Frontiers in reproductive health最新文献

Background: In Tanzania, only 34% of pregnant women come for antenatal care (ANC) in first trimester hence miss an opportunity to be checked and get health advice from the health care workers. However, there is scanty of studies which used national representative data to determine the socio-demographic correlates of problem among pregnant women in Tanzania. Therefore, this study aimed at filling the gap.

Methods: This study analysed secondary data involving a weighted sample size of 4,243 pregnant women aged 15-49 years from the 2022 Tanzania Demographic and Health Survey (TDHS). The analysis adapted a two-level multilevel weighted modified Poisson regression model using Stata 18 software. The dependent variable, "ANC in the first trimester of pregnancy" defined as the binary outcome variable. The independent variables included maternal factors and household factors.

Results: The two-level multilevel modified Poisson regression indicated that one year increase in age of a mother at first birth results to 2% increase in prevalence of attending ANC in the first trimester (p-value = 0.019). Those in the richest wealth status had 31% higher prevalence of attending ANC in the first trimester compared to counterparts in poorest wealth status (p-value = 0.011). Those with first pregnancy had 23% higher prevalence of attending ANC in the first trimester compared to those with 24-48 months preceding birth interval (p-value = 0.005). Those with more than 48 months preceding birth interval had 28% higher prevalence of attending ANC in the first trimester compared to counterparts who had 24-48 months preceding birth interval (p-value <0.001). Those living in a household with more than 6 members had 32% less prevalence of attending ANC in the first trimester compared to those living in household with 1-4 members (p-value <0.001). Study participants who reported large walking distance to health facility in their residing communities indicated 24% less prevalence of attending ANC in the first trimester (p-value = 0.007).

Conclusion: ANC attendance in the first trimester of pregnancy was significantly associated with wealth index, household size, preceding birth interval, age at first birth and distance to health facility. Programs aiming at increasing early ANC booking should prioritize activities that improve women's livelihoods, particularly those targeting lower socioeconomic and educational groups.

Polycystic ovary syndrome (PCOS) is a major factor in female infertility. The global burden of PCOS has generally been neglected due to insufficient data. This study aims to comprehensively assess the burden of PCOS among females aged 10-54 years globally from 1990 to 2021, to project trends for the next two decades, and to evaluate the impact of health system levels on PCOS prevalence. The incidence, prevalence, and disability-adjusted life years (DALYs) from the Global Burden of Disease (GBD) 2021 were analyzed, including global, sociodemographic index (SDI), GBD regions, health system levels, and national data. PCOS global burden escalated by 28% from 1990 to 2021. In 2021, the estimated annual percentage changes (EAPC) value of age-standardized rate of prevalence (ASPR), incidence, and DALYs were 0.77 (95% CI: 0.75-0.79), 0.74 (95% CI: 0.70-0.77), and 0.72 (95% CI: 0.68-0.75), respectively. High SDI regions showed elevated prevalence but slower growth (EAPC = 0.09) vs. low SDI regions, which exhibited the highest acceleration (EAPC = 1.23). Especially, the incidence and prevalence in the advanced health system were highest, but the most dramatic upward trend was observed in the basic level. The top three countries for ASPR were Italy (8,113.16 per 100,000 females, 95% CI: 5,757.74-11,265.85), Japan (6,334.11 per 100,000 females, 95% CI: 4,579.73-8,798.66), and New Zealand (5,689.13 per 100,000 females, 95% CI: 4,094.50-7,762.63). The incidence in adolescents aged 10-19 years was highest, warranting particular concern. This study underscored that health systems and adolescents require attention and strengthening as critical measures to control PCOS globally and to increase the fertility of women.

Introduction: Pregnant or parenting adolescent girls and young women (PPYW) are at greater risk of sexual exposure to HIV than their peers, yet tailored HIV prevention efforts for PPYW remain limited.

