Thai Journal of Obstetrics and Gynaecology

Maternal Iodine Requirements in Pregnancy and Lactation: Critical roles and monitoring strategies

Arissara Kuptarak — 2026-05-01

Iodine plays a vital role in fetal neurodevelopment and is closely linked to thyroid function in both mothers and infants. Iodine deficiency during pregnancy is associated with adverse obstetric outcomes, impaired fetal growth, and in severe cases, can result in neonatal cretinism. An adequate iodine status in pregnancy is defined by a median urinary iodine concentration of 150–249 µg/L. Several methods are available to assess iodine sufficiency in pregnant and lactating women, each with its own strengths and limitations. These include urinary iodine concentration, serum iodine levels, serum thyroglobulin, breastmilk iodine concentration, neonatal thyroid-stimulating hormone levels, and thyroid volume assessment. While iodine supplementation is crucial in deficiency states, excessive iodine intake can also disrupt thyroid function, potentially leading to either hyperthyroidism or hypothyroidism. Therefore, monitoring and maintaining appropriate iodine levels during pregnancy and lactation is essential for maternal and neonatal health.

Intriguing Review and Topics in Third Issue of Thai Journal of Obstetrics and Gynaecology 2026

Vorapong Phupong — 2026-04-30

This third issue of Thai Journal of Obstetrics and Gynaecology 2026 contains many interesting articles. The special article is “Maternal iodine requirements in pregnancy and lactation: Critical roles and monitoring strategies”. The topics included iodine metabolism during pregnancy and lactation, excessive iodine intake, assessment of iodine status, sources of iodine, and impact of iodine deficiency⁽¹⁾.

This issue also contains seven original articles. Deepthi et al performed a case-control study to characterize biochemical, hormonal, and inflammatory alterations in endometriosis. The results showed prolactin and interleukin-6 as the strongest diagnostic predictors, while multivariable analysis confirmed body mass index, abdominal circumference, prolactin, and interleukin-6 as key factors associated with endometriosis⁽²⁾.

Biochemical and Metabolic Disruptions in Endometriosis

Deepthi Sudharma — 2026-05-01

Objectives: Endometriosis is a chronic gynecological disorder characterized by endometrial glands and stroma outside the uterine cavity. This study aimed to characterize biochemical, hormonal, and inflammatory alterations in endometriosis, with the goal of gaining insights into disease mechanisms and exploring candidate biomarkers that could inform future studies on early diagnosis or targeted interventions.
Materials and Methods: A case-control study enrolled 300 participants aged 20 to 45 years, including 150 individuals diagnosed with endometriosis and 150 healthy controls recruited from hospitals across Thiruvananthapuram. Serum interleukin-6 (IL-6), prolactin, luteinizing hormone (LH), and follicle stimulating hormone (FSH) were measured using enzyme linked immunosorbent assay (ELISA), while triiodothyronine (T3), thyroxine (T4), and thyroid stimulating hormone (TSH) were analyzed via chemiluminescent immunoassay (CLIA). Metabolic parameters were assessed using a semi-automated analyzer.
Results: Findings suggested that women with endometriosis had significantly higher body mass index (BMI), abdominal circumference, fasting blood sugar (FBS), triglycerides, low-density lipoprotein (LDL), IL-6, TSH, prolactin, and FSH, while high-density lipoprotein (HDL), T3, T4, and LH levels were lower (p < 0.05). Clinical conditions such as diabetes mellitus, dyslipidemia, thyroid disorders, polycystic ovarian syndrome (PCOS), and psychological stress were more prevalent in cases. Receiver operating characteristic analysis identified prolactin and IL-6 as the strongest diagnostic predictors, while multivariable analysis confirmed body mass index, abdominal circumference, prolactin, and IL-6 as key factors associated with endometriosis.
Conclusion: This study revealed key biochemical and metabolic disruptions in endometriosis, linking obesity, PCOS, and stress to disease progression, and highlighted potential biomarkers for early diagnosis and targeted treatment.

Diagnostic Performance of the International Ovarian Tumor Analysis Simple Rules with CA125 in Differentiating between Benign and Malignant Adnexal Masses

