Physiologic changes of pregnancy: A review of the literature

Recovery Effects of Oral Supplementation with Polar Lipid-Rich Wheat Extracts on Acute Telogen Effluvium: A Randomized Double-Blind Placebo-Controlled Study

Background

Acute telogen effluvium (aTE) is a transient condition characterized by an early entry of the hair into the telogen phase.

Purpose

This clinical study aimed at demonstrating the efficacy of a standardized wheat polar lipid complex both in oil (WPLC-O) and in powder (WPLC-P) form in improving hair shedding.

Subjects and Methods

The study was carried out in 99 healthy women with aTE. Hair growth cycle related parameters (anagen/telogen hair), hair pull test, hair shaft mechanical properties (hair elongation at break) and hair growth were assessed at baseline and after 56 (D56) and/or 84 (D84) days of products use. These parameters were completed by the subject's self-assessment.

Results

Telogen hair density was decreased by up to 26.9% and 24.2% while anagen density was increased by up to 10.3% and 10.8%, for WPLC-O and WPLC-P, respectively. These effects were significant compared with the placebo as early as within 56 days. These variations corresponded to an increase in the anagen/telogen ratio by up to 62.2% and 53.3% for WPLC-O and WPLC-P, respectively. Hair growth was also significantly increased in both active groups. At the end of the study the pull test was negative for aTE, exclusively in active treatment arms.

Conclusion

Our findings demonstrated the efficacy of WPLC in both form in reducing hair shedding and in improving hair growth in women with aTE.

Pregnancy-specific dermatoses for the resident physician

Pregnancy is associated with a wide range of cutaneous changes. Some are physiological and triggered by normal hormonal fluctuations during pregnancy. There are also a small number of pathological pruritic eruptions that exclusively occur during pregnancy, known as pregnancy-specific dermatoses (PSDs). In patients presenting with a PSD, features often include severe pruritus and characteristic inflammatory skin changes differing in onset, morphology and configuration. This article gives an overview of benign dermatological changes during pregnancy and the most important presentations of PSDs in order of prevalence: atopic eruption of pregnancy, polymorphic eruption of pregnancy, pemphigoid gestationis and pustular psoriasis of pregnancy. Importantly, we outline how a resident physician can identify these disorders, how to initiate management and when a specialty referral for further investigations and monitoring of the mother and unborn fetus is warranted.

Microwaves Versus Combined Microwaves and Fractional Carbon Dioxide Laser in the Treatment of Postpartum Abdominal Laxity Among Filipino Patients in a Tertiary Hospital: A Randomized, Prospective, Assessor-Blinded, Simultaneous Split-Abdomen Trial

BACKGROUND

Postpartum abdominal laxity is a growing concern for women. Noninvasive options like microwave technology and fractional carbon dioxide (CO2) laser show promise, but their combined efficacy and safety require further investigation.

AIM

To compare the efficacy and safety of microwaves versus combined microwaves and fractional CO2 laser in the treatment of postpartum abdominal laxity among Filipino patients.

PATIENTS/METHODS

Thirty-two patients with Fitzpatrick skin types III-V and postpartum abdominal laxity received three microwave sessions, with one side randomly assigned an additional fractional carbon dioxide laser session (designated as Side B, while the other as Side A). Global aesthetic improvement scale (GAIS) scores and patient satisfaction (PS) scores were determined at every follow-up. Baseline and completion anthropometric measurements were taken, and adverse effects were recorded.

RESULTS

Significant improvements in GAIS and PS scores were noted for both sides across all sessions (p < 0.001), with side B showing superior scores post-CO2 laser (p < 0.001). A moderate correlation between metabolic equivalent (METs) scores and GAIS scores (p = 0.413, p = 0.019) indicated that higher levels of physical activity were associated with higher GAIS scores. These improvements were attributed to epidermal thickening and dermal collagen and elastin remodeling, the latter seen histologically in a representative patient. Adverse effects were mild and noted only with CO2 laser.

CONCLUSIONS

The combined use of the microwave system and fractional CO2 laser is safe and well tolerated and is superior to microwaves alone in the treatment of postpartum abdominal laxity.

