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The authors have no relevant financial or non-financial interests to disclose. The authors have no competing interests to declare that are relevant to the content of this article. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. The authors have no financial or proprietary interest in any material discussed in this article.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"We have received approval from the Ethics Committee of the Faculty of Medicine, Monastir. Institution\/Organization Number: IORG0009738; CEFMM Registration Number: IRB00011572.","order":2,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Written informed consent was obtained from all participants prior to enrollment. All participants were informed about the study objectives, sample collection procedures, and the use of their data.","order":3,"name":"Ethics","label":"Consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All authors gave their consent for research publication. All participants provided consent for the publication of aggregated, anonymized results from this study.","order":4,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Written informed consent was obtained from all participants prior to their inclusion in the study. Participants were informed about the study objectives, procedures, potential risks, and confidentiality measures. Participants were assured of their right to withdraw from study at any time without consequence.","order":5,"name":"Ethics","label":"Informed consent:","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was conducted in accordance with the Declaration of Helsinki. Ethical approval was obtained from the Ethics Committee of the Faculty of Medicine, Monastir, Tunisia (IORG 0009738; IRB 00011572; Protocol Reference: IORG 0009738 N 292; Approval Date: 05 May 2026). The committee reviewed and approved the study protocol, including the recruitment of pregnant women, biological sample collection, and questionnaire administration. All participants provided written informed consent prior to enrollment.","order":6,"name":"Ethics","label":"Research involving human participants and\/or animals","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"637"}}