JOURNAL ABSTRACTS

Comparative efficacy of conservative interventions for adolescent idiopathic scoliosis: a systematic review and network meta-analysis of randomized controlled trials
Jun Ren, Shoujian Wang, Miaoxiu Li, Xin Zhou, Ya Wen, Zonglin Wen, Jiannan Lin, Lingjun Kong , Min Fang
Syst Rev. 2025 Jul 30;14(1):156.
doi: 10.1186/s13643-025-02893-1

Abstract
Background: Adolescent idiopathic scoliosis (AIS) is a prevalent spinal disorder, and the efficacy of conservative interventions for AIS remains unclear. This study aimed to identify the comparative efficacy of all available conservative interventions for AIS. Methods: Nine databases were searched from their inception to February 2024 for randomized controlled trials comparing conservative interventions for AIS. Paired reviewers independently selected studies, assessed risk of bias, and assessed certainty of the evidence. Pairwise meta-analyses were performed by DerSimonian-Laird random-effects model. Network meta-analysis within the frequentist framework was conducted by R package netmeta, and network plots were generated by the network plot command in Stata. Results: We identified 3903 citations, of which 54 trials including 3,984 participants were included in our review. All subsequent estimates refer to the comparison with minimal interventions. Brace plus physiotherapeutic scoliosis-specific exercises (PSSE, mean difference (MD): 4.80, 95% confidence interval (CI): 0.56 to 9.04, moderate certainty), manual therapy plus PSSE (MD: 5.26, 95% CI: 1.09 to 9.43, moderate certainty), and manual therapy plus mind-body exercise (MD: 5.14, 95% CI: 1.25 to 9.04, moderate certainty) could be intermediately effective in improving Cobb angle of patients with AIS at post-interventions. Although brace alone (MD: 1.53, 95% CI: 1.09 to 2.14, high certainty) could be the intermediate effective intervention in preventing scoliosis progression, moderate to high certainty evidence showed that brace alone and PSSE alone probably have little or no difference in improving Cobb angle, function, mental health, self-image, angle of trunk rotation (ATR), or satisfaction of patients with AIS compared to minimal interventions. There was no evidence on the follow-up effects of conservative interventions for AIS. We did not identify serious adverse events for any included conservative interventions. Conclusions: Brace plus PSSE, manual therapy plus PSSE, and manual therapy plus mind-body exercise could provide short-term effects in improving Cobb angle of patients with AIS. The evidence of brace alone and PSSE alone for managing AIS is still not robust. Our findings are useful for decision-making in clinical practice, as we presented the most comprehensive evidence regarding all available conservative interventions for AIS.

Full text access on line Pub Med: Adolescent Idiopathic Scoliosis
Full text access on line Springer Link: https://link.springer.com/article/10.1186/s13643-025-02893-1.

Efficacy of non-surgical, non-pharmacological treatments for congenital muscular torticollis: a systematic review and meta-analysis
Joyaa B Antares, Mark A Jones, Nga Ting Natalie Chak, Yuan Chi, Hong Li, Mingdi Li, Eva Y W Chan, Tracy Mui Kwan Chen, Crystal Man Ying Lee, Donna M Urquhart
BMC Musculoskelet Disord. 2025 Feb 20;26(1):178.
doi: 10.1186/s12891-025-08407-3

Abstract
Background: Congenital Muscular Torticollis (CMT) is the third most common musculoskeletal condition in infancy, and if untreated can lead to significant disability. While a range of conservative treatments are commonly used in the management of CMT, an understanding of their efficacy and safety is limited. This systematic review and meta-analysis, without language or discipline restriction, was conducted to address this knowledge gap. Methods: Electronic searches of CENTRAL, PubMed, 22 other electronic databases, three trials registers and Google Scholar, were conducted for randomised controlled trials, which examined any non-surgical, non-pharmacological interventions, including but not limited to manual treatments, movement therapy, acupuncture, adjunctive therapies and physical support, in children aged 0 to 5 years with CMT. Two reviewers independently assessed the risk of bias of the included studies using the Cochrane Risk of bias 1 tool, rated their certainty of evidence using grading of recommendations assessment, development and evaluation (GRADE) framework, and performed random-effects meta-analyses. Results: One hundred studies (80 from China) involving 8125 participants published between 1990 and 2023 were included. Adding manual therapy to an active control resulted in short-term improvements in passive cervical rotation (odds ratio (OR) 9.79, 95%CI 4.26,22.50), passive cervical lateroflexion (OR 2.66, 95%CI 1.17,6.04), active cervical rotation (OR 3.94, 95%CI 1.08,14.35), symmetric head posture (OR 4.55, 95%CI 2.57,8.05), sternocleidomastoid tumour thickness (mean difference (MD) -2.12 mm, 95%CI -2.98,-1.26) and development of symmetrical movement (standardised MD -0.70, 95%CI -0.95,-0.45). The addition of an electrophysical agent to an active control reduced sternocleidomastoid tumour thickness (MD -2.03 mm, 95%CI -2.67,-1.39) and optimised Tuina reduced tumour thickness more than traditional Tuina (MD -1.20 mm, 95%CI -1.80,-0.59). Adverse events were uncommon but poorly reported, with 71 (71%) of studies providing no data. Study heterogeneity limited pooling of data for meta-analysis, and there was very low to low certainty evidence for all results, due to high risk of bias, small sample sizes and study heterogeneity. Conclusions: This review found that non-surgical, non-pharmacological treatments may be effective for CMT, but the certainty of evidence is very low to low. These findings are important in informing clinical guidelines and management for CMT and highlight an urgent need for large definitive trials that address the limitations of current studies.

Protocol registration: Cochrane Database of Systematic Reviews (No.: CD012987).
Keywords: Conservative treatment; Electrophysical agents; Infant; Manual therapy; Safety; Traditional Chinese Massage.
Full text online PubMed: https://pubmed.ncbi.nlm.nih.gov/39979901/.
Full text online BMC: https://link.springer.com/article/10.1186/s12891-025-08407-3.

