{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T09:29:42Z","timestamp":1784366982719,"version":"3.55.0"},"reference-count":51,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T00:00:00Z","timestamp":1756080000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Gestational diabetes mellitus (GDM) is a frequently encountered medical complication during pregnancy that is increasing at a rapid pace globally, posing significant public health concerns. Similarly, there is a rising trend in the number of women who have utilized assisted reproductive technology (ART). Numerous studies have been carried out to investigate the relationship between GDM and ART. This comprehensive systematic review seeks to identify potential biomarkers for the early diagnosis of GDM in pregnancies conceived through ART. We conducted a PubMed search covering the past five years to identify studies that explore biomarkers associated with the development of GDM in pregnancies conceived through ART. The outcome measures included human chorionic gonadotropin (HCG), the body mass index (BMI), the Follicle Stimulating Hormone to Luteinizing Hormone (FSH\/LH) ratio, increased hemoglobin A1c levels, fasting insulin concentrations, homeostatic model assessment of insulin resistance (HOMA-IR), triglyceride levels, total cholesterol levels, low-density lipoprotein cholesterol concentrations, low-density lipoprotein\/high-density lipoprotein (LDL\/HDL), total cholesterol to high-density lipoprotein (TC\/HDL), the estradiol\/follicle ratio, soluble fms-like tyrosine kinase-1 (sFlt-1), Placental Growth Factor (PLGF), endometrial thickness, and psychological stress. Seventeen studies were included. The identification and development of serum or ultrasound biomarkers for the early detection of GDM in pregnancies conceived through ART pose considerable challenges. These challenges arise from the multifactorial nature of GDM, the methodological variations in ART, and the limited availability of relevant studies. The most promising biomarker identified was the estradiol\/follicle ratio. Women with a higher estradiol\/follicle ratio exhibited significantly lower rates of GDM. There is a pressing necessity for biomarkers to enable the early detection of GDM in pregnancies conceived through ART. E2 levels, \u03b2-hCG, and the E2\/F ratio, along with the TC\/HDL and LDL\/HDL ratios, show potential as reliable biomarkers for identifying GDM.<\/jats:p>","DOI":"10.3390\/ijms26178234","type":"journal-article","created":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T06:26:31Z","timestamp":1756189591000},"page":"8234","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["A Systematic Review on Biomarkers for Gestational Diabetes Mellitus Detection in Pregnancies Conceived Using Assisted Reproductive Technology: Current Trends and Future Directions"],"prefix":"10.3390","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9296-3688","authenticated-orcid":false,"given":"Angeliki","family":"Gerede","sequence":"first","affiliation":[{"name":"Unit of Maternal-Fetal-Medicine, Department of Obstetrics and Gynecology, Medical School, Democritus University of Thrake, GR-68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2177-953X","authenticated-orcid":false,"given":"Efthymios","family":"Oikonomou","sequence":"additional","affiliation":[{"name":"Unit of Maternal-Fetal-Medicine, Department of Obstetrics and Gynecology, Medical School, Democritus University of Thrake, GR-68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7716-1521","authenticated-orcid":false,"given":"Anastasios","family":"Potiris","sequence":"additional","affiliation":[{"name":"Third Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, GR-11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5895-6887","authenticated-orcid":false,"given":"Christos","family":"Chatzakis","sequence":"additional","affiliation":[{"name":"Second Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, GR-54640 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Drakakis","sequence":"additional","affiliation":[{"name":"First Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, GR-11528 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8899-3040","authenticated-orcid":false,"given":"Ekaterini","family":"Domali","sequence":"additional","affiliation":[{"name":"First Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, GR-11528 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaos","family":"Nikolettos","sequence":"additional","affiliation":[{"name":"Unit of Maternal-Fetal-Medicine, Department of Obstetrics and Gynecology, Medical School, Democritus University of Thrake, GR-68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofoklis","family":"Stavros","sequence":"additional","affiliation":[{"name":"Third Department of Obstetrics and Gynecology, Medical School, National and Kapodistrian University of Athens, GR-11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1093\/humupd\/dmaa011","article-title":"Risk of gestational diabetes mellitus in women achieving singleton pregnancy spontaneously or after ART: A systematic review and meta-analysis","volume":"26","author":"Bosdou","year":"2020","journal-title":"Hum. Reprod. Update"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"993","DOI":"10.1016\/j.fertnstert.2017.09.014","article-title":"Perinatal outcomes after natural conception versus in vitro fertilization (IVF) in gestational surrogates: A model to evaluate IVF treatment versus maternal effects","volume":"108","author":"Woo","year":"2017","journal-title":"Fertil. Steril."