Emerging evidence links dysbiosis in gut microbiota with metabolic irregularities in gestational diabetes mellitus (GDM). However, alterations in blood microbiome of GDM individuals remain unexplored. Blood has traditionally been regarded as a sterile compartment, yet emerging evidence of a circulating microbiome raises the possibility that it also contributes to metabolic disease. This study aims to characterize, for the first time, the blood microbiome of women with gestational diabetes mellitus (GDM) relative to healthy pregnant women using 16 S rRNA sequencing, and to determine whether microbial diversity, taxonomic composition, and predicted functional pathways differ between the two groups, thereby clarifying the potential relevance of the blood microbiome to GDM pathogenesis and biomarker development. In this case-control study, bacterial DNA was extracted from blood samples of 40 GDM patients and 40 healthy pregnant women controls. The V2, V3, V5, V6, and V8 hypervariable regions of the 16 S rRNA gene were amplified using a multiplex (5R) sequencing strategy and sequenced on an Illumina MiSeq platform. α and β diversity indices were used to compare microbial diversity between groups, linear discriminant analysis effect size (LEfSe) was used to identify differentially abundant taxa, and PICRUSt-based Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway predictions were performed to explore potential functional differences. The α diversity, as indicated by the Shannon index, exhibited a noteworthy reduction within the GDM group. We observed notable differences in β-diversity between the cohorts. The GDM group’s blood microbiome was characterized by a significant enrichment of the Nocardioidaceae and Planococcaceae families. Conversely, the microbiome of healthy pregnant controls was significantly enriched with bacteria belonging to the order Enterobacterales, notably the genus Escherichia. Furthermore, functional analysis brought to light substantial differences in 30 pathways between the two groups. Specifically, pathways linked to GDM, such as fatty acid metabolism, propionate metabolism, butyrate metabolism, and several amino acid metabolism pathways (including histidine metabolism, lysine degradation, and tryptophan metabolism), compared to their healthy counterparts were upregulated in the GDM group. In contrast, pathways associated with electron transfer carriers, transcription factors, RNA transport, the phosphotransferase system (PTS), transcriptional regulation proteins, as well as carbohydrate digestion and absorption, compared to their healthy counterparts were markedly downregulated in individuals with GDM. GDM is associated with a distinct blood microbial signature, characterized by reduced α diversity, altered β diversity, and specific taxonomic and predicted functional differences relative to healthy pregnancy. These findings suggest that circulating bacterial DNA signatures may hold promise as candidate biomarkers for GDM and warrant validation in larger, longitudinal studies incorporating direct microbiological and metabolic measurements. This study has been registered in the National Medical Research Registration and Filing Information System, with the registration number MR3324015166 (20231126).
Uterine rupture remains a catastrophic obstetric complication associated with high maternal and perinatal mortality, particularly in low- and middle-income countries with fragile health systems. Evidence from conflict-affected settings such as Yemen is limited. This study aimed to describe the incidence and fetomaternal outcomes of complete uterine rupture in a tertiary referral hospital in Sana’a, Yemen. A descriptive observational hospital-based study was conducted in Al-Sabeen Maternity and Child Hospital between January 2017 and December 2018. All women with complete uterine rupture during the study period were included. Data were extracted from routinely recorded clinical records. Sociodemographic characteristics, obstetric history, antenatal care attendance, place of labor onset, uterine status and maternal and perinatal outcomes were analyzed descriptively. During the study period, 39 women with complete uterine rupture were identified among 16,813 births, yielding an incidence of 0.23