Parental management of autoimmune disease with complementary and alternative medicine: a scoping review of the literature in OECD countries
Jordana Maio, Caroline A Smith, Paul R Ward
BMC Complement Med Ther. 2025 Jul 10;25(1):255.
doi: 10.1186/s12906-025-04929-4

Abstract
Introduction: The prevalence of autoimmune disease (AD) is increasing in both paediatric and adult populations, resulting in a rise in healthcare utilisation for symptom management. With no known cure for ADs, management options include conventional medical treatment and/or complementary and alternative medicine (CAM) approaches. Despite the high cost of CAM therapy in Australia, its use continues to rise, especially among adults and children with chronic disease. Methods: This review was guided by the JBI methodology for scoping reviews. We reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. Database searched included OVID (Medline, Embase, PsycInfo) CINAHL, Scopus, Web of Science, ProQuest, and Google Scholar. Only primary empirical papers were included. Screening and data extraction were conducted by two reviewers independently with a third reviewer resolving discrepancies. Results: Our review identified 42 primary research papers published between 1990 and 2021 that addressed parental management of AD with CAM. Commonly reported CAM practices included massage, homeopathy, chiropractic care, and acupuncture, with vitamins and minerals being the most frequently mentioned CAM products. Parents cited dissatisfaction with conventional medication, concerns about its side effects, and the perception of CAM as natural or safer than conventional medicine as primary reasons for CAM use. Parental CAM use strongly predicted child CAM use, yet there was low disclosure of CAM practices to conventional physicians. Reasons for non-disclosure included concerns about negative responses from physicians and perceptions of limited physician understanding of CAM. Parental educational level and family income were also predictive of CAM use. Conclusions: This review highlights the widespread use of CAM by parents managing their children’s AD and emphasises the need for improved communication between parents and healthcare providers. Methodological inconsistencies highlight the necessity for standardised protocols in future CAM research. Additionally, future studies should recognise the interplay between social structures and individual agency in shaping healthcare decisions.

Clinical trial number: Not applicable. PROTOCOL REGISTRATION
Keywords: Autoimmune disease; Children; Complementary and alternative medicine; Health service use.
Full text online PubMed: https://pubmed.ncbi.nlm.nih.gov/40634980/.

Does sedentary behaviour cause spinal pain in children and adolescents? A systematic review with meta-analysis
Laura R C Montgomery, Michael Swain, Amabile B Dario, Mary O’Keeffe, Tie P Yamato, Jan Hartvigsen, Simon French, Christopher Williams, Steve Kamper
Br J Sports Med. 2025 Mar 3;59(6):409-422.
doi: 10.1136/bjsports-2024-108648.

Abstract
Objective: To evaluate whether sedentary behaviour is a risk or prognostic factor for spinal pain in children and adolescents. Specifically, to estimate the (1) direction and strength of the association; (2) risk of spinal pain onset and (3) effect on spinal pain prognosis. Design: Systematic review with meta-analysis. Data sources: Electronic searches of MEDLINE, Embase, CINAHL and Web of Science up to 23 March 2023. Eligibility criteria for selecting studies: Reports estimating the effect of sedentary behaviour on spinal pain in young people (≤19 years). Results: We included 129 reports, 14 were longitudinal (n = 8 433) and 115 were cross-sectional (n > 697 590). We incorporated 86 studies into meta-analyses. (1) From cross-sectional data, we found low certainty evidence of a small positive association between sedentary behaviour and spinal pain (adjusted odds ratio 1.25 (95% CI 1.17 to 1.33), k = 44, n > 92 617). (2) From longitudinal data, we found low certainty evidence of no increased risk for the onset of spinal pain due to sedentary behaviour (adjusted risk ratio 1.07 (95% CI 0.84 to 1.35), k = 4, n = 1 292). (3) No studies assessed prognosis. Conclusion: Cross-sectional data suggest minimally higher odds of spinal pain for children and adolescents who engage in greater sedentary behaviours. However, longitudinal data do not support a causal relationship, indicating that sedentary behaviour does not increase the risk for onset of spinal pain. Due to the low certainty of evidence, these findings must be interpreted with caution. We found no evidence of the effect sedentary behaviour has on spinal pain prognosis in children and adolescents, highlighting a considerable gap in the literature.

Keywords: Adolescent; Back; Child; Neck; Sedentary Behavior.
Full online access:
PubMed: https://pubmed.ncbi.nlm.nih.gov/39438037/.
BMJ: https://bjsm.bmj.com/content/59/6/409.long.

The characteristics and health service utilization of adolescents with low back pain in a suburban pediatric health care system: analysis of health records data
Aubrianna L Jones, Jeffrey A King, Michael S Swain, Katherine A Pohlman, Channing Tassone, Robert J Trager
Chiropr Man Therap. 2025 Nov 28;33(1):54.
doi: 10.1186/s12998-025-00617-9.

Abstract
Background: Low back pain (LBP) is increasingly common among adolescents, yet little is known about the healthcare utilization in this population. We aimed to describe the characteristics and treatment patterns of adolescents with LBP presenting to a specialized comprehensive pediatric health system. Methods: This retrospective single-arm cohort design analyzed de-identified data from a suburban healthcare system. Using the TriNetX analytics platform, we queried electronic health records for adolescents aged 12-18 years with a new diagnosis of LBP between 2018 through 2022 without serious pathology such as cancer or infection. Key variables included baseline patient demographics, comorbidities, initial care setting, and the proportion and count of use of broad categories of healthcare services over a one-year follow-up window. Results: Our query identified 6,350 adolescents with LBP (mean age [standard deviation] of 14.8 [1.8] years; 60.6% female). The most common initial setting was ambulatory (80.5%). Services received by patients included non-opioid medication (38.8%), non-pharmacological conservative care (26.1%), diagnostic imaging (29.4%), opioids (11.3%), surgery (0.3%), and interventional injection therapies (≤ 0.2%). Conclusion: Among adolescents with newly diagnosed LBP from a specialized comprehensive pediatric healthcare system in Wisconsin from 2018 to 2022, 38.8% were prescribed non-opioid medications, 29.4% obtained diagnostic imaging, 26.1% had non-pharmacological conservative care, and 11.3% were prescribed opioids. Future studies should explore these findings in other care settings and examine optimal care pathways and associated clinical outcomes.

