Category: Obstetrics & Gynaecology

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Hyperemesis Gravida Linked to Pregnancy, Birth Complications

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Pregnant women with a severe form of nausea face increased risks for several pregnancy and birth complications, according to a new Stanford Medicine study of 2.5 million California births.

The research, published in the American Journal of Epidemiology, is the first large, US population-based study of the dangers of severe pregnancy nausea and vomiting, a condition formally known as hyperemesis gravidarum, or HG.

While most pregnant women – 70% to 80% – experience some nausea, it usually leaves no lasting effects. In contrast, as the new research shows, HG puts a major strain on the 1% to 3% of the pregnancies affected.

“Hyperemesis gravidarum is not just bad morning sickness; it’s severe enough to cause dehydration and significant weight loss,” said lead study author Rebecca Gardner, a Stanford Medicine graduate student in epidemiology and clinical research.

The study’s senior authors are Julia Fridman Simard, ScD, associate professor of epidemiology and population health and of immunology and rheumatology, and Gary Shaw, DrPH, the Rosemarie Hess Professor and a professor of pediatrics.

The research team looked at complications in pregnancies in which the mother was hospitalised for HG, compared with pregnancies without such hospitalisations.

“We found hyperemesis gravidarum was linked to higher risk for preterm birth, anaemia, smaller-than-expected babies, preeclampsia, gestational hypertension and placental abruption,” Gardner said. “Hospitalization for HG really does flag a pregnancy as being at higher risk for a range of serious complications.”

Struggling to get nourishment

Pregnant women with HG experience severe, sustained nausea and vomiting, often continuing throughout their pregnancies. They struggle to eat; stay hydrated; and absorb enough nutrients that play key roles in early pregnancy, such as folate. (Adequate folate intake reduces the risk of certain birth defects.) Women with HG can lose a lot of weight at a time when they should be gaining; one study found that about a quarter of HG patients lost more than 15% of their pre-pregnancy weight.

“We know from other studies that women with HG don’t get as many nutrients,” Gardner said. “This could impair placental development, which we think leads to higher risk for some of the outcomes we looked for, such as preeclampsia and babies being smaller than expected at birth.”

But previous studies examining potential links between HG and poor pregnancy outcomes had weaknesses, Gardner said: Many were small, and nearly all used data from European countries with populations that are less diverse than the U.S. population and that have medical systems structured differently from the U.S. system.

The study examined records for single-baby California births from 2007 to 2011. The researchers had access to demographic information about mothers, pre-pregnancy body mass index and census tract data that was used to calculate each patient’s level of social vulnerability. The researchers also had access to diagnostic codes from patients’ pregnancy and birth medical records.

Of the 2 476 492 births included in the final analysis, 53,681, or 2.2%, were to mothers with HG, meaning they received emergency department or hospital inpatient care for hyperemesis gravidarum.  

Compared with those who were never hospitalised for HG, women with HG had higher risk for preeclampsia, a pregnancy complication that can cause seizures if untreated; gestational hypertension, or high blood pressure in pregnancy; preterm birth, meaning delivery three or more weeks before the due date; babies that were small for their gestational age, meaning they had grown less than expected during foetal development, anaemia, and placental abruption, in which the placenta becomes partly or completely detached from the uterus before delivery.

The increase in relative risk for each complication varied. For instance, after adjusting for possible confounding factors, women with HG were about 18% more likely to have preeclampsia, about 25% more likely to deliver early, about 37% more likely to be anaemic and about 14% more likely to experience a placental abruption than women without HG.

Women who were first hospitalised for HG during the second trimester of pregnancy were more likely to experience complications than those hospitalised during the first trimester, the study found.

A flag for closer monitoring

Guidelines from the American College of Obstetricians and Gynecologists for treating HG changed in 2018, after the data used for this study was collected, Gardner noted. The guidelines now encourage treating pregnancy nausea faster and more aggressively, and two medications are now approved by the US Food and Drug Administration for nausea and vomiting in pregnancy. More research could help clarify the effects of these newer guidelines, Gardner said.

More research could also show whether HG should prompt physicians to offer additional preventive care, such as low-dose aspirin, which is already used to prevent preeclampsia in patients who are at risk for other reasons.

The research team hopes that its findings will motivate physicians and pregnant women to pay closer attention to HG.

“For physicians, I think this data means that pregnancies with HG hospitalisation may warrant closer monitoring for certain complications,” Gardner said.

