Pregnant women living with HIV (PWLHIV) are at increased risk of infectious complications during pregnancy, and HIV-exposed but uninfected women are more susceptible to serious infectious diseases. Therefore, maternal immunization during pregnancy is an essential standard of care for this patient population. However, vaccination during pregnancy is suboptimal among these patients. This is a single-center retrospective observational study, conducted at the University Hospital Federico II of Naples, Italy. We examined how our Center's vaccination uptake among PWLHIV changed after the introduction of in-hospital vaccine administration. To account for the small sample size and assess the robustness of the findings, Firth’s penalized logistic regression was performed as a sensitivity analysis. Between January 2021 and December 2024, 41 PWLHIV have been referred to the Regional Referral Centre for HIV in Pregnancy. Out of 38 eligible patients, 21 received the Tdap vaccine, resulting in an overall uptake of 55.3

OBJECTIVE:To evaluate whether crown-rump length (CRL) measured at 11-14 weeks is associated with the risk of large-for-gestational-age (LGA) neonates in uncomplicated pregnancies. METHODS:This prospective study included 333 singleton pregnancies undergoing first-trimester ultrasound screening. CRL was measured according to standardized criteria, and gestational age was confirmed or reassigned based on CRL when discrepancies with last menstrual period exceeded 7 days. The primary outcome was the occurrence of LGA neonates, defined according to INTERGROWTH-21st standards. Multivariate regression and receiver operating characteristic (ROC) curve analyses were performed to assess the predictive value of CRL. RESULTS:CRL was significantly associated with the risk of LGA neonates. ROC curve analysis demonstrated a modest discriminative performance, with an area under the curve (AUC) of 0.665 (95% CI: 0.547-0.784). The optimal CRL cut-off showed a sensitivity of 63.6% and specificity of 69.3%, with a high negative predictive value (96.4%). CONCLUSIONS:First-trimester CRL is associated with fetal overgrowth but shows limited predictive accuracy when used alone. Its clinical utility may lie in contributing to combined predictive models rather than serving as a standalone screening tool.

Background:Minimally invasive, uterus-sparing radiofrequency (RF) and microwave (MW) ablation have been introduced under ultrasound or laparoscopic guidance to treat uterine fibroids. These technologies enable targeted coagulative necrosis, potentially minimising surgical time and trauma while shortening recovery. They can also be used under hysteroscopic guidance, although feasibility data is lacking. Objectives:To assess the feasibility and short-term outcomes of hysteroscopic RF and MW ablation for FIGO-type 2 and type 3 fibroids. Participant:Four patients were included: two with FIGO-type 2 fibroids and two with FIGO-type 3 fibroids, all presenting with heavy menstrual bleeding (HMB) and no desire for pregnancy. Intervention:Procedures were performed at a tertiary care university hospital under sedation. As no evidence-based guidelines define selection criteria between MW and RF, both modalities were employed in fibroids with similar presentation. Under direct hysteroscopic visualisation, the needles were inserted through the operative channel into the myoma, maintaining a 10-mm safety margin. Tissue necrosis was confirmed by hyperechogenicity of the treated area. Each procedure lasted approximately 4 minutes. All patients were discharged the same day without complications. Conclusions:Hysteroscopic ablation was technically feasible and safe in this limited case series. The procedure induced necrosis, reduced fibroid vascularisation, and resolved HMB without complications, scarring, or adhesions. Future studies are needed to evaluate long-term outcomes and determine whether it may serve as a standalone option. What is New?:Hysteroscopic myolysis may expand the therapeutic armamentarium for selected patients seeking uterine preservation. By using the natural intracavitary pathway, the technique allows precise ablation while preserving uterine integrity and minimising procedural invasiveness.

