Therapeutic advances in reproductive health最新文献

Background: Globally, adolescent girls aged 15-19 years give birth to approximately 16 million children annually, accounting for 11% of all births. Low- and middle-income nations carry the burden of these births, with 95% happening in Africa, where maternal mortality rates continue to be high. In Sub-Saharan Africa, early marriages persist, with roughly half of women delivering before age 20.

Objectives: This scoping review aimed to map evidence on the accessibility and barriers to maternal health services for adolescent girls in Sub-Saharan Africa.

Eligibility criteria: Included studies were peer-reviewed articles published in English between 2014 and 2025, focusing on adolescent girls (10-19 years) and maternal health services in Sub-Saharan Africa.

Sources of evidence: Literature searches were conducted in PubMed, Scopus, Web of Science, Directory of Open Access Journals and Google Scholar.

Charting methods: The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 Scoping Review extension guidelines. Data were extracted using a pre-designed template and analysed thematically. Results were synthesized narratively and presented in tables.

Results: A total of 652 records were identified, with 26 articles included. Key findings indicate that financial constraints, stigma, geographical distance and restrictive policies are significant barriers to access. While most studies focused on accessibility, aspects of quality such as provider attitudes, adherence to guidelines and respectful care were less frequently and deeply explored, representing a significant evidence gap. Community-based programmes and youth-friendly services were identified as key facilitators. Unmarried adolescents and those with lower education levels faced compounded barriers.

Conclusion: Given their reproductive health vulnerabilities, maternal health services targeting adolescents should be prioritized in Sub-Saharan Africa. Interventions must address both access barriers and critically improve service quality, including provider training in adolescent-sensitive care, though the current evidence base on quality-specific interventions is limited. Further research is needed to develop standardized metrics for quality care in this population.

Background: Adolescents in sub-Saharan Africa shoulder a disproportionate burden of sexually transmitted infections (STIs), yet data for pregnant teenagers in these settings are sparse.

Objectives: The study estimated the prevalence of STI seropositivity and its associated factors, among pregnant adolescents at Mbarara Regional Referral Hospital (MRRH), Uganda.

Design: Hospital-based cross-sectional study.

Methods: Consecutive pregnant adolescents (10-19 years) attending the MRRH antenatal clinic or maternity ward between 1 July and 30 September 2024 were enrolled. A structured questionnaire captured socio-demographic, sexual-behavioural, obstetric, clinical and nutritional variables. Blood samples were tested for HIV (Determine™/STAT-PAK™), syphilis (Treponema pallidum haemagglutination assay) and Hepatitis B (HBsAg rapid test). The composite STI outcome was seropositivity for any infection: HIV, syphilis or HBsAg. Independent associations were examined with Firth-penalised logistic regression; adjusted odds ratios (aOR) and 95% confidence intervals (CI) are reported.

Results: Among 249 participants (median age 18 years, interquartile range 18-19), the overall prevalence of STI seropositivity was 12.1% (95% CI: 8.3-16.8). Prevalence by each STI was HIV 8.8%, syphilis 4.0% and HBV 0.4%. Multigravidae had higher odds of infection than primigravidae (aOR: 2.81, 95% CI: 1.01-7.84). Having ever used a non-barrier modern contraception tripled the odds of STI (aOR 3.04, 95% CI: 1.10-8.45), whereas marriage or cohabitation reduced risk by 63% (aOR 0.37, 95% CI: 0.14-0.96).

Conclusion: Nearly one in eight pregnant adolescents at MRRH were infected with HIV, syphilis or HBV, with these STIs more likely to be among multigravidae and former users of non-barrier contraception and less likely among married/cohabiting pregnant adolescents. These findings support integrating repeat HIV-syphilis testing, dual-method contraceptive counselling and targeted interventions for multigravidae into youth-friendly antenatal services to advance STI-elimination goals.

Background: Understanding women's intention to shift from short-acting methods to long-acting reversible contraceptive methods (LARCMs) in diverse settings, including socioeconomic, behavioural and multicultural contexts, is crucial for improving contraceptive utilization. While short-acting methods are widely used, shifting to LARCMs remains a challenge in resource-limited settings like Ethiopia. Previous studies in Ethiopia either lack theoretical framework or focus on intention spanning a year with theoretical incoherence.

