Search Results (909)

Background/Objectives: Dichorionic triamniotic (DCTA) triplet pregnancies are associated with increased rates of placenta-specific complications primarily attributed to vascular anastomoses in the monochorionic (MC) pair. Selective fetal reduction to twins (of one of the MC pair) is a complex and not a widely available procedure. Multifetal reduction (MFR) to singleton pregnancy can reduce adverse pregnancy outcomes but is controversial due to medico-legal and socio-ethical issues. The aim of this study is to identify the rate of miscarriage < 24 weeks or preterm birth < 34 weeks following MFR to singleton pregnancy in DCTA triplets and compare the results with expectant management. Methods: This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered in the Prospective Register of Systematic Reviews System (ID: CRD42023422585). Results: Overall, from 21 citations of relevance, 6 studies with a total of 548 DCTA triplet pregnancies fulfilled the inclusion/exclusion criteria. In comparison with expectant management (n = 336), meta-analysis demonstrated that MFR to singleton pregnancy (n = 212) was associated with a lower rate (9.4% vs. 48.5%) of preterm birth (RR = 0.19, 95%CI 0.07–0.51), whereas the rate of miscarriage (14.6% vs. 9.2%) did not significantly increase (RR = 1.53, 95%CI 0.91–2.55). Conclusions: In DCTA triplet pregnancies, MFR to singleton pregnancy was associated with a reduced preterm birth rate and not associated with an increased miscarriage rate. Given the fact that the MC pair is reduced only to lower the rate of preterm birth, appropriate counselling and justification are important. In the absence of randomized controlled trials, data from systematic reviews are the best available evidence for counseling on the different management options. Full article

Background: Pelvic floor muscle dysfunction (PFD) is common during pregnancy. To counteract pregnancy-associated PFD, women require sufficient knowledge and structured guidance on correct pelvic floor muscle (PFM) contraction to improve PFM perception and functional control. Identifying pregnant women who are unable to perform correct PFM contraction despite structured teaching may allow early referral for rehabilitative measures. Objective: At measurement stage 1, this study aims to investigate the influence of structured PFM teaching on pregnant women’s ability to perform targeted PFM contraction (tPFMC-A), assess PFM strength, and describe possible early PFD symptoms. Material and Methods: “pelviTrust” is a two-arm randomized, controlled longitudinal study and has been conducted in the Department of Midwifery Science, University of Tuebingen since February 2023. The study sample comprised 221 healthy pregnant women with singleton pregnancy at 18–22 weeks of gestation. The intervention group (IG; n = 113) (69 nulliparous, 40 primiparous and four biparous) completed the validated German Pelvic Floor Questionnaire for Pregnant and Postpartum Women (GPFQppw) and received individualized midwife-led teaching on PFM anatomy, functional activation and PFM-friendly behaviour, followed by visual inspection and vaginal palpation. Objective-targeted PFMC ability (tPFMC-A) and PFM strength (modified Oxford Scale) were compared with self-assessed ability. The control group (n = 101) (61 nulliparous, 38 primiparous, and two biparous) receives routine prenatal and postnatal care and completes the GPFQppw. The present analysis focuses exclusively on the IG at T1. Results: At T1, 88% of the 113 women in the IG believed they could contract their PFM, but only 68% demonstrated a correct tPFMC-A on visual inspection. Following structured teaching with individualized feedback, 97% achieved correct PFM contraction while 2.7% still had deficits. The median PFM strength was three on the modified Oxford Scale (interquartile range: 3–4). Stress urinary incontinence and flatulence were the most frequently reported symptoms. Primiparous and multiparous women reported urinary incontinence and descensus symptoms more often than nulliparous women (p < 0.001). Conclusions: At the first prenatal assessment, pregnant women often overestimate their ability to contract their PFM correctly. A structured, midwife-led PFM teaching improves objectively assessed PFM contraction ability and may be integrated into routine antenatal care to support PFM health in pregnant women. Full article