Keywords: Adolescent; Low back pain; Pain management.
Free online access:
PubMed: https://pubmed.ncbi.nlm.nih.gov/41316272/.
BMC: https://link.springer.com/article/10.1186/s12998-025-00617-9.

Exploring Manual Interventions for Infantile Colic: A Scoping Review of the Evidence
Roberto Tedeschi, Federica Giorgi
Children (Basel). 2025 Sep 17;12(9):1246.
doi: 10.3390/children12091246.

Abstract
Background: Infantile colic affects up to 40% of otherwise healthy infants and can severely distress caregivers. Manual therapies are increasingly employed as non-pharmacological options, yet their effectiveness and safety remain uncertain. Methods: A scoping review was conducted in accordance with Joanna Briggs Institute methodology and reported following PRISMA-ScR. Five databases (MEDLINE, CENTRAL, Scopus, PEDro, Web of Science) were searched from December 2024 to May 2025 without restrictions at the search stage; however, only English-language randomized controlled trials published from 2012 onwards were included at the eligibility stage to ensure consistency and focus on the most recent body of evidence. Randomised controlled trials (RCTs) evaluating hands-on interventions for infants ≤ 6 months with colic were eligible. Two reviewers independently screened records, charted data, and grouped outcomes narratively. Results: Seven RCTs investigated abdominal massage, paediatric Tuina, craniosacral therapy, chiropractic manipulation, osteopathic light touch, reflexology, and acupressure. Five trials reported statistically or clinically significant reductions in daily crying (0.6-6.6 h) compared with usual care or sham. Three studies also documented meaningful gains in sleep duration (1.1-2.8 h). Parent-reported satisfaction improved in most interventions. No serious adverse events were recorded, although safety monitoring was inconsistently reported. Substantial heterogeneity in diagnostic criteria, outcome measures, and intervention dose precluded meta-analysis. Conclusions: Low-force manual therapies may offer modest short-term relief for colicky infants and improve parental experience, with an apparently favourable safety profile. However, methodological variability and small sample sizes limit certainty. Standardized protocols, objective outcome measures, and robust adverse-event surveillance are priorities for future research.

Keywords: craniosacral therapy; infantile colic; manual therapy; massage.
Full Online access:
PubMed: https://pubmed.ncbi.nlm.nih.gov/41007111/.
MDPI: https://www.mdpi.com/2227-9067/12/9/1246/xml.

Osteopathic treatment of infants with infantile colic/excessive crying: a prospective, multicentric, randomized controlled trial and nested observational trial
Florian Schwerla, Marlen Zimmer, Janine Göpfert, Petra Laux, Simone Langenmair, Michaela Rütz, Karl-Ludwig Resch
BMC Pediatr. 2025 Jan 30;25(1):77.
doi: 10.1186/s12887-025-05413-1

Abstract
Background: Colic in infants is defined as excessive crying in an otherwise healthy and thriving baby. Colic is a common but poorly understood and often frustrating problem for caregivers. Objective: To study whether osteopathic treatments of infants with infantile colic / excessive crying (IC/EC) have an impact on the subjectively perceived psychological stress of caregivers compared to usual care. Methods: The study was designed as a prospective, multicenter, randomized controlled trial. Infants aged 1 week to 3 months and who met Rome IV criteria for IC/EC were included. By means of external randomization, infants were allocated to an intervention group or a control group. Infants in the intervention group received three osteopathic treatments at intervals of one weeks. The treatments were custom-tailored and based on osteopathic principles. Controls received their osteopathic treatment after a 3 week untreated period. The primary outcome parameter was the assessment of parental psychological stress (three questions), measured using a numeric rating scale (NRS; 0-10). Furthermore, the average daily crying time (measured using the Likert scale), the crying intensity (measured using the NRS) and the parents’ self-confidence (measured using the Karitane Parenting Confidence Scale) were assessed. Results: A total of 103 infants (average age 39.4 ±19.2 days) were included, 52 in the intervention group and 51 in the control group. An inter-group comparison of changes revealed clinically relevant improvements in favor of the intervention group for the main outcome - parameter psychological stress - for all 3 questions (e.g., for question 2 respectively 3, NRS: between group difference of means 3.5; 95% CI: 2.6 to 4.4; p < 0.001). For the secondary outcome parameters of crying intensity and crying time/day, the changes were of similar magnitude. Conclusion: Three osteopathic treatments given over a period of two weeks led to statistically significant and clinically relevant positive changes of parental psychological stress.

Trial registration: German Clinical Trials Register: DRKS00025867, registration date 10.08.21.
Keywords: Excessive crying; Infantile colic; Infants; OMT; Osteopathic medicine.
Full free online access:
PubMed: https://pubmed.ncbi.nlm.nih.gov/39885436/.
BMC: https://link.springer.com/article/10.1186/s12887-025-05413-1.

Use of osteopathic manipulation techniques for management of acute otitis media in pediatric patients: a scoping review
Cory Hyun-Su Kim, Lauren R McCray, Shaun A Nguyen , Carl Shermetaro, Wayne K Robbins
Eur Arch Otorhinolaryngol. 2025 Nov;282(11):5519-5528.
Data sources: CINAHL, PubMed, and SCOPUS.
Epub 2025 Jun 6.
doi: 10.1007/s00405-025-09492-9.

