Novelli GP, Silvestrini M, Farsetti D
… +7 more, Biscosi CMP, Bertoldo F, Chiricolo G, Stifano G, Valensise H, Natale A, Vasapollo B
Am J Obstet Gynecol
· 2026 Jun · PMID 41690387
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BACKGROUND: Pregnancy triggers substantial cardiovascular adaptations to support the fetoplacental unit; however, increasing evidence suggests that preeclampsia may unmask underlying, asymptomatic cardiovascular dysfunct...BACKGROUND: Pregnancy triggers substantial cardiovascular adaptations to support the fetoplacental unit; however, increasing evidence suggests that preeclampsia may unmask underlying, asymptomatic cardiovascular dysfunction. Although physical exercise is well established for improving cardiovascular health and preventing various chronic diseases, its specific role in reducing the risk of adverse outcomes in pregnancy remains uncertain. OBJECTIVE: This study aimed to determine whether structured aerobic exercise performed between pregnancies reduces the recurrence of preeclampsia. STUDY DESIGN: We conducted a prospective cohort study involving 256 normotensive, nonobese (body mass index < 30) women with prior preeclampsia before 34 weeks who were planning a new pregnancy. All participants were invited to adhere to aerobic exercise recommendations starting 6 months after the index pregnancy. Cardiac function was assessed by transthoracic echocardiography before the exercise recommendations and again 8 to 12 months later, prior to the subsequent pregnancy. Pregnancy outcomes were recorded, and data were analyzed using one-way analysis of variance and binary logistic regression. RESULTS: 82 of 256 women followed the exercise program, while 174 did not. No differences in baseline cardiovascular characteristics were observed between the groups. After 12 to 18 months of exercise, the exercise group demonstrated significant improvements compared to the nonexercise group, showing higher stroke volume (71±12 vs 65±11 mL, P<.05), increased cardiac output (5.3±1.3 vs 4.8±1.1 L/min, P<.05), a greater left atrial volume index (23.1±4.7 vs 21.7±5.3 mL/m, P<.05), lower global longitudinal strain (-23.1±1.6 vs -21.9±2.0, P<.05), and reduced total peripheral vascular resistance (1258±295 vs 1427±313 dyne s/cm, P<.05). In the subsequent pregnancy, recurrent preeclampsia occurred in 12/82 (14.6%) of women who adhered to the exercise program and 48/174 (27.6%) of women who did not; unadjusted odds ratio=0.45 (95% confidence interval, 0.22-0.90; P=.025); relative risk of recurrence in the exercise group was 0.53 (95% confidence interval, 0.30-0.94; P=.031), corresponding to a relative risk reduction of 47%. CONCLUSION: Aerobic exercise performed between pregnancies may markedly enhance the cardiovascular profile of women with a recent history of preeclampsia. The observed improvements in stroke volume, cardiac output, vascular resistance, and global longitudinal strain suggest beneficial cardiovascular adaptations that could reduce the likelihood of recurrent preeclampsia. These findings support the implementation of structured aerobic exercise as an intervention to improve subsequent pregnancy outcomes in this high-risk population.
Rojhani E, Abiad M, Zargarzadeh N
… +11 more, Aghajani F, Lopez MC, Shamshirsaz AA, Shainker SA, Gargiulo A, Khalil A, Mustafa HJ, D'Antonio F, Aagaard K, Shamshirsaz AA, Arian SE
Am J Obstet Gynecol
· 2026 Feb · PMID 41654249
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OBJECTIVE: Placenta Accreta Spectrum (PAS) occurs in approximately 0.17% pregnancies in the general obstetric population. We aimed to estimate the prevalence of PAS following myomectomy surgery and evaluate differences i...OBJECTIVE: Placenta Accreta Spectrum (PAS) occurs in approximately 0.17% pregnancies in the general obstetric population. We aimed to estimate the prevalence of PAS following myomectomy surgery and evaluate differences in the risks by myomectomy surgical approach. DATA SOURCES: PubMed, Embase, Scopus, and Web of Science were searched on prespecified dates (inception-March 2025). STUDY ELIGIBILITY CRITERIA: Studies were eligible if they reported pregnancy outcomes in patients with a documented history of myomectomy in which the surgical approach was specified. STUDY APPRAISAL AND