Background/Objectives: Preterm birth (PTB) is a major global cause of neonatal morbidity and mortality, and its heterogeneous mechanisms limit the development of reliable prediction tools. Recent genomic and proteomic studies have highlighted molecular pathways involving inflammation, extracellular matrix dysfunction, and uterine activation, yet their clinical integration remains limited. Defining distinct clinical phenotypes may facilitate more targeted biomarker research. Methods: We performed a retrospective cohort study of singleton spontaneous preterm births (24–36 + 6 weeks) at Filantropia Clinical Hospital, Bucharest (2022–2024). Maternal and neonatal data were extracted from electronic records. Four phenotypes were defined by presentation (preterm premature rupture of membranes—PPROM vs. contractions) and maternal inflammatory status. Statistical comparisons used ANOVA or Kruskal–Wallis tests, Chi-square tests, and logistic regression adjusted for gestational age and birth weight to assess neonatal outcomes. Results: Of 585 preterm births, 318 spontaneous singleton cases met inclusion criteria. The cohort was predominantly late preterm, with 85.5% of deliveries occurring between 34 and 36 + 6 weeks’ gestation. Four phenotypes were identified: phenotype 1 inflammatory PPROM (22.3%), phenotype 2 structural PPROM (38.1%), phenotype 3 mixed inflammatory + uterine activation (11.9%), and phenotype 4 uterotonic/endocrine phenotype (19.2%). Conclusions: These clinical phenotypes exhibited distinct maternal and neonatal patterns and correspond to mechanisms increasingly supported by genomic and proteomic studies. They may provide a practical framework for integrating clinical and molecular approaches in future PTB research. Full article

Background: Gestational diabetes mellitus (GDM) complicates a significant number of pregnancies and is associated with both short- and long-term risks for the mother and child. Twin pregnancies are inherently high risk, and the coexistence of GDM may amplify these risks. While the effects of GDM in singleton pregnancies have been widely studied, data on its impact in twin gestations remain limited. The aim of this study was to determine differences regarding metabolic characteristics, treatment requirements, and maternal as well as fetal outcomes between twin and singleton pregnancies with GDM to contribute to improved perinatal care. Methods: This retrospective study included obstetric data from 73 twin pregnancies (146 neonates) and 1664 singleton pregnancies with a GDM diagnosis at a tertiary perinatal center in Berlin, Germany, between 2015 and 2022. Baseline characteristics and perinatal outcomes were assessed. Adjusted multiple linear and logistic regression analyses were used for group comparisons. Results: Women with GDM in twin and singleton pregnancies exhibited comparable glucose values in the 75 g oral glucose tolerance test (OGTT) (median fasting: 95 vs. 96 mg/dL; 1 h: 183 vs. 183 mg/dL; 2 h: 144 vs. 139 mg/dL). Despite this, insulin therapy was required significantly less often in twin (5.5%) compared to singleton pregnancies (22.3%) (OR = 0.86; 95% CI: 0.78–0.96). Among insulin-treated women, combined insulin therapy was most common in twins (75%), while singleton mothers most frequently received long-acting insulin alone (61.7%), followed by combined therapy (31.3%) and short-acting insulin alone (7%). Birthweight was significantly lower in twins (β = –0.83 kg; 95% CI: –0.98 to –0.69), and when evaluated using twin-based growth standards, twins were more likely to be classified as having intrauterine growth restriction (IUGR, <3rd percentile) (OR = 3.37; 95% CI: 0.96–9.11), being small for gestational age (SGA, <10th percentile) (OR = 2.50; 95% CI: 1.23–4.76), or having a birthweight below the 30th percentile (OR = 6.11; 95% CI: 3.49–11.12). No large-for-gestational-age (LGA, >90th percentile) neonates were observed in the twin group. Conclusions: GDM manifests differently in twin and singleton pregnancies. Despite similar OGTT values, twin mothers require insulin less frequently. Growth-related complications such as IUGR and SGA are significantly more frequent in twins, likely reflecting the physiological constraints of multiple gestations rather than GDM itself. Conversely, LGA is predominantly a concern in singleton pregnancies. These findings underscore the need for individualized diagnostic criteria and management strategies for GDM in twin pregnancies. Full article

