BACKGROUND:Fetal programming has traditionally been interpreted through metabolic and endocrine paradigms, while maternal psychological regulation remains underdeveloped as a biological determinant of neurodevelopment. Emerging evidence from placental biology, epigenetics, and fetal neuroimaging suggests that maternal psychological states may act not only as contextual exposures but also as dynamic physiological signals during pregnancy. CONTENT:This article proposes an integrative perspective in which maternal psychological homeostasis is conceptualized as a multidimensional regulatory state encompassing endocrine, immune, autonomic, and circadian processes. We hypothesize that the placenta functions as an active signal-processing interface, translating maternal physiological signals into developmental cues. Potential mechanisms include glucocorticoid signaling, inflammatory pathways, and epigenetic regulation, which may influence fetal neural connectivity, stress-response systems, and early neurobehavioral organization. Although converging findings support biological plausibility, the evidence remains heterogeneous, with uncertainties regarding causality and timing. SUMMARY:Within this framework, fetal mental programming may arise, in part, from maternal psychological regulation as it is integrated within placental biology, involving interacting and temporally sensitive regulatory layers rather than a single pathway. OUTLOOK:Future research should prioritize longitudinal human studies, validation of placental biomarkers, and identification of sensitive developmental windows. Improved understanding may support integration of mental health into perinatal care and inform early preventive strategies.
OBJECTIVES:Perinatal depression (PND) impacts a substantial subset of females globally and confers significant risk to maternal-infant health and offspring development, but current evidence on the association between thyroid peroxidase antibody (TPOAb) positivity and the risk of PND is uncertain. This study aims to evaluate the association between TPOAb positivity and the risk of PND. METHODS:We systematically searched PubMed, Web of Science, Embase, the Cochrane Library, and PsycINFO from their inception to March 1, 2025. Cohort, case-control, and cross-sectional studies evaluating the association between TPOAb positivity and the risk of PND were included. This meta-analysis was conducted according to the PRISMA 2020 checklist. The risk of bias in the included studies was assessed by the Newcastle-Ottawa Scale (NOS). Data synthesis was performed using random-effects model and fixed-effects model. RESULTS:After screening, 11 studies with 10,559 patients were eligible. The pooled relative risk (RR) indicated that females positive for TPOAb exhibited a significantly higher risk to develop PND (RR=1.52, 95 %CI [1.16-1.99], p<0.05). A moderate degree of heterogeneity was presented among the included studies (I2=52 %). CONCLUSIONS:This meta-analysis demonstrated that perinatal TPOAb positivity is associated with an increased risk of PND. However, given the moderate heterogeneity and the limited number of included studies, future well-designed prospective studies assessing TPOAb positivity at specific time points during pregnancy are warranted to improve the quality of evidence.
OBJECTIVES:To characterize the microbiological profile of post-cesarean surgical site infection (SSI) wound cultures, examine associations between specific pathogens and clinical or surgical characteristics, and delineate institutional wound culture collection practices. METHODS:A retrospective cohort study including women with positive wound cultures from clinically diagnosed post-cesarean SSIs between 2012 and 2024. Microorganisms were categorized into designated pathogen groups based on taxonomic classification and clinical relevance. Each microorganism group was compared with all remaining cases. Demographic, obstetric, surgical, laboratory, and outcome variables were analyzed using appropriate univariate statistical tests. RESULTS:A total of 207 positive wound cultures were analyzed. The most frequently isolated organisms were Enterobacterales (30.4 %), Staphylococcus aureus and β-hemolytic streptococci (27.1 %), and coagulase-negative staphylococci (20.3 %). Enterobacterales infections were significantly associated with obesity (BMI >35), meconium-stained amniotic fluid, and longer intervals from rupture of membranes to labor onset. Non-fermenting Gram-negative organisms were strongly associated with subcutaneous tissue approximation and intradermal skin closure. Coagulase-negative staphylococci were associated with fewer established risk factors, suggesting possible contamination or colonization. Only Enterobacterales infections demonstrated a statistically significant, though clinically modest, increase in peak white blood cell count. No significant differences were observed in other severity markers or clinical outcomes. CONCLUSIONS:Routine wound cultures in post-cesarean SSIs provide limited information regarding disease severity. However, specific pathogen profiles are associated with distinct obstetric and surgical characteristics, suggesting that selective culture use may be informative in high-risk clinical contexts. These findings may help improve institutional wound-culture practices and inform future studies on culture-guided management strategies.
