Search Results (348)

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

Exosomes are nanoscale extracellular vesicles that mediate intercellular communication by transporting microRNAs, proteins, and lipids. Generated through Endosomal Sorting Complex Required for Transport (ESCRT)-dependent mechanisms or ESCRT-independent pathways, exosomes are released when multivesicular bodies fuse with the plasma membrane. The ESCRT-dependent pathway involves sequential protein complexes (ESCRT-0, I, II, III) that recognize and sort ubiquitinated cargo, induce membrane budding, and facilitate vesicle scission. In contrast, the ESCRT-independent pathway relies on membrane lipids such as ceramide and proteins like tetraspanins (CD9, CD63, CD81) to promote vesicle formation without ESCRT machinery. Furthermore, post-translational modifications, including ubiquitination, sumoylation, and phosphorylation, further serve as molecular switches, modulating the affinity of ESCRT complexes or cargo proteins for membrane domains and affecting ILV formation rates. In reproductive medicine, exosomes regulate oocyte maturation, embryo–endometrial crosstalk, placental development, and maternal–fetal communication. Altered exosomal signaling contributes to obstetric complications, including preeclampsia, gestational diabetes mellitus, and preterm birth, whereas distinct exosomal miRNA signatures serve as potential diagnostic biomarkers. In gynecology, dysregulated exosomes are implicated in endometriosis, polycystic ovary syndrome, premature ovarian insufficiency, and gynecological malignancies. In contrast, mesenchymal stem cell-derived exosomes show therapeutic promise in restoring ovarian function and enhancing fertility outcomes. The distinctive molecular profiles of circulating exosomes enable minimally invasive diagnosis, while their biocompatibility and ability to cross biological barriers position them as vehicles for targeted drug delivery. Characterization of accessible data provides non-invasive opportunities for disease monitoring. However, clinical translation faces challenges, including standardization of isolation protocols, establishment of reference ranges for biomarkers, and optimization of therapeutic dosing. This review summarizes exosome biogenesis, characterization methods, physiological functions, and clinical applications in obstetrics and gynecology, with an emphasis on their diagnostic and therapeutic potential. Future directions include large-scale biomarker validation studies, engineering approaches to enhance exosome targeting, and integration with precision medicine platforms to advance personalized reproductive healthcare. Full article

Feingold syndrome (FS) is a rare congenital disorder with an autosomal dominant inheritance pattern. Two distinct subtypes are recognized based on their molecular pathology: FS type 1 (FS1) and FS type 2 (FS2). Both types share skeletal anomalies such as microcephaly, brachymesophalangia, and clinodactyly; however, gastrointestinal atresia is unique to FS1. Herein, we report a rare prenatal diagnosis of FS1 in a female fetus. The second-trimester ultrasound revealed bilateral clinodactyly and fetal microcephaly, and the subsequent molecular karyotyping identified a ~342 kb deletion at 2p24.3 encompassing the MYCN gene, confirming the diagnosis. The same deletion was detected in the father, verifying the hereditary pattern. The pregnancy was also complicated by preeclampsia and fetal growth restriction, leading to preterm caesarean delivery at 33 + 3 weeks of gestation. The neonate had microcephaly and clinodactyly but no gastrointestinal defects. In conclusion, high clinical suspicion aroused by identifying ultrasound features of FS can lead to early prenatal diagnosis via molecular karyotyping. Detecting accompanying gastrointestinal disorders that require early operation is crucial for the prognosis, genetic counseling, and prenatal management of the affected families. Full article

