The rising incidence of gestational diabetes mellitus (GDM), driven by modern lifestyle and dietary changes, underscores the need for effective management strategies. This prospective observational study evaluates the effectiveness of group prenatal care combined with nutritional guidance in managing GDM.

This research is a prospective study. Convenience sampling was used to identify pregnant women who registered for and received regular prenatal care at the Second Affiliated Hospital of Fujian Medical University obstetrics and gynecology department from February 2023 to February 2024. Based on the recorded antenatal care methods, the study included 50 patients in the observation group and 46 patients in the control group. The control group received routine prenatal care, whereas the observation group received group prenatal care supplemented with nutritional guidance. Dietary compliance, GDM knowledge, self-management ability, and perceived social support were assessed and compared between the two groups.

Post-intervention analysis revealed that the observation group exhibited significantly higher scores in dietary compliance, GDM knowledge, self-management ability, and perceived social support compared to the control group (p < 0.05).

The implementation of group prenatal care combined with nutritional guidance significantly improves dietary compliance, enhances GDM knowledge, and boosts self-management skills and perceptions of social support in pregnant women with GDM.

The study is registered on https://www.isrctn.com/ (registration number: ISRCTN14579442).

Gynecologic cancer refers to a variety of malignancies that originate in the reproductive organs of women, including the cervix, ovaries (epithelial and germ cell), uterus (endometrial or corpus as well as sarcoma), vagina, and vulva. Gynecologic oncology nursing is a specialized field offering an integrated approach to treating and managing gynecological cancers, addressing their physical and psychological needs. This systematic review and meta-analysis aimed to evaluate the efficacy of lifestyle intervention plus gynecological care on quality-of-life (QoL) outcomes in women with a diagnosis of at least one type of gynecological cancer.

A methodological adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines resulted in 1034 articles being identified following an exhaustive search of electronic databases. A meta-synthesis was conducted using Rev Man for the 10 studies that met all eligibility criteria after screening.

Lifestyle interventions showed significant associations with improved QoL outcomes when comparing baseline measurements to those taken six months post-lifestyle intervention (lifestyle: mean difference (MD) = 0.47, 95% confidence interval (95% CI): 0.09 to 0.86), p = 0.02. However, the pooled effect sizes were not statistically significant (lifestyle: MD = 0.77, 95% CI: –3.00 to 4.54), p = 0.69. Nursing interventions showed mixed effects (MD = 0.94, 95% CI: –5.26 to 7.14), p = 0.77 and no statistically significant improvement in QoL compared to control groups. Sensitivity analysis indicated potential publication bias. Nonetheless, most papers exhibited a minimal risk of bias. Significant heterogeneity was also seen in pooled analyses, possibly indicating variations in study populations, intervention types, and outcome measures.

This study suggests lifestyle interventions can improve the QoL in gynecological cancer patients. However, oncology nursing interventions show inconsistent effects, with no significant improvement in the pooled analysis. Future research should standardize interventions to improve understanding of their impact.

The study has been registered on https://www.crd.york.ac.uk/prospero/ (registration number: CRD42024617625).

Embryo quality is a critical determinant of success in assisted reproductive technology (ART). A strong and positive correlation between embryo quality and clinical pregnancy rate (CPR) has been reported. The aim of this study was to evaluate the effect of transferring one good-quality embryo (GQE) alongside one poor-quality embryo (PQE) on CPR and live birth rate (LBR) in fresh ART cycles.

This retrospective cohort study included a total of 1631 women who underwent an in vitro fertilization–intracytoplasmic sperm injection (IVF-ICSI) cycle. The study was conducted at T.C. Ministry of Health, Zeynep Kamil Women’s and Children’s Diseases Training and Research Hospital, İstanbul, Türkiye. Patient data were obtained from medical records. Patients were assigned to 5 different groups according to the number and quality of embryos transferred: Group 1 for 1 GQE transferred; Group 2 for 2 GQEs transferred; Group 3 for 2 embryos transferred with 1 GQE along with 1 PQE; Group 4 for 1 PQE transferred; and Group 5 for 2 PQEs transferred. Age, number of retrieved oocytes, number of captured metaphase II (MII) oocytes, number of formed embryos, number of transferred embryos, and number of GQEs were assessed.

