American journal of obstetrics and gynecology最新文献

{"title":"Associations between parity, age at childbirth, and later-life mortality in postmenopausal women mediated by premature menopause.","authors":"Zailing Xing, Russell S Kirby, Henian Chen, Mary Ashley Cain, Amy C Alman","doi":"10.1016/j.ajog.2025.06.005","DOIUrl":"10.1016/j.ajog.2025.06.005","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to examine the long-term effects of parity, age at first childbirth, and age at last childbirth on mortality in postmenopausal women.</p><p><strong>Study design: </strong>The data were from the Women's Health Initiative involving 106,760 postmenopausal women. We used propensity score matching to create matched samples, where each exposure group was matched with a reference group based on their propensity scores. We employed multilevel Cox proportional hazard models to estimate hazard ratios and 95% confidence intervals to examine the associations of parity and age at childbirth with mortality. We conducted multiple mediation analyses to estimate the effects of potential mediators on the associations.</p><p><strong>Results: </strong>Compared to parity of 2, the hazard ratios (95% confidence intervals) for the association of all-cause mortality with parity of 0, 1, 3, 4, and 5+ were 1.09 (1.05-1.13), 1.11 (1.06-1.16), 1.01 (0.99-1.04), 1.00 (0.97-1.03), and 1.00 (0.96-1.03), respectively. Age at first childbirth of <20, age at last childbirth of <25, and age at last childbirth ≥40 years were associated with increased mortality risks, with the corresponding hazard ratios (95% confidence intervals) of 1.14 (1.09-1.19), 1.06 (1.02-1.11), and 1.07 (1.00-1.15), respectively. Women with parity of 0, 4+, or age at first childbirth <25 years had shorter lifespans than the reference groups. Premature menopause was a pivotal mediator in the associations of parity and age at first childbirth with mortality.</p><p><strong>Conclusion: </strong>We found long-term adverse impacts of nulliparity and young age at first childbirth on women's mortality risk and lifespan. Premature menopause may operate as a critical intermediate between childbirth and later-life mortality, underscoring the importance to identify at-risk women early.</p>","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144281969","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":"Association between urinary incontinence and device-measured physical activity: A cross-sectional study.","authors":"Michele O'Shea, Lynda H Powell, Kelly Karavolos, Bryce Daniels, Sheila Dugan, Kelley Pettee Gabriel, Carrie Karvonen-Gutierrez Phd, Sumihiro Suzuki, L Elaine Waetjen, Imke Janssen","doi":"10.1016/j.ajog.2025.06.006","DOIUrl":"https://doi.org/10.1016/j.ajog.2025.06.006","url":null,"abstract":"<p><strong>Objectives: </strong>Determine the association between urinary incontinence (UI) and physical activity in a well-characterized and racially and ethnically diverse cohort of women. Secondarily, we aimed to determine the association between the frequency of symptoms of UI and UI type (stress, urge, mixed) and accelerometer-based measures of physical activity and sedentary behavior.</p><p><strong>Study design: </strong>Cross-sectional study of 1,098 women who were enrolled in the Study of Women's Health Across the Nation (SWAN), an epidemiologic study of community-dwelling women representing five racial/ethnic groups and seven geographic sites across the United States. For the primary analysis, presence of UI (<1 vs. >1 leakage episode/month) was the primary predictor of selected measures of physical activity including moderate-intensity physical activity (MVPA) minutes, number of MVPA bouts, duration of MVPA bouts, and sedentary minutes. Unadjusted models, and models adjusted age, race and ethnicity, body mass index (BMI), parity, smoking status, mental health status, total comorbidity score, and accelerometer wear time were performed using multivariate linear regression. The same analytic approach was repeated for frequency of episodes of UI and UI subtypes of stress (SUI), urge (UUI), and mixed (MUI) incontinence.</p><p><strong>Results: </strong>Average age was 65±2.7 years, and was comprised of 23.5% Black, 12.5% Chinese, 11.3% Japanese, 4.9% Hispanic/Latina, and 47.8% White women. Prevalence of UI was 65%. In unadjusted analyses, presence of any UI was associated with increased sedentary minutes, decreased MVPA bouts, and decreased amount of time spent in MVPA bouts, but these associations were eliminated when accounting for covariates, particularly age and body mass index. However, frequency of UI episodes (> 1/week) was inversely related to duration of MVPA bouts (beta coefficient: -3.0 minutes, 95% CI: -5.77, -0.24 minutes). This association was strengthened for urgency urinary incontinence (beta coefficient: -3.70, 95% CI: -6.64, -0.77). Any significant unadjusted associations in the remaining variables were primarily accounted for by BMI.</p><p><strong>Conclusions: </strong>Presence of UI was not associated with physical activity estimates. More frequent UUI episodes was associated with less time spent in MVPA. Longitudinal studies are needed to further understand impact of UUI on achievement of physical activity guidelines.