Journal of Perinatal Medicine最新文献

{"title":"Abnormal Doppler and perinatal outcomes according to the placental lesions of maternal and fetal vascular malperfusion in preterm fetal growth restriction.","authors":"Young Eun Chung, You-Ri Lee, Sooji Ham, Boram Park, Kyunga Kim, Ji-Hee Sung, Yun Dan Kang, Suk-Joo Choi, Soo-Young Oh, Jung-Sun Kim, Cheong-Rae Roh","doi":"10.1515/jpm-2025-0140","DOIUrl":"10.1515/jpm-2025-0140","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to identify the associations between specific pathologic placental findings and abnormal Doppler results as well as perinatal outcomes in preterm fetal growth restriction (FGR).</p><p><strong>Methods: </strong>This retrospective study included 465 consecutive singleton pregnancies with FGR delivered between 22+0 and 36+6 weeks of gestation. Abnormal Doppler was defined as absent or reversed end-diastolic flow in the umbilical artery (UA) and a pulsatility index less than the 10th percentile in the middle cerebral artery (MCA). Placental pathology was evaluated focusing on villous or vascular findings of maternal (MVM) and fetal vascular malperfusion (FVM) based on Amsterdam criteria.</p><p><strong>Results: </strong>The average gestational age at delivery and neonatal birth weight were 32 weeks (±4 weeks) and 1,299 g (±575 g), respectively. Placental MVM lesions were observed in the majority of cases (90.3 %) and were significantly related to abnormal UA and MCA Doppler. Meanwhile, FVM lesions was observed in about half of the cases (44.8 %) and were significantly related to abnormal MCA Doppler, but not abnormal UA Doppler. Both villous and vascular lesions of MVM and FVM were associated with lower neonatal birth weight. Among specific key findings of MVM and FVM, distal villous hypoplasia was highly associated with abnormal UA Doppler (crude OR 5.01, 95 % CI 1.27-19.68), while intramural fibrin deposition in large fetal vessels was significantly associated with abnormal MCA Doppler (crude OR 2.49, 95 % CI 1.01-6.13). Of note, intramural fibrin deposition of large fetal vessels was associated with neonatal mortality (crude OR 3.25, 95 % CI 1.52-6.92).</p><p><strong>Conclusions: </strong>We identified key findings among placental MVM and FVM associated with abnormal UA and MCA Doppler as well as neonatal mortality in preterm FGR.</p>","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":"371-380"},"PeriodicalIF":1.4,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145540963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longitudinal changes of left ventricular hypoplasia and ventricular disproportion in congenital diaphragmatic hernia neonates.","authors":"Flaminia Pugnaloni, Bartolomeo Bo, Judith Leyens, Irma Capolupo, Andrea Dotta, Pietro Bagolan, Andreas Mueller, Neil Patel, Florian Kipfmueller","doi":"10.1515/jpm-2025-0327","DOIUrl":"10.1515/jpm-2025-0327","url":null,"abstract":"<p><strong>Objectives: </strong>Ventricular disproportion, defined as a ratio of right ventricle (RV) end-diastolic diameter to left ventricle (LV) end-diastolic diameter (RV_D/LV_D) ≥ 1.1 is commonly observed in neonates with congenital diaphragmatic hernia (CDH) and it is independently associated with adverse outcome. Longitudinal postnatal data on ventricular disproportion of CDH neonates are poorly studied and we aimed to evaluate changes in RV_D/LV_D through serial echocardiographic studies at selected timepoints in the neonatal period.</p><p><strong>Methods: </strong>This retrospective observational study included CDH neonates admitted to the University Children's Hospital of Bonn between January 2011 and March 2021. RV_D/LV_D was measured via apical 4-chamber echocardiographic views at admission, 48 h of life, pre-surgical repair, pre-extubation, and on day 5 of ECMO support, if applicable. Patients receiving palliative care, experiencing early death, or lacking follow-up echocardiographic data were excluded.</p><p><strong>Results: </strong>Of 248 CDH neonates, 80 were excluded, leaving 168 in the final cohort. At baseline, 41.7 % had an RV_D/LV_D ≥1.1. Mortality (34.3 %) and ECMO rates (62.9 %) were significantly higher in these patients compared to those with RV_D/LV_D <1.1. Ventricular disproportion decreased over time: 41.7 % at admission, 23.1 % at 48 h, 15.7 % pre-repair, and 9.1 % pre-extubation. For ECMO patients, RV_D/LV_D ≥1.1 was found in 62.9 % at admission, decreasing over time. Non-survivors had significantly higher RV_D/LV_D at 48 h (p=0.020) and pre-extubation (p=0.001).