Acta Obstetricia et Gynecologica Scandinavica最新文献

{"title":"The flat glucose response curve during oral glucose tolerance tests in Chinese pregnant women and its association with adverse outcomes.","authors":"Ya Xi, Qianqian Wu, Binbin Yin, Jinghua Zhang, Yongying Bai","doi":"10.1111/aogs.70016","DOIUrl":"https://doi.org/10.1111/aogs.70016","url":null,"abstract":"<p><strong>Introduction: </strong>Flat glucose response curves observed during the oral glucose tolerance test (OGTT) in pregnant women are relatively prevalent. This study aimed to investigate the characteristics and perinatal outcomes of Chinese women who presented with flat OGTT curves during pregnancy.</p><p><strong>Material and methods: </strong>A total of 23 576 pregnant women without gestational diabetes mellitus (GDM) were recruited into this study. They were classified into two groups according to the shape of their glucose response curves obtained from OGTTs performed at 24-28 weeks of gestation. The curves were categorized as either flat or normal. Specifically, a flat curve was defined as a less than 16.5% increase in plasma glucose levels during the OGTT, while all other curves were regarded as normal. Logistic regression analysis was employed to examine the associations between these curve types and the risk of perinatal outcomes. Additionally, these relationships were evaluated across different maternal age groups and preconception body mass index (BMI) categories.</p><p><strong>Results: </strong>Among the participants, 932 (3.95%) displayed a flat curve, while 22 644 (96.05%) showed a normal curve. Women with a flat curve were significantly younger (p < 0.001) and had a lower BMI (p < 0.001). Compared with those with a normal curve, women with a flat curve had lower incidences of gestational hypertension and preeclampsia. Additionally, neonates born to mothers with a flat curve had lower birth weights and lower occurrences of large for gestational age (LGA) and macrosomia. Logistic regression analyses, using the normal-curve group as the reference, demonstrated that, regardless of confounder adjustments, the flat-curve group was associated with a protective effect against gestational hypertension, preeclampsia, LGA, and macrosomia development (all p < 0.05). Moreover, these risks differed according to maternal age and preconception BMI. No significant differences were observed in other maternal or neonatal outcomes.</p><p><strong>Conclusions: </strong>A flat OGTT curve is associated with lower birth weight and reduced risks of LGA, macrosomia, gestational hypertension, and preeclampsia. Identifying the flat curve as a protective factor for LGA, macrosomia, gestational hypertension, and preeclampsia, particularly among women with different maternal ages and preconception BMIs, may facilitate personalized risk assessment and management.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving imiquimod use in cervical high-grade squamous intraepithelial lesions: A qualitative study.","authors":"Caroline L P Muntinga, Helena C J Schellekens, Charlotte G J Penders, Hélène van Meir, Gatske M Nieuwenhuyzen-De Boer, Anna J M van de Sande, Heleen J van Beekhuizen, Peggy J de Vos Van Steenwijk, Ruud L M Bekkers, Edith M G van Esch","doi":"10.1111/aogs.70004","DOIUrl":"https://doi.org/10.1111/aogs.70004","url":null,"abstract":"<p><strong>Introduction: </strong>To investigate patient experiences and satisfaction with imiquimod for cervical high-grade squamous intraepithelial lesions and its side effects, possibly influencing the (dis)continuation of treatment. Secondary objectives include evaluating patient counseling and guidance before and during imiquimod treatment for cervical high-grade squamous intraepithelial lesions by gynecologists and nurse practitioners to improve patient guidance.</p><p><strong>Material and methods: </strong>Semi-structured interviews were conducted with patients treated with imiquimod for cervical high-grade squamous intraepithelial lesions and with healthcare professionals from hospitals in the Netherlands. Interviews were transcribed and transcripts were analyzed using thematic analysis.