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The following represent additions to UpToDate from the past six months that were considered by the editors and authors to be of particular interest. The most recent What's New entries are at the top of each subsection.

PRENATAL OBSTETRICS

Perinatal depression and mortality (March 2024)

Perinatal depression is associated with an increased risk of death. An analysis of a national register from Sweden compared outcomes among individuals with and without a diagnosis of depression during pregnancy or postpartum, matched by age and year of delivery [ 1 ]. After controlling for potential confounding factors, all-cause mortality was greater in those with perinatal depression over 18 years of follow-up; the increased risk was largely driven by suicide. These results confirm previous data on the risks of perinatal depression and support our practice of screening for depression during pregnancy and postpartum. Services to ensure follow-up for diagnosis and treatment should accompany screening efforts. (See "Unipolar major depression during pregnancy: Epidemiology, clinical features, assessment, and diagnosis", section on 'All cause' .)

Noninsulin antidiabetic medications and pregnancy (February 2024)

Noninsulin antidiabetic medications such as glucagon-like peptide 1 (GLP-1) agonists, sodium-glucose cotransporter 2 (SGLT-2) inhibitors, and dipeptidyl peptidase 4 (DPP-4) inhibitors are commonly used in nonpregnant individuals but avoided in pregnancy because of lack of safety data in humans and harms observed in animal studies. However, in a multinational population-based cohort study including nearly 2000 individuals with preconception/first trimester exposure to these medications, the frequency of congenital anomalies was not increased compared with insulin [ 2 ]. A limitation of the study is that it did not adjust for potential differences in A1C, diabetes severity, or diabetes duration, which could obscure true effects on risk for congenital anomalies. We continue to avoid use of GLP-1 agonists, SGLT-2 inhibitors, and DPP-4 inhibitors in females planning to conceive and in pregnancy. (See "Pregestational (preexisting) diabetes: Preconception counseling, evaluation, and management", section on 'Patients on preconception noninsulin antihyperglycemic agents' .)

Updates to the United States perinatal HIV clinical guidelines (February 2024)

The United States Department of Health and Human Services has released updates to the perinatal HIV clinical guidelines [ 3 ]. Ritonavir-boosted darunavir is now a preferred agent only for treatment-naïve pregnant individuals who have used cabotegravir-based pre-exposure prophylaxis, because of the concern for integrase inhibitor-resistant mutations; for other pregnant individuals, it is now an alternative rather than preferred agent. Additionally, bictegravir, which was previously not recommended for initial therapy in pregnant individuals, is now an alternative agent based on new pharmacokinetic data that support its use during pregnancy. Our approach to treating HIV during pregnancy is consistent with these updated guidelines. (See "Antiretroviral selection and management in pregnant individuals with HIV in resource-rich settings", section on 'Selecting the third drug' .)

Combined use of metformin and insulin for treating diabetes in pregnancy (February 2024)

In patients with type 2 diabetes, insulin is the mainstay for managing hyperglycemia in pregnancy. The addition of metformin improves maternal glucose control and reduces the chances of a large for gestational age newborn, but a prior randomized trial reported an increased risk for birth of a small for gestational age (SGA) infant. A recent randomized trial comparing use of insulin alone with insulin plus metformin in nearly 800 adult pregnant patients with either preexisting type 2 diabetes or diabetes diagnosed in early pregnancy confirmed the previously reported benefits but found that both treatment groups had low and similar rates of SGA [ 4 ]. The discordancy in SGA risk needs to be explored further, as metformin cotreatment would be undesirable if this risk is real. (See "Pregestational (preexisting) diabetes mellitus: Antenatal glycemic control", section on 'Metformin' .)

Fetoplacental GDF15 linked to nausea and vomiting of pregnancy (February 2024)

Almost all pregnant people experience nausea with or without vomiting in early pregnancy; however, the pathogenesis of the disorder has been unclear. Previous studies have shown that GDF15 is expressed in a wide variety of cells, with the highest expression in placental trophoblast, and that its protein (GDF15) appears to regulate appetite. A recent study confirmed the fetoplacental unit as a major source of GDF15 and also found that higher GDF15 levels correlated with more severe nausea and vomiting of pregnancy [ 5 ]. In the future, drugs targeting the production or action of GDF15 are a potential novel pathway for treating nausea and vomiting of pregnancy, if safety and efficacy are established. (See "Nausea and vomiting of pregnancy: Clinical findings and evaluation", section on 'Pathogenesis' .)

Use of cerebroplacental ratio at term does not reduce perinatal mortality (February 2024)

Cerebral blood flow may increase in chronically hypoxemic fetuses to compensate for the decrease in available oxygen and can be assessed by the cerebroplacental ratio (CPR; middle cerebral artery pulsatility index divided by the umbilical artery pulsatility index). However, increasing evidence indicates that use of the CPR does not reduce perinatal mortality in low-risk pregnancies. In a randomized trial comparing fetal growth assessment plus revealed versus concealed CPR in over 11,000 low-risk pregnancies at term, knowledge of CPR combined with a recommendation for delivery if the CPR was <5th percentile did not reduce perinatal mortality compared with usual care (concealed group) [ 6 ]. We do not perform umbilical artery Doppler surveillance, including the CPR, in low-risk pregnancies. (See "Doppler ultrasound of the umbilical artery for fetal surveillance in singleton pregnancies", section on 'Low-risk and unselected pregnancies' .)

Low- versus high-dose calcium supplements and risk of preeclampsia (January 2024)

In populations with low baseline dietary calcium intake, the World Health Organization recommends 1500 to 2000 mg/day calcium supplementation for pregnant individuals to reduce their risk of developing preeclampsia. However, a recent randomized trial that evaluated low (500 mg) versus high (1500 mg) calcium supplementation in over 20,000 nulliparous pregnant people residing in two countries with low dietary calcium intake found low and similar rates of preeclampsia in both groups [ 7 ]. These findings suggest that a 500 mg supplement is sufficient for preeclampsia prophylaxis in these populations. For pregnant adults in the United States, we prescribe 1000 mg/day calcium supplementation, which is the recommended daily allowance to support maternal calcium demands without bone resorption. (See "Preeclampsia: Prevention", section on 'Calcium supplementation' .)

Respectful maternity care (January 2024)

Respectful maternity care is variably defined but broadly involves both absence of disrespectful conduct and promotion of respectful conduct toward pregnant individuals. A systematic review found that validated tools to measure respectful maternity care were available, but the optimal tool was unclear and high quality studies were lacking on the effectiveness of respectful maternity care for improving any maternal or infant health outcome [ 8 ]. Respectful maternal care is a basic human right, but how to best implement and monitor it and assess outcomes requires further study. (See "Prenatal care: Initial assessment", section on 'Effectiveness' .)

Outcome of a multifaceted intervention in patients with a prior cesarean birth (January 2024)

Patients with a pregnancy after a previous cesarean birth must choose between a trial of labor (TOLAC) and a planned repeat cesarean. The optimal care of such patients is unclear. In a multicenter, cluster-randomized trial including over 20,000 patients with one prior cesarean birth, a multifaceted intervention (patient decision support, use of a calculator to assess chances of a vaginal birth after cesarean [VBAC], sonographic measurement of myometrial thickness, clinician training in best intrapartum practices during TOLAC) reduced perinatal and major maternal morbidity composite outcomes compared with usual care [ 9 ]. VBAC and uterine rupture rates were similar for both groups. Further study is needed to identify the most useful component(s) of the intervention for reducing morbidity. (See "Choosing the route of delivery after cesarean birth", section on 'Person-centered decision-making model' .)

Serial amnioinfusions for bilateral renal agenesis (January 2024)

Bilateral renal agenesis (BRA) is incompatible with extrauterine life because prolonged oligohydramnios results in pulmonary hypoplasia, leading to postnatal respiratory failure. A prospective study (RAFT) assessed use of serial amnioinfusions to treat 18 cases of BRA diagnosed at <26 weeks of gestation [ 10 ]. Of the 17 live births, 14 survived ≥14 days and had placement of dialysis access, but only 6 survived to hospital discharge. Of the 4 children alive at 9 to 24 months of age, 3 had experienced a stroke and none had undergone transplant. These findings show that serial amnioinfusions for BRA mitigates pulmonary hypoplasia and increases short-term survival and access to dialysis; however, long-term outcome remains poor with no survival to transplantation. Serial amnioinfusions remain investigational and should be offered only as institutional review board-approved research. (See "Renal agenesis: Prenatal diagnosis", section on 'Investigative role of therapeutic amnioinfusion' .)

Prenatal genetic testing for monogenic diabetes due to glucokinase deficiency (December 2023)

In pregnant individuals with monogenic diabetes due to glucokinase (GCK) deficiency, management depends on the fetal genotype. If the fetus inherits the maternal GCK variant, maternal hyperglycemia will not cause fetal hyperinsulinemia and excessive growth, and maternal hyperglycemia does not require treatment. However, if the fetus does not inherit the pathogenic variant, maternal insulin therapy is indicated to prevent excessive fetal growth. Fetal ultrasound has been used to predict fetal genotype but has limited diagnostic utility. In a cohort of 38 pregnant individuals with GCK deficiency, fetal genetic testing using cell-free DNA in maternal blood had higher sensitivity (100 versus 53 percent) and specificity (96 versus 61 percent) for prenatal diagnosis of GCK deficiency compared with ultrasound measurement of fetal abdominal circumference [ 11 ]. When available, noninvasive prenatal genotyping should be used to guide management of GCK deficiency during pregnancy. (See "Classification of diabetes mellitus and genetic diabetic syndromes", section on 'Glucokinase' .)

