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Sample records for perinatal maternal institute

  1. Maternal superobesity and perinatal outcomes

    PubMed Central

    Marshall, Nicole E.; Guild, Camelia; Cheng, Yvonne W.; Caughey, Aaron B.; Halloran, Donna R.

    2012-01-01

    OBJECTIVE The purpose of this study was to determine the effect of maternal superobesity (body mass index [BMI], ≥50 kg/m2) compared with morbid obesity (BMI, 40–49.9 kg/m2) or obesity (BMI, 30–39.9 kg/m2) on perinatal outcomes. STUDY DESIGN We conducted a retrospective cohort study of birth records that were linked to hospital discharge data for all liveborn singleton term infants who were born to obese Missouri residents from 2000–2006. We excluded major congenital anomalies and women with diabetes mellitus or chronic hypertension. RESULTS There were 64,272 births that met the study criteria, which included 1185 superobese mothers (1.8%). Superobese women were significantly more likely than obese women to have preeclampsia (adjusted relative risk [aRR], 1.7; 95% confidence interval [CI], 1.4 –2.1), macrosomia (aRR, 1.8; 95% CI, 1.3–2.5), and cesarean delivery (aRR, 1.8; 95% CI, 1.5–2.1). Almost one-half of all superobese women (49.1%) delivered by cesarean section, and 33.8% of superobese nulliparous women underwent scheduled primary cesarean delivery. CONCLUSION Women with a BMI of ≥50 kg/m2 are at significantly increased risk for perinatal complications compared with obese women with a lower BMI. PMID:22542116

  2. Incarceration, maternal hardship, and perinatal health behaviors.

    PubMed

    Dumont, Dora M; Wildeman, Christopher; Lee, Hedwig; Gjelsvik, Annie; Valera, Pamela; Clarke, Jennifer G

    2014-11-01

    Parental incarceration is associated with mental and physical health problems in children, yet little research directly tests mechanisms through which parental incarceration could imperil child health. We hypothesized that the incarceration of a woman or her romantic partner in the year before birth constituted an additional hardship for already-disadvantaged women, and that these additionally vulnerable women were less likely to engage in positive perinatal health behaviors important to infant and early childhood development. We analyzed 2006-2010 data from the Pregnancy Risk Assessment and Monitoring System to assess the association between incarceration in the year prior to the birth of a child and perinatal maternal hardships and behaviors. Women reporting incarceration of themselves or their partners in the year before birth of a child had .86 the odds (95 % CI .78-.95) of beginning prenatal care in the first trimester compared to women not reporting incarceration. They were nearly twice as likely to report partner abuse and were significantly more likely to rely on WIC and/or Medicaid for assistance during pregnancy. These associations persist after controlling for socioeconomic measures and other stressors, including homelessness and job loss. Incarceration of a woman or her partner in the year before birth is associated with higher odds of maternal hardship and poorer perinatal health behaviors. The unprecedented scale of incarceration in the US simultaneously presents an underutilized public health opportunity and constitutes a social determinant of health that may contribute to disparities in early childhood development. PMID:24615355

  3. Incarceration, Maternal Hardship, and Perinatal Health Behaviors

    PubMed Central

    Dumont, Dora M.; Wildeman, Christopher; Lee, Hedwig; Gjelsvik, Annie; Valera, Pamela A.; Clarke, Jennifer G.

    2014-01-01

    Background Parental incarceration is associated with mental and physical health problems in children, yet little research directly tests mechanisms through which parental incarceration could imperil child health. We hypothesized that the incarceration of a woman or her romantic partner in the year before birth constituted an additional hardship for already-disadvantaged women, and that these additionally vulnerable women were less likely to engage in positive perinatal health behaviors important to infant and early childhood development. Methods We analyzed 2006-2010 data from the Pregnancy Risk Assessment and Monitoring System (PRAMS) to assess the association between incarceration in the year prior to the birth of a child and perinatal maternal hardships and behaviors. Results Women reporting incarceration of themselves or their partners in the year before birth of a child had 0.86 the odds (95% CI .78-.95) of beginning prenatal care in the first trimester compared to women not reporting incarceration. They were nearly twice as likely to report partner abuse and were significantly more likely to rely on WIC and/or Medicaid for assistance during pregnancy. These associations persist after controlling for socioeconomic measures and other stressors, including homelessness and job loss. Conclusions Incarceration of a woman or her partner in the year before birth is associated with higher odds of maternal hardship and poorer perinatal health behaviors. The unprecedented scale of incarceration in the U.S. simultaneously presents an underutilized public health opportunity and constitutes a social determinant of health that may contribute to disparities in early childhood development. PMID:24615355

  4. Maternal satisfaction with organized perinatal care in Serbian public hospitals

    PubMed Central

    2014-01-01

    Background Understanding the experiences and expectations of women across the continuum of antenatal, perinatal, and postnatal care is important to assess the quality of maternal care and to determine problematic areas which could be improved. The objective of this study was to identify the factors associated with maternal satisfaction with hospital-based perinatal care in Serbia. Methods Our survey was conducted from January 2009 to January 2010 using a 28-item, self-administered questionnaire. The sample consisted of 50% of women who expected childbirths during the study period from all 76 public institutions with obstetric departments in Serbia. The following three composite outcome variables were constructed: satisfaction with technical and professional aspects of care; communication and interpersonal aspects of care; and environmental factors. Results We analyzed 34,431 completed questionnaires (84.2% of the study sample). The highest and lowest average satisfaction scores (4.43 and 3.25, respectively) referred to the overall participation of midwives during delivery and the quality of food served in the hospital, respectively. Younger mothers and multiparas were less concerned with the environmental conditions (OR = 0.55, p = 0.006; OR = 1.82, p = 0.004). Final model indicated that mothers informed of patients’ rights, pregnancy and delivery through the Maternal Counseling Service were more likely to be satisfied with all three outcome variables. The highest value of the Pearson’s coefficient of correlation was between the overall satisfaction score and satisfaction with communication and interpersonal aspects of care. Conclusions Our study illuminated the importance of interpersonal aspects of care and education for maternal satisfaction. Improvement of the environmental conditions in hospitals, the WHO program, Baby-friendly Hospital, and above all providing all pregnant women with antenatal education, are recommendations which would more strongly affect the perceptions of quality and satisfaction with perinatal care in Serbian public hospitals by women. PMID:24410839

  5. Factors for change in maternal and perinatal audit systems in Dar es Salaam hospitals, Tanzania

    PubMed Central

    2010-01-01

    Background Effective maternal and perinatal audits are associated with improved quality of care and reduction of severe adverse outcome. Although audits at the level of care were formally introduced in Tanzania around 25 years ago, little information is available about their existence, performance, and practical barriers to their implementation. This study assessed the structure, process and impacts of maternal and perinatal death audit systems in clinical practice and presents a detailed account on how they could be improved. Methods A cross sectional descriptive study was conducted in eight major hospitals in Dar es Salaam in January 2009. An in-depth interview guide was used for 29 health managers and members of the audit committees to investigate the existence, structure, process and outcome of such audits in clinical practice. A semi-structured questionnaire was used to interview 30 health care providers in the maternity wards to assess their awareness, attitude and practice towards audit systems. The 2007 institutional pregnancy outcome records were reviewed. Results Overall hospital based maternal mortality ratio was 218/100,000 live births (range: 0 - 385) and perinatal mortality rate was 44/1000 births (range: 17 - 147). Maternal and perinatal audit systems existed only in 4 and 3 hospitals respectively, and key decision makers did not take part in audit committees. Sixty percent of care providers were not aware of even a single action which had ever been implemented in their hospitals because of audit recommendations. There were neither records of the key decision points, action plan, nor regular analysis of the audit reports in any of the facilities where such audit systems existed. Conclusions Maternal and perinatal audit systems in these institutions are poorly established in structure and process; and are less effective to improve the quality of care. Fundamental changes are urgently needed for successful audit systems in these institutions. PMID:20525282

  6. Socioeconomic associations of improved maternal, neonatal, and perinatal survival in Qatar

    PubMed Central

    Rahman, Sajjad; Salameh, Khalil; Bener, Abdulbari; El Ansari, Walid

    2010-01-01

    This retrospective study analyzed the temporal association between socioeconomic development indices and improved maternal, neonatal, and perinatal survival in the State of Qatar over a period of 35 years (1974–2008). We explored the association between reduction in poverty, improvement in maternal education, and perinatal health care on the one hand, and increased maternal, neonatal, and perinatal survival on the other hand. Yearly mortality data was ascertained from the perinatal and neonatal mortality registers of the Women’s Hospital and the national database in the Department of Preventive Medicine at Hamad Medical Corporation in Doha. A total of 323,014 births were recorded during the study period. During these 35 years, there was a remarkable decline (P < 0.001) in Qatar’s neonatal mortality rate from 26.27/1000 in 1974 to 4.4/1000 in 2008 and in the perinatal mortality rate from 44.4/1000 in 1974 to 10.58/1000 in 2008. Qatar’s maternal mortality rate remained zero during 1993, 1995, and then in 1998–2000. The maternal mortality rate was 11.6/100,000 in 2008. For the rest of the years it has been approximately 10/100,000. Across the study period, the reduction in poverty, increase in maternal education, and improved perinatal health care were temporally associated with a significant improvement in maternal, neonatal, and perinatal survival. The total annual births increased five-fold during the study period, with no negative impact on survival rates. Neonatal mortality rates in Qatar have reached a plateau since 2005. We also conducted a substudy to assess the association between improvements in survival rates in relation to health care investment. For this purpose, we divided the study period into two eras, ie, era A (1974–1993) during which major health care investment was in community-based, low-cost interventions, and era B (1994–2008) during which the major health care investment was in high-technology institutional interventions. Although from 1974–1993 (era A) the per capita health expenditure increased by only 19% as compared with a 137% increase in 1994–2008 (era B). The decline in neonatal and perinatal mortality rates was three times steeper during era A than in era B. The decline in neonatal and perinatal mortality rates was also significant (P < 0.001) when analyzed separately for era A and era B. We concluded that across the 35-year period covered by our study, the reduction in poverty, increased maternal education, and improved perinatal health care were temporally associated with improved maternal, neonatal, and perinatal survival in the State of Qatar. From the subanalysis of era A and era B, we concluded that low-cost, community-based interventions, on the background of socioeconomic development, have a stronger impact on maternal, neonatal, and perinatal survival as compared with high-cost institutional interventions. PMID:21151678

  7. Perinatal outcomes following maternal asthma and cigarette smoking during pregnancy.

    PubMed

    Hodyl, Nicolette A; Stark, Michael J; Scheil, Wendy; Grzeskowiak, Luke E; Clifton, Vicki L

    2014-03-01

    Does cigarette smoking in pregnancy explain the increased risk of adverse perinatal outcomes that occur with maternal asthma or does it compound the effect? Using population based birth records, a retrospective analysis was conducted of all singleton pregnancies in South Australia over 10 years (1999-2008; n=172 305), examining maternal asthma, cigarette smoking and quantity of smoking to estimate odds ratios. Compared with nonasthmatic females who did not smoke during pregnancy, both asthmatic females who smoked and those who did not smoke during pregnancy had a significantly increased risk of gestational diabetes, antepartum haemorrhage, polyhydramnios, premature rupture of membranes, emergency Caesarean section, and the child being small for gestational age and having congenital abnormalities. These associations suggest that asthma, independently of maternal smoking, increases the risk of these adverse perinatal outcomes. Maternal smoking was itself associated with an increased risk of a number of poor neonatal outcomes, with a dose-response relationship observed. Notably, maternal asthma combined with cigarette smoking significantly increased the risk of preterm birth and urinary tract infections to a greater degree than with either exposure alone. Maternal asthma and cigarette smoking during pregnancy are both independently associated with adverse perinatal outcomes and, combined, compound the risk of preterm birth and urinary tract infections. PMID:23900987

  8. Linkages among reproductive health, maternal health, and perinatal outcomes.

    PubMed

    Bhutta, Zulfiqar A; Lassi, Zohra S; Blanc, Ann; Donnay, France

    2010-12-01

    Some interventions in women before and during pregnancy may reduce perinatal and neonatal deaths, and recent research has established linkages of reproductive health with maternal, perinatal, and early neonatal health outcomes. In this review, we attempted to analyze the impact of biological, clinical, and epidemiologic aspects of reproductive and maternal health interventions on perinatal and neonatal outcomes through an elucidation of a biological framework for linking reproductive, maternal and newborn health (RHMNH); care strategies and interventions for improved perinatal and neonatal health outcomes; public health implications of these linkages and implementation strategies; and evidence gaps for scaling up such strategies. Approximately 1000 studies (up to June 15, 2010) were reviewed that have addressed an impact of reproductive and maternal health interventions on perinatal and neonatal outcomes. These include systematic reviews, meta-analyses, and stand-alone experimental and observational studies. Evidences were also drawn from recent work undertaken by the Child Health Epidemiology Reference Group (CHERG), the interconnections between maternal and newborn health reviews identified by the Global Alliance for Prevention of Prematurity and Stillbirth (GAPPS), as well as relevant work by the Partnership for Maternal, Newborn and Child Health. Our review amply demonstrates that opportunities for assessing outcomes for both mothers and newborns have been poorly realized and documented. Most of the interventions reviewed will require more greater-quality evidence before solid programmatic recommendations can be made. However, on the basis of our review, birth spacing, prevention of indoor air pollution, prevention of intimate partner violence before and during pregnancy, antenatal care during pregnancy, Doppler ultrasound monitoring during pregnancy, insecticide-treated mosquito nets, birth and newborn care preparedness via community-based intervention packages, emergency obstetrical care, elective induction for postterm delivery, Cesarean delivery for breech presentation, and prophylactic corticosteroids in preterm labor reduce perinatal mortality; and early initiation of breastfeeding and birth and newborn care preparedness through community-based intervention packages reduce neonatal mortality. This review demonstrates that RHMNH are inextricably linked, and that, therefore, health policies and programs should link them together. Such potential integration of strategies would not only help improve outcomes for millions of mothers and newborns but would also save scant resources. This would also allow for greater efficiency in training, monitoring, and supervision of health care workers and would also help families and communities to access and use services easily. PMID:21094418

  9. Maternal nerve growth factor serum levels in the perinatal period.

    PubMed

    Schulte-Herbrüggen, Olaf; Litzke, Julia; Hornych, Katharina; Zingler, Christiana; Höppner, Jacqueline; Virchow, J Christian; Hellweg, Rainer; Lommatzsch, Marek

    2007-06-01

    Neurotrophins, such as nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF), are potent modulators of neuronal and immune function, and have been implicated recently in diseases associated with pregnancy. In contrast to serum BDNF, which is reportedly suppressed in the perinatal period, regulation of NGF in the perinatal period is unknown. In this study, serum NGF concentrations were measured in 40 pregnant (follow-up: 30th and 37th week of gestation, 1 week and 8 weeks after childbirth) and 40 non-pregnant women. Maternal NGF serum levels did not differ significantly from controls (median: 7.6 pg NGF/ml serum) neither before nor after childbirth, although there was a trend towards increased NGF concentrations at the 37th week of gestation (median: 12.5 pg NGF/ml serum) and 1 week after childbirth (median: 11.6 pg NGF/ml serum). There was no association of maternal NGF with 17beta-estradiol, progesterone, dehydroepiandrosterone sulfate (DHEAS) and cortisol concentrations in maternal serum, or maternal depression, as measured by the Edinburgh Postnatal Depression Scale (EPDS). In the non-pregnant control group, NGF serum concentrations were negatively correlated with the number of days since the first day of the menstrual cycle (r=-0.32, p<0.05). In conclusion, NGF is not altered during normal pregnancy on a systemic level. In addition, NGF displays a different regulation compared with BDNF during the menstrual cycle. PMID:17141328

  10. Maternal Stress and Emotional Status during the Perinatal Period and Childhood Adjustment

    ERIC Educational Resources Information Center

    Anhalt, Karla; Telzrow, Cathy F.; Brown, Courtney L.

    2007-01-01

    An emerging literature suggests that maternal distress during the prenatal and perinatal period may adversely affect offspring development. The association between maternal stress and emotional status in the perinatal period (defined as 1 month after birth) and adjustment of first-grade children was examined in 948 mother-child dyads from the…

  11. Under-reporting of maternal and perinatal adverse events in New Zealand

    PubMed Central

    Farquhar, Cynthia; Armstrong, Sarah; Kim, Boa; Masson, Vicki; Sadler, Lynn

    2015-01-01

    Objectives To determine the proportion of maternal and perinatal mortality and morbidity cases, identified by the Perinatal and Maternal Mortality Review Committee (PMMRC), that are also reported within the annual serious adverse events (SAEs) reports published by the Health Quality and Safety Commission (HQSC). Setting Nationally collated data from the PMMRC and HQSC, New Zealand. Participants Analysis of maternal and perinatal mortality and morbidity data 2009–2012. Interventions Every SAE report published by the HQSC from 2009 to 2012 was scrutinised for maternal and perinatal cases using the case history provided by district health boards (DHB). Further detail of each case was requested from each DHB to establish whether they had been identified as maternal or perinatal mortalities or morbidities by the PMMRC. Primary outcome measure The proportion of maternal and perinatal mortality and morbidity cases identified by HQSC SAE reports, compared with PMMRC reporting. Results 58 maternal and perinatal SAEs were identified from the SAE reports 2009–2012. Of these, 50 fit under the PMMRC reporting definitions, all of which were also reported by the PMMRC. In the same time frame, the PMMRC captured 536 potentially avoidable maternal and perinatal mortalities and morbidities that fitted the HQSC SAE definition. Fewer than 9% of maternal and perinatal SAEs are captured by the HQSC SAE reporting process. Conclusions The rate of maternal and perinatal adverse event reporting to the HQSC is low and not improving annually, compared with PMMRC reporting of eligible events. This is of concern as these events may not be adequately reviewed locally, and because the SAE report is considered a measure of quality by the DHBs and the HQSC. Currently, the reporting of SAEs to the HQSC cannot be considered a reliable way to monitor or improve the quality of maternity services provided in New Zealand. PMID:26204910

  12. The Relationship Between Maternal Glycemia and Perinatal Outcome

    PubMed Central

    Landon, Mark B.; Mele, Lisa; Spong, Catherine Y.; Carpenter, Marshall W.; Ramin, Susan M.; Casey, Brian; Wapner, Ronald J.; Varner, Michael W.; Rouse, Dwight J.; Thorp, John M.; Sciscione, Anthony; Catalano, Patrick; Harper, Margaret; Saade, George; Caritis, Steve N; Sorokin, Yoram; Peaceman, Alan M.; Tolosa, Jorge E.; Anderson, Garland D.

    2014-01-01

    Objective To examine the relationship between varying degrees of maternal hyperglycemia and pregnancy outcomes. Methods This was a secondary analysis of a treatment trial for mild gestational diabetes (GDM) including four cohorts: 1) 473 women with untreated mild GDM; 2) 256 women with a positive 50-gram screen and one abnormal oral glucose tolerance test (OGTT) value; 3) 675 women with a positive screen and no abnormal OGTT values; and 4) 437 women with a normal 50-gram screen. Groups were compared by test of trend for a composite perinatal outcome (neonatal hypoglycemia, hyperbilirubinemia, elevated cord c-peptide level, and perinatal trauma or death), frequency of large-for-gestational-age (LGA) infant, shoulder dystocia, and pregnancy-related hypertension. Three-hour OGTT levels (fasting, 1, 2, and 3 hour) levels were divided into categories and analyzed for their relationship to perinatal and maternal outcomes. Results There were significant trends by glycemic status among the four cohorts for the composite and all other outcomes (p<0.001). Analysis for trend according to OGTT categories showed an increasing relationship between fasting and all post load levels and the various outcomes (p<0.05). Fasting glucose ≥ 90 mg/dl and 1 hour ≥ 165 mg/dl were associated with an increased risk for the composite outcome, odds ratios and 95% CI of 2.0 (1.03-4.15) and 1.46 (1.02-2.11) to 1.52 (1.08-2.15), for the fasting and 1 hour, respectively. A 1 hour glucose ≥ 150 mg/dl was associated with an increased risk for LGA (odds ratios 1.8 (1.02-3.18) to 2.35 (1.35-4.14), however 2 and 3 hour glucose levels did not increase the risk for the composite or LGA until well beyond current GDM diagnostic thresholds. Conclusion A monotonic relationship exists between increasing maternal glycemia and perinatal morbidity. Current OGTT criteria require re-evaluation in determining thresholds for the diagnosis and treatment of GDM. PMID:21309194

  13. Maternal education and perinatal outcomes among Spanish women residing in southern Spain (2001-2011).

    PubMed

    Juárez, Sol; Revuelta-Eugercios, Bárbara A; Ramiro-Fariñas, Diego; Viciana-Fernández, Francisco

    2014-10-01

    Evidence suggests that educational differences in perinatal outcomes have increased in some countries (Eastern Europe) while remained stable in others (Scandinavian countries). However, less is known about the experience of Southern Europe. This study aims to evaluate the association between maternal education and perinatal outcomes derived from birthweight (low birthweight and macrosomia) and gestational age (pre-term and post-term births) among Spaniards living in the Autonomous Community of Andalusia during the period 2001-2011 (around 19 % of births in Spain); and to evaluate whether the educational differences narrowed or widened during that period, which includes both an economic boom (2001-2008) and the global economic crisis (2009-2011). This study uses the Andalusian Population Longitudinal Database and the Vital Statistics Data provided by the Spanish National Statistics Institute. We study live and singleton births of Spanish mothers who lived in Andalusia at the time of delivery (n = 404,951). ORs with 95 % confidence intervals (crude and adjusted) were estimated using multinomial regression models. A negative educational gradient is observed in all perinatal outcomes studied (i.e., the higher the educational status, the lower the risk of negative perinatal outcomes). However, when disaggregating the sample in two periods, the gradient is only statistically significant for pre-term birth during 2001-2008, while a full gradient is observed in all perinatal indicators in the period 2009-2011 with an increase in the educational inequalities in macrosomia and post-term. Further studies are needed in order to confirm whether there is a causal association between the widening of the educational differences in perinatal outcomes and the onset of the economic crisis in Spain, or the widening can be explained by other factors, such as changes in childbearing patterns and the composition of women accessing motherhood. PMID:24374730

  14. Maternal health literacy progression among rural perinatal women.

    PubMed

    Mobley, Sandra C; Thomas, Suzanne Dixson; Sutherland, Donald E; Hudgins, Jodi; Ange, Brittany L; Johnson, Maribeth H

    2014-10-01

    This research examined changes in maternal health literacy progression among 106 low income, high risk, rural perinatal African American and White women who received home visits by Registered Nurse Case Managers through the Enterprise Community Healthy Start Program. Maternal health literacy progression would enable women to better address intermediate factors in their lives that impacted birth outcomes, and ultimately infant mortality (Lu and Halfon in Mater Child Health J 7(1):13-30, 2003; Sharma et al. in J Natl Med Assoc 86(11):857-860, 1994). The Life Skills Progression Instrument (LSP) (Wollesen and Peifer, in Life skills progression. An outcome and intervention planning instrument for use with families at risk. Paul H. Brookes Publishing Co., Baltimore, 2006) measured changes in behaviors that represented intermediate factors in birth outcomes. Maternal Health Care Literacy (LSP/M-HCL) was a woman's use of information, critical thinking and health care services; Maternal Self Care Literacy (LSP/M-SCL) was a woman's management of personal and child health at home (Smith and Moore in Health literacy and depression in the context of home visitation. Mater Child Health J, 2011). Adequacy was set at a score of (?4). Among 106 women in the study initial scores were inadequate (<4) on LSP/M-HCL (83 %), and on LSP/M-SCL (30 %). Significant positive changes were noted in maternal health literacy progression from the initial prenatal assessment to the first (p < .01) postpartum assessment and to the final (p < .01) postpartum assessment using McNemar's test of gain scores. Numeric comparison of first and last gain scores indicated women's scores progressed (LSP/M-HCL; p < .0001) and (LSP/M-SCL; p < .0001). Elevated depression scores were most frequent among women with <4 LSP/M-HCL and/or <4 LSP/M-SCL. Visit notes indicated lack or loss of relationship with the father of the baby and intimate partner discord contributed to higher depression scores. PMID:24469358

  15. Maternal drinking water arsenic exposure and perinatal outcomes in Inner Mongolia, China, Journal

    EPA Science Inventory

    BACKGROUND: Bayingnormen is a region located in western Inner Mongolia China with a population that is exposed to a wide range of drinking water Arsenic concentrations. This study evaluated the relationship between maternal drinking water arsenic exposure and perinatal endpoints ...

  16. Maternal drinking water arsenic exposure and perinatal outcomes in Inner Mongolia, China

    EPA Science Inventory

    Exposure to high levels of arsenic has been reported to increase adverse birth outcomes including spontaneous abortion, preterm birth, and low birthweight. This study evaluated the relationship between maternal arsenic exposure and perinatal endpoints (term birthweight, preterm ...

  17. Rate and Time Trend of Perinatal, Infant, Maternal Mortality, Natality and Natural Population Growth in Kosovo

    PubMed Central

    Azemi, Mehmedali; Gashi, Sanije; Berisha, Majlinda; Kolgeci, Selim; Ismaili-Jaha, Vlora

    2012-01-01

    Aim: The aim of work has been the presentation of the rate and time trends of some indicators of the heath condition of mothers and children in Kosovo: fetal mortality, early neonatal mortality, perinatal mortality, infant mortality, natality, natural growth of population etc. The treated patients were the newborn and infants in the post neonatal period, women during their pregnancy and those 42 days before and after the delivery. Methods: The data were taken from: register of the patients treated in the Pediatric Clinic of Prishtina, World Health Organization, Mother and Child Health Care, Reproductive Health Care, Ministry of Health of the Republic of Kosovo, Statistical Department of Kosovo, the National Institute of Public Health and several academic texts in the field of pediatrics. Some indicators were analyzed in a period between year 1945-2010 and 1950-2010, whereas some others were analyzed in a time period between year 2000 and 2011. Results: The perinatal mortality rate in 2000 was 29.1‰, whereas in 2011 it was 18.7‰. The fetal mortality rate was 14.5‰ during the year 2000, whereas in 2011 it was 11.0‰, in 2000 the early neonatal mortality was 14.8‰, in 2011 it was 7.5‰. The infant mortality in Kosovo was 164‰ in 1950, whereas in 2010 it was 20.5‰. The most frequent causes of infant mortality have been: lower respiratory tract infections, acute infective diarrhea, perinatal causes, congenital malformations and unclassified conditions. Maternal death rate varied during this time period. Maternal death in 2000 was 23 whereas in 2010 only two cases were reported. Regarding the natality, in 1950 it reached 46.1 ‰, whereas in 2010 it reached 14‰, natural growth of population rate in Kosovo was 29.1‰ in 1950, whereas in 2011 it was 11.0‰. Conclusion: Perinatal mortality rate in Kosovo is still high in comparison with other European countries (Turkey and Kyrgyzstan have the highest perinatal mortality rate), even though it is in a continuous decrease. Infant mortality considerably decreased (from 164‰ in 1950 to 20.5‰ in 2010). The causes of infant mortality have still been tightly related with the causes of the developing countries. Next to this, natality and the natural population growth have experienced a considerably decrease in Kosovo. Even though there have been some improvements within the health care in Kosovo, there is still a lot to be done with the aim of constant improvement of health care in order to promote the health care for mothers and children. PMID:23678327

  18. Maternal and perinatal risk factors for childhood leukemia

    SciTech Connect

    Zack, M.; Adami, H.O.; Ericson, A. )

    1991-07-15

    This report describes an exploratory population-based study of maternal and perinatal risk factors for childhood leukemia in Sweden. The Swedish National Cancer Registry ascertained 411 cases in successive birth cohorts from 1973 through 1984 recorded in the Swedish Medical Birth Registry. Using the latter, we matched five controls without cancer to each case by sex and month and year of birth. Mothers of children with leukemia were more likely to have been exposed to nitrous oxide anesthesia during delivery than mothers of controls (odds ratio (OR) = 1.3; 95% confidence interval (CI) = 1.0, 1.6). Children with leukemia were more likely than controls to have Down's syndrome (OR = 32.5; 95% CI = 7.3, 144.0) or cleft lip or cleft palate (OR = 5.0; 95% CI = 1.0, 24.8); to have had a diagnosis associated with difficult labor but unspecified complications (OR = 4.5; 95% CI = 1.1, 18.2) or with other conditions of the fetus or newborn (OR = 1.5; 95% CI = 1.1, 2.1), specifically, uncomplicated physiological jaundice (OR = 1.9; 95% CI = 1.2, 2.9); or to have received supplemental oxygen (OR = 2.6; 95% CI = 1.3, 1.3, 4.9). Because multiple potential risk factors were analyzed in this study, future studies need to check these findings. The authors did not confirm the previously reported higher risks for childhood leukemia associated with being male, having a high birth weight, or being born to a woman of advanced maternal age.

  19. Population Attributable Risk Fractions of Maternal Overweight and Obesity for Adverse Perinatal Outcomes.

    PubMed

    MacInnis, Natasha; Woolcott, Christy G; McDonald, Sarah; Kuhle, Stefan

    2016-01-01

    The objective of the current study was to determine the proportion of adverse perinatal outcomes that could be potentially prevented if maternal obesity were to be reduced or eliminated (population attributable risk fractions, PARF); and the number needed to treat (NNT) of overweight or obese women to prevent one case of adverse perinatal outcome. Data from the Atlee Perinatal Database on 66,689 singleton infants born in Nova Scotia, Canada, between 2004 and 2014, and their mothers were used. Multivariable-adjusted PARFs and NNTs of maternal pre-pregnancy weight status were determined for various perinatal outcomes under three scenarios: If all overweight and obese women were to i) become normal weight before pregnancy; ii) shift down one weight class; or iii) lose 10% of their body weight, significant relative reductions would be seen for gestational diabetes mellitus (GDM, 57/33/15%), hypertensive disorders of pregnancy (HDP, 26/16/6%), caesarean section (CS, 18/10/3%), and large for gestational age births (LGA, 24/14/3%). The NNT were lowest for the outcomes GDM, induction of labour, CS, and LGA, where they ranged from 13 to 73. The study suggests that a substantial proportion of adverse perinatal outcomes may be preventable through reductions in maternal pre-pregnancy weight. PMID:26961675

  20. Population Attributable Risk Fractions of Maternal Overweight and Obesity for Adverse Perinatal Outcomes

    PubMed Central

    MacInnis, Natasha; Woolcott, Christy G.; McDonald, Sarah; Kuhle, Stefan

    2016-01-01

    The objective of the current study was to determine the proportion of adverse perinatal outcomes that could be potentially prevented if maternal obesity were to be reduced or eliminated (population attributable risk fractions, PARF); and the number needed to treat (NNT) of overweight or obese women to prevent one case of adverse perinatal outcome. Data from the Atlee Perinatal Database on 66,689 singleton infants born in Nova Scotia, Canada, between 2004 and 2014, and their mothers were used. Multivariable-adjusted PARFs and NNTs of maternal pre-pregnancy weight status were determined for various perinatal outcomes under three scenarios: If all overweight and obese women were to i) become normal weight before pregnancy; ii) shift down one weight class; or iii) lose 10% of their body weight, significant relative reductions would be seen for gestational diabetes mellitus (GDM, 57/33/15%), hypertensive disorders of pregnancy (HDP, 26/16/6%), caesarean section (CS, 18/10/3%), and large for gestational age births (LGA, 24/14/3%). The NNT were lowest for the outcomes GDM, induction of labour, CS, and LGA, where they ranged from 13 to 73. The study suggests that a substantial proportion of adverse perinatal outcomes may be preventable through reductions in maternal pre-pregnancy weight. PMID:26961675

  1. Maternal Chronological Age, Prenatal and Perinatal History, Social Support, and Parenting of Infants

    ERIC Educational Resources Information Center

    Bornstein, Marc H.; Putnick, Diane L.; Suwalsky, Joan T. D.; Gini, Motti

    2006-01-01

    The role of maternal chronological age in prenatal and perinatal history, social support, and parenting practices of new mothers (N=335) was examined. Primiparas of 5-month-old infants ranged in age from 13 to 42 years. Age effects were zero, linear, and nonlinear. Nonlinear age effects were significantly associated up to a certain age with little…

  2. Postpartum bonding: the role of perinatal depression, anxiety and maternal-fetal bonding during pregnancy.

    PubMed

    Dubber, S; Reck, C; Müller, M; Gawlik, S

    2015-04-01

    Adverse effects of perinatal depression on the mother-child interaction are well documented; however, the influence of maternal-fetal bonding during pregnancy on postpartum bonding has not been clearly identified. The subject of this study was to investigate prospectively the influence of maternal-fetal bonding and perinatal symptoms of anxiety and depression on postpartum mother-infant bonding. Data from 80 women were analyzed for associations of symptoms of depression and anxiety as well as maternal bonding during pregnancy to maternal bonding in the postpartum period using the Edinburgh Postnatal Depression Scale (EPDS), the State-Trait Anxiety Inventory (STAI), the Pregnancy Related Anxiety Questionnaire (PRAQ-R), the Maternal-Fetal Attachment Scale (MFAS) and the Postpartum Bonding Questionnaire (PBQ-16). Maternal education, MFAS, PRAQ-R, EPDS and STAI-T significantly correlated with the PBQ-16. In the final regression model, MFAS and EPDS postpartum remained significant predictors of postpartum bonding and explained 20.8 % of the variance. The results support the hypothesized negative relationship between maternal-fetal bonding and postpartum maternal bonding impairment as well as the role of postpartum depressive symptoms. Early identification of bonding impairment during pregnancy and postpartum depression in mothers plays an important role for the prevention of potential bonding impairment in the early postpartum period. PMID:25088531

  3. Maternal High Fat Diet Consumption during the Perinatal Period Programs Offspring Behavior

    PubMed Central

    Sullivan, Elinor L.; Nousen, Libby; Chamlou, Katie

    2012-01-01

    The environment that developing offspring experience during the perinatal period is markedly influenced by maternal health and diet composition. Evidence from both epidemiological studies and animal models indicates that maternal diet and metabolic status play a critical role in programming the neural circuitry that regulates behavior, resulting in long-term consequences for offspring behavior. Maternal diet and metabolic state influence the behavior of offspring directly by impacting the intrauterine environment and indirectly by modulating maternal behavior. The mechanisms by which maternal diet and metabolic profile shape the perinatal environment remain largely unknown, but recent research has found that increases in inflammatory cytokines, nutrients (glucose and fatty acids), and hormones (insulin and leptin) affect the environment of the developing offspring. Offspring exposed to maternal obesity and high fat diet consumption during development are more susceptible to developing mental health and behavioral disorders such as anxiety, depression, attention deficit hyperactivity disorder, and autism spectrum disorders. Recent evidence suggests that this increased risk for behavioral disorders is driven by modifications in the development of neural pathways involved in behavioral regulation. In particular, research indicates that the development of the serotonergic system is impacted by exposure to maternal obesity and high fat diet consumption, and this disruption may underlie many of the behavioral disturbances observed in these offspring. Given the high rates of obesity and high fat diet consumption in pregnant women, it is vital to examine the influence that maternal nutrition and metabolic profile have on the developing offspring. PMID:23085399

  4. Maternal high fat diet consumption during the perinatal period programs offspring behavior.

    PubMed

    Sullivan, Elinor L; Nousen, Elizabeth K; Chamlou, Katherine A

    2014-01-17

    The environment that a developing offspring experiences during the perinatal period is markedly influenced by maternal health and diet composition. Evidence from both epidemiological studies and animal models indicates that maternal diet and metabolic status play a critical role in programming the neural circuitry that regulates behavior, resulting in long-term consequences for offspring behavior. Maternal diet and metabolic state influence the behavior of offspring directly by impacting the intrauterine environment and indirectly by modulating maternal behavior. The mechanisms by which maternal diet and metabolic profile shape the perinatal environment remain largely unknown, but recent research has found that increases in inflammatory cytokines, nutrients (glucose and fatty acids), and hormones (insulin and leptin) affect the environment of the developing offspring. Offspring exposed to maternal obesity and high fat diet consumption during development are more susceptible to developing mental health and behavioral disorders such as anxiety, depression, attention deficit hyperactivity disorder, and autism spectrum disorders. Recent evidence suggests that this increased risk for behavioral disorders is driven by modifications in the development of neural pathways involved in behavioral regulation. In particular, research indicates that the development of the serotonergic system is impacted by exposure to maternal obesity and high fat diet consumption, and this disruption may underlie many of the behavioral disturbances observed in these offspring. Given the high rates of obesity and high fat diet consumption in pregnant women, it is vital to examine the influence that maternal nutrition and metabolic profile have on the developing offspring. PMID:23085399

  5. How the Kidney Is Impacted by the Perinatal Maternal Environment to Develop Hypertension1

    PubMed Central

    Paixão, Ana D.; Alexander, Barbara T.

    2013-01-01

    ABSTRACT Environmental conditions during perinatal development such as maternal undernutrition, maternal glucocorticoids, placental insufficiency, and maternal sodium overload can program changes in renal Na+ excretion leading to hypertension. Experimental studies indicate that fetal exposure to an adverse maternal environment may reduce glomerular filtration rate by decreasing the surface area of the glomerular capillaries. Moreover, fetal responses to environmental insults during early life that contribute to the development of hypertension may include increased expression of tubular apical or basolateral membrane Na+ transporters and increased production of renal superoxide leading to enhanced Na+ reabsorption. This review will address the role of these potential renal mechanisms in the fetal programming of hypertension in experimental models induced by maternal undernutrition, fetal exposure to glucocorticoids, placental insufficiency, and maternal sodium overload in the rat. PMID:24227755

  6. Perinatal depression

    PubMed Central

    Alhusen, Jeanne L.; Alvarez, Carmen

    2016-01-01

    Abstract: Perinatal depression is a common condition with significant adverse maternal, fetal, neonatal, and early childhood outcomes. The perinatal period is an opportune time to screen, diagnose, and treat depression. Improved recognition of perinatal depression, particularly among low-income women, can lead to improved perinatal health outcomes. PMID:26934457

  7. Maternal Affective Illness in the Perinatal Period and Child Development: Findings on Developmental Timing, Mechanisms, and Intervention.

    PubMed

    O'Connor, Thomas G; Monk, Catherine; Burke, Anne S

    2016-03-01

    Maternal mental illness is one of the most reliable risks for clinically significant child adjustment difficulties. The research literature in this area is very large and broad and dates back decades. In this review, we consider recent research findings on maternal mental illness and child development by focusing particularly on affective illness the perinatal period. We do this because maternal affective illness in the perinatal period is common; recent evidence suggests that pre- and postpartum maternal depression may have lasting effects on child behavioral and somatic health; research in the perinatal period raises acute and compelling questions about mechanisms of transmission and effect; and perinatal-focused interventions may offer distinct advantages for benefitting mother and child and gaining insights into developmental mechanisms. Throughout the review, we attend to the increasing integration of psychological and biological models and the trans-disciplinary approach now required for clinical investigation. PMID:26830882

  8. Severe Preeclampsia versus HELLP Syndrome: Maternal and Perinatal Outcomes at <34 and ?34 Weeks Gestation

    PubMed Central

    K?nay, Tu?ba; Kk, Canan; Kay?k?o?lu, Fulya; Karakaya, Jale

    2015-01-01

    Background: Preeclampsia and Hemolysis, Elevated Liver enzymes, Low Platelet (HELLP) syndrome are important disorders affecting the health of both the mother and fetus. Prediction of the maternal and perinatal outcomes at early and late gestational age is important for the management of both disorders. Aims: The purpose of the study was to investigate adverse maternal and perinatal outcomes in severe preeclampsia and HELLP syndrome cases according to gestational age. Study Design: Retrospective cross-sectional study. Methods: One hundred and ninety-seven pregnancies with severe preeclampsia and 56 pregnancies with HELLP syndrome were included the study. Clinical characteristics and adverse maternal and perinatal outcomes were noted from medical records. Participants were divided into two groups at <34 and ?34 weeks gestation: the severe preeclampsia group and the HELLP syndrome group. The differences between the outcomes in the groups were investigated. Statistical analysis was performed using the Student t test, Fisher Exact test and Yates Chi-square test. Results: Eclampsia was more common in HELLP syndrome cases at <34 weeks gestation (p 0.028). However, eclampsia rates were statistically similar between groups at ?34 weeks gestation. The requirement for blood products transfusion was higher in the HELLP group at all gestational weeks. No statistical difference was found in perinatal outcomes between severe preeclampsia and HELLP groups at less than and more than 34 weeks gestation. Conclusion: Eclampsia risk increases in HELLP syndrome, especially at gestations less than 34 weeks. Perinatal morbidity at less than 34 weeks gestation and mortality were similar in severe preeclampsia and HELLP syndrome cases at the same gestational age. PMID:26740894

  9. Maternal adiposity--a determinant of perinatal and offspring outcomes?

    PubMed

    Lawlor, Debbie A; Relton, Caroline; Sattar, Naveed; Nelson, Scott M

    2012-11-01

    Experimental and animal data suggest that maternal obesity during pregnancy adversely affects offspring health in the short-term and the long-term. Whether these effects occur in humans and influence population health is less clear. This Review explores evidence from intervention studies and observational studies that have used designs (such as family-based comparisons and Mendelian randomization) that might help improve understanding of the causal effects of maternal obesity in humans. Collectively, human studies provide evidence that maternal overweight and obesity is causally related to pregnancy complications, increased offspring weight and adiposity at birth, and the difficulties associated with delivery of large-for-gestational-age infants. The underlying mechanisms for these effects probably involve maternal and fetal dysregulation of glucose, insulin, lipid and amino acid metabolism. Some evidence exists that extreme maternal obesity (BMI ≥40 kg/m(2)) is causally related to a long-term increase in offspring adiposity, but further exploration of this relationship is needed. High gestational weight gain may result in a long-term increase in offspring adiposity if women are already overweight or have obesity at the start of pregnancy. To date, little high-quality human evidence exists that any of these effects are mediated by epigenetic mechanisms, but approaches to appropriately test this possibility are being developed. PMID:23007319

  10. Adverse maternal and perinatal outcomes in adolescent pregnancies: The Global Network’s Maternal Newborn Health Registry study

    PubMed Central

    2015-01-01

    Background Adolescent girls between 15 and 19 years give birth to around 16 million babies each year, around 11% of births worldwide. We sought to determine whether adolescent mothers are at higher risk of maternal and perinatal adverse outcomes compared with mothers aged 20–24 years in a prospective, population-based observational study of newborn outcomes in low resource settings. Methods We undertook a prospective, population-based multi-country research study of all pregnant women in defined geographic areas across 7 sites in six low-middle income countries (Kenya, Zambia, India, Pakistan, Guatemala and Argentina). The study population for this analysis was restricted to women aged 24 years or less, who gave birth to infants of at least 20 weeks’ gestation and 500g or more. We compared adverse pregnancy maternal and perinatal outcomes among pregnant adolescents 15-19 years, <15 years, and adults 20-24 years. Results A total of 269,273 women were enrolled from January 2010 to December 2013. Of all pregnancies 11.9% (32,097/269,273) were in adolescents 15-19 years, while 0.14% (370/269,273) occurred among girls <15 years. Pregnancy among adolescents 15-19 years ranged from 2% in Pakistan to 26% in Argentina, and adolescent pregnancies <15 year were only observed in sub-Saharan Africa and Latin America. Compared to adults, adolescents did not show increased risk of maternal adverse outcomes. Risks of preterm birth and LBW were significantly higher among both early and older adolescents, with the highest risks observed in the <15 years group. Neonatal and perinatal mortality followed a similar trend in sub-Saharan Africa and Latin America, with the highest risk in early adolescents, although the differences in this age group were not significant. However, in South Asia the risks of neonatal and perinatal death were not different among adolescents 15-19 years compared to adults. Conclusions This study suggests that pregnancy among adolescents is not associated with worse maternal outcomes, but is associated with worse perinatal outcomes, particularly in younger adolescents. However, this may not be the case in regions like South Asia where there are decreasing rates of adolescent pregnancies, concentrated among older adolescents. The increased risks observed among adolescents seems more likely to be associated with biological immaturity, than with socio-economic factors, inadequate antenatal or delivery care. Trial registration number NCT01073475 PMID:26063350

  11. Personality and Perinatal Maternal Insomnia: A Study Across Childbirth.

    PubMed

    Dørheim, Signe K; Garthus-Niegel, Susan; Bjorvatn, Bjørn; Eberhard-Gran, Malin

    2016-01-01

    Personality may influence sleep in perinatal women. A follow-up study was conducted among 3,752 pregnant, then postpartum women at Akershus University Hospital, Norway. The Big Five personality dimensions were measured by the Mini-International Personality Item Pool in week 17 of pregnancy. Insomnia was measured by the Bergen Insomnia Scale in pregnancy week 32 and 8 weeks postpartum, along with self-reported sleep times. The Edinburgh Postnatal Depression Scale measured depression, and the Hopkins Symptom Checklist measured anxiety. Adjusted for current anxiety, depression, and demographic variables, the personality traits Neuroticism and Agreeableness were associated with insomnia in pregnancy. No personality traits were associated with postpartum insomnia. Extraversion was associated with longer postpartum sleep duration and better sleep efficiency, and Agreeableness with shorter sleep duration. PMID:25174718

  12. Tissue-specific Leptin promoter DNA methylation is associated with maternal and infant perinatal factors.

    PubMed

    Lesseur, Corina; Armstrong, David A; Paquette, Alison G; Koestler, Devin C; Padbury, James F; Marsit, Carmen J

    2013-12-01

    Leptin a regulator of body weight is involved in reproductive and developmental functions. Leptin promoter DNA methylation (LEP) regulates gene expression in a tissue-specific manner and has been linked to adverse pregnancy outcomes. In non-pathologic human pregnancies, we assessed LEP methylation, genotyped the single nucleotide polymorphism (SNP) rs2167270 in placental (n=81), maternal and cord blood samples (n=60), and examined the association between methylation, genotype, and perinatal factors. Maternal blood LEP methylation was lower in pre-pregnancy obese women (P=0.01). Cord blood LEP methylation was higher in small for gestational age (SGA) (P=4.6×10(-3)) and A/A genotype (P=1.6×10(-4)), lower (-1.47, P=0.03) in infants born to pre-pregnancy obese mothers and correlated (P=0.01) with maternal blood LEP. Gender was associated with placental LEP methylation (P=0.05). These results suggest that LEP epigenetic control may be influenced by perinatal factors including: maternal obesity, infant growth, genotype and gender in a tissue-specific manner and may have multigenerational implications. PMID:23911897

  13. Tissue-specific Leptin promoter DNA methylation is associated with maternal and infant perinatal factors

    PubMed Central

    Lesseur, Corina; Armstrong, David A.; Paquette, Alison G.; Koestler, Devin C.; Padbury, James F.; Marsit, Carmen J.

    2013-01-01

    Leptin a regulator of body weight is involved in reproductive and developmental functions. Leptin promoter DNA methylation (LEP) regulates gene expression in a tissue-specific manner and has been linked to adverse pregnancy outcomes. In non-pathologic human pregnancies, we assessed LEP methylation, genotyped the single nucleotide polymorphism (SNP) rs2167270 in placental (n=81), maternal and cord blood samples (n=60), and examined the association between methylation, genotype, and perinatal factors. Maternal blood LEP methylation was lower in pre-pregnancy obese women (P=0.01). Cord blood LEP methylation was higher in small for gestational age (SGA) (P=4.6×10−3) and A/A genotype (P=1.6×10−4), lower (−1.47, P=0.03) in infants born to pre-pregnancy obese mothers and correlated (P=0.01) with maternal blood LEP. Gender was associated with placental LEP methylation (P=0.05). These results suggest that LEP epigenetic control may be influenced by perinatal factors including: maternal obesity, infant growth, genotype and gender in a tissue-specific manner and may have multigenerational implications. PMID:23911897

  14. Maternal perinatal undernutrition modifies lactose and serotranferrin in milk: relevance to the programming of metabolic diseases?

    PubMed

    Wattez, J S; Delmont, A; Bouvet, M; Beseme, O; Goers, S; Delahaye, F; Laborie, C; Lesage, J; Foligné, B; Breton, C; Metges, C C; Vieau, D; Pinet, F

    2015-03-01

    A close link between intrauterine growth restriction and development of chronic adult diseases such as obesity, diabetes, and hypertension has been established both in humans and animals. Modification of growth velocity during the early postnatal period (i.e., lactation) may also sensitize to the development of metabolic syndrome in adulthood. This suggests that milk composition may have long-lasting programming/deprogramming metabolic effects in the offspring. We therefore assess the effects of maternal perinatal denutrition on breast milk composition in a food-restricted 50% (FR50) rat model. Monosaccharides and fatty acids were characterized by gas chromatography, and proteins were profiled by surface-enhanced laser desorption/ionization-time-of-flight analysis in milk samples from FR50 and control rat dams. Milk analysis of FR50 rats demonstrated that maternal undernutrition decreases lactose concentration and modulates lipid profile at postnatal day 10 by increasing the unsaturated fatty acids/saturated fatty acids and diminishes serotransferrin levels at postnatal day 21. Our data indicate that maternal perinatal undernutrition modifies milk composition both quantitatively and qualitatively. These modifications by maternal nutrition open new perspectives to identify molecules that could be used in artificial milk to protect from the subsequent development of metabolic diseases. PMID:25550282

  15. Enhancing Maternal and Perinatal Health in Under-Served Remote Areas in Sub-Saharan Africa: A Tanzanian Model

    PubMed Central

    Nyamtema, Angelo S.; Mwakatundu, Nguke; Dominico, Sunday; Mohamed, Hamed; Pemba, Senga; Rumanyika, Richard; Kairuki, Clementina; Kassiga, Irene; Shayo, Allan; Issa, Omary; Nzabuhakwa, Calist; Lyimo, Chagi; van Roosmalen, Jos

    2016-01-01

    Background In Tanzania, maternal mortality ratio (MMR), unmet need for emergency obstetric care and health inequities across the country are in a critical state, particularly in rural areas. This study was established to determine the feasibility and impact of decentralizing comprehensive emergency obstetric and neonatal care (CEmONC) services in underserved rural areas using associate clinicians. Methods Ten health centres (HCs) were upgraded by constructing and equipping maternity blocks, operating rooms, laboratories, staff houses and installing solar panels, standby generators and water supply systems. Twenty-three assistant medical officers (advanced level associate clinicians), and forty-four nurse-midwives and clinical officers (associate clinicians) were trained in CEmONC and anaesthesia respectively. CEmONC services were launched between 2009 and 2012. Monthly supportive supervision and clinical audits of adverse pregnancy outcomes were introduced in 2011 in these HCs and their respective district hospitals. Findings After launching CEmONC services from 2009 to 2014 institutional deliveries increased in all upgraded rural HCs. Mean numbers of monthly deliveries increased by 151% and obstetric referrals decreased from 9% to 3% (p = 0.03) in HCs. A total of 43,846 deliveries and 2,890 caesarean sections (CS) were performed in these HCs making the mean proportion of all births in EmONC facilities of 128% and mean population-based CS rate of 9%. There were 190 maternal deaths and 1,198 intrapartum and very early neonatal deaths (IVEND) in all health facilities. Generally, health centres had statistically significantly lower maternal mortality ratios and IVEND rates than district hospitals (p < 0.00 and < 0.02 respectively). Of all deaths (maternal and IVEND) 84% to 96% were considered avoidable. Conclusions These findings strongly indicate that remotely located health centres in resource limited settings hold a great potential to increase accessibility to CEmONC services and to improve maternal and perinatal health. PMID:26986725

  16. Survey of trend and factors in perinatal maternal fatigue.

    PubMed

    Cheng, Ching-Yu; Chou, Yu-Hua; Wang, Panchalli; Tsai, Jung-Mei; Liou, Shwu-Ru

    2014-05-18

    Few studies have investigated maternal fatigue, particularly fatigue throughout the duration of pregnancy and the postpartum period. The purpose of this study was to explore changes related to maternal fatigue from pregnancy to postpartum and the factors influencing fatigue. This prospective longitudinal study surveyed 197 pregnant women beyond 24 gestational weeks monthly until one month postpartum. The Multidimensional Assessment of Fatigue scale and one question about fatigue were used. Women at late pregnancy experienced a significant increase in level of fatigue, which remained high after childbirth. Those who were not happy about the pregnancy or were multiparas experienced a higher level of prenatal fatigue than their counterparts. At postpartum, mothers who were unemployed, had no one to help with childcare, or felt that the baby's night-time sleep pattern was a serious problem had a higher level of fatigue. Interventions can be planned and implemented at early pregnancy to reduce the prevalence of fatigue. Encouraging pregnant women to share experiences and thoughts about pregnancy and being a mother is suggested. Further studies that evaluate culturally sensitive instruments for fatigue are needed. PMID:24835296

  17. Maternal serum concentrations of BDNF and depression in the perinatal period.

    PubMed

    Lommatzsch, Marek; Hornych, Katharina; Zingler, Christiana; Schuff-Werner, Peter; Höppner, Jacqueline; Virchow, J Christian

    2006-04-01

    There is accumulating evidence that a deficiency in brain-derived neurotrophic factor (BDNF) plays a critical role in the pathophysiology of depression. This is in line with the postulate that low BDNF levels in serum are associated with depression. However, the regulation of maternal BDNF serum levels in the perinatal period, and its relationship to maternal depression is unknown. In this study, serum BDNF concentrations were measured in 40 pregnant (follow-up: 30th and 37th week of gestation, 1 week and 8 weeks after childbirth) and 40 non-pregnant women (20-40 years old). The Edinburgh Postnatal Depression Scale (EPDS) was assessed in all subjects at all time points. Maternal serum levels of BDNF were markedly decreased, both before and after childbirth (median: <30% of non-pregnant controls). BDNF correlated with decreased Serotonin (5-HT) levels in serum (r>0.6 and p<0.001 at all time points). In contrast, there was no association with altered estrogen, progesterone, dehydroepiandrosterone or cortisol concentrations in serum. There were significantly higher cortisol levels in cases of maternal depression (EPDS scores>9 points) than in cases without depression. There was a trend to a decrease of BDNF and 5-HT levels in cases of maternal depression (as compared to cases without depression), but this was not significant. In conclusion, we demonstrate that women display markedly decreased BDNF serum levels before and after childbirth. This phenomenon might reflect an increased risk for the development of mood disorders in the perinatal period. However, the individual serum concentration of BDNF alone did not predict maternal depression in our study. PMID:16289360

  18. A multidisciplinary program of preparation for childbirth and motherhood: maternal anxiety and perinatal outcomes

    PubMed Central

    2010-01-01

    Background To study maternal anxiety and perinatal outcomes in pregnant women submitted to a Multidisciplinary Program for Childbirth and Motherhood Preparation (MPCM). Methods This is a not randomized controlled trial on 67 nulliparous pregnant women divided into two groups according to participation (MPCM Group; n = 38) or not (Control Group; n = 29) in MPCM. The program consisted of 10 meetings (between the 18th and the 38th gestational week) during which educational, physiotherapeutic and interaction activities were developed. Anxiety was quantified at the beginning and at the end of the gestational period by the Trace-State Anxiety Inventory (STAI). Results Initial maternal anxiety was equivalent between the groups. At the end of the gestational period, it was observed that anxiety levels increased in the Control Group and were maintained in the MPCM Group. A higher occurrence of vaginal deliveries (83.8%) and hospital discharge of three-day-older newborns (81.6%) as a result of MPCM was also significant. Levels of state-anxiety at the end of pregnancy showed a negative correlation with vaginal delivery, gestational age, birth weight and Apgar index at the first minute and positive correlation with the hospital period remaining of the newborns. Conclusion In the study conditions, MPCM was associated with lower levels of maternal anxiety, a larger number of vaginal deliveries and shorter hospitalization time of newborns. It was not related to adverse perinatal outcomes. PMID:21034460

  19. The Effect of Maternal Body Mass Index on Perinatal Outcomes in Women with Diabetes

    PubMed Central

    Marshall, Nicole E.; Guild, Camelia; Cheng, Yvonne W.; Caughey, Aaron B.; Halloran, Donna R.

    2013-01-01

    Objective To determine the effect of increasing maternal obesity, including superobesity (body mass index [BMI] ≥ 50 kg/m2), on perinatal outcomes in women with diabetes. Study Design Retrospective cohort study of birth records for all live-born nonanom-alous singleton infants ≥ 37 weeks’ gestation born to Missouri residents with diabetes from 2000 to 2006. Women with either pregestational or gestational diabetes were included. Results There were 14,595 births to women with diabetes meeting study criteria, including 7,082 women with a BMI > 30 kg/m2 (48.5%). Compared with normal-weight women with diabetes, increasing BMI category, especially superobesity, was associated with a significantly increased risk for preeclampsia (adjusted relative risk [aRR] 3.6, 95% confidence interval [CI] 2.5, 5.2) and macrosomia (aRR 3.0, 95% CI 1.8, 5.40). The majority of nulliparous obese women with diabetes delivered via cesarean including 50.5% of obese, 61.4% of morbidly obese, and 69.8% of superobese women. The incidence of primary elective cesarean among nulliparous women with diabetes increased significantly with increasing maternal BMI with over 33% of morbidly obese and 39% of superobese women with diabetes delivering electively by cesarean. Conclusion Increasing maternal obesity in women with diabetes is significantly associated with higher risks of perinatal complications, especially cesarean delivery. PMID:23696430

  20. The status of women and of maternal and perinatal health in Turkey.

    PubMed

    Kültürsay, Nilgün

    2011-01-01

    Turkey has improved the status of women and the maternal and perinatal health statistics in the last decades. However, discrepancies between urban-rural and east-other regions continue, with some improvements. The education of girls is promoted and maternal age at marriage and at first delivery has increased. Birth control measures are increasingly used. Fertility rates decreased to 2.16 children per fertile woman. Antenatal care standards have improved, and achievement of deliveries by health care personnel and postnatal mother/newborn care has increased to 90%. The maternal death rate decreased to 19.5 in 100,000 pregnants. However, uneducated women marry earlier and have a higher risk of dying from pregnancy-related causes. Perinatal mortality decreased to 19 in 1,000 deliveries. Neonatal mortality rate decreased to 13 in 1,000 live deliveries. Uneducated mothers living in rural areas and having more children receive less antenatal and postnatal care and are more likely to lose their newborn. The major causes of neonatal deaths are prematurity and congenital abnormalities. PMID:21534333

  1. Maternal and perinatal predictors of newborn iron status.

    TOXLINE Toxicology Bibliographic Information

    Morton SB; Saraf R; Bandara DK; Bartholomew K; Gilchrist CA; Atatoa Carr PE; Baylis L; Wall CR; Blacklock HA; Tebbutt M; Grant CC

    2014-09-12

    AIM: To describe iron status at birth in a population sample of children.METHOD: Cord blood samples were obtained at birth from 131 infants enrolled in the cohort study Growing Up in New Zealand. Cord blood serum ferritin (SF) and haemoglobin (Hb) concentrations were measured and associations of SF and Hb with maternal and birth characteristics were determined.RESULTS: Demographics were comparable to the larger cohort, except for having a higher pre-pregnancy body mass index (26.9 vs. 25.4 kg/m2, P=0.005), lower frequency of cigarette smoking during pregnancy (2% vs. 11%, P=0.0004), and smaller proportion with birth-weight <2500 g (0% vs. 5%, P=0.03). Median (interquartile range) SF was 135 (88-180) mcg/L and mean (plus or minus SD) Hb was 160 plus or minus 17 g/L. Eight newborns (7%) had cord SF levels indicative of iron deficiency (SF <35 mcg/L), two newborns were anaemic (Hb <130 g/L) and none had iron deficiency anaemia. Median SF was lower in newborns whose mothers consumed greater than or equal to 3 servings of milk/day during the pregnancy (131 vs. 151 mcg/L, P=0.04). No other associations with SF or Hb were observed.CONCLUSION: Iron deficiency is present in 7% of newborns in New Zealand. Newborns whose mothers consumed more milk during pregnancy had a lower median SF concentration.

  2. Fetal Macrosomia: Risk Factors, Maternal, and Perinatal Outcome

    PubMed Central

    Mohammadbeigi, A; Farhadifar, F; Soufi zadeh, N; Mohammadsalehi, N; Rezaiee, M; Aghaei, M

    2013-01-01

    Background: Macrosomia is defined as birth-weight over 4,000 g irrespective of gestational age and affects 3-15% of all pregnancies. Aim The present study aimed to determine the relationship between mother's characteristics and macrosomic births and also compare macrosomic and normal newborns regarding the maternal and offspring complications of diabetes during pregnancy. Subjects and Methods: In this case control study, among the 420 consecutive births occurring in public and private hospitals of Shiraz, Iran from October 2006 to March 2007, the data of 32 macrosomic and 128 normal newborns were analyzed using t-test and chi square in bivariate and logistic regression in multivariate model. Results: The mean (SD) of neonate weight, height, and head size was 3323.4 (709), 48.95 (3.2), and 34.9 (1.8), respectively. Regression analysis showed that gestational diabetes (Odds Ratio (OR): 11.9, Confidence Interval (CI): 4.6-30.3), preeclampsia in the pregnancy period due to diabetes (OR: 3.81, CI: 1.1-13.2), and macrosomic birth history (OR: 3.3, CI: 1.04-10.4) were the main predictors of macrosomia. Moreover, macrosomia increased neonate hypoglycemia (OR: 4.7, CI: 1.4-15.8) and section delivery (OR: 4.1, CI: 1.27-13.1). Conclusion: Gestational diabetes, preeclampsia due to diabetes, and history of macrosomic birth were the main predictors of macrosomia. Moreover, macrosomia increased some delivery complications for both mothers and newborns. PMID:24380006

  3. Impact of HIV-1 infection and pregnancy on maternal health: comparison between perinatally and behaviorally infected young women

    PubMed Central

    Munjal, Iona; Dobroszycki, Joanna; Fakioglu, Esra; Rosenberg, Michael G; Wiznia, Andrew A; Katz, Mindy; Steiner, Aileen; Sansary, Jorge; Heo, Moonseong; Abadi, Jacobo

    2013-01-01

    Background The introduction of combination antiretroviral therapy has resulted in improved survival and quality of life for individuals infected with the human immunodeficiency virus (HIV). There is, as expected, a growing population of perinatally HIV-infected women who are, have been, or will become pregnant. We describe a large cohort of perinatally infected women, compare it with a similar age-matched behaviorally HIV-infected group, and examine factors affecting maternal and infant health. Methods We reviewed the records of 30 perinatally infected women who gave birth at two hospitals between January 2000 and December 2011. The comparison group comprised behaviorally infected women who delivered at these hospitals during the same period. The outcome measures were differences in CD4 counts and viral load between the cohorts, and comparisons of maternal morbidity, mortality, and mother-to-child HIV transmission. Results Median CD4 counts were significantly lower in the perinatal group before, during, and after pregnancy. The median viral load was significantly higher in the perinatal group. Interval prepregnancy to post partum viral load decline was also greater in the behavioral group. Viral load decreases in the perinatal population were not sustained in the post partum period, at which time viral load trended back to prepregnancy levels. There was one mother-to-child HIV transmission in a perinatally infected woman. Over an extended 4 years of follow-up, there were four deaths in the perinatal group and none in the behavioral group. Conclusion After delivery, the differences between perinatally and behaviorally infected mothers accentuate, with immunologic deterioration in the former group. The perinatal population may require novel management strategies to ensure outcomes comparable with those observed in the behavioral group. PMID:24600295

  4. Alloimmunization due to red cell antibodies in Rhesus positive Omani Pregnant Women: Maternal and Perinatal outcome

    PubMed Central

    Al-Dughaishi, Tamima; Al-Rubkhi, Ikhlass S.; Al-Duhli, Maymoona; Al-Harrasi, Yusra; Gowri, Vaidyanathan

    2015-01-01

    Objective: This study is aimed to determine the prevalence of alloimmunization due to antibodies to red blood cell (RBC) antigens (other than rhesus [Rh] antigen) and report the maternal, perinatal, and neonatal outcomes. Materials and Methods: A retrospective review of medical records of all patients with minor RBCs antibodies alloimmunization who were followed and delivered at Sultan Qaboos University Hospital, Oman from June 2011 to June 2013. Maternal characteristics, antibody type, antibody titer in addition to perinatal and neonatal outcomes were reviewed. Results: There were 1160 patients with Rh positive status in the study. The most common ABO blood group was O, followed by A, B, and AB. We found 33 out of 1160 Rh positive women alloimmunized with minor RBCs antibodies that gave a prevalence of minor RBCs alloimmunization of 2.7%. The most frequent antibody was anti-E 38%, followed by anti-c 17% and anti-kell 17%. 6 of these 33 patients were identified to have significant antibody titer, and two cases showed evidence of fetal anemia. Only one case required an intrauterine blood transfusion. The most common neonatal complication was jaundice in 53%, followed by respiratory distress syndrome in 28%. Two cases complicated by neonatal anemia required a postnatal blood transfusion. Conclusion: Alloimmunization with anti-E, anti-c, and anti-kell were the most common antibodies among the study group. Minor RBCs alloimmunization was an important cause of neonatal morbidity. PMID:26420934

  5. [Effect of sociocultural factors on maternal and perinatal morbidity with or without mortality among adolescents seen in 3 states of the Mexican Republic].

    PubMed

    León Carmona, Julio César; Hernández Alvarez, Luis Alfredo Ignacio; Hernández Hernández, Ma Adriana Cecilia

    2002-07-01

    This study was aimed on comparing the degree of association between social-cultural factors and maternal or perinatal morbidity and/or mortality of the adolescent. A paired case-control study was designed with adolescent in puerperal immediate stage affiliated to the Mexican Institute of Social Security from Tabasco, Tlaxcala and Northern Veracruz, that were adjusted to the selection criteria of the sample, between June of 1998 and February of 1999. Two groups were integrated, cases, with adolescent in puerperal immediate stage affected (with maternal or perinatal morbidity and/or mortality) and controls, with adolescent not affected in puerperal immediate stage. Information concerned to biological and social-cultural risk factors from each subject was obtained applying a validated survey (EFRASEMA 1) and checking their clinical file, whose information was poured in a database (EFRASEMA 2). Interviewers did not know the outcome of the study, which in turn assured the blindness of the information. Once data was obtained, subjects were assigned to each group of study. Matching factors were age, nutritional status, intergenesic interval and previous pregnancy systemic pathology. Proportion of subjects, cases and controls; with or without social-cultural risk factors was determined. The risk of maternal or perinatal morbidity and/or mortality in the exposed subjects was estimated by odds ratio (OR) and the differences inferred through Mantel and Haenszel chi 2 and Fisher's exact tests (confidence intervals alpha = 0.05 and beta = 0.2). There was a sample of 486 subject, 44 were eliminated due to insufficient data. Studied population was integrated finally with 221 cases and 221 paired controls 1: 1. 71.950% of participants were married, 22.62% in free union, 4.98% single and 0.45% separate, average global age was 17.98 +/- 1.39 years. The inferential analysis showed an OR 0.64 (Cornfield 95% confidence limits: 0.40 < OR < 1.03, p = 0.0510600) concerning desired pregnancy in favor to controls. Appropriate reproductive information had an OR = 0.34 (Cornfield 95% confidence limits: 0.21 < OR < 0.54 p = 0.0000014). Ideal cumulated fertility offered an OR 0.62 (Cornfield 95% confidence limits: 0.39 < OR < 0.98, p = 0.0298500). These results show an association between the social-cultural factors and the presence of maternal or perinatal morbidity and/or mortality in the studied adolescents. Desired pregnancy, appropriate reproductive information and ideal cumulated fertility are protection factors to maternal or perinatal morbidity and/or mortality. PMID:12221907

  6. Perinatal risk factors for schizophrenia: diagnostic specificity and relationships with maternal psychopathology.

    PubMed

    Verdoux, Hélène; Sutter, Anne-Laure

    2002-12-01

    Although a growing body of evidence supports the hypothesis that exposure to obstetric complications (OCs) increases the vulnerability for schizophrenia, some questions remain unanswered regarding the diagnostic specificity and the etiological significance of this association. Associations with a history of OCs have been reported for other severe psychiatric disorders, such as autism, anorexia nervosa, or psychotic affective disorder. Thus, OCs may increase in a relatively non-specific way the vulnerability for a range of severe mental disorders, the expression of this vulnerability depending on the interaction between OCs and other risk factors, such as the genetic liability for specific psychiatric disorder, or exposure to later environmental risk factors. The causal pathway between OCs, maternal psychopathology, and psychotic outcome in the offspring is not fully elucidated. The directions of the associations are often bi-directional, and the mediating variables, if any, are not clearly identified. OCs may have a direct negative impact on fetal brain development, may be on the causal pathway between prepartum maternal depression/exposure to stress and increased risk of schizophrenia, or may indirectly increase the risk of child's later psychiatric disorder by acting as risk factors for maternal postpartum depression. The links and possible interactions between somatic perinatal risk factors and maternal psychopathology in the association with offspring's increased vulnerability for psychosis have to be further explored. PMID:12457383

  7. Maternal Ethnic Ancestry and Adverse Perinatal Outcomes in New York City

    PubMed Central

    Stein, Cheryl R.; Savitz, David A.; Janevic, Teresa; Ananth, Cande V.; Kaufman, Jay S.; Herring, Amy H.; Engel, Stephanie M.

    2009-01-01

    Objective To examine the association between narrowly defined subsets of maternal ethnicity and birth outcomes. Study Design Analysis of 1995-2003 New York City birth certificates linked to hospital discharge data for 949,210 singleton births to examine the multivariable associations between maternal ethnicity and preterm birth, subsets of spontaneous and medically indicated preterm birth, term small for gestational age (SGA), and term birthweight. Results Compared to non-Hispanic whites, Puerto Ricans had an elevated odds ratio (OR 1.9, 95% CI 1.9-2.0) for delivering at 32-36 weeks (adjusted for nativity, maternal age, parity, education, tobacco use, pre-pregnancy weight, birth year). We found an excess of adverse outcomes among most Latino groups. Outcomes also varied within regions, with North African infants nearly 100g (adjusted) heavier than sub-Saharan Africans. Conclusions The considerable heterogeneity in risk of adverse perinatal outcomes is obscured in broad categorizations of maternal race/ethnicity, and may help to formulate etiologic hypotheses. PMID:19729145

  8. Maternal and perinatal factors associated with subsequent meningococcal, Haemophilus or enteroviral meningitis in children: database study.

    PubMed

    Goldacre, M J; Wotton, C J; Maisonneuve, J J

    2014-02-01

    We used a database of 248 659 births, with follow-up to subsequent disease, in the Oxford record linkage archive (1979-1999) to study the influence of family, maternal, and perinatal factors on subsequent hospital admission for meningococcal, Haemophilus, and enteroviral meningitis in the children. In this summary, we report key findings that were significant in multivariate analysis. Meningococcal meningitis was significantly associated with maternal smoking [odds ratio (OR) 2·1, 95% confidence interval (CI) 1·2-3·7]. Haemophilus meningitis was associated with having older siblings (e.g. second child compared to first-born, OR 3·3, 95% CI 2·0-5·6). Enteroviral meningitis was associated with low birth weight (OR 2·2, 95% CI 1·3-3·6) and male sex (OR 1·7, 95% CI 1·2-2·3). The mothers of six of the 312 children with enteroviral meningitis had previously had enteroviral meningitis themselves. We concluded that several maternal characteristics influence the risk of these types of meningitis. PMID:23659618

  9. Maternal Alcohol Consumption During the Perinatal and Early Parenting Period: A Longitudinal Analysis.

    PubMed

    Liu, Weiwei; Mumford, Elizabeth A; Petras, Hanno

    2016-02-01

    Objectives Despite potential health risks for women and children, one in five women report alcohol use during pregnancy and a significant proportion of those who quit during pregnancy return to drinking post-delivery. This study seeks to understand the longitudinal patterns of alcohol consumption before, during pregnancy and post-delivery, and the role of maternal characteristics for purposes of informing prevention design. Methods General growth mixture models were used to describe the average developmental patterns of maternal weekly drinking quantity at six time points, from preconception through child entering kindergarten, as well as heterogeneity in these patterns among 9100 mothers from the Early Childhood Longitudinal Study representing the 2001 US national birth cohort. Results Four distinct classes of mothers were defined by their longitudinal alcohol consumption patterns: Low Probability Drinkers (50.3 %), Escalating Risk Drinkers (12.0 %), Escalating Low Risk Drinkers (27.4 %), and Early Parenting Quitters (10.2 %). Heterogeneous covariate associations were observed. For example, mothers who gave birth after age 36 were twice as likely to be Escalating Risk Drinkers and Escalating Low Risk Drinkers (vs Low Probability Drinkers), but not more likely to be Early Parenting Quitters, when compared to mothers who gave birth between the ages of 26 and 35. Conclusions for practice There is significant heterogeneity in maternal longitudinal alcohol use patterns during the perinatal period. Baseline maternal characteristics and behavior associated with these heterogeneous patterns provide valuable tools to identify potential risky drinkers during this critical time period and may be synthesized to tailor pre- and postnatal clinical counseling protocols. PMID:26520156

  10. Reduction of maternal and perinatal mortality in rural and peri-urban settings: what works?

    PubMed

    Kwast, B E

    1996-10-01

    The purpose of this article is two-fold: (i) to lay out conceptual frameworks for programming in the fields of maternal and neonatal health for the reduction of maternal and peri/neonatal mortality; (ii) to describe selected MotherCare demonstration projects in the first 5 years between 1989 and 1993 in Bolivia, Guatemala, Indonesia and Nigeria. In Inquisivi, Bolivia, Save the Children/Bolivia, worked with 50 women's groups in remote rural villages in the Andean mountains. Through a participatory research process, the 'autodiagnosis', actions identified by women's groups included among others: provision of family planning through a local non-governmental organization (NGO), training of community birth attendants, income generating projects. In Quetzaltenango, Guatemala, access was improved through training of traditional birth attendants (TBAs) in timely recognition and referral of pregnancy/delivery/neonatal complications, while quality of care in health facilities was improved through modifying health professionals' attitude towards TBAs and clients, and implementation of management protocols. In Indonesia, the University of Padjadjaran addressed issues of referral and emergency obstetric care in the West-Java subdistrict of Tanjunsari. Birthing homes with radios were established in ten of the 27 villages in the district, where trained nurse/midwives provided maternity care on a regular basis. In Nigeria professional midwives were trained in interpersonal communication and lifesaving obstetric skills, while referral hospitals were refurbished and equipped. While reduction in maternal mortality after such a short implementation period is difficult to demonstrate, all projects showed improvements in referral and in reduction in perinatal mortality. PMID:8909956

  11. Second-stage labor duration in nulliparous women: relationship to maternal and perinatal outcomes

    PubMed Central

    Rouse, Dwight J.; Weiner, Steven J.; Bloom, Steven L.; Varner, Michael W.; Spong, Catherine Y.; Ramin, Susan M.; Caritis, Steve N.; Peaceman, Alan M.; Sorokin, Yoram; Sciscione, Anthony; Carpenter, Marshall W.; Mercer, Brian M.; Thorp, John M.; Malone, Fergal D.; Harper, Margaret; Iams, Jay D.; Anderson, Garland D.

