Frontiers in reproductive health最新文献

{"title":"Comparative machine learning analysis identifies random forest and adaboost as superior models for the evaluation of semen quality and reproductive hormones.","authors":"Shubhadeep Roychoudhury, Saurav Paul, Birupakshya Paul Choudhury, Sandipan Das, Kushal Kumar Kar, Ishani Bhattacharjee, Arun Paul Choudhury, Israel Maldonado Rosas, Saptarshi Paul","doi":"10.3389/frph.2026.1908391","DOIUrl":"https://doi.org/10.3389/frph.2026.1908391","url":null,"abstract":"<p><strong>Background: </strong>Semen analysis is a widely accepted laboratory investigation for evaluating male infertility. However, in cases of idiopathic or unexplained male infertility, comprehensive assessment may require blood-based profiling of a reproductive hormone panel-including follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), and testosterone-to clearly identify endocrine abnormalities that may contribute to infertility. These variables exhibit nonlinear dynamics and multidimensional interdependencies, presenting analytical challenges for conventional statistical approaches to detect subtle, latent patterns within such complex data. In contrast, advanced analytics such as machine learning (ML) algorithms enable robust modelling and interpretation of high-dimensional datasets.</p><p><strong>Methodology: </strong>Pre-processing of data included normalization and correlation analysis. Using a train-test split ratio of 80:20, nine ML algorithms-Linear Regression, Lasso Regression, Ridge Regression, Elastic Net, Random Forest, Support Vector Regression, Gradient Boosting, AdaBoost, and Neural Networks-were trained using cross-validation and hyperparameter optimization. Model performance was assessed using the coefficient of determination (R²), root mean square error (RMSE), and feature importance analysis.</p><p><strong>Results: </strong>Ensemble learning approaches consistently outperformed conventional regression models. AdaBoost achieved the highest predictive accuracy for sperm motility (R² = 0.993), while Gradient Boosting yielded superior predictions for progressive motility (R² = 0.932) and vitality (R² = 0.982). Random Forest demonstrated the strongest performance for semen volume (R² = 0.428), LH (R² = 0.432), and PRL (R² = 0.586). Conversely, predictions for seminal pH (R² = 0.037), liquefaction time (R² = 0.158), FSH (R² = 0.178), and testosterone (R² = -0.114) were limited. Feature importance analysis identified total sperm count, sperm concentration, non-progressive motility, morphology, and non-motile sperm percentage as the most influential predictors across models.</p><p><strong>Conclusions: </strong>Random Forest and AdaBoost emerged as the most effective and broadly applicable models for evaluating male reproductive parameters, whereas Gradient Boosting exhibited exceptional predictive capacity for select semen parameters.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"8 ","pages":"1908391"},"PeriodicalIF":3.1,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13490179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nuclear error phenotypes at the first mitosis predict cleavage-stage outcomes but not blastocyst competence.","authors":"Emma Adolfsson, Amanda Stenberg, Juliane Baumgart","doi":"10.3389/frph.2026.1905720","DOIUrl":"https://doi.org/10.3389/frph.2026.1905720","url":null,"abstract":"<p><strong>Background: </strong>Nuclear errors (NE) observed at the two-cell stage reflect early mitotic disturbances, but their clinical relevance for embryo implantation and live birth remains un-clear. We investigated whether nuclear status at the two-cell stage predicts pregnancy and live birth outcomes following cleavage-stage and blastocyst transfer.</p><p><strong>Methods: </strong>This retrospective cohort study included 3,793 single embryo transfers with clinical outcomes performed at a university-affiliated reproductive medicine centre. Embryos were retrospectively assessed at the two-cell stage and classified as normal or exhibiting nuclear errors, further stratified by the number of affected blastomeres and by phenotype (multinucleation, micronucleation, split nuclei, or mixed errors). Live birth rate (LBR) was the primary outcome; pregnancy and clinical pregnancy rates were secondary outcomes. Associations were evaluated using contingency analyses, regression models of nuclear error occurrence, and mixed-effects logistic regression analyses of clinical outcomes adjusted for maternal age, paternal age, fertilisation method, and patient-level clustering.