Pregnancies complicated by diabetes, including pregestational and gestational diabetes mellitus, are associated with increased maternal and fetal morbidity. Early identification of at-risk pregnancies is crucial for timely intervention and improved outcomes. Emerging evidence highlights the interplay of genetic predisposition, epigenetic modifications, and non-invasive biomarkers in the early detection of diabetic pregnancies. Genetic factors influencing insulin signaling, glucose metabolism, and pancreatic β-cell function may contribute to susceptibility to gestational hyperglycemia. Concurrently, epigenetic alterations, such as DNA methylation and histone modifications in maternal and placental tissues, have been linked to dysregulated metabolic pathways and adverse pregnancy outcomes. Non-invasive biomarkers, including circulating cell-free DNA and microRNAs in maternal blood, show promise for early diagnosis by offering a safer and more practical alternative to invasive testing. Integrating genetic, epigenetic, and molecular marker data could enhance risk stratification and enable personalized monitoring and management strategies. This review synthesizes current knowledge on the molecular underpinnings of diabetic pregnancies, evaluates the potential of emerging biomarkers for early diagnosis, and discusses the challenges and future perspectives for translating these findings into clinical practice. Understanding these mechanisms may pave the way for precision medicine approaches, ultimately improving maternal and neonatal outcomes in pregnancies affected by diabetes.

Objectives: Autism spectrum disorder (ASD) is increasingly conceptualized as a neurodevelopmental condition with prenatal origins. Advances in fetal magnetic resonance imaging (MRI), including high-resolution structural imaging and resting-state functional connectivity analysis, now enable in vivo characterization of the developing human brain before birth. This review examines whether fetal MRI biomarkers are associated with later ASD diagnosis or autistic traits. Methods: We conducted a PRISMA-informed narrative review of human studies identified through MEDLINE, EMBASE, SCOPUS, and Web of Science. Eligible studies included original human investigations using fetal MRI to assess brain structure and/or function, with postnatal ASD diagnosis or standardized autistic-trait outcomes. Results: Eight eligible studies provide converging evidence that neurodevelopmental divergence associated with ASD may be detectable in utero. Structural analyses consistently report prenatal volumetric alterations, particularly enlargement of the insular cortex between the second and third trimesters. Additional findings of regional overgrowth and hemispheric asymmetries suggest distributed deviations in cortical maturation. Functional fetal MRI studies further demonstrate atypical large-scale network organization prior to birth. Altered connectivity within cingulate, prefrontal, temporal, and cerebellar circuits has been prospectively associated with later autistic traits, indicating that network-level integration may diverge before behavioral symptoms emerge. Evidence from high-risk conditions, including isolated ventriculomegaly and tuberous sclerosis complex, reinforces the association between prenatal structural abnormalities and increased ASD risk. Conclusions: Current evidence suggests that structural and functional brain alterations identifiable by fetal MRI may precede the clinical manifestation of ASD. These findings support a model of ASD as a condition potentially rooted in prenatal neurodevelopmental divergence. However, larger, standardized, multicenter studies are required before fetal MRI biomarkers can be translated into predictive or clinical applications.

Objective: To evaluate whether crown‐rump length (CRL) measured at 11–14 weeks is associated with the risk of large‐for‐gestational‐age (LGA) neonates in uncomplicated pregnancies. Methods: This prospective study included 333 singleton pregnancies undergoing first‐trimester ultrasound screening. CRL was measured according to standardized criteria, and gestational age was confirmed or reassigned based on CRL when discrepancies with last menstrual period exceeded 7 days. The primary outcome was the occurrence of LGA neonates, defined according to INTERGROWTH‐21st standards. Multivariate regression and receiver operating characteristic (ROC) curve analyses were performed to assess the predictive value of CRL. Results: CRL was significantly associated with the risk of LGA neonates. ROC curve analysis demonstrated a modest discriminative performance, with an area under the curve (AUC) of 0.665 (95% CI: 0.547–0.784). The optimal CRL cut‐off showed a sensitivity of 63.6% and specificity of 69.3%, with a high negative predictive value (96.4%). Conclusions: First‐trimester CRL is associated with fetal overgrowth but shows limited predictive accuracy when used alone. Its clinical utility may lie in contributing to combined predictive models rather than serving as a standalone screening tool.

