Pregnancy loss: Consequences for mental health

Optimizing Psychological Health Across the Perinatal Period: An Update on Maternal Cardiovascular Health: A Scientific Statement From the American Heart Association

Perinatal psychological health conditions (eg, perinatal depression, anxiety) are some of the leading causes of maternal mortality in the United States and are associated with adverse pregnancy outcomes, long-term cardiovascular outcomes, and intergenerational effects on offspring neurodevelopment. These risks underscore the importance of addressing maternal psychological health as a key determinant of perinatal cardiovascular health. Thus, it is vital to recognize the spectrum of perinatal psychological health and to provide guidance for both patients and clinicians on screening and management options across the perinatal period. In this scientific statement from the American Heart Association, we redefine maternal cardiovascular health to include psychological health, provide robust evidence on the association of psychological health with cardiovascular outcomes, highlight the social and environmental underpinnings, and finally, offer guidance about how to integrate psychological health into maternal cardiovascular health with a specific focus on the perinatal period (ie, pregnancy through 1 year postpartum). We also describe opportunities for creating care delivery models that recurrently address perinatal psychological health in cardio-obstetric care, using behavioral and pharmacological interventions, with an emphasis on better integration of psychological health care, longer postpartum follow-up, and opportunities for evaluating the comparative effectiveness of these models with stakeholder partners.

Predictors of anxiety among women of reproductive age in Nepal: a comprehensive nationwide analysis

PURPOSE AND OBJECTIVE

Anxiety poses a significant challenge for women of reproductive age globally, often leading to other mental health issues. However, research on anxiety prevalence among this demographic, particularly in Nepal, remains scarce. This study aims to fill this gap by identifying demographic, biological, and behavioral predictors of anxiety among reproductive-aged women in Nepal.

METHOD

Using data from the nationally representative Nepal Demographic and Health Survey 2022, this study employed the Generalized Anxiety Disorder (GAD-7) scale to assess anxiety prevalence. Descriptive and inferential statistics, including one-way ANOVA and stepwise multiple regression, were utilized for identifying the potential predictors of anxiety.

RESULT

This study found that 22.2% of reproductive-aged women in Nepal experience moderate to severe anxiety. The stepwise multiple regression revealed seven most influential factors, with depression (mild, moderate, severe) being the most influential predictor of anxiety, explaining 51.8% of the variance (R square change = 0.518; Sig. =<0.001). Self-reported health status (R square change = 0.010; Sig.=<0.001), experienced emotional violence (R square change = 0.007; Sig.=<0.001), and pregnancy termination (R square change = 0.002; Sig.=0.001) accounted for 1.0%, 0.7%, and 0.2% of the variance in anxiety, respectively. Other significant predictors of anxiety included husband's alcohol consumption, genital discharge, and household wealth status.

CONCLUSION

Anxiety is substantially prevalent among reproductive-aged women in Nepal, with sociodemographic factors playing a crucial role. Further research is needed to develop targeted socioeconomic, and behavioral interventions aimed at addressing anxiety and its broader impact on daily life, thereby ensuring the mental well-being of women of reproductive age.

Causes and risk factors for stillbirth in India: A systematic review protocol

OBJECTIVES

Stillbirths, the tragic loss of a baby before or during delivery, presents a profound global health concern. Investigating the diverse causes and risk factors is essential to develop targeted interventions, enhance perinatal care, and reduce the incidence of this devastating outcome. The aim of this study was to identify the causes and possible risk factors of stillbirths in India.

STUDY DESIGN

The study design is a protocol for systematic review.

METHODS

This systematic review will include all types of observational studies, such a cross-sectional surveys, descriptive studies, cohort studies and case-control studies from India. Studies will be retrieved from global databases like CINAHL, Medline through PubMed, EMBASE, SCOPUS, Web of Science, ProQuest Medical Library, Microsoft Academia, DOAJ, and Indian databases like Indian Citation Index, J-Gate, and Neonatal Database using database-specific keywords. Additionally, online hand searching will be done on the websites of the relevant Indian institutions. Primary studies' reference lists will be scrutinized for additional references if required. Two review authors (SN & AR) will independently screen, extract data, and critically appraise included studies. The Joanna Briggs Institute Critical Appraisal Checklist will be used to identify the quality and risk of bias of included studies. Any disagreements will be resolved in consultation with a third reviewer (BSN).

