Background: This research sought to examine alterations in plasma circular RNA (circRNA) expression in women with postpartum depression (PPD), assessing its potential utility as an auxiliary diagnostic biomarker for this condition. Methods: Women examined at 42 days postpartum were recruited between June 2024 and December 2024, during which plasma samples and relevant data were collected. A discovery cohort was established, consisting of 3 women with PPD and 3 control participants. This was followed by a validation cohort of 50 women with PPD and 50 controls, identified using the Structured Clinical Interview. The discovery cohort underwent plasma circRNA microarray analysis, whereas the validation cohort used reverse transcription-quantitative polymerase chain reaction (RT-qPCR) to quantify candidate circRNAs and five circRNAs previously associated with major depressive disorder (MDD). Results: Plasma levels of circRNA derived from the Interferon Gamma Receptor 2 gene (circIFNGR2), circRNA derived from the ATP-Binding Cassette Subfamily C Member 5 gene (circABCC5), circRNA derived from the Activating Transcription Factor 7 Interacting Protein gene (circATF7IP) were significantly upregulated in the PPD group, whereas circRNA derived from the Dystrophia Myotonica Protein Kinase gene (circDYM) was significantly downregulated (p < 0.05). The area under the curve (AUC) of the four circRNAs, circIFNGR2, circABCC5, circDYM, and circATF7IP, was 0.62 (sensitivity 28%, specificity 96%), 0.64 (sensitivity 36%, specificity 96%), 0.69 (sensitivity 54%, specificity 84%), and 0.65 (sensitivity 62%, specificity 72%), respectively. The joint AUC of circIFNGR2, circABCC5, circDYM, and circATF7IP was 0.80 (sensitivity 78%, specificity 70%). After adjustment for covariates, circIFNGR2, circABCC5, and circATF7IP remained independent predictive factors. Conclusions: Changes in the levels of circIFNGR2, circABCC5 identified by microarray analysis, as well as circDYM, and circATF7IP associated with MDD, were associated with the occurrence of PPD. These findings support the potential utility of circRNAs as adjunct diagnostic biomarkers for PPD and offer valuable insights into the molecular mechanisms underlying the disorder. Study Registration: The study has been registered on https://zenodo.org/ (registration number: zenodo. 17906223; registration link: https://zenodo.org/records/17906223).

Objective:This study aimed to investigate age-related variations in baseline characteristics and reproductive outcomes among women with polycystic ovary syndrome (PCOS). Methods:A secondary analysis of the PCOSAct trial included 936 participants stratified into four age groups: 20-24, 25-29, 30-34, and 35-40 years. Differences in anthropometric measures, sex hormones, metabolic parameters, and pregnancy outcomes were analyzed using correlation and multiple logistic regression. Results:With increasing age, linear trends revealed increases in hirsutism score, systolic blood pressure, triglycerides, dyslipidemia, metabolic syndrome, and atherogenic indices (P-trend<0.05). Conversely, luteinizing hormone (LH), LH/FSH ratio, total testosterone, free testosterone, anti-Müllerian hormone (AMH), and HDL levels decreased (P-trend<0.05). Age independently correlated with these metabolic and endocrine shifts (all P<0.05). Advanced age was associated with higher ovulation induction success (adjusted OR = 1.058, 95% CI:1.006-1.114, P = 0.030) but also an increased risk of first-trimester threatened abortion (adjusted OR = 1.11, 95% CI:1.009-1.210, P = 0.031). No significant associations were observed with clinical pregnancy or live birth. Conclusion:The clinical presentation of PCOS evolves significantly with advancing age. It is typically characterized by a shift from a state of hyperandrogenism and reproductive abnormalities in younger women to a profile increasingly dominated by progressive metabolic disturbances and cardiovascular risks in later years. Although ovulation response improves in older patients, they face a higher risk of early pregnancy loss. This underscores the necessity of implementing age-stratified clinical management for individuals with PCOS.