OBJECTIVES:To compare placental inflammatory lesions and basal plate vascularization between pregnancies complicated by maternal vascular-metabolic disorders and normoglycemic, normotensive pregnancies, and to determine whether basal plate vascularization differs among metabolic, hypertensive, thrombophilic, and combined disorder phenotypes. METHODS:This retrospective observational study included 680 singleton pregnancies with placental histopathology. Pregnancies were classified as complicated by maternal vascular-metabolic disorders or as belonging to a normoglycemic, normotensive comparison group without documented maternal vascular-metabolic disease. Placental inflammatory lesions (villitis and decidualitis) were recorded as present or absent. Basal plate vascularization was assessed using a three-level ordinal scoring system and compared between study groups and among vascular-metabolic disorder phenotypes. RESULTS:Maternal vascular-metabolic disorders were documented in 205 pregnancies, whereas 475 pregnancies constituted the comparison group. Villitis was more frequent in the vascular-metabolic disorder group than in the comparison group (13.2 % vs. 3.2 %, p<0.001), as was decidualitis (71.2 % vs. 16.8 %, p<0.001). Basal plate vascularization scores were higher in the vascular-metabolic disorder group (2.76 ± 0.45 vs. 2.59 ± 0.52, p<0.001). However, the absolute difference was modest, and the median score was 3.0 in both groups. Basal plate vascularization did not differ significantly among isolated metabolic, hypertensive, thrombophilic, and combined disorder phenotypes (p=0.216). CONCLUSIONS:Maternal vascular-metabolic disorders were associated with a higher frequency of placental inflammatory lesions and slightly higher basal plate vascularization scores. However, the restricted scoring range, ceiling effect, unadjusted analyses, and retrospective observational design limit the clinical interpretation of these findings and preclude causal inference.
OBJECTIVES:Obstructive uropathy is the impairment of urinary flow resulting from mechanical compression along the urinary tract between the ureter's origin in the renal pelvis and the urethral outlet. While uncommonly encountered during labor, maternal obstructive uropathy (thought to result from ureteral compression by the fetal head) can be associated with acute kidney injury, and its relationship with clinically meaningful endpoints including risk of cesarean delivery, arrest of labor (previously known as cephalopelvic disproportion (CPD)), and high birthweight remain unknown. METHODS:We conducted a retrospective case-control, propensity score-matched study using an institutional database of patients who delivered at one of two hospitals within our healthcare system between January 2017 and December 2023, querying the relationship between ICD-9 and ICD-10 diagnostic codes of maternal obstructive uropathy and labor outcomes. RESULTS:The diagnosis of ureteral obstruction was significantly associated with incidence of cesarean delivery (93 % in cases, 16 % in controls, p<0.001) and clinical suspicion for CPD (80 % in cases, 13 % in controls, p<0.001) but was not significantly associated with birthweight (p=0.729). CONCLUSIONS:These results suggest that intrapartum diagnosis of obstructive uropathy may portend labor dystocia and subsequent indication for intrapartum cesarean delivery.
OBJECTIVES:To examine the interrelationships between maternal anthropometry, trimester-specific metabolic biomarkers, placental morphometry, and neonatal anthropometric outcomes in a South Asian population. METHODS:In this prospective longitudinal cohort (January 2023-December 2024), 250 eligible singleton pregnancies were recruited at <12 weeks' gestation from a tertiary-care center. Maternal anthropometry, glucose metabolism (OGTT), insulin resistance (HOMA-IR), and lipid profile (TC, LDL-C, HDL-C, triglycerides) were assessed across all trimesters. Placental morphometry was measured immediately postpartum. Neonatal anthropometry was assessed within 24-48 h of birth. Associations were analyzed using correlation matrices, regression modelling, and trimester-stratified analyses. RESULTS:Despite a relatively lean maternal profile (mean BMI 23.4 kg/m2), metabolic abnormalities were highly prevalent (GDM: 30-48 %; IR: 72-77 %). Lipid parameters showed trimester specific alterations. Gestational weight gain correlated modestly with birthweight (ρ=0.226). Placental weight and thickness showed strong associations with birthweight (ρ=0.523; ρ=0.517) and neonatal fat mass (ρ=0.423). First-trimester GDM and IR were associated with increased neonatal length, while second-trimester GDM predicted larger head circumference. Across all trimesters, GDM showed inverse associations with neonatal skinfold thickness. Third-trimester LDL-C, triglycerides, and total cholesterol were the strongest predictors of neonatal adiposity, with minimal influence on skeletal growth. CONCLUSIONS:Maternal metabolic perturbations exert trimester-specific influences on placental structure and neonatal anthropometry, with late-pregnancy lipids showing the strongest association with neonatal adiposity. Placental morphometry functions as a key mediator of maternal-fetal metabolic interactions. These findings support comprehensive metabolic screening in pregnancy and provide population-specific evidence to guide targeted antenatal interventions in South Asian settings.