In 891 cases in which a single GQE was transferred, the LBR was 26.3%, whereas in 126 cases in which a GQE with a PQE was transferred, the LBR was 16.7% (p < 0.001). Statistically significant differences were observed for age (p < 0.001), number of oocytes retrieved (p < 0.001), total number of embryos obtained (p < 0.001), number of MII oocyte numbers (p < 0.001), CPR (p < 0.01), and LBR (p < 0.001) between groups classified according to the number and quality of the transferred embryos. The study group was also analyzed as two separate age groupings: <35 years and ≥35 years. Using a regression analysis, day 5 embryo transfer (ET) was found to improve CPRs in both age groups [relative risk (RR), 95% confidence interval (CI): 1.875, 1.267–2.775, p = 0.002 and RR, 95% CI: 2.973 1.277–6.918, p = 0.011]. Day 5 ET improved LBR only in <35 years age group (RR, 95% CI: 1.760, 1.174–2.639, p = 0.006). 2 GQE ETs were found to be more effective than other transfer options in both age groups, when considering CPRs (RR, 95% CI: 2.962, 1.463–6.000, p = 0.003; and RR, 95% CI: 2.001, 1.062–3.773, p = 0.032).

This study indicated that the transfer of an additional PQE alongside a top-quality embryo does not have a favorable effect on clinical pregnancy and LBR. On the contrary, the transfer of an additional PQE negatively affects LBR.

According to the World Health Organization, the cesarean section (CS) rate is alarmingly high. As such, it is urgent to reduce the rate of CS. In this meta-analysis, we aimed to examine the effects of prenatal exercise on delivery outcomes.

A search was carried out in databases including PubMed, ProQuest, Scopus, China National Knowledge Infrastructure (CNKI), Wanfang, and Weipu, from January 1, 2020 to August 27, 2024. Two reviewers independently assessed the articles for quality and risk of bias using the Cochrane handbook. The statistical heterogeneity was determined using the Cochran’s Q test and Higgins’ I² coefficient.

Of the 243 reviewed articles, 11 were included in this review, which contained 2553 pregnant women. The results of the meta-analysis showed that there was a statistical difference in the CS rate between the prenatal exercise group and non-prenatal exercise group (p < 0.05). There were also statistical differences in CS rate between the experimental group and the control group, with aerobic exercise combined with childbirth training (p < 0.05).

Prenatal exercise including aerobic exercise during pregnancy and prenatal training related to delivery was effective in reducing the rate of CS, and aerobic exercise combined with delivery training also reduced the rate of CS and increased the rate of natural delivery.

With the increase in cesarean sections, the occurrence of cesarean scar pregnancies has shown a significant upward trend. To investigate the high-risk factors for hemorrhage during hysteroscopy for cesarean scar pregnancy (CSP).

This is a retrospective case-control study. A total of 338 cases of CSP were divided into-hemorrhage group and non-hemorrhaged group according to the volume of hemorrhage. The collected data included maternal age, duration of amenorrhea, frequency and interval time of cesarean sections, number of induced abortions, pre-treatment human chorionic gonadotropin (hCG) levels, gestational sac length, myometrial thickness at the uterine scar, blood flow signal around the gestational sac as detected by ultrasound, and CSP classification. Statistical analysis was performed to assess differences between the two groups.

Statistically significant differences between the two groups were observed in the duration of amenorrhea, gestational sac length, myometrial thickness at the uterine scar, and blood flow signal around the gestational sac. Hysteroscopic curettage for CSP was found to be safe and feasible when the duration of amenorrhea was <49 days, the gestational sac length was <30 mm, the resistance index (RI) of the blood flow signal around the gestational sac was >0.4, and the myometrial thickness at the uterine scar was >2 mm.

Hysteroscopic curettage is a safe and effective procedure for CSP in carefully selected patients.

This study aimed in this study was to investigate the association between poor sleep patterns (PSPs) and type 2 diabetes mellitus (T2DM) in women with a history of gestational diabetes mellitus (GDM).

Our analysis was based on a population-based sample from National Health and Nutrition Examination Survey (NHANES) data collected between 2007 and 2018. The association between PSPs and T2DM in women with a history of GDM was assessed using logistic regression models. We performed subgroup analyses stratified by age, body mass index (BMI), race, educational level, moderate recreational activities, smoking behavior, and parity.