Within the framework of evidence theory, maximum entropy is regarded as a measure of total uncertainty that satisfies a comprehensive set of mathematical properties and behavioral requirements. However, its practical applicability is severely questioned due to the high computational complexity of its calculation, which involves the manipulation of the power set of the frame of discernment. In the literature, attempts have been made to reduce this complexity by restricting the computation to singleton elements, leading to a formulation based on reachable probability intervals. Although this approach relies on a less specific representation of evidential information, it has been shown to provide an equivalent maximum entropy value under certain conditions. In this paper, we present an experimental comparative study of two algorithms for calculating maximum entropy in evidence theory: the classical algorithm, which operates directly on belief functions, and an alternative algorithm based on reachable probability intervals. Through numerical experiments, we demonstrate that the differences between these approaches are less pronounced than previously suggested in the literature. Depending on the type of information representations to which it is applied, the original algorithm based on belief functions can be more efficient than the one using the reachable probability interval approach. This is an interesting result, and a reason for choosing one algorithm over the other depending on the situation. Full article

Objectives: To evaluate the association between antenatal betamethasone exposure and neonatal respiratory morbidity among late-preterm births. We further examined whether gestational age at delivery and the exposure-to-delivery interval modify this association. Methods: We conducted a retrospective cohort study of singleton live births at 34–36 + 6 weeks in a tertiary center (2011–2023). Betamethasone exposure was classified as none, early (<34 weeks), or late (34–36 + 6 weeks). Among exposed pregnancies, the interval from first dose to delivery was categorized as ≤7 or >7 days and evaluated separately at 34, 35, and 36 weeks. Primary outcomes were RDS and composite respiratory morbidity (RDS, TTN, or ≥3 days of respiratory support); neonatal hypoglycemia was secondary. Adjusted odds ratios were estimated using multivariable logistic regression including maternal age, parity, delivery mode, and birthweight. Results: The study included 2668 late-preterm infants, of whom 2356 (88.3%) were unexposed and 312 (11.7%) were exposed to antenatal corticosteroids (ACSs). Among exposed pregnancies, 138 (44.2%) received early ACS and 174 (55.8%) late ACS; 163 (52.2%) delivered ≤7 days and 149 (47.8%) >7 days after administration. Late ACS exposure was associated with lower odds of RDS (aOR 0.37, 95% CI 0.17–0.69) and composite respiratory morbidity (aOR 0.55, 95% CI 0.31–0.92), but with increased odds of neonatal hypoglycemia (aOR 2.72, 95% CI 1.26–5.31). Among pregnancies delivering at 34 weeks, exposure within ≤7 days was associated with a marked reduction in RDS (aOR 0.25, 95% CI 0.07–0.79; NNT ≈ 3), whereas no respiratory benefit was observed at 35 or 36 weeks or when the interval exceeded 7 days. Conclusions: Antenatal betamethasone exposure among late-preterm births was not uniformly associated with neonatal respiratory outcomes, with associations varying by gestational age at delivery and the exposure-to-delivery interval. These findings may be interpreted in the context of potential respiratory benefit alongside accompanying metabolic risk, with exploratory analyses suggesting a more pronounced signal among deliveries at 34 weeks within ≤7 days. Full article

Background: Maternal thyroid hormones are essential for fetal development and the maintenance of pregnancy. While thyroid dysfunction earlier in gestation has been extensively studied, the clinical relevance of thyroid function assessed at labor admission remains unclear. This study investigated the association between maternal thyroid function parameters measured at labor ward admission and obstetric and neonatal outcomes in term pregnancies. Methods: In this retrospective observational study, 664 women with singleton term pregnancies (≥37 weeks) admitted to the labor ward of a tertiary referral center were included. Maternal thyroid-stimulating hormone (TSH), free thyroxine (FT4), and admission complete blood count parameters (hemoglobin, hematocrit, white blood cell count, and platelet count) were recorded. Obstetric and neonatal outcomes were compared across FT4 tertiles using univariable and multivariable regression analyses adjusted for key obstetric confounders. Results: Gestational age at delivery differed significantly across FT4 tertiles, with higher FT4 levels associated with a greater proportion of late-term deliveries. Lower FT4 levels were independently associated with lower neonatal birth weight categories after adjustment for gestational age and parity. Admission complete blood count parameters did not differ significantly across FT4 tertiles or gestational age categories. Maternal TSH levels were not independently associated with obstetric or neonatal outcomes, and no significant associations were observed with Apgar scores or NICU admission. Conclusions: In term pregnancies, maternal FT4 levels measured at labor admission are associated with delivery timing and neonatal birth weight but do not independently predict intrapartum fetal distress or adverse immediate neonatal outcomes. Full article

