American journal of obstetrics and gynecology最新文献

{"title":"Prenatal Maternal Phosphatidylcholine and Children's Behavior and Cognition through 4 Years of Age: Randomized Clinical Trial.","authors":"Sharon K Hunter, M Camille Hoffman, Amanda J Law, Uwe Christians, Angelo D'Alessandro, Robert Freedman","doi":"10.1016/j.ajog.2026.10.017","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.10.017","url":null,"abstract":"<p><strong>Background: </strong>Increasing popularity of choline supplements may prompt patients to seek advice on safe, effective doses during prenatal visits. Rationale for prenatal phosphatidylcholine supplements stems from the fetal developmental role of α7-nicotinic cholinergic receptor gene CHRNA7, associated with Schizophrenia, Attention Deficit Disorder, and Autism Spectrum Disorder. Fetal brain developmental problems, including those linked to CHRNA7, convey risk for these mental illnesses. Choline derived from maternal phosphatidylcholine intake activates fetal α7-nicotinic receptors, which facilitate brain neurosynaptic development, observed after birth as robust inhibition of cerebral neurophysiological responses to repeated stimuli. A previous study found that maternal prenatal phosphatidylcholine compared to placebo significantly improved newborns' neurophysiology and thereby decreased the children's attention and social withdrawal problems at 40 months of age.</p><p><strong>Objective: </strong>To assess whether maternal prenatal phosphatidylcholine compared to placebo in a larger randomized clinical trial supports fetal brain development to decrease childhood attention and social behavioral problems and increase cognitive performance.</p><p><strong>Study design: </strong>A clinical trial at University of Colorado Hospital Prenatal Clinics and affiliated community hospitals randomized 206 women to 9000 mg phosphatidylcholine (the form of choline occurring naturally in food) or placebo from 16 weeks' gestation through delivery. From 18 months to 4 years of age, 142 children were assessed by parents on the Child Behavior Check List 1.5-5-year version (CBCL<sub>1.5-5yr</sub>). The 2 primary outcomes were Withdrawn and Attention Problems. A secondary outcome was the Wechsler Preschool and Primary Scale of Intelligence-IV Full Scale Intelligence Quotient (Full Scale-IQ). Cerebral neurophysiological inhibition, assessed soon after birth, confirmed phosphatidylcholine's fetal developmental effects.</p><p><strong>Results: </strong>Prenatal phosphatidylcholine supplements compared to placebo produced fewer children with multiple or pervasive Withdrawn problems and increased WPPSI-IV Full-Scale IQ (mean difference 7.78, 95% CI 1.88, 13.7; p = .010). Attention problems did not decrease significantly. In exploratory analyses, 11 children had CBCL<sub>1.5-5yr</sub> Autism Spectrum T-scores in the clinical referral range and language deficits typical of Autism Spectrum Disorder, 10 of 71 from women who had placebo and 1 of 71 who had phosphatidylcholine, Risk Ratio 10.0; 95% CI 1.31, 76.1; p = .026. Twelve children had Full-Scale IQ > 120 (>90 %ile), 10 of 54 from women who had phosphatidylcholine and 2 of 49 who had placebo, Risk Ratio 4.54; 95% CI 1.05, 19.7; p = .044. Positive effects were observed regardless of presence or absence of maternal mental disorders. Phosphatidylcholine produced no significant adverse effects or safety problems for ","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149222996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The molecular architecture of human labor at term during the execution phase: changes across cervical dilatation.","authors":"Arun Meyyazhagan, Roberto Romero, Yoon B O Hyun, Dereje W Gudicha, Piya Chaemsaithong, Eun Jung Jung, Agustin Conde-Agudelo, Offer Erez, Juan Pedro Kusanovic, Nardhy Gomez Lopez, Mariachiara Bosco, Manaphat Suksai, Nandor Gabor Than, Dahianna M Gallo, Amir Gandjbakhche, Sonia S Hassan, Tinnakorn Chaiworapongsa, Awonoyi Awonuga, Adi L Tarca","doi":"10.1016/j.ajog.2026.10.016","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.10.016","url":null,"abstract":"<p><strong>Objective: </strong>Human parturition includes a preparatory phase that precedes the clinical onset of labor and an execution phase represented by clinically established labor. We sought to define the molecular architecture of the execution phase by characterizing the changes in the amniotic fluid proteome associated with increasing cervical dilatation during human labor at term.