</p><p><strong>Results: </strong>NE occurred in 24% of transferred embryos and were more frequent after ICSI than IVF (adjusted OR 1.74). In cleavage-stage transfers, NE were associated with reduced LBR compared with embryos without NE (23.2% vs. 34.8%). The clinical outcomes decreased with increased numbers of affected blastomeres. Micronucleation and split nuclei showed the poorest outcomes and remained adversely associated with reproductive outcomes after adjustment, whereas multinucleation was not detrimental. No association between NE and outcomes was observed after blastocyst transfers.</p><p><strong>Conclusions: </strong>Nuclear error phenotypes at the two-cell stage provided prognostic information relevant for cleavage-stage embryo transfer but had limited influence for blastocyst selection. Outcome differences associated with early nuclear abnormalities were no longer detectable among transferred blastocysts.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"8 ","pages":"1905720"},"PeriodicalIF":3.1,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13490168/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preconception care utilisation among women of reproductive age in Ghana: using Andersen's behavioural model.","authors":"Amidu Alhassan, Boahemaa Adu Otchere, Godswill Sedinam Lanyo, Frederick Acheampong Nimo, Mildred Awinpiini Asore, Justice Enock Kagbo, Bernard Nabe, Edward Odoom, William Akoto-Buabeng, Jerry John Ouner, Mustapha Amoadu, Patience Fakornam Doe","doi":"10.3389/frph.2026.1874979","DOIUrl":"https://doi.org/10.3389/frph.2026.1874979","url":null,"abstract":"<p><strong>Background: </strong>Preconception care is an essential reproductive health intervention aimed at reducing preventable maternal and neonatal risks. Despite its significance, utilisation in low- and middle-income settings remains low. This study examined determinants of PCC utilisation among women of reproductive age in Ghana, applying Andersen's Behavioural Model.</p><p><strong>Methods: </strong>A descriptive cross-sectional design was used, involving 464 women aged 15-49 years in the Koforidua Municipality. Data were collected through structured questionnaires and analysed with descriptive statistics, Chi-square tests, and hierarchical logistic regression using Jamovi version 2.7.23.</p><p><strong>Results: </strong>The study found a PCC utilisation rate of 69.4%. Younger women were less likely to use PCC, with those aged 21-25 years (AOR = 0.03; <i>p</i> = 0.024) to 36-40 years (AOR = 0.01; <i>p</i> = 0.005) showing lower odds compared with women under 20 years. Ethnicity strongly influenced utilisation, with Akan (AOR = 6.94; <i>p</i> < 0.001), Ewe (AOR = 5.65; <i>p</i> = 0.007), and Ga (AOR = 5.10; <i>p</i> = 0.048) women having higher odds. Women with no formal education were less likely to utilise PCC (AOR = 0.09; <i>p</i> = 0.049), while those receiving counselling (AOR = 5.15; <i>p</i> < 0.001) or exposed to radio campaigns (AOR = 3.30; <i>p</i> = 0.003) had increased odds.</p><p><strong>Conclusion: </strong>PCC utilisation in Ghana was moderate and associated with sociodemographic, informational, and health-system factors. Strengthening provider counselling, community-based health education, and consideration of PCC within national reproductive health financing strategies may help improve uptake.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"8 ","pages":"1874979"},"PeriodicalIF":3.1,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13487740/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determinants of antenatal care service satisfaction among pregnant women at Kawaala Health Centre IV, Kampala City: a cross-sectional analytical study.","authors":"Elizabeth Nshabohurira, Eliot Namanya, Ronald Omolo Ouma, Eleanor Turyakira, Patience Amutuhaire, Scovia G Mbabazi, Nathan Mugenyi, Pauline Byakika-Kibwika","doi":"10.3389/frph.2026.1864242","DOIUrl":"https://doi.org/10.3389/frph.2026.1864242","url":null,"abstract":"<p><strong>Background: </strong>Antenatal care (ANC) in developing countries is among strategies aimed at reducing maternal mortality yet its quality and utilization are still low. Only about 60% of pregnant mothers in Uganda attend at least four ANC visits despite it being one of the strategies to curtail maternal mortality. The satisfaction of pregnant mothers with ANC services is associated with increasing their access and utilization. Therefore, there is need to evaluate the extent to which pregnant mothers are satisfied with ANC services and the associated factors.</p><p><strong>Methods: </strong>A cross-sectional analytical study employing quantitative methods of data collection and analysis was conducted. Data was collected from 384 participants using interviewer administered semi structured questionnaires. Bivariate analysis using the Pearson chi-square (<i>χ</i>2) test was conducted to determine the individual and health facility factors associated with satisfaction with ANC services among pregnant women. Multivariate analysis was performed on the variables that were statistically significant (<i>p</i> < 0.05) at bivariate analysis using logistic regression model to control confounding and determine independent factors associated with satisfaction with ANC services among pregnant women.