Background: Adolescent pregnancies remain associated with increased maternal and neonatal morbidity. This study describes the clinical and demographic characteristics of very young pregnant adolescents in Brașov County, Romania. Methods: We conducted a retrospective observational study of 1322 singleton deliveries to adolescents aged 12–16 years at Clinical Hospital “Dr. I.A. Sbârcea”, Brașov (2018–2024). Descriptive statistics, Chi-square tests, t-tests, and correlation analyses were performed. No multivariable adjustment was applied. Results: Mean maternal age was 15.3 ± 0.8 years; 82.8% were from rural areas; 76% were primigravida. Cesarean section rate was 31.5%. Maternal complications included anemia (45%), postpartum hemorrhage (29.4%), preeclampsia (8%), and urogenital infections (28%). Among neonates, 33.7% had low birth weight, 18% were preterm, and 32.4% had APGAR scores < 7 at 1 min. Adolescents aged 12–14 years had lower postpartum hemoglobin (8.72 vs. 10.42 g/dL, p < 0.001) and higher rates of APGAR < 7 at 1 min (51.4% vs. 28.8%, p < 0.001) compared to those aged 15–16 years. Rural residence was associated with higher anemia rates (46.8% vs. 36.4%, p = 0.003) and inadequate prenatal care (40.0% vs. 23.7%, p < 0.001). Conclusions: This single-centre cohort shows high rates of obstetric complications and adverse neonatal outcomes among very young adolescents, with observed differences by age and residence. These descriptive findings may inform further research into risk factors and preventive interventions for adolescent pregnancies in Romania. Full article

Background/Objectives: Hypogonadotropic hypogonadism (HH) is an uncommon but treatable cause of non-obstructive azoospermia (NOA). Fertility can often be restored with gonadotropin therapy. This study evaluated spermatogenic and reproductive outcomes in men with HH-related NOA managed by stepwise gonadotropin therapy, microdissection testicular sperm extraction (microTESE) for persistent azoospermia, and assisted reproduction when indicated. Methods: A retrospective cohort study included 35 men treated between 2010 and 2022. Human chorionic gonadotropin (hCG), with or without follicle-stimulating hormone (FSH), was administered to induce spermatogenesis. Outcomes included sperm appearance in the ejaculate, microTESE sperm retrieval rate in persistent azoospermia, and pregnancy and live birth outcomes after natural conception or in vitro fertilization with intracytoplasmic sperm injection (IVF-ICSI) when required. Results: Mean gonadotropin therapy duration was 12.0 months (range 6–24). Sperm appeared in the ejaculate in 27/35 men (77%). The remaining 8/35 (23%) underwent microTESE, with sperm retrieved in 7/8 (88%). Seven couples proceeded to IVF-ICSI, undergoing 11 cycles that yielded 6 clinical pregnancies (55% per cycle) and 5 live birth deliveries, including 2 twin pregnancies. Among responders, 13 natural pregnancies occurred, resulting in 13 live birth deliveries, including 2 twin pregnancies. Overall, 18/35 men (51%) achieved biological fatherhood, corresponding to 18 live birth delivery events (4 twin and 14 singleton deliveries) and 22 newborns. Conclusions: In men with HH-related NOA, exogenous gonadotropin therapy is expected to induce spermatogenesis in most patients. MicroTESE provides high sperm retrieval rates for those without ejaculatory sperm. Through an integrated approach of hormonal induction, microsurgical sperm retrieval, and assisted reproduction, approximately half of patients may ultimately achieve biological fatherhood in longer-term follow-up, depending on baseline severity and partner factors. Full article

