Placenta

AimsThe Mediterranean diet is associated with reduced cardiometabolic risk, yet its physiological effects during pregnancy and its impact on placental metabolism remain incompletely understood. This study aimed to determine whether maternal adherence to a Mediterranean diet during pregnancy influences placental lipid metabolism and signalling pathways involved in nutrient handling, tissue remodelling, and inflammation, and to assess their relationship with pregnancy outcomes. MethodsPlacental samples and clinical outcome data were analysed from pregnant women participating in an unblinded randomized clinical trial of a Mediterranean diet intervention. Placental lipid composition was quantified and the expression of genes and signalling pathways involved in lipid metabolism, nutrient transport, inflammation, and tissue remodelling was evaluated. ResultsMaternal adherence to a Mediterranean diet during pregnancy was associated with significant alterations in placental lipid composition, including reduced C18:0 and C24:0 and increased C18:1n9c, C20:3n6, and C22:0, with lower total short-chain fatty acids and higher monounsaturated fatty acids. Placental expression of lipid metabolism regulators ALOX15 and PPAR{gamma} was reduced, alongside downregulation of AKT and p38 MAPK signalling pathways. Placentas from mothers adhering to the Mediterranean diet also showed lower expression of amino acid and glucose transporters SLC3A2 and SLC2A1, as well as altered inflammatory and extracellular matrix remodelling markers, including decreased SOCS3 and GHR and increased PAI1 and MMP3. ConclusionsMaternal adherence to a Mediterranean diet during pregnancy modifies placental lipid composition and regulates pathways involved in lipid handling, nutrient transport, inflammation, and tissue remodelling, providing insight into mechanisms linking maternal diet with placental metabolic function.

ObjectivesCD4+ T cells play key roles in regulating immune responses during pregnancy, therefore we aimed to understand the CD4+ T cell surface proteome and transcriptome during pregnancy. MethodsCD4+ T cells were analysed in blood and decidua from term-pregnancies (>37 weeks), and non-pregnant blood. >350 surface proteins were screened via flow cytometry, and transcriptomes were analysed using single-cell RNA sequencing with >130 CITE-seq barcoded antibodies. ResultsSurface protein screening identified changes to ILT4/CD85d, CD9, IFN-{gamma} receptor {beta}-chain, CX3CR1 and CCR5 in the pregnant blood and decidual CD4+ T cells. CX3CR1 and CCR5 had the highest expression on the effector-memory T cell (TEM) subset in the blood, with expression consistent across subsets in decidua. CD126/IL-6R was lower in pregnant blood and decidual CD4+ T cells, while scRNAseq identified enrichment in the IL-6R signalling pathway in naive CD4+ T cells in pregnant blood. Both sIL-6R and IL-6 concentrations were increased in plasma during pregnancy, suggesting perturbations to the IL-6/IL-6R signalling axis. Meanwhile, decidual CD4+ T cells had increased expression of transcription factor RUNX3 in the CD69+ tissue-resident-like subset. ConclusionsOur findings demonstrate altered molecular expression in CD4+ T cells during pregnancy. This provides important mechanistic insight of their adaptation and regulation during placental development, which may drive placental dysfunction or pregnancy complications including preeclampsia, fetal growth restriction and stillbirth. These new data may inform future studies that focus on determining the significance of differentially- expressed immune features in pregnancy to identify potential targets for immune modulation to treat pregnancy complications and infections.

Maternal pancreatic {beta}-cells undergo functional and structural changes to adapt to increased metabolic demands during pregnancy. Lactogen signaling via the prolactin receptor (PRLR) contributes to these adaptations by increasing {beta}-cell mass, insulin transcription and glucose-stimulated insulin secretion[1-4]. In other lactogen-responsive tissues such as the mammary glands and specific hypothalamic nuclei, gestation induces epigenetic changes, some of which persist long after birth[5, 6]. We have previously found that prolactin treatment in islets regulates the expression of epigenetic modifiers[7, 8]. However, whether lactogen signaling in {beta}-cells mediates epigenetic changes to regulate chromatin accessibility has not been examined. Therefore, our objective was to determine whether PRLR signaling alters chromatin accessibility of {beta}-cells to facilitate transcriptional regulation. Using single-cell ATAC-sequencing, we identified differentially accessible regions (DARs) in {beta}-cells which had 718 overrepresented motifs following prolactin treatment of murine islets. Validating this approach, these included motifs bound by established PRLR signaling effectors such as the STAT family of transcription factors (TFs). Using RNA-sequencing we identified transcriptional changes in 41 TFs whose motifs were overrepresented in DARs, including several previously linked to PRLR signaling within {beta}-cells, including Myc, Mafb and Esr1. Importantly, we also identified TFs not previously associated with PRLR signaling, including OVOL2 an established regulator of epigenetic landscape within cells. OVOL2 is a transcription factor involved in EMT inhibition and energy homeostasis with unknown roles in pancreatic {beta}-cells. Here, we establish that OVOL2 acts as a negative regulator of lactogen-dependent effects on {beta}-cell proliferation, establishing a novel regulator of PRLR signaling.

