Journal of Obstetrics and Gynaecology最新文献

Background: With the gradual legalisation of recreational cannabis, associated health effects have received widespread attention, but their association with female infertility remains unclear. The aim of this study was to explore the association between cannabis use and infertility among females of childbearing age in the United States.

Methods: Data were obtained from the National Health and Nutrition Examination Survey 2013-2018; 1694 female participants aged 18-45 years were included. The association between cannabis use and female infertility was analysed by logistic regression analysis. All data were weighted before analysis.

Results: After adjusting for all covariates, former cannabis users demonstrated significantly elevated odds of infertility compared with never-users (odds ratio: 2.04, 95% confidence interval: 1.21-3.43, P = 0.012), whereas current cannabis users exhibited no significant difference in infertility odds relative to never-users. In subgroup analysis, former users aged 18-35 years exhibited higher odds of infertility than never-users (odds ratio: 2.37, 95% confidence interval: 1.11-5.04, P = 0.027); but former cannabis users aged 36-45 years demonstrated no significant difference in infertility odds compared with never-users. Among former cannabis users aged 18-35 years, those with sustained abstinence exceeding 3 years demonstrated significantly elevated odds of infertility compared with never-users (odds ratio: 2.94, 95% confidence interval: 1.29-6.71, P = 0.005). In contrast, individuals with shorter abstinence durations (<3 years) showed no significant difference in infertility odds relative to never-users.

Conclusions: Among females of childbearing age, the odds of infertility was not elevated among current cannabis users compared with never-users, while the odds of infertility was elevated among former users. This relationship between cannabis use and female fertility is more often reflected in the distant term (>3 years of cessation), and this adverse association is more pronounced among females in the most active reproductive years (18-35).

Background: The aetiology and pathogenesis of adenomyosis remain unclear. This study utilised untargeted metabolomics to explore the aberrant amino acid metabolism in adenomyosis. Among the studied metabolites, hydroxyproline is known to promote the proliferation and invasion of tumour cells. Due to detection limitations, hydroxyproline levels were inferred via the expression of prolyl 4-hydroxylase subunit alpha 1 (P4HA1), a crucial enzyme that catalyses the conversion of proline to hydroxyproline.

Methods: Endometrial metabolomic analysis was performed using gas chromatography-mass spectrometry (GC-MS) in 15 and 20 patients with and without adenomyosis. The expression levels of P4HA1 mRNA and protein were detected using quantitative PCR (qPCR), western blotting, and immunohistochemistry. In vitro, Cell Counting Kit-8, and 5-Ethynyl-2'-deoxyuridine (EdU) assays were used to investigate the effect of hydroxyproline on the proliferation of human endometrial stromal cells (hESCs). Additionally, a wound-healing assay was conducted to examine the effect of hydroxyproline on hESCs migration.

Results: In total, 22 differentially expressed metabolites were identified in the adenomyosis group compared to the control group. qPCR results demonstrated that P4HA1 mRNA expression levels were significantly higher in the adenomyosis group than in the control group (p < 0.01), which was further validated at the protein level by western blotting and immunohistochemistry. In vitro, functional assays revealed that hydroxyproline promoted hESCs proliferation and migration in a dose-dependent manner. EdU assays showed a significant increase in the number of EdU-positive hESCs in the 5 mM hydroxyproline treatment group than that in the control group (p < 0.01). Additionally, wound healing assays demonstrated enhanced migration of hESCs after treatment with 5 mM hydroxyproline (p = 0.002).

Conclusion: Hydroxyproline levels were significantly elevated in the endometrial tissues of patients with adenomyosis. Furthermore, hydroxyproline promotes the proliferation and migration of hESCs. These findings provide new insights into the pathogenesis of adenomyosis and suggest potential therapeutic strategies.

Background: Epithelioid and placental site trophoblastic tumours are rare gestational malignancies which have little detailed information on their population incidence or risk related to maternal age.

