Low birth weight (LBW) is a serious global health issue that is indicative of an increased risk of newborn illness and mortality. LBW refers to a newborn weighing under 2,500 g (5.5 pounds) at birth, primarily due to either poor fetal growth, premature labor, or both. It is more prevalent in low and middle-income countries than in high-income countries. The entire study has been completed with the help of secondary data collected from the NFHS-5 of India, a cross-sectional national representative survey conducted from 2019 to 2021. In this study, the low birth weight of children is considered as an outcome variable. Based on previous research, various socio-economic and demographic variables were selected in this study. This study used Pearson's chi-square statistics and multivariable binary logistic regression to identify the association between low birth weight of children and maternal anemia and BMI (Body Mass Index). And descriptive statistics is also performed to analyze the data. The result shows that there is significant association between the maternal anemia and BMI with the occurrence of low birth weight. It is found that the occurrence of low birth weight is higher among severely anemic women and underweight women. Additionally, the prevalence of LBW is high among those women who use cigarettes and tobacco, and those children of multiparity, are female children, and are from central, western, and northern regions. So, it can be said that maternal anaemia and BMI is correlated with the prevalence of low birth weight among children. Hence, implementing appropriate interventions for pregnancy care and ensuring well-planned nutrition can significantly alleviate the challenges associated with LBW in India.
Pregnant individuals may receive antenatal corticosteroids for various conditions, including congenital adrenal hyperplasia (to prevent virilisation in female fetuses) and preterm birth risk (to hasten fetal maturation and improve perinatal survival). This narrative review aimed to evaluate the evidence of sexually-dimorphic offspring outcomes following antenatal corticosteroids for such conditions and explore the potential underlying mechanisms. A comprehensive MEDLINE search identified twenty-eight studies for inclusion: seven focused on congenital adrenal hyperplasia and twenty-one focused on preterm birth risk. For congenital adrenal hyperplasia, evidence suggests that antenatal corticosteroids are associated with sexually-dimorphic outcomes across cognition, behaviour and brain structure. Females demonstrated more consistently negative outcomes, particularly within the congenital adrenal hyperplasia-affected population, where females were exposed to longer treatment durations than males. The outcomes for males were more heterogenous. For preterm birth, some studies suggest preterm males remain at increased risk for mortality and morbidity, while in term-born infants, females may have worse outcomes. The nature of these effects, however, differed with antenatal corticosteroid types, and conflicting findings also existed. Potential mechanisms for sexually-dimorphic outcomes include differences in placental enzyme and receptor expression and activity, fetal hypothalamic-pituitary-adrenal (HPA) axis function, and susceptibility to developing respiratory conditions. The current literature suggests potential sex differences following antenatal corticosteroids, which differ between congenital adrenal hyperplasia and preterm birth risk. Owing to surmounting evidence of negative outcomes and the retracting use of antenatal corticosteroids for congenital adrenal hyperplasia, further research will be challenging. Whereas studies concerning sexually-dimorphic responses to antenatal corticosteroids for preterm birth risk are essential, given their widespread use. Further research in this area may help to understand whether the clinical management of preterm birth should be adjusted according to sex.