Early metformin treatment of gestational diabetes mellitus (November 2023)

Usual initial gestational diabetes mellitus (GDM) care (ie, medical nutritional therapy, exercise) may result in a few weeks of hyperglycemia before a need for pharmacotherapy is established. In a randomized trial evaluating whether initiating metformin at the time of GDM diagnosis regardless of glycemic control improves clinical outcomes compared with usual care, the metformin group had a lower rate of insulin initiation and favorable trends in mean fasting glucose, gestational weight gain, and excessive fetal growth, but more births <2500 grams [ 12 ]. Rates of preeclampsia, neonatal intensive care unit admission, and neonatal hypoglycemia were similar for both groups. Given these mixed results, we recommend not initiating metformin at the time of GDM diagnosis except in a research setting. (See "Gestational diabetes mellitus: Glucose management and maternal prognosis", section on 'Does early metformin initiation improve glycemic control and reduce need for insulin?' .)

Automated insulin delivery in pregnant patients with type 1 diabetes (October 2023)

Hybrid closed-loop insulin therapy is associated with improved glucose control in nonpregnant adults and in children, but little information is available in pregnant people. In the first randomized trial in this population, hybrid closed-loop insulin delivery beginning at 11 weeks gestation improved glycemic control compared with standard insulin therapy in 124 patients with type 1 diabetes, without increasing their risk of severe hypoglycemia [ 13 ]. The system allowed customization of glycemic targets appropriate to pregnancy, in contrast to other commercially available systems in the United States. Additional study is needed to confirm these findings, evaluate the effects on obstetric and neonatal outcomes, and identify optimal candidates. (See "Pregestational (preexisting) diabetes mellitus: Antenatal glycemic control", section on 'Continuous subcutaneous insulin infusion (insulin pump)' .)

Valacyclovir for prevention of congenital cytomegalovirus infection (October 2023)

Emerging evidence suggests that maternal administration of valacyclovir for primary cytomegalovirus (CMV) infection substantially reduces the risk of congenital CMV infection, especially if begun prior to 14 weeks of gestation and within 8 weeks of the maternal infection. In a 2023 individual patient data meta-analysis (one randomized trial, two observational studies), maternal valacyclovir administration upon diagnosis of periconception or first-trimester primary CMV infection was associated with a 66 percent reduction in congenital CMV (11 versus 25 percent) [ 14 ]. We suggest high-dose oral valacyclovir (8g per day) for patients with a primary CMV infection in early pregnancy after a comprehensive discussion of the potential benefits and risks (eg, 2 percent risk of reversible maternal kidney failure). (See "Cytomegalovirus infection in pregnancy", section on 'Antiviral medication' .)

Respiratory syncytial virus vaccination in pregnancy (April 2023, Modified October 2023)

Respiratory syncytial virus (RSV) is a major cause of morbidity and mortality in infants. In October 2023, the United States Centers for Disease Control and Prevention, along with guidelines from other expert groups, endorsed RSV vaccination of pregnant individuals to reduce severe RSV infections in their infants [ 15-18 ]. Nirsevimab , a monoclonal antibody that can be given to infants postnatally to reduce the risk of severe RSV, has also been recently approved and endorsed by expert guidance panels. In settings where nirsevimab is not available, we suggest vaccination of pregnant individuals between 32 0/6 and 36 6/7 weeks of gestation in September through January (in the northern hemisphere) with inactivated nonadjuvanted recombinant RSV vaccine (RSVPreF; Abrysvo). In settings where both maternal vaccination and nirsevimab are available, the optimal preventive strategy remains uncertain, and, in most cases, it will not be possible to use both. For such patients, both options should be discussed and shared decision-making undertaken. (See "Immunizations during pregnancy", section on 'Choosing the optimal strategy' .)

INTRAPARTUM AND POSTPARTUM OBSTETRICS

Intrauterine postpartum hemorrhage control devices for managing postpartum hemorrhage (February 2024)

Intrauterine balloon tamponade and vacuum-induced uterine compression are the most common devices used for intrauterine postpartum hemorrhage (PPH) control in patients with atony, but it is unclear which device is superior as few comparative studies have been performed. In a retrospective study including nearly 380 patients with PPH, quantitative blood loss after placement, rate of blood transfusion, and discharge hematocrit were similar for both devices [ 19 ]. Based on these and other data, in the setting of ongoing uterine bleeding, rapid use of one of these devices is likely to be more important than the choice of device when both devices are available. (See "Postpartum hemorrhage: Use of an intrauterine hemorrhage-control device", section on 'Choice of method' .)

Labor epidural analgesia and risk of emergency delivery (December 2023)

It is well established that contemporary neuraxial labor analgesia does not increase the overall risk of cesarean or instrument-assisted vaginal delivery. However, a new retrospective database study of over 600,000 deliveries in the Netherlands reported that epidural labor analgesia was associated with an increased risk of emergency delivery (cesarean or instrument-assisted vaginal) compared with alternative analgesia (13 versus 7 percent) [ 20 ]. Because of potential confounders and lack of detail on epidural and obstetric management, we consider these data insufficient to avoid neuraxial analgesia or change the practice of early labor epidural placement to reduce the potential need for general anesthesia in patients at high risk for cesarean delivery. (See "Adverse effects of neuraxial analgesia and anesthesia for obstetrics", section on 'Effects on the progress and outcome of labor' .)

Delayed cord clamping in preterm births (December 2023)

Increasing evidence supports delaying cord clamping in preterm births. In an individual participant data meta-analysis of randomized trials of delayed versus immediate cord clamping at births <37 weeks (over 3200 infants), delaying cord clamping for >30 seconds reduced infant death before discharge (6 versus 8 percent) [ 21 ]. In a companion network meta-analysis evaluating the optimal duration of delay, a long delay (≥120 seconds) significantly reduced death before discharge compared with immediate clamping; reductions also occurred with delays of 15 to <120 seconds but were not statistically significant [ 22 ]. For preterm births that do not require resuscitation, we recommend delayed rather than immediate cord clamping. We delay cord clamping for at least 30 to 60 seconds as approximately 75 percent of blood available for placenta-to-fetus transfusion is transfused in the first minute after birth. (See "Labor and delivery: Management of the normal third stage after vaginal birth", section on 'Preterm infants' .)

Vacuum-induced intrauterine tamponade for postpartum hemorrhage (November 2023)

Intrauterine tamponade (with a balloon, packing, or vacuum) may be used to manage patients with postpartum hemorrhage (PPH) resulting from uterine atony that is not controlled by uterotonic medications and uterine massage. However, outcome data regarding vacuum-induced tamponade are limited. A study of data from a postmarketing registry of over 500 patients with PPH and isolated atony treated with vacuum-induced tamponade reported that the device controlled bleeding without treatment escalation or bleeding recurrence in 88 percent following cesarean birth and 96 percent following vaginal birth, typically within five minutes [ 23 ]. These data are consistent with previously published outcomes. Given its efficacy and ease of use, vacuum-induced tamponade is an important option for managing PPH in centers where this device is available. (See "Postpartum hemorrhage: Use of an intrauterine hemorrhage-control device", section on 'Vacuum-induced tamponade' .)

Risk of pregnancy-associated venous and arterial thrombosis in sickle cell disease (November 2023)

Sickle cell disease (SCD) and pregnancy both confer an increased risk of venous thromboembolism (VTE), but the magnitude of the risk is unclear. In a new administrative claims data study involving >6000 people with SCD and >17,000 age- and race-matched controls who were followed for one year postpartum, the risk of VTE was 11.3 percent in the patients with SCD, versus 1.2 percent in controls [ 24 ]. Arterial thromboembolism was also increased (5.2 percent, versus 0.6 percent in controls). This study emphasizes the value of postpartum VTE prophylaxis in people with SCD and the need for vigilance in evaluating suggestive symptoms. (See "Sickle cell disease: Obstetric considerations", section on 'Maternal risks' .)

Racial disparities in anemia during pregnancy (October 2023)

A new study has found that racial disparities in anemia during pregnancy persist and may be increasing. This analysis involved nearly four million births in the state of California from 2011 to 2020 [ 25 ]. Antepartum anemia was most common in Black individuals (22 percent), followed by Pacific Islanders (18 percent), Native American and Alaska Native peoples (14 percent), multiracial individuals (14 percent), Hispanic individuals (13 percent), Asian individuals (11 percent), and White individuals (10 percent). Antepartum anemia is associated with an increase in severe maternal morbidity. The reasons for disparities are multifactorial. (See "Anemia in pregnancy", section on 'Racial disparities' .)

Intrapartum magnesium sulfate before preterm birth and cerebral palsy (October 2023)

Magnesium sulfate is typically administered to pregnant women with impending preterm birth <32 weeks of gestation to decrease the incidence and severity of cerebral palsy in offspring. However, the recent MAGENTA trial comparing the effects of magnesium sulfate versus placebo administered before impending preterm birth between 30 and 34 weeks of gestation found that it did not prevent cerebral palsy among surviving infants [ 26 ]. These findings do not change our current practice because the trial used a single 4 g bolus of magnesium sulfate alone, whereas we also provide an ongoing 1 g/hour infusion until delivery and do not use the medication after 32 weeks; the trial was likely underpowered to find a significant difference. (See "Neuroprotective effects of in utero exposure to magnesium sulfate", section on 'Lower and upper gestational age' .)

