Associations apparent for any, exclusive, and cumulative (at least 1 year) breastfeeding

Breastfeeding may lower mothers’ later life risks of depression and anxiety for up to 10 years after pregnancy, suggest the findings of a small observational study, published in the open access journal BMJ Open.

The observed associations were apparent for any, exclusive, and cumulative (at least 12  months) breastfeeding, the study shows.

Breastfeeding is associated with lower risks of postnatal depression and anxiety, but it’s not clear if these lowered risks might persist in the longer term, say the researchers.

To find out, they tracked the breastfeeding behaviour and health of 168 second time mothers who were originally part of the ROLO Longitudinal Birth Cohort Study for 10 years.

All the women had given birth to a child weighing under 4 kg and they and their children had check-ups 3 and 6 months, and 2, 5, and 10 years after birth by which time the mothers’ average age was 42.

At each check-up, the mothers completed a detailed health history questionnaire. This asked whether they had been diagnosed with, and treated for, depression/anxiety. They also provided information on potentially influential factors, including diet and physical activity levels.

At the check-ups, the mothers provided information on: whether they had ever breastfed or expressed milk for 1 day or more; total number of weeks of exclusive breastfeeding; total number of weeks of any breastfeeding; and cumulative periods of breastfeeding of less or more than 12 months.

Nearly three quarters of the women (73%; 122) reported having breastfed at some point. The average period of exclusive breastfeeding lasted 5.5 weeks and that of any breastfeeding for 30.5 weeks. More than a third (37.5%; 63) reported cumulative periods of breastfeeding adding up to at least 12 months.

Twenty two (13%) of the women reported depression/anxiety at  the 10-year check-up, with a further 35 (21%) reporting depression or anxiety at any time point.

Those reporting depression/anxiety at the 10 year check-up were younger,  less physically active, and had lower wellbeing scores at the start of the study than those who didn’t report this. Those women reporting depression and anxiety at any time point differed only by age at the start of the study.

Analysis of the data showed that women experiencing depression and anxiety 10 years after pregnancy were less likely to have breastfed and had shorter periods of any or exclusive breastfeeding over their lifetime.

Each week of lifetime exclusive breastfeeding was associated with a 2% lower likelihood of reporting depression and anxiety, after accounting for potentially influential factors, including alcohol intake.

This is an observational study, and as such, no firm conclusions can be drawn about cause and effect. And the researchers acknowledge that participants were relatively few in number, not ethnically or socially diverse, and that the study relied on personal recall rather than objective measures of depression/anxiety.

Nevertheless, they write: “We suggest there also may be a protective effect of successful breastfeeding on postpartum depression and anxiety, which in turn lowers the risk of maternal depression and anxiety in the longer term.”

They explain: “The likelihood is that the association is multifactorial, as many socioeconomic and cultural factors influence both breastfeeding and mental health in addition to the impact of health history.  Additionally, women with a prior history of depression and anxiety are at risk of lower breastfeeding success, compounding the association but in the reverse direction.”

They conclude: “We know that improving breastfeeding rates and duration can improve lifetime health outcomes, reducing population level disease burden and resulting in significant healthcare savings.

“The possibility that breastfeeding could further reduce the huge burden of depression on individuals, families, healthcare systems and economies only adds to the argument for policymakers to improve breastfeeding support.”

08/01/2025

Notes for editors
Research: Breastfeeding and later depression and anxiety in mothers in Ireland: a 10- year prospective observational study Doi: 10.1136/bmjopen-2024-097323
Journal: BMJ Open

External funding: Health Research Board, Ireland; Health Research Centre for Health and Diet Research; National Maternity Hospital Medical Fund; European Commission Seventh Framework Programme; Children’s Health Ireland

Link to Academy of Medical Sciences press release labelling system http://press.psprings.co.uk/AMSlabels.pdf  

About the journal
BMJ Open is one of 70 journals published by BMJ Group.
https://bmjopen.bmj.com

Externally peer reviewed? Yes
Evidence type: Observational
Subjects: Mothers

The post Breastfeeding may lower mums’ later life depression/anxiety risks for up to 10 years after pregnancy first appeared on BMJ Group.

Leaves some women anxious and confused about their breast health and may increase demand on health services, say researchers

Recommendations introduced in Australia and being considered in the UK to tell women if they have dense breasts as part of their screening results may have unintended effects and increase demand on health services, finds a clinical trial designed to assess the real-world impact of notification, published by The BMJ today.