Background/Objectives: Vitamin D deficiency has been associated with an increased risk of adverse perinatal outcomes (APOs). This study aimed to examine whether vitamin D deficiency during the first trimester of pregnancy is linked to the development of gestational diabetes mellitus (GDM) in a Mexican population. Methods: A total of 404 pregnant women from the Biochemical and Epigenetic Origin of Overweight and Obesity (OBESO) cohort were included. Maternal vitamin D levels were measured between 11 and 14 weeks of gestation. Vitamin D deficiency was defined as a level below 20.0 ng/mL. The primary goal was to compare APOs between Group 1 (women with vitamin D deficiency) and Group 2 (women without vitamin D deficiency). Adjusted odds ratio (aOR) for APOs—including GDM, preeclampsia, preterm birth, miscarriage, cesarean section, and neonatal size—were calculated, adjusting for pregestational body mass index (BMI) and obesity, with 95% confidence interval (95% CI). Results: Vitamin D deficiency was present in 40.5% of women. Pre-pregnancy BMI and obesity were significantly higher in women with deficiency; other baseline characteristics did not differ between groups. Women with vitamin D deficiency had a higher risk of GDM (aOR 2.04, 95% CI 1.14–3.65, p = 0.01). No association was found between vitamin D deficiency and other APOs. Conclusions: The incidence of vitamin D deficiency in the first trimester was 40.5%. Early pregnancy vitamin D deficiency increases the risk of GDM among Mexican women. These findings highlight the importance of monitoring and supplementing vitamin D during pregnancy to reduce the risk of GDM. Full article

Background: Folic acid supplementation (FAS) before and in early pregnancy prevents neural tube defects, but the benefits of extending FAS to late pregnancy on pregnancy outcomes remain unclear. We aimed to investigate the associations between duration of FAS and a spectrum of pregnancy outcomes, and to determine whether the associations were modified by maternal age or pre-pregnancy body mass index (BMI). Methods: This prospective multicenter study included 15,694 singleton pregnancies. We used mixed-effects log-binomial regression models to estimate the adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) for gestational diabetes mellitus (GDM), gestational hypertensive disorders (GHDs), pre-eclampsia, preterm birth, macrosomia, small (SGA) and large for gestational age (LGA), and the interaction effects of advanced maternal age and pre-pregnancy BMI. Results: Of 15,694 women, 4523 (28.8%) did not take FAS before or during pregnancy, 2854 (18.2%) took FAS only during peri-pregnancy, 921 (5.9%) took FAS from peri- to mid-pregnancy, and 7396 (47.1%) took it through late pregnancy. Compared with women without FAS, those supplemented until mid-pregnancy were associated with lower risks of GHDs (aRR 0.84, 95% CI 0.74, 0.96) and pre-eclampsia (aRR 0.81, 95% CI 0.67, 0.97). Supplementation until late pregnancy was associated with lower risks of preterm birth (aRR 0.67, 95% CI 0.59, 0.76), SGA (aRR 0.74, 95% CI 0.63, 0.87), and LGA (aRR 0.88, 95% CI 0.79, 0.97). Among women of advanced maternal age or with overweight/obesity, supplementation until mid-pregnancy was associated with higher risk of GDM. Conclusions: Extending FAS until mid-pregnancy is associated with lower risks of GHDs and preeclampsia, and extending it until late pregnancy is associated with lower risks of preterm birth, SGA, and LGA. However, women of advanced maternal age or with overweight/obesity should be cautious about prolonging FAS. Full article

Copper (Cu), zinc (Zn), and selenium (Se) play a pivotal role in pregnancy. Both a deficiency and an excess of Cu, Zn, and Se have deleterious consequences for the outcome of pregnancy. Accordingly, maintaining optimal levels of circulating Cu, Zn, and Se is critical for proper fetal growth and development. However, to our knowledge, this is the first narrative global review that not only summarizes Cu, Zn, and Se levels in maternal and cord blood but also examines their associations with multiple adverse pregnancy outcomes. Thus, this up-to-date review seeks to address these key questions. To achieve these goals, literature was collected from the past several decades from three relevant databases (PubMed, Scopus, and Cochrane Library), and rigorous exclusion and inclusion criteria were set for peer-reviewed studies that met the requirements for a final inclusion in the review analysis. In this study, data is presented on the levels of Cu, Zn, and Se in maternal and cord blood across the globe (herein used to suggest optimal maternal levels for Cu, Zn, and Se during a normal, healthy pregnancy), elemental differences between maternal and cord blood, and the fluctuations of their blood levels depending on the trimester of pregnancy. In addition, the review presents findings on the effects of Cu, Zn, and Se on birth weight and anthropometric parameters of newborns, as well as on preterm birth, preeclampsia, gestational diabetes mellitus, neural tube defects, and congenital heart defects. Full article

