Frontiers in reproductive health最新文献

Introduction: Pregnancy perceptions and pregnancy acceptability have been identified as alternative multidimensional constructs to elucidate and integrate people's lived experiences, needs, and goals related to reproduction, pregnancy, and parenting. This study examines the perspectives of Latine emerging adults on a hypothetical pregnancy and what socioecological factors would influence pregnancy-related decisions.

Methods: In a mixed-methods prospective cohort study of emerging adults from an agricultural community in California followed since eighth grade, interviews were conducted with a subset of participants (5/2023-1/2024). In the interviews, participants were asked to reflect on a hypothetical pregnancy. Qualitative data analysis was performed using directed content and inductive analyses of the interview transcripts. Descriptive statistics were used to complement the qualitative findings and describe the participants' demographics, characteristics, and pregnancy desire.

Results: Forty-one participants (ages 19-21 years; N = 20 female, N = 17 male, N = 4 non-binary; 12% first generation, 71% second generation, and 17% third generation immigrants) were interviewed. Most participants (N = 30) reported that they really or mostly did not want to get pregnant or get a partner pregnant now or in the next few months. When asked about a hypothetical pregnancy, most participants discussed continuing the pregnancy and parenting or having an abortion as their preferred pregnancy option. When discussing hypothetical pregnancies and related decisions, participants discussed influences across socioecological levels, including individual (reactions, maturity, readiness, finances, life trajectory), interpersonal (partners, friends, parents, other family members), and community and systems (norms, culture, laws, politics, religion, healthcare access).

Conclusions: These findings deepen our understanding of the influences on Latine emerging adults' perspectives of pregnancy and related decisions, which can inform the development of interventions at different socioecological levels to help individuals realize their reproductive goals.

Background: Preconception care (PCC) plays a critical role in enhancing maternal and neonatal health by addressing risk factors before pregnancy. Most existing reviews focus on PCC outcomes such as utilization with limited attention to factors influencing PCC awareness and knowledge. This review addressed this gap by synthesizing evidence on PCC awareness and knowledge levels and by examining the associated risk and protective factors among women in Africa.

Methods: The review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Five main databases (PubMed Central, African Journals Online, Web of Science, Scopus, and Journal Storage) were searched in March 2025, and 27 articles met the eligibility criteria for inclusion. The Joanna Briggs Institute critical appraisal checklist was used to assess the methodological quality of the studies. Data were analyzed using a narrative review approach to evaluate awareness and knowledge levels, as well as the risk and protective factors influencing PCC.

Results: Awareness levels of PCC ranged from 5.9% in Ethiopia to 91% in Tanzania, while knowledge levels varied from 11% in Sudan to 70% in Tanzania. Low awareness and knowledge were associated with risk factors such as low education, poor socioeconomic status, limited healthcare access, lack of antenatal care (ANC), and adverse pregnancy histories. Protective factors contributing to higher PCC awareness and knowledge included higher educational attainment, greater economic stability, more frequent ANC visits, greater media exposure, and improved access to counseling and support services.

Conclusion: Despite encouraging progress in some regions, significant gaps in PCC awareness and knowledge remain across African countries, particularly in low-resource settings. Bridging these gaps will require context-specific educational strategies, policy support, and expanded access to quality healthcare services tailored to African health systems.

Systematic review registration: https://doi.org/10.17605/OSF.IO/VPWZG.

Background: Gaps in sexual health service uptake and education disproportionately effect Black women in the United States. Education is crucial to increasing health service uptake, and new avenues to provide education are continuously being developed. This current study examines beauty professionals' comfort in discussing important women's health topics with their clients and explores their potential role as community health advocates.

Methods: A total of 38 beauty professionals in Tarrant and Dallas counties, Texas completed a needs assessment survey. Descriptive statistics, t-tests, and correlation analyses were used to explore levels of comfort and frequency in discussing health topics, factors influencing willingness to engage in these conversations, and perceived barriers within beauty shop settings.

Results: Beauty professionals reported significantly greater comfort in discussing health topics than the actual frequency with which these conversations occur. Key factors associated with increased engagement included comfort with sharing health information and the perceived importance of clients' access to healthcare services. Identified barriers included stigma, concerns about privacy, and a lack of confidence or training in providing health information.

Conclusions: Findings highlight several factors that may inhibit health-related conversations in beauty settings. The results underscore the potential for targeted interventions to support beauty professionals as trusted health messengers within their communities.

