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Maternal superobesity and perinatal outcomes  

PubMed Central

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.

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



Fetal and perinatal consequences of maternal obesity  

Microsoft Academic Search

In many industrialised countries, one in five women booking for antenatal care is obese. As well as affecting maternal health, maternal obesity may have important adverse consequences for fetal, neonatal and long-term health and well-being. Maternal obesity is associated with a higher risk of stillbirth, elective preterm birth and perinatal mortality. The incidence of severe birth defects, particularly neural tube

Chakrapani Vasudevan; Mary Renfrew; William McGuire



Fetal and perinatal consequences of maternal obesity.  


In many industrialised countries, one in five women booking for antenatal care is obese. As well as affecting maternal health, maternal obesity may have important adverse consequences for fetal, neonatal and long-term health and well-being. Maternal obesity is associated with a higher risk of stillbirth, elective preterm birth and perinatal mortality. The incidence of severe birth defects, particularly neural tube and structural cardiac defects, appears to be higher in infants of obese mothers. Fetal macrosomia associated with maternal obesity and gestational diabetes predisposes infants to birth injuries, perinatal asphyxia and transitional problems such as neonatal respiratory distress and metabolic instability. Maternal obesity may also result in long-term health problems for offspring secondary to perinatal problems and to intrauterine and postnatal programming effects. Currently, the available interventions to prevent and treat maternal obesity are of limited proven utility and further research is needed to define the effects of maternal weight management interventions on fetal and neonatal outcomes. PMID:20530101

Vasudevan, Chakrapani; Renfrew, Mary; McGuire, William



Perinatal and maternal outcomes of fetal macrosomia  

Microsoft Academic Search

Objective: To determine the perinatal and maternal outcome of the macrosomic infants. Study Design: A case-control, retrospective study is performed in the Department of Gynecology and Obstetrics, Istanbul University Cerrahpasa Medical Faculty, between 1988–1992. The maternal and neonatal records of infants with birthweight of at least 4000g (n=1000) were reviewed. Another 1000 cases amongst the newborns delivered in the same

Engin Oral; Arzu Ca?da?; Altay Gezer; Semih Kaleli; Kiliç Aydinli; Fahri Öçer



Behavioural outcomes of perinatal maternal fluoxetine treatment.  


During and following pregnancy, women are at considerable risk of experiencing depression. For treatment, selective serotonin reuptake inhibitor drugs, such as fluoxetine, are commonly prescribed, yet the potential effects of perinatal exposure to these drugs on the brain and behaviour have not been examined in humans beyond childhood. This is despite abundant evidence from studies using rodents indicating that altered serotonin levels early in life affect neurodevelopment and behavioural outcomes. These reported effects on behaviour are inconsistent, however, and the testing of females has often been overlooked. In the present study, the behavioural outcomes of female mice perinatally (embryonic day 15 to postnatal day 12) treated with fluoxetine (25mg/kg/day) via a non-stressful method of maternal administration were assessed using a battery of tests. Maternal treatment resulted in subtle alterations in anxiety-like and depression-like behaviour in early adulthood, with a decrease in both types of behaviour as well as body weight. Though altered anxiety and depression have previously been reported in this area of research, decreased anxiety is a novel finding. While there was little effect of perinatal maternal fluoxetine treatment on many of the behaviours assessed, the capacity to alter "emotional" behaviours in mice has implications with regard to research on human infant fluoxetine exposure. PMID:23000627

McAllister, B B; Kiryanova, V; Dyck, R H



Maternal and perinatal complications in triplet compared with twin pregnancy  

Microsoft Academic Search

Objective: To compare maternal and perinatal complications in triplet and twin pregnancies. Study design: Case-controlled study in the setting of a University Hospital. Each pregnancy of a consecutive series of 40 triplet pregnancies of 20 weeks or more was matched for parity and maternal age with two sets of twins delivered in the same year. Primary end points of the

Job G. Santema; Petra Bourdrez; Henk C. S. Wallenburg



Cord Blood Banking and Transplantation – Fetal, Maternal and Perinatal Issues  

Microsoft Academic Search

Summary Background: Umbilical cord blood is increasingly used as a source of hematopoietic stem cells for transplantation. While hematopoietic and immunologic properties of cord blood have been studied extensively, fetal, maternal and perinatal issues are yet to be explored. Material and Methods:We reviewed the currently available literature and our own studies concerning fetal and maternal issues in cord blood transplantation,

W. Holzgreve; D. V. Surbek



A thematic analysis of factors influencing recruitment to maternal and perinatal trials  

PubMed Central

Background Recruitment of eligible participants remains one of the biggest challenges to successful completion of randomised controlled trials (RCTs). Only one third of trials recruit on time, often requiring a lengthy extension to the recruitment period. We identified factors influencing recruitment success and potentially effective recruitment strategies. Methods We searched MEDLINE and EMBASE from 1966 to December Week 2, 2006, the Cochrane Library Methodology Register in December 2006, and hand searched reference lists for studies of any design which focused on recruitment to maternal/perinatal trials, or if no studies of maternal or perinatal research could be identified, other areas of healthcare. Studies of nurses' and midwives' attitudes to research were included as none specifically about trials were located. We synthesised the data narratively, using a basic thematic analysis, with themes derived from the literature and after discussion between the authors. Results Around half of the included papers (29/53) were specific to maternal and perinatal healthcare. Only one study was identified which focused on factors for maternal and perinatal clinicians and only seven studies considered recruitment strategies specific to perinatal research. Themes included: participant assessment of risk; recruitment process; participant understanding of research; patient characteristics; clinician attitudes to research and trials; protocol issues; and institutional or organisational issues. While no reliable evidence base for strategies to enhance recruitment was identified in any of the review studies, four maternal/perinatal primary studies suggest that specialised recruitment staff, mass mailings, physician referrals and strategies targeting minority women may increase recruitment. However these findings may only be applicable to the particular trials and settings studied. Conclusion Although factors reported by both participants and clinicians which influence recruitment were quite consistent across the included studies, studies comparing different recruitment strategies were largely missing. Trials of different recruitment strategies could be embedded in large multicentre RCTs, with strategies tailored to the factors specific to the trial and institution.

Tooher, Rebecca L; Middleton, Philippa F; Crowther, Caroline A



Debriefing to help perinatal nurses cope with a maternal loss.  


The death of a mother in a perinatal unit is a devastating event for the family and for the perinatal staff. An unexpected maternal death may be considered a critical incident, requiring leadership to reflect on the emotional well-being of all the staff who were involved in the patient's care. In order to assist staff in coping with the impact of a maternal loss, the organization and leadership team can apply the principles of debriefing, during which an expert in crisis intervention works to help the group recognize both healthy and unhealthy coping skills, and follows up with affected individuals who require ongoing help. This article presents a review of different techniques of debriefing, applies debriefing to maternal loss, and provides a review of coping skills for nurses. The leadership team's support is essential to promoting healthy coping and emotional healing when a tragedy occurs on the perinatal unit. PMID:19587569

Dietz, Deborah


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

PubMed Central

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.

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



Maternal and perinatal mortality and morbidity associated with transverse lie  

Microsoft Academic Search

Objective: The aim of this study of transverse lie in labor of patients admitted to Korle Bu Hospital between 1 January 1996 and 30 June 1998, was to identify the methods of delivery, the perinatal and maternal morbidities and mortalities, and to provide recommendations to improve the outcome. Methods: This was a retrospective study of 152 patients who presented at

J. D Seffah



Perinatal and maternal mortality associated with retained second twins  

Microsoft Academic Search

Objectives: The aim of this study of retained second twins admitted to Korle-Bu Hospital between 1988 and 1993 was to identify the factors contributing to the mode of delivery, perinatal and maternal mortalities, and draw up recommendations to improve outcome. Methods: The study consisted of a review of record cards, outpatient admission and discharge books, delivery books, and inpatient case

A. T. Lassey; T. S. Ghosh



Perinatal complications associated with maternal tobacco use.  


The use of tobacco products by pregnant women is associated with placenta previa, abruptio placentae, premature rupture of the membranes, preterm birth, intrauterine growth restriction and sudden infant death syndrome. Approximately 15-20% of women smoke during pregnancy. It has been suggested that smoking is responsible for 15% of all preterm births, 20-30% of all infants of low birthweight, and a 150% increase in overall perinatal mortality. Cigarette smoking is one of the most important and modifiable risk factors associated with adverse perinatal outcomes. PMID:10956448

Andres, R L; Day, M C



Maternal anaemia and its impact on perinatal outcome in a tertiary care hospital in Pakistan  

Microsoft Academic Search

Maternal anaemia is a common problem in pregnancy, particularly in developing countries. We investigated the relationship between maternal anaemia and perinatal outcome in a cohort of 629 pregnant women from October 2001 to 2002. Of these, 313 were anaemic (haemoglobin < 11 g\\/L). Perinatal outcomes included preterm delivery, low birth weight, intrauterine growth retardation, perinatal death, low Apgar scores and

F. W. Lone; R. N. Qureshi; F. Emmanuel


Maternal and perinatal brain aromatase: effects of dietary soy phytoestrogens.  


Phytoestrogens are extensively investigated for their potential to prevent many hormone-dependent cancers and age-related diseases, however little is known about their effects in brain. Brain aromatase and plasma phytoestrogen levels were determined in Sprague-Dawley rats fed a phytoestrogen-rich diet during pregnancy/lactation. Ingested phytoestrogens cross the placenta and become concentrated in maternal milk as evident from high infantile plasma concentrations. Dietary phytoestrogens, however, do not alter brain aromatase during pregnancy/lactation or perinatal development. PMID:11248356

Weber, K S; Setchell, K D; Lephart, E D



Maternal omega-3 fatty acid supplementation and risk for perinatal maternal depression  

PubMed Central

Objective A systematic review was conducted to assess the possible association between omega-3 polyunsaturated fatty acid (PUFA) supplementation and intake in the perinatal period and the risk of maternal perinatal depression. Methods Two PubMed searches and a BIOSIS Preview, a Web of Science and a PsychInfo search were conducted with the search terms ‘DHA, pregnancy and depression’ and ‘omega-3 fatty acids, pregnancy and depression’. Results Ten articles – three longitudinal cohort studies, five randomized controlled trials and two pilot trials– that met selection criteria were reviewed. Six found no association, two found mixed results, and two found a positive association between omega-3 PUFAs and reduced incidence of maternal perinatal depression. The heterogeneity of results can be explained by dissimilar study designs, including differences in study duration, time period of measurement and number of participants, and in varied dosages and types of supplemental PUFAs. Some of the larger studies and those that found a positive effect were more likely to be using higher doses, close to 2 g of docosahexaeonic acid (DHA) + eicosapentaenoic acid (EPA), and began the supplementation earlier in pregnancy. Conclusions Future RCTs to investigate the role of PUFA supplementation and risk for maternal perinatal depression should begin supplementation early in pregnancy and use a dosage closer to 2 g of DHA + EPA. Depression should also be measured using a diagnostic interview schedule in addition to a screener.

Wojcicki, Janet M.; Heyman, Melvin B.



Maternal perinatal diet induces developmental programming of bone architecture.  


Maternal high-fat (HF) diet can alter offspring metabolism via perinatal developmental programming. This study tests the hypothesis that maternal HF diet also induces perinatal programming of offspring bone mass and strength. We compared skeletal acquisition in pups from C57Bl/6J mice fed HF or normal diet from preconception through lactation. Three-week-old male and female pups from HF (HF-N) and normal mothers (N-N) were weaned onto normal diet. Outcomes at 14 and 26 weeks of age included body mass, body composition, whole-body bone mineral content (WBBMC) via peripheral dual-energy X-ray absorptiometry, femoral cortical and trabecular architecture via microcomputed tomography, and glucose tolerance. Female HF-N had normal body mass and glucose tolerance, with lower body fat (%) but higher serum leptin at 14 weeks vs. N-N (P<0.05 for both). WBBMC was 12% lower at 14 weeks and 5% lower at 26 weeks, but trabecular bone volume fraction was 20% higher at 14 weeks in female HF-N vs. N-N (P<0.05 for all). Male HF-N had normal body mass and mildly impaired glucose tolerance, with lower body fat (%) at 14 weeks and lower serum leptin at 26 weeks vs. N-N (P<0.05 for both). Serum insulin was higher at 14 weeks and lower at 26 weeks in HF-N vs. N-N (P<0.05). Trabecular BV/TV was 34% higher and cortical bone area was 6% higher at 14 weeks vs. N-N (P<0.05 for both). These data suggest that maternal HF diet has complex effects on offspring bone, supporting the hypothesis that maternal diet alters postnatal skeletal homeostasis. PMID:23503967

Devlin, M J; Grasemann, C; Cloutier, A M; Louis, L; Alm, C; Palmert, M R; Bouxsein, M L



The effect of the increasing prevalence of maternal obesity on perinatal morbidity  

Microsoft Academic Search

Objective: In this study, we assessed the temporal trends and relative and attributable perinatal risks of maternal obesity over a 20-year period. Study Design: We conducted a retrospective cohort study between 1980 and 1999 by using a computerized perinatal database of all women who received prenatal care and delivered their infants within a regional health care system. The main outcome

George C. Lu; Dwight J. Rouse; Mary DuBard; Suzanne Cliver; Debora Kimberlin; John C. Hauth



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 ...


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 ...


Maternal and perinatal risk factors for childhood leukemia  

SciTech Connect

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.

Zack, M.; Adami, H.O.; Ericson, A. (Centers for Disease Control, Atlanta, GA (USA))



A study of the biosocial factors affecting perinatal mortality in an Egyptian maternity hospital.  


This article reports on a retrospective study of perinatal deaths in an Egyptian maternity hospital during a 21 month period from March 1977 to November 1978. 6990 babies were delivered in the hospital during the study period. A special precoded maternity record was filled in for each mother. It included detailed information on the social and medical aspects of the mother and the delivery. Another form was filled in for all the perinatal deaths and included a detailed description of possible causes of death together with results of post-mortem examinations when available. The perinatal mortality rates reported in this study are quite high, particularly among patients who start labor at home and come the the hospital when labor is prolonged or complicated. Moreover, 62% of these patients were non-literate and 71.2% had received no antenatal care. Among the various biosocial factors studied, maternal age and education are found to have the most impact on the prevalence of perinatal deaths. Incidence of perinatal mortality was nearly doubled in the cases referred by the Dayas (traditional birth attendants) when compared with booked cases; and 1 1/2 times that of cases referred by a physician. The availability of antenatal care and the hemoglobin % were found to affect perinatal mortality. A higher rate of perinatal mortality was found in women with previous still births, 2 or more spontaneous abortions, a perterm delivery or more than 3 deliveries. The study confirms the findings of other researchers that duration of pregnancy is an important factor in deciding perinatal outcome. Higher mortality rates occurred in preterm and post-term deliveries. In addition, duration of labor and type of delivery together with the time of rupture of membranes are found to affect perinatal outcomes. PMID:12339486

Younis, M N; Bahy, M; Serour, G I; Daghistany, H F; Hefnawi, F; Ahmed, A K



Maternal perinatal depression in the neonatal intensive care unit: the role of the neonatal nurse.  


The onset of depressive symptoms during pregnancy or the first year postpartum, termed perinatal depression, occurs in approximately 15 percent of women. Perinatal depression can have a significant negative impact on health outcomes for the mother and her infant including maternal emotional distress and parenting difficulties and infant behavioral and developmental problems. Nurses caring for patients in the neonatal intensive care unit (NICU) are in a key position to affect positive change in the lives of families affected by perinatal depression. An overview of antepartum and postpartum depression is provided that has been tailored to the educational needs of the neonatal nurse. A discussion of the role of neonatal nurses in the identification and treatment of perinatal depression follows in order that neonatal nurses may improve both short- and long-term outcomes for mothers, infants, and families in the NICU affected by perinatal depression. PMID:22908050

Bicking, Cara; Moore, Ginger A


Agreement between maternal report and antenatal records for a range of pre and peri-natal factors: The influence of maternal and child characteristics  

Microsoft Academic Search

Background: Events during pregnancy and labour may influence the future health and well-being of offspring. Many studies rely on maternal reports of pre and peri-natal factors. Both maternal and child characteristics may potentially influence the reliability and accuracy of maternal recall. However, this has not been previously examined. Aims: To examine agreement between information from maternally reported questionnaires and medical

Frances Rice; Allyson Lewis; Gordon Harold; Marianne van den Bree; Jacky Boivin; Dale F. Hay; Michael J. Owen; Anita Thapar



Perinatal complications and schizophrenia. Data from the Maternal and Child Health Handbook in Japan.  


A number of studies have shown that schizophrenics have increased obstetric complications compared with controls, but conflicting negative results have also been reported. Similarly, some studies found that obstetric complications were more frequently observed among male or nonfamilial schizophrenics than their female or familial schizophrenic counterparts, but others reported negative or inverse results. Since 1948 in Japan, every pregnant woman has been assigned a Maternal and Child Health Handbook in which obstetricians have been obliged to fill in obstetric data. In the current study, perinatal complications assessed using the scale of Parnas et al. (1982), based on information from the maternal and child health handbook were compared between DSM-III-R-diagnosed schizophrenics (N = 59), their healthy siblings (N = 31), and controls (N = 108). We found that female schizophrenics had experienced significantly more perinatal complications than siblings and controls. We could not detect any significant association between perinatal complications and family history. PMID:8831644

Kunugi, H; Nanko, S; Takei, N; Saito, K; Murray, R M; Hirose, T



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

Microsoft Academic Search

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

Elenice B Consonni; Iracema MP Calderon; Marcos Consonni; Marta HS De Conti; Tânia TS Prevedel; Marilza VC Rudge



Maternal and perinatal outcomes of dengue in PortSudan, Eastern Sudan  

PubMed Central

Aim To investigate maternal and perinatal outcomes (maternal death, preterm delivery, low birth weight and perinatal mortality) of dengue at PortSudan and Elmawani hospitals in the eastern Sudan. Method This was a retrospective Cohort study where medical files of women with dengue were reviewed. Results There were 10820 deliveries and 78 (0.7%) pregnant women with confirmed dengue IgM serology at the mean (SD) gestational age of 29.4(8.2) weeks. While the majority of these women had dengue fever (46, 58.9%), hemorrhagic fever and dengue shock syndrome were the presentations in 18 (23.0%) and 12, (15.3%) of these women, respectively. There were 17(21.7%) maternal deaths. Fourteen (17.9%) of these 78 women had preterm deliveries and 19 (24.3%) neonates were admitted to neonatal intensive care unit. Nineteen (24.3%) women gave birth to low birth weight babies. There were seven (8.9%) perinatal deaths. Eight (10.2%) patients delivered by caesarean section due to various obstetrical indications. Conclusion Thus dengue has poor maternal and perinatal outcomes in this setting. Preventive measures against dengue should be employed in the region, and more research on dengue during pregnancy is needed.



The effects of a childbirth psychoeducation program on learned resourcefulness, maternal role competence and perinatal depression: A quasi-experiment  

Microsoft Academic Search

BackgroundLearned resourcefulness plays a significant role in facilitating maternal coping during the transition to motherhood. Given the growing evidence of perinatal depression and the frequent feeling of incompetence in the maternal role, the implementation of an effective intervention to promote maternal role competence and emotional well-being is essential.

Fei-Wan Ngai; Sally Wai-Chi Chan; Wan-Yim Ip



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

Microsoft Academic Search

BackgroundBayingnormen is a region located in western Inner Mongolia China, with a population that is exposed to a wide range of drinking water arsenic concentrations. The relationship between maternal drinking water arsenic exposure and perinatal endpoints (term birth weight, preterm birth, stillbirth and neonatal death) in this region was evaluated in this study.MethodsAn analysis was conducted of all singleton deliveries

S L Myers; D T Lobdell; Z Liu; Y Xia; H Ren; Y Li; R K Kwok; J L Mumford; P Mendola



Are maternal and fetal parameters related to perinatal mortality in HELLP syndrome?  

Microsoft Academic Search

Purpose  We designed this retrospective study to evaluate the association between maternal and fetal parameters and perinatal mortality\\u000a in hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  In this retrospective study, 152 pregnancies complicated with HELLP syndrome were evaluated. Risk factors recorded were maternal\\u000a age, gravidity, gestational age (weeks), systolic and diastolic blood pressure, platelet count, alanine aminotransferase (ALT),

Ali Irfan Guzel; Umur Kuyumcuoglu; Yusuf Celik



Multifetal Gestation – Maternal and Perinatal Outcome of 112 Pregnancies  

Microsoft Academic Search

Purpose: Multifetal pregnancy reduction is a widespread ‘therapy’ to diminish the risk of prematurity and adverse outcome for the survivors in higher order multiple gestation. The aim of our study was to determine the maternal and neonatal outcome of multifetal pregnancies under a conservative pregnancy management. Study Design: A retrospective review of 112 multifetal pregnancies is presented. All higher order

Alexander Strauss; Bettina W. Paek; Orsolya Genzel-Boroviczény; Andreas Schulze; Udo Janssen; Hermann Hepp



Association of maternal, antenatal and perinatal complications with suicide in adolescence and young adulthood.  


The aim of the present study was to investigate whether maternal, antenatal and perinatal complications are associated with adolescent or young adulthood suicide in offspring. Cases consisted of individuals, aged 15-22 years, born in New York City and committing suicide in New York City between 1985 and 1991 (n = 189). Two controls were selected for each case, constituting the hospital birth immediately preceding and following that of the case, matched with the case with regard to sex and ethnicity. Cases were compared with controls using an index that summed a range of maternal, antenatal and perinatal complications and also with regard to the frequency of individual complications. In the total sample, cases and controls did not differ either in the mean number of all complications combined or in the proportions with specific complications. This lack of association between complications and outcome also obtained in separate analyses by sex, ethnicity, socio-economic status and age at suicide. These results fail to replicate the findings of two previous reports implicating maternal, antenatal and perinatal complications in risk of youth suicide. At present, epidemiological evidence that adverse reproductive events increase the risk for suicide in offspring remains inconclusive. PMID:9669512

Neugebauer, R; Reuss, M L



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


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

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



Maternal and perinatal factors associated with hospitalised infectious mononucleosis in children, adolescents and young adults: record linkage study  

Microsoft Academic Search

Background  There is current interest in the role of perinatal factors in the aetiology of diseases that occur later in life. Infectious\\u000a mononucleosis (IM) can follow late primary infection with Epstein-Barr virus (EBV), and has been shown to increase the risk\\u000a of multiple sclerosis and Hodgkin's disease. Little is known about maternal or perinatal factors associated with IM or its\\u000a sequelae.

Imran Mahmud; Omar A Abdel-Mannan; Clare J Wotton; Michael J Goldacre



Maternal Morbidity and Perinatal Outcomes Among Foreign-Born Cambodian, Laotian, and Vietnamese Americans in Washington State, 1993–2006  

Microsoft Academic Search

This study examined differences in perinatal outcomes of Southeast Asian (SEA) women compared with non-Hispanic white women\\u000a in Washington. Using linked birth certificate and hospitalization discharge records for the years 1993–2006, we compared singleton\\u000a births of Cambodian (3,858), Laotian (2,223), and Vietnamese (12,949) women with a random sample of white women (35,581).\\u000a Associations between maternal nativity and perinatal outcomes were

Swee May Cripe; William O’Brien; Bizu Gelaye; Michelle A. Williams



Determination of maternal body composition in pregnancy and its relevance to perinatal outcomes.  


Three models and 10 specific methods for determining maternal body composition are discussed and their perinatal relevance reviewed. English language publications (1950 to January 2004) were searched electronically and by hand. Search terms included "body composition," "human," " pregnancy," "obesity," "adiposity," "regional," "2-, 3-, 4-component," "truncal," "peripheral," "central," "visceral" along with specific techniques and outcomes listed subsequently. Three models of body composition are described: 2-component being fat and fat-free mass; 3-component being fat, water, and protein; and 4-component being fat, water, protein, and osseous mineral. Ten techniques of body composition assessment are described: 1) anthropometric techniques including skinfold thicknesses and waist-hip ratio; 2) total body water (isotopically labeled); 3) hydrodensitometry (underwater weighing); 4) air-displacement plethysmography; 5) bio-impedance analysis (BIA); 6) total body potassium (TBK); 7) dual-energy x-ray absorptiometry (DEXA); 8) computed tomography (CT); 9) magnetic resonance imaging (MRI); and 10) ultrasound (USS). Most methods estimate total adiposity. Regional fat distribution-central (truncal) compared with peripheral (limb) or visceral compared with subcutaneous-is important because of regional variation in adipocyte metabolism. Skinfolds, DEXA, CT, MRI, or USS can distinguish central from peripheral fat. CT, MRI, or USS can further subdivide central fat into visceral and subcutaneous. Perinatal outcomes examined in relation to body composition include pregnancy duration, birth weight, congenital anomalies, gestational diabetes, gestational hypertension, and the fetal origins of adult disease. A few studies suggest that central compared with peripheral fat correlates better with birth weight, gestational carbohydrate intolerance, and hypertension. Means of accurately assessing maternal body composition remain cumbersome and impractical, but may more accurately predict perinatal outcomes than traditional assessments such as maternal weight. PMID:15385859

McCarthy, Elizabeth A; Strauss, Boyd J G; Walker, Susan P; Permezel, Michael



Effect of pregestational maternal, obstetric and perinatal factors on neonatal outcome in extreme prematurity  

Microsoft Academic Search

Purpose  To investigate the effect of pregestational maternal, obstetric and perinatal factors on neonatal outcome in extreme preterm\\u000a deliveries.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Retrospective study of deliveries in a Norwegian tertiary teaching hospital. All women with live births at 24+0– 27+6 weeks of gestation between 2004 and 2007 were included. Major morbidity is defined as intraventricular haemorrhage grade\\u000a 3–4, periventricular leukomalacia, bronchopulmonary dysplasia or necrotizing

Yun Wang; Tom Tanbo; Liv Ellingsen; Thomas Åbyholm; Tore Henriksen


Perinatal hepatitis B virus infection caused by antihepatitis Be positive maternal mononuclear cells.  

PubMed Central

To investigate the infectivity of hepatitis B virus (HBV) from mothers to their newborn offspring, HBV-DNA in plasma and peripheral mononuclear cells from 28 antihepatitis Be positive, hepatitis B surface antigen positive carrier mothers was examined by a highly sensitive polymerase chain reaction/Southern hybridisation technique. HBV specific DNA was detected in three maternal mononuclear cell samples, but was absent in plasma. Two of four infants born to the three mothers with HBV-DNA positive mononuclear cells developed acute or fulminant hepatitis within three months after birth. Two infants were effectively prevented from infection with HBV by combined hepatitis B immunoglobulin/HBV vaccine administration. The 25 infants born to the HBV-DNA negative mothers were free of HBV infection within the next seven months to 3.5 years. These results suggest that latent infection with HBV in maternal mononuclear cells is responsible for perinatal HBV infection. Images Figure 1 Figure 2

Shimizu, H; Mitsuda, T; Fujita, S; Yokota, S



Maternal Ethnic Ancestry and Adverse Perinatal Outcomes in New York City  

PubMed Central

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.

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



Undetectable maternal serum unconjugated estriol levels in the second trimester: Risk of perinatal complications associated with placental sulfatase deficiency  

Microsoft Academic Search

OBJECTIVE: Our purpose was to determine the prevalence of undetectably low second-trimester maternal serum unconjugated estriol levels and the association with increased perinatal morbidity or mortality in pregnancies at risk for placental sulfatase deficiency.STUDY DESIGN: Nine centers in New England identified singleton pregnancies with undetectably low unconjugated estriol levels. Each unexplained case was matched with four controls; pregnancy outcome information

Linda A. Bradley; Jacob A. Canick; Glenn E. Palomaki; James E. Haddow



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

PubMed Central

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-?1 (TGF-?1), 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-?1 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.

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



Perinatal mortality and quality of care at the National Institute of Perinatology: A 3-year analysis  

Microsoft Academic Search

Quality of medical care has been indirectly assessed through the collection of negative outcomes. A preventable death is one that could have been avoided if optimum care had been offered. The general objective of the present project was to analyze the perinatal mortality at the National Institute of Perinatology (located in Mexico City) by social, biological and some available components

Ana Maria Salinas



Maternal Conditions and Perinatal Characteristics Associated with Autism Spectrum Disorder and Intellectual Disability  

PubMed Central

Background As well as being highly comorbid conditions, autism spectrum disorders (ASD) and intellectual disability (ID) share a number of clinically-relevant phenomena. This raises questions about similarities and overlap in diagnosis and aetiological pathways that may exist for both conditions. Aims To examine maternal conditions and perinatal factors for children diagnosed with an ASD, with or without ID, and children with ID of unknown cause, compared with unaffected children. Methods The study population comprised all live singleton births in Western Australia (WA) between January 1984 and December 1999 (N?=?383,153). Univariate and multivariate multinomial logistic regression models were applied using a blocked modelling approach to assess the effect of maternal conditions, sociodemographic factors, labour and delivery characteristics and neonatal outcomes. Results In univariate analyses mild-moderate ID was associated with pregnancy hypertension, asthma, urinary tract infection, some types of ante-partum haemorrhage, any type of preterm birth, elective C-sections, breech presentation, poor fetal growth and need for resuscitation at birth, with all factors showing an increased risk. Severe ID was positively associated with poor fetal growth and need for resuscitation, as well as any labour or delivery complication. In the multivariate analysis no maternal conditions or perinatal factors were associated with an increased risk of ASD without ID. However, pregnancy hypertension and small head circumference were associated with a reduced risk (OR?=?0.64, 95% CI: 0.43, 0.94; OR?=?0.58, 95% CI: 0.34, 0.96, respectively). For ASD with ID, threatened abortion before 20 weeks gestation and poor fetal growth were associated with an increased risk. Conclusion Findings show that indicators of a poor intrauterine environment are associated with an elevated risk of ID, while for ASD, and particularly ASD without ID, the associations are much weaker. As such, these findings highlight the importance of accounting for the absence or presence of ID when examining ASD, if we are to improve our understanding of the causal pathways associated with these conditions.

Langridge, Amanda T.; Glasson, Emma J.; Nassar, Natasha; Jacoby, Peter; Pennell, Craig; Hagan, Ronald; Bourke, Jenny; Leonard, Helen; Stanley, Fiona J.



Effect of a collaborative interdisciplinary maternity care program on perinatal outcomes  

PubMed Central

Background: The number of physicians providing maternity care in Canada is decreasing, and the rate of cesarean delivery is increasing. We evaluated the effect on perinatal outcomes of an interdisciplinary program designed to promote physiologic birth and encourage active involvement of women and their families in maternity care. Methods: We conducted a retrospective cohort study involving 1238 women who attended the South Community Birth Program in Vancouver, Canada, from April 2004 to October 2010. The program offers comprehensive, collaborative, interdisciplinary care from family physicians, midwives, community health nurses and doulas to a multiethnic, low-income population. A comparison group, matched for neighbourhood of residence, maternal age, parity and gestational age at delivery, comprised 1238 women receiving standard care in community-based family physician, obstetrician and midwife practices. The primary outcome was the proportion of women who underwent cesarean delivery. Results: Compared with women receiving standard care, those in the birth program were more likely to be delivered by a midwife (41.9% v. 7.4%, p < 0.001) instead of an obstetrician (35.5% v. 69.6%, p < 0.001). The program participants were less likely than the matched controls to undergo cesarean delivery (relative risk [RR] 0.76, 95% confidence interval [CI] 0.68–0.84) and, among those with a previous cesarean delivery, more likely to plan a vaginal birth (RR 3.22, 95% CI 2.25–4.62). Length of stay in hospital was shorter in the program group for both the mothers (mean ± standard deviation 50.6 ± 47.1 v. 72.7 ± 66.7 h, p < 0.001) and the newborns (47.5 ± 92.6 v. 70.6 ± 126.7 h, p < 0.001). Women in the birth program were more likely than the matched controls to be breastfeeding exclusively at discharge (RR 2.10, 95% CI 1.85–2.39). Interpretation: Women attending a collaborative program of interdisciplinary maternity care were less likely to have a cesarean delivery, had shorter hospital stays on average and were more likely to breastfeed exclusively than women receiving standard care.

