Archives of Gynecology and Obstetrics最新文献

{"title":"Subdermal implants vs. levonorgestrel intrauterine devices outcomes in reproductive-aged women: a systematic review and meta-analysis.","authors":"Juliana Almeida Oliveira, Gabriel Lage Neves, Matheus Eduardo Soares Pinhati, Flávia Ribeiro de Oliveira, Agnaldo Lopes da Silva Filho","doi":"10.1007/s00404-025-07943-6","DOIUrl":"https://doi.org/10.1007/s00404-025-07943-6","url":null,"abstract":"<p><strong>Purpose: </strong>We aimed to conduct a systematic review and meta-analysis comparing the outcomes of subdermal implants and levonorgestrel intrauterine system (LNG-IUS) in reproductive-aged women.</p><p><strong>Methods: </strong>In April 2024, we searched Pubmed, Embase and Cochrane trials using the search terms: \"etonogestrel\", \"levonorgestrel\" and \"randomized controlled trials\". We identified 2862 results comparing the LNG-IUS to subdermal implants. Randomized controlled trials (RCTs) were selected with no restrictions on language or year of publication.</p><p><strong>Results: </strong>We include six RCTs comprising 1503 patients. R Studio was used for statistical analysis. Subdermal implants were associated with a higher risk of dissatisfaction (OR 2.42; 95% CI 1.47-3.98), acne (OR 2.21; 95% CI 1.21-4.04), weight gain (OR 4.63; 95% CI 1.96-10.63), and device removal due to side effects (OR 2.02; 95% CI 1.20-3.41) compared to the LNG-IUS group. Subgroup analysis indicated that irregular bleeding may be influenced by gynecological conditions, and the risk of new ovarian cyst detection was lower in healthy women using subdermal implants. Norplant-2 was associated with an increased risk of irregular bleeding and a decreased risk of amenorrhea or infrequent bleeding. The leave-one-out analysis and heterogeneity were well distributed among studies for all evaluated outcomes.</p><p><strong>Conclusions: </strong>Reproductive-aged women in use of subdermal implants experienced a higher rate of acne, weight gain, device removal due to side effects and dissatisfaction compared to those in use of LNG-IUS.</p><p><strong>Trial registration: </strong>PROSPERO ID: CRD42024516472.</p>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The efficacy of progestins in managing pain associated with endometriosis, fibroids and pre-menstrual syndrome: a systematic review.","authors":"Connor Luke Allen, Saikat Banerjee, Mahantesh Karoshi, Peter Humaidan, Farshad Tahmasebi","doi":"10.1007/s00404-025-07957-0","DOIUrl":"https://doi.org/10.1007/s00404-025-07957-0","url":null,"abstract":"<p><strong>Purpose: </strong>Alongside being contraceptives, progestins have been investigated as potential anti-inflammatory and analgesic therapies for use in painful gynaecological conditions. This review aims to synthesise evidence pertaining to the efficacy of progestins as analgesics for use in endometriosis, fibroids and pre-menstrual syndrome (PMS).</p><p><strong>Methods: </strong>We conducted a systematic review of the extant literature investigating the analgesic efficacy of progestins compared to any comparator interventions for individuals with the three specified gynaecological conditions. The search was carried out across the PubMed and CENTRAL databases on 7 April 2024 for randomised control trials (RCTs) published in the peer-reviewed literature from 2000 onwards. Data pertaining to analgesic efficacy, assessed by changes in pain indices/scores before and after treatment, were synthesised narratively. Data pertaining to adverse effect frequency and changes in bone mineral density (BMD) were also synthesised narratively. Risk of bias was assessed using the Cochrane risk of bias 2 tool.</p><p><strong>Results: </strong>The primary search identified 1220 potentially eligible RCTs of which 21 were ultimately included; 19 RCTs related to endometriosis, two related to fibroids and zero related to PMS. Quality assessment identified nine studies to be at a low risk of bias, nine studies with some concerns surrounding bias and three studies to be at a high risk of bias. The included studies represented a total of 2745 participants of whom 1317 were treated with a progestin and 1428 received a comparator intervention. In 18 of the 19 studies concerning endometriosis, progestins produced a statistically significant reduction in pain, further, in five instances progestins were more efficacious in reducing pain than comparator interventions. In both studies on fibroids, progestins produced significant reductions in pain, however, statistically significant differences compared to comparator interventions were not demonstrated. The most frequently cited adverse effect of progestins was spotting/irregular bleeding whilst those receiving comparator interventions most often reported hot flushes; cited in 12 and seven studies respectively. Five studies assessed the impact of progestins and comparators on BMD. Three studies found progestins significantly reduced BMD, however, in these instances reductions were significantly lower than those produced by comparator interventions and in two studies were not statistically significant after 12 months of follow-up.