OBJECTIVES:This study aimed to evaluate predefined two-dimensional speckle-tracking parameters (2D-STE) to distinguish between growth-restricted fetuses (FGR) and healthy controls (FC) and to identify novel parameters using an exploratory approach. METHODS:The study comprised 112 fetuses, 56 in the FGR cohort and 56 gestational-age-matched healthy fetuses in the FC cohort. We analyzed global longitudinal strain (GLS), as well as segmental strain, displacement, and velocity using 2D Cardiac Performance Analysis software. Dyssynchrony (DYS) was calculated as the difference in time to peak of GLS or segmental parameters inter- and intraventricular. We also measured changes in ventricular length, diameter and area. Additionally, we tested a prototype software with a tracked M-mode approach, which measured annular displacement. RESULTS:Dyssynchrony parameters were generally higher in the FGR cohort than in the FC cohort. Particularly the GLS-DYS was noticeably higher in the FGR cohort than in the FC cohort (median 19.85 vs. 8.40 ms; p<0.001). Also strain-dyssynchrony, displacement- and velocity-dyssynchrony were increased. FGR fetuses showed right ventricular alterations with lower RV-GLS and reduced longitudinal shortening and area change (25.58 vs. 22.06; p=0.040; 0.75 vs. 0.78; p=0.015; 0.58 vs. 0.67; p=0.024), while LV-GLS and LV-geometry did not differ noticeably. The prototype software did not sufficiently discriminate between groups. CONCLUSIONS:FGR was associated with higher cardiac dyssynchrony and altered right-ventricular function and geometry. GLS-based dyssynchrony may complement Doppler for risk stratification and monitoring in suspected placental insufficiency. These results should be considered in the context of the limited sample size. Prospective studies with larger cohorts should validate these parameters and establish standardized reference values.
Wrong-patient errors cause serious harm in newborns. These errors involve ordering and administering tests, procedures, medications, and breast milk to an unintended patient. Newborns receiving care in neonatal intensive care units (NICUs) are at particularly high risk. Although more distinct newborn naming conventions as recommended by the Joint Commission significantly reduce wrong-patient orders, name similarities among multiple-birth infants and truncation of differentiating information in some electronic health record (EHR) systems contribute to this persistent increased risk. Accordingly, novel newborn identifiers are urgently needed. We propose Pictographs - images that are appealing, recognizable, and appropriate - to serve as visual identifiers for newborns in NICUs. Pictographs are selected by caregivers, uploaded into the EHR, and displayed at bedside. As part of a multicenter randomized controlled trial assessing effectiveness of Pictographs to prevent wrong-patient order errors, we initially evaluated feasibility and acceptability of Pictographs at two study sites. Pictographs as novel visual identifiers for newborns in the NICU were generally well received by caregivers and clinicians, and the vast majority of caregivers selected a Pictograph for their infant(s), which was posted at the bedside and uploaded into the EHR. Ordering clinicians - the primary target of the intervention to prevent wrong-patient errors - recognized the potential for Pictographs to provide a visual cue when placing orders, particularly for multiple-birth infants. Here, we describe the rationale, implementation, framework, feasibility, usefulness, and acceptability of Pictographs among key stakeholders. If found effective for preventing wrong-patient errors, Pictographs could be adopted as a patient safety solution in hospitals worldwide.