Methods: We analysed cross-sectional data (2020-2023) from a sample of PPYW (median age 21.5, IQR = 20.3-22.5) in the Eastern Cape, South Africa.

Results: Approximately 88% of PPYW who were HIV-negative (n = 646) had a HIV test in the last few years. Of these-58% knew about PrEP (n = 328). Of those who knew about PrEP, 31% had ever been offered PrEP (n = 100; 15% of HIV-negative PPYW), and 62% of those who were offered PrEP had ever taken PrEP (n = 62; 10% of HIV-negative PPYW). Compared to PPYW who have not had a HIV test in the last few years, PPYW who had accessed HIV testing were more likely to be aware of PrEP (aOR = 2.39, 95% CI:1.44-3.97, p = 0.001), have been offered PrEP (aOR = 2.96, 95% CI:1.16-7.55, p = 0.023), and taken PrEP (aOR = 4.57, 95% CI:1.09-19.16, p = 0.038).

Conclusions: This study highlights missed opportunities in PrEP delivery and offers recommendations to enhance PrEP awareness and uptake among PPYW. Despite high HIV testing rates in this key population, awareness of PrEP, its offer, and uptake remain low.

Background: Diaphragmatic pregnancy is a rare type of ectopic pregnancy, and its clinical manifestations are complicated and easy to misdiagnose, which presents great challenges for clinical diagnosis and treatment. We report a case of diaphragmatic pregnancy and describe its difficult but successful diagnosis and treatment in detail.

Patient presentation: A 34-year-old woman from northern China was admitted to the hospital with delayed menstruation and right upper abdominal pain with right shoulder pain (Kehr's sign). An initial emergency laparoscopy for suspected ruptured ectopic pregnancy revealed hemoperitoneum but failed to identify the ectopic pregnancy tissue, likely due to an incomplete surgical survey. Subsequent serial β-hCG monitoring showed a persistent rise, and MRI localized the ectopic pregnancy tissue at the outer edge of the right lobe of the liver. Conservative treatment with methotrexate and 5-fluorouracil chemotherapy was given in time, which induced a significant biochemical response. However, due to the worsening of abdominal pain despite declining β-hCG levels, indicating a persistent risk of rupture, definitive laparoscopic resection was performed. Intraoperatively, the pregnancy tissue was found to be implanted on the surface of the diaphragm, and the pregnancy tissue was successfully removed completely from the diaphragm with little intraoperative bleeding. Postoperative pathology results confirmed the presence of pregnancy chorionic tissue. The patient recovered well without complications and was discharged 5 days after surgery.

Conclusion: This case highlights that Kehr's sign is a crucial diagnostic clue for upper abdominal ectopic pregnancy. A systematic survey of the entire abdomen, including the diaphragm, is mandatory during laparoscopy to avoid diagnostic omission. The sequential combination of chemotherapy and surgical treatment may represent an effective strategy to minimize surgical risk and optimize outcomes for this high-risk condition.

Period poverty, the lack of access to menstrual products, adequate sanitation, and reliable health information, continues to undermine the health, dignity, and opportunities of millions of girls and women in Nigeria. Closely linked to gender inequality, the problem is compounded by stigma, inadequate infrastructure, and economic barriers, especially for low-income and marginalized groups. While civil society initiatives and isolated government gestures exist, Nigeria still lacks a comprehensive national menstrual health policy. In contrast, countries such as Scotland, Kenya, and Colombia have advanced reforms through product subsidies, menstrual education, and integrated WASH systems. Drawing on these global experiences and local efforts by Nigerian organizations, this commentary calls for a coordinated, government-led response that embeds menstrual health into public health, education, and social protection frameworks. Achieving menstrual equity will require sustained political commitment, structural investment, and culturally responsive policies.

