Frontiers in reproductive health最新文献

{"title":"Development and temporal validation of a prediction model for live birth in infertile women with polyendocrine metabolic ovarian syndrome: a retrospective cohort study.","authors":"Peng Liu, Shuhong Wang, Yubo Lu, Hanbing Jia, Yue Geng, Cuijuan Cao, Le Han, Yingjie Zhou","doi":"10.3389/frph.2026.1891181","DOIUrl":"10.3389/frph.2026.1891181","url":null,"abstract":"<p><strong>Objective: </strong>To develop and temporally validate a prediction model for delivery of a live-born infant within 365 days after the initial infertility consultation in infertile women with a documented diagnosis of polycystic ovary syndrome (PCOS), which was renamed in 2026 as polyendocrine metabolic ovarian syndrome (PMOS), using routine clinical and basal endocrine variables.</p><p><strong>Methods: </strong>This single-center retrospective cohort study included infertile women with a documented diagnosis of PCOS and an index date between December 1, 2021, and December 31, 2024. The index date was the first infertility consultation at which baseline clinical assessment and basal endocrine testing were completed. Patients were assigned to the development cohort (December 1, 2021-December 31, 2023) or the same-center temporal validation cohort (January 1-December 31, 2024). Outcome ascertainment ended on December 31, 2025. Multivariable logistic regression was used to predict delivery of a live-born infant within 365 days under routine individualized care.</p><p><strong>Results: </strong>Among 610 women, 389 were in the development cohort and 221 in the temporal validation cohort. Live-birth proportions within 365 days were 44.7% and 44.3%, respectively. Complete-case model development and validation included 349 and 203 women, respectively. The final model included age, body mass index, infertility duration, gravidity, luteinizing hormone/follicle-stimulating hormone ratio, tubal/pelvic factors, and uterine factors. Older age (OR = 0.91, 95% CI: 0.85-0.98), higher body mass index (OR = 0.92, 95% CI: 0.86-0.98), longer infertility duration (OR = 0.85, 95% CI: 0.77-0.94), higher luteinizing hormone/follicle-stimulating hormone ratio (OR = 0.71, 95% CI: 0.55-0.91), and uterine factors (OR = 0.37, 95% CI: 0.15-0.80) were associated with lower live-birth probability. The AUCs were 0.735 and 0.738, and the Brier scores were 0.208 and 0.205, respectively.</p><p><strong>Conclusion: </strong>This model showed moderate discrimination and acceptable calibration for predicting delivery of a live-born infant within 365 days after initial infertility consultation. Multicenter external validation and impact studies are needed before broader clinical application.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"8 ","pages":"1891181"},"PeriodicalIF":3.1,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13457464/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714619","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":"Exploring the role of group support models for HIV prevention among adolescent girls and young women (AGYW) in sub-Saharan Africa (SSA): a scoping review.","authors":"Faith Mary Musvipwa, Buhle Lubuzo, Mosa Julia Letsielo, Roisin Elizabeth Drysdale, Elmari Briedenhann, Catherine Elizabeth Martin, Saiqa Mullick","doi":"10.3389/frph.2026.1892424","DOIUrl":"10.3389/frph.2026.1892424","url":null,"abstract":"<p><strong>Background: </strong>Adolescent girls and young women (AGYW) remain disproportionately affected by HIV, particularly in sub-Saharan Africa (SSA), where most AGYW living with HIV reside. Although group-based support interventions have been introduced to improve HIV prevention outcomes, evidence on how these models are structured and their effectiveness for AGYW remains limited. This scoping review mapped and synthesised evidence on group support interventions for HIV prevention among AGYW in SSA, with a focus on pre-exposure prophylaxis (PrEP) uptake, adherence, and retention in care.</p><p><strong>Methods: </strong>A scoping review was conducted between September and November 2024 following established methodological guidance. Group support models were defined as structured or semi-structured interventions that bring AGYW together to provide peer support, HIV and sexual and reproductive health education, psychosocial support, and skills-building to improve HIV prevention outcomes. Peer-reviewed qualitative, quantitative, and mixed-methods studies were searched across four databases using keywords. Grey literature was excluded. Data were charted and analysed thematically to map and synthesize evidence on group support interventions.