RESULTS

Results will be reported as per the PRISMA guidelines. This systematic review will. identify and highlight the causes and potential risk factors of stillbirths in India, which will guide the healthcare team in planning and developing a standard protocol and policies to promote successful antenatal care, implement effective early interventions, and improve access to quality healthcare to reduce stillbirth rates in institutional, rural, and underserved areas as per the Indian healthcare system.

CONCLUSION

These findings on causes and risk factors for stillbirth in India address a crucial gap in th literature and allow us to prepare a foundation for targeted interventions and policy recommendations in the healthcare system trajectory.

PROTOCOL REGISTRATION

The Protocol is registered in the International Prospective Register of Systematic reviews PROSPERO (CRD - 42024506186).

Analysis of Maternity Rights Perception: Impact of Maternal Care in Diverse Socio-Health Contexts

Maternity rights are perceived and fulfilled differently according to women's psychosocial characteristics, leading to varying maternal experiences and outcomes. It is necessary to know the impact of cultural context, emotional well-being, and resource availability on the maternal woman's clinical care experience. The aim is to identify if these factors contribute to disparities in the perception of maternity rights fulfillment in Spain and Colombia. This retrospective observational study focused on women who received maternity-related healthcare in Spain or Colombia. A total of 185 women were included (Spanish = 53; Colombian = 132). Data collected included social and obstetric history, as well as psychological variables such as resilience, positive and negative affect, derailment, and maternity beliefs. The study also assessed women's knowledge of healthcare rights (MatCODE), perceptions of resource scarcity (MatER), and the fulfillment of maternity rights (FMR). C-section was more prevalent in Colombia, where women also scored higher on maternity beliefs as a sense of life and as a social duty compared to Spanish women. Conversely, FMR was higher in the Spanish context. Colombian women reported lower levels of social support and less involvement in medical decision-making. The FMR was positively correlated with positive affect, MatCODE, and MatER. Predictive modeling identified negative factors for FMR, including giving birth in Colombia (β = -0.30 [-0.58; -0.03]), previous miscarriage (β = -0.32 [-0.54; -0.09]), C-section in the most recent labor (β = -0.46 [-0.54; -0.0]), and higher MatER scores. Positive predictors included gestational age, maternal age, and previous C-section (β = 0.39 [0.11; 0.66]). The perception of the fulfillment of maternity rights depends on socio-healthcare contexts, women's age, obstetric history, and resources. It is suggested to apply culturally sensitive strategies focused on women's needs in terms of information, emotional and social support, privacy, and autonomy to manage a positive experience.

Communicating neurological prognosis in the prenatal period: a narrative review and practice guidelines

Clinicians may face an array of challenges in conducting fetal neurological consultations including prognostic uncertainty, a lack of training in fetal counseling, and limited opportunity to build rapport with families. In this setting, it is critical to employ high-quality, family-centered care to allow expectant parents to make informed decisions. Despite the challenges and gravity of these consultations, there remains limited data outlining best conduct and communication practices. This narrative review aims to summarize relevant literature around counseling within fetal neurology, focusing on three key themes: (1) discussing neurological prognosis and uncertainty, (2) navigating evolving decision making, (3) recognizing bias and understanding patient context. We provide practical recommendations to clinicians conducting fetal neurological counseling and outline future research priorities. IMPACT: Fetal neurological conditions can have a significant impact on child short- and long-term health outcomes. Prenatal consultations are an important venue to discuss information regarding fetal prognosis and decision making with expectant parents. However, there is limited evidence supporting best communication practices within this setting. This review summarizes current literature around expectant parent prognostic communication preferences and outlines practical recommendations and priorities for future research.

