Search Results (610)

Background and Objectives: Preeclampsia (PE) complicates 2–8% of pregnancies globally, with a higher incidence in developing countries. This condition poses significant risks to maternal and fetal health, contributing substantially to maternal and perinatal mortality, particularly in cases of early-onset PE, which is associated with severe complications. This review aims to synthesize current evidence regarding the predictive utility of ophthalmic artery Doppler for preeclampsia. Current strategies focus on early prediction and prevention to mitigate adverse outcomes and reduce the economic burden of hypertensive disorders in pregnancy. The International Federation of Gynecology and Obstetrics (FIGO) recommends first-trimester screening combining maternal risk factors, mean arterial pressure, serum placental growth factor (PlGF), and uterine artery pulsatility index (UtA-PI). High-risk women are advised to take low-dose aspirin (150 mg daily) until 36 weeks of gestation. Materials and Methods: This review explores an innovative predictive tool for PE: ophthalmic artery (OA) Doppler. Results: As a non-invasive and easily accessible method, OA Doppler provides valuable insights into intracranial vascular resistance, offering potential advantages in early risk assessment, particularly for preterm PE, the most severe form of the disease. Conclusions: Our findings suggest that OA Doppler may serve as a promising adjunct in PE screening, enhancing the early identification of high-risk pregnancies and improving clinical outcomes. Further research is warranted to validate its role in routine prenatal care. Full article

Background and Objectives: Psychomotor developmental delay is a frequent comorbidity in children with congenital heart defects (CHD), especially after surgical correction of the CHD and exposure to risk factors such as anesthesia, cardiopulmonary bypass and postoperative complications. Yet psychomotor delay is present in these patients before surgical correction but is under-recognized. Evidence focusing solely on unrepaired CHD remains limited. Materials and Methods: This prospective cross-sectional study evaluated 153 and included 77 children under 6 years of age with unrepaired CHD, stratified into cyanotic (n = 31) and non-cyanotic (n = 46) CHD, admitted to a pediatric cardiology department over a period of 5 years. Psychomotor development was assessed using the Denver Developmental Screening Test II (DDST-II), standardized for pediatric population. Associations with clinical, perinatal, and demographic factors were analyzed using univariate and multivariate methods. Results: Developmental delay was identified in 97% of cyanotic and 54% of non-cyanotic patients. Compared to healthy norms, CHD patients had significantly lower global developmental scores (p = 0.03). Gross motor and personal-social domains were most frequently affected. Prenatal CHD diagnosis correlated with better global developmental scores (p = 0.012), and breastfeeding was associated with improved outcomes compared with formula or mixed feeding (p = 0.008). Conclusions: Infants and young children with CHD are at increased risk of early psychomotor developmental delay, particularly in the gross motor and personal–social domains, even before exposure to surgical or intensive care damaging factors. Systematic psychomotor surveillance, integration of protective factors such as prenatal diagnosis and breastfeeding, and timely access to multidisciplinary interventions are essential to optimize long-term outcomes in this vulnerable population. Full article

Objective: This study assessed sociodemographic, health-seeking and social services related factors associated with first-trimester prenatal care. Study Design: This cross-sectional study used Phase 8 pooled data from the Kentucky Pregnancy Risk Assessment Monitoring System (PRAMS) for 2017 to 2020 and 2022. A logistic regression model was used to estimate unadjusted and adjusted odds ratios and 95% confidence intervals. Results: Among the 3502 women in the analytic sample, 89.3% had first-trimester prenatal care. Most respondents were White (weighted percentage, 83.3%), between the ages of 25 and 29 (31.2%), had more than a high school education (59.5%), were married (59.8%), lived in an urban area (59.4%), and had public insurance (53.9%). Maternal education was associated with the highest odds of first-trimester prenatal care, relative to other covariates, and was highest among those who completed more than high school (aOR 4.23, 95% CI 2.72–6.59) and high school (aOR 3.09, 95% CI 2.06–4.64) relative to less than high school. Private insurance, having a healthcare visit one year prior to pregnancy, and WIC receipt during pregnancy were associated with higher odds of first-trimester prenatal care. Conclusions: The findings of this study suggest that sociodemographic factors and access to healthcare and social services are important factors in first-trimester prenatal care. Full article

