International Journal of Women's Health最新文献

Background: Maternal obesity is a major global public health issue. Induction of labor (IoL) is common in obstetrics. Both the rate of IoL and induction failure rate are higher in obese women than in those with normal body mass index (BMI). This study aimed to construct a model to predict the failed IoL with a caesarean section (CS) as the outcome among term singleton obese pregnant women.

Methods: Electric health records of term singleton obese pregnant women were retrieved from Beijing Obstetrics and Gynecology Hospital from February 2018 to December 2022 (discovery cohort), and January to December 2024 (validation cohort). CS was defined as the outcome of failed IoL. Univariate logistic regression analysis was used to identify the risk factors, and multivariate logistic regression (stepwise and backward) was used to construct the prediction model. Performance was assessed using the area under the receiver operating characteristic curve (AUC) and internally validated with the validation cohort.

Results: Pre-pregnant BMI (OR 1.074, 95% CI 1.016-1.135, p=0.011), gestational weight gain (OR 1.033, 95% CI 1.006-1.062) and neonatal weight (OR 1.673, 95% CI 1.175-2.380, p=0.004) were identified as the risk factors of a failed IoL, whereas gravidity (OR 0.706, 95% CI 0.592-0.844, p<0.001), parity (OR 0.105, 95% CI 0.055-0.198, p<0.001), height (OR 0.935, 95% CI 0.907-0.963, p<0.001) and Bishop score (OR 0.892, 95% CI 0.799-0.996, p=0.042) as the protective factors. The final model included parity, height, pre-pregnant BMI, gestational weight gain, Bishop score, and neonatal weight, achieving an AUC of 0.752 (95% CI, 0.717-0.788) in the discovery cohort and 0.826 (95% CI 0.757-894) in the validation cohort.

Conclusion: This practical model predicts the failed IoL among term singleton obese women using routinely available variables. It may support obstetric decision-making, enhance counseling, and improve resource planning for women at increased risk of intra- and postpartum complications.

Background: The causal effects of widely used analgesics-paracetamol(acetaminophen), aspirin (acetylsalicylic acid), and ibuprofen-on breast cancer risk and survival remain uncertain. This Mendelian randomization (MR) study investigated their causal relationships with breast cancer incidence, mortality, and estrogen receptor (ER)-subtype heterogeneity.

Methods: Using two-sample MR, genetic instruments for analgesic use were derived from UK Biobank GWAS (N=457,547). Outcome data included breast cancer incidence (122,977 cases/105,974 controls), ER-subtypes (ER+: 69,501 cases; ER-: 21,468 cases), and survival statistics. Inverse-variance weighted (IVW) analyses were primary, supplemented by MR-Egger, weighted median/mode, and sensitivity analyses (MR-PRESSO, leave-one-out). Bidirectional MR assessed reverse causation.

Results: Genetically predicted paracetamol use increased overall breast cancer risk (IVW OR=3.26, 95% CI:1.60-6.63, pFDR=0.005) and ER+ subtype risk (OR=3.65, 1.79-7.45, pFDR=0.003). Aspirin use showed no association with incidence but improved overall survival (HR=0.0036, 0.0001-0.1218, pFDR=0.016). Ibuprofen demonstrated no significant associations with risk or survival. Subtype-specific survival analyses were null. No reverse causation was detected (all p >0.05). Sensitivity analyses confirmed robustness, with minimal pleiotropy (MR-Egger intercept p >0.05) and consistent effects after outlier correction.

Conclusion: This MR study links a genetic predisposition to paracetamol use with increased breast cancer risk (especially ER+), and to aspirin use with improved survival. These divergent findings point to drug-specific mechanisms, warranting caution with long-term paracetamol use and further study of aspirin's therapeutic potential. Clinical decisions should balance analgesic benefits against these potential cancer-related outcomes.

Gliomatosis peritonei (GP) is a rare condition of mature glial tissue within the peritoneum. GP has been reported in approximately 100 cases worldwide, and it rarely occurs in young women or in patients with ovarian mature or immature teratomas during childhood. In patients with ovarian immature teratoma (OIT) combined with gliomatosis peritonei, the tumor is typically large and is often detected intraoperatively. Its neuroglial component may not only spread within the peritoneum but also metastasize via the lymphatic vessels. Pathologically confirmed lymph nodes containing mature neuroglial components and positive for glial fibrillary acidic protein (GFAP) are consistent with nodal gliomatosis (NG). In this report, we present a case of gliomatosis associated with OIT combined with GP, which involves lymph nodes.