Changes in Melanocytic Nevi and Melanoma Associated With Pregnancy: A Scoping Review

Pregnancy is a transformative period characterized by numerous physiological and hormonal changes, including those affecting the skin. Among these changes, alterations in melanocytic nevi and the potential risk of melanoma are areas of significant interest and ambiguity. This scoping review aims to synthesize existing literature on these topics to provide a comprehensive understanding and identify gaps in knowledge. Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews guidelines, a systematic search was conducted; out of 4824 identified articles, 80 met the inclusion criteria. While some studies suggest hormonal influences might accelerate melanocyte growth, others argue that perceived growth is due to mechanical stretching of the skin, and still others found no significant size changes. Pigmentary changes in nevi are more consistently reported, though some researchers advocate viewing them with suspicion until proven benign. The risk of developing pregnancy-associated melanoma is contentious, with some studies proposing that hormonal changes and gestational immunosuppression increase susceptibility, but the evidence remains inconclusive. Prognostic outcomes are equally disputed, with conflicting findings on pregnancy-associated melanoma thickness, recurrence rates, and survival outcomes. We also performed a novel semi-quantitative analysis to assess attitudes on the risk and prognosis of pregnancy-associated melanoma in the literature, demonstrating that authors of narrative reviews are more likely to oppose theories of pregnancy as a trigger for melanoma development or progression than researchers who conducted the primary investigations. These inconsistencies in the literature highlight the need for further research with standardized methodologies and consideration of confounding factors.

Safadi W, Alnsour L, Al‐Halaseh LK. Perceptions and Management of Pregnancy-Related Skin Changes: A Cross-Sectional Study on Knowledge, Practices, and Use of Skincare Product

BACKGROUND

Hormonal, metabolic, and immunologic factors may cause several skin changes during pregnancy. Therefore, it is important for pregnant women to be aware of these expected changes in their skin appearance in order to prevent unwanted effects and to choose the appropriate preventive or treatment measures via trustable sources of information.

OBJECTIVE

This study would highlight the most common normal and abnormal physiological skin changes mothers usually complain about before or after pregnancy. The most commonly used skin care products, their sources of knowledge, information, perception, and experiences on these problems and products were also considered. In addition, patient satisfaction levels and their sources and types of knowledge were also investigated.

METHODS

Across sectional survey was distributed among women who met the inclusion criteria and were citizens in the Hashimate Kingdom of Jordan. This survey was composed of a number of questions used for investigating participant's socio-demographic characteristics, during and post-pregnancy characteristics and medications used, comparison of skin related complains reported by these women, in addition to their use of skin care products. Women's knowledge, perception, and experience regarding their use of skin care products were also included.

RESULTS

Of the 337 participants in this study, 6.5% and 6.8% of women were using thyroid medications and antihypertensive agents. An increase of around 3% in pregnancy-related skin changes, such as hyperpigmentation, hair loss, cellulite, and wrinkles, was predominant among women. Despite the prevalence of hyperpigmentation, only 4% and 17% of women used depigmentation and sunblock products. Moreover, women declare that their information about the use of skin care products was mainly via social media or self-experience. A low rate of consultation with dermatologists and the reliance on self-diagnosis or non-professional advice were shown.

CONCLUSION

This study suggests a lack of awareness about effective preventive measures for skin-related disorders commonly occurring during pregnancy, potentially exacerbated by reliance on unverified sources of information, such as social media. Therefore, incorporating education about skin changes into routine prenatal care could empower women to make informed decisions and reduce the stigma associated with these changes.

An overview of benefits and risks of chronic melanocortin-1 receptor activation

The melanocortin-1 receptor (MC1R) is a G protein-coupled receptor that plays a pivotal role in human skin pigmentation, melanin synthesis, redox homeostasis and inflammation. Loss-of-function MC1R variants suppress G protein-coupled receptor coupling or cell surface expression leading to a decrease in adenyl cyclase activation and intracellular levels of cyclic adenosine monophosphate. Chronic activation of MC1R can occur in certain medical conditions such as Addison's disease and physiologic states such as pregnancy melasma. MC1R activation is more commonly caused by environmental exposure to ultraviolet (UV) radiation. Approved pharmacologic melanocortin agonists that activate MC1R signalling in a targeted manner or as a bystander effect have recently become available for erythropoietic protoporphyria, sexual desire disorders, monogenic obesity and syndromic obesity. Further, small peptide analogues of α-melanocortin-stimulating hormone, human MC1R selective agonists, are photoprotective, decreasing the adverse impact of UV radiation (a primary risk factor for skin cancer) and are being investigated as potential chemoprevention strategies. MC1R activation through induction of UV-protective skin pigmentation increased DNA repair, and control of aberrant cell growth may reduce the risk of melanoma but importantly does not prevent melanoma particularly in individuals with risk factors and regular skin examination remains critical in high-risk individuals.

A bioecological longitudinal study of depressive symptoms from pregnancy to 36 months postpartum

PURPOSE

Depressive symptoms during the perinatal period have broad and enduring health implications for birthing parents and their offspring. Rising prevalence rates of perinatal depression highlight the need for research examining factors influencing depressive symptoms during pregnancy, and trajectories during the early postnatal period. Grounded in bioecological systems theory, this longitudinal multimethod study examined whether prenatal bioecological factors predict depressive symptoms from pregnancy to 36 months postpartum.