Abstract
Objective: To map and summarize the existing literature on the use of osteopathic manipulative techniques (OMT) in the management of acute otitis media (AOM) in pediatric patients, with an emphasis on reported outcomes and identifying gaps in the current evidence. Review methods: A comprehensive literature search was conducted across multiple databases following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Studies were charted and summarized based on key characteristics, including study design, population, types of OMT applied, and reported outcomes on management of AOM and recurrent AOM in pediatric patients using OMT. No formal meta-analysis was performed, and all outcome measures were descriptively synthesized. Results: Three randomized controlled trial (RCT) studies and one pilot cohort study (N = 205) pertaining to application of OMT in pediatric patients with otitis media were included. Mean age for OMT and control (either sham OMT or standard of care) groups were 19.1 months and 16.8 months; proportions of males were 53.2% and 55.9%, respectively. In the pilot cohort study done by Degenhardt and Kuchera, 62.5% of the subjects experienced no documented recurrence of AOM symptoms at one year post-OMT intervention follow-up; however, since no control group was available for this study, any statistical comparison of recurrence-free rate was unfeasible. In the RCT study by Mills et al., the OMT group showed statistically significant effects on reducing frequency of mean monthly AOM episodes, resulting in fewer surgical procedures, delaying surgical interventions, increasing resolution of middle ear effusion and better tympanogram readings based on mean sum of types A and C tympanograms, and higher parental satisfaction with overall experience and perceived effectiveness of the OMT on their children on a scale of 0 to 5 when compared to the control group. While statistical interpretation showed some significance in various aspects, OMT’s clinical significance remained questionable, especially considering natural course of healing in AOM. In the other RCT study by Steele et al., at the second-week visit during the 3-week OMT intervention period, the OMT group showed a significantly higher likelihood of middle ear effusion resolution based on tympanogram findings and acoustic reflectometer measurements, respectively. However, at one month follow-up visit, there was no statistical significance, alluding to the limited effects of OMT. Finally, in the last RCT study by Whal et al., the OMT group failed to show any significant effects on prevention of recurrence of AOM. Conclusion: Current literature on the use of OMT for acute and recurrent otitis media in pediatric patients suggests, with low certainty, that OMT may provide modest benefits in reducing recurrence rates and improving middle ear function. However, the existing evidence is limited in scope and quality. Further research with larger sample sizes and rigorous randomized controlled trial designs is needed to better understand the potential role of OMT in the management of AOM in pediatric patients.

Keywords: Acute otitis media; Children; Ear infection; Osteopathic manipulative treatment (OMT); Pediatric patients; Scoping review; Somatic dysfunction.
Full free online access;
PubMed: https://pubmed.ncbi.nlm.nih.gov/40481343/.
Springer Nature: https://link.springer.com/article/10.1007/s00405-025-09492-9.

Screen Time and Parent-Child Talk When Children Are Aged 12 to 36 Months
Mary E Brushe, Dandara G Haag, Edward C Melhuish, Sheena Reilly, Tess Gregory
JAMA Pediatr. 2024 Apr 1;178(4):369-375.
doi: 10.1001/jamapediatrics.2023.6790.

Abstract
Importance: Growing up in a language-rich home environment is important for children’s language development in the early years. The concept of “technoference” (technology-based interference) suggests that screen time may be interfering with opportunities for talk and interactions between parent and child; however, limited longitudinal evidence exists exploring this association. Objective: To investigate the longitudinal association between screen time and 3 measures of parent-child talk (adult words, child vocalizations, and conversational turns) when children are 12 to 36 months of age. Design, setting, and participants: This Australian prospective cohort study used advanced speech recognition technology to capture young children’s screen time and home language environment, on an average 16-hour day. Data were collected from 220 families once every 6 months in the family home when children were 12, 18, 24, 30, and 36 months of age, from January 1, 2018, to December 31, 2021. Statistical analysis took place from November 1, 2022, to July 31, 2023. Exposure: Language Environment Analysis (LENA) technology provided automated counts of children’s language environment and exposure to electronic noise. The exposure of interest was screen time, which was calculated based on manual coding of LENA electronic noise audio segments. Main outcomes and measures: Three measures of parent-child talk were outcomes of focus: adult words, child vocalizations, and conversational turns. Separate models were run for each of the 3 outcomes and included adjustment for child sex, child age, maternal educational level, number of children at home, number of home activities, and primary caregiver’s psychological distress. Results: The study included 220 families (120 girls [54.6%]; mean [SD] gestational age of children, 39.3 [1.5] weeks; mean [SD] age of mother at childbirth, 31.3 [4.8] years). Adjusted linear mixed-effect models demonstrated that increases in screen time were associated with decreases in measures of parent-child talk. The largest decreases were seen at 36 months, when an additional minute of screen time was associated with a reduction of 6.6 (95% CI, -11.7 to -1.5) adult words, 4.9 (95% CI, -6.1 to -3.7) child vocalizations, and 1.1 (95% CI, -1.4 to -0.8) conversational turns. Conclusion and relevance: Findings of this study support the notion of technoference for Australian families, whereby young children’s exposure to screen time is interfering with opportunities to talk and interact in their home environment. This finding has implications for interventions and supports aimed at promoting a language-rich home environment, with families needing support in understanding the potential association of screen time with opportunities for children and adults to talk and interact in their home environment.

Full free online access:
PubMed: https://pubmed.ncbi.nlm.nih.gov/38436942/.
JAMA: https://jamanetwork.com/journals/jamapediatrics/fullarticle/2815514.

Pregnancy, Labor, Delivery and Postpartum—2025 Update Evaluation of the evidence on acetaminophen use and neurodevelopmental disorders using the Navigation Guide methodology
Diddier Prada, Beate Ritz, Ann Z Bauer, Andrea A Baccarelli
Environ Health. 2025 Aug 14;24(1):56.
doi: 10.1186/s12940-025-01208-0.