“Pregnant women need to know that most HG pregnancies still result in healthy outcomes for the mom and baby, but HG does need to be taken seriously,” she said. It’s important to advocate for yourself by asking your doctor if you need more monitoring or anti-nausea medication, Gardner said, adding, “This is not just something to push through.”

Source: Stanford Medicine

Categories : Obstetrics & Gynaecology Pain ManagementTags : Leave a comment

Supermarket Receipts Show Trends in Menstrual Pain Relief

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An analysis of 211 million supermarket transactions found that more than a quarter of customers buying menstrual products bought pain relief at the same time.

Photo by Sora Shimazaki on Pexels

More than a quarter of women buying menstrual products also purchase pain relief at the same time – and those in lower-income areas are significantly less likely to do so – according to a new study published this week in the open-access journal PLOS Digital Health by Dr. Victoria Sivill of the University of Bristol, UK, and colleagues, which used supermarket loyalty card data to map menstrual pain disparities across England.

Menstrual pain is a common concern affecting many individuals globally. Existing research highlights its negative impact on daily activities, including school and work attendance.

In the new study, researchers analysed anonymised loyalty card data from a major UK health and beauty retailer, encompassing 211 million transactions by 3.4 million individuals between 2006 and 2015. They analysed how often shoppers purchased menstrual products at the same time as pain relief, and how that compared to a customer’s baseline rate of buying pain relief.

The analysis found that 26.7% of customers who purchased menstrual products also bought pain relief in the same transaction. These customers were nearly four times more likely to buy pain relief while buying menstrual products compared to other shopping trips. As a validation of the approach, the most common interval between consecutive menstrual purchases across the dataset was exactly 28 days – consistent with the average menstrual cycle.

Regional income emerged as the strongest predictor of menstrual pain purchases: customers in the lowest-income areas were 32% less likely to purchase pain relief at the same time as menstrual products compared to those in the highest-income areas. The authors note that lower rates of pain relief purchases in deprived areas likely reflect an inability to afford over-the-counter medication rather than lower rates of menstrual pain itself

“The study highlights the need for greater awareness and policy interventions to address the high prevalence of menstrual pain as well as socioeconomic dimensions of menstrual pain,” the authors say. “Public health initiatives should incorporate menstrual pain relief as part of broader efforts to improve health equity.”

 Co-author Dr James Goulding notes: “It is wonderful that smart data research in the UK is able to bring issues which may have once been overlooked in scientific settings – such as the sheer scale and impact of menstrual pain – to light. This is well overdue.”

Co-author Dr Anya Skatova adds: “Like many women, I was aware of how common menstrual pain is, but the scale of painkiller purchases alongside menstrual products was still striking. Using shopping data, we can see just how widespread the need for pain relief really is. This kind of evidence helps make menstrual pain visible at a population level and provides a strong foundation for systemic change in how it is recognised, treated, and prioritised in public health.” 

Provided by PLOS

Press Preview: https://plos.io/42wSl1W

In your coverage please use this URL to provide access to the freely available article in PLOS Digital Health: https://plos.io/4wzrwbh

Contact: Anya Skatova, anya.skatova@bristol.ac.uk; James Goulding, james.goulding@nottingham.ac.uk 

Image Caption: Fig 1. Average (mean) individual summary statistics for Menstrual, Pain and Menstrual Pain customer sets via analysis of transactional logs between 30th April 2006 to 16th April 2015. 

Image Credit: Sivill et al, PLOS Digital Health, 2026

High-Resolution Image Link: https://plos.io/4ujYPxl

Citation: Sivill V, Ljevar V, Goulding J, Skatova A (2026) What can shopping transactional data reveal about relative prevalence of menstrual pain and period poverty in England? PLOS Digit Health 5(5): e0001308. https://doi.org/10.1371/journal.pdig.0001308 

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Why PCOS Is Now Called PMOS and What It Means for Women’s Health

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Polycystic ovaries. Credit: Scientific Animations Wiki CC4.0

For decades, women diagnosed with Polycystic Ovary Syndrome (PCOS) have often been told that the condition centres on cysts forming on the ovaries. In reality, many women who meet the diagnostic criteria never develop ovarian cysts at all, which means that the name has long created confusion for both patients and clinicians alike.

In May 2026, global health experts formally introduced Polyendocrine Metabolic Ovarian Syndrome (PMOS) as the updated terminology for this condition, which reflects the growing scientific consensus that it involves multiple hormonal and metabolic systems, not only the ovaries.