OFFICE GYNECOLOGY

Infertility and autism spectrum disorder (December 2023)

Patients with infertility often ask about the impact of the disorder and its treatment on risk of autism spectrum disorder (ASD) in offspring. In a large population-based cohort study comparing ASD risk among children whose parents had subfertility (an infertility consultation without treatment), infertility treatment, or neither (unassisted conception), children in the subfertility and infertility treatment groups had a small increased risk of ASD compared with unassisted conception but the absolute risk was low (2.5 to 2.7 per 1000 person-years versus 1.9 per 1000 person-years with unassisted conception) [ 27 ]. The increased risk was similar in the subfertile and infertility treatment groups, suggesting that infertility treatment was not a major risk factor. Obstetrical and neonatal factors (eg, preterm birth) appeared to mediate a sizeable proportion of the increased risk for ASD. (See "Assisted reproductive technology: Infant and child outcomes", section on 'Confounders' .)

Macular changes related to pentosan polysulfate sodium (November 2023)

Macular eye disease has been reported in patients who have taken pentosan polysulfate sodium (PPS), which is used for the treatment of interstitial cystitis. In a prospective cohort study of 26 eyes with PPS maculopathy and >3000 g cumulative PPS exposure, progression of macular changes continued 13 to 30 months after drug cessation [ 28 ]. Median visual acuity decreased slightly; most patients reported progression of symptoms, including difficulty in low-light environments and blurry vision. These results indicate that PPS maculopathy progresses despite drug discontinuation, underscoring the importance of regular screening for maculopathy in patients with current or prior PPS exposure. (See "Interstitial cystitis/bladder pain syndrome: Management", section on 'Pentosan polysulfate sodium as alternative' .)

Vaginal laser therapy not effective for genitourinary syndrome of menopause (November 2023)

Laser devices, including the fractional microablative CO 2 laser, have been marketed for treatment of patients with genitourinary syndrome of menopause (GSM), but data regarding their safety and efficacy are limited. In a randomized trial including nearly 50 postmenopausal patients with GSM, treatment with CO 2 laser did not improve symptom severity compared with sham therapy [ 29 ]. Change in vaginal histology, which is a common surrogate determinant of treatment success, was similar in both groups at six months postprocedure. In addition, histologic features associated with a hypoestrogenic state correlated poorly with the severity of vaginal symptoms. Although the trial had limitations, these findings are consistent with other data and support our practice of not using laser treatment for patients with GSM. (See "Genitourinary syndrome of menopause (vulvovaginal atrophy): Treatment", section on 'Laser or radiofrequency devices' .)

Use of vaginal estrogen in breast cancer patients taking aromatase inhibitors (October 2023)

Use of vaginal estrogen to manage symptoms of genitourinary syndrome of menopause (GSM) may be harmful in patients with breast cancer on aromatase inhibitors (AIs). In a subgroup analysis of a claims-based analysis, vaginal estrogen therapy was associated with a higher rate of breast cancer recurrence in patients taking versus not taking an AI [ 30 ]. Time to recurrence in the AI group was approximately 140 days. While this study had many limitations, these data support our general practice of avoiding vaginal estrogen for the management of GSM in most patients with breast cancer taking AIs. (See "Genitourinary syndrome of menopause (vulvovaginal atrophy): Treatment", section on 'Patients with breast cancer' .)

GYNECOLOGIC SURGERY

Risk of unplanned hysterectomy at time of myomectomy (February 2024)

Myomectomy is an option for patients with bothersome fibroid symptoms (eg, bleeding, bulk); however, data are limited regarding the risk of unplanned hysterectomy at the time of myomectomy. In a retrospective study of the American College of Surgeons' National Surgical Quality Improvement Program database from 2010 to 2021 including over 13,000 patients undergoing myomectomy, the risk of unplanned hysterectomy was higher in those undergoing laparoscopic myomectomy compared with an open abdominal or hysteroscopic approach (7.1, 3.2, and 1.9 percent respectively) [ 31 ]. While much lower risks have been reported (<0.4 percent), and expert surgeons at high-volume centers may have fewer conversions to hysterectomy, this study highlights the importance of discussing the risk of unplanned hysterectomy during the informed consent process. (See "Uterine fibroids (leiomyomas): Laparoscopic myomectomy and other laparoscopic treatments", section on 'Unplanned hysterectomy' and "Uterine fibroids (leiomyomas): Open abdominal myomectomy procedure", section on 'Unplanned hysterectomy' and "Uterine fibroids (leiomyomas): Hysteroscopic myomectomy", section on 'Unplanned hysterectomy' .)

Risk of subsequent hysterectomy after endometrial ablation (January 2024)

Endometrial ablation is an alternative to hysterectomy in selected premenopausal patients with heavy menstrual bleeding. Most ablations are performed using a non-resectoscopic technique; however, the long-term efficacy of this approach is unclear. In a meta-analysis of 53 studies including over 48,000 patients managed with non-resectoscopic endometrial ablation (NREA), the rates of subsequent hysterectomy were 4 percent at 12 months, 8 to 12 percent at 18 to 60 months, and 21 percent at 120 months [ 32 ]. Hysterectomy rates were similar for the different NREA devices (eg, thermal balloon, microwave, radiofrequency). These findings are useful for counseling patients about the long-term risk for hysterectomy after NREA. (See "Endometrial ablation: Non-resectoscopic techniques", section on 'Efficacy' .)

Pregnancy and childbirth after urinary incontinence surgery (January 2024)

Patients with stress urinary incontinence (SUI) have historically been advised to delay midurethral sling (MUS) surgery until after childbearing because of concerns for worsening SUI symptoms following delivery. In a meta-analysis of patients with MUS surgery who were followed for a mean of nearly 10 years, similar low SUI recurrence and reoperation rates were reported for the 381 patients with and the 860 patients without subsequent childbirth [ 33 ]. Birth route did not affect the findings. Although the total number of recurrences and reoperations was small, this study adds to the body of evidence suggesting that subsequent childbirth does not worsen SUI outcomes for patients who have undergone MUS. (See "Surgical management of stress urinary incontinence in females: Retropubic midurethral slings", section on 'Subsequent pregnancy' .)

GYNECOLOGIC ONCOLOGY

Types of hysterectomy in patients with stage IB1 cervical cancer (March 2024)

Patients with stage IB1 cervical cancer (ie, >5 mm depth of stromal invasion and ≤2 cm in greatest dimension) are typically treated with radical hysterectomy; however, less extensive surgery is being evaluated. In a randomized trial including over 640 patients with stage IB1 cervical cancer, radical hysterectomy and simple hysterectomy plus lymph node assessment resulted in similar rates of recurrence at three years (2.2 and 2.5 percent, respectively) [ 34 ]. Although the study has limitations, including a short follow-up period, simple hysterectomy with lymph node assessment may be an acceptable alternative to radical hysterectomy in patients with IB1 cervical cancer. (See "Management of early-stage cervical cancer", section on 'Type of surgery' .)

Increasing incidence of cervical and uterine corpus cancer in the United States (February 2024)

In January 2024, the American Cancer Society published their annual report of cancer statistics in the United States [ 35 ]. Notable trends in regard to gynecologic cancers include a 1.7 percent increase in the annual incidence of cervical cancer from 2012 to 2019 in individuals aged 30 to 44 years, after decades of decline. Cancer of the uterine corpus (all ages) continued to increase by approximately 1 percent annually and was the only cancer in the report in which survival decreased. These and other data emphasize the continued importance of both early detection and prevention (eg, for cervical cancer: human papillomavirus vaccination and screening for precursor lesions; for endometrial cancer: achieving and maintaining a normal body mass index). (See "Invasive cervical cancer: Epidemiology, risk factors, clinical manifestations, and diagnosis", section on 'Incidence and mortality' and "Endometrial carcinoma: Epidemiology, risk factors, and prevention", section on 'Epidemiology' and "Endometrial carcinoma: Clinical features, diagnosis, prognosis, and screening", section on 'Prognosis' .)

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• Velez MP, Dayan N, Shellenberger J, et al. Infertility and Risk of Autism Spectrum Disorder in Children. JAMA Netw Open 2023; 6:e2343954.
• Somisetty S, Santina A, Au A, et al. Progression of Pentosan Polysulfate Sodium Maculopathy in a Prospective Cohort. Am J Ophthalmol 2023; 255:57.
• Li FG, Fuchs T, Deans R, et al. Vaginal epithelial histology before and after fractional CO2 laser in postmenopausal women: a double-blind, sham-controlled randomized trial. Am J Obstet Gynecol 2023; 229:278.e1.
• Agrawal P, Singh SM, Able C, et al. Safety of Vaginal Estrogen Therapy for Genitourinary Syndrome of Menopause in Women With a History of Breast Cancer. Obstet Gynecol 2023; 142:660.
• Coyne K, Purdy MP, Bews KA, et al. Risk of hysterectomy at the time of myomectomy: an underestimated surgical risk. Fertil Steril 2024; 121:107.
• Oderkerk TJ, Beelen P, Bukkems ALA, et al. Risk of Hysterectomy After Endometrial Ablation: A Systematic Review and Meta-analysis. Obstet Gynecol 2023; 142:51.
• Nahshon C, Abramov Y, Kugelman N, et al. The effect of subsequent pregnancy and childbirth on stress urinary incontinence recurrence following midurethral sling procedure: a meta-analysis. Am J Obstet Gynecol 2024; 230:308.
• Plante M, Kwon JS, Ferguson S, et al. Simple versus Radical Hysterectomy in Women with Low-Risk Cervical Cancer. N Engl J Med 2024; 390:819.
• Siegel RL, Giaquinto AN, Jemal A. Cancer statistics, 2024. CA Cancer J Clin 2024; 74:12.

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• v.319(7211); 1999 Sep 11

Recent advances

Gynaecology.