Methods: We performed a retrospective UK national population-based study examining all of the cases registered between 2000 and 2020 using the databases at the UK's two gestational trophoblastic treatment centres at Charing Cross Hospital in London and Weston Park Hospital in Sheffield. The data obtained was compared with the contemporary UK birth and pregnancy statistics.

Results: Over the 21-year study period, there were 132 cases of ETT or PSST. PSTT comprised 57% of the cases, 30% were ETT and 13% had mixed pathology. The combined incidence of ETT and PSTT was 1:118,736 relative to live births and 1:150,872 compared to total viable conceptions. For women aged under 20 the incidence relative to live births was 1:412,488, increasing to 1:188,292 for women 30-34 years, and 1:1,426 for women aged 45 and above. The median interval from the antecedent pregnancy to the time of diagnosis was 15 months (0-288) for the PSTT patients compared to 24 months (0-336) for patients with a diagnosis of ETT.

Conclusions: ETT and PSTT are both rare diagnoses with little detailed information on their demographics. The data in this study indicates a wide range in the interval from the antecedent pregnancy to diagnosis and confirms a close relationship between increasing incidence and rising maternal age.

Background: This study aimed to investigate the role of B7H4 and Fas in pre-eclampsia (PE) occurrence and development and reveal its potential mechanisms.

Methods: Thirty healthy individuals and 60 patients with PE were enrolled in the study. In addition, the clinical characteristics of all participants were collected, including age, gestational weeks at delivery, gestational time, number of births, systolic blood pressure, diastolic blood pressure and foetal weight. The chi-square test was used to evaluate differences in clinical characteristics between the high- and low-expression groups. The expression levels of B7H4 and Fas were analysed using western blotting and real-time quantitative polymerase chain reaction (RT-qPCR). The upstream regulators of B7H4 in trophoblasts were predicted and estimated using a luciferase reporter assay. The proliferation and motility of trophoblasts were assessed using CCK8 and transwell assays, respectively.

Results: B7H4 and Fas were upregulated in PE (p < 0.05) and showed diagnostic potential with insufficient sensitivity and specificity [B7H4: area under curve (AUC) = 0.790, sensitivity = 65%, specificity = 83.33%; Fas: AUC = 0.717, sensitivity = 68.34%, specificity = 73.33%]. B7H4 and Fas were closely associated with increased blood pressure in patients with PE (p < 0.05), and the combination of B7H4 and Fas increased the diagnostic efficacy (AUC = 0.864), sensitivity (73.33%) and specificity (86.67%). In trophoblast cells, miR-4319 negatively regulated B7H4 and Fas expression as well as cell proliferation, migration and invasion (p < 0.05). Overexpression of B7H4 alleviated the inhibitory effects of miR-4319, which were reversed by Fas knockdown (p < 0.05).

Conclusions: miR-4319 mediates the progression of trophoblast progression by negatively regulating the expression of B7H4 and Fas. Therefore, B7H4 and Fas may serve as potential biomarkers for the prediction and treatment of PE.

Male foetuses have historically been perceived as more active than females, and foetal movement has been observed to be greater in male foetuses in late pregnancy. Nonstress tests (NSTs), a common form of antepartum assessment, rely on movement in their interpretation. To see if this difference could influence their interpretation, NSTs of patients undergoing clinically indicated testing at 36 weeks' gestation were evaluated. In this cross-sectional observational study, tests were compared between male and female foetuses for maternal indicators of foetal movement and heart rate characteristics including baseline, variability, and number of accelerations. Among 287 foetuses analysed, recordings of foetal movement and heart rate characteristics were similar between the two groups. The results suggest no difference in movement or NST parameters between males and females, and foetal sex should not affect NST interpretation.

Background: This study aimed to assess the prevalence of female sexual dysfunction (FSD) and its association with clinical characteristics in female patients with Sjögren's syndrome (SS).

Methods: In this cross-sectional study, 158 female patients with SS admitted to the Department of Rheumatology and Immunology of three Grade-III Class-A hospitals in Beijing between January 2021 and December 2023 were included. The general clinical data, sexual function feelings, medication use, psychological status, and socioeconomic factors of the patients were collected with a standardised questionnaire and assessed.

