Mackenzie Campbell,Johanna Koegl,Jeffrey N Bone,Sofia Nicolls,Janet Lyons,Chantal Mayer,Kenneth I Lim,Julie Van Schalkwyk,K S Joseph,Sarka Lisonkova,
OBJECTIVETo examine whether the associations between pre-pregnancy risk factors and severe preeclampsia/eclampsia (SPE) and/or HELLP syndrome differ between singleton and twin pregnancies.DESIGNA population-based retrospective cohort study.SETTINGBritish Columbia (BC), Canada.POPULATIONAll pregnancies with singletons or twins that resulted in a stillbirth or live birth at ≥ 20 weeks' gestation from 2008/09 to 2020/21.METHODSData were obtained from the BC Perinatal Database Registry. Logistic regression was used to estimate the association between each risk factor for SPE/HELLP (e.g., body-mass-index (BMI), in vitro-fertilisation (IVF), chronic hypertension, and diabetes) and the modifying effect of plurality by including interaction terms between these risk factors and plurality in the model.MAIN OUTCOME MEASURESSevere preeclampsia, eclampsia, and/or HELLP syndrome.RESULTSAmong 563 252 pregnancies (8841 twin, 554 411 singleton), the rate of SPE/HELLP was 4.7 per 1000 singleton pregnancies and 31.1 per 1000 twin pregnancies (relative risk 6.61; 95% confidence interval (CI) 5.84-7.49). Older maternal age (≥ 35 years), nulliparity, pre-pregnancy and gestational diabetes, chronic hypertension, prior mental health problems, substance use during pregnancy, and prior stillbirth increased the odds, while smoking decreased the odds of SPE/HELLP among both singleton and twin pregnancies. However, the adjusted associations between BMI, IVF, prior abortions, and SPE/HELLP differed by plurality (interaction p-values 0.002, < 0.0001, and 0.04, respectively). IVF was associated with increased odds of SPE/HELLP in singleton pregnancies (adjusted odds ratio (aOR) 1.93; 95% CI 1.64-2.27) but not in twins (aOR 0.85; CI 0.65-1.11). Similarly, overweight BMI was associated with elevated odds in singleton pregnancies (aOR 1.47; CI 1.32-1.64) but not in twins (aOR 0.86; CI 0.59-1.25), as was obese BMI (singleton aOR 1.88; CI 1.67-2.12; twin aOR 0.80; CI 0.51-1.24). Conversely, a history of prior abortions was associated with decreased odds in twin pregnancies (aOR 0.70; CI 0.54-0.92) but not singleton pregnancies (aOR 0.95; CI 0.88-1.04).CONCLUSIONSHigh BMI and IVF are associated with elevated risk of SPE/HELLP syndrome in singleton pregnancies, but not in twin pregnancies. This study provides insights regarding SPE/HELLP syndrome among singleton and twin pregnancies, and useful information for pre-pregnancy counselling.
目的探讨妊娠前危险因素与严重子痫前期/子痫（SPE）和/或HELLP综合征的相关性在单胎和双胎妊娠中是否存在差异。设计：基于人群的回顾性队列研究。背景：加拿大不列颠哥伦比亚省。所有在2008/09至2020/21年度妊娠≥20周导致死产或活产的单胎或双胞胎妊娠。方法数据来自BC省围产期数据库登记处。通过在模型中包括这些危险因素和多元性之间的相互作用项，使用Logistic回归来估计SPE/ help的每个危险因素（例如，身体质量指数（BMI）、体外受精（IVF）、慢性高血压和糖尿病）与多元性的修正效应之间的关联。主要结局指标：重度子痫前期、子痫和/或HELLP综合征。结果563 252例妊娠（双胎8841例，单胎55411例）中，SPE/HELLP发生率为每1000例单胎4.7例，每1000例双胎31.1例（相对危险度6.61,95%可信区间（CI） 5.84 ~ 7.49）。高龄产妇（≥35岁）、无产、孕前和妊娠期糖尿病、慢性高血压、既往精神健康问题、妊娠期间药物使用和既往死产增加了SPE/ help的几率，而吸烟降低了单胎和双胎妊娠发生SPE/ help的几率。然而，BMI、IVF、既往流产和SPE/ help之间调整后的相关性存在较大差异（相互作用p值分别为0.002、< 0.0001和0.04）。IVF与单胎妊娠发生SPE/ help的几率增加相关(校正优势比（aOR） 1.93；95% CI 1.64-2.27)，但在双胞胎中没有（aOR 0.85; CI 0.65-1.11）。同样，超重BMI与单胎妊娠的几率升高相关（aOR 1.47; CI 1.32-1.64），但与双胞胎无关（aOR 0.86; CI 0.59-1.25），肥胖BMI与之相关（单胎aOR 1.88; CI 1.67-2.12；双胞胎aOR 0.80; CI 0.51-1.24）。相反，既往流产史与双胎妊娠的风险降低相关（aOR 0.70; CI 0.54-0.92），但与单胎妊娠无关（aOR 0.95; CI 0.88-1.04）。结论高BMI和体外受精与单胎妊娠发生SPE/ help综合征的风险升高相关，但与双胎妊娠无关。本研究提供了关于单胎和双胎妊娠SPE/ help综合征的见解，并为孕前咨询提供了有用的信息。
{"title":"Differences in Risk Factors for Severe Preeclampsia and HELLP Syndrome in Singleton Versus Twin Pregnancies: A Population-Based Cohort Study.","authors":"Mackenzie Campbell,Johanna Koegl,Jeffrey N Bone,Sofia Nicolls,Janet Lyons,Chantal Mayer,Kenneth I Lim,Julie Van Schalkwyk,K S Joseph,Sarka Lisonkova, ","doi":"10.1111/1471-0528.18351","DOIUrl":"https://doi.org/10.1111/1471-0528.18351","url":null,"abstract":"OBJECTIVETo examine whether the associations between pre-pregnancy risk factors and severe preeclampsia/eclampsia (SPE) and/or HELLP syndrome differ between singleton and twin pregnancies.DESIGNA population-based retrospective cohort study.SETTINGBritish Columbia (BC), Canada.POPULATIONAll pregnancies with singletons or twins