BMC Pregnancy And Childbirth[JOURNAL]
Sun
200 papers
Epigenetic and immunological alterations in umbilical cord blood of overweight/obese women with gestational diabetes mellitus: insights into DNA methylation signatures and immune cell dysregulation.
Wang J, Chen Q, Chen A … +6 more , Zhang Y, Yan F, Wu L, Hu X, You C, He J
BMC Pregnancy Childbirth · 2026 Jun · PMID 42343321 · Full text
BACKGROUND: Gestational diabetes mellitus (GDM) is a common pregnancy complication associated with adverse maternal and neonatal outcomes. Epigenetic modifications may reflect intrauterine metabolic exposure and contribu...
BACKGROUND: Gestational diabetes mellitus (GDM) is a common pregnancy complication associated with adverse maternal and neonatal outcomes. Epigenetic modifications may reflect intrauterine metabolic exposure and contribute to immune and metabolic alterations. This study aimed to explore DNA methylation profiles in umbilical cord blood from overweight and obese women with and without GDM. METHODS: Umbilical cord blood samples from 30 overweight/obese pregnant women (with and without GDM) were analyzed using the Illumina 850 K methylation array to identify differentially methylated positions (DMPs) and regions (DMRs). Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were performed to assess the functional relevance of methylation changes. Immune cell composition was estimated using deconvolution analysis and further examined in an independent single-cell RNA sequencing (scRNA-seq) cohort. Lasso regression was applied to identify CpG sites associated with GDM status and construct a preliminary methylation-based classification model. RESULTS: A total of 23,331 hypermethylated and 29,501 hypomethylated DMPs were identified between women with and without GDM, with hypomethylation predominating. Enrichment analyses indicated associations with neurodevelopmental pathways, metabolic processes, immune regulation, and epigenetic modification. Immune deconvolution analysis suggested reduced proportions of CD4 T cells (p < 0.05) and a trend toward decreased NK cells in the GDM group, alongside increased CD8 T cells and neutrophils. Seven CpG sites were selected for model construction and demonstrated strong discriminatory performance within this cohort. CONCLUSION: This exploratory study identifies distinct cord blood DNA methylation patterns associated with GDM in overweight/obese pregnancies. The findings suggest potential links between epigenetic alterations and immune cell composition in GDM-exposed offspring. The identified CpG signature warrants further validation in larger, prospective cohorts to determine its clinical applicability.
Impacts of maternal lipid and homocysteine levels on the risks of pregnancy complications and adverse outcomes in both singleton and twin pregnancies: a population-based observational cohort study.
Meng L, Yang HS, Lu Y … +9 more , Xu Z, Liu L, Han L, Tang G, Wang J, Zhang Y, Zhai Y, Su S, Cao Z
BMC Pregnancy Childbirth · 2026 Jun · PMID 42343310 · Full text
BACKGROUND: In pregnancy, there is a lack of consensus on reference intervals (RIs) of serum lipids and homocysteine (Hcy) to guide clinical intervention. This population-based cohort study aimed to establish trimester-s...
BACKGROUND: In pregnancy, there is a lack of consensus on reference intervals (RIs) of serum lipids and homocysteine (Hcy) to guide clinical intervention. This population-based cohort study aimed to establish trimester-specific reference intervals of serum lipids and Hcy, and to reveal the associations between maternal lipid profiling and adverse outcomes during pregnancy. METHODS: The laboratory test results of Hcy and lipid profile, including total cholesterol (TC), triglycerides (TG), high-density lipoprotein-cholesterol (HDL-C), and low-density lipoprotein-cholesterol (LDL-C), were collected from 29,380 singleton and 840 twin pregnant women who had their regular antenatal check-ups between October 1st, 2017 and September 30th, 2019. The trimester-specific RIs of lipids and Hcy were established using both the nonparametric approach and the indirect Hoffmann method, followed by the outcome logistic association analysis. RESULTS: There was no significant difference between the observed RIs estimated with healthy pregnant women and the calculated RIs derived from the Hoffmann method (all p > 0.05). The maternal Hcy level was positively associated with the risk of preterm birth (PTB)with adjusted OR values ranged from 1.10 (95% CI 0.97-1.24) to 1.48 (95% CI 1.02-2.14) in the first trimester and from 1.63 (95% CI 1.44-1.83) to 3.46 (95% CI 2.65-4.52) in the third trimester, but negatively associated with the risk of gestational diabetes mellitus (GDM)with OR values ranged from 0.70 (95% CI 0.56-0.88) to 0.81 (95% CI 0.62-1.07). High levels of TC, TG, LDL-C and low level of HDL-C were found to be associated with increased risks in GDM, PTB, postpartum hemorrhage(PPH), intrahepatic cholestasis of pregnancy(ICP) (all OR > 1, p < 0.05). CONCLUSIONS: Our study established trimester-specific RIs of serum lipids and Hcy in both singleton and twin pregnancies, which have important clinical and research value for pregnancy health management and adverse outcome prevention.
Omphalocele-exstrophy-imperforate anus-spinal defect syndrome in a monozygotic twin pregnancy: a case report and literature review.
Hu Q, Liao H, Zeng Z … +2 more , Liu H, Yu H
BMC Pregnancy Childbirth · 2026 Jun · PMID 42343288 · Full text
BACKGROUND: The Omphalocele, Exstrophy, Imperforate Anus, and Spinal Defects Complex (OEIS complex) is a rare birth defect with a prevalence of 1 in 200,000-400000 pregnancies and 1 in 82,000-200000 live births. While ca...
BACKGROUND: The Omphalocele, Exstrophy, Imperforate Anus, and Spinal Defects Complex (OEIS complex) is a rare birth defect with a prevalence of 1 in 200,000-400000 pregnancies and 1 in 82,000-200000 live births. While cases in female monozygotic twins have been reported, the perinatal outcomes of the unaffected co-twin remain insufficiently addressed. CASE PRESENTATION: We report a spontaneously conceived monochorionic monoamniotic twin pregnancy where Twin B was diagnosed with OEIS. Prenatal ultrasound at 12 + 4 weeks identified an abdominal cystic mass in Twin B, which enlarged progressively until 20 + 4 weeks (7.0 × 4.7 × 6.2 cm) and then decreased (3.3 × 2.5 × 2.0 cm) at 22 weeks, suggesting cloacal membrane rupture. Further evaluations confirmed OEIS, single umbilical artery, and sacrococcygeal spinal defect in Twin B. At 33 + 6 weeks, the OEIS fetus underwent selective feticide by intrafetal laser therapy after multidisciplinary consultation, and then the caesarean section was performed. The OEIS fetus was weighed 1769 g, with no external genitalia and anus, and presented with a bulging of 3 × 4 cm at the umbilical location. The healthy co-twin (2020 g, Apgar scores 8/9 at 1/5 min) was followed up to 18 months with normal growth and development. METHODS AND RESULTS OF LITERATURE REVIEW: We conducted an extensive literature review (English and Chinese) using keywords including "OEIS syndrome/complex", "twin pregnancy", and "multiple pregnancy", analyzing 20 relevant cases of OEIS in twin pregnancies. CONCLUSIONS: Based on our case and literature review, OEIS complex is more common in monozygotic twins, with no significant gender predilection. In discordant twin pregnancies (only one fetus affected), the co-twin has a high likelihood of survival without malformations, and selective feticide should be considered. Concordant twin pregnancies (both fetuses affected) are associated with poor prognosis.