The change follows more than a decade of international consultation among endocrinologists, researchers and patient groups. The goal is to align the name of the condition with what research has increasingly shown about how it works in the body.

“Up to 70% of PCOS cases remain undiagnosed due to gaps in awareness, recognition and care, leaving many women navigating years of unexplained symptoms,” says Dr Themba Hadebe, Clinical Executive at Bonitas Medical Fund. “The new terminology recognises that this is a complex endocrine and metabolic disorder that affects several systems in the body.”

A name change to pay attention to

For years, the label Polycystic Ovary Syndrome suggested that ovarian cysts were the defining feature of the condition. Yet the small follicles seen on ultrasound scans are not true cysts, and they are not present in every patient.

Doctors diagnose the condition using a combination of symptom monitoring that may include irregular ovulation, elevated androgen levels and characteristic ovarian changes on ultrasound. This broader clinical picture often sits uneasily with the name itself.

“The terminology shaped how people understood the condition,” says Hadebe. “When patients heard ‘polycystic ovaries’, many assumed the problem was limited to reproductive health. In practice, the condition affects hormones, metabolism and long-term health risk.”

Women living with the syndrome frequently experience a wider set of health concerns. Hormonal imbalances can lead to acne, excess facial or body hair and irregular ovulation. The condition can also influence mood and mental wellbeing.

“Patients often arrive in consulting rooms with a range of symptoms that appear unrelated,” says Hadebe. “When you step back and view the condition as a broader endocrine disorder, those symptoms begin to make sense.”

One of the strongest drivers of the renaming is the role of metabolism in the condition. Research shows that many women living with the syndrome experience insulin resistance, where the body’s cells respond poorly to insulin and struggle to regulate blood sugar effectively. This metabolic disruption can contribute to weight gain and increase the risk of developing Type 2 Diabetes and cardiovascular disease later in life.

The importance of early diagnosis

Despite how common the condition is, many women spend years searching for answers before receiving a diagnosis, with updated NICE guidelines for PMOS aimed at standardising diagnostic pathways expected to be released towards the end of 2026. Symptoms such as irregular periods, persistent acne, excess hair growth or unexplained weight gain are often dismissed as routine hormonal fluctuations.

Delayed diagnosis can carry long-term consequences. Without proper management, metabolic complications may develop gradually over time. “Early detection allows clinicians to manage the condition more effectively and reduce future health risks,” says Hadebe. “Women who notice persistent hormonal or menstrual changes should seek medical advice so that underlying causes can be assessed.”

Addressing stigma and misunderstanding

The name change also addresses the emotional impact many women describe when navigating the condition. Patients frequently report that their symptoms were minimised or attributed to stress, weight or lifestyle factors before they received an explanation.

Language plays a powerful role in shaping how conditions are understood. A name that reflects the complexity of the syndrome helps validate the experiences of those living with it.

“Renaming the condition does not change the biology,” says Hadebe. “However, updating the name to better reflect current scientific understanding will improve awareness, support earlier diagnosis, enhance quality of care, drive greater consistency in research, and ultimately improve the overall patient experience.”

As awareness grows, experts hope the shift to Polyendocrine Metabolic Ovarian Syndrome, or PMOS, will encourage earlier recognition of symptoms and more holistic care for women affected by the condition.

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Postpartum Psychosis Found to Have a Substantial Genetic Component

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Study finds postpartum psychosis is strongly influenced by genetics and reveals links to cholesterol metabolism, immune biology, and psychiatric disorders

Photo by Alina Matveycheva

Researchers at the Icahn School of Medicine at Mount Sinai have uncovered a substantial genetic component to postpartum psychosis, a rare but severe psychiatric illness that occurs in the days to weeks after childbirth. The findings, published May 14 in Molecular Psychiatry, provide new evidence that the condition has a substantial biological and genetic basis and may help guide future research into prediction, prevention, and treatment. 

The study, which combined whole genome sequencing with population-level family data, identified rare damaging mutations in the gene HMGCR as associated with increased risk for postpartum psychosis. The researchers also found significant genetic overlap between postpartum psychosis and bipolar disorder, schizophrenia, and several autoimmune diseases, including rheumatoid arthritis, Sjögren’s syndrome, myasthenia gravis, and Crohn’s disease. 

Postpartum psychosis affects approximately 1 in 1000 mothers and is considered a psychiatric emergency because of the elevated risk of suicide and infanticide. Symptoms can include delusions, hallucinations, severe mood changes, confusion, and disorganised behaviour. 