Results: Of the 158 patients, 124 (78.5%) were diagnosed with FSD based on Female Sexual Function Index scores <26.5. The mean age and course of disease were significantly higher in the FSD group than in the non-FSD group (p < 0.05), with a higher proportion of patients aged ≥40 years in the former (71.8%) than the latter (11.8%). After adjusting for potential confounding factors, including medication use, psychological status and socioeconomic factors, the association between SS and FSD remained significant (p < 0.05). In the FSD group, decreased libido (79.0%), difficulty in sexual arousal (71.8%), difficulty in vaginal lubrication (66.1%), orgasmic disorder (77.4%), decreased sexual satisfaction (81.5%) and dyspareunia (75.0%) were commonly reported.

Conclusions: The findings of this study suggest that early identification and intervention of FSD for female patients with SS is essential to improve their quality of life.

Background: Hearing disabilities are a significant risk factor for adverse pregnancy outcomes. This study aimed to analyse the impact of hearing impairment on maternal and neonatal outcomes, and to evaluate the adequacy of prenatal care among women diagnosed with hearing disabilities.

Methods: A literature search of the PubMed, Medline, Cochrane Library, Embase, and Scopus databases for relevant studies published in English was performed. Two researchers independently performed screening and quality assessments. Adverse maternal outcomes (gestational diabetes, preeclampsia, and caesarean delivery), adverse neonatal outcomes (preterm birth and low birth weight), and utilisation of prenatal care resources were primary outcomes of this review. A comparative effects meta-analysis and a narrative synthesis were performed.

Results: Ten retrospective cohort studies comprising 97,251,223 participants, of whom 63,387 had a hearing disability, were included in this review. Meta-analysis revealed a significantly higher risk for gestational diabetes, preeclampsia, eclampsia, caesarean delivery, placental abruption, preterm birth, low birth weight, and adequate-plus utilisation of prenatal care resources. The results were similar in the sensitivity analyses based on different statistical models. There were no statistical differences in pooled estimates of the incidence of chorioamnionitis, although a significantly higher risk was observed when the model was modified.

Conclusion: Compared to women without disabilities, those with hearing disabilities exhibited a higher risk for adverse maternal and neonatal outcomes and excessive use of prenatal care services.

Background: Inadequate milk production during the immediate postpartum period is a common problem. Shatavari (Asparagus racemosus), a revered herb in Ayurveda, is traditionally used as a galactagogue. The objective of this study is to assess the safety and effectiveness of Shatavari root extract (SHT) on lactation in post-partum women.

Methods: This prospective, randomised, double-blind, placebo-controlled study enrolled post-partum women (≥37 weeks' gestation, aged 20-40 years) with uncomplicated vaginal or caesarean deliveries who intended to breastfeed. Participants received either Shatavari root extract (SHT; 300 mg) or placebo (PL) capsules twice daily for 72 h postpartum. The primary outcomes included time to evident breast fullness after the last feeding and the total milk volume expressed at 72 h. The secondary outcomes were maternal and investigator-rated satisfaction (e.g. noticeable breast fullness, maternal/infant wellbeing), assessed by a five-point Likert scale. Safety was assessed through adverse event reports.

Results: From the 120 enrolled participants, seven participants (3 SHT, 4 PL) did not complete the study, yielding a per-protocol dataset of 113 women (57 SHT and 56 PL). The baseline characteristics were comparable across groups. The time to evident breast fullness after the last feeding was significantly shorter in the SHT group (p = 0.002), and milk volume at 72 h was significantly higher (p < 0.001). Maternal satisfaction with lactation was higher in the SHT group (52.63% vs. 25.00%, p = 0.008). SHT participants also reported greater satisfaction with infant well-being. Investigators rated maternal and infant well-being higher for SHT than placebo (80.70% vs. 64.29%). No adverse events occurred, and treatment compliance was high.

Conclusion: Shatavari root extract improved the milk volume and maternal satisfaction about lactation, indicating its potential as a safe, effective galactagogue.