Kamonlak Limsawan — 2026-05-05

Objectives: To evaluate the diagnostic performance of the International Ovarian Tumor Analysis (IOTA) simple rules in combination with serum tumor marker Cancer Antigen 125 (CA125).
Materials and Methods: This secondary analysis was based on a previous prospective diagnostic single-center study conducted at Siriraj Hospital, Thailand, between May 1, 2018, and May 31, 2019. Gynecological patients scheduled for an elective adnexal surgery at Siriraj Hospital were recruited. Preoperative ultrasound was performed within 120 days before surgery. The assessment included IOTA simple rules, IOTA simple rules with subjective assessment, and IOTA simple rules with CA125. The sensitivity, specificity, positive predictive value, negative predictive value and area under the receiver operating characteristic curve (AUC) were assessed.
Results: A total of 357 patients from the original study cohort were included, and all were found eligible. The IOTA simple rules were applicable in 316 cases (88.5%), and achieved an AUC of 0.938 (95% CI 0.897-0.979). The IOTA simple rules along with subjective assessment demonstrated a similar AUC, 0.933 (95% CI 0.892-0.975). Integrating CA125 with the IOTA simple rules reduced the AUC to 0.825 (95% CI 0.776–0.875). When CA125 was applied exclusively to the inconclusive group, the AUC was 0.909 (95% CI 0.866–0.953). The optimal cutoff value of CA125 calculated from our cohort was 115 U/ml.
Conclusion: The IOTA simple rules are an excellent model for differentiating benign and malignant adnexal masses. Selective use of CA125 or subjective assessment in inconclusive cases can support decision-making.

Effect of Multi-Strain Probiotics on Constipation and Quality of Life in Menopausal Women: A double-blind, Randomized, Placebo-controlled, Single-center trial

Natita Nakapun — 2026-05-01

Objectives: To evaluate the short-term efficacy of a multi-strain probiotic supplement (Bifidobacterium longum, B. breve, B. lactis, B. animalis TA1, Lactobacillus paracasei MSMC 39-1, L. rhamnosus, L. reuteri TF314, and L. gasseri) in improving bowel movement frequency, stool consistency, and menopause-related quality of life in women with functional constipation.
Materials and Methods: A double-blind, randomized, placebo-controlled trial was conducted at the gynecology outpatient clinic of a tertiary care hospital in Bangkok, Thailand, between August 2024 and April 2025. For four weeks, 46 women with functional constipation, as defined by Rome IV, were randomized to receive a probiotic or placebo capsule every day. Simple randomization was carried out by a third party, and the allocation was hidden from the participants and researchers. Pretest and posttest questionnaires were used to measure menopause-specific quality of life (MENQOL) and symptoms associated with constipation. Data were analyzed using the intention-to-treat approach.
Results: In the probiotics group, the median weekly defecation frequency increased significantly (3.0 to 5.0, p = 0.003). Hard stools slightly declined from 32% to 9.1%, although not statistically significant (p = 0.200). There were minimal changes in the placebo group. The total MENQOL score, and physical domain improved from 55.1 ± 31.2 to 40.7 ± 22.4 (p = 0.012) and from 34.2 ± 21.5 to 24.4 ± 14.1 (p = 0.014), respectively, while vasomotor, psychosocial, and sexual domains showed no significant changes. No significant changes occurred in the placebo group. Subgroup analysis of participants over 60 years old showed similar improvements in total score (p = 0.041) and physical domain (p = 0.029). One participant (4.3%) in the probiotic group discontinued due to bloating.
Conclusion: In menopausal women experiencing constipation, a 4-week multi-strain probiotic treatment demonstrated improvements in the frequency of bowel movements, physical domain and total score of menopause-related quality of life. Probiotics may serve as an adjunctive, non-pharmacological approach to support physical well-being in menopausal women.

Effect of Oral Ginger with Early Feeding versus Early Feeding Alone on Breast Milk Volume in Scheduled Cesarean Section: A Randomized Controlled Trial

Prapabhorn Puenprom — 2026-05-01

Objective: To evaluate the effect of oral ginger supplementation, in combination with early maternal oral feeding, on breast milk volume in women undergoing scheduled C-section.

Material and methods: This randomized, double-blind, placebo-controlled trial included women scheduled for C-section. Participants were allocated into two groups. At 6 hours postpartum, the intervention group received 200 mL of a sweetened clear solution along with oral ginger capsules (1.5 g daily in three divided doses), while the control group received the same solution with identical placebo capsules (1.5 g fine brown sugar). The primary outcome was breast milk volume, measured at 72 hours postpartum after a two-hour breast emptying period.

Results: Between August 2024 and May 2025, a total of 84 participants were randomized (n=42 per group). The ginger group showed a significantly higher median breast milk volume at 72 hours postpartum (20 mL [IQR 14–35]) compared to the placebo group (10.5 mL [IQR 9–15]; p <0.001). The self-reported time to onset of lactation was significantly shorter in the ginger group (59 hours vs. 69 hours; p <0.001). No serious adverse events were noted.

Conclusion: Oral ginger supplementation combined with early maternal oral feeding significantly increased breast milk volume and shortened the time to the onset of lactation in women following scheduled C-section without serious adverse events.