</p><p><strong>Results: </strong>Of the 384 pregnant women enrolled, 259 (67.4%) were satisfied with ANC services. Multivariable logistic regression analysis revealed that knowledge about ANC services (AOR=4.2, 95% CI: 2.23-7.81; <i>p</i> < 0.001), waiting time of less than one hour (AOR=2.8, 95% CI: 1.30-5.99; <i>p</i> = 0.009), positive attitude of healthcare providers (AOR=5.9, 95% CI: 3.13-11.25; <i>p</i> < 0.001), and availability of ANC commodities (AOR=3.0, 95% CI: 1.53-6.06; <i>p</i> = 0.002) were independently associated with satisfaction with ANC services.</p><p><strong>Conclusion: </strong>Improving maternal knowledge on ANC services, reducing waiting times, ensuring availability of essential ANC commodities, and promoting respectful provider-client interactions may enhance women's satisfaction with ANC services. Strengthening these aspects of care could improve ANC utilization and contribute to better maternal health outcomes.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"8 ","pages":"1864242"},"PeriodicalIF":3.1,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13485749/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Free but declining: the paradox of contraceptive uptake in Burkina Faso.","authors":"Marie-Jeanne Offosse, Tozé Namalela, Obasanjo Bolarinwa, Awa Yanogo, Yeri Traoré, Aduragbemi Banke-Thomas","doi":"10.3389/frph.2026.1819570","DOIUrl":"https://doi.org/10.3389/frph.2026.1819570","url":null,"abstract":"<p><strong>Introduction: </strong>In 2020, Burkina Faso expanded its national user fee exemption policy to include family planning services, with the objective of reducing financial barriers and increasing uptake of modern contraceptive methods. This study assesses the national and subnational trends in modern contraceptive uptake before and after the user fee exemption policy amongst women of reproductive age (WRA) in Burkina Faso.</p><p><strong>Methods: </strong>To achieve this objective, we collected routine health facility and demographic data spanning the pre-intervention period (2016-2018) and the post-intervention period (2021-2024). Mixed-effects linear models examined district-level variations in modern contraceptive uptake, while descriptive analyses explored group differences and temporal trends in contraceptive uptake among WRA between 2021 and 2024.</p><p><strong>Results: </strong>At the national level, overall contraceptive uptake (all methods) declined by 3.26 percentage points between the pre- and post-policy periods (<i>p</i> < 0.01). The largest reductions were observed in Boucle du Mouhoun (-9.49 percentage points), Sahel (-8.6 percentage points), and Nord (-6.75 percentage points) regions (all <i>p</i> < 0.01). In the post-implementation period, modern contraceptive uptake among WRA declined by 3.6 percentage points nationally, with downward trend observed across all age groups but more pronounced among adult women. Modern contraceptive uptake among adult women declined by 4.5 percentage points, from 24.1% in 2021 to 19.6% in 2024. In contrast, adolescents experienced a smaller decline of 0.7 percentage points, from 16.3% to 15.6% over the same period (<i>p</i> < 0.01). Amongst women who sought care in health facilities in stable areas, modern contraceptive uptake declined by 3.4 percentage while security-challenged areas experienced a slightly higher decline of 3.6 percentage points, from 24.0% to 20.6% (<i>p</i> < 0.01). Similarly, facilities in urban areas experienced a lower decline (-1.1 percentage points) in modern contraceptive uptake compared to those in rural area (-5.2 percentage points (<i>p</i> < 0.01). Nearly one-third of health facilities reported stock-outs exceeding three months for some methods.</p><p><strong>Conclusion: </strong>The removal of user fees for family planning services in Burkina Faso was insufficient to reverse declining modern contraceptive uptake with adult women and those living in rural and conflict-affected areas benefiting least. These findings highlight the need for complementary non-financial strategies to improve potential gains of the user fee exemption policy.