Multivitamin (Prenatal)

OBJECTIVE: To investigate the association between ultrasonically detected fetal urinary system abnormalities and chromosomal copy number variations (CNVs) in Heilongjiang Province, northeastern China. METHODS: Cohort study: 183 fetuses with ultrasound-detected urinary system anomalies (invasive prenatal diagnosis, 2017.01-2025.09, Second Affiliated Hospital of Harbin Medical University) were enrolled. All underwent CNV analysis: 21 without karyotyping, 12 with abnormal karyotypes, 150 with normal karyotypes. The 150 normal-karyotype cases were split into isolated CAKUT (63, 42%) and non-isolated CAKUT (87, 58%) groups; CNV abnormalities were compared between groups. META-ANALYSIS: Studies on CNVs in CAKUT fetuses (2017.01-2025.09) were retrieved from PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang Data, SinoMed. Pooled effect sizes were calculated via Stata 17.0. RESULTS: Among 162 fetuses who underwent conventional karyotyping, chromosomal aneuploidy occurred in 7.41% (12/162). In 150 karyotypically normal cases, pathogenic/likely pathogenic (p/lp) CNVs were detected in 7.33% (11/150): 3.17% (2/63) for isolated CAKUT and 10.34% (9/87) for non-isolated CAKUT (P = 0.120, non-significant). A meta-analysis of 30 studies (9284 pregnant women) demonstrated a weighted pooled incidence of p/lp CNVs of 6% (95% CI 0.05-0.07) in karyotypically normal CAKUT fetuses, with weighted pooled incidences of 5% (95% CI 0.03-0.06) for isolated CAKUT and 8% (95% CI 0.06-0.10) for non-isolated CAKUT. CONCLUSIONS: This is the first cohort study utilizing nine-year data from Heilongjiang Province, a cold region in northeastern China, to analyze the association between fetal urinary system anomalies and CNVs. In this region, the incidence of p/lp CNVs among CAKUT fetuses with normal karyotypes was 7.33%. Notably, seven pathogenic CNV fragments (deletions at 4p15.31, 5p13.1, 15q11.2, 16p11.2, Xq28, and Xp22.31; duplication at 11q15.5) previously unreported in Northeast China were identified, expanding the genetic spectrum associated with CAKUT in cold regions. The meta-analysis noted that the cumulative crude incidence of p/lp CNV in CAKUT fetuses was 5.71% (498/8,723) ac

<p>Introduction: Bronchopulmonary dysplasia (BPD) remains a major complication of prematurity. We aimed to assess whether intratracheal administration of budesonide mixed with surfactant reduces mortality and BPD in preterm infants. METHODS: We conducted a systematic review and meta-analysis of randomised and observational studies enrolling preterm neonates. PubMed, Scopus, and Web of Science were searched from inception to October 2025 without language or year restrictions. Studies comparing bolus administration of bovine or porcine surfactant mixed with budesonide versus surfactant alone were included. Random-effects meta-analyses using inverse variance weighting were performed to estimate risk ratios (RRs) with 95% confidence intervals (CIs). Certainty of evidence was assessed using GRADE. RESULTS: Twenty randomised and five observational studies were included. Surfactant-budesonide combination therapy reduced mortality (RR: 0.83, 95% CI: 0.69-0.99; 18 studies, 5,117 infants) and BPD (RR: 0.84, 95% CI: 0.75-0.94; 25 studies, 5,732 infants). Mortality reduction was observed when all studies were pooled, with no significant difference between study designs. Prenatal steroid exposure was associated with greater mortality reduction. Reduction in BPD remained significant when restricted to randomised trials, irrespective of surfactant type. Sensitivity analyses excluding studies at high risk of bias yielded similar results. Certainty of evidence was moderate for both outcomes. CONCLUSION: Surfactant combined with budesonide may reduce mortality and BPD in preterm infants. However, the evidence remains insufficient to recommend the combination as generalised primary treatment for all preterm neonates. Future studies should incorporate pathophysiological phenotyping to identify infants most likely to benefit. </p>. © 2026 The Author(s). Published by S. Karger AG, Basel.

BACKGROUND: This study aimed to systematically evaluate the effects of psychological interventions during pregnancy on the intervention outcomes and incidence rate in women with postpartum depression. METHODS: Databases (PubMed, Medline, Web of Science, Cochrane Library, EMBASE) were searched from inception to December 2024 for randomised controlled trials assessing prenatal psychological interventions (e.g., mindfulness, psychosocial support) in pregnant women without severe mental illness. Primary outcomes included Edinburgh Postnatal Depression Scale (EPDS), Patient Health Questionnaire-9 (PHQ-9), Perceived Stress Scale-10 (PSS-10), Spielberger State-Trait Anxiety Inventory (STAI) scores, and PPD incidence within 6 weeks postpartum. Quality was assessed using the Cochrane risk-of-bias tool; meta-analysis was performed with RevMan 5.3. RESULTS: A total of 10 articles were included, with 6700 study subjects in total, including 3345 in the intervention group and 3355 in the control group, all of which were randomised controlled trials. The incidence rate of postpartum depression in the intervention group was significantly reduced (OR = 0.73, 95% CI [0.57-0.95], P = 0.02). The scores of EPDS, PHQ-9, PSS-10, and STAI in the intervention group were all lower than those in the control group. CONCLUSION: Psychological interventions during pregnancy can significantly reduce postpartum depression-related scale scores and incidence rates, and improve depressive symptoms, anxiety, and perceived stress. However, due to the heterogeneity of intervention types, this study cannot determine the optimal intervention method and thus provides preliminary evidence for clinical prevention. Clinicians should select interventions based on resource availability and individual characteristics of pregnant women, while future studies should focus on direct comparisons of different intervention types to provide more targeted guidance. Plain Language Summary: Postpartum depression is a common mental health problem that affects many women after childbirth. It can harm both the mother’s well-being and the baby’s development. This study combined data from ten clinical trials, including 6,70

