International Journal of Women's Health最新文献

Objective: About 26% of all pregnancies result in miscarriage, with up to 10% occurring in clinically diagnosed pregnancies. Additionally, recurrent pregnancy loss affects approximately 5% of couples of childbearing age. Although there are several known causes of pregnancy loss in the first half, including parental chromosomal abnormalities, uterine malformations the possible role of placental growth factor (PLGF) remains unclear. The aim of this study was to evaluate the possible predictive role of serum and urinary PLGF for miscarriages in the first trimester of pregnancy.

Materials and methods: Case-control studies were conducted. The study included 347 pregnant women, the group of miscarriages comprised 156 and the control group 191. The study did not include patients with serious health problems or high risk of miscarriage. Miscarriages were identified: confirmed clinical and ultrasound signs of embryo/fetal expulsion, anembryonic pregnancy and missed abortion. Concentrations of serum and urinary PLGF were detected by ELISA.

Results: Serum PLGF concentrations in miscarriage were 19.8 (12.7-31.9) pg/mL, which was significantly lower than serum PLGF concentrations in uncomplicated pregnancy of 45.5 (25.4-60.0) pg/mL p <0.0001. ROC analysis revealed the diagnostic significance of serum PLGF: AUC 0.765 (CI 0.717-0.809) (p <0.0001), Se 84.6% (CI 77.7-90.0) Sp 68.7% (61.7-75.1), with cut-off ≤35.6 pg/mL, diagnostic odds ratio (DOR) 12. Odds ratio for miscarriages for serum PLGF concentration <35.6 pg/mL was 10.9 (6.5-18.4). Evaluation of urinary PLGF did not reveal diagnostic and prognostic efficacy of miscarriages.

Conclusion: The serum PLGF might be considered as a prediction marker of the miscarriages with a suggested cut off concentration of 35.6 pg/mL. A further investigation should be carried out on the larger cohorts from various geographical areas.

Background: Biological aging is a systemic driver of chronic disease, yet its relationship with female urinary incontinence (UI) remains unexamined. We leveraged three conceptually distinct metrics-PhenoAge (PA), Klemera-Doubal Method (KDM), and Homeostatic Dysregulation (HD)-to quantify biological age and assessed their associations with stress UI (SUI), urgency UI (UUI), and mixed UI (MUI) in a nationally representative cohort.

Methods: This cross-sectional study included 8,561 women ≥20 years from NHANES 2005-2010 and 2015-2018. After outlier exclusion and covariate selection via LASSO regression, multivariable logistic regression and restricted cubic splines (RCS) were used to estimate ORs and dose-response shapes. Subgroup analyses, mediation analyses, and sensitivity analyses were performed.

Results: PA and KDM were positively associated with UI. The third quartile of PA and KDM conferred the highest risk for SUI (PA: Q3 OR = 1.58, 95% CI 1.33-1.88; KDM: Q3 OR = 1.39, 95% CI 1.20-1.62). Higher quartiles were also linked to greater UI severity. Fully adjusted RCS models revealed inverted J-shaped relationships for SUI (PA inflection: 43.6; KDM: 34.7) and inverted U-shaped relationships for UUI and MUI with KDM (UUI inflections: 40.7 and MUI inflections: 40.5). Associations were robust across most subgroups but attenuated with increasing reproductive risk factors. No significant mediation by sex steroids or α-Klotho was observed.

Conclusion: Biological aging is significantly positively associated with UI, and its relationship with SUI follows an inverted J-shaped curve. Interventions that slow biological aging may offer a novel strategy for UI prevention; however, longitudinal studies are required to establish causality.

Background: Non-medically indicated caesarean section (CS) is a growing contributor to rising CS rates globally and in Thailand, influenced by maternal preference, socio-cultural factors and clinical decision-making. Understanding women's perspectives is essential to guide counselling strategies and inform policy targeted at reducing unnecessary CS.

