2026年 · 第08卷第01期

Objective: To evaluate the effectiveness of prophylactic tranexamic acid in reducing postpartum hemorrhage (PPH) in high-risk populations, specifically pregnant women with placenta previa, by conducting multicenter randomized controlled trials with sufficient statistical power, in order to establish high-quality evidence for its widespread use in PPH prevention. Methods: This multicenter randomized, double-blind, placeto-controlled trial with two parallel groups will enroll 1680 patients undergoing cesarean delivery with placenta previa. Participants will be randomly assigned to receive either tranexamic acid (1 g) or placebo intravenously immediately after birth. The primary outcome will be the incidence of PPH, defined as a calculated estimated blood loss exceeding 1000 mL or the need for red blood cell transfusion before postpartum day 2. With 80% statistical power, this study aims to detect a 20% reduction in the incidence of PPH, from 33.0% to 26.4%. Discussion: Tranexamic acid is a cost-effective and easily accessible medication that shows promise in reducing the risk of PPH during cesarean delivery in high-risk patients, such as those with placenta previa. This large-scale, adequately powered, multicenter randomized placebo-controlled trial is designed to determine whether the routine prophylactic use of tranexamic acid during cesarean delivery in patients with placenta previa will offer clinical benefits that outweigh the associated risks. Trial registration: ClinicalTrials.gov NCT05811676 (March 15, 2023).

Objective: To investigate whether coronavirus disease 2019 (COVID-19) infection increases the risk of gestational diabetes mellitus (GDM) in pregnant women and to assess whether this risk persists beyond the acute phase of infection. Methods: A retrospective cohort study was conducted at Peking University First Hospital between January and February 2023, enrolling pregnant women who contracted COVID-19 between 16 and 32 weeks of gestation. The primary exposure was the time interval between the oral glucose tolerance test (OGTT) and the onset of COVID-19 infection. The primary outcome was the diagnosis of GDM based on OGTT results. A locally weighted scatterplot smoothing method was applied to visualize trends, and logistic regression was used to estimate odds ratios (ORs). Results: The incidence of GDM increased from 23.1% (18/78) in women who underwent OGTT before COVID-19 infection to 36.6% (37/101) in those tested after infection (P = 0.051). All OGTT values were elevated post-infection, with postprandial glucose levels showing the most pronounced rise. As the time since infection increased, OGTT values gradually normalized. The elevated risk of GDM decreased over time: OR for 1–2 weeks post-infection was 3.58 (95% confidence interval: 1.27–10.23); 3–4 weeks: 2.47 (1.04–5.94); 5–6 weeks: 1.45 (0.44–4.41); and 7–8 weeks: 0.41 (0.08–1.55). Conclusion: COVID-19 infection was associated with a transiently increased risk of GDM, particularly within the first month following symptom onset, suggesting that the infection may have a short-term impact on glucose metabolism during pregnancy.

Objective: To assess the association between delayed fusion of the amniotic and chorion diagnosed at 16 weeks of gestation and maternal-fetal outcomes. Methods: This prospective cohort study was conducted at Tianjin Central Hospital of Gynaecology Obsterics, China, from February 2022 to March 2024. A total of 331 singleton pregnant women with low risk of fetal chromosomal abnormalities were enrolled. Ultrasound examinations at 16 weeks’ gestation identified cases of delayed fusion of amnion and chorion. Maternal and fetal outcomes were compared between the delayed fusion group and the timely fusion group. Results: Delayed fusion occurred in 28.00% (91/325) of cases. Post-delivery fetal membrane histopathology revealed no structural abnormalities attributable to delayed fusion. No significant differences were observed in maternal complications (gestational diabetes mellitus, hypertensive disorders, obesity, anemia) and 5-minute Apgar scores between groups. In addition, miscarriage rates were unaffected by delayed fusion. Notably, the delayed fusion group had a significantly higher incidence of preterm births (8.79% (8/91) vs. 2.56% (6/234), P = 0.028). After adjustment for confounders, infants in the delayed fusion group had a significantly lower mean birth weight (172.05 g less) than those in the timely fusion group. Conclusion: Delayed fusion at 16 weeks did not alter fetal membrane structure after delivery and was not associated with most maternal or neonatal complications in this cohort. However, it may be an independent risk factor for preterm birth and reduced birth weight, warranting further investigation.