BACKGROUND: Opioid use disorder during pregnancy (OUD) continues to pose a significant public health challenge, requiring well-designed interventions. This scoping review identifies effective prenatal OUD interventions to promote the use of evidence-based approaches, such as medication for opioid use disorder (MOUD), and inform future research and clinical practice. METHODS: We searched PubMed, Embase, CINAHL, Scopus, and Web of Science for interventions for OUD during pregnancy from 2013 to 2023. Exclusions were non-English studies, animal research, non-prenatal interventions, pharmacological trials, and studies outside the U.S. Data were extracted on intervention context, sample, study aims, and results. We categorized each intervention by the socioecological model (SEM) level of implementation and applied the RE-AIM framework to evaluate reach, effectiveness, adoption, implementation, and maintenance. RESULTS: After review of 1,381 articles, a total of 31 intervention studies were included. Fourteen studies (45%) included over 75% non-Hispanic white participants. Seventeen studies (55%) were conducted at the individual level, six (19%) at the interpersonal level, and eight (26%) at the society/community level. Individual-level interventions focused on coordinated clinical care models, detoxification/tapering from (MOUD), and prenatal education. Interpersonal interventions included clinician education and group therapy. Community-level interventions targeted regional coordination of services, while society level studies examined the impact of policy change on MOUD access. CONCLUSION: We identified a wide range of prenatal OUD interventions with varying approaches and summarized each by SEM implementation level. While MOUD access remains crucial, community-based interventions that address broader social determinants, and societal barriers may have the greatest impact in improving maternal health outcomes. SYSTEMATIC REVIEW REGISTRATION: https://osf.io/, identifier 10.17605/OSF.IO/8ZUAB.

Maternal stress during lifetime and pregnancy may influence offspring epigenetic age, impacting long-term health. We conducted a systematic review and meta-analysis of associations between maternal stress and epigenetic aging markers: telomere length (TL) and DNA methylation (DNAm) age acceleration. The systematic search was performed according to PRISMA guidelines and registered on PROSPERO (ref. CRD42023474640). Fixed and random effect meta-analyses were carried out, stratified by stress type and marker type (TL, DNAm). Sixteen studies met inclusion criteria; 12 were meta-analyzed (10 TL, 2 DNAm). Due to high heterogeneity, restricted maximum likelihood meta-analysis suggested significant inverse associations between maternal stress and offspring TL. Perceived stress was associated with shorter TL (p-value = 7 × 10-4, β = -0.085, 95%CI [-0.135, -0.036]), as was lifetime stress/trauma (p-value = 0.01, β = -0.209, 95%CI [-0.370, -0.049]). In contrast, maternal stress showed no significant associations with DNAm age acceleration (p-value = 0.32). Both perceived maternal stress and maternal stress were associated with shorter offspring TL, suggesting that stress exposure across the maternal lifespan influences offspring biological aging markers. No significant association was observed with DNAm-based aging clocks. Further studies with larger sample sizes and more homogeneous settings are needed to confirm and expand upon our observations.

BACKGROUND: Transgenerational trauma (TT)/Intergenerational trauma (IT) is the transmission of the effects of traumatic experiences of parents to their children, who have not themselves experienced traumatic events. This transmission occurs through neurobiological and metabolic changes and the environment in which they were raised. METHODS: A systematic review was conducted in accordance with the PRISMA 2020 guidelines. PubMed and Google Scholar databases were searched from 2005 to 2025. Studies focusing on adult offspring, exposure to ancestral trauma, biological markers (DNA methylation, cortisol), and psychological outcomes were included. RESULTS: The main study results are as follows: identification of sex-specific DNA methylation patterns in the NR3C1 gene and accelerated biological aging (GrimAge) in offspring; role of parental reflective functioning (PRF) and impaired mentalization as major psychological channels of trauma transmission; and evidence confirming the impact on three generations, manifested by treatment-resistant depressive disorders, anxiety, and neuroendocrine dysregulation (low cortisol levels). CONCLUSIONS: This article highlights the intergenerational impact of trauma and highlights its epigenetic significance. The primary goal was to explore universal epigenetic mechanisms. Early understanding of ancestral history is crucial for personalized psychiatric care.