Assessment of safety and immunogenicity of a protein subunit COVID-19 vaccine (ABDALA) in pregnant women: a single-cohort, multicenter, observational ESPIRTA study.
Estrada JAA, Castrillo IB, Legrá IC … +22 more , Reyes PAD, Blanco MAC, Martínez YC, de la Caridad Preval Calsado Y, Domínguez BE, Argote OF, Quesada YV, Molina YL, Nápoles MS, Rodríguez KA, Martínez ER, Lizano RS, García JES, Valdés MA, Pérez GL, Pelier YR, Palomares GP, Limonta-Fernández M, Ayala-Avila M, de León LAP, González VLM, Espirta Research Group
BMC Pregnancy Childbirth · 2026 Jun · PMID 42343279 · Full text
BACKGROUND: Pregnant and lactating women are generally excluded from clinical trials during vaccine development. While the safety, inmunogenicity, efficacy, and effectiveness of the Abdala vaccine against COVID-19 have b...
BACKGROUND: Pregnant and lactating women are generally excluded from clinical trials during vaccine development. While the safety, inmunogenicity, efficacy, and effectiveness of the Abdala vaccine against COVID-19 have been demonstrated in the general population, there is a lack of specific information regarding its benefits for pregnant women. Consequently, this study was undertaken to evaluate the safety of the Abdala vaccine in pregnant women and their newborns, as well as to assess the maternal immune response elicited by the vaccination and its capacity for passive immunity transfer to the newborn. METHODS: A simple cohort observational multicenter study was conducted across five maternity hospital in Havana City, Cuba. A hybrid approach was employed, integrating both retrospective and prospective data collection methods. The study analyzed all events occurring from the first dose of the Abdala vaccine during pregnancy, delivery, and the postpartum period, as well as those related to the fetus-/neonate. To provide contextual data from our settings as a reference for descriptive analyses, statistical information concerning some pregnancy-related and fetal-neonatal events from the same five maternity hospitals in the year 2020 was utilized (historical data). Immunogenicity analyses were conducted in a subgroup of participants from a single maternity hospital, measuring antibodies against the receptor-binding domain of SARS-CoV-2 (Anti-RBD IgG antibodies) and neutralizing antibodies (Nab) against two SARS-CoV-2 strains (D614G and Omicron B.1.1.529) were measured in both maternal and umbilical cord sera. Additionally, anti-IgA antibodies were evaluated in a colostrum samples. Antibody transfer across the placenta and breast milk was also analyzed. Various comparisons were made regarding gestational age at birth, vaccination trimester, timing from vaccination to delivery, and receipt of a booster dose, among other analyses. A formal sample size estimate was not made. Pregnant women who attended the aforementioned hospitals and met the established criteria were included in the study cohort. Descriptive statistics were utilized to characterize the study population. The Wilcoxon sum rank test was used for most immunological evaluations, while logistic regression analyses estimated the effects of different variables. The correlation between anti-RBD IgG titers in maternal and umbilical cord sera was assessed using Pearson's correlation coefficient. All statistical tests were performed at a significance level of p < 0.05. RESULTS: The study was conducted in five Cuban hospitals from December 2021 to June 2022, involving a total of 940 pregnant women women who received the Abdala vaccine during their pregnancy. The common adverse events reported within the 72 h post-vaccination with the Abdala vaccine were consistent with previous findings using this vaccine in clinical trials and widespread vaccination campaigns in the general population, predominantly presenting as pain at the injection site (4.9%), somnolence (2.6%), and headache (2.3%). All reported events were of mild intensity. In terms of maternal morbidity, the predominant event noted was SARS-CoV-2 infection, with 83 cases (8.83%), primarily categorized as asymptomatic cases or exhibiting mild symptomatic disease. Overall, IgA titers were detected in 202 colostrum samples, with GMT of 1,227 (95% CI 986; 1,527). High anti-RBD IgG titers were found in 189 maternal and 231 umbilical cord blood samples, with GMT of 1,392.15 (95% CI 1,174; 1,651) and 1,923 (95% CI 1,625; 2,275) respectively. The placental transfer ratio (PTR) of anti-RBD IgG titers had a median of 1.54 (IQR 1.48), indicating effective transfer. The PTR of NAb exceeded 1 for both D614G and Omicron (B.1.1.529), being significantly higher in full-term newborns compared to premature newborns. CONCLUSIONS: The ESPIRTA study provides valuable information concerning the application of the Abdala vaccine in specific populations, such as pregnant women, which was not available prior to this study. The safety evaluation of the Abdala vaccine during pregnancy, delivery and the puerperium, as well as in fetus-newborn, revealed no safety signals, as indicated by this cohort study. Elevated anti-RBD IgG titers were detected, in both in maternal serum and cord samples, indicating a positive correlation between them. Moreover, an efficient transfer of IgG antibodies across the placenta was demonstrated. The high anti-IgA titers found in the colostrum may provide an additional advantage regarding the passive transfer of antibodies from mother to newborn through breastfeeding. Furthermore, neutralizing antibodies against two SARS-CoV-2 strains, D614 G and the more recent Omicron B.1.1.529 variant, were identified. Further research is recommended to assess the long-term safety and efficacy of the Abdala vaccine for pregnant women and their newborns.
Intersecting narratives: exploring generational differences in maternal health factors in Vietnamese mothers of children with orofacial clefts.
Nguyen Q, Bridges K, Phuc HK … +1 more , Glenn J
BMC Pregnancy Childbirth · 2026 Jun · PMID 42343267 · Full text
BACKGROUND: This study explores generational differences in maternal health practices among Vietnamese mothers of children with orofacial clefts (OFCs) living in rural communities in Vietnam. Through narrative interviews...
