Iron (Pregnancy)

Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-specific liver disorder characterized by elevated total bile acid (TBA) levels, leading to adverse maternal and fetal outcomes. While genetic factors contribute to ICP and bile acid metabolism, the underlying mechanisms remain incompletely understood, particularly in East Asian populations. We conducted a genome-wide association study (GWAS) in 13,357 pregnant women from a Chinese cohort to investigate genetic determinants of TBA levels and ICP. Meta-analysis was performed by combining our data with the Shenzhen cohort. Post-GWAS analyses included pathway enrichment, integrative analysis with liver single-cell RNA sequencing (scRNA-seq) data, and Mendelian randomization (MR). We identified genome-wide significant associations at CYP7A1 (rs4738680, p = 1.08 × 10-10) and SLC39A9 (rs17107007, p = 3.46 × 10-28) for TBA, and at SLC39A9 (rs17107007, p = 3.34 × 10-16) for ICP. Pathway analysis highlighted bile acid synthesis and metabolism pathways for TBA and immune-related pathways for ICP. Integrative scRNA-seq analysis revealed enrichment of TBA-associated genes in hepatocytes and ICP-associated genes in neutrophils. MR analysis suggested a potential causal effect of estrone on TBA levels. Our findings provide novel insights into the genetic architecture of TBA and ICP, emphasizing the roles of bile acid metabolism in hepatocytes and immune dysregulation in ICP pathogenesis. The identified genetic loci and pathways may inform future research on risk prediction and targeted therapies for ICP. © 2026 Wiley Periodicals LLC.

Background and Objectives: Endometrial polyps are common in women presenting with subfertility, yet uncertainty persists regarding which lesions warrant removal and how best to integrate hysteroscopic management with contemporary fertility treatment pathways. This narrative review synthesizes current evidence on pathophysiological mechanisms, diagnostic approaches, fertility outcomes, and practical clinical management for women under 40 years of age. Materials and Methods: PubMed/MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Library were searched for English-language human studies published between January 2005 and December 2025. From 2352 records identified, 83 studies were included after screening of 1517 unique records (7 randomized controlled trials, 12 systematic reviews/meta-analyses, 14 prospective cohort studies, 31 retrospective cohort studies, 5 case-control and other study designs, 11 narrative reviews and supporting evidence studies, 1 clinical guideline, and 2 targeted 2025 additions). This structured narrative review employed a systematic search strategy to ensure comprehensive coverage, with evidence synthesized thematically in accordance with the SANRA guidelines. No formal risk-of-bias assessment or pre-registered protocol was used. Results: Across treatment modalities, hysteroscopic polypectomy was consistently associated with improved fertility outcomes. The landmark Pérez-Medina randomized trial reported a relative risk of 2.1 (95% CI 1.5-2.9) for pregnancy after polypectomy before intrauterine insemination. For IVF/ICSI, reported clinical pregnancy rates after polypectomy range from 53-72% and live birth rates from 43-66%. Proposed mechanisms include mechanical interference, chronic inflammation with cytokine dysregulation, altered endometrial receptivity (including dysregulation of HOXA10/HOXA11), and impaired decidualization. Conclusions: Current evidence supports hysteroscopic polypectomy as an effective intervention to improve fertility outcomes in subfertile women with endometrial polyps, particularly prior to intrauterine insemination. For IVF/ICSI, polypectomy of documented polyps appears beneficial, though evidence qualit

Background and Objectives: Intrauterine growth restriction (IUGR) affects 5-10% of pregnancies and is associated with increased perinatal morbidity and long-term complications for the neonate. Extracellular vesicles (EVs), and in particular, microparticles (MPs), have emerged as potential biomarkers of pregnancy complications; however, the literature on their role in neonates remains limited. To investigate the functional characteristics, concertation in maternal blood and potential role of MPs in IUGR. Materials and Methods: PubMed, Scopus and preprint servers were systematically searched for studies on MPs in correlation with IUGR from 1 August until 18 September 2025. Data on MP characteristics and concentration in maternal blood samples in the context of IUGR were collected. The systematic review is registered in PROSPERO (CRD420251156939). Results: A total of 12 studies fulfilled the inclusion criteria and were included in the review. In IUGR-complicated pregnancies, circulating MPs exhibited preserved procoagulant activity despite minimal quantitative differences compared to controls. Platelet-, endothelial-, and placenta-derived MPs were most frequently studied. Clinically, elevated AV+ placenta-derived MPs were associated with increased risk of IUGR, whereas MPs from isolated IUGR pregnancies showed limited predictive value. Conclusions: MPs play a crucial role in the pathophysiology of IUGR through their interplay in coagulation, inflammation, and vascular dysfunction. They show potential as predictive biomarkers, particularly in cases of preeclampsia-associated IUGR, reflecting systemic maternal endothelial and inflammatory changes. However, their utility in isolated IUGR appears limited, likely due to the predominantly local placental origin of the pathology.

Background: Nausea and vomiting in pregnancy affects up to 80% of pregnant women and may progress to hyperemesis gravidarum, leading to maternal morbidity and adverse pregnancy outcomes. Despite numerous pharmacological and non-pharmacological options, the comparative efficacy and safety of these interventions remain unclear. Methods: We conducted a systematic review and network meta-analysis of randomized controlled trials assessing pharmacological and non-pharmacological interventions for nausea and vomiting in pregnancy. The databases searched included CENTRAL, PubMed, and EMBASE (up to 28 May 2024). Eligible trials compared interventions with a placebo in pregnant women with nausea and vomiting in pregnancy. The primary outcomes were symptom severity, assessed using validated tools. Safety outcomes included adverse effects. Data were pooled using frequentist pairwise and network meta-analyses. The risk of bias was assessed using the RoB2 tool, and the certainty of evidence was evaluated using the CINeMA framework. Results: Of 9844 records screened, 24 randomized controlled trials (3017 participants) met the inclusion criteria, encompassing 16 intervention categories. Network analysis ranked quince, vitamin B6 with pomegranate and mint, acupressure P6, dimenhydrinate, and acupuncture combined with doxylamine-pyridoxine as the most effective interventions for reducing symptoms of nausea and vomiting in pregnancy, with considerable uncertainty and low-to-moderate quality of evidence. Reporting of adverse events was limited. Risk of bias was low to moderate. Discussion: Most interventions demonstrated significant benefit over a placebo. However, high heterogeneity and sparse reporting of adverse effects warrant caution when translating these results into clinical practice. Conclusions: This study indicates that both pharmacological (vitamin B6, metoclopramide, dimenhydrinate) and non-pharmacological (ginger, quince, acupressure, acupuncture) interventions might be effective in reducing symptoms of nausea and vomiting in pregnancy.