Abstract
Background: Acetaminophen is the most commonly used over-the-counter pain and fever medication taken during pregnancy, with > 50% of pregnant women using acetaminophen worldwide. Numerous well-designed studies have indicated that pregnant mothers exposed to acetaminophen have children diagnosed with neurodevelopmental disorders (NDDs), including autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD), at higher rates than children of pregnant mothers who were not exposed to acetaminophen. Methods: We applied the Navigation Guide methodology to the scientific literature to comprehensively and objectively examine the association between prenatal acetaminophen exposure and NDDs and related symptomology in offspring. We conducted a systematic PubMed search through February 25, 2025, using predefined inclusion criteria and rated studies based on risk of bias and strength of evidence. Due to substantial heterogeneity, we opted for a qualitative synthesis, consistent with the Navigation Guide’s focus on environmental health evidence.Results: We identified 46 studies for inclusion in our analysis. Of these, 27 studies reported positive associations (significant links to NDDs), 9 showed null associations (no significant link), and 4 indicated negative associations (protective effects). Higher-quality studies were more likely to show positive associations. Overall, the majority of the studies reported positive associations of prenatal acetaminophen use with ADHD, ASD, or NDDs in offspring, with risk-of-bias and strength-of-evidence ratings informing the overall synthesis. Conclusions: Our analyses using the Navigation Guide thus support evidence consistent with an association between acetaminophen exposure during pregnancy and increased incidence of NDDs. Appropriate and immediate steps should be taken to advise pregnant women to limit acetaminophen consumption to protect their offspring’s neurodevelopment.

Keywords: ADHD; ASD; Acetaminophen; Neurodevelopmental; Pregnancy.
Full free text online:
PubMed: https://pubmed.ncbi.nlm.nih.gov/40804730/.
BMC: https://link.springer.com/article/10.1186/s12940-025-01208-0.

Combined Complementary and Alternative Therapies for the Management of a Breech Fetus: A Feasibility Study
Shilpa Babbar, Karen B. Williams, Lisa Vawter
AJP Rep 2025; 15(03): e98-e105.
doi: 10.1055/a-2639-7353.

Abstract
Objective: Cesarean rates are rising in the United States, especially for breech presentations, which complicates 3 to 4% of term pregnancies and contributes to maternal morbidity. Complementary and alternative therapies (CT) like moxibustion, chiropractic, and hypnosis have been suggested as noninvasive options to encourage fetal version. This study assessed the feasibility and acceptability of combined CT for breech management. Study Design: Women aged>18 with a singleton breech fetus at 34 to 37 weeks engaged in three study visits within 2 weeks. The intervention included therapies such as Spinning Babies techniques, yoga postures, mindset techniques, and chiropractic adjustments. Stress levels were assessed pre- and postintervention. Results: Of 24 referrals, 11 completed the study. No fetuses converted to vertex, but participants reported significantly reduced stress (p=0.02). After the intervention, 54.5% opted for an external cephalic version, with a 50% success rate leading to two vaginal deliveries. All participants found the program beneficial, reporting high satisfaction with program duration, structure, and exercises. Conclusion: Although fetal version was not achieved, this CT-based program significantly reduced maternal stress, suggesting its value as an emotional management tool in breech pregnancies. Larger trials are needed to evaluate its efficacy in promoting fetal version and improving maternal outcomes. Key Points:
• Approximately 86.9% of breech fetuses are delivered by cesarean section.
• Complementary therapies are often employed for a breech fetus with varying success.
• Combined complementary therapies for a breech fetus led a significant reduction in stress.

Keywords: yoga - breech - spinning babies - chiropractic care - pregnancy
Full free online access:
Thieme: https://www.thieme-connect.de/products/ejournals/html/10.1055/a-2639-7353.

Association of oxytocin massage with oxytocin hormone levels and breast milk production in mothers with postpartum blues
H Hidayati, M Syafar, S Syamsuddin, E C Jusuf, M Ahmad, R Chaliks
Affiliations Expand
Med J Malaysia. 2025 Nov;80(6):848-852.
PMID: 41328846

Abstract
Introduction: Postpartum blues is a mild adaptation disorder in postpartum mothers that affects psychological and physiological conditions, including breast milk production. This condition significantly impacts maternal health and infant development. This study aimed to examine the association between oxytocin massage, oxytocin hormone levels, and breast milk production in mothers with postpartum blues. Materials and methods: A quasi-experimental pre-test and post-test design with treatment and control groups was used. The study was conducted at Siti Fatimah Special District Hospital for Maternal and Child Makassar and Pertiwi Mother and Child Hospital Makassar, from February to November 2024. A total of 68 postpartum mothers with postpartum blues were divided into two groups (34 participants per group). Screening was performed using the EPDS scale, oxytocin levels were measured using the ELISA method, and breast milk production was assessed using a composite scoring system based on three main indicators: (1) infant weight gain, evaluated using the mean value (X) and standard deviation (SD); (2) breastfeeding frequency, recorded through maternal reports and structured observation; and (3) breastfeeding duration, assessed based on the average time per feeding session. Each indicator was assigned a score ranging from 1 to 3, corresponding to low (score 1), moderate (score 2), and high (score 3) levels. The total score from these three components was used to classify overall breast milk production into three categories: high production (total score 7-8), moderate production (total score 5-6), and low production (total score 3-4). Statistical analysis was conducted using SPSS. Results: The baseline characteristics were evenly distributed across between the groups. The reduction in EPDS scores was greater in the treatment group (13.44 ± 2.765 to 12.12 ± 3.832) than in the control group (13.97 ± 3.196 to 13.26 ± 2.864), with a significant between-group difference (p = 0.000). Moreover, oxytocin levels increased significantly in the treatment group (47.57 ± 10.42 pg/mL to 52.62 ± 11.33, p = 0.001), whereas no significant change was observed in the control group, except for the comparison of the difference in oxytocin levels between the two groups confirming that this difference is statistically significant (p = 0.007). Conclusion: This study suggests that oxytocin massage may serve as a complementary approach therapy for reducing postpartum blues symptoms and enhancing breast milk production. Its integration into clinical practice can support maternal postpartum care by promoting emotional well-being and improving lactation outcomes.