Objective: This study aimed to compare fetal adrenal gland volume (AGV), fetal zone (FZ) depth, and middle adrenal artery pulsatility index (MAA-PI) between pregnancies presenting with preterm labor and gestational age-matched asymptomatic controls, and to evaluate size-adjusted adrenal metrics (corrected AGV [cAGV] and fetal zone–total gland depth ratio) in relation to gestational age at delivery and neonatal outcomes. Methods: This prospective analytical cross-sectional (case–control) study included 60 singleton pregnancies (30 with preterm labor and 30 asymptomatic controls) evaluated at a tertiary perinatology unit between 24 + 0 and 36 + 6 weeks’ gestation. Transvaginal cervical length and transabdominal fetal adrenal measurements (AGV, FZ depth, and MAA-PI) were obtained at enrollment. Estimated fetal weight (EFW) at the index scan was retrieved, and corrected AGV (cAGV = AGV/EFW) and fetal zone–total gland depth ratio were calculated. Outcomes were gestational age at delivery, birthweight, Apgar scores, and neonatal intensive care unit (NICU) admission. Nonparametric group comparisons and Spearman correlations were used. Results: Gestational age at ultrasound was identical between groups (median 31 + 6 weeks). Compared with controls, the preterm labor group had shorter cervical length (12.5 vs. 33.5 mm, p < 0.001), higher AGV (1.53 vs. 1.08 cm³, p < 0.001) and FZ depth (7.45 vs. 5.30 mm, p < 0.001), and lower MAA-PI (1.11 vs. 1.46, p < 0.001). EFW at the index scan did not differ between groups (p = 0.900). Corrected AGV (cAGV) was higher in the preterm labor group (0.87 (0.76–1.06) vs. 0.59 (0.51–0.70), p < 0.001), and the fetal zone–total gland depth ratio was higher (0.328 (0.312–0.346) vs. 0.263 (0.241–0.278), p < 0.001). The preterm labor group delivered earlier (33 + 0 vs. 36 + 2 weeks, p < 0.001), had lower birthweight (1875 vs. 3188 g, p < 0.001), and more frequent NICU admission (50.0% vs. 6.7%; odds ratio 14.0, 95% CI 2.82–69.56; p < 0.001). Within the preterm labor group, gestational age at delivery correlated positively with cervical length (ρ = 0.900) and MAA-PI (ρ = 0.770) and negatively with AGV (ρ = −0.770) and FZ depth (ρ = −0.733), all p < 0.001; correlations were stronger for cAGV (ρ = −0.953, p < 0.001). Conclusions: Enlarged fetal adrenal gland volume and fetal zone depth together with reduced middle adrenal artery pulsatility index are associated with preterm labor and earlier delivery. Size-adjusted adrenal metrics (cAGV and fetal zone–total gland depth ratio) remained significantly different between groups, supporting these measures as potential adjuncts for risk stratification at presentation. Full article

Background/Objectives: Maternal rectovaginal carriage of Group B Streptococcus (GBS, Streptococcus agalactiae) is a major risk factor for vertical transmission and early-onset neonatal infection. Intrapartum antibiotic prophylaxis reduces early-onset disease but does not address antenatal carriage and may affect the maternal–neonatal microbiota. Microbiota-directed interventions, including probiotics, are being explored as complementary strategies. Methods: This prospective, single-centre, open-label pilot intervention study included 10 pregnant women (18–40 years) with singleton pregnancies and a positive vaginal and/or rectal GBS swab, without pre-gestational or gestational diabetes and without antibiotic use in the 4 weeks before enrolment. Participants received OMNi-BiOTiC^® FLORA plus (multi-strain lactic acid bacteria, including Lactobacillus crispatus) orally at 2 × 2 g/day from the 15th to the 34th gestational week. Microbiological swabs were obtained at qualification (12–15 weeks), mid-pregnancy (22–25 weeks), and late pregnancy (34–35 weeks). Outcomes were described descriptively. Results: Among 56 screened pregnant women, 10 were GBS-positive (17.9%) and enrolled. All participants were GBS-positive at baseline. At 22–25 weeks, 5/10 (50%) had a negative GBS result. At 34–35 weeks, 9/10 (90%) were GBS-negative, while 1/10 (10%) remained colonised. Time to first negative result ranged from 7.6 to 20.2 weeks from supplementation start (median 8.6 weeks). No recurrences (negative-to-positive transitions) were observed between the second and third sampling points. No adverse events related to supplementation were reported. In contrast, among the 46 women who were GBS-negative at screening and did not receive probiotic supplementation, 14 (30.4%) were found to be GBS-positive at routine screening performed at 35–37 weeks of gestation. Conclusions: In this pilot single-arm study, oral supplementation with a multi-strain probiotic preparation during pregnancy was associated with a time-dependent reduction in rectovaginal GBS carriage and was well tolerated. These preliminary findings support the feasibility of larger randomised controlled trials incorporating microbiome profiling and neonatal outcomes. Full article

