International Journal of Women's Health最新文献

Maternity care within primary health facility settings is critical for reducing maternal and neonatal mortality in Indonesia. The aim of this study was to analyze research trends over the past decade to identify key strategies for improving maternity care in primary health care facilities in Indonesia. A bibliometric analysis was conducted using data from the Scopus database to map the research landscape and identify latent research topics in maternal health care. The analysis included keyword co-occurrence and network visualization, with assistance from ChatGPT-4.0 for enhanced identification and categorization of keywords. The identified research trends were used as surrogate variables representing the main concerns among researchers, experts, and funders. These variables were used to build strategies, which were then analyzed using SWOT (Strengths, Weaknesses, Opportunities, and Threats) by reflecting on the Indonesian context. The results revealed that key topics in maternity care included midwifery roles, pandemic resilience, and telemedicine. Based on SWOT analysis, most of the constructed strategies were found to have high external opportunities but low internal capabilities, indicating the need to strengthen internal resources. In conclusion, Indonesia must enhance its internal capabilities, particularly human resources and infrastructure, to effectively utilize external opportunities and improve maternal health outcomes.

Background: Few studies have evaluated the correlation between serum uric acid (SUA) levels and the prevalence of female infertility in the general population, and the effect of magnesium intake on this correlation has not been investigated.

Methods: All participants aged 18-45 years at baseline were enrolled from the National Health and Nutritional Examination Surveys (NHANES) 2013-2018. The continuous variable of SUA was divided into quartile (Q1: ≤3.7 mg/dL, Q2: 3.7-4.4 mg/dL, Q3: 4.4-5.1 mg/dL, Q4: ≥5.1 mg/dL). Multivariable logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI). Dietary magnesium was divided into two groups based on the median number of participants (low magnesium intake, <243 mg/day; high magnesium intake, ≥243 mg/day).

Results: A total of 3185 female participants were included in the final analysis, 10.58% of whom were infertile. In the full adjustment model, SUA was positively associated with female infertility (OR=1.13, 95% CI: 1.01-1.27). Compared to the lowest quartile (Q1), female participants with the highest SUA levels (Q4) had an increased risk of infertility by 62% (OR=1.62, 95% CI: 1.1-2.4). Moreover, we found an interactive effect of magnesium intake on the association between SUA and infertility in adjusted models (interaction likelihood ratio test: P=0.029), implying that high magnesium intake may ameliorate the association between SUA and female infertility.

Conclusion: This study is the first to report an interactive effect of dietary magnesium intake on the relationship between SUA and female infertility.

Objective: To analyze the relationship and predictive value of Netrin-1 expression and ultrasonic blood flow parameters with the severity of cervical intraepithelial neoplasia (CIN).

Methods: A retrospective analysis was performed on 115 patients diagnosed with CIN and 37 patients with chronic cervicitis, all of whom underwent surgical intervention. The expression levels of Netrin-1 were evaluated through immunohistochemical staining and quantitative fluorescence PCR. Doppler ultrasound was employed to quantify flow index (FI), vascularization index (VI), and vascularization flow index (VFI) using VOCAL software. Statistical analyses, including correlation analysis, logistic regression, and receiver operating characteristic (ROC) curve analysis, were conducted to assess the predictive value of Netrin-1 expression and ultrasound-derived blood flow parameters.

Results: FI, VI, and VFI increased with CIN grade, showing significant differences between CIN II, CIN III, and the control group (P < 0.05). Netrin-1 levels were negatively correlated with FI, VI, and VFI (correlation coefficients of -0.287, -0.309, and -0.298; P < 0.05). Logistic regression indicated that Netrin-1 positivity was a protective factor against CIN III, while FI, VI, and VFI were risk factors. The AUC for Netrin-1 was 0.712, with sensitivity and specificity of 76.4% and 79.5% (P < 0.05).

Conclusion: Netrin-1 expression is significantly reduced in CIN patients, whereas Doppler ultrasound-derived blood flow parameters-FI, VI, and VFI-are markedly elevated. Both Netrin-1 levels and these ultrasound parameters exhibit a strong correlation with the severity of cervical lesions. Notably, Netrin-1 is negatively correlated with FI, VI, and VFI. Furthermore, Netrin-1 positivity serves as a protective factor against CIN III lesions, while elevated levels of FI, VI, and VFI are associated with increased risk for these lesions. The expression levels of both Netrin-1 and ultrasound parameters provide valuable predictive insights for the early screening, diagnosis, and prevention of cervical cancer.

Purpose: While several studies demonstrate an association between reproductive coercion or a lack of reproductive autonomy and decreased mental health in women, little is known about potential mental health impacts when women are denied prescription contraceptives. The aim of this research was to explore associations between prescription contraceptive denial and perceived ease of future access to contraception, and self-assessed mental health.