Full free online access:
PubMed: https://pubmed.ncbi.nlm.nih.gov/41328846/.
Article: https://www.e-mjm.org/2025/v80n6/oxytocin-massage.pdf.

Back Acupressure, Baby Positioning and Latching, and Breast Massage Increase Breast Milk Production: A Controlled Clinical Trial
Nurul Pujiastuti, Sri Winarni
Acta Med Philipp. 2025 Oct 31;59(16):93–99.
doi: 10.47895/amp.vi0.9130.

Abstract
Background and Objective: Factors that can affect breast milk production include food intake, baby suckling, breast massage, breast anatomy, peace of mind and soul, and rest. Efforts to increase breast milk production can be pharmacological or non-pharmacological therapies. One non-pharmacological method is to use complementary therapy. The aim of this study was to assess the effects of back acupressure, baby attachment position, and breast massage on breast milk production. Methods: This study used a controlled clinical trial design. We recruited 100 breastfeeding mothers, and divided them into two groups of 50 each. In the treatment group, back acupressure, baby attachment position, and breast massage were performed. The control group did not receive any intervention, they only followed the usual breastfeeding practices. Data analysis comparing the pre-test and post-test breast milk production utilized the Wilcoxon Test. The significance level was set at p <0.05. Results: All respondents completed the four-week study period. Back acupressure, baby attachment position, and breast massage significantly increased breast milk production (p = 0.00, Wilcoxon Test). Conclusion: The findings of this study demonstrated that back acupressure, correct baby attachment positioning, and breast massage significantly increased breast milk production in breastfeeding mothers. These non-pharmacological therapies show promise in enhancing lactation. Further research should explore the optimal frequency and duration of these interventions to maximize their effectiveness in promoting breast milk production.

Keywords: acupressure, breast, massage, lactation
Full Free Online Access:
PubMed: https://pmc.ncbi.nlm.nih.gov/articles/PMC12666091/.
PDF: https://actamedicaphilippina.upm.edu.ph/index.php/acta/article/view/9130/6900.

Relaxation Therapy and Human Milk Feeding Outcomes: A Systematic Review and Meta-Analysis
Ilana Levene, Nurul Husna Mohd Shukri, Frances O’Brien, Maria A Quigley, Mary Fewtrell
JAMA Pediatr. 2024 Jun 1;178(6):567-576.
doi: 10.1001/jamapediatrics.2024.0814.

Abstract
Importance: Human milk feeding is a key public health goal to optimize infant and maternal/parental health, but global lactation outcomes do not meet recommended duration and exclusivity. There are connections between lactation and mental health. Objective: To appraise all available evidence on whether the provision of relaxation interventions to lactating individuals improves lactation and well-being. Data sources: Embase, MEDLINE, CINAHL, Allied and Complementary Medicine Database, Web of Science, and the Cochrane Library were searched on September 30, 2023, and topic experts were consulted. Study selection: Two independent reviewers screened for eligibility. Inclusion criteria were full-text, peer-reviewed publications with a randomized clinical trial design. Techniques that were entirely physical (eg, massage) were excluded. A total of 7% of initially identified studies met selection criteria. Data extraction and synthesis: Two independent reviewers extracted data and assessed risk of bias with the Cochrane Risk of Bias 2 tool. Fixed-effects meta-analysis and Grading of Recommendations, Assessment, Development, and Evaluations guidelines were used to synthesize and present evidence. Main outcomes and measures: Prespecified primary outcomes were human milk quantity, length and exclusivity of human milk feeding, milk macronutrients/cortisol, and infant growth and behavior. Results: A total of 16 studies were included with 1871 participants (pooled mean [SD] age for 1656 participants, 29.6 [6.1] years). Interventions were music, guided relaxation, mindfulness, and breathing exercises/muscle relaxation. Provision of relaxation was not associated with a change in human milk protein (mean difference [MD], 0 g/100 mL; 95% CI, 0; 205 participants). Provision of relaxation was associated with an increase in human milk quantity (standardized mean difference [SMD], 0.73; 95% CI, 0.57-0.89; 464 participants), increased infant weight gain in breastfeeding infants (MD, z score change = 0.51; 95% CI, 0.30-0.72; 226 participants), and a slight reduction in stress and anxiety (SMD stress score, -0.49; 95% CI, -0.70 to -0.27; 355 participants; SMD anxiety score, -0.45; 95% CI, -0.67 to -0.22; 410 participants). Conclusions and relevance: Results of this systematic review and meta-analysis suggest that provision of relaxation was associated with an increase in human milk quantity and infant weight gain and a slight reduction in stress and anxiety. Relaxation interventions can be offered to lactating parents who would like to increase well-being and improve milk supply or, where directly breastfeeding, increase infant weight gain.

Full free online access:
PubMed: https://pubmed.ncbi.nlm.nih.gov/38709505/.
JAMA: https://jamanetwork.com/journals/jamapediatrics/fullarticle/2818395.

Maternal dietary intervention during lactation impacts the maternal faecal and human milk microbiota
Azhar S Sindi, Lisa F Stinson, Zoya Gridneva, Gabriela E Leghi, Merryn J Netting, Mary E Wlodek, Beverly S Muhlhausler, Alethea Rea, Michelle L Trevenen, Donna T Geddes, Matthew S Payne
J Appl Microbiol. 2024 May 1;135(5):lxae024.
doi: 10.1093/jambio/lxae024.

