BMC Pregnancy and Childbirth最新文献

Background: Despite the availability of cost-effective treatments, maternal syphilis continues to contribute significantly to preventable stillbirths and congenital syphilis cases worldwide. This scoping review aimed to identify and characterize maternal health interventions designed to prevent mother-to-child transmission (PMTCT) of syphilis globally, using a modified Intervention Mapping (IM) framework.

Methods: We conducted a scoping review of maternal health interventions targeting PMTCT of syphilis published between January 2010 and August 2023. Searches were performed in PubMed, Medline Ovid, and Embase, supplemented by manual reference screening. Eligible studies described at least one maternal health intervention addressing syphilis PMTCT and were analyzed using a five-step modified IM framework. Data extraction focused on intervention characteristics, settings, theoretical foundations, behavioral and environmental outcomes, and delivery strategies. Summary statistics and a narrative synthesis were used to analyze findings.

Results: A total of 32 articles representing 30 unique interventions met the inclusion criteria. Most interventions were conducted in North and South America and targeted pregnant women and healthcare providers. Over 70% of interventions were multi-level, addressing both individual and environmental factors. Behavioral outcomes primarily focused on syphilis screening, treatment, and early prenatal care, while environmental outcomes emphasized provider practices and partner involvement. However, few interventions included community engagement or targeted high-risk subgroups such as sex workers or adolescents. Commonly used approaches included health education, provider training, partner notification, and quality improvement. Only a minority of studies reported the use of theoretical frameworks, and less than one-third included formal evaluation data.

Conclusions: This review highlights both the promise and gaps in existing maternal health interventions for syphilis PMTCT. Interventions frequently addressed individual and provider behaviors but lacked integration of community-level strategies and theoretical guidance. Future interventions should prioritize theory-based designs, rigorous evaluation, and broader inclusion of high-risk populations. The modified IM framework proved useful for systematically mapping intervention components and identifying implementation and evaluation gaps.

Trial registration: Not applicable. This study is a scoping review and does not report results from a clinical trial.

Objective: To characterize patients with non-criteria obstetric antiphospholipid syndrome (NOAPS) and to evaluate how distinct antiphospholipid antibody (aPL) profiles relate to adverse gestational outcomes.

Methods: We retrospectively analyzed 350 women diagnosed from November 2021 to July 2024. Collected information included demographic characteristics, aPL stratification, anticardiolipin antibodies (ACA), anti-β2 glycoprotein I antibodies (aβ2-GPIs), lupus anticoagulant (LA), treatment regimens, therapy duration, and obstetric outcomes (such as recurrent miscarriage, hypertensive disorders, premature delivery, and intrauterine growth restriction). Participants were grouped into high-, medium-, and low-risk categories according to aPL stratification. Propensity score matching (PSM) was conducted in R software, and maternal-fetal outcomes were compared across the three strata. Logistic regression was applied to assess the impact of aPL profiles, and correlation analyses plus heatmaps were used to visualize associations.

Results: Recurrent miscarriage was most frequent in high-risk women (50.56% vs. 13.48% in low-risk, P < 0.001). The incidence of preeclampsia was 38.20% in the high-risk group compared with 16.85% and 20.23% in the medium- and low-risk groups (P = 0.002). Preterm birth (26.97%) and fetal growth restriction (23.60%) were also significantly more common in the high-risk cohort (both P < 0.01). Fetal distress occurred in 49.44% of high-risk patients, exceeding rates in the medium-risk (32.58%) and low-risk (15.73%) groups (both P < 0.01). Multivariable regression indicated that high-risk profiles were strongly linked to poor maternal and neonatal outcomes (Maternal: OR = 5.013, 95% CI 2.683-9.613; Neonatal: OR = 12.302, 95% CI 6.092-26.283). aPL stratification independently predicted placental abruption, miscarriage, preeclampsia, premature birth, growth restriction, and fetal distress (OR = 1.470-6.938). LA was identified as a predictor of maternal venous thrombosis (OR = 17.556, 95% CI 1.541-200.068), while ACA contributed to preeclampsia risk (OR = 1.778, 95% CI 1.283-2.465). Elevated ACA titers and positive aβ2-GPI results were significant for fetal distress (OR = 1.040 and 1.881).

Conclusion: In NOAPS patients, risk stratification based on aPL antibody types, titers, and combination patterns can effectively predict adverse maternal-neonatal pregnancy outcomes. High-risk patients often need prompt, intensive anticoagulant therapy together with coordinated multidisciplinary surveillance.

Objective: This study aims to evaluate the real-world effectiveness of 100 mg aspirin in preventing superimposed preeclampsia (PE) in pregnant women with chronic hypertension (CHTN).

Study design: This retrospective cohort study included pregnant women with CHTN who began prenatal care before 20 weeks of gestation and delivered a singleton at Nanjing Drum Tower Hospital, affiliated with Nanjing University Medical School. The deliveries occurred between January 1, 2018, and May 1, 2025. The primary exposure was 100 mg/day aspirin initiated between 12 and 20 weeks of gestation, and the primary outcome was the incidence of superimposed PE. Secondary outcomes included PE delivery before 34 weeks, PE delivery before 37 weeks, preterm birth, postpartum hemorrhage, gestational diabetes mellitus, small for gestational age (SGA), and a composite of adverse neonatal outcomes. Multivariable logistic regression and inverse probability of treatment weighting (IPTW) were used to adjust for confounding factors.

Results: During the study period, 367 women met the inclusion criteria, with 111 in the aspirin group and 256 in the control group. After IPTW adjustment, baseline characteristics were comparable between the two groups. The incidence of superimposed PE was 34.6% in the aspirin group and 37.7% in the control group, with no statistically significant difference (weighted OR = 0.87, 95% CI: 0.49-1.54; p >0.05). In secondary outcomes, the incidence of SGA was significantly lower in the aspirin group both before and after IPTW adjustment (p<0.05); however, no significant differences were observed for other outcomes (p>0.05). Additionally, subgroup analyses showed no significant heterogeneity in aspirin effect when stratified by aspirin-related factors (initiation timing, adherence, and concurrent calcium supplementation) or CHTN-related factors (timing of diagnosis, blood pressure levels before 20 weeks of gestation, and use of antihypertensive medication within three months prior to conception or before 20 weeks) (p >0.05).

Conclusion: Our study suggests that initiating 100 mg/day of aspirin between 12 and 20 weeks of gestation does not significantly reduce superimposed PE in women with CHTN; however, it significantly reduces the risk of SGA. Subgroup analyses also indicated that even initiation before 16 weeks did not provide additional preventive effect against PE.