BACKGROUND:Monochorionic twin pregnancies provide a unique model to investigate fetal phenotypic discordance, because both fetuses share a single placenta and interconnected vascular circulation. Although most monochorionic twins are monozygotic, clinically relevant differences may arise through genetic, epigenetic, placental, and stochastic developmental mechanisms. METHODS:This systematic review was conducted according to PRISMA 2020 and registered in PROSPERO (CRD420261432361). PubMed/MEDLINE, Embase, and Scopus were searched from inception to June 2026. Eligible studies included monochorionic monozygotic twin pairs with discordant congenital, developmental, or syndromic phenotypes, confirmed or clearly inferable monochorionicity, and at least one genomic, cytogenetic, or epigenetic investigation; studies describing confirmed monochorionic dizygotic twinning were excluded. Findings were synthesized qualitatively. RESULTS:The search identified 1357 records. After duplicate removal and screening, 48 studies fulfilled the eligibility criteria, comprising 441 monozygotic twin pairs; 37 were single-pair case reports, whereas one large retrospective cohort study alone contributed 193 pairs (44% of the entire pooled sample). Reported phenotypes included congenital heart disease, chromosomal abnormalities, disorders of sex development, imprinting disorders, neurodevelopmental disease, endocrine disorders, renal anomalies, skeletal disorders, and multisystem malformations. Molecular methods included karyotyping, FISH, chromosomal microarray, array-CGH, CNV analysis, WES, WGS, targeted sequencing, and methylation profiling. Proposed mechanisms included postzygotic chromosomal errors, somatic mutations, tissue-specific mosaicism, discordant or shared CNVs, differential methylation, imprinting defects, variable expressivity, blood chimerism, unequal placental sharing, TTTS, TAPS, sFGR, and uteroplacental insufficiency. CONCLUSIONS:Phenotypic discordance in monochorionic twins is rarely explained by a single mechanism. Available evidence supports a multifactorial model in which postzygotic genetic events, epigenetic regulation, placental vascular factors, and stochastic developmental processes interact.

OBJECTIVE:To contextualize conflicting evidence regarding the association between maternal HIV infection and preeclampsia STUDY DESIGN: We compared Rittenhouse et al. prospective data (2015-2022), where standardized phenotyping and marginal standardization estimated reduced preeclampsia risk in HIV-positive women, with our retrospective population-based analysis (1989-2015), which found increased risk, particularly in HAART-exposed pregnancies. Differences in surveillance, outcome definitions, covariate adjustment, and ART era/regimen were examined, alongside mechanistic hypotheses and suggested additional analyses. RESULTS:In Zambia, HIV infection was associated with lower preeclampsia risk (adjusted RR 0.42, 95% CI 0.26-0.59), persisting across ART strata, viral load, CD4 count, and severe disease. In Naples, HIV-infected women had higher risk versus HIV-negative women (10.2% vs 4.1%; adjusted OR 2.68, 95% CI 1.96 to 3.64), with excess risk concentrated among HAART users. A unifying mechanistic framework posits that long-standing immune suppression or quiescence may lower risk, whereas rapid immune reconstitution after ART initiation may elevate risk. CONCLUSION:Apparent contradictions between cohorts may reflect context-specific interactions between HIV, ART, maternal immunity, and clinical practice. HIV-positive pregnancies require vigilant monitoring and preconception optimization of ART and cardiometabolic health.

In the original publication [...].