Harris, Susan J.; Janssen, Patricia A.; Saxell, Lee; Carty, Elaine A.; MacRae, George S.; Petersen, Karen L.



Use of video feedback intervention in an inpatient perinatal psychiatric setting to improve maternal parenting.  


This study utilizes video feedback to improve maternal parenting behavior in clinically depressed mothers admitted to a perinatal inpatient psychiatric unit. Depressed mothers (n = 74) were randomized to "video" (n = 25), "verbal" (n = 26), or "standard care" (n = 23). "Video" mothers were taped playing with their infant; interaction was reviewed with a mental health specialist. "Verbal" mothers only discussed interaction with their infant. "Standard care" mothers received only routine inpatient care. Mothers were assessed for mental health status, perceptions of baby behavior, and parenting competence. There was significant improvement in mental health status of all participants, regardless of intervention. Neither intervention had an advantage, compared to standard care, in improving parenting confidence or perceptions of infant behavior. Video mothers were more likely to report no change in their parenting confidence the more feedback sessions completed. The number of intervention sessions for each participant was limited by the duration of their inpatient admission. Most participants were on simultaneous pharmacotherapy and psychotherapy, as well as receiving intensive mothercraft assistance; this may have influenced intervention effectiveness. Results suggest that this type of intervention may be beneficial, but in the current format does not add sufficiently to standard care to be detected by the measures used. PMID:22588508

Bilszta, Justin L C; Buist, Anne E; Wang, Fandy; Zulkefli, Nur Rusydina



Goals in maternal and perinatal care in Latin America and the Caribbean.  


Ten goals have been developed to guide perinatal caregivers by the Latin American Centre for Perinatology (CLAP), a PAHO/WHO unit dedicated to improving perinatal care in Latin America and The Caribbean. The goals were inspired by the current troubled perinatal care situation, the need to make significant changes, principles of evidence-based medicine, and reviews of many sources from other regions or countries. PMID:16128976

Belizán, José M; Cafferata, María L; Belizán, María; Tomasso, Giselle; Chalmers, Beverley



'My Mother…My Sisters… and My Friends': Sources of maternal support in the perinatal period in urban India.  


OBJECTIVE: to explore the wide-ranging sources of support that the maternal-infant dyad need or expect throughout the perinatal period in urban India. DESIGN: qualitative interviews and ethnographic approach. SETTING: homes and community settings in greater metropolitan Bangalore, South India. PARTICIPANTS: using in-depth interviews of 36 mothers from different socio-cultural and socio-economic backgrounds who had given birth within the past two years in a tertiary hospital, we explored the nature of support, advice and emotional sustenance through pregnancy, childbirth and the early child rearing period available to these women. FINDINGS: the overwhelming importance of women's own mothers in practical and emotional terms, the connectedness to 'native' place or 'ooru', the role of the diverse, extensive female network and the more contingent role of the husband emerged as major themes. The family was a major source of support as well as distress. While the support from their own mother was a constant, women used various forms of support throughout the perinatal continuum. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: we call for a more nuanced understanding of what women in urban India expect and need in terms of support throughout the perinatal period. Clinicians and policy makers need to understand the various players, their different roles at critical times through the perinatal continuum and be able to identify those who are vulnerable and in need of enhanced support. Although the health sector is not a strong player in the socio-cultural milieu in the perinatal period, their role as facilitators of this support is crucial. PMID:23561829

Raman, Shanti; Srinivasan, K; Kurpad, Anura; Dwarkanath, Pratibha; Ritchie, Jan; Worth, Heather



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

ERIC Educational Resources Information Center

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…

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



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


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

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



Maternal age and number of children are risk factors for depressive disorders in non-perinatal women of reproductive age.  


Abstract Objective. It remains unclear whether or not the vulnerability of depression in women of reproductive age is related with pregnancy or perinatal period. The aim of the study was to determine the prevalence of depressive disorders and related factors in a large sample of non-perinatal women of reproductive age. Method. This study involved 589 women of reproductive age. At baseline, sociodemographic data and premenstrual assessment forms were completed, and screening tests for the assessment of the severity of depressive symptoms were administered to all of the participants. Participants who had over scale scores of the cut-off point in the screening instruments were assessed with module A of the Structured Clinical Interview for DSM Disorders (SCID-I) to determine DSM IV Axis I disorders. Results. The prevalence of depressive disorders was 32.8%. Depressive disorders had high rates in women who were married at younger ages and who had three or more children. Although the prevalence of depressive disorders was 32.8%, only 10.4% of the women had follow-up and treatment in a psychiatric outpatient clinic. Conclusion. Low education levels, early maternal age, and having more than three children and higher premenstrual symptom scores were risk factors for depressive disorders in non-perinatal reproductive age. PMID:23822181

Aras, Neriman; Oral, Elif; Aydin, Nazan; Gulec, Mustafa



A population-based surveillance study on severe acute maternal morbidity (near-miss) and adverse perinatal outcomes in Campinas, Brazil: The Vigimoma Project  

PubMed Central

Background Auditing of sentinel health events based on best-practice protocols has been recommended. This study describes a population-based investigation on adverse perinatal events including severe acute maternal morbidity (near-miss), maternal and perinatal mortality, as a health intervention to help improve the surveillance system. Methods From October to December 2005, all cases of maternal death (MD), near-miss (NM), fetal deaths (FD), and early neonatal deaths (END), occurring in Campinas, Brazil, were audited by maternal mortality committees. Results A total of 4,491 liveborn infants (LB) and 159 adverse perinatal events (35.4/1000 LB) were revised, consisting of 4 MD (89/100.000 LB) and 95 NM (21.1/1000 LB), 23.7 NM for each MD. In addition, 32 FD (7.1/1000 LB) and 28 END (6.2/1000 LB) occurred. The maternal death/near miss rate was 23.7:1. Some delay in care was recognized for 34%, and hypertensive complications comprised 57.8% of the NM events, followed by postpartum hemorrhage. Conclusion Auditing near miss cases expanded the understanding of the spectrum from maternal morbidity to mortality and the importance of promoting adhesion to clinical protocols among maternal mortality committee members. Hypertensive disorders and postpartum hemorrhage were identified as priority topics for health providers training, and organization of care.



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

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.



Anxiety-like behaviour in adult rats perinatally exposed to maternal calorie restriction  

Microsoft Academic Search

Environmental stimuli such as caloric availability during the perinatal period exert a profound influence on the development of an organism. Studies in this domain have focused on the effects of under- and malnutrition while the effects of more mild levels of restriction have not been delineated. Rat dams and their offspring were subjected to one of five dietary regimens: control,

Elizabeth A. Levay; Antonio G. Paolini; Antonina Govic; Agnes Hazi; Jim Penman; Stephen Kent



The retrospective measurement of prenatal and perinatal events: accuracy of maternal recall  

Microsoft Academic Search

Adverse obstetric events have been implicated as risk factors for schizophrenia. Many studies have relied on retrospective recall of these events, given typical adult onset of schizophrenia, when most studies ascertain their samples. The goal of this study was to assess the validity of an interview for the long-term recall of prenatal and perinatal events. Ninety-six women from the Providence

Stephen L. Buka; Jill M. Goldstein; Eleni Spartos; Ming T. Tsuang



Rethinking maternal-fetal conflict: gender and equality in perinatal ethics  

Microsoft Academic Search

Practitioners who care for pregnant women face dilemmas when their patients use illicit drugs, reject medical recommendations, or cause fetal harm. Many ethics scholars characterize those situations as maternal-fetal conflicts. In conflict-based models, maternal rights are considered to conflict with fetal rights, or moral obligations owed to pregnant women are considered to conflict with those owed to their fetuses. I

Lisa H Harris



Maternal and Perinatal Outcomes by Mode of Delivery in Senegal and Mali: A Cross-Sectional Epidemiological Survey  

PubMed Central

Objective In the context of rapid changes regarding practices related to delivery in Africa, we assessed maternal and perinatal adverse outcomes associated with the mode of delivery in 41 referral hospitals of Mali and Senegal. Study Design Cross-sectional survey nested in a randomised cluster trial (1/10/2007–1/10/2008). The associations between intended mode of delivery and (i) in-hospital maternal mortality, (ii) maternal morbidity (transfusion or hysterectomy), (iii) stillbirth or neonatal death before Day 1 and (iv) neonatal death between 24 hours after birth and hospital discharge were examined. We excluded women with immediate life threatening maternal or fetal complication to avoid indication bias. The analyses were performed using hierarchical logistic mixed models with random intercept and were adjusted for women's, newborn's and hospitals' characteristics. Results Among the 78,166 included women, 2.2% had a pre-labor cesarean section (CS) and 97.8% had a trial of labor. Among women with a trial of labor, 87.5% delivered vaginally and 12.5% had intrapartum CS. Pre-labor CS was associated with a marked reduction in the risk of stillbirth or neonatal death before Day 1 as compared with trial of labor (OR?=?0.2 [0.16–0.36]), though we did not show that maternal mortality (OR?=?0.3 [0.07–1.32]) and neonatal mortality after Day 1 (OR?=?1.3 (0.66–2.72]) differed significantly between groups. Among women with trial of labor, intrapartum CS and operative vaginal delivery were associated with higher risks of maternal mortality and morbidity, and neonatal mortality after Day 1, as compared with spontaneous vaginal delivery. Conclusions In referral hospitals of Mali and Senegal, pre-labor CS is a safe procedure although intrapartum CS and operative vaginal delivery are associated with increased risks in mothers and infants. Further research is needed to determine what aspects of obstetric care contribute to a delay in the provision of intrapartum interventions so that practices may be made safer when they are needed.

Briand, Valerie; Dumont, Alexandre; Abrahamowicz, Michal; Sow, Amadou; Traore, Mamadou; Rozenberg, Patrick; Watier, Laurence; Fournier, Pierre



The retrospective measurement of prenatal and perinatal events: accuracy of maternal recall.  


Adverse obstetric events have been implicated as risk factors for schizophrenia. Many studies have relied on retrospective recall of these events, given typical adult onset of schizophrenia, when most studies ascertain their samples. The goal of this study was to assess the validity of an interview for the long-term recall of prenatal and perinatal events. Ninety-six women from the Providence and Boston cohorts of the National Collaborative Perinatal Project were administered a brief structured telephone interview regarding their recall of pregnancy-related events that had occurred 22 years or more prior to interview. Women accurately reported major medical events such as cesarean section, breech delivery, and multiple birth (kappa=1) and demographic items, such as age at birth and parity. Medical interventions and major medical conditions such as placental (kappa=-0.01) and cord (kappa=-0.10) difficulties were not accurately reported. Estimated birthweight, low birthweight, and length of gestation were recalled with reasonable accuracy. Women who completed high school generally recalled events more accurately than those who did not. It is therefore important to attend to the sources of information, the mode of interviewing, the specific type of event, and sociodemographic characteristics of the informant to improve the accuracy of retrospective data on obstetric events, and to increase the validity of findings relating these to the onset of schizophrenia. PMID:15474913

Buka, Stephen L; Goldstein, Jill M; Spartos, Eleni; Tsuang, Ming T



Perinatal Maternal Food Restriction Induces Alterations in Hypothalamo-Pituitary-Adrenal Axis Activity and in Plasma Corticosterone-Binding Globulin Capacity of Weaning Rat Pups  

Microsoft Academic Search

We investigated the effects of perinatal maternal malnutrition on the hypothalamo-pituitary-adrenal (HPA) axis activity in both basal and stressful conditions in newborn rats at weaning. Mothers from the control group were fed ad libitum. Mothers exposed to food restriction received 50% (FR50) of the daily intake of pregnant dams during the last week of gestation (Pre group), lactation (Post group)

Marion Léonhardt; Jean Lesage; Laurence Dufourny; Anne Dickès-Coopman; Valérie Montel; Jean-Paul Dupouy



Maternal response to high-risk obstetric telemedicine consults when perinatal prognosis is poor.  


This is a qualitative descriptive study evaluating the maternal response after the woman has learned her pregnancy has a poor prognosis via telemedicine rather than in a traditional, face-to-face, consultation method. In general, telemedicine was positively viewed by the participants; however, the experience may be markedly improved by implementing several simple changes in the overall consultative process. PMID:23635010

Wyatt, Stephanie N; Rhoads, Sarah J; Green, Angela L; Ott, Rachel E; Sandlin, Adam T; Magann, Everett F



Brief report: acute viral hepatitis and poor maternal and perinatal outcomes in pregnant Sudanese women.  


Sixteen pregnant women presented at the three main hospitals in Khartoum province, Sudan during the period of March-September 2007 with features of acute viral hepatitis. Their mean (SD) gestational age was 28.0(6.7) weeks. The etiology of acute viral hepatitis was hepatitis B virus in five women (31.3%), hepatitis C virus in one woman (6.3%), hepatitis E virus in eight women (50%), and hepatitis non-A-to-E virus in two women (12.5%). There were four (25%) maternal deaths and three (18.7%) intrauterine fetal deaths. Three of these maternal deaths were due to hepatitis E virus and the fourth was due to hepatitis B virus. PMID:18712815

Ahmed, Rihab E; Karsany, Mubarak S; Adam, Ishag



The Adverse Impact of Maternal Obesity on Intrapartum and Perinatal Outcomes  

PubMed Central

Background. Confidential enquiries into maternal deaths in the UK have repeatedly highlighted increased maternal morbidity and mortality associated with maternal obesity. Objective. To determine the impact of increased body mass index (BMI) on intrapartum outcomes. Materials and Methods. A retrospective case-control analysis of intrapartum outcomes of the study group (100 women), with a BMI above 40?kg/m2 (class III Obesity) at booking and a control group (100 women) with a booking BMI between 20 and 25?kg/m2 was performed. Results. A statistically significant increase in delivery by caesarean section (OR 2.32, 95% CI 1.26–4.29), minor and major postpartum haemorrhage (OR 5.93, 95% CI 2.34–11.98, OR 16.11, 95% CI 2.08–125.09, resp.), perineal trauma (OR 2.59, 95% CI 1.44–4.69), and fetal macrosomia (OR 3.11, 95% CI 1.25–7.79) was noted in the study group. Babies also had an increased risk of having a lower APGAR scores in the study group as compared to the control group (OR 3.09, 95% CI 1.07–8.94). Conclusion. Women with a BMI > 40?kg/m2 experience increased incidence of intrapartum complications and hence, input of skilled birth attendants during labour is essential to improve intrapartum outcomes.

Vinayagam, Dimuthu; Chandraharan, Edwin



Assessment of the perinatal effects of maternal ingestion of Solanum malacoxylon in rats.  


A perinatal study was performed to verify the toxic effects of Solanum malacoxylon, which contains a glycoside conjugated to Vitamin D(3). In the gestational study, female rats received S. malacoxylon leaves in the diet at 0, 0.1, 0.2, 0.5, and 1% from days 6 to 21 of pregnancy. At 21 days of gestation, blood samples were taken from the dams for evaluation of serum Ca and P. A laparotomy was performed and the rats were examined for standard parameters of reproductive performance. Fetuses were examined for skeletal changes and histopathologic evaluation. In the second trial, dams were fed diets containing 0 or 0.1% S. malacoxylon leaves during the gestation and lactation periods. After weaning, all animals were euthanized and biochemical and histopathologic evaluations were performed. The biochemical evaluation showed increase in Ca and P levels in females from all experimental groups; however, this effect did not occurred in a dose-related manner. Pups from dams exposed during gestation and lactationi also showed increased Ca and P levels. Fetal data suggested a delay of fetal development manifested by decreased body weight and skeletal alterations. There was also a reduction in live fetuses. Histopathologic study revealed alterations of the soft tissue in litters from dams given 1% dietary S. malacoxylon during pregnancy and 0.1% during pregnancy and lactation. These findings support our hypothesis that Vitamin D(3) glycoside crosses the placenta and suggests milk transfer of this substance. PMID:12507660

Górniak, Silvana Lima; Maiorka, Paulo Cesar; Raspantini, Paulo Cesar; Hosomi, Rosana; Moraes, Ana Paula; Dagli, Maria Lucia Zaidan


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


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

Cockerham, Anne Z; Keeling, Arlene W




PubMed Central

OBJECTIVE To determine whether supplementation with vitamins C and E during pregnancy reduces the risk of preeclampsia and other adverse maternal and perinatal outcomes. STUDY DESIGN Systematic review and metaanalysis of randomized controlled trials. RESULTS Nine trials involving a total of 19,810 women were included. Overall, there were no significant differences between the vitamin and placebo groups in the risk of preeclampsia (9.6% versus 9.6%; relative risk 1.00, 95% confidence interval 0.92–1.09). Similar results were obtained when subgroup analyses were restricted to women at high risk or low/moderate risk for preeclampsia. Women supplemented with vitamins C and E were at increased risk of developing gestational hypertension and premature rupture of membranes, and a decreased risk of abruptio placentae. There were no significant differences between the vitamin and placebo groups in the risk of other adverse maternal or fetal/perinatal outcomes. CONCLUSION Supplementation with vitamins C and E during pregnancy does not prevent preeclampsia.

CONDE-AGUDELO, Agustin; ROMERO, Roberto; KUSANOVIC, Juan Pedro; HASSAN, Sonia



Association of Proteinuria Threshold in Pre-Eclampsia with Maternal and Perinatal Outcomes: A Nested Case Control Cohort of High Risk Women  

PubMed Central

Objectives To evaluate occurrence of adverse maternal and perinatal outcomes with different thresholds of proteinuria (300-499mg and ?500mg/24 hours) in pre-eclamptic women, comparing outcomes against women with chronic and gestational hypertension. Design Secondary analysis of the Vitamins in Pre-Eclampsia Trial. Setting 25 UK hospitals in ten geographical areas. Population 946 women with pre-existing risk factors for pre-eclampsia. Methods Women with pre-eclampsia and proteinuria 300-499mg/24h (PE300, referent group, n=60) or proteinuria ?500 mg/24h (PE500, n=161) were compared with two groups of non-proteinuric women with chronic hypertension (CHT, n=615) or gestational hypertension (GH, n=110). Main Outcome Measures Maternal: progression to severe hypertension. Perinatal: small for gestational age (SGA) <5th centile, gestation at delivery. Results Severe hypertension occurred more frequently in PE500 (35%) and PE300 (27%) than CHT (5.9%; P?0.01) and GH (10%; p?0.001). Gestation at delivery was earlier in PE500 (33.2w) than PE300 (37.3w; P?0.001), and later in CHT (38.3w; P?0.05) and GH (39.1w; P?0.001). SGA infants were more frequent in PE300 (32%) than in CHT (13.3%; P?0.001) and GH (16.5%; P?0.05). Women in PE500 were more likely to have a caesarean section than PE300 (78% vs. 48%; P?0.001), and to receive magnesium sulphate (17% vs. 1.7%, P?0.05). Conclusion Women with PE300 have complication rates above those of women managed as out-patients (GH and CHT), meriting closer surveillance and confirming 300 mg/d as an appropriate threshold for determining in-patient management. Adverse perinatal outcomes are higher still in women with PE500.

Seed, Paul T.; Briley, Annette L.; Poston, Lucilla; Shennan, Andrew H.; Chappell, Lucy C.



Long-term stability of maternal prenatal steroid hormones from the National Collaborative Perinatal Project: Still valid after all these years  

PubMed Central

Large epidemiological samples, including the National Collaborative Perinatal Project (NCPP), in which blood/serum was collected during pregnancy and offspring followed longitudinally, offer the unique opportunity to examine neuroendocrine mechanisms underlying prenatal “programming” of adult health and disease. However, in order to conduct longitudinal analyses, it is critical to determine the validity of maternal prenatal samples stored over long periods. We investigated the validity of cortisol, testosterone, and their binding globulins (corticosteroid binding globulin (CBG) and sex hormone binding globulin (SHBG)) in maternal prenatal serum from the NCPP after over 40 years of storage. Study 1 included 64 maternal serum samples collected on the day of delivery; study 2 involved 1099 third trimester serum samples collected between gestational weeks 31 and 36. Across both studies, cortisol and testosterone concentrations were consistent with values from published studies of fresh samples collected at similar points in gestation. CBG and SHBG were present but showed some differences from published studies. Results support the validity of cortisol and testosterone values following 40+ years of storage. Results also provide validation for future longitudinal tests of prenatal “programming” hypotheses within the NCPP. Stability of steroid hormones over decades suggests that stored samples from other longitudinal studies may also allow opportunities to investigate links between prenatal steroids and long-term offspring outcomes.

Stroud, Laura R.; Solomon, Catherine; Shenassa, Edmond; Papandonatos, George; Niaura, Raymond; Lipsitt, Lewis P.; LeWinn, Kaja; Buka, Stephen L.



Stepped Care for Maternal Mental Health: A Case Study of the Perinatal Mental Health Project in South Africa  

Microsoft Academic Search

As one article in a series on Global Mental Health Practice, Simone Honikman and colleagues from South Africa provide a case study of the Perinatal Mental Health Project, which delivered mental health care to pregnant women in a collaborative, step-wise manner, making use of existing resources in primary care.

Simone Honikman; Thandi van Heyningen; Sally Field; Emily Baron; Mark Tomlinson



GCN2 in the Brain Programs PPAR?2 and Triglyceride Storage in the Liver during Perinatal Development in Response to Maternal Dietary Fat  

PubMed Central

The liver plays a central role in regulating lipid metabolism and facilitates efficient lipid utilization and storage. We discovered that a modest increase in maternal dietary fat in mice programs triglyceride storage in the liver of their developing offspring. The activation of this programming is not apparent, however, until several months later at the adult stage. We found that the perinatal programming of adult hepatic triglyceride storage was controlled by the eIF2? kinase GCN2 (EIF2AK4) in the brain of the offspring, which stimulates epigenetic modification of the Ppar?2 gene in the neonatal liver. Genetic ablation of Gcn2 in the offspring exhibited reduced hepatic triglyceride storage and repressed expression of the peroxisome proliferator-activated receptor gamma 2 (Ppar?2) and two lipid droplet protein genes, Fsp27 and Cidea. Brain-specific, but not liver-specific, Gcn2 KO mice exhibit these same defects demonstrating that GCN2 in the developing brain programs hepatic triglyceride storage. GCN2 and nutrition-dependent programming of Ppar?2 is correlated with trimethylation of lysine 4 of histone 3 (H3K4me3) in the Ppar?2 promoter region during neonatal development. In addition to regulating hepatic triglyceride in response to modest changes in dietary fat, Gcn2 deficiency profoundly impacts the severity of the obese-diabetic phenotype of the leptin receptor mutant (db/db) mouse, by reducing hepatic steatosis and obesity but exacerbating the diabetic phenotype. We suggest that GCN2-dependent perinatal programming of hepatic triglyceride storage is an adaptation to couple early nutrition to anticipated needs for hepatic triglyceride storage in adults. However, increasing the hepatic triglyceride set point during perinatal development may predispose individuals to hepatosteatosis, while reducing circulating fatty acid levels that promote insulin resistance.

Xu, Xu; Hu, Jingjie; McGrath, Barbara C.; Cavener, Douglas R.



GCN2 in the Brain Programs PPAR?2 and Triglyceride Storage in the Liver during Perinatal Development in Response to Maternal Dietary Fat.  


The liver plays a central role in regulating lipid metabolism and facilitates efficient lipid utilization and storage. We discovered that a modest increase in maternal dietary fat in mice programs triglyceride storage in the liver of their developing offspring. The activation of this programming is not apparent, however, until several months later at the adult stage. We found that the perinatal programming of adult hepatic triglyceride storage was controlled by the eIF2? kinase GCN2 (EIF2AK4) in the brain of the offspring, which stimulates epigenetic modification of the Ppar?2 gene in the neonatal liver. Genetic ablation of Gcn2 in the offspring exhibited reduced hepatic triglyceride storage and repressed expression of the peroxisome proliferator-activated receptor gamma 2 (Ppar?2) and two lipid droplet protein genes, Fsp27 and Cidea. Brain-specific, but not liver-specific, Gcn2 KO mice exhibit these same defects demonstrating that GCN2 in the developing brain programs hepatic triglyceride storage. GCN2 and nutrition-dependent programming of Ppar?2 is correlated with trimethylation of lysine 4 of histone 3 (H3K4me3) in the Ppar?2 promoter region during neonatal development. In addition to regulating hepatic triglyceride in response to modest changes in dietary fat, Gcn2 deficiency profoundly impacts the severity of the obese-diabetic phenotype of the leptin receptor mutant (db/db) mouse, by reducing hepatic steatosis and obesity but exacerbating the diabetic phenotype. We suggest that GCN2-dependent perinatal programming of hepatic triglyceride storage is an adaptation to couple early nutrition to anticipated needs for hepatic triglyceride storage in adults. However, increasing the hepatic triglyceride set point during perinatal development may predispose individuals to hepatosteatosis, while reducing circulating fatty acid levels that promote insulin resistance. PMID:24130751

Xu, Xu; Hu, Jingjie; McGrath, Barbara C; Cavener, Douglas R



[Institutional iatrogeny and maternal death: semmelweis and puerperal fever].  


Puerperal fever is a disease that becomes epidemic in the eighteenth century as a result of two factors: the urban working masses generated by the industrial revolution and the progressive hegemonization and medicalization of birth care in large public hospitals. Institutionalized maternal death reached figures above 30%, while in the case of birth care provided by midwives, it was than 2%. Semmelweis, an Hungarian physician, sustained that physicians contaminated women in labor due to insufficient hygiene after performing necropsies and established prophylactic measures in the Vienna Hospital that reduced mortality dramatically. However, his ideas were rejected because they affected the institutionalization process of medicine, based on altruism and honor, which would make it impossible to cause harm to patients. He was forced to leave Vienna Hospital and he continued his struggle in Budapest, but the rejection and disagreement of his peers with his doctrine affected his mental health. He died in an asylum, a few years before Pasteur and Koch proved the existence of the bacteria that caused diseases such as puerperal fever. PMID:24100831

Salaverry García, Oswaldo



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

SciTech Connect

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.

Kransler, Kevin M. [Department of Pharmacology and Toxicology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Farber Hall 102, 3435 Main Street, Buffalo, NY 14214 (United States)], E-mail:; Tonucci, David A. [Givaudan Flavors Corp., 1199 Edison Drive, Cincinnati, OH 45216 (United States)], E-mail:; McGarrigle, Barbara P. [Department of Pharmacology and Toxicology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Farber Hall 102, 3435 Main Street, Buffalo, NY 14214 (United States)], E-mail:; Napoli, Joseph L. [Department of Nutritional Science and Toxicology, College of Natural Resources, University of California, Berkeley, Berkeley, CA 94720 (United States)], E-mail:; Olson, James R. [Department of Pharmacology and Toxicology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Farber Hall 102, 3435 Main Street, Buffalo, NY 14214 (United States)], E-mail:



The feasibility of a randomized clinical perinatal trial: Maternal magnesium sulfate for the prevention of cerebral palsy  

Microsoft Academic Search

OBJECTIVE: Because recent epidemiologic data suggest an association between maternal magnesium sulfate use and a decreased risk of cerebral palsy in infants who survive preterm birth, we investigated the feasibility of a randomized trial of intrapartum maternally administered magnesium sulfate to prevent cerebral palsy in children who were born before term. STUDY DESIGN: On the basis of a literature review,

Hauth; Goldenberg



Goals and Standards for Perinatal Services.  

National Technical Information Service (NTIS)

The goal of modern perinatal services is to maximize the quality of maternal, fetal, and neonatal care. Perinatal is defined as the period between 19 weeks gestation and 28 days after birth. Three levels of perinatal care have been defined by the Committe...



Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study  

PubMed Central

Objective To compare perinatal outcomes, maternal outcomes, and interventions in labour by planned place of birth at the start of care in labour for women with low risk pregnancies. Design Prospective cohort study. Setting England: all NHS trusts providing intrapartum care at home, all freestanding midwifery units, all alongside midwifery units (midwife led units on a hospital site with an obstetric unit), and a stratified random sample of obstetric units. Participants 64?538 eligible women with a singleton, term (?37 weeks gestation), and “booked” pregnancy who gave birth between April 2008 and April 2010. Planned caesarean sections and caesarean sections before the onset of labour and unplanned home births were excluded. Main outcome measure A composite primary outcome of perinatal mortality and intrapartum related neonatal morbidities (stillbirth after start of care in labour, early neonatal death, neonatal encephalopathy, meconium aspiration syndrome, brachial plexus injury, fractured humerus, or fractured clavicle) was used to compare outcomes by planned place of birth at the start of care in labour (at home, freestanding midwifery units, alongside midwifery units, and obstetric units). Results There were 250 primary outcome events and an overall weighted incidence of 4.3 per 1000 births (95% CI 3.3 to 5.5). Overall, there were no significant differences in the adjusted odds of the primary outcome for any of the non-obstetric unit settings compared with obstetric units. For nulliparous women, the odds of the primary outcome were higher for planned home births (adjusted odds ratio 1.75, 95% CI 1.07 to 2.86) but not for either midwifery unit setting. For multiparous women, there were no significant differences in the incidence of the primary outcome by planned place of birth. Interventions during labour were substantially lower in all non-obstetric unit settings. Transfers from non-obstetric unit settings were more frequent for nulliparous women (36% to 45%) than for multiparous women (9% to 13%). Conclusions The results support a policy of offering healthy women with low risk pregnancies a choice of birth setting. Women planning birth in a midwifery unit and multiparous women planning birth at home experience fewer interventions than those planning birth in an obstetric unit with no impact on perinatal outcomes. For nulliparous women, planned home births also have fewer interventions but have poorer perinatal outcomes.



Birthweight of Offspring, Maternal Pre-pregnancy Characteristics and Mortality of Mothers: The Jerusalem Perinatal Study Cohort  

PubMed Central

Purpose To explore the association between birthweight in offspring, a marker of the intrauterine environment, and mortality in their mothers taking into account maternal pre-pregnancy characteristics, including maternal BMI, smoking, and socioeconomic status. Distinguishing the effects of offspring’s birthweight and pre-pregnancy characteristics on maternal outcome may provide clues regarding mechanisms underlying the association between birth weight and maternal mortality. Methods We studied long-term total mortality (average follow-up period 29.1 years) in a population-based cohort of 13,185 mothers, aged 15 to 48 years at their offspring’s birth, who delivered in West Jerusalem during 1974–76 Results Univariate and multivariate Cox-proportional hazard models used to estimate the hazard of overall mortality among mothers indicated a non-linear relationship with birthweight of offspring when introduced into the models as a continuous variable, and a linear positive association with maternal pre-pregnancy BMI. Inclusion of maternal BMI and other pre-pregnancy characteristics in the model did not alter the association between offspring’s birthweight and mothers’ all-cause mortality. When birthweight was introduced as a categorical variable, higher mortality was observed among mothers who gave birth to babies with birthweight < 2500 gr (HR=1.90; 95%CI 1.23–2.94) as compared to mothers whose offspring had birthweight between 3000 and 3499 gr. The hazard ratio for mothers who gave birth to babies with birth weight ? 4000 gr was 1.30 (95%CI 0.88–1.91). Conclusions Independent of pre-pregnancy maternal BMI and other characteristics, birthweight of offspring was associated with mortality in their mothers, suggesting that intra-uterine metabolic events reflected by birth weight and not explained by maternal obesity, smoking, and SES have remote consequences for maternal health. These findings underline the need to explore specific genetic and/or environmental mechanisms that account for these associations.

Friedlander, Yechiel; Manor, Orly; Paltiel, Ora; Meiner, Vardiella; Sharon, Nir; Calderon, Ronit; Hochner, Hagit; Sagy, Yael; Avgil, Meytal; Harlap, Susan; Siscovick, David S.



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

PubMed Central

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.

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



Epidemiology of perinatal mortality: a hospital baed study.  


