Journal of Obstetrics and Gynaecology最新文献

Background: This study aimed to investigate the potential causal association between chronic hepatitis B (CHB) infection and the risk of pre-eclampsia/eclampsia using a Mendelian randomisation (MR) design.

Methods: We conducted a two-sample MR analysis using genome-wide association study (GWAS) summary statistics from three large-scale datasets. For CHB infection, we used data from 351,885 individuals UK Biobank. For pre‑eclampsia/eclampsia, we analysed two FinnGen datasets with sample sizes of 118,291 and 126,760 individuals, respectively. Genetic variants strongly associated with CHB infection (p < 5 × 10^-8) were selected as instrumental variables. The inverse-variance weighted (IVW) method was employed as the primary analysis. Sensitivity analyses included MR-Egger regression, weighted median, weighted mode and MR-PRESSO. Cochran's Q test and MR-Egger intercept tests were performed to assess heterogeneity and horizontal pleiotropy, respectively.

Results: MR analysis revealed significant positive genetic associations between CHB infection and increased risk of pre-eclampsia (OR = 1.154, 95%CI = 1.014-1.313, p = .029) and eclampsia (OR = 1.561, 95%CI = 1.030-2.366, p = .035). Findings were robust across sensitivity analyses for both outcomes.

Conclusions: Our study provides genetic evidence that CHB infection increases the risk of both pre-eclampsia and eclampsia. These findings suggest that considering CHB status as a risk factor and implementing targeted HBV screening programmes may be beneficial for pregnant women.

Bisphenol A and di-(2-ethylhexyl) phthalate are among the most widespread endocrine-disrupting chemicals (EDCs), widely present in consumer products and the environment. Preclinical studies have shown that these compounds and their metabolites may interfere with key reproductive processes, including folliculogenesis and steroidogenesis. However, translating these findings into clinical relevance remains challenging. Human studies have yielded conflicting results, with some suggesting associations between EDC levels and reduced ovarian reserve or poorer in vitro fertilisation outcomes, while others report no significant correlations. Differences in study design, population characteristics and exposure assessment contribute to this heterogeneity. Despite the current limitations, the topic warrants attention within reproductive medicine, particularly from a preventive perspective. While evidence remains inconclusive, raising awareness and considering lifestyle factors potentially linked to environmental exposures may be a reasonable step in clinical practice. Further studies are needed to clarify their clinical impact and to guide evidence-based reproductive care.

Background: Although most cases of endometrial cancer (EC) are diagnosed at an early stage with favourable outcomes, the prognosis for advanced or recurrent disease remains poor, highlighting the need for novel therapeutic targets. This study aimed to examine the correlation between Cyclin B1 (CCNB1) and Cyclin B2 (CCNB2) expression and disease severity in EC through bioinformatics analysis.

Methods: Common differentially expressed genes were identified in two EC cohorts from the Gene Expression Omnibus. A protein-protein interaction (PPI) network was constructed to identify hub genes. Aberrant expression of the hub genes was validated in external datasets. Their prognostic values were evaluated in a cohort from The Cancer Genome Atlas (TCGA). Knockdown of the hub genes was conducted to explore their functions in the malignant behaviour of EC cells in vitro.

Results: CCNB1 and CCNB2 were identified as the top 2 hub genes in the PPI network. High CCNB1/CCNB2 expression was significantly associated with shorter survival in EC patients. Overexpression of CCNB1/CCNB2 in endometrial tumour tissue was validated in public datasets. In TCGA cohort, high expression of CCNB1/CCNB2 correlated with greater disease severity and predicted poor prognosis. In addition, high expression of CCNB1/CCNB2 was strongly associated with immune cell infiltration, as well as increased expression of immune checkpoint genes and mismatch repair genes. Furthermore, knockdown of CCNB1/CCNB2 significantly suppressed the proliferation, migration, and invasion of HEC-1 and Ishikawa cells in vitro.

Conclusions: CCNB1 and CCNB2 may serve as potential prognostic markers and therapeutic targets for the management of EC.

Background: Gestational diabetes mellitus (GDM) can negatively impact newborn cardiac health, particularly causing myocardial hypertrophy. This study examined the relationship between umbilical cord blood levels of angiopoietin-like protein 7 (ANGPTL7) in term neonates born to mothers with GDM and myocardial development, assessing its potential as an early predictive marker.

Methods: The study involved 46 newborns exposed to GDM and 46 healthy controls. Measure the interventricular septum (IVS) thickness through cardiac ultrasound and evaluate the level of ANGPTL7 in umbilical cord blood using the ELISA method.