Pre-eclampsia affects several physiological systems, often changing the course of pregnancy and manifesting with both maternal and foetal adversities, with a higher burden in rural Sub-Saharan African settings. This study presents maternal and foetal adverse outcomes associated with pre-eclampsia at a rural tertiary hospital in the Eastern Cape Province of South Africa. A prospective analytical case-control study was conducted with 250 pregnant women planned for delivery at the study setting’s labour unit. Pregnant women with pre-eclampsia were considered cases, whereas pregnant women without pre-eclampsia were considered controls. Cases were enrolled first, followed by a matched pair of controls based on their gravidity. A consecutive sampling technique was used to recruit eligible cases and controls. Data was collected using a self-designed questionnaire followed by descriptive and inferential analysis. Adverse foetal outcomes associated with pre-eclampsia were low birth weight [Adjusted odds ratio (AOR) = 2.1, p = 0.006] and foetal distress (AOR = 2.5, p < 0.001). Maternal outcomes associated with pre-eclampsia were haemolysis, elevated liver enzymes, and low platelets syndrome (AOR = 42.7, p < 0.001), as well as preterm delivery (AOR = 3.0, p = 0.001). Early antenatal visits, continuous monitoring of pre-eclamptic pregnant women, and implementation of preventive and curative measures to reduce the possibilities of this condition and its adverse outcomes are needed. Full article

Background/Objectives: Air pollution is a recognized risk factor for preterm birth (PTB), a major cause of neonatal morbidity and mortality. The biological mechanisms underlying this association remain unclear, partly because PTB is a composite outcome that includes both spontaneous (sPTB, from preterm labor or rupture of membranes) and medically indicated (mPTB, for conditions such as preeclampsia or fetal growth restriction) subtypes. Additionally, PTB spans a range of gestational lengths from 20 to 36 completed weeks, which may reflect distinct etiologic pathways. Methods: This scoping review identified studies evaluating two pollutants strongly linked to PTB—particulate matter < 2.5 µm in diameter (PM_2.5) and nitrogen dioxide (NO₂)—in relation to PTB phenotypes and gestational length. A comprehensive PubMed search using targeted MeSH terms and keywords included studies published between 1 January 2011 and 28 February 2024. Eligible studies examined associations of PM_2.5 or NO₂ with PTB and were categorized by whether they specified PTB phenotype (sPTB or mPTB), gestational length, or neither. Results: Of 436 eligible studies, 5 evaluated specific PTB phenotypes, 28 considered gestational length, and 3 addressed both. Reported associations of PM_2.5 or NO₂ with PTB were frequently significant but varied in magnitude and direction. Conclusions: Few studies have examined pollutant exposure in relation to PTB phenotypes or gestational lengths, revealing an important knowledge gap. Standardized approaches to exposure assessment and PTB classification are needed to clarify causal pathways and inform targeted prevention strategies and policies to reduce pollution-related PTB. Full article

Objectives: This study aimed to evaluate whether first-trimester metabolic markers—including the triglyceride-glucose (TyG) index and lipid-related ratios (TG/HDL-c, LDL-c/HDL-c, and TyG/BMI)—could predict the development of late-onset preeclampsia, and to assess their associations with birthweight and birth length. Methods: A retrospective cohort study was conducted on 306 pregnant women (153 with late-onset PE and 153 normotensive controls). Demographic and clinical data, including maternal lipid profiles, TyG index, and other biochemical markers, were collected during the first trimester. Statistical analyses, including Mann–Whitney, two-sided t-tests, and receiver operating characteristic curves (ROC), were performed to assess the predictive value of the TyG index and other ratios in predicting late-onset PE. Results: Significant differences between the PE and control groups were observed in delivery method, birthweight, and birthlength (p < 0.05). ROC analysis revealed that the TyG index had an area under the curve (AUC) of 0.79, with a sensitivity of 69.3% and specificity of 75.8%. The TyG index was inversely associated with birthweight (ρ = −0.288) and gestational age at delivery (ρ = −0.218), while positively correlating with systolic blood pressure (ρ = 0.441). Conclusions: The TyG index, along with TG/HDL and LDL-c/HDL ratios, demonstrated predictive value for late-onset PE. These findings suggest that elevated TyG index levels may contribute to adverse pregnancy outcomes such as intrauterine growth restriction and preterm delivery. First-trimester lipid profiles and the TyG index may serve as valuable markers for early prediction of late-onset PE. Full article