Improvements in imaging technology, endoscopic equipment, drug treatment, and scientific innovation have all contributed to recent advances in gynaecology. Advances have also resulted from a change in the attitudes and practice of gynaecologists themselves, in response to the greater expectations and knowledge of their patients, who frequently seek new and innovative procedures on the basis of media publicity and access to non-peer reviewed information including the world wide web. It is increasingly recognised that gynaecological problems affect the quality of life of women in different ways, highlighting the value and importance of patient assessed health status measures to evaluate the subjective severity and treatment efficacy of common gynaecological conditions. 1 , 2 Laparoscopic and hysteroscopic surgery, medical treatment, and expectant management are replacing major gynaecological surgery for many common gynaecological complaints. For example, ectopic pregnancy is being diagnosed earlier by the use of transvaginal ultrasonography and quantitative measurements of human chorionic gonadotrophin concentrations. Thus women can be treated either medically as outpatients with methotrexate injections 3 , 4 or by laparoscopic surgery, reducing stay in hospital and preserving tubal function in most cases. 4 – 6 Minor procedure units for gynaecology, with one stop investigation and treatment (including ultrasonography and hysteroscopy), and early pregnancy assessment units, where bleeding in early pregnancy can be dealt with rapidly and sympathetically, are becoming more commonplace. The prolonged life expectancy of menopausal women and their higher expectations for health have encouraged new developments in hormone replacement therapy. The increased use of such therapy has also increased surveillance and thus recognition of other common problems affecting older women. Delaying childbearing has resulted in a greater demand for effective fertility treatments and for surgical procedures that preserve fertility.

• Although hysterectomy is an effective treatment for menorrhagia, the appropriate use of medical treatment, the progestogen releasing intrauterine system, and hysteroscopic endometrial surgery should offer successful treatment for most women
• Large uterine fibroids can be managed conservatively with gondatrophin releasing hormone analogue therapy or embolisation of the uterine arteries
• New techniques in assisted reproductive technology have transformed the previous poor prognosis for fertility in men with low sperm counts or azoospermia
• A new selective antimuscarinic drug for bladder overactivity has improved the treatment of this condition and reduced the side effects
• Injury to the anal sphincter is common after vaginal childbirth, although its prevention and appropriate management are incompletely understood

We asked consultant gynaecological staff at a London teaching hospital for their views on important recent advances in gynaecological practice. Overlap occurred in topics believed to be important, and these are detailed here. To supplement our knowledge of the relevant recent literature, we electronically searched Medline, hand searched the major British and US gynaecological journals published over the past 2 years, and read presentations and abstracts from the 1998 British congress of obstetrics and gynaecology.

Treatment of menorrhagia

Hysterectomy.

Heavy menstrual loss is a common complaint and accounts for about 12% of referrals to gynaecology outpatient departments. 7 Many of these women will undergo hysterectomy—a woman’s lifetime risk of hysterectomy is estimated at 20%. 8 , 9 Despite the success of the procedure compared with other treatments for menorrhagia, 10 the morbidity and complication rates (before and after discharge from hospital) are high. 11 The frequency of the operation and its complications have provided incentives to re-evaluate simple medical treatment and to explore new conservative and surgical treatments for dysfunctional uterine bleeding.

Medical treatment

Randomised controlled trials of commonly prescribed medical treatments for menorrhagia have confirmed the efficacy of tranexamic acid 12 and have shown that norethisterone, the most commonly prescribed drug in the United Kingdom for the treatment of ovulatory menorrhagia, 13 is ineffective at its recommended dosage. 14 , 15 Despite this evidence, a recent survey of 206 general practitioners showed that 69% would still consider prescribing cyclical norethisterone for this condition. 16

Even when used appropriately simple medical treatment may not relieve the symptoms of menorrhagia. Although this may result from inappropriate prescribing, evidence from studies of patient satisfaction and quality of life have shown that women with severe self assessed symptoms are unlikely to experience improvement with drugs. 17

Hysteroscopic ablative surgery

If medical treatment fails to treat menorrhagia, an alternative treatment is hysteroscopic ablation of the endometrium. Several techniques are available, and despite initial concerns about safety a recent survey of more than 10 000 operations (MISTLETOE; miminally invasive surgical techniques, laser, endothermal or endoresection) showed that the techniques are safe even in inexperienced hands. 18 At the start of the survey in 1993, 83% of NHS hospitals in the United Kingdom offered ablative surgery. Although randomised trials have shown ablative surgery to be more effective than medical management, 19 the technique is invasive, requires general anaesthesia, is not without complications, and has reduced long term efficacy in women under 45 years of age. 20 Recently introduced balloon devices for ablative treatment may prove to be equally efficacious, simpler, and even safer to use than ablative surgery, although further evaluation is awaited. 21

Intrauterine progestogen releasing system

The levonorgestrel intrauterine system (Mirena; Schering Health Care) may prove to be both an effective contraceptive and a long term treatment for menorrhagia, offering a genuine alternative to surgical intervention for this condition (fig ​ (fig1). 1 ). The device can be inserted or removed easily in the outpatient clinic by practitioners with no additional training other than that required for insertion of intrauterine contraceptives, and its effects are completely reversible. 22 Recent randomised controlled studies showed that the efficacy of the levonorgestrel intrauterine system is comparable to that of invasive endometrial ablation 23 and that reduction of menstrual loss is significant in most cases. 22 – 25 Studies have also shown that between 64% and 80% of women awaiting hysterectomy cancel their surgery after a 6 month trial of the device. 24 , 25 The many other potential uses for the device include endometrial protection in hormone replacement therapy, the reduction of climacteric symptoms, and possibly an alternative to sterilisation in women with menorrhagia, although these uses are incompletely evaluated at present. Recent evidence has shown that the levonorgestrel intrauterine system may also reduce the risks of pelvic infection. 24

Progestogen releasing intrauterine system (Mirena) releases low dose of progestogen within endometrial cavity (with permission of Schering Health Care)

Treatment of fibroids

The hysteroscopic resection of small submucous fibroids distorting the endometrial cavity is now standard practice (fig ​ (fig2), 2 ), but not all fibroids are amenable to this surgical option because of their position and size. In the presence of large symptomatic fibroids, hysterectomy or myomectomy has remained the major treatment option. Recent advances in the long term interventional radiological and medical treatment of large symptomatic myomas offer an important alternative approach.

Submucosal fibroid in endometrial cavity viewed before (above) and during (below) hysteroscopic myomectomy (diathermy resection loop seen)

Bilateral embolisation of uterine arteries

An alternative approach for the treatment of large symptomatic fibroids is bilateral embolisation of the uterine arteries, currently available only at specialist centres as part of an ongoing evaluation process. It has been shown that embolisation of the uterine arteries with polyvinyl alcohol particles introduced transfemorally by catheter can significantly reduce the size of large fibroids (60%-65%) and produce significant symptomatic improvement or complete resolution of symptoms (fig ​ (fig3 3 ). 26 The technique is generally well tolerated and requires only a brief admission to hospital for analgesia, although short term side effects such as pyrexia, profuse discharge, and the passage of small or large fibroids through the vagina are common. The treatment is new, and the long term safety and efficacy of fibroid shrinkage are still unknown. Significant morbidity and even mortality as a consequence of infection have resulted from embolisation of the uterine arteries, and it must therefore be considered a new treatment under evaluation until further results are available from large randomised studies. Although pregnancy has been recorded after treatment, 27 , 28 embolisation of the uterine arteries is not recommended for nulliparous women until more data on fertility are available. However, it may be a useful alternative for difficult or dangerous surgery, for those who decline blood transfusion, or for those who refuse surgery.

Catheter course during bilateral embolisation of uterine arteries (normal sized uterus and enlarged uterus with abnormal vasculature)

Gonadotrophin releasing hormone agonists

Although the gonadotrophin releasing hormone agonists are more frequently used in assisted conception, in the management of endometriosis, for the premenstrual syndrome, and to prepare the endometrium before hysteroscopic surgery, they have also been shown to reduce the size of fibroids by up to 50% with short term treatment (3-6 months). This has made them an ideal adjunct to surgery for large symptomatic fibroids. 29 The main disadvantages of gonadotrophin releasing hormone agonists are secondary to the induced hypo-oestrogenic state, affecting the cardiovascular, skeletal, and urogenital systems and producing vasomotor symptoms. This has limited their use to short term treatment, the cessation of which leads to a rapid increase of fibroids to their previous dimensions. Thus the short term treatment of fibroids with gonadotrophin releasing hormone agonists alone is a costly and ineffective treatment option. 30

Gonadotrophin releasing hormone agonists and “add back” therapy

Add back hormone replacement therapy, the concomitant use of oestrogens, progestogens, or both, aims to counteract the hypo-oestrogenic side effects of gonadotrophin releasing hormone agonists without exacerbating the condition for which they are being used. 31 This allows the possibility of extended or repeat treatment courses with gonadotrophin releasing hormone agonists for a variety of conditions. Although the best combination has yet to be determined, it would seem that continuous combined oestrogen and progestogen or tibolone (Livial) 32 preparations are the most sensible option.

Gonadotrophin releasing hormone agonists are usually used for only a short period of time to reduce the size of fibroids, but add back therapy reduces the side effects that patients experience with this treatment. Current evidence suggests that for the treatment of fibroids, add back therapy should be commenced 3 months after the start of gonadotrophin releasing hormone agonists.

