Women’s healthcare in Malaysia spans several programmes and clinical settings, yet continuity between life stages is less well understood. This narrative review examines care, access and opportunities for service integration from adolescence through the reproductive years, pregnancy and postpartum, to menopause. It draws on PubMed and supplementary Malaysian public sources, grey literature and citation searches for publications from 1 January 2000 to 20 October 2026. The literature comprised 83 reports representing 81 underlying evidence sources. Of these reports, 45 concerned pregnancy and postpartum care, 15 preconception and reproductive care, 13 adolescence and 10 menopauses. Recurring barriers involved confidentiality, sociocultural acceptability, cost, reproductive planning, follow-up and referral coordination. Findings from individual studies are interpreted within their settings and distinguished from gaps in published evidence. Priorities for evaluation include trusted adolescent entry points, discussion of reproductive intentions during routine care, completion of postpartum and mental-health follow-up, and access to appropriate midlife care. We propose a primary-care framework that connects these functions through shared information and clearly assigned follow-up responsibilities. Limited database coverage, heterogeneous study designs and the absence of formal quality appraisal constrain the conclusions. The review identifies practical opportunities to improve continuity, while recognising that the proposed framework requires evaluation and that the available literature cannot establish the extent of service gaps nationally.
Background: Preeclampsia is a complex hypertensive disorder of pregnancy characterized by placental dysfunction and maternal multiorgan injury. Circulating angiogenic and antiangiogenic biomarkers may improve risk stratification and prediction of adverse outcomes. Methods: This retrospective cohort study evaluated the predictive and prognostic performance of the soluble fms-like tyrosine kinase-1 (sFlt-1)/placental growth factor (PlGF) ratio in patients with singleton pregnancy from 24 to 36 + 6 weeks who had clinical or biochemical suspicion of preeclampsia. The sFlt-1/PlGF ratio was calculated from maternal serum concentrations measurements of both biomarkers in 144 women at the Hospital of Gynecology and Obstetrics, Unidad Medica de Alta Especialidad, Centro Medico Nacional de Occidente in Guadalajara, Jalisco, Mexico from April 2024-January 2026. Results: Among 144 women included in the final analysis, 57 (39.5%) developed preeclampsia; 39 (68.4%) had early-onset and 18 (31.6%) late-onset preeclampsia. The median sFlt-1/PlGF ratio was higher in women who developed the disease than in those in the control group (98.65 vs 11.86; p<0.001). The diagnostic performance of the sFlt-1/PlGF ratio using a cut-off value≥38 to predict preeclampsia yielded a sensitivity of 73.68% (95% CI: 61.02-83.35) and specificity of 81.61% (95% CI: 72.19-88.35). Higher sFlt-1/PlGF ratios were also observed among pregnancies with adverse maternal or perinatal outcomes. Conclusions: The sFlt-1/PlGF ratio demonstrated good discriminatory performance for preeclampsia and association with adverse maternal and perinatal outcomes in our cohort. The sFlt-1/PlGF ratio correlates accurately with prognostic value.
Background: Gestational diabetes mellitus (GDM) is associated with major maternal and neonatal complications contributing to perinatal morbidity. This study evaluated fetomaternal outcomes and predictors of adverse neonatal outcomes among women with GDM. Methods: This prospective observational study was conducted at Sylhet MAG Osmani Medical College Hospital, Bangladesh, from January to December 2025. A total of 120 pregnant women with GDM who delivered at the tertiary hospital were included. Participants received either diet therapy alone or diet plus insulin according to glycemic control. Maternal complications, mode of delivery, and neonatal outcomes were recorded. Data were analyzed using SPSS version 26 with descriptive statistics, chi-square tests, and logistic regression. Results: Mean maternal age was 29.8±4.6 years, and 61.7% were multigravida. Treatment consisted of diet alone in 43.3% and diet plus insulin in 56.7%. Maternal complications included pregnancy-induced hypertension (21.7%), preeclampsia (15.0%), and polyhydramnios (18.3%). The cesarean section rate was 53.3%. Neonatal complications included macrosomia (23.3%), hypoglycemia (21.7%), respiratory distress syndrome (15.0%), and NICU admission (28.3%). Compared with the diet-only group, insulin-treated women had significantly higher rates of cesarean delivery (73.5% versus 26.9%, p=0.001), macrosomia (32.4% versus 11.5%, p=0.006), and NICU admission (38.2% versus 15.4%, p=0.005). Independent predictors of NICU admission were maternal age ≥35 years (OR=1.92), BMI≥30 kg/m2 (OR=2.38), insulin therapy (OR=2.76), poor glycemic control (OR=3.12), and preterm delivery (OR=2.54). Conclusions: GDM is associated with substantial maternal and neonatal morbidity, particularly among women requiring insulin therapy, emphasizing the need for strict glycemic control and specialized tertiary-level care.