Background/Objectives: Hypertensive disorders of pregnancy (HDP) remain a major contributor to maternal morbidity and mortality worldwide, yet early-life reproductive factors such as age at menarche have been insufficiently explored in relation to HDP. Therefore, we aimed to evaluate the association between age at menarche and the risk of HDP in a cohort of Mexican pregnant women. Methods: We conducted a retrospective cohort study among 1344 women with singleton pregnancies receiving care at a tertiary hospital in Mexico City in 2024. Age at menarche was categorized as <12, 12–14, and >14 years. HDP diagnoses were extracted from clinical records. Poisson regression with robust variance was used to estimate adjusted risk ratios (RRs). Sensitivity analyses included alternative menarche categorizations and restricted cubic spline models. Counterfactual mediation analyses assessed indirect effects through reconstructed prepregnancy BMI and gestational diabetes. Results: Both early (<12 years) and late (>14 years) menarche were associated with higher HDP risk than the 12–14-year reference (adjusted RR = 1.81; 95% CI 1.42–2.30, and 1.74; 95% CI 1.27–2.38, respectively). Spline models confirmed a U-shaped association. Mediation analyses indicated that prepregnancy BMI did not meaningfully mediate the association for either early or late menarche (<5% mediated). Gestational diabetes explained a modest proportion of the association for early menarche (≈14%), but not for late menarche. Conclusions: Age at menarche showed a robust U-shaped association with HDP, mostly independent of adiposity and gestational diabetes, within the limits of the available measurements. Incorporating pubertal timing into routine reproductive history taking may enhance contextual risk assessment for HDP. Full article

Background: Congenital anomalies are influenced by genetic and environmental factors. While interventions including folic acid supplementation have reduced neural tube defects, data on modifiable socio-demographic risk factors remain limited. Aim: This study aimed to assess variation in the prevalence of selected congenital anomalies across the United States according to socio-demographic factors. Methods: A population-based analysis was conducted using CDC-WONDER natality data from 2016 to 2023. Included anomalies were anencephaly, spina bifida, cyanotic heart disease, diaphragmatic hernia, omphalocele, gastroschisis, limb reduction, cleft lip/palate, Down syndrome, chromosomal disorders, and hypospadias. Associations with maternal age, BMI, race, tobacco use, diabetes, and fertility treatments were analyzed. Prevalence rates were calculated per 1000 live births. Relative risks (RRs) and 95% confidence intervals (CIs) were estimated. Joinpoint regression was used to assess annual percent changes (APCs), with p < 0.05 considered significant. Results: Among 3,482,944 singleton live births in 2023, the overall prevalence of the selected congenital anomalies was 3.3 per 1000. Compared to Caucasian mothers, risk was lower in Asian (RR 0.57; 95% CI: 0.52–0.63) and Black (RR 0.81; 95% CI: 0.76–0.85) infants and higher in American Indian/Alaska Native infants. Significant risk factors included pre-pregnancy diabetes (RR 2.41; 95% CI: 2.16–2.69), maternal age > 45 (RR 2.95; 95% CI: 2.36–3.69), and tobacco use (RR 1.78; 95% CI: 1.64–1.94). A significant decline in prevalence was observed from 2016 to 2023 (APC: −0.6%; 95% CI: −1.1 to −0.2; p = 0.006). Conclusions: Significant disparities and modifiable maternal risk factors were associated with the prevalence of selected congenital anomalies in the U.S. from 2016 to 2023. A modest statistically significant decline in overall prevalence was observed during the study period, supporting the importance of continued national surveillance and targeted preconception and prenatal interventions to reduce risk and address inequities. Full article

