Medical sciences (Basel, Switzerland)最新文献

{"title":"Understanding Preeclampsia: Cardiovascular Pathophysiology, Histopathological Insights and Molecular Biomarkers.","authors":"Kaltrina Kutllovci Hasani, Nurxhan Ajeti, Nandu Goswami","doi":"10.3390/medsci13030154","DOIUrl":"10.3390/medsci13030154","url":null,"abstract":"<p><p>Preeclampsia (PE) is not merely a pregnancy complication but a clinical manifestation of underlying vascular dysfunction with long-term health implications. It is diagnosed after 20 weeks of gestation as new-onset hypertension with proteinuria or organ involvement. The condition arises from impaired placental development, particularly defective spiral artery remodeling, which leads to placental ischemia and the release of antiangiogenic factors such as soluble fms-like tyrosine kinase-1 (sFlt-1) and soluble endoglin (sEng). These circulating factors contribute to systemic endothelial dysfunction, resulting in hypertension, inflammation, and multiorgan stress. Histopathological findings, including acute atherosis and abnormal vascular remodeling, further reflect the cardiovascular damage underlying PE. This review synthesizes emerging evidence on the vascular and histological mechanisms of PE, highlighting novel biomarkers such as microRNAs and neprilysin, and the potential of advanced diagnostic tools, including machine learning. Importantly, PE is now recognized not only as an obstetric disorder but also as an early marker of future cardiovascular disease. This paradigm shift emphasizes the need for personalized prevention strategies, close surveillance of high-risk women, and long-term cardiovascular follow-up. Pregnancy thus represents a critical window for early detection and intervention in women's cardiovascular health.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"13 3","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12452302/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145115138","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 Expanding Genetic Architecture of Arteriopathies: From Canonical TAAD Genes to Emerging Connective Tissue and Signaling Pathways.","authors":"Luke Dreher, Hussein Abdul Nabi, Hunter Vandolah, Stephen Brennan, George Bcharah, Hend Bcharah, Mayowa A Osundiji, Linnea M Baudhuin, Fadi E Shamoun","doi":"10.3390/medsci13030155","DOIUrl":"10.3390/medsci13030155","url":null,"abstract":"<p><p>Thoracic aortic aneurysm and dissection (TAAD) encompasses a clinically heterogeneous group of diseases characterized by high morbidity and mortality. Genetic studies over the past two decades have significantly expanded our understanding of the molecular landscape underlying heritable TAAD, revealing contributions from multiple interconnected biological pathways. This review systematically summarizes more than 75 genes implicated in TAAD pathogenesis, categorizing them according to major mechanistic roles including TGF-β signaling, extracellular matrix remodeling, smooth muscle cell contractility and cytoskeletal regulation, cell-matrix and cell-cell adhesion, metabolic processes, ion transport, and transcriptional regulation. Special emphasis is placed on emerging genes with variable or overlapping clinical phenotypes, dual-mechanism candidates, and their implications for personalized clinical management, including surveillance and surgical intervention thresholds. The integration of molecular insights into clinical practice, along with cautious consideration of genes of uncertain significance, promises to enhance diagnostic precision and risk stratification in individuals and families affected by heritable aortic disease.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"13 3","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12452550/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145115179","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":"Multidimensional Determinants of Obesity: The Role of Life Purpose, Sociodemographics, and Health Habits Across Four Adiposity Scales in a Large Occupational Cohort.","authors":"Pilar García Pertegaz, Pedro Juan Tárraga López, Irene Coll Campayo, Carla Busquets-Cortés, Ángel Arturo López-González, José Ignacio Ramírez-Manent","doi":"10.3390/medsci13030153","DOIUrl":"10.3390/medsci13030153","url":null,"abstract":"<p><p><b>Background:</b> Obesity is multifactorial, shaped by biological, behavioral, and psychosocial factors. Traditional sociodemographic and lifestyle influences are well studied, but psychological well-being, particularly life purpose, remains less