Background: To assess the diagnostic efficacy of the detection of serum Pregnancy-Associated Plasma Protein A2 (PAPP-A2), placental growth factor (PIGF), and SFRP5 for the detrimental effects of gestational diabetes mellitus (GDM) on pregnant patients. Methods: 242 patients who received a GDM diagnosis at this hospital between January 2023 and December 2024 were chosen to be the GDM group. The control group consisted of 156 healthy expectant mothers who received prenatal care at this hospital during the same time frame. Patients in the GDM group were divided into the well-controlled diabetes, poorly controlled diabetes, and high-risk groups based on glycated haemoglobin (HbA1c) levels. Based on their follow-up results, patients in the GDM group were divided into two groups: those with poor pregnancy outcomes and those with favourable outcomes. Serum PAPP-A2, PIGF , Adipokine SFRP5, and urine microalbumin (mAlb) levels varied between the GDM and normal pregnancy groups. Univariate and multivariate analyses were used to examine the factors influencing pregnancy outcomes and the relationships between serum PAPP-A2, PIGF, Adipokine SFRP5, and urine mAlb levels, and the degree of blood glucose control and adverse pregnancy outcomes. In addition, it has diagnostic efficacy for adverse pregnancy outcomes in patients with GDM. Results: Serum PAPP-A2, PIGF , and Adipokine SFRP5 levels were considerably lower in the GDM group than in the group with a normal pregnancy (P<0.01). The levels of serum PAPP-A2, PIGF and Adipokine SFRP5 in the well-controlled diabetes group were greater than those in the poorly controlled diabetes group and the high-risk group (P<0.01). However, the urine mAlb level was lower than in the poorly managed diabetes group and the high-risk group (P<0.01). Compared to the group with good pregnancy outcomes, the group with poor pregnancy outcomes had significantly lower serum levels of Adipokine SFRP5, PIGF , and PAPP-A2 (P<0.01), while HbA1c, fasting blood glucose, and urinary mAlb levels were significantly higher in the poor pregnancy outcome group than in the good pregnancy outcome group. However, there was no statistically significant difference between the two groups in terms of body mass index, number of pregnancies, gestational age, or age (P>0.05). Serum PAPP-A2, PIGF , and Adipokine SFRP5 levels were protective factors against unfavourable pregnancy outcomes, according to multivariate logistic regression analysis (P<0.05), whereas urinary mAlb was a risk factor for adverse pregnancy outcomes (P<0.05). The efficacy of serum PAPP-A2, PIGF , and Adipokine SFRP5 detection for the diagnosis of adverse pregnancy outcomes was significantly greater than that of urinary mAlb detection (P<0.05). With a sensitivity of 96.7 , specificity of 90.8 , and an area under the curve (AUC) of 0.967, the combined detection approach outperformed the single-indication PAPP-A2 by a substantial margin (Z=3.088, P<0.01). PIGF (Z=2.615, P<0.01) and Adipokine SFRP5 (Z=3.560, P<0.01) were included, but there was no statistically significant difference in the AUC among the three indicators (P>0.05). Conclusions: The levels of serum PAPP-A2, PIGF and Adipokine SFRP5 are correlated with the degree of diabetes control in patients with gestational diabetes mellitus (GDM). Combined detection helps improve the diagnostic efficacy for adverse pregnancy outcomes in GDM patients.

AIMS/BACKGROUND:Postpartum depression (PPD) is a common perinatal mental health disorder that leads to adverse maternal and infant outcomes. Existing screening strategies rely on self-reported symptom presence, potentially delaying early identification. This study aims to integrate biological, psychological, and social predictive factors using an ensemble learning (EL) strategy to develop a superior early prediction machine learning (ML) model for PPD. METHODS:By integrating sociodemographic characteristics, clinical baseline data, and psychological test results of 1323 postpartum women, PPD status was classified using the Edinburgh Postnatal Depression Scale (EPDS). Eight selection methods were used, and eleven base ML models were optimized through EL strategies (Voting and Stacking) to identify the model with the optimal predictive performance. RESULTS:Twenty predictor features were selected for the model construction. The Voting top 5+XGBoost (eXtreme Gradient Boosting, Weight) model demonstrated the best overall performance (area under the curve [AUC] = 0.835) and the highest specificity (0.906), indicating that it is more suitable for differential diagnosis following an initial positive screening result. The Voting (Synthetic Minority Over-sampling Technique [SMOTE]) model performed exceptionally well in sensitivity (0.758) and clinical net benefit at low-risk thresholds, indicating its suitability for early screening for PPD. CONCLUSION:The results demonstrate that ensemble learning models outperform individual ML prediction models. Voting top 5+XGBoost (Weight) and Voting (SMOTE) show respective advantages in predictive specificity and sensitivity. This suite of models can provide distinct data-driven prediction strategies tailored to different clinical application contexts.