</p><p><strong>Results: </strong>The initial search yielded 1,901 results after 62 duplicates were removed. 40 papers were eligible. Following title/abstract and full-text screening, 11 studies met the inclusion criteria. Full-text articles were excluded because they did not meet the target population criteria (<i>n</i> = 5), lacked focus on group support models (<i>n</i> = 12), were irrelevant to study outcomes (<i>n</i> = 10), or were not behavioural/health-related studies (<i>n</i> = 2). Group-based HIV prevention models commonly included peer-led support, HIV and sexual and reproductive health education, psychosocial support, mentorship or buddy systems, communication and negotiation skills-building, and PrEP adherence discussions. Across studies, these interventions were reportedly associated with improved HIV prevention knowledge, increased PrEP uptake and early adherence, stronger motivation to remain engaged in care, reduced stigma, improved social support, and greater confidence in sexual health decision-making. The findings suggest that group support models may help address social, cultural, and gender-related barriers to HIV prevention by creating supportive and empowering spaces for AGYW. However, evidence on long-term PrEP adherence, retention in care, scalability, sustainability, cost-effectiveness, and comparative effectiveness of different approaches was limited. Few studies reported objective adherence outcomes or longer-term HIV prevention impacts.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"8 ","pages":"1892424"},"PeriodicalIF":3.1,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13454023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148708741","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":"Prevalence, patterns, and associated factors of intraperitoneal adhesions among women undergoing gynaecological laparoscopy at a private endoscopic centre in Southeastern Nigeria.","authors":"Onyecherelam Monday Ogelle, Lazarus Ugochukwu Okafor, Gbenga Olorunfemi, Martin C Andeh, John Chukwuebuka Nkesi, Chukwunonso Isaiah Enechukwu, Ifeanyi O J Okonkwo, Chijioke Ogomegbulam Ezeigwe, Josephat Chukwudi Akabuike, Alexander A Mathias, Wellington-Joseph N Ogelle, Ayotunde T Adeyinka, Olatunde O Alabi, Julian Mthombeni, Chidimma M Okeke, Emmanuel C Ogelle, Toochukwu B Ejikeme, Christian G Ikpeze, Chukwuemeka Okoro, Emmanuel Chukwubuikem Egwuatu, Vincent C Ani, George Uchenna Eleje, Ikechukwu I Mbachu, Joseph O Ugboaja, Anthony O Igwegbe, Nnabuike C Ngene","doi":"10.3389/frph.2026.1880168","DOIUrl":"10.3389/frph.2026.1880168","url":null,"abstract":"<p><strong>Background: </strong>Intraperitoneal adhesions are a major cause of chronic pelvic pain, infertility, tubal ectopic pregnancy, intestinal obstruction and increased surgical time globally<b>.</b></p><p><strong>Objective: </strong>To determine the prevalence, pattern and factors associated with intraperitoneal adhesions among women undergoing laparoscopy in a private hospital in Southeastern Nigeria.</p><p><strong>Methods: </strong>We conducted a retrospective analytical cross-sectional study involving women who underwent laparoscopy at a private endoscopic centre. Sociodemographic and clinical characteristics, indications, surgical history, indications for laparoscopy, and intraoperative findings were extracted from the medical records. Peritoneal adhesion index (PAI) scores were calculated for each patient; descriptive and bivariate analyses were conducted.</p><p><strong>Results: </strong>A total of 384 women were included. The mean age was 34.89 ± 6.69 years, and the median parity was 0 (IQR: 0-1). Most of the women had endoscopy on account of infertility (<i>n</i> = 307, 79.95%). The prevalence of intraperitoneal adhesions in the cohort was 49.22% (95% CI: 44.23% to 54.23%; <i>n</i> = 189/384), while the prevalence among women with previous surgery was 72.90% (<i>n</i> = 78/107). Among women who had adhesions (<i>n</i> = 189), the median PAI score was 6 (3-12) out of a total score of 30. The prevalence of adhesions was higher among women with primary infertility compared to women with secondary infertility (<i>p</i> = 0.013). Previous abdominal surgery, type of surgery, and surgical indication were also significantly associated with adhesion formation (<i>p</i> < 0.05).</p><p><strong>Conclusion: </strong>Nearly half of the women undergoing laparoscopy had intraperitoneal adhesions. Targeted preventive strategies, including minimally invasive surgical approaches and improved reproductive health services, are essential to reduce adhesion-related morbidity. Factors predictive of intraperitoneal adhesions will assist with patient counselling, choice of therapy and optimal operative planning.