    2009-01-01

    Objective To assess maternal and perinatal outcomes as a function of second stage labor duration. Methods We assessed outcomes in nulliparous laboring women enrolled in a trial of fetal pulse oximetry. Results Of 5,341 participants, 4,126 reached the second stage. As duration of the second stage increased, spontaneous vaginal delivery rates declined, from 85% when the duration was under one hour to 9% when it was 5 hours or more. Adverse maternal outcomes significantly associated with the duration of the second stage included chorioamnionitis (overall rate 3.9%), 3rd or 4th degree perineal laceration (8.7%), and uterine atony (3.9%). Odds ratios (ORs) for each additional hour of the second stage ranged from 1.3 to 1.8. Among individual adverse neonatal outcomes, only admission to a neonatal intensive care unit was significantly associated with second stage duration (OR 1.4). Conclusions The second stage does not need to be terminated for duration alone. PMID:19788967

  12. Maternal and neonatal hair and breast milk in the assessment of perinatal exposure to drugs of abuse.

    PubMed

    Joya, Xavier; Pacifici, Roberta; Salat-Batlle, Judith; García-Algar, Oscar; Pichini, Simona

    2015-01-01

    Perinatal exposure to one or more drugs of abuse can affect the neonate temporarily or permanently. In addition to meconium, the evaluation of perinatal exposure to drugs of abuse has been achieved by testing biological matrices coming from the newborn (neonatal hair) and from the pregnant or nursing mother (maternal hair and breast milk). These matrices have the advantage of noninvasive collection and account for a sizable time window of active and passive exposure. Sensitive and specific analytical methods are required to determine minute amounts of drugs of abuse and metabolites in these matrices. The present manuscript reviews the newest analytical methods developed to detect drugs of abuse as well as ethanol biomarkers in maternal and neonatal hair and breast milk. PMID:26045006

  13. Maternal Factors and Adverse Perinatal Outcomes in Women with Preeclampsia in Maceió, Alagoas

    PubMed Central

    de Oliveira, Alane Cabral Menezes; Santos, Arianne Albuquerque; Bezerra, Alexandra Rodrigues; de Barros, Amanda Maria Rocha; Tavares, Myrian Cicyanne Machado

    2016-01-01

    Background Preeclampsia has been associated with several risk factors and events. However, it still deserves further investigation, considering the multitude of related factors that affect different populations. Objective To evaluate the maternal factors and adverse perinatal outcomes in a cohort of pregnant women with preeclampsia receiving care in the public health network of the city of Maceió. Methods Prospective cohort study carried out in 2014 in the public health network of the city with a sample of pregnant women calculated based on a prevalence of preeclampsia of 17%, confidence level of 90%, power of 80%, and ratio of 1:1. We applied a questionnaire to collect socioeconomic, personal, and anthropometric data, and retrieved perinatal variables from medical records and certificates of live birth. The analysis was performed with Poisson regression and chi-square test considering p values < 0.05 as significant. Results We evaluated 90 pregnant women with preeclampsia (PWP) and 90 pregnant women without preeclampsia (PWoP). A previous history of preeclampsia (prevalence ratio [PR] = 1.57, 95% confidence interval [95% CI] 1.47 - 1.67, p = 0.000) and black skin color (PR = 1.15, 95% CI 1.00 - 1.33, p = 0.040) were associated with the occurrence of preeclampsia. Among the newborns of PWP and PWoP, respectively, 12.5% and 13.1% (p = 0.907) were small for gestational age and 25.0% and 23.2% (p = 0.994) were large for gestational age. There was a predominance of cesarean delivery. Conclusion Personal history of preeclampsia and black skin color were associated with the occurrence of preeclampsia. There was a high frequency of birth weight deviations and cesarean deliveries. PMID:26761076

  14. Effective Linkages of Continuum of Care for Improving Neonatal, Perinatal, and Maternal Mortality: A Systematic Review and Meta-Analysis

    PubMed Central

    Kikuchi, Kimiyo; Enuameh, Yeetey; Yasuoka, Junko; Nanishi, Keiko; Shibanuma, Akira; Gyapong, Margaret; Owusu-Agyei, Seth; Oduro, Abraham Rexford; Asare, Gloria Quansah; Hodgson, Abraham; Jimba, Masamine

    2015-01-01

    Background Continuum of care has the potential to improve maternal, newborn, and child health (MNCH) by ensuring care for mothers and children. Continuum of care in MNCH is widely accepted as comprising sequential time (from pre-pregnancy to motherhood and childhood) and space dimensions (from community-family care to clinical care). However, it is unclear which linkages of care could have a greater effect on MNCH outcomes. The objective of the present study is to assess the effectiveness of different continuum of care linkages for reducing neonatal, perinatal, and maternal mortality in low- and middle-income countries. Methods We searched for randomized and quasi-randomized controlled trials that addressed two or more linkages of continuum of care and attempted to increase mothers’ uptake of antenatal care, skilled birth attendance, and postnatal care. The outcome variables were neonatal, perinatal, and maternal mortality. Results Out of the 7,142 retrieved articles, we selected 19 as eligible for the final analysis. Of these studies, 13 used packages of intervention that linked antenatal care, skilled birth attendance, and postnatal care. One study each used packages that linked antenatal care and skilled birth attendance or skilled birth attendance and postnatal care. Four studies used an intervention package that linked antenatal care and postnatal care. Among the packages that linked antenatal care, skilled birth attendance, and postnatal care, a significant reduction was observed in combined neonatal, perinatal, and maternal mortality risks (RR 0.83; 95% CI 0.77 to 0.89, I2 79%). Furthermore, this linkage reduced combined neonatal, perinatal, and maternal mortality when integrating the continuum of care space dimension (RR 0.85; 95% CI 0.77 to 0.93, I2 81%). Conclusions Our review suggests that continuous uptake of antenatal care, skilled birth attendance, and postnatal care is necessary to improve MNCH outcomes in low- and middle-income countries. The review was conclusive for the reduction of neonatal and perinatal deaths. Although maternal deaths were not significantly reduced, composite measures of all mortality were. Thus, the evidence is sufficient to scale up this intervention package for the improvement of MNCH outcomes. PMID:26422685

  15. A matched pair cluster randomized implementation trail to measure the effectiveness of an intervention package aiming to decrease perinatal mortality and increase institution-based obstetric care among indigenous women in Guatemala: study protocol

    PubMed Central

    2013-01-01

    Background Maternal and perinatal mortality continue to be a high priority problem on the health agendas of less developed countries. Despite the progress made in the last decade to quantify the magnitude of maternal mortality, few interventions have been implemented with the intent to measure impact directly on maternal or perinatal deaths. The success of interventions implemented in less developed countries to reduce mortality has been questioned, in terms of the tendency to maintain a clinical perspective with a focus on purely medical care separate from community-based approaches that take cultural and social aspects of maternal and perinatal deaths into account. Our innovative approach utilizes both the clinical and community perspectives; moreover, our study will report the weight that each of these components may have had on reducing perinatal mortality and increasing institution-based deliveries. Methods/Design A matched pair cluster-randomized trial will be conducted in clinics in four rural indigenous districts with the highest maternal mortality ratios in Guatemala. The individual clinic will serve as the unit of randomization, with 15 matched pairs of control and intervention clinics composing the final sample. Three interventions will be implemented in indigenous, rural and poor populations: a simulation training program for emergency obstetric and perinatal care, increased participation of the professional midwife in strengthening the link between traditional birth attendants (TBA) and the formal health care system, and a social marketing campaign to promote institution-based deliveries. No external intervention is planned for control clinics, although enhanced monitoring, surveillance and data collection will occur throughout the study in all clinics throughout the four districts. All obstetric events occurring in any of the participating health facilities and districts during the 18months implementation period will be included in the analysis, controlling for the cluster design. Our main outcome measures will be the change in perinatal mortality and in the proportion of institution-based deliveries. Discussion A unique feature of this protocol is that we are not proposing an individual intervention, but rather a package of interventions, which is designed to address the complexities and realities of maternal and perinatal mortality in developing countries. To date, many other countries, has focused its efforts to decrease maternal mortality indirectly by improving infrastructure and data collection systems rather than on implementing specific interventions to directly improve outcomes. Trial registration ClinicalTrial.gov,http://NCT01653626. PMID:23517050

  16. Maternal and perinatal aspects of birth defects: a case-control study

    PubMed Central

    Nhoncanse, Geiza César; Germano, Carla Maria R.; de Avó, Lucimar Retto da S.; Melo, Débora Gusmão

    2014-01-01

    Objective: To assess the prevalence of congenital defects and to investigate their maternal and perinatal associated aspects by reviewing Birth Certificates. Methods: Among all born alive infants from January 2003 to December 2007 in Maternidade da Santa Casa de Misericórdia of São Carlos, Southeast Brazil (12,199 infants), cases were identified as the newborns whose Birth Certificates registered any congenital defect. The same sex neonate born immediately after the case was chosen as a control. In total, 13 variables were analyzed: six were maternal related, three represented labor and delivery conditions and four were linked to fetal status. The chi-square and Fisher's exact tests were used to compare the variables, being significant p<0.05. Results: The prevalence of congenital defects was 0.38% and the association of two or more defects represented 32% of all cases. The number of mothers whose education level was equal or less than eight years was significantly higher among the group with birth defects (p=0.047). A higher frequency of prematurity (p<0.001) and cesarean delivery (p=0.004) was observed among children with birth defects. This group also showed lower birth weight and Apgar scores in the 1st and the 5th minute (p<0.001). Conclusions: The prevalence of congenital defect of 0.38% is possibly due to underreporting. The defects notified in the Birth Certificates were only the most visible ones, regardless of their severity. There is a need of adequate epidemiological monitoring of birth defects in order to create and expand prevention and treatment programs. PMID:24676186

  17. Prenatal management and perinatal outcome in giant placental chorioangioma complicated with hydrops fetalis, fetal anemia and maternal mirror syndrome

    PubMed Central

    2012-01-01

    Background Giant placental chorioangiomas have been associated with a number of severe fetal complications and high perinatal mortality. Case presentation We report a case of giant chorioangioma with fetal hydrops, additionally complicated by severe anemia, mild cardiomegaly with hyperdinamic heart circulation and maternal mirror syndrome. Intrauterine blood transfusion and amniodrainage was performed at 29 weeks. Worsening of the fetal and maternal condition prompted us to proceed with delivery at 29 + 5 weeks. The newborn died 3 hours later due to pulmonary hypoplasia and hemodynamic failure. Maternal course was favourable, mirror syndrome resolved in the second day and the patient was discharged four days following delivery. Conclusions In the case described here, fetal condition got worse despite of the anemia correction and amniodrainage. Our outcome raises the issue whether additional intrauterine clinical intervention, as intersticial laser, should have been performed to stop further deterioration of the fetal condition when progressive severe hydrops develops. PMID:22840187

  18. Ischemic perinatal stroke: summary of a workshop sponsored by the National Institute of Child Health and Human Development and the National Institute of Neurological Disorders and Stroke.

    PubMed

    Raju, Tonse N K; Nelson, Karin B; Ferriero, Donna; Lynch, John Kylan

    2007-09-01

    Ischemic perinatal stroke is a disorder associated with significant long-term neurologic morbidity. With an estimated incidence of 1 in 2300 to 5000 births, stroke is more likely to occur in the perinatal period than at any time in childhood. The incidence of ischemic perinatal stroke ranks second only to that of strokes in the elderly population. Although ischemic perinatal stroke is a well-recognized disorder, many aspects remain to be studied. There is no consensus on its terminology, definition, or classification. Several risk factors have been identified, but their precise roles in causing stroke are not well understood. There are no reliable predictors of ischemic perinatal stroke on which to base prevention or treatment strategies. To review these important issues and propose a research agenda, the National Institute of Child Health and Human Development and the National Institute of Neurological Disorders and Stroke convened a workshop in August 2006. This article provides a summary of the workshop. PMID:17766535

  19. [Influence of prenatal control on maternal and perinatal morbidity/mortality in a 2nd-level hospital center].

    PubMed

    Rivera López, T; Salas Ramirez, M; Amato Martínez, J D

    1994-07-01

    The objective of this study was to determine the effectiveness of prenatal care on maternal and perinatal morbi-mortality. The obstetrics hospitalizations from "Hospital General Regional, Orizaba, Veracruz" were reviewed from 1991 to 1992. 2595 patients were studied and classified according to the attendance or not to the prenatal care program. We analyzed data related to mother, child and obstetric care. 73% of women had prenatal care with 9.4% of complications. From the group without prenatal care 8.9% had complications. When we compared the demographic characteristics of groups, we found that they came from different populations, and it could explain the different percentage of complications. The most frequent maternal complications were membrane premature rupture, pregnancy toxemia (preeclampsia-eclampsia) and endometritis. There was no association between the frequency of product complications with attendance to prenatal care program (OR = 1.4, CI = 1.05-2.09). The group without prenatal care had higher premature rate. PMID:8063184

  20. Maternal Obesity: Lifelong Metabolic Outcomes for Offspring from Poor Developmental Trajectories During the Perinatal Period.

    PubMed

    Zambrano, Elena; Ibáñez, Carlos; Martínez-Samayoa, Paola M; Lomas-Soria, Consuelo; Durand-Carbajal, Marta; Rodríguez-González, Guadalupe L

    2016-01-01

    The prevalence of obesity in women of reproductive age is increasing in developed and developing countries around the world. Human and animal studies indicate that maternal obesity adversely impacts both maternal health and offspring phenotype, predisposing them to chronic diseases later in life including obesity, dyslipidemia, type 2 diabetes mellitus, and hypertension. Several mechanisms act together to produce these adverse health effects including programming of hypothalamic appetite-regulating centers, increasing maternal, fetal and offspring glucocorticoid production, changes in maternal metabolism and increasing maternal oxidative stress. Effective interventions during human pregnancy are needed to prevent both maternal and offspring metabolic dysfunction due to maternal obesity. This review addresses the relationship between maternal obesity and its negative impact on offspring development and presents some maternal intervention studies that propose strategies to prevent adverse offspring metabolic outcomes. PMID:26827819

  1. Maternal immunization efforts of the National Institutes of Health.

    PubMed

    Rubin, Fran A; Koso-Thomas, Marion; Isaacs, Maggie Brewinski; Piper, Jeanna; Read, Jennifer; Nesin, Mirjana

    2015-11-25

    Over the last 35 years, efforts at the National Institutes of Health (NIH) to protect mothers and their infants against infectious diseases have involved a bench-to-bedside approach. Basic and translational research that provided a foundation for clinical trials of vaccines in pregnancy include natural history and vaccine antigen identification studies. Development of laboratory assays and reagents have been funded by NIAID; these are critical for the advancement of vaccine candidates through the preclinical and clinical steps along the maternal immunization research pathway to support vaccine efficacy. Animal models of maternal immunization have been developed to evaluate efficacy of vaccine candidates. Clinical studies required development of maternal immunization protocols to address specific pregnancy related issues, for enrollment and safety assessment of mothers and their infants. NIH has organized and participated in meetings, workshops and other collaborative efforts with partners have advanced maternal immunization efforts. Partners have included many institutes and offices at NIH as well as other Department of Health and Human Services agencies and offices (Food and Drug Administration, Centers for Disease Control and Prevention, National Vaccine Program Office), World Health Organization, academic investigators, Biotech and pharmaceutical companies, and nonprofit organizations such as the Bill and Melinda Gates Foundation. These research and development partnership are essential for advancing maternal immunization. Continued efforts are needed to promote maternal immunization to protect pregnant women and their infants against vaccine-preventable infectious disease, especially in resource-limited settings where the burden of infections is high. PMID:26458798

  2. Effects of Perinatal HIV Infection and Early Institutional Rearing on Physical and Cognitive Development of Children in Ukraine

    ERIC Educational Resources Information Center

    Dobrova-Krol, Natasha A.; van IJzendoorn, Marinus H.; Bakermans-Kranenburg, Marian J.; Juffer, Femmie

    2010-01-01

    To study the effects of perinatal HIV-1 infection and early institutional rearing on the physical and cognitive development of children, 64 Ukrainian uninfected and HIV-infected institutionalized and family-reared children were examined (mean age = 50.9 months). Both HIV infection and institutional care were related to delays in physical and…

  3. Effects of Perinatal HIV Infection and Early Institutional Rearing on Physical and Cognitive Development of Children in Ukraine

    ERIC Educational Resources Information Center

    Dobrova-Krol, Natasha A.; van IJzendoorn, Marinus H.; Bakermans-Kranenburg, Marian J.; Juffer, Femmie

    2010-01-01

    To study the effects of perinatal HIV-1 infection and early institutional rearing on the physical and cognitive development of children, 64 Ukrainian uninfected and HIV-infected institutionalized and family-reared children were examined (mean age = 50.9 months). Both HIV infection and institutional care were related to delays in physical and

  4. Perinatal depression: A clinical update.

    PubMed

    Alhusen, Jeanne L; Alvarez, Carmen

    2016-05-19

    Perinatal depression is a common condition with significant adverse maternal, fetal, neonatal, and early childhood outcomes. The perinatal period is an opportune time to screen, diagnose, and treat depression. Improved recognition of perinatal depression, particularly among low-income women, can lead to improved perinatal health outcomes. PMID:26934457

  5. Caesarean section without medical indications is associated with an increased risk of adverse short-term maternal outcomes: the 2004-2008 WHO Global Survey on Maternal and Perinatal Health

    PubMed Central

    2010-01-01

    Background There is worldwide debate about the appropriateness of caesarean sections performed without medical indications. In this analysis, we aim to further investigate the relationship between caesarean section without medical indication and severe maternal outcomes. Methods This is a multicountry, facility-based survey that used a stratified multistage cluster sampling design to obtain a sample of countries and health institutions worldwide. A total of 24 countries and 373 health facilities participated in this study. Data collection took place during 2004 and 2005 in Africa and the Americas and during 2007 and 2008 in Asia. All women giving birth at the facility during the study period were included and had their medical records reviewed before discharge from the hospital. Univariate and multilevel analysis were performed to study the association between each group's mode of delivery and the severe maternal and perinatal outcome. Results A total of 286,565 deliveries were analysed. The overall caesarean section rate was 25.7% and a total of 1.0 percent of all deliveries were caesarean sections without medical indications, either due to maternal request or in the absence of other recorded indications. Compared to spontaneous vaginal delivery, all other modes of delivery presented an association with the increased risk of death, admission to ICU, blood transfusion and hysterectomy, including antepartum caesarean section without medical indications (Adjusted Odds Ratio (Adj OR), 5.93, 95% Confidence Interval (95% CI), 3.88 to 9.05) and intrapartum caesarean section without medical indications (Adj OR, 14.29, 95% CI, 10.91 to 18.72). In addition, this association is stronger in Africa, compared to Asia and Latin America. Conclusions Caesarean sections were associated with an intrinsic risk of increased severe maternal outcomes. We conclude that caesarean sections should be performed when a clear benefit is anticipated, a benefit that might compensate for the higher costs and additional risks associated with this operation. PMID:21067593

  6. Adverse perinatal outcomes of HIV-1-infected women in relation to malaria parasitemia in maternal and umbilical cord blood.

    PubMed

    Villamor, Eduardo; Msamanga, Gernard; Aboud, Said; Urassa, Willy; Hunter, David J; Fawzi, Wafaie W

    2005-10-01

    Malaria infection during pregnancy increases the risk of adverse birth outcomes among HIV-infected women. The role of umbilical cord parasitemia is not well characterized. We examined the risk of adverse perinatal outcomes in relation to maternal or umbilical cord Plasmodium falciparum parasitemia among 275 HIV-infected women from Tanzania, who participated in a randomized trial of zinc supplementation during pregnancy. Maternal parasitemia (> or = 1/microL) at the first antenatal visit was associated with increased risk of low birth weight < 2,500 g (adjusted relative risk [ARR] = 2.66; P = 0.01) and preterm delivery < 37 weeks (ARR = 1.87; P = 0.06). Maternal parasitemia at delivery was associated with preterm delivery (ARR = 2.27; P = 0.008), intrauterine growth retardation (ARR = 1.92; P = 0.03), and neonatal death (ARR = 3.22; P = 0.07). Cord parasitemia was associated with a large and significant increase in the risk of neonatal death (ARR = 8.75; P = 0.003). Maternal parasitemia at the first antenatal visit was strongly related to parasitemia at delivery, and the latter was associated with cord blood parasitemia. CD4 cell counts, parity, or assignment to the zinc arm (25 mg daily) were not associated with parasitemia in maternal or cord blood at delivery. Successful treatment of HIV-infected women who present to the first prenatal visit with malaria parasitemia and avoidance of reinfection are likely to decrease the risk of adverse outcomes during pregnancy and the early postpartum period. Cord blood parasitemia is a strong predictor of neonatal death. The potential effect of zinc supplementation on clinical malaria outcomes deserves future investigation. PMID:16222011

  7. Catalase Prevents Maternal Diabetes–Induced Perinatal Programming via the Nrf2–HO-1 Defense System

    PubMed Central

    Chang, Shiao-Ying; Chen, Yun-Wen; Zhao, Xin-Ping; Chenier, Isabelle; Tran, Stella; Sauvé, Alexandre; Ingelfinger, Julie R.; Zhang, Shao-Ling

    2012-01-01

    We investigated whether overexpression of catalase (CAT) in renal proximal tubular cells (RPTCs) could prevent the programming of hypertension and kidney disease in the offspring of dams with maternal diabetes. Male offspring of nondiabetic and diabetic dams from two transgenic (Tg) lines (Hoxb7-green fluorescent protein [GFP]-Tg [controls] and Hoxb7/CAT-GFP-Tg, which overexpress CAT in RPTCs) were studied from the prenatal period into adulthood. Nephrogenesis, systolic blood pressure, renal hyperfiltration, kidney injury, and reactive oxygen species (ROS) generation were assessed. Gene expression of transforming growth factor-β1 (TGF-β1), nuclear factor erythroid 2p45–related factor-2 (Nrf2), and heme oxygenase-1 (HO-1) was tested in both in vitro and in vivo studies. Renal dysmorphogenesis was observed in offspring of Hoxb7-GFP-Tg dams with severe maternal diabetes; the affected male offspring displayed higher renal ROS generation and developed hypertension and renal hyperfiltration as well as renal injury with heightened TGF-β1 expression in adulthood. These changes were ameliorated in male offspring of diabetic Hoxb7/CAT-GFP-Tg dams via the Nrf2–HO-1 defense system. CAT promoted Nrf2 nuclear translocation and HO-1 gene expression, seen in both in vitro and in vivo studies. In conclusion, CAT overexpression in the RPTCs ameliorated maternal diabetes–induced perinatal programming, mediated, at least in part, by triggering the Nrf2–HO-1 defense system. PMID:22733796

  8. Psychosocial stress moderates the relationships between oxytocin, perinatal depression, and maternal behavior.

    PubMed

    Zelkowitz, Phyllis; Gold, Ian; Feeley, Nancy; Hayton, Barbara; Carter, C Sue; Tulandi, Togas; Abenhaim, Haim A; Levin, Pavel

    2014-07-01

    The hormone oxytocin (OT) is of particular interest in the study of childbearing women, as it has a role in the onset and course of labor and breastfeeding. Recent research has linked OT to maternal caregiving behavior towards her infant, and to postpartum depressive symptomatology. There is also evidence that psychosocial adversity affects the oxytocin system. The present study investigated the relationship of endogenous OT in women during pregnancy and at 8weeks postpartum to psychosocial stress, maternal symptoms of depression, and maternal sensitive behavior. It was hypothesized that OT would mediate the effects of maternal depressive symptoms on maternal interactive behavior. We also tested the hypothesis that psychosocial stress would moderate the relationship between OT and maternal depressive symptoms and sensitive behavior. A community sample of 287 women was assessed at 12-14weeks of gestation, 32-34weeks of gestation, and 7-9weeks postpartum. We measured plasma OT, maternal symptoms of depression and psychosocial stress. At the postpartum home visit, maternal behavior in interaction with the infant was videotaped, and then coded to assess sensitivity. In the sample as a whole, OT was not related to maternal depressive symptoms or to sensitive maternal behavior. However, among women who reported high levels of psychosocial stress, higher levels of plasma OT were associated with fewer depressive symptoms and more sensitive maternal behavior. These results suggest that endogenous OT may act as a buffer against the deleterious effects of stress, thereby protecting high risk women from developing depressive symptoms and promoting more sensitive maternal interactive behavior. PMID:24956026

  9. The influence of n-3 fatty acids on maternal behavior and brain monoamines in the perinatal period.

    PubMed

    Harauma, Akiko; Sagisaka, Takayuki; Horii, Taku; Watanabe, Yoshitake; Moriguchi, Toru

    2016-04-01

    The aim of this study was to use n-3 fatty acid-deficient pregnant mice to assess maternal behavior in the perinatal period. Female mice were fed either an n-3 fatty acid-deficient (n-3 Def) or -adequate (n-3 Adq) diet for two generations. The nest score and volume of the n-3 Def dams were lower than those of the n-3 Adq dams. In the observation of the post-delivery conditions, 40% of the n-3 Def dams attacked their newborns or did not nurse them. The brain docosahexaenoic acid (DHA) levels of the n-3 Def dams were lower than those of the n-3 Adq dams. In the hippocampus, moreover, positive correlations were observed between the DHA and the 5-HT or 5-HIAA, and a negative correlation was observed between the DHA and the DA. These results suggest that dietary n-3 fatty acids may normalize the development of maternal behavior and prevent postpartum depression. PMID:27033419

  10. Dynamic changes in lipids and proteins of maternal, fetal, and pup blood and milk during perinatal development in CD and Wistar rats.

    PubMed

    McMullin, Tami S; Lowe, Ezra R; Bartels, Michael J; Marty, Mary Sue

    2008-10-01

    An understanding of the physiological factors that regulate perinatal dosimetry is essential to improve the ability of physiologically based (PB) pharmacokinetic (PK) models to predict chemical risks to children. However, the impact of changing maternal/offspring physiology on PK during gestation and lactation remains poorly understood. This research determined lipid and protein changes in blood, milk and amniotic fluid of CD and Wistar dams, fetuses and neonates to improve the precision of perinatal PBPK modeling. Samples were collected from time-mated CD dams, fetuses, and pups on gestation day (GD) 18 and 20 (sperm positive = GD 0) or lactation day 0 (day of birth), 1, 3, 5, 10, 15, and 20 (n > or = 5 per time point). Fewer time points were sampled in Wistar rats, which showed similar patterns to CDs. Relative to nonpregnant dams, maternal serum protein levels (albumin, total protein and globulin) each decreased by approximately 20% during late gestation, whereas maternal serum lipids (triglycerides, low density lipoproteins, and phospholipids) increased up to fourfold. These physiological changes can impact maternal PK of both protein-bound and lipophilic chemicals. During lactation, triglycerides in milk were greater than 100-fold higher than maternal serum, favoring the disposition of lipophilic chemicals into milk and potentially increasing neonatal rodent exposure during critical stages of postnatal development. Serum protein levels in pups were two- to threefold lower than adults at birth, which may increase the bioavailability of protein-bound compounds. These data will aid in the interpretation of perinatal toxicity studies and improve the accuracy of predictive perinatal PBPK models. PMID:18593729

  11. Understanding and meeting the needs of women in the postpartum period: the Perinatal Maternal Health Promotion Model.

    PubMed

    Fahey, Jenifer O; Shenassa, Edmond

    2013-01-01

    A new model for the care of women in the postpartum focuses on the development of life skills that promote complete well-being. The year following childbirth is a time of significant transition for women. In addition to the physiologic changes associated with the postpartum period, a woman undergoes marked psychosocial changes as she transitions into a motherhood role, reestablishes relationships, and works to meet the physical and emotional needs of her infant and other family members. It is a time when women are vulnerable to health problems directly related to childbirth and to compromised self-care, which can manifest in the development or reestablishment of unhealthy behaviors such as smoking and a sedentary lifestyle. In addition to long-term implications for women, compromised maternal health in the postpartum period is associated with suboptimal health and developmental outcomes for infants. Maternal health experts have called for a change in how care is provided for women in the postpartum period. This article presents the rationale for a health promotion approach to meeting the needs of women in the postpartum period and introduces the Perinatal Maternal Health Promotion Model. This conceptual framework is built around a definition of maternal well-being that asserts that health goes beyond merely the absence of medical complications. In the model, the core elements of a healthy postpartum are identified and include not only physical recovery but also the ability to meet individual needs and successfully transition into motherhood. These goals can best be achieved by helping women develop or strengthen 4 key individual health-promoting skills: the ability to mobilize social support, self-efficacy, positive coping strategies, and realistic expectations. While the model focuses on the woman, the health promotion approach takes into account that maternal health in this critical period affects and is affected by her family, social network, and community. Clinical implications of the model are addressed, including specific health promotion strategies that clinicians can readily incorporate into antepartum and postpartum care. PMID:24320095

  12. Daily Life or Diagnosis? Dual Perspectives on Perinatal Depression within Maternal and Child Health Home Visiting

    PubMed Central

    Price, Sarah Kye; Cohen-Filipic, Katherine

    2013-01-01

    This study describes a qualitative inquiry–informing program development in a maternal and child home visiting program. Low-income women's perceptions of the meaning and experiences of depression were ascertained through focus groups and interviews. Simultaneously, the study examines staff member perceptions and roles related to depression. Specific findings from clients and staff reveal culturally situated beliefs about depression and stressful life events; comparing and contrasting these beliefs offers a novel perspective on identification and intervention for maternal depression. This study offers a foundation for a translational research agenda that will be used for program and policy development to enhance mental health services situated within maternal and child health home visiting programs. PMID:23944165

  13. Maternal and Fetal Acid-Base Chemistry: A Major Determinant of Perinatal Outcome

    PubMed Central

    Omo-Aghoja, L

    2014-01-01

    Very small changes in pH may significantly affect the function of various fetal organ systems, such as the central nervous system, and the cardiovascular system with associated fetal distress and poor Apgar score. Review of existing data on maternal-fetal acid-base balance in pregnancy highlight the factors that are associated with derangements of the acid-base status and the impact of the derangements on fetal outcome. Extensive search of electronic databases and manual search of journals for relevant literature on maternal and fetal acid chemistry, clinical studies and case studies were undertaken. There is a substantial reduction in the partial pressure of carbon dioxide (pCO2) in pregnancy. Adequate buffering prevents significant changes in maternal arterial pH. Normal fetal metabolism results in the production of acids which are buffered to maintain extracellular pH within a critical range. Fetal hypoxia can occur when maternal oxygenation is compromised, maternal perfusion of the placenta is reduced, or delivery of oxygenated blood from the placenta to the fetus is impeded. When adequate fetal oxygenation does not occur, metabolisms proceed along with an anaerobic pathway with production of organic acids, such as lactic acid. Accumulation of lactic acid can deplete the buffer system and result in metabolic acidosis with associated low fetal pH, fetal distress and poor Apgar score. There is a significant reduction in pCO2 in pregnancy. This change, however, does not result in a corresponding significant reduction in maternal arterial pH, because of adequate buffering. Very small changes in pH may cause significant derangement in fetal function and outcome. PMID:24669324

  14. Maternal HIV-1 envelope–specific antibody responses and reduced risk of perinatal transmission

    PubMed Central

    Permar, Sallie R.; Fong, Youyi; Vandergrift, Nathan; Fouda, Genevieve G.; Gilbert, Peter; Parks, Robert; Jaeger, Frederick H.; Pollara, Justin; Martelli, Amanda; Liebl, Brooke E.; Lloyd, Krissey; Yates, Nicole L.; Overman, R. Glenn; Shen, Xiaoying; Whitaker, Kaylan; Chen, Haiyan; Pritchett, Jamie; Solomon, Erika; Friberg, Emma; Marshall, Dawn J.; Whitesides, John F.; Gurley, Thaddeus C.; Von Holle, Tarra; Martinez, David R.; Cai, Fangping; Kumar, Amit; Xia, Shi-Mao; Lu, Xiaozhi; Louzao, Raul; Wilkes, Samantha; Datta, Saheli; Sarzotti-Kelsoe, Marcella; Liao, Hua-Xin; Ferrari, Guido; Alam, S. Munir; Montefiori, David C.; Denny, Thomas N.; Moody, M. Anthony; Tomaras, Georgia D.; Gao, Feng; Haynes, Barton F.

    2015-01-01

    Despite the wide availability of antiretroviral drugs, more than 250,000 infants are vertically infected with HIV-1 annually, emphasizing the need for additional interventions to eliminate pediatric HIV-1 infections. Here, we aimed to define humoral immune correlates of risk of mother-to-child transmission (MTCT) of HIV-1, including responses associated with protection in the RV144 vaccine trial. Eighty-three untreated, HIV-1–transmitting mothers and 165 propensity score–matched nontransmitting mothers were selected from the Women and Infants Transmission Study (WITS) of US nonbreastfeeding, HIV-1–infected mothers. In a multivariable logistic regression model, the magnitude of the maternal IgG responses specific for the third variable loop (V3) of the HIV-1 envelope was predictive of a reduced risk of MTCT. Neutralizing Ab responses against easy-to-neutralize (tier 1) HIV-1 strains also predicted a reduced risk of peripartum transmission in secondary analyses. Moreover, recombinant maternal V3–specific IgG mAbs mediated neutralization of autologous HIV-1 isolates. Thus, common V3-specific Ab responses in maternal plasma predicted a reduced risk of MTCT and mediated autologous virus neutralization, suggesting that boosting these maternal Ab responses may further reduce HIV-1 MTCT. PMID:26053661

  15. SCHIZOPHRENIA AND BIRTHPLACE OF PATERNAL AND MATERNAL GRANDFATHER IN THE JERUSALEM PERINATAL COHORT PROSPECTIVE STUDY

    PubMed Central

    Harlap, S; Perrin, M C; Deutsch, L; Kleinhaus, K; Fennig, S; Nahon, D; Teitelbaum, A; Friedlander, Y; Malaspina, D

    2009-01-01

    Some forms of epigenetic abnormalities transmitted to offspring are manifest in differences in disease incidence that depend on parent-of-origin. To explore whether such phenomena might operate in schizophrenia spectrum disorders, we estimated the relative incidence of these conditions in relation to parent-of-origin by considering the two grandfathers' countries of birth. In a prospective cohort of 88,829 offspring, born in Jerusalem in 1964–76 we identified 637 cases through Israel's psychiatric registry. Relative risks (RR) were estimated for paternal and maternal grandfathers' countries of birth using proportional hazards methods, controlling for parents' ages, low social class and duration of marriage. After adjusting for multiple observations, we found no significant differences between descendants of maternal or paternal grandfathers born in Iraq, Iran, Turkey, Syria, Yemen, Morocco, Algeria, Tunisia, Libya/Egypt, Poland, USSR, Czechoslovakia, Germany or the USA. Those with paternal grandfathers from Romania (RR=1.9, 95% CI=1.3–2.8) or Hungary (1.6, 1.0–2.6) showed an increased incidence; however, those with maternal grandfathers from these countries experienced reduced incidence (RR=0.5, 0.3–0.8 and 0.4, 0.2–0.8). In post-hoc analyses we found that results were similar whether the comparison groups were restricted to descendants of other Europeans or included those from Western Asia and North Africa; and effects of paternal grandfathers from Romania/Hungary were more pronounced in females, while effects of maternal grandfathers from these countries were similar in males and females. These post-hoc “hypothesis-generating” findings lead one to question whether some families with ancestors in Romania or Hungary might carry a variant or mutation at a parentally imprinted locus that is altering susceptibility to schizophrenia. Such a locus, if it exists, might involve the X chromosome. PMID:19361958

  16. Perinatal outcomes of maternal overweight and obesity in term infants: a population-based cohort study in Canada

    PubMed Central

    Vinturache, Angela Elena; McDonald, Sheila; Slater, Donna; Tough, Suzanne

    2015-01-01

    The objective of this study was to assess the impact of increased pre-pregnancy maternal body mass index (BMI) on perinatal outcomes in term, singleton pregnancies who received prenatal care in community-based practices. The sample of 1996 infants included in the study was drawn from the All Our Babies Study, a prospective pregnancy cohort from Calgary. Multivariable logistic regression explored the relationship between the main outcomes, infant birth weight, Apgar score, admission to neonatal intensive care (NICU) and newborn duration of hospitalization, and BMI prior to pregnancy. Approximately 10% of the infants were macrosoms, 1.5% had a low Apgar score (<7 at 5 min), 6% were admitted to intensive care and 96% were discharged within 48 h after delivery. Although the infants of overweight and obese women were more likely to have increased birth weight as compared to infants of normal weight women, there were no differences in Apgar score, admission to NICU, or length of postnatal hospital stay among groups. This study suggests that in otherwise healthy term, singleton pregnancies, obesity does not seem to increase the risk of severe fetal impairment, neonatal admission to intensive care or duration of postnatal hospitalization. PMID:25791339

  17. Maternal and child health services in India with special focus on perinatal services.

    PubMed

    Singh, M; Paul, V K

    1997-01-01

    India has an excellent infrastructural layout for the delivery of MCH services in the community through a network of subcenters, primary health centers, community health centers, district hospitals, state medical college hospitals, and other hospitals in the public and private sectors. However, the health pyramid does not function effectively because of limited resources, communication delays, a lack of commitment on the part of health professionals, and, above all, a lack of managerial skills, supervision, and political will. The allocation of financial resources for the delivery of health care continues to be meager. Nevertheless, in spite of obvious constraints, the country has made laudable progress in reducing post-neonatal mortality in recent years. Indeed, the focus has shifted to the young infants and the perinates. Under the CSSM program, a massive expansion of MCH services has occurred at the sub-district and the district levels. The RCH program, to be launched shortly, aims at effective utilization of these facilities to ensure delivery of integrated services of assured quality through decentralized planning. Simultaneously, as a result of the ongoing economic liberalization, the MCH care in the private sector will also expand rapidly. Indeed, India is on the threshold of an extraordinary improvement in the status of its neonatal-perinatal health. PMID:9069069

  18. Maternal and perinatal outcomes of delivery after a previous Cesarean section in Enugu, Southeast Nigeria: a prospective observational study

    PubMed Central

    Ugwu, George O; Iyoke, Chukwuemeka A; Onah, Hyacinth E; Egwuatu, Vincent E; Ezugwu, Frank O

    2014-01-01

    Background Obstetricians in developing countries appear generally reluctant to conduct vaginal delivery in women with a previous Cesarean because of lack of adequate facilities for optimal fetomaternal monitoring. Objective To describe delivery outcomes among women with one previous Cesarean section at a tertiary hospital in Southeast Nigeria. Methods This was a prospective observational study to determine maternal and perinatal outcomes of attempted vaginal birth after Cesarean sections (VBAC) following one previous Cesarean section. Analysis was done with SPSS statistical software version 17.0 for Windows using descriptive and inferential statistics at 95% level of confidence. Results Two thousand six hundred and ten women delivered in the center during the study period, of whom 395 had one previous Cesarean section. A total of 370 women with one previous Cesarean section had nonrecurrent indications, of whom 355 consenting pregnant women with one previous Cesarean section were studied. A majority of the women (320/355, 90.1%) preferred to have vaginal delivery despite the one previous Cesarean section. However, only approximately 54% (190/355) were found suitable for trial of VBAC, out of whom 50% (95/190 had successful VBAC. Ninety-five women (50.0%) had failed attempt at VBAC and were delivered by emergency Cesarean section while 35 women (9.8%) had emergency Cesarean section for other obstetric indications (apart from failed VBAC). There was no case of uterine rupture or neonatal and maternal deaths recorded in any group. Apgar scores of less than 7 in the first minute were significantly more frequent amongst women who had vaginal delivery when compared to those who had elective repeat Cesarean section (P=0.03). Conclusion Most women who had one previous Cesarean delivery chose to undergo trial of VBAC, although only about half were considered suitable for VBAC. The maternal and fetal outcomes of trial of VBAC in selected women with one previous Cesarean delivery for non-recurrent indications were good. Obstetricians in this area should do more to allow VBAC in women with one previous Cesarean section for nonrecurrent indications. PMID:24648774

  19. Intrauterine Growth Restricted Rats Exercised before and during Pregnancy: Maternal and Perinatal Repercussions

    PubMed Central

    Corvino, S. B.; Volpato, G. T.; Rudge, M. V. C.; Damasceno, D. C.

    2015-01-01

    This study aimed at evaluating the effect of swimming before and during pregnancy on rats born with intrauterine growth restriction (IUGR) and their offspring. For this, nondiabetic and streptozotocin-induced severely diabetic (SD) pregnant rats were mated and generated offspring with appropriate (control, C) and small (IUGR) for pregnancy age, respectively. Following that, C and IUGR groups were further distributed into nonexercised control (C), exercised control (Cex), nonexercised IUGR (IUGR), and exercised IUGR (IUGRex). IUGR rats presented lower mating rate than control rats. Regardless of physical exercise IUGR rats presented decreased body weight from birth to lactation. At 90 days of life, IUGR rats presented glucose intolerance. Maternal organ weights were increased and relative adiposity of IUGRex rats was lower than Cex. IUGR and IUGRex offspring presented reduced body weight than C and Cex, respectively. IUGRex dams presented an increased rate of appropriate for pregnancy age newborns. IUGEex male and female offspring relative brain weight was increased compared with Cex. Therefore, swimming before and during pregnancy prevented glucose intolerance, reduced general adiposity, and increased maternal and offspring organ weight in rats, showing the benefit of physical exercise for IUGR rats. PMID:26345406

  20. Effect of prenatal and perinatal antibiotics on maternal health in Malawi, Tanzania, and Zambia

    PubMed Central

    Aboud, Said; Msamanga, Gernard; Read, Jennifer S.; Wang, Lei; Mfalila, Chelu; Sharma, Usha; Martinson, Francis; Taha, Taha E.; Goldenberg, Robert L.; Fawzi, Wafaie W.

    2009-01-01

    Objective We assessed the effect of prenatal and peripartum antibiotics on maternal morbidity and mortality among HIV-infected and uninfected women. Methods A multicenter trial was conducted at clinical sites in 4 Sub-Saharan African cities: Blantyre and Lilongwe, Malawi; Dar es Salaam, Tanzania; and Lusaka, Zambia. A total of 1558 HIV-infected and 271 uninfected pregnant women who were eligible to receive both the prenatal and peripartum antibiotic/placebo regimens were enrolled. Pregnant women were interviewed at 20–24 weeks of gestation and a physical examination was performed. Women were randomized to receive either antibiotics or placebo. At the 26–30 week visit, participants were given antibiotics or placebo to be taken every 4 hours beginning at the onset of labor and continuing after delivery 3 times a day until a 1-week course was completed. Logistic regression and Cox proportional hazards models were used. Results There were no significant differences between the antibiotic and placebo groups for medical conditions, obstetric complications, physical examination findings, puerperal sepsis, and death in either the HIV-infected or the uninfected cohort. Conclusion Administration of study antibiotics during pregnancy had no effect on maternal morbidity and mortality among HIV-infected and uninfected pregnant women. PMID:19716560

  1. Family centered maternity care: its relationship to perinatal regionalization and neonatal intensive care.

    PubMed

    Swartz, W H; Swartz, J V

    1976-09-01

    For several months prior to birth a major portion of a family's attention, conversation, thought, and often worry, is directed toward the idea of a new child. This prolonged attention and anticipation contribute to making childbirth an emotionally charged experience. In psychological terms, it is therefore a critical period of peak motivation for learning, and a time to peak susceptibility to reinforcement. Theory, reason, and scientific evidence indicate thng with childbirth and early postpartum experiences, can significantly affect subsequent parental behaviors, the child's central environment influence. Evidence strongly suggests that these parental attitudes and behaviors so crucial to the child's ultimate well-being are learned rather than derived instinctually, and therefore they are malleable and can be taught, directed, and corrected. Through education and reinforcement it is possible to encourage parental behaviors and child interactions which are products of feelings of control, competence, accomplishment, understanding, and caring. Similarly we can recognize and work toward replacing attitudes, feelings, and behaviors that express fear, worry, and insecurity about the child. Over the past 50 years major changes have occurred in the practice of obstetrics and newborn pediatrics. Other major changes will necessarily occur as we move toward perinatal regionalization. Changes instigated solely on physiologic data can have unrecognized collateral effects on the psychological component of the childbirth experience. All concerned health care personnel, especially obstetricians and pediatricians, can insist that the importance of desirable mother-father-child interactions be recognized and that practices fostering them be afforded a high priority. I would like to endorse a comment from a recent article by Richmond concerning the advent of behavioral pediatrics by adding that behavioral obstetrics is also "an idea whose time has arrived". PMID:963936

  2. Prenatal enrichment and recovery from perinatal cortical damage: effects of maternal complex housing

    PubMed Central

    Gibb, Robbin L.; Gonzalez, Claudia L. R.; Kolb, Bryan

    2014-01-01

    Birth is a particularly vulnerable time for acquiring brain injury. Unfortunately, very few treatments are available for those affected. Here we explore the effectiveness of prenatal intervention in an animal model of early brain damage. We used a complex housing paradigm as a form of prenatal enrichment. Six nulliparous dams and one male rat were placed in complex housing (condomom group) for 12 h per day until the dams' delivered their pups. At parturition the dams were left in their home (standard) cages with their pups. Four dams were housed in standard cages (cagemom group) throughout pregnancy and with their pups until weaning. At postnatal day 3 (P3) infants of both groups received frontal cortex removals or sham surgery. Behavioral testing began on P60 and included the Morris water task and a skilled reaching task. Brains were processed for Golgi analyses. Complex housing of the mother had a significant effect on the behavior of their pups. Control animals from the condomom group outperformed those of the cagemom group in the water task. Condomom animals with lesions performed better than their cagemom cohorts in both the water task and in skilled reaching. Condomom animals showed an increase in cortical thickness at anterior planes and thalamic area at both anterior and posterior regions. Golgi analyses revealed an increase in spine density. These results suggest that prenatal enrichment alters brain organization in manner that is prophylactic for perinatal brain injury. This result could have significant implications for the prenatal management of infants expected to be at risk for difficult birth. PMID:25009478

  3. Maternal obesity and malnourishment exacerbate perinatal oxidative stress resulting in diabetogenic programming in F1 offspring.

    PubMed

    Saad, M I; Abdelkhalek, T M; Haiba, M M; Saleh, M M; Hanafi, M Y; Tawfik, S H; Kamel, M A

    2016-06-01

    The effect of in-utero environment on fetal health and survival is long-lasting, and this is known as the fetal origin hypothesis. The oxidative stress state during gestation could play a pivotal role in fetal programming and development of diseases such as diabetes. In this study, we investigated the effect of intra-uterine obesity and malnutrition on oxidative stress markers in pancreatic and peripheral tissues of F1 offspring both prenatally and postnatally. Furthermore, the effect of postnatal diet on oxidative stress profile was evaluated. The results indicated that intra-uterine obesity and malnourishment significantly increased oxidative stress in F1 offspring. Moreover, the programming effect of obesity was more pronounced and protracted than malnutrition. The obesity-induced programming of offspring tissues was independent of high-caloric environment that the offspring endured; however, high-caloric diet potentiated its effect. In addition, pancreas and liver were the most affected tissues by fetal reprogramming both prenatally and postnatally. In conclusion, maternal obesity and malnutrition-induced oxidative stress could predispose offspring to insulin resistance and diabetes. PMID:26667119

  4. A Genetically Informed Study of the Associations Between Maternal Age at Childbearing and Adverse Perinatal Outcomes.

    PubMed

    Sujan, Ayesha C; Rickert, Martin E; Class, Quetzal A; Coyne, Claire A; Lichtenstein, Paul; Almqvist, Catarina; Larsson, Henrik; Sjölander, Arvid; Lahey, Benjamin B; van Hulle, Carol; Waldman, Irwin; Öberg, A Sara; D'Onofrio, Brian M

    2016-05-01

    We examined associations of maternal age at childbearing (MAC) with gestational age and fetal growth (i.e., birth weight adjusting for gestational age), using two genetically informed designs (cousin and sibling comparisons) and data from two cohorts, a population-based Swedish sample and a nationally representative United States sample. We also conducted sensitivity analyses to test limitations of the designs. The findings were consistent across samples and suggested that, associations observed in the population between younger MAC and shorter gestational age were confounded by shared familial factors; however, associations of advanced MAC with shorter gestational age remained robust after accounting for shared familial factors. In contrast to the gestational age findings, neither early nor advanced MAC was associated with lower fetal growth after accounting for shared familial factors. Given certain assumptions, these findings provide support for a causal association between advanced MAC and shorter gestational age. The results also suggest that there are not causal associations between early MAC and shorter gestational age, between early MAC and lower fetal growth, and between advanced MAC and lower fetal growth. PMID:26404627

  5. Perinatal mortality in Utrecht, The Netherlands, 1880-1940.

    PubMed

    Ward, W Peter

    2003-12-01

    The secular trend of perinatal mortality in Utrecht between 1880 and 1940 and its causes are examined in this study, based on patient records of two maternity clinics, those of the city's academic hospital, and of its outpatient clinic. The sample includes 17,111 deliveries. Over the period the proportion of births in the city occurring in the two institutions rose from 3 to 90%. The perinatal mortality rate in the hospital declined and then rose slightly at the end of the 19th century, but remained constant, even if cyclical, thereafter in both the hospital and the outpatient clinic. Rates differed substantially between the two maternity services. Logistic regression analysis reveals a cluster of factors related to perinatal death. Low birth weight had a powerful association with perinatal mortality in both samples. Most of the other factors associated with perinatal mortality were related to the health of the patients, to obstetric problems related to deliveries, and to infant sex and maternal age. Relationships between perinatal mortality and other measures of human welfare in The Netherlands are explored. PMID:15463985

  6. Short- and long-term effects of maternal perinatal undernutrition are lowered by cross-fostering during lactation in the male rat.

    PubMed

    Wattez, J-S; Delahaye, F; Barella, L F; Dickes-Coopman, A; Montel, V; Breton, C; Mathias, P; Foligné, B; Lesage, J; Vieau, D

    2014-04-01

    Undernutrition exposure during the perinatal period reduces the growth kinetic of the offspring and sensitizes it to the development of chronic adult metabolic diseases both in animals and in humans. Previous studies have demonstrated that a 50% maternal food restriction performed during the last week of gestation and during lactation has both short- and long-term consequences in the male rat offspring. Pups from undernourished mothers present a decreased intrauterine (IUGR) and extrauterine growth restriction. This is associated with a drastic reduction in their leptin plasma levels during lactation, and exhibit programming of their stress neuroendocrine systems (corticotroph axis and sympatho-adrenal system) in adulthood. In this study, we report that perinatally undernourished 6-month-old adult animals demonstrated increased leptinemia (at PND200), blood pressure (at PND180), food intake (from PND28 to PND168), locomotor activity (PND187) and altered regulation of glycemia (PND193). Cross-fostering experiments indicate that these alterations were prevented in IUGR offspring nursed by control mothers during lactation. Interestingly, the nutritional status of mothers during lactation (ad libitum feeding v. undernutrition) dictates the leptin plasma levels in pups, consistent with decreased leptin concentration in the milk of mothers subjected to perinatal undernutrition. As it has been reported that postnatal leptin levels in rodent neonates may have long-term metabolic consequences, restoration of plasma leptin levels in pups during lactation may contribute to the beneficial effects of cross-fostering IUGR offspring to control mothers. Collectively, our data suggest that modification of milk components may offer new therapeutic perspectives to prevent the programming of adult diseases in offspring from perinatally undernourished mothers. PMID:24847697

  7. The power of two: reflections on the MBRRACE-UK maternal and perinatal deaths reports and the London maternity strategic clinical network.

    PubMed

    Morgan, Victoria

    2015-09-01

    The UK maternal mortality rate is 10 per 100,000-maternities and is falling. The decrease is due to fewer deaths from direct causes; there has been no significant change in the indirect rate over the last 10 years. The UK mortality rate for babies is six stillbirths and neonatal deaths per 100,000 births. Local rates vary from 5.4-7.1. The variation is not due to normal variation or demographic factors. The London Maternity Strategic Clinical Network uses a multi-disciplinary team approach to improve maternity user experience. The Northern New England Cardiovascular Disease Study Group (NNE CVDSG) meet to share data, observe clinical practice and make changes. Maternity units may wish to consider adapting the NNE CVDSG approach to improve their quality of maternity care. PMID:26547992

  8. Gestational exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin alters retinoid homeostasis in maternal and perinatal tissues of the Holtzman rat

    SciTech Connect

    Kransler, Kevin M. Tonucci, David A. McGarrigle, Barbara P. Napoli, Joseph L. Olson, James R.

    2007-10-01

    2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD), one of the most widely studied environmental contaminants, causes a variety of adverse health effects including teratogenesis and altered development which may be related to disruptions in retinoid homeostasis. The purpose of this study was to determine the effect that gestational administration of TCDD has on retinoid homeostasis in both pregnant Holtzman rats and developing fetuses and neonates. A single oral dose of TCDD (0, 1.5, 3, or 6 {mu}g/kg) was administered to pregnant rats on gestation day 10, with fetuses analyzed on gestation days 17 and 20, and neonates analyzed on post natal day 7. Exposure to TCDD generally produced decreases in the concentrations of retinyl esters, such as retinyl palmitate, and retinol in maternal and perinatal liver and lung, while increasing levels in the maternal kidney. Additionally, perinatal hepatic retinol binding protein 1-dependent retinyl ester hydrolysis was also decrease by TCDD. Sensitivity of the developing perinates to TCDD appeared to have an age-related component demonstrated by an increased rate of mortality and significant alterations to body weight and length on post natal day 7 relative to that observed at gestation day 20. A unique observation made in this study was a significant decrease in lung weight observed in the perinates exposed to TCDD. Taken together, these data demonstrate that TCDD significantly alters retinoid homeostasis in tissues of the developing fetus and neonate, suggesting that their unique sensitivity to TCDD may at least be in part the result of altered retinoid homeostasis.

  9. Finance and faith at the Catholic Maternity Institute, Santa Fe, New Mexico, 1944-1969.

    PubMed

    Cockerham, Anne Z; Keeling, Arlene W

    2010-01-01

    In 1944, the Medical Mission Sisters opened the Catholic Maternity Institute in Santa Fe, New Mexico, primarily to serve patients of Spanish American descent. The Maternity Institute offered nurse-midwifery care and functioned as a school to train nurse-midwifery students. Originally planned as a home birth service, the Catholic Maternity Institute soon evolved into a service in which patients chose whether to deliver in their own homes or in a small freestanding building called La Casita. In fact, despite their idealism about home birth and strong feelings that home birth was best, the sisters experienced significant ambivalence concerning La Casita. Births there met many of the institute's pragmatic needs for a larger number of student experiences, quick and safe transfers to a nearby hospital, and more efficient use of the midwives' time. Importantly, as the sisters realized that many of their patients preferred to deliver at La Casita, they came to see that this option permitted these impoverished patients an opportunity to exercise some choice. However, the choice of many patients to deliver at La Casita--which was significantly more expensive for the Maternity Institute than home birth--eventually led to the demise of the Maternity Institute. PMID:20067097

  10. Perinatal programming prevention measures.

    PubMed

    Larguía, A Miguel; González, María Aurelia; Dinerstein, Néstor Alejandro; Soto Conti, Constanza

    2015-01-01

    Over the past 10 years, there has been outstanding scientific progress related to perinatal programming and its epigenetic effects in health, and we can anticipate this trend will continue in the near future. We need to make use and apply these achievements to human neurodevelopment via prevention interventions. Based on the concept of the interaction between genome and ambiome, this chapter proposes low-cost easy-implementation preventive strategies for maternal and infant health institutions.Breastfeeding and human milk administration are the first preventive measures, as has been reviewed in the policy statement of the American Academy of Pediatrics. Another strategy is the Safe and Family-Centered Maternity Hospitals initiative that promotes and empowers the inclusion of the families and the respect for their rights, especially during pregnancy and birth. (This change of paradigm was approved and is recommended by both United Nations Children's Fund, UNICEF, and Pan American Health Organization, PAHO.) Then, there is also an important emphasis given to the sacred hour-which highlights the impact of bonding, attachment, and breastfeeding during the first hour of life-the pain prevention and treatment in newborns, the control of the "new morbidity" represented by late preterm infants, and finally, the importance of avoiding intrauterine and extrauterine growth restriction. (However, there are not yet clear recommendations about nutritional interventions in order to diminish the potential metabolic syndrome consequence in the adult.). PMID:25287552

  11. What about the mothers? An analysis of maternal mortality and morbidity in perinatal health surveillance systems in Europe

    PubMed Central

    Bouvier-Colle, M-H; Mohangoo, AD; Gissler, M; Novak-Antolic, Z; Vutuc, C; Szamotulska, K; Zeitlin, J

    2012-01-01

    Objective To assess capacity to develop routine monitoring of maternal health in the European Union using indicators of maternal mortality and severe morbidity. Design Analysis of aggregate data from routine statistical systems compiled by the EURO-PERISTAT project and comparison with data from national enquiries. Setting Twenty-five countries in the European Union and Norway. Population Women giving birth in participating countries in 2003 and 2004. Methods Application of a common collection of data by selecting specific International Classification of Disease codes from the ‘Pregnancy, childbirth and the puerperium’ chapter. External validity was assessed by reviewing the results of national confidential enquiries and linkage studies. Main outcome measures Maternal mortality ratio, with distribution of specific obstetric causes, and severe acute maternal morbidity, which included: eclampsia, surgery and blood transfusion for obstetric haemorrhage, and intensive-care unit admission. Results In 22 countries that provided data, the maternal mortality ratio was 6.3 per 100 000 live births overall and ranged from 0 to 29.6. Under-ascertainment was evident from comparisons with studies that use enhanced identification of deaths. Furthermore, routine cause of death registration systems in countries with specific systems for audit reported higher maternal mortality ratio than those in countries without audits. For severe acute maternal morbidity, 16 countries provided data about at least one category of morbidity, and only three provided data for all categories. Reported values ranged widely (from 0.2 to 1.6 women with eclampsia per 1000 women giving birth and from 0.2 to 1.0 hysterectomies per 1000 women). Conclusions Currently available data on maternal mortality and morbidity are insufficient for monitoring trends over time in Europe and for comparison between countries. Confidential enquiries into maternal deaths are recommended. PMID:22571748

  12. Maternal Perinatal Mental Health and Offspring Academic Achievement at Age 16: The Mediating Role of Childhood Executive Function

    ERIC Educational Resources Information Center

    Pearson, Rebecca M.; Bornstein, Marc H.; Cordero, Miguel; Scerif, Gaia; Mahedy, Liam; Evans, Jonathan; Abioye, Abu; Stein, Alan

    2016-01-01

    Background: Elucidating risk pathways for under-achieving at school can inform strategies to reduce the number of adolescents leaving school without passing grades in core subjects. Maternal depression can compromise the quality of parental care and is associated with multiple negative child outcomes. However, only a few small studies have…

  13. Maternal and perinatal outcomes in women with placenta praevia and accreta in teaching hospitals in Western Turkey.

    PubMed

    Asıcıoglu, O; Şahbaz, A; Güngördük, K; Yildirim, G; Asıcıoglu, B Besimoğlu; Ülker, V

    2014-08-01

    In this retrospective study, we investigated patient characteristics and fetal and maternal outcomes of placenta praevia and accreta at two tertiary hospitals in Istanbul. A total of 364 pregnancies complicated by placenta praevia with (n = 46) and without (n = 318) placenta accreta managed between January 2005 and December 2010 were reviewed. Among 364 women, 46 (12.6%) had placenta accreta and 318 (87.4%) had placenta praevia without accreta. The rates of curettage history and caesarean delivery were significantly higher in the group with placenta accreta. Furthermore, we found that emergency surgery had negative effects on maternal outcomes in the placenta praevia group. In addition, when accreta was suspected at ultrasound examination in women who had placenta praevia, the mean estimated blood loss during surgery was reduced significantly. If placenta praevia is detected, a careful ultrasound examination should be performed and the patient should undergo elective surgery at a tertiary referral hospital. PMID:24734898

  14. Effects of Prenatal and Perinatal Exposure to Fine Air Pollutants and Maternal Fish Consumption on the Occurrence of Infantile Eczema

    PubMed Central

    Jedrychowski, Wieslaw; Perera, Frederica; Maugeri, Umberto; Mrozek-Budzyn, Dorota; Miller, Rachel L.; Flak, Elzbieta; Mroz, Elzbieta; Jacek, Ryszard; Spengler, John D.

    2011-01-01

    Background As there is a scarcity of evidence on potential hazards and preventive factors for infantile eczema operating in the prenatal period, the main goal of this study was to assess the role of prenatal exposure to fine particulate matter and environmental tobacco smoke (ETS) in the occurrence of infant eczema jointly with the possible modulating effect of maternal fish consumption. Methods The study sample consisted of 469 women enrolled during pregnancy, who gave birth to term babies (>36 weeks of gestation). Among all pregnant women recruited, personal measurements of fine particulate matter (PM2.5) were performed over 48 h in the second trimester of pregnancy. After delivery, every 3 months in the first year of the newborn's life, a detailed, standardized, face-to-face interview was administered to each mother, in the process of which a trained interviewer recorded any history of infantile eczema and data on potential environmental hazards. The estimated risk of eczema related to higher prenatal exposure to fine particulate matter (PM2.5 >53.0 μg/m3) and postnatal ETS as well as the protective effect of maternal fish intake were adjusted for potential confounders in a multivariable logistic regression model. Results While the separate effects of higher prenatal PM2.5 and postnatal ETS exposure were not statistically significant, their joint effect appeared to have a significant influence on the occurrence of infantile eczema [odds ratio 2.39, 95% confidence interval (CI) 1.10–5.18]. With maternal fish intake of more than 205 g/week, the risk of eczema decreased by 43% (odds ratio 0.57, 95% CI 0.35–0.93). The incidence rate ratio (IRR) for eczema symptoms, estimated from the Poisson regression model, was increased with both higher exposure to prenatal PM2.5 and postnatal ETS (IRR 1.55, 95% CI 0.99–2.44) and in children of atopic mothers (IRR 1.35, 95% CI 1.04–1.75) but was lower in girls (IRR 0.78, 95% CI 0.61–1.00). The observed preventive effect of fish consumption on the frequency of eczema symptoms was consistent with the results of the logistic analysis (IRR 0.72, 95% CI 0.52–0.99). Conclusions The findings indicate that higher prenatal exposure to fine particulate matter combined with postnatal exposure to ETS may increase the risk of infant eczema, while maternal fish intake during pregnancy may reduce the risk of infantile eczema. PMID:21293147

  15. An in vivo animal study assessing long-term changes in hypothalamic cytokines following perinatal exposure to a chemical mixture based on Arctic maternal body burden

    PubMed Central

    2011-01-01

    Background The geographic distribution of environmental toxins is generally not uniform, with certain northern regions showing a particularly high concentration of pesticides, heavy metals and persistent organic pollutants. For instance, Northern Canadians are exposed to high levels of persistent organic pollutants like polychlorinated biphenyls (PCB), organochlorine pesticides (OCs) and methylmercury (MeHg), primarily through country foods. Previous studies have reported associations between neuronal pathology and exposure to such toxins. The present investigation assessed whether perinatal exposure (gestation and lactation) of rats to a chemical mixture (27 constituents comprised of PCBs, OCs and MeHg) based on Arctic maternal exposure profiles at concentrations near human exposure levels, would affect brain levels of several inflammatory cytokines Methods Rats were dosed during gestation and lactation and cytokine levels were measured in the brains of offspring at five months of age. Hypothalamic cytokine protein levels were measured with a suspension-based array system and differences were determined using ANOVA and post hoc statistical tests. Results The early life PCB treatment alone significantly elevated hypothalamic interleukin-6 (IL-6) levels in rats at five months of age to a degree comparable to that of the entire chemical mixture. Similarly, the full mixture (and to a lesser degree PCBs alone) elevated levels of the pro-inflammatory cytokine, IL-1b, as well as the anti-inflammatory cytokine, IL-10. The full mixture of chemicals also moderately increased (in an additive fashion) hypothalamic levels of the pro-inflammatory cytokines, IL-12 and tumor necrosis factor (TNF-α). Challenge with bacterial endotoxin at adulthood generally increased hypothalamic levels to such a degree that differences between the perinatally treated chemical groups were no longer detectable. Conclusions These data suggest that exposure at critical neurodevelopmental times to environmental chemicals at concentrations and combinations reflective of those observed in vulnerable population can have enduring consequences upon cytokines that are thought to contribute to a range of pathological states. In particular, such protracted alterations in the cytokine balance within the hypothalamus would be expected to favor marked changes in neuro-immune and hormonal communication that could have profound behavioral consequences. PMID:21745392

  16. Genetic trends in maternal and neonatal behaviors and their association with perinatal survival in French Large White swine

    PubMed Central

    Canario, Laurianne; Bidanel, Jean-Pierre; Rydhmer, Lotta

    2014-01-01

    Genetic trends in maternal abilities were studied in French Large White sows. Two lines representing old-type and modern-type pigs were obtained by inseminating modern sows with semen from boars born in 1977 or 1998. Successive generations were produced by inter-se mating. The maternal performance of sows from the second generation was compared in farrowing crates. Video analysis was performed for the 1st h after the onset of 43 and 36 farrowing events, and for the 6 first hours for 23 and 21 events, in old-type and modern-type sows, respectively. Genetic trends were estimated as twice the difference in estimates between the 2 lines. The contribution of behavior to the probability of stillbirth and piglet death in the first 2 days was estimated as the percentage of deviance reduction (DR) due to the addition of behavior traits as factors in the mortality model. Sow activity decreased strongly from the 1st to the 2nd h in both lines (P < 0.001). In the first 6 h, old-type sows sat (1st parity), stood (2nd parity) and rooted (both parities) for longer than modern-type sows, which were less active, especially in 2nd parity. In modern-type sows, stillbirth was associated positively with lying laterally in the first 6 h (4.6% DR) and negatively in the 1st h (9.1% DR). First-parity old-type sows were more attentive to piglets (P = 0.003) than modern-type sows which responded more to nose contacts at 2nd parity (P = 0.01). Maternal reactivity of modern-type sows was associated with a higher risk of piglet death (4.6% DR). Respiratory distress at birth tended to be higher in modern-type piglets than in old-type piglets (P < 0.10) and was associated with a higher risk of piglet death in both lines (2.7–3.1% DR). Mobility at birth was lower in modern-type than old-type piglets (P < 0.0001). Genetic trends show that sow and piglet behaviors at farrowing have changed. Our results indicate reduced welfare in parturient modern-type sows and their newborn piglets. PMID:25520737

  17. Perinatal and maternal outcomes in planned home and obstetric unit births in women at ‘higher risk’ of complications: secondary analysis of the Birthplace national prospective cohort study

    PubMed Central

    Li, Y; Townend, J; Rowe, R; Brocklehurst, P; Knight, M; Linsell, L; Macfarlane, A; McCourt, C; Newburn, M; Marlow, N; Pasupathy, D; Redshaw, M; Sandall, J; Silverton, L; Hollowell, J

    2015-01-01

    Objective To explore and compare perinatal and maternal outcomes in women at ‘higher risk’ of complications planning home versus obstetric unit (OU) birth. Design Prospective cohort study. Setting OUs and planned home births in England. Population 8180 ‘higher risk’ women in the Birthplace cohort. Methods We used Poisson regression to calculate relative risks adjusted for maternal characteristics. Sensitivity analyses explored possible effects of differences in risk between groups and alternative outcome measures. Main outcome measures Composite perinatal outcome measure encompassing ‘intrapartum related mortality and morbidity’ (intrapartum stillbirth, early neonatal death, neonatal encephalopathy, meconium aspiration syndrome, brachial plexus injury, fractured humerus or clavicle) and neonatal admission within 48 hours for more than 48 hours. Two composite maternal outcome measures capturing intrapartum interventions/adverse maternal outcomes and straightforward birth. Results The risk of ‘intrapartum related mortality and morbidity’ or neonatal admission for more than 48 hours was lower in planned home births than planned OU births [adjusted relative risks (RR) 0.50, 95% CI 0.31–0.81]. Adjustment for clinical risk factors did not materially affect this finding. The direction of effect was reversed for the more restricted outcome measure ‘intrapartum related mortality and morbidity’ (RR adjusted for parity 1.92, 95% CI 0.97–3.80). Maternal interventions were lower in planned home births. Conclusions The babies of ‘higher risk’ women who plan birth in an OU appear more likely to be admitted to neonatal care than those whose mothers plan birth at home, but it is unclear if this reflects a real difference in morbidity. Rates of intrapartum related morbidity and mortality did not differ statistically significantly between settings at the 5% level but a larger study would be required to rule out a clinically important difference between the groups. PMID:25603762

  18. [Social inequalities in perinatal health].

    PubMed

    Azria, E

    2015-10-01

    Social insecurity is a known perinatal risk factor but beyond that, a social gradient in perinatal health is observable. This social gradient is particularly visible for the risk of neonatal mortality from congenital anomalies, premature delivery, and low birth weight. Analysis of mechanisms that would explain how the different dimensions of the social status of women interact with perinatal health indicators are not to this day fully understood. However, numbers of intermediate factors related to both the social status and perinatal risk have been identified. Among them, smoking, drug use, exposure to psychological and physical stress, genital infections, access to care, or drudgery. Finally, it was observed that the interaction of social conditions with the level of maternal education, geographic or ethnic origin, and the environment in which women live are complex and make the generalization of data obtained in a particular context sensitive. PMID:26299909

  19. PeriStats: Perinatal Statistics

    MedlinePlus

    ... is developed by the March of Dimes Perinatal Data Center and provides access to maternal and infant health ... on PeriStats sometimes different from my health department's data? What should I do if pop-up blocker ... We acknowledge the Centers for Disease Control and Prevention for its support ...

  20. Maternal Immunization: Opportunities for Scientific Advancement

    PubMed Central

    Beigi, Richard H.; Fortner, Kimberly B.; Munoz, Flor M.; Roberts, Jeff; Gordon, Jennifer L.; Han, Htay Htay; Glenn, Greg; Dormitzer, Philip R.; Gu, Xing Xing; Read, Jennifer S.; Edwards, Kathryn; Patel, Shital M.; Swamy, Geeta K.

    2014-01-01

    Maternal immunization is an effective strategy to prevent and/or minimize the severity of infectious diseases in pregnant women and their infants. Based on the success of vaccination programs to prevent maternal and neonatal tetanus, maternal immunization has been well received in the United States and globally as a promising strategy for the prevention of other vaccine-preventable diseases that threaten pregnant women and infants, such as influenza and pertussis. Given the promise for reducing the burden of infectious conditions of perinatal significance through the development of vaccines against relevant pathogens, the Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH) sponsored a series of meetings to foster progress toward clinical development of vaccines for use in pregnancy. A multidisciplinary group of stakeholders convened at the NIH in December 2013 to identify potential barriers and opportunities for scientific advancement in maternal immunization. PMID:25425719

  1. Prenatal and Perinatal Determinants of Lung Health and Disease in Early Life: A National Heart, Lung, and Blood Institute Workshop Report.

    PubMed

    Manuck, Tracy A; Levy, Philip T; Gyamfi-Bannerman, Cynthia; Jobe, Alan H; Blaisdell, Carol J

    2016-05-01

    Human lung growth and development begins with preconception exposures and continues through conception and childhood into early adulthood. Numerous environmental exposures (both positive and negative) can affect lung health and disease throughout life. Infant lung health correlates with adult lung function, but significant knowledge gaps exist regarding the influence of preconception, perinatal, and postnatal exposures on general lung health throughout life. On October 1 and 2, 2015, the National Heart, Lung, and Blood Institute convened a group of extramural investigators to develop their recommendations for the direction(s) for future research in prenatal and perinatal determinants of lung health and disease in early life and to identify opportunities for scientific advancement. They identified that future investigations will need not only to examine abnormal lung development, but also to use developing technology and resources to better define normal and/or enhanced lung health. Birth cohort studies offer key opportunities to capture the important influence of preconception and obstetric risk factors on lung health, development, and disease. These studies should include well-characterized obstetrical data and comprehensive plans for prospective follow-up. The importance of continued basic science, translational, and animal studies for providing mechanisms to explain causality using new methods cannot be overemphasized. Multidisciplinary approaches involving obstetricians, neonatologists, pediatric and adult pulmonologists, and basic scientists should be encouraged to design and conduct comprehensive and impactful research on the early stages of normal and abnormal human lung growth that influence adult outcome. PMID:26953657

  2. Rethinking How to Promote Maternity Care-Seeking: Factors Associated With Institutional Delivery in Guinea

    PubMed Central

    Brazier, Ellen; Fiorentino, Renée; Barry, Saidou; Kasse, Yaya; Millimono, Sita

    2014-01-01

    This article presents findings from a study on women's delivery care-seeking in two regions of Guinea. We explored exposure to interventions promoting birth preparedness and complication readiness among women with recent live births and stillbirths. Using multivariate regression models, we identified factors associated with women's knowledge and practices related to birth preparedness, as well as their use of health facilities during childbirth. We found that women's knowledge about preparations for any birth (normal or complicated) was positively associated with increased preparation for birth, which itself was associated with institutional delivery. Knowledge about complication readiness, obstetric risks, and danger signs was not associated with birth preparation or with institutional delivery. The study findings highlight the importance of focusing on preparation for all births—and not simply obstetric emergencies—in interventions aimed at increasing women's use of skilled maternity care. PMID:24821280

  3. [Institutional violence, medical authority, and power relations in maternity hospitals from the perspective of health workers].

    PubMed

    Aguiar, Janaina Marques de; d'Oliveira, Ana Flávia Pires Lucas; Schraiber, Lilia Blima

    2013-11-01

    The current article discusses institutional violence in maternity hospitals from the health workers' perspective, based on data from a study in the city of São Paulo, Brazil. Eighteen health workers from the public and private sectors were interviewed, including obstetricians, nurses, and nurse technicians. A semi-structured interview was used with questions on professional experience and the definition of violence. The analysis revealed that these health workers acknowledged the existence of discriminatory and disrespectful practices against women during prenatal care, childbirth, and the postpartum. Examples of such practices cited by interviewees included the use of pejorative slang as a form of "humor", threats, reprimands, and negligence in the management of pain. Such practices are not generally viewed by health workers as violent, but rather as the exercise of professional authority in what is considered a "difficult" context. The institutional violence is thus trivialized, disguised as purportedly good practice (i.e., "for the patient's own good"), and rendered invisible in the daily routine of care provided by maternity services. PMID:24233043

  4. Risk Factors and Adverse Perinatal Outcomes among Term and Preterm Infants Born Small-for-Gestational-Age: Secondary Analyses of the WHO Multi-Country Survey on Maternal and Newborn Health

    PubMed Central

    Ota, Erika; Ganchimeg, Togoobaatar; Morisaki, Naho; Vogel, Joshua P.; Pileggi, Cynthia; Ortiz-Panozo, Eduardo; Souza, João P.; Mori, Rintaro

    2014-01-01

    Background Small for gestational age (SGA) is not only a major indicator of perinatal mortality and morbidity, but also the morbidity risks in later in life. We aim to estimate the association between the birth of SGA infants and the risk factors and adverse perinatal outcomes among twenty-nine countries in Africa, Latin America, the Middle East and Asia in 359 health facilities in 2010–11. Methods We analysed facility-based, cross-sectional data from the WHO Multi-country Survey on Maternal and Newborn Health. We constructed multilevel logistic regression models with random effects for facilities and countries to estimate the risk factors for SGA infants using country-specific birthweight reference standards in preterm and term delivery, and SGA’s association with adverse perinatal outcomes. We compared the risks and adverse perinatal outcomes with appropriate for gestational age (AGA) infants categorized by preterm and term delivery. Results A total of 295,829 singleton infants delivered were analysed. The overall prevalence of SGA was highest in Cambodia (18.8%), Nepal (17.9%), the Occupied Palestinian Territory (16.1%), and Japan (16.0%), while the lowest was observed in Afghanistan (4.8%), Uganda (6.6%) and Thailand (9.7%). The risk of preterm SGA infants was significantly higher among nulliparous mothers and mothers with chronic hypertension and preeclampsia/eclampsia (aOR: 2.89; 95% CI: 2.55–3.28) compared with AGA infants. Higher risks of term SGA were observed among sociodemographic factors and women with preeclampsia/eclampsia, anaemia and other medical conditions. Multiparity (> = 3) (AOR: 0.88; 95% CI: 0.83–0.92) was a protective factor for term SGA. The risk of perinatal mortality was significantly higher in preterm SGA deliveries in low to high HDI countries. Conclusion Preterm SGA is associated with medical conditions related to preeclampsia, but not with sociodemographic status. Term SGA is associated with sociodemographic status and various medical conditions. PMID:25119107

  5. Perinatal, Maternal, and Fetal Characteristics of Children Diagnosed with Attention-Deficit-Hyperactivity Disorder: Results from a Population-Based Study Utilizing the Swedish Medical Birth Register

    ERIC Educational Resources Information Center

    Gustafsson, Peik; Kallen, Karin

    2011-01-01

    Aim: The aim of this study was to evaluate the impact of pre- and perinatal factors on the risk of developing attention-deficit-hyperactivity disorder (ADHD). Method: We investigated the medical history of 237 children (206 male; 31 female) from Malmo, Sweden born between 1986 and 1996 and in whom a diagnosis of ADHD (Diagnostic and Statistical…

  6. Shanghai needs to improve its perinatal care.

    PubMed

    1992-04-01

    In view of the situation that the perinatal mortality rate of Shanghai keeps dropping, doctor Hua Jiazeng from the Shanghai No. 1 Maternity Hospital told the reporter recently that to further lower down the perinatal mortality rate in Shanghai, the perinatal care should be improved through replacing maternity facilities and equipments, keeping the mother and her baby together in the same ward in hospital, and raising the breastfeeding rate. According to the latest statistics, the maternity mortality rate is now 23.8/100.000 in Shanghai, and the perinatal mortality rate has been 12-13/1000 in the past 10 years. These numbers show that there is still a gap between Shanghai and some developed countries regarding perinatal care. There are 3 reasons behind this: 1) since the early 1980s, Shanghai has been in the birth peak period and each year there are 180,000 babies born on the average, as a result, short of beds and lack of staff, the quality of puerperium monitoring and parturition treatment is impaired; 2) maternity facilities and equipments in quite a few hospitals are obsolete and do not suit the needs of modern maternity care anymore, and many hospitals still put newly-born babies together in a big ward which make babies easy to be infected; and 3) breastfeeding rate is dropping as more families do not choose breastfeeding. Doctor Hua suggests: first, we should make a good use of the 3-level maternal and childcare network covering the whole city, strengthen primary care, and pay particular attention to the women of 1st pregnancy at middle age and the unhealthy pregnant women; 2nd, health and medical sectors should put some funds on improving maternal facilities and equipments, increase maternity staff, and raise the income of maternity workers; lastly, all hospitals should keep the mother and baby in the same ward, and greatest efforts should be made to raise the breastfeeding rate. PMID:12343695

  7. Impact of Janani Suraksha Yojana on institutional delivery rate and maternal morbidity and mortality: an observational study in India.