Background: Pre-eclampsia (PE) is a gestational disorder that significantly endangers maternal and fetal health. Transfer ribonucleic acid (tRNA)-derived small RNAs (tsRNAs) are important in the progression and diagnosis of various diseases. However, their role in the development of PE is unclear. Consequently, we detected the expression profiles of tsRNAs in the plasma of patients with PE as well as those in the plasma of the healthy control group, and a multiplicity of experiments were conducted with the aim of clarifying their roles in the occurrence and development of PE and the feasibility of serving as predictive biomarkers for this disorder. Methods: High-throughput sequencing of tsRNA in plasma from PE cases was performed to evaluate its potential as a diagnostic or therapeutic biomarker. The function of tsRNA in trophoblasts was explored using the HTR-8/SVneo cell line. Plasma from pregnant women with suspected PE was analyzed to assess the potential of tsRNA to act as a predictive marker of PE. Results: High-throughput sequencing of tsRNA was performed on plasma from pregnant women with PE and from healthy pregnant controls. Analysis revealed a significant reduction in the level of tRNA-derived stress-inducing RNA (tiRNA)-Gln-CTG in the plasma (p < 0.001) and placenta (p < 0.001) of pregnant women with PE, suggesting its potential involvement in the development of this condition. tiRNA-Gln-CTG was identified in the cytoplasm and nucleus of HTR-8/SVneo cells. In vitro experiments revealed that tiRNA-Gln-CTG influences the proliferation, cycling, migration, and invasion of HTR-8/SVneo cells, possibly by targeting the 3′UTR region of thrombospondin-2 messenger ribonucleic acid (mRNA) for degradation. Extracellular vesicle (EV) carriers may mediate the level of tiRNA-Gln-CTG in the circulation. Y-box binding protein-1 (YBX1) may be involved in loading tiRNA-Gln-CTG into EVs. The sensitivity of low tiRNA-Gln-CTG levels for predicting the onset of PE in suspected cases was 91.7% within 1 week of delivery, 85.7% within 4 weeks of delivery, and 89.3% before delivery, with corresponding specificities of 84.5%, 79.2%, and 73.4%, respectively. Conclusions: tiRNA-Gln-CTG significantly influences trophoblast function and is associated with the development of PE. It can serve as an effective biomarker for predicting PE progression within one week of delivery in women with suspected PE.

This study aimed to examine the relationship between maternal chronic stress, measured as allostatic load (AL), and the subsequent risk of spontaneous preterm birth (sPTB). This analysis was based on a prospective, single-center cohort study conducted in China. Eligible women were recruited during their second trimester and followed up until giving birth. AL was estimated at enrollment by using 10 biomarkers that reflect cardiovascular, metabolic, immune, and neuroendocrine dysregulation. High AL group was defined as women with AL score greater than the upper sample quartile. Latent class analysis (LCA) was performed to identify underlying AL patterns among pregnant women. Logistic regressions were employed to test the association between AL and sPTB. Additionally, the dose-response associations between AL score and sPTB were evaluated by using a 3-knot restricted cubic spline (RCS). 637 pregnant women with a mean AL score of 2.6 ± 1.7 (mean ± SD) were included in this study. Among these participants, 175 (27.5

Context To investigate how short sleep duration (SSD) during pregnancy is related to neurodevelopmental delays in offspring, we aimed to inform pregnancy sleep guidelines and promote maternal health and child development.Objective To identify the associations between SSD during pregnancy and offspring neurodevelopmental delay and to determine whether fetal glucose metabolism plays a role in SSD and neurodevelopmental delays.Methods This cohort study followed 7059 mother-child pairs from the Maternal & Infants Health in Hefei cohort, and collected sleep data during pregnancy via the Pittsburgh Sleep Quality Index at weeks 24 to 28 and 32 to 36. Neurodevelopmental outcomes from 6 to 36 months postpartum were assessed via the Denver Developmental Screening Test-II and the Gesell Development Diagnosis Scale. Cox proportional hazard regression was used to analyze the link between maternal SSD and neurodevelopmental delay risk. Mediation analysis was used to evaluate the role of cord blood serum C-peptide levels. Three hospitals and children's health centers in Hefei were involved.Results The stratified analysis revealed a significant association between mothers with SSD during midpregnancy and neurodevelopmental delay in boys (adjusted HR 2.05, 95% CI 1.29, 3.25). Cord blood marker analysis revealed a positive relationship between cord blood serum C-peptide levels and neurodevelopmental delay in offspring (RR 0.04, 95% CI 0.00, 0.08). The proportion of the association between SSD and neurodevelopmental delay mediated by cord blood C-peptide was 11.05%.Conclusion Maternal SSD during pregnancy was continuously associated with an increased incidence of neurodevelopmental delay with sex differences among offspring. This association may be mediated in part by increased higher levels of cord C-peptide.