</p><p><strong>Results: </strong>A total of 15 patients, 11 of whom finished imiquimod treatment and four who discontinued imiquimod treatment, and six healthcare professionals were interviewed. Three main themes were identified: counseling and side effects, use of imiquimod, and contact moments during treatment. Many patients believed that sharing patient experiences would help in making treatment decisions. Patients discontinued treatment early due to side effects and the mode of application. Detailed information on application methods and side effect severity during counseling is desirable. Healthcare professionals agreed on the factors that need to be addressed during counseling but held different opinions on imiquimod's side effect severity and application methods.</p><p><strong>Conclusions: </strong>Adequate patient counseling on imiquimod treatment, including the possible application methods and potential side effects, along with optimal guidance during treatment, contributes to a better patient experience and reduces the likelihood of early discontinuation of treatment.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maternal deaths from sepsis in the Nordic countries during 2005-2021: A descriptive study.","authors":"Sedina Atic Kvalvik, Hanna Åmark, Rikke Bek Helmig, Mika Gissler, Lill Trine Nyfløt, Steinar Skrede, Siri Vangen, Svein Rasmussen, Elham Baghestan","doi":"10.1111/aogs.70011","DOIUrl":"https://doi.org/10.1111/aogs.70011","url":null,"abstract":"<p><strong>Introduction: </strong>Maternal sepsis is a heterogenous condition which can arise from several different infections during and after pregnancy. Common for all etiologies is a high mortality rate. In a global perspective, maternal sepsis is an important contributor to maternal death. This study aimed to evaluate the clinical management of maternal deaths from sepsis in the Nordic countries and identify areas for improved clinical handling.</p><p><strong>Material and methods: </strong>We used data from the Nordic Maternal Mortality Collaboration including maternal deaths from the five Nordic countries from 2005 till 2021, identified through linked registers. The national audit groups assessed each maternal death based on hospital records and classified it according to cause and quality of management. We formulated learning points to improve future clinical care in cases of maternal sepsis.</p><p><strong>Results: </strong>In total, 267 maternal deaths were identified, equaling a maternal mortality rate of 5.9 per 100 000 live births (95% CI 5.25-6.62). Maternal sepsis accounted for 9.7% of the maternal deaths (n = 26), ranking sepsis the fifth leading cause. Nongenital sepsis and genital tract sepsis numbers were almost equal. Substandard care was identified in 57% of cases with nongenital infections, and in 83% of genital tract sepsis cases. Improvements in care that possibly could have influenced the outcome were noted in 29% and 67% of cases, respectively. In nongenital sepsis, delayed recognition of sepsis and delayed administration of antimicrobial therapy were the commonest elements in substandard care. Delayed recognition of sepsis, delayed administration of antimicrobial therapy, and postponed or lacking surgical source control were the main elements in substandard care of genital tract sepsis.</p><p><strong>Conclusions: </strong>In the Nordic countries, sepsis was the fifth leading cause of maternal deaths during 2005-2021. In one-third of maternal deaths from nongenital sepsis and two-thirds of maternal deaths from genital tract sepsis, clinical measures could have reduced the risk of fatal outcome, emphasizing the need for maximal awareness and improved clinical handling.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144564290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"External validation of the Fetal Medicine Foundation model for preterm pre-eclampsia prediction at 11-14 weeks in an Australian population.","authors":"Sofonyas Abebaw Tiruneh, Daniel Lorber Rolnik, Roshan Selvaratnam, Fabricio da Silva Costa, Andrew McLennan, Jon Hyett, Helena Teede, Joanne Enticott","doi":"10.1111/aogs.70002","DOIUrl":"https://doi.org/10.1111/aogs.70002","url":null,"abstract":"<p><strong>Introduction: </strong>Pre-eclampsia causes adverse maternal and perinatal complications and is preventable through early screening and aspirin treatment. This study evaluates the predictive performance of the Fetal Medicine Foundation first-trimester preterm pre-eclampsia competing risks model in an Australian population.