    PubMed

    Gupta, Sanjeev K; Pal, Dinesh K; Tiwari, Rajesh; Garg, Rajesh; Shrivastava, Ashish K; Sarawagi, Radha; Patil, Rajkumar; Agarwal, Lokesh; Gupta, Prashant; Lahariya, Chandrakant

    2012-12-01

    The Government of India initiated a cash incentive scheme--Janani Suraksha Yojana (JSY)--to promote institutional deliveries with an aim to reduce maternal mortality ratio (MMR). An observational study was conducted in a tertiary-care hospital of Madhya Pradesh, India, before and after implementation of JSY, with a sample of women presenting for institutional delivery. The objectives of this study were to: (i) determine the total number of institutional deliveries before and after implementation of JSY, (ii) determine the MMR, and (iii) compare factors associated with maternal mortality and morbidity. The data were analyzed for two years before implementation of JSY (2003-2005) and compared with two years following implementation of JSY (2005-2007). Overall, institutional deliveries increased by 42.6% after implementation, including those among rural, illiterate and primary-literate persons of lower socioeconomic strata. The main causes of maternal mortality were eclampsia, pre-eclampsia and severe anaemia both before and after implementation of JSY. Anaemia was the most common morbidity factor observed in this study. Among those who had institutional deliveries, there were significant increases in cases of eclampsia, pre-eclampsia, polyhydramnios, oligohydramnios, antepartum haemorrhage (APH), postpartum haemorrhage (PPH), and malaria after implementation of JSY. The scheme appeared to increase institutional delivery by at-risk mothers, which has the potential to reduce maternal morbidity and mortality, improve child survival, and ensure equity in maternal healthcare in India. The lessons from this study and other available sources should be utilized to improve the performance and implementation of JSY scheme in India. PMID:23304913

  8. Perinatal Generalized Anxiety Disorder: Assessment and Treatment.

    PubMed

    Misri, Shaila; Abizadeh, Jasmin; Sanders, Shawn; Swift, Elena

    2015-09-01

    Perinatal generalized anxiety disorder (GAD) has a high prevalence of 8.5%-10.5% during pregnancy and 4.4%-10.8% postpartum. Despite its attendant dysfunction in the patient, this potentially debilitating mental health condition is often underdiagnosed. This overview will provide guidance for clinicians in making timely diagnosis and managing symptoms appropriately. A significant barrier to the diagnosis of GAD in the perinatal population is difficulty in distinguishing normal versus pathological worry. Because a perinatal-specific screening tool for GAD is nonexistent, early identification, diagnosis and treatment is often compromised. The resultant maternal dysfunction can potentially impact mother-infant bonding and influence neurodevelopmental outcomes in the children. Comorbid occurrence of GAD and major depressive disorder changes the illness course and its treatment outcome. Psychoeducation is a key component in overcoming denial/stigma and facilitating successful intervention. Treatment strategies are contingent upon illness severity. Cognitive behavior therapy (CBT), relaxation, and mindfulness therapy are indicated for mild GAD. Moderate/severe illness requires pharmacotherapy and CBT, individually or in combination. No psychotropic medications are approved by the FDA or Health Canada in pregnancy or the postpartum; off-label pharmacological treatment is instituted only if the benefit of therapy outweighs its risk. SSRIs/SNRIs are the first-line treatment for anxiety disorders due to data supporting their efficacy and overall favorable side effect profile. Benzodiazepines are an option for short-term treatment. While research on atypical antipsychotics is evolving, some can be considered for severe manifestations where the response to antidepressants or benzodiazepines has been insufficient. A case example will illustrate the onset, clinical course, and treatment strategies of GAD through pregnancy and the postpartum. PMID:26125602

  9. Impact of specialization in gynecology and obstetrics departments on pregnant women’s choice of maternity institutions

    PubMed Central

    2013-01-01

    In April 2008, specialization in gynecology and obstetrics departments was introduced in the Sennan area of Osaka prefecture in Japan that aimed at solving the problems of regional provisions of obstetrics services (e.g., shortage of obstetricians, overworking of obstetricians, and provision of specialist maternity services for high-risk pregnancies). Under this specialization, the gynecology and obstetrics departments in two city hospitals were combined and reconstructed into two centers, i.e., the gynecological care center in Kaizuka City Hospital and the prenatal care center in Izumisano City Hospital. This paper investigates to what extent and how this specialization affected pregnant women’s choices of the prenatal care center and other maternity institutions. We used birth certificate data of 15,927 newborns from the Sennan area between April 1, 2007 and March 30, 2010, for Before and After Analysis to examine changes in pregnant women’s choices of maternity institutions before and after the specialization was instituted. Our results indicated that this specialization scheme was, to some extent, successful on the basis of providing maternity services for high-risk pregnancies at the prenatal care center (i.e., Izumisano City Hospital) and having created a positive effect by pregnant women to other facilities in the nearby area. PMID:24364885

  10. Timing of the maternal drug dose and risk of perinatal HIV transmission in the setting of intrapartum and neonatal single-dose nevirapine

    PubMed Central

    Stringer, Jeffrey S. A.; Sinkala, Moses; Chapman, Victoria; Acosta, Edward P.; Aldrovandi, Grace M.; Mudenda, Victor; Stout, Julia P.; Goldenberg, Robert L.; Kumwenda, Rosemary; Vermund, Sten H.

    2009-01-01

    Context: Single-dose intrapartum and neonatal nevirapine (NVP) reduces perinatal HIV transmission and is in increasingly common use throughout the developing world. Objective: We studied risk factors for perinatal transmission in the setting of NVP. Design and setting: A prospective cohort study at two public obstetrical clinics in Lusaka, Zambia. Patients and methods: In a volunteer sample of HIV-infected pregnant women and their newborns, the women received a 200 mg oral dose of NVP at the onset of labor; their infants received 2 mg/kg of NVP syrup within 24 h of birth. The main outcome measure was the infant HIV infection status at 6 weeks of life, determined by DNA polymerase chain reaction. Results: Only 31 of 278 (11.2%) infants were infected at 6 weeks. In logistic regression, viral load exceeding the median [adjusted odds ratio (AOR), 3.1; 95% confidence interval (CI), 1.1–8.7] and 1 h or less elapsing between NVP ingestion and delivery (AOR, 5.0; 95% CI, 1.8–14) were associated with transmission. Women delivering within 1 h of NVP ingestion had a lower mean drug concentration (351 versus 942 ng/ml; P < 0.001) and were more likely to have a ‘sub-therapeutic’ NVP level of less than 100 ng/ml (56 versus 20%; P < 0.001) than those who delivered more than 1 h post-ingestion. However, concentrations < 100 ng/ml were not more likely to be associated with transmission than concentrations ≥ 100 ng/ml (12.9 versus 11.7%; P = 0.8). We did not identify a threshold concentration below which risk of transmission increased. Conclusions: We confirmed low perinatal transmission rates with single-dose NVP. At least 1 h of pre-delivery NVP prophylaxis was a critical threshold for efficacy. PMID:12853748

  11. Inflammatory and Epigenetic Pathways for Perinatal Depression.

    PubMed

    Garfield, Lindsey; Mathews, Herbert L; Janusek, Linda Witek

    2016-05-01

    Depression during the perinatal period is common and can have adverse consequences for women and their children. Yet, the biobehavioral mechanisms underlying perinatal depression are not known. Adverse early life experiences increase the risk for adult depression. One potential mechanism by which this increased risk occurs is epigenetic embedding of inflammatory pathways. The purpose of this article is to propose a conceptual model that explicates the linkage between early life adversity and the risk for maternal depression. The model posits that early life adversity embeds a proinflammatory epigenetic signature (altered DNA methylation) that predisposes vulnerable women to depression during pregnancy and the postpartum period. As proposed, women with a history of early life adversity are more likely to exhibit higher levels of proinflammatory cytokines and lower levels of oxytocin in response to the demands of pregnancy and new motherhood, both of which are associated with the risk for perinatal depression. The model is designed to guide investigations into the biobehavioral basis for perinatal depression, with emphasis upon the impact of early life adversity. Testing this model will provide a better understanding of maternal depressive risk and improve identification of vulnerable women who would benefit from targeted interventions that can reduce the impact of perinatal depression on maternal-infant health. PMID:26574573

  12. Perinatal Health Statistics as the Basis for Perinatal Quality Assessment in Croatia

    PubMed Central

    Rodin, Urelija; Filipović-Grčić, Boris; Đelmiš, Josip; Glivetić, Tatjana; Juras, Josip; Mustapić, Željka; Grizelj, Ruža

    2015-01-01

    Context. Perinatal mortality indicators are considered the most important measures of perinatal outcome. The indicators reliability depends on births and deaths reporting and recording. Many publications focus on perinatal deaths underreporting and misclassification, disabling proper international comparisons. Objective. Description of perinatal health care quality assessment key indicators in Croatia. Methods. Retrospective review of reports from all maternities from 2001 to 2014. Results. According to reporting criteria for birth weight ≥500 g, perinatal mortality (PNM) was reduced by 31%, fetal mortality (FM) by 32%, and early neonatal mortality (ENM) by 29%. According to reporting criteria for ≥1000 g, PNM was reduced by 43%, FM by 36%, and ENM by 54%. PNM in ≥22 weeks' (wks) gestational age (GA) was reduced by 28%, FM by 30%, and ENM by 26%. The proportion of FM at 32–36 wks GA and at term was the highest between all GA subgroups, as opposed to ENM with the highest proportion in 22–27 wks GA. Through the period, the maternal mortality ratio varied from 2.4 to 14.3/100,000 live births. The process indicators have been increased in number by more than half since 2001, the caesarean deliveries from 11.9% in 2001 to 19.6% in 2014. Conclusions. The comprehensive perinatal health monitoring represents the basis for the perinatal quality assessment. PMID:26693484

  13. Adolescent pregnancy and perinatal outcome.

    PubMed

    Malamitsi-Puchner, A; Boutsikou, T

    2006-01-01

    Adolescent pregnancy is associated with adverse maternal and fetal effects. Potential risk factors involve early dating behavior, early initiation of smoking, alcohol and substance abuse, low academic interest, single-parent families and, above all, poverty. Girls younger than 18 years and not legally majors are psychologically and socially underdeveloped, presenting higher obstetrical risks. Maternal complications due to adolescent pregnancy include, among others: anemia; pregnancy induced hypertension; sexually transmitted diseases; and premature labor and delivery. The most common complications concerning the infant are related to: low birth weight, due either to prematurity or intrauterine growth restriction; infection; chemical dependence (due to maternal substance abuse); sudden infant death syndrome; and increased morbidity and mortality during the 1st year of age. In addition, education of teenage mothers on the importance of pre-and postnatal care can reduce the poor perinatal outcome of both mother and infant. PMID:16641854

  14. Perinatal depression: implications for child mental health

    PubMed Central

    2010-01-01

    Perinatal depression is common and primary care holds a crucial role for detecting, treating or, if necessary, providing referrals to mental health care for affected women. Family doctors should be aware of risk factors for peripartum depression, including previous history of depression, life events and interpersonal conflict. Perinatal depression has been associated with many poor outcomes, including maternal, child and family unit challenges. Infants and young children of perinatally depressed mothers are more likely to have a difficult temperament, as well as cognitive and emotional delays. The primary care setting is uniquely poised to be the screening and treatment site for perinatal depression; however, several obstacles, both at patient and systems level, have been identified that interfere with women's treatment engagement. Current published treatment guidelines favour psychotherapy above medicines as first line treatment for mild to moderate perinatal depression, while pharmacotherapy is first choice for severe depression, often in combination with psychosocial or integrative approaches. Among mothers who decide to stop taking their antidepressants despite ongoing depression during the perinatal period, the majority suffer from relapsing symptoms. If depression continues post‐partum, there is an increased risk of poor mother–infant attachment, delayed cognitive and linguistic skills in the infant, impaired emotional development and risk for behavioural problems in later life. Complex, comprehensive and multilevel algorithms are warranted to treat perinatal depression. Primary care doctors are best suited to initiate, carry out and evaluate the effectiveness of such interventions designed to prevent adverse outcomes of maternal perinatal depression on mother and child wellbeing. PMID:22477948

  15. Midwifery training to improve ante- and perinatal health in low- and middle-income countries of the former Soviet Union.

    PubMed

    Glatleider, M Pauline

    2006-02-01

    Whether in the community or in the hospital, high-quality midwifery care is the preferable model of care for mothers and babies at the first level of care. Countries with professional midwifery care within a supportive system have the best outcomes for mother and babies. The low- and middle-income countries of the former Soviet Union report some of the highest maternal mortality and neonatal mortality in the European region, yet childbirth occurs in institutions with 'skilled attendants' (96-100%). Specific characteristics of maternal and neonatal care in countries of the former Soviet Union include over-medicalization, inappropriate use of technology, unnecessary hospitalizations, and ineffective and/or harmful interventions. This article highlights two midwifery trainings developed specifically to change the maternal and newborn care practices in countries of the former Soviet Union: the Family Centred Maternity Care Training of Trainers and the World Health Organization Essential Antenatal, Perinatal and Postpartum Care Training. PMID:16364706

  16. Perinatal Complications and Aging Indicators by Midlife

    PubMed Central

    Caspi, Avshalom; Ambler, Antony; Belsky, Daniel W.; Chapple, Simon; Cohen, Harvey Jay; Israel, Salomon; Poulton, Richie; Ramrakha, Sandhya; Rivera, Christine D.; Sugden, Karen; Williams, Benjamin; Wolke, Dieter; Moffitt, Terrie E.

    2014-01-01

    BACKGROUND: Perinatal complications predict increased risk for morbidity and early mortality. Evidence of perinatal programming of adult mortality raises the question of what mechanisms embed this long-term effect. We tested a hypothesis related to the theory of developmental origins of health and disease: that perinatal complications assessed at birth predict indicators of accelerated aging by midlife. METHODS: Perinatal complications, including both maternal and neonatal complications, were assessed in the Dunedin Multidisciplinary Health and Development Study cohort (N = 1037), a 38-year, prospective longitudinal study of a representative birth cohort. Two aging indicators were assessed at age 38 years, objectively by leukocyte telomere length (TL) and subjectively by perceived facial age. RESULTS: Perinatal complications predicted both leukocyte TL (β = −0.101; 95% confidence interval, −0.169 to −0.033; P = .004) and perceived age (β = 0.097; 95% confidence interval, 0.029 to 0.165; P = .005) by midlife. We repeated analyses with controls for measures of family history and social risk that could predispose to perinatal complications and accelerated aging, and for measures of poor health taken in between birth and the age-38 follow-up. These covariates attenuated, but did not fully explain the associations observed between perinatal complications and aging indicators. CONCLUSIONS: Our findings provide support for early-life developmental programming by linking newborns’ perinatal complications to accelerated aging at midlife. We observed indications of accelerated aging “inside,” as measured by leukocyte TL, an indicator of cellular aging, and “outside,” as measured by perceived age, an indicator of declining tissue integrity. A better understanding of mechanisms underlying perinatal programming of adult aging is needed. PMID:25349321

  17. Impact of Increasing Capacity for Generating and Using Research on Maternal and Perinatal Health Practices in South East Asia (SEA-ORCHID Project)

    PubMed Central

    2011-01-01

    Background Maternal and neonatal mortality and morbidity remain unacceptably high in many low and middle income countries. SEA-ORCHID was a five year international collaborative project in South East Asia which aimed to determine whether health care and health outcomes for mothers and babies could be improved by developing capacity for research generation, synthesis and use. Methods Nine hospitals in Indonesia, Malaysia, the Philippines and Thailand participated in SEA-ORCHID. These hospitals were supported by researchers from three Australian centres. Health care practices and outcomes were assessed for 1000 women at each hospital both before and after the intervention. The capacity development intervention was tailored to the needs and context of each hospital and delivered over an 18 month period. Main outcomes included adherence to forms of care likely to be beneficial and avoidance of forms of care likely to be ineffective or harmful. Results We observed substantial variation in clinical practice change between sites. The capacity development intervention had a positive impact on some care practices across all countries, including increased family support during labour and decreased perineal shaving before birth, but in some areas there was no significant change in practice and a few beneficial practices were followed less often. Conclusion The results of SEA-ORCHID demonstrate that investing in developing capacity for research use, synthesis and generation can lead to improvements in maternal and neonatal health practice and highlight the difficulty of implementing evidence-based practice change. PMID:21915274

  18. Classification of perinatal deaths.

    PubMed

    Wigglesworth, J S

    1994-01-01

    Accurate classification of perinatal deaths is instrumental in efforts to improve the perinatal mortality rate (PNMR). Accurate records should be maintained on birth weight, gestational age, a simple classification of cause of death (possibly the "Wigglesworth" or the author's system), a classification system correlated with birth weight/gestation of dead and live births, and, where possible, detailed coding such as the International Classification of Diseases (ICD) or the Systematized Nomenclature of Medicine (SNOMED). The fetal loss rate in Great Britain is reported as a minimum of 0.1% per week for pregnancies from 22 weeks until term. Obstetric or neonatal management can affect the level of mortality. Terminations due to malformations performed before the 24th week are found to account for a 50% decline in the PNMR. PNMR is affected also by birth weight and the occurrence of multiple births. Neonatal care that prolongs the survival of sick or malformed neonates may decrease PNMR or increase infant death rates. Analysis of trends in PNMR must consider demographic changes such as an increase in preterm multiple births due to fertility treatment. Perinatal deaths may be classified by cause with a variety of systems. The ICD system is a single axis classification which uses three digit codes for primary causes and a fourth and fifth digit for detailed subcategories, which can be accessed in a alphabetically-organized index. SNOMED provides six different fields of information, including topography, morphology, aetiology, function, disease, and procedure. Five subordinate fields are identified and linked to topographic body sites. Choice of classification systems is considered to be based on availability of information and the needs for subsequent analysis. Two other systems of classification are available in the UK. The Aberdeen system is based on maternal factors, but the disadvantage is the high number of unexplained deaths. The Hey et al. system codes by fetal and neonatal factors and does not require modern investigative techniques, but the detail is highly variables from case-to-case and hospital-to-hospital. The author's system is based on routine autopsies of external conditions. Four groupings are identified, including macerated normally-formed stillborn infants, congenital anomalies (stillbirth or neonatal death), conditions associated with prematurity, and fresh stillbirths presumed asphyxiated. A fifth category groups infants dying of specific conditions such as toxoplasmosis. PMID:8147106

  19. [Effects of perinatal nutrition on developmental outcomes].

    PubMed

    Hascoët, Jean-Michel

    2013-12-01

    The multifactorial nature of perinatal growth is now well established. The perinatal environment modulates each infant's genetic potential. Antenatal nutrition is dependent on maternal nutrition and is also subject to environmental factors such as tobacco smoke, which can significantly impact infant development. Current neonatal nutritional guidelines, aimed primarily at ensuring good nutrient tolerance, may no longer be optimal. Indeed, they can lead to malnutrition and growth retardation, and attempts to "catch up" through increased protein and calorie intake may have unwanted effects. Current data point to critical time windows during which nutritional optimization might improve infant development. New approches could help to prevent adult diseases of developmental origin. PMID:26137815

  20. Efficacy of WHO recommendation for continued breastfeeding and maternal cART for prevention of perinatal and postnatal HIV transmission in Zambia

    PubMed Central

    Ngoma, Mary S; Misir, Amita; Mutale, Wilbroad; Rampakakis, Emmanuoil; Sampalis, John S; Elong, Angela; Chisele, Sam; Mwale, Abel; Mwansa, Jonathan K; Mumba, Scholastica; Chandwe, Mula; Pilon, Richard; Sandstrom, Paul; Wu, Samantha; Yee, Kristen; Silverman, Michael S

    2015-01-01

    Introduction To prevent mother-to-child transmission (MTCT) of HIV in developing countries, new World Health Organization (WHO) guidelines recommend maternal combination antiretroviral therapy (cART) during pregnancy, throughout breastfeeding for 1 year and then cessation of breastfeeding (COB). The efficacy of this approach during the first six months of exclusive breastfeeding has been demonstrated, but the efficacy of this approach beyond six months is not well documented. Methods A prospective observational cohort study of 279 HIV-positive mothers was started on zidovudine/3TC and lopinavir/ritonavir tablets between 14 and 30 weeks gestation and continued indefinitely thereafter. Women were encouraged to exclusively breastfeed for six months, complementary feed for the next six months and then cease breastfeeding between 12 and 13 months. Infants were followed for transmission to 18 months and for survival to 24 months. Text message reminders and stipends for food and transport were utilized to encourage adherence and follow-up. Results Total MTCT was 9 of 219 live born infants (4.1%; confidence interval (CI) 2.2–7.6%). All breastfeeding transmissions that could be timed (5/5) occurred after six months of age. All mothers who transmitted after six months had a six-month plasma viral load >1,000 copies/ml (p<0.001). Poor adherence to cART as noted by missed dispensary visits was associated with transmission (p=0.04). Infant mortality was lower after six months of age than during the first six months of life (p=0.02). The cumulative rate of infant HIV infection or death at 18 months was 29/226 (12.8% 95 CI: 7.5–20.8%). Conclusions Maternal cART may limit MTCT of HIV to the UNAIDS target of <5% for eradication of paediatric HIV within the context of a clinical study, but poor adherence to cART and follow-up can limit the benefit. Continued breastfeeding can prevent the rise in infant mortality after six months seen in previous studies, which encouraged early COB. PMID:26140453

  1. [Pseudomonads as a marker of the sanitary-epidemiological state of maternity institutions].

    PubMed

    Stavertiĭ, L V; Mefod'ev, V V; Gileva, S V

    1995-01-01

    In the process of the epidemiological supervision of 4 maternity hospitals in Tyumen 453 Pseudomonas strains, classified with 9 species, were isolated and studied. The overwhelming majority of the strains isolated from nursing articles and medical equipment were classified with P. aeruginosa (86.75 +/- 1.68%) and P. putida (7.11 +/- 1.27%). In the structure of Pseudomonas isolated from humans these species constituted 51.11 +/- 7.45% and 26.67 +/- 6.69% respectively. High occurrence of Pseudomonas contamination of nursing articles and medical equipment in postnatal wards (11.48 +/- 0.82%) and in infants wards (6.92 +/- 0.58%) was established. Sinks of wash-stands (3.76 +/- 1.3-28.5 +/- 2.15%), compressors for the reanimation of infants (11.1 +/- 10.47%), faucets (1.69 +/- 0.7-5.29 +/- 0.92%), etc. were found to be the most contaminated objects which could be the factor of Pseudomonas transmission. The inclusion of bacteriological control into the system of epidemiological supervision in maternity hospitals facilitates the timely detection of unfavorable epidemiological situation and makes it possible to take the necessary measures with a view to decrease the functioning of mechanisms of Pseudomonas transmission well in advance. PMID:7653135

  2. Labour complications remain the most important risk factors for perinatal mortality in rural Kenya.

    PubMed Central

    Weiner, Renay; Ronsmans, Carine; Dorman, Ed; Jilo, Hilton; Muhoro, Anne; Shulman, Caroline

    2003-01-01

    OBJECTIVES: To identify and quantify risk factors for perinatal mortality in a Kenyan district hospital and to assess the proportion of perinatal deaths attributable to labour complications, maternal undernutrition, malaria, anaemia and human immunodeficiency virus (HIV). METHODS: A cross-sectional study of 910 births was conducted between January 1996 and July 1997 and risk factors for perinatal mortality were analysed. FINDINGS: The perinatal mortality rate was 118 per 1000 births. Complications of labour such as haemorrhage, premature rupture of membranes/premature labour, and obstructed labour/ malpresentation increased the risk of death between 8- and 62-fold, and 53% of all perinatal deaths were attributable to labour complications. Placental malaria and maternal HIV, on the other hand, were not associated with perinatal mortality. CONCLUSIONS: Greater attention needs to be given to the quality of obstetric care provided in the rural district-hospital setting. PMID:14576887

  3. Cord blood hyperlipoproteinemia and perinatal stress.

    PubMed

    Cress, H R; Shaher, R M; Laffin, R; Karpowicz, K

    1977-01-01

    In 275 neonates mean cord blood cholesterol level was 70 +/- 17 (SD) mg/dl, with a range from 30 to 153 mg/dl. Mean cord blood triglyceride level was 33 +/- 26 (SD) mg/dl, with a range of 5-192 mg/dl. In an attempt to correlate perinatal problems and hypercholesterolemia in neonates we compared 15 hypercholesterolemic neonates who had cord blood cholesterol levels above 95 mg/dl, range 100-153 mg/dl, and triglyceride levels less than 65 mg/dl, with 65 normal neonates whose cord blood cholesterol levels were less than 95 mg/dl and triglyceride values were less than 65 mg/dl. We also compared 19 hypertriglyceridemic neonates who had cord blood triglyceride levels greater than 65 mg/dl, range 66-192 mg/dl, and cholesterol levels less than 95 mg/dl with the 65 normal neonates. Elevated cord blood cholesterol values greater than 95 mg/dl or triglyceride values greater than 65 mg/dl were associated with maternal-fetal problems related to unfavorable intralterine environment, fetal distress, and fetal anoxia. There was a significant correlation between post-term delivery and hypercholesterolemic neonates, and low Apgar scores and maternal hypertension were more often associated with hypertriglyceridemic infants. There was no association between serum cholesterol or triglyceride levels and prolonged ruptured membranes, cesarean section, maternal diabetes, or maternal hypothyroidism. Consequently, we think that when neonates are identified who have elevated cholesterol or triglyceride levels, the possible influence of maternal-fetal perinatal complications should be considered. Speculation Infants with familial hypercholesterolemia may be identified by increases in cord blood cholesterol concentrations. Elevated cord blood cholesterol or triglyceride values of some neonates, however, may represent hyperlipoproteinemia related to neonatal stress associated with maternal-fetal perinatal problems. PMID:831215

  4. Perinatal mortality in lambs in southern Brazil.

    PubMed

    Hancock, R D; Coe, A J; Silva, F C

    1996-11-01

    Hypothermia and dystocia were found to be the most common causes of perinatal mortality in 8 commercial wool flocks in one region of southern Brazil. It was established that low birth weight and poor maternal instinct in the ewes predisposed to losses due to hypothermia but that there appeared to be no association with adverse weather conditions. Other factors possibly predisposing to losses are discussed. PMID:8983130

  5. Coverage and Financial Risk Protection for Institutional Delivery: How Universal Is Provision of Maternal Health Care in India?

    PubMed Central

    Prinja, Shankar; Bahuguna, Pankaj; Gupta, Rakesh; Sharma, Atul; Rana, Saroj Kumar; Kumar, Rajesh

    2015-01-01

    Background India aims to achieve universal access to institutional delivery. We undertook this study to estimate the universality of institutional delivery care for pregnant women in Haryana state in India. To assess the coverage of institutional delivery, we analyze service coverage (coverage of public sector institutional delivery), population coverage (coverage among different districts and wealth quintiles of the population) and financial risk protection (catastrophic health expenditure and impoverishment as a result of out-of-pocket expenditure for delivery). Methods We analyzed cross-sectional data collected from a randomly selected sample of 12,191 women who had delivered a child in the last one year from the date of data collection in Haryana state. Five indicators were calculated to evaluate coverage and financial risk protection for institutional delivery—proportion of public sector deliveries, out-of-pocket expenditure, percentage of women who incurred no expenses, prevalence of catastrophic expenditure for institutional delivery and incidence of impoverishment due to out-of-pocket expenditure for delivery. These indicators were calculated for the public and private sectors for 5 wealth quintiles and 21 districts of the state. Results The coverage of institutional delivery in Haryana state was 82%, of which 65% took place in public sector facilities. Approximately 63% of the women reported no expenditure on delivery in the public sector. The mean out-of-pocket expenditures for delivery in the public and private sectors in Haryana were INR 771 (USD 14.2) and INR 12,479 (USD 229), respectively, which were catastrophic for 1.6% and 22% of households, respectively. Conclusion Our findings suggest that there is considerably high coverage of institutional delivery care in Haryana state, with significant financial risk protection in the public sector. However, coverage and financial risk protection for institutional delivery vary substantially across districts and among different socio-economic groups and must be strengthened. The success of the public sector in providing high coverage and financial risk protection in maternal health provides encouragement for the role that the public sector can play in universalizing health care. PMID:26348921

  6. Factors influencing early perinatal mortality in a rural district hospital.

    PubMed

    Kavoo-Linge; Rogo, K O

    1992-04-01

    Early perinatal mortality (EPM) was prospectively analysed in a rural District Hospital during a 4 month period. 2,171 deliveries were recorded with an early perinatal mortality rate (EPMR) of 53/1000. Factors significantly influencing EPM included maternal age, education, marital and socio-economic status. Antenatal care, gestation at delivery, birthweight, pregnancy and labour complications were other significant factors. A maternal mortality rate of 2.8/1000 was also recorded. The study findings and possible lines of intervention are discussed. PMID:1644026

  7. Perinatal Morbidity and Mortality in Offsprings of Diabetic Mothers in Qatif, Saudi Arabia.

    ERIC Educational Resources Information Center

    Al-Dabbous, Ibrahim A. Al-; And Others

    1995-01-01

    Studied perinatal and neonatal morbidity and mortality of diabetic mothers and their offspring in Qatif, Saudi Arabia. Suggests diabetes mellitus in pregnancy may be a common problem in Saudi Arabia, as poor maternal diabetic control results in high perinatal morbidity and mortality. Results suggest that health education and improved coverage of…

  8. Fourth goal of perinatal medicine.

    PubMed Central

    Ounsted, C; Roberts, J C; Gordon, M; Milligan, B

    1982-01-01

    Reduction in maternal mortality, infant mortality, and infant morbidity have been successively the goals of perinatal medicine. The fourth is to reduce bonding failure. In July 1978 a preventive service was started in the John Radcliffe Maternity Hospital. A twice-weekly round is made. Midwives refer families who cause them concern. In the first year the referral rate ws 20.5 per 1000 liveborn babies. The referred sample differed from the hospital population in terms of maternal psychiatric history, marital state and babies' admission to special care. The main reasons for referral were: doubt about parenting ability (27%), psychiatric history (15%), disturbed behaviour in hospital (14%), and diffuse social and medical problems (17%). Long-term care was needed for only 14% of families. At their first birthdays, six babies were placed away from their natural parents; the sample had had a slightly higher than expected admission rate to hospital; the distribution of weights did not differ from the expected; doctors and health visitors were still concerned about one-quarter of the families. Seven cases of screening failure were found among those not referred to our service, but only one was seriously abused. No child referred in the first year has been seriously neglected or abused. PMID:6802338

  9. Maternity Leave in Australia: Employee and Employer Experiences. Report of a Survey. Australian Institute of Family Studies Monograph No. 7.

    ERIC Educational Resources Information Center

    Glezer, Helen

    A study was made to obtain a broad overview of the operation of maternity leave in Australia from the perspectives of employees and employers. The study included: (1) an employee survey exploring the use and non-use of maternity leave and identifying determinants of taking maternity leave and of retaining women in the labor force after childbirth;…

  10. The Impact of Antenatal Testing for Advanced Maternal Age on Cesarean Delivery Rate at an Urban Institution

    PubMed Central

    Levine, Lisa D.; Srinivas, Sindhu K.; Paré, Emmanuel; Mehta-Lee, Shilpi S.

    2016-01-01

    Objective Antenatal testing has been implemented for advanced maternal age (AMA) women given their increased stillbirth risk. Our objective was to evaluate cesarean delivery and induction rates after the start of antenatal testing at our institution. Study Design A retrospective cohort study of AMA women (≥ 40 years) who delivered at our institution was performed. Testing for AMA began in 2005. AMA women who delivered before (unexposed) and after (exposed) the implementation were compared. Our primary outcome was cesarean delivery and secondary outcome was induction. Chi-square compared categorical variables and multivariable logistic regression calculated odds ratio (OR) and controlled for confounders. Results A total of 276 women were included (147 unexposed and 129 exposed). The cesarean rate was higher in the exposed group (53 vs. 39%, OR 1.76 [1.09–2.84]). The increased risk of cesarean remained after adjusting for race, previous cesarean, multiple gestations, and parity (adjusted OR 1.85 [1.05–3.28]). When excluding those with previous cesareans, the risk of primary cesarean was not significant (OR 1.57 [0.89–2.76]). The induction rate was not different (38 vs. 33%, p = 0.4). Conclusions While overall cesareans increased, there was no difference in primary cesarean and induction rates for AMA women after implementation of antenatal testing for AMA. PMID:24858316

  11. Chromosomal variation and perinatal mortality in San Diego zoo Soemmerring's gazelles.

    PubMed

    Steiner, Cynthia C; Charter, Suellen J; Goddard, Natalie; Davis, Heidi; Brandt, Margot; Houck, Marlys L; Ryder, Oliver A

    2015-01-01

    Chromosomal translocations play a fundamental role in the evolution and speciation of antelopes (Antilopinae, Bovidae), with several species exhibiting polymorphism for centric fusions. For the past 35 years, the San Diego Zoo Global (SDZG) captive population of Soemmerring's gazelles has revealed complex karyotypes resulting from chromosomal translocations with diploid numbers ranging from 34 to 39. Poor reproductive performance of this species in captivity and elevated mortality the first month of life (perinatal) has been attributed to this chromosomal dynamism. We have extended the studies of karyotypic variation in the SDZG Soemmerring's gazelle population and analyzed the effect of chromosomal and genetic variation upon perinatal mortality. Karyotypes from 149 captive Soemmerring's gazelles were evaluated revealing two unreported autosomal combinations, now constituting a total of 15 distinct karyotypes for the 3 Robertsonian centric fusions originally described for this population. Among SDZG founders, distinct chromosomal variation and nuclear and mitochondrial genetic structure were detected corresponding to the institution of origin of the founders. Low levels of genetic distance and nucleotide diversity among individuals, in addition to high relatedness values, suggested that outbreeding is less of a concern than inbreeding for maintaining a sustainable captive population. Finally, analysis of karyotypes of offspring born into the SDZG Soemmerring's gazelle herds, in conjunction with the maternal karyotype showed association of chromosomal makeup with perinatal mortality. This supports the importance of continuing cytogenetic screening efforts, particularly to evaluate the presence of deleterious chromosomal rearrangements in stillborns. PMID:26011774

  12. Inequalities in institutional delivery uptake and maternal mortality reduction in the context of cash incentive program, Janani Suraksha Yojana: results from nine states in India.

    PubMed

    Randive, Bharat; San Sebastian, Miguel; De Costa, Ayesha; Lindholm, Lars

    2014-12-01

    Proportion of women giving birth in health institutions has increased sharply in India since the introduction of cash incentive program, Janani Suraksha Yojana (JSY) in 2005. JSY was intended to benefit disadvantaged population who had poor access to institutional care for childbirth and who bore the brunt of maternal deaths. Increase in institutional deliveries following the implementation of JSY needs to be analysed from an equity perspective. We analysed data from nine Indian states to examine the change in socioeconomic inequality in institutional deliveries five years after the implementation of JSY using the concentration curve and concentration index (CI). The CI was then decomposed in order to understand pathways through which observed inequalities occurred. Disparities in access to emergency obstetric care (EmOC) and in maternal mortality reduction among different socioeconomic groups were also assessed. Slope and relative index of inequality were used to estimate absolute and relative inequalities in maternal mortality ratio (MMR). Results shows that although inequality in access to institutional delivery care persists, it has reduced since the introduction of JSY. Nearly 70% of the present inequality was explained by differences in male literacy, EmOC availability in public facilities and poverty. EmOC in public facilities was grossly unavailable. Compared to richest division in nine states, poorest division has 135 more maternal deaths per 100,000 live births in 2010. While MMR has decreased in all areas since JSY, it has declined four times faster in richest areas compared to the poorest, resulting in increased inequalities. These findings suggest that in order for the cash incentive to succeed in reducing the inequalities in maternal health outcomes, it needs to be supported by the provision of quality health care services including EmOC. Improved targeting of disadvantaged populations for the cash incentive program could be considered. PMID:25462599

  13. Management of perinatal lung malformations.

    PubMed

    Macardle, C A; Kunisaki, S M

    2015-02-01

    This review uses the most up-to-date literature to help guide obstetrical providers through the diagnosis and management of perinatal lung malformations. These lesions, which include congenital pulmonary airway malformation [CPAM, formerly congenital cystic adenomatoid malformation (CCAM)] and bronchopulmonary sequestration (BPS), are relatively rare but are becoming increasingly common because of the improved resolution and enhanced sensitivity of fetal ultrasound. Serial assessment throughout pregnancy remains the norm rather than the exception. Perinatal management strategies can differ based on the sonographic characteristics and dynamic growth patterns of lung masses. Fetal magnetic resonance imaging and other diagnostic testing can sometimes be helpful in providing additional prognostic information. Over the last decade, the importance of echocardiography and utility of maternal steroids have been recognized in cases of non-immune hydrops. Fetal surgery is now rarely performed. Decisions regarding whether delivery of these fetuses should occur in a tertiary care center with pediatric surgery coverage versus delivery at a local community hospital are now highly relevant in most prenatal counseling discussions with families. Large lung malformations may require urgent surgical removal in the early postnatal period because of respiratory distress. Other complications, such as recurrent pneumonia, pneumothorax, and cancer, are indications for lung resection on an elective basis. In the vast majority of cases, the overall prognosis remains excellent. PMID:25310108

  14. U.S. Public Health Service Task Force recommendations for use of antiretroviral drugs in pregnant HIV-1-infected women for maternal health and interventions to reduce perinatal HIV-1 transmission in the United States.

    PubMed

    Mofenson, Lynne M

    2002-11-22

    These recommendations update the February 4,2002, guidelines developed by the Public Health Service for the use of zidovudine (ZDV) to reduce the risk for perinatal human immunodeficiency virus type 1 (HIV-1) transmission. This report provides healthcare providers with information for discussion with HIV-1-infected pregnant women to enable such women to make an informed decision regarding the use of antiretroviral drugs during pregnancy and use of elective cesarean delivery to reduce perinatal HIV-1 transmission. Various circumstances that commonly occur in clinical practice are presented, and the factors influencing treatment considerations are highlighted in this report. The Perinatal HIV Guidelines Working Group recognizes that strategies to prevent perinatal transmission and concepts related to management of HIV disease in pregnant women are rapidly evolving and will continually review new data and provide regular updates to the guidelines. The most recent information is available from the HIV/AIDS Treatment Information Service (available at http.//www.hivatis.org). In February 1994, the results of Pediatric AIDS Clinical Trials Group (PACTG) Protocol 076 documented that ZDV chemoprophylaxis could reduce perinatal HIV-1 transmission by nearly 70%. Epidemiologic data have since confirmed the efficacy of ZDV for reduction of perinatal transmission and have extended this efficacy to children of women with advanced disease, low CD4+ T-lymphocyte counts, and prior ZDV therapy. Additionally, substantial advances have been made in the understanding of the pathogenesis of HIV-1 infection and in the treatment and monitoring of persons with HIV-1 disease. These advances have resulted in changes in standard antiretroviral therapy for HIV-1-infected adults. More aggressive combination drug regimens that maximally suppress viral replication are now recommended. Although considerations associated with pregnancy may affect decisions regarding timing and choice of therapy pregnancy is not a reason to defer standard therapy. Use of antiretroviral drugs in pregnancy requires unique considerations, including the possible need to alter dosage as a result of physiologic changes associated with pregnancy the potential for adverse short- or long-term effects on the fetus and newborn, and the effectiveness of the drugs in reducing the risk for perinatal transmission. Data to address many of these considerations are not yet available. Therefore, offering antiretroviral therapy to HIV-1-infected women during pregnancy, whether primarily for HIV-1 infection, for reduction of perinatal transmission, or for both purposes, should be accompanied by a discussion of the known and unknown short- and long-term benefits and risks of such therapy to infected women and their infants. Standard antiretroviral therapy should be discussed with and offered to HIV-1-infected pregnant women. Additionally, to prevent perinatal transmission, ZDV chemoprophylaxis should be incorporated into the antiretroviral regimen. PMID:12489844

  15. Social inequalities in perinatal health.

    PubMed

    Masuy-Stroobant, G

    1989-01-01

    In spite of an overall sharp decrease in the infant mortality level since the very beginning of the 20th century, one still observes a persistance of social inequalities, even in perinatal mortality, almost everywhere in Europe. International comparisons or trends are rather difficult to establish due to methodological and conceptual shortcomings. In the years 1979-1980, a comprehensive survey was conducted in one of the Belgian provinces, Hainaut, where information on the mothers' behavior during pregnancy, including everyday life habits, was collected together with the usual identification factors. It appears that future research needs must be based on a new definition of the social gradients, shifting from the usual father's socioeconomic reference to a more sociocultural integration gradient, taking also maternal and family characteristics into account in order to improve the understanding of the phenomenon. PMID:2650744

  16. Revision of Breastfeeding Guidelines in the Setting of Maternal Opioid Use Disorder: One Institution's Experience.

    PubMed

    Wachman, Elisha M; Saia, Kelley; Humphreys, Robin; Minear, Susan; Combs, Ginny; Philipp, Barbara L

    2016-05-01

    Breastfeeding is recommended for women with opioid use disorder who are treated with methadone or buprenorphine. Infants with neonatal abstinence syndrome (NAS) secondary to in-utero opioid exposure have unique challenges related to breastfeeding but also have significant benefits including improved NAS symptoms with a decreased need for pharmacotherapy. Poor understanding of substance use disorder and treatment, lack of evidence-based recommendations, and vague guidelines from national academies create controversy about breastfeeding eligibility for these women. Defining breastfeeding guidelines is often difficult, particularly in large institutions with multiple providers caring for the mother-infant dyad. Based on the available evidence and review of our institutional data, we revised our breastfeeding guidelines for mothers with opioid use disorder. The aims of our new guidelines are (a) to safely promote breastfeeding in all mothers with opioid use disorder who are in recovery, (b) to improve NAS outcomes through use of breastfeeding as a key nonpharmacologic treatment modality, and (c) to improve staff communication and consistency on the subject of breastfeeding in this patient population. PMID:26514156

  17. Older mothers do not confer greater perinatal risk to dichorionic diamniotic twins.

    PubMed

    Mullins, Edward; Kumar, Sailesh

    2012-01-01

    Advanced maternal age may be associated with adverse maternal and perinatal outcomes in singleton pregnancies. It is unclear whether a similar association exists for dichorionic twins. This objective of this study was to ascertain whether advanced maternal age was associated with increased perinatal morbidity and mortality in a 15 year retrospective review of dichorionic diamniotic (DCDA) twins delivered at Queen Charlotte's and Chelsea Hospital, a tertiary referral center in London, UK, between 1994 and 2008. In all, 1 174 DCDA deliveries occurred in the study period. Maternal age was not associated with neonatal unit admission or composite fetal and neonatal mortality. Advanced maternal age appeared to have no deleterious effect on the perinatal outcomes of DCDA twin pregnancies. PMID:21718257

  18. Cytokines in the perinatal period - Part I.

    PubMed

    Chau, A; Markley, J C; Juang, J; Tsen, L C

    2016-05-01

    Successful pregnancy requires a state of immune homeostasis. Maternal tolerance of the genetically distinct fetoplacental unit is in part mediated by maternal and fetal pro- and anti-inflammatory cytokines; these cytokines have also been implicated in different pregnancy-related pathologic states. This two-part series seeks to provide anesthesiologists with an overview on selected perinatal cytokines in an effort to identify opportunities for research and improvements in clinical care. In part one, we review basic and pregnancy-related elements of the immune system, with an emphasis on the role of cytokines. From this foundation, we offer a perspective of a unique phenomenon witnessed within obstetric anesthesia - maternal temperature elevation associated with labor epidural analgesia. PMID:26970932

  19. Perinatal Pitocin as an Early ADHD Biomarker: Neurodevelopmental Risk?

    ERIC Educational Resources Information Center

    Kurth, Lisa; Haussmann, Robert

    2011-01-01

    Objective: To investigate a potential relationship between coincidental increases in perinatal Pitocin usage and subsequent childhood ADHD onset in an attempt to isolate a specific risk factor as an early biomarker of this neurodevelopmental disorder. Method: Maternal labor/delivery and corresponding childbirth records of 172 regionally diverse,…

  20. PREGNANCY AND PERINATAL HEALTH, BAMEN, INNER MONGOLIA, CHINA

    EPA Science Inventory

    For developing countries, especially in remote rural areas, measures of maternal and perinatal health may be difficult to obtain because it is not systematically collected and/or electronic data is not available. We assisted the public health officials of Bayingnormen (BaMen), In...

  1. [Perinatal Information System. Incorporation latency and impact on perinatal clinical registry].

    PubMed

    Simini, F; Fernández, A; Sosa, C; Díaz Rossello, J L

    2001-10-01

    The Perinatal Information System (SIP) is a clinical record, local management and quality assurance software standard in Latin America and the Caribbean. The time to implement SIP in a Maternity Hospital is evaluated as well as the effect of statistics on perinatal health indicators in subsequent years. In the sample of 20 Maternity Hospitals (5 Countries, 40% Private and 60% Public) 85% had a reliable information system by the third year of use of SIP. 15% of hospitals still had problems at that time that were already clear during the second year, a time corrective measures can still be taken. The evaluation of the impact of yearly reports shows that 58% of recommendations were fulfilled, specially those regarding the complete filling-in of clinical records (62%) and to a lesser extent variables that reflect clinical practices and organization of services (52%). The conclusion is that Maternity Hospitals in Latin America and the Caribbean have the capacity to adopt a complex tool of computerized clinical records for quality assurance of perinatal care and monitoring of health indicators. PMID:11816526

  2. Perinatal outcome for women in prison.

    PubMed

    Cordero, L; Hines, S; Shibley, K A; Landon, M B

    1992-09-01

    Pregnancy outcome for 233 women in prison was reviewed. This group of patients presented with multiple perinatal high-risk factors: history of illicit drug use (71%), smoking (70%), and obstetrical (27%), medical (21%), nutritional (20%), and infectious complications (20%). Maternal morbidity was uncommon and the overall cesarean section rate for all prisoners was 16%. There was 1 stillbirth and 236 live-born infants, all of whom were discharged in good health. Prematurity (3%) and delivery of small-for-gestational-age (SGA) (8%) infants was less common among 187 women who received adequate prenatal care than in 46 prisoners with poor or late prenatal care (prematurity 20% and SGA 28%). Good perinatal outcome for women in prison can be achieved if comprehensive prenatal care is available. PMID:1432273

  3. Expanded carrier screening in reproductive medicine-points to consider: a joint statement of the American College of Medical Genetics and Genomics, American College of Obstetricians and Gynecologists, National Society of Genetic Counselors, Perinatal Quality Foundation, and Society for Maternal-Fetal Medicine.

    PubMed

    Edwards, Janice G; Feldman, Gerald; Goldberg, James; Gregg, Anthony R; Norton, Mary E; Rose, Nancy C; Schneider, Adele; Stoll, Katie; Wapner, Ronald; Watson, Michael S

    2015-03-01

    The Perinatal Quality Foundation and the American College of Medical Genetics and Genomics, in association with the American College of Obstetricians and Gynecologists, the Society for Maternal-Fetal Medicine, and the National Society of Genetic Counselors, have collaborated to provide education for clinicians and laboratories regarding the use of expanded genetic carrier screening in reproductive medicine. This statement does not replace current screening guidelines, which are published by individual organizations to direct the practice of their constituents. As organizations develop practice guidelines for expanded carrier screening, further direction is likely. The current statement demonstrates an approach for health care providers and laboratories who wish to or who are currently offering expanded carrier screening to their patients. PMID:25730230

  4. Prenatal and Perinatal Risk Factors for Autism in China

    PubMed Central

    Zhang, Xin; Lv, Cong-Chao; Tian, Jiang; Miao, Ru-Juan; Xi, Wei; Hertz-Picciotto, Irva

    2010-01-01

    We conducted a case–control study using 190 Han children with and without autism to investigate prenatal and perinatal risk factors for autism in China. Cases were recruited through public special education schools and controls from regular public schools in the same region (Tianjin), with frequency matching on sex and birth year. Unadjusted analyses identified seven prenatal and seven perinatal risk factors significantly associated with autism. In the adjusted analysis, nine risk factors showed significant association with autism: maternal second-hand smoke exposure, maternal chronic or acute medical conditions unrelated to pregnancy, maternal unhappy emotional state, gestational complications, edema, abnormal gestational age (<35 or >42 weeks), nuchal cord, gravidity >1, and advanced paternal age at delivery (>30 year-old). PMID:20358271

  5. Undiagnosed xiphopagus twins: a perinatal malady

    PubMed Central

    Dorairajan, Gowri

    2012-01-01

    Conjoined twins are a very rare entity. It is associated with poor survival rate in the presence of vital organ sharing. The entity can be diagnosed as early as the first trimester. A conjoined twin diagnosed late in labor is a malady with high perinatal mortality and maternal morbidity. We present one such case of xiphopagus twins. The management of a case diagnosed late in labor can be very challenging. Such obstetric challenges can be avoided by a meticulous early scan with a high index of suspicion, especially in the absence of separating membrane while scanning multiple pregnancies. PMID:24765422

  6. Prevalence and Factors Influencing Perinatal Mortality in Rural Mysore, India

    PubMed Central

    Siddalingappa, Hugara; Murthy M.R, Nrayana; Kulkarni, Praveen; N.C, Ashok

    2013-01-01

    Background: With decreasing Infant Mortality Rate, Perinatal Mortality is gaining importance as it takes into consideration most of the factors influencing child birth and its survival, mortality during this period is a better indicator of quality of Maternal and Child Health services. Objectives: To estimate the Prevalence of perinatal mortality and its associated risk factors. Methodology: Cross sectional community based study was carried out in rural field practice area catering 26,700 population. All births during 2010 among permanent residents of this area were included. House to house survey was conducted to collect details regarding Antenatal, intra-natal and post-natal history by interviewing mother using a pre-tested questionnaire. Hospital records were also referred when available. Results: Nine perinatal deaths had occurred out of 314 births in a span of one year with a perinatal, early neonatal mortality rates of 28.93, 19.29 per 1000 live births respectively and still birth rate of 9.55 per 100 total births. Higher Perinatal Mortality Rate(PNMR) was observed in mothers who got married before 18 years, conceived during teenage, having anaemia, delivered at home, normal vaginal deliveries and having suffered by intra-partal and placental complications. Male babies, babies fed with prelacteal feeds, born out of intra-uterine complications, having low birth weight, had delayed first cry, premature births and twin births showed higher risk for mortality. Conclusion: The prevalence of perinatal mortality in the present study was 28.93 per 1000 live births. Even though this was well below the national and state values indicating improved quality of Maternal and Child Health care, it also gives way for relooking into strategies for further bringing down the perinatal deaths. PMID:24551640

  7. The experience of the implementation of perinatal audit in Moldova.

    PubMed

    Stratulat, P; Curteanu, A; Caraus, T; Petrov, V; Gardosi, J

    2014-09-01

    The Beyond the Numbers project in Moldova implemented perinatal mortality audit as a means to improve maternity and newborn care. Key activities for this project included training in audit, the setting up of audit committees, implementation of the review of cases and dissemination of information. During the project, a significant reduction was noted of perinatal deaths at term (from 37 weeks gestation and birthweight of ≥2500 g) by 1.5 per 1000; from 5.1 per 1000 in 2006 to 3.6 per 1000 in 2013. PMID:25236652

  8. Impact of Male Partner Antenatal Accompaniment on Perinatal Health Outcomes in Developing Countries: A Systematic Literature Review.

    PubMed

    Aguiar, Carolina; Jennings, Larissa

    2015-09-01

    Encouraging male partners to accompany women to antenatal care (ANC) is an important first step in engaging men on maternal and newborn health. However, little is known regarding the impact of male partner antenatal accompaniment beyond HIV-related perinatal outcomes. A systematic review was conducted to synthesize the evidence on the influence of male accompaniment on non-HIV outcomes during pregnancy and into the postpartum period. Eligible studies were published in English from 2003 to 2013 and evaluated the effect of male antenatal accompaniment on perinatal health in a developing country. Four electronic databases and selected reference lists were searched. Out of 84 potential citations retrieved, seven publications were retained for the assessment of male antenatal accompaniment's influence using iterative thematic analysis. During pregnancy, male antenatal accompaniment positively impacted women's knowledge of danger signs, but did not affect birth preparedness, ANC utilization, or miscarriages. During labor and delivery, men's ANC presence was associated with increases in institutional delivery and skilled birth attendance, but with no effect for birth-related outcomes. During the early postnatal period, male antenatal accompaniment was associated with higher uptake of postnatal services, but with mixed effects on breastfeeding and newborn survival. Couples' increased communication on pregnancy care and men's subsequent motivation to ensure safe delivery may explain these observed benefits. Inadequate communication, late accompaniment, or partner type may explain the lack of influence on some outcomes. More efforts are needed to expand the implementation and evaluation of male involvement strategies to improve perinatal health. PMID:25656727

  9. Serotonin reuptake inhibitor-induced perinatal complications.

    PubMed

    Gentile, Salvatore

    2007-01-01

    There are a growing number of concerns about the utilization of serotonin reuptake inhibitors (SRIs) in late pregnancy and the onset of perinatal complications. This review aimed to analyze and summarize the studies evaluating the risk of perinatal complications (such as low birth weight, preterm delivery, withdrawal or toxic phenomena, and other detrimental events/poor neonatal outcomes) related to maternal SRI use in late pregnancy. A computerized search of MEDLINE (1966-January 2007) and PsycINFO (1974-January 2007) databases was performed. Articles describing perinatal complications after late in utero exposure to SRIs were selected and also reviewed for additional references. Fifty studies met the inclusion criteria. Exposure to SRIs late in pregnancy is clearly associated with an increased risk of infants developing a constellation of symptoms, including CNS and respiratory effects, often requiring close infant observation and supportive or specific treatment in intensive care units. Such symptoms are not always due to toxic or withdrawal reactions. Indeed, some evidence suggests that SRIs may interfere with the physiology of the respiratory system and parasympathetic activity in neonates. Of the most methodologically relevant studies reviewed, 50% have been published in the last 3 years. Hence, it is possible that further concerning data will become available in the future. For these reasons, the opportunity of tapering and discontinuing SRIs in late pregnancy should be taken into consideration, although to date the evidence to support such a clinical decision is preliminary. PMID:17407365

  10. Risk factors for perinatal mortality in Canada

    PubMed Central

    Silins, John; Semenciw, Robert M.; Morrison, Howard I.; Lindsay, Joan; Sherman, Greg J.; Mao, Yang; Wigle, Donald T.

    1985-01-01

    A population-based computer record-linkage study of infant births and deaths in 1978 and 1979 in eight Canadian provinces (Quebec and Newfoundland were excluded) was undertaken to permit analysis of perinatal mortality in relation to maternal and infant characteristics. Perinatal mortality rates were significantly higher in nonurban than in urban areas (p < 0.05). A logistic regression model was used to assess the effects on perinatal mortality of variables reported on birth and stillbirth records. This model included length of gestation, infant's birth weight and sex, number of previous births and number of previous stillbirths as well as an interaction term for length of gestation and birth weight. For early-neonatal mortality, odds ratios over 8 were observed for birth weight less than 2500 g or gestation less than 35 weeks. About 75% of early-neonatal mortality was attributable to low birth weight or fetal immaturity. Greater emphasis should be placed on the prevention of low birth weight. PMID:4063932

  11. Prenatal, Perinatal and Neonatal Risk Factors for Intellectual Disability: A Systemic Review and Meta-Analysis

    PubMed Central

    Qu, Yi; Mu, Dezhi

    2016-01-01

    Background The etiology of non-genetic intellectual disability (ID) is not fully known, and we aimed to identify the prenatal, perinatal and neonatal risk factors for ID. Method PubMed and Embase databases were searched for studies that examined the association between pre-, peri- and neonatal factors and ID risk (keywords “intellectual disability” or “mental retardation” or “ID” or “MR” in combination with “prenatal” or “pregnancy” or “obstetric” or “perinatal” or “neonatal”. The last search was updated on September 15, 2015. Summary effect estimates (pooled odds ratios) were calculated for each risk factor using random effects models, with tests for heterogeneity and publication bias. Results Seventeen studies with 55,344 patients and 5,723,749 control individuals were eligible for inclusion in our analysis, and 16 potential risk factors were analyzed. Ten prenatal factors (advanced maternal age, maternal black race, low maternal education, third or more parity, maternal alcohol use, maternal tobacco use, maternal diabetes, maternal hypertension, maternal epilepsy and maternal asthma), one perinatal factor (preterm birth) and two neonatal factors (male sex and low birth weight) were significantly associated with increased risk of ID. Conclusion This systemic review and meta-analysis provides a comprehensive evidence-based assessment of the risk factors for ID. Future studies are encouraged to focus on perinatal and neonatal risk factors and the combined effects of multiple factors. PMID:27110944

  12. The Black Box of Perinatal Ischemic Stroke Pathogenesis

    PubMed Central

    Mineyko, Aleksandra; Kirton, Adam

    2013-01-01

    An improved understanding of perinatal stroke epidemiology, classification, neuroimaging, and outcomes has emerged in recent years. Despite this, little is known regarding the pathophysiological mechanisms responsible for most cases. A multitude of possible associations and putative risk factors have been reported, but most lack definitive empirical evidence supporting primary causation. These include obstetrical and maternal factors, perinatal conditions, infectious diseases, prothrombotic abnormalities, cardiac disorders, medications, and many others. The bulk of evidence is weak, dominated by case reports and retrospective case series. Findings from the small number of case-control and cohort studies that exist are limited by heterogeneous populations and methodologies. The single largest barrier to ultimately understanding and potentially improving outcomes from this common and disabling condition is the lack of comprehensive, fully-powered risk factor studies required to definitively describe perinatal stroke pathogenesis. This review summarizes current evidence and suggests future directions for research. PMID:21670391

  13. Ethnic determinants of perinatal statistics of Chinese: demography of China, Hong Kong and Singapore.

    PubMed

    Fung, K P; Wong, T W; Lau, S P

    1989-03-01

    Despite limited health resources, the Chinese have achieved reasonably good perinatal and neonatal mortality rates comparable to those of many developed countries. China, Hong Kong and Singapore, areas with different socioeconomic structures, have shared the same favourable ethnic determinants of perinatal mortality. The Chinese have much lower incidence of very low birthweight babies (less than 1000 g) and lethal congenital anomalies. The former is probably related to the rarity of teenage pregnancy, maternal smoking and alcohol consumption. Asphyxia remains a major contributor to perinatal deaths. The perinatal mortality rate in mainland China has remained relatively unchanged in contrast to the dramatic falling trend in Hong Kong and Singapore in the past two decades. This may be accounted for by differences in socioeconomic conditions despite their identical ethnic origin. Studying the Chinese sociocultural pattern may have a great impact on perinatal mortality by preventing low birthweight babies. PMID:2722355

  14. A parsimonious explanation for intersecting perinatal mortality curves: understanding the effect of plurality and of parity.

    PubMed

    Joseph, KS; Liu, Shiliang; Demissie, Kitaw; Wen, Shi Wu; Platt, Robert W; Ananth, Cande V; Dzakpasu, Susie; Sauve, Reg; Allen, Alexander C; Kramer, Michael S

    2003-06-01

    BACKGROUND: Birth weight- and gestational age-specific perinatal mortality curves intersect when compared across categories of maternal smoking, plurality, race and other factors. No simple explanation exists for this paradoxical observation. METHODS: We used data on all live births, stillbirths and infant deaths in Canada (1991-1997) to compare perinatal mortality rates among singleton and twin births, and among singleton births to nulliparous and parous women. Birth weight- and gestational age-specific perinatal mortality rates were first calculated by dividing the number of perinatal deaths at any given birth weight or gestational age by the number of total births at that birth weight or gestational age (conventional calculation). Gestational age-specific perinatal mortality rates were also calculated using the number of fetuses at risk of perinatal death at any given gestational age. RESULTS: Conventional perinatal mortality rates among twin births were lower than those among singletons at lower birth weights and earlier gestation ages, while the reverse was true at higher birth weights and later gestational ages. When perinatal mortality rates were based on fetuses at risk, however, twin births had consistently higher mortality rates than singletons at all gestational ages. A similar pattern emerged in contrasts of gestational age-specific perinatal mortality among singleton births to nulliparous and parous women. Increases in gestational age-specific rates of growth-restriction with advancing gestational age presaged rising rates of gestational age-specific perinatal mortality in both contrasts. CONCLUSIONS: The proper conceptualization of perinatal risk eliminates the mortality crossover paradox and provides new insights into perinatal health issues. PMID:12780942

  15. Multistate Collaboration to Confidentially Review Unanticipated Perinatal Outcomes: Lessons Learned.

    PubMed

    Donnelly, Kyla; Lauria, Michele R; Flanagan, Victoria

    2015-10-01

    This commentary describes the development of The Northern New England Perinatal Quality Improvement Network's Confidential Review and Improvement Board and its lessons learned from reviewing cases of unanticipated perinatal outcomes between 2010 and 2013. The Confidential Review and Improvement Board is a multistate mechanism for rigorous and confidential case review of unanticipated perinatal outcomes among unaffiliated academic medical centers, community hospitals, and home birth midwives. We performed semistructured interviews with key individuals participating in the Confidential Review and Improvement Board since its inception and used inductive content analysis to analyze 22 consecutive case reviews. The Confidential Review and Improvement Board's case reviews involved five key clinical situations: second stage of labor management with neonatal depression, obstetric hemorrhage, uterine rupture, fetal demise, and maternal sepsis. A recurrent theme was failure to differentiate maternal from fetal heart rate associated with the birth of severely compromised newborns. Analysis of the Confidential Review and Improvement Board cases revealed opportunities for improvement in the following categories: 1) timely application of best practice, 2) documentation, and 3) communication. The Confidential Review and Improvement Board's evidence-based recommendations centered on strengthening multidisciplinary training through simulation, improving documentation and communication systems, and developing and implementing guidelines with appropriate tools. The Confidential Review and Improvement Board demonstrates that collaboration among unaffiliated rural perinatal providers--who are often direct market competitors--is possible and catalyzes regional improvement efforts. PMID:26348191

  16. [Perinatal mental health in hospital care of labor and puerperium].

    PubMed

    Hernández, G; Kimelman, M; Montino, O

    2000-11-01

    The biomedical model has successfully reduced mother and child mortality and diseases during the labor and puerperal period. In the perinatal period, the mother and her offspring can also have psychosocial problems, that have been insufficiently studied and that we propose considering. Based on neurobiological information, on bonding theory and on a focus change in the everyday work of human behavior experts in maternity hospitals, we propose that perinatal mental health should have an important place and can be harmoniously articulated with the biomedical model. This mental health work should aim at generating safe mother-child bonds. It should be maintained Thereafter through social networks to prevent child abuse, to promote healthy development and to prevent psychopathology. We review some of the programs carried out in the ten year period in which we have worked as a mental health team in the maternity ward of a public hospital in Santiago, Chile. PMID:11347518

  17. Perinatal outcome in an obstetric cohort of Mozambican women.

    PubMed

    Osman, N B; Challis, K; Cotiro, M; Nordahl, G; Bergstrm, S

    2001-02-01

    A prospective cohort of 908 consecutively enrolled pregnant women with biparietal diameter (DBP) compatible with gestational age equal to or below 21 weeks were followed up regularly at 2-4 weeks intervals. Normal antenatal care routine was applied. The newborns were followed until 7 days postpartum. The setting was two suburban antenatal clinics in Maputo and the delivery ward at the Maputo Central Hospital. The main outcome variables were low birth weight (LBW), preterm delivery, intrauterine fetal death, perinatal death and small for gestational age (SGA). For each of these variables the odds ratio for maternal risk factors was estimated with 95 per cent confidence interval and multiple logistic regression analysis was used. LBW occurred in 16.2 per cent and low maternal weight, low weight gain during pregnancy and not having a living child were risk factors. Prevalence of preterm birth was 15.4 per cent and low weight gain during pregnancy and malaria in the perinatal period were risk factors. Four per cent of mothers delivered stillborns and syphilis serology (positive VDRL test) was a risk factor. Perinatal death occurred in 4.7 per cent. These deaths were associated with being SGA, LBW or preterm at birth. Of the cohort women, 9.7 per cent delivered SGA newborns. It was concluded that maternal constitutional factors, particularly maternal weight gain, maternal height and maternal weight as well as syphilis and malaria during pregnancy, need to be given attention concerning the adverse outcomes addressed. The establishment of an obstetric cohort, followed prospectively, was possible in a low-income setting with limited numbers lost to follow-up at delivery. PMID:11245348

  18. Regionalized perinatal education.

    PubMed

    Kattwinkel, John; Cook, Lynn J; Nowacek, George; Bailey, Carey; Crosby, Warren M; Hurt, Hallam; Short, Jerry

    2004-04-01

    Despite changes in the organization and financing of healthcare delivery, and dramatic increases in the number and distribution of perinatal facilities and professionals over the past three decades, there remains a continuing need for effective and efficient regionalized perinatal outreach education programmes. Both the organizers and the participants should be multidisciplinary and include both inpatient and outpatient providers. Content should be restricted to issues relevant to participants' practice, and include topics ranging from preconception to postpartum and early infant care. There are various effective formats, but consideration should be given to reaching as many providers as possible simultaneously within a given facility, minimizing expense and economizing on participants' time. Evaluation strategies range from assessment of immediate outcomes, which generally examine programme process, to ultimate outcomes, which measure changes in patient care and patient health. PMID:16256719

  19. Screening for perinatal depression.

    PubMed

    Milgrom, Jeannette; Gemmill, Alan W

    2014-01-01

    Perinatal depression is prevalent, under-diagnosed and can have serious long-term effects on the wellbeing of women, their partners and infants. In the absence of active identification strategies, most women with perinatal depression will neither seek nor receive help. To enable early detection and timely intervention, universal screening is coming to be seen as best practice in many settings. Although the strength of recommendations and the preferred methods of identification vary in different countries (e.g. the Edinburgh Postnatal Depression Scale, brief case-finding questions), appropriate training for health professionals in wider psychosocial assessment is essential to maximise usefulness while minimising potential harms. Clear pathways of systematic follow up of all positive screening results with a diagnostic procedure and access to effective treatment are centrally important both for the clinical effectiveness of screening and for health system costs. It is also necessary to further build on the emerging evidence base for the clinical effectiveness of screening. PMID:24095728

  20. Varicella during pregnancy. Maternal and fetal effects.

    PubMed Central

    Katz, V L; Kuller, J A; McMahon, M J; Warren, M A; Wells, S R

    1995-01-01

    To determine the characteristics of maternal varicella at our institution, we reviewed all cases of primary varicella in pregnancy. Using a perinatal database that summarizes all obstetric admissions, we reviewed the medical records of women with varicella infections during pregnancy. Over a 5 1/2-year period, 31 pregnancies were affected by varicella infection among 11,753 deliveries. The mean age of those patients was 19.6 years, significantly different from our overall population of 25.3 years (P < .05). The racial composition of 35% Hispanic, 35% white, and 29% African American was different from that of our general population of 55% white, 38% African American, and 6% Hispanic (P = .023). The mean gestational age of the eruption of vesicles was 25 weeks. Of the 31 women, 7 had preterm labor within a week of their varicella, 3 delivered prematurely, and 3 infants had a birth weight of less than 2,700 grams. Respiratory symptoms developed in 6 women, and pneumonia developed in 4, 2 of whom required ventilatory support, 1 for 5 days, the other for 49 days. Eight women received acyclovir during gestation, and none suffered sequelae. In all, 6 infants had lesions and anomalies noted at birth, 5 possibly associated with varicella. Varicella infection is associated with a greater-than-expected level of both maternal and fetal morbidity. The fetal disease may occur due to maternal infection at any gestation and is most likely a spectrum of complications. The maternal disease appears to be worse in the latter half of pregnancy. Programs of prevention through vaccination must account for a possibly decreased level of immunity in different populations. PMID:8533407

  1. Perinatal data collection: current practice in the Australian nursing and midwifery healthcare context.

    PubMed

    Craswell, Alison; Moxham, Lorna; Broadbent, Marc

    2013-01-01

    The collection of perinatal data within Queensland, Australia, has traditionally been achieved via a paper form completed by midwives after each birth. Recently, with an increase in the use of e-health systems in healthcare, perinatal data collection has migrated to an online system. It is suggested that this move from paper to an ehealth platform has resulted in improvement to error rates, completion levels, timeliness of data transfer from healthcare institutions to the perinatal data collection and subsequent publication of data items. Worldwide, perinatal data are collected utilising a variety of methods, but essentially data are used for similar purposes: to monitor outcome patterns within obstetrics and midwifery. This paper discusses current practice in relation to perinatal data collection worldwide and within Australia, with a specific focus on Queensland, highlights relevant issues for midwives, and points to the need for further research into the efficient use of an e-health platform for perinatal data collection. PMID:23640918

  2. Comments on: "Perinatal toxicity of cyfluthrin in Mice: developmental and behavioral effects" by Soni et al, which is accepted in Human & Experimental Toxicology (DOl: 10.1177/0960327110391386)

    EPA Science Inventory

    Soni and colleagues recently reported that perinatal maternal exposure to cyfluthrin, a pyrethroid insecticide, caused fetal malformations and behavioral changes in offspring, including skeletal malformations and alterations in righting reflexes and locomotion (Soni et al., 2011)...

  3. Effect of Chiranjeevi Yojana on institutional deliveries and neonatal and maternal outcomes in Gujarat, India: a difference-in-differences analysis

    PubMed Central

    Bauhoff, Sebastian; La Forgia, Gerard; Babiarz, Kimberly Singer; Singh, Kultar; Miller, Grant

    2014-01-01

    Abstract Objective To evaluate the effect of the Chiranjeevi Yojana programme, a publicprivate partnership to improve maternal and neonatal health in Gujarat, India. Methods A household survey (n?=?5597 households) was conducted in Gujarat to collect retrospective data on births within the preceding 5years. In an observational study using a difference-in-differences design, the relationship between the Chiranjeevi Yojana programme and the probability of delivery in health-care institutions, the probability of obstetric complications and mean household expenditure for deliveries was subsequently examined. In multivariate regressions, individual and household characteristics as well as district and year fixed effects were controlled for. Data from the most recent District Level Household and Facility Survey (DLHS-3) wave conducted in Gujarat (n?=?6484 households) were used in parallel analyses. Findings Between 2005 and 2010, the Chiranjeevi Yojana programme was not associated with a statistically significant change in the probability of institutional delivery (2.42 percentage points; 95% confidence interval, CI: ?5.90 to 10.74) or of birth-related complications (6.16 percentage points; 95% CI: ?2.63 to 14.95). Estimates using DLHS-3 data were similar. Analyses of household expenditures indicated that mean household expenditure for private-sector deliveries had either not fallen or had fallen very little under the Chiranjeevi Yojana programme. Conclusion The Chiranjeevi Yojana programme appears to have had no significant impact on institutional delivery rates or maternal health outcomes. The absence of estimated reductions in household spending for private-sector deliveries deserves further study. PMID:24700978

  4. Perinatal factors and the risk of bipolar disorder in Finland

    PubMed Central

    Chudal, Roshan; Sourander, Andre; Polo-Kantola, Pivi; Hinkka-Yli-Salomki, Susanna; Lehti, Venla; Sucksdorff, Dan; Gissler, Mika; Brown, Alan S.

    2013-01-01

    Background Complications during the perinatal period have been associated with neurodevelopmental disorders like schizophrenia and autism. However, similar studies on bipolar disorder (BPD) have been limited and the findings are inconsistent. The aim of this study was to examine the association between perinatal risk factors and BPD. Methods This nested case-control study, based on the Finnish Prenatal Study of Bipolar Disorders (FIPS-B), identified 724 cases and 1419 matched controls from population based registers. Conditional logistic regression was used to examine the associations between perinatal factors and BPD adjusting for potential confounding due to maternal age, psychiatric history and educational level, place of birth, number of previous births and maternal smoking during pregnancy. Results Children delivered by planned cesarean section had a 2.5-fold increased risk of BPD (95% CI: 1.324.78, P <0.01). No association was seen between other examined perinatal risk factors and BPD. Limitations The limitations of this study include: the restriction in the sample to treated cases of BPD in the population, and usage of hospital based clinical diagnosis for case ascertainment. In addition, in spite of the large sample size, there was low power to detect associations for certain exposures including the lowest birth weight category and pre-term birth. Conclusions Birth by planned caesarean section was associated with risk of BPD, but most other perinatal risk factors examined in this study were not associated with BPD. Larger studies with greater statistical power to detect less common exposures and studies utilizing prospective biomarker-based exposures are necessary in the future. PMID:24215899

  5. Perinatal risk factors for acute myeloid leukemia.

    PubMed

    Crump, Casey; Sundquist, Jan; Sieh, Weiva; Winkleby, Marilyn A; Sundquist, Kristina

    2015-12-01

    Infectious etiologies have been hypothesized for acute leukemias because of their high incidence in early childhood, but have seldom been examined for acute myeloid leukemia (AML). We conducted the first large cohort study to examine perinatal factors including season of birth, a proxy for perinatal infectious exposures, and risk of AML in childhood through young adulthood. A national cohort of 3,569,333 persons without Down syndrome who were born in Sweden in 1973-2008 were followed up for AML incidence through 2010 (maximum age 38 years). There were 315 AML cases in 69.7 million person-years of follow-up. We found a sinusoidal pattern in AML risk by season of birth (P < 0.001), with peak risk among persons born in winter. Relative to persons born in summer (June-August), incidence rate ratios for AML were 1.72 (95 % CI 1.25-2.38; P = 0.001) for winter (December-February), 1.37 (95 % CI 0.99-1.90; P = 0.06) for spring (March-May), and 1.27 (95 % CI 0.90-1.80; P = 0.17) for fall (September-November). Other risk factors for AML included high fetal growth, high gestational age at birth, and low maternal education level. These findings did not vary by sex or age at diagnosis. Sex, birth order, parental age, and parental country of birth were not associated with AML. In this large cohort study, birth in winter was associated with increased risk of AML in childhood through young adulthood, possibly related to immunologic effects of early infectious exposures compared with summer birth. These findings warrant further investigation of the role of seasonally varying perinatal exposures in the etiology of AML. PMID:26113060

  6. Current concepts in perinatal mineral metabolism.

    PubMed

    Ohata, Yasuhisa; Ozono, Keiichi; Michigami, Toshimi

    2016-01-01

    The serum levels of calcium (Ca) and phosphate are maintained higher in the fetus than in the pregnant mother, especially in late gestation, to meet the demands of fetal bone development. In order to maintain this fetal stage-specific mineral homeostasis, the placenta plays a critical role through active transcellular mineral transport. Although the molecular mechanism of transplacental Ca transport has been well studied, little is known about the transport mechanism of phosphate and magnesium. Maternal mineral homeostasis is also altered during pregnancy to supply minerals to the fetus. In the lactating mother, osteocytic osteolysis is suggested to be involved in the supply of minerals to the baby. The levels of some calcitropic and phosphotropic (Ca- and phosphate-regulating, respectively) hormones in the fetus are also different from those in the adult. The PTH level in the fetus is lower than that in the mother and nonpregnant adult. It is suggested, however, that low fetal PTH plays an important role in fetal mineral metabolism. The concentration of PTHrP in the fetus is much higher than that of PTH and plays a critical role in perinatal Ca homeostasis. Uncovering the molecular mechanisms for fetal stage-specific mineral metabolism will lead to better management of perinatal patients with mineral abnormalities. PMID:26865750

  7. Current concepts in perinatal mineral metabolism

    PubMed Central

    Ohata, Yasuhisa; Ozono, Keiichi; Michigami, Toshimi

    2016-01-01

    Abstract. The serum levels of calcium (Ca) and phosphate are maintained higher in the fetus than in the pregnant mother, especially in late gestation, to meet the demands of fetal bone development. In order to maintain this fetal stage-specific mineral homeostasis, the placenta plays a critical role through active transcellular mineral transport. Although the molecular mechanism of transplacental Ca transport has been well studied, little is known about the transport mechanism of phosphate and magnesium. Maternal mineral homeostasis is also altered during pregnancy to supply minerals to the fetus. In the lactating mother, osteocytic osteolysis is suggested to be involved in the supply of minerals to the baby. The levels of some calcitropic and phosphotropic (Ca- and phosphate-regulating, respectively) hormones in the fetus are also different from those in the adult. The PTH level in the fetus is lower than that in the mother and nonpregnant adult. It is suggested, however, that low fetal PTH plays an important role in fetal mineral metabolism. The concentration of PTHrP in the fetus is much higher than that of PTH and plays a critical role in perinatal Ca homeostasis. Uncovering the molecular mechanisms for fetal stage-specific mineral metabolism will lead to better management of perinatal patients with mineral abnormalities. PMID:26865750

  8. Disasters and Perinatal Health: A Systematic Review

    PubMed Central

    Harville, EW; Xiong, X; Buekens, P

    2012-01-01

    Background The empirical literature on the effects of disaster on pregnancy and the postpartum period is limited. The objective of this review was to examine the existing evidence on the effect of disasters on perinatal health. Methods A systematic review was conducted by searching electronic databases (MEDLINE, EMBASE, Cinahl, PsycInfo), including literature on disasters and pregnancy outcomes (e.g., preterm birth, low birthweight, congenital anomalies), mental health, and child development. 110 articles were identified, but many published reports were anecdotes or recommendations rather than systematic studies. The final review included 49 peer-reviewed studies that met inclusion criteria. Results Studies addressing the World Trade Center disaster of September 11th and other terrorist attacks, environmental/chemical disasters, and natural disasters such as hurricanes and earthquakes were identified. Disasters of various types may reduce fetal growth in some women, though there does not appear to be an effect on gestational age at birth. Severity of exposure is the major predictor of mental health issues among pregnant and postpartum women. The mother's mental health after a disaster may more strongly influence on child development than any direct effect of disaster-related prenatal stress. Conclusions There is evidence that disaster impacts maternal mental health and some perinatal health outcomes, particular among highly-exposed women. Future research should focus on under-studied outcomes such as spontaneous abortion. Relief workers and clinicians should concentrate on the most exposed women, particularly with respect to mental health. PMID:21375788

  9. [Preventive vaccination strategy during the perinatal period].