that resulted in a stillbirth or live birth at ≥ 20 weeks' gestation from 2008/09 to 2020/21.METHODSData were obtained from the BC Perinatal Database Registry. Logistic regression was used to estimate the association between each risk factor for SPE/HELLP (e.g., body-mass-index (BMI), in vitro-fertilisation (IVF), chronic hypertension, and diabetes) and the modifying effect of plurality by including interaction terms between these risk factors and plurality in the model.MAIN OUTCOME MEASURESSevere preeclampsia, eclampsia, and/or HELLP syndrome.RESULTSAmong 563 252 pregnancies (8841 twin, 554 411 singleton), the rate of SPE/HELLP was 4.7 per 1000 singleton pregnancies and 31.1 per 1000 twin pregnancies (relative risk 6.61; 95% confidence interval (CI) 5.84-7.49). Older maternal age (≥ 35 years), nulliparity, pre-pregnancy and gestational diabetes, chronic hypertension, prior mental health problems, substance use during pregnancy, and prior stillbirth increased the odds, while smoking decreased the odds of SPE/HELLP among both singleton and twin pregnancies. However, the adjusted associations between BMI, IVF, prior abortions, and SPE/HELLP differed by plurality (interaction p-values 0.002, < 0.0001, and 0.04, respectively). IVF was associated with increased odds of SPE/HELLP in singleton pregnancies (adjusted odds ratio (aOR) 1.93; 95% CI 1.64-2.27) but not in twins (aOR 0.85; CI 0.65-1.11). Similarly, overweight BMI was associated with elevated odds in singleton pregnancies (aOR 1.47; CI 1.32-1.64) but not in twins (aOR 0.86; CI 0.59-1.25), as was obese BMI (singleton aOR 1.88; CI 1.67-2.12; twin aOR 0.80; CI 0.51-1.24). Conversely, a history of prior abortions was associated with decreased odds in twin pregnancies (aOR 0.70; CI 0.54-0.92) but not singleton pregnancies (aOR 0.95; CI 0.88-1.04).CONCLUSIONSHigh BMI and IVF are associated with elevated risk of SPE/HELLP syndrome in singleton pregnancies, but not in twin pregnancies. This study provides insights regarding SPE/HELLP syndrome among singleton and twin pregnancies, and useful information for pre-pregnancy counselling.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"104 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144959977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aaran H. Patel, Aureliane Pierret, Edouard G. Mills, Alexander N. Comninos, Waljit S. Dhillo, Ali Abbara
The menopause transition is marked by symptoms predominantly attributed to declining oestrogen levels. Approximately 80% of women experience associated symptoms, and 25% experience severe symptoms. The commonest are vasomotor symptoms (VMS), collectively referring to hot flushes and/or night sweats. Menopause hormone therapy (MHT) is the most common treatment for menopause‐related symptoms; however, some treatment‐related risks mean that MHT may not be suitable for all. Furthermore, following the publication of seminal studies, perceived risks of MHT have also led to reduced uptake. Additionally, not all women receiving MHT have full resolution of their symptoms. Therefore, alternative non‐hormonal therapies are of therapeutic interest. Neurokinin B (NKB) signalling via its cognate receptor, neurokinin 3 receptor (NK3R), at the hypothalamus has been identified as a mediator of menopausal VMS. Recently, NK3R antagonists have been developed targeting the NKB signalling pathway as a novel effective non‐hormonal therapeutic option for menopausal VMS. Fezolinetant has received approval from drug regulatory authorities worldwide, with data from multiple clinical trials showing a marked 60%–80% reduction in the frequency and severity of daily moderate–severe VMS, including in those considered unsuitable for MHT. Very recently, elinzanetant has been approved by the MHRA in the UK for the treatment of VMS in menopause, though it has not yet been approved by the FDA in the US. This review explores the neuroendocrine changes that occur in menopause and evidence from animal and human models suggesting that increased NKB signalling is involved in the pathogenesis of menopausal VMS. Data from clinical trials identifying NK3R antagonists as novel therapeutic agents for menopausal VMS are reviewed. Finally, the current status of NK3R antagonists and future directions of study in this area are discussed.