The results show that women who were notified of their dense breasts (which can hide small cancers on a mammogram, making them harder to detect) felt more anxious and confused about their breast health 8 weeks after their screening appointment, and were more likely to want advice from their general practitioner (GP) about what to do next, despite the lack of clear evidence-based and equitable clinical pathways.

As such, the researchers say that population breast density notification “should be carefully considered owing to potential adverse outcomes.”

Breast density notification is already mandatory in the US, is moving in that direction in Australia, and being considered in other countries including the UK on the premise that it helps women to make more informed decisions about their breast health. But robust evidence on whether the benefits of notifying women who are having mammography screening outweigh the potential harms is lacking.

To address this knowledge gap, researchers in Australia set out to investigate the real-world impact of notifying women of their dense breasts on their psychosocial outcomes and their health service use intentions.

Their findings are based on data from 2,401 women (average age 57) screened as part of the national population-based screening programme between September 2023 and July 2024 who were classified as having dense breasts (BI-RADS category C and D).

Details such as age, language/s spoken, and personal and family history of cancer were collected and women were randomised to either standard “control” care (no notification of breast density in their results letter), notification of breast density plus written information about breast density and its implications (intervention 1), or notification of density plus a link to online video based information (intervention 2).

After 8 weeks, women reported their prior awareness of breast density, self-rated health and wellbeing, health literacy, and preferences for more or less healthcare. They were also surveyed about their psychological response to their results (feeling anxious, confused, or informed) and their intentions to talk to their GP and pursue additional screening.

Compared with the control group, women notified of their breast density had greater odds of feeling anxious (control: 18%; intervention 1: 20.8%; intervention 2: 20.5%) and were significantly more confused (control: 2.7%; intervention 1: 11.5%; intervention 2: 9%) about what to do.

Both notified groups also had significantly higher intentions to talk to their GP about their screening results (intervention 1: 22.8%; intervention 2: 19.4%) compared with the control arm (12.9%), although most women did not intend to have additional screening.

And notified women did not feel better informed to make decisions about their breast health compared with controls.

The authors acknowledge several limitations including the low proportion of women from non-English speaking backgrounds in the trial.

However, they say this is the first international trial to rigorously evaluate the immediate consequences of breast density notification, providing key evidence for breast cancer screening programmes outside of the US contemplating introducing density notification or legislation.

They conclude: “Internationally, as the momentum for risk based breast cancer screening continues, breast density will continue to be a risk factor of focus. However, waiting for additional data on beneficial and equitable clinical pathways and carefully planning the provision of breast density information in the context of other risk factors for women may be prudent to ensure that both the short term and longer term benefits outweigh potential harms.”

03/12/2025

Notes for editors
Research: Impact of population based breast density notification: three arm screening programme embedded randomised controlled trial doi: 10.1136/bmj-2024-083649
Journal: The BMJ

External funding: National Health and Medical Research Council, National Breast Cancer Foundation, Cancer Screening Unit, Department of Health, Queensland Government

Link to Academy of Medical Sciences press release labelling system: http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes
Evidence type: Randomised controlled trial
Subjects: Women

The post Telling women as part of mammography screening that they have dense breasts may have unintended effects first appeared on BMJ Group.

Among other things, this should be free of body shaming, idealised body types, and gendered norms, says the world’s first Consensus Statement on this topic

Creating a safe, gender-specific, supportive environment—one that is free of body shaming and idealised female forms, for example—is key to minimising female athletes’ future risks of injury and protecting their health, emphasises the Female/woman/girl Athlete Injury pRevention (FAIR) Consensus Statement—the first of its kind—published online in the British Journal of Sports Medicine.

Women and girls have increasingly been taking part in sports, which has led to a concomitant rise in their risk of injury. But how best to minimise this risk has been hampered by a lack of comprehensive and practical gender-specific evidence.

In a bid to tackle this knowledge gap and both promote and protect female athletes’ health, the International Olympic Committee convened a panel of sports and exercise specialists from around the globe to draw up a series of workable recommendations, with the aim of  informing current policy and practice and guiding future avenues of research.

The 56 recommendations in the Statement are based on syntheses of the best available evidence, combined with the lived experiences of athletes, as well as those involved in regulation, policy, practice, professional and personal support, to span the ‘whole sports system’.

The recommendations, which range from universal to sport specific, also include primary injury prevention strategies; policy, rules, and legislation; personal protective equipment; training; secondary injury prevention; modifiable risk factors; and approaches to diversity and inclusion.