OBJECTIVES:To evaluate the readability and quality of publicly available patient information pamphlets on ultrasound and assess their accessibility for patients with varying literacy levels. METHODS:This was a cross-sectional descriptive study using the publicly available online International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) patient information library. A total of 155 English-language patient information materials ("pamphlets") on pregnancy and gynecology topics available in early 2025 were analyzed. Readability was assessed using Readability Studio™ software and four validated indices: Gunning Fog, SMOG, Coleman-Liau, and Flesch Reading Ease (FRE). The DISCERN instrument, a validated 16-item tool, was applied independently to evaluate reliability, clarity, and balance of treatment information. The main outcomes measures were the grade level of readability and DISCERN quality scores. RESULTS:Only one pamphlet (1 %) met the recommended eighth-grade readability standard. Most pamphlets (124; 80 %) were written at or above the 11th-grade level (mean Gunning Fog 14.8, SMOG 13.5, Coleman-Liau 12.9, FRE 45.2). The LIX index classified the majority as "difficult to technical." Despite the high reading level, DISCERN scores were uniformly high (4-5/5), indicating strong reliability, clarity, and balance of information, but poor accessibility for the average patient. CONCLUSIONS:ISUOG patient information materials are accurate, reliable, and evidence-based but written well above recommended readability standards, limiting comprehension for many patients. Simplifying language, shortening sentences, and involving health-literacy and cultural experts may improve accessibility and promote global equity in patient education.
OBJECTIVES:To compare fetal left ventricular Tei index (TI) values and hemodynamic correlations between high-altitude and low-altitude pregnancies, establishing an altitude-specific framework for fetal cardiac assessment. METHODS:This prospective dual-group study enrolled 234 high-altitude and 252 low-altitude singleton pregnancies in Yunnan, China. Standardized Doppler ultrasound was performed at 20-25, 30-34, and 37-40 weeks. Fetal TI and hemodynamic parameters (umbilical artery [UA], ductus venosus [DV], middle cerebral artery [MCA], uterine artery [UtA]) were measured using a Samsung WS80A ultrasound system with strict angle control (<20° for vessels, <15° for TI). RESULTS:TI elevation: High-altitude TI was consistently higher (all p<0.001): 20-25 w: 0.471 ± 0.027 versus 0.405 ± 0.131 (Δ16.3 %); 30-34 w: 0.492 ± 0.050 versus 0.384 ± 0.121 (Δ28.1 %); 37-40 w: 0.484 ± 0.052 versus 0.365 ± 0.148 (Δ32.6 %). Gestational divergence: TI decreased with gestation in high-altitude group (F=4.037, p=0.019) but remained stable in low-altitude group (F=1.421, p=0.244). TI was negatively correlated with Dominant TI-MCA-PSV (r=-0.383) and TI-DV-PAV (r=-0.314) at high altitude, while showing a positive correlation with Strongest TI-UA-S/D (r=0.257) at low altitude. CONCLUSIONS:Chronic hypoxia induces a distinct fetal cardiovascular phenotype characterized by Tei index elevation (>0.48 post-30w), venous compromise (DV-PAV), and cerebral compensation (MCA-PSV). The tri-parametric model (TI + DV-PAV + MCA-PSV) addresses critical gaps in altitude-agnostic guidelines, offering tailored surveillance for 140 million high-altitude pregnancies globally.
INTRODUCTION:The primary role of a Coroner is to investigate unexpected deaths. However, the global literature on Coroner's role in perinatal death cases is limited. CONTENT:This study used the Joanna Briggs Institute framework and comparative law methodology to evaluate existing literature from high-income countries and jurisdictions (including where relevant states or provinces). A dual-source approach reviewed peer-reviewed and grey literature across 12 electronic databases, alongside national legislation from jurisdictions with a Coronial or equivalent system. SUMMARY:After analysing 24 countries with Coronial or equivalent systems and legislation available in English, the study found that only 12 of these countries had Coroners investigating perinatal deaths, and only one country mandated reporting of all perinatal death cases. A significant gap was found in Coroner's role in perinatal death cases through legislative sources and peer-reviewed literature. OUTLOOK:While global uniformity in Coronial law is not feasible, countries should adopt standardised reporting guidelines, training, and expertise to ensure consistent and high-quality death investigations. Further research is needed on holistic approaches, examining the emotional, social, and systemic factors involved in perinatal death inquiries, understanding their impacts on families, healthcare professionals, and other stakeholders, and encouraging multidisciplinary collaboration to ensure thorough and comprehensive investigations.