BACKGROUND: Maternal health literacy (MHL) represents a potentially modifiable public health determinant concentrated among socioeconomically disadvantaged populations. While 15-45% of pregnant women demonstrate inadequate health literacy, its impact across the full spectrum of infant and early childhood outcomes remains inadequately characterized, limiting understanding of its broader public health significance. OBJECTIVE: To systematically synthesize evidence on associations between MHL and infant/child health outcomes from birth through age three, and to examine whether MHL functions as a systemic determinant across outcome domains. METHODS: Following PRISMA guidelines, we searched MEDLINE, Embase, and Web of Science from inception through March 2025. Studies examining associations between validated MHL measures and any child health outcomes up to age three were included. Methodological quality was assessed using JBI checklists, and the certainty of evidence using the GRADE framework. Narrative synthesis was conducted. RESULTS: Eight studies (n = 13,407 participants) from seven countries met inclusion criteria. Higher MHL was consistently associated with favorable birth weight. A pattern consistent with a behavioral pathway hypothesis emerged: outcomes requiring maternal behavioral competencies (e.g., symptom recognition, care-seeking) showed stronger and more consistent associations (e.g., reduced neonatal jaundice readmission, diaper dermatitis) than medically-determined conditions. Limited evidence also suggested MHL effects beyond the perinatal period, with inadequate MHL associated with increased risks of nutritional deficiencies and developmental delays (over four-fold increased risk in vulnerable populations). JBI assessment indicated generally adequate quality, while GRADE rated the certainty of evidence as Low to Very Low due to cross-sectional designs and imprecision. CONCLUSION: MHL shows promising systematic associations with infant outcomes across multiple domains spanning the early life course, operating primarily through behavioral pathways requiring maternal agency. This pattern supports conceptualizing MHL as a potential foundational public h

INTRODUCTION: Moringa oleifera (M. oleifera) is highlighted as a diverse-purpose feed in the nutrition of small ruminants. This is a systematic review that compared its effects on goats based on a predetermined PICO model (Population: goats in different physiological phases; Intervention: dietary M. oleifera in the forms of leaf meal, extract, or silage; Comparison: no interventions; Outcomes: growth performance, antioxidant status, reproduction, and milk yield and quality). METHODS: The PRISMA guidelines were used to identify the studies from the search included PubMed, Scopus, Web of Science, ScienceDirect, and Google Scholar, and the publication window was January 2015 to December 2025 and screened them with systematic eligibility criteria to minimize selection bias. RESULTS AND DISCUSSION: Regular addition of moderate amounts of Moringa supplements had a consistent beneficial effect on nutrient utilization and growth efficiency, and on nitrogen balance, with fibre digestibility improving by around 25%. An intensive antioxidant response was observed, as evidenced by significant increases in enzymatic defenses (e.g., superoxide dismutase upsurge by more than 100% at certain phases) and dramatic decreases in lipid peroxidation (malondialdehyde drops by approximately 70%). Reproductive performance was positively affected by an improvement in endocrine functionality, and progesterone levels during early pregnancy rose up to ~90%." in supplemented doses, and litter size and offspring viability improved. The benefits of lactational responses were improved milk output and production of milk fat and protein, in addition to a more desirable composition of fatty acids and enhanced oxidative stability of milk. The evidence is that M. oleifera is a highly nutritional phytogenic nutraceutical capable of enhancing metabolic efficiency, oxidative balance, reproductive performance, and quality of milk in goats. It produces benefits at moderate dietary inclusion levels, with physiological optimization as opposed to maximal dosing.

BackgroundPuerperal sepsis remains a preventable contributor to maternal illness. Pregnancy-related sepsis is responsible for ∼10% to 15% of maternal deaths. Despite this burden, no comprehensive review has examined self-care practices related to its prevention. Therefore, this review sought to evaluate self-care behaviors aimed at preventing puerperal sepsis and to explore associated factors among postnatal women in Africa.Data Sources and MethodsWe conducted a systematic review and metaanalysis of 17 eligible studies on the prevalence of self-care practices for puerperal sepsis prevention and their associations among postnatal mothers. Searched PubMed, Web of Science, Wiley Online Library, ScienceDirect, African Journals Online, and Google Scholar from December 10, 2023 to January 15, 2024. A Joanna Briggs Institute adapted tool was used to assess the quality of the studies. Forest plot, Cochran's Q test, subgroup analysis, sensitivity analysis, and metaregression model were used to test heterogeneity between included studies. Funnel plots and Egger's test were used to examine publication bias.ResultsA total of 17 studies that meet the inclusion criteria were included. The pooled prevalence of self-care for puerperal sepsis prevention practices among postpartum women was 36.09% (95% CI: 26.35, 45.82). Among postpartum women, urban dwellers (AOR: 3.23, 95% CI: 1.86, 5.63), those who were above tertiary education status (AOR: 2.81, 95% CI: 1.11, 4.67), those who had a good level of knowledge (AOR: 2.45, 95% CI: 1.11, 4.67), and those who had ≥4 ANC contacts (AOR: 3.75, 95% CI: 2.23, 6.31) were identified as associated factors.ConclusionsOnly 36.09% of postpartum women practiced self-care practices to prevent puerperal sepsis at home. It would be better to design a new healthcare system during maternal healthcare to scale up mothers' self-care puerperal sepsis prevention practices to reduce maternal morbidity and mortality caused by puerperal sepsis. In addition, all healthcare providers recognize the need to foster new thinking and to apply greater action to address identified factors of poor self-care and puerperal sepsis prevention practices.PROSPERO Registrat