“Injury prevention strategies cannot work if female/women/girl athletes do not have access to resources, knowledge or training/competition environments that support implementation of best practice injury prevention, health, and performance strategies that consider their needs,” says the Statement.

“The FAIR recommendations to facilitate a supportive environment include creating equitable funding and resource allocation (eg, injury prevention implementation, equipment, coach/support staff, gender/sex-preferred uniforms and surveillance systems with female/woman/girl-specific health codes) and access to expertise and knowledge through education, targeted research and hiring practices,” it continues.

Everyone who works in sport needs to be involved, urges the Statement.

“Recommendations such as ‘Create safe spaces free from body shaming or promoting ideal body types, or gendered norms’ might appear sensible, but they are NOT always part of female/woman/athletes’ reality. They should be front-of-mind and non-negotiable. At all levels of sport, responsibility must be taken for actions that can influence female/woman/girl athlete health,” it emphasises.

Other related recommendations include creating and enforcing gender based policies and procedures to tackle interpersonal violence and harassment, and fostering a non-judgmental culture in which issues, such as pregnancy, bone health, and breast care can be discussed and accommodated.

Policies to address unconscious and explicit social and cultural biases against women and girls’ sports participation and health are also essential, it says.

Lifelong injury prevention needs to start early to forge good preventive behaviours. And it needs to be a collaborative effort between athletes, coaches, and practitioners, and be evidence based, says the Statement.

Other key recommendations include:

●       Mandatory neuromuscular training warm-ups for all sports and all ages to ward off first and recurrent leg injuries, lasting a minimum of 10 minutes, twice a week

●       Implementation and enforcement of rules/policies that penalise unlawful head/body contact

●       Mandatory injury management across all sports to prevent concussion

●       All child and teen ice hockey players to wear mouthguards

●       All cyclists, skiers, snowboarders, skateboarders, horseriders to wear helmets

●       Neckguards/protectors to be worn for collision/contact ice sports

“We recognise that these recommendations must be responsive to diverse contexts, including uniqueness in experiences, expertise, geography, culture, healthcare access, sport structure, level of participation and sociocultural considerations,” says the Statement.

But it concludes: “To bolster female/women/girl athlete health and safety, every person (at all levels of sport participation and in their own specific context) can, and should, take responsibility to carefully consider and action these recommendations.”

03/12/2025

Notes for editors
*The Statement was informed by 5 systematic reviews, 1 scoping review, and 1 concept mapping study that synthesised more than 600 research articles involving more than 600,000 participants

Consensus statement: Female, woman and/or girl Athlete Injury pRevention (FAIR) practical recommendations: International Olympic Committee (IOC) consensus meeting held in Lausanne, Switzerland, 2025 Doi: 10.1136/bjsports-2025-110889
Journal: British Journal of Sports Medicine

External funding: International Olympic Committee

Link to Academy of Medical Science press release labelling system
http://press.psprings.co.uk/AMSlabels.pdf

About the journal
The British‌ ‌Journal‌ ‌of‌ ‌Sports‌ ‌Medicine‌‌ is one of 70 journals published by BMJ Group. ‌The title is co-owned with the British‌ ‌Association‌ ‌of‌ ‌Sports‌ ‌and‌ ‌Exercise‌ ‌Medicine‌ ‌(BASEM).‌
https://bjsm.bmj.com

Externally peer reviewed? Yes
Evidence type: Consensus statement
Subjects: Female athletes

The post Gender-specific supportive environment key to cutting female athletes’ injury risks first appeared on BMJ Group.

New findings may help inform global standards for healthy growth and weight gain in pregnancy and highlight the need for more support for healthy pregnancy

Around two-thirds (68%) of pregnancies have weight gain that is more or less than recommended and that is associated with complications such as preterm birth, large birth weight, and admission to intensive care, finds a review of data from 1.6 million women published by The BMJ today.

These findings reinforce the need for international standards for healthy GWG alongside lifestyle support and public health measures to improve outcomes for mothers and babies worldwide, say lead researchers Helene Teede and Rebecca Godstein.

Gaining too much or too little weight during pregnancy (known as gestational weight gain or GWG – the combined growth of mother and baby) is associated with increased health risks for both mother and baby, which can continue into later life.

Most countries rely on Institute of Medicine GWG guidelines, but these are based on data from predominantly white women in high income countries in the 1980s so they don’t reflect ethnically diverse populations across low, middle, and high income settings, or the increasing availability of unhealthy foods and other environmental factors that are driving a global trends such as rising weight (BMI).

