Placenta and Reproductive Medicine

An effective and non-invasive prediction model for placenta accreta spectrum early diagnosis: Ultrasound image-based novel deep learning network

2026-03-13T15:44:30+08:00

Background: The study aimed to utilize ultrasound technology to capture quantitative features of placenta accuta spectrum (PAS) and assist in its early diagnosis.

Methods: We proposed an EA-EffV2Net (an improved network combining EfficientNetV2 with an attention mechanism, where EA stands for Efficient Attention) model, trained and validated it by using ultrasound images from 468 pregnant women enrolled between July 2020 and January 2023. A clinical diagnostic model was developed based on important clinicopathological factors for comparison.

Results: Our models can improve performance in both the detection of PAS and the differential diagnosis of placenta accreta (PA) and placenta increta (PI). Compared with the clinical diagnostic model, EA-EffV2Net generated slightly higher misdiagnosis rates when diagnosing PAS and PA.

Conclusions: This study proposed a novel EA-EffV2Net model for the diagnosis of PAS and the differential diagnosis of PA and PI based on ultrasound images, which is suitable for all pregnant women is of clinical importance in individual treatment planning.

D-lactate levels are elevated in women with polycystic ovary syndrome

2026-03-11T16:36:55+08:00

Background: Polycystic ovary syndrome (PCOS) is a complex syndrome with various metabolic disorders. Previous studies have reported that D-lactate is commonly related to metabolic disturbances. However, the role of D-lactate in PCOS remains unclear.

Methods: Serum D-lactate levels from control (n = 132) and women with PCOS (n = 132) were measured, and their relationship with several metabolic parameters were analyzed. The correlation of serum D-lactate with PCOS was assessed using logistic regression analysis, and the performance of serum D-lactate as a potential predictor for PCOS was evaluated using receiver operating characteristic curve analysis.

Results: Serum D-lactate levels were markedly higher in patients with PCOS compared with those of controls (P < 0.001). The proportion of PCOS was substantially higher in increasing quartiles of serum D-lactate levels (P < 0.001). After adjusting for other confounders, there was still a correlation between D-lactate and PCOS (P < 0.001; odds ratio, 5.654; 95% confidence interval, 3.091–10.342). D-lactate levels were positively correlated with fasting serum insulin, homeostasis model assessment of insulin resistance, and triglycerides in patients with PCOS (all P < 0.01), which was not detected in controls (P > 0.05). D-lactate had an area under the curve (AUC) of 79.4% in predicting PCOS, with a similar performance as anti-Müllerian hormone (AMH) and luteinizing hormone (LH), and its combination with AMH and LH yielded a higher AUC of 90.9%.

Conclusions: Substantially elevated serum D-lactate levels are significantly associated with PCOS, highlighting the importance of further research into the role of D-lactate in the pathogenesis of PCOS.

Effects of gut microbiota and their metabolites on benign diseases of the female reproductive system: A Mendelian randomization study

2026-03-11T14:05:05+08:00

Background: Alterations in gut microbiota, including the composition of the flora, the abundance of specific species, and bacterial metabolites are related to the pathogenesis of benign diseases of the female reproductive system. Because of potential biases, such as confounding or reverse causation, the causal relationship between diseases of the female reproductive system and alterations in gut microbiota remains unclear. We applied two-sample Mendelian randomization (MR) to investigate the effect of alterations in gut microbiota on 18 benign diseases of the female reproductive system.

Methods: Instrumental variables for different classification levels of the gut microbiota including phylum, class, order, family, and genus, and several bacterial metabolites were selected. MR analysis was performed using inverse-variance weighted (IVW), MR-Egger, weighted median, MR-Robust Adjusted Profile Scoring (MR-RAPS), and MR pleiotropy residual sum and outlier tests. Cochran's IVW Q statistics were used to detect any potential heterogeneity.

Results: Notably, 49 genera of the gut microbiota exhibited a causal relationship with the benign diseases of the female reproductive system, with more than half of the genera exhibiting a role in two or more diseases. Six metabolites of the gut microbiota can be considered as indicators to detect the presence of the disease.

Conclusions: Alterations in a total of four phyla, five classes, four orders, ten families, and 49 genera of gut microbiota and six kinds of bacterial metabolites exhibited positive or negative effects on the female reproductive system. Our findings provide insights into potential novel biomarkers and therapy targets for many disease of the female reproductive system.

Risk of adverse pregnancy outcomes in patients with pregnancy-harmful rheumatic diseases: A retrospective study

2026-03-11T14:32:31+08:00

Objective: To explore the risks of adverse pregnancy outcomes (APOs) in pregnant women with different pregnancy-harmful rheumatic diseases (PH-RDs), including systemic lupus erythematosus (SLE), primary Sjögren's syndrome (pSS), obstetric antiphospholipid syndrome (OAPS), and undifferentiated connective tissue disease (UCTD).