Delayed onset of lactogenesis (DOL), defined as the absence of breast fullness or milk coming in beyond 72 h postpartum, may impair breastfeeding success. Reliable estimates of its incidence and associated factors are needed to guide clinical support. Following PRISMA 2020, we systematically searched English and Chinese databases from inception to 30 April 2025 for prospective observational studies of factors associated with DOL among women initiating breastfeeding. Two reviewers independently screened studies and extracted data. DOL incidence was pooled using logit-transformed proportions and a Paule–Mandel random-effects model, with subgroup analysis by country. Odds ratios (ORs) for associated factors were synthesised using fixed- or random-effects models according to between-study heterogeneity. Across 48 prospective studies (n = 39,388), the pooled incidence of DOL was 30.3
Labour pain and pain-coping ability have an impact on the labour process. Valid measurement scales are needed for assessing and providing supportive labour strategies for women. This is a Cross-sectional study. Following the modified Brislin’s translation model and cross-cultural adaptation guidelines, the original scale was translated, back translated, subjected to the Delphi process, and pretested after authorization was obtained. A total of 242 women with vaginal delivery were investigated and evaluated through the convenience sampling method via the Chinese version of the CALM at a tertiary hospital in Liaoning Province to analyse the reliability and validity of the scale. The Cronbach’s α was 0.840 and the Interclass Correlation Coefficient (ICC) was 0.965 (P<0.001). The I-CVI ranged from 0.80 to 1.00, and the S-CVI/Ave was 0.99. Exploratory factor analysis extracted 1 common factor and contributed to a cumulative variance rate of 61.045
Amniotic fluid embolism (AFE) can give rise to disseminated intravascular coagulation (DIC), which can result in life-threatening obstetric hemorrhages. There are no reported cases where sudden onset massive pulmonary and intestinal hemorrhages were the main mode of blood loss due to AFE in English literature. A 37-year-old woman who had previously been diagnosed with placenta percreta invading her bladder with placenta previa presented to our hospital with abdominal pain. Her period of gestation was 34 weeks and 6 days. An ultrasound scan showed a single live fetus with placenta accreta spectrum, and no abruption was seen. There was no bleeding, and mother and fetus were stable. Ten hours after her admission, a sudden vaginal bleeding necessitated an emergency cesarean hysterectomy. A healthy boy was delivered, and a minor fresh abruption was noted. 25 min later, the patient experienced a sudden cardiac arrest. She was temporarily resuscitated. She suffered a second cardiac arrest, which was complicated by massive pulmonary hemorrhage (approximately 4500 mL) and gastrointestinal hemorrhage. The surgical blood loss was only 1500 mL. This patient died despite resuscitation attempts. Post-mortem histological examinations of the patient’s lungs and other organs revealed evidence of AFE and DIC and confirmed placenta percreta invading the urinary bladder. This is an extremely rare case of massive pulmonary and intestinal hemorrhage following AFE in a patient with placenta percreta and placenta previa. Placenta percreta and placenta previa would have increased her risk of getting AFE. Greater emphasis is needed on the primary prevention of the increasing global incidence of placenta percreta (part of the placenta accreta spectrum).
Caesarean section (CS) is a life-saving surgical intervention performed when vaginal delivery poses a risk for women with pregnancy complications. In Nigeria, maternally requested caesarean section (MRCS) is not widely accepted as a childbirth option despite increasing awareness. Evidence on MRCS spousal support and the factors influencing its uptake remains limited in Nigeria. Therefore, we investigated the factors associated with MRCS uptake among pregnant women and spousal support in Ibadan, Nigeria. This is a cross-sectional study among 1,804 pregnant women and 442 male spouses, recruited from seven selected health facilities in Ibadan, Nigeria, using a multistage sampling approach. Data were collected through structured interviewer-administered questionnaires. The outcome variable was pregnant women’s willingness to demand MRCS. Explanatory variables were sociodemographic characteristics, spousal support, and knowledge of CS. Bivariate and multivariable logistic regression analyses were conducted at 5