In response, the World Health Organization (WHO) has launched an initiative to develop global healthy GWG standards aimed at defining optimal GWG recommendations across diverse settings.

To support this initiative, researchers analysed data from 40 observational studies involving 1.6 million women aged 18 and over from five of the six WHO defined world regions that reported pregnancy outcomes according to BMI and GWG from 2009 to 2024. Of these 40 studies, 36 (90%) were considered to be high quality.

Around half (53%) of study participants had a healthy pre-pregnancy BMI, with others classified as below (6%), above (19%), or well above healthy weight (obese) (22%). Only a third (32%) had GWG combined for mother and baby, within recommended ranges, with 23% gaining below and 45% gaining above recommended.

According to WHO BMI criteria, GWG below the recommended range was associated with lower risk of caesarean delivery, a large for gestational age infant, and high birth weight (macrosomia) but higher risk of preterm birth, a small for gestational age infant, low birth weight, and respiratory distress.

Conversely, GWG above the recommended range was associated with a higher birth weight and a higher risk of caesarean delivery, hypertensive disorders of pregnancy, a large for gestational age infant, macrosomia, and admission to a neonatal intensive care unit, and a lower risk of preterm birth and a small for gestational age infant.

Similar patterns were apparent when Asian BMI categories were used in studies conducted in this world region.

The researchers point to some limitations, such as variations in BMI and GWG classifications, and note that few studies from low income countries met their inclusion criteria, limiting diversity. Nor can they rule out the possibility that other unmeasured factors, such as smoking status, age, and ethnicity, may have influenced their results.

However, they conclude: “Our findings inform and support the need for optimised, evidence based WHO international GWG reference standards based on individual patient data, applicable across the full BMI range in contemporary and diverse global populations. This will build on and improve current recommendations and are essential to underpin multi level support to improve the health of mothers and babies worldwide.”

Although the review largely confirms longstanding knowledge, its most striking insight is the considerable variation across categories of body mass index and regions, challenging the black and white logic that underpins many clinical guidelines, say Annick Bogaerts and Dominika Osicka in a linked editorial.

They suggest that rather than warning all women against exceeding fixed cut-offs, a more nuanced approach is needed, with a focus on patterns of weight gain, its underlying determinants, and personalised, non-punitive counselling.

“Without comprehensive, life course public health strategies, the obesity epidemic will continue across generations,” they argue. “Governments and (inter)national agencies must act now to support women’s health before, during, and after pregnancy, ensuring that the next generation inherits the opportunity not the risk.”

19/11/2025

Notes for editors
Research: Gestational weight gain and risk of adverse maternal and neonatal outcomes in observational data from 1.6 million women: systematic review and meta-analysis doi: 10.1136/bmj-2025-085710
Editorial: Life course approach to gestational weight gain doi: 10.1136/bmj.r2337
Journal: The BMJ 

External funding: National Health and Medical Research Council of Australia, Heart Foundation Australia

Link to Academy of Medical Sciences press release labelling system: http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes (research); No (linked editorial)
Evidence type: Systematic review and meta-analysis (research); Opinion (linked editorial)
Subjects: Women

The post Two thirds of women experience too much or too little weight gain in pregnancy first appeared on BMJ Group.

Confidence in previous study findings is low to critically low

Women should be advised to take paracetamol when needed to treat pain and fever in pregnancy, say researchers

Existing evidence does not clearly link paracetamol (acetaminophen) use during pregnancy with autism or ADHD in children, finds an in-depth evidence review published by The BMJ today, in direct response to recent announcements around the safety of using paracetamol in pregnancy.

The researchers say confidence in the findings of existing evidence reviews and studies on this topic is low to critically low, and suggest that any apparent effect seen in previous studies may be driven by shared genetic and environmental factors within families.

Regulatory bodies, clinicians, pregnant women, parents, and those affected by autism and ADHD should be informed about the poor quality of the existing reviews and women should be advised to take paracetamol when needed to treat pain and fever in pregnancy, they add.

Paracetamol (acetaminophen) is the recommended treatment for pain and fever in pregnancy and is considered safe by regulatory agencies worldwide.

Existing systematic reviews on this topic vary in quality, and studies that do not adjust for important factors shared by families or parents’ health and lifestyle cannot accurately estimate the effects of exposure to paracetamol before birth on neurodevelopment in babies.