Objective: To evaluate the real-world effectiveness and tolerability of Iron Hydroxide Adipate Tartrate (IHAT^TM) in women with iron deficiency across three common obstetric and gynecologic clinical settings: pregnancy, the postpartum period, and abnormal uterine bleeding. Methods: This prospective multicenter observational real-world study included women with iron deficiency managed in routine clinical practice across Italy. Participating gynecologists collected data using standardized case report forms. Patients received IHAT^TM according to routine clinical practice and were followed for approximately three months. Baseline demographic and hematologic parameters were recorded, including hemoglobin and ferritin levels. The primary outcome was the change in hemoglobin between baseline and follow-up. Secondary outcomes included changes in ferritin levels, treatment adherence, and tolerability. Results: A total of 517 women was included in the analysis. The study population included pregnant women (N = 287, 55.5%), women with abnormal uterine bleeding (N = 161, 31.1%), and women in the postpartum period (N = 69, 13.3%). Improvements in hemoglobin were observed across all clinical settings, with hemoglobin increasing from 10.35 g/dL at baseline to 11.63 g/dL at three months, corresponding to a mean increase of 1.28 g/dL. Mean ferritin levels increased from 22.50 ng/mL to 37.74 ng/mL in three months. Treatment adherence was high or moderate in 93.4% of patients. Gastrointestinal adverse events were infrequent, with constipation (9.7%) and nausea (4.8%) among the most reported. Conclusions: In this prospective real-world multicenter study, treatment with IHAT^TM was associated with meaningful improvements in hemoglobin and iron stores in women with iron deficiency across pregnancy, postpartum, and abnormal uterine bleeding. The treatment showed good adherence and a favorable tolerability profile in routine clinical practice.

Objective To evaluate the real-world effectiveness and tolerability of Iron Hydroxide Adipate Tartrate (IHATTM) in women with iron deficiency across three common obstetric and gynecologic clinical settings: pregnancy, the postpartum period, and abnormal uterine bleeding. Methods This prospective multicenter observational real-world study included women with iron deficiency managed in routine clinical practice across Italy. Participating gynecologists collected data using standardized case report forms. Patients received IHATTM according to routine clinical practice and were followed for approximately three months. Baseline demographic and hematologic parameters were recorded, including hemoglobin and ferritin levels. The primary outcome was the change in hemoglobin between baseline and follow-up. Secondary outcomes included changes in ferritin levels, treatment adherence, and tolerability. Results A total of 517 women was included in the analysis. The study population included pregnant women (N=287, 55.5%), women with abnormal uterine bleeding (N=161, 31.1%), and women in the postpartum period (N=69, 13.3%). Improvements in hemoglobin were observed across all clinical settings with hemoglobin increasing from 10.35 g/dL at baseline to 11.63 g/dL at three months, corresponding to a mean increase of 1.28 g/dL. Mean ferritin levels increased from 22.50 ng/mL to 37.74 ng/mL in three months. Treatment adherence was high or moderate in 93.4% of patients. Gastrointestinal adverse events were infrequent, with constipation (9.7%) and nausea (4.8%) among the most reported. Conclusion In this prospective real-world multicenter study, treatment with IHATTM was associated with meaningful improvements in hemoglobin and iron stores in women with iron deficiency across pregnancy, postpartum, and abnormal uterine bleeding. The treatment showed good adherence and a favorable tolerability profile in routine clinical practice.

The objective of the study is to compare the hematologic response to three oral iron regimens during pregnancy and to evaluate differences in treatment efficacy across distinct obstetric populations. Specifically, we compared ferrous sulfate 100 mg once a day with two doses of Iron Hydroxide Adipate Tartrate (IHAT^TM), 30 mg once a day and 60 mg daily (i.e., 30 mg twice a day) after 24 weeks of supplementation. This retrospective observational study was conducted at the Department of Public Health, University of Naples Federico II, Naples, Italy. We analyzed clinical data retrospectively collected from 60 pregnant women with iron deficiency anemia managed between September 2025 and March 2026, who completed 24 weeks of oral iron therapy and distributed across five predefined population clusters: singleton low-risk pregnancy, multiple gestation, increased surgical risk, high-risk pregnancy, and gastrointestinal disorders affecting iron absorption. Each cluster included 12 participants equally allocated to three treatment groups: ferrous sulfate 100 mg (arm A), IHAT^TM 30 mg (arm B), and IHAT^TM 60 mg (arm C). The primary outcome was the change in hemoglobin concentration from baseline to 24 weeks after treatment initiation. Subgroup analyses were performed according to population cluster. A total of 60 participants were included (20 per treatment group). Hemoglobin levels increased progressively during follow-up in all treatment arms. At 24 weeks, the mean hemoglobin increase from baseline was 0.87 ± 0.29 g/dL in the ferrous sulfate group, 1.48 ± 0.34 g/dL in the IHAT^TM 30 mg group, and 1.96 ± 0.41 g/dL in the IHAT^TM 60 mg group (p < 0.001). Ferritin levels increased by 7.4 ± 2.7 ng/mL, 14.6 ± 3.3 ng/mL, and 21.3 ± 4.6 ng/mL in the three treatment groups, respectively (p < 0.001). Gastrointestinal adverse events were more frequent with ferrous sulfate (55%) compared with IHAT^TM 60 mg (25%) and IHAT^TM 30 mg (0%) (p = 0.0004). Subgroup analysis across the five population clusters showed a consistent pattern, with greater hemoglobin increases observed with IHAT^TM compared with ferrous sulfate, including among women with gastrointestinal conditions affecting iron absorption. In this retrospective observational study, oral IHAT^TM demonstrated greater improvement in hemoglobin and iron parameters compared with conventional ferrous sulfate after 24 weeks of treatment, with the largest effect observed with the 60 mg dose. This pattern was consistent across the predefined obstetric populations and was accompanied by fewer gastrointestinal adverse events.