Comparison of Remimazolam-Flumazenil and Propofol on Psychomotor Function and Emergence Following General Anesthesia in Surgical Abortion: A Randomized Controlled Trial

Objective

 This study aims to compare the recovery profiles of remimazolam combined with flumazenil against those of propofol in patients undergoing painless surgical abortion, focusing on psychomotor function and emergence. Rapid recovery and restoration of psychomotor function are critical for enhancing patient safety and satisfaction in outpatient procedures like surgical abortion.

Methods

A total of 110 patients scheduled for surgical abortion were randomly assigned to either the remimazolam group (Group R) or the propofol group (Group P) in a 1:1 ratio. Both groups received intravenous sufentanil for induction, followed by either remimazolam or propofol. Psychomotor function was assessed using the Digit Symbol Substitution Test (DSST) and Trieger Dot Test (TDT) at 30, 60, and 90 minutes post-anesthesia. Emergence parameters, including time to first eye opening and first verbal response, were recorded. Adverse events and hemodynamic parameters were also monitored.

Results

The DSST scores at 30, 60, and 90 minutes post-anesthesia were similar between the Remimazolam group and the Propofol group (F=50.61, P>0.05, η²=0.0051). The TDT results were also comparable between the groups at all time points (F=0.12, 0.11 and 0.30, all P>0.05, η²=0.0002, 0.0003 and 0.0008). At 30 or 60 minutes post-anesthesia, DSST scores or TDT performance were significantly worse compared to preoperative baseline in both groups, indicating reduced psychomotor function (P<0.05). The Remimazolam group showed significantly shorter times to first eye opening (54.48±3.45 s vs 99.22±11.78 s, P=0.0014, Cohen's d=5.15) and to obey verbal commands (61.85±3.78 s vs 131.1±12.79 s, P<0.0001, Cohen's d=7.34) compared to the Propofol group.The incidence of injection pain and respiratory depression was significantly lower in the remimazolam group (P<0.05), while hiccups were more common. Hemodynamic stability was maintained in both groups, with no significant differences in blood pressure or oxygen saturation (P>0.05).

Conclusion

 Remimazolam combined with flumazenil provides faster emergence and comparable psychomotor function to propofol in patients undergoing painless surgical abortion. This combination offers a promising anesthetic profile for procedures requiring quick recovery and minimal postoperative complications.

Trial Registration

ChiCTR2300075375, date of registration: 03/09/2023.

The landscape of recurrent spontaneous abortion registered on clinical trials.gov

Objective

Recurrent spontaneous abortion (RSA) presents a significant challenge in the field of reproductive medicine, as effective treatments remain limited despite extensive research efforts. A comprehensive understanding of current RSA clinical trials is essential for enhancing trial design and identifying existing research gaps. The aim of this study is to characterize RSA related clinical trials registered on Clinical Trials.gov.

Methods

A thorough search was conducted to identify and review clinical trials focusing on RSA that were registered on Clinical Trials.gov up to March2, 2024.

Results

A total of 138 trials were identified in the analysis, with 72 (52.17%) classified as intervention trials and 66 (47.83%) as observational trials. Approximately half of the studies (67,48.55%) had an enrollment of 100 participants or fewer. The majority of trials included only female participants. Asia hosted the highest number of clinical trials (46,33.33%), followed by Europe (36,26.09%), Africa (29,21.01%), America (13,9.42%). The majority of trials (61,44.20%) focused on individuals with unexplained recurrent spontaneous abortion (URSA). The predominant intervention types examined in the reviewed studies were drug interventions (49,62.82%), with a notable rise in behavioral intervention trials.

Conclusion

Our research findings suggest that existing research efforts in the realm of RSA are inadequate for the progression of prevention and treatment strategies. The majority of clinical trials have primarily targeted individuals with URSA, with a particular emphasis on drug interventions, notably anticoagulants.