BACKGROUND: This study explores generational differences in maternal health practices among Vietnamese mothers of children with orofacial clefts (OFCs) living in rural communities in Vietnam. Through narrative interviews with 21 mothers and five physicians, it highlights significant gaps in prenatal nutrition knowledge, barriers to diagnostic tools, and the conflict between traditional health practices and contemporary medical advice. METHODS: This study employed a narrative research methodology in combination with minimal semi-structured interviews using a topics guided technique to explore individuals' stories, perceptions, and experiences related to having children with OFCs. Eligibility criteria included Vietnamese mothers aged 45 + years who bore children with OFCs; Vietnamese mothers < 45 years of age who bore children with OFCs; and physicians practicing in Vietnam who provide prenatal care. Participants meeting the criteria were presented with a series of open-ended questions focusing on their folic acid consumption, access to healthcare, physician recommendations, cultural health practices, and the impact of social determinants of health during pregnancy. RESULTS: The research brings together insights from mothers and physicians, highlighting complex issues surrounding maternal health and OFCs. Physicians emphasized the importance of folic acid supplementation and early detection, while mothers revealed challenges stemming from poverty, health literacy gaps, and stigma. CONCLUSIONS: Improving maternal health and shifting perceptions of OFCs requires more than education and awareness. The findings underscore the need for culturally sensitive health education, expanded healthcare access, and strategies addressing social and structural determinants to improve maternal care and reduce OFC prevalence in Vietnam. Public health campaigns targeting pregnant women on the benefits of nutrients like folic acid, calcium, and vitamin A is crucial, but must be developed in collaboration with members or community service organizations based in those communities. The many traditional community practices that are protective of moms and babies must be strengthened while offering science-based guidance to counter traditional beliefs that are harmful. Expanding affordable healthcare access and outreach for low-income families is essential to address barriers and promote better outcomes. TRIAL REGISTRATION: Registerd through the Kansas University Medical Center Institutional Review Board on May 1, 2024. IRB study number STUDY00160310.
Predicting the risk of unplanned cesarean delivery at admission to guide labor process management: a retrospective cohort study in Southwest China.
Yang Z, Zhang H, Zheng Y … +2 more , Chang S, Sun J
BMC Pregnancy Childbirth · 2026 Jun · PMID 42343232 · Full text
BACKGROUND: Following the implementation of the three-child policy in China, an increasing number of pregnant people prefer vaginal delivery over cesarean delivery. However, concerns about unplanned cesarean delivery dur...
BACKGROUND: Following the implementation of the three-child policy in China, an increasing number of pregnant people prefer vaginal delivery over cesarean delivery. However, concerns about unplanned cesarean delivery during labor have increased the demand for a quantitative risk assessment tool. Therefore, developing a prediction model tailored for pregnant Chinese people is essential for assisting clinical decision-making. OBJECTIVE: This study aimed to identify risk factors associated with unplanned cesarean delivery during a trial of labor and to develop a predictive model for determining this risk at admission. METHODS: This single-center retrospective cohort study analyzed 1,532 pregnant people with a term, singleton, cephalic pregnancy without a history of uterine surgery who were admitted for a trial of labor (April-December 2021). Of these, 138 underwent unplanned cesarean delivery and 1,394 achieved vaginal delivery. Predictors were selected via LASSO regression from an initial set of 13 candidate variables and used to build a multivariate logistic nomogram. The model was assessed by its AUC, sensitivity, specificity, accuracy, positive predictive value, negative predictive value and calibration (Hosmer-Lemeshow test). Clinical utility was evaluated via decision curve analysis, and internal validation was conducted via 1,000 bootstrap repetitions. RESULTS: Eight variables were identified as significant predictors of delivery mode: maternal height, maternal BMI, history of vaginal delivery, Bishop score at admission, premature rupture of membranes, gestational age, complications, and estimated fetal weight. The predictive model achieved an AUC of 0.811 (95% CI: 0.774-0.848). The Hosmer-Lemeshow test indicated P = 0.513. Internal validation yielded a mean AUC of 0.804 and a Brier score of 0.071, demonstrating good discrimination and calibration. CONCLUSION: A nomogram-based predictive model was developed to assess the risk of unplanned cesarean delivery during trial of labor. This model provides a quantitative tool to guide clinicians in risk assessment and optimize labor management, potentially reducing complications associated with unplanned cesarean deliveries.
Integrated metabolomic and transcriptomic analysis identifies enhanced phosphatidylcholine metabolism in placenta accreta spectrum.
Liu Z, Liu X, Zhang W … +3 more , Sun C, Ma Y, Wang H
BMC Pregnancy Childbirth · 2026 Jun · PMID 42337473 · Full text
BACKGROUND: Placenta accreta spectrum (PAS) is a serious obstetric complication with limited understanding of its molecular basis. This study investigates metabolic and transcriptomic alterations in PAS placentas to unco...
BACKGROUND: Placenta accreta spectrum (PAS) is a serious obstetric complication with limited understanding of its molecular basis. This study investigates metabolic and transcriptomic alterations in PAS placentas to uncover potential mechanisms and biomarkers. METHODS: Placental tissues from PAS patients (n = 19) and controls (n = 10) underwent untargeted metabolomics via Liquid chromatography-tandem mass spectrometry (LC-MS/MS). Differential metabolites were analyzed for pathway enrichment. RNA sequencing was performed to identify differentially expressed genes (DEGs), followed by Kyoto Encyclopedia of Genes and Genomes (KEGG) and disease ontology enrichment. Integrated metabolomic-transcriptomic analysis was used to identify key metabolic pathways, and findings were validated in an expanded cohort (22 PAS cases, 50 controls). Receiver operating characteristic (ROC) curve analysis was performed to assess the diagnostic performance of Lecithin, phosphate cytidylyltransferase 1 beta (PCYT1B), and their combination for predicting PAS. RESULTS: A total of 203 metabolites were differentially expressed in PAS placentas, with lipid and lipid-like molecules comprising the largest class. Several phosphatidylcholine (PC) species were significantly upregulated, indicating dysregulated glycerophospholipid metabolism. Transcriptome analysis identified 578 DEGs, including upregulation of PCYT1B and endothelial lipase (LIPG), both involved in lipid metabolism. Enrichment analysis revealed activation of glycerolipid and glycosphingolipid pathways and the potential involvement with metabolic disorders. Integrated analysis highlighted enhanced phosphatidylcholine biosynthesis, supported by elevated PCYT1B expression and increased total PC levels in PAS placentas. Lecithin showed higher sensitivity but lower specificity, while PCYT1B displayed intermediate performance. Their combination yielded the best discrimination with an area under the curve (AUC) of 0.791 (95% CI: 0.684-0.899). CONCLUSIONS: PAS is characterized by significant alterations in lipid metabolism, particularly increased phosphatidylcholine biosynthesis via the Kennedy pathway. These findings provide new insights into the molecular pathogenesis of PAS and suggest potential metabolic targets for early diagnosis or intervention.