Preeclampsia (PE) remains a major cause of maternal and perinatal morbidity worldwide. Although abnormal placentation and shallow trophoblast invasion are well recognized, increasing evidence suggests that the origins of PE lie earlier, at the stage of implantation and decidualization. A deeper understanding of impaired implantation as the initiating event offers new opportunities for prediction, prevention, and therapy. This narrative review synthesizes mechanistic, epidemiological, and biomarker evidence accumulated over the past two years. Mechanistic studies reveal that defective decidualization and resistance to progesterone signaling impair stromal cell differentiation, angiogenic balance, and vascular remodeling. Immunological dysregulation, including maladaptive KIR-HLA interactions, CD40-CD40L pathway activation, and altered cytokine tolerance, further disrupts maternal-fetal communication. Clinical epidemiology strongly implicates implantation context: programmed frozen embryo transfer cycles lacking a corpus luteum consistently increase the risk of hypertensive disorders, highlighting the importance of peri-conception physiology. First-trimester biomarkers such as low PAPP-A, reduced PlGF, and abnormal uterine artery Doppler indices capture the early "fingerprint" of impaired implantation long before clinical disease. Emerging evidence also supports seminal plasma as a key modulator of immune priming and endometrial receptivity, with reduced exposure linked to higher PE risk. Together, these findings reframe PE not solely as a disorder of placental development in mid-gestation but as a disease with origins in implantation biology. By bringing together molecular, immunological, and clinical evidence, this review positions impaired implantation as a central trigger of PE. Recognition of implantation-era events as the upstream pathway provides a new framework for translational research, emphasizing peri-conception exposures, assisted reproduction practices, and biomarker discovery. Clinically, it highlights novel opportunities for early risk stratification and prevention strategies. This implantation-centered model may help shift the paradigm of PE from late-pregnancy diagnosis toward early-pregnancy prediction and intervention.

Background: Menopausal hormone therapy (MHT) is one of the most recent therapeutic options available for the management of menopausal symptoms. MHT is used in healthy symptomatic women under 60 or within 10 years of menopause without contraindications. Still, as many menopausal women use both MHT and antidepressants, safer alternatives are needed. Herbal remedies like Ashwagandha can offer a safer alternative to existing therapies. Ashwagandha aids in hormonal balance, vitality, and reduces stress and fatigue.

Objective: The study aimed to assess the efficacy and safety of Ashwagandha root extract (ARE) for managing menopausal symptoms.

Methods: A randomized, double-blind, placebo-controlled study included 60 women aged 45-55 years who received either ARE or a placebo (PL) for 56 days. The primary outcome was a change in the Menopause Rating Scale (MRS) score from baseline to 56 days. Secondary outcomes were changes in serum hormonal parameters [estradiol, progesterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH)], hot flash events, Short Form-12 Health Survey (SF-12) (Quality of Life) score, and Perceived Stress Scale-10 (PSS-10) from baseline to day 56. Tolerability was measured using Patient Global Assessment of Tolerability to Therapy. Safety outcomes, such as change in severity and frequency of adverse events, were also assessed from baseline to day 56.

Results: At the end of the study, the total MRS score reduced significantly (p < 0.0001) with ARE intervention, in psychological (p < 0.0001), somatic (p < 0.0001), and urogenital (p < 0.0001) domains as compared to the PL group. Similarly, ARE group showed improved serum estradiol (p < 0.001) and progesterone (p < 0.001) levels, and increase in SF-12 scores (p < 0.001), while presenting reduced serum FSH (p < 0.001) and LH (p < 0.001), hot flashes events (p < 0.001) and PSS-10 scores (p < 0.001) compared to PL.

Conclusion: Ashwagandha root extract can be a potential herbal intervention for managing menopausal symptoms in healthy women.

Clinical trial registration: https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=OTk3Mw==&Enc=&userName=, CTRI/2022/02/040551.

Background: Reproductive coercion (RC) and intimate partner violence (IPV) undermine reproductive autonomy and are prevalent among women seeking family planning (FP) services. In response, Kenya's Ministry of Health (MOH) selected ARCHES (Addressing Reproductive Coercion in Health Settings), an evidence-based intervention (EBI) integrating universal education, screening, and support on RC and IPV during routine FP counseling, for national adaptation and scale-up within a hybrid implementation-effectiveness trial. Institutionalizing such interventions within public health systems requires careful adaptation to ensure contextual fit while preserving core functions.

