The offspring of mothers with gestational diabetes mellitus (GDM) are at a higher risk for metabolic dysregulation and neurodevelopmental impairment. Evidence suggests that serotonin, which is present in both the placenta and the brain, programs the development and growth of the fetal brain. In the current study, we tested the hypothesis that GDM affects the methylation of the serotonin transporter gene (SLC6A4) and serotonin receptor gene (HTR2A) in the placenta. Ninety pregnant women were included in this study. Thirty mothers were diagnosed with GDM, and sixty mothers served as controls in a 1:2 ratio. Ten CpG sites within the promoter regions of SLC6A4 and HTR2A were analyzed using pyrosequencing. The relative expression of genes involved in DNA methylation was evaluated using real-time PCR. The average DNA methylation of placental SLC6A4 was higher in the GDM group than in the control group (2.29 vs. 1.16%, p < 0.001). However, the average DNA methylation level of HTR2A did not differ between the two groups. SLC6A4 methylation showed a positive correlation with maternal plasma glucose level and neonatal birth weight percentile and a negative correlation with the neonatal head circumference percentile. This finding suggests that epigenetic modification of the placental serotonin system may affect placental adaptation to a harmful maternal environment, thereby influencing the long-term outcome in the offspring.

Objective: In this study, we aimed to evaluate the impact of mild thrombocytopenia on the incidence of postpartum hemorrhage (PPH) and associated clinical outcomes in a cohort of pregnant women who delivered via cesarean section. Methods: Women who underwent cesarean delivery at two tertiary medical centers in Korea between January 2009 and December 2019 were included in this retrospective cohort study. Associations between groups and baseline characteristics were assessed using t tests and chi-square tests. Logistic regression was performed to evaluate the increased risk of PPH. All analyses were conducted using R version 4.3.3. Results: Of 15,549 women who gave birth, 6487 met the inclusion criteria; 485 (7.5%) were diagnosed with mild thrombocytopenia, whereas 6002 had normal platelet counts. Women with mild thrombocytopenia had a threefold higher risk of PPH (adjusted OR: 3.74; 95% CI: 1.36–10.30) compared to those with normal platelet counts. They were also more likely to require blood transfusions and experience a >4 g/dL drop in hemoglobin level (adjusted OR: 2.28 and 2.99, respectively). In the subgroup analysis, women with immune-related thrombocytopenia had lower platelet counts than other groups from the third trimester to 2 months postpartum. However, primary and secondary PPH outcomes did not differ significantly among the subgroups. Conclusions: Mild maternal thrombocytopenia before cesarean section was associated with a higher risk of PPH compared to normal platelet counts; however, the overall prognosis was similar regardless of the underlying cause.

Objective To evaluate the association between pre-pregnancy maternal obesity phenotypes—general, abdominal and combined—and the risk of oligohydramnios. Design Nationwide population-based cohort study. Setting South Korean National Health Insurance Service database. Population Women who underwent national health screening within two years before conception (2009–2017) and delivered between 2010 and 2018 (n=571,330). Methods Maternal obesity phenotypes were defined by pre-pregnancy body mass index (general obesity) and waist circumference (abdominal obesity). Oligohydramnios was identified using ICD-10 codes. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated using multivariable regression models controlling for maternal and pregnancy factors. Main outcome measures Risk of oligohydramnios according to pre-pregnancy maternal obesity phenotypes. Results Oligohydramnios occurred in 1.13% of pregnancies (n=6,484). Women with general obesity (BMI≥25kg/m2) had a higher risk compared with those with normal BMI (aOR 1.40, 95% CI 1.21–1.61). Abdominal obesity (WC ≥85cm) also increased risk (aOR 1.21, 95% CI 1.10–1.33). The combined phenotype conferred the highest risk (aOR 1.24, 95% CI 1.12–1.37), while either phenotype alone was not significant after adjustment. Conclusion Coexisting general and abdominal obesity before pregnancy independently increase the risk of oligohydramnios. Phenotype-based assessment may improve preconception risk stratification and guide targeted antenatal surveillance.

Rationale: The incidence of cervical adenocarcinoma is increasing, particularly in women of reproductive age, and presents a unique diagnostic and therapeutic challenge when encountered during pregnancy. Distinguishing malignant cervical lesions from benign entities such as nabothian cysts can be particularly difficult due to overlapping clinical and imaging features, leading to potential delays in diagnosis and management. Patient concerns: A 38-year-old multiparous woman at 7 weeks’ gestation was referred to a tertiary hospital for an abnormal Papanicolaou smear showing atypical glandular cells of undetermined significance and positive for high-risk human papillomavirus (HPV) type 18 infection. She was asymptomatic, with no vaginal bleeding, pelvic discomfort or other suggestive symptoms. Diagnoses: Initial imaging and colposcopic findings suggested a nabothian cyst. However, 4 weeks later, atypical cytological findings and HPV 18 positivity prompted further surveillance. At 26 weeks’ gestation, cervical biopsy confirmed moderately differentiated HPV-associated cervical adenocarcinoma. Magnetic resonance imaging staged the disease as International Federation of Gynecology and Obstetrics stage IB1. Interventions: After multidisciplinary consultation, the patient underwent classical cesarean section followed by type 3 radical hysterectomy, bilateral salpingectomy, pelvic lymphadenectomy and ovarian transposition at 29 weeks 6 days gestation. Magnesium sulfate and corticosteroids were administered for fetal neuroprotection and lung maturation. Outcomes: Pathology confirmed a 1.5 cm cervical adenocarcinoma without lymphovascular space invasion, parametrial extension or lymph node metastasis. The patient has remained disease-free for 4 years under regular oncological surveillance. Lessons: This case highlights the diagnostic complexity of cervical adenocarcinoma in pregnancy, particularly when lesions mimic benign cervical pathology. Persistent atypical cytology and high-risk HPV positivity warrant thorough evaluation, including colposcopic biopsy, despite pregnancy. A multidisciplinary approach is essential for optimal maternal and fetal outcomes.

Background/Objective: Maternal obesity is an established risk factor for adverse obstetric outcomes. However, its association with oligohydramnios remains unclear and has been examined using body mass index (BMI) alone. We assessed pre-pregnancy general and abdominal obesity in relation to oligohydramnios. Methods: We analyzed 762,104 women who delivered between 2010 and 2018 and had undergone a national health examination within two years before conception. Women were classified into four phenotypes by BMI (general obesity: ≥25 kg/m²) and waist circumference (abdominal obesity: ≥85 cm). Odds ratios were estimated by logistic regression adjusted for pre-pregnancy characteristics, and interaction was tested on the additive and multiplicative scales. Results: Oligohydramnios occurred in 13,860 women (1.82%). Relative to women with neither phenotype, adjusted odds were increased for abdominal obesity alone (1.163; 95% CI 1.013–1.336), general obesity alone (1.125; 95% CI 1.051–1.204), and both (1.336; 95% CI 1.241–1.438). Absolute risk was 2.19% among women with both phenotypes and 1.79% among those with neither, with no interaction on either scale (p = 0.811). Conclusions: General and abdominal obesity were each associated with oligohydramnios. Because nearly one in four women with abdominal obesity had a BMI below the obesity threshold, assessment by BMI alone leaves part of this risk unrecognized.