A qualitative study of bereaved parents and healthcare professionals on perinatal loss

INTRODUCTION

Perinatal loss, encompassing stillbirth and neonatal death, can have profound physical and psychological consequences for parents. Effective communication by healthcare professionals during this sensitive period is critical. This study aimed to explore how bereaved parents and professionals experienced verbal and non-verbal communication during perinatal loss.

METHODS

A qualitative, in-depth interview study following grounded theory principles was conducted in Flanders, Belgium, between January and June 2021. Participants were purposively selected via a hospital ward. Face-to-face (n=8) and online (n=13) interviews were carried out by two midwife researchers who were aware of potential biases related to personal/professional interests. A group of bereaved parents and professionals provided feedback during the project. Qualitative analysis was conducted using NVIVO, employing open and axial coding to identify themes.

RESULTS

Eleven bereaved parents and ten professionals participated. Six themes emerged: 1) navigating time and adjusting pace; 2) recognition of parenthood in woman and partner; 3) clear, honest information for shared decision-making; 4) authentic contact while leaving room for alone time; 5) gentle and sensitive verbal communication; and 6) professionals' self-care. Parents valued clear, honest communication, acknowledgment of their parenthood, and the ability to make informed decisions. Healthcare professionals emphasized the challenge of providing adequate time and presence amidst busy schedules, but recognized the importance of empathy and sensitivity.

CONCLUSIONS

Compassionate, patient-centered care with effective verbal and non-verbal communication is vital in supporting bereaved parents during perinatal loss, and it continues to be a challenge. Findings can guide clinical practice to inform professional training initiatives and inform intervention development.

Role of serum kisspeptin as a biomarker to detect miscarriage: a systematic review and meta-analysis

Miscarriage is a common adverse pregnancy outcome with physical and emotional effects. Identifying predictive miscarriage biomarkers should improve early detection and management. Serum kisspeptin, known for its critical role in reproductive biology, has emerged as a potential biomarker for miscarriage. With this systematic review and meta-analysis, we aimed to assess the association between serum kisspeptin levels and the miscarriage risk. We systematically searched PubMed, Embase, and Cochrane Library databases for studies published up to February 2024, examining the association between serum kisspeptin levels and miscarriage. Eligible studies were observational designs that reported kisspeptin levels in women with and without miscarriage. We included 12 studies involving 2,050 participants. Pooled analysis demonstrated that low serum kisspeptin levels were significantly associated with an increased risk of miscarriage (standardized mean difference = -2.750; 95%CI: -4.357 to -1.143), with substantial heterogeneity (I2 = 98.7%). The pooled area under the curve from three studies indicated high diagnostic accuracy (AUC = 0.903; 95%CI: 0.860-0.946). Low serum kisspeptin levels are significantly associated with an increased miscarriage risk, suggesting that kisspeptin could serve as an effective biomarker for early detection. However, the significant heterogeneity among studies and the lack of standardized measurement protocols emphasize the necessity of further research before clinical implementation. SYSTEMATIC REVIEW REGISTRATION: (Registration ID: CRD42024520639).

Investigating the interplay between depression and pregnancy loss: a cross-sectional analysis using NHANES data

OBJECTIVE

This study aimed to investigate the association between depressive symptoms and pregnancy losses, as well as the moderating effects of demographic variables, including age, income level and ethnicity.

METHODS

Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9) questionnaire, with key variables such as "loss of interest," "feeling down," and "sleep disturbances." Weighted linear regression models evaluated the relationship between depressive symptoms and pregnancy losses, while interaction analyses explored the moderating effects of demographic factors.

RESULTS

The findings revealed a significant positive association between depressive symptoms and pregnancy losses. Severe symptoms, particularly "thoughts of self-harm" (p = .013), were strongly linked to multiple losses. Other symptoms such as "feeling down" (p < .001) and "feeling bad about oneself" (p < .001) were also significantly associated. The association was most pronounced among women aged 35-50. Additionally, the effect of depressive symptoms was more significant among low-income and minority women, suggesting socioeconomic and cultural factors play a role.