</p><p><strong>Material and methods: </strong>This was a retrospective cohort study of prospectively collected multisite screening data and pregnancy outcomes between 2014 and 2017 in Australia. Individualized risk for preterm pre-eclampsia was calculated using the Fetal Medicine Foundation model at 11-14 weeks by using maternal factors, biophysical biomarkers (mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI)), and serum biochemical biomarkers (placental growth factor (PlGF) and/or pregnancy-associated plasma protein A (PAPP-A)). The predictive performance was evaluated using the area under the receiver-operating characteristic curve (AUC) and calibration. The detection rates for delivery with preterm pre-eclampsia were calculated at a 10% fixed false-positive rate. Decision curve analysis of the model was evaluated.</p><p><strong>Results: </strong>Of 29 609 women screened, 132 (0.45%) experienced preterm pre-eclampsia. The median age (interquartile range) was 34 (30-38) years. Women with pre-eclampsia had higher multiple of the median values of MAP and UtA-PI and lower values of PIGF and PAPP-A compared to those without pre-eclampsia. Combined screening by maternal factors, biophysical, and biochemical biomarkers yielded an AUC of 0.87 (95% CI 0.79-0.92), detecting 71% of preterm pre-eclampsia cases at 10% fixed false-positive rate, with the addition of PlGF improving the detection rate by 31% over sole PAPP-A use. Preterm pre-eclampsia screening using maternal factors with all biomarkers showed better clinical net benefit at preference thresholds between 1% and 12% compared to default strategies.</p><p><strong>Conclusions: </strong>The Fetal Medicine Foundation model, combining maternal factors with biophysical and biochemical biomarkers, demonstrated similar predictive performance in the Australian population compared to previous validation studies in other settings, detecting 71% of preterm pre-eclampsia cases at 10% fixed false-positive rate. The clinical utility analysis showed that early screening and intervention strategies based on a risk-based screening approach is more beneficial than universal or no intervention strategies.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144537730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A call for deeper insights into intramural pregnancy: An international data registry","authors":"Simrit Nijjar,&nbsp;Cecilia Bottomley,&nbsp;Davor Jurkovic","doi":"10.1111/aogs.70007","DOIUrl":"10.1111/aogs.70007","url":null,"abstract":"<p>Intramural pregnancy (IMP) is a rare and potentially life-threatening uterine ectopic pregnancy implanted within the myometrium. Despite its recognition as a distinct clinical entity, diagnostic challenges and a lack of standardized management protocols persist. IMP occurs when a gestational sac implants into the myometrium beyond the endometrial-myometrial junction, often following uterine trauma. Diagnosis is hindered by non-specific symptoms and frequent misclassification. While ultrasound is the primary diagnostic tool, magnetic resonance imaging (MRI) may be needed in unclear cases. Treatment options range from expectant management to surgical intervention, but no consensus exists on the optimal approach. To enhance understanding and improve clinical outcomes, we propose an international IMP registry to collect data on diagnosis, treatment, and fertility outcomes. This collaborative effort aims to inform evidence-based guidelines, facilitating accurate early diagnosis and optimized patient care.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":"104 8","pages":"1420-1423"},"PeriodicalIF":3.5,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.70007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144537727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differences in pain, bleeding, and satisfaction during medical abortion at very early gestations.","authors":"Frida Gyllenberg, Karin Brandell, Tagrid Jar-Allah, Helena Kopp Kallner, John Reynolds-Wright, Clare Boerma, Sharon Cameron, Helena Hognert, Oskari Heikinheimo, Janina Kaislasuo, Kristina Gemzell-Danielsson","doi":"10.1111/aogs.15177","DOIUrl":"https://doi.org/10.1111/aogs.15177","url":null,"abstract":"<p><strong>Introduction: </strong>Little is known regarding the impact of gestation on pain, bleeding duration, and satisfaction in early medical abortion (termination of pregnancy). This study aimed to determine if pain experience, bleeding duration, and overall satisfaction with medical abortion differed across four ultrasound-defined categories of early pregnancy.