Maternal mortality remains a major public health concern in low-resource settings. Birth preparedness and complication readiness (BPCR) is an established strategy to improve timely care-seeking and reduce preventable maternal and neonatal complications. Utilizing Accredited Social Health Activists (ASHAs) to deliver BPCR interventions may strengthen community-level implementation; however, evidence on feasibility and acceptability is limited. To assess the feasibility and acceptability of an ASHA training strategy for community-level delivery of BPCR interventions in North Karnataka, India. A quasi-experimental pre-post interventional study was conducted among 100 ASHAs from two Primary Health Centres (PHCs) and one Community Health Centre (CHC). All eligible ASHAs who provided informed consent were included using complete enumeration sampling. Baseline BPCR-related knowledge and practice data were collected through face-to-face interviews. ASHAs then received structured BPCR training delivered through a Birth Planner-a pictorial educational pamphlet-over three interactive sessions at 3-, 6-, and 12-month intervals. Post-intervention assessment was conducted using the same questionnaire. Pre- and post-intervention scores were compared using paired t-tests, and effect sizes were estimated using Cohen's dz. Mean baseline knowledge scores for pregnancy, labour and childbirth, and postpartum danger signs were 31.55, 27.11, and 27.27, respectively, increasing to 73.45, 53.22, and 59.27 following the intervention. Self-reported practice scores for birth preparedness improved from 49.33 at baseline to 99.67 post-intervention. All improvements were statistically significant (p < 0.001) with large to very large effect sizes (Cohen's dz ≥ 1.31), indicating feasibility and high acceptance of BPCR implementation through structured ASHA training. Structured BPCR training using a simple, pictorial Birth Planner was feasible and acceptable among ASHAs in a rural district of North Karnataka, resulting in significant improvements in self-reported BPCR knowledge and practices. These findings, while limited by the pre-post design and single-district context, support ASHA-led BPCR integration within the National Health Mission. Future multi-site controlled studies are warranted to assess generalizability and long-term impact on maternal and neonatal health outcomes.
Can non-coding RNAs in exosomes from IVF embryo culture media serve as non-invasive markers for evaluating embryo quality? Spent culture medium (SCM) was prospectively collected from grade 1 eight-cell-stage embryos that resulted in pregnancy success (defined as live birth, n = 34) or failure (n = 33) among patients who underwent IVF and single embryo transfer at a single centre over 5 months. Exosomes were isolated by precipitation, followed by high-throughput small RNA sequencing to profile exosomal non-coding RNAs, including miRNAs, tRFs and piRNAs. The diagnostic potential of validated differentially expressed miRNAs was then evaluated by receiver operating characteristic (ROC) analysis. Specific inhibitors targeting differentially expressed miRNAs were designed and microinjected into mouse embryos to assess their effects on embryonic development. Single-particle immunofluorescence analysis confirmed the presence of exosome-specific markers (CD63, CD9 and CD81) in isolated exosomes. Small RNA sequencing of exosomes identified 51 miRNAs, 547 piRNAs, and 39 tRFs, among which five, 11 and eight were differentially expressed, respectively. Validated by qRT-PCR, expression of hsa-miR-375-3p and hsa-miR-215-5p in SCM-derived exosomes was higher in the successful pregnancy group than in the pregnancy failure group. The ROC curve analysis indicated that hsa-miR-375-3p (AUC = 0.763, sensitivity 85%, specificity 70%) is a potential marker of embryo quality, laying the foundation for a miRNA-based predictive model to improve IVF outcomes. Inhibition of miR-375-3p significantly reduced the eight-cell mouse embryo formation rate (P = 0.0358). hsa-miR-375-3p in exosomes from SCM of embryos is a non-invasive predictive biomarker of live birth after IVF. miR-375-3p is critical for embryonic development during the four- to eight-cell stage transition.
Ureaplasma spp. colonization/infection has been implicated in the inflammatory pathogenesis of bronchopulmonary dysplasia (BPD) in very low birth weight (VLBW) infants, but the benefit of targeted macrolide therapy remains uncertain. We evaluated respiratory outcomes associated with early Ureaplasma positivity in VLBW infants and assessed feasibility and preliminary efficacy of a standardized intravenous azithromycin regimen in a nested pilot randomized trial. This single-center study comprised (1) a retrospective cohort of inborn VLBW infants (< 1,500 g) born between July 2017 and December 2021 who underwent Ureaplasma screening within 24 h after birth, and (2) a prospective, double-blind, randomized, placebo-controlled pilot trial nested among Ureaplasma-positive infants requiring significant respiratory support. In the cohort, outcomes included moderate-to-severe and severe BPD at 36 weeks' postmenstrual age and home oxygen