Methods: We developed and applied FRAME + IS, a unified adaptation-tracking framework that integrates the FRAME and FRAME-IS tools, to systematically document modifications made to the ARCHES intervention and its implementation strategies. The adaptation process was guided by adaptive management and the ADAPT-ITT framework and included formative research, national and county-level workshops, iterative piloting, and implementation planning, led by the Kenya MOH.

Results: We identified 12 key adaptations: six related to intervention content and six related to implementation strategies. Most were planned (75%) and occurred prior to implementation (83%). Adaptations addressed feasibility, sustainability, and alignment with government systems. Examples include integration into national FP counseling protocols, namely the Balanced Counseling Strategy Plus, a shift from paper-based tools to a mobile app, and a formalized provider mentorship schedule. While the majority of adaptations were consistent with the original ARCHES intervention core strategies (58%), several, including removal of discreet contraceptive use counseling from official provider training materials and job-aids, were not consistent with the original model and reflected necessary trade-offs due to political sensitivities and implementation realities. The Kenya MOH was the final decision-maker on all adaptations, incorporating input from national and county-level staff, providers, and intervention experts.

Conclusion: This is the first published example of a government adopting provider training and guidelines to integrate RC and IPV response within FP services while systematically tracking these adaptations within a public health system. By applying FRAME + IS, this study offers both a practical roadmap for governments seeking to institutionalize IPV and RC interventions at scale and a streamlined framework to document changes to EBIs and implementation strategies during complex integration processes.

Introduction: Risky sexual behaviour (RSB) among adolescents in Zimbabwe is a major public health issue, contributing to high rates of HIV, STIs, and unintended pregnancies. Interventions have been ineffective, especially in urban areas like Bulawayo, where "Vuzu parties" worsen the situation. This study aims to assess the prevalence of RSB among high school students in Bulawayo, identify influencing factors, evaluate awareness of sexual health issues, and examine the accessibility and effectiveness of sexual health education from various stakeholders' perspectives.

Methods: The primary study is a school-based, convergent mixed-methods design that includes a quantitative cross-sectional survey and a qualitative key informant study, conducted concurrently. A preliminary systematic review will inform the study's framework and instrument development. The quantitative phase will survey 400 students, selected through stratified random sampling from five schools in Bulawayo, using a self-administered questionnaire. The qualitative phase will consist of in-depth interviews with 10-15 teachers and healthcare workers. Quantitative data will be analysed with descriptive statistics and chi-square tests in SPSS version 28, while qualitative data will undergo thematic analysis. A joint display table will integrate the findings to identify areas of convergence, divergence, and complementarity.

Discussion: The study will provide comprehensive data on the prevalence and drivers of RSB in Bulawayo's adolescents. Findings will inform the development of targeted school-based interventions and policies aimed at reducing RSB and improving sexual health outcomes. The study findings will be reported back to the public and health officials through community meetings and workshops.

Background: Postpartum haemorrhage (PPH) is a preventable yet leading cause of maternal death, demanding urgent attention and action. Every year, tens of thousands of women die from postpartum haemorrhage a tragedy that is both preventable and unacceptable. Each maternal death represents a systemic failure. This umbrella review consolidates global evidence on burden, disparities, and determinants of postpartum haemorrhage (PPH) to inform policymaker's evidence decision making.

Methods: A comprehensive literature search was conducted between July 30 and August 15, 2025, across PubMed, Scopus, Science Direct, Web of Science, Cochrane, and related review databases to identify systematic reviews and meta-analyses on the prevalence, disparities, and determinants of postpartum haemorrhage among women who gave birth. Study quality was assessed using the AMSTAR tool. Heterogeneity was examined with Cochran's Q and I², publication bias via Egger's test and funnel plots, and pooled effect sizes estimated through random-effects meta-analysis using Stata 19. The review protocol was registered in PROSPERO (CRD420251121022).

Result: This umbrella review included 17 systematic reviews with sample size of over 21 million women to estimate the global pooled prevalence of postpartum haemorrhage (PPH) at 9.97% (95% CI: 6.90%-13.04%), with (p < 0.001). Based on studies using objective blood loss measurement (≥500 mL per 100 women giving birth), the prevalence increased to 11.25% (95% CI: 8.78%-13.72%) with p < 0.001.Globally pooled prevalence of severe postpartum haemorrhage is estimated at 4.52% (95% CI: 2.47%-6.57%) with p < 0.001, indicating that nearly 1 in 20 women experience life-threatening bleeding after childbirth.This study identified key risk factors for postpartum haemorrhage, including maternal age, lack of antenatal care, obstetric complications, and rural residence. These determinants highlight the need for targeted prevention strategies to reduce PPH-related morbidity and improve maternal health outcomes.