</p><p><strong>Material and methods: </strong>This is a secondary analysis of the multicenter VEMA-trial, a randomized clinical trial on the efficacy and safety of very early medical abortion before confirming pregnancy location (the VEMA-trial, EudraCT 2018-003675-35, ClinicalTrials.gov NCT03989869). The present study included participants with normally developing pregnancies and known abortion outcomes, including complete abortion, incomplete abortion, and ongoing pregnancy, that is, pregnancy still progressing after medical abortion. Participants were grouped by ultrasound findings at the time of abortion into pregnancy of unknown location, early, normally sited pregnancy (empty sac), and normally sited pregnancy with visible yolk sac or visible embryo. Pain experience was measured on the 0-10 numeric rating scale (higher values for more pain), duration of bleeding in days, and satisfaction on a 0-6 scale (higher values indicating greater satisfaction).</p><p><strong>Results: </strong>Altogether 1253 participants were included: 18% (224 participants) with pregnancy of unknown location, 38% (476) with early, normally sited pregnancy, 24% (301) with visible yolk sac, and 20% (252) with visible embryo. Pain scores were lowest in the pregnancy of unknown location group (mean 5.2 ± SD 2.3) and highest in the pregnancy with visible embryo group (6.2 ± 2.4). Bleeding duration was shortest for pregnancies of unknown location (4.9 ± 3.2) and longest for those with visible embryo (7.5 ± 5.3). Mean satisfaction was over 5 in all groups, highest in early, normally sited pregnancies (5.7 ± 0.7). In regression analyses, both pain scores and bleeding duration increased with advancing ultrasound findings. The pregnancy of unknown location group reported the least pain (1.02 points lower, 95% Confidence Interval [CI] -1.46 to -0.57) and the shortest bleeding duration (34% shorter, incidence rate ratio 0.66, 95% CI 0.61 to 0.71) compared to pregnancies with visible embryo.</p><p><strong>Conclusions: </strong>More advanced ultrasound findings are associated with higher pain scores and longer bleeding duration in very early medical abortion, whereas satisfaction is high across ultrasound-defined categories.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144537729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of childbirth experience over time-A prospective cohort study.","authors":"Susanne Hesselman, Wilma Sten, Yvonne Skogsdal, Anna Wikman, Frida Viirman","doi":"10.1111/aogs.70010","DOIUrl":"https://doi.org/10.1111/aogs.70010","url":null,"abstract":"<p><strong>Introduction: </strong>A woman's childbirth experience is multifaceted and has a great impact on not only the woman, but also the family's health and well-being. Changes in childbirth experience over time have been evaluated with a variety of instruments, at different time points, and with inconsistent findings. In Sweden, the rating of birth experience is routinely collected after birth, but it is still unknown which time point is preferred from a clinical perspective. The primary aim was to investigate changes in childbirth experience over time from childbirth to 6 months postpartum, assessed by both a single and a multi-item instrument. A secondary aim was to test the correlation between these instruments.</p><p><strong>Material and methods: </strong>In a prospective cohort study, 320 women were recruited from two Swedish hospitals. Study participants completed a survey at the maternity ward after giving birth, and again three and 6 months postpartum, rating their overall childbirth experience on a single item 10-point numeric rating scale (NRS) and a multi-item instrument, the Childbirth Experience Questionnaire 2 (CEQ2), encompassing four known dimensions of childbirth: Perceived safety, Own capacity, Participation and Professional support. Changes in childbirth experience (NRS and CEQ2) over time were analyzed using the Friedman test. NRS ratings were analyzed in relation to CEQ2 dimensions with Spearman's correlation.</p><p><strong>Results: </strong>Overall childbirth experience rated using NRS did not change over time. The total CEQ2 score decreased significantly from childbirth to 6 months postpartum (p < 0.001). This change was driven by decreased scoring of the domains Participation and Professional support. The correlations between NRS and CEQ scores were consistent over time, with a moderate to weak correlation of NRS with Participation and Professional support.