therapy. Multivariable logistic regression adjusted for gestational age, sex, preterm premature rupture of membranes, histologic chorioamnionitis, antenatal steroid exposure, patent ductus arteriosus treatment, and sepsis. In the trial, infants were randomized 1:1 to intravenous azithromycin for 14 days (10 mg/kg/day for 7 days, then 5 mg/kg/day for 7 days) or placebo. Microbiologic response at 2 weeks and safety, including QTc, were assessed. Among 536 VLBW infants, 34 (6.3%) were Ureaplasma positive. Ureaplasma-positive infants had higher rates of moderate-to-severe BPD (76.5% vs. 41.0%), severe BPD (67.6% vs. 36.0%), and home oxygen therapy (46.2% vs. 19.1%). After adjustment, Ureaplasma positivity remained associated with moderate-to-severe BPD (adjusted odds ratio [aOR] 3.86, 95% confidence interval [CI] 1.44-10.35) and severe BPD (aOR 2.93, CI 1.21-7.10). In the pilot trial (n = 26; 13 per group), moderate-to-severe BPD occurred in 61.5% (8/13) with azithromycin versus 84.6% (11/13) with placebo, and severe BPD in 46.2% (6/13) versus 76.9% (10/13). Loss of detectable Ureaplasma by culture at 2 weeks occurred in 13/13 azithromycin-treated infants, while 5/13 placebo infants remained positive. No QTc prolongation or clinically significant safety concerns attributable to azithromycin were observed. Early Ureaplasma positivity in VLBW infants was associated with substantially worse respiratory outcomes. A two-week intravenous azithromycin regimen was feasible, microbiologically active, and showed directionally favorable estimates for BPD without an observed safety signal. Larger microbiology-guided trials are warranted. KCT0002373 (registered 7 July 2017).
Imipenem/cilastatin/relebactam (IMI/REL), a fixed-dose combination of imipenem/cilastatin with the β-lactamase inhibitor relebactam, has broad gram-negative coverage. Prospectively obtained safety and efficacy data in neonates and children are needed. Children (birth to <18 years old) with hospital-acquired/ventilator-associated bacterial pneumonia (HABP/VABP), complicated intra-abdominal infection (cIAI) and complicated urinary tract infection (cUTI), including pyelonephritis, were enrolled in an open-label, randomized, active-controlled, multinational phase 2/3 trial (ClinicalTrials.gov: NCT03969901). Participants were randomized 3:1 to IMI/REL or active-control, standard-of-care antibacterial therapy for 7-14 days (HABP/VABP; intravenous [IV] only) or 5-14 days (cIAI, cUTI; with oral step-down permitted after 3 days of IV). The primary endpoint was safety, assessed through 14 days after the end of therapy (EOT) as adverse events (AEs) and AE-related discontinuations of IV therapy. Clinical and microbiologic responses were also assessed at EOT and follow-up visits. This was an estimation study without hypothesis testing. Eighty-six children were randomized to IMI/REL and 29 to active control. AEs were reported in 67.1% of IMI/REL versus 50.0% of active control arm participants (treatment difference: 17.1% [95% confidence interval: -3.5, 37.2]), leading to 3 versus 0 discontinuations of IV therapy, respectively. Treatment outcomes were generally comparable at all time points; at EOT, clinical response was 78.8% versus 75.0% and microbiologic response 95.6% versus 90.9% with IMI/REL and active control, respectively, with no mortality in either arm. IMI/REL was generally well tolerated in neonates and older pediatric patients with HABP/VABP, cIAI, or cUTI, with safety and efficacy profiles comparable to standard-of-care antibacterial therapy.
This study aimed to develop and externally validate machine learning-based models for predicting macrosomia and spontaneous preterm birth (sPTB) using multidimensional clinical data. This retrospective cohort study included 14 238 pregnant women who received prenatal care between 2018 and 2023. Demographic characteristics, laboratory parameters, and delivery outcomes were integrated, with Least Absolute Shrinkage and Selection Operator regression used for feature selection. Predictive models were developed using logistic regression and machine learning algorithms (Light Gradient Boosting Machine, Adaptive Boosting, and gradient boosting decision tree), and performance was evaluated using the area under the curve (AUC), Brier score, decision curve analysis, and external validation results. Key predictors of macrosomia included pre-pregnancy body mass index, 1-h postprandial glucose, maternal education level, and comorbidities. The logistic regression model for macrosomia achieved an AUC of 0.742 (95% CI: 0.617-0.866) in external validation. For sPTB, significant predictors were comorbidities, aspartate aminotransferase, and uric acid, with the logistic regression model yielding an AUC of 0.706 (95% CI: 0.587-0.824) in external validation. Both models showed good calibration, with Brier scores of 0.182 (macrosomia) and 0.192 (sPTB). The predictive models effectively identify pregnancies at high risk of macrosomia and sPTB, facilitating early identification and targeted intervention. External validation highlights the need for prospective, multicenter studies in diverse populations to enhance generalizability.