Pain catastrophizing and its associated factors among puerperal women with vaginal birth : a cross-sectional study.
Yang Y, Zuo H, Wu M … +2 more , Luo B, Yang J
BMC Pregnancy Childbirth · 2026 Jun · PMID 42337469 · Full text
OBJECTIVES: To investigate the prevalence of pain catastrophizing among women with vaginal birth and explore its associated factors. METHODS: In this cross-sectional study, a total of 282 participants who met the inclusi...
OBJECTIVES: To investigate the prevalence of pain catastrophizing among women with vaginal birth and explore its associated factors. METHODS: In this cross-sectional study, a total of 282 participants who met the inclusion and exclusion criteria were selected by convenience sampling from Delivery Room Ward of a hospital in Sichuan Province. Pain Catastrophizing Scale, Pain Numerical Rating Scale, Social Support Rating Scale, Hospital Anxiety and Depression Scale, Pain Self-Efficacy Scale and general information questionnaire were used to assess pain catastrophizing (PC), pain intensity, social support, anxiety, depressive symptoms, pain self-efficacy and sociodemographic information of the participants, respectively. Data were collected in two stages: latent period of the first stage of labor (T1) and the second stage of labor (T2). According to the distribution and type of the data, the mean and standard deviation (SD), median and quartiles, frequency and percentages were used for statistical description. The generalized estimating equation (GEE) was used to analyze the associated factors of pain catastrophizing. Crossed-lagged regression was used to explore the relationship between pain intensity and pain catastrophizing. RESULTS: The median and quartiles of PCS scores at T1 and T2 were 30.00 (21.00, 39.00) and 27.00 (17.00, 40.00) among the participants, respectively. The prevalence of pain catastrophizing at T1 and T2 was 29.08% and 29.43%, respectively. Chi-square test showed that the prevalence of pain catastrophizing at T2 was higher than that at T1 (χ = 55.387, p<0.001). GEE showed that greater gestational week, greater pain intensity at T1 and T2, and depressive symptoms were potential risk factors of pain catastrophizing (p<0.05), and a higher level of pain self-efficacy was a protective factor of pain catastrophizing among the participants [OR = 0.967, p<0.001]. Compared accompanied by husband, maternities accompanied by others during childbirth were more likely to be pain catastrophic [OR = 0.282, p = 0.010]. The results of cross-lagged analysis showed maternal pain intensity was positively correlated with pain catastrophizing at both T1 (r = 0.357, P < 0.001) and T2(r = 0.603, p < 0.001). There was no correlation between pain catastriphizing at T1 and pain intensity at T2, or pain intensity at T1 and pain catastriphizing at T2. As shown in Fig. 2. CONCLUSIONS: There is a high prevalence of pain catastrophizing in women with natural childbirth. Associated factors of pain catastrophizing among women with natural childbirth are multidimensional, including physiological (pain intensity), psychological (gestational age, anxiety, depressive symptoms, pain self-efficacy) and socio-demographic factors (accompanying family members during delivery), suggesting that early evaluation of mental health condition of pregant women should be implemented and targeted interventions should be taken even if during pregnancy by health care workers. During labour, close attention should be paid to the mother's recognition of pain and appropriate measures taken promptly to prevent the occurrence of pain catastrophizing.
Screening tools and programmes for intimate partner violence in antenatal and postpartum healthcare across Europe: a scoping review with quality assessment.
Normann AK, Paradiso MN, Brülle AL … +7 more , Garzon S, Andreasen K, Donisi V, Piccolo LD, Manfredi P, Jørgensen JS, Linde DS
BMC Pregnancy Childbirth · 2026 Jun · PMID 42337467 · Full text
BACKGROUND: Intimate partner violence (IPV) during pregnancy causes serious harm to both the mother and the child. The magnitude of the problem is likely underestimated due to the sensitive nature of the topic and lack o...
BACKGROUND: Intimate partner violence (IPV) during pregnancy causes serious harm to both the mother and the child. The magnitude of the problem is likely underestimated due to the sensitive nature of the topic and lack of consensus on screening practices, including frequency, tools, and whether screening should be systematic or risk-based. This scoping review aimed to map existing screening tools and healthcare-based screening programmes for detecting IPV in European countries within antenatal and postpartum care. METHODS: Joanna Briggs Institute methodology was used and reported following PRISMA-ScR guidelines. Seven databases (Embase, PsycINFO, SocINDEX, PubMed, Web of Science, Scopus, and CINAHL) were searched up to June 2025 to identify screening tools used in European countries. A quality assessment was conducted. To identify current screening programmes within antenatal and postpartum healthcare systems, representatives from 46 European countries were consulted. RESULTS: Twenty-four studies were included, and methodological quality ranged from low to serious risk of bias. Thirteen screening tools for physical, emotional, and sexual IPV were identified. No tools for stalking or digital violence were found. Most studies were cross-sectional. Data were received from 22 of 46 European countries (48%) regarding screening programmes in antenatal or post-partum care: 17 countries have screening programmes, while five reported none. The Abuse Assessment Screen (AAS) and the Woman Abuse Screening Tool (WAST) were the tools most commonly used in both the literature and screening programmes. Most countries with screening program recommendations, recommended a universal screening approach. CONCLUSION: Screening tools and practices for detecting IPV during antenatal and post-partum care vary substantially across Europe, highlighting a lack of evidence and consensus on screening tools for IPV within antenatal and postpartum care.
"We sometimes stress our own wives": perspectives on maternal mental health and emotional support among mothers, fathers, nurses, and community health workers in Western Kenya.
Dieteren CM, Katuwal S, De Sanctis T … +6 more , Waiyaiya E, Wairimu RN, Otieno M, Tol W, Sidze EM, Janssens W
BMC Pregnancy Childbirth · 2026 Jun · PMID 42337464 · Full text
BACKGROUND: In low- and middle-income countries (LMICs), maternal mental health (MMH) during and after pregnancy is often neglected despite ongoing global efforts to reduce maternal mortality and morbidity. The complex n...