Abstract
Aims: To determine the effect of a two-week reduced fat and sugar and increased fibre maternal dietary intervention on the maternal faecal and human milk (HM) microbiomes. Methods and results: Faecal swabs and HM samples were collected from mothers (n = 11) immediately pre-intervention, immediately post-intervention, and 4 and 8 weeks post-intervention, and were analysed using full-length 16S rRNA gene sequencing. Maternal macronutrient intake was assessed at baseline and during the intervention. Maternal fat and sugar intake during the intervention were significantly lower than pre-intervention (P = <0.001, 0.005, respectively). Significant changes in the bacterial composition of maternal faeces were detected after the dietary intervention, with decreases in the relative abundance of Bacteroides caccae (P = <0.001) and increases in the relative abundance of Faecalibacillus intestinalis (P = 0.006). In HM, the diet resulted in a significant increase in Cutibacterium acnes (P = 0.001) and a decrease in Haemophilus parainfluenzae (P = <0.001). The effect of the diet continued after the intervention, with faecal swabs and HM samples taken 4 and 8 weeks after the diet showing significant differences compared to baseline. Conclusion: This pilot study demonstrates that short-term changes in maternal diet during lactation can alter the bacterial composition of the maternal faeces and HM.

Keywords: breastfeeding; human milk microbiome; maternal diet; maternal faecal microbiome.
PubMed: https://pubmed.ncbi.nlm.nih.gov/38323424/.
Journal of Applied Microbiology: https://academic.oup.com/jambio/article/135/5/lxae024/7602404?login=false.

Interventions for Maintaining Pelvic Floor Health During Pregnancy: A Systematic Review
Yuxuan Wu, Yanbo Zhong, Chao Xu, Hang Li, Mengting Chen, Ling Xu
Physiother Res Int. 2025 Jul;30(3):e70077.
doi: 10.1002/pri.70077.

Abstract
Background and purpose: Pregnancy is a unique life stage for women and is also an independent risk factor for pelvic floor disorders (PFD). Physiological changes during pregnancy can weaken pelvic floor support, potentially leading to common pelvic floor dysfunctions such as urinary incontinence, fecal incontinence, chronic pelvic pain, sexual dysfunction, rectus diastasis, and pelvic organ prolapse if left unaddressed. Early preventive interventions are recommended to reduce the overall incidence of PFD. This review aims to summarize various preventive health care strategies for pelvic floor health during pregnancy. Methods: A comprehensive review of the literature was conducted, focusing on studies related to pelvic floor health care during pregnancy. Relevant articles were selected based on their contributions to understanding preventive measures and interventions aimed at maintaining pelvic floor health. Results: The research findings outline effective methods for pelvic floor health care during pregnancy, including health education, breathing exercises, pelvic floor muscle training, weight management, perineal massage, and holistic exercise programs. The literature search spanned six electronic databases (PubMed, Cochrane Library, Web of Science, CNKI, Wanfang, and Weipu) with 60 studies meeting inclusion criteria. Given the profound impact of pelvic floor dysfunction on women’s quality of life, these strategies can specifically alleviate pelvic floor strain during pregnancy, improve delivery outcomes, promote postpartum recovery, and reduce the risk of PFD, thereby playing a significant role in supporting the overall health of mothers. Discussion: Emphasizing early management of pelvic floor health is crucial for the recovery of pelvic floor tissues in pregnant women and should be widely implemented in clinical practice. Healthcare providers should consider each pregnant woman’s individual health status, physical abilities, and maternal-fetal safety to develop personalized exercise plans, employing appropriate strategies for early intervention against the pelvic floor during pregnancy which may successfully prevent pelvic floor disorders in women.

Keywords: pelvic floor; pregnancy; preventive health care.
THIS ONE DOES NOT HAVE - Full free online access:
PubMed: https://pubmed.ncbi.nlm.nih.gov/40492459/.

Pelvic floor muscle exercise practice and its determinants among postpartum women in Central Ethiopia: as a strategy for preventing pelvic floor disorders
Mebratu Demissie Senbeta, Aberash Beyene Derribow, Aynalem Belay, Ayana Benti Terefe, Mangistu Abera
Sci Rep. 2025 Nov 26;15(1):42129.
doi: 10.1038/s41598-025-26029-6.

Abstract
Pelvic floor disorders are highly prevalent among reproductive-age women in sub-Saharan Africa and commonly lead to urinary incontinence, pelvic organ prolapse, bowel dysfunction, sexual problems, and reduced quality of life. Pelvic floor muscle exercise, defined as repeated contraction and relaxation of the pelvic floor muscles, is an effective preventive and non-surgical treatment of pelvic floor disorders. However, despite the high burden of pelvic floor disorders in Ethiopia, the significance and role of pelvic floor muscle exercise have not yet been studied in a study setting. This study aimed to assess the Pelvic Floor Muscle Exercise Practice and Its Determinants among Postpartum Women in Gurage Zone, Central Ethiopia. A community-based cross-sectional study was employed from May 12 to June 12, 2023. 422 postpartum women were selected using a systematic random sampling technique. A pre-tested and structured questionnaire was used for data collection. Data were entered into Epidata 3.1 and exported into SPSS version 26 software for analysis. Both bivariable and multivariable binary logistic regressions were performed. Variables with a P-value < 0.05 at a 95% confidence interval were considered statistically significant. In this study,420 study participants were included with a response rate of 99.5%. The proportion of women practicing pelvic floor exercises was 12.14% (95% CI: 6.3, 18.7). Higher education (AOR = 1.40; 95% CI: 1.27, 4.31), ANC visits (AOR = 4.31;95%CI:1.36, 9.57), women with urinary incontinence (AOR = 6.47;95%CI:3.96, 11.54), and women’s knowledge (AOR = 6.31;95%CI:3.59, 12.23) were determinants of pelvic floor muscle exercise practice. The present study showed that 87.86% of postpartum mothers lacked proper pelvic floor muscle exercise practices. Thus, encouraging women to attend ANC visits as recommended, providing awareness through health education, and offering counseling on pelvic floor muscle exercises can increase their practice and help reduce pelvic floor disorders.

Keywords: Determinants; Ethiopia; Pelvic floor muscle exercise; Postpartum women.
Full Free Online access:
PubMed: https://pubmed.ncbi.nlm.nih.gov/41298630/.
Nature: https://www.nature.com/articles/s41598-025-26029-6.