Is a fresh embryo transfer superior to a frozen embryo transfer after a freeze-all approach in achieving a live birth in IVF cycles? A retrospective matched analysis of 9923 autologous oocyte retrievals and 9716 embryo transfers performed between 2016 and 2023 at a single UK centre was undertaken. Patients underwent a fresh transfer or the decision was made to freeze all embryos. First embryo transfer outcomes from each cycle were assessed, and a separate analysis was undertaken to assess the hazard ratio of live birth across multiple embryo transfers arising from a single oocyte retrieval, with 1664 cumulative live births after 4202 fresh transfer cycles and 1354 cumulative live births after 2312 freeze-all embryo cycles. No difference in the odds of live birth was seen when stratifying by age. Among low responders (fewer than six oocytes), fresh and first frozen embryo transfers demonstrated comparable live birth rates [adjusted OR (aOR) 1, 95% CI 0.7-1.5; 26% versus 27%; P = 1]. In high responders (≥16 oocytes) and high-embryo-yield cycles (five embryos or more), higher outcomes were observed in fresh transfers, but the difference was non-significant. Low-embryo-yield cycles (fewer than three embryos) were associated with significantly improved outcomes after a freeze-all approach controlled for embryo quality (aOR 1.6, 95% CI 1.2-2.1; 38% versus 29%; P = 0.02), with potential greater benefit for patients aged ≥38 years. In transfers of suboptimal-grade embryos, the freeze-all approach was associated with a 2-fold increase in the odds of live birth in patients aged <38 years, but this lost significance after correction. Cumulatively, while a higher live birth rate was observed for fresh cycles compared with freeze-all cycles in patients aged <38 years, overall there was no significant difference in the live birth rate per cycle. A freeze-all approach may improve outcomes in low-embryo-yield cycles and in younger patients with suboptimal-grade embryos, but confirmatory analyses are required.
Embryo cryopreservation plays an essential role in assisted reproductive technology (ART). Vitrification has gradually replaced slow-freezing of embryos. In this study we investigated the effects of embryo vitrification on neonatal and maternal health. The retrospective study involved 19,752 in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) cycles performed at the Reproductive Medicine Center in Women's Hospital, School of Medicine, Zhejiang University between October 2014 and September 2019. 7707 singletons got live birth, among which 427 were born after transfer of vitrified embryos, 3737 slow-frozen and 3543 fresh. Neonatal and maternal outcomes of singleton liveborns following transfer of vitrified were compared with slow-frozen and fresh embryos. Logistic regression analysis was conducted to adjust for possible confounders. Transfer of vitrified embryos was comparable with slow-frozen embryos in low birth weight, macrosomia, small/large for gestational age (SGA/LGA) and birth defects. When compared with transfer of fresh embryos, transfer of vitrified embryos was associated with a higher risk of hypertensive disorders in pregnancy (HDP) aOR 7.12 (3.82-13.06), postpartum hemorrhage (PPH) aOR 6.81 (3.15-14.48) and cesarean section aOR 1.67 (1.34-2.10). No statistical differences were found for birth defects. There was a rising trend in birth weight, fetal macrosomia and LGA, as well as a declining trend in LGA after transfer of vitrified embryos compared to fresh embryos, though no statistical differences were found for risks. Transfer of vitrified embryos was comparable in birth weight and birth defects with slow-frozen embryos. When compared with fresh embryo transfer, transfer of vitrified embryos showed higher risks of HDP, PPH and cesarean section, and a rising trend in birth weight, which needs further follow-up. IRB-20190052, 6th June 2019 retrospectively registered.