METHODS

Participants were 162 pregnant individuals, oversampled for high emotion dysregulation, who completed a life stress interview and physiological assessment during the 3rd trimester and a self-report measure of depression at five time-points (3rd trimester, within 48 h of birth, 7, 18, and 36 months postpartum). Multilevel models were used to test study aims.

RESULTS

Participants exhibited the highest levels of depressive symptoms at 3rd trimester, and substantial variability in depressive symptom trajectories over time. Lower resting respiratory sinus arrhythmia (RSA), an index of parasympathetic nervous system functioning, in the 3rd trimester was associated with higher concurrent depressive symptoms. Higher levels of stress related to partner relationships, finances, and health were concurrently associated with more depressive symptoms during pregnancy and decreases in depressive symptoms over time. Specifically, depressive symptoms decreased only for individuals who reported high levels of stress during pregnancy.

LIMITATIONS

Although grounded in bioecological systems theory, this study did not assess the macrosystem.

CONCLUSIONS

Results of this study underscore the importance of multilevel predictors of perinatal health and highlights potential targets for preventing depression and promoting well-being during the perinatal transition.

Prevention of Melasma During Pregnancy: Risk Factors and Photoprotection-Focused Strategies

Melasma is a benign but emotionally distressing skin condition that reduces patients' quality of life, with prevalence rates during pregnancy ranging from 36.4% to 75%. Troublingly, up to 30% of cases are reported to persist after delivery, even ten years later. And recurrence and aggravation are common in subsequent pregnancies. This review examines the risk factors and mechanisms associated with melasma during pregnancy and summarized corresponding preventive strategies. We emphasize the critical role of photoprotection, including the use of sunscreens from the first trimester, in reducing the incidence of melasma.

The Effects of Emotional Freedom Techniques Implemented During Early Pregnancy on Nausea-Vomiting Severity and Anxiety: A Randomized Controlled Trial

Objective: This randomized controlled trial investigated the effect of emotional freedom techniques (EFT) on the severity of nausea-vomiting and anxiety in early pregnancy. Design: The sample consisted of 131 pregnant women in the experimental and control groups between 6 and 16 weeks of pregnancy attending an antenatal clinic. Participants were randomly assigned to receive training on EFT or a control group. Data were collected using a personal information form, subjective experiences, the Pregnancy-Related Anxiety Questionnaire, and the Pregnancy-Unique Quantification of Emesis. Both groups attended two visits, a week apart. The participants in the EFT group received a session of EFT at each visit and completed two EFT sessions as home assignments, 2 and 4 days after the first visit. The participants in the control group attended two visits a week apart and completed assessments but did not receive EFT. Results: There were 55 women in each group who completed the study, and the groups were similar in terms of baseline measures, including socioeconomic status, smoking status, previous pregnancy, severity of nausea-vomiting, and total pregnancy-related anxiety. EFT significantly reduced anxiety levels from the baseline to the second session (fear of delivery, worries about bearing a handicapped child, concern about one's own appearance) and total pregnancy-related anxiety (total pretest 29.85 ± 9.87, post-test 20.67 ± 8.38; p < 0.001), while the control group showed no reduction in pregnancy-related anxiety (total pretest 26.1 ± 7.79, post-test 25.98 ± 8.49; p = 0.933). Although nausea-vomiting was reduced in both groups over the two-session period, at the end of treatment, the EFT group had significantly lower nausea intensity (EFT group 4.4 ± 1.81, control group 5.36 ± 2.48; p = 0.02). Conclusions: EFT is a nonpharmacologic intervention that can be effective in reducing nausea, vomiting, and anxiety in early pregnancy. Clinical Trials Registration Number: NCT05337852.

Experiential avoidance, thought suppression, meta-cognition, and body-checking among women during pregnancy and postpartum: Buffering effect of self-compassion

OBJECTIVE

The present study attempted to explore the psychological experiences of experiential avoidance, thought suppression, meta-cognition, self-compassion and body-checking during two stages of maternity (pregnancy and postpartum) among women embracing maternity for the first time.

METHODS

The study used a cross sectional correlational design and enrolled 306 women participants who were in their third trimester of pregnancy or of postpartum (pregnant = 154 [50.3%]; postpartum = 152 [49.7%]) with ages ranging between 20 and 35 years (M = 26.62; SD = 2.19). The data was collected using the Brief Experiential Avoidance Questionnaire (BEAQ); Thought Control Questionnaire (TCQ); Metacognitions Questionnaire (MCQ); Self-Compassion Scale (SCS), and Body-checking Questionnaire (BCQ). Data was subjected to statistical analysis using SPSS version 21.