Patients and methods: Polish women (N=424) completed an anonymous online survey with demographic questions; perceived stress (PSS-10), state anxiety (STAI-X1), and depression (CESD-R) assessments, and contraceptive access questions.

Results: Eighty-eight participants (21%) had experienced at least one episode of prescription contraceptive denial from a doctor or pharmacist. There were no differences in stress, anxiety, and depression scores between women who had and had not ever experienced denial. However, women who had experienced contraceptive denial within the last six months, had higher depression scores. In addition, women who perceived future access as very easy had the lowest stress, anxiety and depression scores.

Conclusion: These results suggest that experiences and attitudes related to contraceptive access are related to perceived stress, anxiety, and depression. Contraceptive denial and other access barriers constitute a significant public health issue that may impact the health of women.

Objective: The study aimed to provide clinical evidence regarding the perinatal management of HbH disease by comparing and analyzing blood routine, anemia characteristics, and their influence on pregnancy outcomes in patients with common deletional and non-deletional HbH disease at various pregnancy stages.

Patients and methods: From May 2017 to October 2023, a comparative analysis was conducted on pregnant women undergoing treatment at the Second Affiliated Hospital of Guangxi Medical University and the Second Nanning People's Hospital. The study included 42 cases of deletional HbB disease and 32 cases of non-deletional HbH disease. The study assessed blood routine, anemia, and pregnancy outcomes during early and late pregnancy.

Results: In the deletional group, there was a significantly higher incidence of moderate anemia during both early and late pregnancy compared to the non-deletional group. Moreover, the deletional group exhibited a significantly lower mean corpuscular volume (MCV) during early and late pregnancy and mean corpuscular hemoglobin (MCH) during late pregnancy, with statistically significant differences (p<0.05) compared to the non-deletional group. Additionally, the non-deletional group had a significantly higher incidence of postpartum blood transfusion, fetal growth restriction (FGR), and low birth weight (LBW) compared to the deletional group, with a statistically significant difference (p<0.05).

Conclusion: Pregnant patients with alpha-thalassemia HbH disease and non-deletional HbH disease commonly experience moderate anemia, increasing the risk of adverse pregnancy outcomes, particularly in non-deletional HbH disease cases where negative outcomes are more prevalent. It is crucial to enhance perinatal monitoring and intervention for pregnant women with HbH disease, including regular assessment of hemoglobin (Hb) levels, MCV, and MCH, and implementing measures to manage anemia to mitigate adverse pregnancy outcomes effectively.

Purpose: To investigate the rare obstetric emergency with no specific treatments called acute fatty liver of pregnancy. The primary objective was to evaluate association of adverse perinatal outcomes with blood components transfusion. While the secondary objective focused on further establishing the predictive risk factors for adverse perinatal outcomes.

Participants and methods: This retrospective cohort study included patients, who diagnosed with acute fatty liver of pregnancy without hepatic/malignant diseases in Qilu Hospital of Shandong University over 12-year period (collected 2007-2019, aged 20-41years). Chi-square test was used to explore the relevance between blood transfusion therapy and adverse perinatal outcomes. Meanwhile, logistic regression analysis was performed to identify predictive risk factors.

Results: Of 146 patients, 26 (26/146, 17.8%) received prenatal blood transfusions. These patients had reduced gestational ages and exhibited more severe clinical symptoms. The association between blood transfusion and adverse maternal outcomes yielded a P value of 0.044, while the association with fetal outcomes was highly significant (P<0.001). Multivariate logistic regression analysis identified seven high-risk factors for maternal outcomes and six for fetal outcomes, all demonstrating strong discriminatory capacity.

Conclusion: Blood component transfusion may serve as a marker of disease severity. Prompt identification of patients with high-risk factors is crucial to improve maternal and fetal outcomes.

Background: Female pelvic peritoneal adhesions (FPPA) represent a significant global health burden. Dietary habits play a crucial role in health outcomes, yet their influence on FPPA remains unclear. This study aims to explore the bidirectional causal relationships between 72 eating habits and FPPA using sex-stratified Mendelian randomization (MR).

Methods: We employed a bidirectional MR approach, utilizing single nucleotide polymorphisms (SNPs) significantly associated with 72 different eating habits as instrumental variables. The causal relationships were assessed using five MR methods, including inverse variance weighting (IVW). After Bonferroni correction, eating habits with a p-value < 0.05 were considered to have a significant causal relationship with FPPA. For those habits with significant associations, reverse MR was conducted to assess potential reverse causality. Sensitivity analyses, including IVW, MR-Egger, and leave-one-out tests, were performed to ensure the robustness of the results.

Results: Before Bonferroni correction, five eating habits showed potential associations with FPPA, including non-oily fish intake (OR: 0.989, 95% CI: 0.982-0.995, p=0.000521), side salad intake: OR 1.003 (95% CI: 1.001-1.006), p=0.007779, poultry intake: OR 1.005 (95% CI: 1.001-1.009), p=0.018016, spirits intake: OR 1.010 (95% CI: 1.001-1.019), p=0.036152, hard cheese intake: OR 0.995 (95% CI: 0.991-1.000), p=0.043784. After correction, only non-oily fish intake remained significantly associated with a lower risk of FPPA. No reverse causal relationship was observed between non-oily fish intake and FPPA, and sensitivity analyses revealed no abnormalities, further confirming the robustness of the findings.