Objective: To explore pregnant women's attitudes, perceptions and determinants of preference for non-medically indicated CS and identify factors associated with CS preference.

Methods: This prospective, descriptive, three-phase mixed-methods study was conducted from May 1 to July 30, 2024. The study was conducted at an antenatal clinic. The study comprised three phases: in-depth interviews with 40 pregnant women, questionnaire development and validation, and a survey of 400 participants. Descriptive statistics summarised had demographic data, while univariable chi-squared tests and multivariable logistic regression analysed factors associated with non-medically indicated CSs. Odds ratios and 95% confidence intervals (CIs) were reported, with statistical significance set at P < 0.05. The main outcomes and measures were the attitudes, perceptions, policy, implementation science, counselling frameworks, and clinician-patient power dynamics of pregnant women towards non-medically indicated caesarean sections.

Results: Among the 400 women surveyed, 75% preferred vaginal delivery as a more natural and less risky option. However, 60% 60% reported they would still agree to a CS if recommended by a doctor, indicating high reliance on physician guidance even in situations without clear medical indication. Key factors affecting delivery preferences included prior caesarean delivery (adjusted odds ratio 2.5, 95% CI 1.5‒4.0) and maternal age over 35 years (adjusted odds ratio 1.8, 95% CI 1.1‒2.9). Comprehensive counselling was deemed essential by 80% of participants, who reported greater confidence in choosing vaginal delivery after thorough discussions of risks and benefits. Auspicious timing influenced 39.5%, while 37.3% were swayed by pain perception. Higher education levels, assisted conception methods and concerns about safety, such as blood loss, also shaped CS preferences.

Conclusion: Pregnant women in Thailand generally prefer vaginal birth but are highly influenced by physician recommendations. Strengthening counselling, addressing misconceptions and incorporating shared decision-making into routine antenatal care may reduce non-indicated CS demand. Findings support future development of counselling frameworks and policy interventions to promote safe, evidence-based delivery choices.

Thai clinical trials registry reference: TCTR 20230913007: Date of registration 13 September 2023.

Objective: The aim of this study was to explore potential novel genes associated with Müllerian duct anomalies (MDAs) through next-generation sequencing techniques.

Materials and methods: Whole-exome sequencing (WES) was conducted for 5 unrelated patients of Chinese Han ethnicity diagnosed with congenital absence of the uterus and vagina (CAUV), alongside 10 unaffected women. Genomic data were sourced from a public database. Diagnosis and classification of the anomalies were based on findings from ultrasound imaging, hysterosalpingography, and hysteroscopy. A previously unreported candidate gene, CASKIN2, was identified. Subsequently, 120 unrelated patients with MDAs, who sought infertility treatment at the Center for Reproductive Medicine, The First Affiliated Hospital of Anhui Medical University between January 2008 and December 2011, were included for targeted analysis of candidate genes and variants detected through WES.

Results: Two novel heterozygous missense variants in the CASKIN2 gene (NM_020753: c.969C>A, p.H323Q; c.1228G>A, p.V410M) were identified in two unrelated patients with CAUV through WES. Further direct sequencing of all coding exons of CASKIN2 in the cohort of 120 patients with MDA revealed three additional missense variants (c.1128G>A, p.V410M; c.2816C>T, p.T939M; c.3377G>A, p.R1126H). No pathogenic variants were detected among individuals in the control group.

Conclusion: The CASKIN2 gene, which is evolutionarily conserved across multiple species and known to interact with CASK, may represent a novel candidate gene associated with MDAs in people of Chinese Han ethnicity. The CASKIN2-CASK signaling axis appears to play an evolutionarily conserved and indispensable role during human Müllerian-duct development.

[This retracts the article DOI: 10.2147/IJWH.S542758.].

Objective: To investigate the effects of Diane-35 combined with metformin on hormone levels and pregnancy outcomes in patients with polycystic ovary syndrome (PCOS).