Background: Hypertensive disorders of pregnancy (HDP), including gestational hypertension and preeclampsia, affect up to 10% of pregnancies worldwide and remain a leading cause of maternal and perinatal morbidity and mortality. These conditions are associated with adverse fetal outcomes, including preterm birth, growth restriction, and maternal complications such as stroke, eclampsia, multi-organ dysfunction, and a higher risk of long-term cardiovascular complications. Current management relies largely on intermittent blood pressure monitoring and assessment of symptoms, approaches that provide limited insight into the complex hemodynamic alterations underlying HDP. Objective: This narrative review aims to synthesize the available evidence on noninvasive cardiography through thoracic electrical bioimpedance (TEB) as a tool for maternal hemodynamic monitoring in pregnancy, with a focus on hypertensive disorders. Specifically, we (1) describe maternal cardiovascular adaptations in normal gestations and their disruption in HDP, (2) provide an overview of thoracic electrical bioimpedance cardiac output (TEBCO) technology, (3) summarize validation studies in pregnant populations, (4) explore potential clinical applications, including diagnostic support, therapeutic guidance, fluid management and postpartum surveillance, and (5) identify key limitations and research priorities for future practice. Conclusions: Noninvasive cardiography through thoracic electrical bio-impedance is an underutilized tool in the medical field. As an alternative to invasive assessment, TEBCO can identify underlying pathologic hemodynamic changes susceptible to treatment and allow monitoring of hemodynamic trends. The implementation of TEBCO would allow pathophysiologic-based treatments, improve clinical response to therapy, and lead to potential prolongations of pregnancy and cost-savings in healthcare. Current evidence is limited by small sample sizes, device variability, and lack of outcome-based trials. Future research should focus on standardized validation, multicenter studies, and interventional trials to determine whether non-invasive cardiography-guided care can improve maternal and neonatal outcomes. Full article

Cell migration capacity represents an essential function of the immune system. Pregnancy involves numerous morphogenetic events, angiogenesis, the establishment of intercellular connections, and complex interactions between maternal and fetal immune systems—all requiring precisely coordinated and regulated migratory processes. Chemokines serve as master regulators of cellular migration and communication during pregnancy, with functions extending far beyond classical immunological roles. Physiological chemokine levels maintain feto-maternal tolerance through precise spatiotemporal regulation, while their dysregulation leads to catastrophic pregnancy complications such as preeclampsia and preterm birth. The chemokine system exhibits remarkable complexity through functional redundancy and promiscuity of receptors and ligands; alternative splicing generating protein diversity; decoy receptors enabling the fine-tuning of chemokine concentrations; and heterocomplex formation creating novel biological functions. Chemokines show significant promise as diagnostic and prognostic biomarkers, while specific receptor–ligand pairs represent therapeutic targets for managing pathological and life-threatening conditions during pregnancy. Thus, the chemokine system constitutes both a fundamental biological mechanism supporting pregnancy and a promising translational target for addressing complex clinical challenges in obstetric complications. To fully harness the potential of this system, it is essential to understand both its evolutionarily conserved core functions and its gestational stage-specific adaptations. Full article

Dyslipidemia is a significant risk factor for atherosclerotic cardiovascular disease (ASCVD). Abnormal maternal lipid profiles in pregnancy are associated with pregnancy complications including preeclampsia, gestational diabetes, and pre-term delivery as well as increased ASCVD risk for both mother and child. Dyslipidemia management remains a central tenet for atherosclerotic cardiovascular disease prevention for women who are thinking about becoming pregnant or are already pregnant. Effective individualized guidance and multidisciplinary lifestyle/dietary strategies, along with targeted pharmacological interventions, are required for the successful management of lipid disorders in pregnancy in order to optimize outcomes. This review discusses the physiological changes occurring in lipid metabolism during pregnancy and provides an overview of the current strategies for managing dyslipidemia during pregnancy, with a special focus on consideration of pharmacological therapy. Full article