OBJECTIVE:To evaluate the epidemiology, diagnostic pathway, prenatal surveillance, and pregnancy outcomes of women referred for suspected cytomegalovirus (CMV) infection during pregnancy in a population-based cohort. METHODS:This population-based cohort study included women counselled for suspected CMV infection during pregnancy between January 2002 and December 2021 in Campania, Italy. Maternal infection was classified as primary infection (documented seroconversion), suspected infection (IgG-positive/IgM-positive at first sample), or no infection during pregnancy, based on serial serology and IgG avidity testing. Prenatal diagnosis by amniocentesis for CMV DNA detection and serial ultrasound surveillance were offered in accordance with a standardized local protocol. Pregnancy and neonatal outcomes were recorded. RESULTS:A total of 716 women were included. Primary CMV infection was documented in 320 women (44.7%), suspected infection in 58 (8.1%), and no CMV infection during pregnancy in 294 (41.1%); 44 cases (6.1%) were not classifiable due to incomplete follow-up. IgG avidity testing, available in 211 women, supported diagnosis but showed limited specificity for recent infection. Amniocentesis was performed in 209 cases (29.2%), with CMV DNA detected in 40 (19.1%); all PCR-positive cases were confirmed as congenital CMV infection at birth. Overall, 45 (6.3%) neonates were diagnosed with congenital CMV infection. The majority of infections (84.4%) occurred following early maternal primary infection. Prenatal ultrasound abnormalities were infrequent and heterogeneous; most infected neonates had negative prenatal scans. Several clinically significant neonatal sequelae, including sensorineural hearing loss and neurodevelopmental impairment, occurred in the absence of prenatal ultrasound findings. CONCLUSION:In this large population-based cohort, a substantial proportion of women referred for suspected CMV infection did not acquire infection during pregnancy, highlighting the need for careful interpretation of serological findings and centralized counselling. Primary infection, particularly when acquired early in pregnancy, remains the main determinant of congenital CMV infection and adverse outcomes. While amniocentesis is the most reliable prenatal diagnostic tool, ultrasound surveillance alone has limited sensitivity. These results provide a robust pre-treatment baseline for future studies evaluating the impact of maternal antiviral therapy with valaciclovir on vertical transmission and neonatal outcomes.

Introduction: Spontaneous abortion is the most common complication in early pregnancy, with chromosomal abnormalities accounting for up to 50% of first-trimester losses. Conventional genetic analyses often rely on invasive procedures that may be limited by technical challenges and patient reluctance. This study aimed to evaluate the feasibility and diagnostic performance of cell-free DNA (cfDNA)-based testing as a noninvasive approach for detecting chromosomal abnormalities in first-trimester spontaneous abortion. Methods: This retrospective observational study included pregnant individuals diagnosed with spontaneous abortion between 7 + 0 and 14 + 6 weeks of gestation from 2022 to 2025. cfDNA was extracted from maternal plasma and analyzed using the VeriSeq™ NIPT Solution v2 (Illumina). A subset of participants who underwent dilation and curettage (D&C) also had fetal tissue analyzed via chromosomal microarray analysis (CMA), which served as the reference standard. Primary outcomes included the rate of non-informative results (NIR), fetal fraction (FF) ≥4%, and detection rate of chromosomal abnormalities. Sensitivity, specificity, and predictive values of cfDNA were calculated relative to CMA. Results: A total of 299 participants underwent cfDNA testing, of whom 28 also had fetal tissue CMA. The mean FF was 5.83%, with 231/299 (77.3%) samples having FF ≥4%. NIR occurred in 6 cases (2.0%), while 62 (20.7%) had FF <4%. Among cfDNA results with FF ≥4%, 130/231 (56.3%) showed chromosomal abnormalities, with trisomy 16 being the most common. In the D&C subgroup, cfDNA and CMA results were fully concordant (sensitivity and specificity: 100%). FF was positively correlated with gestational age (r = 0.42, p < 0.001). Conclusions: cfDNA-based testing represents a feasible and accurate noninvasive method for detecting chromosomal abnormalities following first-trimester pregnancy loss. It may offer an effective alternative to invasive genetic testing, particularly when tissue sampling is unavailable or declined. However, the retrospective design and the lack of detailed maternal clinical characteristics, including body mass index and other factors potentially influencing FF, represent important limitations that should be considered when interpreting these findings.