OBJECTIVES:Prokineticin 1 (PROK1), known as endocrine gland-derived endothelial growth factor (EG-VEGF), is a key regulator of pregnancy, playing various roles from implantation to birth. We have shown that maternal serum concentrations of PROK1 are highest during the first trimester and are elevated in pregnancy complications such as spontaneous preterm birth (sPTB). Additionally, PROK1 is described as being largely expressed by the chorion in fetal membranes, suggesting its presence in amniotic fluid. Despite these findings, no information is available about PROK1 concentrations in the amniotic fluid, nor concerning its evolution in the context of spontaneous preterm labor with or without infection. METHODS:PROK1 concentrations were measured in amniotic fluid from patients with spontaneous preterm labor (n=45) and from women at term without sPTB (n=30). RESULTS:Our findings revealed that PROK1 concentrations were, i) significantly elevated in preterm labor patients compared to term laboring controls; ii) higher in spontaneous preterm labor patients with intra-amniotic infection compared to those without infection, and iii) not affected by the process of labor at term. CONCLUSIONS:This study provides the first comprehensive characterization of PROK1 concentrations in amniotic fluid, highlighting its potential involvement in spontaneous preterm labor, with or without infection.
OBJECTIVES:Prolonged neonatal hypoglycemia eventually resolving spontaneously is linked to perinatal stress, whereas persistent congenital hyperinsulinism is caused by genetic alterations leading to dysregulated insulin secretion. We investigated whether birth weight percentiles differ between both disorders. METHODS:Retrospective analysis of birth weight percentiles in infants treated for prolonged neonatal hypoglycemia (n=9) or persistent neonatal hyperinsulinism (n=78) in two referral centers (2001-2023). RESULTS:Infants with prolonged neonatal hypoglycemia had significantly lower birth weight percentiles than those with persistent congenital hyperinsulinism (median 16 [interquartile range 4-72] vs. 89 [50-98]; p=0.003). The area under the receiver operator characteristics curve describing the power to discriminate between infants with prolonged neonatal hypoglycemia and persistent congenital hyperinsulinism was 0.801 (95 % confidence interval 0.660-0.941), p<0.001. Among infants with prolonged neonatal hypoglycemia, 4/9 were small for gestational age (birth weight <10th percentile), while 36/78 infants with persistent congenital hyperinsulinism were large for gestational age (>90th percentile). However, close to half of infants in each group had normal birth weights for gestational age. CONCLUSIONS:While birth weight percentiles reflect differing fetal growth patterns in these conditions, they are insufficient as standalone diagnostic criteria. Additional algorithms are needed for accurate early identification and discrimination.
OBJECTIVES:This study aimed to compare the efficacy of administering carbetocin before versus after placental delivery in preventing PPH in low-risk vaginal deliveries. METHODS:The randomized controlled trial was conducted at Kartal City Hospital, Istanbul, Turkey. A total of 160 primiparous women with uncomplicated pregnancies who underwent vaginal delivery were enrolled. Participants were randomly assigned to receive 100 mcg of carbetocin either before or after placental delivery. The primary outcome was the incidence of PPH. Secondary outcomes included the need for additional uterotonics, manual removal of the placenta with consequent antibiotic administration, blood transfusions, maternal adverse events, and changes in hemoglobin levels at baseline and 24 h postpartum. RESULTS:The incidence of PPH was significantly lower in the carbetocin-before group than in the carbetocin-after group (p=0.015). The carbetocin-before group had a significantly lower mean hemoglobin drop compared to the carbetocin-after group (p<0.001). The need for additional uterotonics was significantly higher in the carbetocin-after group (p<0.001). Manual placenta removal and the need for antibiotics were more frequent in the carbetocin-before group (p=0.017). No significant differences in adverse maternal events were observed between the groups. CONCLUSIONS:Administering carbetocin before placental delivery significantly reduces the incidence of PPH, blood loss, and the need for additional uterotonics. However, the increased rate of manual placenta removal necessitates individualized risk-benefit assessment; pre-placental administration may be most advantageous in women at elevated risk for PPH, in whom the hemorrhagic benefit outweighs the risks associated with manual extraction.