Results: The incidence of myocardial hypertrophy in the GDM group was 19.6%, significantly higher than 0% in the control group, and increased to 27.3% in neonates of mothers with GDM and poor glycaemic control. ANGPTL7 levels in the GDM group were significantly elevated compared to the control group (1.87 vs. 1.11 ng/mL). Furthermore, these levels were positively correlated with IVS thickness. In the poorly-controlled GDM subgroup (GDM-A), neonates had significantly higher ANGPTL7 levels and IVS/LVPW ratio (1.19 vs. 1.03), indicating more severe myocardial abnormalities.

Conclusion: ANGPTL7 may contribute to myocardial hypertrophy in GDM neonates by promoting insulin resistance. Monitoring ANGPTL7 levels in umbilical cord blood could help identify high-risk neonates and guide optimal glycaemic management during pregnancy. Although the sample size was small, the study offers new evidence of ANGPTL7's clinical utility. Future research should expand the sample size and investigate the molecular mechanisms of ANGPTL7 to develop personalised interventions.

Trial registration: This study was not registered prospectively.

Background: Hysterectomy is a significant component of gender-affirming treatment for transgender individuals. The choice of surgical technique and associated complications have been studied, but very few studies have used a standardised classification system to grade surgical complications. This study aimed to describe our hospital's experience on gender-affirming hysterectomies with regards to patient demographics, surgical techniques, and postoperative complications using a validated classification system.

Methods: The study is a prospective follow-up case-series study of 72 consecutive patients undergoing gender-affirming hysterectomy at Karolinska University Hospital between 2016 and 2023. Patient demographics (age and mean body mass index), tobacco and alcohol habits, medical history and comorbidities, route of hysterectomy, complications and 30-days postoperative outcomes were reported. Surgical complications were graded according to the Clavien-Dindo classification system.

Results: The study population, with an average age of 27.6 years, presented diverse medical conditions, with psychiatric diagnoses being the most prevalent. The most common procedure was total laparoscopic hysterectomy, with low intraoperative blood loss. Surgical complications were rare, and primarily required minimal interventions. The 30-day Clavien-Dindo postoperative complication rate of grade II or higher was 19%, although only 4% experienced complications necessitating re-surgery (grade III or higher). Postoperative follow-up emerged as a critical aspect, with 22% of patients seeking non-elective medical attention within the first month, often due to vaginal bleeding or abdominal pain.

Conclusions: Our findings support the safety and feasibility of gender-affirming hysterectomies, particularly when performed laparoscopically, with very few severe complications observed using a validated scoring system. Extensive follow-up care, as well as addressing common postoperative concerns, is essential. Despite a relatively small sample size and lack of a control group, this study provides valuable insights into transgender healthcare from a previously unstudied region. Future research should preferably include larger cohorts, multicentre and registry-based studies.

Foetal growth restriction (FGR) is associated with neonatal morbidity, suboptimal neurodevelopmental outcomes and chronic diseases. Successful pregnancies of women with recurrent mid-trimester pregnancy losses may still be at risk of FGR and small for gestational age (SGA) outcomes. This study aimed to investigate whether patients with recurrent mid-trimester pregnancy losses who undergo transabdominal cerclage (TAC) are at an increased risk of FGR. Due to a paucity of information in this regard, and to inform accurate counselling, we performed a secondary analysis of a unique set of patients with a TAC procedure. Foetal growth restriction (<3rd centile) was present in 8% of cases, with more female than male babies falling in this category (9.2 vs. 7.4%). When combined, FGR plus SGA were present in 19.4% of cases. This rate is not higher than the expected population rate of around 20% in low- and middle-income countries.

Background: The use of cervical length (CL) to predict spontaneous preterm birth (sPTB) is limited in performance due to the low prevalence of a short cervix in the Thai population. Therefore, this study aims to evaluate the diagnostic performance of the uterocervical angle (UCA) in comparison with CL, and the integration of these parameters alongside cervical wedging to predict sPTB.

Methods: This prospective cohort study was designed to assess the diagnostic performance of UCA, CL, and cervical wedging for sPTB in singleton pregnancies, between gestational ages of 16 and 24 weeks, using transvaginal ultrasonography. The primary outcome was the diagnostic performance of the UCA, along with the integration of UCA with other parameters in women who delivered before 37 and 34 weeks.

Results: A total of 261 participants were included in the analysis. The optimal cut-off value for predicting sPTB before 37 weeks was 85 degrees for UCA, with a sensitivity of 44.8%, specificity of 46.6%, and a diagnostic odds ratio (DOR) of 0.71. For predicting sPTB before 34 weeks, the optimal cut-off for UCA was found to be 95 degrees, with a sensitivity of 71.4%, specificity of 59.8%, and a DOR of 3.73. The integration of UCA with CL or cervical wedging did not yield superior results compared to CL alone. The area under the receiver operating characteristic curve showed that UCA over 85 degrees was not as effective as CL under 33 mm for predicting sPTB before 37 weeks (0.54 vs. 0.51, respectively). However, CL under 30 mm was better than UCA over 95 degrees at predicting sPTB before 34 weeks (0.71 vs. 0.66, respectively).