Background: Maternal chronotype, maternal sleep, and breastfeeding practices are separately associated with maternal mood. However, it is not known if maternal mood mediates the associations between maternal chronotype or maternal sleep and breastfeeding duration. Objective: To investigate whether maternal mood mediates the associations of maternal chronotype and maternal prenatal sleep with breastfeeding duration in a multiethnic cohort of Singaporean mothers. Methods: In a prospective cohort study, caregivers of term-born, singleton infants (N = 340) completed the Horne–Östberg Morningness–Eveningness Questionnaire (MEQ; 54 months), Pittsburgh Sleep Quality Index (PSQI; 26 weeks gestation), Edinburgh Postnatal Depression Scale (EPDS; 26–28 weeks gestation) and State–Trait Anxiety Inventory (STAI-state, STAI-trait; 26–28 weeks gestation) and reported breastfeeding practices from 3 weeks to ≥12 months. Regression and mediation analyses were adjusted for maternal age, parity, maternal education, ethnicity, pre-pregnancy BMI, and mode of delivery. Results: Morningness was significantly associated with a longer breastfeeding duration (β = 0.02, p = 0.037) and lower maternal anxiety symptoms (STAI-state: β = −0.19, p = 0.006 and STAI-trait: β = −0.18, p = 0.004). Lower maternal anxiety symptoms were significantly associated with a longer breastfeeding duration (STAI-state: β = −0.02, p = 0.003; STAI-trait: β = −0.02, p = 0.016). STAI-state, but not STAI-trait or EPDS, mediates the association between maternal chronotype and breastfeeding duration (β_indirect = 0.004 (0.0004, 0.009)). Maternal mood did not mediate the association between maternal night sleep duration and breastfeeding duration. Conclusions: Maternal state-anxiety constitutes a behavioral pathway through which maternal chronotype influences breastfeeding duration. Strategies to target maternal anxiety in pregnant women with eveningness tendencies to promote breastfeeding duration are warranted. Full article

Background: Fetal growth restriction (FGR) is a major contributor to adverse perinatal outcomes and is primarily driven by placental insufficiency and chronic fetal hypoxia. While arterial Doppler abnormalities are widely used in clinical surveillance, less is known about venous hemodynamics and intracardiac structural adaptations in FGR. In particular, the clinical relevance of foramen ovale (FO) morphometry and inferior vena cava (IVC) Doppler parameters in different FGR phenotypes remains incompletely understood. This study aimed to evaluate FO measurements and IVC Doppler indices in early- and late-onset FGR and to investigate their associations with adverse perinatal outcomes. Methods: This prospective observational study included 240 singleton pregnancies: 120 fetuses with FGR and 120 gestational age-matched appropriate-for-gestational-age controls. FGR was defined according to Delphi consensus criteria and classified as early onset (<32 weeks) or late onset (≥32 weeks). Ultrasonographic assessment included FO and right atrium dimensions, FO-to-right atrium (FO/RA) ratio, IVC diameter, and IVC Doppler indices (pulsatility index [PI], preload index [PLI], and peak velocity index for veins [PVIV]). A composite adverse perinatal outcome (CAPO) was recorded. Receiver operating characteristic (ROC) curve analysis and multivariable logistic regression were performed. Results: Compared with controls, fetuses with FGR exhibited significantly smaller FO dimensions, lower FO/RA ratios, reduced IVC diameters, and higher IVC Doppler indices (all p < 0.05). The FO/RA ratio demonstrated the highest discriminative performance for CAPO (AUC 0.722). In multivariable analysis, a 0.1-unit increase in the FO/RA ratio was independently associated with a reduced risk of CAPO (OR 0.57), whereas higher IVC PI values were associated with an increased risk (OR 2.64). IVC Doppler alterations were less pronounced in early-onset FGR. Conclusions: FO morphometry and IVC Doppler parameters reflect complementary stages of fetal cardiovascular adaptation in fetal growth restriction, with FO changes representing early adaptive responses and IVC Doppler alterations indicating more advanced hemodynamic compromise, and this may provide additional value for perinatal risk stratification. Full article