Children with myelomeningocele (MMC) are at risk for sleep disordered breathing (SDB). This systematic review evaluated the prevalence, presentation, mortality, and behavioral features of SDB in this population. It is registered with PROSPERO (CRD42024610178) and was completed according to PRISMA guidelines. Embase, PubMed, Scopus, and Clinical Trials were queried for articles published through December 2024. Of the 2654 articles screened, 28 met inclusion criteria. The prevalence of SDB in infants with postnatal repair of MMC was 46-100 %, and 92-97 % among those prenatally repaired. The degree of prematurity did not appear to influence the presence of SDB. Mortality rates in infancy due to SDB were 0-69 %. The prevalence of SDB in individuals aged ≥12 months to 21 years was 49-100 % among the symptomatic, and 39-63 % among the asymptomatic. SDB accounted for 22 % of deaths in one study. Two studies found statistically significant ages when central sleep apnea and obstructive sleep apnea were diagnosed (3 and 4.7 years vs. 8.5 and 11.5 years, respectively). Adolescents with MMC, particularly females, experienced poorer quality and quantity of sleep beginning at an earlier age than their typically developing peers. Poor sleep may impair executive functioning skills. Regardless of the presence or absence of symptoms, this systematic review supports the recommendation that children with MMC should be screened for SDB during three time periods: (1) prior to discharge from the NICU, (2) between 3 and 4 years of age, and (3) between 8 and 11 years of age.

BACKGROUND: Prenatal opioid exposure has been increasingly recognized as a public health concern due to its potential to disrupt fetal brain development. This study aims to synthesize current magnetic resonance imaging (MRI) evidence on the neurodevelopmental effects of prenatal opioid exposure in offspring. METHODS: A systematic search was performed across PubMed, Embase, Web of Science, and Scopus on December 4, 2024. We aimed to include all peer-reviewed articles comparing structural MRI, diffusion tensor imaging (DTI), or functional MRI (fMRI) measurements between offspring exposed to opioids and non-exposed controls. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework was used to assess the certainty of evidence. RESULTS: A total of 25 studies were included, of which 12 studies used anatomical MRI, six used DTI, and seven used fMRI; some used multiple modalities. Structural MRI studies reported reduced total and regional brain volumes (e.g., frontal lobe, amygdala, basal ganglia). DTI studies revealed lower fractional anisotropy and increased diffusivity in major white matter tracts. fMRI studies showed altered connectivity in the visual and default mode networks. GRADE assessments indicated moderate certainty for reduced amygdala and frontal lobe volumes, as well as frontal cortical surface area; however, other findings had low certainty due to small samples and methodological heterogeneity. CONCLUSIONS: Our findings suggested that prenatal opioid exposure is associated with widespread alterations in brain structure and connectivity. Future studies should employ standardized imaging, longitudinal methodologies, and precise exposure timing to enhance comprehension of developmental trajectories.

OBJECTIVE: To systematically evaluate evidence on intrapartum ultrasound markers, deflexion, spine position, asynclitism, and angle of progression (AoP), and their associations with spontaneous rotation and delivery outcomes in foetuses with occiput posterior (OP) position. METHODS: A systematic search of Cochrane, Scopus, PubMed, and Ovid/MEDLINE was conducted using MeSH terms and keywords. Eligible studies included intrapartum ultrasound assessment of foetal position with at least one additional sonographic marker and reported outcomes related to rotation or mode of delivery. Data on study design, population characteristics, ultrasound methods, and outcomes were extracted. Of 543 records identified, 13 studies (predominantly prospective cohorts) published between 2010 and 2023 met inclusion criteria and were critically appraised. RESULTS: Foetal head deflexion and posterior spine position were most consistently associated with persistence of OP and higher operative delivery rates. Evidence for asynclitism and AoP was limited and inconsistent. Small sample sizes, heterogeneous study populations, variable ultrasound timing, and inconsistent reporting limited comparability across studies. CONCLUSIONS: Intrapartum ultrasound markers, particularly deflexion and spine position, are associated with persistent OP, but current evidence is constrained by methodological heterogeneity and underpowered cohorts. Standardised definitions and larger, well-designed studies are required before these markers can be integrated into routine clinical assessment.

BACKGROUND: Posterior placenta accreta spectrum (PAS) represents a diagnostically challenging subtype of PAS, which has long been overlooked in existing literature due to its relatively low incidence and nonspecific clinical manifestations. METHODS: A comprehensive literature search was conducted in PubMed, Web of Science, and other databases, focusing on studies related to the diagnosis and management of posterior PAS. This review systematically analyzes the risk factors, prenatal diagnostic characteristics, and pregnancy outcomes of posterior PAS, with a focus on clarifying the characteristic differences between posterior PAS and PAS involving other uterine locations. RESULTS: Both ultrasound (US) and magnetic resonance imaging (MRI) have limited diagnostic sensitivity for posterior placenta accreta spectrum (PAS): the sensitivity of US ranges from 56.4% to 62%, while the application rate of MRI signs for posterior PAS is 73.5%, and both of which are 20-30% lower than those for anterior PAS. Irregular retroplacental clear zone on US and cervical varices on MRI are prominent diagnostic indicators for the condition. Notably, compared with anterior PAS, posterior PAS is characterized by shallower myometrial invasion and a more favorable prognosis. CONCLUSIONS: Posterior PAS has unique diagnostic and clinical features that distinguish it from anterior PAS. Enhanced recognition of its imaging characteristics and targeted management strategies are crucial to improve maternal outcomes. This review fills the literature gap by systematically summarizing the latest evidence on posterior PAS, providing a reference for clinical practice and future research. © The author(s).