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"8 ","pages":"1819570"},"PeriodicalIF":3.1,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13485707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The value of anti-Mullerian hormone for diagnosing polycystic ovary syndrome in adolescents: a case-control study based on an epidemiological survey.","authors":"Yu Hong, Enping Li, Dongzi Yang, Zehong Zhou, Zhe Dong","doi":"10.3389/frph.2026.1907699","DOIUrl":"https://doi.org/10.3389/frph.2026.1907699","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Updated 2023 international evidence-based guidelines do not recommend anti-Müllerian hormone (AMH) for diagnosing adolescent polycystic ovary syndrome (PCOS, also newly termed polyendocrine metabolic ovarian syndrome [PMOS]) due to limited specificity. Physiological multifollicular ovaries are prevalent in teenagers, and existing studies show massive heterogeneity in participant age, BMI, AMH detection platforms and cut-off thresholds without unified adolescent-specific standards. This study aimed to analyze serum AMH correlations with core adolescent PCOS phenotypes and evaluate the auxiliary diagnostic performance of AMH for adolescent PCOS.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Based on a cross-sectional school-based epidemiological survey among adolescent girls aged 14-18 years, we enrolled 211 healthy girls, 158 girls with oligo-/amenorrhea, 38 girls with isolated clinical hirsutism, 51 girls with isolated biochemical hyperandrogenemia, and 39 adolescent PCOS patients for case-control analysis. Pearson's correlation coefficients were calculated to determine the correlations between AMH and various parameters. Receiver Operating Characteristic (ROC) curve analysis was performed to examine the diagnostic performance of AMH.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Serum AMH concentrations were significantly higher in girls with oligo-/amenorrhea and isolated biochemical hyperandrogenemia relative to healthy controls (&lt;i&gt;P&lt;/i&gt; &lt; 0.05), while isolated hirsutism presented comparable AMH levels with controls (&lt;i&gt;P&lt;/i&gt; &gt; 0.05). Adolescent PCOS patients had the highest AMH levels among all subgroups (&lt;i&gt;P&lt;/i&gt; &lt; 0.05). AMH was positively correlated with all circulating androgen markers (T, FAI, A2, fT, DHEAS) but showed no correlation with age, menarcheal age, gynecological age, BMI, WHR or SHBG. Within the PCOS cohort, only serum testosterone maintained an independent positive correlation with AMH (r = 0.450, &lt;i&gt;P&lt;/i&gt; = 0.004). ROC analysis showed an AUC of AMH for adolescent PCOS of 0.717 (95%CI: 0.625-0.809, &lt;i&gt;P&lt;/i&gt; &lt; 0.001). Bootstrap-validated optimal AMH cut-off value was 4.0 ng/mL, with sensitivity 51.3% (95CI: 35.4%-67.2%) and specificity 86.1% (95CI: 81.2%-90.0%). &lt;i&gt;post-hoc&lt;/i&gt; power analysis demonstrated moderate statistical power of 0.74 for this ROC model due to limited PCOS sample size (&lt;i&gt;n&lt;/i&gt; = 39).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Serum AMH is closely correlated with two core diagnostic manifestations of adolescent PCOS: ovulatory dysfunction and biochemical hyperandrogenemia. Nevertheless, the low sensitivity of the 4.0 ng/mL threshold leads to nearly half missed PCOS cases if used alone for screening. Combined with inherent incorporation bias, absence of ovarian ultrasound data and consistent 2023 guideline recommendations, AMH can only serve as an adjunctive auxiliary biomarker rather than an independent diagnostic or screening tool for adolescent PCOS. Multicenter studies with standardized ovarian ultrasono","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"8 ","pages":"1907699"},"PeriodicalIF":3.1,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13481504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148802515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disability and sexual and reproductive health outcomes among women in Cambodia: a cross-sectional analysis of the 2021-22 demographic and health survey.","authors":"Mariko Fukao, Haruka Sakamoto, Su Myat Han, Sayaka Horiuchi, Hanako Iwashita, Samith Mey, Shuhei Nomura","doi":"10.3389/frph.2026.1897583","DOIUrl":"https://doi.org/10.3389/frph.2026.1897583","url":null,"abstract":"<p><strong>Background: </strong>Women with disabilities may face communication, autonomy-related, provider-level, and structural barriers to sexual and reproductive health (SRH) services. Population-based evidence from low- and middle-income countries remains limited, particularly by functional domain.</p><p><strong>Objective: </strong>To examine associations between disability and contraceptive knowledge, unmet need for family planning, and unintended pregnancy among women in Cambodia.</p><p><strong>Methods: </strong>We analysed data from 19,485 women aged 15-49 years who participated in the 2021-22 Cambodia Demographic and Health Survey. Disability was measured using the Washington Group Short Set and classified by severity and functional domain. Knowledge of modern contraception was assessed among all women, unmet need among currently married or cohabiting women, and unintended pregnancy among currently married or cohabiting women with a recent live birth. Survey-weighted logistic regression was used to estimate crude and adjusted odds ratios, adjusting for age, education, wealth, residence, and marital status where applicable. Additional analyses examined functional-domain associations and stratified unintended pregnancy by age, education, and wealth.