CONCLUSIONS

Depression, especially major depression, is significantly associated with an increased number of pregnancy losses, particularly among women aged 35-50. Socioeconomic and cultural factors are influential, highlighting the need for targeted interventions in high-risk groups.

Service evaluation of an early pregnancy loss support clinic in an inner London early pregnancy unit

BACKGROUND

Early pregnancy loss (EPL) can have profound implications for physical and psychological health. In the UK, significant variation in service provision exists for women affected by EPL. There is very little guidance on what hospital-based follow-up support services should entail, and how these can be implemented and integrated into current care provision to meet the needs of women who experience EPL. This service evaluation (SE) reports on an Early Pregnancy Loss Support Clinic (EPLSC) in an inner-city Hospital Trust.

METHODS

This SE gathered both quantitative and qualitative feedback from women to assess the value of a locally implemented Early Pregnancy Loss Support Clinic (EPLSC). Quantitative feedback was collected using the Short Assessment of Patient Satisfaction (SAPS) questionnaire and the Visual Anxiety Scale (VAS-A), both administered to women attending the EPLSC. Qualitative feedback was collected through semi-structured interviews and focused on four pre-determined themes based on EPL literature - physical health, mental health, role of the bereavement midwife and overall service user experience. Quantitative feedback was summarised using descriptive statistics, while qualitative feedback was analysed using framework analysis.

RESULTS

A total of 127 women were invited to the EPLSC, with 110 (87%) attending, and 17 (13%) not attending their appointment. SAPS scores ranged from 21 to 28, indicating that women were either satisfied or very satisfied with the care they received at the EPLSC. Results from VAS-A scores showed that 76 (69%) women reported a decrease in anxiety immediately after attending the EPLSC, compared to 8 (7%) who reported no change or a small increase in anxiety. Qualitative findings highlighted women's concerns around future fertility, the importance of emotional support and the value of connecting with the bereavement midwife.

CONCLUSION

An EPLSC that focuses on providing emotional support and reassurance, particularly regarding future fertility, is important to women. Further rigorous evaluation of national disparities in EPL follow-up is urgently needed to assess the gaps in clinical care delivery.

Perinatal loss: attachment, grief symptoms and women's quality of life

AIMS/BACKGROUND

Perinatal loss may cause intense distress even psychiatric issues, affecting the woman's quality of life. Attachment may provide a useful perspective in understanding the outcomes of the mourning process. Thus, the objectives of the present study were to evaluate perinatal grief symptoms and the psychological and general quality of life among 137 Italian women (mean age 36,9. ± 6,88 years old) in relation to attachment, specifically measured through parental care and control.

DESIGN/METHODS

About 79.6% of the participants had miscarriages and 20.4% had stillbirths. About 45.3% were childless. The women completed the Parental Bonding Instrument, the Perinatal Grief Scale and the Psychosocial General Well-Being Index online most frequently between 3 and 6 months (56.2%) after the perinatal loss.

RESULTS

All the study participants showed intense grief and severe grief reactions to loss. Moreover, women experiencing optimal bonding towards their own mothers had a more positive effect on perinatal grief and psychological and general quality of life.

CONCLUSIONS

Attachment-based, tailored interventions for women who have experienced perinatal loss should improve their psychological and overall quality of life.

Symptomatic leiomyoma in a patient with a bicornuate uterus: A rare case report

INTRODUCTION AND IMPORTANCE

Uterine anomalies are congenital malformations caused by fusion or resorption defects during embryogenesis. A bicornuate uterus is a rare condition that results from abnormal development of the paramesonephric ducts. It results from an incomplete fundus-level fusion of uterovaginal horns.