Overcoming male factor infertility

It is now 21 years since the first live birth after fertilisation in vitro to alleviate female tubal infertility. Despite only moderate success (between 9% and 26% live births per cycle started), influenced mainly by maternal age, duration of infertility, and previous parity, 33 in vitro fertilisation is now accepted as an alternative to tubal surgery and for protracted unexplained infertility. In a similar way, the recent ability to achieve fertilisation of eggs in vitro by the injection of a single spermatozoon (intracytoplasmic sperm injection; ICSI) 34 has overturned the poor prognosis for men with low sperm counts or azoospermia. 35 Adequate spermatozoal samples for intracytoplasmic sperm injection can be obtained from very poor ejaculates, including semen samples frozen for patients undergoing chemotherapy or radiotherapy but too poor to be used for artificial insemination. In men with obstructive azoospermia of infective origin or after failed reversal of vasectomy, sperm for intracytoplasmic sperm injection can be obtained by percutaneous aspiration from the epidydimis (PESA) or from a small testicular biopsy (testicular sperm extraction; TESE), performed under local anaesthesia. This latter technique may be used in men with small testes and a high follicle stimulating hormone concentration who have testicular failure, as multiple small biopsies will show adequate sperm for intracytoplasmic sperm injection in half the cases. Pregnancy success with intracytoplasmic sperm injection is as good as or even better than with in vitro fertilisation, and the outcome seems to be independent of the source of the sperm. 35

Urinary and faecal incontinence

The prevalence of urinary incontinence increases with age, 36 and important predisposing factors are childbirth and the menopause. 37 Recent developments include tolterodine, a specifically targeted antimuscarinic drug (M3 receptors) for treating detrusor instability. Tolterodine reduces non-specific systemic anticholinergic side effects, a major cause of poor compliance with previous drugs. 38

Embarrassing conditions, including urinary incontinence, are frequently underreported and consequently unrecognised. Accumulating evidence shows that 1% of women sustain anal sphincter injury during childbirth and that occult sphincter injury—identified by endoanal sonography 39 —may occur in up to one third of vaginal deliveries. 40 This results in anal urgency and incontinence in 6%-10% of women post partum, yet less than 20% report their symptoms. 41 Although injury to the anal sphincter cannot be prevented it can be minimised by the use of ventouse in preference to forceps for operative vaginal delivery and by the recognition that liberal use of episiotomy does more harm than good. 42 In addition, the improved recognition and management of anal sphincter injury at the time of delivery and the use of alternative means of repairing third degree tears, including the overlapping repair, may reduce long term morbidity. Until anal sphincter injury is more fully understood and researched, it is likely that the increase in rate of caesarean sections will continue and that, as recently suggested, it may be difficult to decline a patient’s request for caesarean to avoid pelvic floor damage during childbirth on the basis of current evidence. 43

  Competing interests: CK has received reimbursement both from Schering and from Pharmacia and Upjohn for attending symposia.

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Uterine Fibroid Surgery in Gynecology and Obstetrics and Reproduction: Lights and Shadows

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One of the most prevalent and least understood disorders in women is uterine fibroids. Throughout their lives, up to 70% of white women and more than 80% of women of African heritage are diagnosed with these tumors, also known as myomas, which mostly afflict women during their reproductive years. The delivery ...

Keywords : Uterine Fibroid Surgery, Gynecology, Obstetrics, Reproduction

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Critical Care Obstetrics and Gynecology PubMed Indexed Journals | Critical Care Obstetrics and Gynecology Scopus Indexed Journals | Critical Care Obstetrics and Gynecology Medline Indexed Journals | Critical Care Obstetrics and Gynecology ESCI Indexing | Critical Care Obstetrics and Gynecology PubMed Central Indexed Journals | Critical Care Obstetrics and Gynecology Impact factor 2023 2024 2025

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Gynecology and Minimally Invasive Therapy PubMed Indexed Journals | Gynecology and Minimally Invasive Therapy Scopus Indexed Journals | Gynecology and Minimally Invasive Therapy Medline Indexed Journals | Gynecology and Minimally Invasive Therapy ESCI Indexing | Gynecology and Minimally Invasive Therapy PubMed Central Indexed Journals | Gynecology and Minimally Invasive Therapy Impact factor 2023 2024 2025

Gynecology and Minimally Invasive Therapy open access journals, Gynecology and Minimally Invasive Therapy peer reviewed open access journals, Gynecology and Minimally Invasive Therapy PubMed indexing, Gynecology and Minimally Invasive Therapy Scopus indexing, Gynecology and Minimally Invasive Therapy Medline indexing, Gynecology and Minimally Invasive Therapy ESCI indexing, Gynecology and Minimally Invasive Therapy SCI indexing, Gynecology and Minimally Invasive Therapy impact factor, Gynecology and Minimally Invasive Therapy 2023 impact factor, Gynecology and Minimally Invasive Therapy 2024 impact factor, Gynecology and Minimally Invasive Therapy 2025 impact factor, Gynecology and Minimally Invasive Therapy index copernicus value, Gynecology and Minimally Invasive Therapy free journals, Gynecology and Minimally Invasive Therapy top journals,

Journal of Gynecology and Womens Health PubMed Indexed Journals | Journal of Gynecology and Womens Health Scopus Indexed Journals | Journal of Gynecology and Womens Health Medline Indexed Journals | Journal of Gynecology and Womens Health ESCI Indexing | Journal of Gynecology and Womens Health PubMed Central Indexed Journals | Journal of Gynecology and Womens Health Impact factor 2023 2024 2025

Journal of Gynecology and Womens Health open access journals, Journal of Gynecology and Womens Health peer reviewed open access journals, Journal of Gynecology and Womens Health PubMed indexing, Journal of Gynecology and Womens Health Scopus indexing, Journal of Gynecology and Womens Health Medline indexing, Journal of Gynecology and Womens Health ESCI indexing, Journal of Gynecology and Womens Health SCI indexing, Journal of Gynecology and Womens Health impact factor, Journal of Gynecology and Womens Health 2023 impact factor, Journal of Gynecology and Womens Health 2024 impact factor, Journal of Gynecology and Womens Health 2025 impact factor, Journal of Gynecology and Womens Health index copernicus value, Journal of Gynecology and Womens Health free journals, Journal of Gynecology and Womens Health top journals,

Indian Journal of Obstetrics and Gynecology PubMed Indexed Journals | Indian Journal of Obstetrics and Gynecology Scopus Indexed Journals | Indian Journal of Obstetrics and Gynecology Medline Indexed Journals | Indian Journal of Obstetrics and Gynecology ESCI Indexing | Indian Journal of Obstetrics and Gynecology PubMed Central Indexed Journals | Indian Journal of Obstetrics and Gynecology Impact factor 2023 2024 2025

Indian Journal of Obstetrics and Gynecology open access journals, Indian Journal of Obstetrics and Gynecology peer reviewed open access journals, Indian Journal of Obstetrics and Gynecology PubMed indexing, Indian Journal of Obstetrics and Gynecology Scopus indexing, Indian Journal of Obstetrics and Gynecology Medline indexing, Indian Journal of Obstetrics and Gynecology ESCI indexing, Indian Journal of Obstetrics and Gynecology SCI indexing, Indian Journal of Obstetrics and Gynecology impact factor, Indian Journal of Obstetrics and Gynecology 2023 impact factor, Indian Journal of Obstetrics and Gynecology 2024 impact factor, Indian Journal of Obstetrics and Gynecology 2025 impact factor, Indian Journal of Obstetrics and Gynecology index copernicus value, Indian Journal of Obstetrics and Gynecology free journals, Indian Journal of Obstetrics and Gynecology top journals,

Current Obstetrics and Gynecology Reports PubMed Indexed Journals | Current Obstetrics and Gynecology Reports Scopus Indexed Journals | Current Obstetrics and Gynecology Reports Medline Indexed Journals | Current Obstetrics and Gynecology Reports ESCI Indexing | Current Obstetrics and Gynecology Reports PubMed Central Indexed Journals | Current Obstetrics and Gynecology Reports Impact factor 2023 2024 2025

Current Obstetrics and Gynecology Reports open access journals, Current Obstetrics and Gynecology Reports peer reviewed open access journals, Current Obstetrics and Gynecology Reports PubMed indexing, Current Obstetrics and Gynecology Reports Scopus indexing, Current Obstetrics and Gynecology Reports Medline indexing, Current Obstetrics and Gynecology Reports ESCI indexing, Current Obstetrics and Gynecology Reports SCI indexing, Current Obstetrics and Gynecology Reports impact factor, Current Obstetrics and Gynecology Reports 2023 impact factor, Current Obstetrics and Gynecology Reports 2024 impact factor, Current Obstetrics and Gynecology Reports 2025 impact factor, Current Obstetrics and Gynecology Reports index copernicus value, Current Obstetrics and Gynecology Reports free journals, Current Obstetrics and Gynecology Reports top journals,

Journal of Clinical Gynecology and Obstetrics PubMed Indexed Journals | Journal of Clinical Gynecology and Obstetrics Scopus Indexed Journals | Journal of Clinical Gynecology and Obstetrics Medline Indexed Journals | Journal of Clinical Gynecology and Obstetrics ESCI Indexing | Journal of Clinical Gynecology and Obstetrics PubMed Central Indexed Journals | Journal of Clinical Gynecology and Obstetrics Impact factor 2023 2024 2025

Journal of Clinical Gynecology and Obstetrics open access journals, Journal of Clinical Gynecology and Obstetrics peer reviewed open access journals, Journal of Clinical Gynecology and Obstetrics PubMed indexing, Journal of Clinical Gynecology and Obstetrics Scopus indexing, Journal of Clinical Gynecology and Obstetrics Medline indexing, Journal of Clinical Gynecology and Obstetrics ESCI indexing, Journal of Clinical Gynecology and Obstetrics SCI indexing, Journal of Clinical Gynecology and Obstetrics impact factor, Journal of Clinical Gynecology and Obstetrics 2023 impact factor, Journal of Clinical Gynecology and Obstetrics 2024 impact factor, Journal of Clinical Gynecology and Obstetrics 2025 impact factor, Journal of Clinical Gynecology and Obstetrics index copernicus value, Journal of Clinical Gynecology and Obstetrics free journals, Journal of Clinical Gynecology and Obstetrics top journals,