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

INTRODUCTION: Birthing people receiving medication for opioid use disorder (MOUD) face unique challenges during pregnancy and postpartum. This study describes preliminary harm-reduction-focused outcomes specific to the postpartum transition from a pilot trial for pregnant people receiving MOUD in a perinatal addiction clinic. METHOD: Participants were recruited from February 2022 to June 2023. Participants were randomized to the technology-delivered educational intervention or standard practice control (brochure). Inclusion criteria were: ≥18 years of age, <34 weeks pregnant, current MOUD, and engaged in prenatal care for ≤10 weeks. Parenting Sense of Competence (score range = 16-96) scale, intervention-specific Perceived Competence Scales (score range = 1-7) for three topic areas (postpartum transition, neonatal opioid withdrawal syndrome, child welfare), and the Substance Use Recovery Evaluator (score range = 21-63) were administered at baseline, prenatal follow-up, and postpartum follow-up. RESULTS: Participants (n = 29) were of reproductive age (M = 30.0 years, SD = 4.4), 66% White and 31% Black with a median gestational age of 24 weeks. Over half (59%) had been receiving MOUD for ≥1 year, mostly buprenorphine (69%). Overall, 59% reported a prior overdose. Mean (standard deviation) Parenting Sense of Competence, Perceived Competence Scales, and Substance Use Recovery Evaluator scores were high across study condition and time. DISCUSSION: Patients in a multidisciplinary perinatal addiction clinic can achieve positive recovery outcomes during the transition from pregnancy to postpartum while on MOUD. Furthermore, this study demonstrates the utility of formative work to inform the selection of quantitative measures in assessing nonabstinence-based recovery in clinical studies of substance use disorder patient populations. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

OBJECTIVE: To assess whether lifestyle interventions based on Mediterranean diet or stress reduction during pregnancy are associated with differences in fetal brain development detectable by two-dimensional magnetic resonance imaging (MRI) in a high-risk population for small-for-gestational-age neonates. METHODS: This was a secondary analysis of the randomized controlled clinical trial, Improving Mothers for a better PrenAtal Care Trial BarCeloNa (IMPACT BCN), which enrolled 1221 singleton pregnancies at high-risk for a small-for-gestational-age neonate between February 2017 and March 2020. At midgestation, participants were randomly allocated into three groups: a Mediterranean diet intervention; a stress-reduction program; or usual care. A randomly selected subgroup (n = 124) underwent fetal brain MRI between 36.1 and 39.1 weeks' gestation and were analyzed offline. Offline analysis included measurements of biparietal diameter, occipitofrontal diameter, cortical sulci depth, corpus callosum length, vermis height and cerebellar transverse diameter. Differences in brain measurement between groups were analyzed by regression models adjusted for baseline maternal characteristics, gestational age at MRI assessment, fetal sex, fetal head size and MRI scanner model. RESULTS: Fetuses in the Mediterranean-diet group (n = 36) showed a significantly deeper right insula (mean ± SD, 28.78 ± 1.16 mm vs 27.88 ± 1.23 mm; P = 0.03), a deeper left insula (mean ± SD, 28.60 ± 1.21 mm vs 27.49 ± 1.26 mm; P = 0.01) and a longer corpus callosum (mean ± SD, 42.24 ± 2.50 mm vs 40.61 ± 2.13 mm; P < 0.01) compared with fetuses in the usual-care group (n = 44). Fetuses in the stress-reduction group (n = 44) also had a deeper left insula (mean ± SD, 28.39 ± 1.13 mm vs 27.49 ± 1.26 mm; P = 0.04) compared with those in the usual-care group. CONCLUSION: Structured maternal lifestyle interventions during pregnancy may influence fetal neurodevelopment. Although the effect sizes were submillimetric, these effects were detectable using two-dimensional MRI, which highlights its potential as a sensitive tool for detecting subtle brain changes during fetal life. Future studies are warranted to truly

PURPOSE: To evaluate the effect of incorporating twice-weekly telemedicine home ultrasound sessions on maternal anxiety and antenatal attachment in pregnant patients with a history of late pregnancy loss. METHODS: In this quasi-randomized trial, pregnant patients with a previous pregnancy loss beyond 20 weeks of gestation were randomized per day of enrollment to standard high-risk care (control) or additional twice-weekly home ultrasound sessions (intervention). Maternal anxiety and antenatal attachment were assessed at baseline, mid-pregnancy, and final prenatal visit using the State-Trait Anxiety Inventory Scale (STAI-S) and the Maternal Antenatal Attachment Scale (MAAS-2). The primary outcome was the STAI-S score at the final visit. A total of 50 participants (25 per group) were required to detect a 20% difference in the primary outcome. RESULTS: Demographics were comparable between groups. The intervention group demonstrated significantly lower STAI-S scores at mid-pregnancy (46.7 ± 9.3 vs. 52.0 ± 9.0; p = 0.023) and at the final visit (43.6 ± 11.8 vs. 51.5 ± 11.5; p = 0.004), and higher MAAS-2 scores at the final visit (79.5 ± 6.2 vs. 75.0 ± 6.9; p = 0.022). Attachment scores increased significantly during follow-up (4.8 ± 7.3 vs. - 0.36 ± 8.0; p = 0.023). Emergency department visits were fewer in the intervention group (3.1 ± 1.5 vs. 4.9 ± 3.3; p = 0.024). Regression analyses confirmed independent associations between home ultrasound use, reduced anxiety, and improved attachment. CONCLUSION: Telemedicine home ultrasound significantly reduced maternal anxiety and improved antenatal attachment in patients with prior late pregnancy loss. This reassurance strategy may also decrease unscheduled emergency visits, supporting its integration into standard prenatal management in this vulnerable population. © 2026. The Author(s).