</p><p><strong>Study design: </strong>This retrospective cross-sectional study included 98 women who delivered at term by cesarean delivery with intact membranes. Amniotic fluid was obtained from 61 women not in labor and 37 women in spontaneous labor, who were classified according to cervical dilatation: less than 1 cm, 1-3 cm, 4-6 cm, and 7-10 cm. The abundance of 7,288 proteins was measured using an aptamer-based platform. Differential protein abundance was assessed between women in labor and those not in labor and in relation to cervical dilatation. Functional enrichment analyses were performed to identify the biological processes represented by these changes.</p><p><strong>Results: </strong>The principal findings were: 1) established labor was associated with extensive molecular changes in amniotic fluid; 656 of 7,288 proteins differed between women in labor and those not in labor, including 214 with increased abundance and 442 with decreased abundance; 2) at 1-3 centimeters of cervical dilatation, aldo-keto reductase family 1 member B1 (AKR1B1) and L-plastin (LCP1) were selectively increased; the former has prostaglandin F synthase activity, whereas the latter is an actin-bundling protein, findings consistent with prostaglandin-related biology and actin-cytoskeletal organization at this stage of clinically established labor; 3) the molecular differences expanded markedly with increasing cervical dilatation, with 359 proteins differing at 4-6 centimeters and 3,050 at 7-10 centimeters compared with women not in labor; 4) among women in labor, 580 proteins were associated with cervical dilatation; 573 increased and 7 decreased with greater cervical dilatation, and nearly all increased as cervical dilatation advanced; these included interleukin-6, interleukin-8, granulocyte colony-stimulating factor, interferon gamma-inducible protein 16, neutrophil cytosol factor 1, and inducible T-cell costimulator ligand; 5) functional enrichment analysis identified biological processes related to cell-to-cell communication, cell-junction organization, tissue organization, tissue morphogenesis, cell adhesion, extracellular-matrix organization, innate immune activation, myeloid-cell and neutrophil activation, neutrophil degranulation, cytokine signaling, and ribonucleic acid processing; and 6) most proteins associated with labor had not previously been implicated in human parturition, thereby substantially expanding the known molecular landscape of labor.</p><p><strong>Conclusions: </strong>The execution phase of human parturition is characterized by selective differences i","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HSP70-Mediated Macrophage-Stromal Crosstalk is an Immunopathogenic Driver of Recurrent Implantation Failure.","authors":"Minyue Tang, Yunkun Lu, Xiang Huang, Qiu Wu, Yilin Fu, Tianjiao Zhang, Wenjun Hao, Shuonan Zhang, Jiayu Xu, Shan Wan, Qi Jing, Junjie Xu, Yimin Zhu, Peng Xiao","doi":"10.1016/j.ajog.2026.10.015","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.10.015","url":null,"abstract":"<p><strong>Background: </strong>Recurrent implantation failure (RIF) remains a major challenge in assisted reproductive technology (ART), affecting a considerable proportion of patients despite multiple transfers of high-quality embryos. Although impaired endometrial receptivity is recognized as a critical contributor to RIF, the molecular mechanisms responsible for establishing a non-receptive endometrial microenvironment remain incompletely understood. The proliferative phase precedes decidualization and subsequent embryo implantation, representing a critical period for endometrial preparation. The endometrium is a highly dynamic tissue composed of diverse epithelial, stromal, vascular, and immune cell populations that undergo coordinated remodeling throughout the menstrual cycle; however, the cell type-specific alterations and pathogenic immune-stromal interactions during this phase have not been comprehensively characterized.</p><p><strong>Objective: </strong>This study aimed to dissect the transcriptional landscape of the proliferative-phase endometrium in RIF patients, and validate the key pathways through experimental approaches.</p><p><strong>Study design: </strong>We for the first time performed single-cell RNA sequencing (scRNA-seq) of proliferative-phase endometrial tissues from RIF patients and control subjects to characterize cell-type-specific transcriptional alterations and intercellular communication patterns. Peripheral blood scRNA-seq was additionally performed to determine whether immune alterations were tissue-specific or systemic. The impact of HSP70 on the transcriptome of endometrial stromal cells was investigated using RNA sequencing. The production of HSP70 and CCL7 in RIF patients was measured by enzyme-linked immunosorbent assay (ELISA). The HSP70/CCL7 axis-mediated functional crosstalk between macrophages and endometrial stromal cells was investigated using Transwell assay, QPCR, and SA-β-Gal staining. HSP70-induced activation of PI3K signaling was predicted using RNA sequencing data, then validated through Western blot, ELISA, and Transwell assay.