V.F.Snegirev Archives of Obstetrics and Gynecology PubMed Indexed Journals | V.F.Snegirev Archives of Obstetrics and Gynecology Scopus Indexed Journals | V.F.Snegirev Archives of Obstetrics and Gynecology Medline Indexed Journals | V.F.Snegirev Archives of Obstetrics and Gynecology ESCI Indexing | V.F.Snegirev Archives of Obstetrics and Gynecology PubMed Central Indexed Journals | V.F.Snegirev Archives of Obstetrics and Gynecology Impact factor 2023 2024 2025

V.F.Snegirev Archives of Obstetrics and Gynecology open access journals, V.F.Snegirev Archives of Obstetrics and Gynecology peer reviewed open access journals, V.F.Snegirev Archives of Obstetrics and Gynecology PubMed indexing, V.F.Snegirev Archives of Obstetrics and Gynecology Scopus indexing, V.F.Snegirev Archives of Obstetrics and Gynecology Medline indexing, V.F.Snegirev Archives of Obstetrics and Gynecology ESCI indexing, V.F.Snegirev Archives of Obstetrics and Gynecology SCI indexing, V.F.Snegirev Archives of Obstetrics and Gynecology impact factor, V.F.Snegirev Archives of Obstetrics and Gynecology 2023 impact factor, V.F.Snegirev Archives of Obstetrics and Gynecology 2024 impact factor, V.F.Snegirev Archives of Obstetrics and Gynecology 2025 impact factor, V.F.Snegirev Archives of Obstetrics and Gynecology index copernicus value, V.F.Snegirev Archives of Obstetrics and Gynecology free journals, V.F.Snegirev Archives of Obstetrics and Gynecology top journals,

Indonesian Journal of Obstetrics & Gynecology Science PubMed Indexed Journals | Indonesian Journal of Obstetrics & Gynecology Science Scopus Indexed Journals | Indonesian Journal of Obstetrics & Gynecology Science Medline Indexed Journals | Indonesian Journal of Obstetrics & Gynecology Science ESCI Indexing | Indonesian Journal of Obstetrics & Gynecology Science PubMed Central Indexed Journals | Indonesian Journal of Obstetrics & Gynecology Science Impact factor 2023 2024 2025

Indonesian Journal of Obstetrics & Gynecology Science open access journals, Indonesian Journal of Obstetrics & Gynecology Science peer reviewed open access journals, Indonesian Journal of Obstetrics & Gynecology Science PubMed indexing, Indonesian Journal of Obstetrics & Gynecology Science Scopus indexing, Indonesian Journal of Obstetrics & Gynecology Science Medline indexing, Indonesian Journal of Obstetrics & Gynecology Science ESCI indexing, Indonesian Journal of Obstetrics & Gynecology Science SCI indexing, Indonesian Journal of Obstetrics & Gynecology Science impact factor, Indonesian Journal of Obstetrics & Gynecology Science 2023 impact factor, Indonesian Journal of Obstetrics & Gynecology Science 2024 impact factor, Indonesian Journal of Obstetrics & Gynecology Science 2025 impact factor, Indonesian Journal of Obstetrics & Gynecology Science index copernicus value, Indonesian Journal of Obstetrics & Gynecology Science free journals, Indonesian Journal of Obstetrics & Gynecology Science top journals,

Clinical Journal of Obstetrics and Gynecology PubMed Indexed Journals | Clinical Journal of Obstetrics and Gynecology Scopus Indexed Journals | Clinical Journal of Obstetrics and Gynecology Medline Indexed Journals | Clinical Journal of Obstetrics and Gynecology ESCI Indexing | Clinical Journal of Obstetrics and Gynecology PubMed Central Indexed Journals | Clinical Journal of Obstetrics and Gynecology Impact factor 2023 2024 2025

Clinical Journal of Obstetrics and Gynecology open access journals, Clinical Journal of Obstetrics and Gynecology peer reviewed open access journals, Clinical Journal of Obstetrics and Gynecology PubMed indexing, Clinical Journal of Obstetrics and Gynecology Scopus indexing, Clinical Journal of Obstetrics and Gynecology Medline indexing, Clinical Journal of Obstetrics and Gynecology ESCI indexing, Clinical Journal of Obstetrics and Gynecology SCI indexing, Clinical Journal of Obstetrics and Gynecology impact factor, Clinical Journal of Obstetrics and Gynecology 2023 impact factor, Clinical Journal of Obstetrics and Gynecology 2024 impact factor, Clinical Journal of Obstetrics and Gynecology 2025 impact factor, Clinical Journal of Obstetrics and Gynecology index copernicus value, Clinical Journal of Obstetrics and Gynecology free journals, Clinical Journal of Obstetrics and Gynecology top journals,

Obstetrics Gynecology and Reproductive Sciences PubMed Indexed Journals | Obstetrics Gynecology and Reproductive Sciences Scopus Indexed Journals | Obstetrics Gynecology and Reproductive Sciences Medline Indexed Journals | Obstetrics Gynecology and Reproductive Sciences ESCI Indexing | Obstetrics Gynecology and Reproductive Sciences PubMed Central Indexed Journals | Obstetrics Gynecology and Reproductive Sciences Impact factor 2023 2024 2025

Obstetrics Gynecology and Reproductive Sciences open access journals, Obstetrics Gynecology and Reproductive Sciences peer reviewed open access journals, Obstetrics Gynecology and Reproductive Sciences PubMed indexing, Obstetrics Gynecology and Reproductive Sciences Scopus indexing, Obstetrics Gynecology and Reproductive Sciences Medline indexing, Obstetrics Gynecology and Reproductive Sciences ESCI indexing, Obstetrics Gynecology and Reproductive Sciences SCI indexing, Obstetrics Gynecology and Reproductive Sciences impact factor, Obstetrics Gynecology and Reproductive Sciences 2023 impact factor, Obstetrics Gynecology and Reproductive Sciences 2024 impact factor, Obstetrics Gynecology and Reproductive Sciences 2025 impact factor, Obstetrics Gynecology and Reproductive Sciences index copernicus value, Obstetrics Gynecology and Reproductive Sciences free journals, Obstetrics Gynecology and Reproductive Sciences top journals,

World Journal of Obstetrics and Gynecology PubMed Indexed Journals | World Journal of Obstetrics and Gynecology Scopus Indexed Journals | World Journal of Obstetrics and Gynecology Medline Indexed Journals | World Journal of Obstetrics and Gynecology ESCI Indexing | World Journal of Obstetrics and Gynecology PubMed Central Indexed Journals | World Journal of Obstetrics and Gynecology Impact factor 2023 2024 2025

World Journal of Obstetrics and Gynecology open access journals, World Journal of Obstetrics and Gynecology peer reviewed open access journals, World Journal of Obstetrics and Gynecology PubMed indexing, World Journal of Obstetrics and Gynecology Scopus indexing, World Journal of Obstetrics and Gynecology Medline indexing, World Journal of Obstetrics and Gynecology ESCI indexing, World Journal of Obstetrics and Gynecology SCI indexing, World Journal of Obstetrics and Gynecology impact factor, World Journal of Obstetrics and Gynecology 2023 impact factor, World Journal of Obstetrics and Gynecology 2024 impact factor, World Journal of Obstetrics and Gynecology 2025 impact factor, World Journal of Obstetrics and Gynecology index copernicus value, World Journal of Obstetrics and Gynecology free journals, World Journal of Obstetrics and Gynecology top journals,

Advanced Research in Obstetrics and Gynecology PubMed Indexed Journals | Advanced Research in Obstetrics and Gynecology Scopus Indexed Journals | Advanced Research in Obstetrics and Gynecology Medline Indexed Journals | Advanced Research in Obstetrics and Gynecology ESCI Indexing | Advanced Research in Obstetrics and Gynecology PubMed Central Indexed Journals | Advanced Research in Obstetrics and Gynecology Impact factor 2023 2024 2025

Advanced Research in Obstetrics and Gynecology open access journals, Advanced Research in Obstetrics and Gynecology peer reviewed open access journals, Advanced Research in Obstetrics and Gynecology PubMed indexing, Advanced Research in Obstetrics and Gynecology Scopus indexing, Advanced Research in Obstetrics and Gynecology Medline indexing, Advanced Research in Obstetrics and Gynecology ESCI indexing, Advanced Research in Obstetrics and Gynecology SCI indexing, Advanced Research in Obstetrics and Gynecology impact factor, Advanced Research in Obstetrics and Gynecology 2023 impact factor, Advanced Research in Obstetrics and Gynecology 2024 impact factor, Advanced Research in Obstetrics and Gynecology 2025 impact factor, Advanced Research in Obstetrics and Gynecology index copernicus value, Advanced Research in Obstetrics and Gynecology free journals, Advanced Research in Obstetrics and Gynecology top journals,

Clinical Research: Gynecology and Obstetrics PubMed Indexed Journals | Clinical Research: Gynecology and Obstetrics Scopus Indexed Journals | Clinical Research: Gynecology and Obstetrics Medline Indexed Journals | Clinical Research: Gynecology and Obstetrics ESCI Indexing | Clinical Research: Gynecology and Obstetrics PubMed Central Indexed Journals | Clinical Research: Gynecology and Obstetrics Impact factor 2023 2024 2025