Evidence suggests that testicular cancer (TC) originates from germ cell neoplasia in situ arising during fetal development, implying that prenatal environmental exposures may influence disease risk. We investigated whether maternal place of residence during pregnancy is associated with regional variation in TC incidence. We conducted a nationwide cohort study including 1,342,996 men born in Finland between 1960 and 1999. Participants were followed from birth until diagnosis of TC, death, emigration, or the end of follow-up (2021). A total of 2976 TC cases were identified. Information on municipality of birth was used as a proxy for maternal residence during pregnancy. Incidence rates and cumulative incidence were estimated by birth cohort and age at diagnosis. To examine regional variation, cumulative TC incidence by birth cohort and municipality was modeled using Bayesian hierarchical binomial regression allowing incidence to vary across municipalities. TC incidence increased across birth cohorts, peaking among men born in 1975-1979 (16.8 per 100,000). Cumulative incidence rose in all municipalities, ranging from 67.9 to 132.5 per 100,000 among men born in 1960-1969 and from 283.2 to 327.6 among those born in 1980-1989. Marked geographic clustering was observed. Incidence was consistently elevated among men born in southwestern Finland and remained high throughout the study period. Over successive birth cohorts, an eastward shift in higher incidence was observed. Although direct cohort evidence linking specific environmental exposures to TC remains limited, these findings support the hypothesis that prenatal environmental factors contribute to the pathogenesis of TC and may partly explain regional differences in incidence.
Whereas luteinizing hormone (LH) contributes to steroidogenesis and oocyte maturation, its influence on embryo developmental kinetics has not been previously investigated using time-lapse technology. The aim of this retrospective analysis was to assess embryo morphokinetics following rLH supplementation in expected normal responders undergoing ovarian stimulation and evaluate associated embryological and reproductive outcomes. A total of 120 patients were stimulated with either rFSH + rLH (n = 60) or rFSH alone (n = 60). Overall, 927 embryos were cultured in the Geri plus® time-lapse system and annotated for key morphokinetic parameters, including pronuclear dynamics, cleavage stages, morula formation, and blastocyst development. Clinical outcomes following fresh and frozen embryo transfer were also compared between groups. No differences were observed in baseline characteristics or ovarian stimulation outcomes, including oocyte yield, fertilization rate, cleavage rate, or usable blastocyst rate. Clinical pregnancy, miscarriage, live birth, and cumulative live birth rates were comparable between the two treatment groups. Embryo morphological quality was similar in both groups. Time-lapse analysis revealed that embryos derived from rFSH + rLH cycles exhibited accelerated early developmental kinetics, characterized by earlier pronuclear appearance, pronuclear fading, and first cleavage. In contrast, subsequent cleavage timings and later-stage morphokinetic parameters were comparable between groups. No differences in morphological or morphokinetic features were observed among implanted blastocysts. rLH supplementation during ovarian stimulation modulates specific early zygotic events without affecting later embryo development, implantation, or live birth, indicating that routine rLH addition does not alter embryo competence in expected normal responders.
Maternal morbidity and mortality remain major global health challenges, with substantial variation in maternity care delivery across health systems. Although clinical guidelines are widely available, there is limited systematic, multi-country mapping of maternity care systems as integrated architectures. Evidence linking system design and implementation to population outcomes is also limited. This study aims to compare maternity care systems across countries for gestational diabetes, hypertensive disorders of pregnancy, perinatal depression, and uncomplicated pregnancy using a structured, multi-layered care architecture framework. This is a multi-country, cross-sectional, mixed-methods comparative study including twenty countries across all World Health Organization regions and income groups, selected using purposive sampling. Data will be collected using a standardised instrument with more than 140 items mapped to a nine-layer care architecture framework, covering policy, clinical standards, guidelines, models of care, care pathways, clinical protocols, digital systems, patient experience, and financing. Data sources will include structured country submissions, systematic document review, and validation interviews with clinicians and policymakers. Each domain will be independently scored by two reviewers using a four-point ordinal scale, with assessment of inter-rater reliability. Country profiles will be validated through member checking and triangulation of documentary and interview data. Comparative analyses will include descriptive profiling, cross-country comparisons, clustering to identify system typologies, and gap analysis against international benchmarks. Implementation and equity dimensions will be assessed using established frameworks, and physical activity guidance will be examined as a cross-cutting domain. Exploratory ecological analyses will assess associations between system characteristics and publicly available outcomes, including maternal mortality, preterm birth, stillbirth, and caesarean section rates, using regression models. A structured consensus process will be used to develop minimum care architecture standards and harmonisation recommendations. This study will provide a structured and reproducible approach to characterising and comparing maternity care systems globally. By identifying variation in system design, implementation, and equity considerations, the findings will inform policy, support harmonisation of care, and guide improvements in maternal and perinatal outcomes across diverse settings. Open Science Framework.
