Background/Objectives: Gestational weight gain (GWG) is a crucial factor influencing mother and fetal health, as high GWG is associated with adverse pregnancy outcomes and an increased long-term risk of obesity and metabolic issues in the children. In addition to controlling weight, maternal physical activity (PA) during pregnancy may influence fetal development through potential epigenetic mechanisms, including histone modifications, DNA methylation, and the production of non-coding RNA. Methods: This narrative review synthesizes evidence from randomized controlled trials (RCTs; n = 11, 3654 participants) investigating the impact of aerobic PA on GWG, while also highlighting emerging, primarily indirect findings on maternal–fetal epigenetic programming. Results: The majority of RCTs found that supervised PA interventions, especially when paired with nutritional counseling, decreased both the incidence of excessive GWG and total GWG. Enhancements in lipid metabolism, adipokine profiles, and maternal insulin sensitivity point to likely biochemical mechanisms that connect PA to epigenetic modification of fetal metabolic genes (e.g., IGF2, PGC-1α, LEP). Animal and observational studies suggest that maternal activity may influence offspring epigenetic pathways related to obesity and cardiometabolic conditions, although direct human evidence is limited. Conclusions: In addition to potentially changing gene–environment interactions throughout generations, prenatal PA is a low-cost, safe method of improving maternal and newborn health. Future RCTs ought to incorporate molecular endpoints to elucidate the epigenetic processes by which maternal exercise may provide long-term health benefits.

Objective: To examine the differences in retinal structure and vasculature between women with gestational diabetes mellitus (GDM) and normoglycemic pregnant controls. Methods: This was a systematic review of the available literature on retinal assessment in pregnancies with GDM compared with non‐GDM controls, conducted in PubMed, EMBASE via Ovid, The Cochrane Library and Scopus databases in November 2025, following an a‐priori designed and prospectively registered protocol. Studies examining the retina using any non‐interventional method of retinal assessment in women with GDM compared to non‐GDM controls were identified. Potentially eligible studies included prospective and retrospective cohort, case−control and population‐based studies, as well as randomized controlled trials. The Risk Of Bias In Non‐randomized Studies of Interventions version 2 (ROBINS‐I V2) tool was used to evaluate the risk of bias of the included studies. A meta‐analysis was not performed due to considerable heterogeneity in the reported methods of retinal assessment, retinal parameters examined, disease severity, diagnostic criteria for GDM and gestational age at the time of retinal examination. Results: The electronic database search yielded 1326 results, of which 21 were eligible for full‐text review and nine were included. Following citation screening for additional eligible studies, 10 studies were ultimately included in the systematic review. The methods of retinal assessment utilized in the included studies were cross‐sectional and structural optical coherence tomography (OCT), optical coherence tomography angiography (OCTA) and retinal fundus photography. Each method examined various retinal structural and vascular parameters. Studies examining retinal vascular metrics using retinal fundus photography and cross‐sectional OCT found similar retinal arteriolar parameters, increased retinal venular parameters and a reduced retinal arteriovenous ratio in women with GDM compared with normoglycemic controls. Studies utilizing structural OCT reported that the retinal nerve fiber layer (RNFL) thickness was decreased or similar in women with GDM vs non‐GDM controls. Combinations of the ganglion cell layer (GCL) thickness, inner plexiform layer thickness and macular RNFL thickness were found to be lower in women with GDM. All studies reporting on other OCT parameters (acircularity index and retinal, macular and GCL thickness) found them to be similar between the two groups. The superficial and deep capillary plexus vessel densities, assessed using OCTA, were reported to be lower in women with GDM in some studies, whereas others found no significant difference between the two groups. For the remaining OCTA parameters (choriocapillaris vessel density, outer retinal vessel density, whole‐image vessel density, foveal avascular zone area, foveal density and choriocapillaris flow area), no study identified significant differences between women with GDM and non‐GDM controls. The ROBINS‐I V2 tool found the risk of bias to be serious in six studies and moderate in four studies. Conclusion: Existing studies provide inconsistent evidence to clearly establish retinal structural or functional changes in pregnancies complicated by GDM. Future large‐scale prospective studies are required to confirm these findings and evaluate whether the retinal changes observed in GDM persist postpartum. Such evidence may clarify their potential role as biomarkers of cardiovascular insult severity and inform stratified surveillance. © 2026 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Background/Objectives: Ogilvie’s syndrome, or acute colonic pseudo-obstruction (ACPO), is defined by acute colonic dilatation without mechanical obstruction and carries a risk of ischemia and perforation if not promptly managed. Treatment strategies include conservative supportive care, neostigmine administration, colonoscopic decompression, and combinations of these approaches. The aim of this study was to compare the relative effectiveness of these interventions for symptom resolution using a network meta-analysis. Methods: A systematic search of PubMed, Embase, Scopus, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and grey literature was conducted from inception in February 2025 to November 2025. Prospective cohort and case–control studies evaluating conservative supportive care, neostigmine, colonoscopic decompression, or their combinations were included. A random-effects network meta-analysis was performed using odds ratios (ORs) with 95% confidence intervals (CIs). Treatment ranking was assessed using surface under the cumulative ranking curve (SUCRA) values. Risk of bias was evaluated using the Newcastle–Ottawa Scale (NOS). Results: Four studies comprising 172 patients were included. Compared with supportive care alone, supportive care combined with neostigmine was associated with higher odds of symptom resolution (network OR 13.86, 95% CI 3.06–62.83). Supportive care combined with colonoscopic decompression demonstrated an even greater effect (network OR 65.65, 95% CI 11.70–368.50). Colonoscopic decompression versus neostigmine yielded a network OR of 4.74 (95% CI 1.17–19.25). SUCRA rankings indicated that colonoscopic decompression combined with supportive care had the highest probability of being the most effective strategy. Conclusions: Active interventions, particularly colonoscopic decompression or neostigmine combined with supportive care, were associated with a higher incidence of symptom resolution compared to supportive care alone. Larger comparative studies are needed to confirm these findings and refine treatment selection.

