Journal of Obstetrics and Gynaecology Research最新文献

Background: Observational studies have reported associations between various sleep traits and polycystic ovary syndrome (PCOS); however, it remains unclear whether these relationships are causal or driven by confounding factors. This study aimed to clarify the direction and magnitude of potential causal effects between eight self-reported sleep characteristics and PCOS risk using a bidirectional and multivariable Mendelian randomization (MR) framework.

Methods: Genome-wide association study (GWAS) summary statistics for eight sleep traits (sleeplessness/insomnia, sleep duration, snoring, daytime dozing, chronotype, getting up in the morning, daytime napping, and sleep apnea syndrome) and PCOS were analyzed. Univariable MR analyses were conducted using inverse-variance weighted (IVW) meta-analysis as the primary method, supplemented by weighted median and MR-Egger regression. Sensitivity analyses included Cochran's Q test, the MR-Egger intercept, MR-PRESSO, and leave-one-out analyses. Multivariable MR analyses were further performed with adjustment for adiposity and insulin resistance.

Results: Genetically predicted sleeplessness/insomnia was associated with an increased risk of PCOS (IVW OR = 1.67, 95% CI = 1.24-2.27, p = 8.6 × 10^-4). Sleep apnea syndrome was also associated with PCOS in univariable analyses (IVW OR = 1.07, 95% CI = 1.03-1.11, p = 1.3 × 10^-3); however, this association was attenuated after multivariable adjustment (p = 0.20). No evidence of reverse causation from PCOS to sleep traits was observed. The results were consistent across sensitivity analyses, with no evidence of horizontal pleiotropy.

Conclusion: Our MR analyses support a potential causal role of sleeplessness/insomnia in increasing the risk of PCOS, whereas the association with sleep apnea syndrome may be mediated by adiposity or other confounding factors. These findings highlight the importance of sleep management in strategies for the prevention of PCOS.

This review aims to synthesize current evidence on maternal birth weight (MBW) as a determinant of reproductive health and pregnancy outcomes, examining biological mechanisms and potential intergenerational effects within the Developmental Origins of Health and Disease (DOHaD) framework. Evidence from large-scale cohort studies, systematic reviews, and experimental research examining the association between MBW and pregnancy-related outcomes, including hypertensive disorders of pregnancy, gestational diabetes mellitus, preterm birth, offspring birth weight, and selected congenital malformations, is summarized. Findings are interpreted within a DOHaD framework, with attention to methodological heterogeneity, population differences, and potential confounding by shared familial socioeconomic and lifestyle factors. Recent large-scale cohort studies, including those conducted in Japan, further indicate that MBW is associated with pregnancy complications, offspring birth weight, and specific congenital malformations, suggesting potential intergenerational pathways involving genetic, epigenetic, and placental processes. Despite accumulating evidence, substantial heterogeneity persists across populations, and the underlying causal pathways remain incompletely understood. Interpretation is further complicated by family-level factors, such as socioeconomic disadvantage, nutritional patterns, and shared lifestyle behaviors, which may partially influence both MBW and subsequent pregnancy outcomes. Nevertheless, MBW is a simple and widely available metric that may enhance preconception risk assessment, improve risk stratification for pregnancy complications, and contribute to individualized perinatal care. Overall, current epidemiological evidence is consistent with biological mechanisms linking MBW to pregnancy and offspring outcomes. Research priorities are outlined to clarify causal pathways and inform DOHaD-based interventions.

Aims: The aim of the study was to examine the potential risk of vulvar lichen planus (LP), alone or associated with lichen sclerosus (LS) or lichen simplex chronicus (LSC), to evolve towards vulvar cancer (VSCC).

Methods: We retrospectively investigated the incidence of vulvar cancer in women diagnosed with LP, alone or associated with LS and LSC, between 2007 and 2022.

