ethical–clinical issues, contextual challenges, and care orientations proposed within the SDs. Descriptive statistics were used to characterize the cohort and operational aspects of the service. Results: Among 454 patients referred to the CEC service, 154 patients underwent SCP, resulting in 160 SDs. The most frequent ethical issues concerned the proportionality of treatments to initiate (70%) and ongoing treatments (31%). Contextual issues emerged in 74% of cases, particularly pregnancy-related situations (44%) and absence of a legal guardian (19%). Drafting of SD required multiple interdisciplinary meetings (mean: 2.4), with an average processing time of 7 days. The number of healthcare professionals involved increased over time, reflecting growing multidisciplinary participation. The most frequent care orientations included palliative care (58%), withholding invasive/intensive maneuvers (34%), and indications for surgical or diagnostic treatments. Conclusions: The SD emerged as a structured clinical–ethical tool supporting complex shared care planning processes beyond issues of informed consent alone. Its use facilitated multidisciplinary deliberation, the integration of ethical and contextual factors, and continuity in care planning across different clinical trajectories. Full article

Early-onset colorectal cancer is increasing, making reproductive health an increasingly relevant survivorship issue. While immune checkpoint inhibitors have altered the management of deficient mismatch repair/microsatellite instability-high (dMMR/MSI-H) colorectal cancer, their implications for reproductive-age women remain insufficiently defined. We performed a focused narrative review, structured in line with the SANRA framework, to clarify this specific clinical domain. Immunotherapy may reshape female oncofertility counseling through two distinct mechanisms: direct reproductive uncertainty, including established endocrine toxicities and hypothesized, but currently unproven, direct gonadal effects; and indirect pathway-modifying effects, such as the potential avoidance of pelvic radiotherapy or radical surgery in selected patients with locally advanced dMMR/MSI-H rectal cancer. Anatomical organ preservation should not be automatically equated with functional fertility preservation. The key clinical message is that reproductive counseling should not be restricted to historically gonadotoxic chemotherapy. Instead, early multidisciplinary guidance should explicitly distinguish CRC-specific evidence from extrapolated or theoretical concerns, integrate fertility preservation strategies when clinically feasible, and address pelvic and sexual health, contraception, washout, endocrine follow-up, and future pregnancy planning. Until prospective CRC-specific reproductive data become available, immunotherapy should not be presented as either reproductively neutral or fertility-preserving. Full article

Background/Objectives: Postpartum depression (PPD) is a significant public health issue, particularly in high-risk pregnancies where medical complexities increase maternal vulnerability. This study aimed to determine the prevalence of PPD in a high-risk parturient population and to explore factors associated with PPD using a telepsychiatry-based longitudinal follow-up model. Methods: This longitudinal pilot study followed 58 women who met high-risk pregnancy criteria at a university hospital in Turkey. Initial assessments were conducted face-to-face within 72 h post-delivery, followed by telepsychiatric evaluations at the first and second months postpartum. PPD was diagnosed via structured clinical interviews based on DSM-5 criteria, supplemented by the Edinburgh Postnatal Depression Scale (EPDS) and the Multidimensional Scale of Perceived Social Support (MSPSS). Logistic regression was used to explore factors associated with PPD. Results: The cumulative prevalence of PPD during the first two postpartum months was 32.7%: 13 participants (22.4%) were diagnosed at month 1, and 6 additional new-onset cases (10.3%) were identified at month 2. In the exploratory multivariable logistic regression model, low marital satisfaction (OR = 26.13, p = 0.005), lower postpartum MSPSS total scores (OR = 0.90, p < 0.001), the presence of a fetal anomaly (OR = 15.10, p = 0.043), and a lower spousal education level (OR = 17.19, p = 0.014) were associated with PPD. However, these estimates should be interpreted cautiously because of the limited number of PPD events and wide confidence intervals. Notably, comorbid medical conditions and stressful life events during pregnancy did not remain significant in the final model. Conclusions: The observed PPD prevalence in this selected high-risk cohort was higher than previously reported general-population estimates. Psychosocial factors, particularly marital satisfaction and perceived social support, showed strong associations with PPD in this pilot cohort. A fetal anomaly may also represent an important clinical risk marker, but this finding requires confirmation in larger samples. A telepsychiatry-based follow-up model appears feasible for postpartum mental health assessment in this vulnerable group and may help support the early identification of PPD. Full article