A total of 917 women with a history of GDM were included in our study. Compared to the non-PSPs group, participants with PSPs had a higher possibility for T2DM in women with a history of GDM (odds ratio (OR) = 2.37, 95% confidence interval (CI): 1.45–3.86). Furthermore, this association was more prominent in those aged between 35 and 49 (OR = 2.20, 95% CI: 1.03–4.71), a BMI ≥30 kg/m² (OR = 2.56, 95% CI: 1.43–4.60), non-Hispanic white (OR = 5.34, 95% CI: 2.09–13.66) or non-Hispanic black (OR = 5.02, 95% CI: 1.48–17.06), educated beyond high school (OR = 2.65, 95% CI: 1.35–5.23), not engaged in moderate recreational activities (OR = 3.25, 95% CI: 1.72–6.14) groups and parity ≥4 (OR = 2.62, 95% CI: 1.03–6.63).

Our findings suggest that PSPs are positively associated with the prevalence of T2DM in women with a history of GDM, which demonstrates that we need targeted interventions, especially for those at high risk. Future research should evaluate how sleep patterns affect metabolic health and develop new ways to lower the risk of T2DM in women with a history of GDM.

It is estimated that around 20% of women experience mental health problems during the perinatal period, including depression and anxiety, which negatively affect both the mother and the baby’s development. Although previous mental health problems have been identified as important predictors, it is relevant to further explore the role of other psychosocial variables of interest such as coping with worries or maternal confidence in caring for the baby, in order to design effective preventive actions to promote perinatal mental health. This study analyzed the effect of maternal lack of confidence in caring for her infant and depressive symptoms on pregnancy worries (PW) and postpartum depression (PPD) using a multifactorial and prospective approach.

A prospective cohort study (with three points in time) was conducted with 120 pregnant women recruited from a public hospital in Madrid, Spain. Women were evaluated for pregnancy worries in the first trimester of pregnancy, for depressive symptoms in the third trimester, and for PPD and mothers’ lack of confidence 4 months after childbirth. Parallel and serial mediation analyses were conducted using PROCESS (SPSS tool for estimating regression models with mediation and/or moderation effects). According to the Enhancing the Quality and Transparency Of health Research (EQUATOR) checklist, the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) statement was chosen for this study.

A parallel multiple model showed that while depressive symptoms significantly mediated the relationship between pregnancy worries and postpartum depression (a1b1 = 1.4733, [95% confidence interval (95% CI) = 0.7105, 2.2309]), mothers’ lack of confidence did not (a2b2 = 0.2404, [95% CI = –0.0569, 0.5826]). However, when both mediators were analyzed together, a significant indirect effect of depressive symptoms on postpartum depression was found through the effect of depressive symptoms on mothers’ lack of confidence (d21 = 0.2144, [95% CI = 0.0595, 0.4562]).

It is necessary to analyze factors related to postpartum depression from a multifactorial approach focused on the analysis of depression during pregnancy, but also including other variables such as mothers’ lack of confidence as possible risk factors of postpartum depression. The associations found between worries, depressive symptoms, and maternal insecurity with postpartum depression could allow professionals to develop preventive interventions of postpartum depression.

Adolescent pregnancy is a critical issue that affects both mental health and social well-being, increasing the risk of challenges such as depression, anxiety, and suicidal behaviors. The availability of support systems can play a vital role in mitigating these risks. However, the relationship between social support and mental health outcomes in pregnant adolescents (PAs) remains underexplored in Turkey. This prospective case-control study aims to investigate the relationships between perceived social support, suicidality, and psychopathology in PAs compared to a healthy non-PAs (NPAs) control group, while identifying key risk factors for suicidality within the Turkish context.

This study included 50 PAs and 50 NPAs, aged 13–19 years. Data were collected between June 2018 and December 2018 using the Multidimensional Scale of Perceived Social Support (MSPSS), Suicide Probability Scale (SPS), Revised Children’s Anxiety and Depression Scale (RCADS), and the Schedule for Affective Disorders and Schizophrenia for School-Age Children—Present and Lifetime Version (K-SADS-PL-DSM-5).