OBJECTIVE: The role of intrauterine PRP infusion in managing recurrent implantation failure (RIF) remains controversial despite its emerging clinical use. This systematic review aims to evaluate its therapeutic potential in RIF patients and further to investigate variations in outcomes based on transfer cycle type, embryo developmental stage, RIF diagnostic criteria, and endometrial thickness. METHODS: We systematically searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, Scopus, and Web of Science for randomized controlled trials (RCTs) investigating PRP treatment for RIF patients from the beginning of the database to May 2025. RESULTS: This meta-analysis showed that PRP administration significantly improved clinical pregnancy rate (CPR) [OR = 3.18, 95%CI (2.45, 4.14), I2 = 3%], biochemical pregnancy rate (BPR) [OR = 2.84, 95%CI (2.22, 3.63), I2 = 0%], ongoing pregnancy rate (OPR) [OR = 3.41, 95%CI (2.08, 5.60), I2 = 30%] and live birth rate (LBR) [OR=5.10, 95%CI (1.95, 13.37), I2 = 75%] in women with RIF. However, PRP intrauterine infusion did not reduce miscarriage rate (MR). Notably, the preterm birth rate was significantly higher in the PRP group compared to controls [OR = 8.24, 95%CI (2.09, 32.41), I2 = 0%]. Subgroup analysis demonstrated that PRP improved CPR, BPR and LBR in both the fresh and frozen embryo transfer cycles. Additionally, while PRP increased CPR, LBR and reduced MR in blastocyst transfers [CPR OR = 3.84, 95%CI (2.82, 5.23), I2 = 0%; LBR OR = 7.32, 95%CI (3.17, 16.90), I2 = 63%; MR OR = 0.27, 95%CI (0.07, 0.96), I2 = 54%], these effects were not observed in cleavage-stage embryo transfers. Moreover, PRP administration associated with a higher CPR [OR = 3.84, 95%CI (2.82, 5.23), I2 = 0%], OPR[OR = 4.13, 95%CI (1.79, 9.56), I2 = 48%], LBR [OR = 7.32, 95%CI (3.17, 16.90), I2 = 63%] and a lower MR [OR = 0.27, 95%CI (0.07, 0.96), I2 = 54%] in women with ≥3 prior implantation failure, it did not confer the same benefit to those with a history of ≥2 failed cycles. CONCLUSION: These findings suggest a possible beneficial role for PRP on pregnancy outcomes to some extent in women with RIF, particularly in cases with ≥3 prior

BACKGROUND: Recurrent implantation failure (RIF) presents significant clinical and psychological challenges. While acupuncture is a potential adjunctive therapy during embryo transfer (ET), comprehensive evidence regarding its multidimensional effects remains limited. This study systematically evaluates acupuncture's impact on pregnancy outcomes, endometrial receptivity, and psychological status in RIF patients. METHODS: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing acupuncture + ET with ET alone in patients with RIF. Eight major databases were searched from inception through October 2025. Risk of bias was assessed using the Risk of Bias 2 (RoB 2) tool, and the certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. RESULTS: Fourteen RCTs involving 1,428 patients were included. Regarding clinical efficacy, acupuncture + ET significantly increased the clinical pregnancy rate (relative risk [RR] = 1.73, 95% confidence interval [CI] [1.51, 1.99], p < 0.001), the embryo implantation rate (RR = 1.69, 95% CI [1.34, 2.13], p < 0.001), and the live birth rate (RR = 1.82, 95% CI [1.16, 2.86], p = 0.009), while reducing the miscarriage rate (RR = 0.40, 95% CI [0.17, 0.97], p = 0.04). In terms of endometrial receptivity, acupuncture significantly increased endometrial thickness (mean difference [MD] = 1.20, 95% CI [0.75, 1.66], p < 0.001) and reduced the endometrial pulsatility index (MD = -0.49, 95% CI [-0.93, -0.06], p = 0.03) and resistance index (MD = -0.21, 95% CI [-0.30, -0.13], p < 0.001). Furthermore, significant reductions in Self-Rating Anxiety Scale and Self-Rating Depression Scale scores were observed (MD = -5.89, p = 0.02 and MD = -6.83, p = 0.003, respectively). However, the certainty of evidence ranged from very low to moderate due to methodological limitations and high heterogeneity. CONCLUSION: Acupuncture may be a promising adjunctive therapy for RIF patients undergoing ET. However, the current evidence is constrained by significant methodological limitations. These results support the clinical integration of acupuncture into m

AIMS/BACKGROUND: Obstructive sleep apnea (OSA) and intermittent maternal hypoxia during pregnancy have been hypothesised to impact fetal heart rate (FHR). To evidence this possible link, we performed a systematic review of the current evidence about maternal OSA and FHR alteration. METHODS: The following databases were analysed from the inception to June 2024: Cochrane Library, PubMed-Medline, EMBASE, Web of Science, and Google Scholar. We included studies with pregnant women affected by OSA, and FHR assessed via cardiotocography or fetal electrocardiography. Studies without polysomnography or home sleep testing, cross-over designs, or non-English publications were excluded. RESULTS: 168 studies were screened, and six were included. Five were prospective observational studies, and one was a case report. Maternal age showed a value from 26.6 ± 7.1 to 34.8 ± 3.3 years, and gestational age ranged from 32.1 ± 3.4 to 39.4 ± 1.0 weeks. The body mass index (BMI) values ranged between 27.5 ± 7.2 and 55 kg/m2. Polysomnography was the primary diagnostic tool for OSA in most studies; one study utilised a home sleep test. Apnea/hypopnea episodes frequency varied from 8.4 to 159 events per hour. Findings about the FHR alterations were discordant: three studies did not report an association, other three observed FHR changes linked to maternal respiratory events. CONCLUSION: Our systematic review evidenced a significant variability about the maternal OSA impact on fetal heart rate. The study's results were contradictory. These inconsistencies also derive from different study designs, sample sizes, and outcomes analysed. Further studies are necessary to evidence the real impact of the OSA on the fetal cardiac response. SYSTEMATIC REVIEW REGISTRATION: PROSPERO (CRD42024533801). © 2026 The Author(s). Published by IMR Press.

BACKGROUND: There have been discussions as to the time of elective induction of labour to curb the continuation of pregnancy that might endanger the lives of both the mother and child. This research was conducted to assess foetal and maternal consequences of planned delivery at 40 and 41weeks in women with low-risk singleton pregnancy. MATERIAL AND METHODS: A randomised controlled trial with equal allocation of participants (96 pregnant women in each arm) into 40weeks and 41weeks. Participants were randomised at the antenatal clinic at 39 weeks for induction of labour. The main outcome was the caesarean section rate. Secondary outcomes were maternal (genital tract laceration rate) and foetal (rates of meconium staining of amniotic fluid, SCBU admission, perinatal mortality, birth trauma, birth weight, and neonatal APGAR score at 1 and 5 minutes). Student t-test and chi-square test were used for inter-group comparison. RESULTS: Incidence of caesarean delivery (26.6% vs. 21.3%; p=0.406), and genital laceration (2.1% vs. 5.6%; p=0.268) did not differ between groups. Significantly higher birth weight was noted among women induced at 41weeks (3.41 ± 0.37kg) than 40weeks (3.28 ± 0.46kg) (p=0.043). Also, there was significant variation in meconium staining of amniotic fluid between 40weeks (11.7%) and 41weeks (25.8%) (p=0.014). Other foetal outcomes showed no significant difference. CONCLUSION: Inducing labour at 40weeks is safe for low-risk women as it does not significantly increase the cesarean delivery rate and adverse perinatal outcomes. Therefore, elective induction of labour at 40weeks should be recommended and introduced into obstetric practice without the fear of adverse outcomes. © 2026 Oluwadare Martins Ipinnimo et al., published by Institute of Mother and Child.