{"title":"Advent of NK3R Antagonists for the Treatment of Menopausal Hot Flushes: A Narrative Review","authors":"Aaran H. Patel, Aureliane Pierret, Edouard G. Mills, Alexander N. Comninos, Waljit S. Dhillo, Ali Abbara","doi":"10.1111/1471-0528.18338","DOIUrl":"https://doi.org/10.1111/1471-0528.18338","url":null,"abstract":"The menopause transition is marked by symptoms predominantly attributed to declining oestrogen levels. Approximately 80% of women experience associated symptoms, and 25% experience severe symptoms. The commonest are vasomotor symptoms (VMS), collectively referring to hot flushes and/or night sweats. Menopause hormone therapy (MHT) is the most common treatment for menopause‐related symptoms; however, some treatment‐related risks mean that MHT may not be suitable for all. Furthermore, following the publication of seminal studies, perceived risks of MHT have also led to reduced uptake. Additionally, not all women receiving MHT have full resolution of their symptoms. Therefore, alternative non‐hormonal therapies are of therapeutic interest. Neurokinin B (NKB) signalling via its cognate receptor, neurokinin 3 receptor (NK3R), at the hypothalamus has been identified as a mediator of menopausal VMS. Recently, NK3R antagonists have been developed targeting the NKB signalling pathway as a novel effective non‐hormonal therapeutic option for menopausal VMS. Fezolinetant has received approval from drug regulatory authorities worldwide, with data from multiple clinical trials showing a marked 60%–80% reduction in the frequency and severity of daily moderate–severe VMS, including in those considered unsuitable for MHT. Very recently, elinzanetant has been approved by the MHRA in the UK for the treatment of VMS in menopause, though it has not yet been approved by the FDA in the US. This review explores the neuroendocrine changes that occur in menopause and evidence from animal and human models suggesting that increased NKB signalling is involved in the pathogenesis of menopausal VMS. Data from clinical trials identifying NK3R antagonists as novel therapeutic agents for menopausal VMS are reviewed. Finally, the current status of NK3R antagonists and future directions of study in this area are discussed.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144915500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maryam Ghiasi, Lonnie Zwaigenbaum, Diane Moddemann, Ruth Rennicks White, Alysha L. J. Dingwall‐Harvey, Kimberly P. Grattan, Marisa Murray, Natalie Rybak, Heather Walker, Thierry Lacaze‐Masmonteil, Elizabeth Asztalos, Laura M. Gaudet, Stephen Robson, William Hague, Donnette Simms‐Stewart, Graeme Smith, Emmanuel Bujold, Daniel J. Corsi, Gary Goldfield, Darine El‐Chaâr, Shi Wu Wen, Mark C. Walker
ObjectiveTo assess the impact of high‐dose folic acid supplementation (4.0–5.1 mg), started between 8+0 and 16+6 weeks of gestation and continued until delivery, on social impairments associated with Autism Spectrum Disorders, deficiencies in executive function, and emotional and behavioural problems in children.DesignFACT 4 Child is a follow‐up of mothers and their children born during the Folic Acid Clinical Trial (FACT), an international multi‐centre double‐blinded randomised trial to assess the effect of high‐dose folic acid supplementation on preventing preeclampsia in women with increased risk.SettingMulti‐centre international follow‐up study.PopulationMothers and their children enrolled in FACT, among them 664 completed the follow‐up.MethodsMothers reported on social and executive function and emotional and behavioural problems in their children aged 4–9 years using standardised, validated questionnaires.Main OutcomeThe proportion of children with at least one score > 1.5 SD above expected mean.ResultsAmong 319 children in the intervention group, 43 (13.5%) had a score in the elevated range, compared with 51/345 (14.8%) in the placebo group (RR = 0.91; 95% CI: 0.63 to 1.33; p = 0.63).ConclusionIn children born to women at risk for preeclampsia, rates of neurodevelopmental outcomes were not different between high‐dose folic acid and control groups in this study. Our finding suggests that a high dose of folic acid supplementation may not be needed in pregnant women with increased risk. A larger‐scale study is needed to determine neurodevelopmental outcomes associated with different dosages and timing of folic acid supplementation during pregnancy.
{"title":"Follow‐Up of Children Born to Mothers in Folic Acid Clinical Trial (FACT 4 Child): A Prospective Cohort Study Based on a Double‐Blinded Randomised Controlled Trial","authors":"Maryam Ghiasi, Lonnie Zwaigenbaum, Diane Moddemann, Ruth Rennicks White, Alysha L. J. Dingwall‐Harvey, Kimberly P. Grattan, Marisa Murray, Natalie Rybak, Heather Walker, Thierry Lacaze‐Masmonteil, Elizabeth Asztalos, Laura M. Gaudet, Stephen Robson, William Hague, Donnette Simms‐Stewart, Graeme Smith, Emmanuel Bujold, Daniel J. Corsi, Gary Goldfield, Darine El‐Chaâr, Shi Wu Wen, Mark C. Walker","doi":"10.1111/1471-0528.18341","DOIUrl":"https://doi.org/10.1111/1471-0528.18341","url":null,"abstract":"ObjectiveTo assess the impact of high‐dose folic acid supplementation (4.0–5.1 mg), started between 8<jats:sup>+0</jats:sup> and 16<jats:sup>+6</jats:sup> weeks of gestation and continued until delivery, on social impairments associated with Autism Spectrum Disorders, deficiencies in executive function, and emotional and behavioural problems in children.DesignFACT 4 Child is a follow‐up of mothers and their children born during the Folic Acid Clinical Trial (FACT), an international multi‐centre double‐blinded randomised trial to assess the effect of high‐dose folic acid supplementation on preventing preeclampsia in women with increased risk.SettingMulti‐centre international follow‐up study.PopulationMothers and their children enrolled in FACT, among them 664 completed the follow‐up.MethodsMothers reported on social and executive function and emotional and behavioural problems in their children aged 4–9 years using standardised, validated questionnaires.Main OutcomeThe proportion of children with at least one score > 1.5 SD above expected mean.ResultsAmong 319 children in the intervention group, 43 (13.5%) had a score in the elevated range, compared with 51/345 (14.8%) in the placebo group (RR = 0.91; 95% CI: 0.63 to 1.33; <jats:italic>p</jats:italic> = 0.63).ConclusionIn children born to women at risk for preeclampsia, rates of neurodevelopmental outcomes were not different between high‐dose folic acid and control groups in this study. Our finding suggests that a high dose of folic acid supplementation may not be needed in pregnant women with increased risk. A larger‐scale study is needed to determine neurodevelopmental outcomes associated with different dosages and timing of folic acid supplementation during pregnancy.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144905849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anne Armstrong,Ashu Gandhi,Suzanne Frank,David Williams,Samantha Nimalasena,