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"8 ","pages":"1880168"},"PeriodicalIF":3.1,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13447415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148690438","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":"Evaluation of vision transformers and vision foundation models for sperm morphology analysis.","authors":"Rawan AlSaad, Shima Albasha, Hasan Burjaq, Moza AlBader, Rajat Thomas","doi":"10.3389/frph.2026.1883326","DOIUrl":"10.3389/frph.2026.1883326","url":null,"abstract":"<p><strong>Background: </strong>Sperm morphology assessment is an essential but highly variable component of semen analysis, influenced by staining, image quality, acquisition conditions, and observer interpretation. Modern pretrained visual encoders may improve the objectivity and reproducibility of this assessment, but their performance and robustness in sperm morphology analysis remain insufficiently characterized.</p><p><strong>Objectives: </strong>To compare vision transformers and vision foundation models with established pretrained CNNs for sperm morphology classification; assess the effect of adaptation strategy; and evaluate performance consistency across image sources, generalization to unseen datasets, and the morphological relevance of model attributions.</p><p><strong>Methods: </strong>We evaluated binary normal-versus-abnormal sperm morphology classification using 7,770 microscopy images (1,253 normal and 6,517 abnormal sperm images) obtained from three independent institutional sources and representing abnormalities of the sperm head, neck/midpiece, and tail. Ten pretrained vision transformers and vision foundation-models spanning supervised, self-supervised, masked-image, and vision-language pretraining were evaluated using linear probing, light fine-tuning, and full fine-tuning. Five pretrained CNNs served as reference baselines. Primary analyses used source-stratified training, validation, and test partitions within each dataset to assess pooled performance, source-specific performance, and class-specific recall. Secondary analyses evaluated generalization to completely unseen datasets through leave-one-source-out validation and examined model attribution patterns using architecture-appropriate explainability methods.</p><p><strong>Results: </strong>SigLIP2 with full fine-tuning and ConvNeXt-Tiny achieved comparable weighted F1 scores (0.958 and 0.955, respectively), while BEiT with full fine-tuning and SigLIP2 with light fine-tuning achieved the highest ROC-AUC (0.982). SigLIP2 with full fine-tuning also produced the highest equal-weight cross-source macro-F1 (0.91) and normal-class recall (0.91). External generalization varied markedly across held-out image sources, with DINOv2 under full fine-tuning achieving ROC-AUCs ranging from 0.654 to 0.928 across the three external evaluations. Explainability analyses generally localized predictions to sperm-related structures.</p><p><strong>Conclusions: </strong>Pretraining strategy, adaptation depth, and dataset shift substantially influenced performance. Vision transformers and vision foundation models demonstrated strong potential for AI-assisted sperm morphology assessment, supporting their further development as scalable tools to improve the objectivity, consistency, and efficiency of semen analysis.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"8 ","pages":"1883326"},"PeriodicalIF":3.1,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13442368/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148686803","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":"Endometrial thickness evaluation with ultrasonography assessment among normal and endometrial cancer across multi-ethnic Indonesian women.","authors":"Andi Darma Putra, Aldi Tamara Rahman, Naufal Syafiq Darmawan, Lasmini Syariatin, Firda Puspita","doi":"10.3389/frph.2026.1826142","DOIUrl":"10.3389/frph.2026.1826142","url":null,"abstract":"<p><strong>Introduction: </strong>Endometrial thickness is a crucial indicator for reproductive health evaluation and initial detection of abnormalities. This study aims to comprehensively characterize and evaluate the endometrium in normal and cancer of Indonesian women using ultrasonography.</p><p><strong>Methods: </strong>This retrospective investigation analyzed ultrasound data from three hospitals during 2021-2024 in women who met predefined inclusion criteria. Subjects were classified according to age, ethnicity, menopausal status, and ultrasound-based examination category.