Background Extrapulmonary tuberculosis (EPTB) accounts for a substantial proportion of tuberculosis diagnoses in low-incidence countries. Comprehensive data on disease localization, associated determinants and clinical outcomes remain limited. Objectives To explore anatomical localization, demographic determinants and clinical outcomes of EPTB in The Netherlands. Methods Using national tuberculosis surveillance data (1993-2022), individuals were categorized as having pulmonary TB (PTB), EPTB-only, or combined EPTB+PTB. Determinants of localization, hospitalization and TB-related mortality were assessed using multinomial and multivariate regression analyses with PTB as reference category. Results Among 34,048 individuals diagnosed with TB, 14,186 (41.7%) had EPTB-only, 16,382 (48.1%) had PTB and 3480 (10.2%) had combined EPTB+PTB. The most frequent EPTB localizations were peripheral lymph node (30.8%) and pleura (25.8%). Secondary extrapulmonary localizations occurred particularly in combined EPTB+PTB. Miliary and meningeal/central nervous system (CNS) TB had the poorest outcomes. Female sex and birth in South Asia or the Horn of Africa were associated with lymph node and intestinal TB. Younger age was associated with primary complex and meningeal/CNS TB and older age with miliary TB. Hospitalization and mortality risks were highest for meningeal/CNS and miliary TB and positively associated with older age, HIV, diabetes and immunosuppressive medication. Across most EPTB localizations, treatment success remained below WHO End TB targets. Conclusion EPTB localization and treatment outcomes in the Netherlands vary by age, sex and country of birth. Severe and disseminated forms continue to contribute substantially to morbidity and mortality. Recognizing localization-specific patterns can support earlier diagnosis and tailored management to improve EPTB outcomes in low-incidence settings.
Porcine circovirus type 2 (PCV2) is the major causative agent of porcine circovirus-associated disease. We investigated the dynamics of maternally derived anti-PCV2 antibodies (MDA) in 40 piglets born to five healthy, unvaccinated sows on a Japanese swine farm. Anti-PCV2 antibody levels were measured by ELISA from birth to 19 days of age and analyzed together with serum total protein and IgG concentrations. Data were stratified by sow, and uncertainty was estimated using sow-cluster bootstrap analysis. The S/P ratio increased after colostrum intake, peaked at 1-3 days of age, and then declined exponentially until day 19. These findings characterize pre-vaccination anti-PCV2 MDA kinetics and indicate that serum total protein at birth may reflect passive immune status.
Congenital cytomegalovirus (CMV) infection remains the most common congenital infection worldwide. The implementation of systematic first-trimester CMV screening during pregnancy has been widely debated. In June 2025, the French National Authority for Health recommended nationwide screening in pregnant women. This study aimed to describe maternal-fetal transmission, neonatal infection, and pregnancy outcomes following the implementation of early CMV screening within a regional perinatal network prior to national adoption. We conducted a retrospective multicenter observational study in three maternity units in Alsace between April 2021 and November 2023. Eligible patients had a primary CMV infection diagnosed periconceptionally or during the first trimester, based on serological screening performed up to 14 weeks of gestation. The primary objective of this study was to describe maternal-fetal transmission rates and neonatal outcomes following first-trimester CMV screening within a regional perinatal network. Secondary objectives included describing antenatal management strategies, including valaciclovir use, and pregnancy outcomes. Thirty-eight patients with primary CMV infection were identified among 29,657 deliveries during the study period. Valaciclovir was administered in 47% of cases. Amniocentesis was performed in 68% of patients, with three positive results. Neonatal CMV testing was available in 80% of live births. Three newborns tested positive for CMV at birth, and one pregnancy was medically terminated due to confirmed CMV infection. The overall rate of congenital CMV infection among infected mothers was 10.5%. Early CMV screening enabled identification and management of primary maternal infection in routine practice. However, the descriptive design and limited sample size preclude conclusions regarding clinical effectiveness or impact on vertical transmission.