Objective: Guided by the theory of planned behaviour, this study aims to assess the intention to shift from short- to long-acting methods in 6 months and identify associated factors among women attending public health facilities in Hossana Town, Central Ethiopia.

Design: A facility-based cross-sectional study was conducted in public health facilities of Hossana town, Central Ethiopia Region.

Methods: The 336 reproductive-age women who were using short-acting contraceptive methods were included. The data were collected through face-to-face interviews using a pre-tested structured questionnaire. A generalized linear model (GLM) with a Gamma distribution and log link function was applied to model the positively skewed intention scores. Adjusted exponentiated beta coefficients (Exp(β)) and their corresponding 95% confidence intervals were used to quantify associations and declared statistically significant at p-value < 0.05.

Results: The proportion of women who intended to shift from short-acting contraceptives to LARCMs was only 42.3%. In the multivariable GLM, primary education (Exp(β) = 1.10; 95% CI: 1.033-1.170), secondary education (Exp(β) = 1.15; 95% CI: 1.078-1.227), and tertiary education (Exp(β) = 1.19; 95% CI: 1.061-1.329) were significantly associated to shift from short- to LARCMs. Additionally, attitude (Exp(β) = 1.011; 95% CI: 1.007-1.015), subjective norm (Exp(β) = 1.007; 95% CI: 1.001-1.013), and perceived behavioural control (Exp(β) = 1.012; 95% CI: 1.004-1.020) were also positively and significantly associated with the intention to shift.

Conclusion: These findings suggest that enhancing educational access, improving service delivery through informed decision-making support, addressing social influences and strengthening psychosocial factors such as attitude and self-confidence could improve the intention for uptake of long-acting contraceptive methods.

Infertility is a complex condition influenced by genetic and biological factors. In men, it is often caused by abnormalities in chromosome number or structure, alterations in DNA structure, specific gene mutations, or missing segments of the Y chromosome. Recent studies have also highlighted the impact of epigenetic mechanisms-such as DNA methylation, histone modifications, and noncoding RNAs-on gene function and fertility. Abnormal methylation patterns, particularly in genes such as DNMT3A/B/L, H19, MEST, SOX30, and those involved in the piRNA pathway, have been linked to poor sperm production and reduced fertility. These epigenetic changes can lower sperm quality, impair embryo health, and decrease the chances of success with fertility treatments. The role of biological and epigenetic factors in female reproduction is more limited. This narrative review aims to examine well-established genetic and epigenetic mechanisms associated with infertility, with a focus on key molecular pathways and regulatory processes. A literature review was conducted to summarize the most relevant and recent publications addressing genetic and epigenetic mechanisms as contributing factors to human infertility.

Background: Polycystic ovary syndrome (PCOS) is a common endocrine disorder among women of childbearing age, affecting 8%-13% globally, associated with hyperandrogenism, anovulation, insulin resistance, cardiovascular diseases, and psychological issues, contributing to infertility and long-term health risks.

Objective: To estimate the prevalence of PCOS and its association with infertility, hormonal disturbances, metabolic comorbidities, and lifestyle factors among reproductive-aged women in the Barak Valley region of Assam, Northeast India-an ethnically diverse and underserved area where genetic, lifestyle, and healthcare disparities may influence the prevalence and clinical presentation of PCOS.

Design: Case-control study.

Methods: A pre-validated questionnaire-based screening and multi-stage stratified random sampling method was applied among women aged 18-40 years based on Rotterdam criteria (2003) and NHMRC guidelines (2018). Clinical and biochemical hyperandrogenism, anthropometric, metabolic, hormonal, and ultrasonographic parameters were assessed.

Results: The prevalence of PCOS was 9.18% (n = 53), with higher occurrence among native Bengali women. Phenotypes A, B, C, and D were identified at 39.62%, 20.75%, 7.54%, and 32.07%, respectively. Clinical hyperandrogenism manifested as acne (49.05%), hirsutism (43.39%), and alopecia (28.3%), while biochemical hyperandrogenism was observed in 92.45% based on elevated free testosterone levels. Menstrual issues involved oligomenorrhea (45.28%), amenorrhea (30.18%), and dysmenorrhea (33.96%). Metabolic abnormalities such as type II diabetes (52.83%), overweight (30.18%), obesity (9.43%), and obstructive sleep apnea (37.73%) were frequent. Elevated BMI, waist-hip ratio, luteinizing hormone (LH), anti-Müllerian hormone, and LH/FSH (follicle-stimulating hormone) ratio were observed. Free testosterone correlated strongly with clinical symptoms. Urban women reported poorer dietary habits (61.36%). Family history of PCOS and anxiety were commonly associated factors.