Background/Objectives: Migraine is a common, disabling neurological disorder disproportionately affecting women during hormonally sensitive phases like menarche, pregnancy, and menopause. Despite awareness of sex-specific risk factors, management remains fragmented and predominantly neurologist-led, with limited coordination. To address these gaps, this project aimed to develop a national expert consensus, endorsed by scientific societies, on multidisciplinary migraine management in women across the lifespan, integrating perspectives from neurology, gynecology, endocrinology, cardiology, and general medicine. Methods: A two-round Delphi survey was conducted among 145 Italian clinicians representing the five specialties. The Scientific Board formulated 50 questions, each consisting of a variable number of statements, covering diagnostic approaches, hormonal therapies, comorbidities, and organizational care pathways. Statements were rated on a nine-point Likert scale, and consensus was defined using pre-specified criteria based on median scores and agreement. Results: Overall, 79 of 145 statements (54%) achieved consensus. High-level agreement emerged on sex-informed diagnostic strategies, including systematic gynecological and endocrinological evaluation and hormonal profiling in women with migraine. Round 2 facilitated consensus on contentious issues, such as avoiding estrogen-containing contraceptives in migraine with aura, individualized thrombotic risk assessment during menopause, and structured interdisciplinary coordination—particularly among neurologists, gynecologists, and general practitioners—during fertility planning and assisted reproduction. Qualitative feedback emphasized the need to update clinical pathways, implement standardized referral models, and strengthen interprofessional communication. However, persistent divergence remained on selected topics, particularly the role of hormonal contraceptives as a first-line approach to migraine management in women of reproductive age, reflecting different priorities between gynecologists and neurologists. Conclusions: This Delphi initiative provides the first national multidisciplinary consensus on migraine management in women in Italy. The findings support the development of sex- and life-stage-specific clinical guidance and integrated care models tailored to the complex needs of women with migraine. Full article

Background: The transition to motherhood represents a critical life phase marked by profound biological, psychological and social changes. During this period, women’s nutritional practices are shaped not only by physiological needs but also by shifting identities, caregiving responsibilities and social expectations. Although nutrition during pregnancy and the postpartum period has been widely studied from a biomedical perspective, less attention has been paid to how women experience, negotiate and attribute meaning to food during the transition to motherhood. Objective: This systematic qualitative review aimed to synthesise existing qualitative evidence on women’s experiences of nutritional practices during the transition to motherhood, with particular attention to food as self-care, control, autonomy, identity formation and mental well-being. Methods: A systematic search of electronic databases was conducted to identify qualitative studies exploring women’s experiences of nutrition during pregnancy and early motherhood. Eligible studies employed qualitative methodologies such as interviews, focus groups or ethnographic approaches. Study selection followed PRISMA guidelines. Methodological quality was appraised using established qualitative appraisal tools. A thematic synthesis approach was used to integrate findings across studies. Results: The synthesis identified several interrelated themes: nutrition as a form of self-care and emotional regulation; loss of autonomy and heightened moral surveillance around food choices; food practices as a means of performing and negotiating “good motherhood”; and the emotional burden of dietary expectations in relation to mental health and identity. Women described navigating competing demands between their own nutritional needs and those of their infants, often within contexts of social judgement and limited support. Conclusions: Nutritional practices during the transition to motherhood extend beyond health behaviours and are deeply embedded in issues of identity, autonomy and care. Recognising the social and emotional dimensions of maternal nutrition may inform more holistic, woman-centred approaches to nutritional guidance and maternal health support. Full article

Background/Objectives: Folate is a water-soluble B vitamin that is essential for DNA synthesis, cell division and proper growth and development, particularly during pregnancy to prevent neural tube defects (NTDs). A large, fully randomized clinical trial (RCT) from the United Kingdom in 1991 (the Medical Research Council (MRC) Vitamin Study), where participants had a prior NTD-affected pregnancy, demonstrated a 72% reduction in NTD recurrence in the folic acid treatment group. Based on this data and the high rate of unplanned pregnancies, about 90 countries fortify cereal grains with folic acid with the goal to prevent NTDs during pregnancy. This critical narrative review and policy perspective addresses the difference between folate and folic acid and between supplementation and food fortification, critically evaluates the data in three recent publications supporting mandatory fortification of food products with folic acid, and presents the case for a more personalized medicine approach to the prevention of NTDs. Methods: Relevant literature was identified through PubMed searches using the keywords “fortification”, “folic acid”, and “systematic review” or by Googe Scholar Alerts. Three studies were identified based on relevance to the topic and publication dates between January and February of 2026. Results: There is a disregard in published studies, which use pre-fortification groups as controls, for the confounding issue of changing socioeconomic factors over time. Improved socioeconomic conditions are associated with subsequent decreases in NTD prevalence regardless of fortification. Conclusions: The efficacy of folic acid supplementation for recurrent NTDs is supported by evidence-based literature, but evidence in favor of mandatory food fortification to prevent NTDs is limited. Food fortification is widely debated, raises numerous ethical issues, and has broad implications for human health. 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 prevalence of women who exclusively pump (EP) their breast milk to feed their infants is increasing; however, this group is underrepresented in research. This study aimed to examine maternal and infant characteristics and the experiences of EP women. Methods: An online survey explored the experiences and characteristics of EP women with <24-month-old infants. Quantitative data included demographics and maternal and infant characteristics; qualitative data included perspectives on how support for EP women can be improved. Results: The survey of 195 EP women revealed that while most had intended to exclusively breastfeed (50%) or breastfeed and pump (26%) their milk for an average of 12 months, the average time of EP cessation was 6 months postpartum. Compared with the general population, EP women had higher rates of pregnancy complications (p < 0.001) and lactation/breastfeeding challenges (p < 0.001). Themes developed from the qualitative data relating to how health professionals/support people could better assist EP women were: ‘Respect for the EP Journey’, ‘EP Information and Logistical Needs’ and ‘Mental and Physical Load’. Conclusions: Most EP women had originally intended to breastfeed but utilised EP because of latching issues, breast refusal and/or neonatal unit admission. They face unique challenges associated with EP, yet current professional acceptance and support are lacking. Targeted education for health professionals on EP is needed so that they can better support women with tailored, evidence-based guidelines aimed at extending lactation and improving maternal well-being. Full article