BACKGROUND: In low- and middle-income countries (LMICs), maternal mental health (MMH) during and after pregnancy is often neglected despite ongoing global efforts to reduce maternal mortality and morbidity. The complex nature of MMH problems and the stigma surrounding them require a thorough understanding of the perspectives of the different parties involved. Hence, we assessed the drivers of MMH problems, challenges in seeking help, and perceptions towards emotional and psychological support for pregnant women among four stakeholder groups in Western Kenya. METHODOLOGY: A qualitative approach was taken to examine the perspectives towards MMH among mothers, fathers, nurses and community health workers (CHWs). Focus Group Discussions (FGDs) were organized among the four groups. Participants were drawn from three hospitals in Kisumu County, Western Kenya. The socio-ecological model for health behavior structured the analyses, with an initial deductive approach. The identification of specific themes within each level was conducted inductively. Additionally, suggestions for locally acceptable MMH care were collected. RESULTS: In total, ten FGDs were held with 73 participants. We found a large level of consensus among stakeholders regarding common causes, consequences and coping strategies for MMH challenges, such as poverty, stigma, intimate partner violence and a lack of social support. In contrast to mothers, fathers also highlighted domestic disputes stemming from disagreements over (resuming) sexual activity. Nurses predominantly mentioned medical consequences of MMH challenges, while CHWs had a more holistic perspective. Participants expressed a need and made recommendations for contextualized MMH care, particularly for a group-based intervention led by CHWs with partner involvement. CONCLUSIONS: The findings show that there is a need for MMH support in rural, low-resource settings. Mothers and CHWs showed a high level of convergence illustrating the importance of the liaison function of the CHWs between the nurses and mothers. Group-based MMH care was perceived as suitable by all stakeholders. The results of this study guided the design of an MMH intervention that was tested for feasibility and acceptability in the same setting.
Knowledge, attitude and practice of labor neuraxial analgesia in pregnant women and their partners: a cross-sectional survey in China.
Du M, Zhong L, Hu P … +6 more , Huang M, Wu S, Dai H, Zhang Z, Han Z, Wu L
BMC Pregnancy Childbirth · 2026 Jun · PMID 42337452 · Full text
BACKGROUND: Labor neuraxial analgesia (NA) is considered the gold standard for labor pain management worldwide, yet its use remains low in China. This study aimed to evaluate the barriers and facilitators regarding the u...
BACKGROUND: Labor neuraxial analgesia (NA) is considered the gold standard for labor pain management worldwide, yet its use remains low in China. This study aimed to evaluate the barriers and facilitators regarding the use of NA from the perspectives of pregnant women and their partners. METHODS: A cross-sectional survey using a knowledge-attitude-practice (KAP) questionnaire was conducted in 13 hospitals from April to December 2022. A total of 1,164 pairs of pregnant women and their partners attending prenatal care clinics were recruited using a convenience sampling technique. Data were analyzed using univariate analysis and multivariable linear regression. RESULTS: Both pregnant women and their partners exhibited a lack of knowledge about NA, and online information and communicating with others were the primary ways to learn about NA. Multivariable regression indicated education level (B = 1.33, 95% confidence interval [CI]: 0.94-1.73), gestational age (B = 1.29, 95% CI: 0.96-1.63), hospital level 2 (B = 1.73, 95% CI: 0.73-2.73), level 3 (B = 2.11, 95% CI: 1.25-2.97), and parity (B = 1.32, 95% CI: 0.68-1.97) influenced pregnant women's knowledge. Similarly, education level (B = 1.04, 95% CI: 0.66-1.42) and gestational age (B = 0.68, 95% CI:0.33-1.03) were positively associated with their partners' knowledge. For pregnant women, annual income (B = 1.39, 95% CI: 0.72-2.05) and parity (B = -1.43, 95% CI: -2.71- -0.15) affected attitudes, while gestational age (B = 0.67, 95% CI: 0.23-1.11), annual income (B = 1.18, 95% CI: 0.57-1.79) and parity (B = -1.43, 95% CI: -2.61- -0.26) affected in practice. For partners, hospital level and age positively influenced attitudes and practice towards NA. Most concerns regarding NA were attributed to inadequate awareness and misconception about the safety of NA. CONCLUSIONS: Knowledge regarding NA was found to be inadequate among both pregnant women and their partners, while annual income, parity, hospital level and age were the influencing factors regarding attitudes and practice. Online hospital-based educational programs incorporating tailored information about NA could potentially improve the decision-making process of NA in China.
The quintessential high-risk profile: advanced management strategies for placenta accreta spectrum in patients with advanced maternal age and IVF conception.
Waseem S, Zeng S, Xiao X … +4 more , Han L, Zhao H, Zhan J, Bai P
BMC Pregnancy Childbirth · 2026 Jun · PMID 42337440 · Full text
BACKGROUND: The convergence of Advanced Maternal Age (AMA ≥ 35), In Vitro Fertilization (IVF) conception, and Placenta Accreta Spectrum (PAS) represents a clinical nexus of potentially elevated obstetric risk, hypothetic...
BACKGROUND: The convergence of Advanced Maternal Age (AMA ≥ 35), In Vitro Fertilization (IVF) conception, and Placenta Accreta Spectrum (PAS) represents a clinical nexus of potentially elevated obstetric risk, hypothetically associated with a high probability of massive peripartum hemorrhage (MPH). Based on limited observational evidence, this case-based narrative review hypothesizes that this risk profile warrants protocol-driven management considerations, which are presented as hypothesis-generating rather than definitive. CASE PRESENTATION: A 54-year-old gravida 4, para 2 (2 living children) with an IVF-conceived twin pregnancy and two prior cesarean deliveries presented at 34 1/7 weeks with catastrophic hemorrhage. Prenatal MRI confirmed placenta percreta. During a planned, coordinated admission for delivery, the patient experienced acute hemorrhage, prompting an emergency classical cesarean hysterectomy with partial cystectomy. This was performed by a multidisciplinary team employing a comprehensive hemostatic strategy including prophylactic arterial balloon occlusion, tranexamic acid, intraoperative cell salvage, and a massive transfusion protocol. Estimated blood loss was 4,500 mL. Both neonates required NICU admission but were discharged in stable condition. CONCLUSIONS: Based on this single case and the available observational literature (summarized in Supplementary Tables S1-S7), we hypothesize that this case exemplifies a potential the compounded pathophysiology that may amplify morbidity in the AMA/IVF/prior uterine scar risk profile. While the management principles discussed are derived from limited evidence and should be considered hypothesis-generating, they may inform care for similar high-risk patients. We suggest that effective management may include: 1)Aggressive prenatal diagnosis with early MRI where available; 2) Consideration of delivery at a Level IV center with a multidisciplinary team; and 3) Implementation of a proactive Patient Blood Management plan. These suggestions derive from limited evidence and require prospective validation.