Conclusion: PCOS in Barak Valley shows strong hormonal and metabolic abnormalities that may be influenced by lifestyle factors and underlying genetic predisposition. Early detection, targeted lifestyle changes, and regional awareness strategies are essential for improving reproductive and metabolic outcomes.

Background: Modern contraceptive use is vital for women's reproductive autonomy and maternal-child health, yet recent nationally representative studies on its determinants among married women in Lesotho are limited.

Objective: This study addresses these gaps using the latest Lesotho Demographic and Health Survey to provide updated evidence on prevalence and determinants.

Design: A cross-sectional study using nationally representative survey data.

Methods: The 2023-2024 Lesotho Demographic and Health Survey data were used for analysis. A weighted sample of 3102 married women of reproductive age from 400 enumeration areas across 10 districts was included in the analysis. A multilevel mixed-effects binary logistic regression model was employed to identify individual- and community-level factors associated with modern contraceptive use. Significant factors were determined using odds ratios with 95% confidence intervals and a p value of <0.05.

Results: Modern contraceptive use was reported by 65.6% of married women. Women aged 35-49 were less likely to use modern contraceptives than younger women (adjusted odds ratio (AOR) = 0.65, 95% CI: 0.43-0.98). Women with primary (AOR = 4.5, 95% CI: 1.9-10.4), secondary (AOR = 5.6, 95% CI: 2.4-13.1), or higher education (AOR = 6.1, 95% CI: 2.3-16.5), as well as those whose husbands had higher education (AOR = 1.8, 95% CI: 1.02-3.2), were more likely to use modern contraceptives. Employed women (AOR = 1.4, 95% CI: 1.07-1.5), joint decision-making with husbands (AOR = 1.45, 95% CI: 1.13-1.7), and knowledge of modern contraceptives (AOR = 1.8, 95% CI: 1.09-3.7) were also associated with higher use. Women with one to two living children (AOR = 9.7, 95% CI: 6.3-14.9) and those with three or more children (AOR = 16.4, 95% CI: 9.0-29.9) were more likely to use modern contraceptives. At the community level, women in all other districts had lower odds of use than those in Butha-Buthe.

Conclusion: Current modern contraceptive use among married women was moderately high. Key predictors included women's and husbands' education, employment, parity, joint decision-making, and contraceptive knowledge, while older women and certain districts had lower odds. These findings highlight the need for targeted interventions to enhance education, economic empowerment, spousal communication, and equitable access.

Background: Adolescent pregnancy remains a critical global health challenge, disproportionately affecting low-resource settings and jeopardizing the health, well-being and socioeconomic prospects of young mothers and their children. Globally, 75% of adolescent births occur without adequate medical care, exacerbating risks of maternal and neonatal complications. In Zimbabwe, where cultural, economic and structural barriers further limit healthcare access, adolescent girls face heightened vulnerabilities.

Objectives: This qualitative study explores the lived experiences and perceptions of adolescent mothers regarding maternal health services in Chiredzi district, Zimbabwe.

Design: This study employed a phenomenological approach to capture diverse perspectives on maternal healthcare.

Methods: In-depth interviews with 20 purposively sampled adolescent mothers (aged 15-19) attending Chiredzi General Hospital were conducted in March 2025, immediately after ethical approval was obtained (ethics number: NUST/IRB/2025/38). Data collection continued until thematic saturation was achieved. Interviews were transcribed verbatim and analysed using inductive thematic analysis.

Results: Analysis revealed 4 primary themes and 24 subthemes, highlighting key barriers to maternal healthcare access. Financial constraints, inadequate transportation and fragmented health services were prominent structural challenges. Sociocultural factors, including stigma, discriminatory attitudes and restrictive gender norms, further deterred care-seeking behaviours. Participants emphasized the need for adolescent-friendly health services, community-based education programs and economic support to mitigate these barriers. Stakeholder engagement, involving policymakers, traditional leaders and healthcare providers, was identified as critical for developing sustainable intervention strategies.