OBJECTIVE: To describe healthcare resource use in rural Mozambique among postpartum women with HIV, their seroconcordant male partners (MPs), and their infants to estimate costs and inform program planning. METHODS: We collected self-reported resource use data alongside a clinical trial and used WHO-CHOICE methodology to estimate associated healthcare costs. RESULTS: We enrolled 927 postpartum women with HIV, 836 MPs, and 756 infants from birth/delivery to 18 months postpartum. We found that 55%, 38% and 8% of women had 0, 1-2, and ≥ 3 health center visits during the first postpartum month, whereas 44%, 47%, and 8% of infants had 0, 1-2, and ≥ 3 health center visits during the same period. 77%, 18%, and 5% of women and 77%, 20%, and 3% of infants spent 0, 1-2, and ≥ 3 nights in a hospital, respectively. From 15 to 18 months postpartum, 38%, 50%, and 12% of women, 45%, 47%, and 8% of MPs, and 33%, 55%, and 12% of infants had 0, 1-2, and ≥ 3 health center visits; hospitalization was infrequent. Average per-person costs of inpatient and outpatient care in the first month postpartum were $4.34-$5.36 and $2.15-3.40, respectively. CONCLUSION: Overall healthcare resource use was low for this population in rural Mozambique in the 18 months after birth/delivery. © 2026. The Author(s).

BACKGROUND: Prenatal multiple micronutrient supplementation (MMS) including iron, folic acid, and other essential micronutrients, has shown potential to improve birth outcomes in controlled studies. We did an effectiveness study in Ethiopia to determine the effect on mean birthweight of MMS provided as part of routine antenatal care, relative to iron-folic acid supplementation (IFA). METHODS: A pragmatic, two-arm, facility-based, cluster-randomised controlled trial was conducted across 42 districts in five regions of Ethiopia to determine the effect on birthweight of MMS relative to IFA. Districts were randomly assigned to either retain IFA as part of routine antenatal care or switch to MMS. Randomisation was stratified by region and done using a random number generator within statistical software. All live singleton births at participating health facilities were eligible for inclusion and birthweights were recorded. Additionally, data were collected on maternal receipt and utilisation of MMS or IFA. The primary outcome was birthweight, analysed in the intention-to-treat population. This completed trial is registered at ClinicalTrials.gov, NCT05708183. FINDINGS: Between Jan 1, 2023, and Dec 31, 2024, birthweights were recorded for 47 325 babies in the 21 IFA districts and 36 473 babies in the 21 MMS districts. Mean age of mothers was 26·2 years (SD 5·3) and median gestational age of babies at birth was 38 weeks (IQR 38-39). The effect of MMS on birthweight was a mean increase of 38 g (95% CI 20-55) in the MMS arm relative to the IFA arm after adjustment for time, geographical region stratification factor, gestational age, sex of baby, and parity. Among women who reported taking at least 90 tablets of their assigned supplement, the increase in mean birthweight in the MMS arm relative to the IFA arm was 58 g (38-79). Stillbirth risk was 7·5 per 1000 births in the IFA arm and 6·9 per 1000 births in the MMS arm. INTERPRETATION: The findings of this trial are consistent with those from efficacy trials in other settings, indicating that the transition from IFA to MMS as part of routine antenatal care in Ethiopia could lead to a small but clear improvement in birthweig

BACKGROUND: Fetal alcohol spectrum disorders (FASD) affect 1.1% to 5% of the general population. Yet, most children with FASD and their families cannot access evidence-based interventions. Mobile health (mHealth) interventions have the potential to increase access to care on a broad scale. While numerous self-directed parenting apps exist, none have been tested for FASD. The FMF (Families Moving Forward) Connect app is a self-directed intervention derived from an empirically supported intervention for caregivers raising children with FASD. FMF Connect is the first self-directed parenting app for FASD, and also one of the first parenting apps to be systematically developed and tested. OBJECTIVE: This study aimed to test the efficacy of FMF Connect for caregivers raising children with FASD on targeted primary (child behavior, caregiver attributions, parenting efficacy and satisfaction, FASD knowledge, and family needs met) and secondary (child adaptive behavior, caregiver self-care, and app satisfaction) outcomes. METHODS: This study involved a 3-arm randomized controlled trial with equal allocation to groups (1) FMF Connect+coaching, (2) FMF Connect, or (3) waitlist control. Participants from the United States were recruited online through an open access website. Recruitment materials were distributed by the Collaborative Initiative on FASD, FASD listserves, and social media. In total, 129 caregivers of children (aged 3-12 y) with FASD or prenatal alcohol exposure (PAE) were enrolled. Online surveys were administered at baseline, 6 weeks, and 12 weeks. Data were analyzed with linear mixed modeling, linear regressions, and structural equation modeling using SPSS (version 29.0; IBM) and Mplus 8 (Muthén & Muthén). RESULTS: A total of 43 participants were randomized to each group. Caregivers were predominantly White adoptive mothers. Of the total, 64% (n=83) of participants were retained through the 12-week follow-up. Groups did not differ in terms of demographic characteristics, baseline levels of functioning, or attrition. Usage patterns were similar across groups, suggesting coaching did not increase engagement. Given a few differences, app intervention groups wer