Background/Objectives: Pregnancy loss is a common and multifactorial complication of human reproduction, traditionally attributed to fetal chromosomal abnormalities, maternal anatomical and endocrine disorders, and immune dysfunction. Growing evidence now indicates that the maternal microbiome, particularly within the reproductive tract, plays a critical role in implantation, placental development, and the maintenance of immune tolerance during early pregnancy. Importantly, the influence of the microbiome on miscarriage appears to be strongly modulated by host genetic background and immune regulation. Methods: This narrative review summarizes current evidence linking alterations in the vaginal, endometrial, placental, and gut microbiomes to miscarriage, with a specific focus on host genetics and immune–microbial interactions. Results: We discuss how genetic variation in innate and adaptive immune pathways, inflammatory signaling, and mucosal barrier function may shape host responses to microbial communities, thereby influencing susceptibility to PL. In addition, we highlight emerging data on microbiome-driven regulation of gene expression and epigenetic modifications in the endometrium and decidua, emphasizing the role of microbial metabolites in immune tolerance and placental function. Conclusions: By integrating findings from microbiome research, host genomics, immunology, and epigenetics, this review proposes a framework in which miscarriage is viewed as a consequence of disrupted host–microbe crosstalk rather than isolated pathology. Finally, we address key methodological challenges and outline future research directions aimed at advancing mechanistic understanding and translational applications.

Preterm birth defined as delivery before 37 gestational weeks, is a leading cause of neonatal and infant morbidity and mortality. Understanding its multifactorial nature may improve prediction, prevention and the clinical management. We performed an umbrella review to summarize the evidence from meta-analyses of observational studies on risks factors associated with PTB, evaluate whether there are indications of biases in this literature and identify which of the previously reported associations are supported by robust evidence. We included 1511 primary studies providing data on 170 associations, covering a wide range of comorbid diseases, obstetric and medical history, drugs, exposure to environmental agents, infections and vaccines. Only seven risk factors provided robust evidence. The results from synthesis of observational studies suggests that sleep quality and mental health, risk factors with robust evidence should be routinely screened in clinical practice, should be tested in large randomized trial. Identification of risk factors with robust evidence will promote the development and training of prediction models that could improve public health, in a way that offers new perspectives in health professionals.