This single-site, pilot-scale randomized controlled study intended to evaluate the effects of a self-determination theory-informed (D6 gamification model-based) gamified breastfeeding counselling program on breastfeeding self-efficacy, breastfeeding success, and breast-related problems in postpartum participants. A pretest-posttest randomized controlled trial was conducted with 60 pregnant individuals recruited from a single university-affiliated private hospital in Türkiye, using a pilot-scale parallel group design. Participants were assigned to experimental (n = 30) and control (n = 30) groups by block randomization that was performed by an independent statistician. Due to the behavioural nature of the intervention, participant blinding was not feasible; however, outcome analyses were conducted by a blinded biostatistician. The intervention group received a digitally delivered gamified breastfeeding counselling program from gestational week 35 until week 2 postpartum, while the control group received routine prenatal and postnatal care. Data were obtained for validated measures of breastfeeding self-efficacy, breastfeeding success, and breast-related problems. Descriptive and inferential statistical analyses were conducted with SPSS 28.0 software. At week 2 postpartum, the mean breastfeeding self-efficacy scale-short form scores were significantly higher in the gamified counselling group than the control group (63.6 ± 6.2 versus 54.3 ± 8.4, P < .001, Cohen's d = 1.26). Breastfeeding performance also favoured the intervention group, with higher infant breastfeeding assessment tool scores (8.6 ± 1.1 versus 7.3 ± 1.4, P < .001) and LATCH breastfeeding assessment scores (9.3 ± 0.7 versus 8.4 ± 1.1, P = .002). Furthermore, breast fullness severity that was assessed using a dichotomous self-reported outcome (present/absent) checklist in which higher scores indicate more severe fullness, was lower in the intervention group than the control group (2.5 ± 1.1 versus 4.0 ± 1.2, P < .001). Gamified breastfeeding counselling was effective in enhancing breastfeeding self-efficacy and breastfeeding success and reduced common breast-related problems. These findings provide pr

BackgroundCurrently, there is no consensus on the optimal dose of fentanyl that should be combined with bupivacaine in spinal anesthesia for cesarean section deliveries.ObjectiveTo determine the optimal dose of intrathecal fentanyl to be combined with bupivacaine that is needed to obtain an optimal mix of sensory and motor block, analgesia, and acceptable incidence of adverse effects in spinal anesthesia for cesarean section deliveries.MethodsA prospective, randomized, double-blind clinical trial that was conducted in adherence to the Consolidated Standards of Reporting Trials (CONSORT) guidelines. Women who opted for elective cesarean section deliveries were randomized into 4 groups. Groups 1-3 received 7.5 mg of 0.5% hyperbaric bupivacaine with 10, 15, and 25 μg of fentanyl, respectively. Group 4 received 10 mg of 0.5% hyperbaric bupivacaine without fentanyl. Sensory and motor block, analgesia, hemodynamic stability, the incidence of adverse effects, and neonatal health outcomes were assessed.ResultsA total of 160 women completed the study (40 women in each group). The women who received 25 μg of fentanyl with 7.5 mg of 0.5% hyperbaric bupivacaine had significantly shorter (p-value < 0.0001) sensory block latency, longer duration of sensory block, longer duration of analgesia, less need for rescue analgesia, expressed higher satisfaction with analgesia, experienced less hemodynamic instabilities, and experienced fewer episodes of bradycardia and vomiting compared to those who received bupivacaine alone or in combination with lower doses of fentanyl. On the other hand, more episodes of pruritus were reported when bupivacaine was combined with fentanyl compared to bupivacaine alone (p-value < 0.01).ConclusionsThe combination of 25 µg intrathecal fentanyl with 7.5 mg of 0.5% hyperbaric bupivacaine in spinal anesthesia for cesarean section was associated with a favorable balance of sensory blockade, motor blockade, analgesia, and adverse effects. However, the increased incidence of pruritus should be considered.

The aim of this paper was to assess the impact of predictive nursing on preventing postpartum hemorrhage in parturients undergoing vaginal delivery. From January 2020 to December 2022, eighty parturients who underwent vaginal delivery at The Second People's Hospital of Lianyungang were selected as study participants. They were randomly divided into a control group (Routine nursing) and a study group (Predictive nursing, a forward-looking nursing model that employs various methods to analyze and predict the potential health issues that patients may encounter, and then formulates intervention measures in advance, aiming to prevent problems before they occur). Compared to the control group, the study group had shorter labor time at the first, second and third stages, less postpartum blood loss 2 h and 24 h after delivery, lower scores of depression and anxiety, higher quality of life scores, lower incidence of complications and higher nursing satisfaction. Our study indicates predictive nursing model can effectively reduce postpartum bleeding, decrease the risk of neonatal asphyxia, promote maternal quality of life, and achieve the nursing goal of optimizing pregnancy outcomes for parturients who underwent vaginal delivery. Publisher: Cette étude visait à évaluer l'impact des soins infirmiers prédictifs sur la prévention des hémorragies du post-partum chez les parturientes ayant accouché par voie basse. De janvier 2020 à décembre 2022, quatre-vingts parturientes ayant accouché par voie basse à l'Hôpital populaire n° 2 de Lianyungang ont été sélectionnées pour participer à l'étude. Elles ont été réparties aléatoirement en deux groupes : un groupe témoin (soins infirmiers de routine) et un groupe expérimental (soins infirmiers prédictifs, un modèle de soins prodigués qui utilise diverses méthodes pour analyser et prédire les problèmes de santé potentiels que les patientes pourraient rencontrer, puis formuler des mesures d'intervention en amont, afin de prévenir leur apparition). Comparé au groupe témoin, le groupe expérimental a présenté une durée de travail plus courte lors des première, deuxième et troisième phases du travail, des pertes sanguines post-partum moin