BackgroundPreterm birth is one of the most significant etiologies for neonatal morbidity and mortality. Preterm delivery is classified as iatrogenic preterm delivery and spontaneous preterm delivery. The role of placental pathology is studied. Materials and methodsWe have previously collected placental pathology data with maternal pregnancy and neonatal birth data, and we investigated the role of placental pathology in preterm delivery. Preterm delivery was categorized as late preterm (34-36 weeks), moderate preterm (32 to 33 weeks), and extreme preterm (less than 32 weeks). Neonatal, maternal, placental gross and histologic features, and laboratory parameters were compared across groups using chi-square tests for categorical variables and Kruskal-Wallis tests for continuous variables using various programs in R-package. ResultsTotally 3723 singleton placentas including 3307 term (88.8%) and 416 preterm placentas (11.2%) were examined with maternal pregnancy data and neonatal birth data. There were 614 placentas from patients with preeclampsia/pregnancy induced hypertension (PRE/PIH) (16.5%). Preterm delivery showed significantly lower fetal birth weight, placental weight, and fetal-placental ratio (all p<0.01). Maternal Black race was more prevalent in preterm groups (up to 50.8% in extreme preterm vs. 33.2% in term, p<0.01). Preterm delivery was statistically associated with PRE/PIH and maternal vascular malperfusion (MVM), maternal and fetal inflammatory response (MIR and FIR), and increased pre-delivery white blood count (WBC). Extreme preterm deliveries were markedly associated with intrauterine fetal death (27.5%, p<0.01) and MIR/FIR (56.7%, p<0.01). After excluding PRE/PIH patients, preterm delivery was statistically associated with MIR/FIR and increased WBC. ConclusionsDistinct clinicopathologic profiles exist across preterm subcategories, with MVM predominating in late/moderate preterm and severe pathologic features (including fetal demise and acute inflammation) in extreme preterm. These findings highlight heterogeneous etiologies of preterm delivery.

Human embryo implantation, occurring approximately one week after fertilization, remains poorly understood due to ethical and technical limitations of in vivo investigation. To overcome these barriers, and model this critical developmental event, encompassing peri- and early post-implantation stages, we used an in vitro embryo attachment model composed of donor-derived endometrial epithelial cells forming an open-faced endometrial layer (OFEL) and human stem cell-derived blastoids recapitulating human day 5 blastocysts in peri-implantation model. Following attachment, developmental progression was further investigated on laminin-coated substrates to capture early post-implantation dynamics. Despite its central role as the primary endocrine signal of early pregnancy, human chorionic gonadotropin (hCG) remains largely uncharacterized in this context. Here, we describe the transcriptomic profile of blastoid-endometrial co-cultures relative to OFEL alone, identifying CGA and CGB3/5/8 as among the most strongly upregulated genes following blastoid attachment to hormonally stimulated OFEL. Consistent with these findings, immunoassays and luteinizing hormone/choriogonadotropin receptor (LHCGR) activation assays of conditioned media confirmed the secretion of heterodimeric, biologically active hCG and its free subunits in co-cultures, but not in endometrial layers alone. Notably, the hyperglycosylated hCG heterodimer was the predominant isoform detected. Co-culture with the endometrial component significantly increased hCG secretion compared with blastoids cultured alone, an effect further enhanced by hormonal priming in the peri-implantation model. Collectively, these findings indicate that a hormonally primed endometrial environment not only promotes blastoid attachment but also amplifies embryonic hCG production and bioactivity, underscoring the importance of maternal endocrine cues in early embryo-endometrium communication. Furthermore, our peri- and early post-implantation models recapitulate key aspects of reciprocal endocrine signaling between embryonic and endometrial tissues, providing a tractable experimental framework to investigate embryo-endometrium crosstalk.