Elevated maternal body mass index (BMI) increases miscarriage risk in assisted reproductive technology, but it is unclear whether this risk differs between singleton and twin pregnancies. Twin gestations impose greater metabolic and hemodynamic demands, which may amplify the adverse effects of elevated BMI. This study aimed to determine whether pregnancy plurality modifies the association between maternal BMI and miscarriage risk following frozen-thawed embryo transfer (FET). In this retrospective cohort study, 13,911 FET cycles performed at a tertiary reproductive medicine center between January 2019 and June 2024 were included. Maternal BMI was categorized as underweight (< 18.5 kg/m²), normal weight (18.5-24.9 kg/m²), overweight (25.0-29.9 kg/m²), and obese (≥ 30.0 kg/m²). The primary outcome was total miscarriage (pregnancy loss before 28 weeks), with secondary outcomes including early miscarriage (< 12 weeks), late miscarriage (12-28 weeks), clinical pregnancy and live birth. Generalized estimating equation (GEE) models were used to estimate adjusted odds ratios (aORs) with 95% confidence intervals (CIs), accounting for repeated cycles from the same patient. Subgroup analyses stratified by pregnancy plurality (singleton vs. twin) and interaction tests were performed to evaluate whether plurality modifies the association between BMI and miscarriage. Overall, early and late miscarriage rates were 11.71% and 4.59%. After adjustment, obesity (BMI ≥ 30 kg/m²) was significantly associated with increased risks of early miscarriage (adjusted odds ratio [aOR] 1.74, 95% CI 1.31-2.31), late miscarriage (aOR 2.35, 95% CI 1.55-3.57) and total miscarriage (aOR 2.04, 95% CI 1.58-2.62) compared with normal-weight women. Overweight women also exhibited elevated risks of late miscarriage (aOR 1.66, 95% CI 1.30-2.12) and total miscarriage (aOR 1.30, 95% CI 1.13-1.50). Subgroup analyses demonstrated that the association between elevated BMI and total miscarriage was significantly stronger in twin pregnancies than in singleton pregnancies (P for interaction = 0.018). Increasing BMI was not associated with clinical pregnancy or live birth. Elevated maternal BMI was associated with an increased risk of miscarriage after FET, and this association may be more pronounced in twin pregnancies. These findings highlight preconception weight optimization and support elective single embryo transfer in overweight and obese patients.
Gestational diabetes mellitus (GDM) is a common metabolic complication of pregnancy associated with substantial maternal and neonatal morbidity. Asian populations demonstrate increased susceptibility to glucose intolerance and may develop gestational diabetes earlier in pregnancy. However, the prevalence and outcomes of early-diagnosed gestational diabetes mellitus (E-GDM) in Asian populations remain incompletely understood. A systematic review and meta-analysis was conducted following PRISMA guidelines. PubMed, ScienceDirect, and Web of Science were searched from database inception to February 2026 to identify studies evaluating gestational diabetes diagnosed before 24 weeks of gestation in Asian populations. A total of 2329 records were identified, and 17 studies were included, with 16 eligible studies for meta-analysis. E-GDM prevalence ranged from 0.75% to 22.81%, accounting for 9.43%-78.78% of total GDM cases. Compared with conventional GDM, E-GDM was associated with increased risks of C-section or instrumental delivery (OR = 1.13, 95% CI 1.01-1.26), preterm birth (OR = 1.38, 95% CI 1.07-1.78), and insulin therapy requirement (OR = 1.60, 95% CI 1.09-2.36). Most neonatal outcomes were similar between groups. Women with E-GDM showed greater metabolic vulnerability and possible postpartum metabolic dysfunction. E-GDM in Asian populations identifies women with greater metabolic vulnerability and increased obstetric risk. E-GDM was associated with higher insulin requirements, increased risks of preterm birth and operative delivery, and possible long-term metabolic dysfunction. Harmonized diagnostic criteria and region-specific screening strategies are needed.