Clinical Research: Gynecology and Obstetrics open access journals, Clinical Research: Gynecology and Obstetrics peer reviewed open access journals, Clinical Research: Gynecology and Obstetrics PubMed indexing, Clinical Research: Gynecology and Obstetrics Scopus indexing, Clinical Research: Gynecology and Obstetrics Medline indexing, Clinical Research: Gynecology and Obstetrics ESCI indexing, Clinical Research: Gynecology and Obstetrics SCI indexing, Clinical Research: Gynecology and Obstetrics impact factor, Clinical Research: Gynecology and Obstetrics 2023 impact factor, Clinical Research: Gynecology and Obstetrics 2024 impact factor, Clinical Research: Gynecology and Obstetrics 2025 impact factor, Clinical Research: Gynecology and Obstetrics index copernicus value, Clinical Research: Gynecology and Obstetrics free journals, Clinical Research: Gynecology and Obstetrics top journals,

Journal of Clinical Obstetrics, Gynecology & Infertility PubMed Indexed Journals | Journal of Clinical Obstetrics, Gynecology & Infertility Scopus Indexed Journals | Journal of Clinical Obstetrics, Gynecology & Infertility Medline Indexed Journals | Journal of Clinical Obstetrics, Gynecology & Infertility ESCI Indexing | Journal of Clinical Obstetrics, Gynecology & Infertility PubMed Central Indexed Journals | Journal of Clinical Obstetrics, Gynecology & Infertility Impact factor 2023 2024 2025

Journal of Clinical Obstetrics, Gynecology & Infertility open access journals, Journal of Clinical Obstetrics, Gynecology & Infertility peer reviewed open access journals, Journal of Clinical Obstetrics, Gynecology & Infertility PubMed indexing, Journal of Clinical Obstetrics, Gynecology & Infertility Scopus indexing, Journal of Clinical Obstetrics, Gynecology & Infertility Medline indexing, Journal of Clinical Obstetrics, Gynecology & Infertility ESCI indexing, Journal of Clinical Obstetrics, Gynecology & Infertility SCI indexing, Journal of Clinical Obstetrics, Gynecology & Infertility impact factor, Journal of Clinical Obstetrics, Gynecology & Infertility 2023 impact factor, Journal of Clinical Obstetrics, Gynecology & Infertility 2024 impact factor, Journal of Clinical Obstetrics, Gynecology & Infertility 2025 impact factor, Journal of Clinical Obstetrics, Gynecology & Infertility index copernicus value, Journal of Clinical Obstetrics, Gynecology & Infertility free journals, Journal of Clinical Obstetrics, Gynecology & Infertility top journals,

Obstetrics and Gynecology Clinics of North America PubMed Indexed Journals | Obstetrics and Gynecology Clinics of North America Scopus Indexed Journals | Obstetrics and Gynecology Clinics of North America Medline Indexed Journals | Obstetrics and Gynecology Clinics of North America ESCI Indexing | Obstetrics and Gynecology Clinics of North America PubMed Central Indexed Journals | Obstetrics and Gynecology Clinics of North America Impact factor 2023 2024 2025

Obstetrics and Gynecology Clinics of North America open access journals, Obstetrics and Gynecology Clinics of North America peer reviewed open access journals, Obstetrics and Gynecology Clinics of North America PubMed indexing, Obstetrics and Gynecology Clinics of North America Scopus indexing, Obstetrics and Gynecology Clinics of North America Medline indexing, Obstetrics and Gynecology Clinics of North America ESCI indexing, Obstetrics and Gynecology Clinics of North America SCI indexing, Obstetrics and Gynecology Clinics of North America impact factor, Obstetrics and Gynecology Clinics of North America 2023 impact factor, Obstetrics and Gynecology Clinics of North America 2024 impact factor, Obstetrics and Gynecology Clinics of North America 2025 impact factor, Obstetrics and Gynecology Clinics of North America index copernicus value, Obstetrics and Gynecology Clinics of North America free journals, Obstetrics and Gynecology Clinics of North America top journals,

The Journal of Obstetrics and Gynecology of India PubMed Indexed Journals | The Journal of Obstetrics and Gynecology of India Scopus Indexed Journals | The Journal of Obstetrics and Gynecology of India Medline Indexed Journals | The Journal of Obstetrics and Gynecology of India ESCI Indexing | The Journal of Obstetrics and Gynecology of India PubMed Central Indexed Journals | The Journal of Obstetrics and Gynecology of India Impact factor 2023 2024 2025

The Journal of Obstetrics and Gynecology of India open access journals, The Journal of Obstetrics and Gynecology of India peer reviewed open access journals, The Journal of Obstetrics and Gynecology of India PubMed indexing, The Journal of Obstetrics and Gynecology of India Scopus indexing, The Journal of Obstetrics and Gynecology of India Medline indexing, The Journal of Obstetrics and Gynecology of India ESCI indexing, The Journal of Obstetrics and Gynecology of India SCI indexing, The Journal of Obstetrics and Gynecology of India impact factor, The Journal of Obstetrics and Gynecology of India 2023 impact factor, The Journal of Obstetrics and Gynecology of India 2024 impact factor, The Journal of Obstetrics and Gynecology of India 2025 impact factor, The Journal of Obstetrics and Gynecology of India index copernicus value, The Journal of Obstetrics and Gynecology of India free journals, The Journal of Obstetrics and Gynecology of India top journals,

Yearbook of Obstetrics, Gynecology and Women's Health PubMed Indexed Journals | Yearbook of Obstetrics, Gynecology and Women's Health Scopus Indexed Journals | Yearbook of Obstetrics, Gynecology and Women's Health Medline Indexed Journals | Yearbook of Obstetrics, Gynecology and Women's Health ESCI Indexing | Yearbook of Obstetrics, Gynecology and Women's Health PubMed Central Indexed Journals | Yearbook of Obstetrics, Gynecology and Women's Health Impact factor 2023 2024 2025

Yearbook of Obstetrics, Gynecology and Women's Health open access journals, Yearbook of Obstetrics, Gynecology and Women's Health peer reviewed open access journals, Yearbook of Obstetrics, Gynecology and Women's Health PubMed indexing, Yearbook of Obstetrics, Gynecology and Women's Health Scopus indexing, Yearbook of Obstetrics, Gynecology and Women's Health Medline indexing, Yearbook of Obstetrics, Gynecology and Women's Health ESCI indexing, Yearbook of Obstetrics, Gynecology and Women's Health SCI indexing, Yearbook of Obstetrics, Gynecology and Women's Health impact factor, Yearbook of Obstetrics, Gynecology and Women's Health 2023 impact factor, Yearbook of Obstetrics, Gynecology and Women's Health 2024 impact factor, Yearbook of Obstetrics, Gynecology and Women's Health 2025 impact factor, Yearbook of Obstetrics, Gynecology and Women's Health index copernicus value, Yearbook of Obstetrics, Gynecology and Women's Health free journals, Yearbook of Obstetrics, Gynecology and Women's Health top journals,

Journal of Gynecology Obstetrics and Human Reproduction PubMed Indexed Journals | Journal of Gynecology Obstetrics and Human Reproduction Scopus Indexed Journals | Journal of Gynecology Obstetrics and Human Reproduction Medline Indexed Journals | Journal of Gynecology Obstetrics and Human Reproduction ESCI Indexing | Journal of Gynecology Obstetrics and Human Reproduction PubMed Central Indexed Journals | Journal of Gynecology Obstetrics and Human Reproduction Impact factor 2023 2024 2025

Journal of Gynecology Obstetrics and Human Reproduction open access journals, Journal of Gynecology Obstetrics and Human Reproduction peer reviewed open access journals, Journal of Gynecology Obstetrics and Human Reproduction PubMed indexing, Journal of Gynecology Obstetrics and Human Reproduction Scopus indexing, Journal of Gynecology Obstetrics and Human Reproduction Medline indexing, Journal of Gynecology Obstetrics and Human Reproduction ESCI indexing, Journal of Gynecology Obstetrics and Human Reproduction SCI indexing, Journal of Gynecology Obstetrics and Human Reproduction impact factor, Journal of Gynecology Obstetrics and Human Reproduction 2023 impact factor, Journal of Gynecology Obstetrics and Human Reproduction 2024 impact factor, Journal of Gynecology Obstetrics and Human Reproduction 2025 impact factor, Journal of Gynecology Obstetrics and Human Reproduction index copernicus value, Journal of Gynecology Obstetrics and Human Reproduction free journals, Journal of Gynecology Obstetrics and Human Reproduction top journals,

Indian Journal of Obstetrics and Gynecology Research PubMed Indexed Journals | Indian Journal of Obstetrics and Gynecology Research Scopus Indexed Journals | Indian Journal of Obstetrics and Gynecology Research Medline Indexed Journals | Indian Journal of Obstetrics and Gynecology Research ESCI Indexing | Indian Journal of Obstetrics and Gynecology Research PubMed Central Indexed Journals | Indian Journal of Obstetrics and Gynecology Research Impact factor 2023 2024 2025

Indian Journal of Obstetrics and Gynecology Research open access journals, Indian Journal of Obstetrics and Gynecology Research peer reviewed open access journals, Indian Journal of Obstetrics and Gynecology Research PubMed indexing, Indian Journal of Obstetrics and Gynecology Research Scopus indexing, Indian Journal of Obstetrics and Gynecology Research Medline indexing, Indian Journal of Obstetrics and Gynecology Research ESCI indexing, Indian Journal of Obstetrics and Gynecology Research SCI indexing, Indian Journal of Obstetrics and Gynecology Research impact factor, Indian Journal of Obstetrics and Gynecology Research 2023 impact factor, Indian Journal of Obstetrics and Gynecology Research 2024 impact factor, Indian Journal of Obstetrics and Gynecology Research 2025 impact factor, Indian Journal of Obstetrics and Gynecology Research index copernicus value, Indian Journal of Obstetrics and Gynecology Research free journals, Indian Journal of Obstetrics and Gynecology Research top journals,