“Our findings show that postpartum psychosis is a biological illness with a substantial genetic basis,” said Behrang Mahjani, PhD, Assistant Professor in the Departments of Psychiatry, Genetics and Genomic Sciences and Artificial Intelligence and Human Health at the Icahn School of Medicine and senior author of the paper. “It is not a parenting failure or a personal weakness, and women affected by it deserve the same medical seriousness afforded to other severe illnesses.”  

This condition has historically been understudied, particularly at the genetic level, and we hope these results help move the field toward a more mechanistic understanding of why some women become vulnerable during the postpartum period.” 

The study estimated that approximately 55 percent of risk for postpartum psychosis is attributable to inherited genetic factors based on family data, while whole genome sequencing analyses estimated heritability from common genetic variants at approximately 46 percent. 

Researchers were particularly surprised by the identification of HMGCR, which encodes the rate-limiting enzyme in cholesterol biosynthesis. The study also revealed broader-than-expected overlap between postpartum psychosis and immune-related conditions. Researchers say the findings are consistent with longstanding clinical observations that autoimmune disease activity often changes during the postpartum period and suggest that immune biology may play a role in the illness. 

“Cholesterol biosynthesis was not a pathway we had anticipated, but once HMGCR emerged, the biology became highly coherent in light of the changing dynamics of cholesterol during and after pregnancy, because cholesterol serves as the precursor for steroid hormone synthesis and prior reports linking low serum cholesterol to first episode psychosis and suicidal behaviour,” said Dr Mahjani. “The postpartum period is marked by dramatic hormonal and metabolic shifts, and this gene sits directly within pathways affected during that transition.” 

The research, with analyses performed by Seulgi Jung, PhD, a postdoctoral fellow in the Mahjani Lab at Mount Sinai, is the first study to apply whole genome sequencing to postpartum psychosis, allowing investigators to examine rare damaging mutations across the genome rather than focusing solely on common genetic risk variants. The team combined data from Swedish national health registers with genomic information from the National Institutes of Health’s All of Us Research Program, enabling researchers to study one of psychiatry’s rarest and least understood conditions at an unprecedented scale. 

“It is important to understand that multiple genes are involved in postpartum psychosis and that HMGCR can be used as a research tool for further scientific discovery,” said Veerle Bergink, MD, PhD, Director of the Women’s Mental Health Research Center at Mount Sinai and an author of the paper.  

Future work will focus on expanding sample sizes and improving ancestral diversity. The team is now pursuing functional studies of HMGCR and other candidate genes in neuronal and immune cell models relevant to pregnancy and the postpartum period. Researchers also plan to integrate genetic findings with hormonal and immunological changes associated with childbirth to better understand why the illness emerges during such a tightly defined window. 

“In the long term, our goal is to understand postpartum psychosis well enough to predict it, prevent it where possible, and develop treatments that target the underlying biology rather than symptoms alone,” said Dr Bergink. 

The investigators also emphasized the importance of large-scale collaborative research infrastructure in enabling discoveries for rare conditions. 

“This work would not have been possible without the NIH’s All of Us Research Program and the participants who contributed their data,” said Dr. Mahjani.  “For rare and historically neglected illnesses such as postpartum psychosis, equitable access to large genomic datasets is essential for scientific progress.” 

Source: Mount Sinai

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Immune System Overreaction Linked to Deadly Flu in Pregnancy

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Researchers have discovered why influenza can lead to life-threatening complications during pregnancy.

Source: Pixabay CC0

In most people, influenza stays in the upper respiratory tract – mainly the nose – and clears without spreading further. But during pregnancy, the virus can extend beyond the lungs into the cardiovascular system, increasing the risk of severe complications for mothers and babies.

Now a new preclinical study using animal models reveals precisely why the virus can spill into the bloodstream during pregnancy, opening the door for targeted treatment. The study is a bilateral partnership between Trinity College Dublin, with collaborators from RMIT University and the University of Adelaide and is published in Science Advances.

Researchers identified a viral sensor in the immune system, known as TLR7, that can become overactive during pregnancy, amplifying inflammation and spreading disease into the bloodstream.

Blocking TLR7 could help prevent the harmful inflammation that makes flu in pregnancy so dangerous. This work can help protect developing babies by stopping the placenta from becoming overly inflamed during flu infection.

Professor John O’Leary, School of Medicine, Trinity, said: “This international research is of high impact in relation to our understanding of viruses and pregnancy and the role of the maternal immune response.”