SYNTHESIS METHODS: This systematic review and meta-analysis was conducted per PRISMA guidelines and registered on PROSPERO (CRD42024513596). Pooled prevalence estimates and 95% confidence intervals (CIs) were calculated using random-effects meta-analysis. Planned subgroup analyses were conducted for myomectomy surgical approach and PAS-accompanying morbidities of postpartum hemorrhage, placenta previa, placental abruption, and uterine rupture, and heterogeneity was assessed using I statistics. RESULTS: Seventy-six studies comprising 11065 pregnancies across 24 countries were included. The pooled prevalence of PAS following myomectomy was 1% (95% CI, 1-2%). Prespecified subgroup analyses demonstrated that PAS prevalence was highest after open myomectomy (2%; 95% CI, 1-4%; 111/4474) compared to laparoscopic (1%; 95% CI, 0-3%; 36/1172), robotic (1%; 95% CI, 0-4%; 4/262), and hysteroscopic approaches (<1%; 95% CI, 0-1%; 3/271), although differences between surgical groups were not statistically significant (P = 0.67). Secondary outcomes-including postpartum hemorrhage (2%), placenta previa (1%), placental abruption (1%), and uterine rupture (<1%)-showed similar prevalence patterns across surgical approaches. CONCLUSIONS: In this meta-analysis of over 11,000 patients, the overall prevalence of PAS following myomectomy was approximately 1-2% and did not significantly differ by surgical approach. Likewise, major obstetric complications, including postpartum hemorrhage, placenta previa, and uterine rupture, showed no significant variations among open, laparoscopic, hysteroscopic, and robotic myomectomies. Therefore, the choice of surgical approach for myomectomy can be individualized based on patient characteristics, myoma features, and surgical expertise.
OBJECTIVE: To systematically review the current literature on gynecologic function and dysfunction in transmasculine and gender-diverse individuals in the context of testosterone therapy, with a focus on menstrual suppre...OBJECTIVE: To systematically review the current literature on gynecologic function and dysfunction in transmasculine and gender-diverse individuals in the context of testosterone therapy, with a focus on menstrual suppression, contraceptive needs, pelvic pain, vulvovaginal changes, and sexual health. DATA SOURCES: PubMed, Embase, and Web of Science databases were searched through September 2025 using search terms related to transmasculine individuals, assigned female at birth, reproductive organs, and testosterone and gender-affirming hormone therapy. No restrictions on publication year were applied. STUDY ELIGIBILITY CRITERIA: Studies were included if they reported on the impact of exogenous testosterone on gynecologic or sexual (dys)function and contraceptive use and choices, in transmasculine and gender-diverse individuals. Only original human research studies were eligible. Studies focusing on fertility, reproductive outcomes, malignancy, histology, animal models, or individuals with differences of sex development were excluded. STUDY APPRAISAL AND SYNTHESIS METHODS: All included studies were critically appraised using Joanna Briggs Institute quality assessment tools, and findings were synthesized narratively. RESULTS: Fifty-seven studies were included. Testosterone was generally effective in achieving menstrual suppression, although breakthrough bleeding and ovulatory activity occurred in a substantial proportion of individuals. Contraceptive needs were frequently unmet, partly due to misinformation and provider-related barriers. Pelvic pain was commonly reported, with varied etiologies. While testosterone often increased sexual desire, dyspareunia and genital discomfort were frequently described. Vaginal microbiome alterations and epithelial changes were observed, although their clinical implications remain unclear. CONCLUSION: Testosterone-based gender-affirming hormone therapy has diverse effects on gynecologic function in transmasculine and gender-diverse individuals, including both physiologically expected as well as underexplored effects. Clinicians should adopt an individualized and affirming approach to care, while further research is needed to understand long-term outcomes, improve assessment tools, and close gaps in inclusive gynecologic healthcare.