</p><p><strong>Results and discussion: </strong>Endometrial thickness was quantified in 170 women with normal gynecological result and 82 women with histopathologically confirmed endometrial cancer. The average age of the normal group was 40.63 ± 0.91 years while the cancer group had an average age of 52.28 ± 1.33 years, significantly indicating that cancer subjects were generally of greater age. Endometrial thickness significantly decreased with advancing age, with the reduces values in women over 50 years (post-menopausal). There was a significant difference in endometrial thickness between normal and cancer cases, with optimal diagnostic cut-off values of 12.85 mm (AUC 0.89, sensitivity 0.83, specificity 0.94) for women aged ≤50 years and 10.20 mm (AUC 0.99, sensitivity 0.97, specificity 1.00) for women aged >50 years. These results underscore the robust relationship between age, menopausal status, and endometrial pathology, and support the clinical utility of ultrasound as a non-invasive method for early detection and risk profiling of endometrial abnormalities.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"8 ","pages":"1826142"},"PeriodicalIF":3.1,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13443303/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148686780","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":"Unlearning prohibition: the de-implementation of HIV breastfeeding restrictions in the United States.","authors":"Paige M Anderson, Molly Bachmann, Marielle S Gross","doi":"10.3389/frph.2026.1869376","DOIUrl":"10.3389/frph.2026.1869376","url":null,"abstract":"<p><p>In January 2023, U.S. perinatal HIV guidelines shifted to support shared decision-making in infant feeding, ending categorical prohibition of breastfeeding for people living with HIV (PLHIV). This change did not reflect new safety evidence, low transmission risk and near-normal life expectancy with antiretroviral therapy has been established for over a decade, but the convergence of evidence with sustained ethical critique of the harms of prohibition. Three years later, uptake remains inconsistent: clinicians report uncertainty, and patient experiences suggest limited change in counseling or practice. We argue that eliminating prohibition of breastfeeding for PLHIV is fundamentally a de-implementation challenge. It calls for deconstruction of a practice that functioned not only as clinical guidance but as moral certainty, reinforced by legal and institutional structures. Standard implementation strategies were never designed for this task. Effective change requires deliberate unlearning of outdated assumptions at the individual and institutional level, healing between clinicians and communities whose trust was broken, and active dismantling of the legal, structural, and cultural infrastructure that encoded prohibition. We outline priorities, including structured unlearning activities, institutional reform, equity-centered training, privacy-protective research infrastructure, and advocacy for repeal of HIV criminalization statutes. The goal is to replace a paternalistic, physician-centered fiction of zero-risk with an allyship model where women's and infants' interests are maximally advanced in collaboration with their physicians, systems, and communities.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"8 ","pages":"1869376"},"PeriodicalIF":3.1,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13437937/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148681404","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":"Evaluating infant feeding practice guidelines for individuals with HIV: a pilot study using qualitative findings with healthcare workers and normalization process theory.","authors":"Julia D López, Elaine Schmidt, Kneeshe Parkinson, Virginia McKay, Sydney M Thayer, Amanda Zofkie","doi":"10.3389/frph.2026.1867104","DOIUrl":"10.3389/frph.2026.1867104","url":null,"abstract":"<p><strong>Introduction: </strong>In 2023, the WHO and CDC updated HIV infant feeding guidelines, emphasizing the role of antiretroviral therapy (ART) in reducing breastfeeding/chestfeeding transmission risk among birthing people living with HIV (BPLWH). Despite this update, clinical integration remains inconsistent, shaped by provider knowledge, bias, patient engagement, and systemic barriers.