explored. This study investigates associations between demographics, health behaviors, and life purpose and obesity prevalence, assessed through four validated adiposity indices in Spanish workers. <b>Methods:</b> This cross-sectional study included 93,077 workers (mean age: 43.8 ± 9.6 years; 54.1% men). Obesity was defined according to four measures: body mass index (BMI), waist-to-height ratio (WtHR), Clínica Universidad de Navarra Body Adiposity Estimator (CUN-BAE), and Metabolic Score for Visceral Fat (METS-VF). Sociodemographic, lifestyle (Mediterranean diet, physical activity, smoking), and psychological (Purpose in Life Test, PIL-10) variables were assessed. Logistic regression was used to evaluate associations with obesity risk. <b>Results:</b> Low life purpose was significantly associated with increased odds of obesity across all indices, particularly for CUN-BAE (OR = 4.58; 95% CI: 3.99-6.28) and BMI (OR = 5.45; 95% CI: 4.71-6.30). Traditional risk factors such as physical inactivity, poor adherence to the Mediterranean diet, older age, a lower social class, and smoking also demonstrated strong associations with higher adiposity levels. METS-VF showed the greatest sensitivity to male sex and unhealthy behaviors. <b>Conclusions:</b> This study identifies life purpose as an independent psychosocial determinant of obesity. Using multiple adiposity measures strengthens the findings, emphasizing psychological well-being in prevention. Longitudinal research is needed to confirm causality and develop interventions enhancing life purpose to improve cardiometabolic health. Given the cross-sectional design, causal inferences cannot be drawn and the directionality of associations remains uncertain.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"13 3","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12452433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114844","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":"Reactive Oxygen and Nitrogen Species in Myocardial Infarction: Mechanistic Insights and Clinical Correlations.","authors":"Hussein M Ismail, Sameh A Ahmed, Ahmed M Alsaedi, Waleed H Almaramhy, Man K Alraddadi, Muhannad S Albadrani, Ibraheam M Alhejaily, Faisal A Mohammad, Anas M Ghaith, Ali A Youssef","doi":"10.3390/medsci13030152","DOIUrl":"10.3390/medsci13030152","url":null,"abstract":"<p><strong>Background/objectives: </strong>Myocardial infarction (MI) remains a leading cause of morbidity and mortality worldwide, driven largely by underlying coronary artery disease (CAD). Reactive oxygen species (ROS) and reactive nitrogen species (RNS) play pivotal mechanistic roles in endothelial dysfunction, atherosclerotic plaque progression, and subsequent cardiac injury. Excessive production of these reactive species disrupts cellular redox balance, promotes mitochondrial dysfunction, and accelerates vascular inflammation, ultimately contributing to plaque rupture and MI. This study aimed to investigate the mechanistic associations and clinical correlations of individual ROS and RNS markers in patients with MI.</p><p><strong>Methods: </strong>We conducted a case-control study including 86 patients with MI and 60 age- and sex-matched controls without cardiovascular disease, recruited from the Medina Cardiac Center in Saudi Arabia. The MI cohort was subdivided into ST-elevation MI (STEMI, <i>n</i> = 62) and non-ST-elevation MI (NSTEMI, <i>n</i> = 24) to explore potential differences in oxidative and nitrosative stress profiles. Serum levels of multiple ROS (including hydrogen peroxide, hydroxyl radical, and superoxide anion) and RNS (including nitric oxide and peroxynitrite) were quantified using validated fluorescence-based assays. Clinical and biochemical parameters, including lipid profiles, troponin, and left ventricular ejection fraction, were also assessed.</p><p><strong>Results: </strong>Most ROS and RNS markers were significantly elevated in MI patients compared to controls (<i>p</i> < 0.05), except for nitrogen dioxide. Moderate to strong positive correlations were observed between ROS/RNS levels and serum total cholesterol and LDL-cholesterol (<i>p</i> < 0.001). In contrast, weak or non-significant correlations were found between ROS/RNS markers and serum troponin or left ventricular ejection fraction. Both STEMI and NSTEMI subgroups demonstrated significantly higher oxidative and nitrosative stress levels compared to controls, with distinct patterns between the subtypes.