Background The limits of viability, commonly defined by gestational age and/or birth weight thresholds associated with a survival probability exceeding 50 %, have evolved with advances in neonatal care. However, these thresholds vary substantially across countries, reflecting differences in health system capacity rather than fixed biological boundaries. ContentThis review critically examines the definition of the limits of viability as a context-dependent construct shaped by access to perinatal and neonatal care. It analyzes global disparities in survival at the margins of prematurity, with marked differences between high-income (HIC) and low- and middle-income countries (LMIC). These inequities are discussed within the framework of the Sustainable Development Goals (SDG), particularly SDG 3 and SDG 10, and in relation to the child's right to the highest attainable standard of health. The role of global health governance, including the World Health Organization (WHO), and emerging challenges affecting international collaboration are also considered. Current trends in both HIC and LMIC are evaluated to assess alignment between technological progress and global health equity.SummaryThe limits of viability are not fixed biological thresholds but reflect health system capacity. Persistent disparities in periviable survival remain substantial and result in outcomes determined largely by place of birth rather than biological potential.OutlookReducing inequities requires prioritizing equitable implementation of evidence-based interventions, strengthening health systems, and sustaining global collaboration. Aligning advances in neonatal care with global equity is essential to improving outcomes for the most vulnerable newborns.
INTRODUCTION:Peripartum cardiomyopathy (PPCM) may initially present with prominent respiratory symptoms that resemble primary pulmonary disease, particularly in late pregnancy and the early postpartum period. In clinical practice, this presentation often triggers alternative diagnostic pathways, introducing delay at a time when rapid cardiac assessment is critical. Although respiratory-dominant presentations are repeatedly described across case-based and observational reports, they have not been systematically examined as a distinct diagnostic pathway within the PPCM literature. CONTENT:This PRISMA-guided systematic review synthesized evidence relating to respiratory-onset presentations of PPCM. Major databases and registers were searched comprehensively. Following screening of 589 records and full-text assessment of 145 reports, 49 studies met inclusion criteria. Twenty studies were qualitatively prioritized for narrative synthesis using ROBIS-informed methodological appraisal. Evidence was examined across diagnostic misclassification patterns, cardiopulmonary mechanisms, differential diagnoses, investigative strategies, and acute and longitudinal management considerations. SUMMARY:Respiratory-led presentations were commonly misattributed to asthma, pneumonia, pulmonary embolism, or perioperative causes, with diagnostic delay frequently reported. Across heterogeneous study designs, cardiogenic pulmonary edema with left-ventricular systolic dysfunction emerged as a recurring unifying mechanism. Early use of echocardiography, natriuretic peptides, and targeted imaging consistently aided differentiation from primary respiratory pathology. Severe clinical deterioration was often described in the context of delayed recognition. OUTLOOK:Respiratory-onset PPCM represents a high-risk diagnostic pathway rather than a discrete disease entity. Prospective registries, standardized diagnostic algorithms, and closer integration of obstetric and cardiopulmonary care are needed to refine early recognition and improve maternal outcomes.
INTRODUCTION:Although inflammasome activation has been repeatedly linked to preeclampsia, the field has tended to frame this biology around NLRP3 alone, leaving other sensors - particularly NLRP1 - and their mitochondrial upstream signals only partially examined. Recent experimental work hints at a more intricate narrative in which dysregulated BNIP3-mediated mitophagy and escalating mitochondrial ROS form a convergent pathway toward trophoblast injury. Yet no systematic review has stitched these elements together. CONTENT:Following PRISMA 2020 guidance, we synthesized evidence across experimental, observational, and mechanistic studies, mapping how impaired mitochondrial quality control, oxidative stress, and inflammasome signaling intersect within the placenta and maternal vasculature. The retrieved literature was analyzed for methodological transparency and biological coherence, allowing a layered reconstruction of how BNIP3 overexpression, mitophagy failure, and mtROS collectively prime NLRP1 activation. SUMMARY:Across 31 eligible studies, a consistent picture emerged: mitochondrial injury acts less as a by-product and more as a central instigator of the inflammatory cascade that shapes the preeclampsia phenotype. The BNIP3→mtROS→NLRP1 axis appears particularly relevant, even when data are fragmented or derived from heterogeneous models. OUTLOOK:Recognizing this pathway opens conceptual space for a new therapeutic toolkit - one aimed at mitochondrial stabilization, inflammasome modulation, and restoring trophoblast resilience.