</p><p><strong>Conclusion: </strong>Our review demonstrates the potential scope for the use of progestins as analgesics in the management of pain associated with endometriosis. Further research will need to be conducted to identify their efficacy in the management of pain associated with fibroids and PMS.</p>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evolution of lymphovascular space invasion in early-stage endometrial carcinoma: stratification, quantification, and clinical implications: a systematic review.","authors":"Hai-Yan Sun, Xu Wang, Li-Xian Wang, Qiu-Man Wang, Shan Kang","doi":"10.1007/s00404-025-07997-6","DOIUrl":"https://doi.org/10.1007/s00404-025-07997-6","url":null,"abstract":"<p><strong>Purpose: </strong>Endometrial carcinoma (EC) represents the most prevalent malignancy of the female genital tract in the United States, with lymphovascular space invasion (LVSI) recognized as a critical prognostic factor that significantly influences disease outcomes. This review aims to elucidate the evolving understanding of LVSI in early-stage EC, highlighting its implications for stratification, quantification, and clinical management.</p><p><strong>Methods: </strong>A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Comprehensive searches of the PubMed, Web of Science, and Embase/MEDLINE databases were performed for studies published from January 1, 1985, to November 16, 2024. Peer-reviewed articles that reported multivariable hazard ratios (HR) for LVSI in endometrial cancer were included, while meta-analyses, reviews, and case reports were excluded from analysis.</p><p><strong>Results: </strong>A total of 6 studies involving 2,345 patients were included. The majority of the population was characterized by endometrioid histotype (85.7%) and classified as FIGO stage I (75.1%). LVSI was documented in 21.5% of cases, with 62.4% of patients receiving adjuvant treatment. The literature on LVSI was categorized into three thematic areas: stratification classifications, quantitative assessments, and guideline development, illustrating the progression from binary systems to more nuanced tiered classifications that enhance prognostic accuracy.</p><p><strong>Conclusion: </strong>Foundational studies established LVSI as a significant risk factor in endometrial cancer, while subsequent research has refined its classification and quantification. However, inconsistencies in LVSI thresholds among current clinical guidelines pose challenges for standardization in practice. Addressing these discrepancies through future research, including multicenter studies and the integration of emerging technologies, is crucial for improving risk stratification and clinical management of endometrial carcinoma.</p>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The combined impact of meconium stained amniotic fluid and small for gestational age on delivery outcomes.","authors":"Gal Cohen, Adi Shilony, Reut Batia Amrami, Tal Biron-Shental, Michal Kovo, Hanoch Schreiber","doi":"10.1007/s00404-025-07995-8","DOIUrl":"https://doi.org/10.1007/s00404-025-07995-8","url":null,"abstract":"<p><strong>Purpose: </strong>To assess the delivery complications in neonates with meconium stained amniotic fluid (MSAF) and small for gestational age (SGA) birthweight.</p><p><strong>Methods: </strong>The medical records of all term, singleton deliveries during 2014-2021 were reviewed. Obstetric characteristics and neonatal outcomes were evaluated among the following groups: SGA neonates with MSAF (SGA-MSAF group), SGA neonates without MSAF (SGA group), appropriate for gestational age (AGA) neonates with MSAF (AGA-MSAF group) and AGA without MSAF (AGA group).</p><p><strong>Results: </strong>A total of 44,911 deliveries were included in the study, with 673 in the SGA-MSAF group, 2,762 in the SGA group, 6,958 in the AGA-MSAF group, and 34,518 in the AGA group. The SGA-MSAF group exhibited higher rates of nulliparity and hypertensive disorders compared to the SGA, AGA-MSAF, and AGA groups (p ≤ 0.001). Oligohydramnios, labor induction, vacuum extractions (VE), and intrapartum cesarean deliveries (CD) were significantly more frequent in the SGA-MSAF group compared to the SGA, AGA-MSAF, and AGA groups (p ≤ 0.003). The SGA-MSAF group had the highest rates of adverse composite neonatal outcomes compared to the SGA, AGA-MSAF, and AGA groups (p < 0.001). Multivariable logistic regression, adjusted for confounders, revealed increased ORs for the adverse neonatal composite outcome, VE, VE due to NRFHR, intrapartum CD, and CD due to NRFHR, in the presence of MSAF or SGA, and mostly when both risk factors were present (p ≤ 0.002).