A 30-year-old woman with a body mass index of 20.6 kg/m² consulted due to two years of primary infertility. The patient had a history of two unsuccessful previous rounds of ovarian stimulation for IVF due to poor ovarian response. A novel ovarian stimulation approach incorporating luteal phase estradiol priming in a stop GnRH agonist plus delta follitropin-GnRH antagonist protocol was followed. in vitro fertilization was performed resulting in eight mature oocytes, which were fertilized and developed into two usable blasts. The patient did not achieve pregnancy from either the fresh or subsequent frozen embryo transfer. Our case demonstrates that this combined strategy (estradiol and GnRH agonist) offers dual suppression of FSH and LH, with E2 playing a critical role in preventing premature FSH surges and enhancing granulosa cell receptivity. To our knowledge, this is the first study to provide initial evidence supporting the clinical utility of combining luteal E2 priming, stop GnRH agonist and follitropin delta in this context. This case report constitutes a proof of principle that requires further studies with a large number of patients to replicate and validate the stimulation protocol.

Background: Hyperhomocysteinemia (HHcy) is associated with an increased risk of cardiovascular diseases, particularly in perimenopausal women, who are more susceptible to metabolic disorders due to declining estrogen levels. This study aimed to identify risk factors and develop a predictive model for HHcy in this population.

Methods: A retrospective study included 687 perimenopausal women, divided into a training set (481) and an internal validation set (206). Demographic characteristics, pregnancy-related factors, lifestyles, and diet information were collected by questionnaire. 63 perimenopausal women hospitalized from March to June 2025 were selected as the external validation set. The least absolute shrinkage and selection operator (LASSO) regression was used to select variables. The logistic regression model was developed to predict HHcy risk, with results visualized using a nomogram. Model performance was evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA).

Results: 137 of 687 (19.94%) perimenopausal women had HHcy. Through Lasso regression and multifactor logistic regression, 4 predictors were identified, including egg consumption frequency, LDL, TP, and CysC for constructing the nomogram model. The AUC of the training set was 0.765 (95% CI = 0.708-0.822), for the internal validation set was 0.854 (95% CI = 0.781-0.928), and for the external validation set was 0.776 (95% CI = 0.603-0.949), indicating good predictive performance of the model.

Conclusion: The nomogram demonstrated high predictive accuracy and clinical utility, providing a potential tool for HHcy risk prediction and selection of treatment strategies in perimenopausal women.

Introduction: The World Health Organization (WHO) recently updated its guidelines for HIV post-exposure prophylaxis (PEP). These guidelines recommend community delivery and task-sharing for PEP administration and suggest enhanced adherence counseling for those who initiate PEP. This work provides insights into considerations for optimizing people's knowledge, demand for, use of and adherence to PEP through new channels. This mixed-method study examined five research questions concerning the perceptions and experiences of various groups regarding accessing and utilizing PEP and explored opinions on alternate delivery options to broaden access.

Methods: The total number of end-users interviewed for this study via qualitative and quantitative interview methodologies was 1,156. We spoke with a total of 236 end-users through qualitative Focus Groups (FGs) and in-depth interviews (IDIs) and surveyed 920 end-users with a questionnaire in Kenya, Nigeria and Zimbabwe, including members of key populations (Female Sex Workers, Members of the LGBTQ + Community, People Who Inject Drugs).

Results: Prompted awareness of PEP varied across the study countries (56.2% overall). Healthcare providers (doctors and nurses) were cited by end-user respondents as primary sources of information on HIV and PEP. PEP information evaluation revealed that condomless sex or condom malfunction were the emergency situations that resonated most with end-users. The majority (86.4%) cited a perceived likelihood to use PEP if exposed to HIV. A general hospital was deemed most acceptable for PEP access by end-users in all three countries (81.2%); clinical routes were perceived as preferable in terms of broadening access to PEP, with key reasons being convenience (68.2%), trustworthiness (56.5%) and knowledge (56.5%). End-users emphasized the need for consistent, correct, and supportive interaction points with healthcare providers to complete PEP treatment and follow-up.