</p><p><strong>Materials & methods: </strong>Between August 2025 and January 2026, we conducted 10 semi-structured, in-depth interviews with healthcare workers (HCWs) to assess their understanding of and engagement with updated HIV breastfeeding/chestfeeding guidelines. The Normalization Process Theory (NPT) informed the development of the interview guide and the thematic analysis. Transcripts were double-coded in Dedoose and thematic analysis was conducted deductively.</p><p><strong>Results: </strong>Healthcare workers generally accepted the guidelines as evidence-based, but their implementation varied across the four NPT constructs. While the guidelines were seen as logically coherent, OB-GYNs highlighted reproductive autonomy, whereas infectious disease and pediatric providers prioritized infant HIV susceptibility. Uncertainty about viral load thresholds led to variability among providers. Ethical motivation strongly supported implementation, but inconsistent training and low patient volumes reduced confidence. Institutional leaders and interdisciplinary workflows were identified as vital facilitators. Major obstacles included fragmented OB-GYN-to-pediatrics handoffs, services located in different areas, and structural patient burdens such as monitoring requirements and insurance issues, which the guidelines did not specifically address.</p><p><strong>Discussion: </strong>Systematically identifying how new breastfeeding/chestfeeding practices become embedded in healthcare among HCWs, and assessing where knowledge gaps, misunderstandings, and engagement barriers exist regarding the guidelines, will inform the development of a decision-making guide to enhance implementation of HIV breastfeeding/chestfeeding guidelines for pregnant people.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"8 ","pages":"1867104"},"PeriodicalIF":3.1,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13437786/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148681367","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":"Serum PAPP-A as a potential biomarker for early detection of ectopic pregnancy: an exploratory case-control study.","authors":"Xiaoyan Sun, Ning Wang, Zongtao Liu, Hang Lu, Xiaohui Yang, Mingming Ma, Haixia Liu","doi":"10.3389/frph.2026.1891223","DOIUrl":"10.3389/frph.2026.1891223","url":null,"abstract":"<p><strong>Introduction: </strong>In this exploratory case-control study, we investigated the potential associations of pregnancy-associated plasma protein-A (PAPP-A), β-human chorionic gonadotrophin (β-HCG), vascular endothelial growth factor (VEGF), and leukemia inhibitory factor (LIF) with ectopic pregnancy (EP), using logistic regression to describe unadjusted associations and receiver operating characteristic (ROC) curve analysis to characterise exploratory biomarker performance.</p><p><strong>Methods: </strong>We conducted a case-control study including 48 patients with EP and 46 patients with normal intrauterine pregnancy as controls, recruited between October 2022 and May 2024 at a single center. Logistic regression was applied to describe associations between each biomarker and EP. ROC curves were derived from these models to explore discrimination, and an exploratory threshold was identified using the Youden index.</p><p><strong>Results: </strong>The area under the curve (AUC) for β-HCG and PAPP-A were the highest (0.85 and 0.84, respectively), compared with VEGF (0.73) and LIF (0.54). PAPP-A showed the strongest association among the candidate markers (OR = 0.774), with an exploratory sensitivity of 0.77. VEGF had the highest specificity (0.96). The combined exploratory AUC of PAPP-A and β-HCG (0.89) was similar to that of PAPP-A and VEGF (0.88).</p><p><strong>Conclusion: </strong>This exploratory study suggests that PAPP-A may be a promising candidate biomarker for early EP detection in the context of an exploratory case-control comparison with normal intrauterine pregnancy, with performance comparable to β-HCG. Further prospective studies with external validation in clinically relevant populations are needed to confirm these preliminary findings and assess clinical potential.