RESULTS

A significant positive association was observed between experiential avoidance, thought suppression, meta-cognition, and body-checking while self-compassion showed reverse association with these variables. The body-checking outcome was significantly negatively predicted by self-compassionate attitude and positively by thought suppression in both groups (i.e., pregnant and postpartum). The experiential avoidance positively predicted body-checking among women in post-partum group only. Moreover, a mediating association of experiential avoidance and a moderating effect of self-compassion (self-kindness and common humanity) and meta-cognition (positive beliefs about worry and need to control thought) were also observed to moderate between thought suppression and body-checking outcomes.

CONCLUSION

The study concluded that experiential avoidance and thought suppression contribute in developing body-checking behaviors among women who are pregnant or at postpartum stage of maternity. In addition, self-compassion and meta-cognition moderate this association with self-compassion playing potential buffer.

V-EMF therapy: A new painless and completely non-invasive treatment for striae gravidarum

BACKGROUND

The appearance of striae gravidarum (SG) during pregnancy is a common problem. The most common SG are abdominal striae, which can cause the greatest sequelae after pregnancy, and in the long term. There are several solutions to prevent and treat these striae, but not all are completely effective, and not without side effects.

AIMS

The aim of this study was to evaluate the effectiveness of a treatment that applies an electromagnetic field under vacuum (V-EMF therapy) on the abdominal SG.

METHODS

A retrospective analysis was conducted on the medical records of 26 women affected by abdominal SG and treated with V-EMF therapy. The results were evaluated using two different 5-point Likert Scales: one administered to the treated subjects to evaluate their satisfaction, and one to the doctors who performed the treatment, to evaluate the improvement of the striae. The presence of side effects, and the effects of sun exposure after treatment were also considered.

RESULTS

Only two treated subjects rated their level of satisfaction with a Score III on the Liker Scale. Everyone else expressed higher levels of satisfaction. Only one doctor rated the improvement of the striae with a Liker scale score of III. All the others reported greater improvements. No discomfort or side effects were noted either during the individual treatment sessions, or at the end of the treatment. The striae showed a newfound ability to tan.

CONCLUSIONS

V-EMF therapy proves to be a valid, safe, and effective treatment modality for SG.

The prevalence and linkage disequilibrium of 21 genetic variations related to thrombophilia, folate cycle, and hypertension in reproductive age women of Rostov region (Russia)

Several maternal genetic variations are known to play an important role during pregnancy since they can affect mother health and/or fetal growth. The frequency of these variants is variable among different populations. This study aimed to investigate thrombophilia, folate metabolism and hypertension genetic variants in reproductive age women of Rostov region (Russia) and then assess their linkage disequilibrium (LD) and heterogeneity among populations. A total of 3108 reproductive age women were included (33.75 ± 5.13 years). Twenty-one genetic variants were detected with RT-PCR. LD was tested according to (D') coefficient and p value. The highest frequency of mutant allele in studied population was as follows: PAI-1 rs1799768, MTRR rs1801394, AGT rs699, and AGTR2 rs1403543. We showed a high possibility of coinheritance of MTHFR rs1801133 with rs1801131 and AGT rs699 with rs4762 (D'=0.992 and 0.999, respectively). In addition, comparative analysis showed F7 rs6046, FGB rs1800790, MTR rs1805087, and AGT rs699 significantly more frequent among Rostov females by 1.3-1.5 times than European. MTHFR rs1801133, ADD1 rs4961, AGTR2 rs1403543, NOS3 rs2070744, and rs1799983 were with higher frequencies in Europeans than those in the studied group. Our data could be used as a reference for further associative studies of targeted genetic variations in different pregnancy complications specifically in this population.

Updates on the dermatopathology of pregnancy-associated skin conditions

Pathologists provide valuable input in the dermatological care of pregnant patients in various contexts. This article provides dermatopathology updates on cutaneous changes associated with pregnancy, organized based on the following classification system: physiological skin changes in pregnancy, specific dermatoses of pregnancy, dermatoses modified in pregnancy, and skin neoplasms in pregnancy. Awareness of the impact of pregnancy on the skin by pathologists is important, as this is an opportunity to contribute to diagnostic precision in this patient population.