</p><p><strong>Conclusion: </strong>Deliveries complicated with MSAF and SGA were associated with increased obstetric complications compared to each alone. Clinicians should be aware of this and manage labor accordingly.</p>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143596188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of vaginal breech deliveries with and without magnetic resonance imaging in primigravidas: a retrospective cohort analysis and literature review.","authors":"G Cinari, A Edner, A Rody, K Kraft","doi":"10.1007/s00404-024-07915-2","DOIUrl":"https://doi.org/10.1007/s00404-024-07915-2","url":null,"abstract":"<p><strong>Purpose: </strong>Pelvimetry is often recommended in primiparous patients before offering vaginal breech delivery. Later studies show a reduction in perinatal mortality in women undergoing pelvimetry while earlier studies show the opposite. Magnetic resonance imaging (MRI), considered a new technology in 1990, has become the more expensive method for pelvimetry with lower-radiation, believed to prevent unnecessary cesarean sections and \"falsely attempted vaginal deliveries\".</p><p><strong>Methods: </strong>This retrospective cohort study (November 2019-February 2024) involved 160 primigravidas with breech presentation. The deliveries were attended by a team of experienced obstetricians (defined as attending at least 20 vaginal breech deliveries per year). Our cohort without MRI was compared with four study cohorts with MRI that were also used in a 2022 systematic review assessing delivery outcomes.</p><p><strong>Results: </strong>Neonatal outcomes, cesarean section rate and vaginal delivery rate were compared. Umbilical artery pH was significantly lower in two study cohorts (Hoffmann et al. 2016 7.18 vaginal vs. 7.24 caesarean section (p < 0.001), our cohort 7.19 vaginal vs. 7.27 cesarean section (p < 0.001)). The vaginal delivery rate without MRI (our cohort) was 65.6%. In studies with prior MRI as a selection criterion, the rate was between 65.4% and 67.5% (Hoffmann, Van Loon, Klemt). 25.5% of our patients who had to be delivered by cesarean had non-reassuring fetal heart tones in the second stage of labor. Only 4.4% of the patients attempted delivery with epidural anesthesia.</p><p><strong>Conclusion: </strong>Pelvimetry has not been shown to predict neonatal outcome and there is still no consensus on the interpretation of MRI measurements. Many authors argue, as confirmed by our results, that the outcomes are not dependent on pelvimetry, but on the competence of the obstetric delivering team.</p>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143571651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hysteroscopic niche resection can effectively reduce the niche volume, increase residual myometrial thickness, and improve postmenstrual spotting symptoms.","authors":"Yang Wang, Wei Xia, Taotao Sun, Lirong Yan, Chuqing He, Judith A F Huirne, Jian Zhang","doi":"10.1007/s00404-025-07980-1","DOIUrl":"https://doi.org/10.1007/s00404-025-07980-1","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the anatomical changes of the uterine niche in women before and after hysteroscopic niche resection (HNR) and to investigate the correlation between these changes and the improvement in postoperative spotting symptoms by thin-slice MRI.</p><p><strong>Methods: </strong>This prospective observational study enrolled women with symptomatic uterine niches between June 2019 and February 2024. All participants underwent thin-slice magnetic resonance imaging (MRI) before and after HNR. We assessed the effective rate of postoperative spotting at the 6-month follow-up (effective treatment was defined as a reduction of at least 50% in spotting days relative to baseline during the 6-month follow-up period) and the pre- and post-HNR anatomical indicators.</p><p><strong>Results: </strong>A total of 108 women were included in the study. Six months after HNR, 70.4% (76/108) of women experienced at least a 50% reduction in spotting days from baseline. Residual myometrial thickness (RMT) significantly increased by 1.9 ± 2.2 mm (p < 0.01). The volume of niche significantly decreased, with a median reduction rate of 38.5% (IQR 8.5-88.2%) (p < 0.01). Based on the ROC curve, a cut-off value of 50 mm² for volume was identified as an optimal threshold for subclassifying large niches and small niches, according to treatment efficacy. The reduction in niche volume was more pronounced in the small niche group compared to the large niche group, with median reduction rates of 51.9% (IQR 13.5-100.0%) and 12.4% (IQR -15.4-43.9%), respectively (p < 0.01). There is an interesting finding that most cases in the anatomical failure group (those with an enlarged niche) had a preoperative volume of ≥ 50 mm² (19.2%, p < 0.01). Furthermore, the effective treatment group exhibited a more significant increase in RMT and a greater reduction in niche volume after HNR compared to the ineffective group. Multivariate logistic regression analysis indicated that small niches [OR 16.85 (3.36-84.47), p < 0.01] and greater reductions in niche volume [OR 1.14 (1.07-1.21), p < 0.01] were associated with effective treatment.