OBJECTIVE: Pregnancy outcomes may be improved by optimizing preconception health; however, designing preconception research studies presents distinct challenges. These include estimating feasible recruitment, attrition,...OBJECTIVE: Pregnancy outcomes may be improved by optimizing preconception health; however, designing preconception research studies presents distinct challenges. These include estimating feasible recruitment, attrition, and expected pregnancy rates. We systematically reviewed existing preconception studies to quantify recruitment rates, retention, and pregnancies to inform feasibility assessments and sample size calculations for future preconception and pregnancy-related research. DATA SOURCES: NHS Knowledge Hub, TRIP database, Cochrane Library, PubMed, MEDLINE, Embase, CINAHL, Emcare, Web of Science, Scopus, ASSIA, and PsycINFO were searched (database inception-September 2025). STUDY ELIGIBILITY CRITERIA: Eligible studies reported recruitment of nonpregnant women intending to conceive into studies reporting at least one pregnancy outcome. STUDY APPRAISAL AND SYNTHESIS METHODS: Risk of bias and quality assessment were performed using the Newcastle-Ottawa Scale and Cochrane Risk of Bias tool, followed by the Grading of Recommendations Assessment, Development and Evaluation framework. Statistical analysis was performed in R v4.4.1. RESULTS: 79 studies (n=117,603 participants; n=53,838 pregnancies) were included. Overall, risk of bias was fair across studies. The heterogeneity across all meta-analyses was high. Recruitment via healthcare settings yielded higher weekly recruitment than other methods (median 9 participants/week; interquartile range, 4-19), compared with studies using only non-healthcare-based recruitment methods (2; interquartile range, 2-4). Weekly recruitment was higher in larger studies and in low- and middle-income countries compared to high-income countries. Attrition prior to conception was lower in observational than in interventional studies and among those with fertility issues compared to those with other medical comorbidities. Among participants who conceived, retention during pregnancy was high across all studies (97.7%; interquartile range, 95.2-99.0), with higher retention in interventional than in observational studies. CONCLUSION: This review provides a quantitative synthesis of recruitment and retention patterns in preconception research, addressing a critical but understudied period to improve maternal and child health. We found that participant characteristics, recruitment strategy, and study design substantially influence recruitment rates, preconception attrition, and pregnancy retention, with important implications for feasibility assessment, anticipated loss to follow-up, and sample size estimation. Our findings highlight the need for recruitment of diverse populations and methodological tools tailored to preconception research. These findings offer empirically grounded parameters to support the design of more efficient, inclusive, and adequately powered preconception and pregnancy-related studies.
Mans-Gallart N, Carlhäll S, Hildebrand E
… +2 more, Axelsson D, Lilliecreutz C
Am J Obstet Gynecol
· 2026 Feb · PMID 41642697
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BACKGROUND: Preeclampsia is a substantial cause of maternal and perinatal morbimortality, with complications becoming more severe the earlier it manifests during pregnancy. The Fetal Medicine Foundation has developed a m...BACKGROUND: Preeclampsia is a substantial cause of maternal and perinatal morbimortality, with complications becoming more severe the earlier it manifests during pregnancy. The Fetal Medicine Foundation has developed a method that combines anamnestic risk factors and biochemical and biophysical tests to assess the individual risk of developing preterm preeclampsia. Previous studies have demonstrated that the combination of the Fetal Medicine Foundation method with the use of aspirin significantly reduces the prevalence of preterm preeclampsia. To our knowledge, no published studies have applied this method to an entire population before. OBJECTIVE: To evaluate the prevalence of preterm preeclampsia, defined as preterm birth with a preeclampsia diagnosis, before and after the Fetal Medicine Foundation method was introduced in an unselected Swedish population. STUDY DESIGN: This population-based, retrospective cohort study included 61,840 deliveries from 5 obstetric units in Sweden from 2012 to 2022. Two cohorts were defined: one before and one after the implementation of the Fetal Medicine Foundation method. The primary outcome was the prevalence of preterm preeclampsia. The analysis followed an intention-to-treat approach. The intervention cohort comprised 30,777 women. Individuals with a risk score of ≥1:100 were considered high risk and were subsequently recommended a daily dose of 150 mg of aspirin until 36 weeks of gestation or until the onset of preeclampsia. RESULTS: No significant reduction in the prevalence of preterm preeclampsia was observed (adjusted odds ratio, 1.13; 95% confidence interval, 0.9-1.5) but a tendency toward an increase in term preeclampsia rates was noted (adjusted odds ratio, 1.14; 95% confidence interval, 1.00-1.30). No other differences in obstetrical or neonatal outcomes were found between the cohorts (P=not significant, not significant). The Fetal Medicine Foundation method was successfully conducted in more than 85% of the pregnant population. CONCLUSION: The implementation of the Fetal Medicine Foundation method showed no reduction in preterm birth combined with preeclampsia in this intention-to-treat analysis. The Fetal Medicine Foundation method was both feasible and well accepted in this unselected population, demonstrating its applicability in routine clinical practice. Further population-based studies using a per-protocol approach are needed to evaluate the efficacy of aspirin prophylaxis among individuals identified as high risk according to the Fetal Medicine Foundation method.