Objective: To determine the prevalence of and risk factors for congenital toxoplasmosis in neonates treated in the public health network of the eastern region of the Brazilian Amazon, northern Tocantins state. Methods: A retrospective cohort study was conducted with neonates born to mothers with gestational toxoplasmosis who received care between 2017 and 2024. The outcome under analysis was positivity for immunoglobulin M in the electrochemiluminescence assay (CLIA). We estimated the prevalence of transplacental infection and respective 95% confidence intervals (95% CI) and its association with risk factors using the odds ratio (or) with a p-value < 0.05 in infected neonates before and after 16 gestational weeks at maternal infection diagnosis. Results: A total of 1142 neonates were surveyed, in which 496 were diagnosed with congenital toxoplasmosis (IgM positive), thus obtaining a prevalence of vertical transmission of 45.4%. The main risk factors for vertical transmission were the mother’s education level equal to or less than eight years, (OR = 1.5; 95% CI 1.2; 2.0) and having less than six prenatal consultations (OR = 22.8; 95% CI 3.0; 172.6). Conclusions: A high prevalence of congenital toxoplasmosis was observed, with higher rates of infection in neonates born to mothers with lower levels of education. Full article

Rubella virus (RV) IgG quantification is essential for verifying immunity, particularly in prenatal care. However, substantial variability exists among commercial immunoassays, especially when testing low-antibody sera. In this study, we evaluated five commercial assays—four chemiluminescent immunoassays (CLIAs) and one Enzyme-linked Immunosorbent Assay (ELISA)—using a recombinant immunoblot (IB) as the reference method. A panel of 137 serum samples with low or undetectable IgG levels was analyzed. Sensitivity ranged from 19.6% to 70.1%, while specificity exceeded 94%. Only 18.6% of immunoblot-positive samples tested positive across all assays. Marked quantitative differences were observed, with the Atellica assay yielding the highest titers and Alinity the lowest. Reclassifying equivocal results as positive improved concordance without compromising specificity. These findings suggest that current cut-off values, derived from post-infection sera, may be inadequate for vaccinated populations. A single universal threshold may lead to misclassification and underestimation of immunity. Harmonization of assay calibrations, antigenic targets, and interpretation criteria is urgently needed to ensure reliable rubella immunity assessments in clinical and public health settings. Full article

Background/Objectives: Although morbidity and mortality are more pronounced in extremely and very preterm infants, there is also considerable morbidity in preterm infants of more advanced gestations. Delivery via cesarean section is associated with a higher risk of perinatal complications even when performed electively. Our aim was to examine the possible contribution of prenatal and perinatal factors to the risk for respiratory morbidity in a population of late-preterm and early-term infants delivered with a high rate of elective cesarean section. Methods: In a retrospective cohort study, all late-preterm and early-term infants (34 to 38 completed weeks of gestation) that were admitted with respiratory distress to the Neonatal Intensive Care Unit of the University Hospital of Patras over a recent period of two years were included in the study. Results: In the study period, 489 infants of all gestations were admitted to the neonatal unit, of whom 221 were born between 34 and 38 + 6 gestational weeks. Ventilated infants had a significantly lower incidence of antenatal corticosteroids (41%) compared to non-ventilated infants (51%, p = 0.036) and a higher duration of parenteral nutrition [4 (1–6) days] compared to non-ventilated infants [2 (1–3) days, p < 0.001]. The incidence of late-onset sepsis was higher in the ventilated infants (26%) compared to the non-ventilated ones (8%, p < 0.001). Conclusions: Late preterm and early term infants who were invasively ventilated had less often received antenatal corticosteroids and had a higher incidence of late-onset sepsis compared to those who were not ventilated. Full article

Background and Clinical Significance: The crista terminalis (CT) is a fibromuscular ridge located on the posterolateral wall of the right atrium, formed by the junction of the sinus venosus and the primitive right atrium. A hypertrophic or prominent CT (HCT) refers to a thickened or conspicuous configuration of this normal anatomical structure. In prenatal ultrasound (US) and/or echocardiographic assessments, HCT can mimic a right atrial mass, such as a tumor or a thrombus. Case Presentation: Herein, we describe a case of a fetal right atrial echogenic mass detected at 32 weeks, which remained stable through gestation and was confirmed postnatally as a likely HCT. No hemodynamic compromise, growth, or pathological sequelae were observed. Conclusions: Our case reinforces the importance of including atrial structural variants in the differential diagnosis of intracardiac masses, particularly when features favor stability and low risk. Serial imaging, avoidance of premature invasive measures, and careful counseling are key to appropriate management. Full article