Opportunities for Systems Biology and Quantitative Systems Pharmacology to Address Knowledge Gaps for Drug Development in Pregnancy

Pregnant women are still viewed as therapeutic orphans to the extent that they are avoided as participants in mainstream clinical trials and not considered a priority for targeted drug research despite the fact that many clinical conditions exist during pregnancy for which pharmacotherapy is warranted. Part of the challenge is the uncertain risk potential that pregnant women represent in the absence of timely and costly toxicology and developmental pharmacology studies, which only partly mitigate such risks. Even when clinical trials are conducted in pregnant women, they are often underpowered and absent biomarkers and exclude evaluation across multiple stages of pregnancy where relevant development risk could have been assessed. Quantitative systems pharmacology model development has been proposed as one solution to fill knowledge gaps, make earlier and perhaps more informed risk assessment, and design more informative trials with better recommendations for biomarker and end point selection including design and sample size optimality. Funding for translational research in pregnancy is limited but will fill some of these gaps, especially when joined with ongoing clinical trials in pregnancy that also fill certain knowledge gaps, especially biomarker and end point evaluation across pregnancy states linked to clinical outcomes. Opportunities exist for further advances in quantitative systems pharmacology model development with the inclusion of real-world data sources and complimentary artificial intelligence/machine learning approaches. The successful coordination of the approach reliant on these new data sources will require commitments to share data and a diverse multidisciplinary group that seeks to develop open science models that benefit the entire research community, ensuring that such models can be used with high fidelity. New data opportunities and computational resources are highlighted in an effort to project how these efforts can move forward.

Diagnosing Arterial Stiffness in Pregnancy and Its Implications in the Cardio-Renal-Metabolic Chain

Cardio-renal and metabolic modifications during gestation are crucial determinants of foetal and maternal health in the short and long term. The cardio-renal metabolic syndrome is a vicious circle that starts in the presence of risk factors such as obesity, hypertension, diabetes, kidney disease and ageing, all predisposing to a status dominated by increased arterial stiffness and alteration of the vascular wall, which eventually damages the target organs, such as the heart and kidneys. The literature is scarce regarding cardio-renal metabolic syndrome in pregnancy cohorts. The present paper exposes the current state of the art and emphasises the most important findings of this entity, particularly in pregnant women. The early assessment of arterial function can lead to proper and individualised measures for women predisposed to hypertension, pre-eclampsia, eclampsia, and diabetes mellitus. This review focuses on available information regarding the assessment of arterial function during gestation, possible cut-off values, the possible predictive role for future events and modalities to reverse or control its dysfunction, a fact of crucial importance with excellent outcomes at meagre costs.

Foot health status in pregnant women

BACKGROUND

Pregnancy is associated with physiological changes such as increased body mass index, postural changes, hormonal imbalance and changes in foot morphology. Due to an increased uterus and body mass, the centre of gravity is displaced anteriorly and superiorly as a means to produce and maintain stability and balance. An influx of relaxin mostly in the third trimester leads to ligament laxity which in turn causes the feet to become longer, flatter and broader. This structural change may remain permanent in some women. Structural changes, increased body weight and increased pressure in the lower limbs may also lead to lower limb oedema which makes it harder to find adequate fitting shoes and may be associated with causing or exacerbating foot pain in pregnant women. The purpose of this study was to determine the overall Foot Health Status (FHS) in pregnant women and also to compare the foot health status in the different trimesters.

METHODS

A quantitative approach, using a descriptive cross-sectional study design was utilized and a validated foot health status questionnaire was used. Data was analysed using a Statistical Package for Social Sciences (SPSS) version 1.04 program and presented in the form of tables.

RESULTS

All pregnant women had a poor foot health status in the area of vigour, particularly in the third trimester. In the third trimester, women's physical activity was diminished and they appeared to have greater footwear difficulties. However, it was found that despite having minimal foot pain, pregnant women maintained good foot function and good social capacity. The least amount of foot pain was felt in the second trimester.

CONCLUSION

As a woman progresses in her pregnancy, her foot health status declined in the areas of footwear, physical activity and vigour.

Does Prenatal Physical Activity Affect the Occurrence of Postnatal Anxiety and Depression? Longitudinal Study