ObjectiveThis study aimed to evaluate the predictive value of the Metabolic Score for Insulin Resistance (Mets-IR) for metabolism-related disorders and its association with hormonal status and fertility outcomes in Chinese women with Polycystic Ovary Syndrome (PCOS).MethodsThis secondary analysis included 957 women from the PCOSAct trial. Participants were stratified by Mets-IR quartiles. Linear regression analyzed correlations between Mets-IR and metabolic/hormonal parameters. ROC curves assessed Mets-IR’s predictive performance for metabolic disorders. Multivariable logistic regression evaluated associations with fertility outcomes.ResultsSignificant linear correlations were observed between Mets-IR and key metabolic parameters (e.g., HOMA-IR, TG, WHR) and hormonal parameters (PG, E2, FT, LH, FSH, LH/FSH ratio, SHBG, FAI, AMH) (all P < 0.05). Specifically, Mets-IR was negatively correlated with PG, E2, LH, SHBG and AMH, and positively correlated with FT and FAI. After adjusting for age and BMI, Mets-IR remained significantly negatively associated with LH, FSH, SHBG and AMH (all P < 0.01), while it showed a significant positive association with FAI (P < 0.001) and a significant negative association with TT (P < 0.05). Mets-IR exhibited superior independent predictive ability compared to BMI for key hormonal parameters, including SHBG (ΔR² = 17.2% vs 13.7%), FAI (ΔR² = 16.8% vs 14.9%), and AMH (ΔR² = 3.9% vs 2.8%). ROC analysis demonstrated high predictive performance of Mets-IR for IR (AUC = 0.814), MetS (AUC = 0.878), and NAFLD (AUC = 0.818). In predicting ovulation, Mets-IR demonstrated moderate predictive performance comparable to BMI (AUC = 0.606), with an optimal cut-off value of 23.46. Mets-IR was negatively associated with ovulation but not with other fertility outcomes (conception, clinical pregnancy, live birth, and pregnancy loss).ConclusionIn women with PCOS, Mets-IR demonstrates significant associations with both metabolic and hormonal parameters and exhibits superior predictive ability over BMI for key hormonal markers (SHBG, FAI, AMH). This index serves as an effective non-invasive predictor for IR, MetS, and NAFLD. For the assessment of ovulatory dysfunction, its predictive performance is comparable to that of BMI, yet it demonstrates no significant association with other fertility outcomes.

Background: The relationship between gut microbiota and red blood cell folate levels in preeclampsia remains unclear. This study aimed to assess the differences in red blood cell folate levels and gut microbiota between pregnant women diagnosed with preeclampsia and healthy pregnant women and to investigate the association between gut microbiota composition and red blood cell folate concentrations. Methods: We employed a case-control study to investigate gut microbiota composition and red blood cell folate levels in preeclampsia, as well as the correlation between them. 10 pregnant women diagnosed with preeclampsia and 16 healthy pregnant women were recruited, and whole blood and stool samples were collected from all participants. For the blood samples, levels of total folate, 5-methyltetrahydrofolate, 5,10-methylenetetrahydrofolate, erythrocyte unmetabolized folate, and 5-formyltetrahydrofolate in red blood cells were measured utilizing high-performance liquid chromatography coupled with tandem mass spectrometry in Multiple Reaction Monitoring (MRM) mode. Microbial diversity in fecal samples was analyzed by 16S rRNA sequencing. The correlation between the microbiota α-diversity and red blood cell folate levels was calculated through Pearson correlation analysis. Results: There were no statistically significant differences in age, gestational age at the time of specimen collection, or body mass index between the preeclampsia group and the control group (all p > 0.05). Compared to the control group, the preeclampsia group showed significantly lower levels of total folate in red blood cells (p < 0.001), 5-methyltetrahydrofolate (p = 0.001), and 5,10-methylenetetrahydrofolate (p = 0.002). However, there were no differences in the levels of 5-acyltetrahydrofolate (p = 0.816) and unmetabolized folate (p = 0.241) in red blood cells between the two groups. Statistical analysis revealed significant differences between the two groups in several α-diversity indices of the gut microbiota, including the abundance-based coverage estimator (ACE) index (p = 0.011), Chao1 index (p = 0.010), PD_whole_tree index (p = 0.046), Shannon index (p = 0.015), and Simpson index (p = 0.043). These findings highlight notable differences in microbial diversity between the groups. The β-diversity analysis demonstrated significant compositional differences in the gut microbiota between samples, which were evident across multiple taxonomic ranks, including phyla, classes, orders, families, genera, and species. The Pearson correlation analysis revealed that levels of total folate, 5-methyltetrahydrofolate, and 5,10-methylenetetrahydrofolate in red blood cells were significantly associated with the α-diversity of gut microbiota. Conclusions: Significant changes in erythrocyte folate level and intestinal microbiota diversity were observed in preeclampsia patients. Based on the limited data, the results of the Pearson correlation analysis indicate a significant association between red blood cell folate levels and gut microbiota diversity. However, this association should be interpreted with caution.