A recent mouse study has shown that deficiency in 12-hydroxyeicosatetraenoic acid (12-HETE) affects neonatal alveolar macrophage imprinting and associates with increased respiratory morbidity, but this has not been investigated in humans. Utilizing data from two mother-child cohorts, COPSAC2010 and VDAART, we demonstrate that undetectable maternal plasma 12-HETE during pregnancy associates with increased risk of childhood asthma and respiratory infections alongside an altered infant airway microbiota structure and airway immune profile. Further, we observed an interaction between maternal 12-HETE levels and maternal N-3 long-chain polyunsaturated fatty acid (n-3 LCPUFA) supplementation in a randomized clinical trial in COPSAC2010 and maternal dietary n-3 LCPUFA intake in VDAART in relation to offspring respiratory morbidity; higher prenatal n-3 LCPUFA exposure reduced asthma and respiratory infection among mothers with detectable 12-HETE levels. These findings identify maternal 12-HETE as a potential biomarker for risk of offspring respiratory morbidity and suggest that maternal 12-HETE status may determine responsiveness to prenatal n-3 LCPUFA supplementation.

This study examined whether a high protein/energy-controlled diet and exercise pregnancy intervention influences putative emotional regulation (ER) neural activity in two-year-old offspring. Participants were recruited from the Be Healthy in Pregnancy randomized controlled trial. Pregnant individuals (n = 24; >18 years, singleton pregnancy, 12-17 weeks gestation) were randomized to either an intervention (high-protein, energy-controlled diet, nutrition counseling, walking program plus usual pregnancy care [UPC]) or control (UPC only) group. Offspring (n = 12 intervention, n = 12 control) completed resting-state EEG using a 128-channel EEG and a delayed gratification task at age two. Delta-Beta Coupling, an EEG-derived index of ER-related neural function, was measured via correlation between delta (2-4 Hz) and beta (13-30 Hz) power. Children of intervention group participants exhibited a significantly lower delta-beta correlation in frontal (Z = -2.20, p = 0.03), central (Z = -2.34, p = 0.02), and parietal (Z = -2.32, p = 0.02) regions, as well as superior performance on the delayed gratification task (p = 0.04, Hedges' g = 0.89). Prenatal diet and exercise interventions may promote more efficient ER-related neural functioning and behavioral self-regulation in early childhood. These findings suggest modifiable prenatal factors can shape offspring neurodevelopment, supporting early interventions to enhance emotional and cognitive outcomes.

Despite well-documented benefits of omega-3 for maternal and child health, evidence on high-docosahexaenoic acid (DHA) supplementation in low-risk pregnant women is limited. A randomized, double-blind, placebo-controlled trial was conducted among low-risk pregnant women aged 20-40 years at 22-24 weeks of gestation to evaluate the effects of high-DHA omega-3 supplementation on maternal and neonatal health outcomes. The control group (CG, n = 30) received oral olive oil supplementation, and the intervention group (IG, n = 30) received omega-3 [1700 mg, 260 mg of eicosapentaenoic acid (EPA), and 1440 mg of DHA] for ∼16 weeks or until delivery. Maternal and neonatal health outcomes were collected by telephone 15 days after delivery. Forty-five pregnant women completed the study (IG: 20; CG: 25). Adherence to supplementation was above 90% and did not differ between groups (P > .05). There were no differences between groups in mean gestational age (CG: 39.3 ± 1.6; IG: 39.2 ± 1.6; P = .877), adequate gestational weight gain (CG: 24.0%; IG: 50.0%; P = .088), adequate gestational BMI before delivery (CG: 33.3%; IG: 27.8%; P = .261), vaginal delivery (CG: 72.0%; IG: 60.0%; P = .396), full-term birth (CG: 92%; IG: 90%; P = .815), adequate weight (CG: 91.3%; IG: 94.7%; P = .237), and adequate length for gestational age (CG: 82.6%; IG: 100%; P = .056). Omega-3 supplementation with a higher concentration of DHA had no effect on the maternal and neonatal health outcomes investigated in a Brazilian sample of low-risk pregnant women. Further studies are needed to evaluate this effect in pregnant women at higher nutritional risk and with low dietary intake of omega-3. © The Author(s) [2026]. Published by Oxford University Press. All rights reserved. For commercial re-use, please contact [email protected] for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact [email protected].

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

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.

Objective: We aimed to determine the ability of prenatal ultrasound to detect velamentous cord insertion (VCI) in twin pregnancies and identify factors influencing diagnostic sensitivity. Methods: This single-center retrospective study included twins delivered between April 2018 and March 2024. We excluded monochorionic monoamniotic twins, those without chorionicity or umbilical cord insertion data, and fetuses that died in utero. Umbilical cord insertion sites assessed by second-trimester transabdominal ultrasound (16 + 0 to 21 + 6 weeks of gestation) using color Doppler imaging were classified as normal, marginal, or velamentous. The results of postnatal macroscopic examinations served as reference standards. We calculated accuracy, sensitivity, specificity, positive (PPV) and negative (NPV) predictive values. The effects of examiner expertise, chorionicity, placental location, ultrasound device, and maternal body mass index (BMI) on diagnostic sensitivity were analyzed in subgroups. Results: We confirmed VCI in 45 (8.8%) of 514 delivered fetuses. Prenatal ultrasound correctly identified 14 VCI cases. Sensitivity, specificity, PPV, and NPV were 31.1% (14/45), 98.9% (464/469), 73.7% (14/19), and 93.7% (464/495), respectively. The overall accuracy was 93.0% (478/514). Sensitivity was significantly higher when ultrasound specialists conducted examinations compared with non-specialists and when twins were monochorionic diamniotic twins than dichorionic. Anterior placental location and high-performance ultrasound equipment were also associated with increased sensitivity, but were not statistically significant. Maternal BMI did not affect diagnostic sensitivity. Conclusions: Prenatal ultrasonographic detection of VCI in twin pregnancies has high specificity but limited sensitivity. Diagnostic performance was influenced by examiners' experience and chorionicity. Routine assessment of cord insertion sites and targeted training might improve detection and support the optimized perinatal management of twin pregnancies.