What is the potential impact of this research? 

Earlier studies from RMIT have shown that severe flu in pregnancy can have long‑term impacts on babies’ brain development, by inflaming blood vessels and reducing the flow of oxygen and nutrients from mother to baby.

This new study pinpoints the underlying cause of that damage, reshaping our understanding of flu‑related risk in pregnancy and opening the door to more targeted therapies.

RMIT co-lead author, Prof. Stavros Selemidis, said future treatments could focus on the immune system rather than the virus itself.

“Our study shows that in pregnancy, the problem isn’t just the flu virus – it’s the immune system overreacting. That’s where future treatments could really make a difference,” he explained.

“We’re ready to work with partners to help develop the next generation of therapies and clinical guidelines.”

Next steps for this work: The team is planning further research on how to target TLR7 to reduce the risk of severe influenza and pregnancy complications.

You can read the paper: ‘TLR7 alters the maternal immune landscape during influenza A infection to increase maternal and fetal morbidity’, on the Science Advances website.

Source: Trinity College Dublin

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Sedatives in Pregnancy Not Linked to Psychiatric Disorders in Children

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Findings offer reassurance to clinicians and pregnant women, say researchers 

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A large South Korean study published by The BMJ finds no increased risk of psychiatric or neurodevelopmental disorders, such as ADHD and autism, in children whose mothers used sedative drugs (benzodiazepines or Z-hypnotics) during pregnancy.

Benzodiazepines and Z-hypnotics are used to alleviate anxiety and insomnia, which are among the most common conditions during pregnancy.

Previous studies have examined the short term safety of benzodiazepine and Z-hypnotic use in pregnancy, but evidence on their psychiatric and neurodevelopment effects in children remains scarce.

To fill this evidence gap, researchers used South Korea’s National Health Information Database to track nearly 3.8 million children born between 2010 and 2022.

Pregnancies exposed to benzodiazepines or Z-hypnotics were compared with unexposed pregnancies and with women who had used these drugs before but not during pregnancy (past users).

Twelve specific neurodevelopmental and general psychiatric disorders were assessed, including substance use disorder, schizophrenia, personality disorder, intellectual disability, autism, ADHD, and behavioural disorder.

Factors, such as mother’s age, income, underlying conditions and other medication use were also taken into account.

Among the 3 809 949 children, 94,482 (2.5%) were exposed to benzodiazepines or Z-hypnotics during pregnancy, 3 715 467 were unexposed, and 147 307 were born to past users.

During the tracking period of up to 14 years, a total of 10 060, 311 997, and 15 645 events occurred in the exposed, unexposed, and past user groups, respectively.

Overall, rates of psychiatric disorders were slightly higher (19.2%) in exposed children compared with 13.8% in unexposed children and 16.5% in the past user group.

However, these associations were no longer significant when the researchers used sibling analysis to disentangle drug effects from shared family, genetic, and environmental factors, and no increased risk was found for individual psychiatric disorders.

Further analyses were generally consistent with the main findings, although some estimates, such as exposure in early and late pregnancy, and longer durations of Z-hypnotic use specifically, remained modestly elevated in certain groups.

This is an observational study, so can’t establish cause and effect, and the researchers acknowledge that a prescription may not always reflect actual ingestion and their follow-up period may be insufficient to capture late onset conditions such as schizophrenia or personality disorders. What’s more, this study was not designed to assess the overall safety of these drugs but specific psychiatric outcomes in children.

However, use of a large, nationally representative database and rigorous methods to overcome confounding suggest the results withstand scrutiny.

As such, they say this study suggests “no substantial evidence that prenatal exposure to benzodiazepines or Z-hypnotics increases the risk of psychiatric disorders in children.”

Although these findings provide reassurance about neuropsychiatric safety, further research is needed to clarify the modest elevations seen in some analyses and help inform discussions when considering sedative therapy in pregnancy, they add.

In a linked editorial, researchers agree that this evidence is reassuring, but this does not mean that sedatives should be prescribed without caution.

Clinicians should be mindful of signals around prolonged use and late pregnancy exposure, while also balancing the risks of untreated maternal psychiatric illness, they write.

However, they conclude that this study “offers a compelling example of how observational research can generate reliable estimates of prenatal drug safety.