    PubMed

    Pinquier, Didier; Gagneur, Amaud; Gaudelus, Jol; Marret, Stphane

    2010-12-20

    Preventive vaccination strategy around the birth is a global approach requiring the coordination of several actors. To be efficacious, general practitioners are in the front line to provide preventive care and health education. The perinatal period represents a privileged situation from listening to this approach of vaccine prevention. The raising awareness around the birth contains several additional steps to bring to the future mother and child the best protection against infectious diseases with vaccine prevention. By being vaccinated, parents and other family members indirectly provide protection to very young infants until they are old enough to be vaccinated and so directly protected themselves. Numerous opportunities exist to make sensitive the parents in this preventive way, for them and their child, whether it is from the adolescence in the adulthood above all parental project, on the occasion of a pregnancy, at birth, during the stay in maternity hospital, or along the first weeks of the postpartum. The general practitioner is the key actor to coordinate this global approach in perinatal health around the mother, his child and his family. The arrival of the newborn will be the opportunity to update vaccinations of the whole family particularly according chicken pox, measles, rubella, whooping cough and flu vaccines. PMID:21425528

  10. Perinatal problems in developing countries: lessons learned and future challenges.

    PubMed

    Kurjak, A; Bekavac, I

    2001-01-01

    Every year, approximately 600,000 women die of pregnancy-related causes--98% of these deaths occur in developing countries. Complications of pregnancy and childbirth are the leading cause of death and disability among women of reproductive age in developing countries. Of all human development indicators, the maternal mortality ratio shows the greatest discrepancy between developed and developing countries. In fact, maternal mortality itself contributes to underdevelopment, because of its severe impact on the lives of young children, the family and society in general. Furthermore, in addition to more than half a million maternal deaths each year 7 million perinatal deaths are recorded and 8 million infants die during the first year of life. Maternal morbidity and mortality as well as perinatal mortality can be reduced through the synergistic effect of combined interventions, without first attaining high levels of economic development. These include: education for all; universal access to basic health services and nutrition before, during and after childbirth; access to family planning services; attendance at birth by professional health workers and access to good quality care in case of complications; and policies that raise women's social and economic status, and their access to property, as well as the labor force. PMID:11447922

  11. Perinatal health care in a conflict-affected setting: evaluation of health-care services and newborn outcomes at a regional medical centre in Iraq.

    PubMed

    Ahamadani, F A B; Louis, H; Ugwi, P; Hines, R; Pomerleau, M; Ahn, R; Burke, T F; Nelson, B D

    2014-12-01

    A field-based assessment was conducted to assess maternal and newborn health-care services, perinatal and newborn outcomes and associated risk factors at Bint Al-Huda Maternal and Newborn Teaching Hospital, a large referral hospital in southern Iraq. The multi-method approach used interviews, discussions, observation and review of perinatal and newborn outcome data. There is limited assessment of maternal vital signs, labour pattern, fetal response, and complications during pregnancy and labour. Perinatal and neonatal mortality rates are 27.4/1000 births and 30.9/1000 live births respectively. Associated neonatal mortality factors were gestational age < 37 weeks, male sex, birth weight < 2.5 kg, maternal age > 35 years, rural maternal residence and vaginal delivery. Improving birth outcomes in southern Iraq requires evidence-based clinical guidelines, additional supplies and equipment, quality improvement initiatives and in-service training. PMID:25664517

  12. Pre-pregnancy obesity and maternal circadian cortisol regulation: Moderation by gestational weight gain.

    PubMed

    Aubuchon-Endsley, Nicki L; Bublitz, Margaret H; Stroud, Laura R

    2014-10-01

    We investigated main and interactive effects of maternal pre-pregnancy obesity and gestational weight gain on circadian cortisol from the second to third trimester. A diverse sample of 215 pregnant women was enrolled. Maternal height and most recent pre-pregnancy weight were collected at study initiation (22% obese). Weight and circadian salivary cortisol samples were measured during second (24±4) and third (35±1 weeks) trimesters. During the third trimester, women who were obese prior to conception showed elevated evening cortisol versus normal weight women. This pattern was moderated by weight gain in excess of Institute of Medicine guidelines, such that women who were obese prior to conception and gained greater than 7.94kg by the 35±1 week visit displayed greatest elevations in evening cortisol. Given links between excessive prenatal glucocorticoid exposure and both poor maternal and offspring health outcomes, elevated maternal cortisol may be one mechanism underlying links between maternal obesity and adverse perinatal outcomes. PMID:25038305

  13. Evaluation of the natural perinatal transmission of bovine leukaemia virus.

    PubMed

    Mekata, Hirohisa; Sekiguchi, Satoshi; Konnai, Satoru; Kirino, Yumi; Honkawa, Kazuyuki; Nonaka, Nariaki; Horii, Yoichiro; Norimine, Junzo

    2015-03-01

    The perinatal transmission of bovine leukaemia virus (BLV) plays a critical role in the spread and persistence of BLV infection in cattle herds. The purpose of this study was to examine the frequency of perinatal infections in an area in Japan and investigate some risk factors associated with infection. Altogether, 129 calves born to BLV-infected cows in a herd in Japan were tested for infection immediately after birth and again at one month of age using nested PCR. Twenty-four calves (18.6 per cent) were infected with BLV, of which 14 (10.8 per cent) and 10 (7.7 per cent) calves were infected via the transplacental and the birth canal routes, respectively. Maternal viral loads, breed, the presence or absence of assistance during parturition and the number of births per dam were evaluated to investigate risk factors associated with infection. Maternal viral load was significantly correlated with the frequency of perinatal infection, and more than 40 per cent of newborn calves born to dams with high viral loads were infected with BLV. The results of this study could contribute towards developing effective eradication programmes by providing necessary data for replacement of breeding cow in the field. PMID:25510867

  14. Intimate partner violence among women with eating disorders during the perinatal period

    PubMed Central

    Easter, Abigail; Lewis, Rebecca; Howard, Louise M.; Micali, Nadia

    2015-01-01

    ABSTRACT Objective  Prevalence of intimate partner violence (IPV) during pregnancy is estimated to be 4%–8%. Women with mental health difficulties are at increased risk for IPV during the perinatal period. Prevalence of IPV is high among women with eating disorders (ED); however, prevalence of IPV during the perinatal period among women with ED is unknown. Method  We studied women from a population‐based cohort, the Avon Longitudinal Study of Parents and Children. Prevalence and odds of physical and emotional IPV during and after the perinatal period was investigated among women with lifetime ED, with (n = 174) or without pregnancy shape and weight concern and/or purging behaviors (n = 189), and women with no ED (n = 8723). Results  Women with lifetime ED showed higher prevalence of IPV during and after the perinatal period (physical = 9.6%–14.3% and emotional = 24.1%–28.1%). Lifetime ED was associated with higher odds of physical IPV during the perinatal period (odds ratio: 2.34, 95% confidence interval: 1.11–4.93, p = .03). Lifetime ED with and without pregnancy shape and weight concerns and/or purging was associated with higher odds of IPV after the perinatal period, and higher odds of reporting emotional IPV at all time points. Associations were moderated by partner's response to pregnancy and maternal experience of childhood sexual abuse. Discussion  Mothers with ED and their children may be vulnerable to negative effects due to maternal ED and IPV combined, both of which have been associated with severe and long‐lasting harmful consequences. Partner's response to pregnancy and maternal experience of childhood sexual abuse might contribute to the association between ED and IPV perinatally. © 2015 The Authors. International Journal of Eating Disorders published by Wiley Periodicals, Inc. (Int J Eat Disord 2015; 48:727–735) PMID:26032597

  15. Early Intervention and Perinatal Depression: Is There a Need for Provider Training?

    ERIC Educational Resources Information Center

    Thomason, Elizabeth; Stacks, Ann M.; McComish, Judith Fry

    2010-01-01

    An estimated 5-25% of women suffer from perinatal depression (PD). If left untreated, PD can have negative consequences for maternal and child mental health. During pregnancy and the postpartum period, women are in contact with a variety of professionals and paraprofessionals such as public health nurses, early childhood providers and home

  16. Impact on neonatal nursing globally: exemplars of how US neonatal/perinatal nurses can get involved.

    PubMed

    Kenner, Carole; Boykova, Marina; Eklund, Wakako

    2011-01-01

    Neonatal and perinatal nurses are responding to the global call by the United Nations Millennium Development Goals to decrease maternal, neonatal, and child mortality. But how does one get involved? This article describes the global needs with exemplars from Japan and Russia illustrating how nurses work globally. PMID:21540685

  17. Birth, Interaction and Attachment: Exploring the Foundations for Modern Perinatal Care. Pediatric Round Table: 6.

    ERIC Educational Resources Information Center

    Klaus, Marshall H., Ed.; Robertson, Martha Oschrin, Ed.

    Provided are summaries of conference presentations discussing aspects of birth, parent/child interaction, and attachment behavior. Material in part I explores perspectives on pregnancy and the perinatal period. Included are discussions of birth in nonindustrial societies, progress in the study of maternal behavior in animals, the physiological…

  18. Early Intervention and Perinatal Depression: Is There a Need for Provider Training?

    ERIC Educational Resources Information Center

    Thomason, Elizabeth; Stacks, Ann M.; McComish, Judith Fry

    2010-01-01

    An estimated 5-25% of women suffer from perinatal depression (PD). If left untreated, PD can have negative consequences for maternal and child mental health. During pregnancy and the postpartum period, women are in contact with a variety of professionals and paraprofessionals such as public health nurses, early childhood providers and home…

  19. Prevalence and Predictors of Maternal Anemia during Pregnancy in Gondar, Northwest Ethiopia: An Institutional Based Cross-Sectional Study

    PubMed Central

    Alem, Meseret; Enawgaw, Bamlaku

    2014-01-01

    Background. Anaemia is a global public health problem which has an eminence impact on pregnant mother. The aim of this study was to assess the prevalence and predictors of maternal anemia. Method. A cross-sectional study was conducted from March 1 to April 30, 2012, on 302 pregnant women who attended antenatal care at Gondar University Hospital. Interview-based questionnaire, clinical history, and laboratory tests were used to obtain data. Bivariate and multivariate logistic regression was used to identify predictors. Result. The prevalence of anemia was 16.6%. Majority were mild type (64%) and morphologically normocytic normochromic (76%) anemia. Anemia was high at third trimester (18.9%). Low family income (AOR [95% CI] = 3.1 [1.19, 8.33]), large family size (AOR [95% CI] = 4.14 [4.13, 10.52]), hookworm infection (AOR [95% CI] = 2.72 [1.04, 7.25]), and HIV infection (AOR [95% CI] = 5.75 [2.40, 13.69]) were independent predictors of anemia. Conclusion. The prevalence of anemia was high; mild type and normocytic normochromic anemia was dominant. Low income, large family size, hookworm infection, and HIV infection were associated with anemia. Hence, efforts should be made for early diagnosis and management of HIV and hookworm infection with special emphasis on those having low income and large family size. PMID:24669317

  20. Stages of change: A qualitative study on the implementation of a perinatal audit programme in South Africa

    PubMed Central

    2011-01-01

    Background Audit and feedback is an established strategy for improving maternal, neonatal and child health. The Perinatal Problem Identification Programme (PPIP), implemented in South African public hospitals in the late 1990s, measures perinatal mortality rates and identifies avoidable factors associated with each death. The aim of this study was to elucidate the processes involved in the implementation and sustainability of this programme. Methods Clinicians' experiences of the implementation and maintenance of PPIP were explored qualitatively in two workshop sessions. An analytical framework comprising six stages of change, divided into three phases, was used: pre-implementation (create awareness, commit to implementation); implementation (prepare to implement, implement) and institutionalisation (integrate into routine practice, sustain new practices). Results Four essential factors emerged as important for the successful implementation and sustainability of an audit system throughout the different stages of change: 1) drivers (agents of change) and team work, 2) clinical outreach visits and supervisory activities, 3) institutional perinatal review and feedback meetings, and 4) communication and networking between health system levels, health care facilities and different role-players. During the pre-implementation phase high perinatal mortality rates highlighted the problem and indicated the need to implement an audit programme (stage 1). Commitment to implementing the programme was achieved by obtaining buy-in from management, administration and health care practitioners (stage 2). Preparations in the implementation phase included the procurement and installation of software and training in its use (stage 3). Implementation began with the collection of data, followed by feedback at perinatal review meetings (stage 4). The institutionalisation phase was reached when the results of the audit were integrated into routine practice (stage 5) and when data collection had been sustained for a longer period (stage 6). Conclusion Insights into the factors necessary for the successful implementation and maintenance of an audit programme and the process of change involved may also be transferable to similar low- and middle-income public health settings where the reduction of the neonatal mortality rate is a key objective in reaching Millennium Development Goal 4. A tool for reflecting on the implementation and maintenance of an audit programme is also proposed. PMID:21958353

  1. Perinatal Grief in Latino Parents

    PubMed Central

    Whitaker, Claudia; Kavanaugh, Karen; Klima, Carrie

    2013-01-01

    Extensive research exists that describes the meaning of perinatal loss to some parents, but the experience of loss from the perspective of Latino parents is not clearly understood. Additionally, current perinatal bereavement practices used often to facilitate memory-making for parents (such as viewing or holding the baby, taking photographs, or collecting mementos) are based upon research done primarily with non-Latino families. Are these common practices appropriate for this population? Because there is a paucity of research on this topic, this article describes what has been written over the past 30 years on the topic of grief and perinatal loss in Latino culture. PMID:20975393

  2. Provider communication on perinatal depression: a population-based study.

    PubMed

    Farr, Sherry L; Ko, Jean Y; Burley, Kim; Gupta, Seema

    2016-02-01

    Women's lack of knowledge on symptoms of perinatal depression and treatment resources is a barrier to receiving care. We sought to estimate the prevalence and predictors of discussing depression with a prenatal care provider. We used the 2011 population-based data from 24 sites participating in the Pregnancy Risk Assessment Monitoring System (n = 32,827 women with recent live births) to examine associations between maternal characteristics and report that a prenatal care provider discussed with her what to do if feeling depressed during or after pregnancy. Overall, 71.9 % of women reported discussing perinatal depression with their prenatal care provider (range 60.7 % in New York City to 85.6 % in Maine). Women were more likely to report a discussion on perinatal depression with their provider if they they were 18-29years of age than over 35 years of age compared to older (adjusted prevalence ratio [aPR] 18 to 19 y = 1.08, 20 to 24 y = 1.10, 25 to 29 y = 1.09), unmarried (aPR = 1.07) compared to married, had <12 years of education (aPR = 1.05) compared to >12 years, and had no previous live births (aPR = 1.03) compared to ≥1 live births. Research is needed on effective ways to educate women about perinatal depression and whether increased knowledge on perinatal depression results in higher rates of treatment and shorter duration of symptoms. PMID:25578631

  3. Mozambican midwives' views on barriers to quality perinatal care.

    PubMed

    Pettersson, Karen Odberg; Johansson, Eva; Pelembe, Maria de Fatima M; Dgedge, Clemencia; Christensson, Kyllike

    2006-02-01

    Our purpose in this study was to explore the midwives' perception of factors obstructing or facilitating their ability to provide quality perinatal care at a central labor ward in Maputo. In-depth interviews were undertaken with 16 midwives and were analyzed according to grounded theory technique. Barriers to provision of quality perinatal care were identified as follows: (i) the unsupportive environment, (ii) nonempowering and limited interaction with women in labor, (iii) a sense of professional inadequacy and inferiority, and (iv) nonappliance of best caring practices. A model based on the midwives' reflections on barriers to quality perinatal care and responses to these were developed. Actions aimed at overcoming the barriers were improvising and identifying areas in need of change. Identified evading actions were holding others accountable and yielding to dysfunction and structural control. In order to improve perinatal care, the midwives need to see themselves as change agents and not as victims of external and internal causal relationships over which they have no influence. It is moreover essential that the midwives chose actions aiming at overcoming barriers to quality perinatal care instead of choosing evading actions, which might jeopardize the health of the unborn and newborn infant. We suggest that local as well as national education programs need to correspond with existing reality, even if they provide knowledge that surpasses the present possibilities in practice. Quality of intrapartum and the immediate newborn care requires a supportive environment, however, which in the context of this study presented such serious obstacles that they need to be addressed on the national level. Structural and administrative changes are difficult to target as these depend on national organization of maternal health care (MHC) services and national health expenditures. PMID:16484159

  4. Perinatal Outcomes in Pregnant Women Users of Illegal Drugs.

    PubMed

    Oliveira, Tenilson Amaral; Bersusa, Ana Aparecida Sanches; Santos, Tatiana Fiorelli Dos; Aquino, Márcia Maria Auxiliadora de; Mariani Neto, Corintio

    2016-04-01

    Objective The purpose of this study was to evaluate the perinatal outcomes in pregnant women who use illicit drugs. Methods A retrospective observational study of patients who, at the time of delivery, were sent to or who spontaneously sought a public maternity hospital in the eastern area of São Paulo city. We compared the perinatal outcomes of two distinct groups of pregnant women - illicit drugs users and non-users - that gave birth in the same period and analyzed the obstetric and neonatal variables. We used Student's t-test to calculate the averages among the groups, and the Chi-square test or Fisher's exact test to compare categorical data from each group. Results We analyzed 166 women (83 users and 83 non-users) in both groups with a mean of age of 26 years. Ninety-five percent of the drug users would use crack or pure cocaine alone or associated with other psychoactive substances during pregnancy. Approximately half of the users group made no prenatal visit, compared with 2.4% in the non-users group (p < 0.001). Low birth weight (2,620 g versus 3,333 g on average, p < 0.001) and maternal syphilis (15.7% versus 0%, p < 0.001) were associated with the use of these illicit drugs. Conclusions The use of illicit drugs, mainly crack cocaine, represents an important perinatal risk. Any medical intervention in this population should combine adherence to prenatal care with strategies for reducing maternal exposure to illicit drugs. PMID:27088708

  5. Can the preterm lung recover from perinatal stress?

    PubMed

    Hütten, Matthias C; Wolfs, Tim G A M; Kramer, Boris W

    2016-12-01

    After birth, adequate lung function is necessary for the successful adaptation of a preterm baby. Both prenatal and postnatal insults and therapeutic interventions have an immediate effect on lung function and gas exchange but also interfere with fetal and neonatal lung development. Prenatal insults like chorioamnionitis and prenatal interventions like maternal glucocorticosteroids interact but might also determine the preterm baby's lung response to postnatal interventions ("second hit") like supplementation of oxygen and drug therapy. We review current experimental and clinical findings on the influence of different perinatal factors on preterm lung development and discuss how well-established interventions in neonatal care might be adapted to attenuate postnatal lung injury. PMID:27075524

  6. Maternal microchimerism

    PubMed Central

    Ye, Jody; Vives-Pi, Marta; Gillespie, Kathleen M

    2014-01-01

    Increased levels of non-inherited maternal HLA alleles have been detected in the periphery of children with type 1 diabetes and an increased frequency of maternal cells have been identified in type 1 diabetes pancreas. It is now clear that the phenotype of these cells is pancreatic,1 supporting the hypothesis that maternal cells in human pancreas are derived from multipotent maternal progenitors. Here we hypothesize how increased levels of maternal cells could play a role in islet autoimmunity. PMID:25093746

  7. Requesting perinatal autopsy: multicultural considerations.

    PubMed

    Chichester, Melanie

    2007-01-01

    The subject of perinatal autopsy is not frequently seen in the literature. Perinatal loss, particularly stillbirth, frequently remains unexplained, despite current technology and diagnostic procedures. Parents may automatically refuse an autopsy, despite the potentially valuable information it could provide about the current pregnancy and subsequent pregnancies and despite the possible comfort the results could provide for relatives. Other reasons for declining an autopsy could be cultural or religious prohibitions. In addition, healthcare providers sometimes lack the knowledge of circumstances under which a postmortem examination is permitted, and fail to use culturally sensitive and culturally competent discussions about the reasons a postmortem examination is important and permissible. This purpose of this article is to provide information on selected cultural and religious groups to assist the nurse who is seeking consent for a perinatal autopsy. PMID:17356412

  8. Perinatal mortality--an intervention study.

    PubMed

    Wilkinson, D

    1991-05-01

    Perinatal mortality is high in rural hospitals in South Africa. In part this is due to less than optimal care. This study determined the perinatal mortality experienced by a rural hospital and its clinics. Avoidable causes of death are described and various intervention strategies that effectively and rapidly prevented such deaths, reducing perinatal mortality by one-third, are outlined. PMID:2024213

  9. Perinatal mental health: What every neonatologist should know.

    PubMed

    Khalifeh, Hind; Brauer, Ruth; Toulmin, Hilary; Howard, Louise M

    2015-11-01

    Perinatal mental disorders are common and can impact adversely both on maternal functioning and on foetal and neonatal outcomes. For the more severe disorders, such as schizophrenia, bipolar disorder and severe depression, medication may be needed during pregnancy and breastfeeding, and there is a growing but complex evidence based on the effects of psychotropic medication on the foetus and neonate. In addition, the neonatologist needs to be aware of the co-morbid problems that women with mental disorders are more likely to have as these may also impact on the neonate. Close liaison with family physicians and primary care where there are concerns about mental health is important to ensure maternal mental health is optimal for the mother and her infant. PMID:26386609

  10. Periviable birth: executive summary of a joint workshop by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Academy of Pediatrics, and American College of Obstetricians and Gynecologists.

    PubMed

    Raju, Tonse N K; Mercer, Brian M; Burchfield, David J; Joseph, Gerald F

    2014-05-01

    This is an executive summary of a workshop on the management and counseling issues of women anticipated to deliver at a periviable gestation (broadly defined as 20 0/7 through 25 6/7 weeks of gestation) and the treatment options for the newborn infant. Upon review of the available literature, the workshop panel noted that the rates of neonatal survival and neurodevelopmental disabilities among the survivors vary greatly across the periviable gestations and are significantly influenced by the obstetric and neonatal management practices (eg, antenatal steroid, tocolytic agents, and antibiotic administration; cesarean birth; and local protocols for perinatal care, neonatal resuscitation, and intensive care support). These are, in turn, influenced by the variations in local and regional definitions of limits of viability. Because of the complexities in making difficult management decisions, obstetric and neonatal teams should confer prior to meeting with the family, when feasible. Family counseling should be coordinated with the goal of creating mutual trust, respect, and understanding and should incorporate evidence-based counseling methods. Since clinical circumstances can change rapidly with increasing gestational age, counseling should include discussion of the benefits and risks of various maternal and neonatal interventions at the time of counseling. There should be a plan for follow-up counseling as clinical circumstances evolve. The panel proposed a research agenda and recommended developing educational curricula on the care and counseling of families facing the birth of a periviable infant. PMID:24725732

  11. Periviable birth: executive summary of a Joint Workshop by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Academy of Pediatrics, and American College of Obstetricians and Gynecologists.

    PubMed

    Raju, T N K; Mercer, B M; Burchfield, D J; Joseph, G F

    2014-05-01

    This is an executive summary of a workshop on the management and counseling issues of women anticipated to deliver at a periviable gestation (broadly defined as 20 0/7 through 25 6/7 weeks of gestation), and the treatment options for the newborn. Upon review of the available literature, the workshop panel noted that the rates of neonatal survival and neurodevelopmental disabilities among the survivors vary greatly across the periviable gestations and are significantly influenced by the obstetric and neonatal management practices (for example, antenatal steroid, tocolytic agents and antibiotic administration; cesarean birth; and local protocols for perinatal care, neonatal resuscitation and intensive care support). These are, in turn, influenced by the variations in local and regional definitions of limits of viability. Because of the complexities in making difficult management decisions, obstetric and neonatal teams should confer prior to meeting with the family, when feasible. Family counseling should be coordinated with the goal of creating mutual trust, respect and understanding, and should incorporate evidence-based counseling methods. Since clinical circumstances can change rapidly with increasing gestational age, counseling should include discussion of the benefits and risks of various maternal and neonatal interventions at the time of counseling. There should be a plan for follow-up counseling as clinical circumstances evolve. The panel proposed a research agenda and recommended developing educational curricula on the care and counseling of families facing the birth of a periviable infant. PMID:24722647

  12. Periviable birth: executive summary of a joint workshop by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Academy of Pediatrics, and American College of Obstetricians and Gynecologists.

    PubMed

    Raju, Tonse N K; Mercer, Brian M; Burchfield, David J; Joseph, Gerald F

    2014-05-01

    This is an executive summary of a workshop on the management and counseling issues of women anticipated to deliver at a periviable gestation (broadly defined as 20 0/7 through 25 6/7 weeks of gestation), and the treatment options for the newborn. Upon review of the available literature, the workshop panel noted that the rates of neonatal survival and neurodevelopmental disabilities among the survivors vary greatly across the periviable gestations and are significantly influenced by the obstetric and neonatal management practices (eg, antenatal steroid, tocolytic agents, and antibiotic administration; cesarean birth; and local protocols for perinatal care, neonatal resuscitation, and intensive care support). These are, in turn, influenced by the variations in local and regional definitions of limits of viability. Because of the complexities in making difficult management decisions, obstetric and neonatal teams should confer prior to meeting with the family, when feasible. Family counseling should be coordinated with the goal of creating mutual trust, respect, and understanding and should incorporate evidence-based counseling methods. Since clinical circumstances can change rapidly with increasing gestational age, counseling should include discussion of the benefits and risks of various maternal and neonatal interventions at the time of counseling. There should be a plan for follow-up counseling as clinical circumstances evolve. The panel proposed a research agenda and recommended developing educational curricula on the care and counseling of families facing the birth of a periviable infant. PMID:24785861

  13. Collecting population-based perinatal data efficiently: the example of the Lebanese National Perinatal Survey

    PubMed Central

    Blondel, Béatrice; Zein, Ali; Ghosn, Nada; Du Mazaubrun, Christiane; Bréart, Gérard

    2006-01-01

    Summary We describe the methodology and the main results of the Lebanese perinatal health survey; the aim of the survey was to obtain a minimum data set on all births occurring during a short period of time. The survey was carried out during two consecutive weeks in fall 1999 and in spring 2000. All live births and stillbirths occurring during these periods in medical settings were recorded. The sample included 5231 women and 5333 newborns. Data were obtained from medical records and by interviewing the women in hospital after delivery. All maternity units and birth centers agreed to participate. Maternal characteristics, medical care during pregnancy and delivery, and pregnancy outcome were similar for the two study periods. However gestational age distribution differed between the two periods. In total, 9.0% of infants were born before 37 weeks of gestation and 7.0% weighed less than 2500 grams at birth. Wide regional variations were observed for many indicators of health, care and risk factors. For instance, the cesarean section rate varied from 16.2% in the North Region to 28.0% in Beirut. The survey protocol was successfully applied in Lebanon and may be useful in other countries that have a relatively well-developed health care system, but few sources of reliable population-based statistics on health and medical care. This type of survey may also be an appropriate instrument for collecting additional data for health policy evaluations. PMID:16911021

  14. Effects of Maternal Medication on Mother-Infant Interaction: Methodological Considerations.

    ERIC Educational Resources Information Center

    Bakeman, Roger; And Others

    This report examines the relationship between maternal medication during labor and mother-infant interaction on the third day of life. Subjects were 45 black low-income mothers and their healthy full-term infants. The mothers' perinatal drug history was obtained, and a coded observational schedule was used to record maternal and infant behaviors

  15. Adverse Effects of Heavy Prenatal Maternal Smoking on Attentional Control in Children with ADHD

    ERIC Educational Resources Information Center

    Motlagh, Maria G.; Sukhodolsky, Denis G.; Landeros-Weisenberger, Angeli; Katsovich, Liliya; Thompson, Nancy; Scahill, Lawrence; King, Robert A.; Peterson, Bradley S.; Schultz, Robert T.; Leckman, James F.

    2011-01-01

    Objective: Exposure to heavy maternal cigarette smoking in pregnancy and severe maternal psychosocial stress during pregnancy appear to be important risk factors for the development of ADHD. This study aimed to determine whether these perinatal risk factors were associated with neuropsychological deficits commonly seen in ADHD. Method: We examined

  16. Adverse Effects of Heavy Prenatal Maternal Smoking on Attentional Control in Children with ADHD

    ERIC Educational Resources Information Center

    Motlagh, Maria G.; Sukhodolsky, Denis G.; Landeros-Weisenberger, Angeli; Katsovich, Liliya; Thompson, Nancy; Scahill, Lawrence; King, Robert A.; Peterson, Bradley S.; Schultz, Robert T.; Leckman, James F.

    2011-01-01

    Objective: Exposure to heavy maternal cigarette smoking in pregnancy and severe maternal psychosocial stress during pregnancy appear to be important risk factors for the development of ADHD. This study aimed to determine whether these perinatal risk factors were associated with neuropsychological deficits commonly seen in ADHD. Method: We examined…

  17. The role of oxytocin in mothers' theory of mind and interactive behavior during the perinatal period.

    PubMed

    MacKinnon, Anna L; Gold, Ian; Feeley, Nancy; Hayton, Barbara; Carter, C Sue; Zelkowitz, Phyllis

    2014-10-01

    The present longitudinal study examined the relations between plasma oxytocin, theory of mind, and maternal interactive behavior during the perinatal period. A community sample of women was assessed at 12-14 weeks gestation, 32-34 weeks gestation, and 7-9 weeks postpartum. Oxytocin during late pregnancy was significantly positively correlated with a measure of theory of mind, and predicted theory of mind ability after controlling for parity, maternal education, prenatal psychosocial risk, and general anxiety, measured during the first trimester. Theory of mind was associated with less remote and less depressive maternal interactive behavior. Oxytocin, across all time points, was not directly related to maternal interactive behavior. However, there was a significant indirect effect of oxytocin during late pregnancy on depressive maternal behavior via theory of mind ability. These preliminary findings suggest that changes in the oxytocinergic system during the perinatal period may contribute to the awareness of social cues, which in turn plays a role in maternal interactive behavior. PMID:24995584

  18. A Collaborative Care Telemedicine Intervention to Overcome Treatment Barriers for Latina Women with Depression during the Perinatal Period

    PubMed Central

    Baker-Ericzén, Mary J.; Connelly, Cynthia D.; Hazen, Andrea L.; Dueñas, Cecilia; Landsverk, John A.; Horwitz, Sarah McCue

    2013-01-01

    Maternal depression is highly prevalent (10 to 20%) during the perinatal period with rates as high as 35 to 40% for Latinas. However, few Latinas are either identified or treated during the perinatal period. To address these disparities, the Perinatal Mental Health Model (PMH) was designed to ameliorate the barriers that prevent adequate diagnoses and intervention. The PMH is a culturally sensitive, short-term telemedicine, and collaborative care intervention for addressing depression among Mexican American mothers. It attends to sociocultural and socioeconomic dimensions and is delivered by trained mental health advisors within obstetric care settings. This article describes the feasibility and acceptability of utilizing the PMH. Participants (n=79) were selected from a first year ongoing randomized trial in community obstetric clinics. The intervention seems feasible and acceptable; low-income Latinas, identified as depressed during the perinatal period, reported having access to a range of appropriate community services and high satisfaction. PMID:22709321

  19. Obesity Trends and Perinatal Outcomes in Black and White Teenagers

    PubMed Central

    Halloran, Donna R.; Marshall, Nicole E.; Kunovich, Robert M.; Caughey, Aaron B.

    2012-01-01

    Objective Our objective was to explore the trends in prepregnancy BMI for Black and White teenagers over time and the association between elevated BMI and outcomes based on race. Study Design This was a retrospective cohort study of singleton infants (n=38,158) born to Black (34%) and White teenagers (< 18 years of age). We determined the prevalence of elevated prepregnancy BMI between 1993 and 2006 and the association between elevated prepregnancy BMI (primary exposure) and maternal and perinatal outcomes based on race (2000–2006). Results The percent of White teenagers with elevated prepregnancy BMI increased significantly from 17% to 26%. White and Black overweight and obese teenagers were more likely to have pregnancy-related hypertension than normal weight teenagers while postpartum hemorrhage was only increased in obese Black teenagers and infant complications only in overweight and obese White teenagers. Conclusion As the percent of elevated prepregnancy BMI has increased in White teenagers, specific risks for poor maternal and perinatal outcomes in the overweight and obese teenagers varies by race. PMID:23174388

  20. Developing a Family-Centered, Hospital-Based Perinatal Education Program

    PubMed Central

    Westmoreland, Marcia Haskins; Zwelling, Elaine

    2000-01-01

    The development of a family-centered, comprehensive perinatal education program for a large, urban hospital system is described. This program was developed in conjunction with the building of a new women's center and, although the authors were fortunate that several opportunities for educational program development were linked to this project, many of the steps taken and the lessons learned can be helpful to anyone desiring to develop a similar program. This article relates perinatal education to the principles of family-centered maternity care, outlines the criteria for a quality educational program, gives rationale for this type of program development, and offers practical suggestions for starting or enhancing a perinatal education program within a hospital system. PMID:17273228

  1. Perinatal outcomes and related factors: social class differences within and between geographical areas.

    PubMed

    Elbourne, D; Pritchard, C; Dauncey, M

    1986-12-01

    This paper makes use of the opportunity provided by comparable obstetric data bases to examine area and social class variations in perinatal outcome and associated factors in areas smaller than those usually reported. Analyses are based on singleton births to primiparous residents in the catchment areas of the Aberdeen Maternity and Neonatal Database (n = 4948) and the Cardiff Births Survey (n = 11893) between 1976 and 1981. The factors considered relate to the obstetric population (height, age, and smoking), obstetric practice (induction and assisted delivery), and perinatal outcome (curtailed gestation, low birthweight, and perinatal death). Our analysis confirms the existence of both area and social class differences and suggests that, except in the case of teenage pregnancy and smoking, the association observed between those factors and area and social class are largely independent of each other. PMID:3655622

  2. Factors affecting perinatal mortality (PNM) in women attending Bab El-Shaaria University Hospital.

    PubMed

    Azab, M A

    1995-01-01

    This study aimed to identify and to assess the important factors affecting perinatal mortality (PNM) in Cairo. 200 women were selected randomly from the gynecology and obstetric department of Bab El-Shaaria University Hospital. 100 women were the case group of perinatal deaths, while the other 100 women formed the control group. Both groups had similar life styles. The attendance rate for prenatal care was more frequent among the control group. High parity, short birth intervals, twins, preterm births, a birth order of 4 or higher, anemia, diabetes mellitus, and maternal age of 30 years and older were more prevalent among the case group and considered risk factors for perinatal mortality. Adequate health care and family planning services must be available to all women of reproductive age. Good prenatal care is needed for the prevention and control of coexisting diseases, and good obstetric care is needed to prevent the premature rupture of membranes. PMID:12295112

  3. State health agencies and quality improvement in perinatal care.

    PubMed

    Johnson, K A; Little, G A

    1999-01-01

    The origin of the federal-state partnership in Maternal and Child Health (MCH) can be traced from the Children's Bureau grants of 1912, through the Sheppard-Towner Act, to the creation of Title V and other programs of today that mandate planning, accountability, and systems development. In the past decade with the transformation of the health care system and the emergence of managed care, there has been a resurgence of interest in public, professional, and governmental interest in quality measurement and accountability. Regional perinatal systems have been implemented in all states with varying levels of involvement by state health agencies and the public sector. This historical framework discusses two primary themes: the decades of evolution in the federal-state partnership, and the emergence in the last three decades of perinatal regional system policy, and suggests that the structure of the federal-state partnership has encouraged state variation. A survey of state MCH programs was undertaken to clarify their operational and perceived role in promoting quality improvement in perinatal care. Data and information from the survey, along with five illustrative state case studies, demonstrate great variation in how individual state agencies function. State efforts in quality improvement, a process to make things better, have four arenas of activity: policy development and implementation, definition and measurement of quality, data collection and analysis, and communication to affect change. Few state health agencies (through their MCH programs and perinatal staff) are taking action in all four arenas. This analysis concludes that there are improvements MCH programs could implement without significant expansion in their authority or resources and points out that there is an opportunity for states to be more proactive as they have the legal authority and responsibility for assuring MCH outcomes. PMID:9917467

  4. Nephron function and perinatal homeostasis.

    PubMed

    Horster, M

    1977-01-01

    A) The proximal nephron and perinatal regulation of extracellular volume. 1. The glomerular capillary permeability coefficient (Kf) changes mainly because of an increasing capillary hydraulic conductance (Lp) within the autoregulatory range of renal perfusion pressure. 2. Proximal tubule hydrostatic hydraulic conductance and response to transmural protein concentration gradients is high during perinatal adaptation. 3. Proximal tubule paracellular shunt pathways are more important for absorption during differentiation than at maturity. 4. Basolateral membrane area of the single epithelial segment (10(-6) micron2 mm-1) increases and the typical basal labyrinth architecture develops. 5. The activity of the transport enzyme Na-K-ATPase increases in parallel to the basolateral membrane area to result in a constant number of enzyme sites during normal ontogeny. B) The distal nephron and perinatal regulation of extracellular osmotic activity. 6. Inner medullary urea content increases at osmotic equilibrium between interstitium and collecting duct. 7. The loop of Henle gradually dilutes the isotonic luminal fluid in the course of perinatal differentiation. 8. The thick ascending segment of the loop of Henle differentiates its anisotonic transport by increasing the Na-Chloride transport at constant hydraulic conductivity. 9. Ultrastructure and N-A-K-ATPase activity of the diluting segment (TAL) change greatly during ontogeny. 10. The centrifugal pattern of renal maturation from the juxtamedullary towards the superficial cortical layers leads to an intracortical profile of structure and function. PMID:150248

  5. Wessex perinatal mortality survey 1982.

    PubMed

    Buckell, E W; Wood, B S

    1985-06-01

    A survey of 335 perinatal deaths in the Wessex region revealed a perinatal mortality rate of 10.1 per 1000 total births. Lethal malformations accounted for 82 (24%) deaths. Of the 253 normally formed infants, 124 (49%) died during pregnancy and 33 (13%) in labour. More than 60% of the stillbirths weighed greater than 1500 g. Of the 96 postpartum deaths, half occurred within 24 h of delivery, mostly following complications of labour and circumstances suggesting hypoxia. The Aberdeen classification showed half of the mothers had pregnancy complications: other predisposing factors were identified in 10% of perinatal deaths. There were 185 neonatal deaths of which 150 occurred within 7 days and 35 within the next 3 weeks. Sixteen (46%) of the late neonatal deaths were due to a congenital abnormality; pregnancy or labour complications were present in six (32%) of the remaining 19 normally formed infants. Review of existing methods of antenatal supervision in particular, followed by the use of better monitoring systems for earlier detection of fetal distress and prompt action when indicated, together with improvement in neonatal care in the first 24 h after birth should further reduce the perinatal mortality. PMID:4005197

  6. [Retinopathy and perinatal outcome in diabetic pregnancy].

    PubMed

    Sameshima, H; Kai, M; Kajiya, S; Kamitomo, M; Matsuda, Y; Kuraya, K; Hatae, M; Uchida, H; Fukushima, S; Ikenoue, T

    1995-10-01

    Sixty patients with diabetes mellitus (DM) antedated pregnancy were enrolled; seven had proliferative retinopathy, 13 had simple retinopathy, and 40 were intact. Diet and/or insulin was prescribed to adjust their glucose control at fasting to < 100 mg/dl, as well as at 2 hours postprandial to < 120 mg/dl. Glycohemoglobin (Hemoglobin A1c) levels ranged between 5.4% and 6.4% in the third trimester in three groups. Incidences of pregnancy complications (toxemia, hydramnios, urinary tract infection and cesarean section) and neonatal complications (low Apgar score, hypoglycemia, jaundice, polycythemia, respiratory distress syndrome and anomaly) did not differ significantly with the grade of retinopathy. Compared with the intact group, the duration of DM was significantly longer in the retinopathy groups and the incidence of fetal distress was significantly higher in the proliferative retinopathy group. In ten of 60 patients (16.7%) the grade of retinopathy progressed during pregnancy. In four patients photocoagulation was performed for neovascularization, and proved to be effective. There was a tendency for those whose retinopathy progressed to the proliferative stage during pregnancy to have larger decreases in glycohemoglobin and for their retinopathy to worsen after delivery. With tight maternal glucose control and intensive fetal surveillance, we obtained good perinatal outcome in pregnancies with diabetic retinopathy, as compared to diabetic pregnancy without diabetic microangiopathy. Careful and frequent monitoring of retinal changes should be required during pregnancy and the postpartum period. PMID:8522882

  7. Behavioral effects of perinatal opioid exposure.

    PubMed

    Fodor, Anna; Tímár, Júlia; Zelena, Dóra

    2014-05-28

    Opioids are among the world's oldest known drugs used mostly for pain relief, but recreational use is also widespread. A particularly important problem is opioid exposure in females, as their offspring can also be affected. Adverse intrauterine and postnatal environments can affect offspring development and may lead to various disabilities later in life. It is clear that repetitive painful experiences, such as randomly occurring invasive procedures during neonatal intensive care, can permanently alter neuronal and synaptic organization and therefore later behavior. At the same time, analgesic drugs can also be harmful, inducing neuronal apoptosis or withdrawal symptoms in the neonate and behavioral alterations in adulthood. Hence, risk-benefit ratios should be taken into consideration when pain relief is required during pregnancy or in neonates. Recreational use of opioids can also alter many aspects of life. Intrauterine opioid exposure has many toxic effects, inducing poor pregnancy outcomes due to underdevelopment, but it is believed that later negative consequences are more related to environmental factors such as a chaotic lifestyle and inadequate prenatal care. One of the crucial components is maternal care, which changes profoundly in addicted mothers. In substance-dependent mothers, pre- and postnatal care has special importance, and controlled treatment with a synthetic opioid (e.g., methadone) could be beneficial. We aimed to summarize and compare human and rodent data, as it is important to close the gap between scientific knowledge and societal policies. Special emphasis is given to gender differences in the sensitivity of offspring to perinatal opioid exposure. PMID:24746901

  8. Preventing newborn infection with maternal immunization.

    PubMed

    Black, Steven; Margarit, Immaculada; Rappuoli, Rino

    2013-07-24

    Group B streptococcal disease is a common cause of bacterial sepsis in newborns and is often fatal. To protect these babies, a vaccination program must target pregnant women for immunization so that the resulting antibodies can be passively delivered from the mother to the fetus. Scientists met in Siena, Italy, to discuss potential approaches to maternal immunization for the prevention of perinatal group B streptococcal disease. PMID:23884465

  9. Promise and challenges of maternal health collaboratives.

    PubMed

    Louis, Judette M

    2015-06-01

    Quality-improvement collaboratives are just one of many tools used by health care delivery systems to address quality and safety gaps. These initiatives usually encompass specific aims, multidisciplinary teams, and information sharing. In the recent years, there has been a significant increase in the number of maternal health collaboratives with 31 states having a State Perinatal Quality Collaborative. These programs have shown promise with significant gains in the reduction of early elective deliveries. Further investments by stakeholders can help contribute the resources needed to evaluate the effectiveness and cost savings of maternal health collaboratives. PMID:25851849

  10. Factors associated with clinically significant perinatal asphyxia in the Malaysian neonates: a case-control study.

    PubMed

    Boo, N Y; Lye, M S

    1992-12-01

    A 2-month prospective study was carried out in a Kuala Lumpur maternity hospital to determine the antenatal and intrapartum factors associated with perinatal asphyxia in the Malaysian neonates. The incidence of perinatal asphyxia was 18.7 per 1000 livebirths. Of the 75 asphyxiated neonates born during this period, 70 (93.3 per cent) were of term or post-term gestation. The incidence of perinatal asphyxia was more common in the neonates with one of the following characteristics: low birth weight (< 2500 g), breech delivery, or delivery by instrumentation or lower segment Caesarean section (P < 0.001). Conditional logistic regression analysis of the asphyxiated and the control neonates in a nested case-control study (after controlling for sex, race, birth weight, modes of delivery, and maternal gravida) showed that there were two associated factors which were of statistical significance. These were: small-for-gestation neonates and the presence of intrapartum problems. Our study suggests that to reduce the incidence of perinatal asphyxia, the common causes of small-for-gestation neonates and the common types of intrapartum problems should be identified to enable appropriate preventive measures to be carried out. PMID:1844086

  11. Adverse Prenatal, Perinatal and Neonatal Experiences in Children with Anxiety Disorders.

    PubMed

    Johnco, Carly; Lewin, Adam B; Salloum, Alison; Murphy, Tanya K; Crawford, Erika A; Dane, Brittney F; McBride, Nicole M; Storch, Eric A

    2016-04-01

    This study examined the incidence of adverse prenatal, perinatal, and neonatal experiences amongst children with anxiety disorders, and the relationship to clinical symptomology and functional impairment in treatment-seeking children (N = 107) with a primary anxiety disorder. Anxious children had higher rates of reported maternal prescription medication use during pregnancy, maternal smoking and illness during pregnancy and neonatal complications (including neonatal intensive care and feeding issues) compared with population base rates and non-affected children. Almost one-third had early problems with sleep. Developmental problems were common with more than half having at least one area of delay. More than three quarters of anxious children had a first-degree family member with a psychiatric history. There were several associations between neonatal complications and subsequent clinical symptomology, including attention deficit hyperactivity disorder and depressive comorbidity, anxiety severity and functional impairment. Findings suggest higher rates of perinatal complications in anxious children. PMID:26206734

  12. Screening in high-risk group of gestational diabetes mellitus with its maternal and fetal outcomes

    PubMed Central

    Nilofer, Angadi Rajasab; Raju, V. S.; Dakshayini, B. R.; Zaki, Syed Ahmed

    2012-01-01

    Background: Gestational diabetes mellitus (GDM) is a metabolic disorder defined as glucose intolerance with the onset or first recognition during pregnancy. Women with GDM are at increased risk for adverse obstetric and perinatal outcome. The complications associated with GDM can be prevented by early recognition, intense monitoring and proper treatment. Aims: The present study was done to screen the high-risk pregnancy group for GDM, to find the incidence of abnormal results on screening and to correlate the abnormal results with the maternal and fetal outcomes. The study was done in a tertiary care hospital and teaching institute. It was a prospective cohort study. Materials and Methods: Selective screening for GDM was done in 150 pregnant women with high-risk factors. Screening was done with 50 g glucose challenge test (GCT) after 18 weeks, and if GCT was negative then the test was repeated after 28 weeks of pregnancy. The patients who were having an abnormal GCT were subjected to 100 g oral glucose tolerance test (OGTT). All GDM patients were followed up and treated with diet and/or insulin therapy till delivery to know maternal and fetal outcomes. The period of study was from April 2008 to March 2009. Results: 7.3% of study population was OGCT positive. 6% of the study population was OGTT positive. Age >25 years, obesity, family history of DM, and past history of GDM were the risk factors significantly associated with GDM. One newborn had hypoglycemia and one had hyperbilirubinemia. The fetal and maternal outcome in GDM patients was good in our study due to early diagnosis and intervention. Conclusion: Women with GDM are at an increased risk for adverse obstetric and perinatal outcome. The increased morbidity in GDM is preventable by meticulous antenatal care. PMID:22701851

  13. Perinatal management of fetal supraventricular tachycardia complicated by maternal pertussis.

    PubMed

    Dejong, Stephanie; Salmanian, Bahram; Shamshirsaz, Alireza A; Ruano, Rodrigo

    2015-01-01

    Prenatal pertussis has become a concern once again with the reappearance of the disease in the USA. A 30-year-old mother whose pregnancy was complicated with fetal arrhythmia was referred for further evaluation in the third trimester. After initial treatment with antiarrhythmic medications due to continued irregular rhythm, she was revisited for persistent hacking cough at 38 weeks gestational age. PCR examination confirmed pertussis diagnosis. Owing to increased risk of digoxin toxicity with concurrent antibiotic administration, antiarrhythmic medication was discontinued. Delivery was induced 2 days after the initiation of azithromycin therapy to prevent the transmission of the disease to the neonate. A well-planned delivery in a patient with prenatal diagnosis prevents neonatal infection while considering the obstetrical dilemma for concurrent management of the intrauterine arrhythmia and antibiotic administration. PMID:26153285

  14. Allocation of health care resources in the neonatal and perinatal area –CPS Symposium 1996

    PubMed Central

    McMillan, DD; Lee, SK; Serediak, M; Finn, JG; Saigal, S; Walker, CR

    1999-01-01

    There have been publically expressed concerns about the costs and allocation of neonatal and perinatal health care resources in Canada and elsewhere for the past 15 years. This paper reports information from a symposium held during the 1996 Canadian Paediatric Society (CPS) annual meeting sponsored by the CPS Section on Perinatal Medicine. Experts in perinatal epidemiology, health care economics, public policy and finance, and consumer perspectives on the outcomes of neonatal and perinatal intensive care explored the following questions: How should the need for health care resources in the neonatal and perinatal area be objectively determined? When there are competing needs between the maternal-newborn area and other areas, how should these be rationalized? What evidence should be used (or should be available) to support the present use of resources? What evidence should be available (or is needed) to change or introduce new uses of resources? The conclusions indicated that there are no generally accepted methods to determine the allocation of health care resources but that considerations need to include population characteristics, desired outcomes, achievable results, values, ethics, legalities, cost-benefit analyses and political objectives. Information from families and adolescents who required the use of high technology and/or high cost programs will contribute individual, family and societal values that complement cost-efficacy analyses. PMID:20212990

  15. Perinatal outcome in singleton pregnancies complicated with preeclampsia and eclampsia in Ecuador.

    PubMed

    Phoa, K Y N; Chedraui, P; Pérez-López, F R; Wendte, J F; Ghiabi, S; Vrijkotte, T; Pinto, P

    2016-07-01

    Preeclampsia in Ecuador is an understudied subject since available epidemiological data are scarce. The aim of this study was to describe perinatal outcomes among singleton pregnancies complicated with preeclampsia and eclampsia in a sample of low-income Ecuadorian women. Pregnant women complicated with preeclampsia (mild and severe) and eclampsia (defined according to criteria of the ACOG) delivering at the Enrique C. Sotomayor Obstetrics and Gynecology Hospital, Guayaquil, Ecuador were surveyed with a structured questionnaire containing maternal (socio-demographic) and neonatal data. Perinatal outcomes were compared according to severity of clinical presentation. A total of 163 women with preeclampsia [mild (23.9%), severe (68.7%) and eclampsia (7.4%)] were surveyed. Perinatal mortality and stillbirth rate was similar among studied groups (mild vs. severe preeclampsia/eclampsia cases). However, severe cases displayed higher rates of adverse perinatal outcomes: lower birth Apgar scores, more preterm births, and more low birth weight and small for gestational age infants. Caesarean-section rate and the number of admissions to intensive or intermediate neonatal care were higher in severe cases. A similar trend was found when analysis excluded preterm gestations. In conclusion, in this specific low-income Ecuadorian population perinatal outcome was adverse in pregnancies complicated with severe preeclampsia/eclampsia. PMID:26790539

  16. Allocation of health care resources in the neonatal and perinatal area -CPS Symposium 1996.

    PubMed

    McMillan, D; Lee, S; Serediak, M; Finn, J; Saigal, S; Walker, C

    1999-01-01

    There have been publically expressed concerns about the costs and allocation of neonatal and perinatal health care resources in Canada and elsewhere for the past 15 years. This paper reports information from a symposium held during the 1996 Canadian Paediatric Society (CPS) annual meeting sponsored by the CPS Section on Perinatal Medicine. Experts in perinatal epidemiology, health care economics, public policy and finance, and consumer perspectives on the outcomes of neonatal and perinatal intensive care explored the following questions: How should the need for health care resources in the neonatal and perinatal area be objectively determined? When there are competing needs between the maternal-newborn area and other areas, how should these be rationalized? What evidence should be used (or should be available) to support the present use of resources? What evidence should be available (or is needed) to change or introduce new uses of resources? The conclusions indicated that there are no generally accepted methods to determine the allocation of health care resources but that considerations need to include population characteristics, desired outcomes, achievable results, values, ethics, legalities, cost-benefit analyses and political objectives. Information from families and adolescents who required the use of high technology and/or high cost programs will contribute individual, family and societal values that complement cost-efficacy analyses. PMID:20212990

  17. DHA suppresses chronic apoptosis in the lung caused by perinatal inflammation.

    PubMed

    Ali, Mehboob; Heyob, Kathryn M; Velten, Markus; Tipple, Trent E; Rogers, Lynette K

    2015-09-01

    We have previously shown that an adverse perinatal environment significantly alters lung growth and development and results in persistently altered cardiopulmonary physiology in adulthood. Our model of maternal LPS treatment followed by 14 days of neonatal hyperoxia exposure causes severe pulmonary disease characterized by permanent decreases in alveolarization and diffuse interstitial fibrosis. The current investigations tested the hypothesis that dysregulation of Notch signaling pathways contributes to the permanently altered lung phenotype in our model and that the improvements we have observed previously with maternal docosahexaenoic acid (DHA) supplementation are mediated through normalization of Notch-related protein expression. Results indicated that inflammation (IL-6 levels) and oxidation (F2a-isoprostanes) persisted through 8 wk of life in mice exposed to LPS/O2 perinatally. These changes were attenuated by maternal DHA supplementation. Modest but inconsistent differences were observed in Notch-pathway proteins Jagged 1, DLL 1, PEN2, and presenilin-2. We detected substantial increases in markers of apoptosis including PARP-1, APAF-1, caspase-9, BCL2, and HMGB1, and these increases were attenuated in mice that were nursed by DHA-supplemented dams during the perinatal period. Although Notch signaling is not significantly altered at 8 wk of age in mice with perinatal exposure to LPS/O2, our findings indicate that persistent apoptosis continues to occur at 8 wk of age. We speculate that ongoing apoptosis may contribute to persistently altered lung development and may further enhance susceptibility to additional pulmonary disease. Finally, we found that maternal DHA supplementation prevented sustained inflammation, oxidation, and apoptosis in our model. PMID:26138643

  18. Metabolic imprinting: critical impact of the perinatal environment on the regulation of energy homeostasis

    PubMed Central

    Levin, Barry E

    2006-01-01

    Epidemiological studies in humans suggest that maternal undernutrition, obesity and diabetes during gestation and lactation can all produce obesity in offspring. Animal models have allowed us to investigate the independent consequences of altering the pre- versus post-natal environments on a variety of metabolic, physiological and neuroendocrine functions as they effect the development in the offspring of obesity, diabetes, hypertension and hyperlipidemia (the metabolic syndrome). During gestation, maternal malnutrition, obesity, type 1 and type 2 diabetes and psychological, immunological and pharmacological stressors can all promote offspring obesity. Normal post-natal nutrition can reduce the adverse impact of some of these pre-natal factors but maternal high-fat diets, diabetes and increased neonatal access to food all enhance the development of obesity and the metabolic syndrome in offspring. The outcome of these perturbations of the perinatal environmental is also highly dependent upon the genetic background of the individual. Those with an obesity-prone genotype are more likely to be affected by factors such as maternal obesity and high-fat diets than are obesity-resistant individuals. Many perinatal manipulations appear to promote offspring obesity by permanently altering the development of central neural pathways, which regulate food intake, energy expenditure and storage. Given their strong neurotrophic properties, either excess or an absence of insulin and leptin during the perinatal period are likely to be effectors of these developmental changes. Because obesity is associated with an increased morbidity and mortality and because of its resistance to treatment, prevention is likely to be the best strategy for stemming the tide of the obesity epidemic. Such prevention should begin in the perinatal period with the identification and avoidance of factors which produce permanent, adverse alterations in neural pathways which control energy homeostasis. PMID:16815795

  19. Perinatal mental distress and infant morbidity in Ethiopia: a cohort study

    PubMed Central

    Ross, Joanna; Hanlon, Charlotte; Medhin, Girmay; Alem, Atalay; Tesfaye, Fikru; Worku, Bogale; Dewey, Michael; Patel, Vikram; Prince, Martin

    2011-01-01

    Objectives (1) To investigate the impact of perinatal common mental disorders (CMD) in Ethiopia on the risk of key illnesses of early infancy: diarrhoea, fever and acute respiratory illnesses (ARI) and (2) to explore the potential mediating role of maternal health behaviours. Design Population-based cohort study. Setting Demographic surveillance site in a predominantly rural area of Ethiopia. Participants 1065 women (86.3% of eligible) in the third trimester of pregnancy were recruited and 954 (98.6%) of surviving, singleton mother–infant pairs were followed up until 2 months after birth. Main exposure measure High levels of CMD symptoms, as measured by the locally validated Self-Reporting Questionnaire (SRQ-20 ≥6), in pregnancy only, postnatally only and at both time-points (‘persistent’). Main outcome measures Maternal report of infant illness episodes in first 2 months of life. Results The percentages of infants reported to have experienced diarrhoea, ARI and fever were 26.0%, 25.0% and 35.1%, respectively. Persistent perinatal CMD symptoms were associated with 2.15 times (95% CI 1.39 to 3.34) increased risk of infant diarrhoea in a fully adjusted model. The strength of association was not affected by including potential mediators: breast feeding practices, hygiene, the infant's vaccination status or impaired maternal functioning. Persistent perinatal CMD was not associated with infant ARI or fever after adjusting for confounders. Conclusions Persistent perinatal CMD was associated with infant diarrhoea in this low-income country setting. The observed relationship was independent of maternal health-promoting practices. Future research should further explore the mechanisms underlying the observed association to inform intervention strategies. PMID:20667895

  20. Perinatal Resveratrol Supplementation to Spontaneously Hypertensive Rat Dams Mitigates the Development of Hypertension in Adult Offspring.

    PubMed

    Care, Alison S; Sung, Miranda M; Panahi, Sareh; Gragasin, Ferrante S; Dyck, Jason R B; Davidge, Sandra T; Bourque, Stephane L

    2016-05-01

    This study was undertaken to determine whether perinatal maternal resveratrol (Resv)-a phytoalexin known to confer cardiovascular protection-could prevent the development of hypertension and improve vascular function in adult spontaneously hypertensive rat offspring. Dams were fed either a control or Resv-supplemented diet (4 g/kg diet) from gestational day 0.5 until postnatal day 21. Indwelling catheters were used to assess blood pressure and vascular function in vivo; wire myography was used to assess vascular reactivity ex vivo. Perinatal Resv supplementation in dams had no effect on fetal body weights, albeit continued maternal treatment postnatally resulted in growth restriction in offspring by postnatal day 21; growth restriction was no longer evident after 5 weeks of age. Maternal perinatal Resv supplementation prevented the onset of hypertension in adult offspring (-18 mm Hg;P=0.007), and nitric oxide synthase inhibition (withl-NG-nitroarginine methyl ester) normalized these blood pressure differences, suggesting improved nitric oxide bioavailability underlies the hemodynamic alterations in the Resv-treated offspring. In vivo and ex vivo, vascular responses to methylcholine were not different between treatment groups, but prior treatment withl-NG-nitroarginine methyl ester attenuated the vasodilation in untreated, but not Resv-treated adult offspring, suggesting a shift toward nitric oxide-independent vascular control mechanisms in the treated group. Finally, bioconversion of the inactive precursor big endothelin-1 to active endothelin-1 in isolated mesenteric arteries was reduced in Resv-treated offspring (-28%;P<0.05), and this difference could be normalized byl-NG-nitroarginine methyl ester treatment. In conclusion, perinatal maternal Resv supplementation mitigated the development of hypertension and causes persistent alterations in vascular responsiveness in spontaneously hypertensive rats. PMID:26928803

  1. The Microbiota and Transgenomic Networks: Potential Implications for Maternal-Fetal Medicine.

    PubMed

    Santolaya-Forgas, Joaquin; Townsend, Ryan; Santolaya, Jacobo L; Patel, Priya; Herrera-Garcia, Guadalupe; Castracane, V Daniel

    2016-01-01

    The maternal microbiota has long been considered a potential cause for adverse perinatal outcomes. Gene expression regulators in prokaryotic and eukaryotic cells are influenced by changes in their microenvironments. We propose the novel idea that during in utero development, an adaptive and dynamic gene-regulatory cross talk might exist between the host genome and the maternal microbiota. Understanding these cross talks could increase the appreciation for the discovery of new diagnostics and therapeutics in maternal-fetal medicine. PMID:26544907

  2. [Perinatal neonatal lesions: retrovaginal tears].

    PubMed

    Tirado Pascual, M; Primelles Díaz, A; Sánchez Díaz, F; Pérez Rodríguez, J; Rodríguez, Argos

    2011-08-01

    Neonatal injuries produced during the childbirth or in the maneuvers of resuscitation they have a high morbidity and suppose the 8th reason of mortality in newborns. The aim of this article is to check our casuistry in the last 10 years and to present a case report of rectovaginal tear with the possible therapeutic options published in the literature. There were gathered a total of 8 perinatal neonatal injuries, being the majority of them clause-contused (5) in hairy leather, pinna and thorax. Other cases were affecting the perine: an anal tear and two rectovaginal tears; one of these patients needed colostomy and surgical repair of the perine. Only a small percentage of the perinatal neonatal injuries are valued by the paediatric surgeon. Some of them are serious and can have important consequences. The colostomy and primary or secondary closing is a therapeutic sure option in rectovaginal tears. PMID:22295663

  3. Estimating risks of perinatal death.

    PubMed

    Smith, Gordon C S

    2005-01-01

    The relative and absolute risks of perinatal death that are estimated from observational studies are used frequently in counseling about obstetric intervention. The statistical basis for these estimates therefore is crucial, but many studies are seriously flawed. In this review, a number of aspects of the approach to the estimation of the risk of perinatal death are addressed. Key factors in the analysis include (1) the definition of the cause of the death, (2) differentiation between antepartum and intrapartum events, (3) the use of the appropriate denominator for the given cause of death, (4) the assessment of the cumulative risk where appropriate, (5) the use of appropriate statistical tests, (6) the stratification of analysis of delivery-related deaths by gestational age, and (7) the specific features of multiple pregnancy, which include the correct determination of the timing of antepartum stillbirth and the use of paired statistical tests when outcomes are compared in relation to the birth order of twin pairs. PMID:15671996

  4. Social Support Following Perinatal Loss

    PubMed Central

    Kavanaugh, Karen; Trier, Darcie; Korzec, Michelle

    2005-01-01

    The purpose of this project was to examine parents' descriptions of the ways family and friends supported them after they had experienced a perinatal loss. For this project, a secondary analysis of data from two phenomenological studies on perinatal loss was performed. A combined total of 62 interview transcripts from 22 mothers and 9 fathers were examined. Data analysis included identifying all statements in the interview transcripts that pertained to the ways that family and friends supported parents. The modes of supportive behavior (emotional, advice/feedback, practical, financial, and socializing) in Vaux's theory of social support served as a useful framework for presenting the findings. Parents received emotional support most frequently. Findings from the current study provide data for health care professionals to use to provide guidance to family and friends of bereaved parents. PMID:17426820

  5. Visual outcomes and perinatal adversity.

    PubMed

    O'Connor, Anna R; Fielder, Alistair R

    2007-10-01

    Preterm birth per se, the neonatal environment, retinopathy of prematurity (ROP) and neurological damage are all causes of visual impairment and the impact of these factors is discussed in relation to the resultant ophthalmic deficits. Visual acuity impairments range from blindness, due to ROP or cortical visual impairment, which can be identified at an early age, to subtle deficits related to preterm birth only identified at a later age. Visual function deficits are not limited to visual acuity but can affect contrast sensitivity, field of vision and colour vision. Strabismus and refractive errors are also very common in children following perinatal adversity. Although more is now known about the types of deficits affecting these children, there is still a poor understanding of how these deficits impact on a child's functional ability. The impact of these ophthalmic deficits on the long term ophthalmic care required, and the role of perinatal factors, is discussed. PMID:17704016

  6. Influence of pre- and peri-natal nutrition on skeletal acquisition and maintenance

    PubMed Central

    Devlin, MJ; Bouxsein, ML

    2011-01-01

    Early life nutrition has substantial influences on postnatal health, with both under-and overnutrition linked with permanent metabolic changes that alter reproductive and immune function and significantly increase metabolic disease risk in offspring. Since perinatal nutrition depends in part on maternal metabolic condition, maternal diet during gestation and lactation is a risk factor for adult metabolic disease. Such developmental responses may be adaptive, but might also result from constraints on, or pathological changes to, normal physiology. The rising prevalence of both obesity and osteoporosis, and the identification of links among bone, fat, brain, and gut, suggest that obesity and osteoporosis may be related, and moreover that their roots may lie in early life. Here we focus on evidence for how maternal diet during gestation and lactation affects metabolism and skeletal acquisition in humans and in animal models. We consider the effects of overall caloric restriction, and macronutrient imbalances including high fat, high sucrose, and low protein, compared to normal diet. We then discuss potential mechanisms underlying the skeletal responses, including perinatal developmental programming via disruption of the perinatal leptin surge and/or epigenetic changes, to highlight unanswered questions and identify the most critical areas for future research. PMID:21723972

  7. Support for parents experiencing perinatal loss.

    PubMed Central

    1983-01-01

    Grief following perinatal loss is just as debilitating as that following the death of an older person and may not be completely resolved for years. The physician's role in assisting parents following perinatal loss is one of a sympathetic listener and compassionate informant, but each category of perinatal loss--miscarriage, stillbirth, neonatal death and sudden infant death syndrome--requires a somewhat different approach. To be of assistance, physicians must understand the normal process of grief and the differences between the reactions of mothers, fathers and siblings. The advent of liberal attitudes to family visiting in perinatal units has helped parents better understand perinatal illness, and appropriate management in the event of perinatal death can greatly benefit the family. PMID:6871800

  8. Building a community-based maternity program.

    PubMed

    Kwast, B E

    1995-06-01

    The MotherCare Project has as its goal the reduction of maternal and neonatal mortality and related morbidities, and the promotion of the health of women and newborns. To achieve these goals, maternal and family planning programs were strengthened in both rural and urban settings through three intervention strategies--policy reform, affecting behaviors and improving services. The fundamental premise in each project was to strengthen the weakest part of the maternity care pyramid, ensuring linkages among all levels of service--from community through to the referral hospital level. In rural Andean populations of Bolivia, knowledge of danger signs and women's response to them improved, increasing in use of prenatal and family planning services through a participatory problem-solving and community-based strategy. In West Java, Indonesia, bringing professional midwifery services and facilities closer to women together has resulted in a positive response to their use. Augmenting this intervention with a transport and intercommunication system together with improved hospital practice through perinatal mortality meetings and in-service training for doctors and midwives has reduced the maternal and perinatal mortality over a four year period. Hospital practice has improved in Uganda and in two states of Nigeria, maternal mortality and morbidity have been reduced in the training facility where seminars for physicians, training of midwives in life saving midwifery and interpersonal communication skills have taken place, and equipment and supplies have been improved. Furthermore, in rural Guatemala, implementation of norms and protocols, expert supervision and sensitization of hospital staff to the needs of the community has increased referral by traditional birth attendants (TBAs) to the hospital and reduced perinatal mortality. PMID:7672176

  9. Effects of perinatal daidzein exposure on subsequent behavior and central estrogen receptor α expression in the adult male mouse.

    PubMed

    Yu, Chengjun; Tai, Fadao; Zeng, Shuangyan; Zhang, Xia

    2013-06-01

    Daidzein is one of the most important isoflavones present in soy and it is unique as it can be further metabolized to equol, a compound with greater estrogenic activity than other isoflavones. The potential role of daidzein in the prevention of some chronic diseases has drawn public attention and increased its consumption in human, including in pregnant women and adolescent. It is unclear whether perinatal exposure to daidzein through maternal diets affects subsequent behavior and central estrogen receptor α (ERα) expression in male adults. Following developmental exposure to daidzein through maternal diets during perinatal period, subsequent anxiety-like behavior, social behavior, spatial learning and memory of male mice at adulthood were assessed using a series of tests. The levels of central ER α expression were also examined using immunocytochemistry. Compared with the controls, adult male mice exposed to daidzein during the perinatal period showed significantly less exploration, higher levels of anxiety and aggression. They also displayed more social investigation for females and a tendency to improve spatial learning and memory. The mice with this early daidzein treatment demonstrated significantly higher levels of ERα expression in several brain regions such as the bed nucleus of the stria terminalis, medial preoptic, arcuate hypothalamic nucleus and central amygdaloid mucleus, but decreased it in the lateral septum. Our results indicated that perinatal exposure to daidzein enhanced masculinization on male behaviors which is assocciated with alterations in ERα expression levels led by perinatal daidzein exposure. PMID:23268192

  10. Perinatal distress in women in low- and middle-income countries: allostatic load as a framework to examine the effect of perinatal distress on preterm birth and infant health.

    PubMed

    Premji, Shahirose

    2014-12-01

    In low- and middle-income countries (LMIC), determinants of women's and children's health are complex and differential vulnerability may exist to risk factors of perinatal distress and preterm birth. We examined the contribution of maternal perinatal distress on preterm birth and infant health in terms of infant survival and mother-infant interaction. A critical narrative and interpretive literature review was conducted. Peer-reviewed electronic databases (MEDLINE, Embase, Global Health, CINHAL), grey literature, and reference lists were searched, followed by a consultation exercise. The literature was predominantly from high-income countries. We identify determinants of perinatal distress and explicate changes in the hypothalamic-pituitary-adrenal axis, sympathetic, immune and cardiovascular systems, and behavioral responses resulting in pathophysiological effects. We suggest cultural-neutral composite measures of allostatic mediators (i.e., several biomarkers) of maternal perinatal distress as objective indicators of dysregulation in body systems in pregnant women in LMIC. Understanding causal links of maternal perinatal distress to preterm birth in women in LMIC should be a priority. The roles of allostasis and allostatic load are considered within the context of the health of pregnant women and fetuses/newborns in LMIC with emphasis on identifying objective indicators of the level of perinatal distress and protective factors or processes contributing to resilience while facing toxic stress. We propose a prospective study design with multiple measures across pregnancy and postpartum requiring complex statistical modeling. Building research capacity through partnering researchers in high-income countries and LMIC and reflecting on unique ethical challenges will be important to generating new knowledge in LMIC. PMID:24748241

  11. Determinants of neonatal outcome in a Malaysian maternity hospital, 1980-1981.

    PubMed

    Abdul Kader, H

    1983-01-01

    This article descripes the compilation and analysis of basic perinatal statistics in the Maternity Hospital, Kuala Lumpur (MHKL), the largest maternity hospital in the country. The study period covered is 1980-1. Because consented autopsies are difficult to obtain in the social and religious setting of Malaysia, the approach of clinical classification of causes of neonatal deaths was adopted. Determinants of neonatal mortality included very low birthweight (less than 1.5kg), gestational age of less than 32 weeks, and clinical conditions of asphyxia, meconium aspiration syndrome, bacterial sepsis, and respiratory distress syndrome. The resulting charts underscore how simple neonatal data can be compiled to assess perinatal performance in a way which requires little statistical sophistication. Accurate perinatal statistics will enable better comprehension of preventable causes of perinatal deaths, and enhanced outcomes. Wider application of this approach is recommended in hospitals throughout Malaysia. PMID:12279886

  12. Pregnancy, prison and perinatal outcomes in New South Wales, Australia: a retrospective cohort study using linked health data

    PubMed Central

    2014-01-01

    Background Studies from the United States and the United Kingdom have found that imprisoned women are less likely to experience poorer maternal and perinatal outcomes than other disadvantaged women. This population-based study used both community controls and women with a history of incarceration as a control group, to investigate whether imprisoned pregnant women in New South Wales, Australia, have improved maternal and perinatal outcomes. Methods Retrospective cohort study using probabilistic record linkage of routinely collected data from health and corrective services in New South Wales, Australia. Comparison of the maternal and perinatal outcomes of imprisoned pregnant women aged 18–44 years who gave birth between 2000–2006 with women who were (i) imprisoned at a time other than pregnancy, and (ii) community controls. Outcomes of interest: onset of labour, method of birth, pre-term birth, low birthweight, Apgar score, resuscitation, neonatal hospital admission, perinatal death. Results Babies born to women who were imprisoned during pregnancy were significantly more likely to be born pre-term, have low birthweight, and be admitted to hospital, compared with community controls. Pregnant prisoners did not have significantly better outcomes than other similarly disadvantaged women (those with a history of imprisonment who were not imprisoned during pregnancy). Conclusions In contrast to the published literature, we found no evidence that contact with prison health services during pregnancy was a “therapunitive” intervention. We found no association between imprisonment during pregnancy and improved perinatal outcomes for imprisoned women or their neonates. A history of imprisonment remained the strongest predictor of poor perinatal outcomes, reflecting the relative health disadvantage experienced by this population of women. PMID:24968895

  13. Congenital Malformations in Perinatal Autopsies – A Study of 100 Cases

    PubMed Central

    Andola, Uma S; AM, Anita; Ahuja, Mukta; Andola, Sainath K

    2012-01-01

    Background Congenital malformations remain a common cause of perinatal deaths and even though ultrasonogram can give fairly accurate diagnosis, perinatal autopsy is essential to confirm the diagnosis and look for associated malformations. Objectives To emphasize the importance of perinatal autopsy in diagnosing congenital malformations and to compare the same with the prenatal ultrasound findings. Methods The present study comprises 100 consecutive perinatal autopsies conducted after obtaining the approval from the Institutional Ethics Committee. In cases where prenatal ultrasound findings were available they were compared with the autopsy findings. Results Out of 100 perinatal autopsies, 44 cases were congenital anomalies with M:F = 1:1.5. Majority of the fetuses with congenital malformations (36.36%) were therapeutically terminated, Cental nervous system malformations being the commonest indication. The most common timing of therapeutic termination being 20 -24weeks. Congenital malformations were common between 35-39 weeks gestational age and birth weight range 350- 1000g. The malformations involving the central nervous system were commonest, seen in 15 cases (34.09%) followed by renal anomalies in 9 cases (20.45%) and multiple malformations in 7cases ( 15.91%). Autopsy confirmed the prenatal ultrasound findings in 50% of the cases, added to diagnosis in 29.54%, while it completely changed the primary diagnosis in 9.09% of the cases. Conclusion This study highlights the importance of perinatal autopsy in confirming the diagnosis of congenital anomalies by prenatal ultrasound findings. PMID:23373038

  14. Moral Reinstatement: The Characteristics of Maternity Homes

    ERIC Educational Resources Information Center

    Rains, Prudence M.