We aimed to evaluate disparities in perinatal ICU admissions at an urban medical center and to contextualize these findings relative to national U.S. data provided by the Centers for Disease Control and Prevention (CDC). To do so, we performed a retrospective review of all pregnant and < 6-week postpartum patients admitted to the ICU between October 2023 and June 2025. The cohort included 58 patients: 81% were non-Hispanic Black, and 91% were publicly insured. These local data can be compared to national data, which demonstrate higher rates of severe maternal morbidity (SMM) and ICU admission among Black patients and those insured by Medicaid. In 2023, the U.S. maternal mortality rate was 18.6 per 100,000 live births, down from 22.3 in 2022. However, significant disparities persist, with mortality rates of 50.3 per 100,000 among Black women compared with 14.5 per 100,000 among White women. The most frequently reported indications for obstetric ICU admission include hypertensive disorders of pregnancy, obstetric hemorrhage, and severe underlying medical comorbidities.

Background: APOL1 risk alleles are prevalent in individuals of West African ancestry and associated with increased risk of kidney disease. Although preeclampsia disproportionately affects women of Black ethnic backgrounds, evidence linking APOL1 alleles to preeclampsia remains conflicting. Objectives: The purpose of this study was to explore whether maternal APOL1 alleles contribute to preeclampsia risk and associated adverse pregnancy outcomes. Study design: We conducted a nested case-control study of 5210 pregnant women, including 745 preeclampsia cases and 949 controls of Black self-reported ethnicity, 1385 preeclampsia cases and 2131 controls of White self-reported ethnicity. APOL1 G1 and G2 risk alleles were directly genotyped on the Illumina Infinium Global Screening Array. Associations with preeclampsia, early preeclampsia, recurrent preeclampsia, birthweight centiles and gestational age at delivery were examined using regression models assuming a recessive mode of inheritance with adjustment for established risk factors and stratification by self-reported ethnicity and genetically-determined ancestry. Results: Presence of APOL1 risk alleles was almost exclusively observed in women of Black self-reported ethnicity. 168/949 controls (17.7%) and 133/745 cases (17.9%) carried two APOL1 risk alleles, and these women did not have a significantly increased risk of preeclampsia compared to those with zero or one APOL1 risk alleles in adjusted analyses (OR 1.00, 95% CI 0.76-1.29, p=0.972). When restricting analysis to women of Black self-reported ethnicity only, no association was observed between APOL1 genotype and preeclampsia risk (adjusted OR 0.94, 95% CI 0.61-1.25, p=0.673). When restricting analysis to women of pan-African genetically-determined ancestry only, also no association was observed between APOL1 genotype and preeclampsia risk (adjusted OR 1.00, 95% CI 0.76-1.32). No associations were found between number of APOL1 risk alleles and early preeclampsia, recurrent preeclampsia, birthweight centile or gestational age at delivery after adjustment for established risk factors and stratification by self-reported ethnicity or genetically-determined ancestry. Conclusions: Maternal APOL1 risk alleles do not independently influence preeclampsia risk or related adverse outcomes in a multi-ethnic pregnancy study. Future studies should examine whether fetal APOL1 genotypes, alone or in interaction with maternal genotypes, contribute to preeclampsia risk.

Based on the 2023 Global Burden of Disease (GBD) database, this study analyzed the global burden of preterm birth from 1990 to 2023 and predicted its development trend by 2050, while exploring the disparities in disease burden across regions with different Socio-demographic Index (SDI) levels, income groups and countries. A retrospective trend analysis was conducted to collect data on preterm birth incidence, prevalence, death and disability-adjusted life years (DALYs) in 204 countries and regions worldwide from 1990 to 2023 from the GBD 2023 database. ARIMA model (p=2,d=1,q=1) and grey prediction model (GM(1,1)) were combined to predict the preterm birth burden from 2023 to 2050. In 2023, preterm birth was the primary cause of the global neonatal disease burden, with its four core indicators significantly higher than other neonatal diseases. From 1990 to 2023, the global incidence, death and DALYs of preterm birth decreased to 0.91, 0.44 and 0.52 times of the 1990 levels respectively, while the prevalence increased to 1.54 times of the baseline. Projection results showed that by 2050, the incidence, death and DALYs of preterm birth would drop to 0.79, 0.08 and 0.32 times of the 2023 levels, and the prevalence would rise to 1.23 times of 2023. Low SDI regions, lower-middle income countries, as well as India and Nigeria, bore the heaviest disease burden. Over the past three decades, the global acute health burden of preterm birth such as death has decreased notably, but the continuous rise in prevalence and severe regional and age disparities remain prominent public health challenges. The 0-6 days and 6-11 months age groups are the key time windows for preterm birth intervention. It is urgent to implement targeted prevention and control measures for low SDI regions and lower-middle income countries to reduce the global burden of preterm birth.