Conclusion and recommendation: The study underscores postpartum haemorrhage (PPH) as a critical global health issue, with approximately 1 in 10 women experiencing PPH worldwide and 1 in 20 affected by severe PPH, highlighting the urgent need to address persistent disparities. An immediate policy action is essential to guarantee timely, effective care and to uphold maternal health as a fundamental human right. As the global call reminds us: "No woman should die giving life."

Systematic review registration: [https://www.crd.york.ac.uk/PROSPERO/view/CRD420251121022], identifier CRD420251121022.

Background: Although azithromycin has demonstrated potential therapeutic efficacy in the treatment of chronic endometritis (CE), comprehensive studies on the optimal timing of administration are lacking. Our study aims to evaluate the impact of different timing of azithromycin treatment on cure rates and pregnancy outcomes in patients with CE.

Methods: A retrospective cohort study was conducted involving infertile women diagnosed with CE via hysteroscopy during the proliferative phase. Participants with mild CE were assigned to either: immediate treatment (500 mg oral azithromycin daily for 5 days within the same cycle), or delayed treatment (identical treatment dosage and duration in the subsequent cycle). Follow-up endometrial biopsy with CD138 immunohistochemistry was performed during the secretory phase. Cure rates and pregnancy outcomes were compared between the two groups.

Results: No significant differences in cure rates were observed between the Immediate treatment group (88.40%) and the delayed treatment group (93.63%) (P > 0.05). The average time from initial diagnosis to follow-up was significantly shorter in the Immediate treatment group (14.80 ± 3.23 days) compared to the delayed treatment group (44.20 ± 7.00 days) (P < 0.0001). Additionally, there were no significant differences in biochemical pregnancy (80.90% vs. 86.39%), clinical pregnancy (70.91% vs. 76.87%), ongoing pregnancy (88.46% vs. 89.38%), or early miscarriage rates (11.54% vs. 8.85%) between the two groups (P > 0.05). To further elucidate the relationship between treatment timing and pregnancy outcomes, we performed multivariate regression analysis. This analysis demonstrated that the different treatment timings for CE were not identified as independent risk factors for biochemical pregnancy [1.44 (0.77-2.68), P = 0.25], clinical pregnancy [1.35 (0.80-2.28), P = 0.264] and ongoing pregnancy [0.83 (0.36-1.88), P = 0.65].

Conclusions: In patients with CE, same-cycle treatment offers the advantage of a significantly shorter follow-up time, which may be beneficial for patients undergoing assisted reproductive technology (ART) cycles. Our analysis confirmed that same-cycle treatment significantly accelerates the entire ART process. Furthermore, although the effect of azithromycin treatment timing in chronic endometritis patients did not reach statistical significance, the observed positive trends of pregnant outcomes justify further investigation with larger sample sizes to determine its clinical efficacy.

Objective: To evaluate the predictive value of hematologic inflammatory indices derived from complete blood count (CBC) parameters for in vitro fertilization (IVF) outcomes in women with unexplained infertility, and to determine their potential role as biomarkers of subclinical inflammation affecting reproductive success.

Materials and methods: This retrospective cohort study included 430 women with unexplained infertility who underwent IVF/ICSI cycles at Ege University Hospital between January 2020 and January 2025. CBC parameters and derived systemic inflammatory indices-including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and pan-immune-inflammation value (PIV)-were measured on the ovulation trigger day. Patients were divided into pregnant and non-pregnant groups according to clinical pregnancy outcomes. Demographic, hormonal, hematologic, and embryologic variables were compared using appropriate statistical tests, and logistic regression and ROC analyses were performed to identify independent predictors of pregnancy.

Results: None of the CBC-derived inflammatory indices showed significant differences between pregnant and non-pregnant groups (all p > 0.05). ROC analysis revealed poor discriminative ability for predicting pregnancy (AUC values 0.48-0.52). In contrast, embryologic variables-particularly the number of two-pronuclei (2PN) embryos and total embryos-were independent predictors of clinical pregnancy (p < 0.05), while excessive oocyte yield was inversely associated with pregnancy (p = 0.028).

Conclusion: Systemic inflammatory indices derived from CBC parameters, including NLR, PLR, MLR, SII, SIRI, and PIV, do not predict IVF/ICSI outcomes in women with unexplained infertility. Embryologic parameters, especially 2PN and total embryo counts, remain the most reliable predictors of clinical pregnancy.