Background/Objectives: Gastroschisis is a congenital abdominal wall defect characterized by herniation of bowel loops without a covering membrane and typically located to the right of the umbilical cord. Although contemporary management is well established, its historical study development has not been comprehensively synthesized. This review examines the chronological evolution of focus of interest in gastroschisis and highlights how research priorities shifted across eras, shaping current anatomical understanding, diagnostic strategies, and surgical management. Methods: A structured literature search was performed in PubMed, Web of Science, and Scopus. Studies in English, Spanish, Turkish, and Arabic were included. Titles, abstracts, and full texts were screened independently. Eligible publications addressed historical descriptions, differentiation from omphalocele, advancements in imaging, surgical techniques, or experimental modeling. Results: Sixty-eight studies met the inclusion criteria. Early reports from the sixteenth to eighteenth centuries provided descriptive accounts without distinguishing gastroschisis from omphalocele. The nineteenth century introduced the term “gastroschisis,” and definitive clinical differentiation was achieved in the mid twentieth century. Surgical innovation progressed from primary closure in the 1940s to the development of preformed and spring-loaded silos, which improved physiologic tolerance and survival. Animal models clarified mechanisms of bowel injury, including the effects of amniotic exposure and delayed maturation of interstitial cells of Cajal. Advances in ultrasound and magnetic resonance imaging facilitated prenatal risk stratification and shifted research attention toward predicting complex gastroschisis and optimizing perinatal planning. Conclusions: The historical trajectory of studies about gastroschisis demonstrates a coherent pattern in which developments in anatomical definition, surgical innovation, and mechanistic research sequentially enabled modern prenatal diagnostic and prognostic strategies. Recognizing these temporal shifts provides important context for current practice and highlights opportunities to improve prenatal markers of bowel compromise and refine individualized postnatal care. Full article

Since the 1960s, Grassy Narrows First Nation, Canada, has been exposed to methylmercury (MeHg) from fish consumption following Hg discharge from a chloralkali plant. Prenatal exposure to MeHg is known to affect the neurodevelopment of fetuses and the retina is sensitive to neurodevelopmental damage. The multidisciplinary, cross-sectional Niibin study, developed with Grassy Narrows First Nations, included visual examinations with retinal evaluation using optical coherence tomography (OCT). The present analyses focused on the 59 participants (116 eyes) with umbilical cord Hg measurements, sampled between 1971 and 1992. Associations between cord blood Hg and retinal thickness layers surrounding the optic nerve head (RNFL) and inner macula (GC-IPL) were examined using mixed-effect models. Higher cord blood Hg was significantly associated with reduced thickness of GC-IPL layers across all macular sectors; less pronounced associations were observed for RNFL. A qualitative clinical assessment of the OCT results showed that persons with cord blood Hg concentrations ≥ 5.8 µg/L were more likely to present bilateral abnormal retinal thinning (OR = 3.51; [95% CI: 1.06–11.53]). These findings suggest that, in this Indigenous community, prenatal MeHg exposure may have enduring effects on retinal thickness and underline the importance of OCT technology in providing tailored eye care. Full article

Background: Obesity during pregnancy increases the risk of adverse maternal and neonatal outcomes, and excessive gestational weight gain (GWG) remains highly prevalent worldwide. Although physical activity (PA) interventions have shown potential benefits, evidence on the optimal type, intensity, and duration of exercise for overweight or obese pregnant women remains limited. Methods: Electronic searches of EBSCOhost, Embase, PubMed and Web of Science were performed through August 2025 to identify randomized controlled trials comparing PA interventions versus usual prenatal care in overweight or obese pregnant women. Two reviewers independently screened studies, extracted data, and assessed risk of bias using Cochrane ROB domains. Continuous outcomes were pooled using inverse-variance meta-analytic methods and heterogeneity was quantified by I². Results: Ten randomized trials (twelve intervention arms) comprising 1150 participants met the inclusion criteria. In the domain of blinding of participants and personnel, three studies (30%) were judged as low risk, while seven (70%) were unclear. PA interventions varied in modality (aerobic, resistance, endurance, walking), setting (clinic, community, home/mHealth), and the intervention period ranges from 10 to 34 weeks. Most interventions (80%) employed moderate intensity, and 30% combined aerobic and resistance training. Results of the meta-analysis showed that the pooled mean GWG was 9.93 ± 5.48 kg in the treatment group and 10.65 ± 5.70 kg in the control group. Overall, PA interventions produced a modest but statistically significant reduction in GWG compared with controls, with negligible between-study heterogeneity (I² = 0%). Conclusions: Tailored, moderate-intensity PA may have the potential to modestly reduce GWG. Although 30% included trials employed combined aerobic and resistance training, current evidence is insufficient to establish whether combined modalities are more effective than aerobic-only or resistance-only interventions. However, the current evidence is limited by small trial sizes, methodological variability and geographic concentration in higher-income settings. Larger, rigorously designed RCTs, including evaluations of digital delivery platforms and carefully supervised higher-intensity protocols, are needed to refine exercise prescriptions and inform clinical guidelines. Full article