Suicide attempts were reported by 18% of PAs and 6% of NPAs (p = 0.065). Suicidal thoughts were noted in 10% of both groups (p = 1.000). Past psychiatric disorders were significantly more common in PAs compared to NPAs (p = 0.005). A history of physical and sexual trauma was also significantly higher in PAs (p < 0.05). No significant differences were observed in the total SPS or RCADS scores between the groups (p > 0.05). Stepwise regression analysis identified depressive symptoms (β = 1.619, p < 0.001), lack of school attendance (β = 19.213, p = 0.010), illicit drug use (β = 13.583, p = 0.026), and a history of suicide attempts (β = 11.815, p = 0.005) as predictors of suicide probability in PAs. Family support was identified as a protective factor (β = –2.431, p = 0.009).

PAs are at increased risk for suicidality, particularly those with depressive symptoms, histories of abuse, or delinquent behaviors. Family support emerges as a crucial protective factor. Interventions focused on mental health, social support, and access to education are essential for mitigating these risks.

Bronchopulmonary dysplasia (BPD) is a major contributor to mortality in extremely preterm infants. Therefore, it is essential to identify effective clinical prognostic indicators of BPD and implement early interventions. The objective of this study was to evaluate the predictive value of erythrocyte-related indices, such as hemoglobin (Hb) and hematocrit (Hct), for BPD.

This retrospective cohort study included 413 neonates with a gestational age (GA) of < 32 weeks who were admitted to The First Affiliated Hospital of Wenzhou Medical University between January 2019 and January 2024. Maternal and infant characteristics were recorded, and Hb and Hct levels were measured on days 1, 3, 14 and 28 of life (DOL1, DOL3, DOL14, and DOL28, respectively).

Compared to non-BPD patients (n = 170), BPD patients (n = 218) had a lower GA (p < 0.001), birth weight (p < 0.001), 1-minute postnatal Apgar scores (p < 0.001) and 5-minute postnatal Apgar scores (p < 0.001). However, they exhibited higher rates of intubation in the delivery room (p < 0.001), surfactant treatment (p < 0.001), diuretic treatment (p < 0.001), caffeine treatment (p < 0.001), postnatal steroid use (p < 0.001), hemodynamically significant patent ductus arteriosus (hsPDA) (p < 0.001), intraventricular hemorrhage (IVH) (p = 0.001), retinopathy of prematurity (ROP) (p < 0.001), duration of invasive mechanical ventilation (IMV) ≥1 week (p < 0.001), and number of packed red blood cell (PRBC) transfusions (p < 0.001). In addition, BPD patients received PRBC transfusions earlier (p = 0.004), had lower Hb levels on DOL1 (p = 0.001), DOL3 (p < 0.001) and DOL14 (p < 0.001), but higher levels on DOL28 (p = 0.003). They also had lower Hct levels on DOL1 (p = 0.004), DOL3 (p < 0.001) and DOL14 (p < 0.001), but higher levels on DOL28 (p = 0.001). An Hb level of ≤150 g/L on DOL3 (DOL3-Hb) was an early predictor for BPD (adjusted odds ratio (OR) = 3.222, p = 0.002), with high sensitivity (69.72%) and specificity (78.24%). The number of PRBC transfusions was also a significant risk factor for BPD (adjusted OR = 4.436, p < 0.001).

Significant predictors of BPD included DOL3-Hb 150 g/L and the number of PRBC transfusions, with DOL3-Hb serving as an early predictor.

The molecular mechanisms of intrauterine adhesions (IUA) are not yet fully understood, and there is a lack of specific diagnostic markers and effective molecularly targeted treatments in clinical practice. This study employed proteomic techniques to analyze differentially expressed proteins (DEPs) and associated signaling pathways in pathological tissues, aiming to identify potential diagnostic markers and therapeutic targets.

This study collected 15 endometrial tissue samples from 10 patients treated at Changzhou Maternity and Child Health Care Hospital from March 2022 to September 2022. The tissue samples were divided into 3 groups: the adhesion group (Adhes group), the peri-adhesion endometrial group (Endome group), and the control group (Control group). Pairwise comparisons of the three groups were performed. Label-free quantitative (LFQ) proteomics was used to identify DEPs, and bioinformatics analyses, such as the Kyoto Encyclopedia of Genes and Genomes (KEGG), Gene Ontology (GO), and protein domain analysis, were employed to identify the functions and pathways of DEPs. Parallel reaction monitoring (PRM) was used for the quantitative analysis of selected target proteins.