Perinatal mortality reflects the amount of pregnancy wastage due to fetal and neonatal deaths, and is considered a sensitive indicator of maternal and child health status in particular and community health status in general. The perinatal mortality rate (PNMR) in India is 5-6 times higher than in developed countries. Findings are presented from a study conducted to determine the effect of various epidemiological correlates upon perinatal mortality observed in the population attending the Maternal and Child Hospital at Sher-i-Kashmir Institute of Medical Sciences, Srinagar, between January 1994 and January 1995. The total PNMR was 43.1/1000 total births, and the still birth rate (SBR) and early neonatal death rate (ENDR) were 27.5/1000 and 16.0/1000 births, respectively. PNMR was almost 6 times higher in multiple births when compared to singleton births. Furthermore, PNMR was significantly higher among illiterate mothers, in extremes of age, among those living in joint families, and those having incomplete antenatal care. PNMR was low among the higher socioeconomic classes. Maternal weight had a significant effect upon perinatal loss. PMID:12295050

Fazili, F; Mattoo, G M


Perinatal and maternal complications related to postterm delivery: A national register-based study, 1978-1993  

Microsoft Academic Search

Objective: This study was undertaken to estimate the risk of fetal and maternal complications associated with postterm delivery in Denmark. Study Design: A cross-sectional study that used records from the Danish Medical Birth Registry from 1978 to 1993 was performed. All women with registered prolonged pregnancy (n = 78,022) and a 5% random sample of all women who gave birth

Annette W. Olesen; Jes G. Westergaard; Jorn Olsen



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

Microsoft Academic Search

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

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



Perinatal maternal food restriction induces alterations in hypothalamo-pituitary-adrenal axis activity and in plasma corticosterone-binding globulin capacity of weaning rat pups.  


We investigated the effects of perinatal maternal malnutrition on the hypothalamo-pituitary-adrenal (HPA) axis activity in both basal and stressful conditions in newborn rats at weaning. Mothers from the control group were fed ad libitum. Mothers exposed to food restriction received 50% (FR50) of the daily intake of pregnant dams during the last week of gestation (Pre group), lactation (Post group) or both periods (PP group) in order to compare the long-term effects of gestational and/or lactational restriction. FR50 reduced the body growth of pups from the Post and PP groups as soon as day 11 until day 21 after birth. At weaning, pups of the Post and PP groups showed reduced adrenal, thymus and liver weights. Although the plasma adrenocorticotropic hormone (ACTH) level was reduced in pups, FR50 affected neither corticotropin-releasing hormone expression and peptide synthesis in the hypothalamus nor proopiomelanocortin expression in the adenohypophysis. Basal circulating levels of corticosterone were not markedly affected by FR50, but free corticosterone concentration was increased in the PP group. Plasma corticosterone-binding globulin (CBG) was decreased in newborns from both the Post and PP groups. Mineralocorticoid receptor gene expression was significantly increased in both CA1 and CA3 hippocampal areas in the PP group. Glucocorticoid receptor gene expression was increased in CA1, CA2 and dentate gyrus hippocampal areas in the Pre group, as well as in CA1, CA3 and DG areas in the Post group. The ether inhalation-induced plasma ACTH increase was weaker in pups from the Post and PP groups. Similarly, the ether inhalation-induced plasma corticosterone increase returned to basal levels in the Post group, or to weaker values than baseline in the PP group 90 min after this stressful procedure. The present work suggests that maternal food restriction during the perinatal period (gestation and lactation) or during lactation only reduces the postnatal somatic growth of pups and disturbs the activity of the HPA axis at weaning under both resting and stress conditions. A reduction in the plasma CBG-binding capacity, associated with a probable increase in hippocampal corticosteroid receptors, could reinforce glucocorticoid-mediated negative feedback and shorten stress-induced activation of the HPA axis in pups at weaning. PMID:11810034

Léonhardt, Marion; Lesage, Jean; Dufourny, Laurence; Dickès-Coopman, Anne; Montel, Valérie; Dupouy, Jean-Paul



A Population-Based Study of Maternal and Perinatal Outcomes Associated with Assisted Reproductive Technology in Massachusetts  

Microsoft Academic Search

Objective: To assess associations between assisted reproductive technology (ART) and adverse maternal and infant outcomes, with an\\u000a emphasis on singletons. Methods: We linked data from the US ART surveillance system with Massachusetts live birth-infant death records data for resident births\\u000a in 1997–1998 and compared births conceived with ART (N = 3316) with births not conceived with ART or infertility medications (N = 157,066) on:

Laura A. Schieve; Bruce Cohen; Angela Nannini; Cynthia Ferre; Meredith A. Reynolds; Zi Zhang; Gary Jeng; Maurizio Macaluso; Victoria C. Wright



Perinatal maternal dietary supplementation of ?3-fatty acids transiently affects bone marrow microenvironment, osteoblast and osteoclast formation, and bone mass in male offspring.  


It is increasingly evident that micronutrient environment experienced before birth and in infancy is important for achieving optimal bone mass by adolescence and maintaining bone health. This study determined whether maternal supplementation with ?3-polyunsaturated fatty acids (n3FA) improved offspring bone growth and adult bone mass. Female rats were fed a diet containing 0.1% (control, n = 10) or 1% (n3FA, n = 11) docosahexanoic acid (DHA) during pregnancy and lactation. Offspring were weaned onto a control rat chow diet. Tibial growth plate and metaphysis structure, osteoblast/osteoclast density and differentiation, and gene expression were assessed in offspring at 3 wk (weaning), 6 wk (adolescent), and 3 months (adult). Maternal n3FA supplementation elevated offspring plasma n3FA levels at 3 and 6 wk. Although total growth plate heights were unaffected at any age, the resting zone thickness was increased in both male and female offspring at 3 wk. In n3FA males, but not females, bone trabecular number and thickness were increased at 3 wk but not other ages. The wk 3 n3FA males also exhibited an increased bone volume, an increased osteoblast but decreased osteoclast density, and lower expression of osteoclastogenic cytokines receptor activator of nuclear factor-?B ligand, TNF-?, and IL-6. No effects were seen at 6 wk or 3 months in either sex. Thus, perinatal n3FA supplementation is associated with increased bone formation, decreased resorption, and a higher bone mass in males, but not in females, at weaning; these effects do not persist into adolescence and adulthood and are unlikely to produce lasting improvements in bone health. PMID:22374977

Fong, Laura; Muhlhausler, Beverly S; Gibson, Robert A; Xian, Cory J



Neonatal Body Composition According to the Revised Institute of Medicine Recommendations for Maternal Weight Gain  

PubMed Central

Background: In 2009, the Institute of Medicine (IOM) released revised pregnancy weight gain guidelines. There are limited data regarding the effect of maternal weight gain on newborn adiposity. Objective: The aim of this study was to estimate neonatal fat mass, lean body mass, and percentage body fat according to current Institute of Medicine (IOM) pregnancy weight gain guidelines. Design: This is a secondary analysis of a prospective observational cohort study of neonates delivered at least 36 wk gestation and evaluated for fat mass, lean body mass, and percentage body fat. Women with abnormal glucose tolerance testing and other known medical disorders or pregnancies with known fetal anomalies were excluded. Pregravid body mass index (BMI) was categorized as normal weight (<25 kg/m2), overweight (25–30 kg/m2), or obese (>30 kg/m2). Maternal weight gain was quantified as less than, equal to, or greater than current IOM guidelines. Newborn body composition measurements were compared according to weight gain and BMI categories. Results: A total of 439 maternal-newborn pairs were evaluated; 19.8% (n = 87) of women gained less than IOM guidelines; 31.9% (n = 140), equal to IOM guidelines; and 48.3% (n = 212), greater than IOM guidelines. Significant differences for each component of body composition were found when evaluated by IOM weight gain categories (all ANOVA, P < 0.001). When controlling for pregravid BMI, only weight gain for women who were of normal weight before pregnancy remained significant. Conclusion: Maternal weight gain during pregnancy is a significant contributor to newborn body composition, particularly for women who are of normal weight before pregnancy.

Huston-Presley, Larraine; Catalano, Patrick M.



Maternal and Perinatal Outcomes in Second Hemoglobin Measurement in Nonanemic Women at First Booking: Effect of Altitude of Residence in Peru  

PubMed Central

Objective. To determine changes in hemoglobin concentration at second measurements after a normal hemoglobin concentration was detected at first booking during pregnancy at low and at high altitudes. Methods. This is a secondary analysis of a large database obtained from the Perinatal Information System in Peru which includes 379,816 pregnant women and their babies from 43 maternity units in Peru. Results. Most women remained with normal hemoglobin values at second measurement (75.1%). However, 21.4% of women became anemic at the second measurement. In all, 2.8% resulted with moderate/severe anemia and 3.5% with erythrocytosis (Hb>14.5?g/dL). In all cases Hb was higher as altitude increased. Risk for moderate/severe anemia increased associated with higher gestational age at second measurement of hemoglobin, BMI <19.9?kg/m2, living without partner, <5 antenatal care visits, first parity, multiparity, and preeclampsia. Lower risk for moderate/severe anemia was observed with normal high Hb level at first booking living at moderate and high altitude, and high BMI. Conclusion. Prevalence of anemia increases as pregnancy progress, and that a normal value at first booking may not be considered sufficient as Hb values should be observed throughout pregnancy. BMI was a risk for anemia in a second measurement.

Gonzales, Gustavo F.; Tapia, Vilma; Fort, Alfredo L.



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

PubMed Central

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 ?g/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.

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



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

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-?). 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.



[Duration of breastfeeding from 15 maternity wards of the perinatal network in the Pays de la Loire area].  


The "sécurité naissance - naître ensemble" network in the Pays de la Loire region of France, with 24 maternity units, conducted a survey of nursing women to determine the duration of breastfeeding and to study the factors influencing this practice. Phone calls were made to mothers at 1 month, 2 months, 3 months, and 6 months or until weaning. The statistical methods used were the Kaplan-Meier survival curve method with the calculation of the median duration of breastfeeding (exclusive or partial) in weeks, and the Cox multivariate model. The hazard ratio or relative risk (RR) was used in univariate analysis, and the adjusted odds ratio (aOR) in multivariate analysis (>1 related to short duration, and<1 related to long duration). Fifteen maternity units participated, and 239 women were followed. The median duration of breastfeeding was 15 weeks (3.5 months) with 10% discontinuing the first month and 25% continuing breastfeeding at 6 months. The final model of risk of duration contains the following variables: maternal age less than 30 years (aOR=1.54; 1.08-2.19), the time the decision was made before pregnancy (aOR=0.56; 0.38-0.83), BMI greater or equal to 30 (aOR=2.12 (1.18-3.79), and for the first month, the administration of bottle feeding or complements (aOR=2.51; 1.62-3.89), the baby's need to be stimulated to feed (aOR=5.07; 3.24-7.90), breastfeeding on demand (aOR=0.56; 0.39-0.82), and problems breastfeeding (aOR=1.45; 1.005-2.09). This survey to determine the duration of breastfeeding in western France, a region with low initiation rates, duration appears to be relatively long compared to other studies. The factors influencing breastfeeding duration were for some non-modifiable (age, time of the decision, etc.), and for others assistance by a professional (supplements, need for stimulation, difficulty sucking, breastfeeding on demand, etc.). Criteria for identifying difficulties are presented. PMID:23031316

Branger, B; Dinot-Mariau, L; Lemoine, N; Godon, N; Merot, E; Brehu, S; Winer, N; Brossier, J-P



Perinatal mortality in rural Malawi.  

PubMed Central

Reported are the results of a study to assess the prevalence and risk factors for perinatal death among pregnant women in Malawi over the period 1987-90. There were 264 perinatal deaths among the 3866 women with singleton pregnancies (perinatal mortality rate, 68.3 per 1000 births). Among the risk factors for perinatal mortality were the following: reactive syphilis serology, nulliparity, a late fetal or neonatal death in the most recent previous birth, maternal height < 150 cm, home delivery, and low socioeconomic status. Although unexplained perinatal deaths will continue to occur, perinatal mortality can be reduced if its causes and risk factors in a community are given priority in antenatal and intrapartum care programmes. The following interventions could potentially reduce the perinatal mortality in the study population: screening and treating women with reactive syphilis serology; and management from early labour, by competent personnel in a health facility, of nulliparous women and multiparous women who are short or have a history of a perinatal death.

McDermott, J.; Steketee, R.; Wirima, J.



Infant and Perinatal Mortality in Scotland.  

National Technical Information Service (NTIS)

The report is an analysis of infant mortality trends in Scotland by age at death, sex of child, cause of death, social class, and geographic region. It also includes maternal mortality trends; stillbirth and perinatal mortality trends; effects of illegiti...

C. A. Douglas



Impact of Janani Suraksha Yojana on Institutional Delivery Rate and Maternal Morbidity and Mortality: An Observational Study in India  

PubMed Central

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.

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



Factors influencing the obstetric and perinatal outcome after oocyte donation  

Microsoft Academic Search

BACKGROUND: We evaluated interactions between perinatal outcome after oocyte donation and various maternal factors. METHODS: The study included 134 parturients after oocyte donation. Data were collected from medical files and personal interviews. Stepwise logistic regression analyses were used to evaluate associations between perinatal outcomes and selected maternal variables. RESULTS: Fifty percent of the women were >43 years old, 30.6% were

Galit Sheffer-Mimouni; Shlomo Mashiach; Jehoshua Dor; David Levran; Daniel S. Seidman


The impact of training non-physician clinicians in Malawi on maternal and perinatal mortality: a cluster randomised controlled evaluation of the enhancing training and appropriate technologies for mothers and babies in Africa (ETATMBA) project  

PubMed Central

Background Maternal mortality in much of sub-Saharan Africa is very high whereas there has been a steady decline in over the past 60 years in Europe. Perinatal mortality is 12 times higher than maternal mortality accounting for about 7 million neonatal deaths; many of these in sub-Saharan countries. Many of these deaths are preventable. Countries, like Malawi, do not have the resources nor highly trained medical specialists using complex technologies within their healthcare system. Much of the burden falls on healthcare staff other than doctors including non-physician clinicians (NPCs) such as clinical officers, midwives and community health-workers. The aim of this trial is to evaluate a project which is training NPCs as advanced leaders by providing them with skills and knowledge in advanced neonatal and obstetric care. Training that will hopefully be cascaded to their colleagues (other NPCs, midwives, nurses). Methods/design This is a cluster randomised controlled trial with the unit of randomisation being the 14 districts of central and northern Malawi (one large district was divided into two giving an overall total of 15). Eight districts will be randomly allocated the intervention. Within these eight districts 50 NPCs will be selected and will be enrolled on the training programme (the intervention). Primary outcome will be maternal and perinatal (defined as until discharge from health facility) mortality. Data will be harvested from all facilities in both intervention and control districts for the lifetime of the project (3–4 years) and comparisons made. In addition a process evaluation using both quantitative and qualitative (e.g. interviews) will be undertaken to evaluate the intervention implementation. Discussion Education and training of NPCs is a key to improving healthcare for mothers and babies in countries like Malawi. Some of the challenges faced are discussed as are the potential limitations. It is hoped that the findings from this trial will lead to a sustainable improvement in healthcare and workforce development and training. Trial registration ISRCTN63294155



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

|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…

Gustafsson, Peik; Kallen, Karin



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

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…

Gustafsson, Peik; Kallen, Karin



Perinatal transmission of hepatitis C virus infection.  


In industrialized countries, hepatitis C virus (HCV) is the most common cause of chronic liver disease in children. Perinatal transmission is the leading cause of infection. Perinatal transmission is confined almost always to women with detectable HCV ribonucleic acid (RNA) in the peripheral blood by the polymerase chain reaction but all children born to women with anti-HCV antibodies should be tested for HCV. Some but not all studies found that a high concentration of serum HCV RNA is associated with a higher risk of transmission. Maternal peripheral blood mononuclear cell infection by HCV, membrane rupture of longer than 6 hr before delivery, and procedures exposing the infant to maternal blood infected with HCV during vaginal delivery are associated with an increased risk of transmission. Maternal coinfection with HCV and human immunodeficiency virus, maternal history of intravenous drug use and of HCV infection of the sexual partner of the mother predict the risk of perinatal transmission and are dependent on the peripheral blood mononuclear cell infection by HCV. Delivery by Cesarean section is not recommended in pregnant women infected with HCV. Infected mothers can breast feed safely their infants if the nipples are not damaged. A previous delivery of a child infected perinatally with HCV does not increase the risk of transmission in subsequent pregnancies. Immunogenetic factors and HCV genotypes are not related to HCV perinatal transmission. Despite an increased understanding of the risk factors involved in perinatal transmission of HCV, to date little is known about the transmission mechanisms and timing. PMID:19319981

Indolfi, Giuseppe; Resti, Massimo



[Transcultural approach in perinatality].  


Over the last years, our approach to the perinatal period has become more complex with the integration of new tools designed for better comprehension and cultural awareness. In this area of medical practice, perhaps more than in others, the complementary contribution of different approaches, ways of thinking, and practical interventions is essential. Pregnancy, delivery, early mother-infant interactions, and construction of the parent-child relationship involve not only profoundly intimate, intrapsychic and intersubjective events but also medical, social, and cultural events which all become a part of the process of transmitting life in an open group. The junction between somatic, intrapsychic, intersubjective and cultural elements was analyzed in the everyday clinical setting of a multicultural suburban area near Paris. The therapeutic impact of this perspective was noted. Two therapeutic processes specific to the perinatal period were studied: the need to assist vulnerable migrant mothers in reconstructing their defense systems (possible because of the psychic transparency and the primary maternal priority of this special period of life) and direct work with the baby. Working directly with the baby and not only the mother creates an open triad around the baby. This baby/mother/therapist group relationship develops progressively and is initially perceived as a virtual group before developing into a more concrete transferential relationship based on familial and social resources. The perinatal clinic is by definition a very pluridisciplinary and very context-related unit. PMID:14968011

Moro, M R



Global and cultural perinatal nursing research: improving clinical practice.  


High-quality perinatal nursing care should be based on the best evidence including research findings, clinical expertise, and the preferences of women and their families. Principles of perinatal research initiatives are defined, with suggested research priorities designed to close current gaps in the micro and macro environments of perinatal nursing throughout the world. Nearly a decade ago, the following question was asked, "Where is the 'E' (evidence) in maternal child health?" Improving the quality and safety of perinatal nursing care for culturally diverse women globally is the primary goal of nurse researchers leading the future of perinatal healthcare. PMID:21540688

Callister, Lynn Clark


Perinatal outcomes of singleton term breech deliveries in Basra.  


This study aimed to assess the perinatal morbidity and mortality in breech deliveries, to study the correlation of parity and birth weight with perinatal mortality by mode of delivery. Of 210 women in labour in Basra maternity and child hospital, 97 underwent vaginal breech deliveries and 113 delivered by caesarean section. Birth trauma was restricted to vaginal deliveries. The perinatal mortality was significantly higher in vaginal deliveries (8.2%) compared with caesarean deliveries (0.9%). A higher perinatal mortality was recorded among infants > 3500-4000 g birth weight in vaginal deliveries. Caesarean section reduced the perinatal mortality in both nulliparous and parous women in term breech infants. PMID:20214155

Alshaheen, H; Abd Al-Karim, A



Shanghai needs to improve its perinatal care.  


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



Maternal-Fetal Pharmacokinetics of Methanol. (Includes the Commentary of the Institute's Health Review Committee).  

National Technical Information Service (NTIS)

This study defines the physiological factors that govern methanol delivery to the developing fetus after maternal methanol exposure. The disposition of methanol after oral or intravenous administration was similar in pregnant and nonpregnant rats, regardl...

G. M. Pollack K. L. R. Brouwer



Maternal-child blood group incompatibility and other perinatal events increase the risk for early-onset type 1 (insulin-dependent) diabetes mellitus  

Microsoft Academic Search

Summary  The nationwide Swedish Childhood Diabetes Registry, which ascertains 99% of recent-onset Type 1 (insulin-dependent) diabetic children (0–14 years) in Sweden, was linked with the Swedish Medical Birth Registry. A matched case-control study was carried out analysing about 20 perinatal variables concerning mother and child. A total of 2757 infants who became diabetic during the period 1978–1988 were analysed. For each

G. Dahlquist; B. Källén



Maternal high fat diet during the perinatal period alters mesocorticolimbic dopamine in the adult rat offspring: reduction in the behavioral responses to repeated amphetamine administration  

Microsoft Academic Search

Rationale  Early environment can shape the development and function of the mesocorticolimbic dopamine (DA) system and represents a possible\\u000a risk factor for adult pathologies. One critical variable in the early environment is nutrition, and exposure to high fat (HF)\\u000a in adulthood is known to change this DA system.\\u000a \\u000a \\u000a \\u000a Objectives  We tested whether perinatal HF intake in rats could have long-term effects on

Lindsay Naef; Lalit Srivastava; Alain Gratton; Howard Hendrickson; S. Michael Owens; Claire-Dominique Walker



Perinatal Complications and Child Abuse in a Poverty Sample.  

ERIC Educational Resources Information Center

This study explored to what extent perinatal morbidity is a risk factor for maltreatment through review of the medical charts of 206 children, ages 0-3, who had been referred to child protective services based on either prenatal findings of maternal inadequacy or postnatal findings of child maltreatment. Perinatal complications were associated…

Zelenko, Marina; Lock, James; Kraemer, Helena C.; Steiner, Hans



Perinatal transmission of hepatitis B virus: an Australian experience  

Microsoft Academic Search

Objective: To determine the rate of perinatal hepatitis B virus (HBV) transmission in an Australian setting and to identify maternal virological factors associated with highest risk of transmission. Design, participants and setting: A prospective, observational study of perinatal transmission of HBV. Participants were pregnant women attending Sydney South West Area Health Service antenatal clinics who tested positive for hepatitis B

Elke Wiseman; Melissa A Fraser; Sally Holden; Anne Glass; Bronwynne L Kidson; Leon G Heron; Michael W Maley; Anna Ayres; Stephen A Locarnini; Miriam T Levy



Classification of perinatal death in a developing country  

Microsoft Academic Search

Objectives: To evaluate and compare the three most commonly used perinatal death classification systems: (1) the Nordic–Baltic; (2) the Aberdeen; and (3) the Wigglesworth, and assess their applicability in a developing country (Sudan) with a high perinatal mortality rate, and their justification for practical use in quality assurance and audit activities. Methods: At Omdurman Maternity Hospital (OMH), Khartoum, Sudan, 166

S Elamin; J Langhoff-Roos; B Boedker; S. A Ibrahim; A. L Ashmeig; G Lindmark



Perinatal Outcomes of Twin Pregnancies Discordant for Major Fetal Anomalies  

Microsoft Academic Search

Objective: The aim of this study was to determine perinatal outcomes of twin pregnancies discordant for a major fetal anomaly and to compare with twins without anomaly. Methods: All twin pregnancies admitted or referred to the maternal-fetal unit were prospectively entered into a computer database. Chorionicity, fetal anomaly, mean gestational age at delivery, birth weight and perinatal survival rate were

Ahmet Gul; Altan Cebeci; Halil Aslan; Ibrahim Polat; Ilker Sozen; Yavuz Ceylan



Perinatal Loss: The Effect on Attachment in Subsequent Pregnancies.  

National Technical Information Service (NTIS)

The purpose of the study was to explore the effect of perinatal loss on attachment behaviors in subsequent pregnancies. A modified version of Cranley's Maternal-Fetal Attachment Tool was utilized to measure the difference in attachment, during subsequent ...

F. Cruz



Maternal and Perinatal Outcomes of Exercise in Pregnant Women with Chronic Hypertension and/or Previous Preeclampsia: A Randomized Controlled Trial.  


Objectives. To evaluate the association between physical exercise supervised in pregnant women with chronic hypertension and/or previous preeclampsia and maternal and neonatal outcomes. Method. Randomized controlled trial, which included 116 pregnant women with chronic hypertension and/or previous preeclampsia, considered risk of preeclampsia development. They were divided into two groups: study group that performed physical exercise with a stationary bicycle once a week, for 30 minutes; the intensity was controlled (heart rate 20% above resting values), under professional supervision and a control group that was not engaged in any physical exercise. The data was retrieved from medical charts. Significance level assumed was 5%. Results. Women from study group performed 9.24 ± 7.03 of physical exercise sessions. There were no differences between groups comparing type of delivery and maternal outcomes, including maternal morbidity and hospitalization in intensive unit care, and neonatal outcomes, including birth weight, adequacy of weight to gestational age, prematurity, Apgar scale at first and fifth minutes, hospitalization in intensive unit care, and neonatal morbidity. Conclusions. Physical exercise using a stationary bicycle in pregnant women with chronic hypertension and/or previous preeclampsia, once a week, under professional supervision, did not interfere in the delivery method and did not produce maternal and neonatal risks of the occurrence of morbidity. This trial is registered with NCT01395342. PMID:23997960

Kasawara, Karina Tamy; Burgos, Camila Schneider Gannuny; do Nascimento, Simony Lira; Ferreira, Néville Oliveira; Surita, Fernanda Garanhani; Pinto E Silva, João Luiz



Perinatal psychiatry  

Microsoft Academic Search

Psychiatric disorders contribute significantly to maternal morbidity; 10–15% of pregnant and post-partum women are depressed or anxious, and suicide is the most common cause of maternal death. Mild disorders in early pregnancy often relate to psychosocial factors and are treated with psychosocial interventions. Depression later in pregnancy is likely to continue after delivery, and 3–5% of these cases are severe

Carol Henshaw



Perinatal outcome at Benghazi and implications for perinatal care in developing countries  

Microsoft Academic Search

During the period January to December 1984 there were 434 perinatal deaths among 16,466 births in a developing North African\\u000a country. The perinatal, still birth and early neonatal death rates were 263, 11.4 and 149 per 1000 respectively. The major\\u000a causes of still births included antepartum hemorrhage, cord accidents, maternal diabetes mellitus and fetal malformations.\\u000a The clinical causes of early

Jai Kishan; A. L. Soni; A. Y. Elzouki; N. A. Mir; M. R. Magoub



Comparison of Insulin Lispro Protamine Suspension with NPH Insulin in Pregnant Women with Type 2 and Gestational Diabetes Mellitus: Maternal and Perinatal Outcomes  

PubMed Central

Insulin therapy is still the gold standard in diabetic pregnancy. Insulin lispro protamine suspension is an available basal insulin analogue. Aim. To study pregnancy outcomes of women with type 2 and gestational diabetes mellitus when insulin lispro protamine suspension or human NPH insulin was added to medical nutrition therapy and/or short-acting insulin. Methods. In this retrospective study, for maternal outcome we recorded time and mode of delivery, hypertension, glycaemic control (fasting blood glucose and HbA1c), hypoglycemias, weight increase, and insulin need. For neonatal outcome birth weight and weight class, congenital malformations was recorded and main neonatal complications. Two-tail Student's t-test and chi-square test were performed when applicable; significant P < 0.05. Results. Eighty-nine pregnant women (25 with type 2 diabetes and 64 with gestational diabetes mellitus; 53 under insulin lispro protamine suspension and 36 under human NPH insulin) were recruited. Maternal and neonatal outcomes were quite similar between the two therapeutic approaches; however, insulin need was higher in NPH. At the end of pregnancy, eight women with gestational diabetes continued to use only basal insulin analogue. Conclusions. Pregnancy outcome in type 2 and gestational diabetes mellitus with insulin lispro protamine suspension was similar to that with NPH insulin, except for a lower insulin requirement.

Visalli, Natalia; Abbruzzese, Santina; Bongiovanni, Marzia; Napoli, Angela



Transitioning to Family Centered Maternity Care from Traditional Maternity Care  

Microsoft Academic Search

United States perinatal statistics indicate that maternity care needs improvement. In this evidence-based project, guided by the promoting action on research implementation in health services (PARIHS) framework, it is posited that no practice change will occur unless nurses understand and appreciate the relevance of evidence-based maternity care. A within-group design was used to address the clinical question, \\

Kathleen Kleefisch



A Collaborative Care Telemedicine Intervention to Overcome Treatment Barriers for Latina Women With Depression During the Perinatal Period  

Microsoft Academic Search

Maternal depression is highly prevalent (10–20%) 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. The Perinatal Mental Health (PMH) model was designed to ameliorate the barriers that prevent adequate diagnoses and intervention. The PMH is a culturally sensitive, short-term telemedicine, collaborative care

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



Use of previous maternal health services has a limited role in reattendance for skilled institutional delivery: cross-sectional survey in Northwest Ethiopia  

PubMed Central

Background Maternal mortality rates are unacceptably high in Ethiopia. Institutional delivery with skilled care of the mother is one of the interventions proven to reduce the risk of complications that can cause maternal and neonatal mortality. Quality of service given during antenatal visits and childbirth are important measures. The purpose of this study was to investigate the use of skilled institutional delivery and its repeat use during a subsequent pregnancy and to identify any reasons why women avoid institutional delivery. Methods A community-based cross-sectional study was conducted from March to June 2012 in Chilga Woreda, Northwest Ethiopia. Data were collected from women who gave birth during the year preceding the survey. Information was entered and cleaned using the Statistical Package for Social Sciences. Multivariate and binary logistic regression was used to identify the relative effect of each explanatory variable on the outcome. Results A total of 402 (84.2%) women gave birth at home. Previous experience of skilled institutional delivery had a limited role in subsequent acceptance or use of institutional delivery. Most mothers who had previously had institutional delivery gave birth at home. Although 111 (40.8%) women visited the health facility during their pregnancy only because of illness, 184 (38.8%) did not know when to visit for antenatal care. In multivariate analysis, lower maternal education, being a rural resident, previous use of institutional delivery, remoteness of the health facility, and multiparity were factors significantly associated with less likelihood of institutional delivery. Number of months pregnant at the time of the first antenatal visit had no role in increasing the likelihood of institutional delivery. Conclusion The quality of the obstetric services presently available for women living in Ethiopia needs review.

Kebede, Bekana; Gebeyehu, Abebaw; Andargie, Gashaw



Perinatal complications as predictors of infantile autism.  


This study investigated the relationship between reported perinatal complications and autism. The biological mothers of 183 autistic children and 209 normals completed the Maternal Perinatal Scale (MPS), a maternal self-report that surveys complications of pregnancies and medical conditions of the mother. Previous research in this area has been limited, with no definitive conclusions. A discriminant analysis was performed to consider perinatal complications as predictors between the autistic and normal subjects. Using the MPS, 65% of the autistic cases were correctly grouped. The results further indicated significant differences on 3 of the 10 factors of the MPS, in particular, Gestational Age, Maternal Morphology, and Intrauterine Stress. When considered in an item by item fashion, 5 items were found to significantly predict group membership (prescriptions taken during pregnancy, length of labor, viral infection, abnormal presentation at delivery, and low birth weight). Finally, 3 maternal medical conditions were found to be highly significant and contribute to the separation between groups, including urinary infection, high temperatures, and depression. PMID:12487097

Wilkerson, Diana Sue; Volpe, Alessandra G; Dean, Raymond S; Titus, Jeffrey B



Levels and risk factors for perinatal mortality in Ahmedabad, India.  

PubMed Central

To estimate levels and determinants of perinatal mortality, we conducted a hospital-based surveillance and case-control study, linked with a population survey, in Ahmedabad, India. The perinatal mortality rate was 79.0 per 1000, and was highest for preterm low-birth-weight babies. The case-control study of 451 stillbirths, 160 early neonatal deaths and 1465 controls showed that poor maternal nutritional status, absence of antenatal care, and complications during labour were independently associated with substantially increased risks of perinatal death. Multivariate analyses indicate that socioeconomic factors largely operate through these proximate factors and do not have an independent effect. Estimates of attributable risk derived from the prevalence of exposures in the population survey suggest that improvements in maternal nutrition and antenatal and intrapartum care could result in marked reductions of perinatal mortality.

Mavalankar, D. V.; Trivedi, C. R.; Gray, R. H.



Relative Risk of Perinatal Complications in Common Childhood Disorders  

Microsoft Academic Search

Perinatal complications have been associated with a myriad of later-developing behavioral, neurological, and psychological disorders. These have included school-related disorders such as attention-deficit\\/hyperactivity disorder, autism, mood and anxiety disorders, and learning disabilities. This article reviews the research that considers the relative risk relationship between prepregnancy, pregnancy, neonatal complications, and later childhood disorders. Specifically, research with the Maternal Perinatal Scale (MPS),

Raymond S. Dean; Andrew S. Davis



Perinatal risk factors for neuroblastoma.  