Methods: Medical records for women confirmed of ongoing pregnancy at 20 weeks of gestation at West China Second University Hospital, Sichuan University from January 2018 to December 2023 were retrospectively scanned. Patients diagnosed of SLE, pSS, OAPS, and/or UCTD with singleton pregnancies were included. The primary outcomes were live birth rate, preterm birth rate, preeclampsia, and fetal growth restriction (FGR).

Results: A total of 102, 427 medical records were scanned for the study, resulting in the inclusion of 2518 patients with SLE (n = 281), pSS (n = 144), OAPS (n = 1870), UCTD (n = 175), or the combination of two of these PH-RDs (n = 48). For the difference between single and two combined PH-RDs, the live birth rate was comparable, and the incidence of preterm birth, preeclampsia, and FGR were significantly higher in the combined PH-RDs groups (P < 0.001, P = 0.009, P = 0.003). For the difference between different PH-RDs, the live birth rate in the OAPS group was significantly lower than in the UCTD group (P = 0.019). The incidence of preeclampsia was higher in the SLE group than in the pSS and UCTD groups (P = 0.004).

Conclusion: The effects of PH-RD on pregnancy are mainly seen in placenta-related APOs and complications such as preterm birth, preeclampsia, and FGR, especially SLE and OAPS. The combination of two PH-RDs may further affect the pregnancy outcomes.

Klotho in placenta related pregnancy complications: A systematic review and meta-analysis

2026-03-14T11:34:34+08:00

Background: Klotho is an anti aging protein implicated in oxidative stress regulation, endothelial protection, placental senescence, and fetal growth. Its role in placenta related pregnancy complications remains unclear. To systematically review the evidence on Klotho in placenta related pregnancy complications and to quantitatively synthesize eligible studies.

Methods: This systematic review and meta-analysis was reported in accordance with the PRISMA 2020 statement. Of 54 records identified, 9 studies were included in the systematic review and 7 in the meta-analysis. Study quality was assessed using a structured tool for non randomized studies. Random-effects models with Hartung-Knapp adjustment were used to calculate pooled standardized mean differences as Hedges' g with 95% confidence intervals (CIs).

Results: Most included studies suggested reduced Klotho expression in placenta related pathological pregnancies. Meta-analysis showed significantly lower serum Klotho levels in pregnancies complicated by intrauterine growth restriction, fetal growth restriction, and small for gestational age (Hedges'g = -1.07, 95% CI: -1.34 to -0.80) and in pregnancies with adverse fetal outcomes (Hedges'g = -1.13, 95% CI: -1.29 to -0.97). Placental Klotho levels were also significantly reduced in pregnancy complications (Hedges'g = -1.35, 95% CI: -1.80 to -0.90). By contrast, pooled associations for serum Klotho in preeclampsia and overall pregnancy complications were not statistically significant due to substantial heterogeneity.

Conclusions: Reduced Klotho is consistently associated with placental dysfunction, particularly in pregnancies with fetal growth impairment and adverse fetal outcomes. Placental Klotho appears to provide a more stable signal than circulating Klotho.

Mitochondrial dysfunction in placental ischemic diseases: Mechanisms and therapeutic implications

2026-03-11T22:04:04+08:00

Placental ischemic diseases, including preeclampsia (PE) and intrauterine growth restriction (IUGR), are leading causes of maternal and neonatal morbidity and mortality worldwide. These conditions originate from defective spiral artery remodeling, leading to reduced uteroplacental perfusion and chronic placental ischemia. The resultant hypoxia/reoxygenation injury creates a hostile environment that profoundly impacts placental cellular function. Central to this dysfunction is the mitochondrion, an organelle critical for energy production, calcium homeostasis, and the regulation of apoptosis. Emerging evidence positions mitochondrial dysfunction as a key nexus in the pathophysiology of placental ischemia. This review synthesizes current knowledge on the mechanisms driving mitochondrial impairment in the ischemic placenta. We explore the role of oxidative stress, the opening of the mitochondrial permeability transition pore (mPTP), disrupted mitochondrial dynamics (fusion/fission), and subsequent activation of apoptotic and inflammatory cascades. Furthermore, we discuss the potential of mitochondrial-targeted therapeutics, such as specific antioxidants and inhibitors of the mPTP, as novel strategies to alleviate placental damage and improve pregnancy outcomes. A comprehensive literature search was conducted in PubMed, Scopus, and Web of Science to identify relevant preclinical studies and mechanistic insights, which were synthesized narratively. Understanding these intricate mitochondrial pathways is crucial for developing effective interventions for these devastating disorders.