Preeclampsia (PE) is one of the serious complications of pregnancy, and the management of PE remains an important problem for obstetricians. This study aims to identify the characteristics and trends of published articles on PE management through bibliometric analysis. We searched the Web of Science database for articles related to PE management from 2000 to 2022. Metadata was obtained, including the titles, publication dates, authors, institutions, countries, and keywords of all articles, and then network visualization and burst keyword analysis were performed using Citespace and VOSviewer software. A total of 5190 articles were included in the analysis. The number of publications in the field of PE management has steadily increased over the years, and a visual analysis of collaborative networks of authors, institutions, and countries revealed that the United States, United Kingdom, Australia, and Canada have contributed the most to the field and formed extensive collaborations. The Journal of maternal-fetal neonatal medicine has the most publications in this field, and the Journal of Obstetrics and gynecology has not only more publications but also 64.75 citations per article. The keywords mainly focused on prevention, diagnosis, risk factors, and outcome of PE. In addition, hypertensive disorders of pregnancy and fetal growth restriction have received a lot of attention in this field in recent years. We analyzed the partnerships in the field of PE management through bibliometrics and showed trends and developments in the field. The available results suggest that PE management will continue to be a focus of attention for obstetricians and researchers.

Objective: This study aimed to determine the association between vaginal microbiota and chorioamnionitis and its predictive value. Methods: Thirty pregnant women in their third trimester were prospectively recruited. The participants were categorized into three groups based on their clinical manifestations and placental pathology: the clinical chorioamnionitis group (IP group), the asymptomatic histological chorioamnionitis group (CP group), and the healthy control group (CN group). Basic data and medical history were collected from each participant. Vaginal samples were collected before delivery and analyzed using microbial diversity sequencing. Results: No significant differences were observed in age, body mass index, and education among the groups (P > 0.05). However, the IP group exhibited higher rates of low birth weight (60 % vs 20 % vs 0 %, P = 0.008) and respiratory distress syndrome (50 % vs 20 % vs 0 %, P = 0.003) compared with the CP and CN groups. The Shannon index [2.09 (1.16-3.86) vs 0.84 (0.19-1.11) vs 0.44 (0.25-0.85), P = 0.009] and Simpson index [0.70 (0.41-0.81) vs 0.26 (0.04-0.39) vs 0.11 (0.05-0.29), P = 0.010] in the IP group were higher than those in the CN and CP groups. beta diversity analysis indicated that the microbial community structure differed among the three groups, with a 14.1 % variation associated with group differences (P = 0.002). At the genus level, the random forest model revealed that Lactobacillus, Dialister, Prevotella, Ligilactobacillus, and Anaerococcus had Gini indexes higher than 1. Further, linear discriminant analysis (LDA) demonstrated that the abundance of Lactobacillus crispatus in the IP group was lower than in the CN group (LDA >4.0, mean relative abundance 9.19 % vs 54.40 %, P = 0.031). The logistic regression analysis indicated that a decreased abundance of L. crispatus was associated with an increased risk of clinical chorioamnionitis. Conclusions: The reduction of L. crispatus and increasing trend of specific anaerobic groups are associated with the onset of chorioamnionitis, suggesting their potential value in chorioamnionitis identification. The vaginal microbiota could serve as a useful biomarker for predicting future disease and tailoring surveillance efforts. Additionally, it may present a viable target for developing prevention and therapeutic strategies.