Objective: To determine whether rheumatoid arthritis (RA) contributes to the increased risk of preeclampsia (PE) and to identify potential underlying biological mechanisms. Methods: We performed an integrated bidirectional two-sample Mendelian randomization (MR) and transcriptomic analysis to elucidate the potential relationship between RA and PE. Instrumental variables (IVs) were selected from large-scale GWAS summary datasets from openGWAS and FinnGen databases. Primary analysis used inverse-variance weighted (IVW) method, supplemented by MR-Egger and weighted median. The odds ratio (OR) and 95% confidence interval (CI) were used to evaluate the causal effect of the exposure on the outcome. Transcriptomic profiling of disease-relevant tissues (RA synovium and PE placenta from GEO datasets) identified shared differentially expressed genes (DEGs), which were subsequently characterized through Gene Ontology (GO) enrichment, Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis, and protein-protein interaction network reconstruction. Results: The forward MR analysis revealed a significant causal effect of RA on PE risk (ORmeta = 1.05, 95% CImeta: 1.02–1.07, Pmeta < 0.001), while reverse analysis showed directionally inconsistent associations (ORmeta = 0.99, 95% CImeta: 0.84–1.17, Pmeta = 0.89). Transcriptomic analysis of diseased tissues identified 98 shared DEGs enriched in calcium signaling (GO, P < 0.001) and FoxO pathways (KEGG, P = 0.003), with protein-protein interaction networks highlighting ACTN2 and EGF as central nodes. Disease-specific DEG profiles revealed upregulated MMP13 in RA and IL5 in PE. Conclusion: This study confirms that RA is a significant risk factor for developing PE during pregnancy. Identifying crucial genes presents opportunities for targeted interventions. Future work should focus on validating these findings and exploring the functional implications of the identified biomarkers.

Objective: To investigate whether a supervised exercise program during pregnancy induces modifications in the maternal lipid profile. Methods: This unplanned secondary analysis of a multicenter randomized controlled trial (March 2021–June 2023) was conducted at Hospital Universitario de Torrejón, the only participating center with routine lipid profiling during all three trimesters and postpartum. Eligible women had a singleton pregnancy < 14+3 weeks without complications. Participants were randomized (1:1) to a supervised exercise program (three 55–60 min sessions/week, virtual or onsite) or control (usual activity). Exercise adherence was defined as ≥ 80% session attendance. Maternal characteristics, blood pressure, and weight were recorded at baseline and follow-up visits in the second and third trimesters and 6–12 months postpartum. Venous blood samples were collected for lipid profiling, including total cholesterol, triglycerides, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C). Between-group differences were tested with Wilcoxon signed-rank tests, and repeated measures were analyzed with generalized estimating equations including gestational age, intervention group, delivery status, and obesity interaction. Both intention-to-treat and per-protocol analyses were performed. Statistical significance was considered at P < 0.05. Results: A total of 202 pregnant women were enrolled, and 182 were included in the final analysis (90 in the control group and 92 in the intervention group). No significant between-group differences were observed in lipid profiles at the second trimester, third trimester, or postpartum. Longitudinal analysis showed higher HDL-C levels in the IG (+3.24 mg/dl; 95% confidence interval (CI): 0.13–6.35, P = 0.041), persisting postpartum, and a nonsignificant trend toward lower LDL-C (−6.02 mg/dl; 95% CI: −13.18 to 1.14, P = 0.099). These effects were not confirmed in the per-protocol analysis, and no interaction with obesity was observed. Conclusion: A supervised exercise program throughout pregnancy may increase HDL-C levels and potentially reduce LDL-C, thereby improving the maternal lipid profile. Further studies are needed to confirm and expand upon these findings. Registration: No. NCT04563065 (Randomized Controlled Clinical Trial).