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1111\/1471-0528.15747","article-title":"Severe maternal morbidity associated with in vitro fertilisation","volume":"126","author":"Messinis","year":"2019","journal-title":"BJOG"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/j.ejogrb.2014.02.009","article-title":"Risk of gestational diabetes mellitus in patients undergoing assisted reproductive techniques","volume":"176","author":"Ashrafi","year":"2014","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1177\/1933719113492206","article-title":"Global methylation in the placenta and umbilical cord blood from pregnancies with maternal gestational diabetes, preeclampsia, and obesity","volume":"21","author":"Nomura","year":"2014","journal-title":"Reprod. Sci."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1007\/s00404-003-0518-5","article-title":"Pregnancy complications, obstetric risks, and neonatal outcome in singleton and twin pregnancies after GIFT and IVF","volume":"268","author":"Strowitzki","year":"2003","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1093\/humupd\/dms018","article-title":"Obstetric and perinatal outcomes in singleton pregnancies resulting from IVF\/ICSI: A systematic review and meta-analysis","volume":"18","author":"Pandey","year":"2012","journal-title":"Hum. Reprod. Update"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1053\/j.semperi.2017.07.001","article-title":"In vitro fertilization and adverse obstetric and perinatal outcomes","volume":"41","author":"Senapati","year":"2017","journal-title":"Semin. Perinatol."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Li, M., Chen, Y., Wang, Y., Wang, H., Ding, X., and Li, G. (2023). Maternal gestational diabetes in singleton pregnancies conceived by ART may be modified by periconceptional B vitamins. Front. Nutr., 9.","DOI":"10.3389\/fnut.2022.1069911"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1080\/09513590.2018.1525702","article-title":"Risk of preterm delivery in singletons conceived by in vitro fertilization","volume":"35","author":"Yang","year":"2019","journal-title":"Gynecol. Endocrinol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"666","DOI":"10.5114\/aoms.2019.82670","article-title":"Perinatal outcome of in vitro fertilization singletons\u201410 years\u2019 experience of one center","volume":"15","author":"Szymusik","year":"2019","journal-title":"Arch. Med. Sci."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1186\/s40842-024-00164-x","article-title":"Potential risk of gestational diabetes mellitus in females undergoing in vitro fertilization: A pilot study","volume":"10","author":"Ghanem","year":"2024","journal-title":"Clin. Diabetes Endocrinol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"b2700","DOI":"10.1136\/bmj.b2700","article-title":"The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: Explanation and elaboration","volume":"339","author":"Liberati","year":"2009","journal-title":"BMJ"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1016\/j.eprac.2020.10.020","article-title":"Early Predictors of Gestational Diabetes Mellitus in IVF-Conceived Pregnancies","volume":"27","author":"Coussa","year":"2021","journal-title":"Endocr. Pract."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Wu, W., Zhang, L.F., Li, Y.T., Hu, T.X., Chen, D.Q., and Tian, Y.H. (2022). Early Rise of Serum hCG in Gestational Diabetes Mellitus Women With Live Birth Through In Vitro Fertilization Procedure. Front. Endocrinol., 13.","DOI":"10.3389\/fendo.2022.724198"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Liu, Y., Hocher, J.G., Ma, S., Hu, L., Chen, H., Zhang, X., Gong, F., Kr\u00e4mer, B.K., Lin, G., and Hocher, B. (2024). Pre-pregnancy LDL\/HDL and total Cholesterol\/HDL ratios are strong predictors of gestational diabetes mellitus in women undergoing assisted reproductive technologies. Reprod. Biol. Endocrinol., 22.","DOI":"10.1186\/s12958-024-01320-9"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Chen, H., Liu, Y., Xu, X., Hu, L., Cai, S., Gong, F., Lin, G., Kalk, P., Kr\u00e4mer, B.K., and Hocher, B. (2024). Estradiol-to-follicle ratio on human chorionic gonadotropin day is a novel predictor of gestational diabetes mellitus in women receiving fresh embryo transfer. Front. Endocrinol., 15.","DOI":"10.3389\/fendo.2024.1465069"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Xia, L., Fan, L., Huang, J., Zhao, Y., Tian, L., Chen, H., Cai, L., Wu, Q., and Xia, L. (2024). Effect of serum uric acid level on reproductive outcome in women without polycystic ovary syndrome undergoing in vitro fertilization. Reprod. Biol. Endocrinol., 22.","DOI":"10.1186\/s12958-024-01313-8"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1016\/j.tjog.2023.09.023","article-title":"Ultrasonographic placental parameters at 11\u201313+6 weeks\u2019 gestation in the prediction of complications in pregnancy after assisted reproductive technology","volume":"63","author":"Ip","year":"2024","journal-title":"Taiwan J. Obstet. Gynecol."