</p><p><strong>Results: </strong>We identified excessive inflammatory immune infiltration as a microenvironmental hallmark of RIF endometrium, as reflected by increased percentages of T cells, monocytes, and NK cells. This alteration is associated with pathogenic macrophage - stromal crosstalk. Mechanistically, an inflammatory milieu promotes the expression of 70-kDa heat shock protein (HSP70) in macrophages, which stimulates CCL7 production in endometrial stromal cells via PI3K signaling. CCL7 drives the recruitment of multiple types of immune cells that further amplify the inflammation. Neutralization of CCL7 or inhibition of PI3K signaling prevented this pro-inflammatory infiltration. The HSP70-CCL7 axis facilitates endometrial stromal cell senescence and leads to impaired decidualization.</p><p><strong>Conclusion: </strong>This study provides the first single-cell transcr","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Placental abruption as a marker of long-term maternal cardiovascular risk.","authors":"Huan Zhang, Hui Wang, Imre Janszky, Jette Möller, Yajun Liang, Xingbo Mo, Krisztina D László","doi":"10.1016/j.ajog.2026.10.013","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.10.013","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149190677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcriptomic study supports association, not biological steps, between PLK3 expression and senescence (Reply to Letter-to-the-Editor).","authors":"Carolyn W Swenson, Yves A Lussier","doi":"10.1016/j.ajog.2026.10.011","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.10.011","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to \"Hypertensive Disorders of Pregnancy: A Systematic Review of International Clinical Practice Guidelines\": [American Journal of Obstetrics and Gynecology 235/2 (2026) 280-302].","authors":"Micol Febles, Georgia Scott, Tessa Gillon, Anouk Pels, Kristina Klepp, Maria Laura Costa, Peter von Dadelszen, Laura A Magee","doi":"10.1016/j.ajog.2026.09.034","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.09.034","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does the TP53BP1-PLK3 Pattern Identify Senescence or Unresolved Repair? (Letter-to-the-Editor).","authors":"Xiao Yuan, Taotao Zheng, Zhen Qin","doi":"10.1016/j.ajog.2026.10.010","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.10.010","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reoperations Following Surgical Treatment of Ovarian Endometriosis: Incidence, Risk Factors, and Surgical Approaches.","authors":"Sanna Ylävuo, Liisu Saavalainen, Juuso Saavalainen, Päivi Härkki, Oskari Heikinheimo","doi":"10.1016/j.ajog.2026.10.009","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.10.009","url":null,"abstract":"<p><strong>Background: </strong>Ovarian endometriosis is one of the most frequently diagnosed endometriosis subtypes. Surgical treatment may be required in selected cases, and indications for surgery have evolved over the years. However, recurrence is common and reoperation is likely to compromise ovarian reserve, while long-term data on rates of reoperation and its risk factors remain limited.</p><p><strong>Objective: </strong>The aim was to assess long-term reoperation risk and its predictors in surgically verified ovarian endometriosis.</p><p><strong>Study design: </strong>We used Finnish national registers to identify women with first surgically verified diagnosis of ovarian endometriosis who underwent an ovarian procedure at the index surgery between 1987 and 2012 (n = 13,912). Follow-up continued until 2019. Subsequent operations were identified using predefined procedural codes at plausible endometriosis sites, with a concurrent diagnosis of endometriosis or adenomyosis, excluding procedures within 30 days. We classified all procedures as ovarian, peritoneal, deep infiltrating endometriosis, or other procedures, and compared women with a single versus repeat surgeries (overall and ovarian) and across index eras (ICD-9 1987-1995; ICD-10 1996-2012). Cumulative reoperation risk was estimated using Kaplan-Meier analyses, and associated factors were evaluated using Cox regression.