</p><p><strong>Conclusions: </strong>In CDH neonates, ventricular disproportion improves over time, but RV_D/LV_D≥1.1 remains strongly associated with mortality, particularly in ECMO patients, where non-survivors exhibit persistently elevated RV_D/LV_D.</p>","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":"415-423"},"PeriodicalIF":1.4,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145541087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Second pregnancy vaginal birth after cesarean- impact of maternal age on outcomes from a retrospective cohort study.","authors":"Syed Mariyam, Fathima Minisha, Salwa Abu Yaqoub, Nader AlDewik, Thomas Farrell","doi":"10.1515/jpm-2025-0440","DOIUrl":"10.1515/jpm-2025-0440","url":null,"abstract":"<p><strong>Objectives: </strong>The rate of cesarean delivery (CD) in Qatar is rising at an alarming rate. Vaginal birth after cesarean section (VBAC) is associated with lower maternal morbidity and is an important option for younger mothers. This study compared the pregnancy outcomes of second pregnancies in women with prior CD, according to their age groups, with the aim of individualising VBAC counselling.</p><p><strong>Methods: </strong>This retrospective study divided women in their second pregnancies based on age: young group (YG<25 years), control group (CG, 25-35 years), and advanced age group (AG>35 years). The primary outcome was the mode of delivery.</p><p><strong>Results: </strong>Out of 2,729 women, 18.2 % had a VBAC (27.4 % in YG vs. 9.5 % in AG). Nearly 48 % agreed to a TOLAC (57.9 % in YG and 41.8 % in AG), 38 % of whom had a successful VBAC. Among those who opted for TOLAC, 47.3 % in YG had a successful VBAC, compared to only 22.8 % in AG (p<0.001). While hypertension, diabetes, macrosomia and preterm birth reduced VBAC, postdated and uncomplicated pregnancies increased the rates. Compared to CG, YG had 35 % lower odds of repeat CD (aOR=0.64, CI=0.49-0.85, p=0.002), while AG had nearly two times higher odds (CI=1.26-2.95, p=0.003), after adjusting for confounders.</p><p><strong>Conclusions: </strong>Maternal age emerged as an important predictor of repeat cesarean, with younger mothers having a much higher chance of successful VBAC. More than half with uncomplicated pregnancies opted for an elective CD, highlighting the requirement for improving counselling services that motivate women to take up VBAC and improve their confidence in the healthcare system.</p>","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":"481-492"},"PeriodicalIF":1.4,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145541085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ten years of experience with screening for diabetes in pregnancy according to IADPSG criteria in Slovenia.","authors":"Lili Steblovnik, Renata Košir Pogačnik, Mateja Sladič","doi":"10.1515/jpm-2025-0357","DOIUrl":"10.1515/jpm-2025-0357","url":null,"abstract":"<p><p>This review presents analysis of gestational diabetes mellitus (GDM) in Slovenia based on national data and published research over a decade. Slovenia adopted the International Association of Diabetes and Pregnancy Study Groups (IADPSG) recommendations in 2011 and integrated them into routine antenatal care by 2023. Universal screening has increased the prevalence of GDM from 4 % before 2010 to 21 % in 2023. The analysed perinatal outcomes improved: the overall rates of large for gestational age (LGA) neonates and Erb's palsy decreased (AOR 0.93, 95 % CI 0.91-0.96 and AOR 0.72, 95 % CI 0.60-0.86 respectively) as did rates of preeclampsia (AOR 0.72, 95 % CI 0.68-0.76) and gestational hypertension (AOR 0.80, 95 % CI 0.77-0.83). The population of pregnant women changed, mean age at delivery, pre-pregnancy body mass index (BMI), proportion of obesity and parity increased. A dose-response relationship was found between pre-pregnancy BMI and GDM as there was synergistic effect of parity and maternal obesity on excessive fetal growth. Despite the nutrition interventions and tight control of blood glucose levels LGA infants could not be completely prevented. Beyond metabolic effects, GDM imposes a significant psychological burden; distinct psychological profiles were identified, emphasizing the need for tailored psychosocial support.