To address this uncertainty, researchers carried out an umbrella review (a high-level evidence summary) of systematic reviews to assess the overall quality and validity of existing evidence and the strength of association between paracetamol use during pregnancy and the risks of autism or ADHD in offspring.

They identified nine systematic reviews that included a total of 40 observational studies reporting on paracetamol use during pregnancy and the risk of autism, ADHD, or other neurodevelopmental outcomes in exposed babies.

Four reviews included meta-analysis (a statistical method that combines data from several studies to give a single, more precise estimate of an effect).

The researchers used recognised tools to carefully assess each review for bias and rated their overall confidence in the findings as high, moderate, low, or critically low. They also recorded the degree of study overlap across reviews as very high.

All reviews reported a possible to strong association between a mother’s paracetamol intake and autism or ADHD, or both in offspring. However, seven of the nine reviews advised caution when interpreting the findings owing to the potential risk of bias and impact of unmeasured (confounding) factors in the included studies.

Overall confidence in the findings of the reviews was low (two reviews) to critically low (seven reviews).

Only one review included two studies that appropriately adjusted for possible effects of genetic and environmental factors shared by siblings, and accounted for other important factors such as parents’ mental health, background, and lifestyle.

In both these studies, the observed association between exposure to paracetamol and risk of autism and ADHD in childhood disappeared or reduced after adjustment, suggesting that these factors explain much of the observed risk, say the researchers.

They acknowledge some limitations. For example, the included reviews differed in scope and methods, they were unable to explore the effects of timing and dose, and their analyses were limited to autism and ADHD outcomes only.

However, they say this overview brings together all relevant evidence and applies established methods to assess quality, and shows “the lack of robust evidence linking paracetamol use in pregnancy and autism and ADHD in offspring.”

They conclude: “The current evidence base is insufficient to definitively link in utero exposure to paracetamol with autism and ADHD in childhood. High quality studies that control for familial and unmeasured confounders can help improve evidence on the timing and duration of paracetamol exposure, and for other child neurodevelopmental outcomes.”

10/11/2025

Notes for editors
Research: Maternal paracetamol (acetaminophen) use during pregnancy and risk of autism spectrum disorder and attention deficit/hyperactivity disorder in offspring: umbrella review of systematic reviews doi: 10.1136/bmj-2025-088141
Journal: The BMJ

External funding: None

Link to Academy of Medical Sciences press release labelling system: http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes
Evidence type: Umbrella review of existing systematic reviews
Subjects: Pregnant women

The post Existing evidence does not clearly link paracetamol use during pregnancy with autism or ADHD in children first appeared on BMJ Group.

Trial identifies possible benefits for some women, which must be balanced against potential harms from antibiotics

Giving antibiotics to women within 24 hours of an obstetric tear during childbirth is associated with a reduced risk of larger/clinically relevant wound complications, find the results of a clinical trial from Denmark published by The BMJ today.

The researchers say this finding supports the use of preventive (prophylactic) antibiotics after a second degree tear or episiotomy, which affects millions of women each year across the globe.

But more research is needed to determine which patients are most at risk of “clinically relevant” wound infections and will therefore benefit the most.

Prophylactic antibiotics are recommended after instrumental deliveries (eg, when vacuum or forceps are used) as evidence suggests they may reduce infection, but little is known about their effect in patients with obstetric tears after any type of vaginal delivery.

To address this, the researchers identified 442 women aged 18 or over with episiotomies or second degree tears after a vaginal delivery at a Copenhagen hospital between March and December 2023.

Participants were randomly assigned to receive either three doses of oral antibiotics (treatment group) or placebo (control group) starting within six hours of delivery (postpartum) and repeated at eight hour intervals. They were assessed four to 14 days later.

Outcome measures were wound complications, including separation of a surgically closed wound (dehiscence) and infection, and clinically relevant wound complications, defined as those requiring further clinical care.

The researchers found no significant difference in overall wound complications between the two groups (22% for antibiotics vs 29% for placebo).

However, clinically relevant wound complications were significantly reduced (9% for antibiotics vs 17% for placebo) and this protective effect was also significant in patients at low risk of wound complications.

The researchers estimate that for every 12 women given antibiotics, one clinically relevant wound complication would be prevented. The treatment group also received fewer additional antibiotics and reported better wellbeing. No serious adverse reactions occurred.

The authors acknowledge some trial limitations and point out that the findings may not apply to other settings or populations, but they say key strengths include a low drop-out rate and short timeframe, reducing the risk of change in clinical practice.