</p><p><strong>Results: </strong>Overall, 16.5% of women reported at least some functional difficulty, including 1.0% with severe disability. Severe disability was associated with lower adjusted odds of knowing a modern contraceptive method (adjusted odds ratio 0.13, 95% confidence interval 0.06-0.29). Among currently married or cohabiting women, severe disability was associated with higher adjusted odds of unmet need for family planning (adjusted odds ratio 1.93, 95% confidence interval 1.06-3.49). Among married or cohabiting women with a recent live birth, mild disability was associated with higher adjusted odds of unintended pregnancy (adjusted odds ratio 1.37, 95% confidence interval 1.05-1.79); for severe disability, the confidence interval included the null (adjusted odds ratio 1.42, 95% confidence interval 0.39-5.18). Functional-domain analyses suggested lower knowledge and higher unintended pregnancy among women with communication, hearing, remembering/concentrating, or self-care difficulties. In descriptive stratified analyses, disability-related differences in unintended pregnancy were more pronounced among older women, women with less than primary education, and women in the poorest wealth quintile.</p><p><strong>Conclusions: </strong>Disability-related SRH inequities in Cambodia vary by outcome, severity, and functional domain. Family-planning services should address communication access, supported decision-making, provider competence, privacy, and socioeconomic barriers.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"8 ","pages":"1897583"},"PeriodicalIF":3.1,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13472998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148762451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Threatened preterm labor in Japan: an evidence-practice gap in diagnosis, tocolysis, and guideline implementation.","authors":"Katsuaki Inami","doi":"10.3389/frph.2026.1883392","DOIUrl":"https://doi.org/10.3389/frph.2026.1883392","url":null,"abstract":"<p><p>Preterm birth remains a major perinatal challenge, and management of women presenting with symptoms suggestive of early labor can shape admission, monitoring, medication use, and transfer pathways. In contemporary international practice, threatened preterm labor is generally managed within a risk-stratified framework, and tocolysis is used mainly for short-term obstetric purposes such as antenatal corticosteroid completion, maternal transfer, and fetal neuroprotection. In Japan, however, threatened preterm labor has often been diagnosed across a relatively broad clinical spectrum and managed with prolonged inpatient observation, bed rest, and extended ritodrine-based tocolysis. This review examines that pattern as a policy and practice problem rather than a narrow therapeutic controversy. It argues that the Japanese approach reflects a persistent evidence-practice gap involving broad diagnostic labeling, limited evidence supporting routine maintenance ritodrine, heterogeneous real-world practice, and guideline wording that remains more permissive than prohibitive. The available literature does not support prolonged maintenance ritodrine as routine care, while associations with maternal and neonatal safety concerns have been increasingly reported. Persistence is interpreted as potentially related to diagnostic breadth, institutional routines, limited therapeutic pathways, and uncertainty about de-escalation, not as evidence of a single cultural or medico-legal cause. This review proposes clearer negative recommendations on prolonged maintenance ritodrine, stronger diagnostic precision, and operational protocols that distinguish high-risk women requiring inpatient care from lower-risk women suitable for reassessment, treatment reduction, or outpatient follow-up.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"8 ","pages":"1883392"},"PeriodicalIF":3.1,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13468797/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148763539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypertensive disorders of pregnancy in the United Arab Emirates.","authors":"Ayatullah Hegazy, Minat Allah Alhusami, Ruzaina Sait, Komal Sundeep Hazari, Deemah Harab, Widad Abdelkareem, Muna Tahlak, Fadi Mirza, Lisa Jackson, Yrsa Bergmann Sverrisdottir, William Atiomo, Amar Khamis, Aida J Azar","doi":"10.3389/frph.2026.1866855","DOIUrl":"https://doi.org/10.3389/frph.2026.1866855","url":null,"abstract":"<p><p>Hypertensive disorders of pregnancy (HDP), including chronic hypertension, gestational hypertension, pre-eclampsia, eclampsia, and HELLP syndrome, are major