    1970-01-01

    While maternity homes are deviant-housing institutions, they differ from institutions that have been typically studied in a number of respects crucial to the inmates' experience. In a variety of ways, maternity homes underwrite moral reprieve and moral reinstatement. (Author/DB)

  15. Severe acute respiratory syndrome: implications for perinatal and neonatal nurses.

    PubMed

    Rebmann, Terri

    2005-01-01

    Severe acute respiratory syndrome (SARS) is an emerging infection that causes a potentially fatal respiratory disease. Although the SARS outbreak lasted less than 1 year, it resulted in significant morbidity and mortality and impacted nursing practices. A literature review was conducted. Only English language research articles in peer-reviewed journals, national organization publications, and book chapters were utilized. Data from 37 relevant articles were extracted, analyzed, and summarized. SARS' clinical description is presented, including its common signs/symptoms, diagnosis, and treatment. Recommended isolation practices for labor and delivery and proper procedures for donning, using, and doffing personal protective equipment are provided. Potential maternal outcomes include spontaneous miscarriage during the first trimester, preterm birth, emergency cesarean section, renal failure, secondary bacterial pneumonia, sepsis, adult respiratory distress syndrome, disseminated intravascular coagulation, surgical site infection, and maternal death. There have been no documented cases of vertical transmission; passive immunity is suspected on the basis of the presence of antibodies in some maternal body fluids. Potential neonatal outcomes include complications related to premature birth, intrauterine growth restriction, respiratory distress syndrome, and severe gastrointestinal manifestations. It is not known if or when SARS will reemerge, but perinatal and neonatal nurses should become familiar with its clinical description and proper infection control procedures to halt potential outbreaks. PMID:16292134

  16. The role of telemetry in perinatal monitoring.

    PubMed

    Di Renzo, G C; Luzi, G; Caserta, G; Clerici, G; Cosmi, E V

    1994-01-01

    In the field of transmission and exchange of clinical information particularly good results are foreseen with the development of data telemetry. In perinatal medicine the telemetric technologies are being employed in several situations. It is possible to subdivide the telemetric technologies into short and long distance systems. Short distance telemetry employs devices which utilize radiowaves or laser techniques to transmit data from the original source to centralized equipment; the main application is the transmission of the cardiotocographic signal to permit ambulation of the patient during recording. It may allow fetal heart rate testing to be performed in a setting more acceptable to patients telemetric not be physically confined to a bed or a chair. The telemetric transmission of the cardiotocogram (CTG) may solve problems of organization when the ratio of parturient to midwife exceeds 1:1. Long distance telemetry consists of the telephone transmission of data obtained from distant source to a consultation center where the data can be evaluated, stored and where hospital staff may suggest appropriate decision related to clinical course. In prenatal medicine, the system can offer the monitoring of maternal blood pressure, automatic urine and glucose analyses, surveillance of fetal heart rate and uterine contractions. CTG telemetry has been used with good results for the prevention of preterm labor while blood pressure control by telemetry may be useful for the prevention and management of gestational hypertension. Knowledge by the pregnant woman that it is possible to continuously monitor by telemetric technology her health and the health of her fetus provides reassurance during a delicate period.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7674106

  17. Comparative carcinogenicity of 5,5-diphenylhydantoin with or without perinatal exposure in rats and mice.

    PubMed

    Chhabra, R S; Bucher, J R; Haseman, J K; Elwell, M R; Kurtz, P J; Carlton, B D

    1993-08-01

    Chronic toxicity and carcinogenicity studies of 5,5-diphenylhydantoin (DPH), were conducted in F344/N rats and B6C3F1 mice of each sex. The major objective of the study was to determine if incorporating exposure to DPH during the perinatal period, in addition to conventional exposure of animals for 2 years, enhances the sensitivity of the bioassay to identify the carcinogenic potential of chemical. The studies were designed to determine the toxic and carcinogenic effects of dietary DPH in rats and mice receiving; (1) the perinatal administration including exposure of maternal animals prior to breeding, through gestation, lactation, weaning, and continued dietary exposure of offspring to the age of 8 weeks followed by control diet for 2 years, (2) exposure for 2 years beginning at the age of 8 weeks, and (3) of combined perinatal/adult exposure to DPH (perinatal exposure to 8 weeks of age followed by the adult exposure for 2 years). During the perinatal period, rats were exposed to DPH at dose levels ranging from 63 to 630 ppm and adult exposure concentrations ranged from 240 to 2400 ppm in diet. In the mice, the perinatal exposure ranged from 21 to 210 ppm in both males and females. In the adult exposure portion of the mouse studies, the dietary levels ranged from 30 to 300 ppm in males and 60 to 600 ppm in females. A total of eight dose groups (including controls) were used with 60 animals in each group. The only effect of perinatal exposure alone on tumor rate was a marginal increase in the incidence of hepatocellular neoplasms in female mice. The adult exposure to DPH significantly increased the incidence of hepatocellular neoplasms in female mice. There were also marginal increases in the incidence of liver tumors in male rats exposed to high DPH dietary concentrations during the adult-only regimen. Combined perinatal and adult dietary exposure to 5,5-diphenylhydantoin confirmed the findings for the increased incidences of hepatocellular neoplasms in male rats and female mice, although combined exposure did not enhance these effects. However, in male mice, perinatal and adult exposure resulted in an increase in the incidence of hepatocellular neoplasms that was not seen when dietary exposure was limited to the adult period only. PMID:8405780

  18. Improved Perinatal Mortality in Twins-Changing Practice and Technologies.

    PubMed

    Hehir, Mark P; Mctiernan, Aoife; Martin, Aisling; Carroll, Stephen; Gleeson, Ronan; Malone, Fergal D

    2016-01-01

    Objective We set out to examine rates of perinatal mortality in twin pregnancies over a 17-year study period. Changes in mode of delivery were also examined as well as causes of death in twin mortalities. Study Design This retrospective cohort study was performed at three large tertiary referral centers from 1996 to 2012. It included all normally formed twin infants with a birth weight more than 500 g. All cases of perinatal mortality in twin pregnancies (infants more than 500 g who suffered an intrauterine or early neonatal (≤ 7 days of age) death were recorded. The changing rate of cesarean delivery as well as varying causes of death in twins over the course of the study were also examined. Results During the study period, there were 395,830 pregnancies across the three institutions, this included 6,727 twin gestations. The perinatal mortality rate was 21.5/1,000 twin infants. The perinatal mortality rate in twins decreased over the study period (p = 0.0006; R (2) = 0.55; slope = -1.2). Rates of cesarean delivery in twin gestations were found to have increased over the course of the study (p < 0.0001; R (2) = 0.84; slope = 1.7). There were 288 intrauterine and early neonatal deaths in twin infants, 50% (147/288) occurred in twins born extremely premature (< 26 weeks). Prematurity was the leading cause of mortality in twins, followed by twin-to-twin transfusion syndrome (TTTS). TTTS was found to have a decreasing contribution to perinatal mortality during the study (p = 0.008; R (2) = 0.38; slope = -1.5). Conclusion The perinatal mortality rate in twins improved during the study. The rate of cesarean delivery increased by 1.7% for each year of the study, culminating in a cesarean delivery rate of 62% in 2012. TTTS made a decreasing contribution to the mortality rate in twins during the study. PMID:26295967

  19. Guidelines for Perinatal Care. Second Edition.

    ERIC Educational Resources Information Center

    American Coll. of Obstetricians and Gynecologists, Washington, DC.

    The basic concept emphasized in this book is that a coordinated, multidisciplinary approach within a regionalized system of perinatal care is a constant factor improving the quality of pregancy outcomes. This coordinated multidisciplinary approach has had an impact on perinatal care in three important areas: (1) improved and expanded understanding

  20. Inflammation processes in perinatal brain damage.

    PubMed

    Degos, Vincent; Favrais, Graldine; Kaindl, Angela M; Peineau, Stphane; Guerrot, Anne Marie; Verney, Catherine; Gressens, Pierre

    2010-08-01

    Once viewed as an isolated, immune-privileged organ, the central nervous system has undergone a conceptual change. Neuroinflammation has moved into the focus of research work regarding pathomechanisms underlying perinatal brain damage. In this review, we provide an overview of current concepts regarding perinatal brain damage and the role of inflammation in the disease pathomechanism. PMID:20473533

  1. Guidelines for Perinatal Care. Second Edition.

    ERIC Educational Resources Information Center

    American Coll. of Obstetricians and Gynecologists, Washington, DC.

    The basic concept emphasized in this book is that a coordinated, multidisciplinary approach within a regionalized system of perinatal care is a constant factor improving the quality of pregancy outcomes. This coordinated multidisciplinary approach has had an impact on perinatal care in three important areas: (1) improved and expanded understanding…

  2. Efforts to Improve Perinatal Outcomes for Women Enrolled in Medicaid.

    PubMed

    Daniel-Robinson, Lekisha; Cha, Stephen; Lillie-Blanton, Marsha

    2015-08-01

    Improving women's health and perinatal health outcomes is a high priority for Medicaid, the jointly financed federal-state health coverage program. The authorities provided by the Affordable Care Act give Medicaid new resources and opportunities to improve coverage and perinatal care. Given that the Medicaid program currently covers almost half of all births in the United States, the Centers for Medicare and Medicaid Services, working in partnership with states and other stakeholders, is using new and existing authorities to improve birth outcomes. Quality measurement, quality-improvement projects, and expanded models of care underscore the major quality approach of the center. As an outgrowth of an expert panel that included membership of several state Medicaid medical directors, Medicaid providers, and consumer representatives, the Centers for Medicare and Medicaid Services' Center for Medicaid and CHIP Services launched the Maternal and Infant Health Initiative, which aims to increase postpartum visit rates and the use of effective contraception among women covered by Medicaid. This Initiative provides focus on key opportunities and strategies to improve the rate, measurement, timing, and content of postpartum visits. Additionally, a focus on contraception will serve to improve pregnancy planning and spacing and prevent unintended pregnancy. As the Initiative evolves, the Center for Medicaid and CHIP Services plans to identify policy, service delivery, and reimbursement policies to advance the Initiative's goals and improve outcomes for women covered by Medicaid. PMID:26241435

  3. Neurobehavioral and somatic effects of perinatal PCB exposure in rats

    SciTech Connect

    Overmann, S.R.; Kostas, J.; Wilson, L.R.; Shain, W.; Bush, B.

    1987-10-01

    Developing rats were exposed to TCBs via provision of diets containing 0.02 (no PCB added), 2.4, 26, or 269 ppm Aroclor 1254 to sperm-positive female rats from mating to weaning of their pups. Provision of the 269 ppm diet decreased the number of impregnated rats that delivered a litter and lowered pup birth weight, and most pups died within 7 days of birth. Preweaning pup growth was reduced in the 26 ppm condition and slightly reduced in the 2.5 ppm condition. The ontogeny of negative geotaxis, auditory startle, and air righting was delayed in pups from the 26 ppm condition. Pups in the 2.5 ppm condition had slightly delayed development of auditory startle. Maximal electroshock seizure tests on postweaning rats showed that perinatal PCB exposure decreased seizure severity of both the 2.5 and 26 ppm groups. PCB exposure increased pup liver weights at birth and dam and pup liver weights at weaning. Spleen and thymus weights were lower in PCB-exposed pups, while brain weights were unaffected. Analytical determination of PCB levels in brain showed greater maternal transfer of PCBs during lactation than during gestation. Elevated PCB levels were detectable in brains of perinatally exposed adult rats.

  4. Importance of fatty acids in the perinatal period.

    PubMed

    Demmelmair, Hans; Koletzko, Berthold

    2015-01-01

    Long-chain polyunsaturated fatty acids (LC-PUFAs) influence a variety of cellular and physiological processes during the perinatal period by serving as membrane components, precursors of eicosanoids and docosanoids, and nuclear receptor activators. These processes include the growth of neural cells and signal transduction, the growth and differentiation of adipocytes, and the function of regulatory T cells. LC-PUFA levels depend on these fatty acids' dietary availability and their endogenous synthesis from essential fatty acids, which is known to differ among subjects according to fatty acid desaturase genotype. Intrauterine placental mechanisms support the preferential transfer of LC-PUFAs from the mother to the foetus. After birth, breast milk provides arachidonic acid and docosahexaenoic acid, although not in amounts that can prevent lower percentages in infant plasma than in umbilical cord blood plasma. The available epidemiological data suggest associations of perinatal LC-PUFAs with later body weight, the risk of allergic diseases and cognitive performance. Randomised clinical trials that compare different maternal or infant intakes of n-3 LC-PUFAs or combinations of n-3 and n-6 fatty acids so far have not led to firm conclusions about the optimal LC-PUFA status of pregnant women or infants, but there are good indications of beneficial effects of a higher pre- or postnatal docosahexaenoic acid status on visual function and asthma risk. PMID:25471800

  5. Perinatal exercise improves glucose homeostasis in adult offspring

    PubMed Central

    Carter, Lindsay G.; Lewis, Kaitlyn N.; Wilkerson, Donald C.; Tobia, Christine M.; Ngo Tenlep, Sara Y.; Shridas, Preetha; Garcia-Cazarin, Mary L.; Wolff, Gretchen; Andrade, Francisco H.; Charnigo, Richard J.; Esser, Karyn A.; Egan, Josephine M.; de Cabo, Rafael

    2012-01-01

    Emerging research has shown that subtle factors during pregnancy and gestation can influence long-term health in offspring. In an attempt to be proactive, we set out to explore whether a nonpharmacological intervention, perinatal exercise, might improve offspring health. Female mice were separated into sedentary or exercise cohorts, with the exercise cohort having voluntary access to a running wheel prior to mating and during pregnancy and nursing. Offspring were weaned, and analyses were performed on the mature offspring that did not have access to running wheels during any portion of their lives. Perinatal exercise caused improved glucose disposal following an oral glucose challenge in both female and male adult offspring (P < 0.05 for both). Blood glucose concentrations were reduced to lower values in response to an intraperitoneal insulin tolerance test for both female and male adult offspring of parents with access to running wheels (P < 0.05 and P < 0.01, respectively). Male offspring from exercised dams showed increased percent lean mass and decreased fat mass percent compared with male offspring from sedentary dams (P < 0.01 for both), but these parameters were unchanged in female offspring. These data suggest that short-term maternal voluntary exercise prior to and during healthy pregnancy and nursing can enhance long-term glucose homeostasis in offspring. PMID:22932781

  6. Perinatal nicotine/smoking exposure and carotid chemoreceptors during development.

    PubMed

    Stéphan-Blanchard, E; Bach, V; Telliez, F; Chardon, K

    2013-01-01

    Tobacco smoking is still a common habit during pregnancy and is the most important preventable cause of many adverse perinatal outcomes. Prenatal smoking exposure can produce direct actions of nicotine in the fetus with the disruption of body and brain development, and actions on the maternal-fetal unit by causing repeated episodes of hypoxia and exposure to many toxic smoke products (such as carbon monoxide). Specifically, nicotine through binding to nicotinic acetylcholine receptors have ubiquitous effects and can affect carotid chemoreception development through structural, functional and neuroregulatory alterations of the neural circuits involved in the chemoafferent pathway, as well as by interfering with the postnatal resetting of the carotid bodies. Reduced carotid body chemosensitivity and tonic activity have thus been reported by the majority of the human and animal studies. This review focuses on the effects of perinatal exposure to tobacco smoke and nicotine on carotid chemoreceptor function during the developmental period. A description of the effects of smoking and nicotine on the control of breathing related to carotid body activity, and of the possible physiopathological mechanisms at the origin of these disturbances is presented. PMID:22743051

  7. Engaging and Retaining Abused Women in Perinatal Home Visitation Programs

    PubMed Central

    Alhusen, Jeanne L.; Bullock, Linda; Bhandari, Shreya; Ghazarian, Sharon; Udo, Ifeyinwa E.; Campbell, Jacquelyn

    2013-01-01

    OBJECTIVES: Intimate partner violence (IPV) during pregnancy affects 0.9% to 17% of women and affects maternal health significantly. The impact of IPV extends to the health of children, including an increased risk of complications during pregnancy and the neonatal period, mental health problems, and cognitive delays. Despite substantial sequelae, there is limited research substantiating best practices for engaging and retaining high-risk families in perinatal home visiting (HV) programs, which have been shown to improve infant development and reduce maltreatment. METHODS: The Domestic Violence Enhanced Home Visitation Program (DOVE) is a multistate longitudinal study testing the effectiveness of a structured IPV intervention integrated into health department perinatal HV programs. The DOVE intervention, based on an empowerment model, combined 2 evidence-based interventions: a 10-minute brochure-based IPV intervention and nurse home visitation. RESULTS: Across all sites, 689 referrals were received from participating health departments. A total of 339 abused pregnant women were eligible for randomization; 42 women refused, and 239 women were randomly assigned (124 DOVE; 115 usual care), resulting in a 71% recruitment rate. Retention rates from baseline included 93% at delivery, 80% at 3 months, 76% at 6 months, and 72% at 12 months. CONCLUSIONS: Challenges for HV programs include identifying and retaining abused pregnant women in their programs. DOVE strategies for engaging and retaining abused pregnant women should be integrated into HV programs’ federal government mandates for the appropriate identification and intervention of women and children exposed to IPV. PMID:24187115

  8. Perinatal lamb model of respiratory syncytial virus (RSV) infection.

    PubMed

    Derscheid, Rachel J; Ackermann, Mark R

    2012-10-01

    Respiratory syncytial virus (RSV) is the most frequent cause of bronchiolitis in infants and children worldwide. Many animal models are used to study RSV, but most studies investigate disease in adult animals which does not address the unique physiology and immunology that makes infants more susceptible. The perinatal (preterm and term) lamb is a useful model of infant RSV disease as lambs have similar pulmonary structure including airway branching, Clara and type II cells, submucosal glands and Duox/lactoperoxidase (LPO) oxidative system, and prenatal alveologenesis. Lambs can be born preterm (90% gestation) and survive for experimentation although both preterm and term lambs are susceptible to ovine, bovine and human strains of RSV and develop clinical symptoms including fever, tachypnea, and malaise as well as mild to moderate gross and histologic lesions including bronchiolitis with epithelial injury, neutrophil infiltration and syncytial cell formation. RSV disease in preterm lambs is more severe than in term lambs; disease is progressively less in adults and age-dependent susceptibility is a feature similar to humans. Innate and adaptive immune responses by perinatal lambs closely parallel those of infants. The model is used to test therapeutic regimens, risk factors such as maternal ethanol consumption, and formalin inactivated RSV vaccines. PMID:23202468

  9. Perinatal Safety: From Concept to Nursing Practice

    PubMed Central

    Kennedy, Holly Powell

    2010-01-01

    Communication and teamwork problems are leading causes of documented preventable adverse outcomes in perinatal care. An essential component of perinatal safety is the organizational culture in which clinicians work. Clinicians individual and collective authority to question the plan of care and take action to change the direction of a clinical situation in the patients best interest can be viewed as their agency for safety. However, collective agency for safety and commitment to support nurses in their advocacy role is missing in many perinatal care settings. This paper draws from Organizational Accident Theory, High Reliability Theory, and Symbolic Interactionism to describe the nurses role in maintaining safety during labor and birth in acute care settings, and suggests actions for supporting the perinatal nurse at individual, group, and systems levels to achieve maximum safety in perinatal care. PMID:20147827

  10. A literature review on integrated perinatal care

    PubMed Central

    Rodríguez, Charo; des Rivières-Pigeon, Catherine

    2007-01-01

    Context The perinatal period is one during which health care services are in high demand. Like other health care sub-sectors, perinatal health care delivery has undergone significant changes in recent years, such as the integrative wave that has swept through the health care industry since the early 1990s. Purpose The present study aims at reviewing scholarly work on integrated perinatal care to provide support for policy decision-making. Results Researchers interested in integrated perinatal care have, by assessing the effectiveness of individual clinical practices and intervention programs, mainly addressed issues of continuity of care and clinical and professional integration. Conclusions Improvements in perinatal health care delivery appear related not to structurally integrated health care delivery systems, but to organizing modalities that aim to support woman-centred care and cooperative clinical practice. PMID:17786177

  11. Prenatal and perinatal factors associated with intellectual disability.

    PubMed

    Bilder, Deborah A; Pinborough-Zimmerman, Judith; Bakian, Amanda V; Miller, Judith S; Dorius, Josette T; Nangle, Barry; McMahon, William M

    2013-03-01

    Prenatal and perinatal risk factors associated with intellectual disability (ID) were studied in 8-year-old Utah children from a 1994 birth cohort (N  =  26,108) using broad ascertainment methods and birth records following the most current recording guidelines. Risk factor analyses were performed inclusive and exclusive of children with a known or suspected underlying genetic disorder. Risk factors identified were poly/oligohydramnios, advanced paternal/maternal age, prematurity, fetal distress, premature rupture of membranes, primary/repeat cesarean sections, low birth weight, assisted ventilation greater than 30 min, small-for-gestational age, low Apgar scores, and congenital infection. Although several risk factors lost significance once children with underlying genetic disorders were excluded, socioeconomic variables were among those that maintained a prominent association with increased ID risk. PMID:23464612

  12. Diagnosis and acute management of perinatal arterial ischemic stroke

    PubMed Central

    Ferriero, Donna M.

    2014-01-01

    Summary Perinatal arterial ischemic stroke (PAIS) can be an unrecognized cause of short- and long-term neurologic disability. Focal clonic seizure in the newborn period is the most common clinical presentation of PAIS. MRI is optimal in diagnosing PAIS; negative cranial ultrasound or CT does not rule out PAIS. Given the low rate of recurrence in combination with risk factors thought to be isolated to the maternal-fetal unit, anticoagulation or antiplatelet treatment is usually not recommended. The majority of newborns with PAIS do not go on to develop epilepsy, although further research is warranted in this area. Long-term morbidity, including motor, cognitive, and behavioral disabilities, can follow PAIS, necessitating early recognition, diagnosis, and therapy initiation. PMID:25317375

  13. Perinatal Factors in Neonatal and Pediatric Lung Diseases

    PubMed Central

    Britt, Rodney D.; Faksh, Arij; Vogel, Elizabeth; Martin, Richard J.; Pabelick, Christina M.; Prakash, Y.S.

    2014-01-01

    Wheezing and asthma are significant clinical problems for infants and young children, particularly following premature birth. Recurrent wheezing in infants can progress to persistent asthma. As in adults, altered airway structure (remodeling) and function (increased bronchoconstriction) are also important in neonatal and pediatric airway diseases. Accumulating evidence suggests that airway disease in children is influenced by perinatal factors including perturbations in normal fetal lung development, postnatal interventions in the intensive care unit, and environmental and other insults in the neonatal period. Here, in addition to genetics, maternal health, environmental processes, innate immunity, and impaired lung development/function can all influence pathogenesis of airway disease in children. We summarize current understanding of how prenatal and postnatal factors can contribute to development of airway diseases in neonates and children. Understanding these mechanisms will help identify and develop novel therapies for childhood airway diseases. PMID:24090092

  14. Perinatal and background risk factors for childhood autism in central China.

    PubMed

    Duan, Guiqin; Yao, Meiling; Ma, Yating; Zhang, Wenjing

    2014-12-15

    Perinatal and background risk factors for autism were identified in a cohort of autistic children in Zhengzhou, China, to formulate preventative and treatment strategies for high-risk families. In this case-control study, children were screened for suspected autism using the Autism Behavior Checklist (ABC) and diagnosed according to DSM-IV and the Childhood Autism Rating Scale (CARS). We collected perinatal histories and clinical data of 286 confirmed autistic children treated at the Third Affiliated Hospital Children׳s Psychological Clinic of Zhengzhou University from 2011 to 2013. The control group consisted of 286 healthy children from area kindergartens. Maternal age>30 years, parental introversion as measured by the Eysenck Personality Questionnaire, low level of parental education, smoking, abortion threat, pregnancy complications, maternal illness during pregnancy, maternal mental health, family history of mental illness, neonatal jaundice, birth asphyxia, premature rupture of the fetal membrane, and gestational age<37 weeks were significantly higher in the autism group. These factors were significantly correlated with behavioral symptoms as measured by ABC scores (Kendall rank correlation). Birth asphyxia, neonatal jaundice, maternal age, parental introversion, family history of mental illness, abortion threat, premature delivery, and smoking were identified as independent risk factors by multivariate logistic regression. PMID:25085792

  15. Racial disparity in placental pathology in the collaborative perinatal project

    PubMed Central

    Chen, Yan; Huang, Lisu; Zhang, Huijuan; Klebanoff, Mark; Yang, Zujing; Zhang, Jun

    2015-01-01

    Objective: There is substantial disparity in perinatal outcomes between white and African-American women, but the underlying biological mechanisms are poorly understood. The placenta is the principal metabolic, respiratory, excretory, and endocrine organ of the fetus. We studied the association between maternal race and types and severity of placental pathology. Methods: Using data from the U.S. Collaborative Perinatal Project (1959-1966), we studied 32,295 African-American and white women with singleton births. CPP pathologists conducted detailed placental examinations following a standard protocol with quality control procedures. Logistic regression modeling was used to test the association between race and placental pathology adjusting for potential confounders. Results: Compared to white women, African-American women had a higher risk of fetal neutrophilic infiltration (adjusted odds ratio [aOR], 1.2; 95% confidence interval [CI], 1.0-1.4), and 1.5-fold higher risk of low placental weight (95% CI, 1.3-1.7). However, various placental vascular lesions were significantly less common in African-American women, including infarcts and thrombosis in the cut surface, villous infarcts in the intervillous space, emergence of stromal fibrosis and Langerhans layer in the terminal villi, old hemorrhage in the maternal surface, thrombosis in the intervillous space, and calcification throughout the cut surface (aOR ranging from 0.5 to 0.8). Similar patterns were observed in pregnancies with pregnancy associated hypertension, small-for-gestational-age, and preterm birth. Conclusion: As compared with white women, African-American had higher prevalence of inflammatory lesions but lower prevalence of vascular lesions in placental pathology. PMID:26823843

  16. Maternal Immunization

    PubMed Central

    Chu, Helen Y.; Englund, Janet A.

    2014-01-01

    Maternal immunization has the potential to protect the pregnant woman, fetus, and infant from vaccine-preventable diseases. Maternal immunoglobulin G is actively transported across the placenta, providing passive immunity to the neonate and infant prior to the infant's ability to respond to vaccines. Currently inactivated influenza, tetanus toxoid, and acellular pertussis vaccines are recommended during pregnancy. Several other vaccines have been studied in pregnancy and found to be safe and immunogenic and to provide antibody to infants. These include pneumococcus, group B Streptococcus, Haemophilus influenzae type b, and meningococcus vaccines. Other vaccines in development for potential maternal immunization include respiratory syncytial virus, herpes simplex virus, and cytomegalovirus vaccines. PMID:24799324

  17. Maternal phenylketonuria.

    PubMed

    Davidson, D C

    1989-01-01

    The exact mechanism of fetal damage in maternal phenylketonuria (PKU) is uncertain and although the fetus is heterozygotic for the gene coding for phenylalanine hydroxylase its immature hepatic enzyme system may be the reason for its inability to deal adequately with transplacental phenylalanine uptake. Several aspects of the management of maternal PKU are discussed and several case studies are presented. Dietary treatment should begin preconceptually despite evidence that post-conceptual treatment can have an acceptable outcome. Maternal recognition of the need for pre-conceptual treatment should increase with improvements in intellectual abilities of PKU girls resulting from neonatal screening and appropriate dietary management. PMID:2622813

  18. Maternal immunization.

    PubMed

    Chu, Helen Y; Englund, Janet A

    2014-08-15

    Maternal immunization has the potential to protect the pregnant woman, fetus, and infant from vaccine-preventable diseases. Maternal immunoglobulin G is actively transported across the placenta, providing passive immunity to the neonate and infant prior to the infant's ability to respond to vaccines. Currently inactivated influenza, tetanus toxoid, and acellular pertussis vaccines are recommended during pregnancy. Several other vaccines have been studied in pregnancy and found to be safe and immunogenic and to provide antibody to infants. These include pneumococcus, group B Streptococcus, Haemophilus influenzae type b, and meningococcus vaccines. Other vaccines in development for potential maternal immunization include respiratory syncytial virus, herpes simplex virus, and cytomegalovirus vaccines. PMID:24799324

  19. Effectiveness of an integrated approach to reduce perinatal mortality: recent experiences from Matlab, Bangladesh

    PubMed Central

    2011-01-01

    Background Improving perinatal health is the key to achieving the Millennium Development Goal for child survival. Recently, several reviews suggest that scaling up available effective perinatal interventions in an integrated approach can substantially reduce the stillbirth and neonatal death rates worldwide. We evaluated the effect of packaged interventions given in pregnancy, delivery and post-partum periods through integration of community- and facility-based services on perinatal mortality. Methods This study took advantage of an ongoing health and demographic surveillance system (HDSS) and a new Maternal, Neonatal and Child Health (MNCH) Project initiated in 2007 in Matlab, Bangladesh in half (intervention area) of the HDSS area. In the other half, women received usual care through the government health system (comparison area). The MNCH Project strengthened ongoing maternal and child health services as well as added new services. The intervention followed a continuum of care model for pregnancy, intrapartum, and post-natal periods by improving established links between community- and facility-based services. With a separate pre-post samples design, we compared the perinatal mortality rates between two periods--before (2005-2006) and after (2008-2009) implementation of MNCH interventions. We also evaluated the difference-of-differences in perinatal mortality between intervention and comparison areas. Results Antenatal coverage, facility delivery and cesarean section rates were significantly higher in the post- intervention period in comparison with the period before intervention. In the intervention area, the odds of perinatal mortality decreased by 36% between the pre-intervention and post-intervention periods (odds ratio: 0.64; 95% confidence intervals: 0.52-0.78). The reduction in the intervention area was also significant relative to the reduction in the comparison area (OR 0.73, 95% CI: 0.56-0.95; P = 0.018). Conclusion The continuum of care approach provided through the integration of service delivery modes decreased the perinatal mortality rate within a short period of time. Further testing of this model is warranted within the government health system in Bangladesh and other low-income countries. PMID:22151276

  20. Perinatal Mortality in the United States, 1950-81.

    ERIC Educational Resources Information Center

    Powell-Griner, Eve

    1986-01-01

    This report describes long-term trends in perinatal mortality in the United States in three basic parts: development of perinatal mortality measures, components of fetal and infant mortality, and trends and differentials in perinatal mortality. Perinatal deaths refer to the sum of spontaneous fetal deaths occurring after 20 weeks gestation plus…

  1. Perinatal inflammation: a common factor in the early origins of cardiovascular disease?

    PubMed

    Nguyen, Maria U; Wallace, Megan J; Pepe, Salvatore; Menheniott, Trevelyan R; Moss, Timothy J; Burgner, David

    2015-10-01

    Cardiovascular disease continues to be the leading cause of global morbidity and mortality. Traditional risk factors account for only part of the attributable risk. The origins of atherosclerosis are in early life, a potential albeit largely unrecognized window of opportunity for early detection and treatment of subclinical cardiovascular disease. There are robust epidemiological data indicating that poor intrauterine growth and/or prematurity, and perinatal factors such as maternal hypercholesterolaemia, smoking, diabetes and obesity, are associated with adverse cardiovascular intermediate phenotypes in childhood and adulthood. Many of these early-life risk factors result in a heightened inflammatory state. Inflammation is a central mechanism in the development of atherosclerosis and cardiovascular disease, but few studies have investigated the role of overt perinatal infection and inflammation (chorioamnionitis) as a potential contributor to cardiovascular risk. Limited evidence from human and experimental models suggests an association between chorioamnionitis and cardiac and vascular dysfunction. Early life inflammatory events may be an important mechanism in the early development of cardiovascular risk and may provide insights into the associations between perinatal factors and adult cardiovascular disease. This review aims to summarise current data on the early life origins of atherosclerosis and cardiovascular disease, with particular focus on perinatal inflammation. PMID:26223841

  2. Evaluating the Clinical Effectiveness of a Specialized Perinatal Psychiatry Inpatient Unit

    PubMed Central

    Meltzer-Brody, Samantha; Brandon, Anna R.; Pearson, Brenda; Burns, Lynne; Raines, Christena; Bullard, Elizabeth; Rubinow, David

    2013-01-01

    Women experiencing severe perinatal mental illness during pregnancy or postpartum have unique needs when psychiatric hospitalization is indicated. Although many countries have established mother-baby psychiatric units, similar facilities have not been available in the US. In 2011, the University of North Carolina at Chapel Hill inaugurated the first Perinatal Psychiatry Inpatient Unit (PPIU) in the US. We describe the unique characteristics of the patient population and report clinical outcomes guiding development and refinement of treatment protocols. Ninety-two perinatal patients were admitted between September 2011 and September 2012, and 91 completed self-report measures at admission and discharge. Perinatal unipolar mood disorder was the most frequent primary diagnosis (60.43%), and eleven patients (12%) were admitted with psychosis. The data document clinically and statistically significant improvements in symptoms of depression, anxiety and active suicidal ideation between admission and discharge (p < .0001), as assessed by the Edinburgh Postnatal Depression Scale, Patient Health Questionnaire, and Generalized Anxiety Disorder Scale. Overall functioning was also improved, demonstrated by a significant mean difference of −10.96 in total scores of the Work and Social Adjustment Scale (p < 0.0001). Data suggest that delivering specialized and targeted interventions for severe maternal mental illness in a safe and supportive setting produces positive patient outcomes. PMID:24201978

  3. Anxiety Disorders and Obsessive Compulsive Disorder Nine Months after Perinatal Loss

    PubMed Central

    Boggs, Martha E.; Muzik, Maria; Sen, Ananda

    2015-01-01

    Objective Perinatal loss (stillbirth after 20 weeks gestational age or infant death in the first month) impacts 1–2 infants per hundred live births in the United States and can be a devastating experience for parents. We assessed prevalence of anxiety disorders and obsessive compulsive disorder (OCD) among bereaved and live-birth mothers. Methods We collaborated with the Michigan Department of Public Health to survey Michigan mothers with perinatal death or live birth. We measured symptoms of generalized anxiety disorder, social phobia, panic disorder, and OCD using validated written self-report screens and collected data on maternal demographics, psychiatric history, social support, and intimate partner violence. Results 609/1400 mothers (44%) participated, returning surveys nine months post-delivery. 232 mothers had live birth and 377 had perinatal loss. In unadjusted analyses, bereaved mothers had higher odds of all four disorders. In logistic regression adjusted for covariates, bereaved mothers still had higher odds of moderate-severe generalized anxiety disorder (OR: 2.39, CI: 1.10–5.18, p=0.028) and social phobia (OR: 2.32, CI: 1.52–3.54, p<0.0005 but not panic disorder or OCD. Conclusion Bereaved mothers struggle with clinically-significant anxiety disorders in the first year after perinatal loss; improved identification and treatment are essential to improve mental health for this vulnerable population. PMID:25305711

  4. Impact of the Perinatal Environment on the Child's Development: Implications for Prevention Policies.

    PubMed

    Molenat, Françoise

    2015-01-01

    Basic emotional security is central to the construction of the child and has an impact on the brain's organisation, the personal autonomy and the capacity to explore the world. The key concept of the attachment theory is supported by recent neuroimaging findings of brain development and the structuring of the hypothalamic-pituitary-adrenal axonal regulatory systems.In addition to the child's potential, the essential variable lies in the quality of the environment's responses, and consequently in the quality of the maternal security, from the very early intrauterine life. The understanding of the effects of parental stress during the early developmental stages is advancing. In France, the emotional security of pregnant women and future parents has become a major stake of perinatal policies for the prevention of developmental disorders.Specific strategies are being developed to improve both the maternal and the infant well-being. These are not restricted only to mental health specialists but rather involve every health-care professional of the perinatal period. The mechanisms of change for vulnerable parents emerge from the prospective analysis of support methods. Continuity and coherence of such care serve as a holding function, which enables the restructuring of previous emotional traumas.A new interdisciplinary perinatal medicine is emerging, structured rigorously around a well-coordinated obstetrical and paediatric follow-up. Considering the future of children, teenagers and adults, the stakes are enormous. PMID:25287551

  5. Role of the Placenta in Adverse Perinatal Outcomes Among HIV-1 Seropositive Women

    PubMed Central

    Ackerman, William; Kwiek, Jesse J.

    2014-01-01

    Women seropositive for human immunodeficiency virus type 1 (HIV-1) are at an increased risk for a number of adverse perinatal outcomes. Although efforts to reduce mother-to-child transmission of HIV (MTCT) remain a priority in resource-limited countries, HIV testing and treatment have led to steep declines in MTCT in well-resourced countries. Even so, HIV seropositive pregnant women in the United States continue to deliver a disproportionately high number of preterm and low birth weight infants. In this mini-review, we address the role of the placenta in such HIV-related perinatal sequelae. We posit that adverse perinatal outcomes may result from two mutually non-exclusive routes: (1) HIV infection of the placenta proper, potentially leading to impaired maternal-fetal exchange; and (2) infection of the maternal decidual microenvironment, possibly disrupting normal placental implantation and development. Further research into the relationship between HIV-1 infection and placental pathology may lead to the development of novel strategies to improve birth outcomes among HIV-1 seropositive parturients. PMID:23657060

  6. Preventing the First Cesarean Delivery: Summary of a Joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, and American College of Obstetricians and Gynecologists Workshop

    PubMed Central

    Spong, Catherine Y.; Berghella, Vincenzo; Wenstrom, Katharine D.; Mercer, Brian M.; Saade, George R.

    2012-01-01

    With over one-third of pregnancies in the United States being delivered by cesarean and the growing knowledge of morbidities associated with repeat cesarean deliveries, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the Society for Maternal-Fetal Medicine, and the American College of Obstetricians and Gynecologists convened a workshop to address the concept of preventing the first cesarean. The available information on maternal and fetal factors, labor management and induction, and non-medical factors leading to the first cesarean were reviewed as well as the implications of the first cesarean on future reproductive health. Key points were identified to assist with reduction in cesarean rates including that labor induction should be performed primarily for medical indication; if done for non-medical indications, the gestational age should be at least 39 weeks or more and the cervix should be favorable, especially in the nulliparous patient. Review of the current literature demonstrates the importance of adhering to appropriate definitions for failed induction and arrest of labor progress. The diagnosis of “failed induction” should only be made after an adequate attempt. Adequate time for normal latent and active phases of the first stage, and for the second stage, should be allowed, as long as the maternal and fetal conditions permit. The adequate time for each of these stages appears to be longer than traditionally estimated. Operative vaginal delivery is an acceptable birth method when indicated, and can safely prevent cesarean delivery. Given the progressively declining use, it is critical that training and experience in operative vaginal delivery is facilitated and encouraged. When discussing the first cesarean with a patient, counseling should include its effect on future reproductive health. PMID:23090537

  7. Can maternal DHA supplementation offer long-term protection against neonatal hyperoxic lung injury?

    PubMed

    Lingappan, Krithika; Moorthy, Bhagavatula

    2015-12-15

    The effect of adverse perinatal environment (like maternal infection) has long-standing effects on many organ systems, including the respiratory system. Use of maternal nutritional supplements is an exciting therapeutic option that could be used to protect the developing fetus. In a recent issue of the journal, Ali and associates (Ali M, Heyob KM, Velten M, Tipple TE, Rogers LK. Am J Physiol Lung Cell Mol Physiol 309: L441-L448, 2015) specifically look at maternal docosahexaenoic acid (DHA) supplementation and its effect on chronic apoptosis in the lung in a mouse model of perinatal inflammation and postnatal hyperoxia. Strikingly, the authors show that pulmonary apoptosis was augmented even 8 wk after the hyperoxia-exposed mice had been returned to room air. This effect was significantly attenuated in mice that were subjected to maternal dietary DHA supplementation. These findings are novel, significantly advance our understanding of chronic effects of adverse perinatal and neonatal events on the developing lung, and thereby offer novel therapeutic options in the form of maternal dietary supplementation with DHA. This editorial reviews the long-term effects of adverse perinatal environment on postnatal lung development and the protective effects of dietary supplements such as DHA. PMID:26361877

  8. The effects of maternal depression and maternal selective serotonin reuptake inhibitor exposure on offspring

    PubMed Central

    Olivier, J. D. A.; Åkerud, H.; Kaihola, H.; Pawluski, J. L.; Skalkidou, A.; Högberg, U.; Sundström-Poromaa, I.

    2013-01-01

    It has been estimated that 20% of pregnant women suffer from depression and it is well-documented that maternal depression can have long-lasting effects on the child. Currently, common treatment for maternal depression has been the selective serotonin reuptake inhibitor medications (SSRIs) which are used by 2–3% of pregnant women in the Nordic countries and by up to 10% of pregnant women in the United States. Antidepressants cross the placenta and are transferred to the fetus, thus, the question arises as to whether children of women taking antidepressants are at risk for altered neurodevelopmental outcomes and, if so, whether the risks are due to SSRI medication exposure or to the underlying maternal depression. This review considers the effects of maternal depression and SSRI exposure on offspring development in both clinical and preclinical populations. As it is impossible in humans to study the effects of SSRIs without taking into account the possible underlying effects of maternal depression (healthy pregnant women do not take SSRIs), animal models are of great value. For example, rodents can be used to determine the effects of maternal depression and/or perinatal SSRI exposure on offspring outcomes. Unraveling the joint (or separate) effects of maternal depression and SSRI exposure will provide more insights into the risks or benefits of SSRI exposure during gestation and will help women make informed decisions about using SSRIs during pregnancy. PMID:23734100

  9. Identifying 'at risk' women and the impact of maternal obesity on National Health Service maternity services.

    PubMed

    Heslehurst, Nicola

    2011-11-01

    Obesity is a public health concern worldwide, arising from multifaceted and complex causes that relate to individual choice and lifestyle, and the influences of wider society. In addition to a long-standing focus on both childhood and adult obesity, there has been more recent concern relating to maternal obesity. This review explores the published evidence relating to maternal obesity incidence and associated inequalities, the impact of obesity on maternity services, and associated guidelines. Epidemiological data comprising three national maternal obesity datasets within the UK have identified a significant increase in maternal obesity in recent years, and reflect broad socio-demographic inequalities particularly deprivation, ethnicity and unemployment. Obese pregnancies present increased risk of complications that require more resource intensive antenatal and perinatal care, such as caesarean deliveries, gestational diabetes, haemorrhage, infections and congenital anomalies. Healthcare professionals also face difficulties when managing the care of women in pregnancy as obesity is an emotive and stigmatising topic. There is a lack of good-quality evidence for effective interventions to tackle maternal obesity. Recently published national guidelines for the clinical management and weight management of maternal obesity offer advice for professionals, but acknowledge the limitations of the evidence base. The consequence of these difficulties is an absence of support services available for women. Further evaluative research is thus required to assess the effectiveness of interventions with women before, during and after pregnancy. Qualitative work with women will also be needed to help inform the development of more sensitive risk communication and women-centred services. PMID:21854697

  10. Partner Support and Maternal Depression in the Context of the Iowa Floods

    PubMed Central

    Brock, Rebecca L.; O’Hara, Michael W.; Hart, Kimberly J.; McCabe, Jennifer E.; Williamson, J Austin; Laplante, David P.; Yu, Chunbo; King, Suzanne

    2014-01-01

    A systematic investigation of the role of prenatal partner support in perinatal maternal depression was conducted. Separate facets of partner support were examined (i.e., received support and support adequacy) and a multidimensional model of support was applied to investigate the effects of distinct types of support (i.e., informational, physical comfort, emotional/esteem, and tangible support). Both main and stress-buffering models of partner support were tested in the context of prenatal maternal stress resulting from exposure to a natural disaster. Questionnaire data were analyzed from N=145 partnered women using growth curve analytic techniques. Results indicate that received support interacts with maternal flood stress during pregnancy to weaken the association between stress and trajectories of maternal depression from pregnancy to 30 months postpartum. Support adequacy did not interact with stress, but was associated with levels of depressive symptoms controlling for maternal stress and received support. Results demonstrate the distinct roles of various facets and types of support for a more refined explanatory model of prenatal partner support and perinatal maternal depression. Results inform both main effect and stress buffering models of partner support as they apply to the etiology of perinatal maternal depression, and highlight the importance of promoting partner support during pregnancy that matches support preferences. PMID:25243576

  11. Maternal postprandial glucose levels and infant birth weight: the Diabetes in Early Pregnancy Study. The National Institute of Child Health and Human Development--Diabetes in Early Pregnancy Study.

    PubMed

    Jovanovic-Peterson, L; Peterson, C M; Reed, G F; Metzger, B E; Mills, J L; Knopp, R H; Aarons, J H

    1991-01-01

    The cause of macrosomia in the infant of the diabetic woman is still not completely defined. The National Institute of Child Health and Human Development--Diabetes in Early Pregnancy Study, which recruited insulin-dependent diabetic and control women before conception, provided an opportunity to address the relationship between maternal glycemia and percentile birth weight. Data were analyzed from 323 diabetic and 361 control women. Fasting and nonfasting venous plasma glucose were measured on alternate weeks in the first trimester and monthly thereafter. Glycosylated hemoglobin was measured weekly in the first trimester and monthly thereafter. More infants of the diabetic women were at or above the 90th percentile for birth weight than infants of control women (28.5% versus 13.1%, p less than 0.001). Although first-trimester nonfasting glucose and glycosylated hemoglobin levels were positively correlated with infant birth weight (p less than 0.001 and p = 0.008), when the analyses were adjusted for the variables of the subsequent trimesters the values became insignificant, whereas the third-trimester nonfasting glucose levels adjusted for values in prior trimesters emerged as the stronger predictor of percentile birth weight (p = 0.001). After adjusting for maternal hypertension, smoking, and ponderal index, the above relationships remained. In conclusion, monitoring of nonfasting glucose levels rather than the fasting levels, which are more commonly monitored in clinical practice, are necessary to prevent macrosomia. PMID:1986596

  12. Peritraumatic Distress Mediates the Effect of Severity of Disaster Exposure on Perinatal Depression: The Iowa Flood Study

    PubMed Central

    Brock, Rebecca L.; O’Hara, Michael W.; Hart, Kimberly J.; McCabe-Beane, Jennifer E.; Williamson, J. Austin; Brunet, Alain; Laplante, David P.; Yu, Chunbo; King, Suzanne

    2015-01-01

    Disaster exposure during pregnancy has received limited attention. This study examined the impact of the 2008 Iowa Floods on perinatal maternal depression and well-being, and the role of peritraumatic distress as a possible mechanism explaining this link. Perinatal women (N = 171) completed measures of depressive symptoms and general well-being at 5 timepoints from pregnancy to 30 months postpartum. Objectively assessed prenatal flood exposure was associated with greater depression (r = .15). Further, flood-related peritraumatic distress was uniquely associated with greater depression (r = .23), and was a key mechanism through which flood exposure led to depression. Prenatal flood exposure was also associated with general well-being (r = .18); however, a mechanism other than peritraumatic distress appears to have been responsible for the effect of flood exposure on well-being. We discuss the implications of these findings for informing etiological models and enhancing the efficacy of interventions for maternal psychopathology. PMID:26584403

  13. Peritraumatic Distress Mediates the Effect of Severity of Disaster Exposure on Perinatal Depression: The Iowa Flood Study.

    PubMed

    Brock, Rebecca L; O'Hara, Michael W; Hart, Kimberly J; McCabe-Beane, Jennifer E; Williamson, J Austin; Brunet, Alain; Laplante, David P; Yu, Chunbo; King, Suzanne

    2015-12-01

    Disaster exposure during pregnancy has received limited attention. This study examined the impact of the 2008 Iowa Floods on perinatal maternal depression and well-being, and the role of peritraumatic distress as a possible mechanism explaining this link. Perinatal women (N = 171) completed measures of depressive symptoms and general well-being at 5 timepoints from pregnancy to 30 months postpartum. Objectively assessed prenatal flood exposure was associated with greater depression (r = .15). Further, flood-related peritraumatic distress was uniquely associated with greater depression (r = .23), and was a key mechanism through which flood exposure led to depression. Prenatal flood exposure was also associated with general well-being (r = .18); however, a mechanism other than peritraumatic distress appears to have been responsible for the effect of flood exposure on well-being. We discuss the implications of these findings for informing etiological models and enhancing the efficacy of interventions for maternal psychopathology. PMID:26584403

  14. Developmental programming of brain and behavior by perinatal diet: focus on inflammatory mechanisms

    PubMed Central

    Bolton, Jessica L.; Bilbo, Staci D.

    2014-01-01

    Obesity is now epidemic worldwide. Beyond associated diseases such as diabetes, obesity is linked to neuropsychiatric disorders such as depression. Alarmingly maternal obesity and high-fat diet consumption during gestation/lactation may “program” offspring longterm for increased obesity themselves, along with increased vulnerability to mood disorders. We review the evidence that programming of brain and behavior by perinatal diet is propagated by inflammatory mechanisms, as obesity and high-fat diets are independently associated with exaggerated systemic levels of inflammatory mediators. Due to the recognized dual role of these immune molecules (eg, interleukin [IL]-6, 11-1β) in placental function and brain development, any disruption of their delicate balance with growth factors or neurotransmitters (eg, serotonin) by inflammation early in life can permanently alter the trajectory of fetal brain development. Finally, epigenetic regulation of inflammatory pathways is a likely candidate for persistent changes in metabolic and brain function as a consequence of the perinatal environment. PMID:25364282

  15. Proceedings of the XIIth World Congress of Perinatal Medicine, Madrid, Spain, 3-6 November 2015.

    PubMed

    Mariona, Federico G

    2016-03-01

    XIIth World Congress of Perinatal Medicine, Madrid, Spain, 3-6 November 2015 The World Association of Perinatal Medicine convened its XIIth meeting in Madrid, Spain, 3-6 November 2015. More than 3000 health professionals from the world over and 200 speakers presented up-to-date clinical and basic material related to the care of pregnant women, fetus and neonate. Preceding the formal Congress several individual mini courses were offered. They were well attended and the audience had the opportunity to relate very closely to the speakers, an issue of great importance for young clinicians to share relevant clinical information. The identification and alternative treatments of threatened preterm birth and the care of the growth restricted newborn occupied significant amount of the speakers' efforts. Obesity, postpartum hemorrhage, maternal infections and morbidly adherent placenta were also addressed. 4 days of intensive learning and experience sharing were the result. PMID:26935143

  16. Ethics education in neonatal-perinatal medicine in the United States.

    PubMed

    Salih, Zeynep N Inanc; Boyle, David W

    2009-12-01

    Neonatology is one of the specialties that has immensely benefited from advances in medical technology in the last few decades. These advances have paralleled the rise of the civil rights movements and wider recognition of individual rights. As a result, ethical decision-making has become more complex, involving patients, parents, members of the health care team, and society in general. This has created a need for formal ethics education in neonatal-perinatal medicine fellowship programs. In this article, we briefly explore the current published data on ethics education in pediatric residency and neonatal-perinatal medicine fellowship programs. Then, we discuss the questions an academic educator may face while developing an ethics curriculum in his/her medical institution. Finally, we present the ethics curriculum that we developed in our neonatal-perinatal medicine fellowship program. PMID:19914525

  17. Genetic analysis of malformations causing perinatal mortality.

    PubMed Central

    Young, I D; Rickett, A B; Clarke, M

    1986-01-01

    An analysis of congenital malformations, other than neural tube defects, which have contributed to perinatal mortality in Leicestershire is presented for the years 1976 to 1982 inclusive. Chromosomal, single gene, or polygenic inheritance accounted for 67% of cases. PMID:3950936

  18. Exposure to Pre- and Perinatal Risk Factors Partially Explains Mean Differences in Self-Regulation between Races

    PubMed Central

    Barnes, J. C.; Boutwell, Brian B.; Miller, J. Mitchell; DeShay, Rashaan A.; Beaver, Kevin M.; White, Norman

    2016-01-01

    Objectives To examine whether differential exposure to pre- and perinatal risk factors explained differences in levels of self-regulation between children of different races (White, Black, Hispanic, Asian, and Other). Methods Multiple regression models based on data from the Early Childhood Longitudinal Study, Birth Cohort (n ≈ 9,850) were used to analyze the impact of pre- and perinatal risk factors on the development of self-regulation at age 2 years. Results Racial differences in levels of self-regulation were observed. Racial differences were also observed for 9 of the 12 pre-/perinatal risk factors. Multiple regression analyses revealed that a portion of the racial differences in self-regulation was explained by differential exposure to several of the pre-/perinatal risk factors. Specifically, maternal age at childbirth, gestational timing, and the family’s socioeconomic status were significantly related to the child’s level of self-regulation. These factors accounted for a statistically significant portion of the racial differences observed in self-regulation. Conclusions The findings indicate racial differences in self-regulation may be, at least partially, explained by racial differences in exposure to pre- and perinatal risk factors. PMID:26882110

  19. Genetic and perinatal effects of abused substances

    SciTech Connect

    Brande, M.C.; Zimmerman, A.M.

    1987-01-01

    This book provides an overview of the effects of several abused drugs, including opiates, cannabinoids, alcohol, nicotine, and cocaine, with special emphasis on the actions of these substances at the molecular and cellular levels. The first half deals with genetic effects, including molecular genetics, biochemical genetics, pharmacogenetics, cytogenetics, and genetic toxicity. The second half focuses on perinatal effects and covers: drug abuse during pregnancy; biochemical aspects of marihuana on male reproduction; and long-term behavioral and neuroendocrine effects of perinatal alcohol exposure.

  20. More similar than you think: Frog metamorphosis as a model of human perinatal endocrinology.

    PubMed

    Buchholz, Daniel R

    2015-12-15

    Hormonal control of development during the human perinatal period is critically important and complex with multiple hormones regulating fetal growth, brain development, and organ maturation in preparation for birth. Genetic and environmental perturbations of such hormonal control may cause irreversible morphological and physiological impairments and may also predispose individuals to diseases of adulthood, including diabetes and cardiovascular disease. Endocrine and molecular mechanisms that regulate perinatal development and that underlie the connections between early life events and adult diseases are not well elucidated. Such mechanisms are difficult to study in uterus-enclosed mammalian embryos because of confounding maternal effects. To elucidate mechanisms of developmental endocrinology in the perinatal period, Xenopus laevis the African clawed frog is a valuable vertebrate model. Frogs and humans have identical hormones which peak at birth and metamorphosis, have conserved hormone receptors and mechanisms of gene regulation, and have comparable roles for hormones in many target organs. Study of molecular and endocrine mechanisms of hormone-dependent development in frogs is advantageous because an extended free-living larval period followed by metamorphosis (1) is independent of maternal endocrine influence, (2) exhibits dramatic yet conserved developmental effects induced by thyroid and glucocorticoid hormones, and (3) begins at a developmental stage with naturally undetectable hormone levels, thereby facilitating endocrine manipulation and interpretation of results. This review highlights the utility of frog metamorphosis to elucidate molecular and endocrine actions, hormone interactions, and endocrine disruption, especially with respect to thyroid hormone. Knowledge from the frog model is expected to provide fundamental insights to aid medical understanding of endocrine disease, stress, and endocrine disruption affecting the perinatal period in humans. PMID:25744725

  1. Effects of early maternal employment on maternal health and well-being

    PubMed Central

    Markowitz, Sara; Brooks-Gunn, Jeanne

    2012-01-01

    This study uses data from the National Institute of Child Health and Human Development Study on Early Child Care to examine the effects of maternal employment on maternal mental and overall health, self-reported parenting stress, and parenting quality. These outcomes are measured when children are 6 months old. Among mothers of 6-month-old infants, maternal work hours are positively associated with depressive symptoms and parenting stress and negatively associated with self-rated overall health. However, maternal employment is not associated with quality of parenting at 6 months, based on trained assessors’ observations of maternal sensitivity. PMID:23645972

  2. Maternity waiting facilities for improving maternal and neonatal outcome in low-resource countries

    PubMed Central

    van Lonkhuijzen, Luc; Stekelenburg, Jelle; van Roosmalen, Jos

    2014-01-01

    Background A maternity waiting home (MWH) is a facility within easy reach of a hospital or health centre which provides emergency obstetric care (EmOC). Women may stay in the MWH at the end of their pregnancy and await labour. Once labour starts, women move to the health facility so that labour and giving birth can be assisted by a skilled birth attendant. The aim of the MWH is to improve accessibility to skilled care and thus reduce morbidity and mortality for mother and neonate should complications arise. Some studies report a favourable effect on the outcomes for women and their newborns. Others show that utilisation is low and barriers exist. However, these data are limited in their reliability. Objectives To assess the effects of a maternity waiting facility on maternal and perinatal health. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (27 January 2012), CENTRAL (The Cochrane Library 2011, Issue 4 of 4), MEDLINE (1966 to January 2012), EMBASE (1980 to January 2012), CINAHL (1982 to January 2012), African Journals Online (AJOL) (January 2012), POPLINE (January 2012), Dissertation Abstracts (January 2012) and reference lists of retrieved papers. Selection criteria Randomised controlled trials including quasi-randomised and cluster-randomised trials that compared perinatal and maternal outcome in women using a MWH and women who did not. Data collection and analysis There were no randomised controlled trials or cluster-randomised trials identified from the search. Main results There were no randomised controlled trials or cluster-randomised trials identified from the search. Authors’ conclusions There is insufficient evidence to determine the effectiveness of maternity waiting facilities for improving maternal and neonatal outcomes. PMID:23076927

  3. Perinatal inflammation and lung injury.

    PubMed

    Viscardi, Rose Marie

    2012-02-01

    Bronchopulmonary dysplasia (BPD) remains the major morbidity of extreme preterm birth. The incidence of BPD has remained stable despite recent efforts to reduce postnatal exposures to volutrauma and hyperoxia. This review will focus on recent clinical and experimental insights that provide support for the concept that the 'new BPD' is the result of inflammation-mediated injury and altered lung development during a window of vulnerability in genetically susceptible infants that is modified by maternal and postnatal exposures. PMID:21855435

  4. Circulating levels of fibrin/fibrinogen degradation fragment E in normal pregnancy, and in association with intrauterine growth retardation and perinatal asphyxia.

    PubMed

    Gordon, Y B; Ratky, S M; Sola, C M; Lewis, J; Baker, L R; Chard, T

    1975-12-01

    Levels of fibrin/fibrinogen degradation products have been measured by aspecific and sensitive radioimmunoassay for degradation fragment E (FgE) in pregnant patients. Maternal FgE levels rose from the 16th week reaching a plateau at the 36th week in normal pregnancy. There was no correlation between maternal FgE levels and maternal age, parity or the occurrence of perinatal asphyxia. A minority of patients (5 per cent) with evidence of intrauterine growth retardation showed prolonged elevation of FgE levels. PMID:1203212

  5. Maternal nutrition in pregnancy. Part I: a review.

    PubMed Central

    Leader, A.; Wong, K. H.; Deitel, M.

    1981-01-01

    Maternal undernutrition may result in a greater deprivation of the fetus than has previously been believed. The infant not only may be "light for dates" but also has an increased risk of perinatal disability or death secondary to gross neurologic and developmental abnormalities. This article reviews current knowledge of the energy, protein, iron, vitamin, sodium and calcium requirements in pregnancy, with special reference to the management of the underweight and overweight pregnant women. PMID:7026013

  6. Therapeutic Targets for Neurodevelopmental Disorders Emerging from Animal Models with Perinatal Immune Activation

    PubMed Central

    Ibi, Daisuke; Yamada, Kiyofumi

    2015-01-01

    Increasing epidemiological evidence indicates that perinatal infection with various viral pathogens enhances the risk for several psychiatric disorders. The pathophysiological significance of astrocyte interactions with neurons and/or gut microbiomes has been reported in neurodevelopmental disorders triggered by pre- and postnatal immune insults. Recent studies with the maternal immune activation or neonatal polyriboinosinic polyribocytidylic acid models of neurodevelopmental disorders have identified various candidate molecules that could be responsible for brain dysfunction. Here, we review the functions of several candidate molecules in neurodevelopment and brain function and discuss their potential as therapeutic targets for psychiatric disorders. PMID:26633355

  7. Murine model: maternal administration of stem cells for prevention of prematurity

    PubMed Central

    Lei, Jun; Firdaus, Wance; Rosenzweig, Jason M.; Alrebh, Shorouq; Bakhshwin, Ahmed; Borbiev, Talaibek; Fatemi, Ali; Blakemore, Karin; Johnston, Michael V.; Burd, Irina

    2016-01-01

    OBJECTIVE Using a mouse model of intrauterine inflammation, we have demonstrated that exposure to inflammation induces preterm birth and perinatal brain injury. Mesenchymal stem cells (MSCs) have been shown to exhibit immunomodulatory effects in many inflammatory conditions. We hypothesized that treatment with human adipose tissue-derived MSCs may decrease the rate of preterm birth and perinatal brain injury through changes in antiinflammatory and regulatory milieu. STUDY DESIGN A mouse model of intrauterine inflammation was used with the following groups: (1) control; (2) intrauterine inflammation (lipopolysaccharide); and (3) intrauterine lipopolysaccharide + intraperitoneal (MSCs). Preterm birth was investigated. Luminex multiplex enzyme-linked immunosorbent assays were performed for protein levels of cytokines in maternal and fetal compartments. Immunofluorescent staining was used to identify and localize MSCs and to examine microglial morphologic condition and neurotoxicity in perinatal brain. Behavioral testing was performed at postnatal day 5. RESULTS Pretreatment with MSCs significantly decreased the rate of preterm birth by 21% compared with the lipopolysaccharide group (P < .01). Pretreatment was associated with increased interleukin-10 in maternal serum, increased interleukin-4 in placenta, decreased interleukin-6 in fetal brain (P < .05), decreased microglial activation (P < .05), and decreased fetal neurotoxicity (P < .05). These findings were associated with improved neurobehavioral testing at postnatal day 5 (P < .05). Injected MSCs were localized to placenta. CONCLUSION Maternally administered MSCs appear to modulate maternal and fetal immune response to intrauterine inflammation in the model and decrease preterm birth, perinatal brain injury, and motor deficits in offspring mice. PMID:25555657

  8. Clinical characteristics and perinatal outcome of fetal hydrops

    PubMed Central

    Yeom, Wonkyung; Paik, E Sun; An, Jung-Joo; Oh, Soo-young; Roh, Cheong-Rae; Kim, Jong-Hwa

    2015-01-01

    Objective To investigate the clinical characteristics of fetal hydrops and to find the antenatal ultrasound findings predictive of adverse perinatal outcome. Methods This is a retrospective study of 42 women with fetal hydrops who delivered in a tertiary-referral center from 2005 to 2013. Fetal hydrops was defined as the presence of fluid collection in ≥2 body cavities: ascites, pleural effusion, pericardial effusion, and skin edema. Predictor variables recorded included: maternal characteristics, gestational age at diagnosis, ultrasound findings, and identifiable causes. Primary outcome variables analyzed were fetal death and neonatal death. Results The mean gestational age at diagnosis was 29.3±5.4 weeks (range, 18 to 39 weeks). The most common identifiable causes were cardiac abnormality (10), followed by syndrome (4), aneuploidy (3), congenital infection (3), twin-to-twin transfusion syndrome (3), non-cardiac anormaly (2), chorioangioma (2), inborn errors of metabolism (1), and immune hydrops by anti-E antibody isoimmunization (1). Thirteen cases had no definite identifiable causes. Three women elected termination of pregnancy. Fetal death occurred in 4 cases. Among the 35 live-born babies, only 16 survived (54.0% neonatal mortality rate). Fetal death and neonatal mortality rate was not significantly associated with Doppler velocimetry indices or location of fluid collection, but increasing numbers of fluid collection site was significantly associated with a higher risk of neonatal death. Conclusion The incidence of fetal hydrops in our retrospective study was 24.4 per 10,000 deliveries and the perinatal mortality rate was 61.9% (26/42). The number of fluid collection sites was the significant antenatal risk factor to predict neonatal death. PMID:25798421

  9. The Aboriginal Maternal and Infant Health Service: a decade of achievement in the health of women and babies in NSW.

    PubMed

    Murphy, Elisabeth; Best, Elizabeth

    2012-06-01

    The Aboriginal Maternal and Infant Health Service was established to improve the health of Aboriginal women during pregnancy and decrease perinatal morbidity and mortality for Aboriginal babies. The Service is delivered through a continuity-of-care model, where midwives and Aboriginal Health Workers collaborate to provide a high quality maternity service that is culturally sensitive, women centred, based on primary health-care principles and provided in partnership with Aboriginal people. An evaluation of the Service found that the program is achieving its goals in relation to the provision of antenatal and postnatal care and has demonstrated improvements in perinatal morbidity and mortality rates. PMID:22697102

  10. Perinatal Practices & Traditions Among Asian Indian Women.

    PubMed

    Goyal, Deepika

    2016-01-01

    As the population in the United States grows more diverse, nurses caring for childbearing women must be aware of the many cultural traditions and customs unique to their patients. This knowledge and insight supports women and their families with the appropriate care, information, and resources. A supportive relationship builds trust, offers guidance, and allows for the new family to integrate information from nurses and other healthcare providers with the practice of certain perinatal cultural traditions. The Asian Indian culture is rich in tradition, specifically during the perinatal period. To support the cultural beliefs and practices of Asian Indian women during this time, nurses need to be aware of and consider multiple factors. Many women are navigating the new role of motherhood while making sense of and incorporating important cultural rituals. The purpose of this article is to provide an overview of perinatal cultural practices and traditions specific to the Asian Indian culture that perinatal nurses may observe in the clinical setting. Cultural traditions and practices specific to the pregnancy and postpartum period are described together with symbolism and implications for nursing practice. It is important to note that information regarding perinatal customs is provided in an effort to promote culturally sensitive nursing care and may not pertain to all Asian Indian women living in the United States. PMID:26909722

  11. Neonatal-perinatal medicine: Diseases of the fetus and infant

    SciTech Connect

    Fanaroff, A.A.; Martin, R.J.

    1987-01-01

    This book consists of 40 chapters. Some of the chapter titles are: Perinatal services and resources; Diabetes in pregnancy; Erythroblastosis fetalis; Placental pathology; Genetic disease and chromosomal abnormalities; Perinatal ultrasound; and Diagnostic imaging.

  12. Maternal immunization.

    PubMed

    Glezen, W P; Alpers, M

    1999-02-01

    Maternal immunization can enhance passive immunity of infants to pathogens that cause life-threatening illnesses. In most instances, immunization during pregnancy will provide important protection for the woman as well as for her offspring. The tetanus toxoid and influenza vaccines are examples of vaccines that provide a double benefit. Other vaccines under evaluation include those for respiratory syncytial virus, pneumococci, group B streptococci, and Haemophilus influenzae type b. Although most IgG antibody crosses the placenta in the third trimester, the process is time-dependent, dictating that immunization should be accomplished ideally at least 6 weeks prior to delivery. IgG1 antibodies are transferred preferentially. Maternal immunization has not interfered with active immunization of the infant. Inactivated vaccines administered in the third trimester of pregnancy pose no known risk to the woman or to her fetus. PMID:10064230

  13. Maternal-fetal medicine--how can we practically connect the "M" to the "F"?

    PubMed

    Hod, Moshe; Lieberman, Nicky

    2015-02-01

    Maternal-fetal medicine (MFM) is a multidisciplinary subspecialty dedicated to optimization of pregnancy and perinatal outcomes. MFM utilizes novel technologies for diagnostics and treatments in order to optimize obstetrical care and pregnancy outcome. Although defined as maternal and fetal medicine, originally aiming to equally address fetal and/or maternal issues, in reality the main focus of MFM has been shifted from improving maternal outcome and preventing maternal short- and long-term complications to improving fetal and neonatal outcome. In this article, we address the lack of communication between the two subspecialties and propose a resolution that will bridge the discrepancies by proposing to connect the leading hypotheses in MFM and in fetal medicine to those in maternal medicine. PMID:25225060

  14. Causes of death and associated conditions (Codac) – a utilitarian approach to the classification of perinatal deaths

    PubMed Central

    Frøen, J Frederik; Pinar, Halit; Flenady, Vicki; Bahrin, Safiah; Charles, Adrian; Chauke, Lawrence; Day, Katie; Duke, Charles W; Facchinetti, Fabio; Fretts, Ruth C; Gardener, Glenn; Gilshenan, Kristen; Gordijn, Sanne J; Gordon, Adrienne; Guyon, Grace; Harrison, Catherine; Koshy, Rachel; Pattinson, Robert C; Petersson, Karin; Russell, Laurie; Saastad, Eli; Smith, Gordon CS; Torabi, Rozbeh

    2009-01-01

    A carefully classified dataset of perinatal mortality will retain the most significant information on the causes of death. Such information is needed for health care policy development, surveillance and international comparisons, clinical services and research. For comparability purposes, we propose a classification system that could serve all these needs, and be applicable in both developing and developed countries. It is developed to adhere to basic concepts of underlying cause in the International Classification of Diseases (ICD), although gaps in ICD prevent classification of perinatal deaths solely on existing ICD codes. We tested the Causes of Death and Associated Conditions (Codac) classification for perinatal deaths in seven populations, including two developing country settings. We identified areas of potential improvements in the ability to retain existing information, ease of use and inter-rater agreement. After revisions to address these issues we propose Version II of Codac with detailed coding instructions. The ten main categories of Codac consist of three key contributors to global perinatal mortality (intrapartum events, infections and congenital anomalies), two crucial aspects of perinatal mortality (unknown causes of death and termination of pregnancy), a clear distinction of conditions relevant only to the neonatal period and the remaining conditions are arranged in the four anatomical compartments (fetal, cord, placental and maternal). For more detail there are 94 subcategories, further specified in 577 categories in the full version. Codac is designed to accommodate both the main cause of death as well as two associated conditions. We suggest reporting not only the main cause of death, but also the associated relevant conditions so that scenarios of combined conditions and events are captured. The appropriately applied Codac system promises to better manage information on causes of perinatal deaths, the conditions associated with them, and the most common clinical scenarios for future study and comparisons. PMID:19515228

  15. Impact of antenatal depression on perinatal outcomes and postpartum depression in Korean women

    PubMed Central

    Choi, Sae Kyung; Park, Yong Gyu; Park, In Yang; Ko, Hyun Sun; Shin, Jong Chul

    2014-01-01

    Background: Maternal prenatal mental health has been shown to be associated with adverse consequences for the mother and the child. However, studies considering the effect of prenatal depressive symptoms are lacking. The aim of this study was to examine the influence of antenatal depressive symptoms on obstetric outcomes and to determine associations between antenatal and postpartum depressions. Materials and Methods: This was a prospective cohort study. The Edinburgh postnatal depression scale (EPDS) questionnaire was completed by pregnant women receiving obstetrical care at Seoul St. Mary's hospital in the third trimester of gestation. The electronic medical records were reviewed after delivery and perinatal outcomes were evaluated. The association between antenatal and postpartum depression was analyzed using the EPDS questionnaire, which was completed by the same women within 2 months of delivery. Results: Of the 467 participants, 26.34% (n = 123) had antenatal depressive symptoms, with EPDS scores of ≥10. There were no significant perinatal outcomes associated with antenatal depressive symptoms. During the postpartum period, 192 of the women in the initial study cohort were given the EPDS again as a follow-up. Of the 192 participants, 56 (29.17%) scored >10. Spearman correlation coefficient between the antenatal and postpartum EPDS scores was 0.604, which was statistically significant (P < 0.001). Conclusion: Antenatal depression does not lead to unfavorable perinatal outcomes. However, screening for antenatal depression may be helpful to identify women at risk of postpartum depression. PMID:25535492

  16. Classification of perinatal and late neonatal deaths in Iceland. A survey from a defined population.

    PubMed

    Georgsdóttir, I; Geirsson, R T; Jóhannsson, J H; Biering, G; Snaedal, G

    1989-01-01

    A retrospective case record analysis of all perinatal and late neonatal deaths in Iceland in the periods 1976-80 and 1981-85 was done and the causes of death classified according to the extended Aberdeen classification. There was a significant (p less than 0.0001) reduction in number of deaths between the two periods with perinatal mortality rates declining from 10.6/1000 in 1976-80 to 6.8/1000 in 1981-85. In 1976-80 there were 81 (33%) antepartum, 37 (15%) intrapartum and 128 (52%) neonatal deaths compared to 61 (38%) antepartum, 13 (8%) intrapartum and 86 (54%) neonatal deaths in 1981-85. Fetal abnormality was the most common cause of death in both periods followed by the category Low birthweight in 1976-80. In 1981-85 increased morphological detection of infection in infants of very low birthweight by placental examination and autopsies lead to a shift from the category Low birthweight to Maternal Disease, the second most common cause in that period. To achieve lower perinatal mortality rates efforts should be directed towards lowering antepartum losses near term and increasing survival of very low birthweight infants. PMID:2589036

  17. Hospital-based perinatal outcomes and complications in teenage pregnancy in India.

    PubMed

    Mukhopadhyay, Prianka; Chaudhuri, R N; Paul, Bhaskar

    2010-10-01

    Teenage pregnancy is a worldwide problem bearing serious social and medical implications relating to maternal and child health. A cross-sectional observational study was undertaken to compare the different sociodemographic characteristics and perinatal outcomes of teenage primigravida mothers with those of adult primigravida mothers in a tertiary-care hospital in eastern India. A sample of 350 each in cases and comparison group comprised the study subjects. Data were collected through interviews and by observations using a pretested and predesigned schedule. Results revealed that the teenage mothers had a higher proportion (27.7%) of preterm deliveries compared to 13.1% in the adult mothers and had low-birthweight babies (38.9% vs 30.4% respectively). Stillbirth rate was also significantly higher in teenage deliveries (5.1% vs 0.9% respectively). The teenage mothers developed more adverse perinatal complications, such as preterm births, stillbirths, neonatal deaths, and delivered low-birthweight babies, when compared with those of the adult primigravida mothers. Teenage pregnancy is still a rampant and important public-health problem in India with unfavourable perinatal outcomes and needs to be tackled on a priority basis. PMID:20941901

  18. Perinatal Outcomes of Uninsured Immigrant, Refugee and Migrant Mothers and Newborns Living in Toronto, Canada

    PubMed Central

    Wilson-Mitchell, Karline; Rummens, Joanna Anneke

    2013-01-01

    Canadian healthcare insurance is not universal for all newcomer populations. New immigrant, refugee claimant, and migrant women face various barriers to healthcare due to the lack of public health insurance coverage. This retrospective study explored the relationships between insurance status and various perinatal outcomes. Researchers examined and compared perinatal outcomes for 453 uninsured and provincially insured women who delivered at two general hospitals in the Greater Toronto Area between 2007 and 2010. Data on key perinatal health indicators were collected via chart review of hospital medical records. Comparisons were made with regional statistics and professional guidelines where available. Four-in-five uninsured pregnant women received less-than-adequate prenatal care. More than half of them received clearly inadequate prenatal care, and 6.5% received no prenatal care at all. Insurance status was also related to the type of health care provider, reason for caesarean section, neonatal resuscitation rates, and maternal length of hospital stay. Uninsured mothers experienced a higher percentage of caesarian sections due to abnormal fetal heart rates and required more neonatal resuscitations. No significant difference was found for low birth weight, preterm birth, NCIU admissions, postpartum hemorrhage, breast feeding, or intrapartum care provided. PMID:23727901

  19. Parents Experiencing Perinatal Loss: The Physician's Role

    PubMed Central

    Swanson, Richard W.

    1986-01-01

    The three cases presented in this article highlight some of the problems that family physicians encounter when their patients experience perinatal loss. By understanding the process of normal grieving, the family physician can help prevent pathological grief reactions. With cooperation from other members of the perinatal support team, the family doctor can keep parents informed, teach them about the grieving process, support them in seeing and touching the infant, arrange for photographs of the infant, discuss autopsy and funeral arrangements, and help them inform siblings. PMID:21267157

  20. A Psychoneuroimmunologic Examination of Cumulative Perinatal Steroid Exposures and Preterm Infant Behavioral Follow-Up

    PubMed Central

    Purdy, Isabell B.; Smith, Lynne; Wiley, Dorothy; Badr, Lina

    2014-01-01

    Purpose This studys aim was to explore relationships between preterm infant behavioral outcomes and maternal/infant glucocorticoid (dexamethasone [DEX]) treatments using a psychoneuroimmunologic approach. Research questions were (a) do relationships exist between infant cumulative perinatal steroid (PNS) exposure and child behavioral problems? and (b) do maternal/infant characteristics (e.g., immune markers and biophysiologic stressors) influence these relationships? Methods The convenience sample comprised 45 motherchild dyads in which the children (mean age 8 years 2.3) had been born at a mean postconceptional age of 28 weeks ( 4.2). We used the Child Behavior Checklist (CBCL) to assess behavior, the Clinical Risk Index for Babies (CRIB) to score stress at birth, and retrospective record review to identify additional perinatal factors (PNS dosage, sepsis, and maternal and infant complete blood counts near delivery). Results Children were dichotomized into high (> 0.2mg/kg; n = 20) versus lowno (? 0.2 mg/kg; n = 25) PNS exposure groups. Significant relationships existed between CBCL Total Problems score and sepsis, PNS exposure, timing of initial PNS, and infant length percentile at discharge. Competence problems were significantly associated with PNS, neonatal intensive care unit (NICU) infant length percentile, CRIB score, sepsis, retinopathy of prematurity, hearing deficit, and immunity markers (i.e., maternal lymphocyte percentage and infant band/seg ratio). Children in the higher PNS group exhibited more behavioral problems (e.g., withdrawn, attention, conduct, social, and rule breaking problems), but there were no significant differences. The findings are reassuring regarding long-term effects of this PNS dose on preterm infant behavioral outcomes. PMID:21900308

  1. Trajectories of Maternal Depressive Symptoms, Maternal Sensitivity, and Children's Functioning at School Entry

    ERIC Educational Resources Information Center

    Campbell, Susan B.; Matestic, Patricia; von Stauffenberg, Camilla; Mohan, Roli; Kirchner, Thomas

    2007-01-01

    Using data from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development, the authors modeled trajectories of maternal depressive symptoms from infant age 1 month to 7 years. The authors identified 6 trajectories of maternal depressive symptoms: high-chronic, moderate-increasing, high-decreasing,…

  2. Social exclusion, infant behavior, social isolation, and maternal expectations independently predict maternal depressive symptoms

    PubMed Central

    Eastwood, John; Jalaludin, Bin; Kemp, Lynn; Phung, Hai; Barnett, Bryanne; Tobin, Jacinta

    2013-01-01

    The objective of the study was to identify latent variables that can be used to inform theoretical models of perinatal influences on postnatal depressed mood and maternal–infant attachment. A routine survey of mothers with newborn infants was commenced in South Western Sydney in 2000. The survey included the Edinburgh Postnatal Depression Scale (EPDS) and 46 psychosocial and health-related variables. Mothers (n = 15,389) delivering in 2002 and 2003 were surveyed at 2–3 weeks for depressive symptoms. Nonlinear principal components analysis was undertaken to identify dimensions that might represent latent variables. Correlations between latent variables and EPDS >12 were assessed by logistic regression. A five-dimension solution was identified, which accounted for 51% of the variance among the items studied. The five dimensions identified were maternal responsiveness, social exclusion, infant behavior, migrant social isolation, and family size. In addition, the variable maternal expectation contributed significantly to total variance and was included in the regression analysis. Regression on EPDS >12 was predictive for all variables except for maternal responsiveness, which was considered an outcome variable. The findings are consistent with the proposition that social exclusion, infant behavior, social isolation among migrant mothers, and maternal expectations are determinants of maternal mood. PMID:23408743

  3. Maternal Exposure to Synthetic Chemicals and Obesity in the Offspring: Recent Findings.

    PubMed

    Liu, Yun; Peterson, Karen E

    2015-12-01

    Experimental studies suggest perinatal exposures to synthetic chemicals may be associated with early onset obesity, although this hypothesis has not been extensively examined in humans. This article summarizes the evidence relating maternal perinatal exposure to common persistent organic compounds (polychlorinated biphenyl, dichlorodiphenyldichloroethylene, dichlorodiphenyltrichloroethane, hexachlorobenzene, hexachlorocyclohexane), perfluoroalkyls, perfluorooctane sulfonate, polybrominated diphenyl ethers and tributyltin, and nonpersistent compounds (phthalates, bisphenol A) on child obesity during sensitive developmental periods. Twenty-two epidemiologic studies published from 2011 to 2015 offer inconsistent support for the obesogenic effects of most substances and are limited by relatively small sample sizes and indirect measures of adiposity. The clearest findings suggest an influence of maternal dichlorodiphenyldichloroethylene exposure on offspring overweight and obesity. Recommendations for future epidemiological research include longer follow-up of effects of pre- and postnatal exposures in large samples; utilization of direct measures of adiposity; and consideration of effect modification by sex, birth weight, dietary fat, and maternal weight status. PMID:26403844

  4. Maternal and Child Health, FY 1983. Special Report to Congress.

    ERIC Educational Resources Information Center

    National Inst. of Child Health and Human Development (NIH), Bethesda, MD.

    Providing several examples of current research efforts, this report describes the research on maternal and child health supported by the National Institute of Child Health and Human Development (NICHD). The Institute conducts a coordinated program of research and research training to advance knowledge related to pregnancy and maternal health,…

  5. [Adverse perinatal and infant outcomes among children born to mothers with major mental disorders in a psychiatric hospital in Rio de Janeiro, Brazil].