Background: Thyroid disorders constitute the most prevalent endocrine abnormality encountered during pregnancy, with well-documented potential for significant adverse effects on both maternal and fetal health. Physiological adaptations unique to gestation alter thyroid hormone economy, making diagnosis and interpretation of thyroid function tests particularly challenging in this population. The burden of undetected thyroid dysfunction in pregnant Indian women remains incompletely characterised, with most available evidence derived from non-Indian cohorts. Methods: This prospective observational study enrolled 150 antenatal women attending the Department of Obstetrics and Gynaecology, Dr. D.Y. Patil Hospital, Nerul, Navi Mumbai, over 16 months (March 2023–June 2024). Thyroid function tests (T3, T4, TSH) were performed each trimester using chemiluminescent and ELFA techniques, with trimester-specific TSH reference ranges as per the 2011 American Thyroid Association guidelines. Maternal and feto-neonatal outcomes were documented at delivery. Results: The prevalence of thyroid dysfunction was 28%, with hypothyroidism accounting for 25.3% (overt 8.7%, subclinical 16.7%) and hyperthyroidism for 2.7%. Thyroid dysfunction was significantly associated with preterm delivery (p=0.001), low birth weight (p=0.001), and lower APGAR scores at 1 minute (p=0.015) and 5 minutes (p=0.001). Higher rates of NICU admission (p=0.012), stillbirth, IUGR, abortion (p=0.004), and miscarriage (p=0.006) were observed in women with thyroid disorders. No significant associations were found with maternal age (p=0.969) or mode of delivery (p=0.686). Conclusions: Thyroid dysfunction in pregnancy carries a significant burden of adverse feto-maternal outcomes. The high observed prevalence underscores the need for universal thyroid function screening in early pregnancy and the pre-conceptional period to enable timely detection and management.
During controlled ovarian stimulation for in vitro fertilization (IVF), a luteinizing hormone (LH) surge can trigger the release of a premature oocyte before scheduled oocyte retrieval. Suppressing this surge is critical in order to achieve a successful round of IVF. Gonadotropin Releasing Hormone (GnRH) antagonists bind to the GnRH receptor in the pituitary gland and prevent endogenous GnRH from stimulating LH release. This is a rapid and reversible blockade used by clinicians to enable successful IVF outcomes. Traditionally, injectable antagonist agents like ganirelix/cetrorelix have been popular but are reported as painful and expensive. Recently, new literature regarding the use of elagolix, an oral non-peptide GnRH antagonist, as a potentially less invasive and cheaper alternative has been published. This review critically appraises the present evidence on elagolix as an oral alternative for LH surge suppression in IVF. A literature search was conducted using PubMed as the primary database, supplemented by Google Scholar to identify additional relevant sources. Search terms included combinations of phrases like “elagolix,” “IVF,” “GnRH antagonist,” “ovarian stimulation,” “ganirelix,” “cetrorelix,” “HPO axis.” Studies were included if they reported original data or reviewed existing evidence on GnRH antagonist use in the context of ovarian stimulation for IVF. Studies examining elagolix’s use in the management of endometriosis-associated pain were also included. Reference lists of identified studies were further reviewed to pull additional relevant information. This search yielded additional studies that met the inclusion criteria. Across the available studies, elagolix demonstrates comparable LH suppression to injectable GnRH antagonists, offering a reduced injection and per-cycle cost burden for IVF patients. However, this evidence is limited to a small number of majorly retrospective and a few prospective cohort studies. No randomized controlled trials have been published to date. Dosage and safety data relevant to elagolix’s use in IVF also remains scarce. According to our analysis, elagolix shows promise, but larger clinical trials and prospective studies are needed to solidify elagolix as a cost-effective and hypoalgesic alternative.