As such, they conclude: “Although no significant effect was seen for overall wound complications, prophylactic antibiotics significantly reduced the risk of clinically relevant wound complications in women with episiotomies and second degree tears.”

“This finding supports the use of prophylactic antibiotics in routine clinical practice after a second degree tear or episiotomy.”

29/10/2025

Notes for editors
Research: Risk of infection and wound dehiscence after use of prophylactic antibiotics in episiotomy or second degree tear (REPAIR study): single centre, double blind, placebo controlled randomised trial doi: 10.1136/bmj-2025-084312
Journal: The BMJ

Funding: Herlev Hospital

Link to Academy of Medical Sciences press release labelling system: http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes
Evidence type: Randomised controlled trial
Subjects: Women

The post Antibiotics linked to lower risk of complications after obstetric tear first appeared on BMJ Group.

Women’s foot anatomy, biomechanics, life stages completely different from men’s
Female-based designs might boost women’s comfort, injury prevention, and performance

Sports footwear manufacturers need to ditch the ‘shrink it and pink it’ approach to women’s running shoes, because this is failing to differentiate their distinct anatomical and biomechanical needs across the life course from those of men, concludes a small qualitative study published in the open access journal BMJ Open Sports & Exercise Medicine.

Female-, rather than male-based, designs might not only boost women runners’ comfort, but also enhance injury prevention, and their performance, say the researchers.

Over the past 50 years, manufacturers have invested billions of dollars on developing running shoes that can prevent injury, maximise comfort, and improve runners’ performance.

Yet both industry and academic research to inform these advances has predominantly been designed for, and tested on, men and boys, point out the researchers.

Running shoes are designed by creating a three-dimensional foot-shaped mould called a ‘last, which is typically based on male foot anatomy, they explain.

Most brands use the same last for their entire range, and beyond making the shoes smaller and changing the colour—a process known as ‘shrink it and pink it’—often only minimal modifications are made to create women’s shoes, they add.

The researchers therefore wanted to hear from recreational and competitive women runners which features they prioritise in a running shoe and how these might differ across the lifespan, with a view to informing future shoe design.

They recruited 21 study participants via posters displayed at local running stores in Vancouver, Canada, with the aim of including a broad range of ages, running experience, and weekly running volume and frequency.

Eleven of the women were recreational runners who clocked up a weekly average of 30 km; and 10 were competitive runners, who averaged 45 km. Nine of the women ran during pregnancy or soon after giving birth. Their ages ranged from 20 to 70, and their years of running experience ranged from 6 to 58.

The women were asked to rank in order of importance the factors informing their choice of running shoes. The responses showed that their primary considerations were the comfort and feel of the shoe, injury prevention, and performance.

In terms of comfort, most of them said they wanted a wider toe box, a narrower heel, and more cushioning; competitive runners also wanted shoes incorporating performance enhancing features, such as a carbon plate, as long as these didn’t compromise comfort.

The women said that they actively sought out running shoes that they believed would help prevent running injuries, and with this in mind, both groups emphasised the high value they placed on buying shoes from trusted retailers or personnel.

They highlighted the need for different shoe designs or components to align with different running contexts—taking part in races, training, speed work, or running with an injury, for example.

And those who were mothers, reported needing a larger shoe size and wider fit as well as more support and cushioning during pregnancy and after giving birth. Competitive runners also said they needed added cushioning and support features in their footwear as they got older.

This study involved only a small number of participants, and the researchers acknowledge that participants came from a specific geographical area, which may limit the generalisability of the findings.

Nevertheless, they suggest: “Overall, our findings highlight a critical gap in the design of running footwear, which has been traditionally based on male anatomy and biomechanics.

“While participants did not always report an inability to find footwear, their narratives reflected a process of trial-and-error adaptation, often without guidance or purpose-built solutions. This suggests that their needs are not proactively addressed through current footwear design or communication.”

And they conclude: “We strongly recommend that the footwear industry should move beyond simply scaling down men’s shoes to fit women’s feet. Instead, there is a need for sex- and gender- specific designs that accommodate the distinct foot morphology of women and their social constructs and preferences, all of which evolve across the lifespan.”

14/10/2025

Notes for editors
Research:  “If a shoe had been designed from a woman’s foot, would I be running without getting the injuries?”: running footwear needs and preferences of recreational and competitive women runners across the lifespan Doi: 10.1136/ bmjsem-2025-002597

Journal: BMJ Open Sports & Exercise Medicine

External funding: Hettas Sport Ltd; Natural Sciences & Engineering Research Council of Canada

Link to Academy of Medical Sciences press release labelling system http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes
Evidence type: Qualitative
Subjects: Women

The post Ditch ‘shrink it and pink it’ approach to women’s running shoes, manufacturers urged first appeared on BMJ Group.