The aim of the foregoing study was to assess whether physical activity during pregnancy affects the occurrence of anxiety and depression during pregnancy, postpartum and 6 months following childbirth. This study tried to answer the following questions: How was the incidence of depression and anxiety different in the pre- and postpartum periods? What intensity level of physical activity protects against the symptoms of anxiety and depression? Does the time spent engaged in sedentary activities and MVPA affect the occurrence of depression and anxiety before and after childbirth? The study group under analysis consisted of 187 women aged 19–41 years. The research was conducted between April 2016 and November 2020. The study was divided into four stages: T0—qualification to participate in the study; T1—medical history acquisition, consisting of a short questionnaire and two long questionnaires (the Edinburgh Postnatal Depression Scale (EPDS) and General Anxiety Disorder-7 (GAD-7)), as well as an assessment of 7-day physical activity using Actigraph accelerometers during the pregnancy; T2—the completion of the EPDS and GAD-7 questionnaires after the birth; T3—the completion of the EPDS and GAD-7 questionnaire 6 months after giving birth. The obtained results were statistically processed in the Statistica 13.3 software package. A significance level of p < 0.05 was assumed. The highest percentage of depression occurred immediately after the delivery, followed by 6 months after delivery, and the smallest number of women suffered from depression before the birth (p < 0.001). The analysis of correlations of physical activity with anxiety symptoms did not show significant correlations. However, the situation is different in the case of depression symptoms. Women taking fewer steps before delivery showed a greater tendency to develop depressive symptoms before, immediately after and 6 months after the delivery (p < 0.001). Women who were less active (took fewer steps per day, spent less time in moderate-to-vigorous physical (MVPA) activities or spent more time being sedentary) showed symptoms of depression on the EPDS scale. It appeared that those with severe anxiety symptoms had the highest sedentary time scores before the delivery (p = 0.020). Reduced physical activity promotes the onset of postnatal depression, while being active reduces this risk. Interestingly, even light physical activity “protects” against the occurrence of depression and is better than sedentary activities. Such clear conclusions cannot be drawn in relation to anxiety symptoms. Sedentary behaviour may promote anxiety symptoms immediately after childbirth, but this study should be continued in order to confirm it during other time periods.

Skin Changes and Safety Profile of Topical Products During Pregnancy

OBJECTIVE

We sought to know the efficacy and safety profile of topical products for use during pregnancy.

METHODS

We used PubMed, Embase, and Cochrane Library to review literature on topical products and pregnancy.

RESULTS

A majority of pregnant women develop skin changes, including physiological or hormonal changes, worsening of preexisting skin conditions, or the appearance of new dermatoses during pregnancy. Most pregnant women are concerned about the availability of treatments options with good safety profiles, especially for skin and hair treatments, to maintain their appearance and health. Although most of the treatments are recommended to be used after delivery, there are some alternatives to prevent and treat skin lesions during pregnancy.

CONCLUSION

The most current and comprehensive information about the efficacy and safety profile of topical products in pregnancy are necessary.

The Sexual Function of Primiparous Women after Normal Delivery and Cesarean Section According to the Female Sexual Function Index

BACKGROUND: Various anatomical and physiological changes occur to provide a suitable environment for fetal development during pregnancy. Changes in body shape and other physical changes also undergo changes and are associated with postpartum sexual dysfunction. AIM: This study aims to measure and determine the difference in female sexual function index scores for primiparous women post normal delivery and post-cesarean section. METHODS: An observational analytic study with a cross-sectional study design conducted in a hospital. This study involved 60 women with inclusion criteria aged 20–35 years, primiparous women with post-term pregnancy, primiparous women after normal delivery and cesarean section at 3–4 months, women who were married and living with their husbands and were willing to participate in this study. Data were analyzed descriptively and statistically. RESULTS: The results showed that the cause of perineal damage was mostly due to the mediolateral episiotomy, the degree of perineal damage with Grade II status, and there was variation in the indication of an elective cesarean section. The statistical test results show that there was no difference in the type of delivery, both normal delivery and cesarean delivery on desire, arousal, satisfaction, lubrication, orgasm, and dyspareunia and the total female sexual index in primiparous (P > 0.05). CONCLUSION: This study recommends that in primiparous women care, it is not advisable to choose one type of delivery as a form of prevention of postpartum sexual dysfunction. In addition, in the management of complaints of sexual dysfunction in primiparous it is not required to consider the type of delivery as the main cause.

Dermatologic Care of Hair in Transgender Patients: A Systematic Review of Literature

Transgender patients on masculinizing and feminizing hormonal therapy undergo myriad physical and psychologic changes. Dermatologists are uniquely qualified to guide patients in the gender-affirming process, especially as it relates to hair. Given the paucity of literature guiding dermatologists in this process, a systematic review was performed to better understand the physiologic changes of hair in patients on masculinizing and feminizing hormonal therapy as well as the variety of treatment options that exist to help transgender patients to attain their desired hair growth pattern. This review reports findings and treatment options supported by the performed literature review as well as treatment recommendations based on the authors' own experiences treating this unique patient population.

