Frontiers in global women's health最新文献

Background: According to the WHO, violence is the intentional use of force or power against oneself, another person, or a community, causing injury, death, or harm. National data from 2021 reveal that as many as 70.1% of women in Mexico have experienced some form of violence. Pregnancy represents a period of heightened vulnerability, with negative impacts on material and infant health.

Material and methods: This cross-sectional observational study was conducted on women during the immediate postpartum period. Domestic violence was assessed using the Woman Abuse Screening Tool (WAST) scale, the Affective Bonding and Prenatal Adjustment Assessment Scale survey, and postpartum depression was evaluated through the Centre for Epidemiological Studies-Depression Scale (CES-D) scale.

Results: Four hundred women were included using the short version of the WAST scale, with 31.5% (126) testing positive for the screening questions. Women who experienced abuse showed higher odds of postpartum depression (OR = 2.95; 95% IC: 1.87-4.63; p = 0.000) and tobacco use (OR = 2.28; 95% IC: 1.31-3.94; p = 0.003). Adverse perinatal effects, such as preterm delivery (35.7%), admission to intensive care (40.5%), and low birth weight (19.8%), were frequent but without statistical significance.

Conclusions: One-third of the pregnant women in the study suffered intimate partner violence, mainly psychological and economic. Unwanted pregnancy, lack of emotional bonding, postpartum depression, alcohol/smoking, and low education levels were frequent factors.

Aim: Hepatitis B virus (HBV) infection during pregnancy is one of the most common comorbidities, which may increase the risk of adverse obstetric and perinatal outcomes. However, the association between maternal HBV infection and postpartum hemorrhage (PPH) remains uncertain. The aim of this study is to evaluate whether maternal HBV infection will increase the risk of PPH.

Methods: Five English and three Chinese databases were searched from inception to 30 June 2024, with the aim to include recently published eligible studies. Cohort and case-control studies that evaluated the association between maternal HBV infection and PPH were included. The Newcastle-Ottawa scale was used to evaluate the risk of bias for the included studies. We pooled crude relative risk (cRR) and adjusted odds ratio (aOR) as effect sizes. Three subgroup analyses and seven sensitivity analyses were performed.

Results: A total of 21 cohort studies involving 379,782 participants were included. The pooled results of the unadjusted data revealed that maternal HBV infection was associated with an increased risk of PPH [cRR = 1.18, 95% confidence interval (CI): 1.06-1.31]. Furthermore, the pooled results of adjusted data showed a similar risk of PPH (aOR = 1.50, 95% CI: 1.29-1.73). The effect was similar in three subgroup analyses (i.e., sample size, study region, and prevalence of HBV infection). Sensitivity analyses confirmed that the primary results were robust.

Conclusions: Maternal HBV infection is associated with an increased risk of PPH. Further studies are warranted to evaluate the impact of maternal HBeAg serostatus and HBV DNA levels on PPH.

Systematic review registration: identifier CRD42023442626.

Background: It is estimated that 13% of adolescent girls globally give birth before the age of 18. Several studies have shown that pre-eclampsia, eclampsia, puerperal infections, preterm birth, low birth weight, and neonatal death are more common in adolescent mothers than in adult mothers. This study aimed to investigate whether adolescent pregnancy increases the risk of adverse obstetric and perinatal outcomes compared with pregnancies among women aged 20-35 years in the West Bank, occupied Palestinian territory.

Methods: A retrospective cohort study utilizing data extracted from the electronic health information system database. The study population comprised 11,189 women who gave birth in three governmental hospitals in the West Bank during the year 2022, of whom 762 (6.8%) were aged ≤19 years. Differences between the two age groups were analyzed using chi-square test (χ ²) for categorical variables and independent student test for continuous variables. Multiple logistic regression and sensitivity analyses were performed to adjust for confounders and to examine the association between the adolescent age group and adverse obstetric and perinatal outcomes.

Results: Most adolescent mothers were primiparous (82.2%) and had a singleton pregnancy (98.2%). Adolescent mothers were more likely to experience preterm birth (aOR 1.568, CI 95% 1.262-1.949, p < 0.001) and low birth weight (aOR 1.657, CI 1.327-2.068, p < 0.001). Low Apgar score at first minute was demonstrated among primiparous adolescents (aOR 1.774, CI 1.149-2.737, p = 0.01). While adolescent primiparous mothers were less likely to deliver by cesarean section compared to older mothers (aOR 0.270, CI 0.212-0.342, p = 0.00), fetal malpresentation as an indication for cesarean section was higher among adolescents (aOR 2.150, CI 1.329-3.479, p = 0.002). No significant differences were observed between the two age groups in terms of gestational diabetes, hypertensive disorders, antepartum or postpartum hemorrhage, blood transfusion, induction of labor, instrumental delivery, five-minute Apgar score, admission to neonatal intensive care unit, neonatal malformation, or stillbirth.