Spotlight on safety

Raised global awareness

of a rare but serious risk of uterohydronephrosis linked to menstrual cup use

25,000+ views

of the study in the first month alone

29 media stories

across 23 major international outlets

Featured on the BBC World Service Newshour programme

and picked up by journalists in the UK, Germany, and the USA

Sparked four opinion pieces in the UK, the USA, and Russia,

prompting professional and public discussion

Altmetric score of 234,

placing it in the top 5% of all tracked research outputs

Triggered practical guidance

Many news outlets included safety advice and how-to videos for the public

Demonstrated value with no funding required,

just a sharp clinical eye and the right publishing partner

Download our full impact report

“The submission process was straightforward, and the response was fast. I’d had other papers published with other publishers, and this was by far the smoothest experience.”

Dr Clara Maarup Prip
Aarhus University Hospital, Denmark

The post Raising awareness of a rare but serious risk linked to menstrual cup use first appeared on BMJ Group.

Commercial hormone testing is unnecessary and does not improve care
Symptoms should be prioritised ahead of testing

Many direct to consumer menopause services are unnecessary and do not improve care, warn experts in The BMJ today.

They argue that the sharp rise in commercial services for women seeking relief for menopausal symptoms raises concerns about the reliability and potential commercial bias of the information, and that symptoms are best assessed by a thorough clinical history with treatment decisions guided by clinical response and patient preferences.

One of the most troubling trends arising from this surge is the promotion of routine hormone panel testing for the evaluation of menopausal symptoms, they write. These tests can cost hundreds of dollars and are marketed to patients and clinicians as necessary for “individualising” hormone therapy.

Yet in reality, these tests are of limited clinical use because there is no clearly defined therapeutic window for menopausal hormone therapy, and some testing techniques do not offer accurate or precise assessment of hormone levels.

For perimenopause and menopause, hormone testing offers no reliable way to determine who will benefit from treatment, when the final menstrual period will occur, or whether it is safe to discontinue contraception, they explain.

Clinical guidelines from the British Menopause Society, National Institute for Health and Care Excellence, American College of Obstetricians and Gynecologists and others agree: in women over age 45 presenting with validated symptoms of menopause, including menstrual irregularity, menopause is a clinical diagnosis, and hormone testing is unnecessary.

Despite this, many women now present with detailed hormone panels from wellness providers or online services that are often used to justify taking custom-made hormone preparations or supplements based on marginal deviations from hormone thresholds that are not grounded in evidence, write the authors.

Such custom-made hormone preparations (known as compounded hormone regimens) are not regulated in the same way as standard menopausal hormone therapy and have not been tested for effectiveness and safety.

There is also concern that inconsistencies in the quantities of oestrogen or progestogen in compounded hormone regimens can result in abnormal cell growth or cancer in the womb (uterus) lining, they add.

Until we can establish individualised target hormone levels, there is no role for commercial hormonal panel testing to guide therapy, they argue. In the meantime, such testing offers only a false sense of precision.

They acknowledge that innovation is needed but suggest that the normalisation of hormone panel testing could be a symptom of a larger problem: the commercialisation of women’s health and a movement away from evidence based practice.

For midlife women, effective treatment begins not with numbers, but with listening, they conclude.

20/08/2025

Notes for editors
Editorial: Menopause misinformation is harming care doi: 10.1136/bmj.r1695
Journal: The BMJ

Link to Academy of Medical Sciences press release labelling system: http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes
Evidence type: Editorial
Subject: Menopause care

The post Menopause misinformation is harming care, warn experts first appeared on BMJ Group.

They were at heightened risk of dying from psychiatric causes and being murdered
Uncoordinated appointment schedules added to the many disadvantages they already faced
Changes to maternity care practice and policy now urgently required, say researchers

The involvement of children’s social care services was a common factor in nearly a third of UK maternal deaths occurring during, or within a year of, pregnancy between 2014 and 2022, finds research published in the open access journal BMJ Medicine.

These women were at heightened risk of dying from psychiatric causes and being murdered, the findings indicate.

But uncoordinated appointment schedules across a wide number of services added to the many disadvantages these women already faced. Changes to maternity care practice and policy are now urgently required, say the researchers.