1328, 290, and 1335 DEPs were found in the Adhes vs Control, Endome vs Control, and Adhes vs Endome groups, respectively. Bioinformatics analysis showed that these proteins are primarily involved in key processes such as muscle contraction, cytoskeletal dynamics balance, extracellular matrix (ECM) remodeling, and immune regulation. PRM validation identified out 14 target proteins, among which ADIPOQ, TGFB1, MYLK, and CAMK2G were closely associated with ECM remodeling and cytoskeletal regulation, while lactoferrin (LTF) was involved in immune regulation.

This study identified a series of key proteins associated with IUA and found that they may participate in the disease process through mechanisms such as ECM remodeling, actin cytoskeleton regulation, and immune regulation. The identified target proteins (such as ADIPOQ, TGFB1, MYLK, and CAMK2G) provide potential biomarkers and intervention targets for the diagnosis and treatment of IUA.

Oocyte cryopreservation is a crucial technique in contemporary society since it provides a means for future fertility preservation at a time when delayed marriage and pregnancy are common. However, oocyte cryopreservation remains challenging because of the inherent vulnerability of oocytes becoming damaged during freezing and thawing. This study investigated the effects of uniform versus multi-gradient equilibration during vitrification on mitochondrial integrity and distribution in mouse oocytes.

We compared a conventional uniform equilibration method involving a 10-minute exposure to cryoprotective agents using a multi-gradient equilibration method that reduced the exposure time to 2.5 minutes. The survival rates of the vitrified oocytes and the mitochondrial fluorescence intensity and distribution were assessed using confocal microscopy.

The survival rates were not significantly different between the two methods. However, the multi-gradient equilibration method presented a higher mitochondrial fluorescence intensity and more uniform distribution, indicating better preservation of mitochondrial function.

These findings suggest that the multi-gradient equilibration method may offer a viable alternative to conventional vitrification that can reduce mitochondrial damage and potentially improve oocyte quality post-thawing.

Postoperative ileus after cesarean section prolongs hospital stays and increases perioperative costs. The impact of fennel tea and chewing gum on bowel motility remains unclear. Therefore, this study aimed to evaluate the effects of chewing gum and fennel tea on intestinal motility after cesarean section.

A randomized controlled trial was conducted between January 2018 and April 2018 with 120 participants divided into four groups: chewing gum, fennel tea, chewing gum plus fennel tea, and control (n = 30 per group). Bowel sounds, time to first flatulence, and defecation were recorded. Data were analyzed using statistical tests with p < 0.05 considered statistically significant.

The chewing gum plus fennel tea group exhibited the earliest onset of bowel sounds (6.96 ± 3.41 hours). The fennel tea group demonstrated the shortest time to first flatulence (15.47 ± 7.77 hours) and first defecation (21.02 ± 8.75 hours) compared to the other groups (p < 0.05). Although chewing gum alone promoted enhanced bowel motility, it was less effective than fennel tea alone. No complications or adverse events were reported in any group.

Chewing gum and fennel tea are cost-effective interventions to improve intestinal motility post-cesarean section. Incorporating these remedies into postoperative care may reduce gastrointestinal complications.

This study has been registered on https://classic.clinicaltrials.gov/ (registration number: NCT06403215).

Advanced maternal age (AMA) has been associated with various adverse obstetric, perinatal, and neonatal outcomes. This study primarily aimed to compare pregnancy outcomes in women aged 40 years and older with those aged 35–39 years, with a secondary aim to determine advanced maternal age by comparing these two age groups with those aged 20–34 years.

This was a retrospective review of adults who gave birth between January 2020 and August 2024. All pregnant women in this study were single pregnancies and aged 20 years and older. Pregnant women using assisted reproductive technology and those with missing data were excluded from the study. This study included three groups of pregnant women: 20–34, 35–39, and 40 years and older. Perinatal outcomes of the three groups were compared.