CASE PRESENTATION

A 30-year-old female presented with a longstanding abdominal distension. An abdomino-pelvis CT scan result was suggestive of a huge right ovarian mass (25.8 × 25.9 × 14.3 cm). Intraoperatively, a bicornuate uterus with normal left cornua was encountered. The right cornua was not extending to the vagina vault and had a huge cystic mass arising from the fundus. The right cornua excision along with the mass was performed, preserving the left normal cornua and its adnexa. Histopathology confirmed the diagnosis of leiomyoma. The patient was kept in follow-up. To date, six months have passed; she has resumed her menstrual cycles and is free from symptoms.

DISCUSSION

Symptomatic fibroids in patients with a birconuate uterus are rare. Thus, diagnostic challenges can be encountered, as was seen in this case. A huge size of the fibroid in one horn of the bicornuate uterus projecting into the pelvic cavity can contribute to recurrent pregnancy loss. An MRI of the pelvis is recommended for assessment of the internal and external contours of the uterus.

CONCLUSION

A bicornuate uterus with lieomyomas is an uncommon but difficult condition. An appropriate pre-operative assessment of the mullerian anomaly type, quantity, location, and size of lieomyomas, as well as urinary tract mapping, are essential for effective management.

Screening for perinatal depression and stress: a prospective cohort study

PURPOSE

There is currently a heightened need for perinatal medical services to timely recognize and accurately meet the psychological needs of pregnant women. Psychological disturbances a mother experiences during pregnancy, such as depression and anxiety, can be later associated with inadequate maternal capacity for antenatal care for herself and the baby, and may lead to subsequent mental health problems later in the mother's life. Routine prenatal assessment could significantly benefit from being proactively enriched with early prevention mental health screening tools to assess, appropriately manage vulnerable populations, and subsequently implement preventive actions.

METHODS

178 pregnant women, under routine prenatal medical assessment, were measured regarding depressive symptomatology and stress, through the use of two validated psychometric tools (the Edinburgh Postnatal Depression Scale (EPDS) and the Perceived Stress Scale (PSS-14)).

RESULTS

Heightened perceived stress and depressive symptomatology levels were associated with younger maternal age, an obstetrical record of more than one births and a history of abortion. Results additionally showed a connection between the requirement for a psychiatric referral-based on the levels of symptomatology recorded through the psychometric assessment and a clinical interview-and currently running the earlier stages (weeks) of pregnancy.

CONCLUSION

Our revised proposed prenatal screening protocol for depression and stress suggests an amplified follow-up assessment including all pregnant women scoring high in both depression and in perceived stress, regardless of previous history of prenatal depression or of suicidality, to detect earlier or less manifest expressions of distress during pregnancy, in vulnerable perinatal populations.

Validation of the Revised Impact of Miscarriage Scale in the Republic of Burundi: A cross-sectional multicenter study

OBJECTIVE

The objective of this study was to translate and validate the Revised Impact of Miscarriage Scale (RIMS) into Kirundi for use among women and men in Burundi. Additionally, the study aimed to compare the experience and personal meaning of miscarriage between women and men.

METHODS

This is a cross-sectional multicentered study. The RIMS was translated into Kirundi. Cronbach coefficient alpha and its internal consistency were measured for both genders. An exploratory factor analysis (EFA) was used to determine the underlying factors and the shared variance. Both women and men completed the RIMS questionnaire, while women completed sociodemographic, reproductive and mental health questions.

RESULTS

In all, 79 couples completed the RIMS. The original factor structure was retained after the EFA, with 68% of the shared variance explained in the three-factor solution with 16 questions. Isolation/guilt, Loss of baby, and Devastating event. The internal consistency for women and men combined was α = 0.928. Although women scored higher on the factors of Isolation/guilt and Loss of baby, there were no significant differences in the Devastating event factor between women and men. Couples scores were positively correlated. Women who had experienced a previous miscarriage were more significantly impacted by all three factors compared to women experiencing their first miscarriage.

CONCLUSIONS

The Kirundi translation of the RIMS retained the original factor structure and demonstrated excellent internal consistency α = 0.928 in women and men combined. The RIMS could be a tool for caregivers to identify individuals who require additional support after a miscarriage.