</p><p><strong>Conclusion: </strong>HNR is a promising approach for managing postmenstrual spotting, especially in treating small uterine niches (volume < 50 mm²). After HNR, RMT increases, and niche size decreases slightly.</p>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143555725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing infertility treatment for ovarian endometrioma: is surgical intervention preferable before or after in-vitro fertilization programs?","authors":"Ivan Sini,&nbsp;Aries Joe,&nbsp;Nining Handayani,&nbsp;Tri Aprilliana Wulandari,&nbsp;Ayu Mulia Sundari,&nbsp;Batara Sirait,&nbsp;Arie Adrianus Polim,&nbsp;Irham Suheimi,&nbsp;Arief Boediono,&nbsp;Andrew Kan","doi":"10.1007/s00404-025-07954-3","DOIUrl":"10.1007/s00404-025-07954-3","url":null,"abstract":"<div><h3>Purpose</h3><p>Endometriosis is one of the common endometrial pathologies that occurs in reproductive-age women and could lead to infertility. This study set out to observe which clinical management of endometriosis with endometrioma is prominent in improving IVF outcomes.</p><h3>Materials and methods</h3><p>This was a retrospective cross-sectional controlled study at Bunda General Hospital and Morula IVF Jakarta Clinic, Indonesia from Jan 2018 to Dec 2022. A total of 279 patients diagnosed with endometriosis were recorded. Of that, 86 couples with endometrioma underwent an in vitro fertilization program (IVF). Forty-eight women performed IVF prior to the removal of endometrioma through surgery (IVF-OPS) while the remaining underwent surgery for endometrioma removal followed by an IVF program (OPS-IVF). Each group was compared to the control group which was administered to an IVF program without the removal of endometriosis. The primary outcome was the clinical pregnancy rate. Mann–Whitney or Kruskal–Wallis and Chi square were used for statistical analysis. A <i>p</i> value of &lt; 0.05 was considered statistically significant.</p><h3>Results</h3><p>A comparable clinical pregnancy rate was observed across the three groups (<i>p</i> = 0.068). Nonetheless, the IVF-OPS approach led to an improved number of top-quality blastocysts compared to both the control and OPS-IVF groups (<i>p</i> &lt; 0.05). Eventually, IVF-OPS was shown to be a prominent approach for endometriosis with endometrioma management in comparison to OPS-IVF in terms of clinical pregnancy rate as well as embryology laboratory outcomes (<i>p</i> &lt; 0.05).</p><h3>Conclusion</h3><p>Our result suggested that intervention of endometriosis with removal surgery was superior when performed after the IVF program.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"311 3","pages":"781 - 787"},"PeriodicalIF":2.1,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00404-025-07954-3.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143565885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of acupuncture-related therapies in symptomatic endometriosis: a systematic review and network meta-analysis","authors":"Yang Su,&nbsp;Ran Ji,&nbsp;Xiaoyan Zheng,&nbsp;Yan Jia,&nbsp;Hao Zhu,&nbsp;Chaoliang Li,&nbsp;Zheng Yu,&nbsp;Manjia Zhu,&nbsp;Siyi Yu,&nbsp;Xiaoping Tian,&nbsp;Jie Yang","doi":"10.1007/s00404-025-07979-8","DOIUrl":"10.1007/s00404-025-07979-8","url":null,"abstract":"<div><h3>Objective</h3><p>To compare the effectiveness and safety of different acupuncture-related therapies combined with pharmacotherapies for treating symptomatic endometriosis.</p><h3>Methods</h3><p>A pre-defined search strategy was conducted across eight databases (Chinese Biomedical Literature Service System, China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, China Science and Technology Journal Database, PubMed, Embase, Cochrane Library, and Web of Science) from inception to May 1, 2023. The included studies were evaluated for methodological quality using the Cochrane risk of bias assessment tool. The surface under the cumulative ranking (SUCRA) was applied to rank the acupuncture-related therapies for each outcome.</p><h3>Results</h3><p>Twenty-three randomized controlled trials (RCTs) involving one thousand five hundred forty-five patients were included in the network meta-analysis. Ear electroacupuncture (SUCRA = 83.0%), needle warming moxibustion with Modified Neiyi Zhitong Formula (SUCRA = 80.6%), and auricular needle-embedding (SUCRA = 79.6%) demonstrated a statistically significant reduction in comprehensive symptoms compared to the control group. Studies have shown that body electroacupuncture (OR = 4.33, 95% CI 1.20–15.61), acupoint catgut (OR = 4.32, 95% CI 1.08–17.25), and auricular needle-embedding (OR = 7.56, 95% CI 1.89–30.28) are statistically significantly more effective than conventional treatment.