Conclusion: Adolescent pregnancies should be classified as high-risk given their association with multiple adverse obstetric and perinatal outcomes. These findings underscore the need for policymakers to strengthen preventive strategies and to ensure strict enforcement of the child marriage prohibition law.

Background: Postpartum posttraumatic stress disorder (PTSD) occurs commonly in individuals after childbirth and is associated with adverse maternal and neonatal outcomes. The primary objective of this pilot study was to determine the acceptability and feasibility of administering glucocorticoids to reduce posttraumatic stress symptoms after a traumatic birth event.

Methods: This was a single-center, non-randomized, open-label pilot trial conducted at Michigan Medicine. Postpartum patients who screened positive for PTSD DSM-V Criterion A (felt a threat to life or injury to self or neonate) were enrolled. Participants self-selected to either (1) receive hydrocortisone within 12 h of the traumatic event or (2) defer hydrocortisone and remain in an observational control arm. Participants were assessed at the time of enrollment and multiple time points postpartum (days 3, 14, and 42) for posttraumatic stress symptoms using the City Birth Trauma Scale. The analysis compared the distribution of PTSD symptom scores in the intervention and control arms over time via weighted generalized estimating equations.

Results: Study recruitment was highly successful, with 133 of 138 eligible patients (96%) enrolled, and only 9 of 261 approached patients (3%) refused to be screened for study participation. Among participants who chose to receive hydrocortisone, the study drug was administered within 12 h of birth in all cases (20/20, 100%). For the primary clinical outcome, PTSD score, 127 participants were included in the longitudinal analysis; n = 19 self-selected to receive the hydrocortisone intervention, and n = 108 enrolled in the control arm. In the hydrocortisone arm, PTSD scores significantly increased from baseline to postpartum day 14 [6.29, 95% CI (0.36, 12.22), p = 0.038] and from baseline to postpartum day 42 [7.46, 95% CI (0.30, 14.61) p = 0.041] when compared with the control's change in PTSD scores from baseline to postpartum day 14 and from baseline to postpartum day 42.

Conclusions: These pilot findings demonstrate the acceptability and feasibility of enrolling obstetric patients into a pharmacologic clinical trial immediately postpartum. In those at high risk for PTSD, glucocorticoids did not decrease, and may have increased, PTSD symptomatology. Future larger and randomized trials are needed to confirm or refute these initial findings.Clinical Trial Registration: https://clinicaltrials.gov/study/NCT04852458, identifier, NCT04852458.

Introduction: There is limited research on disrupted maternal representations of the child, including possible mechanisms that may account for their impact on very young children's social-emotional well-being. Existing research suggests that maternal mental health symptoms, particularly those that may be related to experiences of interpersonal trauma, may be important to investigate.

Method: Utilizing multi-method data, including the Working Model of the Child Interview, from a longitudinal study involving a community sample (N = 120) of women aged 18-42 who participated from their third trimester of pregnancy through 2 years post birth, the present study examined associations between disrupted prenatal maternal representations, infant and toddler social-emotional functioning, and perinatal (third trimester and 1-year post birth) maternal mental health symptoms (PTSD, depression, and anxiety).

Results: Prenatal PTSD symptoms were the only maternal mental health symptoms significantly associated with degree of disrupted prenatal maternal representations and later infant and toddler social-emotional functioning. Mediation models revealed that maternal prenatal PTSD symptoms mediated the association between degree of disrupted prenatal maternal representations and infant, but not toddler, social-emotional functioning.

Discussion: Findings highlight the importance of screening for maternal PTSD symptoms during the prenatal period as well as the value of early intervention when disrupted prenatal maternal representations are identified.