First-trimester plasma targeted metabolomics for eicosanoids reveals predictive potential and preventive targets for severe preeclampsia: a nested case-control study.
Ma Y, Li L, Fang Y … +12 more , Cai W, Yang J, Zhang L, Zuo L, Niu X, Chen S, Yang Q, Yu Y, Han C, Cong H, Zhang X, Zhou X
BMC Pregnancy Childbirth · 2026 Jun · PMID 42332673 · Full text
BACKGROUND: Eicosanoids are a diverse family of oxygenated derivatives of 20-carbon polyunsaturated fatty acids that play crucial roles in maintaining cardiovascular homeostasis. The metabolic profiles of eicosanoids pre...
BACKGROUND: Eicosanoids are a diverse family of oxygenated derivatives of 20-carbon polyunsaturated fatty acids that play crucial roles in maintaining cardiovascular homeostasis. The metabolic profiles of eicosanoids preceding the onset of severe preeclampsia remain incompletely understood. This study aimed to use a targeted metabolomic approach to identify eicosanoid metabolites in first-trimester blood samples and assess their potential to predict severe preeclampsia. METHODS: Within a prospective cohort of 5,809 pregnant women, a nested case-control study analyzed 45 participants who later developed severe preeclampsia and 41 controls with uncomplicated pregnancies. Targeted metabolomic analysis was performed using Ultra-Performance Liquid Chromatography-Tandem Mass Spectrometry (UPLC-MS/MS). Metabolomic data were examined, and predictive performance of these metabolites was evaluated using receiver operating characteristic curves. RESULTS: Among 40 eicosanoids metabolites quantified, 10 metabolites differed statistically between the severe preeclampsia and control groups. Specifically, metabolites in the cyclooxygenase (COX) pathway, such as thromboxane B2 (TXB2), and the 12/15-lipoxygenase (LOX) pathway, such as 14-hydroxy-docosahexaenoic acid (14-HDoHE), were significantly upregulated in the severe preeclampsia group. Conversely, metabolites in the cytochrome P450 (CYP450) pathway, notably 19,20-epoxy-docosapentaenoic acid (19,20-EDP), were significantly downregulated. The 14-HDoHE/19,20-EDP ratio was identified as the most significant predictive marker. Integrating this ratio into the Fetal Medicine Foundation (FMF) screening algorithms significantly improved the area under the curve (AUC) from 0.77 to 0.87 (ΔAUC = 0.10, 95% confidence interval [CI]: 0.03-0.18, P = 0.008). This combined model demonstrated a sensitivity of 0.73 (95% CI: 0.60-0.86) and a specificity of 0.85 (95% CI: 0.75-0.96). CONCLUSIONS: Our findings revealed novel prediction models for severe preeclampsia based on first-trimester eicosanoid metabolomics, and provide mechanistic evidence supporting early aspirin use for COX pathway inhibition and suggest that rebalancing the 12/15-LOX and CYP450 pathways may be a potential strategy for preventing severe preeclampsia. TRIAL REGISTRATION: Chinese Clinical Trial Registry Identifier ChiCTR-EOC-15007644, registered on 03 December 2015.
Assessing the impact of indication for labor induction on delivery outcomes: a five-year cohort study.
Kruit H, Gissler M, Rahkonen L
BMC Pregnancy Childbirth · 2026 Jun · PMID 42332655 · Full text
INTRODUCTION: As the rate of induction of labor (IOL) is steadily increasing with the increasing rates of maternal age and obesity, having consequences on perinatal morbidity, health economics, and maternal childbirth ex...
INTRODUCTION: As the rate of induction of labor (IOL) is steadily increasing with the increasing rates of maternal age and obesity, having consequences on perinatal morbidity, health economics, and maternal childbirth experience, evidence for decision making should be available related to the indications. This study investigates the association of IOL indications with the delivery outcomes and provides clinicians with valuable information to weigh the benefits and potential risks associated with IOL. MATERIALS AND METHODS: This retrospective five-year cohort study was conducted in Helsinki University Hospital between 2017 and 2021. A total of 16 377 pregnant women undergoing IOL ≥ 37 gestational weeks with a live singleton fetus in cephalic presentation were included. The primary outcome measures were the rates of cesarean delivery (CD) and composite adverse neonatal outcome (including one or more of the following: perinatal death, neonatal intensive care admission, umbilical artery blood pH value ≤ 7.05, base excess value <-12, and 5-minute Apgar score 0-6). RESULTS: The study population consisted of 16 377 women. The most common indications for IOL were post-term pregnancy (31.3%) and pre-labor rupture of membranes (PROM) (26.3%). Overall, the CD rate was 20.3%, and the incidence of composite adverse neonatal outcome was 12.7%. Delivery outcomes varied according to the indication for induction. The highest CD rate of 27.9% was observed among women induced for hypertensive disorders (adjusted OR 1.6, 95% CI 1.4-1.8), whereas inductions for maternal exhaustion were associated with the lowest CD rate. Composite adverse neonatal outcomes were most frequent (19.1%, n = 179) following induction for fetal indications and least frequent (7.4%, n = 42) among women induced because of fear of childbirth. In analyses, performed separately for each IOL indication, nulliparity, unfavorable cervix, maternal age ≥ 35 years, maternal height < 164 cm, and pre-pregnancy BMI ≥ 30 remained independent risk-factors for CD. CONCLUSIONS: The indication for IOL is associated with both CD and adverse neonatal outcomes. While indication-specific differences should be considered when counseling women and planning induction, maternal characteristics and parity remain important determinants of CD risk. These findings may support individualized clinical decision-making regarding IOL.
Depression in mothers at four weeks and twenty-four weeks postpartum: a study on the prevalence and selected risk factors in Sri Lanka.
Aththanayaka ALDM, de Zoysa P
BMC Pregnancy Childbirth · 2026 Jun · PMID 42332650 · Full text
BACKGROUND: Although Sri Lanka has shown a significant improvement in maternal health care indicators during the past few decades, PPD could be identified as a significant public health concern. The main purpose of the c...