Neuroblastoma is the most common cancer among infants, suggesting an etiologic role for prenatal factors. In this case-cohort study, neuroblastoma cases (n = 529) diagnosed between 1985 and 2001 were identified from the New York State Cancer Registry and were matched to the electronic birth records for 1983-2001 from New York State and New York City. Controls (n = 12,010) were selected from the same birth cohorts. Analysis was stratified by age at diagnosis, with one to six months (younger infants), seven to 18 months (older infants), and older than 18 months (older children) analyzed separately. Perinatal exposure data was obtained from the birth certificates. No risk factors were identified to be consistently associated with risk across all three age groups. Generally, more risk factors were identified as associated with neuroblastoma among younger infants relative to older ages, including high birth weight, heavier maternal gestational weight gain, maternal hypertension, older maternal age, ultrasound, and respiratory distress. Among older infants, low birth weight was associated with increased risk while heavier maternal gestational weight gain was protective. In the oldest age group, first born status, primary cesarean delivery, prolonged labor and premature rupture of the membranes were associated with increased risk. PMID:18941915

McLaughlin, Colleen C; Baptiste, Mark S; Schymura, Maria J; Zdeb, Michael S; Nasca, Philip C



Perinatal Problems and Psychiatric Comorbidity Among Children With ADHD.  


Among two large, independent samples of girls with attention-deficit/hyperactivity disorder (ADHD), we examined associations between specific (maternal gestational smoking and drug use, early labor, low birth weight, and infant breathing problems at birth) and cumulative prenatal and perinatal risk factors and psychiatric comorbidity during childhood. Data from the (a) Multimodal Treatment Study of Children with ADHD, a randomized clinical trial with 579 children aged 7 to 9.9 years with combined-type ADHD, and the (b) Berkeley Girls ADHD Longitudinal Sample, a naturalistic study of 140 girls with ADHD (93 combined-type and 47 inattentive-type) who were first seen when they were 6 to 12 years old, were analyzed separately. In each sample, perinatal risk factors were assessed retrospectively by maternal report, and current childhood psychiatric comorbidity was assessed using maternal report on the Diagnostic Interview Schedule for Children. Consistent findings across these two studies show that infant breathing problems, early labor, and total perinatal problems predicted childhood comorbid depression but not comorbid anxiety or externalizing disorders. These associations remained significant, in both samples, with control of family socioeconomic status (SES) and maternal symptoms of ADHD and depression. Results attenuated slightly with control of the number of child comorbidities plus SES and maternal symptoms. Accumulating evidence suggests that perinatal risk factors are important precursors of childhood psychiatric comorbidity and that the association between these risk factors and detrimental psychiatric outcomes cannot be explained by maternal psychiatric symptoms or SES during childhood. PMID:23581554

Owens, Elizabeth B; Hinshaw, Stephen P



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

ERIC Educational Resources Information Center

|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…

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



The Role of the Social Worker in Perinatal Substance-Abuse  

Microsoft Academic Search

Perinatal substance use affects approximately 10-15% of the population at any given time. Although it is not completely clear whether perinatal substance use is the cause of poor outcomes or a result of related factors such as poverty, environmental deprivation, violence in the home, or depression, the impact on maternal well-being and neonatal outcomes is enormous and the cost to

Cathy Cook



Perinatal Statistics Report 2007  

Microsoft Academic Search

The Perinatal Statistics Report 2007 presents information on babies born in Ireland in 2007, together with the demographic characteristics of their parents. In 2007, 71,963 births were notified to the National Perinatal Reporting System. The birth rate for 2007 was 16.5 per 1,000 population (an increase from 15.4 for 2006). The Perinatal Mortality Rate was 7.3 per 1,000 live births


The Relationship Between Perinatal Risk Factors and Sensory Processing Difficulties in Preschool Children  

Microsoft Academic Search

This study examined the relationship between reported perinatal risk factors and sensory processing difficulties in young\\u000a children. The biological mothers of 152 preschool-age children completed two measures: the Maternal Perinatal Scale (MPS),\\u000a a maternal self-report that surveys complications of pregnancies and medical conditions of the mother, and the Short Sensory\\u000a Profile (SSP), a measure designed to provide information about the

M. Franci Crepeau-Hobson



Caesarean section on maternal request for non-medical reasons: putting the UK National Institute of Health and Clinical Excellence guidelines in perspective.  


The past decade has seen an unprecedented rise in the demand for caesarean sections on maternal request (CSMR), in the absence of any medical or obstetric indication. Much of this rise is the result of the perceived myth of safety of caesarean sections and the changing attitudes of society and the medical profession to childbirth. The debate on the medical, ethical and cost implications of rising rates of caesarean section on maternal request have prompted the issuing of numerous guidelines over the past few years, including one by the National Institute of Health and Clinical Excellence (NICE) in the UK. All these guidelines are uniformly less critical of CSMR than guidelines issued even a decade ago, and suggest valid management strategies. In this chapter, I explore the reasons behind the increase in CSMR and review the current published research, including the risks, benefits, controversies, cost and ethics surrounding CSMR. I then discuss various guidelines, putting the NICE guidelines in perspective. PMID:23116717

D'Souza, Rohan



Perinatal complications associated with maternal tobacco use  

Microsoft Academic Search

The use of tobacco products by pregnant women is associated with placenta previa, abruptio placentae, premature rupture of the membranes, preterm birth, intrauterine growth restriction and sudden infant death syndrome. Approximately 15–20% of women smoke during pregnancy. It has been suggested that smoking is responsible for 15% of all preterm births, 20–30% of all infants of low birthweight, and a

Robert L. Andres; Mary-Clare Day



Maternal and Perinatal Effects of Adolescent Childbearing.  

ERIC Educational Resources Information Center

|Investigated developmental consequences of adolescent childbearing in 60 low-income, pregnant adolescents and a low-income control group of pregnant adult women. Racial and age influences were investigated. Adolescents did not differ from controls on emotionality; a significant age by race interaction was found for depression. (Author/DB)|

Gunter, Nancy C.; LaBarba, Richard C.



Useless Perinatal Therapies  

Microsoft Academic Search

With respect to Professor Bengt Robertson whose research studies were very instrumental in the development of one of the most important and evidence-based therapies in perinatal medicine, namely surfactant therapy, I thought it might be appropriate to review some useless or harmful perinatal therapies. Although the term ‘neonatology’ has only been in existence for about 50 years, care of the

Henry L. Halliday



Integrated perinatal health framework  

Microsoft Academic Search

RationaleDespite great strides in improving prenatal care utilization among American women, key perinatal indicators have remained stagnant or worsened in the past decade, and the United States continues to rank near the bottom compared to other developed countries. A new approach is needed if we are to achieve improvements in perinatal health.

Dawn P. Misra; Bernard Guyer; Adam Allston



Maternal Stress is Associated With Bacterial Vaginosis in Human Pregnancy  

Microsoft Academic Search

Objectives: Maternal infection, particularly bacterial vaginosis (BV) in pregnancy, is one of the leading causes of adverse perinatal outcomes. The determinants of individual differences in susceptibility, or vulnerability, to maternal infections are poorly understood. This study examines whether chronic maternal stress predisposes women to infection during pregnancy, and if so, whether the effects of chronic stress on infection are independent

Jennifer F. Culhane; Virginia Rauh; Kelly Farley McCollum; Vijaya K. Hogan; Kathy Agnew; Pathik D. Wadhwa



Pregnancy on Intensified Hemodialysis: Fetal Surveillance and Perinatal Outcome  

Microsoft Academic Search

Objectives: To evaluate the effect of intensive fetal surveillance via Doppler ultrasound and fetal non-stress test on the perinatal outcome of pregnant women undergoing an intensified hemofiltration scheme. Methods: Five consecutive pregnancies of women undergoing intensified hemodialysis were analyzed due to the following parameters: maternal background, hemodialysis schedule during pregnancy, blood pressure, occurrence of fetal complications, occurrence of obstetric complications,

Christian Bamberg; Fritz Diekmann; Michael Haase; Klemens Budde; Berthold Hocher; Horst Halle; John Hartung



Perinatal transmission of dengue: a report of 7 cases.  


Perinatal transmission of dengue virus was confirmed by the evidence of virus in fetal tissue, newborn serum, and placenta of pregnant women. Abortion, several different clinical findings, and placental inflammatory findings were documented. No association was seen between severity of maternal dengue and disease of the newborn. PMID:23916226

Ribeiro, Christiane Fernandes; Lopes, Vânia Glória Silami; Brasil, Patrícia; Coelho, Janice; Muniz, Adriana Gouveia; Nogueira, Rita Maria Ribeiro



Perinatal Pitocin as an Early ADHD Biomarker: Neurodevelopmental Risk?  

Microsoft Academic Search

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, heterogeneous children, ages 3 to 25, were examined with respect to 21 potential predictors

Lisa Kurth; Robert Haussmann



Perinatal Pitocin as an Early ADHD Biomarker: Neurodevelopmental Risk?  

ERIC Educational Resources Information Center

|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,…

Kurth, Lisa; Haussmann, Robert



Customised birthweight standards accurately predict perinatal morbidity  

PubMed Central

Objective Fetal growth restriction is associated with adverse perinatal outcome but is often not recognised antenatally, and low birthweight centiles based on population norms are used as a proxy instead. This study compared the association between neonatal morbidity and fetal growth status at birth as determined by customised birthweight centiles and currently used centiles based on population standards. Design Retrospective cohort study. Setting Referral hospital, Barcelona, Spain. Patients A cohort of 13?661 non?malformed singleton deliveries. Interventions Both population?based and customised standards for birth weight were applied to the study cohort. Customised weight centiles were calculated by adjusting for maternal height, booking weight, parity, ethnic origin, gestational age at delivery and fetal sex. Main outcome measures Newborn morbidity and perinatal death. Results The association between smallness for gestational age (SGA) and perinatal morbidity was stronger when birthweight limits were customised, and resulted in an additional 4.1% (n?=?565) neonates being classified as SGA. Compared with non?SGA neonates, this newly identified group had an increased risk of perinatal mortality (OR 3.2; 95% CI 1.6 to 6.2), neurological morbidity (OR 3.2; 95% CI 1.7 to 6.1) and non?neurological morbidity (OR 8; 95% CI 4.8 to 13.6). Conclusion Customised standards improve the prediction of adverse neonatal outcome. The association between SGA and adverse outcome is independent of the gestational age at delivery.

Figueras, Francesc; Figueras, Josep; Meler, Eva; Eixarch, Elisenda; Coll, Oriol; Gratacos, Eduard; Gardosi, Jason; Carbonell, Xavier



Perinatal outcomes of failed vacuum extraction.  


The aims of this study were to compare the perinatal outcomes of successful vacuum extraction (VE) or failed VE and to compare the perinatal outcomes of failed VE followed by forceps delivery (FD) or Cesarean section (CS) from 2000 through 2007. Compared with cases of successful VE, cases of failed VE followed by CS had a significantly higher incidence of neonatal complications, whereas cases of failed VE followed by FD had a significantly higher incidence of maternal injury. Both CS and FD remain important yet distinct treatments for emergency cases of failed VE. Therefore, the decision to use a second instrument (FD) or to proceed to CS should be made in each case on the basis of these differences. PMID:22976607

Hiraizumi, Yoshie; Miura, Atsushi; Miyake, Hidehiko; Suzuki, Shunji



Perinatal care: cultural and technical differences between China and the United States.  


A comparison of perinatal care in the U.S. and China is presented. Perinatal care has made tremendous achievements in both countries since mid-century. However, the outcomes in the two cultures are different due to the different focus on caring concepts, the strengths of a nursing philosophy, and the emphasis on the nursing role in maternal care. Perinatal family in the U.S. will have advantages in perinatal education physical facilities, and a philosophy of care. North American women have greater access to early prenatal and continuing care, and less infant mortality. Chinese women have less access to qualified nursing services, higher infant mortality rates, and limited perinatal education. Overall, Chinese perinatal care is far behind that which is found in the U.S. This comparison analyzes the strengths and weaknesses in both cultures with a focus on change that will produce healthier and more consistent optimal outcomes. PMID:11982074

Liu, H G; Moore, J F



Estimates of illicit drug use during pregnancy by maternal interview, hair analysis, and meconium analysis  

Microsoft Academic Search

Objective: To compare the sensitivity and specificity of maternal interview, maternal hair analysis, and meconium analysis in detecting perinatal exposure to cocaine, opiate, and cannabinoid. Design\\/methods: The use of cocaine, opiate, and cannabinoid during pregnancy was determined prospectively in 58 women by 3 methods: structured maternal interview, maternal hair analysis, and meconium analyses. The results of the 3 methods were

Enrique M. Ostrea; D. Kirk Knapp; Libby Tannenbaum; Anthony R. Ostrea; Al Romero; Valiollah Salari; Joel Ager



Care for perinatal illness in rural Nepal: a descriptive study with cross-sectional and qualitative components  

Microsoft Academic Search

BACKGROUND: Maternal, perinatal and neonatal mortality rates remain high in rural areas of developing countries. Most deliveries take place at home and care-seeking behaviour is often delayed. We report on a combined quantitative and qualitative study of care seeking obstacles and practices relating to perinatal illness in rural Makwanpur district, Nepal, with particular emphasis on consultation strategies. METHODS: The analysis

Natasha Mesko; David Osrin; Suresh Tamang; Bhim P Shrestha; Dharma S Manandhar; Madan Manandhar; Anthony M de L Costello



Preterm birth--prediction, prevention, and consequences: an unmet challenge to perinatal medicine, science, and society: the declaration of Dubrovnik.  


Preterm birth is the defining challenge to modern perinatal medicine. It is now clear that preterm birth is not caused by one pathologic process but many, some not identified. Prevention of preterm birth is possible if perinatal medicine, science, and society give the necessary priority to this most urgent problem of maternal, fetal, and neonatal patients. PMID:20528219

Kurjak, Asim



National Vital Statistics Reports, Volume 57, Number 8, January 28, 2009. Fetal and Perinatal Mortality, United States, 2005.  

National Technical Information Service (NTIS)

This report presents 2005 fetal and perinatal mortality data by a variety of characteristics, including maternal age, marital status, race, Hispanic origin, and state of residence; and by fetal gestational age at delivery, birthweight, plurality, and sex....

M. F. MacDorman S. Kirmeyer



National Vital Statistics Reports, Volume 56, Number 3, October 11, 2007. Fetal and Perinatal Mortality, United States, 2004.  

National Technical Information Service (NTIS)

This report presents 2004 fetal and perinatal mortality data by a variety of characteristics, including maternal age, marital status, race, Hispanic origin and state of residence; and by infant birthweight, gestational age, plurality and sex. Trends in fe...

M. F. MacDorman M. L. Munson S. Kirmeyer



The spectrum of perinatal group B streptococcal disease.  


The progressive unfolding, over four decades, of an understanding of group B Streptococcus (GBS) and its global disease burden support the rationale for maternal immunization as a key strategy to prevent GBS perinatal infections. This review highlights, in historical context, the recognition of GBS as a human pathogen, definition of epidemiologic features of disease, pathogenesis, outcomes, impact of intrapartum antibiotic prophylaxis, development of glycoconjugate vaccines and appreciation of the global scope of GBS perinatal disease. These cumulative advances in the GBS field coupled with an increasing acceptance of immunization during pregnancy suggest the timing is optimal for introduction of a glycoconjugate GBS vaccine for use in pregnant women. PMID:23973344

Baker, Carol J



Perinatal nicotine-induced transgenerational asthma.  


Asthma is a major public health hazard worldwide. Its transgenerational inheritance has been inferred from epidemiological studies. More recently, using nicotine as a proxy for maternal smoking, we have demonstrated that an asthma-like phenotype can be inherited by rat offspring for up to two generations, i.e., multigenerationally, after the initial intrauterine exposure. We hypothesized that asthma transmission to offspring following perinatal nicotine exposure is not restricted up to F2 generation, but it also extends to subsequent generations. To test this hypothesis, using a well-established rat model of nicotine exposure-induced childhood asthma, we determined if perinatal nicotine exposure of F0 gestating dams would transmit asthma transgenerationally to F3 offspring. We now extend our findings to third-generation offspring, including abnormal pulmonary function, particularly as it relates to the occurrence in the upper airway exclusively in males, and to its effects on molecular functional markers (fibronectin and peroxisome proliferator-activated receptor ?), previously shown to be consistent with the asthma phenotype, herein expressed in fibroblasts isolated from the lung. These data, for the first time, demonstrate the transgenerational transmission of the asthma phenotype to F3 offspring following perinatal nicotine exposure of F0 dams. PMID:23911437

Rehan, Virender K; Liu, Jie; Sakurai, Reiko; Torday, John S



Serotonin reuptake inhibitor-induced perinatal complications.  


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

Gentile, Salvatore



The black box of perinatal ischemic stroke pathogenesis.  


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

Mineyko, Aleksandra; Kirton, Adam



Effects of perinatal exposure to bisphenol A on the behavior of offspring in F344 rats  

Microsoft Academic Search

The objective of this investigation is to evaluate whether perinatal maternal exposure to bisphenol A (BPA) at 4, 40, and 400 mg\\/kg per day affects the behavior of offspring in F344 rats. Perinatal BPA exposure inhibited the body weight increases of male and female offspring in a dose-dependent manner, which continued after weaning. Spontaneous activity analyses revealed that BPA elongated

Takayuki Negishi; Katsuyoshi Kawasaki; Atsushi Takatori; Yoshiyuki Ishii; Shigeru Kyuwa; Yoichiro Kuroda; Yasuhiro Yoshikawa



Training Health Care and Human Services Personnel in Perinatal Substance Abuse  

Microsoft Academic Search

\\u000a Perinatal substance abuse treatment is composed of overlapping areas: maternal and child health care, alcohol and other drug\\u000a abuse treatment, child abuse prevention, and domestic violence prevention. The field of perinatal substance abuse lies at\\u000a the intersection of the complex social, medical, and psychological needs of women who abuse substances before, during, and\\/or\\u000a after pregnancy, and the subsequent needs of

Kathleen J. Farkas


Perinatal Brain Damage Causation  

Microsoft Academic Search

The search for causes of perinatal brain damage needs a solid theoretical foundation. Current theory apparently does not offer a unanimously accepted view of what constitutes a cause, and how it can be identified. We discuss nine potential theoretical misconceptions: (1) too narrow a view of what is a cause (causal production vs. facilitation), (2) extrapolating from possibility to fact

Olaf Dammann; Alan Leviton



Family Planning as a Priority for Maternal and Child Health  

Microsoft Academic Search

Maternal, perinatal, Infant and child mortality rates in the developing world are significantly higher than in Industrialized countries. Much of this mortality is attributable to pregnancies “too young, too old, too many and too close.” It Is therefore obvious that the potential impact of family planning on maternal and child health can be immense. Such measures successfully implemented will improve

OAC Viegas; K Singh; SS Ratnam



The Perinatal Advantage of Mexican-Origin Latina Women  

Microsoft Academic Search

PURPOSE: To determine if there is a perinatal advantage for birth outcomes among Mexican-origin Latina (Latina) women compared to white non-Hispanic (white) women, after adjusting for maternal, paternal, and infant factors.METHODS: 1,439,583 births from the 1990–1993 California linked birth and infant death certificate data sets were analyzed for the risk of low birth weight infants and infant mortality.RESULTS: Latina women

Nancy A Hessol; Elena Fuentes-Afflick



The Parental Experience of Pregnancy after Perinatal Loss  

PubMed Central

Objective To review the research literature on the parental experience of pregnancy, primarily maternal, subsequent to perinatal loss. Data Sources Computerized searches on CINAHL and PubMed databases. Study Selection Articles from indexed journals relevant to the objective were reviewed from January 1997 to December 2007. Only research-based studies in English were included. Data Extraction The review was performed using the methodology of Whittemore and Knafl (2005). Data were extracted and organized under headings: author/year/setting; purpose; sample; design/instruments; results; and nursing implications for parents during a pregnancy following a perinatal loss. Data Synthesis Depression and anxiety are frequently seen in pregnant women subsequent to a perinatal loss. The parental experience is filled with intense and conflicting emotions as parents balance being hopeful while worrying about another potential loss. Conclusions It is important for health care providers to evaluate the woman's obstetric history, acknowledge and validate previous perinatal loss, and discuss with her what would be helpful during the prenatal period with respect to the previous perinatal loss.

Hill, Pamela D.; DeBackere, Katrina; Kavanaugh, Karen L.



Maternal-fetal transport. A nurse team.  


Northwestern Perinatal Center in Chicago, Illinois, developed and implemented a maternal-fetal transport system. The system is unique not only because it is in a metropolitan area but also because the transport teams are nurses only in more than 95% of the maternal-fetal transports. Rationale and design of the system, development of the team, discussion of problems, and certification process for nurses is presented. PMID:6562259

Reedy, N J; Alonso, B K; Bozzelli, J E; Depp, R


Prenatal depression predicts postpartum maternal attachment in low-income Latina mothers with infants  

Microsoft Academic Search

Although maternal attachment is an important predictor of infant attachment security and other developmental outcomes, little is known about the formation of maternal attachment in the first few months of the infant's life, particularly among ethnic minority mothers. The current study examined the predictors of postpartum maternal attachment in a sample of 217 Latina women enrolled in a perinatal depression

Deborah F. Perry; Anna K. Ettinger; Tamar Mendelson; Huynh-Nhu Le



Mothers of IVF twins: The mediating role of employment and social coping resources in maternal stress  

Microsoft Academic Search

Twin pregnancies and births resulting from assisted reproductive technologies (ART) have been associated with adverse perinatal outcomes and maternal health complications, leading to psychologically complex parenting. The current study assessed the prevalence of clinical levels of maternal stress among mothers of twins resulting from in vitro fertilization (IVF) and examined the associations of social coping resources with three maternal stress

Liora Baor; Varda Soskolne



Birth weight, maternal weight and childhood leukaemia  

Microsoft Academic Search

There is mounting evidence that childhood leukaemia is associated with high birth weight, but few studies have examined the relationship between leukaemia and other perinatal factors that influence birth weight, such as maternal weight or gestational weight gain. This case-cohort study included 916 acute lymphocytic leukaemia (ALL) and 154 acute myeloid leukaemia (AML) cases diagnosed prior to age 10 years

C C McLaughlin; M S Baptiste; M J Schymura; P C Nasca; M S Zdeb



Severe psychosocial stress and heavy cigarette smoking during pregnancy: an examination of the pre- and perinatal risk factors associated with ADHD and Tourette syndrome  

Microsoft Academic Search

Attention-deficit\\/hyperactivity disorder (ADHD) is frequently diagnosed in children with Tourette syndrome (TS). The basis\\u000a for this co-occurrence is uncertain. This study aimed to determine if specific pre- and perinatal risk factors, including\\u000a heavy maternal smoking and severe psychosocial stress during pregnancy, were associated with one or both disorders, or neither.\\u000a We compared maternal report data on pre- and perinatal risk

Maria G. Motlagh; Liliya Katsovich; Nancy Thompson; Haiqun Lin; Young-Shin Kim; Lawrence Scahill; Paul J. Lombroso; Robert A. King; Bradley S. Peterson; James F. Leckman



Perinatal outcomes of multiple births in southwest Nigeria.  


Compared to singletons, multiple births are associated with a substantially-higher risk of maternal and perinatal mortality worldwide. However, little evidence exists on the perinatal profile and risk of neurodevelopmental disabilities among the survivors, especially in developing countries. This cross-sectional study, therefore, set out to determine the adverse perinatal outcomes that are potential markers for neurodevelopmental disabilities in infants with multiple gestations in a developing country. In total, 4,573 mothers, and their 4,718 surviving offspring in an inner-city maternity hospital in Lagos, Nigeria, from May 2005 to December 2007, were recruited. Comparisons of maternal and infant outcomes between single and multiple births were performed using multivariable logistic regression and generalized estimation equation analyses. Odds ratio (OR) and the corresponding 95% confidence interval (CI) for each marker were estimated. Of the 4,573 deliveries, there were 4,416 (96.6%) singletons and 157 (3.4%) multiples, comprising 296 twins and six triplets together (6.4% of all live 4,718 infants). After adjusting for maternal age, ethnicity, occupation, parity, and antenatal care, multiple gestations were associated with increased risks of hypertensive disorders and caesarean delivery. Similarly, after adjusting for potential maternal confounders, multiple births were associated with low five-minute Apgar score (OR: 1.47, 95% CI 1.13-1.93), neonatal sepsis (OR: 2.16, 95% CI 1.28-3.65), severe hyperbilirubinaemia (OR: 1.60, 95% CI 1.00-2.56), and admission to a special-care baby unit (OR: 1.56, 95% CI 1.12-2.17) underpinned by preterm delivery before 34 weeks (OR: 1.91, 95% CI 1.14-3.19), birthweight of less than 2,500 g (OR: 6.45, 95% CI 4.80-8.66), and intrauterine growth restriction (OR: 9.04, 95% CI 6.62-12.34). Overall, the results suggest that, in resource-poor settings, infants of multiple gestations are associated with a significantly-elevated risk of adverse perinatal outcomes. Since these perinatal outcomes are related to the increased risk of later neurodevelopmental disabilities, multiple-birth infants merit close developmental surveillance for timely intervention. PMID:22283038

Olusanya, Bolajoko O



Regulation of Maternal Metabolism by Pituitary and Placental Hormones: Roles in Fetal Development and Metabolic Programming  

Microsoft Academic Search

This review outlines the regulation of maternal metabolism by hormones, cytokines and growth factors, highlighting recent studies that implicate disordered somatolactogen signalling in the pathogenesis of perinatal growth failure and the development of the metabolic syndrome.

M. Freemark



Regulation of maternal metabolism by pituitary and placental hormones: roles in fetal development and metabolic programming.  


This review outlines the regulation of maternal metabolism by hormones, cytokines and growth factors, highlighting recent studies that implicate disordered somatolactogen signalling in the pathogenesis of perinatal growth failure and the development of the metabolic syndrome. PMID:16612113

Freemark, M



Disasters and Perinatal Health: A Systematic Review  

PubMed Central

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.

Harville, EW; Xiong, X; Buekens, P



[Preventive vaccination strategy during the perinatal period].  


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

Pinquier, Didier; Gagneur, Amaud; Gaudelus, Joël; Marret, Stéphane



Excitotoxicity in Perinatal Brain Injury  

Microsoft Academic Search

Excitotoxicity is an important mechanism involved in perinatal brain injuries. Gluta- mate is the major excitatory neurotransmitter, and most neurons as well as many oligo- dendrocytes and astrocytes possess receptors for glutamate. Perinatal insults such as hypoxia-ischemia, stroke, hypoglycemia, kernicterus, and trauma can disrupt synaptic function leading to accumulation of extracellular glutamate and excessive stimulation of these receptors. The activities

Michael V. Johnston



Informed Decision Making in Maternity Care  

PubMed Central

In the United States, federal acts and regulations, as well as professional guidelines, clearly dictate that every pregnant woman has the right to base her maternity care decisions on accurate, up-to-date, comprehensible information. Despite these efforts, evidence suggests that informed consent within current health-care practice is restricted and inconsistently implemented. Patient access to evidence-based research is imperative under the scope of informed consent and is particularly important during a time when perinatal mortality and morbidity rates, interventions, and disparities are on the rise in the United States. This article describes the Coalition for Improving Maternity Services’ investigation of the breakdown of informed consent in maternity care.

Goldberg, Holly



Perinatal lethal Gaucher disease.  


Perinatal Lethal Gaucher Disease (PLGD) is a rare form of Gaucher disease and is often considered a distinct form of type 2 Gaucher disease. The authors report on an infant who presented with progressive hepatosplenomegaly, ichthyosis, generalized skin edema and neonatal encephalopathy and died at 6 h of age. Autopsy revealed massive hepatosplenomegaly, ichthyosis, a diffuse collodion picture and histological evidence of infiltration by Gaucher cells in the liver, spleen, lung, thymus, lymph node and bone marrow. Genetic testing of the parents revealed both to be carriers of Gaucher disease. PMID:20924719

Plakkal, Nishad; Soraisham, Amuchou Singh; Jirapradittha, Junya; Pinto-Rojas, Alfredo



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

PubMed Central

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.



A subsidized perinatal care program in a rural Colorado county.  


A large number of medically indigent women in rural areas currently receive little or no prenatal care, raising major concerns regarding perinatal health. In Colorado, subsidized prenatal and labor/delivery programs have been instituted to address this problem. This article describes the implementation of two programs in one rural county. In these rural programs, private physicians, health department personnel, and social work staff at the local hospital collaborate to provide financial assistance, comprehensive health education, and quality medical care for eligible pregnant women. The identified benefits and barriers unique to the provision of quality perinatal care in rural settings are discussed. PMID:10296595

Main, D S; Tressler, C J; Calonge, N; Joffe, L; Robichaux, A



Perinatal Exposure to High-Fat Diet Programs Energy Balance, Metabolism and Behavior in Adulthood  

PubMed Central

The perinatal environment plays an important role in programming many aspects of physiology and behavior including metabolism, body weight set point, energy balance regulation and predisposition to mental health-related disorders such as anxiety, depression and attention deficit hyperactivity disorder. Maternal health and nutritional status heavily influence the early environment and have a long-term impact on critical central pathways, including the melanocortinergic, serotonergic system and dopaminergic systems. Evidence from a variety of animal models including rodents and nonhuman primates indicates that exposure to maternal high-fat diet (HFD) consumption programs offspring for increased risk of adult obesity. Hyperphagia and increased preference for fatty and sugary foods are implicated as mechanisms for the increased obesity risk. The effects of maternal HFD consumption on energy expenditure are unclear, and future studies need to address the impact of perinatal HFD exposure on this important component of energy balance regulation. Recent evidence from animal models also indicates that maternal HFD consumption increases the risk of offspring developing mental health-related disorders such as anxiety. Potential mechanisms for perinatal HFD programming of neural pathways include circulating factors, such as hormones (leptin, insulin), nutrients (fatty acids, triglycerides and glucose) and inflammatory cytokines. As maternal HFD consumption and obesity are common and rapidly increasing, we speculate that future generations will be at increased risk for both metabolic and mental health disorders. Thus, it is critical that future studies identify therapeutic strategies that are effective at preventing maternal HFD-induced malprogramming.

Sullivan, Elinor L.; Smith, M. Susan; Grove, Kevin L.



Perinatal outcomes of prenatal probiotic and prebiotic administration: an integrative review.  


The purpose of this integrative review was to identify, critique, and synthesize the maternal and neonatal evidence on the prenatal use of probiotics and prebiotics to inform perinatal health professionals. A comprehensive literature search resulted in 37 studies of prenatal probiotics and 1 on antepartal prebiotics published from 1990 through 2011 that reported maternal, fetal, and/or neonatal outcomes. The methodologic quality of the studies reviewed was high, although investigators used different probiotic combinations and inconsistently reported perinatal clinical outcomes. The extraction of perinatal outcome variables resulted in identification of 9 maternal and 5 neonatal categories. Prenatal probiotics significantly reduced the incidence of bacterial vaginosis, increased colonization with vaginal Lactobacillus and intestinal Lactobacillus rhamnosus, altered immune markers in serum and breast milk, improved maternal glucose metabolism, and reduced the incidence of gestational diabetes and preeclampsia. Antepartally, probiotics were associated with significantly higher counts of Bifidobacterium and Lactococcus lactis (healthy intestinal flora) in neonatal stool. Prenatal prebiotics significantly increased maternal intestinal Bifidobacterium. No adverse events were reported and there was evidence of safety and tolerance of prenatal probiotics and prebiotics in the scientific investigations reviewed. It is recommended that in future investigations of prenatal probiotics researchers explicitly report maternal and neonatal outcomes. PMID:24164813

Vandevusse, Leona; Hanson, Lisa; Safdar, Nasia


Early intervention and perinatal depression: is there a need for provider training?  