Τhe intrauterine environment has a strong connection with the growing fetus and possible effects that can continue up to adulthood. Currently, stress is conceptualized as a modern teratogen. The overwhelming majority of studies indicate that maternal stress during pregnancy may have effects on pregnancy outcomes and fetal development, with long-lasting consequences on child and adult vulnerability to disease. Glucocorticoids are essential for regulating fetal development, growth, and metabolism. The two isoforms of 11beta-hydroxysteroid dehydrogenase enzyme (11β-HSD) mediate and regulate glucocorticoid actions and biological activity. It has not yet been fully elucidated whether maternal stress during pregnancy affects 11β-HSD isoenzyme activity and expression and results in possible adverse effects on fetal development, metabolism, and pregnancy outcomes. This review examines a possible pathophysiological mechanism by which maternal stress during pregnancy affects placental 11β-HSD isoenzyme activity, thereby causing adverse effects on the physiological status of pregnancy, fetal development, and metabolism. Furthermore, the main outcome of the review is the following: chronic and acute maternal stress during pregnancy affects the activity and the expression of placental 11β-HSD isoenzymes and has possible subsequent unfavorable results on preeclampsia, preterm birth, and fetuses with intrauterine growth restriction (IUGR) or small for gestational age (SGA) fetuses. Full article

Implementation of universal antiretroviral treatment (ART) in pregnancy has improved maternal health and reduced vertical transmission. However, women living with HIV (WLHIV) still experience worse perinatal outcomes. This retrospective study compared demographic, virological factors, ART regimens and perinatal outcomes in pregnant WLHIV between 2000–2010 (n = 318) and 2011–2021 (n = 140) at a tertiary center in Barcelona. Significant demographic shifts included changes in ethnic distribution, substance use, educational attainment, and maternal BMI. Significant progress in infection control was observed, with increased ART coverage up to 97%, improved viral suppression (80% to 91.3%, p = 0.002), and enhanced immunological status. ART regimens shifted significantly, with an increase in integrase strand transfer inhibitors (INSTI)-based regimens (0.7% to 39.2%, p < 0.001). Obstetric management evolved, with a rise in vaginal deliveries (24.8% to 44.3%, p < 0.001) and a decline in intrapartum zidovudine (93.7% to 54.7%, p < 0.001). Notably, preterm birth rates sharply declined, yet small-for-gestational-age (SGA) infants (26.4% vs. 20%, p = 0.323) and preeclampsia rates remained unchanged and higher than in the general population. All statistical analyses were performed in IBM SPSS statistics 23. In conclusion, although maternal and perinatal outcomes in pregnant WLHIV have improved over the past two decades, a high rate of adverse perinatal outcomes related to placental dysfunction (SGA, preeclampsia) persist. Our findings highlight the need for optimized prenatal care and further research to develop targeted interventions for WLHIV. Full article

Background: Gestational hypertension (GHT) is associated with adverse maternal and perinatal outcomes, and reliable biomarkers for risk stratification remain limited. Thrombospondin-4 (TSP-4), a matricellular glycoprotein implicated in vascular remodeling, may play a role in hypertensive disorders of pregnancy. This study aimed to investigate maternal serum TSP-4 levels in GHT and their associations with obstetric and neonatal outcomes. Methods: This prospective cohort study included 44 women with GHT and 44 normotensive controls. Maternal serum TSP-4 levels were measured between 20–30 weeks’ gestation, and demographic, obstetric, and neonatal data were recorded. The development of preeclampsia (PE) and composite adverse perinatal outcomes (CAPO) was subsequently compared between the groups. Results: TSP-4 levels were significantly higher in the GHT group compared with controls (9.50 vs. 7.92 ng/mL, p < 0.001). Women with GHT had lower gestational age at delivery and birth weight, with higher rates of preterm delivery, fetal distress, NICU admission, and composite adverse perinatal outcomes (all p < 0.01). Within the GHT group, patients who developed PE had notably higher TSP-4 levels (13.45 vs. 9.33 ng/mL, p < 0.001). Conclusions: Elevated maternal serum TSP-4 is independently associated with GHT and progression to PE. TSP-4 may serve as a novel biomarker for risk assessment in hypertensive disorders of pregnancy. Full article