</p>","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":"123-128"},"PeriodicalIF":1.4,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145541013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Umbilical venous flow and maternal hemodynamics as predictors of impaired fetal growth in gestational diabetes: a prospective study.","authors":"Daniele Farsetti, Sara Nardini, Lavinia Maffi, Giulia Gagliardi, Roberta Frantellizzi, Francesca Pometti, Barbara Vasapollo, Gian Paolo Novelli, Herbert Valensise","doi":"10.1515/jpm-2025-0353","DOIUrl":"10.1515/jpm-2025-0353","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to evaluate the association between maternal cardiovascular function, umbilical vein blood flow (UV-Q), and impaired fetal growth in pregnancies complicated by gestational diabetes mellitus (GDM).</p><p><strong>Methods: </strong>In this prospective observational study, 84 singleton pregnancies complicated by GDM between 28 and 32 weeks of gestation were enrolled. All participants underwent a standardized maternal hemodynamic assessment using USCOM device and fetal ultrasound including Doppler-based measurement of UV-Q. Impaired fetal growth was defined as either small for gestational age (SGA, birthweight <10th centile) or a ≥40 centile drop between estimated fetal weight (EFW) at enrolment and actual birthweight centile (\"DROP\"). Predictive performance was assessed using ROC analysis and multivariate logistic regression.</p><p><strong>Results: </strong>Fetuses with impaired growth (n=24) had significantly lower UV-Q centiles (median 29.50 vs. 50.00, p=0.04), higher maternal systemic vascular resistance (SVR) (1,004.50 vs. 915.00 dyn s cm^-5, p<0.01), lower cardiac output (CO) (6.5 vs. 7.2 L/min, p=0.03), and reduced oxygen delivery (DO₂) (1,021.22 vs. 1,131.06 mL/min, p<0.01) compared to those with normal growth. Multivariate analysis identified UV-Q centile ≤24, SVR>916 dyn s cm^-5, and DO₂≤1,061.4 as independent predictors of impaired growth (AUC up to 0.78). These associations remained significant after adjusting for EFW at enrolment.</p><p><strong>Conclusions: </strong>In pregnancies complicated by GDM, impaired fetal growth may reflect placental dysfunction and maternal cardiovascular maladaptation. Maternal hemodynamic parameters and UV-Q may enhance fetal growth surveillance, particularly when incorporating longitudinal metrics such as DROP. These findings suggest a potential role for integrating maternal-fetal hemodynamics into standard care to identify \"hidden\" growth restriction phenotypes in GDM pregnancies.</p>","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":"51-60"},"PeriodicalIF":1.4,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145541064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Detection of isolated fetal limb anomalies using 3D/4D ultrasound.","authors":"Eberhard Merz, Sonila Pashaj","doi":"10.1515/jpm-2025-0352","DOIUrl":"10.1515/jpm-2025-0352","url":null,"abstract":"<p><strong>Objectives: </strong>Demonstration of the advantage of 3D/4D ultrasound compared to 2D imaging in the precise detection and parental counseling of isolated fetal limb defects.</p><p><strong>Methods: </strong>Prospective observational study of 201 fetal limb defects over a 30-year period (1994-2023) in a level III center.</p><p><strong>Results: </strong>Comparison of 2D and 3D ultrasound showed a benefit in the precise demonstration of isolated limb abnormalities in 154 of the 201 cases (76.6 %), particularly in subtle malformations. In the demonstration of the defects to the parents-to-be, 3D/4D ultrasound was superior to 2D ultrasound in 100 % of cases by the fact that the abnormalities could be better understood by the parents when using a spatial presentation.</p><p><strong>Conclusions: </strong>3D/4D ultrasound is superior to 2D sonography in the demonstration of isolated limb defects, particularly in subtle limb defects.</p>","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":"139-145"},"PeriodicalIF":1.4,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145540955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations between previous cesarean section and maternal and neonatal complications: the modification of long inter-pregnancy interval.","authors":"Yuxin Xiang, Qing Zhao, Wenbin Dong, Yujiao Zhang, Xiaoping Lei","doi":"10.1515/jpm-2025-0280","DOIUrl":"10.1515/jpm-2025-0280","url":null,"abstract":"<p><strong>Objectives: </strong>We aim to explore whether the long inter-pregnancy interval (IPI) modifies the association between previous cesarean section (CS) and adverse maternal and neonatal outcomes in a population with a high rate of CS and a long IPI.