Frontiers in reproductive health最新文献

[This corrects the article DOI: 10.3389/frph.2026.1764331.].

Background: The advancement of artificial reproductive technologies (ART) has outpaced many existing legal and ethical frameworks, challenging foundational notions of parenthood, consent, and the temporality of reproductive decisions. Among the most complex developments is posthumous assisted reproduction. While medically feasible, this practice raises profound legal and ethical questions, especially regarding the nature and validity of consent to parenthood to a child who will be born to a deceased father.

Aim: This article provides a comparative analysis of legislation and regulatory frameworks governing posthumous reproduction via embryo transfer (a topic less investigated compared to gamete retrieval) across selected European countries to contextualize this practice.

Materials and methods: The study adopts a comparative methodology, analyzing laws, regulatory guidelines from several European countries: Belgium, France, Greece, Italy, Portugal, Spain, the Netherlands, United Kingdom. Sources include legal databases, national ART authority publications, and academic articles.

Results: The analysis reveals a fragmented European landscape. France maintains a categorical prohibition on posthumous reproduction, while all other countries investigated permit it under different degrees of procedural and temporal safeguards, emphasizing explicit, written, and pre-mortem consent.

Conclusions: Overall, posthumous reproduction is framed as a continuation of a parental project, but consent models and temporal limits vary, ranging from specific post-mortem authorization to reliance on prior ART consent alone. Most countries impose waiting periods of six to twelve months and temporal limits of one to five years, while the Netherlands applies the general ART age limit of forty-nine years, and Italy stands out for the absence of any time restriction.

Introduction: Factors underlying reproductive decisions, including contraceptive method choice, are poorly understood, especially in humanitarian settings where sexual and reproductive health (SRH) needs may be highest due to heightened risk of sexual violence and disruptions of health services. The study examined the association between method-specific beliefs and future method choice among women in refugee settlements in Uganda.

Methods: Data were from a baseline of a one-year prospective study involving a cohort of 2,498 women aged 15-45 years living in Kiryadongo and Kyangwali refugee settlements. Analysis used cross-tabulation with chi-square test and conditional logistic regression analysis to examine associations between method-specific beliefs and intention to use injectables, implants, or pills among contraceptive non-users.

Result: Among contraceptive non-users (n = 1,486), 32% intended to use a method within the next 12 months or later. Injectable was the most preferred future method (39%), followed by implants (25%) and pills (17%). Concerns about interference with menstruation, unpleasant side effects, and safety for long-term use were common across all three methods (range 58% - 90%). The likelihood that a woman intended to use injectable, implant, or pill in future was positively associated with perceived ease to access (AOR = 1.95; 95% CI: 1.03-3.66), ease of use (AOR = 4.17; 95% CI: 2.22-7.86), safety for long use (AOR = 4.51; 95% CI: 1.61-12.64), and satisfaction with past use (AOR = 2.87; 95% CI: 1.51-5.46).

Conclusion: Intention to use contraception in future among non-users in refugee settlements is low, coupled with widespread negative beliefs about available methods. There is need to improve counseling to counter negative beliefs and to expand access to a range of modern contraceptive methods.

Background: Genitourinary syndrome of menopause (GSM) is a chronic condition that impairs quality of life and sexual function. Fractional CO₂ laser therapy is a non-hormonal option, but large real-world data on symptom trajectories, durability, and ultrasonographic vulvar changes are limited. We evaluated symptom trajectories, responder rates, exposure-outcome associations, and vulvar tissue changes in a clinical cohort.

Methods: We conducted a retrospective observational study at a single clinic in Japan. From 2016 to 2023, 826 women underwent fractional CO₂ vaginal and vulvar laser therapy (2,129 sessions). Symptoms were assessed using VAS (0-10) scores for six domains. Short-term outcomes were evaluated 20-59 days after the first session (n = 327), and long-term outcomes 10-14 months after the final session (n = 94). Responders were defined as a ≥2-point VAS improvement among women with baseline VAS ≥2.

Objective: outcomes included ultrasonographic labia majora thickness; post-treatment imaging corresponded to the same windows when paired measurements were available. Patient satisfaction and adverse events were recorded.

Results: Mean age at first treatment was 61.9 ± 10.2 years (range, 29-87). All six symptoms improved short term, with the largest improvements typically in dyspareunia and vaginal dryness. At 10-14 months, improvements in dryness and urinary leakage attenuated, whereas dyspareunia was most durable. Labia majora thickness increased overall (16.9 ± 4.5-18.9 ± 3.1 mm), with thickening in 81.5% of women with paired measurements. Higher responder rates were observed among women receiving more sessions; however, these findings are associational and may reflect baseline severity and follow-up engagement. Satisfaction was high, and no serious adverse events were observed.