Background/Objectives: Myotonic dystrophy type 1 (DM1) is a rare, multisystemic disorder caused by an expanded (CTG)n repeat in the DMPK gene. Although DM1 has been studied in several populations, access to molecular diagnosis and comprehensive care remains limited in many low- and middle-income countries. This study provides an updated overview of DM1 in Mexico, from diagnostic implementation to patient management, describing key clinical and genetic findings. Methods: We conducted a nationwide, 15-year prospective study at Mexico’s National Reference Center for neuromuscular diseases. A total of 853 individuals at risk were subjected to clinical and molecular evaluation using PCR, TP-PCR, and SP-PCR, encompassing symptomatic, pre-symptomatic, prenatal, and preimplantation genetic diagnosis. Socioeconomic, clinical, and molecular variables were analyzed. Results: A total of 488 individuals were confirmed as DM1 carriers, with the most prevalent phenotypes being classic (36.5%) and juvenile (28.5%). Genomic analysis revealed a correlation between CTG tract sizes and phenotypes. Intriguingly, interrupted CTG repeat tracts were identified in 2.8% of DM1 carriers, who exhibited milder clinical phenotypes and a reduced degree of somatic and intergenerational instability. Survival analysis revealed a reduction in symptom-free survival in patients with larger expansions, while interrupted CTG tracts were associated with delayed onset. Conclusions: The centralization of diagnostic services in Mexico resulted in regional disparities, impacting early diagnosis and family planning. This study highlights the clinical and molecular diversity of DM1 in a Latin American population and underscores the urgent need for decentralized diagnostic services, integrated care models, and tailored prognostic tools in underserved settings. Full article

Artificial intelligence (AI) is rapidly transforming cardiovascular medicine, with profound implications for congenital heart disease (CHD). Tetralogy of Fallot (ToF), the most common cyanotic disease, requires lifelong surveillance and complex management because of late complications such as pulmonary regurgitation, arrhythmias, and right ventricular dysfunction. This review synthesizes current evidence on AI applications across the continuum of ToF care—from prenatal diagnosis to adulthood follow-up. We examine advances in imaging, perioperative planning, intraoperative monitoring, intensive care, and long-term surveillance, including wearable and implantable technologies. Machine learning (ML), deep learning (DL), and natural language processing (NLP) are revolutionizing diagnostic accuracy, risk stratification, surgical decision-making, and personalized long-term care. The future lies in the integration of multimodal data, including imaging, electronic health records (EHRs), genomic information, and continuous monitoring, to support precision medicine. Challenges remain regarding dataset limitations, interpretability, regulatory standards, and ethical concerns. Nevertheless, ongoing innovation and collaboration between clinicians, engineers, and regulators promise a new era in congenital cardiology. By embedding AI throughout the patient journey, healthcare systems may improve outcomes and quality of life for individuals with ToF. Full article