Background Maternal iron requirements increase substantially during pregnancy, and ferritin concentrations typically decline as gestation progresses. However, the physiologic significance of this decline remains uncertain, and whether reductions in maternal iron stores relate to birth outcomes is unclear. Objectives To examine associations between maternal ferritin trajectories during pregnancy and postpartum and infant anthropometric outcomes. Methods We conducted a secondary longitudinal analysis of 1,496 mother - infant pairs from the Alberta Pregnancy Outcomes and Nutrition cohort. Serum ferritin was measured longitudinally in the second and third trimesters and at three months postpartum, with limited first-trimester data available. Values below 15 g/L indicated iron deficiency. Multivariable linear regression assessed associations between inflammation-adjusted third-trimester serum ferritin and infant birthweight and length. Change in serum ferritin between the second and third trimesters ({delta} ferritin) was examined as a marker of late-gestation iron mobilization. Postpartum serum ferritin was modelled using restricted cubic splines to account for nonlinear associations with birth weight and length. Results Ferritin concentrations declined progressively across pregnancy, with 61% of women classified as iron deficient in the third trimester. Lower inflammation-adjusted third-trimester ferritin was associated with higher birthweight, corresponding to approximately 84g higher birthweight per 2.7 - fold decrease in ferritin (p < 0.001). Women experiencing the largest decline in ferritin between the second and third trimester delivered infants approximately 155 g heavier than those with minimal change (p = 0.001). Higher birthweight was associated with greater odds of postpartum iron deficiency (OR per 1 kg = 1.83; 95% CI: 1.12 - 2.99). Conclusions In this healthy cohort, maternal iron depletion in late pregnancy was associated with higher birthweight, consistent with preferential fetal iron transfer. Women delivering larger infants exhibited higher odds of iron deficiency, suggesting sustained maternal iron depletion following greater fetal iron accretion.

Importance: Assessment of cardiovascular health (CVH) during may unmask latent metabolic vulnerability and indicate long-term disease risk. However, the prognostic value of the AHA's Life's Essential 8 (LE8) framework during pregnancy remains uncertain. Objective: To evaluate CVH during using a modified Life's Essential 8 (mLE8) score in association with time to incident cardiometabolic disease. Design: Prospective cohort study with electronic medical record (EMR) surveillance for 7 years postpartum (August 2018-March 2026). Adjusted accelerated time-to-failure models estimated mLE8 associations with incident conditions. Setting: A population-based prenatal cohort recruited from a large academic medical system in South Carolina. Participants: Singleton pregnancies in individuals aged 18 to 44 years without pre-existing diabetes or cardiovascular disease (CVD) Exposures: A 7-component mLE8 score assessed during pregnancy, incorporating hypertensive disorders of pregnancy (HDP), 50-g glucose tolerance test results, pre-pregnancy body mass index, smoking status, sleep adequacy, diet quality, and physical activity. Scores ranged from 0 to 100, with higher scores indicating more favorable CVH. Main Outcomes and Measures: Post-delivery incident cardiometabolic conditions captured through EMRs and classified as chronic hypertensive conditions, chronic metabolic conditions (e.g., dyslipidemia, impaired glucose regulation), and CVD (e.g. cardiac arrest, cardiomyopathy). Time to incident diagnosis was measured in days from delivery. Results: Among 1,225 pregnancies (mean age, 25.0 [5.3] years), 499 incident cardiometabolic events occurred over a median follow-up of 6.2 (2.8) years. Each 10-point higher mLE8 score was associated with a longer time to incident diagnosis of chronic hypertensive conditions (time ratio [TR], 1.26; 95% CI, 1.11, 1.42) and chronic metabolic conditions (TR, 1.20; 95% CI, 1.11, 1.29). Healthier HDP, glucose, BMI, and sleep scores were most strongly associated with longer time to diagnosis of chronic metabolic disease. Results were robust to sensitivity analyses excluding individuals who developed gestational diabetes or HDP. Conclusions and Relevance: In this racially diverse, low-income cohort study of 1,225 pregnancies, better CVH during pregnancy was associated with a longer time to incident post-delivery diagnosis of cardiometabolic conditions. Pregnancy-based CVH assessment may help identify individuals with elevated and emerging cardiometabolic risk who could benefit from early, targeted intervention and enhanced longitudinal surveillance.