Although international recommendations strongly support regular physical activity during pregnancy due to the improved maternal and fetal outcomes, adherence to physical activity remains low, particularly in early gestation. Understanding activity patterns during the first trimester is crucial, as behaviors established in this phase often persist throughout pregnancy. To describe physical activity levels and adherence to international recommendations among low-risk pregnant women in the first trimester, using the Italian version of the Pregnancy Physical Activity Questionnaire (PPAQ). This cross-sectional observational study includes 498 low-risk singleton pregnant women between 11+3 and 13+6 weeks’ gestation, recruited at the University Hospital of Naples Federico II, Italy, between January 2022 and December 2023. Participants completed the Italian version of the PPAQ. Total energy expenditure was expressed in MET-h/week, and women were classified as exercisers (≥ 150 mines/week of moderate-intensity activity) or non-exercisers. Participants reported a median of 11.5 (IQR 8.2–15.0) h/week of total activity, corresponding to 155.7 (102.6–241.7) METs-h/week. While 51

Background and Objectives: Maternal nutrition during pregnancy has been associated with fetal development and long-term health trajectories through mechanisms potentially involving epigenetic and metabolic programming. However, the molecular mediators linking dietary quality to fetal biochemical profiles remain poorly characterized. This exploratory pilot study aimed to investigate associations between maternal nutritional adequacy and the amniotic-fluid metabolomic profile during the second trimester. Materials and Methods: In this prospective study, AF samples from 41 pregnant women undergoing second-trimester amniocentesis were analyzed using gas chromatography–mass spectrometry (GC-MS). Nutritional status was assessed via the FIGO Nutrition Checklist. Subjects were divided into two groups based on dietary adequacy (FIGO Score >5 vs. ≤5). Multivariate analysis (PLS-DA, VIP scores, volcano plots) and pathway enrichment were performed to identify discriminatory metabolites. Results: Exploratory metabolomic analysis suggested differences between the two nutritional groups. Several candidate metabolites, including stearic acid, lactic acid, proline, and scyllo-inositol, contributed to the observed differences between groups. These features may provide preliminary hypotheses regarding energy-, amino acid-, and lipid-related biochemical pathways. Conclusions: Maternal dietary quality was associated with differences in the amniotic-fluid metabolomic profile. These preliminary findings support further investigation of amniotic-fluid metabolomics as a potential tool for studying the fetal biochemical environment.

Cytomegalovirus (CMV) is a major cause of morbidity in immunocompromised individuals and represents the leading infectious cause of neonatal congenital deafness. When acquired during pregnancy, CMV can be vertically transmitted to the fetus, potentially resulting in permanent sequelae characterized by intellectual and neurosensory impairments. To investigate metabolic alterations associated with primary maternal CMV infection, we conducted a metabolomics-based analysis of amniotic fluid (AF) from pregnant women who acquired CMV infection during the first trimester, as confirmed by IgG seroconversion, IgM positivity, and low-to-moderate IgG avidity indices. Our findings revealed that the AF metabolomic profiles from CMV transmitter and nontransmitter mothers were remarkably similar. In contrast, both the CMV-exposed groups showed profound metabolic dysregulation compared to uninfected controls, suggesting that CMV-related metabolic disparities may persist irrespective of vertical transmission. Specifically, we observed a significant downregulation of glutamate (p < 0.0001) and acetylcarnitine (p < 0.0001) in CMV groups compared to control AF samples. Notably, the combined reduction of these two metabolites emerged as a surrogate biomarker signature of recent primary CMV infection of the mother, indicating that AF from both transmitting and nontransmitting pregnancies may share common metabolic adaptations. These alterations may reflect early perturbations of neurobiochemical pathways with unknown effects on babies negative at birth, supporting the need for risk assessment and clinical monitoring even in the absence of congenital CMV infection.