Background The aim of this study is to identify risk factors associated with histological chorioamnionitis (HCA) and develop a predictive model for antepartum assessment of the risk of PPROM with HCA. Methods This study retrospectively analyzed pregnant women who experienced PPROM between 25 + 0 and 35 + 0 weeks of gestational age. The women were divided into two groups based on the presence or absence of HCA. Univariate and multivariate logistic regression analyses were conducted to identify maternal risk factors and develop a clinical prediction model for HCA. The model's discrimination and consistency were evaluated using receiver operating characteristic (ROC) and calibration curves. Results Seventeen thousand one hundred forty-six (17,146) pregnant women were screened, and 726 (4.23 %) had PPROM. Out of the 286 subjects with PPROM, 160 developed HCA. The maternal age of these subjects ranged from 18 to 43 years (30.0 ± 5.4), while their gestational age (GA) ranged from 25 + 0 to 35 + 0 weeks (31.6 ± 2.0). The average GA at delivery was 32.2 ± 2.0 (weeks).Compared with the non-HCA group, the expectant time > 48 h, GA at delivery > 32 weeks, twin pregnancy, HGB (<110 g/Lg/L), degree of LGB (IIb-III), and WBC (>9.5 × 109 /L) were significantly more than in the PPROM with HCA group. The results show that the best model was obtained by leave-one-out logistic regression (AUC = 0.785, CA = 0.741, F1 = 0.739, Precision = 0.740, Recall = 0.741). In the validation set, logistic regression also achieved good results (AUC = 0.710, CA = 0.671, F1 = 0.654, Precision = 0.683, Recall = 0.671). Combining the previous analysis, we found that the prognostic model constructed using the core six features had the best predictive effect. Conclusions Six features were associated with the occurrence of chorioamnionitis. These features were used to construct a diagnostic model that can accurately predict the probability of chorioamnionitis occurrence and provide a beneficial tool for the prevention and management of PPROM with HCA.

Objective This study aimed to conduct a bibliometric analysis of literature related to the diagnosis of chorioamnionitis (CAM) and to point out the current research progress, hotspots, and development trends of CAM research.Study Design Literature on the diagnosis of CAM from the Web of Science Core Collection (WoSCC) between 2010 and 2022 was retrieved. CiteSpace, VOSviewer, and Online Analysis Platform (OALM) were used to draw maps of authors, articles, journals, institutions, countries/regions, and keywords.Results A total of 312 articles were included, and the number of articles gradually increased over the study period. The author with the largest number of articles was Roberto Romero. The institution with the largest number of articles was Wayne State University School of Medicine, and the United States was the country that produced the largest number of articles. Analysis of keywords and outbreak words suggested that future research hotspots and trends may focus on early treatment of CAM and more precise, noninvasive, and more sensitive diagnoses.Conclusion In this study, visualization software and data information mining were innovatively used to conduct a bibliometric analysis of articles in the field of CAM diagnosis, and the current status, hotspots, and development of this field were obtained. Future research hotspots may be the precision diagnosis and treatment of CAM.

OBJECTIVE:Although the association of rheumatoid arthritis (RA) to multiple adverse pregnancy outcomes has been well-studied, the association between serum antibody levels in patients with RA and multiple adverse pregnancy outcomes has not been conclusively demonstrated. Here, we comprehensively assessed the causal impact of RA, serologic antibody-positive RA (pRA), and serologic antibody-negative RA (nRA) on the risk of 14 adverse pregnancy outcomes. METHODS:The causal impact of RA, pRA, and nRA on 14 adverse pregnancy outcomes was comprehensively assessed using two-sample Mendelian randomization (MR). Evidence maps based on the results of these two-sample MR analyses were developed. Data from the UK Biobank and FinnGen databases were utilized for this analysis. The inverse variance weighted (IVW) test was employed as the primary method to estimate causality. "TwoSampleMR" and "MR-PRESSO" packages were used for data analysis in this study. RESULTS:Using two-sample MR analysis, we found a significant positive causal association between RA and increased risk of cesarean section (p = 0.003), gestational hypertension (p < 0.001), number of spontaneous miscarriages (p = 0.041), preeclampsia (p = 0.008), premature rupture of membranes (p = 0.030), and preterm (p = 0.010). pRA had a significant positive causal association with an increased risk of cesarean section (p = 0.012), gestational hypertension (p < 0.001), preeclampsia (p = 0.002), and preterm (p = 0.007). A significant positive causal association was also established between nRA and gestational hypertension (p = 0.010), the number of spontaneous miscarriages (p = 0.024), and placental abruption (p = 0.027). In addition, we found a causal association between nRA and birth weight (p = 0.007), but not between RA and pRA and birth weight. CONCLUSION:The results of this study have important implications for the individualized treatment of RA patients, especially those with positive serum antibody levels.