Background: Parental diabetes and obesity influence offspring phenotype, but their relative contributions remain unclear. Aim: To examine the relative contributions of parental diabetes and obesity to offspring overweight-obesity and glucose intolerance. Methods: We studied 200 offspring of mothers with diabetes in pregnancy (ODM; 176 indexes, 24 siblings), 176 mothers (133 gestational diabetes (GDM), 22 type 1, 21 type 2 diabetes), and 150 fathers. Controls included 177 offspring of non-diabetic mothers (ONDM), 177 mothers without diabetes in pregnancy, and 163 fathers. Overweight-obesity was defined by WHO criteria, central obesity as waist-to-height ratio >0.5, and glucose intolerance by ADA criteria (fasting glucose for <10 years; oral glucose tolerance test (OGTT) for >=10 years). Generalized linear mixed-effects models assessed parental determinants of offspring outcomes. Results: ODM were more overweight-obese, centrally obese, and glucose intolerant than ONDM. Younger ODM had higher capillary glucose (5.6 vs 5.1 mmol/L, p<0.001). Among ODM >=10 years, 37% had prediabetes and 5% diabetes versus 20% and 0% in ONDM. Overweight-obesity was associated with maternal (OR 7.81; 95% CI 2.19-27.85), paternal (OR 6.21; 95% CI 1.57-24.53), and biparental obesity (OR 9.59; 95% CI 2.73-33.69), but not parental diabetes. Glucose intolerance was associated only with maternal diabetes in pregnancy (OR 3.90; 95% CI 2.05-7.41). Conclusions: Preventing offspring obesity will require addressing parental obesity, whereas preventing glucose intolerance will require optimal glycemic control in the mothers before and during pregnancy.

BackgroundPreeclampsia, a maternal hypertensive syndrome affect fetal brain development and cerebral angiogenesis, with potential acute and long-term consequences. Underlying mechanisms of these brain vascular alterations are unknown. This study investigates the role of thrombospondin-1 (TSP-1), an antiangiogenic glycoprotein, as a key mediator of communication between the fetoplacental and fetal brain endothelium in the context of preeclampsia. MethodsConditioned media (CM) of human umbilical vein endothelial cells (HUVECs) from normal pregnancies (NP-CM) and preeclamptic pregnancies (PE-CM), were used to treat human (hCMEC/D3) and murine brain microvascular endothelial cells (BMECs). A proteomic analysis was performed in plasma of the umbilical cord of normal pregnancy and preeclampsia. TSP-1 was identify using proteomic analysis and confirmed by Western blot. PE-CM depleted of TSP-1, using immunoprecipitation, was used to evaluate protein-protein interaction with vascular endothelial growth factor (VEGF). Antibody-mediated blockage of TSP-1 was used to investigate antiangiogenic effect and pro-angiogenic signaling pathways in brain endothelial cells exposed to PE-CM. ResultsPE-CM significantly reduced angiogenesis, migration, and invasion of brain endothelial cells and altered cytoskeletal organization. These effects were accompanied by reduced VEGFR2 and AKT signaling, indicating impaired angiogenic pathways. Proteomic analysis of umbilical cord plasma revealed elevated TSP-1 levels in preeclampsia, which was confirmed by Western blotting. TSP-1 was also increased in PE-CM, and immunoprecipitation assays suggested a protein-protein interaction with VEGF. Antibody-mediated blockade of TSP-1 restored angiogenesis, as reflected by increased total tube length, and rescued VEGFR2 and AKT signaling in brain endothelial cells exposed to PE-CM. ConclusionTSP-1-mediated endothelium-endothelium communication between placenta-brain axis in offspring of mothers with preeclampsia. This communication mediated by TSP-1 may contribute to acute and long-lasting cerebrovascular dysfunction observed in infants exposed to preeclampsia.

Pregnancy is a unique period regarding immune cell regulation. Within the placenta, maternal immune cells play a central role in immune surveillance and tissue remodeling. However, regulatory mechanisms of systemic immunity during pregnancy are less clear. Here, we show that neutrophil function is altered in pregnant mice (E13.5), indicated by increased slow rolling velocity and reduced adhesion. Mechanistically, PreImplantation factor (PIF), a 15 amino acid peptide which is produced by human and murine trophoblast cells of the placenta, is continuously secreted into the maternal circulation and plays a key role in modulating neutrophil function via blocking the voltage-gated potassium channel KV1.3. This resulted in impaired intracellular Ca2+ signaling and subsequently disturbance of neutrophil post-arrest modifications and a higher susceptibility to physiological shear forces in vivo and in vitro. Furthermore, PIF-mediated KV1.3 blockade impaired E-selectin-mediated release of S100A8/A9 and phagocytosis. Taken together, we have identified PIF as an important modulator of neutrophil function during pregnancy suggesting a critical role in regulating innate immune responses throughout gestation.