</p><p><strong>Conclusions: </strong>This study underscores a mechanistic link between elevated ROS/RNS levels and myocardial infarction, supporting the importance of targeting oxidative and nitrosative pathways as potential therapeutic strategies.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"13 3","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12452750/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145115230","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":"Association of Gut Dysbiosis with Disease Phenotype and Treatment in Systemic Lupus Erythematosus.","authors":"Irene Medina-Martínez, Rocío Gil-Gutiérrez, Jorge García-García, Francisco Javier de la Hera-Fernández, Nuria Navarrete-Navarrete, Mónica Zamora-Pasadas, Norberto Ortego-Centeno, José Luis Callejas-Rubio, Federico García-García, Julio Gálvez-Peralta, Alba Rodríguez-Nogales, María Correa-Rodríguez, Blanca Rueda-Medina","doi":"10.3390/medsci13030151","DOIUrl":"10.3390/medsci13030151","url":null,"abstract":"<p><p><b>Introduction</b>: Gut dysbiosis has been associated with the development of autoimmune diseases, including systemic lupus erythematosus (SLE). Although previous studies suggest microbial alterations in SLE, evidence at the species level and its clinical relevance remain limited. This study aimed to characterise the gut microbiota at species level in SLE patients and evaluate its association with clinical features. <b>Materials and methods</b>: A total of 57 SLE patients and 57 matched controls were included. Faecal samples were collected using the OMNIgene-GUT kit, and microbial DNA was extracted with the Maxwell RSC PureFood GMO kit. Metagenomic sequencing was performed using the Illumina MiSeq platform, and the data was analysed with QIIME2. Microbial diversity and relative abundance were assessed using the phyloseq package, and differentially abundant taxa were identified using DESeq2. Clinical subgroups among SLE patients were identified via k-means clustering. <b>Results</b>: SLE patients exhibited significantly different beta diversity compared to controls (<i>p</i> = 0.001), with increased abundance of <i>Pseudomonadota</i> (3.81% vs. 6.80%, <i>p</i> < 0.05) and decreased <i>Bacteroidota</i> (53.42% vs. 38.04%, <i>p</i> < 0.05). Only 10 bacterial species were consistently present across all SLE samples, including <i>Akkermansia muciniphila</i>, <i>Bacteroides dorei</i>, and <i>Lactobacillus gasseri.</i> Hypertensive patients and those treated with corticosteroids presented a marked depletion of key microbial taxa. Conversely, Belimumab-treated patients displayed a distinct microbiota enriched in species such as <i>Alistipes shahii</i> and <i>Prevotella corporis</i>. <b>Conclusions</b>: This study confirms significant gut microbiota alterations in SLE and pinpoints microbial profiles associated with clinical subgroups. These findings suggest gut dysbiosis may contribute to SLE pathogenesis and indicate biomarkers for disease stratification.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"13 3","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12452298/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145115311","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 Effects of Chronic Opioid Therapy on Achalasia and the Upper Esophageal Sphincter.","authors":"Joshua Kalapala, Promila Banerjee, Emma Schnittka, Christine Son, Jeff Leya, Stephen Sontag, Thomas Schnell, Bani Chander-Roland","doi":"10.3390/medsci13030150","DOIUrl":"10.3390/medsci13030150","url":null,"abstract":"<p><p><b>Background:</b> The rise of opioid drug usage in the U.S. correlates with increasing recognition of gastrointestinal side effects, especially in the esophagus. The literature has recently noted that abnormalities in the upper esophageal sphincter (UES) are a poor prognostic factor in Achalasia treatment response. A better understanding of the relationship between opioid therapy and esophageal motility and sphincter function may shape our management guidelines for esophageal dysmotilities. This study aimed to evaluate dysmotility patterns, specifically UES function, among the veteran population, where opioid use is reportedly high. <b>Methods:</b> We performed a retrospective search of all the veterans at a large urban veteran affairs hospital who had undergone esophageal manometry from 2013 to 2022, collecting data on patient demographics, indication for procedure, diagnosis, sphincter pressure values, and presence of chronic opioid use. <b>Results:</b> Of 395 patients, 29% had a history of chronic opioid therapy. Notably, patients that were diagnosed with Achalasia had a greater proportion of chronic opioid use as compared to those who were not. Additionally, there was a statistically significant lower average upper esophageal resting pressure in opioid patients compared to non-opioid patients. <b>Conclusions:</b> Veteran patients with Achalasia have a greater proportion of chronic opioid use as compared to those without. There are significant manometric pressure differences at the upper esophageal sphincter among chronic opioid users when compared to non-opioid users.