Effectiveness of Topical 2% Lidocaine Gel for Post-episiotomy Pain Relief: A randomized, Double-blind trial

Nattakrid Sintrakulchai — 2026-05-01

Objectives: To evaluate the effectiveness and safety of topical 2% lidocaine gel versus a placebo for post-episiotomy analgesia, assessed using the numeric rating scale (NRS) pain scores at 6, 12, and 24 hours postpartum.
Materials and Methods: This randomized, double-blind, placebo-controlled trial was conducted at a tertiary care hospital in Thailand. A total of 184 women who underwent vaginal delivery with episiotomy were randomized to receive topical 2% lidocaine gel (n = 92) or placebo gel (n = 92), applied as a thin layer to the perineal wound every 4 hours for 12 hours post-repair. Pain was assessed with the NRS at 6, 12, and 24 hours by blinded assessors. Secondary outcomes included rescue-analgesic use within 24 hours, lochia pad count, perineal wound events (hematoma, dehiscence, infection), adverse events and length of hospital stay.
Results: Mean NRS pain scores at 6, 12, and 24 hours were not different between groups: mean difference -0.11 (95% confidence interval (CI) -0.5, 0.28), -0.21 (-0.56, 0.15), and -0.21 (-0.51, 0.10), respectively. Rescue-analgesic use was similar in both groups (46.7% vs 56.5%; relative risk (RR) 0.83, 95% CI 0.62, 1.10). No drug-related adverse events or maternal complications were observed. The lidocaine group had a significantly higher lochia pad count (p < 0.001), whereas the length of hospital stay was significantly shorter than in the placebo group (p = 0.019).
Conclusion: Topical 2% lidocaine gel did not provide a statistically significant reduction in post-episiotomy perineal pain during the first 24 hours compared with placebo. Therefore, it should not be recommended as a first-line analgesic in this setting.

Efficacy of Preoperative Intravenous Tranexamic Acid to Reduce Blood Loss in Difficult Abdominal Hysterectomy for Benign Gynecological Disease: A randomized double-blind placebo-controlled trial

Jinjuta Jindaluang — 2026-05-01

Objectives: To determine the efficacy of tranexamic acid (TXA) in reducing intraoperative blood loss in difficult abdominal hysterectomy for benign gynecological disease.
Materials and Methods: A double-blind randomized controlled trial was conducted. Women who were at risk of a difficult abdominal hysterectomy for benign gynecological disease, with or without adnexal surgery, were included. The participants were randomly assigned into two groups, comprising an intervention group who received intravenous TXA 10mg/kg (diluted with normal saline up to 100 ml), and a control group who received 100 ml of normal saline 15 minutes before skin incision.
Results: Ninety-two eligible participants were randomly allocated into the intervention group (n = 46) and control groups (n = 46) between September 2024 and July 2025. Intraoperative measurement of blood loss was comparable between the TXA group and control group (median [interquartile range]: 239 [104–384] vs 280 [187–400] mL, p = 0.24), and the incidence of blood loss exceeding 500 mL did not differ significantly between the groups (11.1% vs 22.2%, p = 0.26). There were no statistically significant differences, including changes in hemoglobin levels and blood transfusion requirements. Additional perioperative TXA in the TXA group was significantly lower than in the control group (4.4% vs 22.2%, p = 0.03). No serious adverse effects were observed.
Conclusion: Preoperative intravenous TXA did not reduce blood loss in cases of difficult abdominal hysterectomy for benign gynecological disease.

Preeclampsia and Pregnancy outcome in Pregnant Women with Gestational Hypertension at Chonburi Hospital

Achiraya Wangsri — 2026-05-05

Objectives: To determine the incidence of preeclampsia (PE) and pregnancy outcome in women diagnosed with gestational hypertension (GH) at Chonburi Hospital.
Materials and Methods: This combined retrospective-prospective cohort study collected the data of pregnant women diagnosed GH between January 2019 and April 2025. Pregnant women with chronic hypertension, abortion, or multifetal gestation were excluded. The data predicting progression from GH to PE were analyzed by logistic regression analysis.
Results: 238 pregnancies with GH were enrolled and followed until delivery. 12 of these (5.0%) lost to follow-up or delivery at other hospitals. 58 pregnant women (25.7%, 95% confidence interval (CI) 20.10, 31.88%) developed preeclampsia, and 38 of these cases (16.8%, 95% CI 8.39, 17.41%) were classified as having severe features. Logistic regression reveals that the patient diagnosed with GH before 34 weeks had a higher risk of developing PE (adjusted odds ratio (OR) 3.30, 95% CI 1.65, 6.61). Additionally, women with diastolic blood pressure ≥ 100 mmHg at diagnosis also had a higher risk of PE progression (adjusted OR 3.16, 95% CI 1.58, 6.34). The pregnant women with PE progression had higher rate of cesarean section (relative risk (RR) 1.69, 95% CI 1.44,1.98), early preterm birth (RR 8.69, 95% CI 1.80, 41.86), late preterm birth (RR 5.07, 95% CI 2.66, 9.65) and low birth weight (RR 4.34, 95% CI 2.37, 7.97).
Conclusion: PE progression occurred for a quarter number in GH pregnant women. The risks of PE progression are early gestational age of GH diagnosis and high diastolic blood pressure at diagnosis. Adverse pregnancy outcomes in preeclampsia women are preterm delivery and high cesarean section rate.