BACKGROUND:Previous studies mainly concentrate on neoadjuvant chemotherapy (NACT) for delivery delay in FIGO Stage IB1-IIIB cervical cancer during pregnancy to prevent early preterm delivery while not affecting maternal outcome. CASE:Here, we described two pregnant patients with FIGO Stage IIIC cervical cancer about their diagnosis, treatment, and outcome. Both patients underwent cesarean delivery, left enlarged lymph node dissection, and longitudinal monitoring by circulating tumor DNA. Our study suggested that pregnant patient was completely response to NACT, which was confirmed by ctDNA monitoring, followed by left pelvic enlarged lymph node dissection during cesarean section and adjuvant chemoradiotherapy postpartum. The infant grew normally, without any evidence of chemotherapy-related side effects after delivery. CONCLUSION:In pregnant women with advanced cervical cancer, longitudinal ctDNA monitoring might be able to evaluate maternal response to NACT and confirm if delivery delay to optimize fetal outcome would compacting the maternal outcomes or not. Cervical cancer may not transmit across the placental barrier and so it is safe for delayed delivery until fetal maturity in utero during pregnancy.

ObjectiveIn recent years, several studies have reported an association between unsaturated fatty acids (UFAs) and the risk of developing preeclampsia; however, its exact causal effect is unclear. This study assessed the causal association between circulating UFAs and preeclampsia.MethodsA two-sample Mendelian randomization (MR) study using publicly available genome-wide association study (GWAS) summary data for circulating UFA s (N = 114,999) and preeclampsia (N = 118,291) was performed. Single nucleotide polymorphisms (SNPs) significantly associated with exposure was selected as instrumental variables (IVs). The inverse variance weighted (IVW) test was used as the primary method for estimating causality in MR analysis, while MR pleiotropy residual sum and outlier (MR-PRESSO) and MR-Egger regression methods were used to assess horizontal pleiotropy. Cochran's Q test was used to evaluate heterogeneity among SNPs, and leave-one-out sensitivity analysis was used to determine the effect of individual SNPs on the results of the MR analysis. Bonferroni correction was used as a correction for multiple corrections.ResultsTwo-sample MR analysis suggested that the ratio of monounsaturated fatty acids (MUFAs) to total fatty acids (OR 1.150, 95% CI 1.006-1.315, p = 0.041), the ratio of polyunsaturated fatty acids (PUFAs) to total fatty acids (OR 0.805, 95% CI 0.658-0.986, p = 0.036) and the ratio of PUFAs to MUFAs (OR 0.807, 95% CI 0.694-0.938, p = 0.005) were causally associated with preeclampsia. After Bonferroni correction, the causal association between the ratio of polyunsaturated to MUFAs and preeclampsia remained statistically different.ConclusionsThis MR analysis provides evidence for a genetic causal association between circulating UFAs and preeclampsia.

Idiopathic pulmonary fibrosis (IPF) is a prevalent chronic pulmonary fibrosis disease characterized by alveolar epithelial cell damage, fibroblast proliferation and activation, excessive extracellular matrix deposition, and abnormal epithelial-mesenchymal transition (EMT), resulting in tissue remodeling and irreversible structural distortion. The mortality rate of IPF is very high, with a median survival time of 2–3 years after diagnosis. The exact cause of IPF remains unknown, but increasing evidence supports the central role of epigenetic changes, particularly microRNA (miRNA), in IPF. Approximately 10% of miRNAs in IPF lung tissue exhibit differential expression compared to normal lung tissue. Diverse miRNA phenotypes exert either a pro-fibrotic or anti-fibrotic influence on the progression of IPF. In the context of IPF, epigenetic factors such as DNA methylation and long non-coding RNAs (lncRNAs) regulate differentially expressed miRNAs, which in turn modulate various signaling pathways implicated in this process, including transforming growth factor-β1 (TGF-β1)/Smad, mitogen-activated protein kinase (MAPK), and phosphatidylinositol-3-kinase/protein kinase B (PI3K/AKT) pathways. Therefore, this review presents the epidemiology of IPF, discusses the multifaceted regulatory roles of miRNAs in IPF, and explores the impact of miRNAs on IPF through various pathways, particularly the TGF-β1/Smad pathway and its constituent structures. Consequently, we investigate the potential for targeting miRNAs as a treatment for IPF, thereby contributing to advancements in IPF research.