Pre-pregnancy overweight and gestational diabetes mellitus (GDM) increase the risk of accelerated fetal growth, but the effect of their individual or combined exposure on infant growth trajectory remains unclear. Clarifying whether these exposures will lead to sustained or time-limited growth patterns is essential for developing tailored, time-sensitive early childhood monitoring strategies.Methods We analyzed a population-based cohort of 16,712 mother-infant pairs from Jiangsu Province (2024) using longitudinal data. Infant weight was measured at birth, 1, 3, and 6 months. Linear mixed effects models were employed to examine the independent and joint associations of pre-pregnancy overweight and GDM with infant weight-for-age z-scores (WAZ), examining how the associations changed with infant age.Results Pre-pregnancy overweight showed a strong, positive association with higher infant WAZ (β = 0.160, 95% CI: 0.130 to 0.191), with no statistically significant change over time (overweight × age interaction: β = 0.005, 95% CI: 0.000 to 0.009; P = 0.060). In contrast, GDM alone had a statistically significant but relatively small initial effect (β = 0.065, 95% CI: 0.031 to 0.100), which significantly attenuated from birth to 6 months (GDM × age interaction: β = -0.008, 95% CI: -0.013 to -0.002; P = 0.006). The combined exposure yielded the highest initial β coefficient (β = 0.217, 95% CI: 0.175 to 0.259) and the most rapid attenuation (combined × age interaction: β = -0.017, 95% CI: -0.023 to -0.010; P < 0.001). At 6 months of age, the adjusted mean WAZ remained highest in the combined exposure group. The combined effect was approximately additive in magnitude (β_combined ≈ β_OW + β_GDM), and additive interaction metrics (RERI = 0.001, 95% CI: -0.112 to 0.114; AP = 0.005, 95% CI: -0.582 to 0.592; S = 1.01, 95% CI: 0.88 to 1.15) indicated no statistical additive interaction, with confidence intervals including the null values.Conclusions Different growth patterns were found in this study: pre-pregnancy overweight showed no statistically significant attenuation over the study period, while GDM's influence was time‑limited. The combined exposure presents peak early risk that moderates over time. Clinically, infants exposed to both maternal pre-pregnancy overweight and GDM (the combined exposure group) should receive the most intensive growth monitoring during the first six months of life. These findings highlight the necessity of developing targeted monitoring protocols and implement risk stratification and personalized interventions based on maternal metabolic profiles.
Internalizing problems rise during adolescence, yet the stable underlying dimensions remain unclear. Using two longitudinal samples (Sample A: [Formula: see text], 43% girls at birth, adopted children, ages 7-16; Sample B: [Formula: see text], 50% girls at birth, biological children from low-income families, ages 7-17), we examined dimensions of internalizing symptoms (excluding somatic complaints) on the Child Behavior Checklist using exploratory structural equation modeling (ESEM) and confirmatory factor analyses. In Sample A, three dimensions emerged: low self-worth/depression (LSW/Dep), social/general anxiety (S/GA), and depression/withdrawal (Dep/With). In Sample B, S/GA and Dep/With combined into the social anxiety/withdrawal (SA/With) factor, alongside LSW. Both solutions were largely stable across age and sex. Factor trajectory analyses revealed that levels of all dimensions increased from childhood to early adolescence, for both sexes. Trajectories subsequently diverged: LSW/Dep became more pronounced in girls only, S/GA increased in girls and declined in boys, and Dep/With showed the steepest increase for both sexes. Dimensions showed strong homotypic but weak heterotypic continuity. Findings highlight distinct developmental and sex-specific pathways of internalizing vulnerability detectable in middle childhood, supporting earlier and more targeted identification and intervention.