{"title":"Pregnancy and Breast Cancer: Green-top Guideline No. 12.","authors":"Anne Armstrong,Ashu Gandhi,Suzanne Frank,David Williams,Samantha Nimalasena, ","doi":"10.1111/1471-0528.18270","DOIUrl":"https://doi.org/10.1111/1471-0528.18270","url":null,"abstract":"","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144960010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sarah A L Price,Pauline M Maki,Samar R El Khoudary,Alison Brand,Rakibul M Islam,Susan M Domchek,Hadine Joffe,Gita D Mishra,Katrina M Moss,Fiona C Baker,Sabine Braat,John D Wark,Martha Hickey
Surgical menopause, the removal of both ovaries prior to natural menopause, may impact short-and long-term physical and emotional health. An increasingly common cause of surgical menopause is risk-reducing salpingo-oophorectomy (RRSO) in those at high inherited risk of ovarian cancer. The WHAM (What Happens After Menopause?) study is the largest prospective controlled study of RRSO. It measured the effect of RRSO compared to controls on physical and mental health over 2 years, and the potential modifying effects of menopausal hormone therapy (MHT). WHAM consists of 104 premenopausal women with BRCA1/2 pathogenic variants undergoing RRSO and 102 age-matched comparators who retained their ovaries. Outcomes including sexual function, vasomotor symptoms, cognition, mood, cardiometabolic health and bone health were measured between baseline and 24 months. MHT uptake after RRSO and the impact of MHT on these outcomes were assessed. Findings of WHAM have been published in more than ten manuscripts. Key findings include that RRSO adversely affects sexual function, sleep, and mood compared to comparison women. After RRSO, vasomotor symptoms (VMS) are generally mild, peak at 3 months, and do not worsen by 24 months. MHT reduces but does not resolve VMS. Loss of bone density was observed at 24 months and was partially mitigated by MHT. Cardiometabolic health and cognition were largely maintained at 24 months. This manuscript summarises the published findings of WHAM. These unique data will enhance evidence-based care in surgical menopause and will support shared decision-making around RRSO, ensuring rapid translation of new evidence into clinical practice. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: registration no: ACTRN12615000082505; anzctr.org.au.
{"title":"What Happens After Menopause (WHAM)? A Progress Report of a Prospective Controlled Study of Women After Pre-Menopausal Risk-Reducing Bilateral Salpingo-Oophorectomy.","authors":"Sarah A L Price,Pauline M Maki,Samar R El Khoudary,Alison Brand,Rakibul M Islam,Susan M Domchek,Hadine Joffe,Gita D Mishra,Katrina M Moss,Fiona C Baker,Sabine Braat,John D Wark,Martha Hickey","doi":"10.1111/1471-0528.18304","DOIUrl":"https://doi.org/10.1111/1471-0528.18304","url":null,"abstract":"Surgical menopause, the removal of both ovaries prior to natural menopause, may impact short-and long-term physical and emotional health. An increasingly common cause of surgical menopause is risk-reducing salpingo-oophorectomy (RRSO) in those at high inherited risk of ovarian cancer. The WHAM (What Happens After Menopause?) study is the largest prospective controlled study of RRSO. It measured the effect of RRSO compared to controls on physical and mental health over 2 years, and the potential modifying effects of menopausal hormone therapy (MHT). WHAM consists of 104 premenopausal women with BRCA1/2 pathogenic variants undergoing RRSO and 102 age-matched comparators who retained their ovaries. Outcomes including sexual function, vasomotor symptoms, cognition, mood, cardiometabolic health and bone health were measured between baseline and 24 months. MHT uptake after RRSO and the impact of MHT on these outcomes were assessed. Findings of WHAM have been published in more than ten manuscripts. Key findings include that RRSO adversely affects sexual function, sleep, and mood compared to comparison women. After RRSO, vasomotor symptoms (VMS) are generally mild, peak at 3 months, and do not worsen by 24 months. MHT reduces but does not resolve VMS. Loss of bone density was observed at 24 months and was partially mitigated by MHT. Cardiometabolic health and cognition were largely maintained at 24 months. This manuscript summarises the published findings of WHAM. These unique data will enhance evidence-based care in surgical menopause and will support shared decision-making around RRSO, ensuring rapid translation of new evidence into clinical practice. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: registration no: ACTRN12615000082505; anzctr.org.au.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144684172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Penelope Anne Beddoes, Helen Francesca Stanworth, Luke William Budworth, Vivien Anne Dolby, Brian Raymond Wilkinson, Thomas Oldroyd Lawton, Deborah Louise Horner
ObjectiveTo describe the characteristics, care needs and outcomes of the enhanced maternal care (EMC) population.DesignA descriptive observational study.Setting13 acute NHS trusts in the Yorkshire and Humber region from January 2021 to October 2024.Population4321 patient care episodes captured in the Maternal Enhanced and Critical Care (MEaCC) database.MethodsA retrospective analysis of data from the MEaCC database for all care episodes between January 2021 and October 2024.Outcome MeasuresOutcomes included patient demographics, mode of delivery, leading causes for EMC, physiological support needs, overall outcomes including mortality and requirement for ICU among the EMC population and proportion of EMC care delivered by EMC trained midwives.Results4321 episodes of EMC were recorded during this period. 9% of women required EMC or critical care, with most managed in maternity units: only 4% of EMC patients required critical care admission. 7% had invasive monitoring. The mean BMI was higher among MEaCC patients than regionally. Women of black ethnicity are more likely to require EMC or ICU. Most needing EMC would have been considered ‘low risk’ pregnancies.ConclusionsA significant proportion of women require higher levels of support during and after pregnancy. Training of midwives in EMC should be a priority. UK‐wide capture of EMC data would allow benchmarking of care, highlight best practice, inform service commissioning and drive further research.