Discussion: Our study identifies non-oily fish intake as a protective dietary factor against FPPA, with no evidence of reverse causality. These findings highlight the importance of dietary interventions in managing FPPA risk and suggest potential avenues for future research and public health strategies.

Objective: Failure to resolve inflammation is a novel feature of angiogenic-dependent diseases such as endometriosis and atherosclerosis.The correlation and causality between endometriosis and coronary heart disease is unclear. Here, we investigated the correlation and causality between endometriosis and coronary heart disease.

Methods: The relevant data was extracted from the NHANES database (Year range: 1999-2006) and analyzed to determine the correlation between endometriosis and coronary heart disease using weighted multivariable logistic regression models. Mendelian randomization analysis was used to assess the causal relationship between endometriosis and coronary heart disease risk.

Results: We evaluated the data obtained from 3943 participants and did not observe any association between endometriosis and coronary heart disease in weighted multivariable logistic regression models (Model 1, OR: 1.85, 95% CI: 0.66-5.15, P: 0.23; Model 2, OR: 0.89, 95% CI: 0.30-2.62, P: 0.82; Model 3, OR: 0.61, 95% CI: 0.19-1.95, P: 0.38). Two-sample Mendelian randomization analysis did not reveal a causal relationship between endometriosis and coronary heart disease (OR: 1.00, 95% CI: 0.94-1.07, P: 0.882).

Conclusion: Our findings did not indicate any association or causal relationship between endometriosis and coronary heart disease.

Objective: This study analyzed the role of traditional Chinese medicine (TCM) treatment on the cumulative live birth rate (CLBR) in women with poor ovarian response to the patient-oriented strategies encompassing individualized oocyte number (POSEIDON) criteria.

Methods: This cohort study selected 3347 patients with low ovarian response and divided them into four subgroups according to the POSEIDON criteria: Group 1 (n=947), Group 2 (n=778), Group 3 (n=164), and Group 4 (n=1458). Logistic regression analysis was used to evaluate the role of TCM treatment on the CLBR of patients with poor ovarian response to POSEIDON criteria.

Results: In the unadjusted model, TCM treatment might be related to the heightened CLBR (OR=2.052, 95% CI: 1.745-2.413). After adjusting for the POSEIDON group, a higher CLBR was identified in those with TCM treatment (OR=1.927, 95% CI: 1.615-2.300). In Model 3, covariates including the POSEIDON group, age, body mass index (BMI), anti-mullerian hormone (AMH), and/or antral follicle count (AFC) were adjusted, and TCM treatment was associated with elevated CLBR of patients with poor ovarian response to the POSEIDON criteria (OR=1.905, 95% CI: 1.586-2.289). This suggested that TCM increased CLBR by 19.05% in patients who used TCM compared with those who did not. Subgroup analysis indicated that TCM treatment might increase the CLBR of patients in POSEIDON criteria Group 1 (OR=1.83, 95% CI: 1.33-2.51), indicating that TCM elevated the CLBR by 8.3% in POSEIDON criteria Group 1.

Conclusion: TCM treatment was related to increased CLBR in patients with poor ovarian response to the POSEIDON criteria.

Purpose: This study was conducted to analyze the relationship between plasma D-dimer levels and the risk of recurrence after surgical treatment in patients with early-stage cervical cancer (CC).

Methods: In this cohort study, 888 participants with early-stage CC undergoing surgical treatment in Fujian Cancer Hospital between June 2016 and December 2019 were identified. Univariate logistic regression was used to screen confounding factors affecting the recurrence of early CC after surgical treatment. Variables significantly associated with the recurrence of early CC after surgical treatment were confounding factors. Univariate and multivariate logistic regression models were established to explore the association between D-dimer levels and the risk of recurrence of early CC after surgical treatment. ORs and 95% CIs were calculated.

Results: The end of follow-up was when CC recurred or 3 years after surgery. In sum, 80 patients suffered CC recurrence, accounting for 9% of all participants. The risk of recurrence was elevated in CC patients from the elevated group (EG), with an adjusted OR of 2.16 (95% CI 1.28-3.62). The risk of recurrence was increased in the EG in patients with cervical squamous cell carcinoma undergoing surgery in the adjusted model (OR 3.58, 95% CI 1.02-12.89). As for cervical adenocarcinoma patients, the increased risk of recurrence was identified in patients from the EG (OR 1.87, 95% CI 1.01-3.48).

Conclusion: High levels of D-dimer were associated with increased recurrence risk of CC in patients at the early stage of surgical treatment.