Bartels HC, Chandran AR, Parks WT
… +6 more, Huszti E, Pardo A, Staatsen K, Windrim RC, Hobson SR, Kingdom JC
Am J Obstet Gynecol
· 2026 Jun · PMID 41638616
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BACKGROUND: Chronic histiocytic intervillositis is a rare placental disorder characterized by maternal macrophage accumulation within the intervillous space of the placenta. Local cytokine release by these immune cells m...BACKGROUND: Chronic histiocytic intervillositis is a rare placental disorder characterized by maternal macrophage accumulation within the intervillous space of the placenta. Local cytokine release by these immune cells mediates injury to the developing placental villi, resulting in a spectrum of early pregnancy loss, severe fetal growth restriction, or stillbirth. Despite good evidence that chronic histiocytic intervillositis begins in early pregnancy, no effective risk assessment tools exist to predict pregnancy outcomes and, thus, appropriate fetal surveillance. OBJECTIVE: This study aimed to explore the role of serial circulating placental growth factor and uterine artery Doppler waveform assessments beginning in the early second trimester in pregnancies that were found to be complicated by chronic histiocytic intervillositis of the placenta. STUDY DESIGN: Single-center historical cohort study of pregnancy outcomes in pregnancies with a confirmed pathologic diagnosis of placental chronic histiocytic intervillositis between March 2010 and August 2025. Maternal demographics, uterine artery Doppler waveform indices, circulating placental growth factor levels, and maternal and perinatal outcomes were abstracted from electronic medical record systems. Placental growth factor testing was available from 2017 onward. Abnormal uterine artery Doppler was defined as a mean pulsatility index of >95th percentile or bilateral early diastolic notching. Placental growth factor levels of <10th percentile for gestational age were considered abnormal. Diagnostic test characteristics (with 95% confidence intervals), including sensitivity, specificity, and likelihood ratios, were estimated to assess the performance of low circulating placental growth factor and uterine artery Doppler waveforms for subsequent stillbirth. RESULTS: Overall, 66 patients met the inclusion criteria, with a mean maternal age of 33.2 ± 5.1 years. Only 13 pregnancies (20%) were delivered at term (>37 weeks of gestation). Stillbirth occurred in 17 pregnancies (26%), and 44 infants (67%) were discharged alive. Among live births, 50% had birthweights below the 10th percentile (birth weight: mean ± standard deviation, 1341 ± 1009 g). Placental growth factor was below the 10th percentile in nearly all cases, including all 17 pregnancies resulting in a stillbirth. Between 16 and 23 weeks of gestation, low placental growth factor showed high sensitivity for stillbirth (0.95 [95% confidence interval, 0.77-0.99]) but limited specificity (0.50 [95% confidence interval, 0.18-0.82]), with a modest positive likelihood ratio (1.9 [95% confidence interval, 0.82-4.40]) and a low negative likelihood ratio (0.10 [95% confidence interval, 0.02-0.65]), indicating strong rule-out performance. Of note, 27 of 45 tested patients (60%) had normal uterine artery mean pulsatility index values. Of the 18 patients with abnormal uterine artery Dopplers, 7 (39%) had coexistent maternal vascular malperfusion. Abnormal uterine artery Doppler at 16 to 23 weeks of gestation was not associated with the subsequent risk of stillbirth (likelihood ratio, 1.22 [95% confidence interval, 0.19-7.61]); sensitivity, 0.22 [95% confidence interval, 0.05-0.50]; and specificity, 0.81 [95% confidence interval, 0.05-0.25]). CONCLUSION: Pregnancies complicated by chronic histiocytic intervillositis have a high rate of adverse pregnancy outcomes, including extreme preterm delivery and associated stillbirth due to severe fetal growth restriction. Low circulating maternal placental growth factor level in the early second trimester of pregnancy may serve as a useful early biomarker for evolving chronic histiocytic intervillositis. In contrast, uterine artery Doppler waveforms were less informative when chronic histiocytic intervillositis was the only placental pathology diagnosis. Serial placental growth factor tests in the early second trimester of pregnancy may be a useful prognostic marker in subsequent pregnancies after a placental diagnosis of chronic histiocytic intervillositis, including the potential to provide in vivo evidence of the effects of various proposed drug regimens to prevent chronic histiocytic intervillositis recurrence.
Pregnancies complicated by diabetes mellitus are at increased risk of adverse perinatal outcomes. The American College of Obstetricians and Gynecologists recommends universal screening for gestational diabetes mellitus d...Pregnancies complicated by diabetes mellitus are at increased risk of adverse perinatal outcomes. The American College of Obstetricians and Gynecologists recommends universal screening for gestational diabetes mellitus during pregnancy at 24 to 28 weeks of gestation. However, there is controversy on the utility of screening or identification of patients with early gestational diabetes mellitus. In this clinical perspective, an evidence-based classification of diabetes in pregnancy (ie, diagnostic criteria for standard gestational diabetes mellitus vs early gestational diabetes mellitus vs pregestational diabetes mellitus) has been provided to help define subgroups along the spectrum of glucose intolerance/insulin resistance to inform future outcome-based studies.