{"title":"Maternal Enhanced and Critical Care and Outcomes Over Three Years: A Descriptive Observational Study","authors":"Penelope Anne Beddoes, Helen Francesca Stanworth, Luke William Budworth, Vivien Anne Dolby, Brian Raymond Wilkinson, Thomas Oldroyd Lawton, Deborah Louise Horner","doi":"10.1111/1471-0528.18299","DOIUrl":"https://doi.org/10.1111/1471-0528.18299","url":null,"abstract":"ObjectiveTo describe the characteristics, care needs and outcomes of the enhanced maternal care (EMC) population.DesignA descriptive observational study.Setting13 acute NHS trusts in the Yorkshire and Humber region from January 2021 to October 2024.Population4321 patient care episodes captured in the Maternal Enhanced and Critical Care (MEaCC) database.MethodsA retrospective analysis of data from the MEaCC database for all care episodes between January 2021 and October 2024.Outcome MeasuresOutcomes included patient demographics, mode of delivery, leading causes for EMC, physiological support needs, overall outcomes including mortality and requirement for ICU among the EMC population and proportion of EMC care delivered by EMC trained midwives.Results4321 episodes of EMC were recorded during this period. 9% of women required EMC or critical care, with most managed in maternity units: only 4% of EMC patients required critical care admission. 7% had invasive monitoring. The mean BMI was higher among MEaCC patients than regionally. Women of black ethnicity are more likely to require EMC or ICU. Most needing EMC would have been considered ‘low risk’ pregnancies.ConclusionsA significant proportion of women require higher levels of support during and after pregnancy. Training of midwives in EMC should be a priority. UK‐wide capture of EMC data would allow benchmarking of care, highlight best practice, inform service commissioning and drive further research.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Karen Omann Binderup,Joachim Boers,Line Winther Gustafson,Berit Andersen,Lone Kjeld Petersen,Pinar Bor,Joost Gribnau,Wim G V Quint,Henk Van Den Munckhof,Mette Tranberg,Anne Hammer
OBJECTIVETo evaluate the performance of DNA methylation markers for the detection of cervical precancer among screening-positive older women without a fully visible transformation zone at colposcopy (TZ3).DESIGNCross-sectional study.SETTINGColposcopy clinics, Central Denmark Region, 2019-2021.POPULATIONWomen ≥ 45 years with a TZ3 at colposcopy.METHODSParticipants referred for colposcopy due to an abnormal cervical screening test underwent cervical cytology sampling, biopsies and a large loop excision of the transformation zone (LLETZ). Cytology samples were analysed for DNA methylation markers: FAM19A4/miR124-2, ARID3C/ARL5C and METloc001/METloc002 according to the manufacturer's instructions. LLETZ histology was the reference standard.MAIN OUTCOME MEASURESSensitivity and specificity of the methylation markers for cervical intraepithelial grade 2 or worse (CIN2+) and cervical intraepithelial grade 3 or worse (CIN3+).RESULTSAmong 89 women (median age: 67.9 years), 31 (34.8%) had CIN2+ and 16 (18.0%) had CIN3+ detected. Sensitivity for CIN2+ was similar across markers, ranging from 74.2% (95% CI: 55.4-88.1) to 77.4% (95% CI: 58.9-90.4), while specificity was lower for FAM19A4/miR124-2 (39.7%; 95% CI: 27.0-53.4) compared to ARID3C/ARL5C (65.5%; 95% CI: 51.9-77.5) and METloc001/METloc002 (82.8%; 95% CI: 70.6-91.4). Sensitivity for CIN3+ was slightly lower for FAM19A4/miR124-2 (75.0%; 95% CI: 47.6-92.7) compared to ARID3C/ARL3C (87.5%; 95% CI: 61.7-98.4) and METloc001/METloc002 (93.8%; 95% CI: 69.8-99.8). Similarly, specificity was lowest for FAM19A4/miR124-2 (35.6%; 95% CI: 24.7-47.7), higher for ARID3C/ARL5C (60.3%; 95% CI: 48.1-71.5) and highest for METloc001/METloc002 (93.8%; 95% CI: 63.9-84.7).CONCLUSIONSMethylation markers, particularly METloc001/METloc002, may be useful for risk-based management of women with a TZ3 at colposcopy.TRIAL REGISTRATIONClinicalTrials.gov identifier: NCT04298957 (https://www.CLINICALTRIALSgov/ct2/show/NCT04298957?term=NCT04298957&draw=2&rank=1).