ABSTRACT/SUMMARYVascular remodeling within the developing fetus and placenta is essential for supporting the growth and function of emerging tissues and organs. Pericytes (PCs) play a central role in stabilizing and maturing microvascular networks by extending along endothelial cells (ECs) and reinforcing vessel integrity. In the placenta, as in other organs, PC-EC communication is mediated in part by platelet-derived growth factor-BB (PDGF-BB) signaling, which governs PC differentiation, proliferation, migration, and survival, ultimately enabling their recruitment and retention along capillaries. In this study, we identified progressive PC investment along feto-placental capillaries in both murine and human tissues across gestation, supported by morphological and molecular evidence. Placental PCs displayed phenotypic heterogeneity comparable to that observed in the brain and heart, suggesting conserved diversity across organ systems. In addition to characterizing PC dynamics, we examined the expression of recently identified soluble PDGF Receptor-{beta} (sPDGFR{beta}) isoforms. These variants were detected at the protein and transcript levels in mouse and human placentas, as well as in a murine trophoblast-embryonic stem cell (TESC) differentiation model that recapitulates aspects of early placental vascular development. Within this model, sPDGFR{beta} expression was independent of ADAM10 activity and exogenous growth factors during early vessel formation but was markedly upregulated during hypoxia. To assess how elevated sPDGFR{beta} might influence PDGF-BB signaling, we exposed TESCl-derived vascular networks to excess PDGF-BB with or without a sPDGFR{beta} mimetic. PDGF-BB alone reduced full-length PDGFR{beta} levels while increasing receptor phosphorylation, consistent with known ligand-induced regulatory mechanisms. Inclusion of the sPDGFR{beta} mimetic shifted these responses toward baseline, suggesting a potential modulatory or feedback role for soluble receptor variants. Together, these findings demonstrate that PCs are progressively recruited to placental capillaries and exhibit diverse phenotypes during development, and that soluble PDGFR{beta} isoforms may modulate PDGF-BB signaling in a manner sensitive to oxygen tension. Understanding these mechanisms provides insight into the regulation of placental vascular maturation and may inform strategies to improve human health by targeting disorders rooted in impaired placental development.

This study investigates the therapeutic potential of secretomes derived from Adipose-derived Mesenchymal Stem Cells (ADMSC-CM) and Limbal-derived Mesenchymal Stem Cells (LMSC-CM) against oxidative stress-induced damage in Retinal Pigment Epithelium (RPE-1) cells. RPE dysfunction, often triggered by oxidative stress, is a hallmark of various retinal degenerations. Here, we induced RPE-1 injury using H2O2 and evaluated the restorative effects of both MSC-conditioned media (CM). Our results demonstrated that both ADMSC-CM and LMSC-CM significantly enhanced cell viability and successfully reversed H2O2-induced G2/M phase cell cycle arrest. While oxidative stress triggered a pro-inflammatory response characterized by elevated IL-1{beta}, IL-6, and IL-10 expression, MSC-CM treatment, particularly ADMSC-CM, effectively modulated these levels and suppressed the p38 MAPK signaling pathway. Furthermore, MSC-CM reduced the Bax/Bcl-2 ratio, indicating an anti-apoptotic effect, and appeared to stabilize autophagic flux. To investigate the impact of oxidative-stress induced alterations in retinal pigment epithelial cells on angiogenesis, the effects of RPE-derived secreted factors on endothelial cell function were evaluated. Crucially, in terms of safety and secondary complications, neither secretome exhibited pro-angiogenic tendencies; instead, they significantly inhibited HUVEC migration and invasion compared to the H2O2 damaged group. These findings suggest that both ADMSC and LMSC secretomes provide a potent multi-targeted therapeutic effect, making them promising candidates for cell-free therapies in retinal diseases.