Background: Gestational guilt is an understudied emotional experience that can affect maternal well-being and prenatal bonding. This study aimed to develop and validate the Pregnancy Guilt Assessment Scale (PGAS) in a sample of Spanish pregnant women, assessing its factorial structure, reliability, and validity. Methods: Four phases were conducted: (1) item generation through focus groups (n = 17) and cognitive interviews (n = 8); (2) expert content validation (n = 3); (3) exploratory factor analysis (EFA) in a pilot sample (n = 85); and (4) confirmatory factor analysis (CFA) and validity testing in an independent sample (n = 171). Additional measures included antenatal depression, prenatal distress, affect, self-esteem, social support, and dispositional guilt. Internal consistency, correlations, and multiple regressions assessed reliability and convergent and incremental validity. Results: The final 16-item PGAS showed a bifactor structure with a general factor and four dimensions: G-LSC (Lack of self-care), G-UEE (Unmet emotional expectations), G-SP (Social pressure), and G-CWR (Conflict with work role). The model demonstrated good fit (χ² = 109.42, df = 88, p = 0.061; CFI = 0.974; TLI = 0.965; RMSEA = 0.069; SRMR = 0.030) and high reliability (α total = 0.96; ω = 0.98; subscales α = 0.90–0.94). PGAS scores correlated positively with dispositional guilt, negative affect, prenatal distress, and antenatal depression. In regressions, G-UEE uniquely predicted depression (β = 0.213, p = 0.002) and G-SP predicted distress (β = 0.303, p < 0.001). Women who had considered pregnancy termination scored higher on guilt (p < 0.001). Conclusions: The PGAS is a reliable and valid instrument for assessing pregnancy-related guilt in Spanish women, with potential relevance for perinatal mental health research and clinical practice, while future studies should evaluate its performance in other cultural settings. Full article

Background/Objectives: Health literacy (HL) plays a fundamental role in maternal and neonatal outcomes by influencing women’s ability to access, understand, and apply health information during pregnancy. However, evidence regarding the determinants of HL among pregnant women remains limited, particularly within the Spanish context. This study aimed to assess HL levels among pregnant women and to examine their association with personal, socioeconomic, and health-related factors. Methods: A cross-sectional study was conducted between January 2023 and February 2024 across nine primary care centres within the Vigo Health Area (Spain), including 182 pregnant women receiving prenatal care. HL was measured using the 16-item European Health Literacy Survey Questionnaire (HLS-EU-Q16). Sociodemographic, obstetric, and health-related variables were collected through structured interviews. Descriptive and inferential analyses were performed to explore associations between HL and the selected variables. Results: Limited HL was observed in 35.7% of participants. A significant association was found between HL and family income (p = 0.037), with limited HL being more frequent among women with a monthly family income below €2000. No associations were identified with other sociodemographic or health-related variables. Thirty-nine per cent of participants visited hospital emergency services on two or more occasions, mostly without admission. The main source of information was healthcare professionals, although Internet use was also relevant. Conclusions: The prevalence of limited HL was lower than that reported in other national studies, although inequalities related to family income persisted. These findings highlight the need to incorporate systematic, HL-tailored strategies into prenatal care, based on prior HL assessment, to promote informed decision-making and improve maternal and neonatal outcomes. Full article

Background: premature birth is a significant public health problem, especially in developing countries such as Brazil. Premature newborns require special care from birth, often requiring prolonged hospitalization and continuous monitoring by various specialists after discharge. Infant Mortality among children under five years of age in Brazil is alarming, with prematurity being the main cause of death in this age group. Objectives: we aim to analyze the prevalence and temporal trend of premature live births in the state of São Paulo, Brazil, in the period 2000–2023. Methods: this is an Ecological, Time-Series Study with secondary data on premature live births in the state of São Paulo, Brazil, from 2000 to 2023. The variables in this study are aggregated measures by year. The Annual Percentage Change and the Average Annual Percentage Change in the percentage of premature live births were estimated by Joinpoint regression. Results: the percentage of premature live births in the period 2000 to 2023 was 9.71%. The average annual percentage change showed an increase of 2.30% per year. In the 2010 to 2013 segment, there was an increase of 12.58% per year (p ≤ 0.05), with subsequent stability in the 2013 to 2016 segment (p ≥ 0.05). The largest annual increases occurred in the number of 4 to 6 prenatal consultations and cesarean sections, with an annual percentage change of 4.51% per year and 2.68% per year, respectively. In the birth weight category equal to or greater than 2500 g, there was an increase in premature live births of 2.50% per year. All categories of the variables sex, type of pregnancy, and type of delivery increased in the period 2000–2023 (p ≤ 0.05). Conclusions: given the increase in the prematurity rate in the period 2000–2023, a long-term growing trend is expected in the largest and most developed state in Brazil. Full article