Ergonomic Stressors Among Pregnant Healthcare Workers: Impact on pregnancy outcomes and recommended safety practices

Workplace environment can have a considerable impact on the physical, psychological and maternal health of pregnant healthcare workers. This article aimed to summarise the impact of work-related ergonomic stressors on pregnancy outcomes for healthcare workers, along with potential interventions to resolve these stressors. A narrative review analysis using the Pearl Growing Strategy was conducted between February 2019 and June 2020 to identify English-language articles published between 2000 and 2020. A total of 89 studies were identified from the SCOPUS (Elsevier, Amsterdam, Netherlands), MEDLINE® (National Library of Medicine, Bethesda, Maryland, USA) databases and Google Scholar (Google LLC, Menlo Park, California, USA). The results indicated that poor work-related ergonomics had detrimental effects on pregnancy outcomes, resulting in spontaneous abortions, preterm delivery, low birth weight babies and infertility. Policymakers and employers should conduct ergonomic assessments and implement appropriate practices to ensure the safety of pregnant healthcare workers.

Association of Self-Reported Physical Fitness with Pregnancy Related Symptoms the GESTAFIT Project

We explored the association of physical fitness (PF) with pregnancy-related symptoms, at the 16th and 34th gestational weeks (g.w.). The International Fitness Scale and the Pregnancy Symptoms Inventory were employed to assess self-reported PF and pregnancy-related symptoms, respectively. At the 16th g.w. greater self-reported overall PF was associated with lower incidence of urinary frequency (p = 0.020); greater overall PF, cardiorespiratory fitness (CRF), muscular strength and speed-agility were associated with lower incidence of tiredness-fatigue (all, p < 0.05); greater overall PF and speed-agility were associated with lower incidence of poor sleep (both, p < 0.05); greater CRF and flexibility were associated with lower limitations by tiredness-fatigue (both, p < 0.05); and greater flexibility was associated with lower limitations by poor sleep (p = 0.021). At the 34th g.w. greater self-reported overall PF, CRF and muscular strength were associated with lower incidence of tiredness-fatigue (all, p < 0.05); greater CRF was associated with lower incidence of poor sleep (p = 0.019); and, greater flexibility was associated with lower incidence of increased vaginal discharge (p = 0.023). Adequate levels of PF, especially CRF, may help women to cope with the most endorsed pregnancy-related symptoms and its limitations, especially tiredness-fatigue and poor sleep.

Factors influencing stress, anxiety, and depression among Iranian pregnant women: the role of sexual distress and genital self-image

Background

Pregnancy is a unique period with the increased likelihood of psychological changes and emotional disturbances such as depression, anxiety, and stress. In this study, we investigated the factors influencing depression, anxiety, and stress in pregnancy and identify their associations with Sexual Distress (SD) and Genital Self-Image (GSI).

Methods

This was a descriptive, correlational, cross-sectional study performed using the two-stage cluster sampling method between September 2019 and January 2020. Overall, 295 pregnant women completed a demographics and obstetric information checklist, Depression Anxiety and Stress Scale-21 (DASS-21), Female Genital Self-Image Scale (FGSI), and Female Sexual Distress Scale-Revised (FSDS-R).

Results

Analysis of Variance (ANOVA) showed significant differences in the mean scores of SD between the groups with varying degrees of depression, anxiety, and stress (P <  0.001) and in the mean score of GSI between the groups with varying degrees of depression (P = 0.01) and anxiety (P <  0.001). In multivariate linear regression analysis, higher (worse) depression, anxiety, and stress scores were found in women with more advanced age and higher SD scores; however, these scores were lower (better) in those with increased gestational age. Lower depression and anxiety scores were associated with moderate satisfaction with income, moderate satisfaction with BI in pregnancy, and lower stress and depression scores were linked to planned pregnancy. Higher (better) GSI score was a predictor of lower depression score, complication in a previous pregnancy was a predictor of higher stress score, and finally, fear of fetal abortion and being a housewife were predictors of a higher anxiety score.

Conclusion

Various factors contribute to the development of antenatal depression, anxiety, and stress. A positive correlation was found between SD and the severity of depression, anxiety, and stress, while a negative correlation was noted between GSI and the severity of depression and anxiety. Therefore, raising awareness regarding SD and GSI through screening and counseling sessions can have beneficial effects for mothers and their fetuses.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-03575-1.

Physiological changes of the skin during pregnancy

The appearance of skin changes during pregnancy is inevitable and physiologically determined. This period is characterized by hormonal, immunological and metabolic changes and associated physiological changes in the skin. These include pigmentation (linea nigra, melasma, pseudoacanthosis, growth and appearance of pigmented nevi), changes in connective tissue (striae distensae, skin tags), blood vessels (stellate hemangiomas, erythema of the palms, vasodilatation, edema, cutis marmorata) and skin appendages (increased sebaceous and eccrine glands activity, reduced hair loss and increased hair density, onychodystrophy). It is important to inform women about possible changes, to recognize them in time to reduce the impact of their appearance on the health and course of pregnancy, as well as to avoid unnecessary tests and interventions.