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"8 ","pages":"1891223"},"PeriodicalIF":3.1,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13437613/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148681391","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":"\"It's exactly what's needed\": a call to action for breastmilk studies of vertical HIV transmission in high-income countries.","authors":"Nell Freeman-Romilly, Bakita Kasadha, Shema Tariq, Angelina Namiba, Farai Nyatsanza, Nick Phillips, Tanvi Rai","doi":"10.3389/frph.2026.1902552","DOIUrl":"10.3389/frph.2026.1902552","url":null,"abstract":"<p><p>Increasing numbers of parents living with HIV in England and the United Kingdom choose to breastfeed their infants, yet guidelines for high-income countries (HICs) still recommend exclusive formula feeding to eliminate all risk of vertical transmission. The risk of HIV transmission through breastmilk is less than 1% when the feeding parent is virally suppressed on antiretroviral therapy. However, this data comes from studies conducted in low- and middle-income countries limiting their generalisability to contexts where parents are more likely to be virally suppressed on long-term antiretroviral therapy with access to regular viral load monitoring. The risk of HIV transmission through breastfeeding in the context of <i>long-term pre-pregnancy HIV viral suppression</i> is largely understood through indirect observational studies in HICs, suggesting the risk of HIV transmission may be lower than currently understood. We may be providing parents living with HIV in high income countries with infant feeding guidance that does not adequately reflect their level of risk. In this perspective paper, we explore the reasons behind the paucity of large-scale microbiological lactational research in this population group. We also present brief findings from the NOURISH-UK study which explored experiences of infant feeding decisions among UK-based mothers living with HIV: our participants expressed frustration about the lack of evidence applicable to their situation and were universally enthusiastic about donating breastmilk samples to enable research to take place. We deliver a call to action to researchers, clinicians, research funders and clinical networks to explore the logistics and practicalities of how this work could be supported.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"8 ","pages":"1902552"},"PeriodicalIF":3.1,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13437536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148681415","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":"Case Report: Anti-N-methyl-D-aspartate receptor encephalitis associated with bilateral mature ovarian teratomas in early pregnancy.","authors":"Gulshat Bilyalova, Elmira Gassanova, Dinara Turzhanova, Saira Iskalieva, Aigerim Butabekova, Aisulu Tulemissova, Bahit Anapina, Assel Boshanova, Aida Baibusunova, Zhansulu Akylzhanova","doi":"10.3389/frph.2026.1895027","DOIUrl":"10.3389/frph.2026.1895027","url":null,"abstract":"<p><p>Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune encephalitis that may present with acute psychiatric symptoms, seizures, movement disorders, impaired consciousness and autonomic dysfunction. A 30-year-old previously healthy woman at 10-11 weeks of gestation was admitted to the intensive care unit after an approximately 2-3-week history, reported by relatives, of insomnia, behavioral change, auditory and visual hallucinations, psychomotor agitation, aggressive behavior, and a generalized tonic-clonic seizure before admission. On admission, the patient had severe encephalopathy and subsequently required mechanical ventilation because of hypoventilation. Cerebrospinal fluid testing detected IgG antibodies against NMDAR at a titer of 1:160. Brain magnetic resonance imaging showed a right hippocampal lesion consistent with limbic encephalitis, and pelvic ultrasonography identified adnexal masses suspicious for teratoma. Prolonged EEG demonstrated diffuse delta-theta slowing with a delta-brush pattern, without findings consistent with focal or myoclonic seizures. The patient received high-dose methylprednisolone, intravenous immunoglobulin, plasma exchange, rituximab, pregnancy-conscious antiseizure therapy, individualized pregnancy management, and laparoscopic removal of bilateral mature ovarian teratomas. Following combined immunotherapy, ventilatory and supportive ICU care, antiseizure therapy, individualized maternal-fetal management, and tumor removal, the recurrent motor events ceased by the end of the first postoperative week. The patient's consciousness, speech, and motor function gradually improved. This case highlights that anti-NMDAR encephalitis in pregnancy requires early cerebrospinal fluid antibody testing, exclusion of infectious mimics, supportive neurocritical care, prompt immunotherapy, timely teratoma removal and individualized reasoning regarding pregnancy management.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"8 ","pages":"1895027"},"PeriodicalIF":3.1,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13438315/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148681401","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}