Conclusion: Addressing the maternal health disparities faced by adolescent girls requires a multifaceted, intersectional approach. Structural interventions, such as improving healthcare accessibility and affordability, must be coupled with community-level initiatives to combat stigma and promote gender equity. Empowering adolescents through education, economic opportunities and culturally sensitive support networks is essential to fostering long-term resilience. Policymakers and program implementers must prioritize adolescent-inclusive health strategies to ensure equitable maternal health outcomes in Zimbabwe and similar settings.

Background: High fertility rates and low infant mortality hurt maternal and child health and increase child dependency ratios, leading to poor economic development, low standards of living and low educational attainment. Despite efforts over the years, Ghana's fertility rates have declined at a rate lower than the global average. Using the multi-indicator cluster survey (MICS) data, we analysed the factors associated with three fertility dimensions: parity, high fertility and the desire for more children in Ghana.

Objective: The study aimed to investigate the factors associated with parity, high fertility and the desire for another child in Ghana.

Design: The MICS are cross-sectional, nationally representative surveys that employ a multi-stage, stratified cluster sampling approach to select sample units.

Methods: The data for this study were obtained from the 2017 to 2018 Multiple Indicator Cluster Survey (MICS) conducted in Ghana. Three outcome variables - parity, high fertility and the desire for another child - were defined. The explanatory variables consisted of respondents' sociodemographic and economic variables. The sample consisted of 11,228 women. We employed descriptive statistics, logistic regression and the generalised Poisson regression for the data analysis.

Results: Factors that are negatively associated with parity and high fertility include higher educational level, frequency of watching television, being insured and computer use. Residing in an urban location, being older, being in a higher wealth quintile (compared to the poorest) and the frequency of listening to the radio are all positively related to parity and being in a high-fertility zone. Women who have attained a higher level than middle/JHS, the older ones and those who are insured tend to desire another child.

Conclusion: The study found that educational level, media (television) exposure, insurance uptake and computer use are associated with a lower likelihood of having fewer children, while being in a union, residing in an urban location, being older, having higher wealth and exposure to radio are associated with parity and being in a high-fertility zone. Our study contributes to a deeper understanding of the drivers of fertility and the desire for more children in the context of low- and middle-income countries.

Background: Polycystic ovary syndrome (PCOS) is one of the most prevalent endocrine system disorders affecting reproductive-aged women of all races and ethnicities. A high prevalence of obesity exists in women with PCOS, who are also vulnerable to attrition from weight management programs. Despite recommendations the implementation of multidisciplinary approaches in weight management programs, there is a lack of literature evaluating their usage in their treatment programs.

Objectives: The objectives of this scoping review are to critically examine existing empirical literature to describe multidisciplinary approaches to weight management in populations diagnosed with PCOS and to identify potential factors associated with attrition.

Eligibility criteria: This review includes prospective studies of individuals aged 15 and older diagnosed with PCOS enrolled in a multidisciplinary weight management program. Multidisciplinary interventions were defined as participants receiving two or more multidisciplinary lifestyle interventions.

Sources of evidence: A systematic search of five electronic databases (MEDLINE, Cochrane, Embase, Cumulative Index to Nursing and Allied Health Literature, and Web of Science) identified articles with a multidisciplinary approach and reported data on attrition in PCOS weight management programs.

Charting methods: A descriptive analytical approach and narrative synthesis was conducted to identify themes related to intervention delivery, attrition, and facilitators/barriers of PCOS lifestyle interventions.

Results: From a total of 10,944 unique results, 11 articles met inclusion criteria for this review. Attrition rates ranged from 0% to 79.2%. Longer interventions were associated with higher rates of attrition. Control groups generally had lower attrition rates than their corresponding intervention groups. Studies incorporating technology-based interventions reported greater weight loss among participants.

Conclusion: Attrition is inconsistently reported among PCOS weight management studies. Variation in attrition rates is likely influenced by several factors such as intervention length and intensity, identified facilitators and barriers to PCOS weight management, and the extent to which care plans are individualized.