Source: The BMJ Group

Categories : Obstetrics & Gynaecology Surgeries & ProceduresTags :

Tranexamic Acid Prevents Severe Bleeding in Caesarean Births

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New trial adds high quality evidence on benefits of tranexamic acid for high-risk women

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Giving tranexamic acid to women with placenta praevia (when the placenta covers the cervical opening) undergoing caesarean birth leads to a significant yet modest reduction in severe bleeding after delivery with no evidence of an increase in serious adverse events, finds a trial from China published by The BMJ today.

Tranexamic acid is widely used to prevent or reduce heavy bleeding usually after surgery or trauma. It works by inhibiting blood clot breakdown and is recommended for the treatment of severe bleeding after childbirth (postpartum haemorrhage).

But high quality evidence on its prophylactic use to prevent postpartum haemorrhage in high risk women remains scarce.

To address this gap, researchers in China set out to examine the effect of tranexamic acid in women with placenta praevia, a group at high risk of severe bleeding.

The trial included 1694 pregnant women with placenta praevia who were scheduled for caesarean delivery at 24 maternity units across China between July 2023 and March 2025.

Participants received prophylactic oxytocin – standard treatment to reduce blood loss after delivery – and were randomly assigned to receive either intravenous tranexamic acid (845 women) or placebo (849 women) over 10 minutes, starting within five minutes of umbilical cord clamping.

The main outcome measure was postpartum haemorrhage, defined as blood loss of at least 1000 mL or red blood cell transfusion within two days after delivery. Serious adverse events including blood clots, seizures, acute kidney or liver injury, and maternal death, were also recorded.

The results show that prophylactic tranexamic acid reduced the rate of postpartum haemorrhage by 15%, from 35.1% to 29.7% compared with placebo. This means that for every 19 women receiving prophylactic tranexamic acid, one case of postpartum haemorrhage would be prevented.

Rates of serious adverse effects were similar between the two groups.

The researchers acknowledge various limitations including that the findings are specific to women with placenta praevia receiving prophylactic oxytocin and therefore may not apply to other obstetric populations. However, this was a well-designed trial and results were consistent after further analyses, suggesting that the findings are robust.

As such, they conclude: “In a high risk population – specifically, women with placenta praevia undergoing caesarean delivery – prophylactic tranexamic acid leads to a statistically significant but modest reduction in the incidence of postpartum haemorrhage.”

“Future studies in diverse international settings are warranted to validate these results and to identify specific patient subgroups most likely to benefit from prophylactic use of tranexamic acid,” they add.

In a linked editorial, UK researchers point out that this modest reduction in bleeding understates the impact, particularly in women at high risk of harm from bleeding, for whom even modest relative risk reductions translate into worthwhile benefits.

The focus should now shift from whether tranexamic acid reduces bleeding to how it is used to maximise patient benefit, they say, noting that in non-obstetric surgery, tranexamic acid is given before incision, but in caesarean section trials it is delayed until after cord clamping to avoid placental transfer.

They recommend evaluating pre-incision administration for caesarean section, while carefully monitoring maternal and neonatal outcomes.

Source: The BMJ Group

Categories : Environmental Effects Obstetrics & GynaecologyTags :

Plastic Additives Tied to Millions of Preterm Births Worldwide

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Photo by FLY:D on Unsplash

Exposure to a chemical commonly used to make plastic more flexible may have contributed to about 1.97 million preterm births in 2018 alone, or more than 8 percent of the world’s total, a new analysis of population surveys shows. The chemical was also linked to the deaths of 74 000 newborns, the researchers further estimate.

The toxin, di-2-ethylhexylphthalate (DEHP), is part of a group of chemicals called phthalates, which appear in cosmetics, detergents, bug repellents, and other household products. Experts have found that these substances can break down into microscopic particles and enter the body through food, air, and dust.

Led by NYU Langone Health researchers, the new study focused on preterm birth, which is a major risk factor for lasting learning and developmental issues and is a leading cause of infant death, according to the World Health Organization.

The new analysis provides the first global estimate of preterm births connected to exposure to DEHP and explores which parts of the world are most affected, according to the authors. A report on the findings published online March 31 in the journal eClinicalMedicine.

“By estimating how much phthalate exposure may contribute to preterm birth worldwide, our findings highlight that reducing exposure, especially in vulnerable regions, could help prevent early births and the health problems that often follow,” said study lead author Sara Hyman, MS.

Past studies have linked DEHP exposure to cancer, heart disease, and infertility, among many other health concerns, added Hyman, an associate research scientist at NYU Grossman School of Medicine. There is also a large body of research connecting the chemical to preterm birth.