Objective: To investigate the impact of the second division timing on pregnancy outcome after in vitro fertilization. Methods: In this unpaired retrospective study, 16,696 embryos from 6571 patients were analyzed. Patients were divided into four groups according to the number of blastomeres observed on day 2 (44 ± 1 h) and day 3 (68 ± 1 h) of development. Blastocyst formation rates and pregnancy outcomes were compared among the groups. Propensity Score Matching was applied to eliminate discrepancies among the baseline data of the different groups. Results: The blastocyst formation rates in Group A (delayed second cleavage) and Group B (delayed second cleavage and early compaction) were significantly lower than that of Group C (normal cleavage) (P < 0.001). For both day 3 single embryo transfer and frozen single blastocyst transfer, the clinical pregnancy and live birth rates in Group A were comparable to those of Group C. For day 3 double embryo transfer, the biochemical pregnancy, clinical pregnancy, and live birth rates following the combined transfer of embryos from Groups A and C were significantly lower than those obtained when two embryos from Group C were transferred. Conclusion: Embryos with delayed second cell cleavage exhibited reduced blastocyst formation rates and resulted in poorer pregnancy outcomes even when the third cleavage was completed on time. These findings indicate that the kinetics of embryo development are closely associated with developmental competence and pregnancy outcomes.

Objective: To evaluate the efficacy and safety of internal iliac artery (IIA) ligation in the management of placenta accreta spectrum (PAS). Methods: PubMed, Embase, Scopus, ScienceDirect, Cochrane Library, and Clinical Trials Registry were searched up to December 2024 for studies on IIA ligation in PAS. This PROSPERO-registered review followed PRISMA guidelines and included randomized controlled trials (RCTs) and non-RCTs comparing IIA ligation with no intervention, IIA balloon, uterine artery ligation, or temporary common iliac artery occlusion. Outcomes included intraoperative blood loss, transfusion needs, procedure duration, complications, intensive care unit admission, and hospital stay, with risk of bias assessed using Cochrane criteria and the Newcastle-Ottawa Scale, and evidence quality rated via GRADE. Effect estimates were reported as mean differences or odds ratios (95% confidence interval (CI)) using fixed- or random-effects models based on heterogeneity (I2), with P < 0.05 considered significant. Results: A total of 13 studies, including five RCTs and eight non-RCTs, involving 939 participants, met the inclusion criteria and were included in the study. Intraoperative blood loss was evaluated in 10 studies involving 631 participants (299 undergoing IIA ligation and 332 controls). The mean difference was −177.10 mL (95% CI: −701.46–347.27; P = 0.51; I2 = 95%). Postoperative hemoglobin reduction was analyzed in four studies with 233 participants (109 subjected to IIA ligation and 124 controls), yielding a mean difference of −0.17 g/dL (95% CI: −0.47–0.14, P = 0.29, I2 = 1%). Blood transfusion was assessed in five studies enrolling 248 participants (125 in the IIA ligation group and 123 controls). The mean difference was found to be −0.06 units (95% CI: −2.08–1.95, P = 0.95, I2 = 93%). The duration of the procedure was investigated in eight studies comprising 539 participants (271 undergoing IIA ligation and 268 controls). The mean difference was calculated as 12.85 minutes (95% CI: −7.2–32.9, P = 0.21, I2 = 87%). Conclusion: Current evidence suggests that IIA ligation in PAS may not significantly reduce intraoperative blood loss, transfusion requirements, procedure duration, bladder injury, or hospital stay; however, the available studies are heterogeneous and of variable quality, and further high-quality research is needed to confirm these findings. Registration: CRD42024626882, Date 13/12/2024.

The advent of liquid biopsy technologies has revolutionized the non-invasive monitoring of various medical conditions, including complications during pregnancy. Fetal and placental health are crucial to maternal and neonatal outcomes, yet many of the conventional diagnostic techniques for detecting placental dysfunction and perinatal complications, such as preeclampsia, preterm birth, and fetal growth restriction, are invasive or pose a risk to the fetus. Liquid biopsy offers a promising alternative by using biomarkers such as cell-free DNA, cell-free RNA, and extracellular vesicles to provide a non-invasive, real-time, and dynamic assessment of placental and fetal health. This review discusses the advancements in liquid biopsy technologies, with a focus on their potential for early detection, monitoring, and understanding of placental dysfunction and perinatal complications.