contributors to adverse maternal and neonatal outcomes. However, epidemiological data from the United Arab Emirates (UAE) remain limited. This study aimed to investigate the prevalence and clinical characteristics of HDP in a large tertiary center, providing evidence from an underrepresented region and a basis for future studies. This six-year retrospective cohort study (2018-2023) was conducted at a tertiary referral center in Dubai, UAE. HDP cases were identified from electronic medical records using ICD-9/10 codes among all deliveries. Maternal and neonatal outcomes were compared by HDP status and World Health Organization (WHO) regions. Multivariate logistic regression was used to identify factors independently associated with HDP. <i>P</i> < 0.05 was considered significant. Among 21,415 deliveries, HDP prevalence was 4.7% (<i>n</i> = 1,011), while pre-eclampsia prevalence was 2.3%. In multivariable logistic regression, increasing maternal age [OR 1.10 (1.08-1.12)], BMI [OR 1.06 (1.05-1.07)], diabetes [OR 2.31 (1.78-3.00)], renal disease [OR 5.41 (3.12-9.36)], and origin from the Western Pacific Region [OR 1.94 (1.46-2.58)] were independently associated with HDP. Increasing gravidity was associated with lower odds of HDP [OR 0.90 (0.87-0.93)]. Women with HDP delivered earlier, had lower Apgar scores, and had more caesarean delivery. No significant difference in HDP prevalence occurred between UAE nationals and non-UAE nationals. HDP prevalence varied across WHO regions, ranging from 4.3% in the South-East Asian region to 9.1% in the Western Pacific region. In this large multi-ethnic UAE cohort, HDP affected 4.7% of pregnancies and showed regional variation. This study provides one of the first UAE-based estimates of HDP prevalence. Despite prevalence within global estimates, HDP remains a significant public health burden. Strengthened screening and preventive strategies are needed to improve maternal and neonatal outcomes.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"8 ","pages":"1866855"},"PeriodicalIF":3.1,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13469279/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148762925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Platelet-rich plasma and folliculogenesis: a systematic mechanistic review and computational pathway analysis.","authors":"Adamantia Kontogeorgi, George-Konstantinos Papaioannou, Fanourios Makrygiannakis, Ioannis Boutas, Antonis Makrigiannakis, Sophia N Kalantaridou","doi":"10.3389/frph.2026.1883067","DOIUrl":"https://doi.org/10.3389/frph.2026.1883067","url":null,"abstract":"<p><strong>Introduction: </strong>Platelet-rich plasma (PRP) has been proposed as a potential intervention for promoting ovarian follicular development. However, its underlying biological mechanisms remain unclear. This study investigated whether the mechanisms through which PRP may influence follicular development are consistent with previously established regulatory mechanisms of human folliculogenesis.</p><p><strong>Methods: </strong>A systems biology approach was used to examine the mechanistic relationships between growth factors present in PRP and known regulators of human follicular development. Gene databases were compared, and pathway enrichment analysis and integrated network modeling were performed to identify shared signaling pathways and patterns of molecular connectivity.</p><p><strong>Results: </strong>Although there was limited overlap between the two gene databases, substantial convergence was observed in pathway enrichment and integrated network modeling. This convergence involved receptor tyrosine kinase-centered intracellular signaling pathways, particularly the PI3K-AKT and MAPK pathways. Network topology demonstrated coherent connectivity between extracellular growth factors and established survival and proliferation signaling axes. However, no overlap was identified between genes associated with PRP and genes encoding oocyte-specific transcriptional regulators involved in primordial follicle formation and differentiation.</p><p><strong>Discussion: </strong>These findings support a model in which PRP does not replace the endogenous transcriptional program governing follicular development. Instead, PRP may increase upstream growth factor signaling and enhance intrinsic survival and proliferation pathways within the ovarian microenvironment. This systems-level framework provides mechanistic insight into the biological plausibility of PRP use in reproductive medicine and offers a rational basis for targeted experimental validation.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"8 ","pages":"1883067"},"PeriodicalIF":3.1,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13468918/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148766017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}