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"M\u00ednguez-Alarc\u00f3n, L., Williams, P.L., Souter, I., Ford, J.B., Hauser, R., and Chavarro, J.E. (2024). Women\u2019s preconception psychological stress and birth outcomes in a fertility clinic: The EARTH study. Front. Glob. Womens Health., 5.","DOI":"10.3389\/fgwh.2024.1293255"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Liu, X., Wang, J., Fu, X., Li, J., Zhang, M., Yan, J., Gao, S., and Ma, J. (2021). Thin endometrium is associated with the risk of hypertensive disorders of pregnancy in fresh IVF\/ICSI embryo transfer cycles: A retrospective cohort study of 9,266 singleton births. Reprod. Biol. Endocrinol., 19.","DOI":"10.1186\/s12958-021-00738-9"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1016\/j.fertnstert.2019.12.014","article-title":"Endometrial thickness is associated with incidence of small-for-gestational-age infants in fresh in vitro fertilization-intracytoplasmic sperm injection and embryo transfer cycles","volume":"113","author":"Guo","year":"2020","journal-title":"Fertil. Steril."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Sun, H., Liu, Y., Huang, S., Liu, X., Li, G., and Du, Q. (2022). Association Between Pre-Pregnancy Body Mass Index and Maternal and Neonatal Outcomes of Singleton Pregnancies After Assisted Reproductive Technology. Front. Endocrinol., 12.","DOI":"10.3389\/fendo.2021.825336"},{"key":"ref_24","first-page":"32","article-title":"Diagnostic Accuracy of Body Mass Index and Fasting Glucose for The Prediction of Gestational Diabetes Mellitus after Assisted Reproductive Technology","volume":"13","author":"Kouhkan","year":"2019","journal-title":"Int. J. Fertil. Steril."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"bvad140","DOI":"10.1210\/jendso\/bvad140","article-title":"The Degree of Prepregnancy Vitamin D Deficiency Is Not Associated With Gestational Diabetes in Women Undergoing ART","volume":"7","author":"Liu","year":"2023","journal-title":"J. Endocr. Soc."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Xiong, Y., Wang, J., Qi, Y., Liu, C., Li, M., Yao, G., Sun, W., Qian, Y., Ye, L., and Liu, H. (2022). Dose-response association between maternal pre-pregnancy bodyweight and gestational diabetes mellitus following ART treatment: A population-based cohort study. Reprod. Biol. Endocrinol., 20.","DOI":"10.1186\/s12958-022-00964-9"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1080\/09513590.2019.1648418","article-title":"Risk factors of gestational diabetes mellitus during assisted reproductive technology procedures","volume":"36","author":"Shiqiao","year":"2020","journal-title":"Gynecol. Endocrinol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1007\/s00404-018-4772-y","article-title":"Predictive factors of gestational diabetes in pregnancies following assisted reproductive technology: A nested case-control study","volume":"298","author":"Kouhkan","year":"2018","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1178","DOI":"10.1002\/ijgo.15786","article-title":"Biomarkers in the prediction of complications in pregnancy after assisted reproductive technology","volume":"167","author":"Chaemsaithong","year":"2024","journal-title":"Int. J. Gynecol. Obstet."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e14191","DOI":"10.1111\/jsr.14191","article-title":"Association of sleep duration and sleep quality with gestational diabetes mellitus in pregnant women after treatment with assisted reproductive technology: A birth cohort study","volume":"33","author":"Gao","year":"2024","journal-title":"J. Sleep Res."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1007\/s00592-022-01975-z","article-title":"In vitro fertilization increases the odds of gestational diabetes: A nationwide register-based cohort study","volume":"60","author":"Vaajala","year":"2023","journal-title":"Acta Diabetol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"107914","DOI":"10.1016\/j.jdiacomp.2021.107914","article-title":"The diagnosis of Gestational Diabetes Mellitus and its impact on In Vitro Fertilization pregnancies. A pilot study","volume":"35","author":"Thomakos","year":"2021","journal-title":"J. Diabetes Complicat."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1941","DOI":"10.1093\/humrep\/dex243","article-title":"Maternal hyperglycemia in singleton pregnancies conceived by IVF may be modified by first-trimester BMI","volume":"32","author":"Cai","year":"2017","journal-title":"Hum. Reprod."