Allostatic load provides a valuable framework for examining how cumulative stress impacts multiple physiological systems simultaneously, making it a powerful tool for understanding the mechanisms through which stress contributes to adverse pregnancy outcomes. This multisystem perspective is especially important during pregnancy, a period characterized by heightened vulnerability to stress and significant physiological changes that can themselves contribute to allostatic load. Although the impact of allostatic load during pregnancy is well documented, the mechanisms and moderators involved by trimester remain unclear, particularly given wide variation in social, cultural, and structural determinants of maternal health worldwide. In this review, we discuss the progress that has been made over the past two decades in studying prenatal allostatic load and describe the clinical implications of this by highlighting sensitive periods of interest throughout gestation. Despite these advances, key questions remain regarding the intergenerational transmission of risk, the specificity of findings to the pregnancy period, and the role of factors that often accompany elevated allostatic load, such as poor sleep, limited social support, systemic inequities, and comorbid mental or physical health conditions, which may manifest differently across global contexts. Most existing studies have been conducted in high-income settings, yet the burden of adverse pregnancy outcomes is greatest in low- and middle-income countries, where structural, environmental, and social stressors are pervasive. Expanding this framework to include diverse global contexts is essential for understanding how social inequities and chronic stressors shape maternal physiology worldwide. We discuss these issues and offer directions for future research, including the goal of developing a standardized metric for measuring allostatic load - one that we believe will advance the field's understanding of how prenatal allostatic load markers by trimester relate to maternal and infant outcomes.

Introduction: Sexual strangulation, commonly referred to as "choking", has become increasingly common among young adults, yet its neurobiological consequences remain poorly understood. Preclinical and clinical evidence suggests strangulation may trigger axonal injury, neuroinflammation, and blood-brain barrier dysfunction. Blood biomarkers of neural injury and inflammation provide a sensitive means to detect subtle effects.

Aim: To examine whether consensual sexual choking/strangulation acutely alters blood biomarkers of neural injury and inflammation compared to non-choking sexual activity in young adult women.

Methods: In a randomized crossover study, 29 women (mean age 21.5 ± 2.7) completed three laboratory visits: baseline (≥24 h abstinence), post-choking sex, and post-non-choking sex. Blood was collected within 24 h of sexual events. Neural injury biomarkers (NfL, tau, GFAP, UCH-L1, S100B) and inflammatory markers (IL-1ra, TNF-R1, CCL-2, VEGF-A, VCAM-1) were analyzed using Quanterix and Luminex multiplex immunoassays. Mixed-effects regression models tested exposure-by-time interactions, adjusting for age and brain trauma history.

Results: Neurofilament light (NfL) significantly increased after choking-involved sex but remained unchanged after non-choking, which resulted in a statistically significant exposure-by-time interaction [β = -0.21, 95% CI (-0.38, -0.03), p = 0.021]. Other neural biomarkers did not differ by exposure. Among inflammatory markers, CCL-2 and VEGF-A demonstrated a similar pattern as NfL, with acute increases after choking-involved sex, but not following non-choking sex, yielding in exposure-by-time interaction effects (CCL-2: β = -14.60, 95% CI [-25.70, -3.43, p = 0.011; VEGF-A: β = -9.29 (-19.71, 1.13), p = 0.079]. IL-1ra, TNF-R1, and VCAM-1 remained stable.

Discussion: Consensual sexual strangulation elicited acute increases in NfL and CCL-2, with VEGF-A showing a similar pattern, suggesting transient axonal stress and hypoxia-related inflammatory signaling. These findings indicate that sexual choking/strangulation, even in consensual contexts, may have subtle, yet detectable cellular burden. Future studies with larger samples, refined temporal sampling, and multimodal outcomes are needed to clarify short- and long-term implications.

Background: Contraceptive prevalence in the Karamoja region of Northeastern Uganda is 10%, compared to the national prevalence of 38%. Young people aged 15-24 years have limited access to contraceptive services in this region. This study assessed the determinants of contraceptive use and intention to use among youths aged 15-24 years.

Methods: A cross-sectional study using quantitative methods was conducted. Data were collected from 409 randomly selected youth. A modified Poisson regression model was used to identify determinants of contraceptive use and intention to use.