</p><p><strong>Results: </strong>Median follow-up was 20.7 years (IQR 14.8-27.2). The 30-year cumulative risks of any and ovarian reoperation were 17.3% and 16.5%, respectively. Median time to first reoperation was 3.4 years (IQR 1.4-7.2), but subsequent reoperations occurred sooner (median <2 years). Reoperated women had fewer births (61.6% vs 70.7%, P<.001) and more infertility (51.5% vs 17.1%, P<.001) than those with a single surgery. Reoperation was more common during the ICD-10 than ICD-9 era (19.0% vs 12.4%, P<.001) and occurred sooner (median 3.1 vs 4.5 years, P<.001). Despite restriction ovarian endometriosis as the sole diagnosis at index surgery, peritoneal (3.6%) and deep infiltrating endometriosis (1.8%) procedures were recorded. At subsequent surgeries, all endometriosis and adenomyosis diagnosis were permitted, and the proportion of deep infiltrating endometriosis procedures increased to 13.4% by the fourth or subsequent operation. In multivariable Cox regression, young age, family history of endometriosis, and primary endometriosis diagnosis were associated with increased risks of both any and ovarian reoperations, whereas hysterectomy before or at index surgery reduced the risks. Infertility before index surgery was associated with any reoperation. Compared with oophorectomy/ies, enucleation/resection (aHR 1.43, 95% CI 1.28-1.60) and other ovarian procedures (aHR 2.20, 95% CI 1.67-2.89) increased the risk of any reoperation; for ovarian reoperation, increased risk was observed only with other ovarian procedures (aHR 1.68, 95% Cl 1.23-2.31). Index surger","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Myo-inositol to prevent gestational diabetes: \"What do conflicting trials tell clinicians?\"","authors":"Serena Lecis, Rosario D'Anna, Simone Garzon, Fabio Facchinetti","doi":"10.1016/j.ajog.2026.09.007","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.09.007","url":null,"abstract":"<p><strong>Background: </strong>A recent meta-analysis reported that myo-inositol supplementation was associated with a reduced risk of gestational diabetes mellitus. However, the primary outcome showed substantial between-study heterogeneity, complicating the interpretation and clinical applicability of the evidence.</p><p><strong>Objective: </strong>To discuss why randomized trials may have produced different results and identify the information needed to guide future research and clinical interpretation.</p><p><strong>Study design: </strong>We critically appraised the clinical and methodological characteristics of the randomized controlled trials included in the published meta-analysis to explore factors that may have contributed to their variability in results.</p><p><strong>Results: </strong>Substantial differences were found in population characteristics, including the prevalence of a family history of diabetes, previous gestational diabetes mellitus, and overweight or obesity. Trials also differed in the timing of treatment initiation (before or after the 14^th week) and in their supplementation protocols. The available evidence does not allow conclusions regarding treatment effect modification, because study-level analyses cannot distinguish true differences in treatment effects from differences in statistical power or other study characteristics. Short-term tolerability has been consistently reported; however, long-term neonatal outcomes have rarely been reported, and safety data remain limited.</p><p><strong>Conclusion: </strong>The recent meta-analysis provided a signal of benefit of myo-inositol for prevention of gestational diabetes mellitus. This clinical perspective identifies and discusses clinical and methodological differences that may have contributed to the variability in results across trials. However, the available evidence does not establish the optimal target population, supplementation protocol, or timing of treatment initiation. Adequately powered randomized trials focusing on short- and long-term neonatal outcomes are needed to better define the efficacy and safety of myo-inositol for the prevention of gestational diabetes mellitus.</p>","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to \"The impact of birth settings on pregnancy outcomes in the United States\" American Journal of Obstetrics and Gynecology 228 (2023) S965-S976.","authors":"Amos Grünebaum, Eran Bornstein, Renee McLeod-Sordjan, Tricia Lewis, Shane Wasden, Adriann Combs, Adi Katz, Risa Klein, Ashley Warman, Alex Black, Frank A Chervenak","doi":"10.1016/j.ajog.2026.09.033","DOIUrl":"https://doi.org/10.1016/j.ajog.2026.09.033","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":7.9,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}