Microsoft Academic Search

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 visitors, which provides an excellent opportunity for identification, referral

Elizabeth Thomason; Ann M. Stacks; Judith Fry McComish



Racial variation in the association between gestational age and perinatal mortality: prospective study  

Microsoft Academic Search

Objectives To determine if the risks of perinatal mortality and antepartum stillbirth associated with post term birth increase earlier during pregnancy in South Asian and black women than in white women, and to investigate differences in the factors associated with antepartum stillbirth between the racial groups.Design Prospective study using logistic regression analysis.Setting 15 maternity units in northwest London from 1988

Imelda Balchin; John C Whittaker; Roshni R Patel; Ronald F Lamont; Philip J Steer



Perinatal Complications in Births to Low Socioeconomic Status Schizophrenic and Depressed Women  

Microsoft Academic Search

Pregnancy and birth complications in births to 57 schizophrenic, 28 depressed, and 31 well women were studied. The sample was of low socioeconomic status and predominantly African-American. The study extended earlier work on the perinatal status of infants born to schizophrenic women by including measures of severity of maternal disturbance, mother's age, IQ, and premorbid social competence, and family composition.

Sherryl H. Goodman; Eugene K. Emory



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

ERIC Educational Resources Information Center

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…

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



Perinatal Exposure to High-Fat Diet Programs Energy Balance, Metabolism and Behavior in Adulthood  

Microsoft Academic Search

The perinatal environment plays an important role in programming many aspects of physiology and behavior including metabolism, body weight set point, energy balance regulation and predisposition to mental health-related disorders such as anxiety, depression and attention deficit hyperactivity disorder. Maternal health and nutritional status heavily influence the early environment and have a long-term impact on critical central pathways, including the

Elinor L. Sullivan; M. Susan Smith; Kevin L. Grove



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

ERIC Educational Resources Information Center

|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…

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



Can managed care networks improve perinatal mental healthcare for Black and minority ethnic (BME) women?  

Microsoft Academic Search

Purpose – Perinatal mental illness is an important public health issue. Conditions such as postnatal depression increase mothers' risk of suicide and can herald onset of recurrent and chronic mental health problems. Maternal mental illness can also adversely impact the cognitive, physical, and psychological health and development of children. In light of known psychosocial risks, there is concern that fewer

Dawn Edge



Pregnancy and Perinatal Outcomes Associated with Acinetobacter baumannii Infection  

PubMed Central

Objective?To determine perinatal and pregnancy outcomes of Acinetobacter baumannii infection using clinicopathologic material from pregnant women, neonates, and perinatal postmortem examinations with positive cultures. Study Design?This is a retrospective record review with placental and postmortem examination. Results?During a 5-year period, 40 positive cultures were found. Three pregnancies with positive cultures close in the peripartum period were all associated with adverse outcomes including spontaneous abortion, preterm labor, and one full-term birth with histological chorioamnionitis. Two positive cultures were found in preterm neonates in the neonatal intensive care unit. Two of three cases of perinatal death grew pure cultures from blood and/or fetal tissue with placental or fetal examination demonstrating evidence of infection/inflammation with fetal inflammatory response. Conclusion?This is the first case series report of A. baumannii-positive cultures in maternal, fetal, and neonatal specimen, with histopathologic evidence of infection. The results suggest a significant role of A. baumannii infection in adverse pregnancy and perinatal outcomes.

He, Mai; Kostadinov, Stefan; Gundogan, Fusun; Struminsky, Judith; Pinar, Halit; Sung, C. James



Perinatal transmission of human papilomavirus DNA  

PubMed Central

The purpose was to study the perinatal transmission of human papillomavirus DNA (HPV-DNA) in 63 mother-newborn pairs, besides looking at the epidemiological factors involved in the viral DNA transmission. The following sampling methods were used: (1) in the pregnant woman, when was recruited, in cervix and clinical lesions of the vagina, vulva and perineal region; (2) in the newborn, (a) buccal, axillary and inguinal regions; (b) nasopharyngeal aspirate, and (c) cord blood; (3) in the children, buccal was repeated in the 4th week and 6th and 12th month of life. HPV-DNA was identified using two methodologies: multiplex PCR (PGMY09 and MY11 primers) and nested-PCR (genotypes 6/11, 16, 18, 31, 33, 42, 52 and 58). Perinatal transmission was considered when concordance was found in type-specific HPV between mother/newborn or mother/child. HPV-DNA genital was detected in 49 pregnant women submitted to delivery. Eleven newborns (22.4%, n = 11/49) were HPV-DNA positive. In 8 cases (16.3%, n = 8/49) there was type specific HPV concordance between mother/newborn samples. At the end of the first month of life three children (6.1%, n = 3/49) became HPV-DNA positive, while two remained positive from birth. In 3 cases (100%, n = 3/3) there was type specific HPV concordance between mother/newborn samples. In the 6th month, a child (2%, n = 1/49) had become HPV-DNA positive between the 1st and 6th month of life, and there was type specific HPV concordance of mother/newborn samples. All the HPV-DNA positive children (22.4%, n = 11/49) at birth and at the end first month of life (6.1%, n = 3/49) became HPV-DNA negative at the age of 6 months. The HPV-DNA positive child (2%, n = 1/49) from 1st to the 6th month of life became HPV-DNA negative between the 6th and 12th month of life and one child had anogenital warts. In the twelfth month all (100%, n = 49/49) the children studied were HPV-DNA negative. A positive and significant correlation was observed between perinatal transmission of HPV-DNA and the immunodepression of maternal variables (HIV, p = 0.007). Finally, the study suggests that perinatal transmission of HPV-DNA occurred in 24.5% (n = 12/49) of the cases studied.

Rombaldi, Renato L; Serafini, Eduardo P; Mandelli, Jovana; Zimmermann, Edineia; Losquiavo, Kamille P



Perinatal Grief in Latino Parents  

PubMed Central

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.

Whitaker, Claudia; Kavanaugh, Karen; Klima, Carrie



Perinatal Progesterone and Gender Differentiation.  

National Technical Information Service (NTIS)

The effects of perinatal progesterone, haloperidol, alpha-methyl-para-tyrosine, and apomorphine on sex differentiation in rats was studied. All treatments, including those designed to facilitate masculine development, have impaired it. The significance of...

E. M. Hull



Ethics and maternity care: from principles to practice.  


In this column, the associate editor of The Journal of Perinatal Education (JPE) discusses the decision to devote an issue of JPE to the ethics of childbirth and maternity care. The current crisis in maternity care mandates a careful look at the ethical principles that provide the foundation for practice. The contents of this special issue include: a broad overview of ethics of childbearing, historical perspectives and contemporary understanding of informed decision making, the ethical issues faced by childbirth educators, and the challenges and moral distress experienced by childbirth educators and other maternity care providers when their values, beliefs, and ethical standards are in conflict with standard maternity care practices. PMID:19415107

Lothian, Judith A



Twisted Maternalism  

Microsoft Academic Search

Much of the recent work on Palestinian female suicide bombers (shahidas) explains their violence in domestic and maternal language. These descriptions read shockingly similar to the maternalist position. Maternalism typically equates women's participation in the political arena with peace and non-violence, and is criticized for essentializing women's role. The application of a ‘twisted’ maternalism to women's political violence also appears

Caron E. Gentry



Fetal arrhythmia: prenatal diagnosis and perinatal management.  


The importance of managing fetal arrhythmia has increased over the past three decades. Although most fetal arrhythmias are benign, some types cause fetal hydrops and can lead to fetal death. With the aim of improving the outcome in such cases, various studies for prenatal diagnosis and perinatal management have been published. Detailed analysis of the type of arrhythmia in utero is possible using M-mode and Doppler echocardiography. In particular, a simultaneous record of Doppler waveform at the superior venous cava and the ascending aorta has become an important and useful method of assessing the interval between atrial and ventricular contractions. Common causes of fetal tachycardia (ventricular heart rate faster than 180 bpm), are paroxysmal supraventricular tachycardia (SVT) with 1:1 atrioventricular (AV) relation and atrial flutter with 2:1 AV relation. Of fetal SVT, short ventriculo-atrial (VA) interval tachycardia due to atrioventricular reentrant tachycardia is more common than long VA interval. Most fetuses with tachycardia are successfully treated in utero by transplacental administration of antiarrhythmic drugs. Digoxin is widely accepted as a first-line antiarrhythmic drug. Sotalol, flecainide and amiodarone are used as second-line drugs when digoxin fails to achieve conversion to sinus rhythm. Fetal bradycardia is diagnosed when the fetal ventricular heart rate is slower than 100 bpm, mainly due to AV block. Approximately half of all cases are caused by associated congenital heart disease, and the remaining cases that have normal cardiac structure are often caused by maternal SS-A antibody. The efficacy of prenatal treatment for fetal AV block is limited compared with treatment for fetal tachycardia. Beta stimulants and steroids have been reported as effective transplacental treatments for fetal AV block. Perinatal management based on prospective clinical study protocol rather than individual experience is crucial for further improvement of outcome in fetuses with tachycardia and bradycardia. PMID:19751319

Maeno, Yasuki; Hirose, Akiko; Kanbe, Taro; Hori, Daizo



Perinatal mortality in a first generation immigrant population and its relation to unemployment in The Netherlands.  

PubMed Central

STUDY OBJECTIVE--To consider the association between biological and social risk factors and perinatal mortality in an ethnically mixed population in Amsterdam, The Netherlands. DESIGN--This was a matched case-control study. Cases included all registered stillborn infants and all registered liveborn infants who died within seven days of birth. Controls were selected from infants remaining alive. Each case was matched with two controls by date of registration. SETTING--Civil registry of births and deaths, Amsterdam, The Netherlands, 1975-80. PATIENTS--All 666 babies who died in the perinatal period and 1332 controls selected from the liveborn survivors. OUTCOME--Perinatal mortality. MAIN RESULTS--Perinatal mortality was independently associated with the father's and mother's employment status, maternal age, parity, and infant sex, but not with the father's or mother's country of birth. CONCLUSIONS--Employment status and not country of birth should be the main focus in studies of perinatal mortality in this population of mixed ethnicity. Future studies on selected behavioural, socio-economic, and cultural factors are needed to provide a better understanding of the causes of increased perinatal mortality among families in which the parents are unemployed.

Lumey, L H; Reijneveld, S A



Perinatal Outcomes Among Foreign-Born and US-Born Chinese Americans, 1995–2000  

Microsoft Academic Search

This paper examines nativity differences in adverse perinatal outcomes of Chinese-American mothers. Singleton live births\\u000a to US-resident Chinese women (150,620 foreign-born, 15,040 US-born) and a random sample of 150,620 non-Hispanic White mothers\\u000a were selected from 1995 to 2000 national linked birth\\/infant death certificate files. Associations between maternal nativity\\u000a status and adverse perinatal outcomes were assessed using multivariable logistic regressions. Compared

Qing Li; Louis G. Keith; Russell S. Kirby



Health related quality of life across the perinatal period among Australian women.  


AIMS AND OBJECTIVES: To investigate the significant features in health-related quality of life and to examine the changes over time during the perinatal period. BACKGROUND: Health-related quality of life during the perinatal period is significant for women. Screening or surveillance during the perinatal period is inconsistent and often not part of continued assessment. DESIGN: Prospective. METHODS: Setting involved antenatal clinics at three public hospitals in metropolitan Brisbane, Australia. A total of 363 participants out of a cohort of 605 women completed all items of the Short Form-12 Health Survey in late pregnancy and again at 6 and 12 weeks postpartum. RESULTS: There was a significant difference across the three perinatal time periods in all the health-related quality-of-life subscales. Significant improvements were noted from late pregnancy to 6 weeks following childbirth and again at 12 weeks particularly in physical health, role physical, bodily pain, vitality, role emotional and mental health. Even when confounding variables such as maternal ages, partner status, parity, delivery type and ethnicity were introduced, significant improvements were noted. Maternal distress significantly related to almost all quality-of-life factors over time even when all possible confounding factors were controlled. CONCLUSION: Significant changes occur in health-related quality of life across the perinatal period. All dimensions of health-related quality of life except for social functioning and maternal distress showed marked improvement following childbirth. During this period, maternal distress was negatively related to health-related quality of life. RELEVANCE TO CLINICAL PRACTICE: Nurses need to be mindful of the broader view of health as encompassed in health-related quality-of-life measures and the potential these have for alerting health professionals when providing care. More rigorous health assessment for mothers at risk is useful so that appropriate support and follow-up can be given. PMID:23750859

Emmanuel, Elizabeth N; Sun, Jing



Microbiome Aspects of Perinatal and Neonatal Health  

PubMed Central

Our human cells are outnumbered ten to one by bacterial cells. For this reason, the role of microorganisms, specifically bacteria, in health and disease has brought forth intense research via the Human Microbiome Project (HMP). The HMP is a National Institutes of Health sponsored effort to build upon the Human Genome Project in understanding human genetic and physiologic diversity. Perinatal and neonatal health represents areas of high importance for knowledge generated by the HMP as the microbiome is largely influenced during pregnancy, birth, and the neonatal period by nutrition, lifestyle, environmental factors of care, and the administration of medications, specifically antibiotics. As nurses have a depth of expertise in these areas, they will make a significant contribution towards better understanding the role of the microbiome in disease, and how to manipulate the microbiome to advantage patients towards health. This paper describes the human microbiome and why it is important to overall health and disease. Three major unsolved problems in perinatal and neonatal health including (i) preterm birth; (ii) the neonatal consequences of vaginal versus cesarean birth; and (iii) neonatal gastrointestinal disease, specifically, necrotizing enterocolitis, are discussed in the context of current and future research on the human microbiome.

Gregory, Katherine E.



Regional perinatal mortality differences in the Netherlands; care is the question  

PubMed Central

Background Perinatal mortality is an important indicator of health. European comparisons of perinatal mortality show an unfavourable position for the Netherlands. Our objective was to study regional variation in perinatal mortality within the Netherlands and to identify possible explanatory factors for the found differences. Methods Our study population comprised of all singleton births (904,003) derived from the Netherlands Perinatal Registry for the period 2000–2004. Perinatal mortality including stillbirth from 22+0 weeks gestation and early neonatal death (0–6 days) was our main outcome measure. Differences in perinatal mortality were calculated between 4 distinct geographical regions North-East-South-West. We tried to explain regional differences by adjustment for the demographic factors maternal age, parity and ethnicity and by socio-economic status and urbanisation degree using logistic modelling. In addition, regional differences in mode of delivery and risk selection were analysed as health care factors. Finally, perinatal mortality was analysed among five distinct clinical risk groups based on the mediating risk factors gestational age and congenital anomalies. Results Overall perinatal mortality was 10.1 per 1,000 total births over the period 2000–2004. Perinatal mortality was elevated in the northern region (11.2 per 1,000 total births). Perinatal mortality in the eastern, western and southern region was 10.2, 10.1 and 9.6 per 1,000 total births respectively. Adjustment for demographic factors increased the perinatal mortality risk in the northern region (odds ratio 1.20, 95% CI 1.12–1.28, compared to reference western region), subsequent adjustment for socio-economic status and urbanisation explained a small part of the elevated risk (odds ratio 1.11, 95% CI 1.03–1.20). Risk group analysis showed that regional differences were absent among very preterm births (22+0 – 25+6 weeks gestation) and most prominent among births from 32+0 gestation weeks onwards and among children with severe congenital anomalies. Among term births (? 37+0 weeks) regional mortality differences were largest for births in women transferred from low to high risk during delivery. Conclusion Regional differences in perinatal mortality exist in the Netherlands. These differences could not be explained by demographic or socio-economic factors, however clinical risk group analysis showed indications for a role of health care factors.

Tromp, Miranda; Eskes, Martine; Reitsma, Johannes B; Erwich, Jan Jaap HM; Brouwers, Hens AA; Rijninks-van Driel, Greta C; Bonsel, Gouke J; Ravelli, Anita CJ



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

ERIC Educational Resources Information Center

|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…

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.



Maternal and Fetal Well-being  

PubMed Central

Pregnancy outcomes can be improved by following modern recommendations for personal health maintenance. Adequate caloric intake, reflected by a weight gain of about 10 to 12.3 kg (22 to 27 lb) for women of average build, is associated with the lowest rate of perinatal mortality. Maternal dietary protein supplementation should generally be avoided because it may be associated with low-birth-weight pregnancies. Abstinence from social drugs offers the greatest positive opportunity to modify the health of a fetus. Serious perinatal infection can be prevented by preconception immunization (rubella), food hygiene (toxoplasmosis) and attention to the expression of virus in the mother (herpes simplex). Available data do not correlate exercise programs begun before pregnancy and continued during pregnancy with adverse fetal effects. Athletic capacity need not diminish postpartum. Most employment may safely continue until delivery. Routine recommendations for prolonged maternal disability leaves are not medically warranted.

Shy, Kirk K.; Brown, Zane A.



[Perinatal obsessive-compulsive disorder].  


A perinatal obsessive-compulsive disorder (OCD) is defined as an illness exhibiting first symptoms in the context of pregnancy and the postpartal period. There are no valid data up to date concerning the incidence of OCD, which might be of multifactorial origin, in this period in which females are highly vulnerable for psychiatric diseases. From a clinical point of view, obsessions and compulsions are mainly related to the well-being of the foetus or newborn baby. Differential diagnosis of perinatal OCD including pregnancy psychosis and post-partum depression is often difficult. Concerning treatment, non-pharmacological approaches should be preferred. Administration of SSRIs should be strongly restricted. However, there are no controlled therapy studies in patients with perinatal OCD. Furthermore, current knowledge about these patients is still limited. The aim of this review article is the presentation of phenomenology, pathogenesis, differential diagnosis and treatment of perinatal OCD. The mental situation of the female patients can be improved and stabilised if early diagnosis of a perinatal OCD leads to early initiation of an adequate therapy. This will then enable a good and stable mother-child relationship to develop. PMID:21830184

Mavrogiorgou, P; Illes, F; Juckel, G



Preventing newborn infection with maternal immunization.  


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

Black, Steven; Margarit, Immaculada; Rappuoli, Rino



Maternal anxiety and infants' hippocampal development: timing matters  

PubMed Central

Exposure to maternal anxiety predicts offspring brain development. However, because children's brains are commonly assessed years after birth, the timing of such maternal influences in humans is unclear. This study aimed to examine the consequences of antenatal and postnatal exposure to maternal anxiety upon early infant development of the hippocampus, a key structure for stress regulation. A total of 175 neonates underwent magnetic resonance imaging (MRI) at birth and among them 35 had repeated scans at 6 months of age. Maternal anxiety was assessed using the State-Trait Anxiety Inventory (STAI) at week 26 of pregnancy and 3 months after delivery. Regression analyses showed that antenatal maternal anxiety did not influence bilateral hippocampal volume at birth. However, children of mothers reporting increased anxiety during pregnancy showed slower growth of both the left and right hippocampus over the first 6 months of life. This effect of antenatal maternal anxiety upon right hippocampal growth became statistically stronger when controlling for postnatal maternal anxiety. Furthermore, a strong positive association between postnatal maternal anxiety and right hippocampal growth was detected, whereas a strong negative association between postnatal maternal anxiety and the left hippocampal volume at 6 months of life was found. Hence, the postnatal growth of bilateral hippocampi shows distinct responses to postnatal maternal anxiety. The size of the left hippocampus during early development is likely to reflect the influence of the exposure to perinatal maternal anxiety, whereas right hippocampal growth is constrained by antenatal maternal anxiety, but enhanced in response to increased postnatal maternal anxiety.

Qiu, A; Rifkin-Graboi, A; Chen, H; Chong, Y-S; Kwek, K; Gluckman, P D; Fortier, M V; Meaney, M J



Maternal anxiety and infants' hippocampal development: timing matters.  


Exposure to maternal anxiety predicts offspring brain development. However, because children's brains are commonly assessed years after birth, the timing of such maternal influences in humans is unclear. This study aimed to examine the consequences of antenatal and postnatal exposure to maternal anxiety upon early infant development of the hippocampus, a key structure for stress regulation. A total of 175 neonates underwent magnetic resonance imaging (MRI) at birth and among them 35 had repeated scans at 6 months of age. Maternal anxiety was assessed using the State-Trait Anxiety Inventory (STAI) at week 26 of pregnancy and 3 months after delivery. Regression analyses showed that antenatal maternal anxiety did not influence bilateral hippocampal volume at birth. However, children of mothers reporting increased anxiety during pregnancy showed slower growth of both the left and right hippocampus over the first 6 months of life. This effect of antenatal maternal anxiety upon right hippocampal growth became statistically stronger when controlling for postnatal maternal anxiety. Furthermore, a strong positive association between postnatal maternal anxiety and right hippocampal growth was detected, whereas a strong negative association between postnatal maternal anxiety and the left hippocampal volume at 6 months of life was found. Hence, the postnatal growth of bilateral hippocampi shows distinct responses to postnatal maternal anxiety. The size of the left hippocampus during early development is likely to reflect the influence of the exposure to perinatal maternal anxiety, whereas right hippocampal growth is constrained by antenatal maternal anxiety, but enhanced in response to increased postnatal maternal anxiety. PMID:24064710

Qiu, A; Rifkin-Graboi, A; Chen, H; Chong, Y-S; Kwek, K; Gluckman, P D; Fortier, M V; Meaney, M J



Association between Method of Delivery and Puerperal Infectious Complications in the Perinatal Database of Baden-Württemberg 1998–2001  

Microsoft Academic Search

The strongest argument against caesarean delivery relates to maternal complications. Evidence supporting this for elective operations is controversial. The perinatal database 1998–2001 of the German state of Baden-Württemberg was studied to assess the maternal obstetrical risk associated with caesarean delivery with regard to puerperal infectious complications. For statistical analysis the ?2 test, Fisher’s exact test, Mantel-Haenszel statistics and relative risks

E. Simoes; S. Kunz; F. W. Schmahl



Perinatal complications of assisted reproduction.  


The main perinatal complications of assisted reproduction include congenital malformation, chromosomal aberrations, multiple pregnancy, and prematurity. Earlier studies and in vitro fertilization (IVF) registries showed that there was no increased incidence of congenital malformations in children conceived by IVF/intracytoplasmic sperm injection (ICSI). However, a large Australian study has found that by one year of age, the incidence of congenital malformations in IVF/ICSI children is increased in comparison with those naturally conceived. Several investigators found a slight but increased risk of chromosomal aberrations in ICSI children. Multiple pregnancy is a major cause of increased perinatal mortality due to increased incidence of both prematurity and congenital malformations. Even in singleton pregnancies conceived by assisted reproductive technologies, the risk of prematurity and newborns small for gestational age is increased. In this article, recently published work on perinatal complications associated with assisted reproductive technologies is reviewed. PMID:16158467

Aboulghar, Mohamed A



Requesting perinatal autopsy: multicultural considerations.  


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

Chichester, Melanie


[Maternal phenylketonuria].  


Elevated maternal phenylalanine levels during pregnancy are teratogenic, and may result in embryo-foetopathy, which could lead to stillbirth, significant psychomotor handicaps and birth defects. This foetal damage is known as maternal phenylketonuria. Women of childbearing age with all forms of phenylketonuria, including mild variants such as hyperphenylalaninaemia, should receive detailed counselling regarding their risks for adverse foetal effects, optimally before contemplating pregnancy. The most assured way to prevent maternal phenylketonuria is to maintain the maternal phenylalanine levels within the optimal range already before conception and throughout the whole pregnancy. Authors review the comprehensive programme for prevention of maternal phenylketonuria at the Metabolic Center of Budapest, they survey the practical approach of the continuous maternal metabolic control and delineate the outcome of pregnancies of mothers with phenylketonuria from the introduction of newborn screening until most recently. PMID:23628728

Bókay, János; Kiss, Erika; Simon, Erika; Sz?nyi, László



A collaborative care telemedicine intervention to overcome treatment barriers for Latina women with depression during the perinatal period.  


Maternal depression is highly prevalent (10-20%) 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. The Perinatal Mental Health (PMH) model was designed to ameliorate the barriers that prevent adequate diagnoses and intervention. The PMH is a culturally sensitive, short-term telemedicine, 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 in obstetric care settings. This article describes the feasibility and acceptability of using the PMH. Participants (N = 79) were selected from a 1st-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

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



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

PubMed Central

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.

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



Women's health groups to improve perinatal care in rural Nepal  

PubMed Central

Background Neonatal mortality rates are high in rural Nepal where more than 90% of deliveries are in the home. Evidence suggests that death rates can be reduced by interventions at community level. We describe an intervention which aimed to harness the power of community planning and decision making to improve maternal and newborn care in rural Nepal. Methods The development of 111 women's groups in a population of 86 704 in Makwanpur district, Nepal is described. The groups, facilitated by local women, were the intervention component of a randomized controlled trial to reduce perinatal and neonatal mortality rates. Through participant observation and analysis of reports, we describe the implementation of this intervention: the community entry process, the facilitation of monthly meetings through a participatory action cycle of problem identification, community planning, and implementation and evaluation of strategies to tackle the identified problems. Results In response to the needs of the group, participatory health education was added to the intervention and the women's groups developed varied strategies to tackle problems of maternal and newborn care: establishing mother and child health funds, producing clean home delivery kits and operating stretcher schemes. Close linkages with community leaders and community health workers improved strategy implementation. There were also indications of positive effects on group members and health services, and most groups remained active after 30 months. Conclusion A large scale and potentially sustainable participatory intervention with women's groups, which focused on pregnancy, childbirth and the newborn period, resulted in innovative strategies identified by local communities to tackle perinatal care problems.

Morrison, Joanna; Tamang, Suresh; Mesko, Natasha; Osrin, David; Shrestha, Bhim; Manandhar, Madan; Manandhar, Dharma; Standing, Hilary; Costello, Anthony



[Pregnancy and perinatality: biological follow-up].  


Blood and urinary tests which are necessary for pregnancy diagnosis and follow-up, for newborn and mother medical supervision, during the month following birthday, are today described in reglementary texts, laws, and recommendations such as advised medical references (RMO). These documents specify the nature of obligatory tests, the checking rhythm and the list of useless tests. hCG research remains necessary for pregnancy diagnosis, but hCG dosage is essential only in case of programmed medical assistance or pathological pregnancy (extrauterine pregnancy, hydatiform mole, choriocarcinoma). The obligatory follow-up of a pregnant woman includes determination of blood groups, research of infectious agents responsible for diseases (toxoplasmosis, rubeola, hepatitis B, syphilis), proteinuria and glycosuria research and blood count according to a given calendar. When the mother's condition is bad and reminiscent of a pathological pregnancy, when a genetic risk exists for the fetus or when fetal growth is abnormal as indicated by echographic control (intra-uterine growth retardation), laboratory tests are used to follow the maternal pathological course (arterial hypertension, diabetes mellitus, anemia, bacterial, viral or parasitic disease), to verify the existence of a genetic disease, to know about the fetal functional state (by amniocentesis or cordocentesis), to identify an erythrocyte fetomaternal incompatibility. Since last trimester pregnancy accidents are able to endanger mother's and fetus lives, the feto-maternal follow-up must be adjusted to pathological diagnosis types and requires a particular supervision of the delivery. Finally mother and child must undergo a post-natal follow-up during the four weeks after birthday (perinatality control). PMID:9309227

Badonnel, Y; Berland, M; Lacroix, I; Patricot, M C; Revol, A


Perinatal exposure of rats to Bisphenol A affects fertility of male offspring--an overview.  


Endocrine disruptors (ED) induce both functional and behavioral reproductive abnormalities. Bisphenol A (BPA) is a known ED that leaches from polycarbonate plastics, as such human exposure is common. Maternal BPA exposure has been shown to have negative effects on the fertility of male offspring. Pregnant rats exposed perinatally to environmentally relevant doses of BPA gave birth to offspring with significantly impaired spermatogenesis and fertility. Perinatal exposure had deleterious effects on the male germ line which manifested as impairments in the fertility of F(1) male offspring and subsequent F(2) and F(3) generations. This overview is an attempt to summarize the currently available data in the literature with regards to perinatal BPA exposure and male fertility. PMID:20965246

Salian, Smita; Doshi, Tanvi; Vanage, Geeta



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

PubMed Central

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.

Westmoreland, Marcia Haskins; Zwelling, Elaine



Occupation and risk of cesarean section: study based on the perinatal survey of Baden-Württemberg, Germany  

Microsoft Academic Search

Objectives: The aim of this study was to assess the current influence of educational attainment and occupation on maternal obstetrical risk associated with cesarean section under the conditions of an industrial- ized country and provision of universal coverage. Materials and methods: The perinatal survey data 1998- 2001 of the German state of Baden-Wurttemberg were studied comparing method of delivery for

Elisabeth Simoes; Siegfried Kunz; Margarete Bosing-Schwenkglenks; Friedrich-Wilhelm Schmahl



Perinatal mortality in hypertensive disorders of Jewish and Bedouin populations.  


The aim of this study was to retrospectively compare the perinatal mortality of Jewish and Bedouin hypertensive patients in the Southern area of Israel. Since almost 100% of the deliveries took place in the Soroka Medical Center, the sole hospital of the area, the computerized files of our department during 5 years (1986-1990) were used in the study. Data on the frequency of hypertensive disorder types, rates of stillbirths and neonatal deaths, maternal age and parity, pre-term and term deliveries, prenatal care, intrauterine growth retardation, mode of delivery and fetal sex, were analysed according to ethnicity. Among a total of 40,780 deliveries, 2343 were of hypertensive pregnancies. No difference in the prevalence of hypertensive disorders was found between Jewish and Bedouin women. Perinatal mortality in Jewish hypertensive women was 16.8/1,000 compared with 11.8/1,000 in normotensive, while among the Bedouins the rates were 44.4/1,000 and 22.9/1,000, respectively. In both populations half the rate of perinatal deaths were stillbirths, except among the Jewish hypertensive patients whose fetal deaths reached 72%. Of the risk factors examined the rate of inadequate prenatal care was higher among Bedouins than in Jews. Among women without prenatal care the Jewish hypertensives had a relative risk of 5.29 for perinatal mortality, compared to normotensive pregnant women, whereas in the Bedouins the relative risk was 2.54. Ethnicity was found not to have influence on the prevalence of hypertensive disorders among Jewish and Bedouin pregnant women.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8335133

Leiberman, J R; Kasis, A; Shoham-Vardi, I



Perinatal exposure to bisphenol-A impairs learning-memory by concomitant down-regulation of N-methyl- d -aspartate receptors of hippocampus in male offspring mice  

Microsoft Academic Search

Bisphenol-A (BPA) has been shown to influence development of the brain and behaviors. The purpose of the present report was to investigate the effects of perinatal exposure to BPA on learning\\/memory and its mechanism of action, especially focusing on N-methyl-d-aspartate receptor (NMDAR). Perinatal maternal exposure to BPA at 0.5, 5, and 50mg\\/kg\\/d significantly extended the escape length to find the

Xiao-hong Xu; Jing Zhang; Ya-min Wang; Yin-ping Ye; Qing-qing Luo



Prenatal and Perinatal Complications: Is It the Link Between Race and SES and Childhood Sleep Disordered Breathing?  

PubMed Central

Study Objectives: Recent evidence has suggested that low socioeconomic status (SES), race, prematurity, and maternal smoking during pregnancy are associated with childhood sleep disordered breathing (SDB). We investigated (1) the association of SDB with a wide range of risk factors, including prenatal and perinatal complications; (2) the association of these complications with SES and race; and (3) the association of SDB with developmental milestones. Methods: Six hundred thirteen school-aged children (105 clinically referred and 508 community control subjects) underwent overnight polysomnography and had a complete history and physical examination. A comprehensive child development questionnaire was completed by a parent. We compared clinically referred children with SDB to population-based control children without SDB from The Penn State Children's Cohort. Results: Maternal smoking during pregnancy; maternal age and weight gain during pregnancy; prenatal complications, such as maternal high blood pressure and gestational diabetes; perinatal complications related to prematurity; delayed motor milestones; race and SES were significantly associated with the presence of childhood SDB. Most of the risk factors became nonsignificant when analyses controlled for race and SES. Delayed motor milestones remained significantly associated with SDB after controlling for race and SES. Conclusion: These data suggest that there is a significant association between children who experience prenatal or perinatal distress and the development of moderate to severe childhood SDB. SES and race may be mediating the impact on SDB through increased prenatal and perinatal risks. The significant delay in motor milestones suggests that prenatal and perinatal distress may result in neurologic insult, which could influence the development of SDB in later childhood. Citation: Calhoun SL; Vgontzas AN; Mayes SD; Tsaoussoglou M; Sauder K; Mahr F; Karippot A; Wisner K; Bixler EO. Prenatal and perinatal complications: is it the link between race and SES and childhood sleep disordered breathing? J Clin Sleep Med 2010;6(3):264-269.