According to the new work, DEHP exposure may have contributed to 1.2 million years lived with disability, a measure of all the years that people have lived or will live with illnesses, injuries, and other health issues caused by being born prematurely.

Hyman said that while the phthalate is in widespread use, certain regions are estimated to bear a much larger share of the health impacts than others, with the Middle East and South Asia representing 54 percent of estimated illness from preterm birth. These areas have rapidly growing plastics industries and high levels of global plastic waste.

Africa, which accounted for 26 percent of health problems from DEHP-linked preterm birth, has a disproportionate share of deaths compared with its share of overall premature cases. The researchers said this reflects the region’s higher underlying death toll from preterm birth.

For the study, the research team estimated DEHP exposure in 2018 across 200 countries and territories by pulling data from large national surveys in the United States, Europe, and Canada. They also used estimates from earlier investigations to fill in regions that did not have their own data.

The team then drew on earlier research that assessed how phthalate exposure may affect preterm birth and combined those findings with their global exposure estimates. Finally, they combined this information with worldwide figures on preterm births and deaths to gauge what share of these outcomes might be linked to DEHP.

The scientists repeated these steps for another phthalate called diisononyl phthalate (DiNP), a common replacement for DEHP. According to the results, DiNP may pose a similar risk as DEHP, having contributed to about 1.88 million preterm births around the world. The financial costs associated with newborn deaths ranged from millions to hundreds of billions of dollars for both phthalates.

“Our analysis makes clear that regulating phthalates one at a time and swapping in poorly understood replacements is unlikely to solve the larger problem,” said study senior author Leonardo Trasande, MD, MPP, Professor of Pediatrics at NYU Grossman School of Medicine. “We are playing a dangerous game of Whac-A-Mole with hazardous chemicals, and these findings highlight the urgent need for stronger, class-wide oversight of plastic additives to avoid repeating the same mistakes.”

Dr Trasande, who is also a professor in the Department of Population Health and director of the Division of Environmental Pediatrics and the Center for the Investigation of Environmental Hazards, cautions that the investigation was not designed to establish that DEHP and DiNP directly or alone cause preterm birth, nor did it take into account other types of phthalates.

In addition, because there is some uncertainty in the data, the researchers looked at a range of possible values rather than just one estimate. This uncertainty range showed that the true impact of DEHP could be up to four times smaller than the main estimate or slightly higher. Even under the most conservative estimates, the results point to a substantial health burden, said Hyman.

Despite the limits of this kind of global modelling, added Hyman, the work lays important groundwork for future studies to confirm and refine these results and begins to fill a major gap in understanding the extent to which plastic chemicals affect preterm birth worldwide.

Source: NYU Langone Health

Categories : Expert Opinion Obstetrics & GynaecologyTags :

How Women Are Harmed When Clinicians Rely on the Lab More Than the Patient

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Photo by Karolina Grabowska on Pexels

Across the world, countless women enter perimenopause only to be told that “everything is normal” because their blood tests do not match their symptoms.

This is one of the most damaging failures in modern women’s health. Perimenopause is not a laboratory diagnosis. It is a clinical diagnosis, made by listening to the woman and recognising the pattern of hormonal transition. Yet many clinicians continue to rely on FSH, LH and oestrogen levels – tests that were never designed to diagnose perimenopause and are physiologically incapable of doing so.

1. Hormone levels in perimenopause are wildly erratic

Oestrogen does not decline smoothly. It surges, crashes, and oscillates unpredictably. FSH and LH follow the same chaotic pattern. A single blood test captures only a moment in this turbulence. It cannot represent the hormonal instability that defines the transition.

This is why women with severe vasomotor symptoms often have “normal” results, while women with mild symptoms may show “abnormal” ones.

Erratic physiology produces erratic numbers. The numbers do not reflect the suffering.

2. Lab ranges do not correlate with symptoms

Laboratory ranges were created for research and population studies – not for diagnosing perimenopause. They do not account for:

  • daily hormonal swings
  • stress
  • sleep deprivation
  • illness
  • cycle timing
  • individual sensitivity to hormonal change

A woman may be drenched in night sweats, unable to sleep, emotionally unstable, and struggling to function – yet her blood tests may look “normal”. This leads to the most common and harmful phrase in women’s health: “Your results are normal, so this is not hormonal.”