BACKGROUND: Although Sri Lanka has shown a significant improvement in maternal health care indicators during the past few decades, PPD could be identified as a significant public health concern. The main purpose of the current study was to assess the most recent status of PPD in Sri Lanka in relation to its prevalence and selected risk factors. METHODS: A population-based quantitative study was conducted among 401 mothers from 18 maternal clinics in the Colombo district, Sri Lanka. The cross-culturally validated Sinhala translation of the Edinburgh Postnatal Depression Scale (EPDS), with a cut-off score of nine or more, was used to estimate the prevalence of PPD. Two questionnaires were designed specifically for the present study to collect data on sociodemographic factors and to extract data from the pregnancy record card. RESULTS: The prevalence of postpartum depression (PPD) was 29.2% (95% CI 21.6-36.8) at four weeks postpartum and 18.0% (95% CI 13.2-22.8) at twenty-four weeks postpartum. Multivariable analysis identified maternal age 20-24 years (AOR 9.1, 95% CI 1.5-57.2, p < 0.05), age 25-34 years (AOR 2.8, 95% CI 1.3-6.4, p < 0.05), having three children (AOR 7.9, 95% CI 0.4-44.7, p < 0.05), maternal education at Ordinary Level (AOR 4.9, 95% CI 1.2-21.0, p < 0.05), maternal history of psychiatric illness (AOR 1.31, 95% CI 1.12-1.55, p < 0.01), and abnormalities in the baby (AOR 3.7, 95% CI 1.5-9.1, p < 0.01) as factors significantly associated with PPD. In contrast, higher paternal education (AOR 0.3, 95% CI 0.1-0.8, p < 0.05) and was associated with lower odds of PPD. Mothers who did not attend prenatal care sessions had markedly higher odds of PPD (AOR 38.1, 95% CI 6.5-222.3, p < 0.001). CONCLUSION: This study indicates that PPD is highly prevalent among mothers residing in the Colombo district of Sri Lanka. Screening mothers for PPD at various postpartum periods and a multidisciplinary team approach could be introduced to better manage this condition.
Psychometric properties of the weight self-stigma questionnaire and weight bias internalization scale in postpartum women.
Pan T, Peng J, Tan X … +1 more , Sun M
BMC Pregnancy Childbirth · 2026 Jun · PMID 42332646 · Full text
BACKGROUND: Weight stigma internalization among postpartum women may differ from other populations owing to childbirth, breastfeeding, and postnatal physical recovery. Two instruments to assess the concept of weight stig...
BACKGROUND: Weight stigma internalization among postpartum women may differ from other populations owing to childbirth, breastfeeding, and postnatal physical recovery. Two instruments to assess the concept of weight stigma internalization-the Weight Self-Stigma Questionnaire (WSSQ) and the Weight Bias Internalization Scale (WBIS)-have not been validated in postpartum women. This study aims to evaluate and compare the reliability, factor structure, and concurrent validity between the WBIS and WSSQ in Chinese postpartum women. METHODS: A total of 476 postpartum women (mean age 30.96 ± 4.67 years) completed the WSSQ and WBIS, as well as other relevant measures regarding perceived weight stigma, psychological outcomes, and eating behaviors. Height and weight were used to calculate the body mass index (BMI). Statistical analyses were performed using internal consistency analysis, confirmatory factor analysis, and correlation analysis. RESULTS: Both the WSSQ and the WBIS were found to have excellent internal consistency. In addition, both were associated with postpartum BMI, perceived weight stigma, adverse psychological outcomes, and restrained and emotional eating behaviors. Differently, the two-factor structure of the WSSQ was supported among postpartum women, but the one-factor WBIS was not. CONCLUSION: The WSSQ is a reliable and valid measurement tool for assessing weight stigma internalization in postpartum women. The structure of WBIS requires further validation and modification in future research.
"Actionable" risk for preterm birth: patterns and prediction in California singleton births 2016-2020.
Jelliffe-Pawlowski LL, Baer RJ, Oltman S … +20 more , McKenzie-Sampson S, Adeyemi D, Becker A, Blackman KCA, Blebu B, Brandt JS, Flowers E, Gossett DR, Hanselman EC, Hernandez S, Liang L, Lyndon A, Momany AM, Rogers EE, Ryckman KK, Swander LM, Tabb KM, Taylor KD, Wiggins SL, Subramaniam A
BMC Pregnancy Childbirth · 2026 Jun · PMID 42332637 · Full text
BACKGROUND: Preterm birth (PTB, < 37 weeks of gestation) is the leading cause of child mortality in the United States (U.S.) and worldwide, and has substantial short- and long-term health consequences for mothers and inf...
BACKGROUND: Preterm birth (PTB, < 37 weeks of gestation) is the leading cause of child mortality in the United States (U.S.) and worldwide, and has substantial short- and long-term health consequences for mothers and infants. Each year, > 350,000 infants in the U.S. are born preterm, and rates continue to rise in parallel with maternal risk factors such as hypertension, diabetes, anemia, asthma, and mental health conditions. Evidence-based interventions exist for many of these conditions and are associated with improved pregnancy outcomes, including low-dose aspirin for preeclampsia prevention in individuals with chronic hypertension or pregestational diabetes, inhalers for asthma, iron for anemia, and therapy or medication for mental health disorders, but fewer than half of eligible individuals receive them, reflecting persistent gaps in use. To address this, we developed the PTB Actionable Risk Index (PTB-ARIx), which leverages factors with known evidence-based interventions to identify individuals who are pregnant and are at increased risk for PTB. This study evaluates performance of the PTB-ARIx throughout pregnancy with respect to risk determination and characterization of actionable risk factors, including their combined contributions to PTB. METHODS: A retrospective cohort study was conducted using linked data for 1.9 million singleton live births in California in 2016-2020, divided into training and testing sets. Poisson regression estimated associations between 18 candidate risk factors for PTB with evidence-based interventions spanning clinical, behavioral, and social risks, including preeclampsia risk composites (≥ 1 high-risk or ≥ 2 moderate-risk factors based on U.S. Preventive Services Task Force (USPSTF) criteria), maternal conditions (e.g., gestational hypertension, asthma), substance use, and social adversity. Beta coefficients were combined to construct the PTB-ARIx, evaluated by per-unit associations with PTB and by area under the receiver operating characteristic curve (AUC) overall, by early (< 32 weeks), late (32-36 weeks), spontaneous, and medically-indicated PTB, and by PTB co-occurring with preeclampsia. FINDINGS: All risk factors were found to be associated with increased PTB risk. Having ≥ 1 high-risk or ≥ 2 moderate-risk factors for preeclampsia (based on composites) was most strongly related to PTB (relative risk (RR) 6.73, 95% confidence interval (CI) 6.57, 6.89). Each unit increase in PTB-ARIx was associated with > 60% higher PTB risk (RRs 1.66-1.72) across training and testing samples, with consistent findings across PTB and race/ethnicity-insurance subgroups. Model performance was modest for late PTB (AUC ≈ 0.63), stronger for early PTB (0.69-0.72), and especially high for early PTB with preeclampsia (AUCs up to 0.97). Over 70% of individuals with PTB-ARIx scores ≥ 3.00 experienced PTB or another adverse outcome such as low birth weight (< 2,500 grams). CONCLUSIONS: The PTB-ARIx is a well-performing metric for identifying individuals at increased risk for PTB and other adverse pregnancy outcomes. By centering on modifiable risks, the PTB-ARIx combines risk identification with opportunities for intervention. Demonstrating strong performance across subgroups, including for early PTB and PTB with preeclampsia, the PTB-ARIx provides a potential pathway to improve patient-provider communication and uptake of equitable, evidence-based care. Further validation, including integration with treatment data, is needed to confirm its potential to reduce PTB risk and rates.