Purpose: This study aims to explore the classification characteristics of alexithymia in patients undergoing in vitro fertilization-embryo transfer (IVF-ET) and analyze the differences among these classifications in female patients, in order to alleviate the patients' alexithymia and improve their mental health and reproductive quality of life.

Methods: A total of 385 patients undergoing IVF-ET were selected through convenience sampling from the Reproductive Endocrinology Clinic of a Grade III A-level obstetrics and gynecology hospital in mainland China between June 2024 and December 2024. Data collection included the general information survey form, the Toronto Alexithymia Scale, and the General Self-efficacy Scale. Latent profile analysis was used to explore the potential categories of alexithymia among patients receiving IVF-ET treatment. Univariate and multiple logistic regression analyses were conducted to identify the factors correlated with the potential profiles.

Results: The alexithymia in patients receiving IVF-ET treatment was categorized into three potential groups: low-risk (48.0%), moderate-risk (46.0%), and high-risk alexithymia groups (6.0%). Multiple logistic regression analysis results indicated that educational level, average monthly household income, and self-efficacy are correlated with alexithymia in patients receiving IVF-ET treatment (P < 0.05).

Conclusion: The alexithymia in patients receiving IVF-ET treatment can be categorized into three potential profile types. The clinical medical staff should consider the characteristics of patients and implement targeted interventions for those with lower levels of education, lower average monthly household income, and poorer self-efficacy, in order to reduce the degree of alexithymia.

Objective: This study aimed to comprehensively assess the global, regional, and national burden and trends of maternal hypertensive disorders (MHD) from 1990 to 2021.

Methods: By analyzing MHD data from 1999 to 2021, age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR) and age-standardized disability-adjusted life years (ASDR) were screened, and estimated annual percentage change (EAPC) was calculated. This study used joinpoint regression analysis to examine trends during the period. This study investigated the differences in the burden of MHD among different Socio-demographic Index (SDI) regions through health inequalities analysis. Finally, we used the Bayesian age-period-cohort (BAPC) model to predict the trend in incidence, mortality, and DALYs rates of MHD over the next 25 years.

Results: The results showed that in 2021, the global ASIR, ASMR and ASDR were 461.94, 0.97 and 63.47, respectively (per 100000 population). From 1990 to 2021, the EAPC results showed a decreasing trend in the global ASIR, ASMR, and ASDR of MHD. The joinpoint regression results showed that the global ASIR, ASMR, and ASDR of MHD showed an overall downward trend from 1990 to 2021. Countries with lower SDI levels bore a higher burden. The predicted incidence, mortality, and DALYs rates of MHD for the next 25 years are both showing a downward trend.

Conclusion: The global ASIR, ASMR, and ASDR of MHD were all showing a downward trend from 1990 to 2021. However, this study found that Africa and low SDI regions bore a significant burden. The disparity in economic development could lead to an exacerbation of health inequalities. Therefore, it was emphasized that relevant public health policies should be formulated for African and low SDI regions. Medical staff should raise awareness of the risks of MHD and actively handle emergencies caused by MHD to reduce mortality, and DALYs rates and alleviate social burden.

Background: Placenta previa (PP) is a major obstetric complication that can cause significant physical and emotional stress for expectant mothers. However, its psychological impact has received limited research attention. The purpose of this study was to examine perceived stress, depression, anxiety, post-traumatic stress symptoms, and sleep disturbances in patients diagnosed with PP.

Methods: This cross-sectional study with prospectively collected obstetric outcomes included 70 cases of PP and 78 healthy pregnant women (HPs) in the third trimester of pregnancy. Depression, anxiety, post-traumatic stress symptoms, sleep disturbances, perceived stress, and resilience were assessed using the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Impact of Events Scale-Revised (IES-R), Jenkins Sleep Scale (JSS), Perceived Stress Scale (PSS-10), and Brief Resilience Scale (BRS), respectively.