Results: We retrieved the data of 77 women with LP with a mean age of 63.5 ± 11.9 years old. Of these, 53 had LP, 19 had LP+LS, and 5 had LP+LSC. Ultrapotent topical corticosteroids were the first-line treatment. The mean follow-up time was 45 ± 30.14 months, during which four patients developed VSCC (5.19%). All four cases were found to be associated with the presence of multiple lichen, and the frequency of developing a neoplasm in the presence of LS or LSC superimposed on LP was found to be significant with Fisher's exact test (p = 0.0079).

Conclusion: Analyzing our data, we can point out a concrete possibility regarding the relationship between multiple lichen and VSCC compared to LP alone. However, the sample size is too small to allow definitive conclusions to be drawn, and multicenter studies would, therefore, be desirable in the future both to examine more thoroughly and in large numbers the relationship between LP, multiple lichen, and vulvar cancer and to find new treatment and follow-up strategies for pathogenesis.

Aims: One in ten pregnant women with diabetes turns to herbal products due to certain concerns about pharmacological agents. Although herbal medicines have been used since ancient times, their nonstandardized formulations and methods of use may endanger the health of the mother and fetus. Therefore, herbal medicines should be comprehensively evaluated in terms of efficacy, side effects, toxicity, and drug interactions, and approached with caution. On the other hand, it is important to approach the subject objectively without disregarding herbs that can truly benefit the mother and fetus. We aim to shed light on this subject for both pregnant women and physicians.

Methods: A targeted PubMed/MEDLINE search (inception-November 2025) was conducted using combinations of pregnancy/diabetes terms with herbal medicine and safety keywords, repeated for each herb discussed. Eligible evidence was summarized through qualitative synthesis with emphasis on glycemic outcomes and maternal-fetal safety.

Literature results: Diabetes treatment during pregnancy includes lifestyle changes, pharmacological treatment, and herbal medicines. Lifestyle changes are effective in most patients. Pharmacological treatment is considered for patients whose diabetes cannot be controlled through lifestyle changes. However, pharmacological agents are limited due to the risk of teratogenicity. Furthermore, pregnant women's fear of the side effects of medical drugs, the lower cost and easier availability of herbal medicines, and their perception as a natural and harmless alternative based on ancient traditions lead pregnant women to use herbal medicines.

Conclusions: In this review, we scientifically evaluate herbal medicines used in the treatment of diabetes during pregnancy in terms of their place, importance, and considerations.

Objective: This paper aims to evaluate the effectiveness of manual lymph drainage (MLD) and complex decongestive therapy (CDT) in managing lower limb lymphedema (LLL) following cervical cancer surgery and its impact on patient quality of life.

Methods: Patients with postoperative LLL following cervical cancer surgery were included. A total of 57 patients in the control group received pneumatic compression therapy, while 57 patients in the CDT group received additional CDT. Outcomes included symptom relief rates, maximum limb circumference, tissue water content, and Gynecologic Cancer Lymphedema Questionnaire (GCLQ), Visual Analog Scale (VAS), and EORTC QLQ-C30 score.

Results: Posttreatment, the CDT group had a higher total remission rate, smaller affected limb circumference, less extracellular and truncated water, lower GCLQ, VAS, and QLQ-C30 symptom scores, and higher 50 kHz bioelectrical impedance and QLQ-C30 health/function scores than the control group (p < 0.05).

Conclusion: CDT combined with pneumatic compression therapy was effective in treating LLL after cervical cancer surgery, reducing edema and pain in the lower limbs, and improving patients' quality of life.

Aim: Myotonic dystrophy (MD) has been associated with an increased risk of endometrial cancer (EC) in Western countries; however, data from Japan are limited. This study aimed to evaluate the incidence and clinical characteristics of EC and its precursor lesion, atypical endometrial hyperplasia (AEH), in Japanese patients with MD.

Methods: We retrospectively reviewed medical records of female patients with MD (MD group, n = 36) and those with other types of muscular dystrophy (control group, n = 84) treated at a single institution between 2008 and 2023.