Background: SARS-CoV-2 specific antibodies exist in human milk expressed by lactating parents after vaccination. In the existing research, the effects of vaccine types on human milk are inconsistent. Research Aim: This study aims to perform a systematic review and meta-analysis of the existing observational studies to compare the positive rates of SARS-CoV-2 specific antibodies in human milk according to mRNA and adenovector-based vaccination. Methods: PubMed, Web of Science, Elsevier Science Direct and Cochrane Library databases were systematically searched for relevant articles published from December 30, 2019 to February 15, 2023. Observational studies were considered eligible provided they reported data on SARS-CoV-2 specific antibodies in human milk. The risk of bias in non-randomized studies of interventions (ROBINS-I) tool, the Newcastle-Ottawa Scale (NOS), and the Agency for Healthcare Research and Quality (AHRQ) were used to assess risk of bias. Seven studies, including 511 lactating participants, were included in this review and meta-analysis. Results: The positive rate of SARS-CoV-2 IgA is higher in mRNA vaccine groups than in adenovector-based vaccine groups (OR = 4.80, 95% CI [3.04, 7.58], p < 0.001). The positive rate of SARS-CoV-2 IgG was higher in mRNA vaccines than in adenovector-based vaccines. Conclusions: Compared to adenovector-based vaccines, mRNA vaccines present a higher positivity rate of IgA and IgG in human milk after vaccination. In other words, mRNA vaccinations may offer breastfed children a higher level of protection than adenovector-based vaccinations. Further high-quality data is still required to substantiate these findings.

Postpartum depression (PPD), a prevalent social-mental condition, impacts the mother and the newborn and several facets of their lives. It has been suggested that insomnia is related to both the occurrence and progression of PPD. However, because of lingering confounding and bias, it is impossible to determine the cause of this connection using observational analysis. In this study, we evaluate the causal importance of insomnia on postpartum depression using Mendelian randomization (MR). Utilizing summary data from genome-wide association studies (GWAS), a two-sample MR study was conducted. A GWAS dataset of IEU study of the United Kingdom Biobank phenotypes comprising 462,341 people of European heritage yielded 38 single-nucleotide polymorphisms (SNPs) for insomnia. The PPD data were provided by the FinnGen project and comprised 7604 cases and 59,601 controls. Inverse variance weighting (IVW) was utilized for the primary MR analysis, with weighted median and MR-Egger as sensitivity analyses. As a result, we found that genetically predicted insomnia was positively associated with postpartum depression. The odds ratios (OR) of PPD were 1.849 (95

目的:探讨孕晚期至产后6 个月抑郁状态发生变化的相关因素及其与纯母乳喂养行为的关联.方法:基于前瞻性队列研究设计,于 2021 年 6 月至 2022 年 2 月在东南大学附属中大医院产科门诊招募孕妇填写心理健康筛查问卷及爱丁堡产后抑郁量表(EPDS)评估孕晚期孕妇的抑郁状态,并在产后6 个月开展电话随访,调查227 例产妇产后抑郁状态及纯母乳喂养情况.根据分娩前后的抑郁状态分为4 组:正常组(孕晚期和产后均不抑郁)106 例,孕晚期抑郁状态组 23 例,产后抑郁状态组19 例,持续抑郁状态组(孕晚期和产后均处于抑郁状态)79 例.采用Logistic回归分析孕产妇抑郁状态变化的影响因素及其与纯母乳喂养行为的关联.结果:①单因素Logistic回归分析示,孕晚期处于抑郁状态的孕产妇发生产后抑郁状态的风险升高(OR 19.162,95%CI 9.768～37.592,P＜0.001).②4 组在职业、既往疾病史和家庭支持间差异有统计学意义(P＜0.05);多因素Logistic回归分析示,无工作的孕产妇持续处于抑郁状态的风险升高(OR＞1,P＜0.05);觉得家庭更加重视宝宝的孕产妇出现产后抑郁状态和持续抑郁状态的风险升高(OR＞1,P＜0.05).③纯母乳喂养共165 例(72.69%),单因素和多因素Logistic回归均显示,产后抑郁状态和持续处于抑郁状态的女性在产后6 个月内进行纯母乳喂养的可能性明显下降(OR＜1,P＜0.05).结论:孕晚期至产后 6 个月,无工作、觉得家庭更重视宝宝的孕产妇更容易出现抑郁状态,且抑郁状态会影响产后纯母乳喂养行为.在孕晚期干预孕妇心理健康问题或有利于降低产后抑郁状态的发生风险并提高产后6 个月内纯母乳喂养率.