    PubMed

    Pereira, Priscila Krauss; Vieira, Cludia Lima; Santos, Jacqueline Fernandes de Cintra; Lima, Lcia Abelha; Legay, Letcia Fortes; Lovisi, Giovanni Marcos

    2014-08-01

    Adverse perinatal and infant outcomes are the leading causes of infant morbidity and mortality in developing countries like Brazil. Among the risk factors are maternal mental disorders. A retrospective longitudinal study was conducted based on passive follow-up using probabilistic record linkage to estimate the prevalence of adverse perinatal and infant outcomes in children of women admitted to a public psychiatric hospital in Rio de Janeiro, Brazil, and who gave birth from 1999 to 2009. Prevalence rates were: low birth weight (27.6%), prematurity (17.4%), malformations (2.5%), stillbirths (4.8%), and neonatal deaths (3.7%). Associated factors were deficient prenatal care, schizophrenia, and low income. The results corroborate the high prevalence of adverse perinatal and infant outcomes in mothers with major mental disorders, and that screening of psychiatric symptoms and specialized care by mental health professionals are essential throughout prenatal and postpartum care. PMID:25210906

  6. Dynamic Metabolic Disruption in Rats Perinatally Exposed to Low Doses of Bisphenol-A

    PubMed Central

    Tremblay-Franco, Marie; Cabaton, Nicolas J.; Canlet, Cécile; Gautier, Roselyne; Schaeberle, Cheryl M.; Jourdan, Fabien; Sonnenschein, Carlos; Vinson, Florence; Soto, Ana M.; Zalko, Daniel

    2015-01-01

    Along with the well-established effects on fertility and fecundity, perinatal exposure to endocrine disrupting chemicals, and notably to xeno-estrogens, is strongly suspected of modulating general metabolism. The metabolism of a perinatally exposed individual may be durably altered leading to a higher susceptibility of developing metabolic disorders such as obesity and diabetes; however, experimental designs involving the long term study of these dynamic changes in the metabolome raise novel challenges. 1H-NMR-based metabolomics was applied to study the effects of bisphenol-A (BPA, 0; 0.25; 2.5, 25 and 250 μg/kg BW/day) in rats exposed perinatally. Serum and liver samples of exposed animals were analyzed on days 21, 50, 90, 140 and 200 in order to explore whether maternal exposure to BPA alters metabolism. Partial Least Squares-Discriminant Analysis (PLS-DA) was independently applied to each time point, demonstrating a significant pair-wise discrimination for liver as well as serum samples at all time-points, and highlighting unequivocal metabolic shifts in rats perinatally exposed to BPA, including those exposed to lower doses. In BPA exposed animals, metabolism of glucose, lactate and fatty acids was modified over time. To further explore dynamic variation, ANOVA-Simultaneous Component Analysis (A-SCA) was used to separate data into blocks corresponding to the different sources of variation (Time, Dose and Time*Dose interaction). A-SCA enabled the demonstration of a dynamic, time/age dependent shift of serum metabolome throughout the rats’ lifetimes. Variables responsible for the discrimination between groups clearly indicate that BPA modulates energy metabolism, and suggest alterations of neurotransmitter signaling, the latter finding being compatible with the neurodevelopmental effect of this xenoestrogen. In conclusion, long lasting metabolic effects of BPA could be characterized over 200 days, despite physiological (and thus metabolic) changes connected with sexual maturation and aging. PMID:26517871

  7. Timing of treatment initiation for mild gestational diabetes and perinatal outcomes

    PubMed Central

    Palatnik, Anna; Mele, Lisa; Landon, Mark B.; Reddy, Uma M.; Ramin, Susan M.; Carpenter, Marshall W.; Wapner, Ronald J.; Varner, Michael W.; Rouse, Dwight J.; Thorp, John M.; Sciscione, Anthony; Catalano, Patrick; Saade, George R.; Caritis, Steve N.; Sorokin, Yoram

    2015-01-01

    Objective To examine the association between gestational age (GA) at the time of treatment initiation for gestational diabetes (GDM) and maternal and perinatal outcomes. Study Design A secondary analysis of a multicenter randomized treatment trial of mild GDM in which women with mild GDM were randomized to treatment versus usual care. The primary outcome of the original trial, as well as this analysis, was a composite perinatal adverse outcome that included neonatal hypoglycemia, hyperbilirubinemia, hyperinsulinemia, and perinatal mortality. Other outcomes examined included the frequency of large for gestational age (LGA), birth weight, neonatal intensive care unit admission (NICU), gestational hypertension / preeclampsia and cesarean delivery. The interaction between GA at treatment initiation (stratified as 24-26 weeks, 27 weeks, 28 weeks, 29 weeks, ≥30 weeks) and treatment group (treated vs. routine care), with the outcomes of interest, was used to determine whether GA at treatment initiation was associated with outcome differences. Results Of 958 women analyzed, those who initiated treatment at an earlier GA did not gain an additional treatment benefit compared to those who initiated treatment at a later GA (p-value for interaction with the primary outcome is 0.44). Similarly, there was no evidence that other outcomes were significantly improved by earlier initiation of GDM treatment (LGA p=0.76; NICU admission p=0.8; cesarean delivery p=0.82). The only outcome that had a significant interaction between GA and treatment was gestational hypertension/preeclampsia (p=0.04), although there was not a clear cut GA trend where this outcome improved with treatment. Conclusion Earlier initiation of treatment of mild GDM was not associated with stronger effect of treatment on perinatal outcomes. PMID:26071920

  8. Safety of Perinatal Exposure to Antiretroviral Medications: Developmental Outcomes in Infants

    PubMed Central

    Sirois, Patricia A.; Huo, Yanling; Williams, Paige L.; Malee, Kathleen; Garvie, Patricia A.; Kammerer, Betsy; Rich, Kenneth; Van Dyke, Russell B.; Nozyce, Molly L.

    2013-01-01

    Background This study evaluated effects of perinatal exposure to antiretroviral (ARV) medications on neurodevelopment of HIV-exposed, uninfected infants. Methods HIV-exposed, uninfected infants (age 9-15 months) enrolled in SMARTT, a multisite prospective surveillance study, completed the Bayley Scales of Infant and Toddler Development—Third Edition (Bayley-III), assessing cognition, language, motor skills, social-emotional development, and adaptive behavior. Linear regression models were used to evaluate associations between Bayley-III outcomes in infants with and without perinatal and neonatal ARV exposure, by regimen (combination ARV [cARV] versus non-cARV), type of regimen (defined by drug class), and individual ARVs (for infants with cARV exposure), adjusting for maternal and infant health and demographic covariates. Results As of May 2010, 374 infants had valid Bayley-III evaluations. Median age at testing was 12.7 months; 49% male, 79% black, 16% Hispanic. Seventy-nine percent were exposed to regimens containing protease inhibitors (PIs; 9% of PI-containing regimens also included non-nucleoside reverse transcriptase inhibitors [NNRTIs]), 5% to regimens containing NNRTIs (without PI), and 14% to regimens containing only nucleoside reverse transcriptase inhibitors (NRTIs). Overall, 83% were exposed to cARV. No Bayley-III outcome was significantly associated with overall exposure to cARV, ARV regimen, or neonatal prophylaxis. For individual ARVs, following sensitivity analyses, the adjusted group mean on the Language domain was within age expectations but significantly lower for infants with perinatal exposure to atazanavir (p=0.01). Conclusions These results support the safety of perinatal ARV use. Continued monitoring for adverse neurodevelopmental outcomes in older children is warranted, and the safety of atazanavir merits further study. PMID:23340561

  9. Perinatal Outcomes in Hispanic and Non-Hispanic White Women With Mild Gestational Diabetes

    PubMed Central

    Berggren, Erica K.; Mele, Lisa; Landon, Mark B.; Spong, Catherine Y.; Ramin, Susan M.; Casey, Brian; Wapner, Ronald J.; Varner, Michael W.; Rouse, Dwight J.; Sciscione, Anthony; Catalano, Patrick; Harper, Margaret; Saade, George; Caritis, Steve N.; Sorokin, Yoram; Peaceman, Alan M.; Tolosa, Jorge E.

    2012-01-01

    OBJECTIVE To compare perinatal outcomes between self-identified Hispanic and non-Hispanic white women with mild gestational diabetes mellitus (GDM) or glucose intolerance. METHODS In a secondary analysis of a mild GDM treatment trial, we compared perinatal outcomes by race and ethnicity for 767 women with glucose intolerance (abnormal 50g 1-hour screen, normal 100g 3-hour oral glucose tolerance test [OGTT]), 371 women with mild GDM assigned to usual prenatal care, and 397 women with mild GDM assigned to treatment. Outcomes included: composite adverse perinatal outcome (neonatal death, hypoglycemia, hyperbilirubinemia, hyperinsulinemia; stillbirth; birth trauma), gestational age at delivery, birthweight, and hypertensive disorders of pregnancy. Adjusted regression models included: 100g 3-hour OGTT results; parity; gestational age, body mass index, maternal age at enrollment; and current tobacco use. RESULTS The sample of 1535 women was 68.3% Hispanic and 31.7% non-Hispanic White. Among women with glucose intolerance, Hispanic women had more frequent composite outcome (37% vs. 27%, aOR 1.62 95%CI 1.10, 2.37), with more neonatal elevated C-cord peptide (19% vs. 13%, aOR 1.79 95%CI 1.04, 3.08) and neonatal hypoglycemia (21% vs. 13%, aOR 2.04 95%CI 1.18, 3.53). Among women with untreated mild GDM, outcomes were similar by race/ethnicity. Among Hispanic women with treated mild GDM, composite outcome was similar to non-Hispanic White women (35% vs. 25%, aOR 1.62 95% CI 0.92, 2.86), but Hispanic neonates had more frequent hyperinsulinemia (21% vs. 10%, aOR 2.96 95%CI 1.33, 6.60). CONCLUSION Individual components of some neonatal outcomes were more frequent in Hispanic neonates, but most perinatal outcomes were similar between Hispanic and non-Hispanic ethnic groups. PMID:23090528

  10. Is there an association between female circumcision and perinatal death?

    PubMed Central

    Essen, Birgitta; Bodker, Birgit; Sjoberg, N-O; Gudmundsson, Saemundur; Ostergren, P-O; Langhoff-Roos, Jens

    2002-01-01

    OBJECTIVE: In Sweden, a country with high standards of obstetric care, the high rate of perinatal mortality among children of immigrant women from the Horn of Africa raises the question of whether there is an association between female circumcision and perinatal death. METHOD: To investigate this, we examined a cohort of 63 perinatal deaths of infants born in Sweden over the period 1990-96 to circumcised women. FINDINGS: We found no evidence that female circumcision was related to perinatal death. Obstructed or prolonged labour, caused by scar tissue from circumcision, was not found to have any impact on the number of perinatal deaths. CONCLUSION: The results do not support previous conclusions that genital circumcision is related to perinatal death, regardless of other circumstances, and suggest that other, suboptimal factors contribute to perinatal death among circumcised migrant women. PMID:12219153

  11. A Perinatal Care Quality and Safety Initiative: Hospital Costs and Potential Savings

    PubMed Central

    Kozhimannil, Katy B.; Sommerness, Samantha; Rauk, Phillip; Gams, Rebecca; Hirt, Charles; Davis, Stanley; Miller, Kristi K.; Landers, Daniel V.

    2013-01-01

    Background There is increasing national focus on hospital initiatives to improve obstetric and neonatal outcomes. While costs of providing care may decrease with improved quality, the accompanying reduced adverse outcomes may impact hospital revenues. The purpose of this study was to estimate, from a hospital perspective, the financial impacts of implementing a perinatal quality and safety initiative. Methods In 2008, a Minnesota-based health system (Fairview Health Services) launched the Zero Birth Injury (ZBI) initiative, which uses evidence-based care bundles to guide management of obstetric services. We conducted a pre-post analysis of financial impacts of ZBI, using hospital administrative records to measure costs and revenues associated with changes in maternal and neonatal birth injuries before (2008) and after (2009–11) the initiative. Results After adjusting for relevant covariates, implementation of ZBI was associated with an 11% decrease in the rate of maternal and neonatal adverse outcomes between 2008 and 2011 (AOR=0.89, p=0.076). As a result of the adverse events avoided, the hospital system saved $284,985 in costs but earned $324,333 less revenue, which produced a net financial decrease of $39,348 (or a $305 net financial loss per adverse event avoided) in 2011, compared with 2008. Conclusions Adoption of a perinatal quality and safety initiative that reduced birth injuries had little net financial impact on the hospital. ZBI produced better clinical results at a lower cost, which represents potential savings for payers, but the hospital system offering increased quality reaped no clear financial rewards. These results highlight the important role for shared-savings collaborations (among patients, providers, government and third-party payers, and employers) to incentivize quality improvement. Widespread adoption of perinatal safety initiatives combined with innovative payment models may contribute to better health at reduced cost. PMID:23991507

  12. [Exploring the facets of perinatal care].

    PubMed

    Cognat, Éloïse

    2015-04-01

    Perinatal care has long been the sector towards which Éloïse Cognat has wanted to direct her career. From her initial training, she felt drawn to working closely with the patient and the care practices; the nursing profession was an obvious choice for her. Here she tells us of the fulfilling start to her career. PMID:26145423

  13. Perinatal Major Depression Biomarkers: A systematic review.

    PubMed

    Serati, M; Redaelli, M; Buoli, M; Altamura, A C

    2016-03-15

    Postpartum depression, now termed perinatal depression by the DSM-5, is a clinically relevant disorder reaching 15% of incidence. Although it is quite frequent and associated with high social dysfunction, only recently its underpinning biological pathways have been explored, while multiple and concomitant risk factors have been identified (e.g. psychosocial stress). Peripartum depression usually has its onset during the third trimester of pregnancy or in the postpartum, being one of the most common medical complications in new mothers. Purpose of the present review is to summarize the state of art of biological biomarkers involved in the pathogenesis of perinatal depression, in view of the fact that suboptimal prenatal milieu can induce permanent damage in subsequent offspring life and have a negative impact on mother-child relationship. Furthermore, parents' biological changes due to medical/psychiatric disorders or stress exposure could influence offspring life: a concept known as 'intergenerational transmission', acting by variations into gametes and the gestational uterine environment. Given the evidence that perinatal mental disorders involve risks for the mother and offspring, the search for reliable biomarkers in high-risk mothers actually represents a medical priority to prevent perinatal depression. PMID:26802316

  14. Perinatal home care: one entrepreneur's experience.

    PubMed

    Eaton, D G

    1994-10-01

    Nurses have responded to the entrepreneurial movement by entering into various nontraditional roles and starting their own businesses. This article describes the author's experience in establishing a perinatal home-care business. The characteristics of women and nurse entrepreneurs are discussed, as are the components of a business plan and how to manage a business. PMID:7836999

  15. DRINKING WATER ARSENIC AND PERINATAL OUTCOMES

    EPA Science Inventory

    Drinking Water Arsenic and Perinatal Outcomes
    DT Lobdell, Z Ning, RK Kwok, JL Mumford, ZY Liu, P Mendola

    Many studies have documented an association between drinking water arsenic (DWA) and cancer, vascular diseases, and dermatological outcomes, but few have investigate...

  16. Perinatal Risk Factors for Mild Motor Disability

    ERIC Educational Resources Information Center

    Hands, Beth; Kendall, Garth; Larkin, Dawne; Parker, Helen

    2009-01-01

    The aetiology of mild motor disability (MMD) is a complex issue and as yet is poorly understood. The aim of this study was to identify the prevalence of perinatal risk factors in a cohort of 10-year-old boys and girls with (n = 362) and without (n = 1193) MMD. Among the males with MMD there was a higher prevalence of postpartum haemorrhage,

  17. Perinatal Depression Treatment Preferences Among Latina Mothers

    PubMed Central

    Lara-Cinisomo, Sandraluz; Wisner, Katherine L.; Burns, Rachel M.; Chaves-Gnecco, Diego

    2014-01-01

    The study described here was designed to determine treatment preferences among Latinas to identify treatment options that meet their needs and increase their engagement. Focus group interviews were conducted with 22 prenatal and postpartum Latinas at risk for depression. The group interviews were conducted in Spanish and English using a standardized interview protocol. Focus group transcripts were analyzed to identify themes regarding perinatal depression coping strategies, preferred approaches to treating perinatal depression, and recommendations for engaging perinatal Latinas in treatment. The results suggest that Latinas’ treatment preferences consist of a pathway (i.e., hierarchical) approach that begins with the use of one’s own resources, followed by the use of formal support systems (e.g., home-visiting nurse), and supplemented with the use of behavioral therapy. Antidepressant use was judged to be acceptable only in severe cases or after delivery. The data indicate that to increase health-seeking behaviors among perinatal Latinas, practitioners should first build trust. PMID:24469693

  18. Perinatal Outcomes and Unconventional Natural Gas Operations in Southwest Pennsylvania

    PubMed Central

    Stacy, Shaina L.; Brink, LuAnn L.; Larkin, Jacob C.; Sadovsky, Yoel; Goldstein, Bernard D.; Pitt, Bruce R.; Talbott, Evelyn O.

    2015-01-01

    Unconventional gas drilling (UGD) has enabled extraordinarily rapid growth in the extraction of natural gas. Despite frequently expressed public concern, human health studies have not kept pace. We investigated the association of proximity to UGD in the Marcellus Shale formation and perinatal outcomes in a retrospective cohort study of 15,451 live births in Southwest Pennsylvania from 2007–2010. Mothers were categorized into exposure quartiles based on inverse distance weighted (IDW) well count; least exposed mothers (first quartile) had an IDW well count less than 0.87 wells per mile, while the most exposed (fourth quartile) had 6.00 wells or greater per mile. Multivariate linear (birth weight) or logistical (small for gestational age (SGA) and prematurity) regression analyses, accounting for differences in maternal and child risk factors, were performed. There was no significant association of proximity and density of UGD with prematurity. Comparison of the most to least exposed, however, revealed lower birth weight (3323 ± 558 vs 3344 ± 544 g) and a higher incidence of SGA (6.5 vs 4.8%, respectively; odds ratio: 1.34; 95% confidence interval: 1.10–1.63). While the clinical significance of the differences in birth weight among the exposure groups is unclear, the present findings further emphasize the need for larger studies, in regio-specific fashion, with more precise characterization of exposure over an extended period of time to evaluate the potential public health significance of UGD. PMID:26039051

  19. Metabolic imprinting by prenatal, perinatal, and postnatal overnutrition: a review.

    PubMed

    Dyer, Jennifer Shine; Rosenfeld, Charles R

    2011-05-01

    Epidemiological studies have suggested that metabolic programming is one of the critical factors contributing to the etiology of obesity as well as concurrent increase in related chronic diseases (e.g., type 2 diabetes and cardiovascular disease). Metabolic programming is the phenomenon whereby a nutritional stress/stimulus applied during critical periods of early development permanently alters an organism's physiology and metabolism, the consequences of which are often observed much later in life. The idea of metabolic programming originated from the fetal origins hypothesis proposed by Barker in which he suggested that disproportionate size at birth of the newborn due to an adverse intrauterine environment correlated well with an increased risk of adult-onset ill health outcomes (type 2 diabetes, hypertension, and cardiovascular disease). The fetal origins hypothesis, proposed by Barker, suggests that adequate nutrition during fetal development is critical. Overnutrition is a form of malnutrition that has increased in the United States over the past several decades in which nutrients are oversupplied relative to the amounts required for normal growth, development, and metabolism. Evidence for the effects of maternal obesity and overnutrition on metabolic programming is reviewed during critical prenatal, perinatal, and postnatal periods. PMID:21769766

  20. Perinatal outcomes and unconventional natural gas operations in Southwest Pennsylvania.

    PubMed

    Stacy, Shaina L; Brink, LuAnn L; Larkin, Jacob C; Sadovsky, Yoel; Goldstein, Bernard D; Pitt, Bruce R; Talbott, Evelyn O

    2015-01-01

    Unconventional gas drilling (UGD) has enabled extraordinarily rapid growth in the extraction of natural gas. Despite frequently expressed public concern, human health studies have not kept pace. We investigated the association of proximity to UGD in the Marcellus Shale formation and perinatal outcomes in a retrospective cohort study of 15,451 live births in Southwest Pennsylvania from 2007-2010. Mothers were categorized into exposure quartiles based on inverse distance weighted (IDW) well count; least exposed mothers (first quartile) had an IDW well count less than 0.87 wells per mile, while the most exposed (fourth quartile) had 6.00 wells or greater per mile. Multivariate linear (birth weight) or logistical (small for gestational age (SGA) and prematurity) regression analyses, accounting for differences in maternal and child risk factors, were performed. There was no significant association of proximity and density of UGD with prematurity. Comparison of the most to least exposed, however, revealed lower birth weight (3323 ± 558 vs 3344 ± 544 g) and a higher incidence of SGA (6.5 vs 4.8%, respectively; odds ratio: 1.34; 95% confidence interval: 1.10-1.63). While the clinical significance of the differences in birth weight among the exposure groups is unclear, the present findings further emphasize the need for larger studies, in regio-specific fashion, with more precise characterization of exposure over an extended period of time to evaluate the potential public health significance of UGD. PMID:26039051

  1. Effects of perinatal mental disorders on the fetus and child.

    PubMed

    Stein, Alan; Pearson, Rebecca M; Goodman, Sherryl H; Rapa, Elizabeth; Rahman, Atif; McCallum, Meaghan; Howard, Louise M; Pariante, Carmine M

    2014-11-15

    Perinatal mental disorders are associated with increased risk of psychological and developmental disturbances in children. However, these disturbances are not inevitable. In this Series paper, we summarise evidence for associations between parental disorders and offspring outcomes from fetal development to adolescence in high-income, middle-income, and low-income countries. We assess evidence for mechanisms underlying transmission of disturbance, the role of mediating variables (underlying links between parent psychopathology and offspring outcomes) and possible moderators (which change the strength of any association), and focus on factors that are potentially modifiable, including parenting quality, social (including partner) and material support, and duration of the parental disorder. We review research of interventions, which are mostly about maternal depression, and emphasise the need to both treat the parent's disorder and help with associated caregiving difficulties. We conclude with policy implications and underline the need for early identification of those parents at high risk and for more early interventions and prevention research, especially in socioeconomically disadvantaged populations and low-income countries. PMID:25455250

  2. Frequency of Maternal and Newborn Birth Outcomes, Lima, Peru, 2013

    PubMed Central

    Wynn, Adriane; Cabeza, Jeanne; Adachi, Kristina; Needleman, Jack; Garcia, Patricia J.; Klausner, Jeffrey D.

    2015-01-01

    Objective This study describes the pregnancy and birth outcomes at two hospitals in Lima, Peru. The data collection and analysis is intended to inform patients, providers, and policy makers on Peru’s progress toward achieving the Millennium Development Goals and to help set priorities for action and further research. Methods Data were collected retrospectively from a sample of 237 women who delivered between December 2012 and September 2013 at the Instituto Nacional Materno Perinatal or the Hospital Nacional Arzobispo Loayza. The outcomes were recorded by a trained mid-wife through telephone interviews with patients and by review of hospital records. Associations between participant demographic characteristics and pregnancy outcomes were tested with Chi-squared, Fisher’s exact, or Student’s t-test. Results Over 37% of women experienced at least one maternal or perinatal complication, and the most frequent were hypertension/preeclampsia and macrosomia. The women in our sample had a cesarean section rate of 50.2%. Conclusion Maternal and perinatal complications are not uncommon among women in the lower socioeconomic strata of Lima. Also, the high cesarean rate underpins the need for a more comprehensive understanding of the indications for cesarean section deliveries, which could help reduce the number of unnecessary procedures and preventable complications. PMID:25806522

  3. Maternal Cardiac Arrest: A Practical and Comprehensive Review

    PubMed Central

    Jeejeebhoy, Farida M.; Morrison, Laurie J.

    2013-01-01

    Cardiac arrest during pregnancy is a dedicated chapter in the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care; however, a robust maternal cardiac arrest knowledge translation strategy and emergency response plan is not usually the focus of institutional emergency preparedness programs. Although maternal cardiac arrest is rare, the emergency department is a high-risk area for receiving pregnant women in either prearrest or full cardiac arrest. It is imperative that institutions review and update emergency response plans for a maternal arrest. This review highlights the most recent science, guidelines, and recommended implementation strategies related to a maternal arrest. The aim of this paper is to increase the understanding of the important physiological differences of, and management strategies for, a maternal cardiac arrest, as well as provide institutions with the most up-to-date literature on which they can build emergency preparedness programs for a maternal arrest. PMID:23956861

  4. Maternity Care in Russia: Issues, Achievements, and Potential.

    PubMed

    Shuvalova, Marina P; Yarotskaya, Ekaterina L; Pismenskaya, Tatiana V; Dolgushina, Nataliya V; Baibarina, Elena N; Sukhikh, Gennady T

    2015-10-01

    In this review, we provide basic facts about maternity care services within the health care system in Russia. We give a short overview of such key aspects as the demographic situation, reproductive behaviour, regulatory framework for providing health care for women and children, maternal and perinatal mortality, and the availability of medical personnel. In 2012, Russia began registration of births in accordance with the WHO recommendations (births with weight ≥ 500 g at ≥ 22 weeks' gestation). Introduction of this new registration system increased the completeness and quality of the collected information and expanded possibilities for future international comparative assessments. A three-level system of specialized medical care has been introduced in Russia for women and newborns during pregnancy, childbirth, and the postpartum period. In 2014, the system included 1942 state (public) maternity hospitals providing 20 obstetric beds per 10 000 women aged 15 to 49 years. More than 100 perinatal centres (level III) are currently functioning in the country, with 32 new perinatal centres planned to open by 2016. The total number of obstetrician-gynaecologists in Russia is approximately 44 000, providing a ratio of 5.7 specialists per 10 000 women. The total number of midwives is 62 000, providing a ratio of 8.1 midwives per 10 000 women. In recent years we have succeeded in optimizing the maternity care system by increasing its accessibility and quality. This was achieved through qualitative and quantitative progress in the training of neonatologists, the development of intensive care technologies and neonatal critical care, capacity building of medical-genetic services and counselling, prenatal diagnosis, and the standardization of health care with data collection. PMID:26606698

  5. Nontraumatic Fat Embolism Found Following Maternal Death after Cesarean Delivery.

    PubMed

    Schrufer-Poland, Tabitha; Singh, Paul; Jodicke, Cristiano; Reynolds, Sara; Maulik, Dev

    2015-04-01

    Introduction Fat embolism is a rare form of nonthrombotic embolization. Limited literature exists regarding the diagnosis of fat embolism during the perinatal period. We present the first case of maternal death that resulted from nontraumatic fat embolization following Cesarean delivery. Case Description A 29-year-old gravida 1 with a complex medical and surgical history underwent a primary Cesarean delivery at term. On postoperative day 2 the patient was found to be unresponsive. Despite resuscitative efforts, the patient succumbed. Autopsy findings were remarkable for diffuse pulmonary fat emboli. Furthermore, there was no histological evidence of either amniotic fluid embolism or thromboembolism. The primary cause of death was attributed to nontraumatic fat embolization. Discussion Multiple risk factors may have contributed to the development of nontraumatic fat embolization in our patient. Obstetricians should maintain a high level of suspicion for nontraumatic fat embolization in cases of maternal respiratory decompression and sudden maternal mortality. PMID:26199788

  6. Nontraumatic Fat Embolism Found Following Maternal Death after Cesarean Delivery

    PubMed Central

    Schrufer-Poland, Tabitha; Singh, Paul; Jodicke, Cristiano; Reynolds, Sara; Maulik, Dev

    2014-01-01

    Introduction Fat embolism is a rare form of nonthrombotic embolization. Limited literature exists regarding the diagnosis of fat embolism during the perinatal period. We present the first case of maternal death that resulted from nontraumatic fat embolization following Cesarean delivery. Case Description A 29-year-old gravida 1 with a complex medical and surgical history underwent a primary Cesarean delivery at term. On postoperative day 2 the patient was found to be unresponsive. Despite resuscitative efforts, the patient succumbed. Autopsy findings were remarkable for diffuse pulmonary fat emboli. Furthermore, there was no histological evidence of either amniotic fluid embolism or thromboembolism. The primary cause of death was attributed to nontraumatic fat embolization. Discussion Multiple risk factors may have contributed to the development of nontraumatic fat embolization in our patient. Obstetricians should maintain a high level of suspicion for nontraumatic fat embolization in cases of maternal respiratory decompression and sudden maternal mortality. PMID:26199788

  7. a Comparison Between Chemically Dependent Mothers and Drug-Free Mothers: Lifestyle during the Perinatal Period

    NASA Astrophysics Data System (ADS)

    Uskokovic, Lila Milica

    This study compared maternal lifestyle variables pertinent to the perinatal period in groups of chemically dependent mothers and drug-free mothers. Twenty-nine cocaine -abusing mothers were compared to 29 drug-free mothers carefully matched on age, race, education, and primipara versus multipara status. The drug history of each chemically dependent woman was explicitly documented. The chemically dependent group was subdivided into two groups, mothers who abused cocaine and those who abused cocaine with concomitant opiate use. Each of these two subgroups was compared to its respective matched drug-free control group. Finally, a comparison was made between the two drug subgroups. All subjects were interviewed within 48 hours after delivery using the following measures: State-Trait Anxiety Inventory (A-State), Center for Epidemiologic Studies - Depression Scale, The Self-Esteem Scale, Maternal Adjustment and Maternal Attitude Questionnaire, The Neonatal Perception Inventory, The Psychiatric Epidemiology Research Interview Life Events Scale, Maternal Social Support Index, and Short Marital Adjustment Test. A t-test analysis revealed significant differences (p <.05) between the total experimental group and its matched control group on state anxiety, depression, self-esteem, maternal adjustment and attitudes, and life events. An analysis of covariance indicated that life events was the only significant variable when the influence of all other variables was removed. Comparisons made between each drug subgroup and its respective matched control group showed similar results, except that those who abused opiates with cocaine did not differ from their controls on depression and maternal adjustment and attitudes. No significant differences were obtained in the drug subgroup comparisons. These results identify increased life events and specific negative affect states that clinical intervention programs should address to assure the best possible outcome for chemically dependent mothers and their infants.

  8. The Maternal Microbiome and Pregnancy Outcomes that Impact Infant Health: A Review

    PubMed Central

    Mulle, Jennifer G.; Ferranti, Erin P.; Edwards, Sara; Dunn, Alexis B.; Corwin, Elizabeth J.

    2015-01-01

    The maternal microbiome is recognized as a key determinant of a range of important maternal and child health outcomes, and together with perinatal factors influences the infant microbiome. This manuscript provides a summary review of research investigating: (1) the role of the maternal microbiome in pregnancy outcomes known to adversely influence neonatal and infant health, including preterm birth, cardiometabolic complications of pregnancy such as preeclampsia and gestational diabetes, and excessive gestational weight gain; (2) factors with an established link to adverse pregnancy outcomes that are known to influence the composition of the maternal microbiome; and (3) strategies for promoting a healthy maternal microbiome, recognizing that much more research is needed in this area. PMID:26317856

  9. “Nothing Special, Everything Is Maamuli”: Socio-Cultural and Family Practices Influencing the Perinatal Period in Urban India

    PubMed Central

    Raman, Shanti; Srinivasan, Krishnamachari; Kurpad, Anura; Razee, Husna; Ritchie, Jan

    2014-01-01

    Background Globally, India contributes the largest share in sheer numbers to the burden of maternal and infant under-nutrition, morbidity and mortality. A major gap in our knowledge is how socio-cultural practices and beliefs influence the perinatal period and thus perinatal outcomes, particularly in the rapidly growing urban setting. Methods and Findings Using data from a qualitative study in urban south India, including in-depth interviews with 36 women who had recently been through childbirth as well as observations of family life and clinic encounters, we explored the territory of familial, cultural and traditional practices and beliefs influencing women and their families through pregnancy, childbirth and infancy. We found that while there were some similarities in cultural practices to those described before in studies from low resource village settings, there are changing practices and ideas. Fertility concerns dominate women’s experience of married life; notions of gender preference and ideal family size are changing rapidly in response to the urban context; however inter-generational family pressures are still considerable. While a rich repertoire of cultural practices persists throughout the perinatal continuum, their existence is normalised and even underplayed. In terms of diet and nutrition, traditional messages including notions of ‘hot’ and ‘cold’ foods, are stronger than health messages; however breastfeeding is the cultural norm and the practice of delayed breastfeeding appears to be disappearing in this urban setting. Marriage, pregnancy and childbirth are so much part of the norm for women, that there is little expectation of individual choice in any of these major life events. Conclusions A greater understanding is needed of the dynamic factors shaping the perinatal period in urban India, including an acknowledgment of the health promoting as well as potentially harmful cultural practices and the critical role of the family. This will help plan culturally appropriate integrated perinatal health care. PMID:25369447

  10. Perinatal depression: treatment options and dilemmas

    PubMed Central

    Pearlstein, Teri

    2008-01-01

    The treatment of depression during pregnancy and the postpartum period raises unique concerns about safety for the developing fetus and the infant. An increasing number of studies suggest adverse effects from untreated stress, anxiety and depression as well as adverse effects from antidepressant and other psychotropic medications. Even when studies suggest a lack of short-term adverse effects with some medications, the paucity of systematic longitudinal follow-up studies investigating the development of children exposed to medications during pregnancy and breastfeeding causes apprehension. This review's objective is to highlight what is currently known about the negative effects of untreated disease and exposure to psychotropic medication, the treatment dilemmas confronting women with perinatal depression and issues that future studies should address so that a woman with perinatal depression can make an optimally informed decision. PMID:18592032

  11. [Main trends in restructuring of maternal and child health services].

    PubMed

    Baranov, A A

    1988-01-01

    Russia's success in the 1990s with the perestroika programs aimed at benefitting public health depends to a large degree upon constructive solutions to the many existing problems with maternity and pediatric health services. In a resolution by the Central Committee of the CPSU the necessity for increased prophylaxis is emphasized. Leading a healthy life is considered most important, since half of all factors influencing the health status of the population depends on it. Most pediatrists and medical assistants, however, are either undisposed or lack the skills to educate children, adolescents and parents in personal hygiene. The fight against controllable infections, whose frequency in the USSR is one of the highest among developed nations due to a low level of or even falsified immunizations, is to be stepped up. In order to combat childhood diseases, infant mortality, and invalidity, the quality of clinical examinations of pregnant women and newborn babies must be enhanced through implementing prenatal diagnostics, mass screenings of the newborn, ultrasound diagnostics, chorionic biopsies, and genetic medical consultations for families with a history of perinatal and infant mortality. Prophylaxis of intrauterine fetal infections is planned in 20-25 regional diagnostic centers. The need for decentralization, regionalization, and demographic distribution analyses is stressed. Regional centers are to upgrade skills of doctors, medical workers, and administrators, that to a large degree are lacking in adequate education. A centralized fund has been created by the Soviet Health Ministry, earmarked for concrete scientific projects instead of blanket financing of medical institutions, who, in addition, by 1989 will start being financially self-supporting. Expert councils for obstetrics, gynecology, and pediatrics are to be created in order to increase efficiency and applying results of scientific research. PMID:3200638

  12. Perinatal mortality attributable to complications of childbirth in Matlab, Bangladesh.

    PubMed Central

    Kusiako, T.; Ronsmans, C.; Van der Paal, L.

    2000-01-01

    Very few population-based studies of perinatal mortality in developing countries have examined the role of intrapartum risk factors. In the present study, the proportion of perinatal deaths that are attributable to complications during childbirth in Matlab, Bangladesh, was assessed using community-based data from a home-based programme led by professional midwives between 1987 and 1993. Complications during labour and delivery--such as prolonged or obstructed labour, abnormal fetal position, and hypertensive diseases of pregnancy--increased the risk of perinatal mortality fivefold and accounted for 30% of perinatal deaths. Premature labour, which occurred in 20% of pregnancies, accounted for 27% of perinatal mortality. Better care by qualified staff during delivery and improved care of newborns should substantially reduce perinatal mortality in this study population. PMID:10859856

  13. Sleep and perinatal mood disorders: a critical review.

    PubMed

    Ross, Lori E; Murray, Brian J; Steiner, Meir

    2005-07-01

    Pregnancy and the postpartum period are recognized as times of vulnerability to mood disorders, including postpartum depression and psychosis. Recently, changes in sleep physiology and sleep deprivation have been proposed as having roles in perinatal psychiatric disorders. In this article we review what is known about changes in sleep physiology and behaviour during the perinatal period, with a focus on the relations between sleep and postpartum "blues," depression and psychosis and on sleep-based interventions for the treatment and prevention of perinatal mood disorders. The interaction between sleep and perinatal mood disorders is significant, but evidence-based research in this field is limited. Studies that measure both sleep and mood during the perinatal period, particularly those that employ objective measurement tools such as polysomnography and actigraphy, will provide important information about the causes, prevention and treatment of perinatal mood disorders. PMID:16049568

  14. Perinatal Risk Factors for Mild Motor Disability

    ERIC Educational Resources Information Center

    Hands, Beth; Kendall, Garth; Larkin, Dawne; Parker, Helen

    2009-01-01

    The aetiology of mild motor disability (MMD) is a complex issue and as yet is poorly understood. The aim of this study was to identify the prevalence of perinatal risk factors in a cohort of 10-year-old boys and girls with (n = 362) and without (n = 1193) MMD. Among the males with MMD there was a higher prevalence of postpartum haemorrhage,…

  15. Prevention of perinatal group B streptococcal disease--revised guidelines from CDC, 2010.

    PubMed

    Verani, Jennifer R; McGee, Lesley; Schrag, Stephanie J

    2010-11-19

    Despite substantial progress in prevention of perinatal group B streptococcal (GBS) disease since the 1990s, GBS remains the leading cause of early-onset neonatal sepsis in the United States. In 1996, CDC, in collaboration with relevant professional societies, published guidelines for the prevention of perinatal group B streptococcal disease (CDC. Prevention of perinatal group B streptococcal disease: a public health perspective. MMWR 1996;45[No. RR-7]); those guidelines were updated and republished in 2002 (CDC. Prevention of perinatal group B streptococcal disease: revised guidelines from CDC. MMWR 2002;51[No. RR-11]). In June 2009, a meeting of clinical and public health representatives was held to reevaluate prevention strategies on the basis of data collected after the issuance of the 2002 guidelines. This report presents CDC's updated guidelines, which have been endorsed by the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, the American College of Nurse-Midwives, the American Academy of Family Physicians, and the American Society for Microbiology. The recommendations were made on the basis of available evidence when such evidence was sufficient and on expert opinion when available evidence was insufficient. The key changes in the 2010 guidelines include the following: • expanded recommendations on laboratory methods for the identification of GBS, • clarification of the colony-count threshold required for reporting GBS detected in the urine of pregnant women, • updated algorithms for GBS screening and intrapartum chemoprophylaxis for women with preterm labor or preterm premature rupture of membranes, • a change in the recommended dose of penicillin-G for chemoprophylaxis, • updated prophylaxis regimens for women with penicillin allergy, and • a revised algorithm for management of newborns with respect to risk for early-onset GBS disease. Universal screening at 35-37 weeks' gestation for maternal GBS colonization and use of intrapartum antibiotic prophylaxis has resulted in substantial reductions in the burden of early-onset GBS disease among newborns. Although early-onset GBS disease has become relatively uncommon in recent years, the rates of maternal GBS colonization (and therefore the risk for early-onset GBS disease in the absence of intrapartum antibiotic prophylaxis) remain unchanged since the 1970s. Continued efforts are needed to sustain and improve on the progress achieved in the prevention of GBS disease. There also is a need to monitor for potential adverse consequences of intrapartum antibiotic prophylaxis (e.g., emergence of bacterial antimicrobial resistance or increased incidence or severity of non-GBS neonatal pathogens). In the absence of a licensed GBS vaccine, universal screening and intrapartum antibiotic prophylaxis continue to be the cornerstones of early-onset GBS disease prevention. PMID:21088663

  16. Neoplasms in young dogs after perinatal irradiation

    SciTech Connect

    Benjamin, S.A.; Lee, A.C.; Angleton, G.M.; Saunders, W.J.; Miller, G.K.; Williams, J.S.; Brewster, R.D.; Long, R.I.

    1986-08-01

    For a study of the life-time effects of irradiation during development, 1,680 beagles were given single, whole-body exposures to /sup 60/Co gamma-radiation at one of three prenatal (preimplantation, embryonic, and fetal) or at one of three postnatal (neonatal, juvenile, and young adult) ages. Mean doses were 0, 0.16, or 0.83 Gy. For comparison with data on childhood cancer after prenatal irradiation, examination was made of tumors occurring in young dogs in this life-span experiment. Up to 4 years of age, 18 dogs had neoplasms diagnosed, 2 of these being in controls. Four dogs that were irradiated in the perinatal (late fetal or neonatal) period died of cancers prior to 2 years of age. This risk was of significant increase compared to the risks for other experimental groups and for the canine population in general. Overall, 71% (5 of 7) of all cancers and 56% (10 of 18) of all benign and malignant neoplasms seen in the first 4 years of life occurred in 29% (480 of 1680) of the dogs irradiated in the perinatal period. These data suggest an increased risk for neoplasia after perinatal irradiation in dogs.

  17. Biochemical markers of perinatal brain damage.

    PubMed

    Florio, Pasquale; Abella, Raul; Marinoni, Emanuela; Di Iorio, Romolo; Li Volti, Giovanni; Galvano, Fabio; Pongiglione, Giacomo; Frigiola, Alessandro; Pinzauti, Serena; Petraglia, Felice; Gazzolo, Diego

    2010-01-01

    Hypoxia-ischemia constitutes a risk in infants by altering cerebral blood flow regulatory mechanisms and causing loss of cerebral vascular auto-regulation. Hypotension, cerebral ischemia, and reperfusion are the main events involved in vascular auto-regulation leading to cell death and tissue damage. These dramatic phenomena represent a common repertoire in infants complicated by perinatal acute or chronic hypoxia. To date, despite accurate perinatal and intra-operative monitoring, the post-insult period is crucial, since clinical symptoms and monitoring parameters may be of no avail and therapeutic window for pharmacological intervention (6-12 hours) may be limited, at a time when brain damage is already occurring. Therefore, the measurement of circulating biochemical markers of brain damage, such as vasoactive agents and nervous tissue peptides is eagerly awaited in clinical practice to detect high risk infants. The present review is aimed at investigating the role as circulating biochemical markers such as adrenomedullin, S100B, activin A, neuronal specific enolase (NSE), glial fibrillary acid protein (GFAP), in the cascade of events leading to ischemia reperfusion injury in infants complicated by perinatal asphyxia. PMID:20036928

  18. Duration of incarceration and perinatal outcome.

    PubMed

    Cordero, L; Hines, S; Shibley, K A; Landon, M B

    1991-10-01

    The number of incarcerated women is increasing, thus pregnancy in prison is no longer uncommon. We reviewed the perinatal outcome of 53 women with short-term incarceration (fewer than 90 days) and of 53 women who experienced long-term incarceration (more than 120 days). Poor prenatal care, history of drug abuse, hepatitis, and poor nutrition were more common among the short-incarceration group. Of infants born to short-incarceration women, 32 (60%) were normal, four (7%) stillborn, eight (15%) premature, six (11%) small for gestational age, and four (7%) septic. Women in the long-incarceration group delivered 48 normal infants (91%), whereas two were offspring of diabetic mothers and three were premature. Birth weight for infants born to smokers in the short-incarceration group was significantly lower than that of infants born to smokers in the long-incarceration group. Women who suffer short incarcerations experience high perinatal mortality and morbidity. In contrast, those incarcerated longer appear to benefit from better prenatal care, improved nutrition, and a structured environment, and thus a more favorable perinatal outcome. PMID:1923168

  19. Mechanisms of perinatal arterial ischemic stroke

    PubMed Central

    Fernndez-Lpez, David; Natarajan, Niranjana; Ashwal, Stephen; Vexler, Zinaida S

    2014-01-01

    The incidence of perinatal stroke is high, similar to that in the elderly, and produces a significant morbidity and severe long-term neurologic and cognitive deficits, including cerebral palsy, epilepsy, neuropsychological impairments, and behavioral disorders. Emerging clinical data and data from experimental models of cerebral ischemia in neonatal rodents have shown that the pathophysiology of perinatal brain damage is multifactorial. These studies have revealed that, far from just being a smaller version of the adult brain, the neonatal brain is unique with a very particular and age-dependent responsiveness to hypoxiaischemia and focal arterial stroke. In this review, we discuss fundamental clinical aspects of perinatal stroke as well as some of the most recent and relevant findings regarding the susceptibility of specific brain cell populations to injury, the dynamics and the mechanisms of neuronal cell death in injured neonates, the responses of neonatal bloodbrain barrier to stroke in relation to systemic and local inflammation, and the long-term effects of stroke on angiogenesis and neurogenesis. Finally, we address translational strategies currently being considered for neonatal stroke as well as treatments that might effectively enhance repair later after injury. PMID:24667913

  20. Dynamic influence of maternal and pup traits on maternal care during lactation in an income breeder, the antarctic fur seal.

    PubMed

    McDonald, Birgitte I; Goebel, Michael E; Crocker, Daniel E; Costa, Daniel P

    2012-01-01

    Life-history theory predicts that selection will favor optimal levels of parental effort that balance benefits of current reproduction with costs to survival and future reproduction. The optimal level of effort depends on parental traits, offspring traits, and provisioning strategy. Additionally, how these factors influence effort may differ depending on the stage of reproduction. The relative importance of maternal and offspring traits on energy allocation to offspring was investigated in known-age Antarctic fur seals Arctocephalus gazella across four stages of reproduction, using birth mass and milk-consumption measurements. Maternal traits were important during three of the four stages investigated, with larger females giving birth to larger pups and investing more in pups during perinatal and molt stages. Pup mass influenced maternal effort during the premolt stage, and provisioning strategy influenced postnatal maternal effort at all stages. Energy provided to the offspring during an attendance visit was positively related to the duration of the foraging-trip/visit cycle; however, when investment was controlled for trip/visit cycle duration, the overall rate of energy transfer was similar across trip durations. In addition to strong effects of maternal mass, pup traits affected energy allocation, suggesting that pup demand is important in determining maternal care. These findings emphasize the importance of considering state variables in life-history studies and suggest that timing of measurements of effort in species with long provisioning periods may influence conclusions and our ability to make comparisons of reproductive effort among species. PMID:22494980

  1. Perinatal Flavour Learning and Adaptation to Being Weaned: All the Pig Needs Is Smell

    PubMed Central

    Oostindjer, Marije; Bolhuis, J. Elizabeth; Simon, Kristina; van den Brand, Henry; Kemp, Bas

    2011-01-01

    Perinatal flavour learning through the maternal diet is known to enhance flavour preference and acceptance of flavoured food in many species, yet still little is known about the mechanism underlying perinatal flavour learning. Previously we found positive effects of perinatal flavour learning on food intake, growth and behaviour of piglets postweaning, but no increased preference for the flavour. This suggests that flavour learning in pigs works through a reduction of weaning stress by the presence of the familiar flavour instead. The aim of this study was to investigate whether perinatal flavour learning reduces stress at weaning, and whether the effect is stronger when the familiar flavour is present in the food. Sows were offered an anethol-flavoured diet (Flavour treatment) or control diet (Control treatment) during late gestation and lactation. Flavour and Control piglets were provided with anethol either in their food (Food treatment) or in the air (Air treatment) after weaning. Preweaning and postweaning treatments did not affect food intake, preference or growth in the first two weeks postweaning but flavour treatment reduced the latency to eat (24 versus 35 hours, P = 0.02) and within-pen variation in growth (SD within-pen: 0.7 versus 1.2 kg, P<0.001). Salivary cortisol levels tended to be lower four and seven hours postweaning for Flavour piglets compared to Control piglets (4 hours: 2.5 versus 3.0 ng/ml, P = 0.05, 7 hours: 3.1 versus 3.4 ng/ml, P = 0.08). Flavour piglets played more and showed less damaging behaviours than Control piglets, indicating that the familiar flavour reduced stress around weaning. Few interaction effects were found between preweaning and postweaning treatment, and no effects of postweaning treatment. We conclude that in the newly weaned pig, perinatal flavour learning results in a reduction of stress when the familiar flavour is present, regardless of providing the flavour in the food or in the air. PMID:22039409

  2. Measuring perinatal health equity and migration indicators for international comparisons.

    PubMed

    Gagnon, Anita J; Small, Rhonda; Sarasua, Irene; Lang, Carly

    2015-01-01

    An international research collaboration answered, "Can equity in perinatal health for migrant women be measured for comparison across countries?" In nine countries, perinatal databases were assessed for the availability of equity indicators. Equity data were also sought from women and health records. Optimal sources of data differed depending on the migrant perinatal health equity indicator. Health and migration data, required to capture equity, were often not reported in the same location. Migration indicators other than country of birth were underreported. Perinatal health equity can be measured for international comparisons, although a standardized protocol is required to capture all indicators. PMID:25036335

  3. New uses of legacy systems: examples in perinatal care.

    PubMed Central

    Margolis, A.; Vázquez, R.; Mendoza, G.; Zignago, A.; López, A.; Lucián, H.

    1999-01-01

    In this article, new uses of the Perinatal Information System at the Uruguayan Social Security health care facilities are described. The perinatal information system has been in place for over 13 years, with about 40 thousand clinical records on electronic files. A newly created Web interface allows a distributed access to existing perinatal information within the National Social Security Wide Area a Network. Perinatal data is also exported to a management information system, allowing to dynamically answer questions and make managerial decisions, and eventually link these data with other sources. Future steps regarding clinical information systems are outlined. Images Figure 1 Figure 2 PMID:10566481

  4. Dual role of astrocytes in perinatal asphyxia injury and neuroprotection.

    PubMed

    Romero, J; Muñiz, J; Logica Tornatore, T; Holubiec, M; González, J; Barreto, G E; Guelman, L; Lillig, C H; Blanco, E; Capani, F

    2014-04-17

    Perinatal asphyxia represents an important cause of severe neurological deficits including delayed mental and motor development, epilepsy, major cognitive deficits and blindness. However, at the moment, most of the therapeutic strategies were not well targeted toward the processes that induced the brain injury during perinatal asphyxia. Traditionally, experimental research focused on neurons, whereas astrocytes have been more related with the damage mechanisms of perinatal asphyxia. In this work, we propose to review possible protective as well as deleterious roles of astrocytes in the asphyctic brain with the aim to stimulate further research in this area of perinatal asphyxia still not well studied. PMID:24172702

  5. What neonatal complications should the pediatrician be aware of in case of maternal gestational diabetes?

    PubMed Central

    Mitanchez, Delphine; Yzydorczyk, Catherine; Simeoni, Umberto

    2015-01-01

    In the epidemiologic context of maternal obesity and type 2 diabetes (T2D), the incidence of gestational diabetes has significantly increased in the last decades. Infants of diabetic mothers are prone to various neonatal adverse outcomes, including metabolic and hematologic disorders, respiratory distress, cardiac disorders and neurologic impairment due to perinatal asphyxia and birth traumas, among others. Macrosomia is the most constant consequence of diabetes and its severity is mainly influenced by maternal blood glucose level. Neonatal hypoglycemia is the main metabolic disorder that should be prevented as soon as possible after birth. The severity of macrosomia and the maternal health condition have a strong impact on the frequency and the severity of adverse neonatal outcomes. Pregestational T2D and maternal obesity significantly increase the risk of perinatal death and birth defects. The high incidence of maternal hyperglycemia in developing countries, associated with the scarcity of maternal and neonatal care, seriously increase the burden of neonatal complications in these countries. PMID:26069722

  6. What neonatal complications should the pediatrician be aware of in case of maternal gestational diabetes?

    PubMed

    Mitanchez, Delphine; Yzydorczyk, Catherine; Simeoni, Umberto

    2015-06-10

    In the epidemiologic context of maternal obesity and type 2 diabetes (T2D), the incidence of gestational diabetes has significantly increased in the last decades. Infants of diabetic mothers are prone to various neonatal adverse outcomes, including metabolic and hematologic disorders, respiratory distress, cardiac disorders and neurologic impairment due to perinatal asphyxia and birth traumas, among others. Macrosomia is the most constant consequence of diabetes and its severity is mainly influenced by maternal blood glucose level. Neonatal hypoglycemia is the main metabolic disorder that should be prevented as soon as possible after birth. The severity of macrosomia and the maternal health condition have a strong impact on the frequency and the severity of adverse neonatal outcomes. Pregestational T2D and maternal obesity significantly increase the risk of perinatal death and birth defects. The high incidence of maternal hyperglycemia in developing countries, associated with the scarcity of maternal and neonatal care, seriously increase the burden of neonatal complications in these countries. PMID:26069722

  7. From planning to practice: building the national network for the surveillance of severe maternal morbidity

    PubMed Central

    2011-01-01

    Background Improving maternal health is one of the Millennium Development Goals for 2015. Recently some progress has been achieved in reducing mortality. On the other hand, in developed regions, maternal death is a relatively rare event compared to the number of cases of morbidity; hence studying maternal morbidity has become more relevant. Electronic surveillance systems may improve research by facilitating complete data reporting and reducing the time required for data collection and analysis. Therefore the purpose of this study was to describe the methods used in elaborating and implementing the National Network for the Surveillance of Severe Maternal Morbidity in Brazil. Methods The project consisted of a multicenter, cross-sectional study for the surveillance of severe maternal morbidity including near-miss, in Brazil. Results Following the development of a conceptual framework, centers were selected for inclusion in the network, consensus meetings were held among the centers, an electronic data collection system was identified, specific software and hardware tools were developed, research material was prepared, and the implementation process was initiated and analyzed. Conclusion The conceptual framework developed for this network was based on the experience acquired in various studies carried out in the area over recent years and encompasses maternal and perinatal health. It is innovative especially in the context of a developing country. The implementation of the project represents the first step towards this planned management. The system online elaborated for this surveillance network may be used in further studies in reproductive and perinatal health. PMID:21549009

  8. The Impact of Cardiac Diseases during Pregnancy on Severe Maternal Morbidity and Mortality in Brazil

    PubMed Central

    Campanharo, Felipe F.; Cecatti, Jose G.; Haddad, Samira M.; Parpinelli, Mary A.; Born, Daniel; Costa, Maria L.; Mattar, Rosiane

    2015-01-01

    Background To evaluate maternal heart disease as a cause or complicating factor for severe morbidity in the setting of the Brazilian Network for Surveillance of Severe Maternal Morbidity. Methods and Findings Secondary data analysis of this multicenter cross-sectional study was implemented in 27 referral obstetric units in Brazil. From July 2009 to June 2010, a prospective surveillance was conducted among all delivery hospitalizations to identify cases of severe maternal morbidity (SMM), including Potentially Life-Threatening Conditions (PLTC) and Maternal Near Miss (MNM), using the new criteria established by the WHO. The variables studied included: sociodemographic characteristics, clinical and obstetric history of the women; perinatal outcome and the occurrence of maternal outcomes (PLTC, MNM, MD) between groups of cardiac and non-cardiac patients. Only heart conditions with hemodynamic impact characterizing severity of maternal morbidity were considered. 9555 women were included in the Network with severe pregnancy-related complications: 770 maternal near miss cases and 140 maternal death cases. A total of 293 (3.6%) cases were related to heart disease and the condition was known before pregnancy in 82.6% of cases. Maternal near miss occurred in 15% of cardiac disease patients (most due to clinical-surgical causes, p<0.001) and 7.7% of non-cardiac patients (hemorrhagic and hypertensive causes, p<0.001). Maternal death occurred in 4.8% of cardiac patients and in 1.2% of non-cardiac patients, respectively. Conclusions In this study, heart disease was significantly associated with a higher occurrence of severe maternal outcomes, including maternal death and maternal near miss, among women presenting with any severe maternal morbidity. PMID:26650684

  9. Perinatal Dyadic Psychotherapy for postpartum depression: a randomized controlled pilot trial.

    PubMed

    Goodman, Janice H; Prager, Joanna; Goldstein, Richard; Freeman, Marlene

    2015-06-01

    An integrated approach addressing maternal depression and associated mother-infant relationship dysfunction may improve outcomes. This study tested Perinatal Dyadic Psychotherapy (PDP), a dual-focused mother-infant intervention to prevent/decrease maternal postpartum depression and improve aspects of the mother-infant relationship related to child development. Women recruited from hospital postpartum units were screened using a three-stage process. Forty-two depressed first-time mothers and their 6-week-old infants were enrolled and randomized to receive the PDP intervention or usual care plus depression monitoring by phone. The intervention consisted of eight home-based, nurse-delivered mother-infant sessions consisting of (a) supportive, relationship-based, mother-infant psychotherapy, and (b) a developmentally based infant-oriented component focused on promoting positive mother-infant interactions. Data collected at baseline, post-intervention, and three-month follow-up included measures of maternal depression, anxiety, maternal self-esteem, parenting stress, and mother-infant interaction. Depression and anxiety symptoms and diagnoses decreased significantly, and maternal self-esteem increased significantly across the study time frame with no between-group differences. There were no significant differences between groups on parenting stress or mother-infant interaction at post-intervention and follow-up. No participants developed onset of postpartum depression during the course of the study. PDP holds potential for treating depression in the context of the mother-infant relationship; however, usual care plus depression monitoring showed equal benefit. Further research is needed to explore using low-intensity interventions as a first step in a stepped care approach and to determine what subset of at-risk or depressed postpartum mothers might benefit most from the PDP intervention. PMID:25522664

  10. The advantage of professional organizations as advocates for improved funding of maternal and child health services in Uganda.

    PubMed

    Beyeza-Kashesya, Jolly; Kaharuza, Frank; Murokora, Daniel

    2014-10-01

    The attainment of United Nations Millennium Development Goal 5 has proven elusive for many countries. Efforts to reduce maternal mortality require concerted evidence-based efforts from all key players, including professional organizations. The Association of Obstetricians and Gynaecologists of Uganda used the results of maternal and perinatal death review to develop and pilot advocacy programs with parliamentarians, media, and government that aimed to improve maternal and newborn health in Uganda. This work translated to further parliamentary debate on the topic, increased resource allocation by government, and improved media-related public education. PMID:25124100

  11. Environmental risk factors and perinatal outcomes in preterm newborns, according to family recurrence of prematurity

    PubMed Central

    Krupitzki, Hugo B.; Gadow, Enrique C.; Gili, Juan A.; Comas, Belén; Cosentino, Viviana R.; Saleme, César; Murray, Jeffrey C.; Lopez Camelo, Jorge S.

    2014-01-01

    Objetive We analyzed the role of environmental risk factors, socio-demographic characteristics, clinical characteristics, and reproductive history in preterm births and their associated perinatal outcomes in families classified according to their histories of preterm recurrence among siblings. Study Design A retrospective study was conducted at “Nuestra Señora de la Merced” Maternity Hospital in the city of Tucumán, Argentina. A total of 348 preterm, non-malformed, singleton children born to multipara women were reviewed. The family history score described by Khoury was applied, and families were classified as having no, medium or high genetic aggregation. Results Families with no familial aggregation showed a higher rate of short length of cohabitation, maternal urinary tract infections during the current pregnancy and maternal history of miscarriage during the previous pregnancy. Families with a high level of aggregation had a significantly higher incidence of pregnancy complications, such as diabetes, hypertension and immunological disorders. Conclusion Reproductive histories clearly differed between the groups, suggesting both a different response to environmental challenges based on genetic susceptibility, and the activation of different pathophysiological pathways to determine the duration of pregnancy in each woman. PMID:23132119

  12. Maternal and neonatal individual risks and benefits associated with caesarean delivery: multicentre prospective study

    PubMed Central

    Carroli, Guillermo; Zavaleta, Nelly; Donner, Allan; Wojdyla, Daniel; Faundes, Anibal; Velazco, Alejandro; Bataglia, Vicente; Langer, Ana; Narváez, Alberto; Valladares, Eliette; Shah, Archana; Campodónico, Liana; Romero, Mariana; Reynoso, Sofia; de Pádua, Karla Simônia; Giordano, Daniel; Kublickas, Marius; Acosta, Arnaldo

    2007-01-01

    Objective To assess the risks and benefits associated with caesarean delivery compared with vaginal delivery. Design Prospective cohort study within the 2005 WHO global survey on maternal and perinatal health. Setting 410 health facilities in 24 areas in eight randomly selected Latin American countries; 123 were randomly selected and 120 participated and provided data Participants 106 546 deliveries reported during the three month study period, with data available for 97 095 (91% coverage). Main outcome measures Maternal, fetal, and neonatal morbidity and mortality associated with intrapartum or elective caesarean delivery, adjusted for clinical, demographic, pregnancy, and institutional characteristics. Results Women undergoing caesarean delivery had an increased risk of severe maternal morbidity compared with women undergoing vaginal delivery (odds ratio 2.0 (95% confidence interval 1.6 to 2.5) for intrapartum caesarean and 2.3 (1.7 to 3.1) for elective caesarean). The risk of antibiotic treatment after delivery for women having either type of caesarean was five times that of women having vaginal deliveries. With cephalic presentation, there was a trend towards a reduced odds ratio for fetal death with elective caesarean, after adjustment for possible confounding variables and gestational age (0.7, 0.4 to 1.0). With breech presentation, caesarean delivery had a large protective effect for fetal death. With cephalic presentation, however, independent of possible confounding variables and gestational age, intrapartum and elective caesarean increased the risk for a stay of seven or more days in neonatal intensive care (2.1 (1.8 to 2.6) and 1.9 (1.6 to 2.3), respectively) and the risk of neonatal mortality up to hospital discharge (1.7 (1.3 to 2.2) and 1.9 (1.5 to 2.6), respectively), which remained higher even after exclusion of all caesarean deliveries for fetal distress. Such increased risk was not seen for breech presentation. Lack of labour was a risk factor for a stay of seven or more days in neonatal intensive care and neonatal mortality up to hospital discharge for babies delivered by elective caesarean delivery, but rupturing of membranes may be protective. Conclusions Caesarean delivery independently reduces overall risk in breech presentations and risk of intrapartum fetal death in cephalic presentations but increases the risk of severe maternal and neonatal morbidity and mortality in cephalic presentations. PMID:17977819

  13. Perinatal depression and birth outcomes in a Healthy Start project.

    PubMed

    Smith, Megan V; Shao, Lin; Howell, Heather; Lin, Haiqun; Yonkers, Kimberly A

    2011-04-01

    Given the risk of adverse perinatal outcomes associated with a depressive disorder, the Health Resources and Services Administration's (HRSA) Maternal and Child Health Bureau (MCHB) from 2001-2005 devoted resources through the Federal Healthy Start Initiative to screen pregnant women for depression and link them with services. In this report, we present the evaluation of a program that screened for depression and provided services for women with depressive symptoms or psychiatric distress in pregnancy to assess whether the program was associated with a reduction in babies born low birth weight, small for gestational age, or preterm. The program impact was examined among 1,100 women in three cohorts enrolled from 2001-2005 that included: (1) subjects recruited prior to the inception of the Healthy Start Initiative; (2) subjects enrolled in the Healthy Start Initiative; and (3) a comparison group recruited during the project period but not enrolled in the Healthy Start Initiative. After adjustment for covariates, women with probable depression were over one and a half times more likely to give birth to a preterm baby than non depressed women. Neither adjusted nor unadjusted risks for delivery of preterm, low birth weight or small for gestational age infants were significantly lower for women enrolled in Healthy Start as compared to women not enrolled in Healthy Start. However, regardless of enrollment in Healthy Start, women who delivered babies after the Healthy Start program began were 85% less likely to deliver preterm babies than women giving birth before the program began. Depression status conferred increased risk of adverse birth outcomes, results that were not altered by participation in the Healthy Start program. We cannot exclude the possibility that the community activities of the Healthy Start program promoted increased attention to health issues among depressed women and hence enhance birth outcomes. PMID:20300813

  14. Goodbye, Mandatory Maternity Leaves

    ERIC Educational Resources Information Center

    Nation's Schools, 1972

    1972-01-01

    In precedent-setting decrees, courts and federal and State authorities have branded compulsory maternity leaves either unconstitutional or illegal. School administrators are urged to prod boards of education to adopt more lenient maternity leave policies -- now. (Author)

  15. Perinatal consequences of a category 1 caesarean section at term

    PubMed Central

    Grace, Leah; Greer, Ristan M; Kumar, Sailesh

    2015-01-01

    Objective To characterise maternal demographics, obstetric risk factors and neonatal outcomes associated with term category 1 caesarean sections (CS). Design and setting and main outcome measures Retrospective study of term singleton pregnancies delivering at a major tertiary unit in Brisbane, Australia. Category 1 CS were defined as one that required a decision-to-delivery time interval of <30 min when there was an immediate threat to the life of a woman or fetus. Neonatal outcomes analysed were gestation at delivery, birth weight, Apgar scores, acidosis at birth, need for resuscitation, admission to neonatal intensive care and neonatal seizures and death. Results A total of 30 719 women delivering at term were included. Of these, 1179 (3.8%) women required a category 1 CS. A further 3527 women underwent non-category 1 CS. Most category 1 CS were performed for non-reassuring fetal status (65.9%, 777/1179). The indications for non-category 1 CS were for failure to progress (46.5%, 1641/3527) and non-reassuring fetal status (19%, 671/3527). Maternal age, body mass index and medical disease did not differ significantly between the two cohorts. Caucasian women were equally as likely to undergo a category 1 CS as a non-category 1 CS, while indigenous women and women of Asian ethnicity were more likely to undergo a category 1 CS. Significantly higher (p<0.001) perinatal complications were seen in the category 1 CS cohort—Apgar scores <7 at 1 min (20.4%, 241/1179 vs 10.7%, 377/3527) and 5 min (5.8%, 68/1179 vs 1.9%, 67/3527), umbilical arterial pH<7.2 (23.7%, 279/1179 vs 9.1%, 321/3527), neonatal resuscitation (59.9%, 706/1179 vs 51.8%, 1828/3527), neonatal intensive care unit admission (9.8%, 116/1179 vs 2.5%, 87/3527) and seizures (0.8%, 10/1179 vs 0.3%, 9/3527), respectively. Conclusions These results demonstrate significantly poorer outcomes associated with term category 1 CS compared with non-category 1 emergency CS. PMID:26224015

  16. [Tasks of family-oriented obstetrics in the maternity ward].

    PubMed

    Schulze, G; May, E

    1984-01-01

    Psychological drawbacks of intensive obstetrics on the one hand and the results from psychology in the perinatal period on the other hand demand a new mental hygiene in the delivery room and on maternity wards. The "family-oriented obstetrics" met these problems best. Interviews were made with 650 mothers, just after delivery to find on the attitude for "family-oriented obstetrics". Presence of husband in the delivery room is wanted from 47,4% of the married couple. 98,15% from the mothers wanted nursing and 83,69% rooming-in. PMID:6495922

  17. Guillain-Barré syndrome complicating pregnancy and correlation with maternal and fetal outcome in North Eastern India: A retrospective study

    PubMed Central

    Sharma, Shri Ram; Sharma, Nalini; Masaraf, Hussain; Singh, Santa A.

    2015-01-01

    Background: Guillain-Barré syndrome (GBS) is rare in pregnancy with an estimated incidence between 1.2 and 1.9 cases per 100,000 people annually, and it is generally accepted that it carries a high maternal risk. Most reports of GBS with pregnancy are case reports only. Aim: Purpose of this retrospective study was to find the correlation between pregnancy and GBS. Settings and Design: Records of patients admitted in neurology division were analyzed in a tertiary care teaching hospital in the northeastern Indian pregnant female population with GBS between 15-49 years during the period of 2009-2013. Materials and Methods: We analyzed the records of 47 patients with pregnancy and GBS, evaluated and treated in our institute from August 2009 to December 2013. This is retrospective observational study done in North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), India. Result: Predominant form of GBS was acute inflammatory demyelinating polyneuropathy (AIDP). The weakness started from the lower limbs in majority of patients. Ten percent of women had bifacial weakness. Most of patients had good maternal and fetal outcome. Two patients received intravenous immunoglobulin (IVIG). Only two patient required ventilator supports and one patient had intrauterine death (IUD) and died due to respiratory failure. Conclusion: Our results indicate that risk of GBS increases in third trimester and first 2 weeks after delivery. Demyelinating variety of GBS was common in our population. GBS natural course during pregnancy is mild and showed quick recovery. Maternal and perinatal outcome was good. PMID:26019422

  18. Maternal anxiety, maternal sensitivity, and attachment.

    PubMed

    Stevenson-Hinde, Joan; Chicot, Rebecca; Shouldice, Anne; Hinde, Camilla A

    2013-01-01

    Previous research has related maternal anxiety to insecurity of attachment. Here we ask whether different aspects of maternal sensitivity mediate this link. From a community sample of intact families with 1-3 children, mothers with 4.5-year-olds were selected for low, medium, or high anxiety levels (N = 98). Following Mary Ainsworth's lead, our maternal sensitivity measures were primarily based on ratings of direct observations. Six sets of measures were obtained: positive maternal style at home (a mean of four different ratings); providing a sensitive framework, limit setting, allowing autonomy, criticizing/cutting in (each a mean over two laboratory joint tasks); and tension-making (a mean of three different ratings in a fear-inducing task). Regression analyses showed firstly that maternal anxiety rather than behavioral inhibition or sex of child was the significant predictor of each maternal sensitivity measure; and secondly that these measures rather than maternal anxiety or sex were the significant predictors of security of attachment. Finally, ANOVA's indicated which sets of maternal ratings were associated with each pattern of attachment (Avoidant, Secure, Ambivalent, or Controlling). PMID:24299138

  19. Chronic Activation of FXR in Transgenic Mice Caused Perinatal Toxicity and Sensitized Mice to Cholesterol Toxicity

    PubMed Central

    Cheng, Qiuqiong; Inaba, Yuka; Lu, Peipei; Xu, Meishu; He, Jinhan; Zhao, Yueshui; Guo, Grace L.; Kuruba, Ramalinga; de la Vega, Rona; Evans, Rhobert W.; Li, Song

    2015-01-01

    The nuclear receptor farnesoid X receptor (FXR) (nuclear receptor subfamily 1, group H, member 4, or NR1H4) is highly expressed in the liver and intestine. Previous reports have suggested beneficial functions of FXR in the homeostasis of bile acids, lipids, and glucose, as well as in promoting liver regeneration and inhibiting carcinogenesis. To investigate the effect of chronic FXR activation in vivo, we generated transgenic mice that conditionally and tissue specifically express the activated form of FXR in the liver and intestine. Unexpectedly, the transgenic mice showed several intriguing phenotypes, including partial neonatal lethality, growth retardation, and spontaneous liver toxicity. The transgenic mice also displayed heightened sensitivity to a high-cholesterol diet-induced hepatotoxicity but resistance to the gallstone formation. The phenotypes were transgene specific, because they were abolished upon treatment with doxycycline to silence the transgene expression. The perinatal toxicity, which can be rescued by a maternal vitamin supplement, may have resulted from vitamin deficiency due to low biliary bile acid output as a consequence of inhibition of bile acid formation. Our results also suggested that the fibroblast growth factor-inducible immediate-early response protein 14 (Fn14), a member of the proinflammatory TNF family, is a FXR-responsive gene. However, the contribution of Fn14 induction in the perinatal toxic phenotype of the transgenic mice remains to be defined. Because FXR is being explored as a therapeutic target, our results suggested that a chronic activation of this nuclear receptor may have an unintended side effect especially during the perinatal stage. PMID:25719402

  20. Upper respiratory tract infection during pregnancy: is it associated with adverse perinatal outcome?

    PubMed

    Stiller-Timor, Liran; Levy, Amalia; Holcberg, Gershon; Sheiner, Eyal

    2010-09-01

    We sought to determine whether there is an association between upper respiratory tract infection (URTI) requiring hospitalization during pregnancy and adverse perinatal complications. A retrospective population-based study comparing all singleton pregnancies of patients with and without URTI requiring hospitalization was performed. Multiple logistic regression models were performed to control for confounders. Data were collected from the computerized perinatal database. Out of 186,373 deliveries, 0.13% ( N = 246) required hospitalization due to URTI during pregnancy. URTI was significantly associated with preterm deliveries (PTD; 15.9% versus 7.9%; P < 0.001), lower birth weight (3082 +/- 624 versus 3183 +/- 546 g; P < 0.001), and higher rate of cesarean deliveries (CD; 20.3% versus 13.2%; P < 0.001) as compared with the comparison group. Even after controlling for possible confounders using multivariable analyses, the significant association between URTI and PTD (weighted odds ratio [OR] = 2.2; 95% confidence interval [CI] 1.6 to 3.1; P < 0.001) and CD (weighted OR = 1.5; 95% CI 1.1 to 2.2; P = 0.020) persisted. In contrast, no significant association was documented between URTI and premature rapture of membranes (4.9% versus 6.9%; P = 0.212), low Apgar scores (< 7) at 5 minutes (0.4% versus 0.6%; P = 0.761), and perinatal mortality (0 to 4% versus 1.3%; P = 0.223). Maternal URTI requiring hospitalization is an independent risk factor for PTD and CD. PMID:20200806

  1. Barriers in Referring Neonatal Patients to Perinatal Palliative Care: A French Multicenter Survey

    PubMed Central

    Tosello, Barthélémy; Dany, Lionel; Bétrémieux, Pierre; Le Coz, Pierre; Auquier, Pascal; Gire, Catherine; Einaudi, Marie-Ange

    2015-01-01

    Background When an incurable fetal condition is detected, some women (or couples) would rather choose to continue with the pregnancy than opt for termination of pregnancy for medical reasons, which, in France, can be performed until full term. Such situations are frequently occurring and sometimes leading to the implementation of neonatal palliative care. The objectives of this study were to evaluate the practices of perinatal care french professionals in this context; to identify the potential obstacles that might interfere with the provision of an appropiate neonatal palliative care; and, from an opposite perspective, to determine the criteria that led, in some cases, to offer this type of care for prenatally diagnosed lethal abnormality. Methods We used an email survey sent to 434 maternal-fetal medicine specialists (MFMs) and fetal care pediatric specialists (FCPs) at 48 multidisciplinary centers for prenatal diagnosis (MCPD). Results Forty-two multidisciplinary centers for prenatal diagnosis (87.5%) took part. In total, 102 MFMs and 112 FCPs completed the survey, yielding response rate of 49.3%. One quarter of professionals (26.2%) estimated that over 20% of fetal pathologies presenting in MCPD could correspond to a diagnosis categorized as lethal (FCPs versus MFMs: 24% vs 17.2%, p = 0.04). The mean proportion of fetal abnormalities eligible for palliative care at birth was estimated at 19.30% (± 2.4) (FCPs versus MFMs: 23.4% vs 15.2%, p = 0.029). The degree of diagnostic certainty appears to be the most influencing factor (98.1%, n = 207) in the information provided to the pregnant woman with regard to potential neonatal palliative care. The vast majority of professionals, 92.5%, supported considering the practice of palliative care as a regular option to propose antenatally. Conclusions Our study reveals the clear need for training perinatal professionals in perinatal palliative care and for the standardization of practices in this field. PMID:25978417

  2. Zinc status in pregnancy: the effect of zinc therapy on perinatal mortality, prematurity, and placental ablation.

    PubMed

    Jameson, S

    1993-03-15

    Zinc is present in and indispensable to all forms of life. Zinc is essential for the normal growth of human beings, and zinc proteins have been shown to be involved in the transcription and translation of the genetic material. Zinc deficiency has been incriminated in infertility, abortions, malformations, fetal intrauterine growth retardation, premature and postmature births, perinatal death, and abnormal deliveries with dystocia and placental ablation. Risk groups for developing zinc deficiency, which in turn might modify the expression of the underlying disease, are found among those with insufficient food intake, especially in protein malnutrition; abnormal mucosal uptake, as in celiac disease; abnormal intestinal losses, as in steatorrhea and inflammatory bowel disease; abnormal renal excretion, as in diabetes with insufficient metabolic control; alcoholism; and treatment with diuretic drugs. Zinc deficiency could be identified by means of fasting serum or plasma samples or the more laborious estimation of zinc in leucocytes or monocytes if sampling and handling is carefully performed and if stressful situations and acute-phase reactions as fever, delivery, or abortion are avoided. Zinc therapy in identified low-zinc groups has given favorable results and has reduced the frequencies of premature birth, placental ablation, perinatal death, and postmaturity. It is suggested, as we did in 1980, that these data are compatible with the presence of a zinc-deficiency syndrome in pregnancy, which includes increased maternal morbidity, abnormal taste sensations, abnormally short or prolonged gestations, inefficient labor, atonic bleeding, and increased risks to the fetus such as malformations, growth retardation, prematurity, postmaturity, and perinatal death. PMID:8494261

  3. Perinatal depression and omega-3 fatty acids: A Mendelian randomisation study

    PubMed Central

    Sallis, Hannah; Steer, Colin; Paternoster, Lavinia; Davey Smith, George; Evans, Jonathan

    2014-01-01

    Background There have been numerous studies investigating the association between omega-3 fatty acids (FAs) and depression, with mixed findings. We propose an approach which is largely free from issues such as confounding or reverse causality, to investigate this relationship using observational data from a pregnancy cohort. Methods The Avon Longitudinal Study of Parents and Children (ALSPAC) cohort collected information on FA levels from antenatal blood samples and depressive symptoms at several time points during pregnancy and the postnatal period. Conventional epidemiological analyses were used in addition to a Mendelian randomisation (MR) approach to investigate the association between levels of two omega-3 FAs (docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA)) and perinatal onset depression, antenatal depression (AND) and postnatal depression (PND). Results Weak evidence of a positive association with both EPA (OR=1.07; 95% CI: 0.99–1.15) and DHA (OR=1.08; 95% CI: 0.98–1.19) with perinatal onset depression was found using a multivariable logistic regression adjusting for social class and maternal age. However, the strength of association was found to attenuate when using an MR analysis to investigate DHA. Limitations Pleiotropy is a potential limitation in MR analyses; we assume that the genetic variants included in the instrumental variable are associated only with our trait of interest (FAs) and thus cannot influence the outcome via any other pathway. Conclusions We found weak evidence of a positive association between omega-3 FAs and perinatal onset depression. However, without confirmation from the MR analysis, we are unable to draw conclusions regarding causality. PMID:25012420

  4. [Delayed-onset dystonia due to asphyxia in the perinatal period].