Shifts in Female Facial Attractiveness during Pregnancy

It has been proposed that women’s physical attractiveness is a cue to temporal changes in fertility. If this is the case, we should observe shifts in attractiveness during pregnancy—a unique physiological state of temporal infertility. The aim of this study was to examine how women’s facial attractiveness changes during the subsequent trimesters of pregnancy and how it compares to that of nonpregnant women. Sixty-six pictures of pregnant women (22 pictures per trimester) and 22 of nonpregnant women (a control group) were used to generate four composite portraits, which were subsequently assessed for facial attractiveness by 117 heterosexual men. The results show considerable differences between facial attractiveness ratings depending on the status and progress of pregnancy. Nonpregnant women were perceived as the most attractive, and the attractiveness scores of pregnant women decreased throughout the course of pregnancy. Our findings show that facial attractiveness can be influenced by pregnancy and that gestation, even at its early stages, affects facial attractiveness. Considerable changes in women’s physiology that occur during pregnancy may be responsible for the observed effects.

Combined microwaves and fractional microablative CO2 laser treatment for postpartum abdominal laxity

BACKGROUND

Postpartum abdominal changes represent a major esthetic concern affecting women. As the abdomen stretches during pregnancy and some of the muscles lose tone, there is an increased skin laxity and a loss of abdominal elasticity. As a result, the abdomen becomes saggy.

AIMS

To evaluate the performance of a combined microwaves and fractional microablative CO2 laser treatment for reshaping and improvement of abdomen texture/laxity and striae distensae in postpartum women.

PATIENTS/METHODS

Fifteen women (median age 38 years) received three monthly abdomen treatments with a new microwaves platform, the ONDA Coolwaves^® (DEKA) system, followed by a treatment with fractional microablative CO2 laser (SmartXide2; DEKA) a month thereafter. We followed up each patient's weight and nutritional habits. Outcome was assessed using reproducible circumference and abdominal measurements, digital and 3D photography, the laxity score as well as patient satisfaction index.

RESULTS

The overall mean circumferences reduction was 3.6 ± 1.2 cm. Significant improvement in skin laxity and tightening was noted by physicians and patients as well as a reduction of striae distensae. Interestingly, as a result of skin remodeling, repositioning of the umbilicus was also demonstrated. Treatments were well tolerated with no side effects.

CONCLUSIONS

Our data showed a sustainable reduction in circumference and improvement in appearance of abdomen in postpartum women, without compromising patients' safety.

Hepatitis B-management of acute infection and active inflammation in pregnancy-a hepatologist's perspective

Women at childbearing age and pregnant ladies living in the areas of high or intermediate prevalence of hepatitis B virus (HBV) remain at risk of getting the infection and passing the infections to their offspring via mother-to-child transmission (MTCT) of HBV. HBV infection may affect the mothers by active hepatitis, very occasionally liver cirrhosis and rarely fulminant hepatitis and liver failure. The virus may be transmitted to the babies despite immunoprophylaxis in the setting of very high maternal viral load. Tenofovir disoproxil fumarate (TDF) has been shown to be efficacious to reduce MTCT of HBV, which contributes to the elimination of chronic HBV infection by 2030, the goal set by World Health Organization.

Global guidelines trends and controversies in lower limb venous and lymphatic disease: Narrative literature revision and experts' opinions following the vWINter international meeting in Phlebology, Lymphology & Aesthetics, 23-25 January 2019

Guidelines are fundamental in addressing everyday clinical indications and in reporting the current evidence-based data of related scientific investigations. At the same time, a spatial and temporal issue can limit their value. Indeed, variability in the recommendations can be found both among the same nation different scientific societies and among different nations/continents. On the other side, Garcia already published in 2014 data showing how, after three years in average, one out of five recommendations gets outdated (Martinez Garcia LM, Sanabria AJ, Garcia Alvarez E, et al. The validity of recommendations from clinical guidelines: a survival analysis. CMAJ 2014;186(16):1211–1219). The present document reports a narrative literature revision on the major international recommendations in lower limb venous and lymphatic disease management, focusing on the different countries’ guidelines, trends and controversies from all the continents, while identifying new evidence-based data potentially influencing future guidelines. World renowned experts’ opinions are also provided. The document has been written following the recorded round tables scientific discussions held at the vWINter international meeting (22–26 January 2019; Cortina d’Ampezzo, Italy) and the pre- and post-meeting literature search performed by the leading experts.