Semaphorin 4A Maintains Trophoblastic Function via Activating the STAT3 Pathway

The migration, proliferation, and apoptosis of trophoblastic cells play a crucial role in ensuring the effective preservation of pregnancy at the maternal-fetal interface. Any deviations in the structure and function of these cells might potentially result in the development of numerous pregnancy-related disorders, including missed abortion (MA). This study involved the examination of semaphorin 4A (SEMA4A) expression in missed abortion (n = 18) and normal early pregnancy (n = 18) villus. The findings of this study indicate a statistically significant decrease in the expression of SEMA4A in the villi of individuals diagnosed with missed abortion, as compared to the control group. The results of our vitro study showed that SEMA4A promoted the migration and proliferation of trophoblast cells and inhibited their apoptosis. Subsequent studies have shown that SEMA4A may be involved in regulating p-STAT3/STAT3, MMP9, bcl-2, and BAX levels. In summary, the findings of this study indicate a correlation between the decreased level of SEMA4A in chorionic villi and missed abortion. These results offer novel theoretical insights into the proper implantation and development of SEMA4A embryos at the maternal-fetal interface.

Exploring Progesterone Deficiency in First-Trimester Miscarriage and the Impact of Hormone Therapy on Foetal Development: A Scoping Review

Background and Objectives: Progesterone deficiency during pregnancy may lead to various complications, including first-trimester miscarriage, which is the most common pregnancy complication. However, progesterone therapy may play a role in pregnancy maintenance and foetal development. The aim of this scoping review is to present evidence on the link between progesterone deficiency and first-trimester miscarriage among pregnant women and assess the impact of progesterone therapy on foetal development. Methods: A comprehensive global systematic search of mainly primary research studies was conducted using several databases. Peer-reviewed studies published between 2010 and 2023 were included. The scoping review was conducted using the framework outlined by the Joanna Briggs Institute (JBI) and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Extension for Scoping Reviews (PRISMA-ScR) statement. Results: Twenty-three articles (which included 35,862 participants) were included in the analysis. Most studies were conducted in mid- to high-income countries. All 23 articles reported a significant positive relationship between progesterone deficiency and first-trimester miscarriage. Furthermore, the majority of studies reported a higher risk of miscarriage when lower levels of progesterone are combined with other declined hormones. While most studies reported that progesterone therapy may reduce the rate of first-trimester miscarriage among pregnant women, no evidence of health-related harm to offspring development was reported. Conclusions: The findings from this systematic-scoping review indicate possible benefits of progesterone replacement therapy in maintaining a healthy pregnancy and foetal development. Rigorous studies that include large sample sizes and systematic reviews are required to confirm these findings further.

Perinatal Mental Health: The Need For Broader Understanding And Policies That Meet The Challenges

Perinatal mental health is gaining recognition as a key antecedent of adverse maternal and child outcomes as the United States experiences a maternal mortality and morbidity crisis. Recent policy efforts have attempted to mitigate adverse outcomes through legislation such as the Taskforce Recommending Improvements for Unaddressed Mental Perinatal and Postpartum Health (TRIUMPH) for New Moms Act of 2021 and postpartum coverage through Medicaid expansion. Even with progress, perinatal mental health policy continues to grapple with a basic truth: The United States lacks an overarching health care system capable of meeting the mental health care needs of perinatal people and their families.  Moreover, the burden of undiagnosed and untreated perinatal mental health challenges remains greatest among racially minoritized populations, such as Black, Asian, and multiracial people. A broader understanding of perinatal mental health is needed, grounded in the tenets of reproductive justice. From this perspective, we articulate specific policies to meet perinatal mental health challenges and promote thriving for birthing people and their families.

Association between semen parameters and recurrent pregnancy loss: An umbrella review of meta-analyses

AIM

Recurrent pregnancy loss (RPL) is a common clinical reproductive problem. With research advancements, an increasing number of studies have suggested that male factors play an important role in RPL. However, the evaluation results of male sperm quality in published meta-analyses are inconsistent. We aimed to summarize the evidence of the association between semen factors and RPL and evaluate the level and validity of the evidence.