Conclusions: In this real-world cohort, fractional CO₂ vaginal and vulvar laser therapy for GSM was associated with reduced symptom severity and ultrasonographic thickening of the labia majora in a subset with paired measurements. Given the retrospective uncontrolled design, incomplete follow-up, and placebo effects in sham-controlled trials, findings should be interpreted as descriptive associations, not causal effects. Controlled studies are needed to confirm effectiveness, durability, and maintenance strategies.

Background: Women in Mexico are not considered a key population for acquiring HIV and are often not perceived at risk by themselves or their physicians. This limited risk perception can delay testing and contribute to advanced HIV disease. We aimed to determine the frequency of missed opportunities for HIV diagnosis (MOHD) in a tertiary center in Mexico City and compare characteristics between men and women.

Methods: We conducted a retrospective observational study using standardized questionnaires administered to adults newly enrolled in care at a tertiary HIV Clinic between 2013 and 2023. MOHD was defined as a healthcare encounter for HIV related symptoms in which diagnosis was not made within 30 days and or the patient attended at least two medical consultations before diagnosis. We described sociodemographic characteristics, the proportion of MOHD, and advanced HIV defined as baseline CD4 < 200 cells or an AIDS defining condition. Comparisons were made by sex, proportions were stratified by age group, and logistic regression identified factors associated with MOHD.

Results: Of 1,332 questionnaires, 619 individuals reported symptoms and sought medical care before diagnosis; 320 (51.6 percent) met MOHD criteria, including 39 women and 281 men. MOHD was more frequent in women than men (67.2 percent vs. 50.1 percent, p = 0.03). Advanced HIV was also more frequent among women with MOHD (51.3 percent vs. 33.8 percent, p = 0.02). Women had longer symptom duration, more medical consultations, and longer delays from first medical contact to diagnosis. Increasing age (OR 1.01, CI 1.00 to 1.1, p = 0.02) and being a woman (OR 2.3, CI 1.21 to 4.52, p = 0.01) were independently associated with MOHD.

Conclusions: In this cohort, missed opportunities for HIV diagnosis were common and occurred more frequently among women than men. Women experienced longer delays to diagnosis and higher rates of advanced disease. These findings highlight persistent gaps in timely HIV diagnosis among women.

Introduction: The introduction of new pre-exposure prophylaxis (PrEP) methods presents an opportunity to expand choice and better integrate HIV prevention and broader sexual and reproductive health (SRH) services. Integrating HIV prevention services, including PrEP, and SRH services presents an opportunity to improve healthcare access and outcomes. However, implementation within real-world healthcare settings requires an understanding of both enablers and barriers from the perspective of healthcare providers (HCPs).

Methods: A qualitative descriptive study was conducted using in-depth interviews (IDIs) to describe the integration of PrEP and SRH services, drawing on the perspectives of HCPs. Thirty-four HCPs were purposively sampled and interviewed between October and November 2024 across four South African locations: eThekwini, Gqeberha, Mthatha, and Tshwane. Audio recordings were transcribed, translated, and analysed using inductive thematic analysis with NVIVO 14 software.

Results: Key benefits of service integration expressed by HCPs included increased continuity of care with the same HCP, convenience, and a higher uptake of SRH services, such as contraception and sexually transmitted infection (STI) screening and management. Facilitators included integrated education and awareness, flexibility in alignment of appointment schedules, and positive staff attitude. Challenges and barriers included misalignment between injectable PrEP and injectable contraceptive visit schedules and infrastructural limitations within some public health facilities.

Conclusions: Successful integration requires adaptable systems, responsive scheduling, functional infrastructure, and positive staff attitude. To improve uptake and continuity of SRH services, health systems should be flexible and provide holistic services that align with client needs.

Introduction: Advanced maternal age (AMA) and assisted reproductive technologies (ART) are becoming more common and are linked with higher obstetric and perinatal risks. Genomic tools and real-world data (RWD) are transforming risk prediction and care strategies, yet their application to the AMA + ART setting remains uneven.

Objective: To synthesize recent evidence on risks associated with AMA and ART, incorporate insights from reproductive genomics and RWD, and discuss their implications for clinical care and guideline development.

Methods: Narrative review of cohort studies, systematic reviews, and meta-analyses, supplemented by focused analyses of genomic approaches: expanded carrier screening, clinical exome sequencing, preimplantation genetic testing for monogenic disorders (PGT-M) and aneuploidy (PGT-A), emerging non-invasive PGT, and pharmacogenomics, as well as RWD infrastructures such as registries, EHR datasets, and trusted research environments.