Objective: Nutrition is a key determinant of women's health across all life stages. Clinical practice remains heterogeneous because of lack of evidence and non-homogeneous guidelines. Despite growing research on micronutrient supplementation, skeptical opinions persist around universal versus individualized approaches, optimal dosages, and life-stage-specific recommendations. Material and methods: This is a modified Delphi process conducted under the supervision of the Italian Association of University Gynecologists and Obstetricians (AGUI). Thirteen Italian experts in gynecology and obstetrics completed two rounds of anonymous online surveys (September-November 2025). The questionnaire, developed through a scoping review, covered six domains: pre-/periconception, pregnancy, postpartum, routine supplementation in non-pregnant women, nutrition in gynecological conditions, and menopause. Consensus was defined as ≥75% agreement on a 10-point Likert scale. Quantitative data were summarized descriptively, and qualitative comments contextualized findings. Results: Experts strongly supported personalized nutritional strategies across all life stages. Consensus was reached on individualized micronutrient supplementation in the preconception period and on the prescription of active folates for women undergoing assisted reproduction. In pregnancy, agreement emerged for universal DHA supplementation (200-300 mg/day); however, universal vitamin D supplementation lacked consensus except in gestational diabetes. In the postpartum period, iron supplementation for non-breastfeeding women reached consensus, while micronutrient recommendations for breastfeeding women remained uncertain. Strong agreement supported personalized dietary approaches for PCOS, endometriosis, and gestational diabetes, including inositol use, while evidence for interventions in severe premenstrual syndrome remained insufficiently supported. In menopause, consensus was reached for macronutrient adjustments and universal calcium and vitamin D supplementation. Conclusions: This Delphi consensus highlights shared expert perspectives on nutritional care in women and identifies key evidence gaps, particularly regarding vitamin D in physiological pregnancy, postpartum micronutrient needs during breastfeeding, and nutritional strategies for premenstrual disorders. Unified life-course guidelines and future research on standardized nutritional assessments are necessary for nutritional approach management.

INTRODUCTION:Pre-eclampsia (PE) involves systemic endothelial dysfunction and microvascular injury, yet routine obstetric care lacks noninvasive readouts of maternal microvascular health. We evaluated whether hypertensive retinopathy (HR) detected during pregnancy is associated with maternal disease severity and adverse neonatal outcomes. METHODS:We performed a retrospective cohort study of singleton pregnancies with PE and at least one ophthalmic assessment during pregnancy. Retinal findings were graded as none, mild, moderate, or severe. Primary outcomes were maternal composite adverse outcome (severe features, HELLP syndrome, eclampsia, admission to intensive care unit) and neonatal composite adverse outcome (indicated delivery <34 weeks, small for gestational below the third percentile, admission to neonatal intensive care unit). Multivariable models adjusted for maternal confounders were performed. RESULTS:Of 584 patients with PE with analyzable data, 182 (31.2%) had any HR (mild 20.4%, moderate 9.8%, severe 1.0%). HR was independently associated with maternal composite adverse outcome (adjusted odds ratio [aOR], 2.21 [95% CI, 1.45-3.36]) and neonatal composite adverse outcome (aOR, 2.40 [95% confidence interval (CI), 1.60-3.60]). HR was linked to earlier delivery (adjusted mean difference, -1.17 weeks) and lower birthweight z score (adjusted β, -0.34). Each one-grade increase in HR was associated with higher odds of both primary outcomes (maternal composite outcome aOR, 1.45 [95% CI, 1.10-1.90]; neonatal composite outcome aOR, 1.53 [95% CI, 1.17-1.99]). CONCLUSIONS:In women with PE, HR is common and independently associated with maternal and neonatal adverse outcomes.