</p><p><strong>Conclusions: </strong>Women perceive their birthing experience more negatively over time when assessed using the CEQ2 questionnaire, but this was not captured by a single-item question assessing overall childbirth experience.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144537728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A comparative study on infant growth between assisted reproductive technology pregnancy and natural pregnancy.","authors":"Anni Chen, Dongyang Wang, Yuyu Zhang, Qianqian Dai, Weixia Yang, Zixiao Zhou, Xuan Shi, Ziyue Zhou, Zijun Ni, Xun Zhuang","doi":"10.1111/aogs.15178","DOIUrl":"https://doi.org/10.1111/aogs.15178","url":null,"abstract":"<p><strong>Introduction: </strong>Globally, the number of assisted reproductive technology (ART) infants has surpassed 10 million, with its utilization steadily increasing. Numerous studies have shown that ART pregnancies are more prone to adverse pregnancy outcomes. ART infants are at a higher risk for adverse birth outcomes. However, the differences in growth between ART and natural pregnancy (NP) infants remain controversial. This study aims to explore differences in pregnancy outcomes, birth outcomes, and growth rates between ART and NP infants during the first year of life, and to analyze the association between ART and rapid growth.</p><p><strong>Material and methods: </strong>Birth records of the Nantong area, China, from January 2020 to June 2021 were extracted. A total of 29 886 pregnant women and 30 051 infants were included in the characteristic analysis. Based on the use of ART recorded in the database, the pregnant women and infants were categorized into ART and NP groups, with the NP serving as the control group. For the growth analysis, 29 447 singleton infants were included. Growth within 12 months was examined using the LMS method. The association between reproductive methods, perinatal sociodemographic characteristics, infant birth characteristics, and rapid growth was analyzed using GEE model. To further explore the association between ART and rapid growth, we performed subgroup analyses based on infants' sex, birth weight, and perinatal residence, which were statistically associated with rapid growth in the multivariate GEE model.</p><p><strong>Results: </strong>ART infants had higher rates of preterm birth (7.4% vs. 4.8%) and cesarean section (57.7% vs. 49.1%; p < 0.001 for both). Growth analysis displayed faster overall growth rates and higher rapid growth incidence in ART singleton infants. Multivariate GEE analysis showed that ART was associated with a higher incidence of rapid growth in both length (OR = 1.415, 95% CI: 1.316-1.521) and weight (OR = 1.236, 95% CI: 1.134-1.348).</p><p><strong>Conclusions: </strong>ART singleton infants demonstrated a greater likelihood of experiencing rapid growth, despite being at higher risk of SGA, and achieved growth trajectories comparable to NP singleton infants. The findings suggest that ART may not influence postnatal growth. These results underscore the importance of tailored clinical monitoring and interventions for ART infants to ensure optimal growth and long-term health.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144525951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metabolic associations of human placental lactogen in pregnancies at high metabolic risk: An observational cohort study.","authors":"Kate Rassie, Simon Alesi, Adriana C H Neven, Taitum Mason, Eveline Jona, Stacey J Ellery, Joanne Enticott, Aya Mousa, Anju E Joham, David Simmons, Helena Teede","doi":"10.1111/aogs.70000","DOIUrl":"https://doi.org/10.1111/aogs.70000","url":null,"abstract":"<p><strong>Introduction: </strong>Human placental lactogen (hPL) is a placental hormone which, according to preclinical research, appears to have key metabolic roles in pregnancy. We aimed to examine pregnancy hPL levels in relation to maternal metabolic parameters and fetal outcomes within an ethnically diverse cohort at high metabolic risk. Design was an observational cohort study, nested within a randomized controlled trial.</p><p><strong>Material and methods: </strong>Pregnant women (n = 130), recruited for high metabolic risk, underwent measurement of hPL, plus clinical and metabolic parameters, in early pregnancy (15.8 ± 2.5 weeks of gestation). Univariable and multivariable simple linear regression models were used to examine relationships between early pregnancy hPL and key maternal anthropometric and biochemical variables. Fifty-four women progressed to serial measurement of hPL and metabolic parameters across pregnancy. Univariable and multivariable mixed effects regression models were used to explore relationships between hPL and maternal variables across pregnancy, with repeated measures adjusted for using random effects.