    PubMed

    Kostić, V S; Covicković-Sternić, N; Svetel-Stojanović, M; Filipović, S

    1997-01-01

    The phenomenon of delayed-onset dystonia following presumed "static" brain injuries was described after stroke and head trauma. Burke et al. described a different category of secondary dystonia, where perinatal injury (asphyxia) caused minimal or no immediate neurological deficit, with the delay of years before dystonia emerged. This type of dystonia following perinatal injury has been termed "delayed onset dystonia due to static encephalopathy of childhood". According to the definition of dystonia, we were able to select 5 patients with the aetiologic diagnosis of perinatal asphyxia from the group of 347 out- and inpatients (1.4%) treated for various types of dystonia at the Movement Disorders Department (Institute of Neurology, CCS, Belgrade) from November 1986 to November 1994. At onset of dystonia the mean age of patients was 13.2 years (range from 10 to 17), with combined initial involvement of the arm and neck in 3 patients. The period from the onset of the disease to the maximum severity lasted 8.2 years (range from 4 to 14), resulting in segmental brachial dystonia in 3, hemidystonia and generalized dystonia in one patient each (Table 1). The adverse perinatal events are described in Table 2. Three of our patients had delayed achievements of developmental milestones. All patients were regularly schooled and had preserved intellectual capacities, except the patient 3 whose achievements were below average (IQ = 86). Different drugs were administered (Table 3), but moderate effects were achieved only with trihexyphenidyl in two patients (daily doses of 24 mg and 30 mg, respectively), and baclofen (80 mg p.d.) in one patient. In this study we describe 5 new patients who fulfilled the criteria for the diagnosis of delayed-onset dystonia due to perinatal asphyxia (Tables 1 and 2). We accepted the approach of Saint-Hilaire et al. to suggest a relationship between perinatal asphyxia and later occurrence of dystonia in our 5 patients. However, coincident occurrence of a primary dystonia with a static encephalopathy of childhood due to perinatal asphyxia cannot be excluded. This phenomenon of delayed appearance of dystonia was also described in other forms of static cerebral injury; i.e. stroke, head trauma or anoxic brain damage. Interestingly enough, age at the time of anoxia or brain insults seemed to be crucial for the development of dystonia: those who suffer acute brain insults during childhood or early life are more likely to develop dystonia than the older patients. Therefore, the "static" nature of encephalopathy induced by perinatal asphyxia is questionable. Finally, this study strengthens the suggestion that perinatal asphyxia can lead to delayed-onset dystonia, and, since "some of these patients closely resemble cases of idiopathic torsion dystonia, the prior occurrence of asphyxia should be used as a criterion of exclusion for that diagnosis". PMID:9221523

  5. Men in maternal care: evidence from India.

    PubMed

    Chattopadhyay, Aparajita

    2012-03-01

    Men's supportive stance is an essential component for making women's world better. There are growing debates among policymakers and researchers on the role of males in maternal health programmes, which is a big challenge in India where society is male driven. This study aims to look into the variations and determinants of maternal health care utilization in India and in three demographically and socioeconomically disparate states, namely Uttar Pradesh, West Bengal and Maharashtra, by husband's knowledge, attitude, behaviour towards maternal health care and gender violence, using data from the National Family Health Survey III 2005-06 (equivalent to the Demographic and Health Survey in India). Women's antenatal care visits, institutional delivery and freedom in health care decisions are looked into, by applying descriptive statistics and multivariate models. Men's knowledge about pregnancy-related care and a positive gender attitude enhances maternal health care utilization and women's decision-making about their health care, while their presence during antenatal care visits markedly increases the chances of women's delivery in institutions. From a policy perspective, proper dissemination of knowledge about maternal health care among husbands and making the husband's presence obligatory during antenatal care visits will help primary health care units secure better male involvement in maternal health care. PMID:22004658

  6. Appraisal of WHO Guidelines in Maternal Health Using the AGREE II Assessment Tool

    PubMed Central

    Polus, Stephanie; Lerberg, Priya; Vogel, Joshua; Watananirun, Kanokwaroon; Souza, Joao Paulo; Mathai, Matthews; Gülmezoglu, A. Metin

    2012-01-01

    In 2007, the World Health Organization (WHO) received a criticism for a lack of transparency and systematic methods in the development of guidelines, which were at that time perceived as substantially driven by expert opinion. In this paper we assessed the quality of maternal and perinatal health guidelines developed since then. We used the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool to evaluate the quality of methodological rigour and transparency of four different WHO guidelines published between 2007 and 2011. Our findings showed high scores among the most recent guidelines on maternal and perinatal health suggesting higher quality. However, there is still potential for improvement, especially in including different stakeholder views, transparency of guidelines regarding the role of the funding body and presentation of the guideline document. PMID:22912662

  7. Cortical Reorganization of Language Functioning Following Perinatal Left MCA Stroke

    ERIC Educational Resources Information Center

    Tillema, Jan-Mendelt; Byars, Anna W.; Jacola, Lisa M.; Schapiro, Mark B.; Schmithorst, Vince J.; Szaflarski, Jerzy P.; Holland, Scott K.

    2008-01-01

    Objective: Functional MRI was used to determine differences in patterns of cortical activation between children who suffered perinatal left middle cerebral artery (MCA) stroke and healthy children performing a silent verb generation task. Methods: Ten children with prior perinatal left MCA stroke (age 6-16 years) and ten healthy age matched…

  8. [A proposed new interpretation and revised definition of perinatal mortality].

    PubMed

    Berko, Péter

    2006-02-12

    A proposed new interpretation and revised definition of perinatal mortality. Perinatal mortality rate is a commonly used index, which reflects the quality of obstetrical and neonatological care. Relying on critical remarks considered for his study, the author believes that a novel classification should be developed in order to redefine the term perinatal mortality and pregnancy-related losses. The author points out that intrauterine death during pregnancy cannot be associated with fatal incidents about birth, because the former precedes the latter. While regarding the cases of intrauterine death at late pregnancy as being important specific indicators, the author proposes excluding them from the cases covered by the term perinatal mortality. Furthermore, the author argues that all cases of neonatal death, that is, those at birth and those occurring in the first 28 days of life should be regarded as cases of perinatal mortality. It is reasonable to extend perinatal period this way, because due to a more advanced neonatological care, immature preterm babies may be lost 6 or even 27 days after birth. A novel interpretation of perinatal mortality, not including the cases of intrauterine death at late pregnancy, but including all cases of neonatal mortality makes perinatal mortality rate a more exact qualifier of obstetrical and neonatological care. PMID:16610618

  9. Asperger Syndrome: Familial and Pre- and Perinatal Factors

    ERIC Educational Resources Information Center

    Gillberg, Christopher; Cederlund, Mats

    2005-01-01

    Objective: Study familial and pre- and perinatal factors in Asperger Syndrome (AS). Methods: Hundred boys with AS had their records reviewed. "Pathogenetic subgroups" were defined according to presence of medical syndromes/chromosomal abnormalities, indices of familiarity, and pre- and perinatal risk factors predisposing to brain damage. Results:…

  10. Cortical Reorganization of Language Functioning Following Perinatal Left MCA Stroke

    ERIC Educational Resources Information Center

    Tillema, Jan-Mendelt; Byars, Anna W.; Jacola, Lisa M.; Schapiro, Mark B.; Schmithorst, Vince J.; Szaflarski, Jerzy P.; Holland, Scott K.

    2008-01-01

    Objective: Functional MRI was used to determine differences in patterns of cortical activation between children who suffered perinatal left middle cerebral artery (MCA) stroke and healthy children performing a silent verb generation task. Methods: Ten children with prior perinatal left MCA stroke (age 6-16 years) and ten healthy age matched

  11. Modifying CBT for Perinatal Depression: What Do Women Want?

    ERIC Educational Resources Information Center

    O'Mahen, Heather; Fedock, Gina; Henshaw, Erin; Himle, Joseph A.; Forman, Jane; Flynn, Heather A.

    2012-01-01

    The evidence for the efficacy of CBT for depression during the perinatal period is mixed. This was a qualitative study that aimed to understand the perinatal-specific needs of depressed women in an effort to inform treatment modifications that may increase the relevance and acceptability of CBT during this period. Stratified purposeful sampling

  12. Modifying CBT for Perinatal Depression: What Do Women Want?

    ERIC Educational Resources Information Center

    O'Mahen, Heather; Fedock, Gina; Henshaw, Erin; Himle, Joseph A.; Forman, Jane; Flynn, Heather A.

    2012-01-01

    The evidence for the efficacy of CBT for depression during the perinatal period is mixed. This was a qualitative study that aimed to understand the perinatal-specific needs of depressed women in an effort to inform treatment modifications that may increase the relevance and acceptability of CBT during this period. Stratified purposeful sampling…

  13. Community Conversations with Parents to Improve Perinatal Care

    ERIC Educational Resources Information Center

    Martin, Joanne

    2007-01-01

    The state of Indiana took a unique approach to developing a statewide plan to improve perinatal health outcomes by engaging parents in a series of focus groups, called Community Conversations in Perinatal Care (CCPC), to hear directly from consumers about their health care experiences and needs. Recognizing that disparities exist among different…

  14. Maternal near miss and death among women with severe hypertensive disorders: a Brazilian multicenter surveillance study

    PubMed Central

    2014-01-01

    Background Hypertensive disorders represent the major cause of maternal morbidity in middle income countries. The main objective of this study was to identify the prevalence and factors associated with severe maternal outcomes in women with severe hypertensive disorders. Methods This was a cross-sectional, multicenter study, including 6706 women with severe hypertensive disorder from 27 maternity hospitals in Brazil. A prospective surveillance of severe maternal morbidity with data collected from medical charts and entered into OpenClinica®, an online system, over a one-year period (2009 to 2010). Women with severe preeclampsia, severe hypertension, eclampsia and HELLP syndrome were included in the study. They were grouped according to outcome in near miss, maternal death and potentially life-threatening condition. Prevalence ratios and 95% confidence intervals adjusted for cluster effect for maternal and perinatal variables and delays in receiving obstetric care were calculated as risk estimates of maternal complications having a severe maternal outcome (near miss or death). Poisson multiple regression analysis was also performed. Results Severe hypertensive disorders were the main cause of severe maternal morbidity (6706/9555); the prevalence of near miss was 4.2 cases per 1000 live births, there were 8.3 cases of Near Miss to 1 Maternal Death and the mortality index was 10.7% (case fatality). Early onset of the disease and postpartum hemorrhage were independent variables associated with severe maternal outcomes, in addition to acute pulmonary edema, previous heart disease and delays in receiving secondary and tertiary care. Conclusions In women with severe hypertensive disorders, the current study identified situations independently associated with a severe maternal outcome, which could be modified by interventions in obstetric care and in the healthcare system. Furthermore, the study showed the feasibility of a hospital system for surveillance of severe maternal morbidity. PMID:24428879

  15. Maternity Protection at Work.

    ERIC Educational Resources Information Center

    World of Work, 1998

    1998-01-01

    Discusses the need for maternity benefits for working women. Suggests that although most countries provide paid maternity leave by law, there is a gap between that law and practice. Includes a chart depicting maternity protection (length of leave, cash benefits, who pays) around the world. (JOW)

  16. Role of maternal 5-HT1A receptor in programming offspring emotional and physical development

    PubMed Central

    van Velzen, Annelies; Toth, Miklos

    2010-01-01

    Serotonin1A receptor (5-HT1AR) deficiency has been associated with anxiety and depression and mice with genetic receptor inactivation exhibit heightened anxiety. We have reported that 5-HT1AR is not only a genetic but also a maternal “environmental” factor in the development of anxiety in Swiss-Webster mice. Here we tested if the emergence of maternal genotype dependent adult anxiety is preceded by early behavioral abnormalities or if it is manifested following a normal emotional development. Pups born to null or heterozygote mothers had significantly reduced ultrasonic vocalization between postnatal day (P) 4 and 12 indicating an influence of the maternal genotype. The offspring’s own genotype had an effect limited to P4. Furthermore, we observed reduced weight gain in the null offspring of null but not heterozygote mothers indicating that a complete maternal receptor deficiency compromises offspring physical development. Except a short perinatal deficit during the dark period, heterozygote females displayed normal maternal behavior which, with the early appearance of ultrasonic vocalization deficit, suggests a role for 5-HT1AR during pre/perinatal development. Consistent with this notion, adult anxiety in the offspring is determined during the pre/perinatal period. In contrast to heterozygote females, null mothers exhibited impaired pup retrieval and nest building that may explain the reduced weight gain of their offspring. Taken together, our data indicate an important role for the maternal 5-HT1AR in regulating offspring emotional and physical development. Since reduced receptor binding has been reported in depression, including postpartum depression, reduced 5-HT1AR function in mothers may influence the emotional development of their offspring. PMID:20633050

  17. Preventing Workplace Injuries Among Perinatal Nurses.

    PubMed

    Harolds, Laura; Hurst, Helen

    2016-01-01

    Many aspects of perinatal nursing put nurses at risk for injuries, including frequent repetitive bending, lifting of clients, and exposure to potentially large amounts of body fluids such as blood and amniotic fluid. Violence is also a potential risk with stressful family situations that may arise around childbirth. Workplace injuries put a health care facility at risk for staff turnover, decreases in the number of skilled nurses, client dissatisfaction, workers' compensation payouts, and employee lawsuits. Through the use of safety equipment, improved safety and violence training programs, "no manual lift" policies, reinforcement of personal protective equipment usage, and diligent staff training to improve awareness, these risks can be minimized. PMID:26902445

  18. Clinical benchmarking: implications for perinatal nursing.

    PubMed

    Fitzgerald, K

    1998-06-01

    Health care is a dynamic environment where expectations of quality must be balanced with appropriateness of treatment and cost of care. Managers often have inadequate information on which to base decisions, policy, and practice. Clinical benchmarking is a tool and a process of continuously comparing the practices and performances of one's operations against those of the best in the industry or the focused area of service and then using that information to enhance and improve performance and productivity. The article discusses the advantages and disadvantages of benchmarking as well as the factors influencing the need for such tools in health care and in perinatal nursing. PMID:9782874

  19. Induced abortion as a risk factor for perinatal complications: a review.

    PubMed Central

    Bracken, M. B.

    1978-01-01

    Past and continuing studies of the influence of a prior induced abortion on subsequent perinatal complications are reviewed. Many definitive conclusions are precluded because of design problems in the extant studies and these methodological issues, therefore, form the focus for the current review. The available studies do suggest that abortion by vacuum aspiration is not a risk factor for complications of subsequent pregnancies, labor, delivery, or of newborns. Abortion by dilatation and curettage, however, may increase the risk of subsequent spontaneous abortion, low birth weight, and prematurity but these findings need to be confirmed. The impact of other abortion techniques or perinatal complications has not been studied. The more common design problems in the extant literature include: (1) failure to control for confounding maternal factors; (2) problems in reliability of reporting previous abortion; and (3) nonspecific measurement of abortion techniques. Since approximately three-quarters of all abortions performed annually in the United States are on young never-married women who may eventually wish to bear children, further rigorous research to define the risks of induced abortion is urgently required. PMID:373267

  20. Birth and perinatal outcomes and complications for babies conceived following ART.

    PubMed

    Henningsen, Anna-Karina Aaris; Pinborg, Anja

    2014-08-01

    Children born after assisted reproductive techniques (ART) have an increased risk of several adverse perinatal outcomes compared with their naturally conceived peers. This has various causes such as higher multiple birth rates, parental characteristics and higher maternal age, with more being nulliparous. Furthermore the in-vitro techniques, the controlled ovarian stimulation, culture media, and possibly additional freezing or vitrification procedures seem to play a role. However, when analyzing the perinatal trends over time, the differences between ART and naturally conceived children appear to have diminished. This is probably due to ART being more accessible and therefore couples have shorter duration of infertility before referral to ART; hence couples are nowadays less reproductively ill than in the past. A refinement of both clinical and laboratory skills during the past three decades of assisted reproduction may be another explanation. However, caution should be taken, as we do not yet know the full consequences of the observed increase in fetal growth and potential epigenetic changes in the early embryonic stages of fetal development. PMID:24840403

  1. Prenatal, perinatal and neonatal risk factors of Autism Spectrum Disorder: a comprehensive epidemiological assessment from India.

    PubMed

    Mamidala, Madhu Poornima; Polinedi, Anupama; P T V, Praveen Kumar; Rajesh, N; Vallamkonda, Omsai Ramesh; Udani, Vrajesh; Singhal, Nidhi; Rajesh, Vidya

    2013-09-01

    Incidence of Autism Spectrum Disorder (ASD) is increasing across the globe and no data is available from India regarding the risk factors of ASD. In this regard a questionnaire based epidemiological assessment was carried out on prenatal, perinatal and neonatal risk factors of ASD across 8 cities in India. A retrospective cohort of 942 children was enrolled for the study. 471 children with ASD, under age of 10, were analyzed for pre-, peri-, and neonatal factors and were compared with the observations from equal number of controls. The quality control of the questionnaire and data collection was done thoroughly and the observations were computed statistically. A total of 25 factors were evaluated by unadjusted and adjusted analysis in this study. Among the prenatal factors considered, advanced maternal age, fetal distress and gestational respiratory infections were found to be associated with ASD and had an odds ratio of 1.8. Evaluation of perinatal and neonatal risk factors showed labor complications, pre-term birth, neonatal jaundice, delayed birth cry and birth asphyxia to be associated with ASD with an odds ratio greater than 1.5. This important study, first of its kind in Indian population gives a firsthand account of the relation of pre-, peri- and neonatal risk factors on ASD from an ethnically and socially diverse country like India, the impact of which was unknown earlier. This advocates additional focused investigations on physiological and genetic changes contributed by these risk factor inducing environments. PMID:23816633

  2. Incorporating recognition and management of perinatal and postpartum depression into pediatric practice.

    PubMed

    Earls, Marian F

    2010-11-01

    Every year, more than 400,000 infants are born to mothers who are depressed, which makes perinatal depression the most underdiagnosed obstetric complication in America. Postpartum depression leads to increased costs of medical care, inappropriate medical care, child abuse and neglect, discontinuation of breastfeeding, and family dysfunction and adversely affects early brain development. Pediatric practices, as medical homes, can establish a system to implement postpartum depression screening and to identify and use community resources for the treatment and referral of the depressed mother and support for the mother-child (dyad) relationship. This system would have a positive effect on the health and well-being of the infant and family. State chapters of the American Academy of Pediatrics, working with state Early Periodic Screening, Diagnosis, and Treatment (EPSDT) and maternal and child health programs, can increase awareness of the need for perinatal depression screening in the obstetric and pediatric periodicity of care schedules and ensure payment. Pediatricians must advocate for workforce development for professionals who care for very young children and for promotion of evidence-based interventions focused on healthy attachment and parent-child relationships. PMID:20974776

  3. Missed opportunities for prevention of perinatal transmission of hepatitis B: A retrospective cohort study

    PubMed Central

    van Schalkwyk, Julie; Nourmoussavi, Melica; Massey, Andrea; Gustafson, Reka; Brodkin, Elizabeth; Petric, Martin; Krajden, Mel; Dobson, Simon; Buxton, Jane; Bigham, Mark; Pick, Neora; Schreiber, Richard; Sherlock, Christopher H; Money, Deborah; Yoshida, Eric M

    2014-01-01

    BACKGROUND: Perinatal transmission of hepatitis B virus (HBV) can occur despite postexposure prophylaxis (PEP). Recent literature suggests that antiviral treatment during pregnancy when maternal HBV DNA levels are elevated can further decrease vertical transmission. However, HBV DNA screening is not routinely performed antenatally. OBJECTIVE: To determine the rates of HBV prevalence and perinatal transmission in an antenatal cohort. METHODS: A retrospective review of public health records (December 2008 to December 2010) was performed for both mothers and newborns. RESULTS: A total of 725 mother-infant pairs were included. Of these, 574 of 715 (80%) women had antenatal hepatitis B e antigen (HBeAg) testing performed, and 127 of 574 (22%) were HBeAg positive (HBeAg+). Of babies born to hepatitis B surface antigen-positive (HBsAg+) mothers, only 573 of 725 (79%) received complete PEP. In addition, 172 of 725 (24%) infants did not receive post-PEP blood testing or were lost to follow-up. Of the 552 infants with results available, seven cases (1.3%) of mother-to-child HBV transmission were observed, six of which involved infants born to HBeAg+ women. CONCLUSIONS: Our findings suggest that routine HBeAg screening could identify a subset of mother-infant pairs among HBsAg+ pregnant women who are at higher risk for vertical HBV transmission. Determination of viral load in expectant HBeAg+ mothers may provide more precise insight into HBV transmission to their infants. PMID:25390612

  4. Presumed Perinatal Stroke: Risk Factors, Clinical and Radiological Findings.

    PubMed

    Ilves, Pilvi; Laugesaar, Rael; Loorits, Dagmar; Kolk, Anneli; Tomberg, Tiiu; Lõo, Silva; Talvik, Inga; Kahre, Tiina; Talvik, Tiina

    2016-04-01

    It is unknown why some infants with perinatal stroke present clinical symptoms late during infancy and will be identified as infants with presumed perinatal stroke. The risk factors and clinical and radiological data of 42 infants with presumed perinatal stroke (69% with periventricular venous infarction and 31% with arterial ischemic stroke) from the Estonian Pediatric Stroke Database were reviewed. Children with presumed perinatal stroke were born at term in 95% of the cases and had had no risk factors during pregnancy in 43% of the cases. Children with periventricular venous infarction were born significantly more often (82%) vaginally (P = .0213) compared to children with arterial stroke (42%); nor did they require resuscitation (P = .0212) or had any neurological symptoms after birth (P = .0249). Periventricular venous infarction is the most common type of lesion among infants with the presumed perinatal stroke. Data suggest that the disease is of prenatal origin. PMID:26446909

  5. Use of Wigglesworth pathophysiological classification for perinatal mortality in Malaysia.

    PubMed Central

    Amar, H. S.; Maimunah, A. H.; Wong, S. L.

    1996-01-01

    A one year prospective study of perinatal deaths was conducted to test the feasibility of using the Wigglesworth pathophysiological classification in the Malaysian health service. Four regions with high perinatal mortality rates were selected. Deaths were actively identified. Nursing staff were trained to use the classification and every death was reviewed by a clinician. A total of 26,198 births and 482 perinatal deaths were reported. The perinatal mortality rate was 18.4. Only 14 (2.9%) deaths had their Wigglesworth category reclassified. Most deaths were in the normally formed macerated stillbirths (34.4%), asphyxial conditions (26.8%), and immaturity (20.1%) subgroups. The results were compared with data from other countries that used this classification. This study has shown that the Wigglesworth pathophysiological classification can be applied to perinatal deaths in the existing Malaysian health service. PMID:8653438

  6. Effect of the timing of delivery on perinatal outcomes at gestational hypertension

    PubMed Central

    Keskin, Müge; Seval, Mehmet Murat; Söylemez, Feride

    2015-01-01

    Objective We aimed to evaluate the perinatal outcomes of women diagnosed with gestational hypertension and no proteinuria according to the gestational weeks. Methods We included women diagnosed with gestational hypertension between 2010 and 2014 at our institution and excluded the patients with preeclampsia and chronic hypertension. Women with gestational hypertension were grouped according to the gestational weeks. One group consisted of the pregnancies between 37 and 38*6, whereas the other group included pregnancies between 39 and 41 weeks. Then the outcomes of these pregnancies were compared with healthy women who had delivery between the same weeks (37–38*6 weeks and 39–41 weeks). We analyzed the mode of delivery, birth weight, and neonatal outcomes of these pregnancies. Results First and fifth minute Apgar scores were significantly decreased in women with gestational hypertension who had delivery between 39 and 41 weeks compared to healthy subjects (respectively, p = 0.005 and p = 0.033). Perinatal outcomes were adversely affected if the time of delivery was beyond 39 weeks in pregnancies complicated with gestational hypertension. Conclusion We concluded that perinatal outcomes were adversely affected if the time of delivery was beyond 39 weeks in pregnancies complicated with gestational hypertension, and outcomes of such pregnancies can be improved if time for delivery is <39 weeks. PMID:26120477

  7. Perinatal Obstetric Office Depression Screening and Treatment: Implementation in a Health Care System.

    PubMed

    Flanagan, Tracy; Avalos, Lyndsay A

    2016-05-01

    Perinatal depression affects between 12% and 20% of pregnant and postpartum women and is underdiagnosed. The American College of Obstetricians and Gynecologists and the U.S. Preventive Services Task Force recently recommended universal perinatal depression screening. We discuss challenges to instituting universal screening, describe the development and implementation between 2007 and 2014 of Kaiser Permanente Northern California's successful program, and highlight key measures of success. A quality improvement system approach with four steps guided development: 1) identify and use best practices, 2) identify champions and educate clinicians, 3) use data that drive performance, and 4) streamline office workflow. Clinical success was determined by at least 50% improvement in depression care metrics from diagnosis to 120 days afterward. Depression diagnoses, Patient Health Questionnaire-9 scores, medication dispensation, and treatment for all births in 2014 (N=37,660) were extracted from electronic health records. Ninety-six percent of pregnant and postpartum women were screened at least once. Fourteen percent screened positive for depression (Patient Health Questionnaire-9 score of 10 or greater). Approximately 6% of pregnant and postpartum women had severe depression with a Patient Health Questionnaire-9 of 15 or greater and a depression diagnosis, and 80% of these women received treatment. Forty percent of women with a depression diagnosis demonstrated improved symptoms. Kaiser Permanente Northern California's universal perinatal depression screening program can serve as a model for the feasibility and clinical effectiveness of universal depression screening in obstetric care. PMID:27054937

  8. Ontogeny of catecholamine and GABA levels in rat brain: lack of effect of perinatal lead exposure.

    PubMed

    Bailey, C C; Kitchen, I

    1986-01-01

    In this study we report the ontogeny of noradrenaline, adrenaline, dopamine, and gamma-aminobutyric acid (GABA) in the rat striatum and the effect of perinatal exposure to low levels of lead. Lead administered in the maternal drinking water (100, 300 and 1000 ppm) from conception to weaning had no effect on the ontogeny of catecholamines. There was a 50% decrease in the levels of GABA at 10 days in rats exposed to the highest dose of lead, but no other changes were observed in lead-exposed rats at 21 and 30 days of age. These results contrast with our previously reported decrease in the levels of striatal proenkephalin products in lead-exposed rats, and suggest that this inhibitory effect of lead does not represent a generalised neurochemical toxicity. PMID:3952777

  9. Lack of effect of perinatal lead exposure on kappa-opioid receptor function.

    PubMed

    Jackson, H C; Kitchen, I

    1990-01-01

    The effects of lead exposure have been studied upon the behavioural and diuretic responses to the kappa-opioid receptor agonist U-50488H in neonatal rats. Lead was administered in the maternal drinking water (100, 300 and 1000 ppm) from conception to postnatal day 14. The hyperactivity, wall climbing behaviours and diuretic effects of U-50488H (0.1-30 mg/kg, i.p.) in 5- and 20-day-old rat pups were unaffected at all 3 lead dose levels. Lead treatment per se produced a decrease in activity at 20 days. These results contrast with our previously reported disruption of mu- and delta-opioid receptor systems following perinatal lead exposure and suggest that the toxic effects of this metal may be confined to particular types of opioid receptor. PMID:2153320

  10. Placental malaria and perinatal transmission of human immunodeficiency virus type 1.

    PubMed

    Inion, Ingrid; Mwanyumba, Fabian; Gaillard, Philippe; Chohan, Varsha; Verhofstede, Chris; Claeys, Patricia; Mandaliya, Kishorchandra; Van Marck, Eric; Temmerman, Marleen

    2003-12-01

    Prevalence of placental malaria in human immunodeficiency virus (HIV) type 1-infected and -uninfected women and the effect of placental malaria on genital shedding and perinatal transmission of HIV-1 were examined. Genital samples for HIV-1 DNA RNA were collected during labor. Infants were tested for HIV-1 at 1 day and 6 weeks postpartum. Placental malaria was diagnosed by histopathological examination: 372 placentas of HIV-1-infected women and 277 of HIV-1-uninfected women were processed. A higher prevalence of placental malaria was seen in HIV-1-infected women. No association was found between placental malaria and either maternal virus load, genital HIV-1 DNA, or HIV-1 RNA. Placental malaria did not correlate with in utero or peripartal transmission of HIV-1. PMID:14639538

  11. Perinatal HIV Prevention Outcomes in U.S.-Born Versus Foreign-Born Blacks, PSD Cohort, 1995-2004.

    PubMed

    Myles, Ranell L; Artstein-McNassar, Melissa; Dean, Hazel D; Bohannon, Beverly; Melville, Sharon K; Yeager, Richard; Wheeling, John; Rose, Charles E; Zhu, Julia; Dominguez, Kenneth L

    2015-08-01

    We examined differences in HIV-infected U.S.-born and foreign-born black mothers who delivered perinatally HIV-exposed and -infected children during 1995-2004 in the Pediatric Spectrum of HIV Disease Project, a longitudinal cohort study. Prevalence ratios were calculated to explain differences in perinatal HIV prevention opportunities comparing U.S.-born to foreign-born and African-born to Caribbean-born black mothers. U.S.-born compared with foreign-born HIV-infected black mothers were significantly more likely to have used cocaine or other non-intravenous illicit drugs, exchanged money or drugs for sex, known their HIV status before giving birth, received intrapartum antiretroviral (ARV) prophylaxis, and delivered a premature infant; and were significantly less likely to have received prenatal care or delivered an HIV-infected infant. African-born compared with Caribbean-born black mothers were more likely to receive intrapartum ARV prophylaxis. These differences by maternal geographical origin have important implications for perinatal HIV transmission prevention, and highlight the validity of disaggregating data by racial/ethnic subgroups. PMID:24841594

  12. Effect of embryo freezing on perinatal outcome after assisted reproduction techniques: lessons from the Latin American Registry of Assisted Reproduction.

    PubMed

    Schwarze, Juan-Enrique; Crosby, Javier A; Zegers-Hochschild, Fernando

    2015-07-01

    Embryo cryopreservation is an integral part of assisted reproduction techniques; it allows the sequential transfer of all embryos, thus diminishing the risk of multiple pregnancies and associated perinatal complications. To address concerns about the safety of this procedure, neonatal outcome after 43,070 fresh embryo transfers was compared with 12,068 frozen-thawed embryo transfers (FET). After adjusting for maternal age, gestational age, embryo development at time of transfer, number of babies born and gestational order, FET was not found to be associated with an increase in perinatal mortality (odds ratio [OR] 1.72, 95% confidence interval [CI] 0.81 to 3.62); preterm birth (OR 1.05, 95% CI 0.93 to 1.18); or extreme preterm birth (OR 0.82, 95% CI 0.64 to 1.06). Furthermore, after correcting for known confounding factors, FET was found to be associated with an increase in neonatal weight of 39.7 g (95% CI 1.54 to 64.10; P < 0.0001). Embryo cryopreservation was, therefore, not associated with an increase in the risk of poor perinatal outcome. PMID:25982094

  13. Perinatal Bereavement: A Principle-based Concept Analysis

    PubMed Central

    FENSTERMACHER, Kimberly; HUPCEY, Judith E.

    2013-01-01

    Aim This paper is a report of an analysis of the concept of perinatal bereavement. Background The concept of perinatal bereavement emerged in the scientific literature during the 1970s. Perinatal bereavement is a practice based concept, although it is not well defined in the scientific literature and is often intermingled with the concepts of mourning and grief. Design Concept Analysis. Data Sources Using the term ‘perinatal bereavement’ and limits of only English and human, Pub Med and CINAHL were searched to yield 278 available references dating from 1974 – 2011. Articles specific to the experience of perinatal bereavement were reviewed. The final data set was 143 articles. Review Methods The methods of principle-based concept analysis were used. Results reveal conceptual components (antecedents, attributes and outcomes) which are delineated to create a theoretical definition of perinatal bereavement. Results The concept is epistemologically immature, with few explicit definitions to describe the phenomenon. Inconsistency in conceptual meaning threatens the construct validity of measurement tools for perinatal bereavement and contributes to incongruent theoretical definitions. This has implications for both nursing science (how the concept is studied and theoretically integrated) and clinical practice (timing and delivery of support interventions). Conclusions Perinatal bereavement is a multifaceted global phenomenon that follows perinatal loss. Lack of conceptual clarity and lack of a clearly articulated conceptual definition impede the synthesis and translation of research findings into practice. A theoretical definition of perinatal bereavement is offered as a platform for researchers to advance the concept through research and theory development. PMID:23458030

  14. Hormonal Physiology of Childbearing, an Essential Framework for Maternal-Newborn Nursing.

    PubMed

    Sakala, Carol; Romano, Amy M; Buckley, Sarah J

    2016-01-01

    Knowledge of the hormonal physiology of childbearing is foundational for all who care for childbearing women and newborns. When promoted, supported, and protected, innate, hormonally driven processes optimize labor and birth, maternal and newborn transitions, breastfeeding, and mother-infant attachment. Many common perinatal interventions can interfere with or limit hormonal processes and have other unintended effects. Such interventions should only be used when clearly indicated. High-quality care incorporates salutogenic nursing practices that support physiologic processes and maternal-newborn health. PMID:26826397

  15. Prenatal Exposure to Persistent Organochlorines and Childhood Obesity in the U.S. Collaborative Perinatal Project

    PubMed Central

    Klebanoff, Mark A.; Brock, John W.; Longnecker, Matthew P.

    2013-01-01

    Background: In some previous studies, prenatal exposure to persistent organochlorines such as 1,1,-dichloro-2,2-bis(p-chlorophenyl)ethylene (p,p´-DDE), polychlorinated biphenyls (PCBs), and hexachlorobenzene (HCB) has been associated with higher body mass index (BMI) in children. Objective: Our goal was to evaluate the association of maternal serum levels of β-hexachlorocyclohexane (β-HCH), p,p´-DDE, dichlorodiphenyltrichloroethane (p,p´-DDT), dieldrin, heptachlor epoxide, HCB, trans-nonachlor, oxychlordane, and PCBs with offspring obesity during childhood. Methods: The analysis was based on a subsample of 1,915 children followed until 7 years of age as part of the U.S. Collaborative Perinatal Project (CPP). The CPP enrolled pregnant women in 1959–1965; exposure levels were measured in third-trimester maternal serum that was collected before these organochlorines were banned in the United States. Childhood overweight and obesity were defined using age- and sex-specific cut points for BMI as recommended by the International Obesity Task Force. Results: Adjusted results did not show clear evidence for an association between organochlorine exposure and obesity; however, a suggestive finding emerged for dieldrin. Compared with those in the lowest quintile (dieldrin, < 0.57 μg/L), odds of obesity were 3.6 (95% CI: 1.3, 10.5) for the fourth and 2.3 (95% CI: 0.8, 7.1) for the highest quintile. Overweight and BMI were unrelated to organochlorine exposure. Conclusions: In this population with relatively high levels of exposure to organochlorines, no clear associations with obesity or BMI emerged. Citation: Cupul-Uicab LA, Klebanoff MA, Brock JW, Longnecker MP. 2013. Prenatal exposure to persistent organochlorines and childhood obesity in the U.S. Collaborative Perinatal Project. Environ Health Perspect 121:1103–1109; http://dx.doi.org/10.1289/ehp.1205901 PMID:23799652

  16. Perinatal Oxygen in the Developing Lung

    PubMed Central

    Vogel, Elizabeth R.; Britt, Rodney D.; Trinidad, Mari Charisse; Faksh, Arij; Martin, Richard J.; MacFarlane, Peter M.; Pabelick, Christina M.; Prakash, Y.S.

    2015-01-01

    Lung diseases, such as bronchopulmonary dysplasia (BPD), wheezing, and asthma, remain significant causes of morbidity and mortality in the pediatric population, particularly in the setting of premature birth. Pulmonary outcomes in these infants are highly influenced by perinatal exposures including prenatal inflammation, postnatal intensive care unit interventions, and environmental agents. Here, there is strong evidence that perinatal supplemental oxygen administration has significant effects on pulmonary development and health. This is of particular importance in the preterm lung, where premature exposure to room air represents a hyperoxic insult that may cause harm to a lung primed to develop in a hypoxic environment. Preterm infants are also subject to increased episodes of hypoxia, which may also result in pulmonary damage and disease. Here, we summarize current understanding of the effects of oxygen on the developing lung and how low vs. high oxygen may predispose to pulmonary disease that may extend even into adulthood. Better understanding of the underlying mechanisms will help lead to improved care and outcomes in this vulnerable population. PMID:25594569

  17. Perinatal testicular torsion and medicolegal considerations.

    PubMed

    Massoni, F; Troili, G M; Pelosi, M; Ricci, S

    2014-06-01

    Perinatal testicular torsion (PTT) is a very complex condition because of rarity of presentation and diagnostic and therapeutic difficulties. In presence of perinatal testicular torsion, the involvement of contralateral testis can be present also in absence of other indications which suggest the bilateral involvement; therefore, occurrences supported by literature do not exclude the use of surgery to avoid the risk of omitted or delayed diagnosis. The data on possible recovery of these testicles are not satisfactory, and treatment consists of an observational approach ("wait-and-see") or an interventional approach. The hypothesis of randomized clinical trials seems impracticable because of rarity of disease. The authors present a case of PTT, analyzing injuries due to clinical and surgical management of these patients, according to medicolegal profile. The delayed diagnosis and the choice of an incorrect therapeutic approach can compromise the position of healthcare professionals, defective in terms of skill, prudence and diligence. Endocrine insufficiency is an unfortunate event. The analysis of literature seems to support, because of high risk, a surgical approach aimed not only at resolution of unilateral pathology or prevention of a relapse, but also at prevention of contralateral testicular torsion. PMID:24826979

  18. Staff and Institutional Factors Associated with Substandard Care in the Management of Postpartum Hemorrhage

    PubMed Central

    Perrodeau, E.; Deneux-Tharaux, C.

    2016-01-01

    Objective to identify staff and institutional factors associated with substandard care by midwives managing postpartum hemorrhage (PPH). Methods A multicenter vignette-based study was e-mailed to a random sample of midwives at 145 French maternity units that belonged to 15 randomly selected perinatal networks. Midwives were asked to describe how they would manage two case-vignettes about PPH and to complete a short questionnaire about their individual (e.g., age, experience, and full- vs. part-time practice) and institutional (private or public status and level of care) characteristics. These previously validated case-vignettes described two different scenarios: vignette 1, a typical immediate, severe PPH, and vignette 2, a severe but gradual hemorrhage. Experts consensually defined 14 criteria to judge adherence to guidelines. The number of errors (possible range: 0 to 14) for the 14 criteria quantified PPH guideline adherence, separately for each vignette. Results 450 midwives from 87 maternity units provided complete responses. Perfect adherence (no error for any of the 14 criteria) was low: 25.1% for vignette 1 and 4.2% for vignette 2. After multivariate analysis, midwives’ age remained significantly associated with a greater risk of error in guideline adherence in both vignettes (IRR 1.19 [1.09; 1.29] for vignette 1, and IRR 1.11 [1.05; 1.18] for vignette 2), and the practice of mortality and morbidity reviews in the unit with a lower risk (IRR 0.80 [0.64; 0.99], IRR 0.78 [0.66; 0.93] respectively). Risk-taking scores (IRR 1.41 [1.19; 1.67]) and full-time practice (IRR 0.83 [0.71; 0.97]) were significantly associated with adherence only in vignette 1. Conclusions Both staff and institutional factors may be associated with substandard care in midwives’ PPH management. PMID:27010407

  19. Maternal and neonatal death associated with Eisenmenger's syndrome.

    PubMed

    Heytens, L; Alexander, J P

    1986-01-01

    Pregnancy in patients with Eisenmenger's syndrome is known to be associated with a high incidence of maternal and perinatal death. Complications can occur before and during parturition but are most hazardous in the early postpartum period. If the exact causes of maternal death remain in most instances unknown, hypovolemia with augmented pulmonary to systemic shunt, thromboembolism and cardiac arrythmias are often mentioned as the primary causes of mortality. We report the unsuccessful management of a pregnant patient with Eisenmenger's disease despite all possible precautions as reported in the literature had been taken. We discuss these precautions and more specifically the type of anesthesia that is best given, the prophylactic methods of anticoagulation and the benefit of monitoring techniques in the management of such complex pathologies. PMID:3705908

  20. Development of a linked perinatal data resource from state administrative and community-based program data.

    PubMed

    Hall, Eric S; Goyal, Neera K; Ammerman, Robert T; Miller, Megan M; Jones, David E; Short, Jodie A; Van Ginkel, Judith B

    2014-01-01

    To demonstrate a generalizable approach for developing maternal-child health data resources using state administrative records and community-based program data. We used a probabilistic and deterministic linking strategy to join vital records, hospital discharge records, and home visiting data for a population-based cohort of at-risk, first time mothers enrolled in a regional home visiting program in Southwestern Ohio and Northern Kentucky from 2007 to 2010. Because data sources shared no universal identifier, common identifying elements were selected and evaluated for discriminating power. Vital records then served as a hub to which other records were linked. Variables were recoded into clinically significant categories and a cross-set of composite analytic variables was constructed. Finally, individual-level data were linked to corresponding area-level measures by census tract using the American Communities Survey. The final data set represented 2,330 maternal-infant pairs with both home visiting and vital records data. Of these, 56 pairs (2.4 %) did not link to either maternal or infant hospital discharge records. In a 10 % validation subset (n = 233), 100 % of the reviewed matches between home visiting data and vital records were true matches. Combining multiple data sources provided more comprehensive details of perinatal health service utilization and demographic, clinical, psychosocial, and behavioral characteristics than available from a single data source. Our approach offers a template for leveraging disparate sources of data to support a platform of research that evaluates the timeliness and reach of home visiting as well as its association with key maternal-child health outcomes. PMID:23420307

  1. Exposures to Airborne Particulate Matter and Adverse Perinatal Outcomes: A Biologically Plausible Mechanistic Framework for Exploring Potential Effect Modification by Nutrition

    PubMed Central

    Kannan, Srimathi; Misra, Dawn P; Dvonch, J. Timothy; Krishnakumar, Ambika

    2006-01-01

    Objectives The specific objectives are threefold: to describe the biologically plausible mechanistic pathways by which exposure to particulate matter (PM) may lead to the adverse perinatal outcomes of low birth weight (LBW), intrauterine growth retardation (IUGR), and preterm delivery (PTD); review the evidence showing that nutrition affects the biologic pathways; and explain the mechanisms by which nutrition may modify the impact of PM exposure on perinatal outcomes. Methods We propose an interdisciplinary conceptual framework that brings together maternal and infant nutrition, air pollution exposure assessment, and cardiopulmonary and perinatal epidemiology. Five possible albeit not exclusive biologic mechanisms have been put forth in the emerging environmental sciences literature and provide corollaries for the proposed framework. Conclusions Protecting the environmental health of mothers and infants remains a top global priority. The existing literature indicates that the effects of PM on LBW, PTD, and IUGR may manifest through the cardiovascular mechanisms of oxidative stress, inflammation, coagulation, endothelial function, and hemodynamic responses. PM exposure studies relating mechanistic pathways to perinatal outcomes should consider the likelihood that biologic responses and adverse birth outcomes may be derived from both PM and non-PM sources (e.g., nutrition). In the concluding section, we present strategies for empirically testing the proposed model and developing future research efforts. PMID:17107846

  2. Perinatal mortality in pregnancies with omphalocele: data from the Chinese national birth defects monitoring network, 1996–2006

    PubMed Central

    2014-01-01

    Background Previous studies on the mortality rate of omphalocele are limited. The risk of death of non-isolated omphalocele and that of cases of omphalocele that are diagnosed prenatally by ultrasound are unclear. This study aimed to estimate the perinatal mortality of pregnancies with omphalocele. This study also examined the potential risk of death of non-isolated omphalocele and that of cases that are prenatally diagnosed by ultrasound. Methods Data were retrieved from the national birth defects registry in China, for 1996–2006. Multinomial logistic regression was used to calculate the adjusted odds ratios (AORs) and 95% confidence intervals (CIs) between perinatal mortality and selected maternal and fetal characteristics. Results Among 827 cases of omphalocele, 309 (37.4%) cases resulted in termination of pregnancy and stillbirth, and 124 (15.0%) cases resulted in death in the first 7 days after delivery, yielding a perinatal mortality rate of 52.4% (95% CI: 49.0–55.8%). The late fetal death rate (LFDR) of omphalocele that was diagnosed prenatally by ultrasound was 15.91-fold (AOR: 15.91, 95% CI: 10.18–24.87) higher than that of postnatally diagnosed cases. The LFDR of non-isolated omphalocele was 2.64-fold (AOR: 2.64, 95% CI: 1.62–4.29) higher than that of isolated cases. For the early neonatal death rate, neonates with non-isolated omphalocele had a 2.96-fold (AOR: 2.96, 95% CI: 1.82–4.81) higher risk than isolated cases, but the difference between prenatal ultrasound diagnosis and postnatal diagnosis was not significant. Conclusions Selected fetal characteristics are significantly associated with the perinatal risk of death from omphalocele. Our findings suggest that improving pregnancy and delivery care, as well as management for omphalocele are important. PMID:24953381

  3. Reduced Perinatal Leptin Availability May Contribute to Adverse Metabolic Programming in a Rat Model of Uteroplacental Insufficiency.

    PubMed

    Nüsken, Eva; Wohlfarth, Maria; Lippach, Gregor; Rauh, Manfred; Schneider, Holm; Dötsch, Jörg; Nüsken, Kai-Dietrich

    2016-05-01

    Leptin availability in perinatal life critically affects metabolic programming. We tested the hypothesis that uteroplacental insufficiency and intrauterine stress affect perinatal leptin availability in rat offspring. Pregnant rats underwent bilateral uterine vessel ligation (LIG; n = 14), sham operation (SOP; n = 12), or no operation (controls, n = 14). Fetal livers (n = 180), placentas (n = 180), and maternal blood were obtained 4 hours (gestational day [E] 19), 24 hours (E20), and 72 hours (E22) after surgery. In the offspring, we took blood samples on E22 (n = 44), postnatal day (P) 1 (n = 29), P2 (n = 16), P7 (n = 30), and P12 (n = 30). Circulating leptin (ELISA) was significantly reduced in LIG (E22, P1, P2) and SOP offspring (E22). Postnatal leptin surge was delayed in LIG but was accelerated in SOP offspring. Placental leptin gene expression (quantitative RT-PCR) was reduced in LIG (E19, E20, E22) and SOP (E20, E22). Hepatic leptin receptor (Lepr-a, mediating leptin degradation) gene expression was increased in LIG fetuses (E20, E22) only. Surprisingly, hypoxia-inducible factors (Hif; Western blot) were unaltered in placentas and were reduced in the livers of LIG (Hif1a, E20; Hif2a, E19, E22) and SOP (Hif2a, E19) fetuses. Gene expression of prolyl hydroxylase 3, a factor expressed under hypoxic conditions contributing to Hif degradation, was increased in livers of LIG (E19, E20, E22) and SOP (E19) fetuses and in placentas of LIG and SOP (E19). In summary, reduced placental leptin production, increased fetal leptin degradation, and persistent perinatal hypoleptinemia are present in intrauterine growth restriction offspring, especially after uteroplacental insufficiency, and may contribute to perinatal programming of leptin resistance and adiposity in later life. PMID:27007072

  4. The Alteration of Neonatal Raphe Neurons by Prenatal-Perinatal Nicotine. Meaning for Sudden Infant Death Syndrome.

    PubMed

    Cerpa, Verónica J; Aylwin, María de la Luz O; Beltrán-Castillo, Sebastián; Bravo, Eduardo U; Llona, Isabel R; Richerson, George B; Eugenín, Jaime L

    2015-10-01

    Nicotine may link maternal cigarette smoking with respiratory dysfunctions in sudden infant death syndrome (SIDS). Prenatal-perinatal nicotine exposure blunts ventilatory responses to hypercapnia and reduces central respiratory chemoreception in mouse neonates at Postnatal Days 0 (P0) to P3. This suggests that raphe neurons, which are altered in SIDS and contribute to central respiratory chemoreception, may be affected by nicotine. We therefore investigated whether prenatal-perinatal nicotine exposure affects the activity, electrical properties, and chemosensitivity of raphe obscurus (ROb) neurons in mouse neonates. Osmotic minipumps, implanted subcutaneously in 5- to 7-day-pregnant CF1 mice, delivered nicotine bitartrate (60 mg kg(-1) d(-1)) or saline (control) for up to 28 days. In neonates, ventilation was recorded by head-out plethysmography, c-Fos (neuronal activity marker), or serotonin autoreceptors (5HT1AR) were immunodetected using light microscopy, and patch-clamp recordings were made from raphe neurons in brainstem slices under normocarbia and hypercarbia. Prenatal-perinatal nicotine exposure decreased the hypercarbia-induced ventilatory responses at P1-P5, reduced both the number of c-Fos-positive ROb neurons during eucapnic normoxia at P1-P3 and their hypercapnia-induced recruitment at P3, increased 5HT1AR immunolabeling of ROb neurons at P3-P5, and reduced the spontaneous firing frequency of ROb neurons at P3 without affecting their CO2 sensitivity or their passive and active electrical properties. These findings reveal that prenatal-perinatal nicotine reduces the activity of neonatal ROb neurons, likely as a consequence of increased expression of 5HT1ARs. This hypoactivity may change the functional state of the respiratory neural network leading to breathing vulnerability and chemosensory failure as seen in SIDS. PMID:25695895

  5. Prenatal and Perinatal Morbidity in Children with Tic Disorders: A Mainstream School-based Population Study in Central Spain

    PubMed Central

    Cubo, Esther; Hortigüela, Montesclaros; Jorge-Roldan, Sandra; Ciciliani, Selva Esther; Lopez, Patricia; Velasco, Leticia; Sastre, Emilio; Ausin, Vanesa; Delgado, Vanesa; Saez, Sara; Gabriel-Galán, José Trejo; Macarrón, Jesús

    2014-01-01

    Background While current research suggests that genetic factors confer the greatest risk for the development of tic disorders, studies of environmental factors are relatively few, with a lack of consistent risk factors across studies. Our aim is to analyze the association of tic disorders with exposure to prenatal and perinatal morbidity. Methods This was a nested case–control study design. Cases and controls were selected and identified from a mainstream, school-based sample. The diagnosis of tic disorders was assigned by a movement disorder neurologist using ‘Diagnostic and statistical manual of mental disorders, 4th edition, text revision’ criteria, and neuropsychiatric comorbidities were screened using the Spanish computerized version of the Diagnostic Interview Schedule for Children Predictive Scale. Information regarding the exposure to pre-perinatal risk factors was collected by a retrospective review of the birth certificates. Logistic regression analyses were then performed to test the association of tic disorders with pre-perinatal risk factors. Results Out of 407 participants, complete pre-perinatal data were available in 153 children (64 with tics and 89 without tics). After adjusting for family history of tics, neonatal respiratory distress syndrome, body mass index, prenatal infection, and coexisting comorbid neuropsychiatric disturbances, tic disorders were associated with prenatal exposure to tobacco (odds ratio [OR] = 3.07, 95% confidence interval [CI] 1.24–7.60, p = 0.007), and cesarean section (OR = 5.78, 95% CI 1.60–20.91, p = 0.01). Discussion This nested case–control study of children with tic disorders demonstrates higher adjusted odds for tics in children with exposure to cesarean delivery and maternal smoking. Longitudinal, population-based samples are required to confirm these results. PMID:25562036

  6. Perinatal bisphenol A exposure promotes dose-dependent alterations of the mouse methylome

    PubMed Central

    2014-01-01

    Background Environmental factors during perinatal development may influence developmental plasticity and disease susceptibility via alterations to the epigenome. Developmental exposure to the endocrine active compound, bisphenol A (BPA), has previously been associated with altered methylation at candidate gene loci. Here, we undertake the first genome-wide characterization of DNA methylation profiles in the liver of murine offspring exposed perinatally to multiple doses of BPA through the maternal diet. Results Using a tiered focusing approach, our strategy proceeds from unbiased broad DNA methylation analysis using methylation-based next generation sequencing technology to in-depth quantitative site-specific CpG methylation determination using the Sequenom EpiTYPER MassARRAY platform to profile liver DNA methylation patterns in offspring maternally exposed to BPA during gestation and lactation to doses ranging from 0 BPA/kg (Ctr), 50?g BPA/kg (UG), or 50mg BPA/kg (MG) diet (N?=?4 per group). Genome-wide analyses indicate non-monotonic effects of DNA methylation patterns following perinatal exposure to BPA, corroborating previous studies using multiple doses of BPA with non-monotonic outcomes. We observed enrichment of regions of altered methylation (RAMs) within CpG island (CGI) shores, but little evidence of RAM enrichment in CGIs. An analysis of promoter regions identified several hundred novel BPA-associated methylation events, and methylation alterations in the Myh7b and Slc22a12 gene promoters were validated. Using the Comparative Toxicogenomics Database, a number of candidate genes that have previously been associated with BPA-related gene expression changes were identified, and gene set enrichment testing identified epigenetically dysregulated pathways involved in metabolism and stimulus response. Conclusions In this study, non-monotonic dose dependent alterations in DNA methylation among BPA-exposed mouse liver samples and their relevant pathways were identified and validated. The comprehensive methylome map presented here provides candidate loci underlying the role of early BPA exposure and later in life health and disease status. PMID:24433282

  7. Adverse effects of young maternal age on neonatal outcomes

    PubMed Central

    Kang, Gavrielle; Lim, Jia Yi; Kale, Anita Sugam; Lee, Le Ye

    2015-01-01

    INTRODUCTION Teenage pregnancy is associated with poor neonatal outcomes, which may burden the young mothers and their families. The aim of this study was to determine the effect young maternal age and single motherhood has on neonatal outcomes. METHODS We conducted a retrospective cohort study of 267 infants born to mothers aged ≤ 21 years in National University Hospital, Singapore, from January 2011 to December 2012. We compared the maternal demographics and neonatal outcomes of single mothers with those of married mothers. The neonatal outcomes of our study cohort were also compared to the hospital’s birth cohort during the same period. RESULTS Unsatisfactory antenatal care was more prevalent among the young single mothers than among the young married mothers (odds ratio [OR] 2.90, 95% confidence interval [CI] 1.71–4.92, p < 0.01). The infants of the young single mothers had a lower mean birth weight (p = 0.01), with a significant proportion weighing < 2.5 kg (OR 2.91, 95% CI 1.35–6.37, p < 0.01). Young maternal age was linked to a higher incidence of prematurity (OR 1.70, 95% CI 1.18–2.43, p < 0.01), major congenital defects (OR 4.68, 95% CI 2.10–10.13, p < 0.01), and a perinatal mortality of 18.7 per 1,000 births (OR 3.76, 95% CI 1.26–10.32, p = 0.02). CONCLUSION Young single mothers were more likely to have unsatisfactory antenatal care and lighter infants. Young maternal age was associated with a higher risk of prematurity, major congenital malformations and perinatal mortality. More studies are needed to ascertain the cause of these adverse outcomes. PMID:25532516

  8. Does advanced maternal age confer a survival advantage to infants born at early gestation?

    PubMed Central

    2013-01-01

    Background Recent studies have shown that older mothers who deliver at preterm gestation have lower neonatal mortality rates compared with younger mothers who deliver at preterm gestation. We examined the effect of maternal age on gestational age-specific perinatal mortality. Methods We compared fetal, neonatal and perinatal mortality rates among singleton births in the United States, 2003–2005, to mothers aged ≥35 versus 20–29 years. The analysis was stratified by gestational age and perinatal mortality rates were contrasted by maternal age at earlier (22–33 weeks) and later gestation (≥34 weeks). Gestational age-specific perinatal mortality rates were calculated using the traditional perinatal formulation (deaths among births at any gestation divided by total births at that gestation) and also the fetuses-at-risk model (deaths among births at any gestation divided by fetuses-at-risk of death at that gestation). Logistic regression was used to estimate adjusted odds ratios (AOR) for perinatal death. Results Under the traditional approach, fetal death rates at 22–33 weeks were non-significantly lower among older mothers (AOR 0.97, 95% confidence interval [CI] 0.91-1.03), while rates were significantly higher among older mothers at ≥34 weeks (AOR 1.66, 95% CI 1.56-1.76). Neonatal death rates were significantly lower among older compared with younger mothers at 22–33 weeks (AOR=0.93, 95% CI 0.88-0.98) but higher at ≥34 weeks (AOR 1.26, 95% CI 1.21-1.31). Under the fetuses-at-risk model, both rates were higher among older vs younger mothers at early gestation (AOR for fetal and neonatal mortality 1.35, 95% CI 1.27-1.43 and 1.31, 95% CI 1.24-1.38, respectively) and late gestation (AOR for fetal and neonatal mortality 1.66, 95% CI 1.56-1.76) and 1.21, 95% CI 1.14-1.29, respectively). Conclusions Although the traditional prognostic perspective on the risk of perinatal death among older versus younger mothers varies by gestational age at birth, the causal fetuses-at-risk model reveals a consistently elevated risk of perinatal death at all gestational ages among older mothers. PMID:23566294

  9. Where does distance matter? Distance to the closest maternity unit and risk of foetal and neonatal mortality in France

    PubMed Central

    Blondel, Béatrice; Drewniak, Nicolas; Zeitlin, Jennifer

    2014-01-01

    Background: The number of maternity units has declined in France, raising concerns about the possible impact of increasing travel distances on perinatal health outcomes. We investigated impact of distance to closest maternity unit on perinatal mortality. Methods: Data from the French National Vital Statistics Registry were used to construct foetal and neonatal mortality rates over 2001–08 by distance from mother’s municipality of residence and the closest municipality with a maternity unit. Data from French neonatal mortality certificates were used to compute neonatal death rates after out-of-hospital birth. Relative risks by distance were estimated, adjusting for individual and municipal-level characteristics. Results: Seven percent of births occurred to women residing at ≥30 km from a maternity unit and 1% at ≥45 km. Foetal and neonatal mortality rates were highest for women living at <5 km from a maternity unit. For foetal mortality, rates increased at ≥45 km compared with 5–45 km. In adjusted models, long distance to a maternity unit had no impact on overall mortality but women living closer to a maternity unit had a higher risk of neonatal mortality. Neonatal deaths associated with out-of-hospital birth were rare but more frequent at longer distances. At the municipal-level, higher percentages of unemployment and foreign-born residents were associated with increased mortality. Conclusion: Overall mortality was not associated with living far from a maternity unit. Mortality was elevated in municipalities with social risk factors and located closest to a maternity unit, reflecting the location of maternity units in deprived areas with risk factors for poor outcome. PMID:24390464

  10. Parental and Perinatal Correlates of Neonatal Behaviors.

    ERIC Educational Resources Information Center

    Standley, Kay

    This paper discusses the analyses of antecedent correlates of the behavior of 60 infants as measured by the Brazelton Neonatal Assessment Scale on the third day after birth. The data include two sets of antecedent variables: maternal adaptation to pregnancy as reported in prenatal interviews and measured describing the conditions of labor and…

  11. Cytomegalovirus myelitis in perinatally acquired HIV.

    PubMed Central

    Güngör, T; Funk, M; Linde, R; Jacobi, G; Horn, M; Kreuz, W

    1993-01-01

    A 7 year old child perinatally infected with HIV who died from progressive muscular paralysis and central nervous respiratory failure is described. Cytomegalovirus (CMV) prophylaxis with a special intravenous CMV hyper-immunoglobulin had been successfully conducted for more than four years. Macroscopic and microscopic immunohistochemical examination of the spinal cord revealed a diffuse CMV infiltration of the entire myelon. CMV infected cells were identified as astrocytes, oligodendrocytes, neurons, macrophages, ependymal, endothelial, and Schwann cells. Other organs had no signs of CMV infection. Central nervous spinal CMV infection was most probably due to insufficient penetration of the blood-brain barrier by the CMV hyper-immunoglobulin. In suspicious cases early spinal magnetic resonance imaging (1.5 tesla) combined with an examination of urine and cerebrospinal fluid for CMV is recommended. Images Figure 1 Figure 2 Figure 3 PMID:8385439

  12. Perinatal mortality at pre-Columbian Teotihuacan.

    PubMed

    Storey, R

    1986-04-01

    The skeletal population of 166 individuals from a low-status apartment compound of the pre-Columbian city of Teotihuacan contained 52 perinatal individuals. The most perilous time of the lifespan was around birth, as revealed by life table analysis. Femur length was not increasing during the last month of gestation, and individuals were probably shorter somatically at birth than modern standards or historic-period Arikara skeletal controls. The possibility of intrauterine growth retardation is investigated through paleo-pathological indicators of prenatal growth arrest. The evidence of prenatal stress and the high rate of mortality at birth seem to indicate that this New World preindustrial urban population faced similar health and nutritional stresses as Old World preindustrial cities. PMID:3521307

  13. Maternal lactation for preterm newborn infants.

    PubMed

    Aguayo, J

    2001-11-01

    In recent decades, neonatologists have made considerable progress in life support techniques, especially in the treatment and prevention of respiratory disorders, which has led to a higher neonatal survival rate. Research into neonatal nutrition has also produced great benefits. It has been found that one of the key points regarding the improved survival rate of infants is the necessity for nutrition that is both adequate and as natural as possible. In this respect, it is necessary to achieve a better understanding of the process, protection, support and maintenance of maternal lactation in neonatal units. Humanization of perinatal attention during delivery, respect for the rights of parents and their children, protection of the mother and child bonding process, early skin contact with the mother and greater attention to individualized care are all key factors in the reinforcement of maternal lactation and are issues that must be addressed within the field of neonatology. Research activities need to concern themselves with: (1) acquiring greater knowledge concerning the common problems and difficulties that arise with mothers and their preterm babies; (2) training healthcare professionals in these aspects, for example in the extraction and storage of milk and in improving techniques of emotional and communicational skills; (3) by means of specific programmes such as the setting up of support groups, so that the effort made to encourage the initiation of breastfeeding is justified by its continuation for as long as possible. Thus, we hope to establish standards of care based on starting, encouraging and prolonging maternal lactation, in sufficient quantity and quality, always remembering that the fundamental goal of our research is the well-being of the child and its family. PMID:11755032

  14. [Perinatal clomiphene citrate treatment changes sexual orientations of male mice].

    PubMed

    He, Feng-Qin; Zhang, Heng-Rui

    2013-10-01

    Perinatal period and adolescence are critical for brain development, which is the biological basis of an individual's sexual orientation and sexual behavior. In this study, animals were divided into two groups and their sexual orientations were observed: one group experienced drug treatments during the perinatal period, and the other group was castrated at puberty. The results showed that estradiol treatment had no effect on mature male offspring's sexual orientations, but 9 days and 14 days of clomiphene citrate treatment significantly increased the chance of homosexuality and effeminized behavior. In addition, the sexual orientation of mature normal male offspring, which were castrated when they were 21 days old,was not significant different from the control animals. These findings suggest that the inhibition of perinatal estrogen activities could suppress individual male-typical responses, enhance female-typical responses and induce homosexual orientations. Moreover, the masculinizing effects of estrogen were more obvious during perinatal period than adolescence. PMID:24115661

  15. Optimizing the treatment of mood disorders in the perinatal period

    PubMed Central

    Meltzer-Brody, Samantha; Jones, Ian

    2015-01-01

    The perinatal period is a time of high risk for women with unipolar and bipolar mood disorders. We discuss treatment considerations for perinatal mood disorders, including unipolar and bipolar depression as well as postpartum psychosis. We further explore the unique issues faced by women and their families across the full trajectory of the perinatal period from preconception planning through pregnancy and following childbirth. Treatment of perinatal mood disorders requires a collaborative care approach between obstetrics practitioners and mental health providers, to ensure that a thoughtful risk : benefit analysis is conducted. It is vital to consider the risks of the underlying illness versus risks of medication exposure during pregnancy or lactation. When considering medication treatment, attention must be paid to prior medication trials that were most efficacious and best tolerated. Lastly, it is important to assess the impact of individual psychosocial stressors and lifestyle factors on treatment response. PMID:26246794

  16. Risk factors for perinatal death in two different levels of care: a case–control study

    PubMed Central

    2014-01-01

    Background According to the World Health Organization, there are over 6.3 million perinatal deaths (PND) a year worldwide. Identifying the factors associated with PND is very helpful in building strategies to improve the care provided to mothers and their babies. Objective To investigate the maternal, gestational and neonatal factors associated with PND at two different levels of care. Methods Case–control study including 299 PND cases and 1161 infants that survived the early neonatal period (controls) between 2001–2006 in two hospitals at different care levels (secondary and tertiary) located in southeastern Brazil. Correlations between study variables and PND were evaluated by univariate analysis. PND-related variables were included in a multiple logistic regression model, and independent estimates of PND risk were obtained. Results Although five-minute Apgar score <7, low birthweight and maternal hemorrhage were associated with PND in the secondary care center, no independent risk factors were identified at this level of care. In the tertiary hospital, PND was positively associated with primiparity, male sex, prematurity, low 5-minute Apgar score, and pregnancy complicated by arterial hypertension or intrauterine infection. Conclusions Several risk factors positively associated with PND were indentified in the tertiary, but not in the secondary care level hospital. Since most of the risk factors herein identified are modifiable through effective antenatal and intrapartum care, greater attention should be given to preventive strategies. PMID:24476422

  17. Perinatal considerations in the hospital disaster management process.

    PubMed

    Orlando, Susan; Danna, Denise; Giarratano, Gloria; Prepas, Robbie; Johnson, Cheri Barker

    2010-01-01

    Nurses play a vital role in providing care to mothers and infants during a disaster, yet few are fully prepared for the challenges they will encounter under extreme conditions. The ability to provide the best possible care for families begins with understanding the perinatal issues in relation to each phase of the disaster management process. This article reviews the hospital and perinatal nursing role in the mitigation, preparedness, response, and recovery phases of disaster management. PMID:20629934

  18. Endoplasmic reticulum stress, inflammation, and perinatal brain damage

    PubMed Central

    Bueter, Wolfgang; Dammann, Olaf; Leviton, Alan

    2009-01-01

    Inflammation appears to play a role in the pathogenesis of perinatal brain damage in fetuses/infants born much before term. We raise the possibility that non-inflammatory phenomena induce endoplasmic reticulum (ER) stress, which, in turn, leads to the unfolded protein response (UPR), which is followed by apoptosis-promoting processes and inflammation. Perhaps by these events, non-inflammatory stimuli lead to perinatal brain damage. PMID:19668101

  19. Physical Activity and Excess Weight in Pregnancy Have Independent and Unique Effects on Delivery and Perinatal Outcomes

    PubMed Central

    Morgan, Kelly L.; Rahman, Muhammad A.; Hill, Rebecca A.; Zhou, Shang-Ming; Bijlsma, Gunnar; Khanom, Ashrafunnesa; Lyons, Ronan A.; Brophy, Sinead T.

    2014-01-01

    Background This study examines the effect of low daily physical activity levels and overweight/obesity in pregnancy on delivery and perinatal outcomes. Methods A prospective cohort study combining manually collected postnatal notes with anonymised data linkage. A total of 466 women sampled from the Growing Up in Wales: Environments for Healthy Living study. Women completed a questionnaire and were included in the study if they had an available Body mass index (BMI) (collected at 12 weeks gestation from antenatal records) and/or a physical activity score during pregnancy (7-day Actigraph reading). The full statistical model included the following potential confounding factors: maternal age, parity and smoking status. Main outcome measures included induction rates, duration of labour, mode of delivery, infant health and duration of hospital stay. Findings Mothers with lower physical activity levels were more likely to have an instrumental delivery (including forceps, ventouse and elective and emergency caesarean) in comparison to mothers with higher activity levels (adjusted OR:1.72(95%CI: 1.05 to 2.9)). Overweight/obese mothers were more likely to require an induction (adjusted OR:1.93 (95%CI 1.14 to 3.26), have a macrosomic baby (adjusted OR:1.96 (95%CI 1.08 to 3.56) and a longer hospital stay after delivery (adjusted OR:2.69 (95%CI 1.11 to 6.47). Conclusions The type of delivery was associated with maternal physical activity level and not BMI. Perinatal outcomes (large for gestational age only) were determined by maternal BMI. PMID:24722411

  20. Agricultural pesticide exposure and perinatal mortality in central Sudan.

    PubMed Central

    Taha, T. E.; Gray, R. H.

    1993-01-01

    Hospital- and community-based studies were conducted in central Sudan to investigate the association between pesticide exposure and perinatal mortality. The cases were 197 stillbirths in the hospital and 36 perinatal deaths in the community; the controls were 812 liveborn, normal-birth-weight infants in the hospital, and 1505 liveborn infants who survived for the first 7 days after birth in the community. The odds ratio (OR) of perinatal death associated with pesticide exposure was estimated using multiple logistic regression. There was a consistent and significant association between pesticide exposure and perinatal mortality in the hospital (adjusted OR = 1.9; 95% confidence interval (CI): 1.3-2.8) and the community populations (adjusted OR = 2.7; 95% CI: 1.1-6.4). The OR was significantly higher among women engaged in farming (3.6; 95% CI: 1.6-8.0), but not among women in nonfarming occupations (1.6; 95% CI: 0.8-3.3). The estimated attributable risks of perinatal death owing to pesticide exposure were 22.6% for hospital stillbirths and 15.7% for community perinatal deaths; but among women engaged in farming in the hospital population the attributable risks were substantially higher (34.5%). PMID:8324850

  1. The influence of natural variations in maternal care on play fighting in the rat.

    PubMed

    Parent, Carine I; Meaney, Michael J

    2008-12-01

    Naturally occurring variations in maternal care in the rat influence the sensitivity of offspring to stress in adulthood. The offspring of mothers that show lower levels of pup licking/grooming (i.e., low-LG mothers) demonstrate enhanced responses to stress and increased anxiety compared to those of high-LG mothers. Low-LG offspring are also more sensitive to the influence of environmental enrichment than high-LG offspring. This study examined play fighting in the juvenile offspring of high-LG and low-LG dams in a multiple-play partners housing environment. Male offspring from low-LG dams demonstrated a significantly higher frequency of pouncing, pinning and aggressive social grooming than did high-LG males and high-LG and low-LG females. Consistent with earlier reports, male pups engaged in more play fighting than did females and maternal care was associated with differences in play fighting but only in males. Lower levels of stimulation in the form of LG from the dam during perinatal development may thus increase sensitivity for the stimulating effects of play behavior in periadolescence, in part explaining the increased solicitation of play fighting through increased pouncing in the male offspring of the low-LG mothers. These findings identify a possible influence of variations in maternal care on play fighting and suggest that maternal care in the perinatal period influence social interactions during periadolescence. PMID:18846499

  2. Maternal vitamin D status and infant anthropometry in a US multi-centre cohort study

    PubMed Central

    Eckhardt, Cara L.; Gernand, Alison D.; Roth, Daniel E.; Bodnar, Lisa M.

    2015-01-01

    Background Maternal vitamin D status in pregnancy is linked to foetal growth and may impact infant growth. Aim This study examined the association between maternal vitamin D status and infant anthropometry. Subjects and methods Data came from n = 2473 mother–child pairs from the 12-site US Collaborative Perinatal Project (1959–1965). Maternal serum 25-hydroxyvitamin D (25(OH)D) was measured at ≤26 weeks gestation. Multivariate-adjusted linear mixed models were used to relate maternal vitamin D status to infant z-scores for length (LAZ), head circumference (HCZ), weight (WAZ) and BMI (BMIZ), measured at birth and 4, 8 and 12 months. Results Infants with maternal 25(OH)D ≥30 nmol/L vs <30 nmol/L had LAZ and HCZ measures 0.13 (95% CI = 0.03–0.23) and 0.20 (95% CI = 0.11–0.28) units higher, respectively, across the first year of life. Similar differences in WAZ and BMIZ at birth were resolved by 12 months of age due to interactions indicating steeper age slopes in infants with maternal 25(OH)D <30 nmol/L. Conclusion Low maternal vitamin D status was associated with deficits at birth in infant weight and BMI that were recouped across the first year of life; associations with reduced measures of linear and skeletal growth were sustained from birth to 12 months. PMID:25268792

  3. Maternal Language Classification Scale.

    ERIC Educational Resources Information Center

    Mahoney, Gerald; Petersen, Gail

    This study reports the interrater agreement of the Maternal Language Classification Scale (MLCS), a functional language classification system, developed partly to avoid problems identified with previous scales. The MLCS is a comprehensive system for classifying the functional content of maternal language addressed to children whose mean length of…

  4. Gestational Diabetes and Subsequent Growth Patterns of Offspring: The National Collaborative Perinatal Project

    PubMed Central

    Nicholson, Wanda K.; Wang, Nae-Yuh; Brancati, Frederick L.

    2013-01-01

    Our objective was to test the hypothesis that intrauterine exposure to gestational diabetes [GDM] predicts childhood growth independent of the effect on infant birthweight. We conducted a prospective analysis of 28,358 mother-infant pairs who enrolled in the National Collaborative Perinatal Project between 1959 and 1965. The offspring were followed until age 7. Four hundred and eighty-four mothers (1.7%) had GDM. The mean birthweight was 3.2 kg (range 1.15.6 kg). Maternal characteristics (age, education, race, family income, pre-pregnancy body mass index and pregnancy weight gain) and measures of childhood growth (birthweight, weight at ages 4, and 7) differed significantly by GDM status (all P < 0.05). As expected, compared to their non-diabetic counterparts, mothers with GDM gave birth to offspring that had higher weights at birth. The offspring of mothers with GDM were larger at age 7 as indicated by greater weight, BMI and BMI z-score compared to the offspring of mothers without GDM at that age (all P < 0.05). These differences at age 7 persisted even after adjustment for infant birthweight. Furthermore, the offspring of mothers with GDM had a 61% higher odds of being overweight at age 7 compared to the offspring of mothers without GDM after adjustment for maternal BMI, pregnancy weight gain, family income, race and birthweight [OR = 1.61 (95%CI:1.07, 1.28)]. Our results indicate that maternal GDM status is associated with offspring overweight status during childhood. This relationship is only partially mediated by effects on birthweight. PMID:21327952

  5. Evidence from community level inputs to improve quality of care for maternal and newborn health: interventions and findings.