Introduction Cesarean delivery accounts for nearly one-third of U.S. births and is associated with substantial maternal morbidity and health care costs. Persistent racial disparities have been documented, yet the structural factors contributing to these differences remain incompletely understood. The extent to which insurance coverage shapes racial disparities in cesarean delivery remains unclear. Objective To evaluate the independent and interactive associations of race/ethnicity and insurance coverage with cesarean delivery in the United States. Methods Population-based retrospective cohort study using singleton live births recorded in the United States Vital Statistics Natality files from 2014 to 2024. Multivariable logistic regression was used to estimate the independent effects of race/ethnicity and insurance status on cesarean delivery, including interaction terms to test effect modification, using national birth certificate data. Models were adjusted for maternal demographics, clinical factors, and temporal covariates. Adjusted odds ratios, predicted probabilities, and absolute risk differences were derived from post-estimation marginal effects. The main outcome measure was cesarean delivery (yes vs no). Results Among 41,543,568 deliveries from 2014 to 2024, 13,312,221 (32.0%) were cesarean deliveries. After adjustment, both race and ethnicity and insurance status were independently associated with cesarean delivery. Compared with non-Hispanic White women, non-Hispanic Black women had higher odds of cesarean delivery (odds ratio [OR], 1.22; 95% CI, 1.22-1.23). Relative to uninsured women, those with private insurance had 59% higher odds of cesarean delivery (OR, 1.59; 95% CI, 1.58-1.60). Significant interaction effects were observed, indicating that insurance coverage modified racial and ethnic differences in cesarean delivery. Non-Hispanic Black women had the highest predicted probabilities across all insurance categories, with the largest absolute disparities observed among uninsured women. Conclusion Racial and ethnic differences in cesarean delivery persist in the United States and are modified by insurance coverage, suggesting that coverage-related differences may contribute to inequities in obstetric care.

Background: Pregnancy loss, including miscarriage and stillbirth, is a major public health issue with major physical and psychological consequences for pregnant women. Prevalence estimates in low resource settings remain scarce due to the lack of adequate data. This study assessed the prevalence, timing, and maternal characteristics associated with stillbirth and miscarriage using novel longitudinal data collected in five low and middle-income countries (LMICs). Methods and Findings: We analyzed longitudinal data from 5755 pregnant women in Ethiopia, India, Kenya, South Africa, and Cote d'Ivoire. Women were enrolled during pregnancy and followed through delivery. Gestation-specific and cumulative risks of miscarriage and stillbirth were estimated using competing-risks survival analysis, adjusting for timing of enrollment. We examined associations with maternal age, education, wealth, and country using Fine and Gray sub-distribution hazard models. Among pregnancies surviving to 8 weeks, the cumulative risk of pregnancy loss by 28 weeks was 84 per 1,000 pregnancies (95% CI: 69 to 100) and from 28 to 44 weeks the risk was 19 per 1,000 (15 to 24), resulting in a total pregnancy loss risk after 8 weeks of gestation of 103 per 1,000 (88 to 119). Risks were highest in Cote d'Ivoire and lowest in South Africa. Losses peaked between 8 and 6 weeks of gestation, with a secondary rise after 36 weeks. Women aged above 35 years had higher loss risk (HR 1.78, 95% CI: 1.27 to 2.48), whereas wealth and education showed no consistent association. Conclusions: Pregnancy loss remains common across LMICs, with significant risk in both early and late gestation. Conventional estimates that do not account for delayed enrollment underestimate miscarriage rates. Enhanced surveillance and targeted interventions throughout pregnancy, especially during early gestation, are essential to reduce preventable fetal losses and meet associated global goals.

Background: Despite significant advancements in obstetric care, the incidence of preeclampsia remains a substantial public health challenge, and effective strategies to prevent the disease progression remain limited, particularly in low-resource settings. N-acetylcysteine (NAC), an antioxidant and glutathione precursor, has demonstrated anti-inflammatory and vasodilatory effects, making it a promising candidate for repurposing. However, robust evidence from well-powered randomized controlled trials is lacking. Objective: This study will evaluate the impact of NAC on the time-to-disease progression in pregnant women with early-onset preeclampsia in Lagos, Nigeria. Methods: This is the study protocol for a proof-of-concept, double-blind, randomized, controlled trial to be conducted between April 2026 to July 2028 at the maternity units of the two teaching hospitals in Lagos, Nigeria. At baseline, n=153 sexually active women aged 18 years or older diagnosed with early-onset preeclampsia at 24 to 34 weeks gestation will be randomised to receive either daily oral tablet containing 600 mg of NAC or a placebo tablet that is matched for appearance and the dosing regimen in addition to standard antenatal care from diagnosis (randomisation) until either 34 weeks gestation or delivery, whichever comes first. The primary endpoint is the time-to-progression (in days) of early-onset preeclampsia to severe disease. The data analysis will be conducted on an intention-to-treat basis. Kaplan-Meier estimates with a Log-rank test will be used to calculate and compare the time-to-disease progression for the treatment groups, while Cox proportional hazard models with a backwards conditional method will be used to compare the primary endpoint between the treatment arms while adjusting for other covariates for precision using hazard ratios (HRs) and 95% confidence intervals (95%CIs). Subgroup analyses will also be performed to assess the differential effects of significant covariates on the impact of NAC on disease progression. Statistical significance will be reported as P<0.05. Discussion: This study will evaluate the efficacy of daily oral NAC compared to placebo in treating pregnant women with early-onset preeclampsia. If proven effective, NAC could offer a safe, affordable, and scalable intervention to reduce the burden of preeclampsia, particularly in resource-constrained settings.