Calhoun, Susan L.; Vgontzas, Alexandros N.; Mayes, Susan D.; Tsaoussoglou, Marina; Sauder, Katherine; Mahr, Fauzia; Karippot, Anoop; Wisner, Krista; Bixler, Edward O.



Perinatal Complications of Assisted Reproduction  

Microsoft Academic Search

The main perinatal complications of assisted reproduction include congenital malformation, chromo- somal aberrations, multiple pregnancy, and prematurity. Earlier studies and in vitro fertilization (IVF) registries showed that there was no increased incidence of congenital malformations in children con- ceived by IVF\\/intracytoplasmic sperm injection (ICSI). However, a large Australian study has found that by one year of age, the incidence of

Mohamed A. Aboulghar


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


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

Boo, N Y; Lye, M S



Impact of Placental Plasmodium falciparum Malaria on Pregnancy and Perinatal Outcome in Sub-Saharan Africa  

PubMed Central

Placental malaria is one of the major features of malaria during pregnancy and has been widely used as a standard indicator to characterize malaria infection in epidemiologic investigations. Although pathogenesis of placental malaria is only partially understood, placental sequestration of Plasmodium falciparum results in the accumulation of parasitized erythrocytes in the intervillous space, infiltration by inflammatory cells, and release of pro-inflammatory mediators, which cause pathologic alterations that could impair materno-fetal exchanges, often resulting in adverse pregnancy outcome. In this report, the impact of placental malaria on pregnancy and perinatal outcome is reviewed using data from studies conducted in sub-Saharan Africa. Generally, placental malaria was associated with increased risk of maternal anemia, HIV infection, and maternal mortality, with younger women and primigravidae more likely to be affected. A variety of adverse perinatal outcomes, including low birth weight, preterm delivery, intrauterine growth retardation, reduced fetal anthropometric parameters, fetal anemia, congenital malaria, increased mother-to-child HIV transmission, and perinatal mortality, were associated with placental malaria. There were, however, conflicting reports on whether the risk of these adverse perinatal outcomes associated with placental malaria were statistically significant. There is a clear need to strengthen the malaria prevention and intervention measures for pregnant women in sub-Saharan Africa.

Uneke, Chigozie J.



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


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

Abdul Kader, H



A hierarchical model for the location of perinatal facilities in the municipality of Rio de Janeiro  

Microsoft Academic Search

Abstract We present a 3-level hierarchical model,for the location of maternal,and perinatal health care facilities in Rio de Janeiro. Relaxations and,heuristics are developed,for this model,and,computational,results are given for problems available in the literature, for networks ranging from 10 to 400 vertices. The quality of the solutions produced by the procedures,we developed,do not differ significantly among,themselves. The model,is also applied to

Roberto D. Galvão; Luis Gonzalo Acosta Espejo; Brian Boffey



Disseminating Perinatal Depression Screening as a Public Health Initiative: A Train-the-Trainer Approach  

Microsoft Academic Search

This case report describes the development and implementation of the Train-the-Trainer: Maternal Depression Screening Program (TTT), a novel approach to disseminating perinatal depression screening. We trained screeners according to a standard pyramid scheme\\u000a of train-the-trainer programs: three experts trained representatives from health care agencies (the TTT trainers), who in\\u000a turn trained their staff and implemented depression screening at their home

Lisa S. SegreRebecca; Rebecca L. Brock; Michael W. O’Hara; Laura L. Gorman; Jane Engeldinger


Factors affecting perinatal morbidity and mortality in pregnancies complicated by diabetes mellitus in Sudan  

Microsoft Academic Search

To investigate the influence of obstetric factors and indices of maternal metabolic control on perinatal morbidity and mortality, 88 diabetic pregnant Sudanese women (type 1, n=38; type 2, n=31; gestational diabetes, n=19) and 50 non-diabetic pregnant control women were studied. The mean fasting blood glucose was 11.1±2.8 mmol\\/l and the mean HbA1c at booking interview was 8.8±2.1% in the diabetic

M Abdelgadir; M Elbagir; A Eltom; M Eltom; C Berne



Family size and perinatal circumstances, as mental health risk factors in a Scottish birth cohort  

Microsoft Academic Search

Purpose  Higher maternal parity and younger maternal age have each been observed to be associated with subsequent offspring suicidal\\u000a behaviour. This study aimed to establish if these, and other variables from the perinatal period, together with family size,\\u000a are also associated with other psychiatric morbidity.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Linked datasets of the Scottish Morbidity Record and Scottish death records were used to follow up,

Daniel Vincent Riordan; Carole Morris; Joanne Hattie; Cameron Stark


Perinatal characteristics among early (10-14 years old) and late (15-19 years old) pregnant adolescents  

PubMed Central

Background Pregnancy in adolescents is a worldwide health problem and has been mostly common in poor populations. It is not clear if socioeconomic or biological factors are the main determinants of perinatal adverse outcomes in pregnant adolescents. Adolescents under 15 years old may present a high growth rate which may contribute to impair fetal growth. Our aim is to compare perinatal characteristics among early (aged 10 to 14 years) and late (aged 15 to 19 years) pregnant adolescents. Methods A cross-sectional study was performed using data from Pernambuco State 2009, obtained from DATASUS/SISNAC, a Brazilian Government, open-access public health database. Maternal and neonatal outcomes were compared between early (aged 10–14 years) and late (aged 15–19 years) pregnant adolescents. Family income was compared between early and late pregnant adolescents using a sample of 412 subjects evaluated at Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) during 2011. Statistical comparisons were made using the chi-square test was used with a significant level of 0.05; bivariate and multivariate analysis were performed. This project was approved by the Institutional Ethics Review Board. Results Data from 31,209 pregnant adolescents were analyzed. 29,733 (95.2%) were aged 15 to 19 years and 1,476 (4.7%) were aged 10 to 14 years. There were significant differences with respect to marital status, education level and number of prenatal visits of mothers aged 10 to 14 years compared to 15 to 19 years. Of importance, early adolescents had a greater rate of neonates born premature and with low birth weight. Prematurity and low birth weight remained statistically significant after multivariate analysis. Conclusions Early aged adolescents may have an increased risk of prematurity and low birth weight. These findings highlight the potential role of biological factors in newborn outcomes in pregnant adolescents.



Effects of epidermal growth factor on ornithine decarboxylase activity and DNA synthesis in rats during the perinatal period.  


The effects of epidermal growth factor (EGF) on ornithine decarboxylase (ODC) activity and DNA synthesis were studied during the perinatal period in rats. EGF administration to neonatal rats increased ODC activity and DNA synthesis in neonatal rat liver, but not in brain. EGF administration to maternal rats increased ODC activity in maternal rat liver, but not in rat placenta and fetal rat liver. These data suggest that EGF has mitogenic effects on neonatal and maternal rat liver and play some important roles in fetal and neonatal growth. PMID:8353159

Yamamoto, D; Hiramatsu, Y; Eguchi, K; Kudo, T



Umbilical Cord Coiling Index and Perinatal Outcome  

PubMed Central

Objectives: To evaluate the perinatal outcome with the abnormal umbilical cord coiling index. Study Design: This prospective study was carried out in the department of OBG at Adichunchangiri Institute of Medical Sciences, B.G.Nagara, Mandya, Karnataka, India from January 2008 to August 2010. 200 patients who were in active labour with term gestations, irrespective of their parities, who had singleton pregnancies with live babies who were either delivered by vaginal or LSCS were included in the study. Umbilical cord coiling index was calculated and it was correlated with various perinatal parameters like birth weight, meconium stained liquor, Apgar score, ponderal index and foetal growth restriction. Chi square and Fisher exact tests were used to find the significance of study parameters. Results: There was a significant correlation between the hypercoiled cords (UCI >90th percentile) and IUGR of the babies (p value of < 0.001) and low ponderal indices (a p value of 0.022) Hypocoiled cords ( UCI which was < 10th percentile) were significantly associated with meconium staining (p < 0.001), Apgar score at 1 min of <4 and at 5 min of <7 (p value 0.065), LSCS rates (p value of 0.008) and NICU admissions (p <0.001). Conclusion: Hypercoiled cords or UCI which was > 90th percentile was associated with IUGR and low ponderal indices. Hypocoiled cords or UCI which was <10th percentile was associated with meconium staining, Apgar score at 1 min of <4 and at 5 min of <7, more LSCS rates and more NICU admissions.

Patil, Nivedita S.; Kulkarni, Sunanda R.; Lohitashwa, Renu



Effect of Older Maternal Age on the Risk of Spontaneous Preterm Labor: A Population-Based Study  

Microsoft Academic Search

To determine if older maternal age (35 years and older) at first birth was an independent risk factor for spontaneous preterm labor, we conducted a retrospective population-based cohort study. Using provincial perinatal data, we developed separate risk models for low- and high-risk women using multivariate logistic regression. We found that older maternal age exerted a direct and independent effect on

Safina Hassan Mcintyre; Christine V. Newburn-Cook; Beverley OBrien; Nestor N. Demianczuk



Maternal education in relation to early and late child health outcomes: Findings from a Brazilian cohort study  

Microsoft Academic Search

In a population-based cohort of approximately 6000 Brazilian children, the associations between maternal education and a number of child health outcomes were studied while controlling for potentially confounding variables such as family income and education of the husband. In the crude analyses, maternal education was associated with perinatal and infant mortality, hospital admissions in the first 20 months of life

Cesar G. Victoria; Sharon R. A. Huttly; Fernando C. Barros; Cintia Lombardi; J. Patrick Vaughan



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


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 ? (ER?) 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 ? 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 ER? 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 ER? expression levels led by perinatal daidzein exposure. PMID:23268192

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



Early postpartum maternal morbidity among rural women of Rajasthan, India: a community-based study.  


The first postpartum week is a high-risk period for mothers and newborns. Very few community-based studies have been conducted on patterns of maternal morbidity in resource-poor countries in that first week. An intervention on postpartum care for women within the first week after delivery was initiated in a rural area of Rajasthan, India. The intervention included a rigorous system of receiving reports of all deliveries in a defined population and providing home-level postpartum care to all women, irrespective of the place of delivery. Trained nurse-midwives used a structured checklist for detecting and managing maternal and neonatal conditions during postpartum-care visits. A total of 4,975 women, representing 87.1% of all expected deliveries in a population of 58,000, were examined in their first postpartum week during January 2007-December 2010. Haemoglobin was tested for 77.1% of women (n=3,836) who had a postnatal visit. The most common morbidity was postpartum anaemia--7.4% of women suffered from severe anaemia and 46% from moderate anaemia. Other common morbidities were fever (4%), breast conditions (4.9%), and perineal conditions (4.5%). Life-threatening postpartum morbidities were detected in 7.6% of women--9.7% among those who had deliveries at home and 6.6% among those who had institutional deliveries. None had a fistula. Severe anaemia had a strong correlation with perinatal death [p<0.000, adjusted odds ratio (AOR)=1.99, 95% confidence interval (CI) 1.32-2.99], delivery at home [p<0.000, AOR=1.64 (95% CI 1.27-2.15)], socioeconomically-underprivileged scheduled caste or tribe [p<0.000, AOR=2.47 (95% CI 1.83-3.33)], and parity of three or more [p<0.000, AOR=1.52 (95% CI 1.18-1.97)]. The correlation with antenatal care was not significant. Perineal conditions were more frequent among women who had institutional deliveries while breast conditions were more common among those who had a perinatal death. This study adds valuable knowledge on postpartum morbidity affecting women in the first few days after delivery in a low-resource setting. Health programmes should invest to ensure that all women receive early postpartum visits after delivery at home and after discharge from institution to detect and manage maternal morbidity. Further, health programmes should also ensure that women are properly screened for complications before their discharge from hospitals after delivery. PMID:22838163

Iyengar, Kirti



Early Postpartum Maternal Morbidity among Rural Women of Rajasthan, India: A Community-based Study  

PubMed Central

The first postpartum week is a high-risk period for mothers and newborns. Very few community-based studies have been conducted on patterns of maternal morbidity in resource-poor countries in that first week. An intervention on postpartum care for women within the first week after delivery was initiated in a rural area of Rajasthan, India. The intervention included a rigorous system of receiving reports of all deliveries in a defined population and providing home-level postpartum care to all women, irrespective of the place of delivery. Trained nurse-midwives used a structured checklist for detecting and managing maternal and neonatal conditions during postpartum-care visits. A total of 4,975 women, representing 87.1% of all expected deliveries in a population of 58,000, were examined in their first postpartum week during January 2007–December 2010. Haemoglobin was tested for 77.1% of women (n=3,836) who had a postnatal visit. The most common morbidity was postpartum anaemia—7.4% of women suffered from severe anaemia and 46% from moderate anaemia. Other common morbidities were fever (4%), breast conditions (4.9%), and perineal conditions (4.5%). Life-threatening postpartum morbidities were detected in 7.6% of women—9.7% among those who had deliveries at home and 6.6% among those who had institutional deliveries. None had a fistula. Severe anaemia had a strong correlation with perinatal death [p<0.000, adjusted odds ratio (AOR)=1.99, 95% confidence interval (CI) 1.32-2.99], delivery at home [p<0.000, AOR=1.64 (95% CI 1.27-2.15)], socioeconomically-underprivileged scheduled caste or tribe [p<0.000, AOR=2.47 (95% CI 1.83-3.33)], and parity of three or more [p<0.000, AOR=1.52 (95% CI 1.18-1.97)]. The correlation with antenatal care was not significant. Perineal conditions were more frequent among women who had institutional deliveries while breast conditions were more common among those who had a perinatal death. This study adds valuable knowledge on postpartum morbidity affecting women in the first few days after delivery in a low-resource setting. Health programmes should invest to ensure that all women receive early postpartum visits after delivery at home and after discharge from institution to detect and manage maternal morbidity. Further, health programmes should also ensure that women are properly screened for complications before their discharge from hospitals after delivery.



Perinatal tuberculosis associated hemophagocytic lymphohistiocytosis.  


Hemophagocytic lymphohistiocytosis [HLH] is a reactive disorder characterized by generalised non-malignant histiocytic proliferation with prominent hemophagocytosis. It may be either primary [familial (FLH)] or secondary [infection or malignancy associated]. Organisms incriminated for infection associated hemophagocytic syndrome (IAHS) include viruses, bacteria, spirochetes, fungi and parasites. Reports of IAHS associated with tuberculosis in neonates are rare. The authors report a case of perinatal tuberculosis presenting as hemophagocytic lymphohistiocytosis. PMID:22246612

Maheshwari, Prabhat; Chhabra, Rajiv; Yadav, Padam



Informed decision making in maternity care.  


In the United States, federal acts and regulations, as well as professional guidelines, clearly dictate that every pregnant woman has the right to base her maternity care decisions on accurate, up-to-date, comprehensible information. Despite these efforts, evidence suggests that informed consent within current health-care practice is restricted and inconsistently implemented. Patient access to evidence-based research is imperative under the scope of informed consent and is particularly important during a time when perinatal mortality and morbidity rates, interventions, and disparities are on the rise in the United States. This article describes the Coalition for Improving Maternity Services' investigation of the breakdown of informed consent in maternity care. PMID:19436598

Goldberg, Holly



Maternal mortality.  


This article comments on the causes of maternal mortality which are considered preventable if reproductive health services is adequately provided among women belonging to reproductive age. A report from the UN International Children's Emergency Fund announced that 585,000 women die each year from pregnancy and childbirth, which is a 20% increase from the estimates made a decade ago. About 140,000 maternal mortality victims die from violent hemorrhaging, while others perish from blood infections, obstructive deliveries, brain and kidney diseases, and self-administered abortions. It has also been discovered that for every maternal death in childbirth 30 more are grievously wounded. Modest improvements on modern obstetric facilities and proper sanitation and training have been found to dramatically decrease maternal injury and death rates. A foreign aid bill has also been passed to provide a US$600 million fund to address the health issues of both women and children. PMID:12295799



Applying the Net-Benefit Framework for Analyzing and Presenting Cost-Effectiveness Analysis of a Maternal and Newborn Health Intervention  

PubMed Central

Background Coverage of maternal and newborn health (MNH) interventions is often influenced by important determinants and decision makers are often concerned with equity issues. The net-benefit framework developed and applied alongside clinical trials and in pharmacoeconomics offers the potential for exploring how cost-effectiveness of MNH interventions varies at the margin by important covariates as well as for handling uncertainties around the ICER estimate. Aim We applied the net-benefit framework to analyze cost-effectiveness of the Skilled Care Initiative and assessed relative advantages over a standard computation of incremental cost effectiveness ratios. Methods Household and facility surveys were carried out from January to July 2006 in Ouargaye district (where the Skilled Care Initiative was implemented) and Diapaga (comparison site) district in Burkina Faso. Pregnancy-related and perinatal mortality were retrospectively assessed and data were collected on place of delivery, education, asset ownership, place, and distance to health facilities, costs borne by households for institutional delivery, and cost of standard provision of maternal care. Descriptive and regression analyses were performed. Results There was a 30% increase in institutional births in the intervention district compared to 10% increase in comparison district, and a significant reduction of perinatal mortality rates (OR 0.75, CI 0.70?0.80) in intervention district. The incremental cost for achieving one additional institutional delivery in Ouargaye district compared to Diapaga district was estimated to be 170 international dollars and varied significantly by covariates. However, the joint probability distribution (net-benefit framework) of the effectiveness measure (institutional delivery), the cost data and covariates indicated distance to health facilities as the single most important determinant of the cost-effectiveness analysis with implications for policy making. Conclusion The net-benefit framework, the application of which requires household-level effects and cost data, has proven more insightful (than traditional ICER) in presenting and interpreting cost-effectiveness results of the Skilled Care Initiative.

Hounton, Sennen; Newlands, David



Perinatal-lethal Gaucher disease.  


Gaucher disease is a lysosomal storage disease caused by glucocerebrosidase deficiency. Although purely visceral in most cases, some Gaucher disease patients have neurological signs. Signs of Gaucher disease appear after a symptom-free period, except in rare cases with fetal onset. The description of such cases was based mainly on single reports and siblings. We report here a series of perinatal-lethal Gaucher disease cases highlighting the specificity of this phenotype. We retrospectively studied eight original cases of proven Gaucher disease with fetal onset. Non-immune hydrops fetalis was present in all cases but one, and associated with hepatosplenomegaly, ichthyosis, arthrogryposis, and facial dysmorphy. The similarities between our cases and 33 previously described cases allow us to better delineate the perinatal-lethal Gaucher disease phenotype. Hydrops fetalis, in utero fetal death and neonatal distress are prominent features. When hydrops is absent, neurological involvement begins in the first week and leads to death within three months. Hepatosplenomegaly is a major sign, and associated with ichthyosis, arthrogryposis, and facial dysmorphy in some 35-43% of cases. Perinatal-lethal Gaucher disease is a specific entity defined by its particular course and signs that are absent in classical type 2 Gaucher disease. Our study provides clues to the diagnosis of this likely underdiagnosed condition, which must be biochemically confirmed in order to propose appropriate genetic counselling. PMID:12838552

Mignot, C; Gelot, A; Bessières, B; Daffos, F; Voyer, M; Menez, F; Fallet Bianco, C; Odent, S; Le Duff, D; Loget, P; Fargier, P; Costil, J; Josset, P; Roume, J; Vanier, M T; Maire, I; Billette de Villemeur, T



Mental health functioning among children and adolescents with perinatal HIV infection and perinatal HIV exposure  

Microsoft Academic Search

Mental health problems (MHPs) among children with perinatal HIV infection have been described prior to and during the highly active antiretroviral therapy (HAART) era. Yet child, caregiver and socio-demographic factors associated with MHPs are not fully understood. We examined the prevalence of MHPs among older children and adolescents with perinatal HIV exposure, including both perinatally HIV-infected (PHIV + ) and

Kathleen M. Malee; Katherine Tassiopoulos; Yanling Huo; George Siberry; Paige L. Williams; Rohan Hazra; Renee A. Smith; Susannah M. Allison; Patricia A. Garvie; Betsy Kammerer; Suad Kapetanovic; Sharon Nichols; Russell van Dyke; George R. Seage III; Claude A. Mellins



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


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

Rebmann, Terri


Racial and ethnic disparities in perinatal mortality: applying the perinatal periods of risk model to identify areas for intervention.  

PubMed Central

OBJECTIVES: To determine the feto-infant mortality rate for New York City, assess racial/ethnic variations and identify areas for intervention using the Perinatal Periods of Risk (PPOR) approach. METHODS: The PPOR model examines fetal and infant deaths by age at death (fetal, neonatal, postneonatal) and birthweight (500-1499, > or =1500 g). It groups age at death and birthweight into four categories to identify problems hypothesized to lead to the death: factors related to Maternal Health and Prematurity, Maternal Care, Newborn Care and Infant Health. The model was applied to fetal and infant deaths occurring in New York City using Vital Records data from 1996-2000. Analysis was completed for the entire city and by race/ethnicity (white non-Hispanic, black non-Hispanic, Hispanic, Asians/Pacific Islander). RESULTS: The overall feto-infant mortality rate was 11.5/1,000 live births plus fetal deaths. This rate varied by race/ethnicity; black non-Hispanics had a higher rate than other racial/ethnic groups. Conditions related to maternal health and prematurity were the largest contributing factors to feto-infant mortality (5.9/1000) in New York City. Among blacks and Hispanics, problems related to maternal health and prematurity contributed a larger share than among whites and Asians/Pacific Islanders. CONCLUSION: The use of the PPOR approach shows that the racial/ethnic disparities in feto-infant mortality that exist in New York City are largely related to maternal health and prematurity. Interventions to reduce the feto-infant mortality rate should include preconception care and improvements in women's health.

Besculides, Melanie; Laraque, Fabienne



Preventing perinatal transmission of human immunodeficiency virus in the United States  

Microsoft Academic Search

Prenatal human immunodeficiency virus (HIV) testing and treatment instituted in the 1990s is responsible for a substantial reduction in the number of children diagnosed with AIDS, yet the number of children born with HIV infection remains unacceptably high. To prevent perinatal transmission of HIV, the United States must adopt a goal to test all pregnant women for HIV and to

Marie C McCormick; Ezra C Davidson; Michael A Stoto



Neonatal hyperthyrotropinemia in gestational diabetes mellitus and perinatal complications.  


The aim of this study is to explore the relationship between high cord blood thyroid-stimulating hormone (TSH) level and in-utero stress to the fetus in gestational diabetes mellitus (GDM). Cord blood TSH results were analyzed in 1,578 euthyroid infants from singleton pregnancies with GDM: 103 with elevated TSH (>16 mIU/l) and 1,475 with normal TSH. Maternal characteristics, pregnancy outcome and perinatal complications were compared between the two groups. Multiple logistic regression was used to study the association between high cord blood TSH level and various perinatal complications which reflect in-utero stress in GDM after adjusting for the confounding effects of parity, instrumental delivery, cesarean section and baby gender. High cord blood TSH level was found to be associated with the 1-min Apgar score <7 (OR 3.31, 95% CI 1.78-6.16), birth trauma (OR 3.44, 95% CI 1.11-10.69), neonatal jaundice requiring treatment (OR 2.08, 95% CI 1.30-3.32), neonatal sepsis (OR 2.34, 95% CI 1.24-4.42), respiratory complications (OR 3.45, 95% CI 1.37-8.70), neurological complications (OR 8.01, 95% CI 1.91-33.60) and overall perinatal morbidity (OR 2.41, 95% CI 1.58-3.67). Cord blood TSH level seems to be a better and independent indicator of the in-utero stress to the fetus in GDM when compared to the commonly used sugar profile result and HbA1c level. PMID:15475663

Leung, Wing Cheong; Chan, Karen K L; Lao, Terence T



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

PubMed Central

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.

Olivier, J. D. A.; Akerud, H.; Kaihola, H.; Pawluski, J. L.; Skalkidou, A.; Hogberg, U.; Sundstrom-Poromaa, I.



Major depressive disorder in the perinatal period: using data linkage to inform perinatal mental health policy.  


This study aims to investigate hospital admission of major depressive disorders (MDD) before and after birth. Population data for all primiparous women admitted to the hospital with depressive disorders before and after birth were used. The comparison group consisted of 10 % of primiparous women not admitted to the hospital with a diagnosis of a psychiatric disorder or substance use. A total of 728 women had a first admission with depressive disorders (501 in the first postpartum year). The rate of first hospital admission for depressive disorders decreased during pregnancy and increased markedly in the first three months after birth (peaking in the second month with a rate of 10.74/1,000 person year and rate ratio of 12.56) compared with the 6 months prior to pregnancy. Admission remained elevated in the second postpartum year. Older maternal age, smoking, elective caesarian section and admission to a neonatal intensive care unit or special care nursery were associated with a higher rate of admission. Women born outside Australia and those most socioeconomically disadvantaged were less likely to be admitted to the hospital in the first postpartum year. Overall risk of hospital admission with depressive disorders rose significantly across the entire first postpartum year. This has significant implications for policy and service planning for women with mood disorders in the perinatal period. PMID:22643848

Xu, Fenglian; Austin, Marie-Paule; Reilly, Nicole; Hilder, Lisa; Sullivan, Elizabeth A



Neurobehavioral and somatic effects of perinatal PCB exposure in rats  

SciTech Connect

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.

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



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


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

Derscheid, Rachel J; Ackermann, Mark R



Perinatal Lamb Model of Respiratory Syncytial Virus (RSV) Infection  

PubMed Central

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.

Derscheid, Rachel J.; Ackermann, Mark R.



Minimal Brain Dysfunction: Associations with Perinatal Complications.  

ERIC Educational Resources Information Center

Examined with over 28,000 7-year-old children whose mothers registered for prenatal care was the relationship between perinatal complications and such characteristics as poor school achievement, hyperactivity, and neurological soft signs associated with the diagnosis of minimal brain dysfunction (MBD). Ten perinatal antecedents were studied:…

Nichols, Paul L.


Guidelines for Perinatal Care. Second Edition.  

ERIC Educational Resources Information Center

|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…

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


Minimal Brain Dysfunction: Associations with Perinatal Complications.  

ERIC Educational Resources Information Center

|Examined with over 28,000 7-year-old children whose mothers registered for prenatal care was the relationship between perinatal complications and such characteristics as poor school achievement, hyperactivity, and neurological soft signs associated with the diagnosis of minimal brain dysfunction (MBD). Ten perinatal antecedents were studied:…

Nichols, Paul L.


Perinatal mortality and residential proximity to an industrial park.  


The authors' objective was to determine whether residential proximity to an industrial park (IP) is associated with increased perinatal mortality (PM). This semiecological study included 63,850 delivered births with 840 cases of PM (1995-2000). The authors categorized the study populations by ethnicity (ie, Bedouin and Jewish) and type of locality. Residential distance from the IP served as a surrogate indicator of exposure. Among Bedouin newborns, proximity to the IP was associated with increased PM rates (relative risk = 1.45; 95% confidence interval = 1.22-1.72). The excess in PM was not related to maternal or newborn physical characteristics that the authors observed. The risk of PM and its components in the Jewish localities was not associated with IP proximity. The association between residential proximity to the IP and excess in PM among only Bedouin newborns may be related to vulnerability caused by the nomadic nature of the society. PMID:18479994

Sarov, Batia; Bentov, Yaakov; Kordysh, Ella; Karakis, Isabella; Bolotin, Arkady; Hershkovitz, Reli; Belmaker, Ilana



Prenatal and perinatal factors associated with intellectual disability.  


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

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



Perinatal factors in neonatal and pediatric lung diseases.  


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 (ICU) 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

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



Perinatal mortality in rural Burkina Faso: a prospective community-based cohort study  

PubMed Central

Background There is a scarcity of reliable data on perinatal mortality (PNM) in Sub-Saharan Africa. The PROMISE-EBF trial, during which we promoted exclusive breastfeeding, gave us the opportunity to describe the epidemiology of PNM in Banfora Health District, South-West in Burkina Faso. Study objectives To measure the perinatal mortality rate (PNMR) in the PROMISE-EBF cohort in Banfora Health District and to identify potential risk factors for perinatal death. Methods We used data collected prospectively during the PROMISE-EBF-trial to estimate the stillbirth rate (SBR) and early neonatal mortality rate (ENMR). We used binomial regression with generalized estimating equations to identify potential risk factors for perinatal death. Results 895 pregnant women were enrolled for data collection in the EBF trial and followed-up to 7 days after birth. The PNMR, the SBR and the ENMR, were 79 per 1000 (95% CI: 59-99), 54 per 1000 (95% CI: 38-69) and 27 per 1000 (95% CI: 9-44), respectively. In a multivariable analysis, nulliparous women (RR = 2.90, 95% CI: 1.6-5.0), primiparae mothers (RR = 2.20, 95% CI: 1.2-3.9), twins (RR = 4.0, 95% CI: 2.3-6.9) and giving birth during the dry season (RR = 2.1 95% CI: 1.3-3.3) were factors associated with increased risk of perinatal death. There was no evidence that risk of perinatal death differed between deliveries at home and at a health centre Conclusion Our study observed the highest PNMR ever reported in Burkina. There is an urgent need for sustainable interventions to improve maternal and newborn health in the country.



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

PubMed Central

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.

Fr?en, 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



Comparison of Pregnancies between Perinatally and Sexually HIV-Infected Women: An Observational Study at an Urban Hospital  

PubMed Central

As perinatally HIV-infected (PHIV) women reach reproductive age, there is an increasing number who become pregnant. This is a retrospective cohort study of HIV-infected women who delivered from June 2007 to July 2012 at our institution. Maternal demographics, HIV characteristics, and obstetric and neonatal outcomes were compared. 20 PHIV and 80 SHIV pregnancies were reviewed. The groups had similar CD4+ counts, prevalence of AIDS, and use of antiretrovirals (ARV) at initiation of obstetrical care. PHIV women were significantly more likely to be younger, have a detectable viral load (35% versus 74%, P < 0.01), and have HIV-genotype resistance (40% versus 12%, P < 0.01) than the SHIV women. The median gestational age at delivery (38 weeks) and rates of obstetrical and neonatal complications were similar between the groups. While the overall rate of cesarean delivery (CD) was similar, the rates for CD due to HIV were higher in the PHIV group (64% versus 22%, P < 0.01). There was one case (5.3%) of mother-to-child transmission in the PHIV group versus two cases (2.6%) in the SHIV group. In our population, PHIV pregnant women have a higher rate of HIV-genotype resistance and higher rate of detectable viral load leading to a higher rate of CD secondary to HIV.

Badell, Martina L.; Kachikis, Alisa; Haddad, Lisa B.; Nguyen, Minh Ly; Lindsay, Michael



Perinatal Safety: From Concept to Nursing Practice  

PubMed Central

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 patient’s 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 nurse’s 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.

Kennedy, Holly Powell



Obstetric and perinatal complications in placentas with fetal thrombotic vasculopathy.  