Results: According to the cutoff scores of the scales, 50%, 42.9%, 62.9%, and 51.4% of those diagnosed with PP met the criteria for depression, anxiety, sleep disturbances, and post-traumatic stress disorder, respectively, which were significantly higher than those in the HP group. After controlling for maternal age, gravida, parity, and resilience, the PHQ-9, GAD-7, and IES-R scale scores were significantly higher in patients with PP than in the HP group. The mediation model indicated that depression and anxiety partially mediate the relationship between perceived stress and post-traumatic stress symptoms (PSS-10 ➝ GAD-7/PHQ-9 ➝ IES-R).

Conclusion: The findings of this study suggest that women diagnosed with PP who are anticipating labor have a significantly increased likelihood of developing depression, anxiety, sleep disturbances, and post-traumatic stress symptoms. Raising awareness of the adverse psychological effects associated with PP may help facilitate the implementation of screening, assessment, and intervention strategies for these patients.

Purpose: The Treatment Expectation Questionnaire (TEX-Q) is a generic, multidimensional scale that measures patients' expectations of medical and psychological treatments. Currently, it is available in English and German only. This study aims to translate the TEX-Q into Dutch and evaluate its psychometric properties.

Patients and methods: The TEX-Q was translated into Dutch following international guidelines for cross-cultural adaptation of self-report measures. The Dutch version was tested in 163 gynaecological outpatients starting new treatments, a group suitable for validation due to their diverse treatment experiences. Test-retest reliability was assessed in a sample of 25 gynaecological outpatients. We examined data completeness (ie, no missing data), score distributions, internal consistency, construct validity, confirmatory factor analysis (CFA), and test-retest reliability. Convergent validity was tested through correlations with Credibility/Expectancy Questionnaire (CEQ) and a single item from Brief Illness Perception Questionnaire (B-IPQ). Discriminant validity was assessed using Life Orientation Test (LOT-R), General Self-Efficacy Scale (GSES), Generalized Anxiety Disorder Scale (GAD-7) and Patient Health Questionnaire (PHQ-9).

Results: Data completeness was 89%. Internal consistency, measured by Cronbach's α, was good for most subscales, with values mostly above 0.75, except for the 'Process" subscale (Cronbach's α = 0.55). The mean TEX-Q score showed moderate to strong correlations with CEQ and the B-IPQ item (r = 0.29-0.55). Correlations with discriminant measures like LOT-R, GSES, GAD-7 and PHQ-9 were low (r = 0.22, 0.23, -0.17, -0.14 respectively). CFA revealed an acceptable six-factor model. Factor loadings were high (minimum of 0.76). The test-retest reliability was moderate for the mean TEX-Q score (ICC = 0.72).

Conclusion: The Dutch version of the TEX-Q demonstrates acceptable validity and reliability, making it suitable for research and clinical practice in gynaecology. Further validation across diverse clinical populations is recommended.

Purpose: Guided by the Ottawa Decision Support Framework (ODSF), this study aimed to explore the experiences, perceived barriers, and support needs of both reproductive-aged women with gynecological cancer and health care professionals (HCPs) during the process of fertility preservation (FP) shared decision-making (SDM), in order to identify alignments and discrepancies between the two groups.

Patients and methods: A descriptive phenomenological qualitative study was conducted using semi-structured interviews with reproductive-aged women diagnosed with gynecological cancers and HCPs from gynecology, oncology, and reproductive medicine specialties. Patients were recruited via hospital records during outpatient visits or hospitalization, and professionals via departmental announcements and invitations. The ODSF informed the development of the interview guide. Data were analyzed using Colaizzi's descriptive phenomenological method.

Results: A total of 11 reproductive-aged women with gynecological cancer and 12 multidisciplinary HCPs participated in the study. Among the HCPs, 7 were physicians and 5 were nurses. Analysis yielded 35 meaning unites, which were clustered into two main themes: gaps and fragmentation in meeting decisional needs and facilitators of high-quality fertility preservation decision support.

Conclusion: This study suggests that FP SDM among reproductive-aged women with gynecological cancer in China may be influenced by multiple challenges, including limited and untimely information, fragmented referral mechanisms, psychological distress, financial concerns, and sociocultural factors. Multidisciplinary team involvement, nursing support, and culturally adapted decision aids may help enhance patient participation, support preference-sensitive decision-making, and reduce decisional conflict. These findings indicate that integrating structured counseling processes, optimizing multidisciplinary pathways, and developing personalized, culturally sensitive decision aids may contribute to more patient-centered fertility care.

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.