Background/Objectives: Several recent human studies have associated the use of certain medicines, such as antibiotics and antacids, with allergic conditions, potentially through microbiome disruption. In contrast, probiotics which may prevent dysbiosis, could have protective effects. Our meta-analysis aimed to evaluate the impact of these drugs (consumed during pregnancy or early life) on the risk of childhood food allergy, based on the available literature. Methods: Literature searches were conducted in the EMBASE, PubMed, Cochrane, and Web of Science databases using predefined PICO criteria. Overall, our meta-analysis included 25 studies involving 1,662,861 mothers and 5,164,280 children. Results: Using the random-effects model, we found that prenatal and early life antibiotic use (up to 2 years of age) was associated with higher odds of food allergy in childhood (OR: 1.34; 95% CI [1.10, 1.63], OR: 1.53; 95% CI [1.18, 1.98], respectively). Proton pump inhibitors were also associated with a risk of food allergies (OR: 2.65; 95% CI [1.22-5.77]), whereas the impact of H2-receptor antagonists was non-significant (OR: 2.07; 95% CI [0.96-4.45]). Probiotic use during the first two years of life was not associated with decreased risk for food allergy in children (OR: 1.25; 95% CI [0.46, 3.38]). Conclusions: These findings suggest an association between microbiome-disrupting medications during pregnancy and early childhood and an increased risk of childhood food allergy, especially those with a family history of food allergy. However, due to the predominantly observational design of the included studies, causality cannot be established. These results highlight the need for cautious and judicious use of such medications in these populations.

Offspring of preeclamptic (PE) mothers are at increased risk of end-organ damage. Given the widespread use of NSAIDs during pregnancy and their reported ability to mitigate organ damage in PE mothers, this study examined whether prenatal naproxen modifies PE-induced lung injury in male and female offspring. PE was induced by orally administered L-nitro-arginine-methyl ester (L-NAME, 50 mg/kg/day for 7 days) to mothers prior to labor, and lung tissues were excised from 3-month-old offspring. Histopathology revealed increased interstitial inflammation and fibrosis in PE versus non-PE offspring lungs. This was more prominent in male than in female PE offspring and was coupled with more pulmonary expression of Axl tyrosine kinase receptor and downstream interleukin-1α (IL-1α) and antiangiogenic Fms-Like Tyrosine Kinase-1(sFlt1) effectors. These sex-related defects disappeared in offspring of PE dams treated prenatally with naproxen (1 mg/kg/day for 7 days). Further, PE offspring exhibited elevations in other inflammatory cytokines, IL-2 and TNFα, and apoptotic markers, caspase-3 and caspase-cleaved cytokeratin 18 (M-30) and total soluble cytokeratin 18 (M-65). The latter effects were evenly seen in both sexes and similarly offset by naproxen. These findings implicate Axl/IL-1α/sFlt1 signaling in the greater lung injury in male PE offspring and suggest a protective effect of gestational naproxen therapy.

The link between neurodevelopment in infants exposed to maternal gestational diabetes mellitus (GDM) and fetal DNA methylation remains unexplored. We conducted this hypothesis-generating study to investigate the association between fetal DNA methylation and neurodevelopmental outcomes in children of mothers with GDM. We carried out a prospective, observational pilot cohort study comparing infants exposed to maternal GDM with an unexposed control group. Umbilical cord blood DNA methylation was assessed using targeted methylome sequencing covering 3.34 million CpG sites. Infant neurodevelopment was evaluated at age two years using the Bayley-III Scales. Bioinformatics processing identified differentially methylated regions (DMRs), followed by multiple enrichment analyses of DMR-associated genes and partial correlation analyses. Multi-dimensional enrichment analysis of the 1053 identified DMR-associated genes revealed a significant convergence of pathways related to neurogenesis, synaptic components, and axonal guidance. Infants born to mothers with GDM exhibited lower scores in cognitive, language, and motor domains, which were associated with identifiable DNA methylation signatures at birth. Significant correlations were observed in genes essential for brain scaffolding and synaptic circuitry, most notably WNT4, the PCDHG alpha/beta clusters, and PALM. Additionally, methylation patterns in FOXF2 and CHFR suggest a potential impact on blood-brain barrier integrity, while associations with FSTL3 and H6PD highlight a systemic metabolic 'cross-talk' influencing neurodevelopment. Although these pilot findings are hypothesis-generating and require further functional validation, this study provides pioneering evidence that neurodevelopmental alterations in the offspring of mothers with GDM are potentially associated with intrauterine epigenetic modifications detectable at birth.