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2277","DOI":"10.2337\/dc07-0564","article-title":"Increased incidence of gestational diabetes in women receiving prophylactic 17alpha-hydroxyprogesterone caproate for prevention of recurrent preterm delivery","volume":"30","author":"Rebarber","year":"2007","journal-title":"Diabetes Care"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1055\/a-1741-6172","article-title":"Early Initiation and Long-Term Use of Vaginal Progesterone may Cause Gestational Diabetes Mellitus","volume":"226","author":"Oztekin","year":"2022","journal-title":"Z. Geburtshilfe Neonatol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1016\/j.ajog.2019.05.033","article-title":"Progestogens for the prevention of preterm birth and risk of developing gestational diabetes mellitus: A meta-analysis","volume":"221","author":"Pergialiotis","year":"2019","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.1007\/s00404-018-4895-1","article-title":"Is vaginal progesterone treatment associated with the development of gestational diabetes? A retrospective case-control study","volume":"298","author":"Rosta","year":"2018","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1177\/1933719116667229","article-title":"Adverse Obstetric Outcomes Associated With In Vitro Fertilization in Singleton Pregnancies","volume":"24","author":"Qin","year":"2016","journal-title":"Reprod. Sci."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1095\/biolreprod.113.110411","article-title":"Peri-Implantation Hormonal Milieu: Elucidating Mechanisms of Abnormal Placentation and Fetal Growth","volume":"90","author":"Mainigi","year":"2014","journal-title":"Biol. Reprod."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1055\/s-2002-29090","article-title":"VEGF plasma pattern in ovulation induction: Evidence for an episodic secretion and lack of immediate effect of hCG","volume":"110","author":"Licht","year":"2002","journal-title":"Exp. Clin. Endocrinol. Diabetes"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1093\/humupd\/dmx031","article-title":"Is frozen embryo transfer better for mothers and babies? Can cumulative meta-analysis provide a definitive answer?","volume":"24","author":"Maheshwari","year":"2018","journal-title":"Hum. Reprod. Update"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Donjacour, A., Liu, X., Lin, W., Simbulan, R., and Rinaudo, P.F. (2014). In vitro fertilization affects growth and glucose metabolism in a sex-specific manner in an outbred mouse model. Biol. Reprod., 90.","DOI":"10.1095\/biolreprod.113.113134"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1136\/heart.84.6.595","article-title":"Coronary heart disease after prenatal exposure to the Dutch famine, 1944\u201345","volume":"84","author":"Roseboom","year":"2000","journal-title":"Heart"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"3021","DOI":"10.1093\/hmg\/ddv013","article-title":"Maternal gestational diabetes is associated with genome-wide DNA methylation variation in placenta and cord blood of exposed offspring","volume":"24","author":"Finer","year":"2015","journal-title":"Hum. Mol. Genet."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1186\/s13148-016-0247-9","article-title":"Increased global placental DNA methylation levels are associated with gestational diabetes","volume":"8","author":"Reichetzeder","year":"2016","journal-title":"Clin. Epigenet."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1016\/S0015-0282(02)03323-X","article-title":"Effect of ovarian stimulation with recombinant follicle-stimulating hormone, gonadotropin releasing hormone antagonists, and human chorionic gonadotropin on endometrial maturation on the day of oocyte pick-up","volume":"78","author":"Kolibianakis","year":"2002","journal-title":"Fertil. Steril."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1093\/humrep\/den501","article-title":"In GnRH antagonist\/rec-FSH stimulated cycles, advanced endometrial maturation on the day of oocyte retrieval correlates with altered gene expression","volume":"24","author":"Ghislain","year":"2009","journal-title":"Hum. Reprod."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1016\/j.fertnstert.2010.05.049","article-title":"Perinatal morbidity after in vitro fertilization is lower with frozen embryo transfer","volume":"95","author":"Ratcliffe","year":"2011","journal-title":"Fertil. Steril."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1530\/JME-17-0036","article-title":"Serum estradiol levels in controlled ovarian stimulation directly affect the endometrium","volume":"59","author":"Ullah","year":"2017","journal-title":"J. Mol. Endocrinol."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Liebmann, M., Asuaje Pfeifer, M., Grupe, K., and Scherneck, S. (2022). Estradiol (E2) Improves Glucose-Stimulated Insulin Secretion and Stabilizes GDM Progression in a Prediabetic Mouse Model. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms23126693"},{"key":"ref_51","first-page":"169","article-title":"Association of assisted reproductive technology with adverse pregnancy outcomes","volume":"13","author":"Jie","year":"2015","journal-title":"Iran J. Reprod. Med."}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/26\/17\/8234\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:32:23Z","timestamp":1760034743000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/26\/17\/8234"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,25]]},"references-count":51,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["ijms26178234"],"URL":"https:\/\/doi.org\/10.3390\/ijms26178234","relation":{},"ISSN":["1422-0067"],"issn-type":[{"value":"1422-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,25]]}}}