{"title":"DNA-Methylation for Risk-Stratification of Women Without a Fully Visible Transformation Zone at Colposcopy: A Cross-Sectional Study.","authors":"Karen Omann Binderup,Joachim Boers,Line Winther Gustafson,Berit Andersen,Lone Kjeld Petersen,Pinar Bor,Joost Gribnau,Wim G V Quint,Henk Van Den Munckhof,Mette Tranberg,Anne Hammer","doi":"10.1111/1471-0528.18288","DOIUrl":"https://doi.org/10.1111/1471-0528.18288","url":null,"abstract":"OBJECTIVETo evaluate the performance of DNA methylation markers for the detection of cervical precancer among screening-positive older women without a fully visible transformation zone at colposcopy (TZ3).DESIGNCross-sectional study.SETTINGColposcopy clinics, Central Denmark Region, 2019-2021.POPULATIONWomen ≥ 45 years with a TZ3 at colposcopy.METHODSParticipants referred for colposcopy due to an abnormal cervical screening test underwent cervical cytology sampling, biopsies and a large loop excision of the transformation zone (LLETZ). Cytology samples were analysed for DNA methylation markers: FAM19A4/miR124-2, ARID3C/ARL5C and METloc001/METloc002 according to the manufacturer's instructions. LLETZ histology was the reference standard.MAIN OUTCOME MEASURESSensitivity and specificity of the methylation markers for cervical intraepithelial grade 2 or worse (CIN2+) and cervical intraepithelial grade 3 or worse (CIN3+).RESULTSAmong 89 women (median age: 67.9 years), 31 (34.8%) had CIN2+ and 16 (18.0%) had CIN3+ detected. Sensitivity for CIN2+ was similar across markers, ranging from 74.2% (95% CI: 55.4-88.1) to 77.4% (95% CI: 58.9-90.4), while specificity was lower for FAM19A4/miR124-2 (39.7%; 95% CI: 27.0-53.4) compared to ARID3C/ARL5C (65.5%; 95% CI: 51.9-77.5) and METloc001/METloc002 (82.8%; 95% CI: 70.6-91.4). Sensitivity for CIN3+ was slightly lower for FAM19A4/miR124-2 (75.0%; 95% CI: 47.6-92.7) compared to ARID3C/ARL3C (87.5%; 95% CI: 61.7-98.4) and METloc001/METloc002 (93.8%; 95% CI: 69.8-99.8). Similarly, specificity was lowest for FAM19A4/miR124-2 (35.6%; 95% CI: 24.7-47.7), higher for ARID3C/ARL5C (60.3%; 95% CI: 48.1-71.5) and highest for METloc001/METloc002 (93.8%; 95% CI: 63.9-84.7).CONCLUSIONSMethylation markers, particularly METloc001/METloc002, may be useful for risk-based management of women with a TZ3 at colposcopy.TRIAL REGISTRATIONClinicalTrials.gov identifier: NCT04298957 (https://www.CLINICALTRIALSgov/ct2/show/NCT04298957?term=NCT04298957&draw=2&rank=1).","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gilda Sicilia,Salvatore Giovanni Vitale,Maurizio Nicola D'Alterio,Stefania Saponara,Francesco Scicchitano,Anna Maria Fulghesu,Rossella E Nappi,Stefano Angioni
BACKGROUNDPelvic organ prolapse (POP) affects up to 50% of postmenopausal women, negatively impacting sexual function and quality of life. While surgery remains the primary treatment, increasing attention has been given to perioperative vaginal oestrogen therapy and its potential impact on surgical outcomes.OBJECTIVESThis systematic review aims to evaluate the latest evidence on the role of vaginal oestrogen therapy in perioperative management and its impact on surgical outcomes in postmenopausal women with POP.SEARCH STRATEGYA systematic literature search was performed across PubMed, MEDLINE, ClinicalTrials.gov and Embase from inception to December 31, 2024. No geographic restrictions were imposed and only peer-reviewed English-language studies were included.SELECTION CRITERIAOnly prospective, randomised controlled trials (RCT) examining perioperative vaginal oestrogen therapy in postmenopausal women undergoing POP surgery were included.DATA COLLECTION AND ANALYSISStudy identification and data extraction were independently performed by two and three authors, respectively. The Cochrane Collaboration's tool was used to assess bias, with disagreements resolved by a fourth reviewer.MAIN RESULTSTen studies involving 709 patients were analysed. Vaginal oestrogen therapy showed a positive effect on Vaginal Maturation Index (VMI), vaginal thickness and surgeon's perception of tissue quality. It also appeared to reduce postoperative urinary tract infections (UTIs) and antibiotic use. However, no significant impact on sexual function, surgical ease, rates of surgical failure or POP recurrence was observed.CONCLUSIONSDespite potential benefits in enhancing vaginal tissue quality and reducing UTIs and antibiotic use, current evidence is limited. Further standardised trials are needed for more definitive conclusions.