Methods: A retrospective analysis was conducted on patients diagnosed with PCOS who received treatment at our hospital between January 2023 and October 2024. Patients were divided into control and study groups based on their treatment regimens. The control group received conventional metformin therapy, while the study group received Diane-35 in addition to metformin. The inclusion criteria are based on the 2003 Rotterdam Conference criteria (oligoovulation/anovulation, hyperandrogenism, polycystic ovary morphology); Exclusion criteria include liver and kidney dysfunction, pituitary adrenal/thyroid disease, non PCOS infertility factors, fallopian tube obstruction, immune/hematological abnormalities, and severe complications. Finally, 170 PCOS patients were included (85 in each group after propensity score matching, Using propensity score matching (PSM) for 1:1 non replacement matching, based on age BMI, Construct a logistic regression model to calculate propensity score for 9 baseline characteristics, including basal hormone levels, with a caliper value of 0.02. After matching, the standardized deviations of each variable were all <10% and there was no significant difference in t-test). Hormone levels were compared between the two groups, and pregnancy outcomes were analyzed for patients with successful pregnancies.

Results: After treatment, the study group demonstrated significant reductions in ovarian volume and antral follicle count, alongside increased endometrial thickness (P < 0.05). Body mass index (BMI), luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone (T) levels, and insulin resistance index (HOMA-IR) were lower in the study group compared to the control group (P < 0.05), while estradiol (E2) levels were significantly elevated (P < 0.05). The study group achieved a higher pregnancy success rate (89.41% vs 34.12%) and live birth rate (98.68% vs 79.31%) compared to the control group (P < 0.05), with a markedly lower abortion rate (5.88% vs 25.88%) (P < 0.05).

Conclusion: This study confirms the significant efficacy of Diane-35 combined with metformin in improving hormone levels and pregnancy outcomes in PCOS patients, but it should be noted that retrospective design may have selection bias, short-term observation (12 months) limits long-term safety evaluation, and insufficient sample size limits subgroup analysis (such as differences in efficacy among different BMI stratification). Future multicenter prospective studies are needed for validation.

In Somalia, the cultural requirement for male family authorization before surgical procedures even in emergencies remains a silent but deadly barrier to timely care. This practice, particularly in obstetric emergencies such as caesarean section, delays life-saving interventions, heightening risks for mothers and newborns. Evidence from Somaliland shows that nearly half of prolonged caesarean section delays are due to family decision-making for consent, with a measurable increase in severe maternal outcomes. This article is presented as a policy commentary aimed at highlighting the impact of current consent practices on women's health and proposing feasible reforms. Respectfully, this commentary urges lawmakers, healthcare leaders, and community elders to consider a compassionate reform that enshrines a woman's right to make informed decisions about her own health. By aligning policy with both ethical medical practice and Islamic principles of preserving life, Somalia can move toward a safer, more equitable maternal health system. This commentary recommends five key actions: legally affirming women's right to self-consent, enabling emergency presumed consent when delays endanger life, introducing advance antenatal consent to prevent avoidable delays in emergencies, engaging communities to build understanding and acceptance, and strengthening provider training to support respectful and timely decision-making.

Purpose: Breast-conserving surgery (BCS) followed by adjuvant radiotherapy is the standard treatment for early breast cancer in Indonesia. Our aim was to compare the outcomes of BCS with oncoplastic surgery (OPS), a less common method of breast cancer treatment in the country.

Patients and methods: This retrospective cohort study was conducted at Hasan Sadikin General Hospital, Bandung, West Java, Indonesia. Patients with biopsy-proven Stage I to II breast cancer who underwent either OPS or BCS between 1 July 2020 to 30 June 2023, were identified. Data were collected by reviewing patient files and electronic records.

