International Journal of Women's Health最新文献

Introduction: It's estimated that about 121 million unintended pregnancies occur worldwide every year, which has significant impacts on individuals, families, and society. It's important to explore the factors influencing the childbirth decision in these women, thereby informing midwifery practice.

Methods: A qualitative study was performed on women with unintended pregnancies via focus group discussion. The thematic analysis was guided by the theory of planned behavior. Data were analyzed using a combination of deductive and inductive content analysis.

Results: The analysis revealed three main themes and several subthemes: attitudes toward behavior (changes in fertility concepts, impact of fertility policies, conflicts in women's roles), subjective norms (influence from friends, family, societal attitudes towards fertility), and perceived behavioral control (health-related pregnancy factors, pressures of child-rearing responsibilities, concerns about family, workplace support).

Discussion: Women are eager to make informed decisions regarding unintended pregnancies. A collaborative effort from society, healthcare providers, and families is essential to support these women in making appropriate decisions. Healthcare providers hold a pivotal role in caring for pregnant women. Additional studies are required to assess and integrate strategies within healthcare practice.

Trial registration: The study received the approval from the Ethics Committee at Dongguan Maternal and Child Health Care Hospital (No. 2024-14) on 12 April 2024.

Background: Cervical cancer, as the leading malignant tumor among women globally, underscores the critical need for early screening; however, effective models for predicting cervical lesions remain lacking.

Objective: To construct a predictive model for cervical intraepithelial neoplasia II+(CINII+), and to compare the predictive performance of machine learning models integrating thinprep cytologic test (TCT) + human papillomavirus (HPV) testing with clinical data versus TCT combined with traditional clinical data for CIN II+.

Methods: Clinical data from women undergoing cervical cancer screening at Linquan Maternity and Child Healthcare Hospital (2020-2024) were collected, including TCT results, HPV status, cervical pathology, age, sexual history and other clinical data. Ten machine learning algorithms were applied to develop two predictive models: Model 1(TCT+HPV+clinical data) and Model 2(TCT+traditional clinical data). Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), calibration curves and decision curve analysis (DCA).

Results: Multivariate logistic regression analysis showed that HPV positivity, TCT indicates High-Grade Squamous Intraepithelial Lesion(HSIL), colposcopy result indicates a high-grade lesion and the first age of pregnancy as predictors of CINII+. Model 1 (TCT+HPV+clinical data) demonstrated significantly higher predictive efficacy than Model 2(TCT+clinical data), the difference in AUC is statistically significant. (P=0.006 in training set; P=0.035 in testing set).

Conclusion: The TCT+HPV-integrated model outperformed the TCT-only model in predicting CIN II+, supporting the incorporation of HPV testing into routine screening to enhance early diagnostic accuracy.

On December 28, 2016, a 35-year-old female patient presenting with chest pain and a brief fainting spell was admitted to a hospital in Guangzhou and promptly received thrombectomy and catheter-directed thrombolysis. She had experienced two episodes of explosive thrombosis, with the second occurring in May 2020, triggered by pregnancy. Her diagnoses included polycystic ovary syndrome (PCOS), hereditary Protein C (PC) deficiency resulting from a heterozygous mutation deletion of 572_574 in exon 7, recurrent spontaneous abortion (RSA), as well as PCOS-associated insulin resistance and chronic endometritis. Our regimen comprises dydrogesterone for cycle regulation, rivaroxaban for PC deficiency-related thrombophilia, and metformin, amoxicillin, and omeprazole to manage PCOS-associated insulin resistance and chronic endometritis, with the aim of mitigating their contribution to impaired endometrial receptivity. Following our targeted and persistent treatment, the patient gave birth to a healthy baby in April 2023. It is rare for RSA to be caused by PCOS complicated by hereditary PC deficiency, and there are no international treatment guidelines for such cases. This report adds to the existing body of knowledge regarding the treatment of PCOS complicated by hereditary PC deficiency. For RSA patients, a comprehensive approach considering all contributing factors and individual circumstances is essential. Multi-disciplinary treatment (MDT) is crucial. Moreover, there are currently no international, evidence-based guidelines for the use of combined oral contraceptives (COCs) in PCOS complicated by hereditary thrombophilia, highlighting the urgent need for multicenter clinical studies to establish appropriate management strategies.