</p><h3>Conclusion</h3><p>The results of this analysis suggest that acupuncture-related therapies are effective in managing symptomatic endometriosis. Further high-quality randomized controlled trials are warranted to explore their efficacy and safety in greater depth.</p><h3>Trial registration</h3><p>Our study protocol was registered with the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY); registration number: INPLASY202380077.</p></div>","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"311 3","pages":"697 - 714"},"PeriodicalIF":2.1,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00404-025-07979-8.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial Expression of Concern: Is follicular flushing really effective? A clinical study","authors":"Mustafa Kara,&nbsp;Turgut Aydin,&nbsp;Nurettin Turktekin","doi":"10.1007/s00404-025-07987-8","DOIUrl":"10.1007/s00404-025-07987-8","url":null,"abstract":"","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"311 3","pages":"929 - 929"},"PeriodicalIF":2.1,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00404-025-07987-8.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An elevated triglyceride-glucose index in the first-trimester predicts adverse pregnancy outcomes: a retrospective cohort study","authors":"Songhong Song,&nbsp;Qi Luo,&nbsp;Xinyang Zhong,&nbsp;Man Huang,&nbsp;Jinxiu Zhu","doi":"10.1007/s00404-025-07973-0","DOIUrl":"10.1007/s00404-025-07973-0","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;p&gt;The relationship of the first-trimester triglyceride-glucose (TyG) index with GDM (gestational diabetes mellitus) and other adverse pregnancy outcomes has yet to be fully understood. This study aims to investigate the relationship between the first-trimester TyG index and the risk of adverse pregnancy outcomes in pregnant women.&lt;/p&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;The data for the retrospective cohort study were derived from the Maternal and Child Health Hospital of Longgang District, Shenzhen, China. To calculate the TyG index, health indicators were measured in the early pregnancy period (&lt;14 gestational weeks), including triglycerides and fasting blood glucose levels in pregnant women. Multivariable regression analysis and subgroup analysis were used to ascertain the independent association between the TyG index and the possibility of adverse pregnancy outcomes. Interaction analysis was performed to assess the potential heterogeneity of associations among subgroups. Nonlinear associations and the predictive value of the TyG index were explored using restricted cubic splines and receiver operating characteristic (ROC) curves. The discrimination and accuracy of the fully adjusted model were evaluated using calibration curves, Brier scores, and decision curve analysis (DCA). Mediation analysis was conducted to assess the impact of GDM (gestational diabetes mellitus) and PE (preeclampsia) as intermediaries on the risk of Preterm delivery.&lt;/p&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;The study included a cohort of 11,942 pregnant women, with an average TyG index of 8.36 ± 0.41. Logistic regression analysis showed that after adjusting for covariates, for each 1-unit increase in the TyG index, the risk of GDM increased by 2.21-fold, and this result was significantly different across all quartiles. Compared to the lowest quartile group, the highest TyG index group had the highest risk of PE (OR: 2.89; 95% CI 1.39 ~ 6.50), GH (gestational hypertension) (OR: 1.47; 95% CI 1.07 ~ 2.02), and Preterm delivery (OR: 1.75; 95% CI 1.21 ~ 2.56).The analysis of data stratification and interaction confirmed the validity of our study results. However, the analysis found no statistically significant association between the TyG index and low birth weight and macrosomia. GDM and PE were identified as partial mediating factors between TyG and the risk of preterm delivery, with variance contributions of 7.23% and 20.33%. The TyG index demonstrated the highest area under the curve (AUC) values in the ROC curves for GDM, PE, GH, and preterm delivery, with values of 0.61, 0.67, 0.58, and 0.56, respectively. The combination of the TyG index, maternal age, and pre-pregnancy body mass index predicted outcomes better than the TyG index alone (&lt;i&gt;p&lt;/i&gt; &lt; 0.01).After adjustment for confounders, the model showed good accuracy and net benefit in predicting adverse pregnancy outcomes, as supported by calibration curves, Brier scores, and decision curve analysis.&lt;/p&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;","PeriodicalId":8330,"journal":{"name":"Archives of Gynecology and Obstetrics","volume":"311 3","pages":"915 - 927"},"PeriodicalIF":2.1,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00404-025-07973-0.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143498105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}