Objective: To investigate the efficacy and safety of mFOLFOXIRI combined with bevacizumab plus cytoreductive surgery (CRS) in patients with resectable peritoneal metastasis of colorectal cancer (CRC). Methods: A single-center, prospective randomized controlled design was conducted. Inclusion criteria: confirmed synchronous or metachronous peritoneal metastasis of CRC, aged >18 years, adequate organ function and tolerance to chemotherapy, resectable peritoneal lesions with peritoneal cancer index (PCI) <20, Eastern Cooperative Oncology Group (ECOG) performance status score of 0-1, and tolerance to CRS. Exclusion criteria: intolerance or inefficacy to oxaliplatin, distant unresectable metastasis, emergency surgery, active malignancy, history of thromboembolism, pregnancy or lactation, and other severe comorbidities. Between August 2022 and December 2024, eligible patients with resectable peritoneal metastasis of CRC treated at the Sixth Affiliated Hospital, Sun Yat-sen University were enrolled and randomly assigned at a 1:1 ratio to the neoadjuvant therapy group (mFOLFOXIRI plus bevacizumab followed by CRS) or the direct CRS group. The primary endpoint was the 1-year progression-free survival rate. Secondary endpoints included the response to neoadjuvant therapy, completeness of cytoreduction (CC) score, length of postoperative hospital stay, and postoperative complications. Results: A total of 53 patients who underwent surgery were included, with 19 in the neoadjuvant therapy group and 34 in the direct CRS group. There were no statistically significant differences between the two groups in age, sex, BMI, primary tumor location, pathological type, pattern of peritoneal metastasis (synchronous/metachronous), extraperitoneal metastasis, history of prior systemic therapy, baseline radiological PCI score, or tumor markers (CEA, CA19-9, CA125) (all P>0.05). In the neoadjuvant therapy group, post-treatment radiological PCI score was significantly lower than baseline [M(Q1,Q3): 6.0 (4.0, 12.0) vs. 8.0 (5.0, 12.0), Z=-3.086, P=0.002], and CEA was significantly reduced [3.9 (2.8, 7.3) μg/L vs. 7.7 (4.1, 16.1) μg/L, Z=-2.809, P=0.005]. Hemoglobin and albumin levels were als

BACKGROUND: Iron deficiency anemia in pregnancy is a significant health concern. Reticulocyte hemoglobin equivalent (Ret-He) and immature reticulocyte fraction (IRF) are emerging as early markers, yet their response to different iron therapies in pregnancy is underexplored. OBJECTIVE: To determine whether intravenous single-dose iron administration produces a more favorable effect on reticulocyte indices than oral iron therapy in anemic pregnant women. METHODS: This is a secondary analysis of the RAPIDIRON Trial, a multicenter, three-arm randomized controlled trial comparing ferric carboxymaltose (FCM), ferric derisomaltose (FDM) and standard oral ferrous sulfate. Reticulocyte hemoglobin equivalent (Ret-He), Immature Reticulocyte Fraction (IRF) and other red blood cell indices including Mean Corpuscular Volume (MCV), Mean Corpuscular Hemoglobin (MCH), Mean Corpuscular Hemoglobin Concentration (MCHC) were measured at baseline (12-16 weeks), mid-gestation (26-30 weeks) and 42 days postpartum. Cord blood indices were assessed at delivery. RESULTS: By 26-30 weeks of gestation, iron deficient anemic women receiving IV iron demonstrated significant improvements in all red cell indices when compared to those receiving oral iron. Specifically, MCV increased by 2.87 fL (95% CI, 2.41-3.33) in the IV FDM group and 3.02 fL (95% CI, 2.54-3.49) in the IV FCM group compared to oral iron. Similarly Ret-He levels were also significantly increased in IV FDM and FCM compared to oral iron (1.32 (1.02, 1.63) and 1.31 (1.01, 1.62) respectively. By 42 days postpartum, intergroup differences in Ret-He, IRF and other parameters were no longer statistically significant, indicating that hematologic parameters had converged across treatment arms, reflecting restoration of iron homeostasis and stabilization of erythropoiesis in all groups. CONCLUSION: Intravenous iron therapy produces a more rapid and pronounced improvement in maternal red cell and reticulocyte indices than oral iron in moderately anemic pregnant women. Ret-He and IRF are emerging as early and sensitive biomarkers of iron availability and erythropoietic activity, with potential clinical utility for early detection of treatm

INTRODUCTION: Gestational diabetes mellitus (GDM) is associated with a high risk of adverse perinatal outcomes. We evaluated whether a film-based educational intervention for pregnant women and healthcare providers to improve timely detection and management of GDM could reduce the incidence of adverse perinatal outcomes. METHODS: Two parallel-group cluster randomised trials were conducted in Uganda and India. A package of 7 interconnected culturally-tailored educational films was developed following formative research. 30 government-funded health facilities (clusters) in each country were randomised (1:1) to intervention or control arm. In intervention facilities (15 in each country), films were shared with pregnant women and health professionals; control facilities (15 in each country) received usual care. The outcome was an individual self-reported composite of unplanned caesarean section, stillbirth or neonatal death, or neonatal hospitalisation. Mixed effects models were used in an intention-to-treat analysis with multiple imputation by chained equations to address missing data. Analyses were performed separately for each country; random-effects meta-analysis was used to calculate pooled prevalence ratios (PRs). Data analysts were blinded to group allocation, but participants, facility and trial staff were not. RESULTS: In Uganda, 5495 women were screened between May 2021 and April 2022, and 5102 (92.8%) participated in the trial. In India, 12 045 women were screened between July 2021 and January 2022, and 10 899 (90.5%) participated. Loss to follow-up was 31.7% in Uganda and 12.1% in India. In Uganda, the prevalence of the composite adverse perinatal outcome was 19.7% in the control arm and 19.8% in the intervention arm (PR 1.00, 95% CI 0.87 to 1.14). For India, the prevalence was 29.5% and 30.6%, respectively (PR 1.04, 95% CI 0.96 to 1.11). The pooled PR across both countries was 1.03 (95% CI 0.97 to 1.10). CONCLUSIONS: A film-based intervention did not reduce the incidence of adverse perinatal outcomes associated with GDM. Future evaluations should assess educational films delivered alongside more intensive intervention components. TRIAL REGISTRATION NUMB

OBJECTIVES: Propacetamol, an intravenous prodrug of paracetamol, can be employed alongside intravenous patient-controlled analgesia (IVPCA) to decrease opioid consumption and associated side effects. While prior studies focused on propacetamol's efficacy in incisional wound pain, its effectiveness for uterine contraction pain remains underexplored. MATERIALS AND METHODS: This prospective randomized controlled trial recruit parturients with ASA physical status class II, undergoing scheduled cesarean delivery at gestational age 36 weeks or greater. All parturients received spinal anesthesia and were randomly allocated to three groups: 0 g, 1 g and 2 g of propacetamol respectively in combination with morphine based IVPCA. The primary outcome was the postoperative visceral uterine contraction pain and wound incisional pain compared to 0 g group. The secondary outcomes comprised morphine consumption, patient satisfaction, and treatment-related adverse events. Hierarchical linear modeling and one-way ANOVA were used for statistical analysis. RESULTS: A total of 97 parturients were enrolled. Both the 1 g and 2 g propacetamol groups showed significant reductions in incisional wound pain compared with the 0 g group (p = 0.001 and p < 0.001, respectively); however, only the 2 g of propacetamol significantly reduced uterine contraction pain (p = 0.002). Morphine consumption was lesser in 2 g propacetamol group (p < 0.001). Patient satisfaction and treatment-related adverse events did not differ among groups. CONCLUSION: When combined with morphine-based patient-controlled analgesia, regular administration of 2 g propacetamol reduces uterine contraction pain and morphine consumption after cesarean delivery, whereas both 1 g and 2 g reduce incisional wound pain.