Results: A total of 82 patients were included in the study, with 43 (52.4%) undergoing BCS and 39 (47.6%) undergoing OPS. Age in OPS group 39.25 ± 4.9 was not significant difference compare with BCS group 39.86 ± 5.11. The mean tumor volume was higher in the OPS group (34.72 cm³) compared to the BCS group (22.35 cm³), and postoperative complications were also higher in the OPS group (7.6% vs 0%). Despite the use of frozen section analysis in the operating theatre, the frequency of positive margins was greater in the BCS group (9.3% vs 2.5%). There were no significant differences in the histologic type of tumor and immunohistochemistry between the two groups.

Conclusion: OPS is a valid alternative approach to breast cancer treatment that can be offered to women with early stage breast cancer at complex locations owing to the reduced occurrence of positive margins and thus lowered re-excision rates.

Objective: To explore the value of the ThinPrep cytology test (TCT) combined with human papillomavirus (HPV) DNA detection in the screening and triage of cervical lesions.

Methods: A total of 1671 patients with cervical inflammation or lesions who underwent colposcopy and biopsy between April 2020 and December 2022 were analyzed. The data included TCT, HPV DNA, and pathological findings.

Results: The incidence of high-grade squamous intraepithelial lesions (HSILs) or above significantly increased with TCT severity: 25.9% in the negative for intraepithelial lesion or malignancy (NILM) group, 39.4% in the atypical squamous cells of undetermined significance (ASCUS) and low-grade SIL (LSIL) groups, and 76.5% in the HSIL+ group (P<0.001 for all pairwise comparisons). The incidence also varied significantly by HPV status: 58.2% in the HPV 16 or 18 group, 28.6% in the other high-risk groups, and 17.6% in the low-risk and negative groups (P<0.001 for all pairwise comparisons). Multivariate analysis revealed independent risk factors for HSIL+: younger age (OR=0.972), HSIL and above cytology (OR=10.154), ASCUS and LSIL cytology (OR=2.250), HPV 16/18 infection (OR=8.061), and other high-risk HPV infections (OR=2.578). Patients with concurrent HPV 16/18 infection and HSIL or above cytology presented a substantially elevated risk (OR=41.517). Among the cohort, 35 cases of cervical squamous cell carcinoma were identified.

Conclusion: TCT combined with HPV DNA testing provides an effective strategy for risk stratification in cervical screening. Our findings support that patients with HPV16 or 18 should be referred directly for colposcopy, and patients with other high-risk HPV types and TCT results of ASCUS and above are also recommended for colposcopy referrals. These referral suggestions warrant further validation in larger, multicenter studies.

Purpose: To evaluate fetal interventricular septum (IVS) volume in pregnant women with gestational diabetes mellitus (GDM) and compare it with that of healthy pregnant women using 4D ultrasound with spatiotemporal image correlation (STIC) and virtual organ computer-aided analysis (VOCAL) methods.

Patients and methods: This prospective cross-sectional study was conducted at Bhumibol Adulyadej Hospital, Royal Thai Airforce, Bangkok, Thailand, from November 2024 to March 2025. Pregnant women with a gestational age (GA) between 29 and 34 weeks were enrolled and divided into two groups: GDM and healthy controls. Fetal IVS volume was measured using 4D ultrasonography with STIC and VOCAL. Maternal, fetal, and demographic data were collected and analyzed.

Results: A total of 111 participants were included: 63 in the GDM group and 48 in the control group. The GDM group was significantly older (33.0 vs 27.9 years) and had a higher BMI (31.1 vs 26.8 kg/m²). Mean fetal IVS volume was significantly greater in the GDM group (347.1 mm³ vs 221.5 mm³). Adverse neonatal outcomes were comparable. The cut-off fetal IVS volume for predicting neonatal hyperbilirubinemia (HBB) and respiratory distress syndrome (RDS) was 419.8 mm³. Sensitivity for predicting HBB and RDS was 55.0 and 56.0%, with negative predictive values of 94.0 and 95.2%, respectively.

Conclusion: Fetal IVS volume was significantly higher in GDM pregnancies. A cut-off value of 419.8 mm³ may be useful in predicting HBB and RDS risk, with high negative predictive value, suggesting its potential as a screening tool during the early third trimester.