Results: In Karamoja, the prevalence of contraceptive use among sexually active youth was 11.0% (6.4% males, 16.3% females), while intention to use some form of contraceptives was 72.4% (84% males, 59% females). Factors associated with contraceptive use included paid employment (APR = 4.51, 95% CI: 3.80-5.36 for females; APR = 1.6, 95% CI: 1.26-1.92 for males), secondary education or higher (APR = 1.32, 95% CI: 1.15-1.52 for females; APR = 1.25, 95% CI: 0.50-0.77 for males), older age (20-24 years) (APR = 1.30, 95% CI: 1.20-1.41 for females; APR = 1.42, 95% CI: 1.37-1.63 for males), and living with biological parents. Factors associated with intention included paid employment (APR = 5.75, 95% CI: 4.94-6.69 for females; APR = 2.25, 95% CI: 1.76-2.89 for males), having biological children (APR = 3.15, 95% CI: 1.92-5.15 for males), and age. Intention among 20-24-year-old females was half that of 15-19-year-olds (APR = 0.50, 95% CI: 0.44-0.56), and 28% lower among 20-24-year-old males (APR = 0.72, 95% CI: 0.53-0.95). Muslims and married youth reported very low contraceptive use.

Conclusion: Secondary education and above, paid employment, and living with parents were key determinants of contraceptive use and intention. We recommend improving access to education and employment opportunities, promoting parental involvement, and providing adolescent-friendly SRH services to translate intention into actual use.

Registration: The study was registered by Makerere University School of Public Health, Research Ethics Committee, reg number (SPH-2022-294) and Uganda National Council of Science and Technology (UNSCT), reg number HS2547ES.

Objective: Specialized reproductive mental health services help to alleviate symptoms of mental disorders associated with the reproductive system such as menstrual cycle, infertility, pregnancy or birth. However, people by reproductive mental disorders often do not receive the treatment they need or treatment is initiated after a long delay. The current study examined the process of accessing specialized reproductive mental health services in patients (mostly cisgender women) who just attended their first psychotherapy session in these services. Specifically, we examined the role of self-stigmatization related to mental issues as well as experiences with non-mental healthcare professionals and expectations regarding reproductive mental health services.

Method: The sample consisted of 106 cisgender female and 3 cisgender male patients who recently attended the specialized reproductive mental health service (called gynecospsychiatry). Data were collected using a mixed-methods design based on validated questionnaires and open-ended text questions in an online survey. Additionally, clinical information was obtained from the treating psychotherapists. T-tests and regression analyses were applied to quantitative data. Open ended questions were analyzed qualitatively using thematic analysis.

Results: Quantitatively, self-stigma was not significantly associated with the process of help seeking. Furthermore, our results suggest that merely being approached by primary or reproductive healthcare professionals was not associated with lower levels of self-stigma in our sample. Qualitative-analyses showed two major themes: 1) Not beating around the bush - clear words instead of overlooking or downplaying psychological distress, 2) Wanting to feel understood and accepted as opposed to condemned, judged, and devalued.

Conclusion: Based on these findings, recommendations were made for psychotherapists as well as primary or reproductive healthcare professionals about how those affected by reproductive mental disorders can best be supported to seek treatment. Further research is recommended with larger clinical samples of patients with reproductive mental disorders.

Background: Mood swings in reproductive-age women arise from interacting hormonal, metabolic, and lifestyle factors, yet scalable screening tools remain limited. Artificial intelligence (AI) and machine learning (ML) approaches offer the potential to integrate diverse predictors and enable early, data-driven risk stratification.

Objective: To evaluate the performance of ML algorithms in predicting mood swings among reproductive-age women using menstrual, metabolic, and lifestyle survey data and to identify the most influential predictors.

Methods: The study cohort included 465 reproductive-age women, with fifteen survey-derived features categorized into metabolic (e.g., BMI, recent weight gain, polycystic ovary syndrome), menstrual (regular periods, period length), lifestyle (fast-food consumption, daily exercise), symptom burden score, and demographic (age) categories. We compared five ML models: Random Forest, SVM, Gradient Boosting, LightGBM, and CatBoost, using precision, recall, F1, accuracy, and AUCPR metrics. Feature importance was assessed with permutation feature importance (PFI) and shapley additive explanations (SHAP).

Results: Across models, the highest values achieved were precision 0.83, recall 0.91, accuracy 0.74, and AUCPR 0.87. PFI and SHAP converged on symptom burden as the dominant predictor, with additional signal from lifestyle indicators (higher fast-food consumption, lower daily exercise) and metabolic/dermatologic markers. Menstrual regularity/length contributed minimally; age showed a modest inverse association.

Conclusions: Low-cost, self-reported features can support ML prediction of mood swings in reproductive-age women with good performance. Findings motivate prospective validation, dynamic prediction with wearables, and evaluation of AI-based approaches for early detection of women's mental health concerns in community and primary care settings.