</p>","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144281968","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":"Management of late-onset fetal growth restriction by an antenatal risk stratification protocol.","authors":"Si-Yun Li, Dong-Zhi Li","doi":"10.1016/j.ajog.2025.06.007","DOIUrl":"10.1016/j.ajog.2025.06.007","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144281972","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":"Early gestational diabetes: criticism is based on false premises.","authors":"Apolonia García-Patterson, Montserrat Balsells, Ivan Solà, Rosa Corcoy","doi":"10.1016/j.ajog.2025.06.010","DOIUrl":"10.1016/j.ajog.2025.06.010","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144281970","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":"Early gestational diabetes: methodological gaps in the current evidence synthesis.","authors":"Jiwu Huo, Jianzhong Guan","doi":"10.1016/j.ajog.2025.06.009","DOIUrl":"10.1016/j.ajog.2025.06.009","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144281971","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":"Preterm prelabor rupture of membranes: the use of amniocentesis to detect intraamniotic infection reduces maternal and neonatal duration of antibiotic exposure.","authors":"Teresa Cobo, Victoria Aldecoa, Silvia Ferrero, Judith Balcells, Ana Lucia Contreras, Andrea Valenzuela, María Pastor, David Boada, Ana Herranz, Montserrat Izquierdo-Renau, Clara Murillo, Ana Del Río, Marta Hernández-Meneses, Berta Fidalgo, Montserrat Rodriguez-Reyes, Francesc Figueras, Eduard Gratacós, Montse Palacio","doi":"10.1016/j.ajog.2025.06.011","DOIUrl":"10.1016/j.ajog.2025.06.011","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Current management guidelines for patients with preterm prelabor rupture of membranes at &lt;32+0 weeks of gestation recommend administering antibiotics, although evidence on their benefits for short- and long-term neonatal outcomes is poor.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study aimed to evaluate whether the use of amniocentesis to detect intraamniotic infection reduces maternal and neonatal duration of antibiotic exposure.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;This was a retrospective observational cohort study (2014-2023) including patients diagnosed with preterm prelabor rupture of membranes at &lt;32+0 weeks of gestation who underwent amniocentesis at admission to assess the presence of intraamniotic infection. We compared 2 groups according to antenatal antibiotic management. From 2014 to 2019, patients received at least 5 days of broad-spectrum antibiotic treatment (including intravenous ampicillin and gentamicin and a single dose of oral azithromycin), regardless of intraamniotic infection status (standard management group). Beyond 2019, gentamicin was substituted for intravenous ceftriaxone and azithromycin for oral clarithromycin. Antibiotic treatment duration was optimized on the basis of amniotic fluid analysis (amniocentesis-based management): if amniotic fluid glucose concentrations were ≥14 mg/dL and Gram staining did not show the presence of bacteria, antibiotic treatment was discontinued at 48 hours. Otherwise, antibiotic therapy was prolonged at least until microbiological amniotic fluid results. Regardless of the management group, if intraamniotic infection was diagnosed, the type of antibiotic was individualized according to the bacteria isolated, and treatment was prolonged for 7 to 10 days unless delivery occurred earlier. There were no other differences in maternal management between the 2 periods.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 172 patients diagnosed with preterm prelabor rupture of membranes at &lt;32+0 weeks of gestation were included (122 in the standard management group and 50 in the amniocentesis-based management group). The prevalence of intraamniotic infection was 29% in both periods, with most cases (61%) being due to Ureaplasma species. There were no differences in maternal characteristics between the 2 groups. As expected, in the amniocentesis-based management group, maternal exposure to antibiotics was shorter (median [25th centile-75th centile] of 2 [2-3] days [amniocentesis-based management] vs 5 days [4-5] [standard management]; P&lt;.0001). In line with the reduction of the duration of antibiotic therapy, we observed that maternal hospital stay was significantly shorter (5 [4-9] vs 11 [5-21] days; P=.001) and outpatient management was more frequent (68% vs 47%; P=.011) in the amniocentesis-based management group. No differences were observed in maternal morbidity. Similar results were found when neonatal outcomes were evaluated. In the amniocentesis-based management group","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144281973","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":"Role of FcγR3A polymorphism in the treatment of gestational trophoblastic tumors.","authors":"Mengting Zhang, Yong Ni, Lizhong Duan","doi":"10.1016/j.ajog.2025.06.002","DOIUrl":"10.1016/j.ajog.2025.06.002","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245746","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 frequency of placental lesions and adverse pregnancy outcomes: a linked cohort study.","authors":"Mauritia C Marijnen, Carmen J M Oudejans, Alexa A Freedman, Linda M Ernst, Wessel Ganzevoort, Mirthe H Schoots, Lotte-Elisabeth van der Meeren, S J Gordijn","doi":"10.1016/j.ajog.2025.06.004","DOIUrl":"10.1016/j.ajog.2025.06.004","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245747","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":"Intricacies of studying doula care.","authors":"Lara S Lemon, Beth Quinn, Hyagriv N Simhan","doi":"10.1016/j.ajog.2025.05.046","DOIUrl":"10.1016/j.ajog.2025.05.046","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245742","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":"Quantifying an association between doula care with maternal and neonatal outcomes: a critical appraisal.","authors":"Avir Sarkar, Bijoya Mukherjee, Subrat Panda, Amiya Das, Priyanka Mondal, Suman Sandeep Samal","doi":"10.1016/j.ajog.2025.05.045","DOIUrl":"10.1016/j.ajog.2025.05.045","url":null,"abstract":"","PeriodicalId":7574,"journal":{"name":"American journal of obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":8.7,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245744","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}