</p><p><strong>Results: </strong>In early pregnancy, lower hPL levels were independently associated with higher maternal fasting glucose (β = -1.03, p < 0.01). Early pregnancy hPL was not significantly related to maternal obesity, gestational diabetes mellitus (GDM), or polycystic ovary syndrome status. In women with GDM, sampled serially across pregnancy, maternal hPL and leptin levels were inversely associated (adjusted β = -0.098, p ≤ 0.001). There was a significant relationship between higher late pregnancy hPL and increased infant birthweight in the serially sampled GDM cohort, both before (β = 50.81, p = 0.01) and after (β = 41.78, p = 0.02) adjustment for gestational age at birth.</p><p><strong>Conclusions: </strong>Maternal hPL may play a role in maternal metabolic adaptation to pregnancy, particularly in relation to glucose and leptin dynamics. hPL in late pregnancy is positively associated with infant birthweight in women with GDM. Future studies of hPL in well-defined contemporary populations are warranted, both to understand mechanistic interactions in pregnancy and potentially as a biomarker for infant birthweight.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144482832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uterine volume assay after gonadotoxic therapies in childhood, adolescence, and young adulthood: A systematic review and Bayesian network meta-analysis.","authors":"Eloïse Fraison, Stephanie Huberlant, Mathilde Cavalieri, Aurore Gueniffey, Justine Riss, Christine Rousset-Jablonski, Blandine Courbiere","doi":"10.1111/aogs.70003","DOIUrl":"https://doi.org/10.1111/aogs.70003","url":null,"abstract":"<p><strong>Introduction: </strong>Uterine damage after pelvic radiotherapy or total-body irradiation is well described, with decreased uterine volume and high obstetrical morbidity. Some recent studies have reported a smaller uterus in child, adolescent, and young adult cancer survivors treated with chemotherapy only. This systematic review investigated the long-term effects of gonadotoxic therapy on uterine volume during childhood, adolescence, and young adulthood.</p><p><strong>Material and methods: </strong>Data sources were Medline, Embase, and the Cochrane Library databases from 1990 to April 2023 searched using the following search terms: cancer survivors, bone marrow transplantation, chemotherapy, radiotherapy, and uterine volume. Study selection and synthesis: Only comparative studies reporting uterine volume in adult women who had received chemotherapy and/or radiotherapy during childhood, adolescence, or young adulthood (<25 years) were included. Two independent reviewers performed study selection, bias assessment using the ROBINS-I tool, and data extraction. The main outcome was uterine volume (mL). A Bayesian network meta-analysis with meta-regression for parity and serious risk of bias was performed using a random-effects model.</p><p><strong>Results: </strong>After reviewing 2847 abstracts, four studies were selected for the meta-analysis. Uterine volume data were available for 225 women after chemotherapy, 153 women after chemoradiotherapy, and 257 control women without cancer. Uterine volume was significantly lower in the chemoradiotherapy group than in the control group (-29.2 mL [-49.1, -12.5]). Uterine volume was significantly decreased in the chemoradiotherapy group compared to the chemotherapy group (-20.9 mL [-39.1, -0.3]). The difference in the mean uterine volume between the control and chemotherapy groups was 8.2 mL [-11.8, 34.2] and was not significant.</p><p><strong>Conclusions: </strong>Our meta-analysis confirms the well-known data on chemoradiotherapy-induced uterine damage. Although some studies have suggested the potential impact of high doses of chemotherapy on uterine volume, this meta-analysis did not find any significant decrease in uterine volume after chemotherapy. This result could help counsel age-reproductive women and physicians who perform assisted reproductive technologies in long-term CAYA Cancer survivors.</p>","PeriodicalId":6990,"journal":{"name":"Acta Obstetricia et Gynecologica Scandinavica","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144482854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}