    PubMed

    Lassi, Zohra S; Das, Jai K; Salam, Rehana A; Bhutta, Zulfiqar A

    2014-09-01

    Annually around 40 million mothers give birth at home without any trained health worker. Consequently, most of the maternal and neonatal mortalities occur at the community level due to lack of good quality care during labour and birth. Interventions delivered at the community level have not only been advocated to improve access and coverage of essential interventions but also to reduce the existing disparities and reaching the hard to reach. In this paper, we have reviewed the effectiveness of care delivered through community level inputs for improving maternal and newborn health outcomes. We considered all available systematic reviews published before May 2013 on the pre-defined community level interventions and report findings from 43 systematic reviews. Findings suggest that home visitation significantly improved antenatal care, tetanus immunization coverage, referral and early initiation of breast feeding with reductions in antenatal hospital admission, cesarean-section rates birth, maternal morbidity, neonatal mortality and perinatal mortality. Task shifting to midwives and community health workers has shown to significantly improve immunization uptake and breast feeding initiation with reductions in antenatal hospitalization, episiotomy, instrumental delivery and hospital stay. Training of traditional birth attendants as a part of community based intervention package has significant impact on referrals, early breast feeding, maternal morbidity, neonatal mortality, and perinatal mortality. Formation of community based support groups decreased maternal morbidity, neonatal mortality, perinatal mortality with improved referrals and early breast feeding rates. At community level, home visitation, community mobilization and training of community health workers and traditional birth attendants have the maximum potential to improve a range of maternal and newborn health outcomes. There is lack of data to establish effectiveness of outreach services, mass media campaigns and community education as standalone interventions. Future efforts should be concerted on increasing the availability and training of the community based skilled health workers especially in resource limited settings where the highest burden exists with limited resources to mobilize. PMID:25209692

  6. Evidence from community level inputs to improve quality of care for maternal and newborn health: interventions and findings

    PubMed Central

    2014-01-01

    Annually around 40 million mothers give birth at home without any trained health worker. Consequently, most of the maternal and neonatal mortalities occur at the community level due to lack of good quality care during labour and birth. Interventions delivered at the community level have not only been advocated to improve access and coverage of essential interventions but also to reduce the existing disparities and reaching the hard to reach. In this paper, we have reviewed the effectiveness of care delivered through community level inputs for improving maternal and newborn health outcomes. We considered all available systematic reviews published before May 2013 on the pre-defined community level interventions and report findings from 43 systematic reviews. Findings suggest that home visitation significantly improved antenatal care, tetanus immunization coverage, referral and early initiation of breast feeding with reductions in antenatal hospital admission, cesarean-section rates birth, maternal morbidity, neonatal mortality and perinatal mortality. Task shifting to midwives and community health workers has shown to significantly improve immunization uptake and breast feeding initiation with reductions in antenatal hospitalization, episiotomy, instrumental delivery and hospital stay. Training of traditional birth attendants as a part of community based intervention package has significant impact on referrals, early breast feeding, maternal morbidity, neonatal mortality, and perinatal mortality. Formation of community based support groups decreased maternal morbidity, neonatal mortality, perinatal mortality with improved referrals and early breast feeding rates. At community level, home visitation, community mobilization and training of community health workers and traditional birth attendants have the maximum potential to improve a range of maternal and newborn health outcomes. There is lack of data to establish effectiveness of outreach services, mass media campaigns and community education as standalone interventions. Future efforts should be concerted on increasing the availability and training of the community based skilled health workers especially in resource limited settings where the highest burden exists with limited resources to mobilize. PMID:25209692

  7. Quo vadis: perinatal AIDS issues--2004.

    PubMed

    Weiss, S H; Louria, D B

    1994-03-01

    The HIV problem will inexorably increase over the next decade, with an increasing proportionate impact upon women and children over the next decade. HIV will become endemic, essentially worldwide. Some regions in the developed world may be relatively spared if current trends continue. This may reduce the willingness to expend necessary resources, particularly if trends toward increasing isolationism continue. There are already signs of a world becoming "bored" with AIDS and the chronicity of a difficult problem. This engenders an atmosphere ripe for increasing discrimination, with the development of loopholes in protective legislation. Already in the United States, some lawsuits concerning health care access among employees have been decided in the employer's favor, permitting them to restrict access to health insurance, despite other regulations which might have protected such workers. Similarly, some HIV-infected health care workers have been dismissed or lost their privileges in the 1990s, despite passage of the Americans with Disabilities Act as well as preceding legislation. It remains to be seen how society will cope with these complicated issues. The view of AIDS in 2004 presented above is pessimistic. There are some important rays of hope. Recent innovative vaccine work and new theoretical models may put us on the road to success, both with preventive and therapeutic vaccines. In particular, the first success in eliciting protection against vaginal HIV exposure, albeit partial, was reported in mid 1993. In a simian immunodeficiency virus (SIV) in vivo experimental model, cellular immunity to SIV was induced in macaques without their developing any signs of SIV infection. These macaques after rechallenge with low-dose SIV remained free of detectable SIV, so there may be an element of protection associated with specific cellular immune responses to immunodeficiency viruses. However, very high-dose SIV rechallenge experiments in similar macaques still led to acquisition of active SIV infection, suggesting that any such protection was only partial. It is also possible that cellular immune protection may be of varying efficacy against different types of exposure, particularly parenteral versus mucosal (such as sexual) exposures. There is also reason for specific optimism concerning interventions that might directly reduce the risk of perinatal transmission. Data from studies of twins suggest that a substantial proportion of perinatal transmission does not occur until after labor has commenced. Thus, caesarian sections may potentially reduce the risk of transmission to the fetus in some cases.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:8013184

  8. Comparison of Perinatal Data of Immigrant Women of Turkish Origin and German Women – Results of a Prospective Study in Berlin

    PubMed Central

    David, M.; Borde, T.; Brenne, S.; Ramsauer, B.; Henrich, W.; Breckenkamp, J.; Razum, O.

    2014-01-01

    Aims: The aim of the study was to compare obstetrical process indicators and outcomes for German women with women of Turkish origin residing in Germany. Do women of Turkish origin attend antenatal examinations as frequently as non-immigrant women? Are high-risk pregnancies and anemia more common among immigrant women? Are the rates for epidural analgesia (PDA) and combined spinal-epidural analgesia (CSE) during delivery the same for immigrant women compared to German women? Are there identifiable differences in the mode of delivery and in perinatal outcomes? Patient Population/Methods: Data were obtained from 3 maternity clinics in Berlin for the period 2011 to 2012. The questionnaires covered socio-demographic factors and information on prenatal care as well as immigration/acculturation. The data obtained from these questionnaires was supplemented by information obtained from the official maternal record of prenatal and natal care (Mutterpass) and perinatal data recorded by the clinic. Results: The response rate was 89.6 %; the data of 1277 women of Turkish origin who had immigrated to Germany or whose family had immigrated and of 2991 non-immigrant women in Germany were included in the study. Regression analysis showed no statistically significant difference in the number of antenatal examinations between immigrant and non-immigrant women. Women of Turkish origin born in Germany had a significantly higher risk of postpartum anemia. PDA/CSE rate, arterial umbilical cord pH and 5-minute Apgar scores did not differ. The incidence of cesarean sections (elective and secondary) was significantly lower in the population of immigrant women of Turkish origin. Conclusion: Outcomes for most perinatal parameters were comparable for immigrant and non-immigrant women. These results indicate that the achieved standards of antenatal care and medical care during pregnancy are similar for Turkish immigrant women compared to non-immigrant women in maternity clinics in Berlin. The higher rates of anemia among immigrant women should be targeted by preventive measures. PMID:25089056

  9. Perinatal high-fat diet increases hippocampal vulnerability to the adverse effects of subsequent high-fat feeding.

    PubMed

    Lépinay, Amandine L; Larrieu, Thomas; Joffre, Corinne; Acar, Niyazi; Gárate, Iciar; Castanon, Nathalie; Ferreira, Guillaume; Langelier, Bénédicte; Guesnet, Philippe; Brétillon, Lionel; Parnet, Patricia; Layé, Sophie; Darnaudéry, Muriel

    2015-03-01

    Epidemiological observations report an increase in fat consumption associated with low intake of n-3 relative to n-6 polyunsaturated fatty acids (PUFAs) in women of childbearing age. However, the impact of these maternal feeding habits on cognitive function in the offspring is unknown. This study aims to investigate the impact of early exposure to a high-fat diet (HFD) with an unbalanced n-6/n-3 PUFAs ratio on hippocampal function in adult rats. Furthermore, we explored the effects of perinatal HFD combined with exposure to HFD after weaning. Dams were fed a control diet (C, 12% of energy from lipids, n-6/n-3 PUFAs ratio: 5) or HFD (HF, 39% of energy from lipids, n-6/n-3 PUFAs ratio: 39) throughout gestation and lactation. At weaning, offspring were placed either on control (C-C, HF-C) or high-fat (HF-HF) diets. In adulthood, hippocampus-dependent memory was assessed using the water-maze task and potential hippocampal alterations were determined by studying PUFA levels, gene expression, neurogenesis and astrocyte morphology. Perinatal HFD induced long-lasting metabolic alterations and some changes in gene expression in the hippocampus, but had no effect on memory. In contrast, spatial memory was impaired in animals exposed to HFD during the perinatal period and maintained on this diet. HF-HF rats also exhibited low n-3 and high n-6 PUFA levels, decreased neurogenesis and downregulated expression of several plasticity-related genes in the hippocampus. To determine the contribution of the perinatal diet to the memory deficits reported in HF-HF animals, an additional experiment was conducted in which rats were only exposed to HFD starting at weaning (C-HF). Interestingly, memory performance in this group was similar to controls. Overall, our results suggest that perinatal exposure to HFD with an unbalanced n-6/n-3 ratio sensitizes the offspring to the adverse effects of subsequent high-fat intake on hippocampal function. PMID:25614359

  10. Infant difficult behaviors in the context of perinatal biomedical conditions and early child environment

    PubMed Central

    2012-01-01

    Background Problems experienced within the first year of an infant's life can be precursors of later mental health conditions. The purpose of this study was to examine the frequency and continuity of difficult behaviors in infants at 3 and 6 months of age and the associations of these difficulties with biomedical and psychosocial factors. Methods This study was a part of an ongoing prospective birth-cohort study. Study participants were 189 uniparous mothers and their full-term newborns. The index of infant difficult behavior was constructed. This index was then associated with the following factors: delivery mode, newborn function after birth, maternal emotional well-being, risk behavior, subjective evaluation of the quality of the relationship of the couple, and attitudes toward infant-rearing. Results Common difficult behaviors, including crying, sleeping and eating problems, were characteristic for 30.2% of 3 month old and for 22.2% of 6 month old full-term infants. The expression of infant difficult behaviors at the age of 3 months increased the likelihood of the expression of these difficulties at 6 months by more than 5 times. Factors including younger maternal age, poor prenatal and postnatal emotional well-being, prenatal alcohol consumption, low satisfaction with the couple's relationship before pregnancy, and deficiency of infant-centered maternal attitudes towards infant-rearing increased the likelihood of difficult behaviors in infants at the age of 3 months. Low maternal satisfaction with the relationship of the couple before pregnancy, negative emotional reactions of both parents toward pregnancy (as reported by the mother) and the deficiency of an infant-centered maternal attitude towards infant-rearing increased the likelihood of infant difficult behaviors continuing between the ages of 3 to 6 months. Perinatal biomedical conditions were not related to the difficult behaviors in infants. Conclusions Our study suggests that early onset of difficult behavior highly increases the risk for the continuation of difficult behavior during infancy. In general, the impact of prenatal psychosocial environment on infant behavior decreases from the ages of 3 to 6 months; however, some prenatal and preconceptional psychosocial factors have direct associations with the continuity of difficult behaviors through the first half-year of an infant's life. PMID:22494700

  11. Does having cesarean section capability make a difference to a small rural maternity service?

    PubMed Central

    Lynch, Nancy; Thommasen, Harvey; Anderson, Nancy; Grzybowski, Stefan

    2005-01-01

    OBJECTIVE To determine whether having cesarean section capability in an isolated rural community makes a difference in adverse maternal or perinatal outcomes. DESIGN Retrospective study comparing population-based obstetric outcomes of two rural remote hospitals in northwestern British Columbia. One hospital had cesarean section capability; one did not. SETTING Bella Coola General Hospital (with cesarean section capability) in Bella Coola Valley (BCV) and Queen Charlotte Islands General Hospital (without cesarean section capability) in Queen Charlotte City (QCC). PARTICIPANTS Women who carried pregnancies beyond 20 weeks’ gestation and who gave birth between January 1, 1986, and December 31, 2000. INTERVENTIONS British Columbia Vital Statistics Agency data was used to compare obstetric outcomes in the two communities. A chart audit of local births at BCV and QCC was done to validate the vital statistics data. MAIN OUTCOME MEASURES Perinatal death, newborn transfer to a tertiary care facility, birth weight, gestational age at delivery, mode of delivery, and Apgar score. RESULTS The rate of preterm deliveries in QCC was higher (relative risk 1.41, 95% confidence interval 1.00 to 1.99; P = .047) than the rate in BCV. Otherwise, there were no differences in adverse maternal or perinatal outcomes in the two populations. In BCV, 69.8% of women delivered locally compared with 50.2% of women in the southern Queen Charlotte Islands (P < .001). CONCLUSION Having local cesarean section capability is associated with a greater proportion of local deliveries and a lower rate of preterm deliveries. PMID:16926940

  12. Psychoneuroimmunology in Pregnancy: Immune Pathways Linking Stress with Maternal Health, Adverse Birth Outcomes, and Fetal Development

    PubMed Central

    Christian, Lisa M.

    2011-01-01

    It is well-established that psychological stress promotes immune dysregulation in nonpregnant humans and animals. Stress promotes inflammation, impairs antibody responses to vaccination, slows wound healing, and suppresses cell-mediated immune function. Importantly, the immune system changes substantially to support healthy pregnancy, with attenuation of inflammatory responses and impairment of cell-mediated immunity. This adaptation is postulated to protect the fetus from rejection by the maternal immune system. Thus, stress-induced immune dysregulation during pregnancy has unique implications for both maternal and fetal health, particularly preterm birth. However, very limited research has examined stress-immune relationships in pregnancy. The application of psychoneuroimmunology research models to the perinatal period holds great promise for elucidating biological pathways by which stress may affect adverse pregnancy outcomes, maternal health, and fetal development. PMID:21787802

  13. Effects of longitudinal maternal glucose control on infants of diabetic mothers.

    PubMed

    Sameshima, H; Ikenoue, T; Kawahara, S; Kai, M

    1991-07-01

    Between 1980 and 1987, 45 pregnant women with diabetes mellitus who required insulin therapy were delivered at Kagoshima Municipal Hospital. The perinatal mortality rate in the present study was zero. Twelve infants were large for gestational age, ten were small for gestational age, and 23 were appropriate for gestational age. Tight maternal glucose control (fasting values of less than 100mg/dl and 2 hours post-prandial values of less than 120mg/dl) obtained before 32 weeks of gestation significantly decreased the incidence of large for gestational age infants. However, longitudinal control patterns of maternal glucose during pregnancy have little effect on the incidence of small for gestational age infants and neonatal complications. The former was more closely related to maternal vascular complications. Congenital malformations were found in two cases. PMID:1890356

  14. Perinatal induction of Cre recombination with tamoxifen.

    PubMed

    Lizen, Benoit; Claus, Melissa; Jeannotte, Lucie; Rijli, Filippo M; Gofflot, Françoise

    2015-12-01

    Temporal control of site-specific recombination is commonly achieved by using a tamoxifen-inducible form of Cre or Flp recombinases. Although powerful protocols of induction have been developed for gene inactivation at adult stages or during embryonic development, induction of recombination at late gestational or early postnatal stages is still difficult to achieve. In this context, using the ubiquitous CMV-CreER(T2) transgenic mice, we have tested and validated two procedures to achieve recombination just before and just after birth. The efficiency of recombination was evaluated in the brain, which is known to be more problematic to target. For the late gestation treatment with tamoxifen, different protocols of complementary administration of progesterone and estrogen were tested. However, delayed delivery and/or mortality of pups due to difficult delivery were always observed. To circumvent this problem, pups were collected from tamoxifen-treated pregnant dams by caesarian section at E18.5 and given to foster mothers. For postnatal treatment, different dosages of tamoxifen were administered by intragastric injection to the pups during 3 or 4 days after birth. The efficiency of these treatments was analyzed at P7 using a transgenic reporter line. They were also validated with the Hoxa5 conditional allele. In conclusion, we have developed efficient procedures that allow achieving efficient recombination of floxed alleles at perinatal stages. These protocols will allow investigating the late/adult functions of many developmental genes, whose characterization has been so far restricted to embryonic development. PMID:26395370

  15. Perinatal epidemiological risk factors for preeclampsia.

    PubMed

    Bobić, Mirna Vuković; Habek, Dubravko; Habek, Jasna Čerkez

    2015-03-01

    In the present study, the impact of the potential perinatal epidemiological factors on preeclampsia development was assessed. This clinical study included 55 pregnant women with preeclampsia and control group of 50 healthy pregnant women. Positive family history of cardiovascular disease, diabetes mellitus or thromboembolic disease was recorded in 50% of women with preeclampsia versus 28% of control group women. Positive personal history of this disease was recorded in 15% of women with preeclampsia, whereas all control group women had negative personal history of preeclampsia. Dietary habits, i.e. the intake of meat and meat products, fruit and vegetables, coffee and alcohol drinks were similar in the two groups, without statistically significant differences. The women with preeclampsia and control women reported comparable habits; there was no difference in the consumption of meat, fruit, vegetables, coffee and alcohol, smoking, use of folate and oral hormonal contraception before pregnancy, or in physical activity as the potential risk factors for preeclampsia in current pregnancy. However, personal and family history of vascular disease proved to be significant risk factors for the occurrence of preeclampsia, emphasizing the need of lifestyle and dietary modifications with healthy dietary habits, while avoiding adverse habits in pregnancy. PMID:26058236

  16. Perinatal factors in twin mortality in Nigeria.

    PubMed

    Fakeye, O

    1986-08-01

    The results of a retrospective study involving 622 twin-pairs born over an 18-month period among 17,726 births at the University of Ilorin Teaching Hospital, Ilorin, Nigeria, are presented with particular reference to four variables: birthweight, presentation, parity, and intertwin delivery time interval. The twinning incidence was 35.1 per 1000. Monozygous and dizygous rates are 7 and 28 per 1000, respectively. Overall perinatal mortality (PNM) was 15.5%. Mortality was higher in second than in first twin (19.5% vs. 11.6%), and consistently higher when divided into birthweight groups. Corrected PNM increased with breech presentations: 16.3% in breech:breech compared with 3.9% in vertex:vertex presentations. The twinning rate increased with parity; PNM is low in parity 1, of little variation in birth-ranks 2-5, and high in para 6 and above. Delivery of the second twin within 15 min seems optimal, giving a corrected PNM 3.6% in contrast to rates of 10.1%, 14.0% and 19.1%, respectively when delivery occurred between 16 and 30, 31 and 60 and greater than 60 min, respectively. Prevention of preterm delivery, increased use of cesarean section delivery for malpresentation, active management of delivery of second twin within an optimal time of 15 min, and family planning are suggested in order to decrease twin PNM. PMID:2878841

  17. The Chemung County Perinatal Dental Coalition.

    PubMed

    Curran, Tom

    2009-11-01

    This is a preliminary report on the formation and function of a countywide program to facilitate access to periodontal evaluation and care for pregnant women over a three-year period. In Chemung County, all obstetrical deliveries take place at one hospital and all supportive services are located either at the hospital or at or near the County Health Department. The Article 28 dental clinic is also at the Health Department. The statistics for this county for years 2000-2002 for pre-term, low birth weight (PT/LBW) newborns were among the highest in New York State and higher than the national average. For about $3,000 a year, the Perinatal Dental Coalition promotes improved oral health for pregnant women and instructs them on the oral care of their newborns. With improved periodontal care of pregnant women, future analysis will determine the effect on PT/LBW statistics for the county. It is hoped that other counties and communities can duplicate and improve on this coalition. PMID:20069787

  18. Getting the basic rights – the role of water, sanitation and hygiene in maternal and reproductive health: a conceptual framework

    PubMed Central

    Campbell, Oona M R; Benova, Lenka; Gon, Giorgia; Afsana, Kaosar; Cumming, Oliver

    2015-01-01

    Objective To explore linkages between water, sanitation and hygiene (WASH) and maternal and perinatal health via a conceptual approach and a scoping review. Methods We developed a conceptual framework iteratively, amalgamating three literature-based lenses. We then searched literature and identified risk factors potentially linked to maternal and perinatal health. We conducted a systematic scoping review for all chemical and biological WASH risk factors identified using text and MeSH terms, limiting results to systematic reviews or meta-analyses. The remaining 10 complex behavioural associations were not reviewed systematically. Results The main ways poor WASH could lead to adverse outcomes are via two non-exclusive categories: 1. ‘In-water’ associations: (a) Inorganic contaminants, and (b) ‘water-system’ related infections, (c) ‘water-based’ infections, and (d) ‘water borne’ infections. 2. ‘Behaviour’ associations: (e) Behaviours leading to water-washed infections, (f) Water-related insect-vector infections, and (g-i) Behaviours leading to non-infectious diseases/conditions. We added a gender inequality and a life course lens to the above framework to identify whether WASH affected health of mothers in particular, and acted beyond the immediate effects. This framework led us to identifying 77 risk mechanisms (67 chemical or biological factors and 10 complex behavioural factors) linking WASH to maternal and perinatal health outcomes. Conclusion WASH affects the risk of adverse maternal and perinatal health outcomes; these exposures are multiple and overlapping and may be distant from the immediate health outcome. Much of the evidence is weak, based on observational studies and anecdotal evidence, with relatively few systematic reviews. New systematic reviews are required to assess the quality of existing evidence more rigorously, and primary research is required to investigate the magnitude of effects of particular WASH exposures on specific maternal and perinatal outcomes. Whilst major gaps exist, the evidence strongly suggests that poor WASH influences maternal and reproductive health outcomes to the extent that it should be considered in global and national strategies. PMID:25430609

  19. Getting the basic rights - the role of water, sanitation and hygiene in maternal and reproductive health: a conceptual framework.

    TOXLINE Toxicology Bibliographic Information

    Campbell OM; Benova L; Gon G; Afsana K; Cumming O

    2015-03-01

    OBJECTIVE: To explore linkages between water, sanitation and hygiene (WASH) and maternal and perinatal health via a conceptual approach and a scoping review.METHODS: We developed a conceptual framework iteratively, amalgamating three literature-based lenses. We then searched literature and identified risk factors potentially linked to maternal and perinatal health. We conducted a systematic scoping review for all chemical and biological WASH risk factors identified using text and MeSH terms, limiting results to systematic reviews or meta-analyses. The remaining 10 complex behavioural associations were not reviewed systematically.RESULTS: The main ways poor WASH could lead to adverse outcomes are via two non-exclusive categories: 1. 'In-water' associations: (a) Inorganic contaminants, and (b) 'water-system' related infections, (c) 'water-based' infections, and (d) 'water borne' infections. 2. 'Behaviour' associations: (e) Behaviours leading to water-washed infections, (f) Water-related insect-vector infections, and (g-i) Behaviours leading to non-infectious diseases/conditions. We added a gender inequality and a life course lens to the above framework to identify whether WASH affected health of mothers in particular, and acted beyond the immediate effects. This framework led us to identifying 77 risk mechanisms (67 chemical or biological factors and 10 complex behavioural factors) linking WASH to maternal and perinatal health outcomes.CONCLUSION: WASH affects the risk of adverse maternal and perinatal health outcomes; these exposures are multiple and overlapping and may be distant from the immediate health outcome. Much of the evidence is weak, based on observational studies and anecdotal evidence, with relatively few systematic reviews. New systematic reviews are required to assess the quality of existing evidence more rigorously, and primary research is required to investigate the magnitude of effects of particular WASH exposures on specific maternal and perinatal outcomes. Whilst major gaps exist, the evidence strongly suggests that poor WASH influences maternal and reproductive health outcomes to the extent that it should be considered in global and national strategies.

  20. The Fetal Cerebral Circulation: Three Decades of Exploration by the LLU Center for Perinatal Biology

    PubMed Central

    2015-01-01

    For more than three decades, research programs in the Center of Perinatal Biology have focused on the vascular biology of the fetal cerebral circulation. In the 1980s, research in the Center demonstrated that cerebral auto-regulation operated over a narrower pressure range, and was more vulnerable to insults, in fetuses than in adults. Other studies were among the first to establish that compared to adult cerebral arteries, fetal cerebral arteries were more hydrated, contained smaller smooth muscle cells and less connective tissue, and had endothelium less capable of producing NO. Work in the 1990s revealed that pregnancy depressed reactivity to NO in extra-cerebral arteries, but elevated it in cerebral arteries through effects involving changes in cGMP metabolism. Comparative studies verified that fetal lamb cerebral arteries were an excellent model for cerebral arteries from human infants. Biochemical studies demonstrated that cGMP metabolism was dramatically upregulated, but that contraction was far more dependent on calcium influx, in fetal compared to adult cerebral arteries. Further studies established that chronic hypoxia accelerates functional maturation of fetal cerebral arteries, as indicated by increased contractile responses to adrenergic agonists and perivascular adrenergic nerves. In the 2000s, studies of signal transduction established age-dependent roles for PKG, PKC, PKA, ERK, ODC, IP3, myofilament calcium sensitivity, and many other mechanisms. These diverse studies clearly demonstrated that fetal cerebral arteries were functionally quite distinct compared to adult cerebral arteries. In the current decade, research in the Center has expanded to a more molecular focus on epigenetic mechanisms and their role in fetal vascular adaptation to chronic hypoxia, maternal drug abuse, and nutrient deprivation. Overall, the past three decades have transformed thinking about, and understanding of, the fetal cerebral circulation due in no small part to the sustained research efforts by faculty and staff in the Center for Perinatal Biology. PMID:25015811

  1. PERINATAL AND FAMILIAL RISK FACTORS FOR BRAIN TUMORS IN CHILDHOOD THROUGH YOUNG ADULTHOOD

    PubMed Central

    Crump, Casey; Sundquist, Jan; Sieh, Weiva; Winkleby, Marilyn A.; Sundquist, Kristina

    2014-01-01

    Perinatal factors including high birth weight have been associated with childhood brain tumors in case-control studies. However, the specific contributions of gestational age and fetal growth remain unknown, and these issues have never been examined in large cohort studies with follow-up into adulthood. We conducted a national cohort study of 3,571,574 persons born in Sweden in 1973–2008, followed up for brain tumor incidence through 2010 (maximum age 38 years) to examine perinatal and familial risk factors. There were 2,809 brain tumors in 69.7 million person-years of follow-up. After adjusting for potential confounders, significant risk factors for brain tumors included high fetal growth (incidence rate ratio [IRR] per additional 1 standard deviation, 1.04; 95% CI, 1.01–1.08, P=0.02), first-degree family history of a brain tumor (IRR, 2.43; 95% CI, 1.86–3.18, P<0.001), parental country of birth (IRR for both parents born in Sweden vs. other countries, 1.21; 95% CI, 1.09–1.35, P<0.001), and high maternal education level (Ptrend=0.01). These risk factors did not vary by age at diagnosis. The association with high fetal growth appeared to involve pilocytic astrocytomas, but not other astrocytomas, medulloblastomas, or ependymomas. Gestational age at birth, birth order, multiple birth, and parental age were not associated with brain tumors. In this large cohort study, high fetal growth was associated with an increased risk of brain tumors (particularly pilocytic astrocytomas) independently of gestational age, not only in childhood but also into young adulthood, suggesting that growth factor pathways may play an important long-term role in the etiology of certain brain tumor subtypes. PMID:25511376

  2. Human mesenchymal stem cells attenuate experimental bronchopulmonary dysplasia induced by perinatal inflammation and hyperoxia

    PubMed Central

    Chou, Hsiu-Chu; Li, Yuan-Tsung; Chen, Chung-Ming

    2016-01-01

    Background: Systemic maternal inflammation and neonatal hyperoxia arrest alveolarization in neonates. The aims were to test whether human mesenchymal stem cells (MSCs) reduce lung inflammation and improve lung development in perinatal inflammation- and hyperoxia-induced experimental bronchopulmonary dysplasia. Methods: Pregnant Sprague-Dawley rats were intraperitoneally injected with lipopolysaccharide (LPS, 0.5 mg/kg/day) on Gestational Days 20 and 21. Human MSCs (3×105 and 1×106 cells) in 0.03 ml normal saline (NS) were administered intratracheally on Postnatal Day 5. Pups were reared in room air (RA) or an oxygen-enriched atmosphere (O2) from Postnatal Days 1 to 14, and six study groups were obtained: LPS+RA+NS, LPS+RA+MSC (3×105 cells), LPS+RA+MSC (1×106 cells), LPS+O2+NS, LPS+O2+MSC (3×105 cells), and LPS+O2+MSC (1×106 cells). The lungs were excised for cytokine, vascular endothelial growth factor (VEGF) and connective tissue growth factor (CTGF) expression, and histological analyses on Postnatal Day 14. Results: Body weight was significantly lower in rats reared in hyperoxia than in those reared in RA. The LPS+O2+NS group exhibited a significantly higher mean linear intercept (MLI) and collagen density and a significantly lower vascular density than the LPS+RA+NS group did. Administering MSC to hyperoxia-exposed rats improved MLI and vascular density and reduced tumor necrosis factor-α and interleukin-6 levels and collagen density to normoxic levels. This improvement in lung development and fibrosis was accompanied by an increase and decrease in lung VEGF and CTGF expression, respectively. Conclusion: Human MSCs attenuated perinatal inflammation- and hyperoxia-induced defective alveolarization and angiogenesis and reduced lung fibrosis, likely through increased VEGF and decreased CTGF expression. PMID:27158330

  3. Racial inequalities and perinatal health in the southeast region of Brazil.

    PubMed

    Silva, L M; Silva, R A; Silva, A A M; Bettiol, H; Barbieri, M A

    2007-09-01

    Few studies are available about racial inequalities in perinatal health in Brazil and little is known about whether the existing inequality is due to socioeconomic factors or to racial discrimination per se. Data regarding the Ribeirão Preto birth cohort, Brazil, whose mothers were interviewed from June 1, 1978 to May 31, 1979 were used to answer these questions. The perinatal factors were obtained from the birth questionnaire and the ethnic data were obtained from 2063 participants asked about self-reported skin color at early adulthood (23-25 years of age) in 2002/2004. Mothers of mulatto and black children had higher rates of low schooling (< or = 4 years, 27.2 and 38.0%) and lower family income (< or = 1 minimum wage, 28.6 and 30.4%). Mothers aged less than 20 years old predominated among mulattos (17.0%) and blacks (14.0%). Higher rates of low birth weight and smoking during pregnancy were observed among mulatto individuals (9.6 and 28.8%). Preterm birth rate was higher among mulattos (9.5%) and blacks (9.7%) than whites (5.5%). White individuals had higher rates of cesarean delivery (34.9%). Skin color remained as an independent risk factor for low birth weight (P < 0.001), preterm birth (P = 0.01), small for gestational age (P = 0.01), and lack of prenatal care (P = 0.02) after adjustment for family income and maternal schooling, suggesting that the racial inequalities regarding these indicators are explained by the socioeconomic disadvantage experienced by mulattos and blacks but are also influenced by other factors, possibly by racial discrimination and/or genetics. PMID:17713668

  4. Fetal undernutrition is associated with perinatal sex-dependent alterations in oxidative status.

    PubMed

    Rodríguez-Rodríguez, Pilar; de Pablo, Angel Luis López; Condezo-Hoyos, Luis; Martín-Cabrejas, María Angeles; Aguilera, Yolanda; Ruiz-Hurtado, Gema; Gutierrez-Arzapalo, Perla Y; Ramiro-Cortijo, David; Fernández-Alfonso, María Soledad; González, María Del Carmen; Arribas, Silvia M

    2015-12-01

    Intrauterine growth retardation predisposes to hypertension development, known as fetal programming. Females are less susceptible, which has been mainly attributed to estrogen influence. We hypothesize that perinatal differences in oxidative status might also contribute. We studied 21-day-old (prepuberal) and 6-month-old male and female offspring from rats fed ad libitum during gestation (Control) or with 50% of Control daily intake from day 10 to delivery (maternal undernutrition, MUN). We assessed in vivo blood pressure and the following plasma biomarkers of oxidative status: protein carbonyls, thiols, reduced glutathione (GSH), total antioxidant capacity, superoxide anion scavenging activity (SOSA) and catalase activities; we calculated a global score (oxy-score) from them. Estradiol and melatonin concentration was measured in young rats. Prepuberal MUN males were normotensive but already exhibited increased carbonyls and lower thiols, GSH, SOSA and melatonin; oxy-score was significantly lower compared to Control males. Prepuberal MUN females only exhibited reduced SOSA compared to Control females. Adult rats from all experimental groups showed a significant increase in carbonyls and a decrease in antioxidants compared to prepuberal rats; oxy-score was negative in adult rats suggesting the development of a prooxidative status as rat age. Adult MUN males were hypertensive and exhibited the highest increase in carbonyls despite similar or even higher antioxidant levels compared to Controls. Adult MUN females remained normotensive and did not exhibit differences in any of the biomarkers compared to Controls. The better global antioxidant status developed by MUN females during perinatal life could contribute to their protection against hypertension programming. PMID:26350253

  5. Perinatal Exposure to Perfluorooctane Sulfonate Affects Glucose Metabolism in Adult Offspring

    PubMed Central

    Wan, Hin T.; Zhao, Yin G.; Leung, Pik Y.; Wong, Chris K. C.

    2014-01-01

    Perfluoroalkyl acids (PFAAs) are globally present in the environment and are widely distributed in human populations and wildlife. The chemicals are ubiquitous in human body fluids and have a long serum elimination half-life. The notorious member of PFAAs, perfluorooctane sulfonate (PFOS) is prioritized as a global concerning chemical at the Stockholm Convention in 2009, due to its harmful effects in mammals and aquatic organisms. PFOS is known to affect lipid metabolism in adults and was found to be able to cross human placenta. However the effects of in utero exposure to the susceptibility of metabolic disorders in offspring have not yet been elucidated. In this study, pregnant CD-1 mice (F0) were fed with 0, 0.3 or 3 mg PFOS/kg body weight/day in corn oil by oral gavage daily throughout gestational and lactation periods. We investigated the immediate effects of perinatal exposure to PFOS on glucose metabolism in both maternal and offspring after weaning (PND 21). To determine if the perinatal exposure predisposes the risk for metabolic disorder to the offspring, weaned animals without further PFOS exposure, were fed with either standard or high-fat diet until PND 63. Fasting glucose and insulin levels were measured while HOMA-IR index and glucose AUCs were reported. Our data illustrated the first time the effects of the environmental equivalent dose of PFOS exposure on the disturbance of glucose metabolism in F1 pups and F1 adults at PND 21 and 63, respectively. Although the biological effects of PFOS on the elevated levels of fasting serum glucose and insulin levels were observed in both pups and adults of F1, the phenotypes of insulin resistance and glucose intolerance were only evident in the F1 adults. The effects were exacerbated under HFD, highlighting the synergistic action at postnatal growth on the development of metabolic disorders. PMID:24498028

  6. National Partnership for Maternal Safety Consensus Bundle on Obstetric Hemorrhage.

    PubMed

    Main, Elliott K; Goffman, Dena; Scavone, Barbara M; Low, Lisa Kane; Bingham, Debra; Fontaine, Patricia L; Gorlin, Jed B; Lagrew, David C; Levy, Barbara S

    2015-01-01

    Hemorrhage is the most frequent cause of severe maternal morbidity and preventable maternal mortality and therefore is an ideal topic for the initial national maternity patient safety bundle. These safety bundles outline critical clinical practices that should be implemented in every maternity unit. They are developed by multidisciplinary work groups of the National Partnership for Maternal Safety under the guidance of the Council on Patient Safety in Women's Health Care. The safety bundle is organized into 4 domains: Readiness, Recognition and Prevention, Response, and Reporting and Systems Learning. Although the bundle components may be adapted to meet the resources available in individual facilities, standardization within an institution is strongly encouraged. References contain sample resources and "Potential Best Practices" to assist with implementation. PMID:26059199

  7. National Partnership for Maternal Safety: Consensus Bundle on Obstetric Hemorrhage.

    PubMed

    Main, Elliott K; Goffman, Dena; Scavone, Barbara M; Low, Lisa Kane; Bingham, Debra; Fontaine, Patricia L; Gorlin, Jed B; Lagrew, David C; Levy, Barbara S

    2015-07-01

    Hemorrhage is the most frequent cause of severe maternal morbidity and preventable maternal mortality and therefore is an ideal topic for the initial national maternity patient safety bundle. These safety bundles outline critical clinical practices that should be implemented in every maternity unit. They are developed by multidisciplinary work groups of the National Partnership for Maternal Safety under the guidance of the Council on Patient Safety in Women's Health Care. The safety bundle is organized into four domains: Readiness, Recognition and Prevention, Response, and Reporting and System Learning. Although the bundle components may be adapted to meet the resources available in individual facilities, standardization within an institution is strongly encouraged. References contain sample resources and "Potential Best Practices" to assist with implementation. PMID:26241269

  8. National Partnership for Maternal Safety: consensus bundle on obstetric hemorrhage.

    PubMed

    Main, Elliott K; Goffman, Dena; Scavone, Barbara M; Low, Lisa Kane; Bingham, Debra; Fontaine, Patricia L; Gorlin, Jed B; Lagrew, David C; Levy, Barbara S

    2015-07-01

    Hemorrhage is the most frequent cause of severe maternal morbidity and preventable maternal mortality and therefore is an ideal topic for the initial national maternity patient safety bundle. These safety bundles outline critical clinical practices that should be implemented in every maternity unit. They are developed by multidisciplinary work groups of the National Partnership for Maternal Safety under the guidance of the Council on Patient Safety in Women's Health Care. The safety bundle is organized into four domains: Readiness, Recognition and Prevention, Response, and Reporting and System Learning. Although the bundle components may be adapted to meet the resources available in individual facilities, standardization within an institution is strongly encouraged. References contain sample resources and "Potential Best Practices" to assist with implementation. PMID:26091046

  9. Perinatally infected adolescents living with human immunodeficiency virus (perinatally human immunodeficiency virus)

    PubMed Central

    Cruz, Maria Leticia S; Cardoso, Claudete A

    2015-01-01

    The availability of highly potent antiretroviral treatment during the last decades has transformed human immunodeficiency virus (HIV) infection into a chronic disease. Children that were diagnosed during the first months or years of life and received treatment, are living longer and better and are presently reaching adolescence and adulthood. Perinatally HIV-infected adolescents (PHIV) and young adults may present specific clinical, behavior and social characteristics and demands. We have performed a literature review about different aspects that have to be considered in the care and follow-up of PHIV. The search included papers in the MEDLINE database via PubMed, located using the keywords “perinatally HIV-infected” AND “adolescents”. Only articles published in English or Portuguese from 2003 to 2014 were selected. The types of articles included original research, systematic reviews, and quantitative or qualitative studies; case reports and case series were excluded. Results are presented in the following topics: “Puberal development and sexual maturation”, “Growth in weight and height”, “Bone metabolism during adolescence”, “Metabolic complications”, “Brain development, cognition and mental health”, “Reproductive health”, “Viral drug resistance” and “Transition to adult outpatient care”. We hope that this review will support the work of pediatricians, clinicians and infectious diseases specialists that are receiving these subjects to continue treatment. PMID:26279988

  10. Assessment of the perinatal effects of maternal ingestion of Ipomoea carnea in rats

    Technology Transfer Automated Retrieval System (TEKTRAN)

    It is believed that I. carnea toxicosis induces abnormal embryogenesis in livestock. Studies with rats treated with I. carnea aqueous fraction (AF) during gestation, revealed litters with decreased body weight, but the characteristic vacuolar lesions promoted by swainsonine, its main toxic principle...

  11. A prospective study of maternal, fetal and neonatal deaths in low- and middle-income countries

    PubMed Central

    Saleem, Sarah; Goudar, Shivaprasad S; Patel, Archana; Esamai, Fabian; Garces, Ana; Chomba, Elwyn; Althabe, Fernando; Moore, Janet; Kodkany, Bhalachandra; Pasha, Omrana; Belizan, Jose; Mayansyan, Albert; Derman, Richard J; Hibberd, Patricia L; Liechty, Edward A; Krebs, Nancy F; Hambidge, K Michael; Buekens, Pierre; Carlo, Waldemar A; Wright, Linda L; Koso-Thomas, Marion; Jobe, Alan H; Goldenberg, Robert L

    2014-01-01

    Abstract Objective To quantify maternal, fetal and neonatal mortality in low- and middle-income countries, to identify when deaths occur and to identify relationships between maternal deaths and stillbirths and neonatal deaths. Methods A prospective study of pregnancy outcomes was performed in 106 communities at seven sites in Argentina, Guatemala, India, Kenya, Pakistan and Zambia. Pregnant women were enrolled and followed until six weeks postpartum. Findings Between 2010 and 2012, 214 070 of 220 235 enrolled women (97.2%) completed follow-up. The maternal mortality ratio was 168 per 100 000 live births, ranging from 69 per 100 000 in Argentina to 316 per 100 000 in Pakistan. Overall, 29% (98/336) of maternal deaths occurred around the time of delivery: most were attributed to haemorrhage (86/336), pre-eclampsia or eclampsia (55/336) or sepsis (39/336). Around 70% (4349/6213) of stillbirths were probably intrapartum; 34% (1804/5230) of neonates died on the day of delivery and 14% (755/5230) died the day after. Stillbirths were more common in women who died than in those alive six weeks postpartum (risk ratio, RR: 9.48; 95% confidence interval, CI: 7.97–11.27), as were perinatal deaths (RR: 4.30; 95% CI: 3.26–5.67) and 7-day (RR: 3.94; 95% CI: 2.74–5.65) and 28-day neonatal deaths (RR: 7.36; 95% CI: 5.54–9.77). Conclusion Most maternal, fetal and neonatal deaths occurred at or around delivery and were attributed to preventable causes. Maternal death increased the risk of perinatal and neonatal death. Improving obstetric and neonatal care around the time of birth offers the greatest chance of reducing mortality. PMID:25177075

  12. Canine perinatal mortality: a cohort study of 224 breeds.

    PubMed

    Tønnessen, R; Borge, K Sverdrup; Nødtvedt, A; Indrebø, A

    2012-06-01

    Canine perinatal mortality is known to be relatively high. However, the literature on perinatal mortality in dogs is still sparse and often refers to a single or only a few breeds. The aim of this large-scale observational study was to describe the perinatal mortality in purebred dogs of various breeds at both puppy and litter level. In addition, the influence of breed, breed size, litter size, age of the bitch, litter number and season for whelping on the risk of perinatal mortality at litter level was studied and the mean litter size at eight days and eight wks after birth was calculated. A retrospective cohort study was performed by studying 10,810 litters of 224 breeds registered in the Norwegian Kennel Club in 2006 and 2007. Perinatal mortality was defined as the sum of stillborn puppies and puppies that died during the first wk after birth (early neonatal mortality) and was present in 24.6% of the litters. Eight percent of the puppies died before eight days after birth, with 4.3% as stillbirth and 3.7% as early neonatal mortality. For most breeds the perinatal mortality was low, but for some breeds a higher perinatal mortality was found. The mean litter size at eight days and eight wks after birth was 4.97 (±0.02) and 4.92 (±0.02) puppies, respectively. Of all puppies born, only 1% died during the period from eight days to eight wks after birth. Random effects logistic regression analysis indicated that increasing litter size and age of the bitch were associated with an increased risk of stillbirth, early neonatal mortality and total perinatal mortality at the litter level (P < 0.001). The random breed effect was significant for all outcomes. Litter number also had a significant effect on stillbirth, early neonatal mortality and total perinatal mortality at the litter level, with the highest risk of perinatal mortality found in the first litter (P < 0.001). Further, the risk of early neonatal mortality was doubled in litters with stillborn puppies. No significant effect of whelping season on perinatal mortality at litter level was found. An interaction existed between the age of the bitch and litter number and the risk of stillbirth was three times as high (odds ratio = 3.00) in litters from bitches having their first litter after the age of six y. Breed was a more important determinant of perinatal mortality in litters than breed size. However, more than 90% of the variation in perinatal mortality was found at the individual litter level and efforts to minimize puppy mortality should be targeted at the management of the individual litter rather than at the breed level. PMID:22365700

  13. Maternity records in Edinburgh and Aberdeen in 1936: a comparison.

    PubMed

    Nuttall, A M; Ayaz, E; Sherlock, L; Shenkin, S D

    2015-03-01

    Historians have long used maternity records to understand the evolution of maternity services. More recently, epidemiologists have become interested in obstetric hospital records as a source of data (e.g. birth weight, social class), to study the influence of early life on future health and disease: life course epidemiology. Edinburgh and Aberdeen are unusual in holding detailed records from several maternity institutions. The records of 1936 are of particular interest because all children born in this year and at school in Scotland at age 11 sat a cognitive ability test, the Scottish Mental Survey 1947. This study aims to describe the maternity services in Edinburgh and Aberdeen in 1936, between the First and Second World Wars. Understanding the richness of data in birth records, the manner in which they were recorded, and the context of the institutions in their community is essential for interpreting life course epidemiology studies. PMID:25874836

  14. Low perinatal autopsy rate in Malaysia: time for a change.

    PubMed

    Tan, Geok Chin; Hayati, Abdul Rahman; Khong, Teck Yee

    2010-01-01

    Our objectives were to determine the perinatal autopsy rate in a tertiary hospital in Malaysia and to quantify the value of the perinatal autopsy. All stillbirths, miscarriages, therapeutic abortions, and neonatal deaths between January 1, 2004, and August 31, 2009, were identified from the archives. The autopsy findings were compared with the clinical diagnoses. The autopsy reports were also reviewed to determine if it would be possible to improve the quality of the autopsies. There were 807 perinatal deaths, of which 36 (4.5%) included an autopsy. There were ethnic differences in the rate of autopsy, with the lowest rate among the Malays. The autopsy provided the diagnosis, changed the clinical diagnosis, or revealed additional findings in 58.3% of cases. Ancillary testing, such as microbiology, chromosomal analysis, and biochemistry, could improve the quality of the autopsy. This study provides further data on the perinatal autopsy rate from an emerging and developing country. It reaffirms the value of the perinatal autopsy. Attempts must be made to improve on the low autopsy rate while recognizing that the performance of autopsies can be enhanced through the use of ancillary testing. PMID:20367214

  15. Maternal and foetal risk factor and complication with immediate outcome during hospital stay of very low birth weight babies.

    PubMed

    Mannan, M A; Jahan, N; Dey, S K; Uddin, M F; Ahmed, S

    2012-10-01

    This prospective study was done to find out the maternal and foetal risk factors and complications during hospital stay. It was conducted in Special Care Neonatal Unit (SCANU), Department of Child Health, Bangabandhu Memorial Hospital (BBMH), University of Science and Technology Chittagong (USTC) from1st October 2001 to 30th March 2002 and cases were 35 very low birth weight (VLBW) newborns. Common complications of VLBW babies of this series were frequent apnea (40%), Septicemia (25.71%), Hypothermia (17.14%), NEC (14.28%), Convulsion (11.43%), Hyper-bilirubinaemia (8.57%), Anemia (5.71%), IVH (5.71%), RDS (2.86%), HDN (2.86%), CCF (2.86%), ARF (2.86%), either alone or in combination with other clinical conditions. Newborns 62.86% male, 37.14% female & their mortality rate were 40.91% & 38.46% respectively; Preterm 88.57% & their mortality (41.93%) were higher than term babies (25.00%); AGA 62.86%, SGA 37.14% & mortality rate of AGA babies (45.46%) were higher than of SGA (30.77%) babies. The mortality rate of VLBW infants of teen age (≤ 18 years) mothers (57.14%) & high (≥ 30 years) aged mothers (50.00%) were higher than average (19-26 yrs) maternal age mothers (33.33%). Mortality rate was higher among the babies of primi (41.67%) than multiparous (36.36%), poor socioeconomic group (53.33%) than middle class (30.00%) & mothers on irregular ANC (47.83%) than regular ANC (25.00%). It has been also noted the mortality rate of home delivered babies (50.00%) higher than institutional delivered (34.78%) babies; higher in LUCS babies (46.15%) than normal vaginal delivered babies (31.58%); higher in the babies who had antenatal maternal problem (48.15%) than no maternal problems babies (12.50%); higher in the babies who had fetal distress (50.00%) and twin (46.67%) than no foetal risk factors (28.57%) during intrauterine life; higher in the babies who had problems at admission (46.67%) than no problems (35.00%); and mortality higher in twin (46.67%) than singleton babies (35.00%). Maximum VLBW babies who died during hospital stay had multiple problems and mortality was varied from ?60-100%. The babies who had frequent apnea have been carried relative better outcome (mortality rate 35.72%). In this study out of total 35 studied baby 21(60.00%) survived and 14(40.00%) died. Frequent apnea, sepsis, hypothermia, NEC, convulsion, jaundice, anemia, IVH, and RDS are common complications in VLBW babies. Male sex, prematurity, primiparity, average (middle) socio-economic status, irregular ANC, preterm labor, toxemia of pregnancy, prolonged rupture of membrane, malnutrition, multiple gestations and foetal distress are risk factor for VLBW delivery. Clinical outcome depends on maturity, birth weight, centile for weight, maternal age, parity, maternal nutrition & socio-economic status, ANC, place & mode of delivery, maternal problems during antenatal & perinatal period, number of gestation, fetal condition, presentation at admission, postnatal problems, time of start of management & referral and level of care. PMID:23134911

  16. The relationship between maternal attitudes and symptoms of depression and anxiety among pregnant and postpartum first-time mothers

    PubMed Central

    Epperson, C. Neill; Barber, Jacques P.

    2014-01-01

    Two studies examined the relationship between maternal attitudes and symptoms of depression and anxiety during pregnancy and the early postpartum period. In the first study, a measure of maternal attitudes, the Attitudes Toward Motherhood Scale (AToM), was developed and validated in a sample of first-time mothers. The AToM was found to have good internal reliability and convergent validity with cognitive biases and an existing measure of maternal attitudes. Exploratory and confirmatory factor analyses determined that the measure comprises three correlated factors: beliefs about others’ judgments, beliefs about maternal responsibility, and maternal role idealization. In the second study, we used the AToM to assess the relationship between maternal attitudes and other psychological variables. The factor structure of the measure was confirmed. Maternal attitudes predicted symptoms of depression and anxiety, and these attitudes had incremental predictive validity over general cognitive biases and interpersonal risk factors. Overall, the results of these studies suggest that maternal attitudes are related to psychological distress among first-time mothers during the transition to parenthood and may provide a useful means of identifying women who may benefit from intervention during the perinatal period. PMID:24643422

  17. Perinatal iron deficiency and neurocognitive development

    PubMed Central

    Radlowski, Emily C.; Johnson, Rodney W.

    2013-01-01

    Iron deficiency is the most common form of nutrient deficiency worldwide. It is highly prevalent due to the limited availability of high quality food in developing countries and poor dietary habits in industrialized countries. According to the World Health Organization, it affects nearly 2 billion people and up to 50% of women who are pregnant. Maternal anemia during pregnancy is especially burdensome to healthy neurodevelopment in the fetus because iron is needed for proper neurogenesis, development, and myelination. Maternal anemia also increases the risk of low birth weight, either due to premature birth or fetal growth restriction, which is associated with delayed neurocognitive development and even psychiatric illness. As rapid neurodevelopment continues after birth infants that received sufficient iron in utero, but that receive a low iron diet after 6 months of age, also show deficits in neurocognitive development, including impairments in learning and memory. Unfortunately, the neurocognitive complications of iron deficiency during critical pre- and postnatal periods of brain development are difficult to remedy, persisting into adulthood. Thus, preventing iron deficiency in the pre- and postnatal periods is critical as is devising new means to recapture cognitive function in individuals who experienced early iron deficiency. This review will discuss the prevalence of pre- and postnatal iron deficiency, the mechanism, and effects of iron deficiency on brain and cognitive development. PMID:24065908

  18. [Maternal conceptions of infantile diarrhea

    PubMed

    Feliciano, K V; Kovacs, M H

    2001-01-01

    OBJECTIVE: To understand maternal conceptions of infantile diarrhea, encouraging reflection on the importance of communication between mothers and health services. METHODS: Survey carried out in selected areas of six towns in the state of Pernambuco, all of which participated in the diarrhea control project coordinated by the State Health Secretariat. The information was obtained through interviews with 770 mothers, producing a representative sample of 1,026 children younger than five years. RESULTS: In general, mothers associated the occurrence of diarrhea with some kinds of food (fatty or undercooked). Better educated mothers, regardless of their place of residence, attributed it to improper hygiene and sanitation, whereas illiterate and poorly educated mothers, from the metropolitan region of Recife, blamed it on hot weather, and those living in the countryside believe the occurrence of diarrhea is related to teething. Circa 24.2% (63.4% living in the countryside) do not know how to prevent the disease. The two preventive measures most frequently adopted consist in drinking treated water and cooking food thoroughly. Only 0.5% mentioned breast-feeding. The number of children still alive and their ages influence maternal conceptions. The main sources of information about the prevention of diarrhea are the support network (45.5%), the health sector (35.9%) and the media (33.2%). CONCLUSIONS: The insufficient participation of the health sector in the information network about diarrhea, misinformation, and sharp disagreement over maternal conceptions and technical knowledge, which are the cornerstone of institutional measures, show that it is necessary to value the communicative dimension of the educational approach in child care. PMID:14647829

  19. Gestational weight loss and perinatal outcomes in overweight and obese women subsequent to diagnosis of gestational diabetes mellitus

    PubMed Central

    Yee, Lynn M.; Cheng, Yvonne W.; Inturrisi, Maribeth; Caughey, Aaron B.

    2013-01-01

    OBJECTIVE To investigate whether gestational weight loss after the diagnosis of gestational diabetes mellitus (GDM) in overweight and obese women is associated with improved perinatal outcomes. Obesity and GDM are risk factors for adverse perinatal outcomes, but few studies have investigated weight loss during pregnancy in women with these comorbidities. METHODS Retrospective cohort study of 26,205 overweight and obese gestational diabetic women enrolled in the California Diabetes and Pregnancy Program. Women with gestational weight loss (GWL) during program enrollment were compared to those with weight gain. Perinatal outcomes were assessed using chi-square test and multivariable logistic regression analysis. RESULTS: 5.2% of women experienced GWL. GWL was associated with decreased odds of macrosomia (aOR 0.63, 95% CI 0.52–0.77), NICU admission (aOR 0.51, 95% CI 0.27–0.95), and cesarean delivery (aOR 0.81, 95% CI 0.68–0.97). Odds of SGA status (aOR 1.69, 95% CI 1.32–2.17) and preterm delivery <34 weeks (aOR 1.71, 95% CI 1.23–2.37) were increased. CONCLUSIONS In overweight and obese women with GDM, third trimester weight loss is associated with some improved maternal and neonatal outcomes, although this effect is lessened by increased odds of SGA status and preterm delivery. We recommend further research on weight loss and interventions to improve adherence to weight guidelines in this population. PMID:23613187

  20. Perinatal Lead Exposure Alters Gut Microbiota Composition and Results in Sex-specific Bodyweight Increases in Adult Mice.

    PubMed

    Wu, Jianfeng; Wen, Xiaoquan William; Faulk, Christopher; Boehnke, Kevin; Zhang, Huapeng; Dolinoy, Dana C; Xi, Chuanwu

    2016-06-01

    Heavy metal pollution is a principle source of environmental contamination. Epidemiological and animal data suggest that early life lead (Pb) exposure results in critical effects on epigenetic gene regulation and child and adult weight trajectories. Using a mouse model of human-relevant exposure, we investigated the effects of perinatal Pb exposure on gut microbiota in adult mice, and the link between gut microbiota and bodyweight changes. Following Pb exposure during gestation and lactation via maternal drinking water, bodyweight in A(vy) strain wild-type non-agouti (a/a) offspring was tracked through adulthood. Gut microbiota of adult mice were characterized by deep DNA sequencing of bacterial 16S ribosomal RNA genes. Data analyses were stratified by sex and adjusted for litter effects. A Bayesian variable selection algorithm was used to analyze associations between bacterial operational taxonomic units and offspring adult bodyweight. Perinatal Pb exposure was associated with increased adult bodyweight in male (P < .05) but not in female offspring (P = .24). Cultivable aerobes decreased and anaerobes increased in Pb-exposed offspring (P < .005 and P < .05, respectively). Proportions of the 2 predominant phyla (Bacteroidetes and Firmicutes) shifted inversely with Pb exposure, and whole bacterial compositions were significantly different (analysis of molecular variance, P < .05) by Pb exposure without sex bias. In males, changes in gut microbiota were highly associated with adult bodyweight (P = .028; effect size = 2.59). Thus, perinatal Pb exposure results in altered adult gut microbiota regardless of sex, and these changes are highly correlated with increased bodyweight in males. Adult gut microbiota can be shaped by early exposures and may contribute to disease risks in a sex-specific manner. PMID:26962054

  1. Idiopathic Polyhydramnios: Severity and Perinatal Morbidity.

    PubMed

    Wiegand, Samantha L; Beamon, Carmen J; Chescheir, Nancy C; Stamilio, David

    2016-06-01

    Objective To estimate the association between the severity of idiopathic polyhydramnios and adverse outcomes. Study Design Retrospective cohort study of deliveries at one hospital from 2000 to 2012 with an amniotic fluid index (AFI) measurement ≥24 + 0 weeks' gestation. Pregnancies complicated by diabetes, multiples, or fetal anomalies were excluded. Exposure was the degree of polyhydramnios: normal (AFI 5-24 cm), mild (≥ 24-30 cm), and moderate-severe (> 30 cm). Primary outcomes were perinatal mortality, neonatal intensive care unit (NICU) admission, and postpartum hemorrhage. Results There were 10,536 pregnancies: 10,188 with a normal AFI, 274 mild (78.74%), and 74 moderate-severe polyhydramnios (21.26%). Adverse outcomes were increased with idiopathic polyhydramnios: NICU admission (adjusted odds ratio [AOR] 3.71, 95% confidence interval [CI] 2.77-4.99), postpartum hemorrhage (AOR 15.81, 95% CI 7.82-31.96), macrosomia (AOR 3.41, 95% CI 2.61-4.47), low 5-minute Apgar score (AOR 2.60, 95% CI 1.57-4.30), and cesarean (AOR 2.16, 95% CI 1.74-2.69). There were increasing odds of macrosomia (mild: AOR 3.19, 95% CI 2.36-4.32; moderate-severe: AOR 4.44, 95% CI 2.53-7.79) and low 5-minute Apgar score (mild: AOR 2.24, 95% CI 1.23-4.08; moderate-severe: AOR 3.93, 95% CI 1.62-9.55) with increasing severity of polyhydramnios. Conclusion Idiopathic polyhydramnios is independently associated with increased risks of morbidity. There appears to be a dose-response relationship for neonatal macrosomia and low 5-minute Apgar score risks. PMID:26862725

  2. Escherichia coli septicemia associated with lack of maternally acquired immunity in a bottlenose dolphin calf.

    PubMed

    van Elk, C E; van Dep Bildt, M W G; Martina, B E E; Osterhaus, A D M E; Kuiken, T

    2007-01-01

    Stillbirth and neonatal mortality are substantial problems in captive bottlenose dolphins (Tursiops truncatus). The cause of these problems often is unknown. We report a case of Escherichia coli septicemia in a male 3-day-old bottlenose dolphin calf. Lesions included omphalitis, synovitis, and hepatic necrosis associated with the presence of Gram-negative bacilli. E. coli was isolated in pure culture from multiple organs. A serum gammaglobulin level of 1.5 g/L indicated a lack of maternally acquired immunity. The observed failure to nurse may have resulted from brain injury due to perinatal asphyxia. Evidence for perinatal asphyxia was the diffuse presence of a moderate amount of meconium in the lungs. PMID:17197629

  3. Maternal Ultrasonography for the Antenatal Diagnosis of Surgically Significant Neonatal Anomalies

    PubMed Central

    Canty, Timothy G.; Leopold, George R.; Wolf, Deborah A.

    1981-01-01

    The increased use of ultrasonography in the management and evaluation of pregnancy has provided a unique opportunity to observe the anatomy of the developing fetus from 12 weeks gestation until term. Twenty-eight surgically important anatomic abnormalities have been diagnosed in utero by sonographic examinations at our affiliated institutions over the past three and a half years. These include ascites (five cases), gastroschisis (four cases), omphalocele (three cases), sacrococcygeal teratoma, cystic hygroma, hydrocele, duodenal atresia, multicystic kidney (two cases each), and one each of jejunal atresia, conjoined twins, ureteropelvic junction obstruction, urethral valves, urethral agenesis, and hydronephrosis secondary to reflux. Prenatal diagnosis by ultrasonographic examination has signifcantly improved perinatal management. Elective caesarean section has benefited infants with lesions causing dystocia, such as sacrococcygeal teratoma, omphalocele, and conjoined twins. Advance notification of surgeons and neonatalogists has reduced the delays of postnatal evaluation and treatment that contribute, significantly, to complications and death. In addition, transfer of the pregnant mother carrying an infant with a significant surgical anomaly to a center with facilities for neonatal surgery and specialized postoperative care can be properly planned for in advance. In the near future, intrauterine fetal surgery or palliative intervention may provide increased salvage of patients with obstructive uropathy and diaphragmatic hernia, both of which carry high mortality rates secondary to in utero damage. Sonography has proven useful in following the dilatation of either intestinal or urinary tract structures in utero. In our hands, maternal sonography has improved the surgical care of the newborn and may open a new frontier of intrauterine fetal surgery in the future. ImagesFig. 1a.Fig. 1b.Fig. 2a.Fig. 2b.Fig. 3.Fig. 4.Fig. 5.Fig. 6a.Fig. 6b.Fig. 6c.Fig. 7a.Fig. 7b.Fig. 8. PMID:6455975

  4. Trends in perinatal deaths from 2010 to 2013 in the Guatemalan Western Highlands

    PubMed Central

    2015-01-01

    Background While progress has been made in reducing neonatal mortality in Guatemala, stillbirth and maternal mortality rates remain high, especially among the indigenous populations, which have among the highest adverse pregnancy-related mortality rates in Guatemala. Methods We conducted a prospective study in the Western Highlands of Guatemala from 2010 through 2013, enrolling women during pregnancy with follow-up through 42-days postpartum. All pregnant women were identified and enrolled by study staff in the clusters in the Chimaltenango region for which we had 4 years of data. Enrolment usually occurred during the antenatal period; women were also visited following delivery and 42-days postpartum to collect outcomes. Measures of antenatal and delivery care were also obtained. Results Approximately four thousand women were enrolled annually (3,869 in 2010 to 4,570 in 2013). The stillbirth rate decreased significantly, from 22.0 per 1000 births (95% CI 16.6, 29.0) in 2010 to 16.7 (95% CI 13.5, 20.6) in 2013 (p-value 0.0223). The perinatal mortality rate decreased from 43.9 per 1,000 births (95% CI 36.0, 53.6) to 31.6 (95% CI 27.2, 36.7) (p-value 0.0003). The 28-day neonatal mortality rate decreased from 28.9 per 1000 live births (95% CI 25.2, 33.2) to 21.7 (95% CI 17.5, 26.9), p-value 0.0004. The maternal mortality rate was 134 per 100,000 in 2010 vs. 113 per 100,000 in 2013. Over the same period, hospital birth rates increased from 30.0 to 50.3%. Conclusions In a relatively short time period, significant improvements in neonatal, fetal and perinatal mortality were noted in an area of Guatemala with a history of poor pregnancy outcomes. These changes were temporally related to major increases in hospital-based delivery with skilled birth attendants, as well as improvements in the quality of delivery care, neonatal care, and prenatal care. PMID:26062407

  5. Activation of Nod1 Signaling Induces Fetal Growth Restriction and Death through Fetal and Maternal Vasculopathy

    PubMed Central

    Nishio, Hisanori; Takada, Hidetoshi; Sakai, Yasunari; Nanishi, Etsuro; Ochiai, Masayuki; Onimaru, Mitsuho; Chen, Si Jing; Matsui, Toshiro; Hara, Toshiro

    2016-01-01

    Intrauterine fetal growth restriction (IUGR) and death (IUFD) are both serious problems in the perinatal medicine. Fetal vasculopathy is currently considered to account for a pathogenic mechanism of IUGR and IUFD. We previously demonstrated that an innate immune receptor, the nucleotide-binding oligomerization domain-1 (Nod1), contributed to the development of vascular inflammations in mice at postnatal stages. However, little is known about the deleterious effects of activated Nod1 signaling on embryonic growth and development. We report that administration of FK565, one of the Nod1 ligands, to pregnant C57BL/6 mice induced IUGR and IUFD. Mass spectrometry analysis revealed that maternally injected FK565 was distributed to the fetal tissues across placenta. In addition, maternal injection of FK565 induced robust increases in the amounts of CCL2, IL-6, and TNF proteins as well as NO in maternal, placental and fetal tissues. Nod1 was highly expressed in fetal vascular tissues, where significantly higher levels of CCL2 and IL-6 mRNAs were induced with maternal injection of FK565 than those in other tissues. Using Nod1-knockout mice, we verified that both maternal and fetal tissues were involved in the development of IUGR and IUFD. Furthermore, FK565 induced upregulation of genes associated with immune response, inflammation, and apoptosis in fetal vascular tissues. Our data thus provided new evidence for the pathogenic role of Nod1 in the development of IUGR and IUFD at the maternal-fetal interface. PMID:26880761

  6. Moderate Exercise Attenuates Lipopolysaccharide-Induced Inflammation and Associated Maternal and Fetal Morbidities in Pregnant Rats

    PubMed Central

    Macdonald-Goodfellow, Shannyn K.; Surita, Fernanda G.; Pinto e Silva, João L.; Tayade, Chandrakant; Othman, Maha; Ozolinš, Terence R. S.

    2016-01-01

    Fetal growth restriction (FGR) and coagulopathies are often associated with aberrant maternal inflammation. Moderate-intensity exercise during pregnancy has been shown to increase utero-placental blood flow and to enhance fetal nutrition as well as fetal and placental growth. Furthermore, exercise is known to reduce inflammation. To evaluate the effect of moderate-intensity exercise on inflammation associated with the development of maternal coagulopathies and FGR, Wistar rats were subjected to an exercise regime before and during pregnancy. To model inflammation-induced FGR, pregnant rats were administered daily intraperitoneal injections of E. coli lipopolysaccharide (LPS) on gestational days (GD) 13.5–16.5 and sacrificed at GD 17.5. Control rats were injected with saline. Maternal hemostasis was assessed by thromboelastography. Moderate-intensity exercise prevented LPS-mediated increases in white blood cell counts measured on GD 17.5 and improved maternal hemostasis profiles. Importantly, our data reveal that exercise prevented LPS-induced FGR. Moderate-intensity exercise initiated before and maintained during pregnancy may decrease the severity of maternal and perinatal complications associated with abnormal maternal inflammation. PMID:27124733

  7. Activation of Nod1 Signaling Induces Fetal Growth Restriction and Death through Fetal and Maternal Vasculopathy.

    PubMed

    Inoue, Hirosuke; Nishio, Hisanori; Takada, Hidetoshi; Sakai, Yasunari; Nanishi, Etsuro; Ochiai, Masayuki; Onimaru, Mitsuho; Chen, Si Jing; Matsui, Toshiro; Hara, Toshiro

    2016-03-15

    Intrauterine fetal growth restriction (IUGR) and death (IUFD) are both serious problems in the perinatal medicine. Fetal vasculopathy is currently considered to account for a pathogenic mechanism of IUGR and IUFD. We previously demonstrated that an innate immune receptor, the nucleotide-binding oligomerization domain-1 (Nod1), contributed to the development of vascular inflammations in mice at postnatal stages. However, little is known about the deleterious effects of activated Nod1 signaling on embryonic growth and development. We report that administration of FK565, one of the Nod1 ligands, to pregnant C57BL/6 mice induced IUGR and IUFD. Mass spectrometry analysis revealed that maternally injected FK565 was distributed to the fetal tissues across placenta. In addition, maternal injection of FK565 induced robust increases in the amounts of CCL2, IL-6, and TNF proteins as well as NO in maternal, placental and fetal tissues. Nod1 was highly expressed in fetal vascular tissues, where significantly higher levels of CCL2 and IL-6 mRNAs were induced with maternal injection of FK565 than those in other tissues. Using Nod1-knockout mice, we verified that both maternal and fetal tissues were involved in the development of IUGR and IUFD. Furthermore, FK565 induced upregulation of genes associated with immune response, inflammation, and apoptosis in fetal vascular tissues. Our data thus provided new evidence for the pathogenic role of Nod1 in the development of IUGR and IUFD at the maternal-fetal interface. PMID:26880761

  8. Complementary and Alternative Medicine Therapies for Perinatal Depression

    PubMed Central

    Deligiannidis, Kristina M.; Freeman, Marlene P.

    2014-01-01

    Complementary and Alternative Medicine (CAM) therapies are increasingly sought out by patients with psychiatric disorders. This article provides a review of the evidence for several commonly utilized CAM therapies (i.e. omega-3 fatty acids, folate, S-adenosyl-methionine (SAMe), St. John’s Wort, bright light therapy, exercise, massage, and acupuncture) in the treatment of perinatal depression. A number of these treatments may be reasonable to consider for women during pregnancy or the postpartum, but the safety and efficacy of these relative to standard treatments must still be systematically determined. Evidence based use of CAM treatments for perinatal depression is discussed. Adequately powered systematic studies are necessary to determine the role of CAM in the treatment of perinatal depression. PMID:24041861

  9. Perinatal programming of asthma: the role of gut microbiota.

    PubMed

    Azad, Meghan B; Kozyrskyj, Anita L

    2012-01-01

    Perinatal programming, a dominant theory for the origins of cardiovascular disease, proposes that environmental stimuli influence developmental pathways during critical periods of prenatal and postnatal development, inducing permanent changes in metabolism. In this paper, we present evidence for the perinatal programming of asthma via the intestinal microbiome. While epigenetic mechanisms continue to provide new explanations for the programming hypothesis of asthma development, it is increasingly apparent that the intestinal microbiota plays an independent and potentially interactive role. Commensal gut bacteria are essential to immune system development, and exposures disrupting the infant gut microbiota have been linked to asthma. This paper summarizes the recent findings that implicate caesarean delivery, breastfeeding, perinatal stress, probiotics, and antibiotics as modifiers of infant gut microbiota in the development of asthma. PMID:22110540

  10. Obstetric and perinatal complications in an oocyte donation programme. Is it time to limit the number of embryos to transfer?

    PubMed

    Clua, Elisabet; Meler, Eva; Rodríguez, Dalia; Coroleu, Buenaventura; Rodríguez, Ignacio; Martínez, Francisca; Tur, Rosa

    2016-04-01

    The aim of this study is to describe obstetric and perinatal complications in pregnancies from oocyte donation (OD) cycles, delivering in our centre and to determine the impact of maternal age. Retrospective observational study of a 225 singleton pregnancies, 113 multiple pregnancies and 447 live birth. Pearson's χ(2) test or Fisher's exact test were used for the statistical analysis. A higher incidence of obstetric complications was observed in multiple compared to singleton pregnancies with regard to preeclampsia (24.8% versus 8%), premature rupture of membranes (9.7% versus 1.8%), preterm delivery at <37 weeks (54.9% versus 10.2%) and caesarean section (81.4% versus 64%) (p < 0.05). If the age factor is added, the caesarean sections are higher in the single pregnancy group aged ≥40 years than in the group of <40 years (73.5% versus 49.4%) (p < 0.05). A higher incidence is found in multiple versus singleton pregnancies for low birth weight (<2500 g) (61.1% versus 8.2%), admissions to the intensive care unit (15.2% versus 4.7%) and perinatal mortality (13.5‰ versus 0‰) (p < 0.05). It is necessary to consider preconception counselling prior to an OD cycle to inform patients about the incidence complications observed and recommend to transfer only a single embryo. PMID:26490075

  11. Maternal influences on fetal microbial colonization and immune development

    PubMed Central

    Romano-Keeler, Joann; Weitkamp, Jörn-Hendrik

    2014-01-01

    While critical for normal development, the exact timing of establishment of the intestinal microbiome is unknown. For example, although preterm labor and birth have been associated with bacterial colonization of the amniotic cavity and fetal membranes for many years, the prevailing dogma of a sterile intrauterine environment during normal term pregnancies has been challenged more recently. While found to be a key contributor of evolution in the animal kingdom, maternal transmission of commensal bacteria may also constitute a critical process during healthy pregnancies in humans with yet unclear developmental importance. Metagenomic sequencing has elucidated a rich placental microbiome in normal term pregnancies likely providing important metabolic and immune contributions to the growing fetus. Conversely, an altered microbial composition during pregnancy may produce aberrant metabolites impairing fetal brain development and life-long neurological outcomes. Here we review the current understanding of microbial colonization at the feto-maternal interface and explain how normal gut colonization drives a balanced neonatal mucosal immune system, while dysbiosis contributes to aberrant immune function early in life and beyond. We discuss how maternal genetics, diet, medications, and probiotics inform the fetal microbiome in preparation for perinatal and postnatal bacterial colonization. PMID:25310759

  12. Maternal influences on fetal microbial colonization and immune development.

    PubMed

    Romano-Keeler, Joann; Weitkamp, Jörn-Hendrik

    2015-01-01

    While critical for normal development, the exact timing of establishment of the intestinal microbiome is unknown. For example, although preterm labor and birth have been associated with bacterial colonization of the amniotic cavity and fetal membranes for many years, the prevailing dogma of a sterile intrauterine environment during normal term pregnancies has been challenged more recently. While found to be a key contributor of evolution in the animal kingdom, maternal transmission of commensal bacteria may also constitute a critical process during healthy pregnancies in humans with yet unclear developmental importance. Metagenomic sequencing has elucidated a rich placental microbiome in normal term pregnancies likely providing important metabolic and immune contributions to the growing fetus. Conversely, an altered microbial composition during pregnancy may produce aberrant metabolites impairing fetal brain development and life-long neurological outcomes. Here we review the current understanding of microbial colonization at the feto-maternal interface and explain how normal gut colonization drives a balanced neonatal mucosal immune system, while dysbiosis contributes to aberrant immune function early in life and beyond. We discuss how maternal genetics, diet, medications, and probiotics inform the fetal microbiome in preparation for perinatal and postnatal bacterial colonization. PMID:25310759

  13. Perinatal interventions and survival in resource-poor settings: which work, which don’t, which have the jury out?

    PubMed Central

    Osrin, David; Prost, Audrey

    2012-01-01

    Perinatal conditions make the largest contribution to the burden of disease in low-income countries. Although postneonatal mortality rates have declined, stillbirth and early neonatal mortality rates remain high in many countries in Africa and Asia, and there is a concentration of mortality around the time of birth. Our article begins by considering differences in the interpretation of ‘intervention’ to improve perinatal survival. We identify three types of intervention: a single action, a collection of actions delivered in a package and a broader social or system approach. We use this classification to summarise the findings of recent systematic reviews and meta-analyses. After describing the growing evidence base for the effectiveness of community-based perinatal care, we discuss current concerns about integration: of women’s and children’s health programmes, of community-based and institutional care, and of formal and informal sector human resources. We end with some thoughts on the complexity of choices confronting women and their families in low-income countries, particularly in view of the growth in non-government and private sector healthcare. PMID:20980274

  14. Human anogenital distance: an update on fetal smoke-exposure and integration of the perinatal literature on sex differences

    PubMed Central

    Fowler, Paul A.; Filis, Panagiotis; Bhattacharya, Siladitya; le Bizec, Bruno; Antignac, Jean-Philippe; Morvan, Marie-Line; Drake, Amanda J.; Soffientini, Ugo; O'Shaughnessy, Peter J.

    2016-01-01

    STUDY QUESTION Do sex and maternal smoking effects on human fetal anogenital distance (AGD) persist in a larger study and how do these data integrate with the wider literature on perinatal human AGD, especially with respect to sex differences? SUMMARY ANSWER Second trimester sex differences in AGD are broadly consistent with neonatal and infant measures of AGD and maternal cigarette smoking is associated with a temporary increase in male AGD in the absence of changes in circulating testosterone. WHAT IS KNOWN ALREADY AGD is a biomarker of fetal androgen exposure, a reduced AGD in males being associated with cryptorchidism, hypospadias and reduced penile length. Normative fetal AGD data remain partial and windows of sensitivity of human fetal AGD to disruption are not known. STUDY DESIGN, SIZE, DURATION The effects of fetal sex and maternal cigarette smoking on the second trimester (11–21 weeks of gestation) human fetal AGD were studied, along with measurement of testosterone and testicular transcripts associated with apoptosis and proliferation. PARTICIPANTS/MATERIALS, SETTING METHODS AGD, measured from the centre of the anus to the posterior/caudal root of penis/clitoris (AGDapp) was determined in 56 female and 70 male morphologically normal fetuses. These data were integrated with current literature on perinatal AGD in humans. MAIN RESULTS AND THE ROLE OF CHANCE At 11–13 weeks of gestation male fetal AGDapp was 61% (P< 0.001) longer than in females, increasing to 70% at 17–21 weeks. This sexual dimorphism was independent of growth characteristics (fetal weight, length, gonad weight). We confirmed that at 14–16 weeks of gestation male fetal AGDapp was increased 28% (P < 0.05) by in utero cigarette smoke exposure. Testosterone levels were not affected by smoking. To develop normative data, our findings have been integrated with available data from in vivo ultrasound scans and neonatal studies. Inter-study variations in male/female AGD differences lead to the conclusion that normalization and standardization approaches should be developed to enable confidence in comparing data from different perinatal AGD studies. LIMITATIONS, REASONS FOR CAUTION Sex differences, and a smoking-dependent increase in male fetal AGD at 14–16 weeks, identified in a preliminary study, were confirmed with a larger number of fetuses. However, human fetal AGD should, be re-assessed once much larger numbers of fetuses have been studied and this should be integrated with more detailed analysis of maternal lifestyle. Direct study of human fetal genital tissues is required for further mechanistic insights. WIDER IMPLICATIONS OF THE FINDINGS Fetal exposure to cigarette smoke chemicals is known to lead to reduced fertility in men and women. Integration of our data into the perinatal human AGD literature shows that more work needs to be done to enable reliable inter-study comparisons. STUDY FUNDING/COMPETING INTEREST(S) The study was supported by grants from the Chief Scientist Office (Scottish Executive, CZG/1/109 & CZG/4/742), NHS Grampian Endowments (08/02), the European Community's Seventh Framework Programme (FP7/2007-2013) under grant agreement no 212885 and the Medical Research Council, UK (MR/L010011/1). The authors declare they have no competing interests, be it financial, personal or professional. PMID:26732622

  15. Impact of perinatal different intrauterine environments on child growth and development in the first six months of life - IVAPSA birth cohort: rationale, design, and methods

    PubMed Central

    2012-01-01

    Background In the last twenty years, retrospective studies have shown that perinatal events may impact the individual health in the medium and long term. However, only a few prospective studies were designed to address this phenomenon. This study aims to describe the design and methods of the Impact of Perinatal Environmental Variations in the First Six Months of Life - the IVAPSA Birth Cohort. Method/Design This is a clinical study and involves the recruitment of a birth cohort from hospitals in Porto Alegre, Rio Grande do Sul, Brazil. Mothers from different clinical backgrounds (hypertensive, diabetics, smokers, having an intrauterine growth restricted child for idiopathic reasons, and controls) will be invited to join the study twenty-four hours after the birth of their child. Data on economic, social, and maternal health care, feeding practices, anthropometric measures, physical activity, and neuropsychological evaluation will be obtained in interviews at postpartum, 7 and