Background: Preeclampsia is a complex hypertensive disorder of pregnancy, significantly impacting maternal and fetal health worldwide. Despite extensive research, its pathogenesis, involving inflammatory, immune, microbiological, and metabolic factors, requires comprehensive elucidation.

Methods: This study applied Mendelian randomization (MR) to investigate causal relationships between multi-omics traits and the risk of preeclampsia. The genome-wide association studies (GWAS) datasets used consisted of immune cells (N = 3757), inflammatory factors (N = 14,824), gut microbiota (N = 7738), circulating metabolites (N1 = 7824, N2 = 8299), plasma proteins (N = 3301), and preeclampsia (7212 cases, 194,266 controls). The inverse variance-weighted method was used in the main analysis, and the weighted median, weighted mode, and MR Egger regression were used in sensitivity analyses.

Results: Our analysis identified 81 potential causal factors for preeclampsia. Among the most novel and clinically significant findings were several druggable plasma proteins, including Astacin-like metalloendopeptidase (ASTL) and Baculoviral IAP repeat-containing protein 3 (BIRC3), which exhibited strong causal evidence. Furthermore, we identified specific gut microbiota genera, notably Bifidobacterium, as potential protective factors. We also validated the causal roles of key metabolic disturbances, like cysteine and guanidinoacetate, and dysfunctions in specific immune cell populations, particularly regulatory T and B cells.

Conclusion: These findings highlight the intricate interplay of immune, inflammatory, microbiological, metabolic, and protein factors in preeclampsia, suggesting novel diagnostic and therapeutic targets. Further research is warranted to explore these associations in detail.

Background: Osteoporosis (OP) and knee osteoarthritis (KOA) are common comorbidities in postmenopausal women, yet the relationship between OP and localized bone mineral density (BMD) around the knee remains unclear. This study investigated the effect of concomitant OP on periarticular BMD and its associations with the Western Ontario and McMaster University Osteoarthritis Index (WOMAC), radiographic severity, and hip-knee-ankle (HKA) angle in postmenopausal women with KOA.

Methods: In this cross-sectional study, 117 postmenopausal women were classified into a KOA combined with OP group (n=59) and a KOA-only group (n=58) based on dual-energy X-ray absorptiometry (DXA) T-scores. All participants underwent dual-energy computed tomography (DECT) to quantify BMD around the distal femur, proximal tibia, and patella; weight-bearing radiographs to assess Kellgren-Lawrence (K&L) grade and HKA angle; and the WOMAC questionnaire to evaluate pain and joint function.

Results: Patients with KOA combined with OP demonstrated significantly lower knee BMD than those with KOA alone (P < 0.001). This reduction in BMD was more pronounced with increasing OP severity. Notably, even after adjusting for pain levels, BMD remained significantly lower in the KOA combined with OP group (P < 0.05). Furthermore, medial knee BMD in the KOA combined with OP group exhibited an inverted U-shaped relationship with K&L grade, peaking at grade III before declining. In contrast, BMD increased progressively with K&L grade in the KOA group. A significant inverse correlation was also observed between the HKA angle and medial knee BMD in the KOA combined with OP group, suggesting greater bone loss with increasing valgus deformity.

Conclusion: Postmenopausal women with KOA combined with OP have markedly lower periarticular BMD, associated with more severe pain, distinctive radiographic changes, and poorer alignment. These findings highlight the need for active bone preservation and OP management in KOA patients to alleviate symptoms and potentially slow disease progression.