Antenatal care (ANC) is essential for reducing maternal and neonatal morbidity and mortality. In Nigeria, despite efforts to improve maternal health, satisfaction with ANC services remains suboptimal, particularly in rural and semi-urban areas. This study assessed client satisfaction with ANC services and associated factors in public and private health facilities in Igbo Eze South Local Government Area of Enugu State, Nigeria. A facility-based cross-sectional study was conducted from December 2023 to January 2024 among 246 pregnant women attending ANC. Participants were selected using multistage sampling from 11 health facilities. Data were collected using a structured interviewer-administered questionnaire adapted from the SERVQUAL model. Descriptive statistics summarized client characteristics and satisfaction levels. Chi-square tests were used to examine associations between socio-demographic variables and satisfaction, with significance set at p < 0.05. Participants had a mean age of 26.4 ± 6.1 years. The majority (80.1
Loop electrosurgical excision procedure (LEEP) is the standard treatment for high-grade cervical intraepithelial neoplasia (CIN) and is performed predominantly in women of reproductive age. Data on subsequent pregnancy outcomes from Turkish cohorts are limited. We described obstetric outcomes after LEEP and examined whether excision dimensions — depth, diameters and calculated cone volume — were associated with preterm birth and spontaneous miscarriage. Single-centre retrospective cohort study at a tertiary gynaecological oncology referral centre. Forty women who conceived after LEEP for CIN were identified; each contributed one pregnancy. One elective termination of pregnancy was excluded because it is not an obstetric outcome, leaving 39 pregnancies for analysis. Cone volume was calculated from pathology-reported specimen dimensions using the hemi-ellipsoid formula. Group comparisons used the Mann–Whitney U and Fisher exact tests. Because outcome events were few (eight preterm births, seven miscarriages), regression models were restricted to a single predictor and fitted with Firth penalized likelihood; two-predictor models are reported only as sensitivity analyses. There was no concurrent untreated comparison group, so no causal effect of LEEP can be estimated. Of 39 pregnancies, 31 (79.5
It is important to understand the genital hygiene behaviors of pregnant women with diabetes mellitus to prevent urogenital tract infections and to ensure healthy pregnancy and childbirth. The aim of this study was to determine genital hygiene behaviors and identify factors associated with GHBI scores among pregnant women with diabetes mellitus. This descriptive and cross-sectional study was conducted with pregnant women with diabetes mellitus between June 2023 and June 2024 [n = 139]. The data were collected via the “Genital Hygiene Behaviors Inventory [GHBI]”. Comparisons of GHBI scores across participant characteristics were analyzed using independent-samples t-tests and one-way analysis of variance. Factors independently associated with GHBI scores were examined using multivariable linear regression analysis. Ethics committee approval was obtained. The mean score of the GHBI was 80.50 ± 9.62. Only 5
To evaluate associated anomalies, genetic findings, and pregnancy outcomes of fetuses with clenched hand detected on prenatal ultrasonography. This retrospective cohort study included 40 pregnancies with a prenatal diagnosis of clenched hand managed at Ankara Bilkent City Hospital, a tertiary referral center, between January 2020 and October 2025. Prenatal screening results, ultrasound findings, invasive prenatal diagnostic testing, associated fetal anomalies, and pregnancy outcomes were analyzed. Cases in which clenched hand was secondary to arthrogryposis multiplex congenita, fetal akinesia–hypokinesia sequence, neuromuscular disorders, or functional central nervous system disorders causing hand contractures were also excluded. The mean gestational age at diagnosis was 22.15 ± 5.5 weeks. Associated anomalies were present in all cases. Skeletal and facial anomalies were the most common associated findings (80
Globally, more than two million perinatal deaths occur annually attributable to the intrapartum period, the vast majority occurring in low- and middle-income countries (LMICs). We sought to ascertain the incidence of adverse neonatal intrapartum-related outcomes and associated risk factors in tertiary referral centers in LMICs. The Limiting Adverse Birth Outcomes in Resource-limited settings (LABOR) Study was a prospective intrapartum observational cohort of women and their fetuses in Ghana, India and Zambia enrolled from 2019 to 2022 and followed through 42 days postpartum. Women with a singleton pregnancy admitted to the labor ward for a vaginal birth were eligible for inclusion; additionally, women admitted for a cesarean birth were eligible if they