Congenital hemangiopericytoma (HPC) is a rare mesenchymal tumor of perivascular differentiation, characterized by prominent vascularity and heterogeneous clinical behavior in neonates. Prenatal diagnosis, particularly of intracranial lesions, is exceptional and poses significant diagnostic and management challenges. This study offers insights into diagnosing and managing this condition in a young patient, enriched by a systematic review of the literature over the past 15 years. We report a fetus diagnosed prenatally with a 5 cm highly vascular intracranial mass detected on routine third-trimester ultrasound (US) and also characterized by fetal magnetic resonance imaging (MRI). Further prenatal assessment showed cardiomegaly. The pregnancy was managed by a multidisciplinary team with a planned cesarean section performed at 35 weeks of gestation. The neonate was born in good general condition. Postnatal biopsy confirmed the diagnosis of HPC, and a ventriculoperitoneal shunt was placed to manage hydrocephalus. The infant subsequently received neoadjuvant chemotherapy (CHx) to reduce tumor size and vascularity. Follow-up imaging showed a reduction in the tumor size. At 4 months of age, the neonate was readmitted due to newly identified osteolytic lesions along the spine. In the context of suspected multifocal disease and partial response to CHx, a neurosurgical excision of the intracranial mass was performed. At 1-year follow-up, no evidence of tumor progression or new lesion development was observed, and neurological development was normal. In conclusion, this case highlights the importance of early prenatal diagnosis and multidisciplinary management in congenital intracranial HPC, supporting the feasibility of a combined CHx and surgical approach. Further research is needed to refine management strategies and establish standardized follow-up protocols for this neonatal tumor.

INTRODUCTION:Human papillomavirus infection is one of the most prevalent sexually transmitted infections worldwide. Women living with HIV are at increased risk of acquiring and developing persistent infection with high-risk HPV genotypes, leading to higher rates of cervical dysplasia and cancer. However, limited data are available regarding the timing and determinants of HPV clearance in this population. MATERIAL AND METHODS:This is a retrospective, single-center study including women living with HIV with confirmed high-risk HPV infection, followed at an Italian university hospital between 2019 and 2024. Clinical, virological, and immunological data were collected, including HIV viral load, CD4+ T-cell count, and adherence to antiretroviral therapy. HPV persistence, clearance, and time to clearance were assessed over a 5-year follow-up period. Statistical analyses were performed using SPSS version 29, with p < 0.05 considered significant. RESULTS:Seventy-seven women living with HIV were recruited, and fifty-one met the inclusion criteria for analysis. Most participants (92%) were adherent to ART. HR-HPV clearance occurred in 76.5% of patients, with a mean clearance time of 2.08 years. No significant correlation was observed between HPV clearance time and HIV viremia, CD4+ T-cell count, or cytological/colposcopic findings at baseline. However, baseline positivity for the high-risk HPV pool was significantly associated with longer clearance time (p = 0.011). CONCLUSIONS:Women living with HIV showed a high-risk HPV clearance time of approximately 2 years under ART. Our findings suggest that HPV screening every 2 years may represent an appropriate interval in this population, potentially increasing adherence and optimizing healthcare resources. Larger multicenter prospective studies are needed to confirm this observation.

Background/Objectives: Intermittent fasting (IF), such as Ramadan fasting, is common among pregnant women despite religious exemptions. The possible impact of fasting on pregnancy outcome and, in particular, on birthweight is uncertain and was documented with conflicting evidence. Methods: The aim of this meta-analysis and systematic review was to investigate the association between intermittent fasting during pregnancy and neonatal birthweight, along with low birthweight (LBW, <2500 g) risk. Studies evaluating fasting during pregnancy with reported neonatal outcomes were included. We searched (PubMed, Scopus, Web of Science) from 2004 through June 2025. All contributing studies were observational in design; no randomized trials were identified. The risk of bias was assessed using the Newcastle-Ottawa Scale. The pooled relative risks (RR) and mean differences (MD) were calculated according to random-effects models (DerSimonian-Laird method) and heterogeneity was quantified with the I2 statistic. Results: Nineteen studies, all observational in design, were included for qualitative synthesis, and six studies yielded quantitative data to conduct meta-analyses. No randomized controlled trials were identified. Intermittent fasting during pregnancy, encompassing more than 1.3 million pregnancies, was associated with a small but statistically significant reduction in neonatal birth weight. The pooled mean difference was -94 g (95% CI: -176 to -12 g; p = 0.03; I2 = 70%), indicating a minor but statistically significant effect that is unlikely to be clinically meaningful. The pooled RR for LBW was 0.96 (95% CI: 0.88-1.05; p = 0.38; I2 < 10%), showing no association between fasting and low birthweight risk. Sensitivity analyses reduced heterogeneity (I2 ≈ 55%) and confirmed the robustness of these findings. According to the GRADE approach, the certainty of evidence was moderate for birthweight and high for LBW. Conclusions: Intermittent fasting during pregnancy, including Ramadan fasting, was associated with a minor but statistically significant reduction in neonatal birthweight without increasing the risk of low birthweight. This difference was small and clinically negligible. Further prospective studies are needed to clarify trimester-specific effects and long-term developmental outcomes.