Fetal thrombotic vasculopathy (FTV) is a placental lesion characterized by regionally distributed avascular villi and is often accompanied by upstream thrombosis in placental fetal vessels. Previous studies, using preselected populations, have shown associations of this lesion with adverse neurodevelopmental outcomes and potentially obstructive lesions of the umbilical cord. We investigated the prevalence of obstetric complications, perinatal disease, and placental abnormalities in cases with FTV. One hundred thirteen cases of placentas with FTV were identified in our pathology database over an 18-year period. Two hundred sixteen placentas without the diagnosis of FTV, frequency matched on year of birth, were selected as controls. Electronic medical records and pathology reports were used to extract maternal and gestational age, method of delivery, neonatal outcome, lesions of the umbilical cord, obstetric complications, and fetal abnormalities. Placentas with FTV were associated with a 9-fold increase in rate of stillbirth and a 2-fold increase in intrauterine growth restriction. The increase in pregnancy-induced hypertension/preeclampsia was not significant when adjusted for maternal and gestational age. Although the rate of potentially obstructive cord lesions was similar in both groups, there was an almost 6-fold increase in the presence of oligohydramnios in FTV placentas, compared with controls. Finally, FTV was associated with a 6-fold increase in fetal cardiac abnormalities. Fetal thrombotic vasculopathy is associated with a significantly higher rate of obstetric and perinatal complications. This study points to abnormal fetal circulation, either in the form of congenital heart disease or oligohydramnios predisposing to cord compression, as a risk factor for FTV. PMID:20438299

Saleemuddin, Aasia; Tantbirojn, Patou; Sirois, Kathleen; Crum, Christopher P; Boyd, Theonia K; Tworoger, Shelley; Parast, Mana M



Maternal Filicide  

Microsoft Academic Search

Having identified that most violent crime is carried out by men, feminists have recently called attention to the need to also bring a feminist analysis to violent crimes committed by women. This research examines data drawn from coroners court files in Victoria, Australia for the period 1978 to 1991 to explore scenarios of maternal filicide. The data are reviewed in

Christine M. Alder; June Baker



[Effect of high altitude on birth weight and adverse perinatal outcomes in two argentine populations].  


Introduction: Depending on the geographical altitude the purpose of this work was to analyze in two argentine populations the variation of birth weight (BW) and adverse perinatal outcomes, adjusting for maternal and obstetric factors. Material and Methods: Data from 4000 births in the provinces of Jujuy and 4000 in Buenos Aires (Sarda Maternity Hospital) (1996-2000) recruited and randomized from the Perinatal Information System was used. The data were grouped according to an altitudinal gradient composed by Sarda Maternity (20 masl) and the geographic regions of Jujuy province: Ramal (500 masl), Valle (1200 masl), Quebrada (2500 masl) and Puna (3500 masl). Outcome variables were BW > 3000 g, BW <2500 g, ponderal index (PI), prematurity, small for gestational age (SGA) and intrauterine growth restriction (FGR), while potentially confounding variables were: age, type of partner, education, overweight, obesity, smoking, hypertension, preeclampsia, urinary infection, growth restriction and cesarean section. Results: An increasing altitudinal gradient for adolescent mothers (<19years) and decreasing for the rest of the maternal obstetric variables was observed. The BW, BW>3000 g, BW<2500g and PI were negatively associated with altitude (p <0.001). Prematurity, SGA and FGR showed an opposite trend (p <0.001). Adjusted for confounding variables BW <3000 g, SGA, FGR<0.90 and PI <2.53 showed an increased risk with geographical altitude (p <0.05). Conclusions: Altitude was independently associated with BW restriction and adverse perinatal outcomes. Given the impact of BW reduction in the risk of chronic no communicable diseases this relationship in other populations, regardless of their location altitude, should be assess. PMID:24067588

Grandi, Carlos; Dipierri, Jose; Luchtenberg, Guillermo; Moresco, Angelica; Alfaro, Emma



Effect of Social Service Prenatal Care Utilization on Perinatal Outcomes among Women with Socioeconomic Problems in the Tokyo Metropolitan Area  

PubMed Central

Background. To investigate the effect of social service prenatal care (PNC) utilization on perinatal outcomes among women with socioeconomic problems in the Tokyo metropolitan area. Methods. Retrospective study. The study enrolled all women at our hospital who either attended PNC utilizing social services (attenders) or who did not attend PNC (nonattenders) between January 1, 2007, and December 31, 2010. We compared the maternal characteristics and perinatal outcome of attenders with those of nonattenders. Results. A total of 83 attenders and 45 nonattenders were enrolled. The mean gestational age at the first PNC visit was 31.1 weeks in the attenders. Attenders were found to have a lower incidence of preterm delivery, pregnancy-induced hypertension, emergency cesarean section, low birth weight, and the NICU admission than nonattenders (P < 0.05). Conclusions. The utilization of social service PNC greatly improved perinatal outcomes among women with socioeconomic problems problems in the Tokyo metropolitan area.

Kakogawa, Jun; Sadatsuki, Miyuki; Ogaki, Yoko; Nakanishi, Misao; Minoura, Shigeki



Effects of dehydration on endocrine regulation of the electrolyte and fluid balance and atrial natriuretic peptide-binding sites in perinatally malnourished adult male rats  

Microsoft Academic Search

Objective: The first aim of this work was to investigate, under basal conditions in adult male rats, the long-term consequences of perinatal maternal food restriction on the plasma concentrations of vaso- pressin (VP), aldosterone and atrial natriuretic peptide (ANP) and on plasma renin activity (PRA). Furthermore, under these same conditions, the hypothalamic VP gene expression as well as the density

Naima Sebaai; Jean Lesage; Abdelilah Alaoui; Jean-Paul Dupouy; Sylvie Deloof



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


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

Salih, Zeynep N Inanc; Boyle, David W



Assessing the relationship between maternal cigarette smoking during pregnancy and age at first police contact  

Microsoft Academic Search

Several types of pre- and perinatal risk factors, such as maternal cigarette smoking, are related to various manifestations of life-course-persistent criminal offending. Studies have reported evidence of a relationship between maternal prenatal cigarette smoking and antisocial\\/criminal behavior. All of these studies, however, used white male samles, thus limiting the generalizability of research findings. In an attempt to overcome this problem,

Chris L. Gibson; Alex R. Piquero; Stephen G. Tibbetts



Developing evidence-based maternity care in Iran: a quality improvement study  

Microsoft Academic Search

BACKGROUND: Current Iranian perinatal statistics indicate that maternity care continues to need improvement. In response, we implemented a multi-faceted intervention to improve the quality of maternity care at an Iranian Social Security Hospital. Using a before-and-after design our aim was to improve the uptake of selected evidence based practices and more closely attend to identified women's needs and preferences. METHODS:

Siamak Aghlmand; Feizollah Akbari; Aboulfath Lameei; Kazem Mohammad; Rhonda Small; Mohammad Arab



A five-year review of referrals for perinatal palliative care.  


Abstract Background: San Diego Hospice and the Institute for Palliative Medicine created one of the earliest perinatal palliative care programs in the country. Only four studies have reported outcomes for pregnant women referred to perinatal palliative care services for potentially lethal prenatal diagnoses. Objectives: To learn: (1) who is referred for perinatal palliative care at San Diego Hospice; (2) what happens after referral to perinatal palliative care; and (3) what happens after delivery for this population. Design: This was an exploratory retrospective electronic chart review of all patients referred to a home perinatal palliative program. Results: Sixty-six women were referred to the San Diego Hospice and the Institute for Palliative Care home perinatal palliative care program between October 2006 and August 2012. Mean age was 31 years. The majority of women were Hispanic, Christian/Catholic, married, with full prenatal care, and previous children. Average gestational age at referral was 27 (18-39] weeks. Thirty-two cases were referred for Trisomy 13, Trisomy 18, or anencephaly. Palliative care services were given over a mean 45 (0-132) days and 3 (0-12) visits prior to delivery. Most women completed a birth plan prior to delivery, chose palliative treatment only, and made final arrangements with the palliative team. Forty-one deliveries resulted in a liveborn infant. Twelve liveborn infants survived past 72 hours and were admitted to pediatric hospice care. Conclusions: One-third of women met with the palliative care team only once or twice prior to delivery, indicating a need for earlier referral to provide more comprehensive palliative care. PMID:24003992

Leong Marc-Aurele, Krishelle; Nelesen, Rick



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

PubMed Central

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.

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



[Perinatal audit: the most important legal aspects].  


In The Netherlands a perinatal audit system is being prepared. Perinatal audit is seen as a powerful means of identifying substandard factors in perinatal care and of increasing the quality of care with better grounding. The proposed system does not raise insurmountable legal problems. However, certain legal aspects should be given specific attention. These aspects include the rights of patients with respect to privacy and information and the protection of health professionals against use of information from the audit system for reasons other than quality purposes. Legislation from other countries may inspire legislative developments in The Netherlands in this area. PMID:19192588

de Roode, R P; Legemaate, J



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

ERIC Educational Resources Information Center

|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,…

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


Maternal obesity, associated complications and risk of prematurity  

Microsoft Academic Search

Objective:We aimed at (a) examining the rates of obesity over a 12-year period; (b) studying the effect of obesity and morbid obesity on gestational age and birth weight and (c) determining the influence of race on the association between maternal obesity and the gestational age of a newborn.Study Design:We conducted a retrospective analysis using data from the perinatal data set

H Aly; T Hammad; A Nada; M Mohamed; S Bathgate; A El-Mohandes



Maternal MTHFR polymorphisms and risk of spontaneous abortion  

Microsoft Academic Search

Objective. To asses the association between intake of folate and B vitamins and the incidence of spontaneous abortion (SA) according to the maternal methylenetetrahydrofolate reductase (MTHFR) polymorphisms (677 C>T and 1298 A>C). Material and Methods. We conducted a nested case-control study within a perinatal cohort of women re - cruited in the state of Morelos, Mexico. Twenty-three women with SA

María del Rosario Rodríguez-Guillén; Luisa Torres-Sánchez; Jia Chen; Marcia Galván-Portillo; Julia Blanco-Muñoz; Miriam Aracely Anaya; Irma Silva-Zolezzi; María A Hernández-Valero; Lizbeth López-Carrillo



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

ERIC Educational Resources Information Center

|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,…

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



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

ERIC Educational Resources Information Center

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,…

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



Velamentous cord insertion: significance of prenatal detection to predict perinatal complications.  


In the maternal and child health statistics of Japan for 2003, perinatal deaths were most frequent in pregnant women with abnormalities of the placenta, umbilical cord, and fetal membrane. Despite advances in perinatal medicine, approximately 2% of low-risk pregnant women still require an emergency cesarean section after the onset of labor. Because it is likely that half of these cases are associated with placental and umbilical cord abnormalities, it is thought that prenatal detection of such abnormalities would reduce the number of emergency cesarean sections in low-risk women. In our previous studies, some abnormalities of the placenta and umbilical cord were associated with abnormalities of cord insertion. Furthermore, we reported that prenatal detection of velamentous cord insertion (VCI) reduced the number of emergency cesarean sections in low-risk women. In this review, we describe the prenatal detection of abnormalities of umbilical cord insertion and the management of VCI based on our current clinical data. PMID:17272203

Hasegawa, Junichi; Matsuoka, Ryu; Ichizuka, Kiyotake; Sekizawa, Akihiko; Okai, Takashi



Liver morphologic analysis in perinatal autopsies with intrauterine stress liver morphology in perinatal autopsies.  


Quantify steatosis, fibrosis, and focuses of extramedullary erythropoiesis (ER) in the liver and report it to the causes of death in the perinatal. Morphologic analysis of steatosis', percentage of fibrosis, and ER of 467 perinatal autopsies. Cases with hypoxia/perinatal anoxia and ascending infection showed higher percentage of fibrosis. The number of ER was significantly higher among premature infants and in cases with infection. Our results contribute to a better quality of perinatal care through clinical demonstration of which injuries are associated with them, what may help in early diagnosis of these alterations in children who survive. PMID:22417002

Oliveira, Lívia Ferreira; da Silva Monteiro, Ana Paula Fernandes; Espindula, Ana Paula; Morais Pereira, Lívia Helena; Rocha, Laura Penna; de Oliveira Guimarães, Camila Souza; Cavellani, Camila Lourencini; Castro, Eumenia Costa da Cunha; Miranda Correa, Rosana Rosa



Neurodevelopmental consequences of maternal distress: what do we really know?  


A simple internet search of 'maternal stress and pregnancy' turns up hundreds of hits explaining that an adverse intrauterine environment can affect fetal development and potentially lead to various learning, behavioral, and mood disorders in childhood, as well as complex diseases such as obesity and cardiovascular conditions later in life. Indeed, a growing body of literature now links several intrauterine challenges, including maternal obesity and stress, with adverse developmental outcomes in the child. Over the past 5 years, nearly 5000 publications have explored the consequences of maternal distress on young offspring, a marked increase from the 475 published studies over a comparable period 20 years ago. Yet, despite this explosion of research and widespread warnings to pregnant mothers, we still lack a basic understanding of the pathophysiology linking adverse maternal health to the onset of disease in the child, especially regarding how prenatal and perinatal challenges might affect brain development. Recent studies have begun to explore the cellular basis of the abnormal brain cytoarchitecture associated with fetal exposure to intrauterine challenges. Here, our goal is to review the scientific evidence that maternal distress interferes with key neurodevelopmental steps, as an entry point toward mapping the pathophysiology of pre- and perinatal stress on the unborn child's brain. PMID:23140231

Schuurmans, C; Kurrasch, D M



Perinatal dioxin exposure and later effects--a review.  


Negative effects of perinatal exposure to background levels of dioxins and PCBs in Europe and the USA have been documented. Four facets of development are reviewed in this paper: 1. Brain development and thyroid hormone metabolism. 2. Hepatic effects. 3. Hematopoietic system effects. 4. Lung function. Effects on IQ and behaviour have been documented in children on both sides of the Atlantic Ocean. Non-dioxin-like PCBs, measured in maternal and cord blood and current plasma samples have been implicated. Interference with thyroid hormone metabolism in the mother, in the foetus and in the newborn baby could be responsible for these effects on brain development. During early gestation the foetus is completely dependent on maternal thyroxine (T4). Lower T4 levels in the mother, caused by dioxins and PCBs, might negatively influence (early) brain development. It is plausible that the intrauterine dependency on maternal T4 and the high T4 need shortly after birth makes both these periods vulnerable for environmental influences. Effects of dioxin exposure on thyroid hormone metabolism have been described in the period shortly after birth. These effects are no longer found after two years of age indicating a transient effect. In animal studies, in utero exposure has led to effects on brain development due to abnormal induction of liver enzymes. This induction resulted in lower testosterone and estrogen levels, interfering with brain development in the vulnerable period of language development and the development of visuo-spatial abilities. In humans this developmental period occurs around the thirtieth week of pregnancy. Follow-up studies in puberty and adolescence of the different cohorts studied is necessary to evaluate these negative influences. Damaging effects on the liver found shortly after birth have proven to be transient. Effects on the haematopoietic system are clear immediately after birth, for instance on white blood cells and thrombocytes. An increase in middle ear infections (otitis media) in relation to current levels of PCBs at the age of 4 years was described in the Rotterdam study. Negative effects on lung function in the sense of increased obstruction was found after 8 years in relation to perinatal exposure to dioxins in the Zaandam study. This rather new finding might explain the sharp increase in lung problems in children in the Western world. PMID:14659426

ten Tusscher, Gavin W; Koppe, Janna G



Sex and Pregnancy: A Perinatal Educator's Guide  

PubMed Central

This article is a continuation in the author's growing series of articles on intimacy and sexuality in the transition to parenthood and its relationship with perinatal education. So many couples in the author's perinatal education practice feel that health professionals are uncomfortable discussing sex and pregnancy. Indeed, the couples have so many questions and concerns regarding this subject; they are seeking answers so that they may better understand and cope with the changes in this aspect of their relationship. Perinatal education group encounters or special sessions are the ideal setting to discuss intimacy and sexuality during pregnancy. The objectives of this article are to provide the perinatal educator with content for the group sessions and tools for teaching strategies and activities.

Polomeno, Viola




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...


Perinatal mortality in Rh alloimmunized patients  

Microsoft Academic Search

ObjectiveEvaluate and compare the perinatal mortality of Rh-negative pregnancies managed at São Paulo Federal University during a 9-year period, using either amniocentesis or middle cerebral artery peak systolic velocity.

Luciano Marcondes Machado Nardozza; Luiz Camano; Antonio Fernandes Moron; Paulo Alexandre Chinen; Maria Regina Torloni; Eduardo Cordioli; Edward Araújo Junior



Maternal Contributions to Sensory Experience in the Fetal and Newborn Rat (Rattus norvegicus )  

Microsoft Academic Search

Using videographic analyses, we identified and quantified maternal contributions to the sensory environment of the perinatal rat (Rattus norvegicus) by analyzing, from the offspring's perspective, the dam's activities during gestation, labor, and delivery. Our observations indicate that pregnant females remain highly active during the final week of gestation, as compared with nonpregnant control animals. Exploratory movements, feeding, drinking, self-grooming, and

April E. Ronca; Christopher A. Lamkin; Jeffrey R. Alberts



Ultrasonic vocalizations and maternal-infant interactions in a rat model of fetal alcohol syndrome  

Microsoft Academic Search

When isolated from their dams and littermates, rat pups emit ultrasonic vocalizations to elicit attention and retrieval from their dams. This study examined the effects of perinatal alcohol exposure on ultrasonic vocalizations and maternal-infant interactions. Alcohol was administered throughout gestation to the dams and during the early postnatal period to the pups. Control groups consisted of a nontreated control and

Melissa D. Marino; Kim Cronise; Joaquin N. Lugo; Sandra J. Kelly



Obstetric complications in siblings of Japanese schizophrenics: Data from the Maternal and Child Health Handbook  

Microsoft Academic Search

Although the precise etiology of schizophrenia remains unknown, the development of schizophrenia has been associated with a history of obstetric complication (OC). Furthermore, some studies show structural and functional brain abnormalities in the unaffected siblings of schizophrenics. In this study the perinatal histories of 18 unaffected siblings of schizophrenics and 15 unrelated healthy controls, as detailed in their mothers' Maternal

Koichi Ohara; Shigeru Tanabu; Kimiko Yoshida; Yumi Sato; Haruo Shibuya



The effects of maternal narcotic vs nonnarcotic addiction on neonatal neurobehavior and infant development  

Microsoft Academic Search

At the Perinatal Addiction Project of Northwestern Memorial Hospital, the last 5 years have seen a rapid increase in the proportion of women enrolling in our program who are using and abusing non-narcotic substances during pregnancy. Screening of all women presenting to Prentice Women's Hospital and Maternity Center for prenatal care during a 6-month period in 1982 revealed that 3%

Ira J. Chasnoff; W BURNS; K BURNS



Drugs and pregnancy--outcomes of women engaged with a specialist perinatal outreach addictions service.  


Substance misuse during pregnancy may result in harm to both mother and child. The aims of this study were to assess changes in outcomes of women seen by a specialist perinatal addictions outreach service (1989-1991 versus 2002-2005) and compare outcomes to the local hospital maternity population (2004-2005). A cross-sectional audit of health-care records was conducted comparing the outcomes of women in 2002-2005 with earlier data from 1989-1991 and the local maternity population (2004-2005). The service was attended by 126 women, of whom 83% of opioid-dependent women started/continued opioid maintenance treatment. Of 118 babies delivered, there were two stillbirths and one early neonatal death, 20% were premature, 28% were low birth weight, 21% required the Special Care Baby Unit and 21% of babies born to opioid-dependent mothers were treated for neonatal abstinence syndrome (NAS). Fewer babies required treatment for NAS in 2002-2005 compared to 1989-1991 (21% versus 44%). There were higher rates of miscarriage (3% versus <1%), low birth weight (28% versus 9%) and premature babies (20% versus 9%) compared to the local maternity population (2004-2005). Integrated perinatal addictions treatment may deliver benefits; however, engaging women into treatment earlier and reducing substance use before conception remains the objective. PMID:18696296

Mayet, Soraya; Groshkova, Teodora; Morgan, Louise; MacCormack, Tracey; Strang, John



Genetic and perinatal effects of abused substances  

SciTech Connect

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.

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



Perinatal mortality in different ethnic groups  

Microsoft Academic Search

We have analysed the cause of perinatal deaths in four hospitals in the North West Thames region over a six year period commencing January 1980. The Pakistani population had a significantly greater perinatal mortality rate (15.7\\/1000 births) than the Europeans (11.3\\/1000 births). This was due to an increased incidence of macerated stillbirths and lethal malformations, the latter resulting from a

L S Chitty; R M Winter



Perinatal Flavour Learning and Adaptation to Being Weaned: All the Pig Needs Is Smell  

PubMed Central

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.

Oostindjer, Marije; Bolhuis, J. Elizabeth; Simon, Kristina; van den Brand, Henry; Kemp, Bas



Naturalization of immigrants and perinatal mortality  

PubMed Central

Background: Differences in neonatal mortality among immigrants have been documented in Belgium and elsewhere, and these disparities are poorly understood. Our objective was to compare perinatal mortality rates in immigrant mothers according to citizenship status. Methods: This was a population-based study using 2008 data from the Belgian birth register data pertaining to regions of Brussels and Wallonia. Odds ratio (OR) and 95% confidence intervals (95% CIs) for perinatal mortality according to naturalization status were calculated by logistic regression analyses adjusting for parents’ medical and social characteristics. Results: Four hundred and thirty-seven perinatal deaths were registered among 60?881 births (7.2‰). Perinatal mortality rate varied according to the origin of the mother and her naturalization status: among immigrants, non-naturalized immigrants had a higher incidence of perinatal mortality (10.3‰) than their naturalized counterparts (6.1‰) with an adjusted OR of 2.2, 95% CI (1.1–4.5). Conclusion: In a country with a high frequency of naturalization, and universal access to health care, naturalized immigrant mothers experience less perinatal mortality than their not naturalized counterparts.

Englert, Yvon; Buekens, Pierre



[Recommendations of Polish Gynecological Society concerning perinatal care in obese pregnant women].  


Maternal obesity (defined as prepregnancy maternal BMI> or = 30 kg/m2) is a risk factor strongly associated with serious perinatal complications and its prevalence has increased rapidly in a general population during the last decades. Therefore, following international approach to regulate perinatal care in this population, Group of Experts of Polish Gynecological Society developed these new guidelines concerning perinatal care in obese pregnant women, including women after bariatric surgery. The recommendations cover detailed information on specific needs and risks associated with obesity in women of reproductive age, pregnancy planning, antenatal care, screening, prophylaxis and treatment for other pregnancy complications characteristic for maternal obesity fetal surveillance, intrapartum care and post-partum follow-up. Pregnancy planning in these patients should involve dietary recommendations aiming at well balanced diet and daily caloric uptake below 2000 kcal and modest but regular physical activity with sessions every two days starting from 15 min and increased gradually to 40 min. Laboratory work-up should include tests recommended in general population plus fasting glycemia and oral glucose tolerance if necessary thyroid function, lipidprofile, blood pressure and ECG. Patients after bariatric surgery should allow at least one year before they conceive and have their diet fortified with iron, folic acid, calcium and vit. B12. Antenatal care should include monitoring body weight gain with a target increase in body weight less than 7 kg, thromboprophylaxis, strict monitoring of blood pressure and diagnostic for gestational diabetes in early pregnancy. Fetal ultrasonic scans should be arranged following protocols recommended by US section of Polish Gynaecological Society with additional scan assessing fetal growth performed within 7 days before delivery and aiming at assessing a risk for shoulder dystocia in a patient. Intrapartum care should be delivered in referral centers where fetal and maternal intrapartum complications can be addressed, preferably equipped with a proper medical equipment necessary to deal safely with extremely heavy individuals. Medical staff taking intrapartum care for obese parturient should be also aware of reduced reliability of methods used for intrapartum fetal surveillance, increased risk for intrapartum fetal death, maternal injuries, postpartum haemorrhage, shoulder dystocia, thrombophlebitis and infection. Pediatrician should be also available due to increased neonatal morbidity mainly due to meconium aspiration syndrome, hypoglycemia, and respiratory distress syndrome. In puerperium, medical staff should be prepared to deal with breastfeeding disturbances and increased maternal mortality. PMID:23383569

Wender-Ozegowska, Ewa; Bomba-Opo?, Dorota; Brazert, Jacek; Celewicz, Zbigniew; Czajkowski, Krzysztof; Karowicz-Bili?ska, Agata; Malinowska-Polubiec, Aneta; Meczekalski, B?azej; Zawiejska, Agnieszka



Syndromes, disorders and maternal risk factors associated with neural tube defects (III).  


Fetuses with neural tube defects (NTDs) may be associated with syndromes, disorders, and maternal and fetal risk factors. This article provides a comprehensive review of syndromes, disorders, and maternal and fetal risk factors associated with NTDs, such as omphalocele, OEIS (omphalocele-exstrophy-imperforate anus-spinal defects) complex, pentalogy of Cantrell, amniotic band sequence, limb-body wall complex, Meckel syndrome, Joubert syndrome, skeletal dysplasia, diabetic embryopathy, and single nucleotide polymorphisms in genes of glucose metabolism. NTDs associated with syndromes, disorders, and maternal and fetal risk factors are a rare but important cause of NTDs. The recurrence risk and the preventive effect of maternal folic acid intake in NTDs associated with syndromes, disorders and maternal risk factors may be different from those of nonsyndromic multifactorial NTDs. Perinatal identification of NTDs should alert the clinician to the syndromes, disorders, and maternal and fetal risk factors associated with NTDs, and prompt a thorough etiologic investigation and genetic counseling. PMID:18603496

Chen, Chih-Ping



RETRACTED ARTICLE: Perinatal and first year outcomes of spontaneous versus assisted twins: a single center experience  

Microsoft Academic Search

Objective  The aim is to compare naturally conceived twins with twins conceived by assisted reproductive techniques (ART) by means of\\u000a perinatal outcome, behavioural patterns and psychomotor development.\\u000a \\u000a \\u000a \\u000a \\u000a Material and methods  Three hundred and five spontaneous and 119 assisted twins were compared in aspects of behavioural patterns, mental and psychomotor\\u000a development, as well as maternal and gestational age, foetal presentation, birth weight, sex,

Mine Kanat-Pektas; Cigdem Kunt; Tayfun Gungor; Leyla Mollamahmutoglu



Recurrence of adverse perinatal outcomes in developing countries  

PubMed Central

Abstract Objective To evaluate the risk of recurrence of adverse perinatal outcomes in second pregnancies in developing countries. Methods Data from the 2004–2008 Global Survey on Maternal and Perinatal Health were used to determine the outcomes of singleton second pregnancies for 61?780 women in 23 developing countries. The mother–infant pairs had been followed up until discharge or for 7 days postpartum. Findings At the end of their second pregnancies, women whose first pregnancy had ended in stillbirth (n?=?1261) or been followed by neonatal death (n?=?1052) were more likely than women who had not experienced either outcome to have given birth to a child with a birth weight of

Ouyang, Fengxiu; Betran, Ana Pilar; Yang, Zujing; Souza, Joao Paulo; Merialdi, Mario



Natural history of hepatitis B in perinatally infected carriers  

PubMed Central

Objectives: To establish natural seroconversion rates and incidence of hepatic pathology in perinatally infected hepatitis B carriers. Methods: Seventy three perinatally infected hepatitis B carriers identified through maternal screening were evaluated. Fifty three were born to parents from the Indian subcontinent, nine were Oriental, six were Afro-Caribbean, and five were white. Median follow up was 10.24 (range 2.02–20.16) years. Results: Only three of the children followed up had cleared hepatitis B surface antigen during this period, and 30% of the children had seroconverted to anti-HBe. Seroconversions to anti-HBe were observed in Asian (18/50) and white (4/5) children, but not in Oriental or Afro-Caribbean children. More girls (40%) than boys (23%) had seroconverted, but the difference was not significant. All children were asymptomatic with normal physical examination, growth, and development. Almost half (48%) of the hepatitis B e antigen (HBeAg) positive children had normal hepatic transaminases and liver function. Thirty five liver biopsies were performed in children with active virus replication (HBeAg or hepatitis B virus DNA positive) who were being considered for antiviral treatment as part of a clinical trial and were scored using the Ishak method. Two thirds (62%) of the children had mild hepatitis, 60% had mild fibrosis, and 18% had moderate to severe fibrosis. There was a weak correlation between histological evidence of hepatitis and hepatic transaminase activity, implying that biochemical monitoring of hepatic disease activity may be ineffective. Conclusions: These asymptomatic hepatitis B virus carrier children remain infectious in the medium to long term with notable liver pathology. They should receive antiviral treatment to reduce infectivity and to prevent further progression of liver disease. Hepatic transaminases alone are not a reliable marker of liver pathology, and liver histology is essential before consideration for antiviral treatment.

Boxall, E; Sira, J; Standish, R; Davies, P; Sleight, E; Dhillon, A; Scheuer, P; Kelly, D



[Oligohydramnios--perinatal complications and diseases in mother and child].  


In our study, complications of oligohydramnios were examined. In medical records of all 5,210 deliveries of our department between 1987 and 1990 181 cases of oligohydramnios were identified. The diagnosis was confirmed by ultrasound and based on the method described by Mannings and Platt: amniotic fluid depots of less than 1 cm were defined as oligohydramnios. All 181 cases met the above definition, which results in an incidence of 3.5% pregnancies with reduced amniotic fluid. We examined the records of mother and foetus, the delivery and perinatal complications and follow-up of the newborn. In more than 60%, foetal asphyxia, breech position and other anomalies during delivery were followed by Cesarean section or vaginal operative delivery by forceps or vacuum extraction. In 30 cases, oligohydramnios was caused by premature rupture of membranes. In the other cases, the diagnosis based on maternal or foetal complications such as gestosis (n = 7), abruptio placentae (n = 10), foetal growth retardation (n = 47) and malformations or chromosomal anomalies. 89 newborn were transferred to a paediatric hospital immediately after delivery. Potter's syndrome was the main anticipated diagnosed malformation (n = 20). The lack of amniotic fluid was furthermore followed by a higher rate of pulmonary complications such as RDS and hypoplasia of the neonatal lung (n = 21). In conclusion, our study underlines the fact, that oligohydramnios must be regarded as an important reason of high risk pregnancy followed by many complications for foetus and newborn. The incidence of perinatal mortality in our examination was 7.2%. This rate is 10 fold higher than in the total number of deliveries of our department. PMID:8188011

Wolff, F; Schaefer, R



Identifying patients at risk of perinatal mood disorders.  


Perinatal mental illness influences obstetric outcomes, mother-baby interactions and longer term emotional and cognitive development of the child. Psychiatric disorders have consistently been found to be one of the leading causes of maternal deaths, often through suicide. Postnatal depression and puerperal psychosis are two disorders most commonly associated with the perinatal period. The most efficient strategy to identify patients at risk relies on focussing on clinically vulnerable subgroups: enquiries about depressive symptoms should be made at the usual screening visits. Attention should be paid to any sign of poor self-care, avoidance of eye contact, overactivity or underactivity, or abnormalities in the rate of speech. Particular care should be taken to ask about suicidal ideation and thoughts of harming others, including the baby. One of the most important risk factors is a previous history of depression. The degree of risk is directly correlated with severity of past episodes. Both antenatal and postnatal depression are being increasingly recognised in men. Puerperal psychosis is rare (1 to 2 per 1,000). Sixty per cent of women with puerperal psychosis already have a diagnosis of bipolar disorder or schizoaffective disorder. Women with a personal history of postpartum psychosis or bipolar affective disorder should be considered as high risk for postpartum psychosis. All pregnant women who are identified as being at high risk should have a shared care plan for their late pregnancy and early postnatal psychiatric management. Women with current mood disorder of mild or moderate severity who have a first-degree relative with a history of bipolar disorder or postpartum psychosis should be referred for psychiatric assessment. PMID:22774377

Topiwala, Anya; Hothi, Gurjiven; Ebmeier, Klaus P



Maternal body mass index and daughters' age at menarche  

PubMed Central

Background The role of inter-generational influences on age at menarche has not been explored far beyond the association between mothers’ and daughters’ menarcheal ages. Small size at birth and childhood obesity have been associated with younger age at menarche, but the influence of maternal overweight or obesity on daughters’ age at menarche has not been thoroughly examined. Methods In a follow-up study of the prospective Collaborative Perinatal Project grown daughters were asked in 1987-1991 for their age at menarche. Data from the original Collaborative Perinatal Project (1959-1966) included their mothers’ height and pre-pregnancy weight. In the follow-up study, 597 of 627 daughters had complete menarche and maternal data available and were included in the present analysis. We used polytomous logistic regression to examine the association between maternal overweight (body mass index [BMI] = 25-29.9 km/m2) or obesity (BMI ? 30) and daughter’s age at menarche (< 12, 12, 13, > 13 years). Results Compared with those whose mothers had a BMI less than 25, daughters of obese mothers experienced younger age at menarche (OR for menarche at < 12 years=3.1 [1.1 - 9.2]). This association remained after adjusting for maternal age at menarche, maternal parity, socioeconomic status, race, and study site (OR=3.3 [1.1 - 10.0]). Effect estimates for maternal overweight were close to the null. There was limited evidence of mediation by small-for-gestational age or BMI at age 7. Conclusions Maternal obesity is associated with younger menarcheal age among daughters in this study, possibly via unmeasured shared factors.