METHODS

We searched PubMed, Cochrane Library, EMBASE, Web of Science, and Scopus databases for systematic reviews or meta-analyses to evaluate the association between male semen parameters and RPL. The methodological quality of the included meta-analyses was assessed, and data and evidence were re-synthesized and stratified using a random-effects model.

RESULTS

Seven meta-analyses and nine semen parameters were included in the final analysis. The methodological quality of all publications was considered low or very low. There was highly suggestive evidence for the association between sperm DNA fragmentation (SDF), sperm progressive motility rate, and RPL (class II). The evidence level for the association between sperm concentration, normal sperm morphology, sperm deformity rate, total motility, and RPL was suggestive evidence (class III). The evidence level for the association between sperm volume and sperm count and RPL was weak (class IV). There was no significant association between sperm pH and RPL (class NS).

CONCLUSIONS

Our results suggest level II evidence for the association between male SDF and RPL, while the evidence level for the association between conventional semen routine parameters and RPL was low (classes III and IV).

Progesterone in Pregnancy: Evidence-Based Strategies to Reduce Miscarriage and Enhance Assisted Reproductive Technology

The incidence of miscarriage in early pregnancy, between 5-20 weeks, is common, with a prevalence of between 5-22% of all pregnancies. Miscarriage can have physical, social, and mental health impacts on women and their families. In societies such as Taiwan, where the birth rate is falling and life expectancy is increasing, there is concern that factors that reduce birth rates will have detrimental economic and societal effects. Progesterone has a significant role in maintaining early and successful pregnancy to term. Evidence from preclinical and clinical research on the roles of progesterone has supported recent clinical guidelines in obstetrics and gynecology to reduce rates of early miscarriage and improve methods of assisted reproductive technology (ART). This article aims to present an evidence-based review of current recommendations for the use of progesterone in early pregnancy to reduce miscarriage rates and in luteal phase support for ART, including embryo transfer.

Congenital Anomalies of the Female Genital Tract: A Comprehensive Review

This comprehensive review provides an in-depth examination of congenital anomalies of the female genital tract, explicitly focusing on the American Society for Reproductive Medicine (ASRM) Müllerian Anomalies Classification. The classification system is crucial for standardizing communication and guiding accurate diagnoses in clinical practice. The review explores the diverse clinical presentations, etiological factors, and diagnostic modalities associated with these anomalies. Management strategies, ranging from conservative approaches to advanced reproductive technologies, are discussed in the context of individualized treatment plans based on the ASRM classification. The psychosocial impact of female genital tract anomalies is thoroughly examined, emphasizing the importance of holistic care and patient-centered approaches. Looking toward the future, the review outlines emerging research areas, including advances in diagnosis techniques, innovative treatment modalities, and genetic studies. It ultimately underscores the need for a comprehensive understanding of physical and psychosocial dimensions, offering insights for healthcare professionals to navigate this complex landscape and improve the lives of affected individuals.

An Overview for the General Psychiatrist Evaluating Patients With Obstetric and Neonatal Complications and Perinatal Loss

When neonatal and obstetrical complications occur, the identification and management of mood and anxiety disorders become complex with an ever-expanding array of psychiatric needs that include the management of grief- and trauma-related disorders. With high rates of maternal morbidity and mortality in the United States and laws in many states restricting reproductive health access, psychiatrists must be proficient in managing psychiatric sequelae in this context. High-risk groups for peripartum mood and anxiety disorders, posttraumatic stress disorder, and complicated grief include those with neonatal intensive care unit (NICU) stays and those who have experienced infertility and recurrent pregnancy loss. Groups who have been historically marginalized by the medical system (e.g., Black, Indigenous, people of color) and those from LGBTQ+ communities are at similarly high risk, and more interventions are needed to support these groups. Strategies emphasizing trauma-informed care, psychotherapeutic approaches, and using patient-centered language are recommended.