Conclusion: A wider UCA is associated with an increased risk of sPTB. However, while UCA alone does not have as high diagnostic performance as CL or cervical wedging alone in predicting sPTB.

Background: This study aimed to explore and evaluate the effectiveness of WeChat app-based health management in patients with gestational diabetes mellitus (GDM).

Methods: This study retrospectively analysed a cohort of 100 patients with GDM. Since the application we used went live in April 2023, we enrolled patients from April 2022 to June 2022 into the control group (n = 50) and patients from April 2023 to June 2023 into the observation group (n = 50) for contemporaneous comparisons. The control group received routine health management procedures, whereas the observation group received app-based health management. Fasting plasma glucose, 2-hour postprandial blood glucose, and haemoglobin A1c levels were compared between the two groups before and four and eight weeks after app management; the incidence of adverse pregnancy outcomes and weight gain before and after pregnancy was also compared between the two groups.

Results: Fasting plasma glucose and 2-hour postprandial blood glucose levels were lower in the observation group than in the control group four and eight weeks after intervention (p < 0.05). In addition, the incidence of adverse pregnancy outcomes and weight gain was lower in the observation group than in the control group (p < 0.05).

Conclusions: Implementing WeChat app-based health management can effectively improve blood glucose levels, reduce adverse pregnancy events in patients with GDM, and decrease weight gain during pregnancy.

Background: This study aimed to ascertain prognostic indicators impacting progression-free survival (PFS) and overall survival (OS) in patients diagnosed with vulvar cancer. The secondary aim was to determine a quantifiable measure of PFS and OS for these patients.

Methods: A comprehensive retrospective review was conducted of the medical records of vulvar cancer patients treated at Siriraj Hospital from 2006 to 2020. Patient characteristics, surgical outcomes, pathological features and immunohistochemical results for p16, p53 and PD-L1 were analysed for their potential as prognostic indicators for survival outcomes.

Results: In the sample of 104 vulvar cancer patients, four factors were significantly associated with a worsening PFS. They were coexisting vulvar lesions such as lichen sclerosus and extramammary Paget's disease (p = .008); lymphovascular space invasion (LVSI; p = .011); pelvic or paraaortic lymph node metastases (p = .042); and positive p53 status (p = .046). Additionally, a tumour size exceeding 4 cm in diameter was significantly linked with decreased OS (p = .001). The median PFS and OS were calculated as 26.3 and 44.7 months, respectively. Significantly improved PFS and OS were noted in patients with a positive p16 or a negative p53 immunohistochemical profile. The calculated hazard ratios for these two subsets were 3.032 (95% CI = 1.419-6.480; p = .004) and 2.421 (95% CI = 1.120-5.232; p = .025), respectively.

Conclusions: Factors leading to unfavourable PFS are coexisting vulvar lesions, positive LVSI status, pelvic or paraaortic lymph node metastases, and positive p53 status. Regarding OS, a tumour diameter exceeding 4 cm significantly correlates with poorer outcomes.

Background: Insufficient nutrition during pregnancy can lead to negative health outcomes for both mother and foetus. Maternal undernourishment (MUN) can be due to many factors like hyperemesis gravidarum or poor access to nutrition. Just as MUN can affect the mother and foetus, it can adversely affect the vital placental interface between the two. We suspect an observed increase in fetuin-B and oxidative stress in MUN placentas could be major players responsible for the placental insufficiency often seen with MUN.

Methods: To establish a model of MUN during pregnancy, a reduced protein chow was fed to pregnant dams at a caloric deficit. We examined the MUN placentas and the downstream effects of fetuin-B and oxidative stress at the whole organ and trophoblast levels. We examined fetuin-B's role in trophoblast pathology by measuring apoptosis, proliferation, TLR4 activation, expression of NF-ΚB p65, oxidative stress, and mitochondrial superoxide production. The effects of MUN and fetuin-B on mitochondrial superoxide production, antioxidant levels, metabolism, and electron transport chain complex activity were compared directly. Pharmaceutical interventions were utilised to narrow down specific pathways involved.

Results: Studies indicated that MUN and oxidative stress upregulated fetuin-B in the placenta. This relationship displayed a positive feedback loop as fetuin-B, in turn, promoted oxidative stress through activation of TLR4. Consequently, MUN, fetuin-B, and oxidative stress promoted apoptosis and reduced proliferative expansion of trophoblast, thereby reducing their quantity. MUN and fetuin-B reduced mitochondrial metabolism and function, promoting mitochondrial dysregulation and superoxide generation in MUN trophoblasts.

Conclusions: Our study sheds light on the mechanisms responsible for MUN-induced placental insufficiency while identifying therapeutic agents as possible add-on interventions.