{"title":"The Role of Vaginal Oestrogen Therapy in Postmenopausal Women With Pelvic Organ Prolapse: Does It Have Any Impact on Perioperative Outcomes? A Systematic Review of Randomised Controlled Trials.","authors":"Gilda Sicilia,Salvatore Giovanni Vitale,Maurizio Nicola D'Alterio,Stefania Saponara,Francesco Scicchitano,Anna Maria Fulghesu,Rossella E Nappi,Stefano Angioni","doi":"10.1111/1471-0528.18260","DOIUrl":"https://doi.org/10.1111/1471-0528.18260","url":null,"abstract":"BACKGROUNDPelvic organ prolapse (POP) affects up to 50% of postmenopausal women, negatively impacting sexual function and quality of life. While surgery remains the primary treatment, increasing attention has been given to perioperative vaginal oestrogen therapy and its potential impact on surgical outcomes.OBJECTIVESThis systematic review aims to evaluate the latest evidence on the role of vaginal oestrogen therapy in perioperative management and its impact on surgical outcomes in postmenopausal women with POP.SEARCH STRATEGYA systematic literature search was performed across PubMed, MEDLINE, ClinicalTrials.gov and Embase from inception to December 31, 2024. No geographic restrictions were imposed and only peer-reviewed English-language studies were included.SELECTION CRITERIAOnly prospective, randomised controlled trials (RCT) examining perioperative vaginal oestrogen therapy in postmenopausal women undergoing POP surgery were included.DATA COLLECTION AND ANALYSISStudy identification and data extraction were independently performed by two and three authors, respectively. The Cochrane Collaboration's tool was used to assess bias, with disagreements resolved by a fourth reviewer.MAIN RESULTSTen studies involving 709 patients were analysed. Vaginal oestrogen therapy showed a positive effect on Vaginal Maturation Index (VMI), vaginal thickness and surgeon's perception of tissue quality. It also appeared to reduce postoperative urinary tract infections (UTIs) and antibiotic use. However, no significant impact on sexual function, surgical ease, rates of surgical failure or POP recurrence was observed.CONCLUSIONSDespite potential benefits in enhancing vaginal tissue quality and reducing UTIs and antibiotic use, current evidence is limited. Further standardised trials are needed for more definitive conclusions.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144370450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Andrea Dall'Asta, Chiara Melito, Beatrice Valentini, Mariagrazia Capurso, Maria Teresa Baffa, Olga Patey, Basky Thilaganathan, Tullio Ghi
ObjectiveTo assess foetal myocardial deformation in normo‐oxygenated foetuses in early labour and its relationship with intrapartum outcomes.DesignSingle centre prospective study.SettingReferral tertiary maternity unit.PopulationUncomplicated singleton term pregnancies in early labour.MethodsTwo‐dimensional (2D) ultrasound clips of the 4‐chamber view of the foetal heart were collected in labour and sent to TomTec software for the offline speckle tracking echocardiography analysis. The left (LV) and right ventricular (RV) myocardial (MyoGLS) and endocardial longitudinal (EndoGLS) strain were evaluated.Main Outcome MeasuresOperative delivery including caesarean or assisted vaginal birth due to suspected intrapartum foetal compromise (IFC) as defined by standard CTG criteria.ResultsIn total, 208 cases were included. Operative delivery due to suspected IFC was recorded in 20 (9.6%) cases and was associated with higher LV ejection fraction (EF) (47.4 + 8.2 vs. 40.9 + 12.9%, p = 0.03) and increased RV MyoGLS (−15.9 + 4.0 vs. −12.5 + 4.3%, p < 0.01) and RV EndoGLS (−17.7 + 4.4 vs. −14.3 + 4.7%, p < 0.01) compared to cases not having operative delivery due to suspected IFC. Maternal age (OR 1.138, 95% CI [1.010–1.281], p = 0.03), baseline foetal heart rate at acquisition (OR 1.068, 95% CI [1.007–1.134], p = 0.03) and RV MyoGLS (OR 0.575, 95% CI [0.366–0.903], p = 0.02) were independently associated with the primary outcome.ConclusionsIncreased right ventricular myocardial deformation is associated with operative delivery due to suspected IFC, suggesting an early cardiac response to labour‐related hypoxia.
目的探讨正常氧合胎儿在分娩早期的心肌变形及其与产时结局的关系。设计单中心前瞻性研究。转诊第三产科单位。无并发症的单胎足月妊娠。方法在分娩时采集胎儿心脏4腔的二维超声片，发送给TomTec软件进行脱机斑点跟踪超声心动图分析。观察左（LV）、右（RV）心肌（MyoGLS）及心内膜纵（EndoGLS）应变。手术分娩包括剖腹产或辅助阴道分娩，因疑似产时胎儿妥协（IFC），根据标准CTG标准定义。结果共纳入病例208例。20例（9.6%）患者因疑似IFC而手术分娩，并伴有左室射血分数（EF）升高（47.4 + 8.2比40.9 + 12.9%,p = 0.03）和右室MyoGLS升高(- 15.9 + 4.0比- 12.5 + 4.3%,p <；0.01)和RV EndoGLS (- 17.7 + 4.4 vs - 14.3 + 4.7%, p <；0.01)，与怀疑IFC而未手术分娩的病例相比。产妇年龄（OR 1.138, 95% CI [1.010-1.281], p = 0.03）、获得时胎儿基线心率（OR 1.068, 95% CI [1.007-1.134], p = 0.03）和RV MyoGLS （OR 0.575, 95% CI [0.366-0.903], p = 0.02）与主要结局独立相关。结论疑似IFC导致的手术分娩与右心室心肌变形增加有关，提示心脏对分娩相关缺氧有早期反应。
{"title":"Foetal Cardiac Function in Early Labour and Intrapartum Outcomes: A Prospective Observational Study","authors":"Andrea Dall'Asta, Chiara Melito, Beatrice Valentini, Mariagrazia Capurso, Maria Teresa Baffa, Olga Patey, Basky Thilaganathan, Tullio Ghi","doi":"10.1111/1471-0528.18224","DOIUrl":"https://doi.org/10.1111/1471-0528.18224","url":null,"abstract":"ObjectiveTo assess foetal myocardial deformation in normo‐oxygenated foetuses in early labour and its relationship with intrapartum outcomes.DesignSingle centre prospective study.SettingReferral tertiary maternity unit.PopulationUncomplicated singleton term pregnancies in early labour.MethodsTwo‐dimensional (2D) ultrasound clips of the 4‐chamber view of the foetal heart were collected in labour and sent to TomTec software for the offline speckle tracking echocardiography analysis. The left (LV) and right ventricular (RV) myocardial (MyoGLS) and endocardial longitudinal (EndoGLS) strain were evaluated.Main Outcome MeasuresOperative delivery including caesarean or assisted vaginal birth due to suspected intrapartum foetal compromise (IFC) as defined by standard CTG criteria.ResultsIn total, 208 cases were included. Operative delivery due to suspected IFC was recorded in 20 (9.6%) cases and was associated with higher LV ejection fraction (EF) (47.4 + 8.2 vs. 40.9 + 12.9%, <jats:italic>p</jats:italic> = 0.03) and increased RV MyoGLS (−15.9 + 4.0 vs. −12.5 + 4.3%, <jats:italic>p</jats:italic> < 0.01) and RV EndoGLS (−17.7 + 4.4 vs. −14.3 + 4.7%, <jats:italic>p</jats:italic> < 0.01) compared to cases not having operative delivery due to suspected IFC. Maternal age (OR 1.138, 95% CI [1.010–1.281], <jats:italic>p</jats:italic> = 0.03), baseline foetal heart rate at acquisition (OR 1.068, 95% CI [1.007–1.134], <jats:italic>p</jats:italic> = 0.03) and RV MyoGLS (OR 0.575, 95% CI [0.366–0.903], <jats:italic>p</jats:italic> = 0.02) were independently associated with the primary outcome.ConclusionsIncreased right ventricular myocardial deformation is associated with operative delivery due to suspected IFC, suggesting an early cardiac response to labour‐related hypoxia.