Results: EC/AEH was identified in 5 of 36 patients in the MD group (13.9%), including 3 cases of EC and 2 of AEH, whereas 1 case of EC (1.2%) was observed among 84 control patients, indicating a significantly higher incidence in the MD group (p = 0.014). The median age at diagnosis of EC/AEH in the MD group was 45 years, which was significantly younger than that of non-MD EC/AEH cases treated during the same period (median 59 years). All surgically treated EC cases were early-stage endometrioid carcinoma and achieved favorable oncological outcomes, although perioperative respiratory complications were observed.

Conclusions: Japanese MD patients have a significantly higher risk of developing EC/AEH at a younger age compared with non-MD patients. These findings highlight the importance of regular gynecological surveillance in women with MD.

Fertility preservation (FP) is a rapidly expanding field in reproductive medicine with still limited data on outcomes. FP aims to protect the fertility of children, women, and men who face the potential risk of fertility loss for various medical conditions, including but not limited to cancer and its gonadotoxic treatment forms. Therefore, it is crucial to provide evidence-based recommendations to assist health professionals in discussing FP options. Our aim was to provide a guideline for multidisciplinary medical staff in considering the availability of FP options and to help them decide whether to provide FP. The objective of any FP intervention is to minimize or eliminate primary disease burden and to ensure the maintenance or preserving reproductive health. Therefore, people who are at risk of losing fertility should be evaluated for and counseled about future reproductive risks. Embryo, oocyte, and ovarian tissue cryopreservation are the established FP options in adult females, with ovarian tissue cryopreservation the only option for prepubertal girls. A wide range of variables affect the choice of the FP strategy. These include age and ovarian reserve of women, the time available before the initiation of cancer treatment, pubertal status, and cancer type and stage. In males, sperm cryopreservation is a highly effective method in adolescent and adult males, while testicular tissue cryopreservation, which is experimental, is the only available option for prepubertal males. This review addressed the important clinical questions and provided answers for FP in females, males, and children according to the indications and availability of FP.

We report a pregnant woman with diffuse large B-cell lymphoma (DLBCL) presenting as a massive mediastinal tumor causing dyspnea. A 34-year-old multiparous woman was diagnosed with the tumor at 16 weeks of gestation. During attempts at airway management using ECMO cannulation and intubation, she developed cardiopulmonary arrest due to airway compromise but was resuscitated. R-CHOP chemotherapy was initiated empirically, and subsequent biopsy confirmed DLBCL, leading to continuation of therapy using DA-EPOCH-R. Despite repeated discussions, including the option of pregnancy termination, the patient strongly wished to continue the pregnancy. Partial tumor shrinkage was achieved; however, at 24 weeks, she developed sudden massive hemoptysis and cardiopulmonary arrest, which proved fatal despite resuscitation. Postmortem imaging demonstrated tumoral hemorrhage with bronchial communication. Although tumoral hemorrhage is a rare complication of lymphoma, it should be recognized as a possible cause of sudden death in malignant disease. This case highlightsthe potential for catastrophic tumoral hemorrhage during chemotherapy and the complex ethical dilemmas surrounding pregnancy continuation.

Uterine Tumor Resembling Ovarian Sex Cord Tumor (UTROSCT) is a rare mesenchymal neoplasm with uncertain malignant potential. We report a 37-year-old woman with menorrhagia, initially suspected as a leiomyoma on MRI. Hysteroscopic resection revealed an infiltrative tumor with cords, glands, and spindle cells showing mild-to-moderate atypia. Immunohistochemistry was positive for ER, PR, WT-1, Calretinin, and FOXL2. RNA-based NGS identified the GREB1-NCOA2 fusion. Despite treatment, the patient died from metastases within 24 months. This case highlights UTROSCT's aggressive potential in young patients and underscores the diagnostic utility of molecular testing (e.g., GREB1 rearrangements) to distinguish it from mimics like LG-ESS. The fatal outcome suggests GREB1-NCOA2 may correlate with high-risk behavior, warranting close follow-up.