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"13 3","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12452666/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145115219","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":"Pirfenidone in Skin Fibrosis and Scarring: From Bench Insights to Clinical Data.","authors":"Kelson Knighton, Asis Babun, James Turney, Brehyn Evans, Inder Sehgal","doi":"10.3390/medsci13030148","DOIUrl":"https://doi.org/10.3390/medsci13030148","url":null,"abstract":"<p><p>Pirfenidone (PFD) is a pyridine-like compound most well-known for its use in idiopathic pulmonary fibrosis (IPF). However, its broad anti-inflammatory and anti-fibrotic actions make PFD a candidate for other scarring diseases. This review examines the use of PFD for dermatologic conditions. The literature supports the potential for PFD to decrease scarring in a variety of skin conditions. Both oral and topical preparations have been shown to be effective at aiding skin healing. Early clinical evidence demonstrates significant improvements in hypertrophic burn scars, reduction in fibrosis in localized scleroderma, and accelerated epithelialization of skin graft donor sites. These clinical outcomes are supported by PFD's modulation of the transforming growth factor-beta (TGF-β) pathway, which plays a central role in skin fibrosis and scarring. Evidence in this review suggests topical PFD can be used to fill a clinical need for local anti-fibrotic therapies.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"13 3","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12372034/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981399","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 Cardiac Autonomic Function in Patients Undergoing Thoracoscopic Sympathetic Chain Clamping for Primary Focal Hyperhidrosis.","authors":"Danilo Ricciardi, Daniele Valente, Paola Liporace, Enrico Davoli, Elisabetta Sposito, Francesco Picarelli, Flavio Angelo Gioia, Vito Calabrese, Gian Paolo Ussia, Francesco Grigioni","doi":"10.3390/medsci13030147","DOIUrl":"https://doi.org/10.3390/medsci13030147","url":null,"abstract":"<p><p><b>Background/Objectives</b>. Heart rate variability (HRV) is the variability in the beat-by-beat heart period. Primary focal hyperhidrosis (PFHH) is a disease characterized by excessive sweat production, strongly affecting social life. Several authors define this condition as a dysautonomic disorder, mainly driven by exaggerated sympathetic activity. The aim of the study was to demonstrate a possible cardiac involvement in the disease. Other outcomes were the occurrence of dysautonomic disorders after surgery and its possible correlation with baseline characteristics. <b>Methods</b>. This observational, controlled trial enrolled patients with a confirmed clinical diagnosis of severe PFHH candidates to thoracoscopic sympathetic chain clamping. Before and after surgery, ECG was obtained using KardiaMobile 6L (AliveCor^®, Mountain View, CA, USA) device with a five-minute recording and HRV was analyzed using Kubios HRV Premium (Kubios©) software. <b>Results</b>. 111 patients were compared to 222 healthy control subjects. No differences were seen in HRV analysis between the two groups at baseline (time-domain <i>p</i> > 0.05, frequency-domain <i>p</i> > 0.05, autonomic indexes <i>p</i> > 0.05). When comparing autonomic function indexes in patients before and after the surgical procedure, no differences were seen in frequency-domain HRV analysis, but a blunted increase in SNS index (0.2 vs. 1.38, <i>p</i> 0.02). No development of systemic dysautonomic disorders nor significant compensatory hyperhidrosis were seen after the surgery. <b>Conclusions</b>. This study shows that PFHH is a peripheral autonomic nervous system derangement, rather than central. Sympathetic chain clamping resulted safe and effective in improving patients' conditions, with no risks of dysautonomic disorders.