Background: Oxidative stress has been implicated in the pathogenesis of various malignancies, including gynecological cancers (GC). This study aimed to evaluate the association between oxidative balance score (OBS) and GC prevalence using data from the National Health and Nutrition Examination Survey (NHANES) 2011-2018.

Methods: A total of 7816 adult female participants were included, of whom 195 reported a history of GC (cervical, endometrial, or ovarian). OBS was computed from 20 components: 15 antioxidants and five pro-oxidants from dietary and lifestyle sources. Multivariable logistic regression models were used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for GC according to the OBS tertiles and per-unit increases, adjusting for covariates.

Results: Higher total OBS was associated with significantly lower odds of GC (adjusted OR per unit increase = 0.92; 95% CI: 0.86-0.97). Participants in the highest OBS tertile had 34% lower odds of developing GC than those in the lowest tertile. This association was more pronounced among women aged ≥60 years, non-smokers, and those with normal body mass index (BMI).

Conclusion: Greater antioxidant exposure, as reflected by higher OBS, was inversely associated with GC risk. These findings support dietary and lifestyle interventions aimed at improving oxidative balance.

Background: Scar endometriosis is a rare manifestation of extrapelvic endometriosis, characterized by the presence of endometrial tissue within a cesarean section scar. It typically manifests as cyclical pain and swelling at the site of the surgical incision and is often subject to misdiagnosis.

Case presentation: This report examines a case involving a 30-year-old Somali woman with a history of multiple childbirths, presenting with a painful nodule at the location of a previous lower segment cesarean section (LSCS) scar. Her symptoms were cyclical, worsening during menstruation. Ultrasonographic evaluation revealed an endometriotic lesion, and histological examination following surgical excision confirmed the diagnosis. The patient had an uneventful recovery post-surgery.

Conclusion: It is important for clinicians to contemplate scar endometriosis in women presenting with a painful mass near a surgical scar that fluctuates with the menstrual cycle. Early identification and comprehensive surgical removal are crucial for effective management.

Background: Previous studies have reported the correlation between single galectin levels and gynecologic cancers. The present study used the Mendelian randomization (MR) technique to evaluate the causal relationship between galectin levels and gynecologic cancers.

Methods: Data on galectin levels (3394 individuals of the Gal-3 dataset, 3301 individuals of Gal-1, Gal-2, Gal-4, Gal-7, Gal-8, Gal-9, and Gal-10 datasets) and gynecologic cancers were obtained from the IEU Open genome-wide association study (GWAS) project, Ovarian Cancer Association Consortium (OCAC) and FinnGen consortium. Two-sample MR was performed to determine the causal relationship between galectin levels and gynecologic cancers. Meanwhile, a bi-directional MR analysis was also conducted to examine the direction of the causal relations. The results were expressed as odds ratios (ORs) and 95% confidence intervals (CIs).

Results: Gal-3 (OR=1.001, 95% CI: 1.000-1.001) and Gal-8 (OR=1.001, 95% CI: 1.000-1.002) may indicate small effects on cervical cancer. Gal-1 was suggested as risk factors for ovarian cancer (OR=1.108, 95% CI: 1.033-1.188), high grade serous ovarian cancer (OR=1.106, 95% CI: 1.019-1.202), and invasive mucinous ovarian cancer (OR=1.279, 95% CI: 1.041-1.573). Gal-9 showed modest effect in ovarian cancer (OR=1.070, 95% CI: 1.000-1.144), but significantly associated with an elevated risk of mucinous ovarian cancer (OR=1.242, 95% CI: 1.015-1.520). Gal-10 was suggested as a protective factor against ovarian cancer (OR=0.929, 95% CI: 0.867-0.994) and clear cell ovarian cancer (OR=0.803, 95% CI: 0.653-0.987). Gal-2 (OR=0.779, 95% CI: 0.654-0.929) and Gal-4 (OR=0.786, 95% CI: 0.639-0.966) were found as protective factors for malignant neoplasm of corpus uteri. Gal-2 (OR=0.921, 95% CI: 0.851-0.997) and Gal-10 (OR=0.892, 95% CI: 0.815-0.977) were suggested as protective factors against endometrial cancer (endometrioid histology). Similarly, higher Gal-4 was also associated with decreased risk of endometrial cancer (OR=0.902, 95% CI: 0.840-0.969) and endometrial cancer (endometrioid histology) (OR=0.846, 95% CI: 0.778-0.920).