</p><p><strong>Methods: </strong>Adverse maternal and neonatal outcomes were compared between the previous CS and previous vaginal delivery groups. Logistic models were used to adjust for potential confounding factors and calculate the odds ratios (ORs) and 95 % confidence intervals (CIs). The interaction model and stratified analyses were used to evaluate the modifications of IPIs on the associations between previous CS and maternal and neonatal outcomes.</p><p><strong>Results: </strong>Compared with previous vaginal delivery, previous CS was associated with increased risks of uterine-related complications (aOR=1.57, 95 % CI 1.25-1.98), but with decreased risks of preterm birth (aOR=0.73, 95 % CI 0.63-0.85) and severe neonatal adverse outcomes (aOR=0.59, 95 % CI 0.46-0.78). There are synergistic biological interaction effects of previous CS and a long IPI (>60 months) on the risks of placental-related complications (RERI=0.32, 95 % CI 0.05-0.58; AP=0.39, 95 % CI 0.03-0.76) but an antagonistic biological interaction effect on the risk of preterm birth (RERI=-0.35, 95 % CI -0.68 to -0.01; AP=-0.09, 95 % CI -0.68 to -0.03).</p><p><strong>Conclusions: </strong>Previous CS was associated with increased risks of adverse maternal outcomes but decreased risks of certain adverse neonatal outcomes. Prolonged IPIs might not attenuate the adverse effects of previous CS on mothers, and might adversely exert harm on newborns.</p>","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":"354-361"},"PeriodicalIF":1.4,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Community births in the United States, 2016-2024: post-pandemic patterns across racial and ethnic groups.","authors":"Amos Grünebaum, Frank A Chervenak","doi":"10.1515/jpm-2025-0521","DOIUrl":"10.1515/jpm-2025-0521","url":null,"abstract":"<p><strong>Objectives: </strong>Community births in the United States - including planned home and freestanding birth center deliveries - have increased in recent years. Understanding how these patterns have evolved across racial and ethnic groups, particularly in the post-pandemic period, is essential for clinical practice and health policy. Objective: To analyze national trends in community births from 2016 through 2024 by race and ethnicity, and to discuss clinical, ethical, and policy implications.</p><p><strong>Methods: </strong>Birth certificate data from the CDC natality database were examined for 2016-2024. Community births were defined as intended home or freestanding birth center births. Trends were assessed overall and stratified by race/ethnicity, with relative changes indexed to 2016.</p><p><strong>Results: </strong>From 2016 to 2024, community births increased overall but diverged by group. Non-Hispanic White and Hispanic women demonstrated sustained increases relative to 2016, while non-Hispanic Black women showed an increase during the pandemic followed by decline, and non-Hispanic Asian women displayed a modest upward trend. These shifts occurred against the backdrop of declining total births in some groups, affecting proportional comparisons. International comparisons are limited by the distinctive U.S. context, where midwifery is less integrated and credentialing standards are variable.</p><p><strong>Conclusions: </strong>Community birth patterns since the pandemic reveal both growth and divergence across racial and ethnic groups. These findings highlight the need for policy interventions to address maternity care deserts and harmonize midwifery credentialing. Clinically, professional responsibility requires fully informed consent leading to directive counseling, which should not be misinterpreted as paternalism but as an ethical duty to recommend hospital birth as the safest option while respecting patient autonomy.</p>","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":"258-264"},"PeriodicalIF":1.4,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of maternal cardiovascular status prior to labor on birth outcomes: an observational study.","authors":"Daniele Farsetti, Francesca Pometti, Giulio Maria Natali, Greta Carta, Livia Pieri, Benedetta Laudonio, Davide Archelao Dessì, Barbara Vasapollo, Gian Paolo Novelli, Herbert Valensise","doi":"10.1515/jpm-2025-0329","DOIUrl":"10.1515/jpm-2025-0329","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the diagnostic accuracy of maternal characteristics, computerized cardiotocography (cCTG), maternal hemodynamics, and fetal Doppler in predicting adverse perinatal outcomes (APO) in healthy term pregnancies before labor onset.