also had signs/symptoms of labor, elevated blood pressure or fever on admission. Among the 16,369 eligible participants, all 16,369 were approached; of these, 2315 refused and 1982 were excluded. Of the 12,072 enrolled, we excluded an additional 1736 with pre-labor Cesarean birth, analyzing a cohort of 10,336 women for this manuscript. Our primary outcome was a composite of these secondary outcomes: intrapartum stillbirth, neonatal death, intrapartum-related neonatal encephalopathy and culture-proven early onset neonatal sepsis. We estimated the incidence of outcomes using binomial proportions and the adjusted risk of outcomes associated with baseline factors using generalized linear models. We included 10,336 women with a median age of 27; 1788 (17·3
Sleep health is a critical component of maternal well-being, and poor sleep during pregnancy is associated with adverse maternal-fetal and cardiometabolic outcomes. Although sleep across pregnancy has been examined in several longitudinal studies, fewer studies have included frequent repeated assessments in racially and ethnically diverse populations with a high representation of lower socioeconomic status. We aimed to characterize longitudinal patterns of sleep duration, sleep quality, and sleep midpoint across pregnancy; identify groups with similar sleep profiles; and examine maternal and pregnancy characteristics associated with sleep health. This secondary analysis included individuals enrolled in the Human Placenta and Phthalates Study in Norfolk, Virginia and Galveston, Texas (2016–2020). Self-reported sleep duration and quality were collected at up to eight visits (13–36 gestational weeks). Sleep midpoint was calculated from reported bedtime and wake time. Generalized estimating equations evaluated associations between participant characteristics and repeated sleep measures. Group-based trajectory modeling identified joint trajectories of reported bed and wake times for perceived overnight sleep duration and perceived sleep quality; sleep midpoint was excluded because models incorporating it did not converge. Among 303 individuals, 43
Gestational diabetes (GDM) is frequently associated with adverse neonatal outcomes, but the underlying mechanisms linking maternal hyperglycemia to fetal harm are not fully understood. Oxidative stress has been suggested as a key pathway; however, studies simultaneously evaluating multiple oxidative and antioxidant biomarkers in umbilical cord blood are limited. This study aimed to investigate the impact of GDM on the fetus by comprehensively evaluating oxidative stress and antioxidant defense mechanisms in umbilical cord blood and to examine their potential associations with neonatal clinical outcomes. Umbilical cord blood samples were analyzed for malondialdehyde (MDA), membrane attack complex (MAC), total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSI), ischemia-related modified albumin (IMA), 8-hydroxy-2’-deoxyguanosine (8-OHdG), advanced glycation end products (AGEs), reduced glutathione (GSH), and glutathione peroxidase (GPx). Neonatal clinical outcomes were recorded and compared between pregnancies with and without GDM. After correction for multiple biomarker comparisons, MAC, 8-OHdG, and TOS differed significantly between the GDM and non-GDM groups. MAC and 8-OHdG levels were higher in the GDM group, whereas TOS was lower. OSI was higher in the Mann–Whitney analysis but did not remain significant after BH-FDR correction. Exploratory multivariate analyses supported a group-level difference in the combined oxidative-stress biomarker profile, as confirmed by MANOVA and permutation testing. The Spearman heatmap showed that maternal HbA1c was most prominently associated with OSI and also correlated positively with 8-OHdG and GSH. Although neonatal complications were more frequent in the GDM group, oxidative-stress markers were not consistently associated with specific neonatal complications. These findings suggest that GDM is associated with a selective fetal redox-related biomarker pattern rather than a uniform global increase in oxidative stress. The combined biomarker profile and HbA1c-related heatmap correlations indicate that long-term maternal glycemic exposure may influence fetal oxidant–antioxidant balance and oxidative DNA-damage signals, while antioxidant-related responses may remain partially preserved. The comprehensive evaluation of multiple oxidative and antioxidant biomarkers, particularly the inclusion of rarely studied AGEs and IMA, provides a broader perspective on fetal exposure to GDM and its pathophysiological mechanisms.