The hidden power in the miracle of pregnancy: the effect of pelvic floor muscle training on fetal and fetal-maternal blood circulation and pelvic floor muscles during pregnancy, a randomized controlled trial
Melda Baser Seçer, Sinem Çiçek Güvendik, Ozge Çeliker Tosun, Onur Yavuz, Sefa Kurt, Gökhan Tosun, Merve Basol Goksuluk
BMC Pregnancy Childbirth. 2025 Nov 19;25(1):1241.
doi: 10.1186/s12884-025-08412-3.

Abstract
Background: This study aimed to evaluate the effects of individualized pelvic floor muscle training (PFMT) in pregnant women on clitoral artery, umbilical artery (UmA), middle cerebral artery (MCA), uterine artery (UA) blood flow, and pelvic floor muscle (PFM) function. Methods: Forty-seven primiparous women between 20 and 38 weeks of gestation were included in the study. Participants were randomly divided into exercise (n = 23) and control (n = 24) groups. The exercise group received an individualized PFMT home program, while the control group received standard antenatal care. Blood flow measurements of the clitoral, UmA, MCA, and UA were performed with Doppler ultrasonography (USG) in both groups. Additionally, PFM function was assessed by digital palpation using the PERFECT system and USG. Measurements were repeated three times at 20-24, 28-32, and 35-38 weeks of gestation. Results: A statistically significant increase was observed in PFM endurance and fast twitch values in the PFMT group (p < 0.001). No statistically significant difference was found between the groups in the pulsatility indices (PI) of the clitoral, UmA, MCA, and UA at three time points (p > 0.05). However, as pregnancy progressed, UmA PI decreased more in the exercise group (p = 0.004). The time-dependent change in the MCA/UmA PI ratio was not statistically significant across groups (p = 0.075). A Generalized Estimating Equations (GEE) model was used to evaluate the significance of main effects for group, time, and their interaction (group × time). Conclusion: PFMT during pregnancy has positive effects on the PFM function and may play a modulating role in the maternal and fetal circulatory systems. Specifically, the positive changes observed in UmA blood flow support the potential benefits of PFMT for fetal well-being. Therefore, we believe recommending PFMT to pregnant women in clinical practice has the potential to enhance their quality of life and support a healthy pregnancy journey. However, more comprehensive, long-term postnatal follow-up studies are needed to definitively confirm PFMT’s long-term effects on fetal neurodevelopment.

Trial registration: NCT06861335, 02/28/2025 (retrospectively registered).
Keywords: Blood flow; Fetal doppler ultrasonography; Fetal well-being; MCA; PFMT; Uterine artery.
Full free online access:
Pubmed: https://pubmed.ncbi.nlm.nih.gov/41257651/.
BMC: https://link.springer.com/article/10.1186/s12884-025-08412-3.

Teen Pregnancy and Risk of Premature Mortality
Joel G Ray, Longdi Fu, Peter C Austin, Alison L Park, Hilary K Brown, Sonia M Grandi, Ashley Vandermorris, Alexa Boblitz, Eyal Cohen
AMA Netw Open. 2024 Mar 4;7(3):e241833.
doi: 10.1001/jamanetworkopen.2024.1833.

Abstract
Importance: Unintentional injury, suicide, and homicide are leading causes of death among young females. Teen pregnancy may be a marker of adverse life experiences. Objective: To evaluate the risk of premature mortality from 12 years of age onward in association with number of teen pregnancies and age at pregnancy. Design, setting, and participants: This population-based cohort study was conducted among all females alive at 12 years of age from April 1, 1991, to March 31, 2021, in Ontario, Canada (the most populous province, which has universal health care and data collection). The study period ended March 31, 2022. Exposures: The main exposure was number of teen pregnancies between 12 and 19 years of age (0, 1, or ≥2). Secondary exposures included how the teen pregnancy ended (birth or miscarriage vs induced abortion) and age at first teen pregnancy. Main outcomes and measures: The main outcome was all-cause mortality starting at 12 years of age. Hazard ratios (HRs) were adjusted for year of birth, comorbidities at 9 to 11 years of age, and area-level education, income level, and rurality. Results: Of 2 242 929 teenagers, 163 124 (7.3%) experienced a pregnancy at a median age of 18 years (IQR, 17-19 years). Of those with a teen pregnancy, 60 037 (36.8%) ended in a birth (of which 59 485 [99.1%] were live births), and 106 135 (65.1%) ended in induced abortion. The median age at the end of follow-up was 25 years (IQR, 18-32 years) for those without a teen pregnancy and 31 years (IQR, 25-36 years) for those with a teen pregnancy. There were 6030 deaths (1.9 per 10 000 person-years [95% CI, 1.9-2.0 per 10 000 person-years]) among those without a teen pregnancy, 701 deaths (4.1 per 10 000 person-years [95% CI, 3.8-4.5 per 10 000 person-years]) among those with 1 teen pregnancy, and 345 deaths (6.1 per 10 000 person-years [95% CI, 5.5-6.8 per 10 000 person-years]) among those with 2 or more teen pregnancies; adjusted HRs (AHRs) were 1.51 (95% CI, 1.39-1.63) for those with 1 pregnancy and 2.14 (95% CI, 1.92-2.39) for those with 2 or more pregnancies. Comparing those with vs without a teen pregnancy, the AHR for premature death was 1.25 (95% CI, 1.12-1.40) from noninjury, 2.06 (95% CI, 1.75-2.43) from unintentional injury, and 2.02 (95% CI, 1.54-2.65) from intentional injury. Conclusions and relevance: In this population-based cohort study of 2.2 million female teenagers, teen pregnancy was associated with future premature mortality. It should be assessed whether supports for female teenagers who experience a pregnancy can enhance the prevention of subsequent premature mortality in young and middle adulthood.

Full Free Online Access:
PubMed: https://pubmed.ncbi.nlm.nih.gov/38483391/.
JAMA: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2816198.