</p><p><strong>Methods: </strong>In this prospective observational study, 395 term pregnant women were enrolled. Data on obstetric history, cCTG, maternal hemodynamics, and fetal ultrasound were collected. Women undergoing labor induction were excluded. The primary endpoint was a composite APO, defined as cesarean or operative vaginal delivery due to pathological CTG, 5-min Apgar <7, umbilical artery pH <7.1 and/or base excess >12 mmol/L, or NICU admission. A secondary outcome, \"objective APO\", excluded operative delivery for pathological CTG. Logistic regression analyses were performed to assess predictors of APO.</p><p><strong>Results: </strong>Among 307 women with spontaneous labor, 41 (13.36 %) experienced a composite APO. These women were less often multiparous (7.32 vs. 27.07 %, p=0.01), had higher systemic vascular resistance [SVR: 1,353 (1,209-1,498) vs. 1,249 (1,071-1,438) dyn s cm^-5, p=0.01], and lower short-term variability [STV: 7.5 (6.2-10.0) vs. 9.1 (7.6-11.0) ms, p<0.01]. Fetal Doppler indices, including cerebro-placental ratio, showed no significant differences. ROC analysis identified SVR >1,135 dyn s cm^-5 (OR 6.92, 95 % CI 2.08-23.03) and STV ≤7 ms (OR 3.95, 95 % CI 1.97-7.92), as optimal predictors. Multivariate analysis confirmed STV, SVR, and parity as independent predictors. In the secondary analysis of \"objective APO\", both SVR and STV remained significant predictors, and the multivariable model demonstrated excellent discrimination [AUC 0.931 (95 % CI 0.896-0.957)].</p><p><strong>Conclusions: </strong>In term pregnancies, maternal hemodynamic assessment and cCTG performed before labor may improve the identification of women at increased risk of APO.</p>","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":"61-71"},"PeriodicalIF":1.4,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145533798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The fetal exposome and preterm birth: a systematic synthesis of environmental exposures and multi-omics evidence.","authors":"Wiku Andonotopo, Muhammad Adrianes Bachnas, Julian Dewantiningrum, Mochammad Besari Adi Pramono, Nuswil Bernolian, Cut Meurah Yeni, Anak Agung Gede Putra Wiradnyana, I Nyoman Hariyasa Sanjaya, Muhammad Ilham Aldika Akbar, Ernawati Darmawan, Sri Sulistyowati, Milan Stanojevic, Asim Kurjak","doi":"10.1515/jpm-2025-0231","DOIUrl":"10.1515/jpm-2025-0231","url":null,"abstract":"<p><strong>Objectives: </strong>Preterm birth (PTB), defined as delivery before 37 weeks of gestation, is a leading cause of neonatal mortality and long-term developmental impairment. Its complex etiology, spanning environmental, genetic, psychosocial, and socio-economic domains, limits effective prediction and prevention. We systematically synthesized evidence on how environmental exposures influence PTB risk through multi-omic disruptions within a fetal exposome framework.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted in major biomedical databases, following PRISMA guidelines. Ninety-five human studies published through May 2025 were included, encompassing exposures such as ambient air pollution, endocrine-disrupting chemicals, maternal stress, nutrition, occupational hazards, climate variability, and microbiome alterations. Two reviewers independently extracted data (exposure type, omics platform, biospecimen, PTB subtype) with inter-rater reliability assessment, and study quality was evaluated using the Newcastle-Ottawa Scale. Findings were narratively stratified by exposure category, study design, and spontaneous vs. indicated PTB.</p><p><strong>Results: </strong>Environmental exposures were consistently associated with disruptions in oxidative stress, inflammation, immune regulation, hormonal signaling, placental aging, and microbial ecology, mediated by multi-omic signatures in maternal, placental, and fetal tissues. Candidate biomarkers show promise for early risk stratification but lack validation and population-level predictive performance due to heterogeneous exposure assessment and study design.</p><p><strong>Conclusions: </strong>Integrating fetal exposome concepts with multi-omics enhances mechanistic insight into PTB risk and may support biomarker discovery and precision-guided prenatal interventions. Clinical translation requires standardized exposure measurement, biomarker validation, and equity-focused implementation.</p>","PeriodicalId":16704,"journal":{"name":"Journal of Perinatal Medicine","volume":" ","pages":"391-407"},"PeriodicalIF":1.4,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145533865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}