Abstract Background Women on probation (community supervision) report high rates of adverse childhood experiences (ACEs) and ongoing trauma, yet little research has examined how trauma across the life course relates to perinatal outcomes during community supervision. This study examined associations between lifetime trauma and perinatal violence, infant separation, and postpartum mood symptoms among women who experienced pregnancy, childbirth, and postpartum while on probation. Methods We conducted a cross-sectional secondary analysis from N = 60 women in South-Central Texas who had a pregnancy within the past five years while on community supervision. Trauma exposures included selected ACEs and adulthood/perinatal trauma (domestic, intimate partner, and sexual violence). Outcomes were perinatal violence, permanent infant removal after childbirth, and postpartum mood symptoms (PHQ-2/GAD-2). We used logistic regression to examine associations between trauma exposures and outcomes; given the ordinal structure of key trauma measures, we used Kendall’s tau to estimate correlations between cumulative ACEs/lifetime trauma and perinatal outcomes. Results Participants spent an average of 5 years (SD = 3) on community supervision, and most reported partner violence ( n = 52, 87%); no mental health care in the year prior to their last arrest ( n = 55, 92%); and possible major depressive disorder ( n = 20, 33%) and generalized anxiety disorder ( n = 34, 57%). ACE prevalence included caregiver incarceration ( n = 34, 56%), physical abuse ( n = 25, 42%), witnessing abuse ( n = 27, 45%), foster care ( n = 17, 8%), and childhood sexual abuse ( n = 29, 48%); 25% reported four ( n = 9, 16%) or five ( n = 6, 10%) ACEs. Cumulative ACE exposure was correlated with perinatal violence ( p = 0.03), and childhood forced sexual intercourse was associated with perinatal violence ( p = 0.04). Trauma in adulthood was associated with permanent infant removal ( p = 0.003). Sexual violence in adulthood was correlated with cumulative ACE exposure and postpartum mood symptoms ( p = 0.006). Conclusions Trauma across the life course is associated with perinatal violence, infant removal, and postpartum mood symptoms among women on community supervision. Trauma-informed, gender-responsive perinatal and community supervision interventions are needed to improve safety, mental health, and family stability. Trial registration NA
Non-invasive prenatal testing (NIPT), which utilizes fetal cell-free DNA (cffDNA) in maternal peripheral blood to assess the risk of fetal chromosomal abnormalities, has been widely used for prenatal screening. Chromosome karyotyping and low-depth whole-genome copy number variation sequencing (CNV-seq) are commonly used techniques in prenatal diagnosis, each with distinct advantages and limitations. This study aimed to investigate the application value of CNV-seq and chromosome karyotyping in the prenatal diagnosis of pregnant women with high-risk NIPT results. In this study, 73 pregnant women with high-risk NIPT results were enrolled. The women underwent amniocentesis during the second trimester to obtain amniotic fluid for CNV-seq and karyotyping. The detection rates of fetal chromosomal abnormalities between the two methods were compared in high-risk NIPT pregnancies, and the difference was analyzed using the McNemar test. Among 73 pregnant women with high-risk NIPT results, 48 fetal chromosomal abnormalities were detected by karyotyping and CNV-seq combined. Concordant positive results were obtained for 35 cases, which were predominantly common aneuploidies. In addition, CNV-seq alone identified 12 patients with microdeletions or microduplications, all of which were classified as variants of uncertain significance (VUS). Conventional karyotyping alone detected one case of low-level sex chromosome mosaicism. Moreover, we report the first case of a fetus prenatally diagnosed with sex chromosome mosaicism (47,XXY/46,XX/46,XY), identified using chromosome karyotyping combined with CNV-seq following a high-risk NIPT result for sex chromosomes. CNV-seq and chromosomal karyotyping each have advantages and limitations in the prenatal diagnosis of pregnant women with high-risk NIPT results. While CNV-seq is more effective for detecting microdeletions and microduplications, karyotyping is superior in identifying low-level chromosomal mosaicism and specific karyotype compositions in complex mosaic cases. Notably, we report the first prenatal case of the rare 47,XXY/46,XX/46,XY mosaicism, highlighting the complementary benefit of combined cytogenetic and molecular approaches for detecting complex chromosomal aberrations. Overall, the combined application of CNV-seq and karyotyping is recommended for prenatal diagnoses in high‑risk NIPT pregnancies. This study suggests that NIPT is valuable for screening fetal sex chromosome abnormalities and may providing useful support early prenatal counseling and pregnancy management.