Objective: To externally validate, at the national level, a cumulative risk score for vaginal birth after cesarean (VBAC) success and neonatal morbidity derived from single center data. Methods: We conducted a population based cohort study of all trial of labor after cesarean (TOLAC) attempts among term, singleton deliveries recorded in the Centers for Disease Control and Prevention natality files, 2020 to 2024 (N=477,693). The cumulative risk score (range - 1 to 7 points) incorporated body mass index (BMI) 30 or greater (+1), BMI 40 or greater (+1), induction of labor (IOL; +1), diabetes mellitus (+1), hypertensive disorder (+1), maternal age 40 years or older (+1), gestational age 41 weeks or greater (+1), and prior vaginal delivery (-1). VBAC success rates and neonatal intensive care unit (NICU) admission rates were evaluated across risk strata. Results: The overall VBAC rate was 73.3% (350,340/477,693). The cumulative risk score demonstrated a monotonic relationship with VBAC success: score -1, 90.5%; score 0, 76.4%; score 1, 69.4%; score 2, 62.2%; score 3, 55%; and score 4 or higher, 44.8%. NICU admission rates increased concordantly from 43.8 to 111.1 per 1,000 across strata. Prior vaginal delivery was the strongest individual predictor (VBAC 86.4% vs 62.5%). VBAC rates and TOLAC volume were stable across 2020 to 2024. Conclusion: The cumulative risk score derived from single center data was externally validated in a national cohort of 477,693 TOLAC attempts. The monotonic dose-response relationship between risk score and both VBAC success and NICU admission was confirmed, supporting the use of this score for individualized TOLAC counseling.

Objective: To develop and validate a multivariable prediction model and clinically actionable risk score for vaginal birth after cesarean (VBAC) success using machine learning, and to integrate neonatal morbidity outcomes into a decision-analytic framework for trial of labor after cesarean (TOLAC) counseling. Methods: We performed a retrospective cohort study of 1,418 consecutive TOLAC cases at a single tertiary care center in California from 2019 through 2025. Multivariable logistic regression and four machine learning algorithms (logistic regression, random forest, gradient boosting, extreme gradient boosting) were trained using 5-fold stratified cross-validation. A cumulative risk score (negative 1 to 7 points) was constructed from independently significant predictors. Neonatal intensive care unit (NICU) admission rates and uterine rupture rates were evaluated across risk strata. Results: The overall VBAC rate was 76.7% (1,087/1,418). Penalized logistic regression achieved the highest cross-validated AUC (0.71, 95% CI 0.67 to 0.75). A parsimonious multivariable logistic model used for score derivation had an AUC of 0.70 (95% CI 0.67 to 0.73). Independent predictors of failed TOLAC included induction of labor (adjusted odds ratio [aOR] 1.93, 95% CI 1.48 to 2.52), hypertensive disorders (aOR 1.60, 95% CI 1.19 to 2.15), diabetes mellitus (aOR 1.71, 95% CI 1.19 to 2.47), obesity (body mass index [BMI] 30 or greater; aOR 1.46, 95% CI 1.11 to 1.90), maternal age of 40 years or older (aOR 1.49, 95% CI 0.89 to 2.50), and gestational age of 41 weeks or greater (aOR 2.22, 95% CI 1.40 to 3.52). Prior vaginal delivery was independently protective (aOR 0.37, 95% CI 0.28 to 0.48). The cumulative risk score stratified VBAC success from 89.1% (score negative 1) to 37.8% (score 4 or higher). NICU admission rates increased concordantly from 31.7 to 200.0 per 1,000 across risk strata negative 1 through 4 or higher (Spearman rho 0.94, P for trend = .005). Uterine rupture occurred in 28 cases (1.97%) and was associated with severe maternal morbidity (10.7% vs 0.7%; odds ratio 16.56, P < .001) but was not predicted by any antepartum risk factor. Exclusion of patients with risk scores of 3 or higher (11.3% of the cohort) improved overall VBAC success to 80.0% (P = .04) and reduced NICU rates to 66.0 per 1,000. Conclusion: A machine learning to derived cumulative risk score incorporating prior vaginal delivery as a protective factor identifies TOLAC candidates with poor VBAC prognosis and elevated neonatal morbidity, providing an evidence-based tool for individualized delivery counseling. Uterine rupture remains unpredictable by antepartum characteristics.