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144113672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
OBJECTIVETo analyse prescribing trends for oral and transdermal hormone replacement therapy (HRT) in Wales from 1996 to 2023, including predictors of discontinuation within one year of initiation.DESIGNObservational study using the Secure Anonymised Information Linkage (SAIL) databank.SETTINGPrimary and secondary care data from Wales, encompassing 86% of the population.POPULATIONAnnual HRT prescription rates from 1996 to 2023 were assessed for all women in Wales. Predictors of HRT discontinuation within one year were assessed in women aged 40-65 (n = 103 114), excluding those with oophorectomy, hysterectomy, or premature menopause.METHODSHRT prescription rates were calculated per 1000 women per year and stratified by HRT type, age groups and deprivation quintiles. Predictors of discontinuation were assessed using a zero-inflated negative binomial regression.MAIN OUTCOME MEASURESAnnual HRT prescription rates and predictors of discontinuation, including age, deprivation, time period and HRT type.RESULTSFrom 1996 to 2023, 292 707 women were prescribed oral or transdermal HRT in Wales. Transdermal prescriptions rose exponentially post-2021, whereas oral prescriptions declined post-2002. Discontinuation rates followed a curvilinear trend: increasing at ages 40-43 and mid-50s onwards and decreasing in mid-40s to early 50s. Oral formats were linked to decreased discontinuation, whereas transdermals showed increased discontinuation. Deprivation reduced HRT prescriptions overall. Prescriptions post-2000 predicted increased discontinuation, with highest rates seen post-2021.CONCLUSIONSDisparities in HRT prescribing patterns reflect GP and patient perceptions of safety. Women in their mid-40s to early 50s, often at a natural menopause stage, adhered better, particularly to oral tablets, suggesting that administration route and symptom relief influence adherence. Socio-economic deprivation remains a barrier to HRT access. Time trends highlight the influence of widely publicised studies and media on uptake, albeit adherence has continually declined since 2001. Additional research is needed to tackle socio-economic inequalities and assess strategies for achieving cost-effective and efficient HRT prescribing practices.
{"title":"Hormone Replacement Therapy Uptake and Discontinuation Trends From 1996-2023: An Observational Study of the Welsh Population.","authors":"Robin Andrews,Arron Lacey,Kate Bache,Emma J Kidd","doi":"10.1111/1471-0528.18220","DOIUrl":"https://doi.org/10.1111/1471-0528.18220","url":null,"abstract":"OBJECTIVETo analyse prescribing trends for oral and transdermal hormone replacement therapy (HRT) in Wales from 1996 to 2023, including predictors of discontinuation within one year of initiation.DESIGNObservational study using the Secure Anonymised Information Linkage (SAIL) databank.SETTINGPrimary and secondary care data from Wales, encompassing 86% of the population.POPULATIONAnnual HRT prescription rates from 1996 to 2023 were assessed for all women in Wales. Predictors of HRT discontinuation within one year were assessed in women aged 40-65 (n = 103 114), excluding those with oophorectomy, hysterectomy, or premature menopause.METHODSHRT prescription rates were calculated per 1000 women per year and stratified by HRT type, age groups and deprivation quintiles. Predictors of discontinuation were assessed using a zero-inflated negative binomial regression.MAIN OUTCOME MEASURESAnnual HRT prescription rates and predictors of discontinuation, including age, deprivation, time period and HRT type.RESULTSFrom 1996 to 2023, 292 707 women were prescribed oral or transdermal HRT in Wales. Transdermal prescriptions rose exponentially post-2021, whereas oral prescriptions declined post-2002. Discontinuation rates followed a curvilinear trend: increasing at ages 40-43 and mid-50s onwards and decreasing in mid-40s to early 50s. Oral formats were linked to decreased discontinuation, whereas transdermals showed increased discontinuation. Deprivation reduced HRT prescriptions overall. Prescriptions post-2000 predicted increased discontinuation, with highest rates seen post-2021.CONCLUSIONSDisparities in HRT prescribing patterns reflect GP and patient perceptions of safety. Women in their mid-40s to early 50s, often at a natural menopause stage, adhered better, particularly to oral tablets, suggesting that administration route and symptom relief influence adherence. Socio-economic deprivation remains a barrier to HRT access. Time trends highlight the influence of widely publicised studies and media on uptake, albeit adherence has continually declined since 2001. Additional research is needed to tackle socio-economic inequalities and assess strategies for achieving cost-effective and efficient HRT prescribing practices.","PeriodicalId":8984,"journal":{"name":"BJOG: An International Journal of Obstetrics & Gynaecology","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144087545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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