The placenta produces a variety of steroid hormones through the catalytic activity of steroidogenic enzymes, including cytochrome P450 (CYP) hydroxylases and hydroxysteroid dehydrogenases (HSD). Large amounts of progesterone produced by the placenta are essential for the maintenance of pregnancy. Although androgens and estrogens are also elevated in maternal circulation during gestation, there are conflicting reports on whether de novo synthesis of these steroids occurs in the human placenta. To address this issue, we performed a comprehensive analysis of steroidogenic gene expression in early and term placenta. While none of the genes examined showed binary expression changes, 17β-HSDs, including HSD17B1 and AKR1C3, were markedly upregulated in the term placenta. CYP19A1 and HSD11B2 genes were also markedly upregulated. In contrast, CYP17A1, CYP21A2, CYP11B1, CYP11B2, and HSD17B3 were almost undetectable. Consistent with these findings, the plasma ratios of active to precursor sex steroids (estradiol/estrone and testosterone/androstenedione) were higher in pregnant than in non-pregnant women, although concentrations of all steroids increased. In contrast, plasma levels and profiles of 11-oxygenated androgens were unchanged. These results indicate that the human placenta does not significantly contribute to circulating levels of either classical or novel classes of androgens. Therefore, this study provides new insights into the tissue of origin and the physiological significance of sex steroids during gestation. Full article

In this article, we analyze the bioethical issue of brain-dead pregnancy, both from the perspective of its implications for the brain death criterion and with reference to the ethical question of maintaining life support measures for brain-dead pregnant women with the aim of delivering a fetus. In doing so, we will demonstrate that, after having addressed the main critical positions, brain death cannot be considered the death of a human being because its justification (the brain as the body’s “critical organ”) has ceased to exist. “Brain-death survivors” (Shewmon) demonstrate levels of bodily integration even in the absence of the brain’s contribution. We will also evaluate the ethical consequences of carrying a brain-dead patient to term, a procedure to which we give our ethical assent. In doing so, we will be guided by the principle of dignity. Full article

Prenatal alcohol exposure (PAE) is a major public health concern, yet maternal self-reporting remains unreliable. Meconium accumulates alcohol metabolites during the second half of gestation, and ethyl glucuronide (EtG) is considered a stable and specific biomarker of late-pregnancy alcohol exposure. Diapers containing meconium may serve as a noninvasive method for collecting anonymous biological samples, which could help reduce participation bias in studies of this sensitive subject. This pilot study assessed the feasibility of anonymously collecting meconium-containing diapers for subsequent quantitative EtG analysis after extended periods of frozen storage and international transport, and examined intra-pair consistency in samples from the same newborn. Mothers collected their newborns’ diapers, which were then divided into two aliquots (A and B) by a study assistant and stored at −80 °C until analysis. Out of 178 samples collected from 105 infants, 137 samples were analyzable. Eleven samples exceeded the limit of quantification (10 ng/g), while two samples (one pair) surpassed the 30 ng/g cutoff, indicating significant PAE. EtG concentrations showed high intra-pair agreement, supporting the robustness of the biomarker and analytical method. Anonymous diaper-based meconium collection is feasible but operationally demanding. Although the low participation rate and methodological factors, including sample loss, precluded true prevalence estimation, making it exploratory, the detection of quantifiable EtG in 8% of analyzable samples suggests that PAE remains an issue. Full article