Ludovica Niccolini

Objective: To evaluate long‐term gynecological symptoms and reproductive and ultrasound outcomes among women originally enrolled in a randomized controlled trial (RCT) comparing monofilament and multifilament sutures for uterine closure after Cesarean delivery. Methods: This was a secondary analysis of a RCT including women who underwent Cesarean delivery, who were originally assigned to monofilament or multifilament absorbable sutures for uterine closure. In this secondary analysis, participants were contacted 4–6 years after delivery and invited to a follow‐up evaluation, comprising a clinical interview and a voluntary transvaginal ultrasound examination. The primary outcome was the presence of postmenstrual spotting at long‐term follow‐up. Secondary outcomes were other gynecological symptoms, reproductive outcomes and ultrasound outcomes. Analyses were performed according to the original randomized allocation. Effect estimates are reported as relative risk (RR) with 95% CI. Results: Of the 300 women included in the original RCT, 117 (39.0%) were included in the long‐term follow‐up analysis, comprising 51 in the monofilament group and 66 in the multifilament group. There was no significant difference in the primary outcome of postmenstrual spotting between the monofilament and multifilament groups (23.5% vs 22.7%; RR, 1.04 (95% CI, 0.53–2.01)). Similarly, no significant differences were observed between groups for other gynecological symptoms. Ultrasound data were available for 21 women, of whom 13 had a Cesarean‐scar defect. The overall prevalence of Cesarean‐scar defects was similar between groups, although defects ≥ 4 mm were more frequent in the multifilament group (RR, 0.42 (95% CI, 0.18–0.97); P = 0.04). Most reproductive outcomes, including infertility and pregnancy outcomes among women who conceived, were comparable between groups. However, subsequent pregnancy occurred more frequently in the monofilament group (29.4% vs 12.1%; RR, 2.43 (95% CI, 1.12–5.27)). Conclusions: In this long‐term follow‐up of a RCT, monofilament and multifilament sutures for uterine closure were associated with similar long‐term gynecological symptoms. Differences observed in selected ultrasound and reproductive outcomes should be interpreted cautiously because of the limited sample size and exploratory nature of these analyses. Further studies are needed to better evaluate the potential impact of suture material on long‐term reproductive outcomes and sonographic Cesarean‐scar characteristics. © 2026 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

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

Background and Objectives: Maternal nutrition during pregnancy has been associated with fetal development and long-term health trajectories through mechanisms potentially involving epigenetic and metabolic programming. However, the molecular mediators linking dietary quality to fetal biochemical profiles remain poorly characterized. This exploratory pilot study aimed to investigate associations between maternal nutritional adequacy and the amniotic-fluid metabolomic profile during the second trimester. Materials and Methods: In this prospective study, AF samples from 41 pregnant women undergoing second-trimester amniocentesis were analyzed using gas chromatography–mass spectrometry (GC-MS). Nutritional status was assessed via the FIGO Nutrition Checklist. Subjects were divided into two groups based on dietary adequacy (FIGO Score >5 vs. ≤5). Multivariate analysis (PLS-DA, VIP scores, volcano plots) and pathway enrichment were performed to identify discriminatory metabolites. Results: Exploratory metabolomic analysis suggested differences between the two nutritional groups. Several candidate metabolites, including stearic acid, lactic acid, proline, and scyllo-inositol, contributed to the observed differences between groups. These features may provide preliminary hypotheses regarding energy-, amino acid-, and lipid-related biochemical pathways. Conclusions: Maternal dietary quality was associated with differences in the amniotic-fluid metabolomic profile. These preliminary findings support further investigation of amniotic-fluid metabolomics as a potential tool for studying the fetal biochemical environment.