Journal of Turkish Society of Obstetric and Gynecology PubMed Indexed Journals | Journal of Turkish Society of Obstetric and Gynecology Scopus Indexed Journals | Journal of Turkish Society of Obstetric and Gynecology Medline Indexed Journals | Journal of Turkish Society of Obstetric and Gynecology ESCI Indexing | Journal of Turkish Society of Obstetric and Gynecology PubMed Central Indexed Journals | Journal of Turkish Society of Obstetric and Gynecology Impact factor 2023 2024 2025

Journal of Turkish Society of Obstetric and Gynecology open access journals, Journal of Turkish Society of Obstetric and Gynecology peer reviewed open access journals, Journal of Turkish Society of Obstetric and Gynecology PubMed indexing, Journal of Turkish Society of Obstetric and Gynecology Scopus indexing, Journal of Turkish Society of Obstetric and Gynecology Medline indexing, Journal of Turkish Society of Obstetric and Gynecology ESCI indexing, Journal of Turkish Society of Obstetric and Gynecology SCI indexing, Journal of Turkish Society of Obstetric and Gynecology impact factor, Journal of Turkish Society of Obstetric and Gynecology 2023 impact factor, Journal of Turkish Society of Obstetric and Gynecology 2024 impact factor, Journal of Turkish Society of Obstetric and Gynecology 2025 impact factor, Journal of Turkish Society of Obstetric and Gynecology index copernicus value, Journal of Turkish Society of Obstetric and Gynecology free journals, Journal of Turkish Society of Obstetric and Gynecology top journals,

The Internet Journal of Gynecology and Obstetrics PubMed Indexed Journals | The Internet Journal of Gynecology and Obstetrics Scopus Indexed Journals | The Internet Journal of Gynecology and Obstetrics Medline Indexed Journals | The Internet Journal of Gynecology and Obstetrics ESCI Indexing | The Internet Journal of Gynecology and Obstetrics PubMed Central Indexed Journals | The Internet Journal of Gynecology and Obstetrics Impact factor 2023 2024 2025

The Internet Journal of Gynecology and Obstetrics open access journals, The Internet Journal of Gynecology and Obstetrics peer reviewed open access journals, The Internet Journal of Gynecology and Obstetrics PubMed indexing, The Internet Journal of Gynecology and Obstetrics Scopus indexing, The Internet Journal of Gynecology and Obstetrics Medline indexing, The Internet Journal of Gynecology and Obstetrics ESCI indexing, The Internet Journal of Gynecology and Obstetrics SCI indexing, The Internet Journal of Gynecology and Obstetrics impact factor, The Internet Journal of Gynecology and Obstetrics 2023 impact factor, The Internet Journal of Gynecology and Obstetrics 2024 impact factor, The Internet Journal of Gynecology and Obstetrics 2025 impact factor, The Internet Journal of Gynecology and Obstetrics index copernicus value, The Internet Journal of Gynecology and Obstetrics free journals, The Internet Journal of Gynecology and Obstetrics top journals,

GYNECOLOGY PubMed Indexed Journals | GYNECOLOGY Scopus Indexed Journals | GYNECOLOGY Medline Indexed Journals | GYNECOLOGY ESCI Indexing | GYNECOLOGY PubMed Central Indexed Journals | GYNECOLOGY Impact factor 2023 2024 2025

GYNECOLOGY open access journals, GYNECOLOGY peer reviewed open access journals, GYNECOLOGY PubMed indexing, GYNECOLOGY Scopus indexing, GYNECOLOGY Medline indexing, GYNECOLOGY ESCI indexing, GYNECOLOGY SCI indexing, GYNECOLOGY impact factor, GYNECOLOGY 2023 impact factor, GYNECOLOGY 2024 impact factor, GYNECOLOGY 2025 impact factor, GYNECOLOGY index copernicus value, GYNECOLOGY free journals, GYNECOLOGY top journals,

Journal of Obstetrics, Gynecology and Cancer Research PubMed Indexed Journals | Journal of Obstetrics, Gynecology and Cancer Research Scopus Indexed Journals | Journal of Obstetrics, Gynecology and Cancer Research Medline Indexed Journals | Journal of Obstetrics, Gynecology and Cancer Research ESCI Indexing | Journal of Obstetrics, Gynecology and Cancer Research PubMed Central Indexed Journals | Journal of Obstetrics, Gynecology and Cancer Research Impact factor 2023 2024 2025

Journal of Obstetrics, Gynecology and Cancer Research open access journals, Journal of Obstetrics, Gynecology and Cancer Research peer reviewed open access journals, Journal of Obstetrics, Gynecology and Cancer Research PubMed indexing, Journal of Obstetrics, Gynecology and Cancer Research Scopus indexing, Journal of Obstetrics, Gynecology and Cancer Research Medline indexing, Journal of Obstetrics, Gynecology and Cancer Research ESCI indexing, Journal of Obstetrics, Gynecology and Cancer Research SCI indexing, Journal of Obstetrics, Gynecology and Cancer Research impact factor, Journal of Obstetrics, Gynecology and Cancer Research 2023 impact factor, Journal of Obstetrics, Gynecology and Cancer Research 2024 impact factor, Journal of Obstetrics, Gynecology and Cancer Research 2025 impact factor, Journal of Obstetrics, Gynecology and Cancer Research index copernicus value, Journal of Obstetrics, Gynecology and Cancer Research free journals, Journal of Obstetrics, Gynecology and Cancer Research top journals,

Scholars International Journal of Obstetrics and Gynecology PubMed Indexed Journals | Scholars International Journal of Obstetrics and Gynecology Scopus Indexed Journals | Scholars International Journal of Obstetrics and Gynecology Medline Indexed Journals | Scholars International Journal of Obstetrics and Gynecology ESCI Indexing | Scholars International Journal of Obstetrics and Gynecology PubMed Central Indexed Journals | Scholars International Journal of Obstetrics and Gynecology Impact factor 2023 2024 2025

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Future risk of metabolic syndrome after recurrent pregnancy loss: a cohort study using UK Biobank

Affiliations.

• 1 Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.
• 2 Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea; Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea.
• 3 Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
• 4 Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea; Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea.
• 5 Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea; Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea.
• 6 Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea; Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea; Innovative Medical Technology Research Institute, Seoul National University Hospital, Seoul, Korea; Institute of Reproductive Medicine and Population, Medical Research Center, Seoul National University, Seoul, Korea. Electronic address: [email protected].
• PMID: 38008468
• DOI: 10.1016/j.fertnstert.2023.09.012

Objective: To evaluate the risk of metabolic syndrome (MS) after recurrent pregnancy loss (RPL) using UK Biobank data. A history of pregnancy loss is associated with the development of cardiovascular diseases in the future. However, the association between RPL and subsequent MS is poorly understood. Therefore, we aimed to check the risk of MS after RPL.

Design: The study population was divided into 2 groups according to reproductive history: women with a history of RPL and women without a history of RPL. Recurrent pregnancy loss was defined as 2 or more spontaneous miscarriages, and MS was defined as at least 3 of the following: abdominal obesity, hypertriglyceridemia, low high-density lipoprotein cholesterol levels, high-blood pressure, and hyperglycemia.

Setting: UK Biobank resource.

Patients: The UK Biobank is a prospective cohort study that enrolled individuals aged between 40 and 69 years whose medical and reproductive histories were retrieved at enrollment. In this cohort, only women with a history of at least one pregnancy were selected.

Interventions: Recurrent pregnancy loss.

Main outcome measures: The primary outcome was the prevalence of MS. The secondary outcomes were 5 diagnostic components of MS.

Results: We analyzed 228,674 women, including 15,702 with a history of RPL and 212,972 without a history of RPL. Women with a history of RPL have a higher prevalence of MS between the ages of 40 and 60 years (33.0% vs. 31.5%). After adjusting for covariates (age, race, number of live births, early menopause, smoking, alcohol consumption, and physical activity), the increased risk of MS after RPL remained significant (adjusted odds ratio, 1.10; 95% confidence interval, 1.06-1.15). Furthermore, in the analysis of the 5 diagnostic components of MS, a history of RPL significantly increased the risk of abdominal obesity, hypertriglyceridemia, low high-density lipoprotein cholesterol levels, and hyperglycemia.

Conclusion: Middle-aged women with a history of RPL have an increased risk of MS.

Keywords: Spontaneous abortion; UK biobank; metabolic syndrome; pregnancy loss.

Copyright © 2023. Published by Elsevier Inc.

Publication types

• Research Support, Non-U.S. Gov't
• Abortion, Habitual* / diagnosis
• Abortion, Habitual* / epidemiology
• Abortion, Habitual* / etiology
• Biological Specimen Banks
• Cohort Studies
• Hyperglycemia* / complications
• Hypertriglyceridemia* / complications
• Lipoproteins, HDL
• Metabolic Syndrome* / diagnosis
• Metabolic Syndrome* / epidemiology
• Middle Aged
• Obesity, Abdominal / complications
• Prospective Studies
• United Kingdom / epidemiology

Research Matters

Resources for SMHS Research

Obstetrics and Gynecology Funding: Addition to Primary List

NICHD Small Research Grant Program (R03 Basic Experimental Studies with Humans Required)

National Institutes of Health (NIH)

07 May 2024

NICHD Small Research Grant Program (R03 Clinical Trial Required)

16 Jun 2024

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