Exploring the optimal GDM management in twin pregnancies-Comment on Obstetric and neonatal outcomes in the management of twin pregnancies with gestational diabetes using the IADPSG criteria for singleton pregnancies.
Shu X, Yao M, Li C … +1 more , Yang H
BMC Pregnancy Childbirth · 2026 Jun · PMID 42332617 · Full text
Abstract loading — click title to view on PubMed.
A predictive model for high-quality blastocyst formation using Day 3 morphological scores in women of advanced maternal age.
Zheng T, Chen N, Wang X … +2 more , Guo J, Ye H
BMC Pregnancy Childbirth · 2026 Jun · PMID 42332613 · Full text
OBJECTIVE: To develop and validate a simple predictive model based on Day 3 embryo morphology to guide blastocyst culture strategy and optimize transfer outcomes for women of advanced maternal age (AMA). METHODS: This re...
OBJECTIVE: To develop and validate a simple predictive model based on Day 3 embryo morphology to guide blastocyst culture strategy and optimize transfer outcomes for women of advanced maternal age (AMA). METHODS: This retrospective study analyzed a total of 6840 cleavage-stage embryos from 1102 fresh oocyte retrieval cycles with subsequent blastocyst culture in AMA patients. Key parameters including the number of oocytes retrieved, Day 2 and Day 3 cell numbers, embryo fragmentation, embryo grade, and the number of high-quality Day 3 embryos were assessed. Their associations with the blastocyst formation rate (BR), high-quality blastocyst formation rate (HBR) and clinical outcomes were evaluated. RESULTS: Logistic regression identified the number of high-quality Day 3 embryos as a pivotal independent predictor. A threshold of ≥ 4 high-quality embryos was established. For cycles meeting this criterion, the risk of having no Day 5 transferable blastocyst was 19.30%. Within this group, Day 5 blastocyst transfer was associated with significantly higher clinical pregnancy and live birth rates, a lower multiple pregnancy rate, and improved neonatal outcomes (higher gestational age and birth weight) compared to Day 3 cleavage-stage transfer. The threshold showed good predictive performance in a temporally separated validation cohort (AUC 0.91). CONCLUSION: In AMA patients, a threshold of ≥ 4 high-quality Day 3 embryos may serve as a practical, low-cost criterion to guide blastocyst culture and elective single blastocyst transfer. The approach is associated with favorable clinical and neonatal outcomes but requires prospective validation in unselected populations.
A comparative analysis of fetal mirror-image dextrocardia in China pre- and post-COVID-19 lockdown lifting.
Xu W, Wei Y, Gao X … +9 more , Yang X, Gao J, He S, Huo H, Qiao M, Dong X, Chen W, Zhao E, Liu B
BMC Pregnancy Childbirth · 2026 Jun · PMID 42332612 · Full text
OBJECTIVE: To analyze the epidemiological characteristics and incidence of mirror-image dextrocardia in pregnant women and fetuses before and after the lifting of coronavirus disease (COVID-19) control measures in China...
OBJECTIVE: To analyze the epidemiological characteristics and incidence of mirror-image dextrocardia in pregnant women and fetuses before and after the lifting of coronavirus disease (COVID-19) control measures in China on December 7, 2022. METHODS: We retrospectively collected data on the number of pregnant women who underwent prenatal ultrasound examinations and incidence of mirror-image dextrocardia in fetuses at three hospitals in Xi'an during three time periods: before the COVID-19 pandemic (January to April 2019), during the COVID-19 control measures (January to April 2022), and after the lifting of COVID-19 restrictions (January to April 2023). We then conducted an online epidemiological survey among pregnant women across China and collected the names of pregnant women with fetal mirror dextrocardia, as well as the following clinical information: age, location (province and city), gestational week at which mirror-image dextrocardia was detected, last menstrual period date, date of first pregnancy diagnosis, obstetric history, conception method, estimated due date, ultrasound diagnosis result, and genetic testing result. COVID-19-related information was also recorded. RESULTS: Between January and April 2019 (pre-pandemic), 9,112 pregnant women underwent prenatal ultrasound examinations at 3 hospitals in Xi'an. Between January and April 2022 (COVID-19 control measures period), 11,071 pregnant women underwent prenatal ultrasound examinations, and 1 case of fetus with mirror-image dextrocardia was identified (incidence rate, 0.9/10,000). Between January and April 2023 (after the lifting of COVID-19 restrictions), 11,516 pregnant women underwent prenatal ultrasound examinations, and 21 fetuses with mirror-image dextrocardia were detected, with an alarming incidence rate of 18.2/10,000. After the lifting of COVID-19 restrictions, the incidence of mirror-image dextrocardia in fetuses in Xi'an showed a significant increase (8-20-fold higher) compared to that observed in both the pre-pandemic and strictly controlled pandemic periods. An online investigation showed that 111 cases of fetal mirror-image dextrocardia were detected in 22 other provinces of China after the lifting of COVID-19 restrictions. All pregnant women with fetal mirror-image dextrocardia had a history of SARS-CoV-2 infection after the lifting of COVID-19 restrictions, which coincided with the early stages of embryo development, approximately 4-6 weeks after their last menstrual period. CONCLUSIONS: Our data showed that the increase in cases of fetal situs solitus with dextrocardia coincided temporally with the outbreak of COVID-19 in China. This temporal overlap may suggest a potential association between the two events.
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