Endometrial osseous metaplasia is a rare condition defined as the presence of heterotopic bone in the endometrium. A retrospective, monocentric analysis was conducted, including patients with endometrial osseous metaplasia, and a systematic review of the literature was performed. The retrospective analysis included 10 cases. Most patients (n = 9) were of reproductive age and had a history of miscarriage. The main symptoms were infertility (n = 4) and menstrual cycle disorders (n = 4). The size and the uterine site of the metaplasia varied. It is crucial not to underestimate it, especially in infertile patients with anamnesis of recurrent miscarriages.

Background/Objectives: Fetal thigh circumference (ThC) may be a valuable parameter for assessing fetal growth. Thus, this study aimed to establish reference ranges for ThC across gestational ages (GA). Methods: This retrospective study included singleton pregnancies between 12 and 38 weeks of gestation. ThC measurements were obtained during routine ultrasound examinations. GA was confirmed through the last menstrual period and first-trimester crown–rump length measurements. Percentile ranges for ThC were calculated for each gestational week, and statistical analyses evaluated the relationship between ThC and GA. Results: 48,841 singleton pregnancies were included. A positive correlation was observed between ThC and GA, with ThC values increasing progressively from 12 to 38 weeks. The study established the 10th, 50th, and 90th percentile ranges for ThC, providing reference values for clinical assessments. Conclusions: This study provides reference ranges for fetal ThC across a wide GA range, highlighting its potential as a tool in prenatal care. ThC may offer an additional parameter for monitoring fetal growth, especially when standard measurements are challenging. Further research should investigate the integration of ThC with other fetal growth parameters to enhance its clinical utility. Additionally, these nomograms can be used to assess their usefulness in certain conditions, such as intrauterine growth restriction (IUGR), macrosomia, and congenital skeletal dysplasias.

Objective: The objective is to develop expert consensus to inform clinical decision-making in the use of hormonal contraceptives in women over 40 years of age. Methods: A multidisciplinary panel organised by the Italian Society of Contraception performed a systematic literature review up to October 2024, defining the priorities in the choice of a contraceptive and its effects on cardiovascular risk, menstrual bleeding, bone health, and sexual function associated with hormonal contraception in women over 40. Statements summarising the findings were discussed and refined in a dedicated expert meeting. Final statements were presented and subjected to anonymous voting at a national congress, where consensus was defined as a minimum of 75% agreement. Results: Ninety-five to ninety-nine percent of participants endorsed seven consensus statements. Cardiovascular safety is recognised as the primary factor in the selection of contraceptives. The use of progestogen-only methods is considered safe for cardiovascular risk. Combined hormonal contraceptives utilising natural oestrogens or 20 mcg ethynylestradiol in conjunction with non-androgenic progestins are considered more advantageous for the cardiovascular risk profile. The levonorgestrel intrauterine device, oestradiol valerate/dienogest, and the combined contraceptive vaginal ring are identified as the most effective options for menstrual management. The type of hormone and its route of administration can influence sexual function, with implants and vaginal rings showing positive effects. Combined hormonal contraceptives demonstrate protective effects on bone density, whereas progestogen-only methods exhibit a neutral impact. Conclusions: This Italian consensus provides evidence-based guidance on hormonal contraceptive choices for women over 40, incorporating non-contraceptive effects to support individualised care during perimenopause.