Results: Maternal age (≥40 years) increases miscarriage, gestational diabetes, hypertensive disorders, placental abnormalities, cesarean delivery, preterm birth, stillbirth, and NICU admissions. ART independently raises risks of preeclampsia, placenta previa, preterm birth, low birthweight, cesarean delivery, and neonatal complications, including in singleton. Combined AMA + ART may produce additive or synergistic effects. Donor oocytes reduces miscarriage risk but may elevate preeclampsia risk via immunologic mechanisms. Genomic technologies enable the identification of infertility-related variants, prevention of genetic conditions, individualized ovarian stimulation, and AI-assisted embryo selection. RWD enhances evidence by capturing diverse populations, supporting comparative and long-term analyses.

Conclusions: Pregnancies from AMA + ART should be managed as high risk. Integration of genomics technologies and RWD can support predictive, personalized care and inform urgently needed consensus guidelines.

Polygenic scores derived from inborn genetic variation are expected to predict individuals' complex traits. Preimplantation genetic testing for polygenic scores is already offered to help parents select embryos deemed "healthy" and/or "intelligent", raising ethical concerns. This paper analyzes the implications of polygenic embryo selection and proposes policy responses. Although substantial clinical uncertainty persists, use is likely to expand because parents seek desirable traits. Yet resulting offspring may not meet such expectations due to environmental influences (including parental behavior), offspring's genomes, and their autonomy. These practices risk generating socio-ethical harms, including false expectations, child objectification, and trait-based stigma. Professional societies and policymakers should therefore warn parents about these risks, and consider prohibiting polygenic embryo selection, although they might eventually permit cautious use for serious late-onset diseases.

With the rapid progression of urbanization and the widespread adoption of nocturnal work and lifestyle patterns, artificial light at night (ALAN) has emerged as a significant environmental factor impacting women's health. Current research suggests that exposure to artificial light disrupts human circadian rhythms, potentially leading to irregular menstrual cycles, extended cycle durations, and altered hormone levels in women, thereby elevating reproductive health risks. This paper reviews epidemiological evidence concerning the impact of ALAN on menstrual cycles, critically evaluating the strength and limitations of evidence derived from different study designs. It further analyzes the mechanisms through which key parameters-including light intensity, spectral composition, and duration of exposure- influence circadian rhythms and endocrine systems, while explicitly noting that these mechanisms are largely derived from animal models and must be extrapolated to humans with caution. Furthermore, by integrating recent findings from nursing research, we propose evidence-based, tiered intervention strategies, encompassing health education, personalized lighting management, and lifestyle modifications, to mitigate potential disruptions caused by ALAN. The review aims to provide theoretical support and practical guidance for clinical nursing practices and public health policy formulation, and to highlight priority directions for future research.

Introduction: Accurate gestational age (GA) documentation and reliable delivery data are essential for guiding clinical decision-making, classifying preterm and term births, and informing maternal health planning. In Tanzania, inconsistent GA recording and variable facility-based delivery patterns hinder effective monitoring of maternal and newborn outcomes. This study reviewed four years of delivery data to assess the completeness of GA documentation and explore delivery trends across urban and rural facilities in the Kilimanjaro Region.

Methods: A retrospective cross-sectional trend analysis was conducted using delivery records from 2019 to 2022 across five health facilities. Maternal demographics, GA at delivery, and delivery outcomes were extracted. Completeness of GA documentation was assessed, and logistic regression was used to examine factors associated with (1) complete GA documentation and (2) delivery outcomes (preterm vs. term).

Results: A total of 1,656 delivery records were reviewed. GA was documented in 78.4% of records, with higher completeness in urban (82.6%) than rural (69.8%) facilities. Institutional deliveries increased over the four years in both settings. Preterm births accounted for 12.3% of all deliveries, with higher prevalence in rural areas. In adjusted analyses, GA completeness was significantly associated with urban facility type (aOR = 1.74; 95% CI: 1.32-2.29), higher parity (aOR = 1.41; 95% CI: 1.05-1.90), and year of delivery (aOR = 1.26 per year; 95% CI: 1.11-1.43). Preterm birth was significantly associated with incomplete GA documentation (aOR = 2.08; 95% CI: 1.32-3.27).

Conclusion: Delivery rates increased over time, but persistent gaps in GA documentation limit the accuracy of pregnancy classification and reporting. Improving documentation practices-particularly in rural facilities-is essential to strengthen maternal health data systems and inform evidence-based decision-making.