In the UK, children’s social care services might become involved during pregnancy or after birth when concerns are raised that the infant might be at significant risk of harm. And the number of such cases has steadily risen over the past decade, note the researchers.

Although maternal deaths in the UK are relatively rare, recent evidence indicates a substantial increase in deaths from all causes compared with previous years, even allowing for the effects of the COVID-19 pandemic, they add.

To explore this further, in the context of children’s social care services involvement, and analyse the quality of maternity care women received, the researchers drew on national surveillance data—MBRRACE-UK (Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK)—for all mothers who died between 2014 and 2022 either during, or up to a year after, pregnancy.

During this period, 1695 women died, but involvement with children’s social care services wasn’t known for 244, so 1451 women were included in the final analysis.

Children’s social care services had been involved in the care of nearly a third (420; 29%) of the women who died, an involvement that has steadily increased since 2014, reaching 34% in 2019-21, the data show.

Three out of four (75%) of these women died between six weeks and 12 months after the end of pregnancy.

Women with children’s social care involvement were more likely than those with no known involvement with these services to die by suicide (20% vs 10%), other mental health related causes, including drug overdose (30% vs 3%), and murder (5% vs 2%).

And they were nearly twice as likely to be young (aged 20 or below), twice as likely to be living in the most deprived areas, and significantly less likely to be of Black or Asian ethnicity.

A higher proportion of them were unemployed, living alone, and reported to have been subjected to domestic abuse before or during their pregnancy than women with no known involvement with children’s social services: 65% (205) vs 3% (23).

And a higher proportion of them had pre-existing medical problems (75% vs 59%), mental health issues (75% vs 27%), smoked during pregnancy (73% vs 21%), and were known to have substance misuse issues (55% vs 5%).

But they also received antenatal care less often during pregnancy (89% vs 94%). And of those who did, a higher proportion started this after 13 weeks of pregnancy (32% vs 19%).

A review (confidential enquiry) of the care of a random sample of 47 women with children’s social care services involvement showed that these women tended to have complex social risk factors, with almost half having five or more (45%; 21).

Multiple personal barriers hindered their access to, and engagement with, healthcare. These included previous trauma and poor experiences of children’s services involvement (including previous removal of older children); domestic abuse; financial hardship; insecure housing; and challenges related to mental health, neurodiversity, learning disabilities, and language needs.

They also faced barriers in service provision. For example, healthcare professionals often didn’t explore the interplay between medical and social complexity and didn’t consistently consider the wider social circumstances that affected engagement and treatment compliance. And they didn’t always understand the impact of trauma.

Access to appropriate and timely advice about drug treatments was challenging for many women, both before conception and during the perinatal period, with evidence of judgment and stigma in some women’s records.

For most women, coexistence of complex social adversity and medical or obstetric problems triggered a range of health and social care referrals, resulting in a high volume of appointments—more than 30 for some women—across different services and agencies.

These appointments were often uncoordinated and lacked a collective approach to safeguard both women and their babies.

“The complexity of a multi-agency system with various professionals was compounded by communication gaps, uncertainty about professional roles, and disjointed processes, resulting in a rigid system unable to tailor care to the needs of women,” point out the researchers.

They identified risk assessment and recognition, medication management, coordination of care, and staff competencies as essential components of personalised, holistic, and responsive (to trauma) care when dealing with medical and social complexity.

This is an observational study, and as such, no firm conclusions can be drawn about cause and effect. The researchers acknowledge that data for some important demographic variables were missing. The study also only considered women who died: the findings might therefore not be applicable to women with children’s social care services involvement during and after their pregnancy who didn’t die.

But the researchers nevertheless conclude that: “While some women received excellent, coordinated care, we identified that urgent changes to practice, clinical guidance, and policy are required to prioritise this group of marginalised women.

“A critical review of current maternity care pathways is needed to adjust and customise care to the needs of women with complex social adversity, and to look at the existing health inequalities that disproportionately affect [them].”

11/07/2025

Notes for editors
Research: Characteristics, outcomes, and maternity care experiences of women with children’s social care involvement who subsequently died: national cohort study and confidential enquiry  Doi: 10.1136/bmjmed-2025-001464

Journal: BMJ Medicine

External funding: National Institute for Health and Care Research (NIHR); Healthcare Quality Improvement Partnership (HQIP)

Link to Academy of Medical Sciences press release labelling system
http://press.psprings.co.uk/AMSlabels.pdf 

Externally peer reviewed? Yes
Evidence type: Observational
Subjects: People

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