Conclusions: WHO's recent update to the PEP guidelines recommends community-based distribution and task-sharing of PEP. Uptake is dependent on confidentiality and privacy of services as well as on increasing awareness and knowledge of the PEP pathway. Provision of PEP by healthcare providers needs to incorporate multiple end-user touch/access-points with emotional support for greater adherence, and our study highlights the different preferences and access contexts among end-users for PEP.

Background: The value of combining infertility research in the psychological and medical fields, i.e., by exploring psychological factors associated not only with emotional adjustment to infertility experiences but also with treatment outcomes, is well-recognized. However, research that bridges these fields' boundaries is still narrow, is featured by mixed evidence, and often lacks a valid theoretical framework to comprehensively explore and/or identify the multiple psychological risk and protective factors associated with assisted reproductive technology (ART) treatment outcomes. Thus, there is a need for further research in this promising field of reproductive health to foster a high-quality standard of care for infertile couples.

Objective: Based on the infertility-related stress model, this prospective study recruited a group of infertile women at the beginning of their infertility treatment (T1) to explore and identify the psychological variables (predictors and moderating and mediating variables) associated with their treatment outcome (Failure/Success) at the 4-year follow-up (T2).

Methods: At the beginning of their infertility treatments (T1, 2019), 120 women completed self-report measures that provided data on their background information (sociodemographic characteristics and type of diagnosis), infertility-related stressors, coping strategies, psychological health (State-Anxiety and depression), and the couple's dyadic adjustment. After 4 years (T2, 2023), medical records were collected to provide data on their treatment outcome (failure or success), duration of infertility, and number of treatment cycles. The main, moderating, and mediating hypotheses were tested using correlational analyses, logistic regression analyses, and Hayes' PROCESS tool.

Results: The couple's relationship concern stressor, the adoption of a positive attitude coping strategy, and a perceived couple's dyadic adjustment at T1 were significantly associated with treatment success at T2. Conversely, the social concern stressor, the adoption of an avoidant coping strategy, State-Anxiety, and depression at T1, along with a duration of infertility >3 years and a number of treatment cycles >4 at T2, were significantly associated with treatment failure. Duration of infertility, number of treatment cycles, the couple's dyadic adjustment, and the positive attitude and avoiding coping strategies emerged as significant moderating variables. Depression was a significant mediator in the association between the social concern stressor and the treatment outcome.

Conclusions: This study's findings provide evidence on the key psychological dimensions that should be assessed and addressed within multidisciplinary counseling interventions to support ART-treated women effectively throughout their infertility path and reduce the risk of treatment failure.

Background: South African clinical guidelines for sexually transmitted infections (STI) treatment and management recommend that all individuals who test positive should receive a notification slip to pass on to their partners. Despite these guidelines, partner notification and treatment rates remain low. Barriers include misinformation, gendered beliefs, and interpersonal concerns such as fear of stigma, violence, and being blamed for infidelity.

Material and methods: We used a behavioural design approach to explore challenges experienced by adolescent girls and young women (AGYW) in notifying their predominantly asymptomatic male partners about an STI diagnosis. A total of 7 AGYW and 8 Health Care Workers (HCWs) participated in behavioural mapping and co-design workshops in Cape Town, South Africa. Insights and solutions for partner notification were identified using the behavioural science NUDGE theory framework.

Results: Participants experienced various emotions when receiving a positive STI result, including denial, confusion around mode of transmission, fear of the impact on their future, as well as anxiety around their partners' reaction. HCWs noted AGYW's limited understanding of STIs and challenges in communicating the diagnosis to their partners, particularly when one or both partners were asymptomatic. Both groups criticized the current partner notification slip as overly complex and legalistic. Suggestions included simplified slips, and approaches that minimize AGYW's role in partner notification.

Conclusions: Our results provide insight into the barriers experienced and identified by AGYW and HCWs, from AGYW receiving a positive STI test result, through notifying their partners. Next steps involve developing and testing high-fidelity prototypes that reduce the burden on AGYW and are feasible for integration into standard clinical care.