Conclusion: The study explored potential causal relationships between galectin levels and gynecologic cancers. While some associations were modest, the consistent directionality across sensitivity analyses and the biological plausibility of galectins in tumor immunology suggest that these proteins warrant further investigation as potential biomarkers and therapeutic targets. Future research should validate these findings in clinical cohorts and explore underlying mechanisms.

Purpose: Cardiovascular disease (CVD) and chronic pain substantially affect menopausal women. However, evidence is scarce regarding how the course of pain over time-specifically, whether it is persistent and affects multiple body sites-influences the future risk of CVD in this population. This study aimed to investigate the longitudinal association between these novel pain phenotypes and incident CVD, and to evaluate the mediating roles of depressive symptoms and body mass index (BMI).

Patients and methods: This prospective analysis included 4,890 postmenopausal women from the China Health and Retirement Longitudinal Study (CHARLS). Pain status (location, intensity) and CVD were assessed at baseline (2013) and follow-up (2018). Persistent pain was defined as pain reported at both time points. We used regression models to examine the association between pain patterns and incident CVD, and mediation analysis to quantify the contribution of depressive symptoms and BMI.

Results: At baseline (cross-sectional), pain presence, intensity, and multisite distribution were associated with higher CVD prevalence. Over five years (longitudinal), persistent pain phenotypes predicted incident CVD after adjustment: general persistent pain (OR = 1.05, 95% CI: 1.00-1.08, p = 0.012), persistent low back pain (OR = 1.08, 95% CI: 1.03-1.13, p = 0.001), and persistent multisite pain (OR = 1.06, 95% CI: 1.00-1.11, p = 0.020). Depressive symptoms mediated 21.6% of the association for persistent pain; for persistent low back pain, depressive symptoms (14.5%) and BMI (5.4%) were significant mediators.

Conclusion: Among postmenopausal women, long-standing and multisite pain is associated with higher future CVD risk. A modest portion of these associations was statistically accounted for by depressive symptoms and, for low back pain, BMI. Assessing pain persistence and distribution may help identify women who could benefit from integrated appraisal of pain, mood, and metabolic health.

Background: Teratomas usually occur in the gonads. The retroperitoneum is the least common location, which accounts for approximately 4% of primary retroperitoneal tumors and 26% of retroperitoneal teratomas are malignant. Retroperitoneal teratomas occur mainly in childhood, and with a low incidence in adults. Due to its nonspecific clinical and imaging features, the disease is difficult to distinguish from cystadenoma and other diseases, making accurate diagnosis a persistent clinical challenge.

Case presentation: Here, we present a 65-year-old female patient who was admitted to the hospital due to intermittent right upper abdominal pain for half a month. Preoperative abdominal computed tomography imaging revealed a large mass in the left abdominal cavity, which showed mild enhancement. However, the imaging findings were non-diagnostic, and the nature of the mass could not be determined. Postoperative pathological examination revealed a retroperitoneal mature cystic teratoma. Through close follow-up, the patient achieved a favorable prognosis, and had no local recurrence or distant metastasis 6 years after surgery.

Conclusion: This case highlights the importance of considering teratoma in the differential diagnosis of retroperitoneal tumor and emphasizes the importance of complete surgical resection for the patient's prognosis, which are critical to preventing misdiagnosis as malignancy and optimizing patient outcomes.