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"13 3","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12372048/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981531","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":"Effectiveness of a Flossing Protocol and Manual Therapy in Improving the Clinical and Functional Status of Subjects with Recurrent Ankle Sprains; A Double-Blind Randomized Clinical Trial.","authors":"Mario Bermúdez-Egidos, Raúl Pérez-Llanes, Rubén Cuesta-Barriuso","doi":"10.3390/medsci13030149","DOIUrl":"https://doi.org/10.3390/medsci13030149","url":null,"abstract":"<p><p><b>Introduction</b>: Recurrent ankle sprains can lead to chronic ankle instability. The flossing technique aims to modify the function and characteristics of fascial tissue. The objective was to evaluate the effectiveness of flossing and sliding techniques in improving subjects with previous ankle sprains. <b>Methods</b>: Randomized, double-blind clinical study with a follow-up period. Twenty-six subjects were assigned to two study groups: experimental (flossing technique and passive manual therapy techniques) and placebo control group (flossing technique without compression and manual therapy techniques without sliding). The intervention lasted three weeks, with two sessions per week. The study variables were dorsiflexion under load (Leg Motion^®), ankle mobility under unloaded conditions (goniometer), pressure pain threshold (algometer), and stability (Rs Scan^® pressure platform). Three measurements were taken: pre-treatment (T0), post-treatment (T1), and after 3 weeks of follow-up (T2). <b>Results</b>: There were significant intergroup differences in dorsiflexion under load (F = 4.90; <i>p</i> = 0.02). Range of motion in plantar flexion without load (F = 3.78; <i>p</i> = 0.04), in the ellipse area (F = 4.72; <i>p</i> = 0.01), left stability (F = 3.74; <i>p</i> = 0.03), and right stability (F = 3.73; <i>p</i> = 0.03) without visual support. <b>Conclusions</b>: A physiotherapy protocol using flossing and manual sliding therapy can increase loaded dorsal flexion in young adults with previous ankle sprains. This intervention can also improve ankle plantar flexion under unloaded conditions. The area of the ellipse without visual support can improve in young adults with a history of ankle sprains following a program of flossing and manual therapy.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"13 3","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12372161/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981431","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":"Gestational Diabetes Mellitus: The Dual Risk of Small and Large for Gestational Age: A Narrative Review.","authors":"Andreea Fotă, Aida Petca","doi":"10.3390/medsci13030144","DOIUrl":"https://doi.org/10.3390/medsci13030144","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Gestational diabetes mellitus (GDM) complicates approximately 14% of pregnancies worldwide, its prevalence rising with increasing maternal age and obesity. While maternal hyperglycemia is traditionally associated with fetal overgrowth and large-for-gestational-age (LGA) neonates, emerging evidence indicates that GDM may also contribute to small-for-gestational-age (SGA) outcomes. <b>Methods</b>: A comprehensive literature search was conducted using multiple databases, including PubMed, Web of Science, and ScienceDirect, to identify studies related to gestational diabetes mellitus, fetal growth outcomes such as small for gestational age and large for gestational age, and associated pathophysiological mechanisms. <b>Results</b>: This narrative review explores the mechanisms by which GDM influences fetal growth, emphasizing the dual risk of excessive and restricted intrauterine growth. Fetal macrosomia typically results from chronic maternal hyperglycemia, leading to increased transplacental glucose delivery and fetal hyperinsulinemia. In contrast, SGA outcomes are a consequence of vascular and endothelial dysfunction, placental insufficiency, or excessively restrictive glycemic control that limit the availability of nutrients. Both extremes of fetal growth carry a myriad of significant perinatal and long-term metabolic risks. <b>Conclusions</b>: Understanding the diverse pathways through which GDM affects fetal growth is essential for developing individualized clinical strategies.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"13 3","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12372126/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981522","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}