Fetal hypoxia and maternal stress during pregnancy are major risk factors for neurological disorders. The effects of maternal hypoxia may be transmitted to the next generation through persistent alterations in maternal endocrine and metabolic regulation. In this study, using immunohistochemistry, quantitative RT-PCR, and Western blotting, we assessed morphological features and HIF1-dependent processes in the fetal and adult brains of progeny of female rats exposed to maternal hypoxia (PMH). We identified a delay in progenitor cell differentiation into neurons at embryonic day 14, a decreased number of neurons in the hippocampus, an increased number of astrocytes in the prefrontal cortex, and a decreased number of astrocytes in the raphe nuclei of the PMH rats. However, no significant changes were observed in HIF1α protein levels or in the protein levels of HIF1-dependent gene products in the examined brain structures. Thus, the transgenerational effect of maternal hypoxia is manifested as structural disturbances of brain development but is not accompanied by changes in HIF1-dependent metabolism.

Alzheimer's disease (AD) is an age-related neurodegenerative disorder characterized by progressive synaptic dysfunction, axonal pathology, and cognitive decline, with the hippocampal circuits showing particular vulnerability during disease progression. However, early-life nutritional interventions may influence long-term synaptic resilience. In this study, we investigated the long-term effects of prenatal and lactational supplementation with choline, UMP, and fish oil in the 5XFAD mouse model. To this end, hippocampal synaptic and axonal pathology was assessed at 3, 6, and 9 months using Western blotting and immunofluorescence to measure synaptophysin, PSD-95, and neurofilament medium chain (NF-M), alongside a multidimensional behavioral battery that evaluated cognitive, affective, motor, and sensory outcomes. Results showed that early-life supplementation did not significantly improve the learning performance decline, increase nociception, or reverse changes in anxiety behavior in transgenic mice. However, it attenuated synaptic decline in transgenic animals by partially preserving synaptophysin and PSD-95 levels and reducing NF-M elevations. These molecular effects were accompanied by selective behavioral modulation, including preserved learning dynamics, altered anxiety-like behavior, and delayed nociceptive hypersensitivity, while late-stage motor impairments remained largely unaffected. Overall, prenatal and lactational supplementation produced modest, age-dependent effects on synaptic markers and partially prevented neurodegenerative progression in the 5XFAD model.

Background/Objectives: Sufficient sleep quantity/quality in infancy is crucial for healthy development, so it is important to identify early associated predictive factors. Research findings highlight salient endogenous (infant temperament) and exogenous (breastfeeding) influences, though no known studies have examined nuanced and interactive relations among these variables from early to late infancy/toddlerhood. Thus, the current study examined the main and interaction effects of these variables on infant sleep at 6 and 14 months while controlling for prenatal cortisol exposure. Methods: Data from a subsample (n = 79) of the Infant Development and Healthy Outcomes in Mothers Study were used, including prenatal maternal saliva samples assayed for cortisol and maternal questionnaires that included retrospective reporting of infant temperament, sleep quality and quantity, and breastfeeding frequency. Results: Multiple linear regression results include a statistically significant negative relation between prenatal maternal cortisol area under the curve and 6-month infant sleep quantity. A greater breastfeeding frequency at 6 months was associated with decreased 6-month sleep quality via conditional but not interaction effects. Greater 6-month infant Surgency was associated with better sleep quality at 14 months. There were no statistically significant interaction effects. Conclusions: The findings suggest that maternal psychophysiological stress has a significant influence on infant sleep duration, while research should further investigate the role of infant temperament and breastfeeding in shaping infant sleep quality. Significant conditional effects highlight patterns that should be re-examined with a larger sample to determine whether infant temperament may buffer against negative associations between breastfeeding frequency and infant sleep quality in early and late infancy in a developmental stage-consistent manner. Future replication studies should include a multi-method, longitudinal assessment of all key study variables, as well as a larger, more sociodemographically diverse sample of maternal-infant dyads.

Background/Objectives: The coparenting relationship newly formed during the transition to parenthood is a relational system focused on parenting. This study was positioned as an exploratory survey, because it evaluated a preventive intervention program developed for couples expecting their first child with the goal of promoting coparenting, focusing solely on the prenatal period. This self-guided program was primarily composed of brief video for viewing and homework that were provided to couples through the pregnant women. The primary objective of this study was to evaluate the feasibility and acceptability of the intervention, and the secondary objective was to explore its preliminary effects; all assessments were based on data collected from pregnant women. Methods: This was a pilot study employing a mixed-methods approach with intervention and comparison groups. The evaluation utilized self-reported data collected at 22-27 weeks' and 36 weeks' gestation, along with data gathered through responses to questions in Microsoft Forms and semi-structured interviews, particularly in the intervention group. Ultimately, 20 couples in each group were included in the analysis. Results: Approximately 80% of couples in both groups agreed to participate, enhancing the feasibility of the intervention that included approaches to couples through pregnant women. The intervention completion rate was high (87%), and many women found the program acceptable. Analysis of covariance for between-group comparisons revealed no significant differences in relationship satisfaction (p = 0.267) or prenatal coparenting (p = 0.239). Conclusions: This program was recognized as feasible and acceptable, but its preliminary effects during pregnancy were not confirmed. Randomizing participants and including outcome assessments after childbirth in future studies could contribute to enhancing the potential for beneficial interventions.