OBJECTIVE: Atosiban has demonstrated effectiveness in improving pregnancy outcomes in patients with recurrent implantation failure (RIF). However, the optimal dosage protocol is yet to be established, and only a few studies have directly compared different regimens. MATERIALS AND METHODS: This double-blind, randomized controlled trial recruited 100 patients with RIF undergoing treatment at the Assisted Reproductive Technology Center at National Cheng Kung University Hospital between March 2022 and May 2024. Patients were assigned to receive either a bolus protocol of atosiban (6.75 mg; Group A, n = 50) or an infusion protocol of atosiban (total 37.5 mg; Group B, n = 50) before embryo transfer. RESULTS: Although no significant differences were observed, Group B showed a tendency toward higher live birth rates (6.0% vs 20.0%, RR = 3.333; P = 0.071). Other pregnancy outcomes also demonstrated a positive trend, with a notably higher ongoing pregnancy (6.0% vs 20.0%, RR = 3.333; P = 0.071) and a lower miscarriage rate (75.0% vs 33.3%, RR = 0.444; P = 0.054). Subgroup analysis revealed a significant benefit of the infusion protocol in subgroups of patients with high fertility quality of life scores and high-quality embryos (P = 0.039 and 0.048, respectively). CONCLUSION: The atosiban infusion protocol demonstrated a positive trend in pregnancy outcomes among patients with RIF. Further large-scale studies are needed to confirm its effectiveness and establish optimal strategies.

PURPOSE: This study aims to examine the effect of paternal skin-to-skin contact on breastfeeding after cesarean section. BACKGROUND: Skin-to-skin contact can be used to strengthen breastfeeding in newborns. METHODS: The study was conducted between April 2023 and August 2023 in the obstetrics clinic of a hospital in a province in eastern Turkey, with a total of 126 postpartum women who had cesarean sections. A socio-demographic characteristics introduction form, a questionnaire on skin-to-skin contact and breastfeeding process, and the LATCH Breastfeeding Assessment Tool were used to collect research data. RESULTS: The time to initiate breastfeeding was determined as 67.54 ± 10.69 minutes in the skin-to-skin contact group and 86.38 ± 35.14 minutes in the control group. The mean LATCH score of postpartum women in the skin-to-skin contact group was 8.13 ± 1.27, while the mean LATCH score of mothers in the control group was 6.13 ± 1.69. Statistically significant differences were found between the groups in terms of time to initiate breastfeeding, postpartum women's first breastfeeding durations, time for the newborn to latch onto the breast, babies' first latch-on behavior, swallowing movement during sucking, behaviors after feeding, supplementary food intake, postpartum LATCH score, and LATCH score at discharge. CONCLUSIONS: The study concluded that skin-to-skin contact applied through fathers after cesarean section has a positive effect on breastfeeding behaviors. IMPLICATIONS FOR PRACTICE AND RESEARCH: As healthcare professionals, it is recommended that fathers be informed about skin-to-skin contact during the antenatal period, encouraged for skin-to-skin contact in the postpartum process, and that hospital policy health policies include policies that encourage fathers' active participation in the postpartum process.

INTRODUCTION: Topical vaginal estrogens have been used in the management of postmenopausal vulvovaginal atrophy for some time, locally reintroducing exogenous estrogens to the estrogen-receptive tissues of the female urogenital tract following a decline in systemic levels. The postpartum period is similarly a state of relative estrogen depletion due to the antagonistic effect from raised prolactin levels throughout pregnancy and lactation; this is thought to contribute to post-delivery pelvic floor dysfunction and vaginal atrophy. Given the similar etiology, there may be a role for topical vaginal estrogens in postpartum women. MATERIAL AND METHODS: A systematic review was performed evaluating the use of topical vaginal estrogens in postpartum women. This was performed as per PRISMA guidelines, with articles screened from online databases from their inception to October 2025. RESULTS: Three studies were identified that met the inclusion criteria, including a total of 85 women. Two studies focused on the molecular and cellular composition of tissues from postpartum women using topical vaginal estrogens, and one double-blind randomized placebo-controlled trial primarily evaluated postpartum atrophy in the presence and absence of vaginal estrogens. Tissues exposed to estrogen appeared to have increased cellular proliferation, while the Vulval Assessment Score (VuAS), a patient-subjective validated scoring system for vaginal atrophy, was found to be lower in those using vaginal estrogen cream for 12 weeks. No statistically significant difference in bladder, bowel, or sexual function was noted. No serious adverse outcomes were reported, and the use of vaginal estrogens appeared acceptable to women. CONCLUSIONS: There is a paucity of data currently available regarding the use of topical vaginal estrogens in the post-partum period. Although likely safe for use, further evidence is required to be able to make firm conclusions about their efficacy for postpartum vaginal atrophy, and further high-quality trials are required in the future. © 2026 The Author(s). Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation

OBJECTIVES: Cytomegalovirus (CMV) is the leading cause of congenital infectious neurosensory impairment. We aimed to present national epidemiological data on maternal CMV infection during pregnancy in France, focusing in particular on primary infection in the periconceptional period or first trimester, and to assess the impact of changes in screening practices and clinical management of affected pregnant women and their newborns. METHODS: In this retrospective, multicenter study, we retrieved data from the electronic database of the French National Reference Center for Herpesviruses from cases of maternal CMV infection diagnosed during pregnancy between January 2017 and December 2023, with known neonatal infection status (infected or non-infected) at birth. Maternal, fetal and neonatal data in cases with maternal primary infection during the periconceptional period or first trimester were compared between the periods before and after publication of a pivotal randomized controlled trial (RCT) in September 2020 that demonstrated that valacyclovir reduced vertical transmission by two-thirds when administered to women with first-trimester primary CMV infection. RESULTS: Among 451 documented cases of maternal CMV infection during pregnancy with known fetal/newborn CMV status, there were 220 pregnancies (222 fetuses) with periconceptional or first-trimester primary maternal infection (PI), among which maternal-fetal transmission occurred in 176 (79.3%). Compared with the period from 2017 to 2020, in the period from 2021 to 2023 there was a significant increase in both systematic CMV screening (from 22.0% to 40.0%; P = 0.001) and maternal requests for testing (from 0% to 4.2%; P = 0.02). Among cases of maternal infection during the periconceptional period or in the first trimester, antiviral therapy (generally valacyclovir) was administered more frequently in the period from 2021 to 2023 (27.7% vs 59.8%; P < 0.0001). The overall rate of termination of pregnancy (TOP) for early maternal CMV-PI was 20.7% (40/193 with known pregnancy outcome), with significantly fewer TOPs being performed in the period from 2021 to 2023 (25.9% vs 13.0%; P = 0.03). Notably, women who did n