Adrenal tumors during pregnancy are rare, but their detection is increasing due to prenatal imaging. Retroperitoneal fat-containing tumors, such as mature teratomas, can easily mimic renal angiomyolipoma (RAML), especially when the gravid uterus displaces anatomical landmarks. Excluding functional tumors (e.g., pheochromocytoma) is critical to prevent lethal hypertensive crises and guide multidisciplinary team (MDT) management. A 31-year-old primigravida (12 weeks’ gestation) presented with a 9.8 × 13.3 × 10.9 cm fat-containing right retroperitoneal mass on MRI, mimicking renal angiomyolipoma or teratoma. Concurrently, fetal ultrasound at 22 + 4 weeks identified an incidental left-sided fetal pulmonary sequestration. Normal catecholamine and cortisol levels confirmed a non-functional tumor, warranting a multidisciplinary team (MDT) strategy of watchful waiting. The patient successfully delivered a live infant via elective cesarean section at 37 + 1 weeks. Postpartum, she underwent elective laparoscopic resection of the retroperitoneal tumor. Intraoperatively, the massive tumor encased the inferior vena cava (IVC) and right renal vein with dense adhesions. A laceration occurred on the posterior wall of the IVC during dissection, which was successfully repaired using vascular sutures without significant blood loss (200 mL). Postoperative pathology confirmed a mature adrenal teratoma. Both mother and neonate showed excellent outcomes during follow-up. This case highlights the diagnostic challenge of differentiating giant fat-containing retroperitoneal tumors during pregnancy. For non-functional retroperitoneal tumors without signs of malignancy, delaying surgery until the postpartum period is a safe strategy. In cases involving major vascular encasement, the surgical team must be fully prepared to manage unexpected vascular injuries. A multidisciplinary approach is highly recommended to optimize outcomes for rare maternal tumors and incidental fetal anomalies.
The birth of a liveborn infant to a mother affected by choriocarcinoma or other forms of gestational trophoblastic disease (GTD) is rare, and guidance for surveillance is limited. Infantile manifestations may include thyroid dysfunction or choriocarcinoma, which can present with cytopenias and metastatic disease to the liver, lungs, or brain—similar to maternal cases. We present a case of an infant born in the third trimester to a mother with metastatic choriocarcinoma, including data on neonatal β-hCG elimination kinetics in a preterm infant and a multidisciplinary surveillance framework for disease monitoring in offspring. This case highlights the need for standardized neonatal monitoring following maternal GTD and demonstrates a multidisciplinary approach for early detection of infantile complications including choriocarcinoma.
Exposure to intimate partner violence (IPV) during pregnancy is associated with adverse outcomes for maternal and infant health. Evidence indicates that midwives face challenges in routine enquiry for and referring to IPV cases during pregnancy. This study aimed to evaluate the impact of the STOPIPV online educational program on Greek Cypriot midwives’ knowledge, attitudes, preparedness for routine IPV enquiry during pregnancy, and their perceptions of organisational barriers to implementing IPV enquiry. Approximately 49
Home blood pressure (BP) monitoring is an emerging strategy to increase BP monitoring in pregnancy. Effective programs require women to recognize elevated readings, understand when urgent action is needed, and receive clear, consistent advice after contacting healthcare providers. Challenges in low-resource settings include lower health literacy and limited engagement in health monitoring and antenatal care. This qualitative study explored how women measured and responded to elevated BP readings during a home monitoring intervention at a tertiary hospital in Ghana. We purposively sampled 20 postpartum women who had recorded at least five elevated home BP readings during pregnancy. Semi-structured interviews were conducted from November to December 2024 and examined participants’ understanding of high BP, confidence in interpreting readings, responses to elevated values, and experiences communicating with the midwife phoneline. Interviews were coded and analyzed thematically. The Health Belief Model was applied after inductive analysis to organize and interpret the themes. Participants’ mean age was 32.6 years. Thirteen were married and four had chronic hypertension. Interviews revealed three thematic steps in the pathway from measuring high BP at home to seeking medical advice: understanding when BP is high, recognizing it as abnormal and urgent, and engaging with the health system. Most participants could distinguish normal from high readings and understood the risks of hypertension in pregnancy. However, this knowledge did not consistently prompt urgent action. Some attributed high readings to stress, poor sleep, or recent activity, and chose to rest and recheck. Others repeated previous telephone advice to self-manage before calling again. Decisions to contact the phoneline were shaped by prior advice, expected responses, and interpersonal experiences. Barriers included shyness, concern about disturbing midwives, and uncertainty about whether one high reading required action. Women were more willing to call when interactions made them feel reassured, valued, and cared for. Women generally recognized high BP as abnormal and potentially harmful, but patient interpretation, interpersonal communication, and inconsistent health service advice sometimes delayed contact with providers. Home BP monitoring programs in low-resource settings should strengthen patient training and ensure that telephone response staff provide supportive, standardized, and guideline-consistent advice.