3. The harm of relying on lab results

When clinicians wait for “abnormal” results before offering help, women suffer. They are:

  • dismissed
  • misdiagnosed
  • told they are anxious or depressed
  • denied treatment
  • left to struggle through years of avoidable distress

Or are treated inappropriately for life with antidepressants, mood stabilisers, axyiolytics and sedatives. These do little to address the underlying problem but create another set of problems: addiction and a range of side effects. This is not medicine. This is neglect disguised as protocol.

Suffering is prolonged because clinicians rely on lab results rather than the woman’s symptoms. Treating the lab instead of the woman is a betrayal of clinical responsibility.

4. The only test worth doing

There is one test that adds value: TSH and T4 – to exclude thyroid disease, which can mimic some perimenopausal symptoms. Beyond this, further hormone testing wastes time, money, and emotional energy.

5. The clinical truth

Perimenopause is diagnosed by listening to the woman, not by chasing fluctuating hormones. If she has:

• hot flushes

• night sweats

• irritability

• emotional instability

• sleep disturbance

• cycle changes

— she is in perimenopause, regardless of what the blood tests say.

The woman’s story is the evidence.

The numbers are often unreliable and misleading tools.

Dr E.V. Rapiti • April 2026

www.drrapiti.com

Categories : Environmental Effects Obstetrics & GynaecologyTags :

How One ‘Forever Chemical’ Can Disrupt Foetal Facial Development

On By ModernMedia

Researchers discovered perfluorodecanoic acid is the most toxic during foetal craniofacial development

Credit: Chemical Research in Toxicology (2026). doi:10.1021/acs.chemrestox.5c00468

Researchers have long associated per- and polyfluoroalkyl substances (PFAS), commonly known as “forever chemicals,” to certain severe birth defects but exactly how these pollutants harm a developing foetus has remained mostly a mystery. New research now provides the first clear molecular explanation, showing how one PFAS, called perfluorodecanoic acid (PFDA), can trigger craniofacial abnormalities before birth.

The research was published in ACS Chemical Research in Toxicology.

“Most people are exposed to small amounts of PFAS in everyday life but higher exposure can occur through contaminated water, living near manufacturing sites or certain jobs like firefighting and ski waxing, which is why it’s so important to understand the chemicals better,” said the paper’s senior author Jed Lampe, PhD, associate professor at University of Colorado Anschutz Skaggs School of Pharmacy and Pharmaceutical Sciences. “We wanted to understand which PFAS compounds are truly harmful during foetus development, especially for people with higher exposure, and how they cause damage.”

There are approximately 15 000 PFAS used in consumer and industrial products but scientists are increasingly finding that only some pose serious health risks. In this study, Lampe worked with the paper’s first author Michaela Hvizdak and co-author Sylvie Kandel to test 13 commonly found PFAS and discovered PFDA as the most toxic during foetal craniofacial development.

They demonstrated a possible link between PFDA and the extensive facial changes observed in humans and laboratory animals, with some estimates indicating a 10% increased risk at extremely low exposure levels. 

“This finding moves us beyond association by providing a clear explanation for how PFDA can interfere with foetal development. It’s a critical step toward understanding a vast and complex class of environmental chemicals,” said Lampe.

The cause of underdeveloped eyes and an abnormal jaw

They found that PFAS disrupts retinoic acid, a molecule essential for shaping the face and head during early pregnancy. Retinoic acid regulates hundreds of genes and its levels must be controlled. Because a foetus cannot produce or safely eliminate excess retinoic acid, it relies entirely on the mother to maintain the homeostatic balance of the hormone.

The researchers discovered PFDA blocks CYP26A1, a key enzyme responsible for breaking down excess retinoic acid. When this enzyme is inhibited, retinoic acid levels can rise too high, disrupting normal facial development. PFDA also suppresses the genes that produce this enzyme through a separate biological pathway, delivering a “double hit” to the system that regulates early development.

“As a result, severe craniofacial abnormalities can develop, including underdeveloped eyes and abnormal jaw formation, which were the most common effects of PFDA exposure during foetal development,” said Lampe.

The researchers hope by providing a molecular explanation for this abnormality that the research and scientific community can work to develop targeted laboratory assays and computer‑based screening tools to quickly rank PFAS by risk. They say this could help regulators and manufacturers distinguish more dangerous compounds from safer alternatives and guide the design of less toxic chemicals in the future.

They also hope the research can open the door to practical interventions for people with higher exposure, such as firefighters and ski wax technicians. This could include looking into how to reduce exposure levels and whether strategies can be developed to lower PFDA during pregnancy to protect foetal development.

By Julia Milzer

Source: CU Anschutz Medical Campus