BACKGROUND: Manual removal of placenta (MRP) is required in 0.1%-3.3% of vaginal births. For patients who give birth without labor epidural analgesia, the choice between neuraxial or general anesthesia (GA) with or without tracheal intubation presents unique challenges. This study describes anesthetic management practices for these cases. METHODS: This multicenter retrospective cohort study analyzed 423 patients undergoing MRP at two tertiary centers in Israel (Soroka and Rabin Medical Centers) from 2016 to 2022. We collected data on anesthetic techniques, patient characteristics, and clinical outcomes, comparing patients managed with and without tracheal intubation during GA. RESULTS: GA was used in 409 (96.7%) cases, with 269 (65.8%) patients managed with tracheal intubation and 140 (34.2%) receiving tubeless GA. Patients who received tubeless GA had lower rates of intraoperative complications, including hypotension (16.4% vs. 26.0%, p = 0.034), vasopressor use (10.0% vs. 20.8%, p = 0.006), and blood product transfusions (3.6% vs. 11.9%, p = 0.006). Multivariable analysis revealed associations between higher body mass index (aOR = 2.19), elevated heart rate (aOR = 1.86), and tracheal intubation. Tracheal intubation rates significantly declined from 2016 to 2022 following the introduction of gastric ultrasound in our practice. CONCLUSION: Anesthetic management for MRP should be individualized based on clinical factors. In our cohort, tubeless GA was preferred for fasted, lower BMI, and hemodynamically stable patients, with tracheal intubation typically reserved for more complex cases, reflecting inherent selection bias. This study was descriptive in nature and was not designed to establish the safety of any particular technique. Further high-quality research is needed to validate these findings and refine anesthetic guidelines for MRP. EDITORIAL COMMENT: MRP is a rare obstetric procedure that can be challenging to manage without prior epidural analgesia. A retrospective study of 423 patients in two Israeli hospitals (2016-2022) found that most cases (96.7%) used GA, with about two-thirds involving tracheal intubation and one-third using tubeless techniques. Tub

OBJECTIVE: The use of virtual prenatal care is rising, but its effect on the content of care is largely unknown. We examined prenatal care screenings for pregnant women in the United States during the COVID-19 pandemic (2020-2021) and assessed differences in those screenings by mode of prenatal care (ie, any virtual prenatal care vs exclusively in-person care). METHODS: We used Pregnancy Risk Assessment Monitoring System Phase 8 data. Our analytical sample included mothers who gave birth in 2020 and 2021, received prenatal care, and answered both the mode of prenatal care question and all prenatal care screening questions (N = 22 991). The analytical sample included 28 study sites across the United States. RESULTS: Mothers who used any virtual prenatal care had greater adjusted odds than mothers who used in-person care only of being screened about their knowledge of gestational weight gain (adjusted odds ratio [AOR] = 1.18; 95% CI, 1.08-1.30), cigarette use (AOR = 1.26; 95% CI, 1.02-1.54), alcohol use (AOR = 1.23; 95% CI, 1.01-1.49), intimate partner violence (IPV) (AOR = 1.72; 95% CI, 1.54-1.92), depression (AOR = 1.65; 95% CI, 1.46-1.86), substance use (AOR = 1.41; 95% CI, 1.26-1.59), HIV testing (AOR = 1.33; 95% CI, 1.22-1.46), planned breastfeeding (AOR = 1.55; 95% CI, 1.34-1.78), and planned postpartum birth control (AOR = 1.42; 95% CI, 1.27-1.60). CONCLUSIONS: The greatest benefit of virtual prenatal care may be for screening of IPV. However, we cannot definitively attribute increased odds of screenings to virtual care. Further investigation is warranted.

Per- and polyfluoroalkyl substances (PFAS) are persistent environmental contaminants that cross the placenta, posing a potential threat to maternal and fetal health. However, epidemiological evidence linking PFAS exposure to gestational diabetes mellitus (GDM) remains limited, almost exclusively to singleton pregnancies, with mechanistic understanding notably lacking. In this nested case-control study, we integrated exposomic and metabolomic analyses of serum from 462 singleton and 84 twin pregnancies, quantifying 48 PFAS alongside lipid metabolites. PFAS exposure was positively associated with GDM risk, with distinct congener profiles observed between singletons and twins. In mixture analyses, the association was stronger in twins, and PFOA and PFNA emerged as the primary risk contributors for singletons and twins, respectively. Mechanistically, PFAS perturbed lipid metabolism and increased GDM risk through pregnancy-type-specific pathways. In singletons, lipid mediators were linked to branched-chain amino acid and eicosanoid metabolism pathways, whereas in twins, bile acid metabolism emerged as a potentially predominant pathway. Maternal diet significantly shaped this environmental risk, revealing a key exposure-lifestyle interaction. Importantly, maternal PFAS exposure and GDM status together influenced offspring growth trajectories up to age 4, indicating potential long-term developmental consequences. We provide the first evidence that PFAS exposure induces pregnancy-type-specific metabolic disruptions, establishing a novel mechanistic link to GDM and highlighting its public health implications.

The recovery and cryopreservation of epididymal spermatozoa enable genetic preservation in male dogs that die unexpectedly or require castration; however, sperm collection is typically performed immediately after surgery, and artificial insemination is often surgical. This study aimed to evaluate whether epididymides stored at 4-5 °C for 24 h prior to sperm recovery retain fertilizing capacity after cryopreservation and whether pregnancy can be achieved using endoscopically guided transcervical intrauterine insemination. Testes and epididymides from an eight-month-old German Shepherd dog were stored in physiological saline at 4-5 °C for 24 h following castration. Spermatozoa were recovered from the cauda epididymis using single-incision aspiration, evaluated, frozen according to the Uppsala method, and stored in liquid nitrogen for two months. After thawing, 62 × 106 progressive motile spermatozoa were inseminated once into a bitch in heat using transcervical endoscopic guidance. Pregnancy was confirmed by ultrasonography, and nine healthy puppies were delivered at term. These findings demonstrate that 24 h refrigerated storage of the epididymis does not impair post-thaw fertilizing ability and that non-surgical transcervical intrauterine insemination represents an effective alternative to surgical techniques for the use of frozen-thawed epididymal semen in dogs.