AMA has previously been associated with various adverse obstetric outcomes. However, while there was a significant difference in birth weeks between the 20–34 years age group and the ≥40 age group (p = 0.019), the birth weeks of other age groups were similar. Moreover, there was no statistically significant difference between birth weights. Maternal ages of 35–39 and ≥40 years were associated with increased rates of cesarean delivery, pre-eclampsia, low birth weight, gestational diabetes mellitus (GDM), fetal growth restriction (FGR), preterm delivery, and low Apgar score (p < 0.001); however, rates of placental abruption, and preterm premature rupture of membranes (PPROMs) were similar to women aged <35 years. Gestational hypertension (GHT) (adjusted odds ratio (adjOR): 6.710, 95% confidence interval (95% CI): 2.755–16.343, p = < 0.001), oligohydramnios (adjOR: 2.145, 95% CI: 1.056–4.356, p = 0.035), macrosomia (adjOR: 5.459, 95% CI: 1.164–25.609, p = 0.031), and postpartum hemorrhage (adjOR: 5.139, 95% CI: 1.021–25.872, p = 0.047) are more common in women aged ≥40 years compared to both the reference group and the <35 age group.

Adverse perinatal outcomes are more common in pregnant women aged 35 and over. These adverse outcomes are more common in the ≥40 years age group. To prevent these negative outcomes as well as potential maternal and fetal mortality and morbidity, we believe it is crucial to monitor these pregnant women closely during the prenatal period.

Hemolysis, elevated liver enzymes, and low platelet count syndrome (HELLP syndrome), characterized by hemolysis (H), elevated liver enzymes (EL), and a low platelet count (LP), is a severe obstetric complication. We analyzed the clinical characteristics of complete and partial HELLP syndrome.

We conducted a retrospective study to collect data on 96 pregnant women with preeclampsia accompanied by HELLP syndrome. HELLP syndrome was diagnosed based on the Tennessee Classification System. General characteristics, clinical manifestations, laboratory results, complications, as well as maternal and neonatal outcomes were analyzed to compare complete and partial HELLP syndrome.

Among the 96 pregnant women with HELLP syndrome, 76% (73/96) were diagnosed with partial HELLP syndrome, while 24% (23/96) were diagnosed with complete HELLP syndrome. No statistically significant differences were found in maternal and disease characteristics between the partial and complete HELLP groups (all p > 0.05). The main symptoms of HELLP syndrome were headache and epigastric pain. Regarding diagnostic measures, the complete HELLP group had lower platelet counts (PLT) and higher total bilirubin (TBil), lactate dehydrogenase (LDH), alanine transaminase (ALT), and aspartate transaminase (AST) levels compared to the partial HELLP group. For non-diagnostic measures, the complete HELLP group showed higher white blood cell counts and D-dimer levels. No statistically significant differences were observed in the remaining laboratory indexes (all p > 0.05). Similarly, there was no statistically significant differences in the incidence of maternal pregnancy complications and fetal demographic features between the two groups (all p > 0.05).

The distinction between partial and complete HELLP syndromes primarily lies in specific laboratory indexes. Both syndromes can lead to severe perinatal complications, including eclampsia, uteroplacental apoplexy, and fetal demise. Clinical diagnosis does not require strict adherence to all three criteria: H, EL, and LP. Special attention should be given to patients with partial HELLP syndrome, who require immediate treatment and intervention.

The relationship between adenomyosis and vitamin D remains largely unexplored. However, emerging evidence suggests that vitamin D deficiency may increase the risk of developing adenomyosis.

A cross-sectional study was conducted involving 190 patients diagnosed with adenomyosis and 185 healthy controls. Propensity score matching (PSM) was utilized to generate 91 matched pairs. Multivariate logistic regression analysis was employed to examine the relationship between vitamin D levels and the risk of adenomyosis. Additionally, receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic performance of vitamin D levels.

In both unmatched (44.0 nmol/L vs. 61.4 nmol/L, p < 0.001) and matched (42.3 nmol/L vs. 60.7 nmol/L, p < 0.001) groups, patients with adenomyosis exhibited significantly lower serum vitamin D levels compared to healthy controls. Multivariate logistic regression analysis demonstrated a negative association between vitamin D levels and the risk of adenomyosis in both groups. ROC analysis identified an optimal diagnostic threshold of 44.75 nmol/L for vitamin D in predicting adenomyosis.

Reduced serum vitamin D levels represent an independent risk factor for adenomyosis, with levels below 44.75 nmol/L associated with an increased risk. These findings suggest that vitamin D supplementation may serve as a potential preventive strategy against adenomyosis.