Objectives: As widely used first-line antihypertensive drugs, dihydropyridine calcium channel blockers (DHP-CCBs) have relatively few studies comparing their adverse reactions based on real-world data. This study aims to identify and compare the potential adverse drug reaction (ADR) signals of four DHP-CCBs (amlodipine, felodipine, nicardipine, and nifedipine) through the US Food and Drug Administration Adverse Event Reporting System (FAERS), providing a reference for further drug safety assessment and clinical medication risk awareness. Methods: Adverse event reports from medical professionals (Q3 2014-Q4 2024) were analyzed using signal detection methods, including reporting odds ratio (ROR), proportional reporting ratio (PRR), information component (IC), and the Medicines and Healthcare Products Regulatory Agency (MHRA) methods. Risk signals for the four DHP-CCBs were compared with both the full database and the DHP-CCBs background. For high-risk signals in amlodipine, multivariate logistic regression was used for validation. The analysis reveals distinct ADR profiles for the four DHP-CCBs. Results: Amlodipine is strongly linked to suicide-related risks, confirmed by logistic regression. Nicardipine and nifedipine show significant risks for pregnancy-related events, such as premature delivery and exposure during pregnancy. Nicardipine is also associated with hyponatremia, hyperkalemia, and lactic acidosis. These adverse events are not yet included in the FDA labeling for any of the DHP-CCBs. Although palpitations and angioedema are listed for felodipine, their signal strength is much higher compared to the other DHP-CCBs. Conclusions: The ADR risk profiles of the four DHP-CCBs differ significantly. This study identified several high-risk adverse events not included in current labels. Clinical use should consider each drug's risk profile and patient-specific factors, with particular attention to serious risk signals. For pregnant and postpartum women, the benefits and risks of using nicardipine and nifedipine should be carefully evaluated.

Background and Objectives: Placental vascular lesions are significant histopathological findings that indicate disruptions in uteroplacental and fetoplacental circulations and are associated with adverse pregnancy outcomes such as preeclampsia, intrauterine growth restriction (IUGR), and perinatal morbidity. This study aimed to re-examine the frequency and distribution of placental vascular lesions in placentas submitted for histopathological analysis at our center, based on criteria established by the Amsterdam Placental Workshop Group Consensus Statement. Materials and Methods: In this retrospective study, placental samples examined in the Department of Pathology at Akdeniz University Faculty of Medicine from 2016 to 2019 were analyzed. A total of 571 cases with at least one placental vascular lesion identified on histopathology were included. Hematoxylin-eosin-stained sections from all cases were re-evaluated, and maternal vascular malperfusion (MVM), fetal vascular malperfusion (FVM), and other placental vascular pathologies were assessed according to the Amsterdam consensus criteria. Statistical analyses were performed using IBM SPSS Statistics for Windows, Version 25 (IBM Corp., Armonk, NY, USA). Categorical variables were compared using the chi-square or Fisher's exact test, while continuous variables were analyzed with the Mann-Whitney U test. Results: MVM and FVM were considered the primary outcomes of the study. MVM was identified in 95.1% of cases, whereas FVM was present in 1.9%. Among individual lesions, chorangiosis (97.2%) and villous/perivillous fibrinoid deposition (88.3%) were the most frequent findings, followed by mucinous cystic degeneration of the umbilical cord (61.5%) and dystrophic calcification (58.1%). Retroplacental hematoma was observed in 38.4% of cases. Although no significant association was found between MVM and placental weight or size, umbilical cord length was significantly shorter in MVM-positive cases (p = 0.032). In contrast, FVM showed significant associations with chorangiosis (p = 0.035) and placentomegaly (p = 0.003). The high frequency of chorangiosis may reflect a compensatory angiogenic response to chronic intrauteri

Obesity in women of reproductive age is a major issue. It is associated with reduced fertility and an increased risk of obstetric and perinatal complications. Bariatric surgery is the most effective treatment for severe obesity, leading to substantial weight reduction, improvement of metabolic disorders, and enhanced fertility. Consequently, an increasing number of women are becoming pregnant after undergoing bariatric surgery. The aim of this paper is to review current recommendations and research data regarding the care of women after bariatric surgery in the periconceptional and perinatal periods, as well as throughout pregnancy, delivery, and the postpartum period. Research suggests that pregnancy after bariatric surgery is associated with a lower risk of gestational diabetes, hypertension, preeclampsia, and fetal macrosomia compared with pregnancies in women with similar baseline BMI (body mass index) who have not undergone surgical treatment. At the same time, an increased risk is observed for low birth weight, maternal micro- and macronutrient deficiencies, and complications characteristic of bariatric procedures, such as dumping syndrome or intra-abdominal hernias. Most scientific societies recommend postponing pregnancy planning for 12-18 months after surgery and using effective contraception, preferably methods that do not require gastrointestinal absorption. Regular monitoring of laboratory parameters, individually tailored supplementation, and interdisciplinary care are essential for the safe management of pregnancy after bariatric surgery. In particular, care should include achieving a stable body weight before conception, monitoring of nutritional status, verifying proper weight gain during pregnancy, and considering alternative methods for gestational diabetes screening (e.g., glycaemic monitoring instead of oral glucose tolerance testing) due to the risk of dumping syndrome. Appropriate preparation for pregnancy and proper management throughout its course allow for reducing the risk of perinatal complications. Bariatric surgery itself is not a contraindication to vaginal delivery.

Selenium (Se) is an essential trace element. The bioactivity of Se arises from its incorporation into the 21st amino acid, selenocysteine (Sec). Twenty-five human genes have been identified that encode selenoproteins, each of which contains at least one Sec residue. Selenoprotein functions include antioxidant responses, thyroid hormone synthesis, and maintenance of cellular redox homeostasis. Due to its role in critical cellular functions, Se deficiency is associated with morbidities of the cardiovascular system and connective tissue in regions of countries with low soil Se content. While these morbidities are geography-specific and have been mitigated in adults through public health interventions, preterm infants remain susceptible to Se deficiency worldwide. Infants born preterm are deprived of fetal Se accrual in the 3rd trimester of pregnancy, a deficiency compounded by higher Se needs than term infants and older infants and dependence on parenteral nutrition (PN) and fortification. In addition, the composition of selenoproteins and selenometabolites in human milk is different from that in formula and PN, yet little is known about the biological impact of these differences. The knowledge gap in optimal Se supplementation is reflected in discrepant guidelines between North American and European/Chinese nutrition societies, whose recommended Se supplementation in preterm infants differs by more than 2-fold. In this review, we describe the biosynthesis, metabolism, and maternal-fetal transfer of Se. In addition, we address how developmentally regulated aspects of metabolism may impact how preterm infants respond to supplementation with different forms of Se. Lastly, we highlight current challenges and recommendations for optimizing Se levels in neonates based on available data.