Keim, Sarah A.; Branum, Amy M.; Klebanoff, Mark A.; Zemel, Babette S.



Perinatal Air Pollutant Exposures and Autism Spectrum Disorder in the Children of Nurses' Health Study II Participants  

PubMed Central

Objective: Air pollution contains many toxicants known to affect neurological function and to have effects on the fetus in utero. Recent studies have reported associations between perinatal exposure to air pollutants and autism spectrum disorder (ASD) in children. We tested the hypothesis that perinatal exposure to air pollutants is associated with ASD, focusing on pollutants associated with ASD in prior studies. Methods: We estimated associations between U.S. Environmental Protection Agency–modeled levels of hazardous air pollutants at the time and place of birth and ASD in the children of participants in the Nurses’ Health Study II (325 cases, 22,101 controls). Our analyses focused on pollutants associated with ASD in prior research. We accounted for possible confounding and ascertainment bias by adjusting for family-level socioeconomic status (maternal grandparents’ education) and census tract–level socioeconomic measures (e.g., tract median income and percent college educated), as well as maternal age at birth and year of birth. We also examined possible differences in the relationship between ASD and pollutant exposures by child’s sex. Results: Perinatal exposures to the highest versus lowest quintile of diesel, lead, manganese, mercury, methylene chloride, and an overall measure of metals were significantly associated with ASD, with odds ratios ranging from 1.5 (for overall metals measure) to 2.0 (for diesel and mercury). In addition, linear trends were positive and statistically significant for these exposures (p < .05 for each). For most pollutants, associations were stronger for boys (279 cases) than for girls (46 cases) and significantly different according to sex. Conclusions: Perinatal exposure to air pollutants may increase risk for ASD. Additionally, future studies should consider sex-specific biological pathways connecting perinatal exposure to pollutants with ASD.

Lyall, Kristen; Hart, Jaime E.; Laden, Francine; Just, Allan C.; Bobb, Jennifer F.; Koenen, Karestan C.; Ascherio, Alberto; Weisskopf, Marc G.



Perinatal Outcome in the Liveborn Infant with Prenatally Diagnosed Omphalocele  

PubMed Central

Objective To compare perinatal outcomes between liveborn non-isolated and isolated omphaloceles diagnosed during a prenatal ultrasound. Study Design Fetuses (n=86) with omphalocele were identified between 1995–2007 at a single institution. Inclusion criteria were an omphalocele >14 weeks gestation, available fetal and/or neonatal karyotype, and a liveborn infant (n=46). Perinatal outcomes were compared in non-isolated (n=23) and isolated omphaloceles (n=23). Results For all omphaloceles, the majority delivered after 34 weeks by cesarean. Mean birth weight (2782 vs. 2704g), median length of stay (27 vs. 25 days), and mortality (2 in each group) was not different between the non-isolated and isolated groups, P>0.05. In the non-isolated group, 7 major anomalies were not confirmed postnatally. Of the prenatally diagnosed isolated omphaloceles, 8(35%) were diagnosed with a syndrome or other anomalies after birth. Conclusion The outcomes were similar in non-isolated and isolated prenatally diagnosed omphaloceles, but ultrasound did not always accurately determine the presence or absence of associated anomalies.

KOMINIAREK, Michelle A.; ZORK, Noelia; PIERCE, Sara Michelle; ZOLLINGER, Terrell



Neonatal-perinatal medicine: Diseases of the fetus and infant  

SciTech Connect

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.

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



Development of maternal identity  

Microsoft Academic Search

Reva Rubin suggested in her theoretical framework that developmental tasks were necessary for a woman to achieve maternal identity post partum. Rubin defined maternal identity as the woman's internal sense of competence in the maternal role and her knowledge of her infant. If measures of pregnancy developmental tasks could predict maternal identity such measures would be helpful in determining women

Sharon Lynn Dore



The Tohoku Study of Child Development: A cohort study of effects of perinatal exposures to methylmercury and environmentally persistent organic pollutants on neurobehavioral development in Japanese children.  


Several birth cohort studies have shown adverse effects of perinatal exposures to methylmercury (MeHg) and environmentally persistent organic pollutants (POPs). These chemicals are ingested mainly through fish consumption, but little is known about the hazardous effects in Japanese, whose fish consumption is high. The present study, the Tohoku Study of Child Development, was designed to examine the effects of perinatal exposures to MeHg, polychlorinated biphenyls (PCB), dioxins, pesticides, and other chemicals in Japanese children. Six hundred eighty-seven pregnant women were participated in this study with their written informed consent. Maternal peripheral blood, cord blood, cord tissue, placenta, and breast milk samples were collected for chemical analysis. Maternal hair was also taken for MeHg analysis. Infants born at full term were assessed by neurobehavioral tests: the Brazelton Neonatal Behavioral Assessment Scale at three days old, the Kyoto Scale of Psychological Development and the Bayley Scales of Infant Development at 7 and 18 months old, and the Fagan Test of Infant Intelligence at 7 months old. The children will be continuously followed up to ages 6-7 years. Maternal food intake frequency, maternal IQ, socioeconomic status, and home environment were assessed as covariates. The results of this cohort study will allow us to evaluate associations between the neurobehavioral development of children and perinatal exposures to MeHg and environmentally POPs in Japan. PMID:15065649

Nakai, Kunihiko; Suzuki, Keita; Oka, Tomoko; Murata, Katsuyuki; Sakamoto, Mineshi; Okamura, Kunihiro; Hosokawa, Toru; Sakai, Takeo; Nakamura, Tomoyuki; Saito, Yoshinori; Kurokawa, Naoyuki; Kameo, Satomi; Satoh, Hiroshi



Perinatal outcomes associated with low birth weight in a historical cohort  

PubMed Central

Objective To identify perinatal outcomes associated with low birth weight (LBW). Methods A retrospective cohort study in a tertiary maternity hospital. Analysis of the database on 43,499 liveborn infants delivered between 1986 and 2004 with low (n = 6,477) and normal (n = 37,467) birth weight. Outcomes associated with LBW were identified through crude and adjusted risk ratio (RR) and 95%CI with bivariate and multivariate analysis. The main outcomes were: onset of labor, mode of delivery, indication for cesarean section; amniotic fluid, fetal heart rate pattern, Apgar score, somatic gestational age, gender and congenital malformation. Results LBW infants showed more frequently signs of perinatal compromise such as abnormal amniotic fluid volume (especially olygohydramnios), nonreassuring patterns of fetal heart rate, malformation, lower Apgar scores and lower gestational age at birth. They were associated with a greater risk of labor induction and cesarean delivery, but lower risk of forceps. Conclusion There was a clear association between LBW and unfavorable perinatal outcomes.



Hospital-based Perinatal Outcomes and Complications in Teenage Pregnancy in India  

PubMed Central

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-birth-weight 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.

Chaudhuri, R.N.; Paul, Bhaskar



Interpretative views on Hispanics' perinatal problems of low birth weight and prenatal care.  

PubMed Central

From a public health perspective, there is a need to recognize that Hispanics, and in particular Mexican Americans, are a very heterogeneous group. They represent all shades of acculturation, education, income, and citizenship status. As this minority group continues to increase in numbers, pertinent information about their perinatal health problems in the context of their sociocultural characteristics will be required. This review examines critically the recent literature related to low birth weight and prenatal care and suggests alternative ways to address these perinatal health issues. Low birth weight is examined in the context of the problem of intrauterine growth retardation and the potential mechanisms and consequences of different types of growth limitation in utero which have not been studied in this population. The use of prenatal care by Mexican American women and its association with birth weight is examined as an indication of maternal behavior or as a health care intervention. The implications for public health policy are discussed in relation to the identification, interpretation, and evaluation of these perinatal health issues in this minority population.

Balcazar, H; Aoyama, C; Cai, X



Perinatal Outcome in Pregnancies with Extreme Preterm Premature Rupture of Membranes (Mid-Trimester PROM)  

PubMed Central

Objectives: Preterm premature rupture of membranes (PPROM) is defined as the rupture of fetal membranes before 37 weeks. Extreme PPROM occurs before 26 weeks’ gestation and can result in perinatal morbidity and mortality. The aim of this study was to study the perinatal outcomes of mothers with extreme PPROM. Methods: A retrospective cohort study of 44 consecutive pregnant women, presenting with PPROM before 26 weeks’ gestation, was conducted from January 2006 to December 2011 at Sultan Qaboos University Hospital, Oman. Maternal and neonatal information was collected from medical records, and delivery and neonatal unit registries. Women with PPROM presenting after 26 weeks’ gestation, those with multiple gestations, or other types of preterm deliveries were excluded from the study. Results: Of the 44 preterm infants admitted to the Neonatal Intensive Care Unit, 24 (55%) survived, 7 (16%) died within 24 hours of birth, 9 (20%) were miscarried, and 4 (9%) were stillbirths. Neonatal sepsis and pulmonary hypoplasia were the major causes of death. Neonatal complications among the surviving infants included prematurity in 11 (46%), respiratory distress syndrome in 19 (79%), sepsis in 12 (50%), and low birth weight in 11 (46%). The neonatal survival rate was significantly associated with the gestational age at delivery but not with the gestational age upon rupture of membranes. Conclusion: Extreme PPROM was associated with adverse perinatal outcomes. The results of this study will help obstetricians and neonatologists in counselling couples experiencing PPROM. Future studies of long-term neonatal morbidity should have larger sample sizes and include more hospitals.

Al-Riyami, Nihal; Al-Shezawi, Fatma; Al-Ruheili, Intisar; Al-Dughaishi, Tamima; Al-Khabori, Murtadha



Perinatal Care for Women Who Are Addicted: Implications for Empowerment.  

ERIC Educational Resources Information Center

This article explores societal responses to perinatal drug abuse, including stigmatic attitudes and behaviors of health care workers. Empowering strategies are suggested by which social workers and clients can potentially redefine perinatal drug abuse as a health problem rather than a legal issue and improve the environment in which perinatal care…

Carter, Carolyn S.



Perinatal episodes across the mood disorder spectrum.  


CONTEXT Affective disorders are common in women, with many episodes having an onset in pregnancy or during the postpartum period. OBJECTIVE To investigate the occurrence and timing of perinatal mood episodes in women with bipolar I disorder, bipolar II disorder, and recurrent major depression (RMD). SETTING AND PATIENTS Women were recruited in our ongoing research on the genetic and nongenetic determinants of major affective disorders. Participants were interviewed and case notes were reviewed. Best-estimate diagnoses were made according to DSM-IV criteria. The 1785 parous women identified included 1212 women with bipolar disorder (980 with type I and 232 with type II) and 573 with RMD. Data were available on 3017 live births. MAIN OUTCOME MEASURES We report the lifetime occurrence of perinatal mood episodes, the rates of perinatal episodes per pregnancy/postpartum period, and the timing of the onset of episodes in relation to delivery. RESULTS More than two-thirds of all diagnostic groups reported at least 1 lifetime episode of illness during pregnancy or the postpartum period. Women with bipolar I disorder reported an approximately 50% risk of a perinatal major affective episode per pregnancy/postpartum period. Risks were lower in women with RMD or bipolar II disorder, at approximately 40% per pregnancy/postpartum period. Mood episodes were significantly more common in the postpartum period in bipolar I disorder and RMD. Most perinatal episodes occurred within the first postpartum month, with mania or psychosis having an earlier onset than depression. CONCLUSIONS Although episodes of postpartum mood disorder are more common in bipolar I disorder and manic and psychotic presentations occur earlier in the postpartum period, perinatal episodes are highly prevalent across the mood disorder spectrum. PMID:23247604

Di Florio, Arianna; Forty, Liz; Gordon-Smith, Katherine; Heron, Jess; Jones, Lisa; Craddock, Nicholas; Jones, Ian



Perinatal care: the Kuranko context of choice.  


The ethnomedical aspects of childbirth and factors that influence Kuranko women in the northern Sierra Leone center of Kabala (a multiethnic town of some 15,000 inhabitants) in making decisions regarding perinatal care are the focus of this article. I found that Kuranko women develop perinatal care strategies from services available in the formal and informal health-care sectors. The discussion is situated within a context that values primary health care and health promotion and advocates the use of these frameworks in ways that are informed by Kuranko social organization and concepts of development. PMID:2022534

Ross, J S


Introductory engagement within the perinatal nursing relationship.  


In this article, the theme of introductory engagement is developed through the conversational interviews and participatory observations I carried out with perinatal nurses and birthing women in the context of a feminist phenomenological methodology. Positioned against the landscape of hierarchical health care practices embedded with power dynamics and disembodied practices, this research explored the ways in which perinatal nurses related to birthing women in the context of relational care. The focus of attention in this article is to describe the theme of introductory engagement by way of a storied phenomenological text. PMID:16045248

Goldberg, Lisa Sara



Genetics and genomics: impact on perinatal nursing.  


In 1953, Watson and Crick first described the structure of the DNA molecule, an event that led to a new understanding of the nature of heredity. Just 50 years later, a conference was held in Bethesda, Maryland to announce the completion of the sequencing of the human genome. The era of genomic healthcare has begun, and it has profound implications for nursing education, nursing practice, and nursing research. This article will highlight some important areas in perinatal and neonatal nursing that have been affected by genetics and genomics, as well as some emerging areas of research that will be relevant to perinatal and neonatal nursing. PMID:21540689

Lewis, Judith A


Parents Experiencing Perinatal Loss: The Physician's Role  

PubMed Central

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.

Swanson, Richard W.



Pre- and perinatal risk factors for pyloric stenosis and their influence on the male predominance.  


Pyloric stenosis occurs with a nearly 5-fold male predominance. To what extent this is due to environmental factors is unknown. In a cohort of all children born in Denmark, 1977-2008, the authors examined the association between pre- and perinatal exposures and pyloric stenosis and investigated whether these factors modified the male predominance. Information on pre- and perinatal factors and pyloric stenosis was obtained from national registers. Poisson regression models were used to estimate rate ratios. Among 1,925,313 children, 3,174 had surgery for pyloric stenosis. The authors found pyloric stenosis to be significantly associated with male sex, age between 2 and 7 weeks, early study period, being first born, maternal smoking during pregnancy, preterm delivery, small weight for gestational age, cesarean section, and congenital malformations. Among cases, 2,595 were males and 579 were females. Lower male predominance was associated with age at diagnosis outside the peak ages, early study period, no maternal smoking during pregnancy, preterm delivery, and congenital malformations. The authors have previously found a strong familial aggregation of pyloric stenosis indicating a genetic influence. This study shows that environmental factors during and shortly after pregnancy also play a role and that several of these modify the strong male predominance. PMID:22553083

Krogh, Camilla; Gørtz, Sanne; Wohlfahrt, Jan; Biggar, Robert J; Melbye, Mads; Fischer, Thea K



Organophosphate pesticide exposure and perinatal outcomes in Shanghai, China.  


Although pesticide use is widespread in China, little is known about levels of exposure to organophosphate pesticides in the population and its potential adverse health effects. We investigated levels of organophosphate exposure in pregnant women and the association between organophosphate exposure and perinatal outcomes in Shanghai, China, by enrolling 187 healthy pregnant women between September 2006 and January 2007. Pesticide exposure was assessed by a questionnaire administered to the mothers in the hospital after delivery as well as by analyses of maternal urinary nonspecific metabolites of organophosphate pesticides (dimethyl and diethyl phosphates). Information on birth weight and length was collected from medical records. Geometric means of metabolites were 25.75 ?g/L for dimethylphosphate (DMP); 11.99 ?g/L for dimethylthiophosphate (DMTP); 9.03 ?g/L for diethylphosphate (DEP); and 9.45 ?g/L for diethyldithiophosphate (DETP). We found that a log unit increase in urinary DEP was associated with a decrease in gestational duration in girls by 1.79 weeks. [ß(adjusted)=-1.79 weeks per log(10) unit increase; 95% confidence interval (CI), -2.82 to -0.76; p=0.001]. These data suggest that high pesticide level might adversely affect duration of gestation although this association was not present among boys. No associations for any of the organophosphate exposure measures were present for birth weight and length, suggesting that organophosphate pesticides may have no effects on fetal growth. Given that maternal urine pesticide levels in Shanghai were much higher than those reported in developed countries, more studies on the effects of in utero organophosphate exposure on fetal growth and child neurodevelopment are warranted. PMID:21601922

Wang, Pei; Tian, Ying; Wang, Xiao-Jin; Gao, Yu; Shi, Rong; Wang, Guo-Quan; Hu, Guo-Hua; Shen, Xiao-Ming



Association of Selected Phenotypic Markers of Lymphocyte Activation and Differentiation with Perinatal Human Immunodeficiency Virus Transmission and Infant Infection  

PubMed Central

This study of a subset of women and infants participating in National Institutes of Health Pediatric AIDS Clinical Trials Group protocol 185 evaluated lymphocyte phenotypic markers of immune activation and differentiation to determine their association with the likelihood of human immunodeficiency virus (HIV) transmission from the women to their infants and the potential for early identification and/or prognosis of infection in the infants. Lymphocytes from 215 human immunodeficiency virus type 1 (HIV)-infected women and 192 of their infants were analyzed by flow cytometry with an extended three-color panel of monoclonal antibodies. Women who did not transmit to their infants tended to have higher CD4+ T cells. Most notably, levels of total CD8+ T cells and CD8+ CD38+ cells made significant independent contributions to predicting the risk of mother-to-child transmission. Adjusting for HIV-1 RNA level at entry, a one percentage-point increase in these marker combinations was associated with a nine percent increase in the likelihood of maternal transmission. Total as well as naïve CD4+ T cells were significantly higher in uninfected than infected infants. Total CD8+ cells, as well as CD8+cells positive for HLA-DR+, CD45 RA+ HLA-DR+, and CD28+ HLA-DR+ were elevated in infected infants. Detailed immunophenotyping may be helpful in predicting which pregnant HIV-infected women are at increased risk of transmitting HIV to their infants. Increasing differences in lymphocyte subsets between infected and uninfected infants became apparent as early as six weeks of age. Detailed immunophenotyping may be useful in supporting the diagnosis of HIV infection in infants with perinatal HIV exposure.

Lambert, John S.; Moye, Jack; Plaeger, Susan F.; Stiehm, E. Richard; Bethel, James; Mofenson, Lynne M.; Mathieson, Bonnie; Kagan, Jonathan; Rosenblatt, Howard; Paxton, Helene; Suter, Hildie; Landay, Alan



Enhanced mortality of rat pups following inductions of epileptic seizures after perinatal exposures to 5 nT, 7 Hz magnetic fields.  


While investigating the effects of weak complex magnetic fields upon neuroplasticity following induction of early epilepsy, an unprecedented increase in post-seizure mortality (76%) was observed for young rats that had been exposed perinatally to 7 Hz magnetic fields with maximum intensities around 5 nT. Pups exposed to less intense or more intense fields of this frequency did not display this magnitude of significant mortality. Perinatal exposure through the maternal water supply to either a putative nitric oxide donor or inhibitor did not affect this mortality. The non-linear relationship between perinatal 7 Hz magnetic field intensity and post-seizure mortality may be considered analogous to the non-linear relationship between the molarity of ligands and their sequestering to receptor subtypes. These unexpected results suggest that exposure to apparently innocuous stimuli during early development may affect vulnerability to stimuli presented later in ontogeny. PMID:17961603

St-Pierre, L S; Parker, G H; Bubenik, G A; Persinger, M A



Socio-demographic and gynaecological variables of maternal mortality in a Kenyan subdistrict: January 1981-September 1988.  


A study on institutional maternal mortality in Thika subdistrict is presented for the period January 1981 through September 1988. There were 86,248 live births in the various government and private institutions in the sub-district and 164 maternal deaths, giving a maternal mortality rate of 190/100,000. The various associated socio-demographic factors are analysed. PMID:2361445

Ruminjo, J K



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

PubMed Central

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.

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.



Behavioral effects of combined perinatal L-NAME and 0.5 Hz magnetic field treatments.  


The behavioral effects of the nitric oxide synthase inhibitor N-nitro-L-arginine methyl ester (L-NAME), when perinatally (2 d prenatal-14 d postnatal) co-administered with extremely low frequency magnetic fields, were examined in weanling and adult rats. Litters of rat pups and their dams were exposed continuously to biphasic pulsed fields presented once every 2 s. The magnetic fields were amplitude modulated in successively increasing and decreasing steps (each 30 min) between 0 and 1.8 microT or between 0 to 13 nanoT (reference field) during 4-h periods (6 periods per day). These two treatments were subdivided into dams that received tap water and dams that received 1.0 g/L L-NAME in tap water. The behavioral sequelae to these treatments for 242 progeny from 41 litters were followed from weaning (1 wk after termination of treatment) into adulthood. Compared to exposures to water and nanoT magnetic fields, perinatal exposures to the microT magnetic fields or to L-NAME in the maternal water supply were associated with increased activity levels when the rats were tested as weanling, but decreased activity levels when the rats were tested as adults. However, the activity of rats that received the combination of L-NAME and microT magnetic fields did not differ significantly from the activity of the rats that had received water and the nanoT fields. Long-term (adulthood) effects of these perinatal treatments on associative learning, as inferred by learned fear to contextual stimuli, were not evident. These results indicate that L-NAME and this particular pattern of magnetic field antagonized one another when co-administered during the perinatal period. PMID:12691004

McKay, B E; Koren, S A; Persinger, M A



Effects of chronic maternal stress on hypothalamo–pituitary–adrenal (HPA) function and behavior: No reversal by environmental enrichment  

Microsoft Academic Search

Maternal stress during pregnancy is linked to increased risk for impaired behavioral and emotional development and affective disorders in children. In animal models, acute periods of prenatal or postnatal stress have profound effects on HPA function and behavior in adult offspring. However, few animal studies have determined the impact of chronic exposure to stress throughout the perinatal period. The objective

Jeff Emack; Stephen G. Matthews



Efficacy of light therapy for perinatal depression: a review  

PubMed Central

Perinatal depression is an important public health problem affecting 10% to 20% of childbearing women. Perinatal depression is associated with significant morbidity, and has enormous consequences for the wellbeing of the mother and child. During the perinatal period, treatment of depression, which could affect the mother and child during pregnancy and lactation, poses a complex problem for both mother and clinician. Bright light therapy may be an attractive treatment for perinatal depression because it is low cost, home-based, and has a much lower side effect profile than pharmacotherapy. The antidepressant effects of bright light are well established, and there are several rationales for expecting that bright light might also be efficacious for perinatal depression. This review describes these rationales, summarizes the available evidence on the efficacy of bright light therapy for perinatal depression, and discusses future directions for investigation of bright light therapy as a treatment for perinatal depression.



Chlamydia trachomatis seropositivity during pregnancy is associated with perinatal complications.  


Sera from the mothers of all children from the greater Helsinki area who were treated in the Neonatal Intensive Care Unit (NICU) of Children's Hospital (University of Helsinki) during a 22-month period were studied serologically, and antibody levels for mothers were compared with those for matched controls. IgM to Chlamydia trachomatis serotype GFK was detected more often in sera from mothers with children in the NICU than in that from controls; IgM was detected in sera from 39 of 264 mothers vs. 15 of 274 controls (P < .001; two-tailed test). The gestational age of children born to mothers in the IgM-seropositive group was 32.4 weeks whereas that of children born to mothers in the IgG/IgM-seronegative group was 34.3 weeks (all children were treated in the NICU). The frequency of signs of maternal infection (i.e., fever and vaginal discharge), the frequency of meconium-stained amniotic fluid, the frequency of chorioamnionitis, and the mortality rate were higher in the IgM-seropositive group than in the IgM-seronegative group; pneumonia, atelectasis, and pneumothorax occurred more frequently in the seronegative group. Thus, in terms of birth weight and perinatal infections, the outcome was better for children whose mothers did not have antibodies to C. trachomatis. PMID:8562754

Gencay, M; Koskiniemi, M; Saikku, P; Puolakkainen, M; Raivio, K; Koskela, P; Vaheri, A



Experience of the Manitoba Perinatal Screening Program, 1965-85.  

PubMed Central

The Manitoba Perinatal Screening Program is guided by a committee of medical specialists with skills in the diagnosis and management of disorders of metabolism in the newborn. The program is voluntary and is centralized at Cadham Provincial Laboratory, in Winnipeg. A filter card blood specimen is collected from newborns on discharge from hospital, and a filter card urine sample is collected and mailed to the laboratory by the mother when the infant is about 2 weeks of age. The overall compliance rates for the blood and urine specimens are approximately 100% and 84% respectively. The blood specimen is screened for phenylalanine and other amino acids, thyroxine, galactose, galactose-1-phosphate and biotinidase. The urine specimen is screened for amino acids, including cystine, as well as methylmalonic acid and homocystine. Between 1965 and 1985, 83 cases of metabolic disorders were detected, including 23 cases of primary hypothyroidism, 14 of classic phenylketonuria, 5 of galactosemia variants, 3 of galactosemia, 2 of maple syrup urine disease and 1 of hereditary tyrosinemia. The direct cost per infant screened is $5.50, and the cost:benefit ratio is approximately 7.5:1. Maternal serum alpha-fetoprotein screening is being made available as the necessary supporting clinical facilities become available. On the basis of this experience, the author outlines the components that are important for an effective screening program.

Fox, J G



Perinatal Polychlorinated Biphenyl 126 Exposure Alters Offspring Body Composition.  


Polychlorinated biphenyls (PCBs) are ubiquitous environmental contaminants whose exposure levels are associated with various health hazards. We hypothesized that in utero and lactational exposure to PCBs can cause changes in body composition and obesity in a mouse model. Pregnant mice were exposed biweekly to two concentrations of PCB 126 via oral gavage. Maternal PCB exposure did not result in heavier offspring, however, dose-dependent and sex specific changes in body composition were observed. Female offspring displayed the most susceptibility to PCB-induced alterations in body composition, having less percent lean body mass and increased adiposity compared to females born to control dams, and these effects were largely dose-dependent. In contrast to females, and independent of the exposure level of PCB 126, male offspring had reduced lean body mass but no change in fat mass compared to males born to control dams. In conclusion, perinatal PCB 126 exposure did not affect body weight, but rather modulated body composition in a dose-dependent and gender-specific manner. PMID:23741283

Rashid, Cetewayo S; Carter, Lindsay G; Hennig, Bernhard; Pearson, Kevin J



Hydramnios prediction of adverse perinatal outcome  

Microsoft Academic Search

Objective: To determine whether hydramnios is associated with an increased risk of adverse perinatal outcomes.Methods: Computerized records of all ultrasound examinations done at the University of Alabama at Birmingham from 1986 to 1996 (n = 40,065) were reviewed to identify 370 women with singleton pregnancies beyond 20 weeks’ gestation and hydramnios diagnosed sonographically by amniotic fluid index of 25 cm

Joseph R Biggio; Katharine D Wenstrom; Mary B Dubard; Suzanne P Cliver



The Perinatal Database of the Netherlands  

Microsoft Academic Search

Objective: In the Netherlands, the Perinatal Database of the Netherlands (Landelijke Verloskunderegistratie, LVR) was set up in 1982 for secondary care obstetric departments on a voluntary participation basis, its main goal being quality monitoring. At the outset of the database, 70% of Dutch obstetric departments participated immediately. This percentage has now increased to almost 100%. How the LVR was set

P. M Elferink-Stinkens; O. J. S Van Hemel; R Brand; J. M. W. M Merkus



Perinatal outcome of singleton term breech deliveries  

Microsoft Academic Search

Objective: To assess neonatal morbidity and mortality in singleton term infants delivered in breech presentation and to find a possible correlation between outcome and mode of delivery. Study design: Case study of 306 singleton, term (37–42 weeks), breech deliveries, that took place between 1989 and 1994 in one perinatal centre. Results: 170 infants were delivered vaginally, 72 by elective and

Maureen R Koo; Gustaaf A Dekker; Herman P van Geijn



Infants at Risk: Perinatal and Neonatal Factors  

Microsoft Academic Search

Studies have been reviewed to indicate that (a) prematurity and other perinatal hazards impose congenital constraints upon the behavior of the young infant, (b) experimental deficits within the earliest days and weeks of life can compound the risk, (c) infants who succumb to crib death (sudden infant death syndrome) have demonstrably more risk factors present in their prenatal and neonatal

Lewis P. Lipsitt



Perinatal Risk Factors for Mild Motor Disability  

ERIC Educational Resources Information Center

|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,…

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



Current problems of perinatal Chlamydia trachomatis infections  

Microsoft Academic Search

Chlamydia trachomatis has been recognized as a pathogen of trachoma, nongonococcal urethritis, salpingitis, endocervicitis, pelvic inflammatory disease, inclusion conjunctivitis of neonates, follicular conjunctivitis of adults, infantile pneumonia and associated conditions. Chlamydial infections during pregnancy may also cause a variety of perinatal complications. Different antigenic strains of C. trachomatis from endocervical, nasopharyngeal and conjunctival origins have been associated with different clinical

Kei Numazaki



[Listeriosis and borreliosis in perinatal medicine].  


Authors review the available literature on listeriosis and boreliosis in perinatology. A growing clinical importance of listeriosis is noted. Boreliosis is a newly described disease. In the light of the literature data, listeriosis and boreliosis do not seem to play an important role in the perinatal medicine. However, in selected cases, these infections should be considered in diagnostic and therapeutic procedures. PMID:10224781

Sikorski, R; Stroczy?ska-Sikorska, M



Perinatal death and tocolytic magnesium sulfate  

Microsoft Academic Search

Objective: To determine whether there is a significant association between perinatal mortality and exposure to total doses of tocolytic magnesium sulfate larger than 48 g.Methods: We did a case-control study in which cases were defined as neonates or fetuses who died after being exposed to tocolytic magnesium sulfate and controls were those who survived exposure. The study included fetuses and

Rebecca Scudiero; Babak Khoshnood; Peter G Pryde; Kwang-Sun Lee; Stephen Wall; Robert Mittendorf



Fetal Tobacco Syndrome and Perinatal Outcome  

Microsoft Academic Search

Objective: The aim of this study was to evaluate perinatal outcome in newborns of mothers who are smokers. Methods: The study included 87 pregnant women with a single pregnancy in the cephalic position, 64 of them nonsmokers (group 1), 13 who smoked 5–20 cigarettes per day (group 2) and 10 who smoked more than 20 cigarettes per day (group 3).

Dubravko Habek; Josip Djelmiš



Perinatal factors associated with severe intracranial hemorrhage  

Microsoft Academic Search

Objective: The purpose of this study was to assess the incidence of perinatal factors that are associated with severe intracranial hemorrhage in a large and recent multicenter experience. Study Design: Retrospective analyses of nonanomalous newborns who were admitted to 100 neonatal intensive care units from 23 to 34 6\\/7 weeks' gestation were analyzed by multiple regression. Results: There were 12,578

James A. Thorp; Philip G. Jones; Reese H. Clark; Eric Knox; Joyce L. Peabody



Regionalized perinatal care in North America  

Microsoft Academic Search

The aim of this article is to familiarize the reader with the status of regionalized perinatal health care in North America, and specifically in the United States of America, using the Iowa regionalization model. The evolution of the regionalization movement in the late 1960s and early 1970s is reviewed. It is noted that the movement was largely without federal government

Herman A. Hein



Perinatal transmission of human papilomavirus DNA  

Microsoft Academic Search

The purpose was to study the perinatal transmission of human papillomavirus DNA (HPV-DNA) in 63 mother-newborn pairs, besides looking at the epidemiological factors involved in the viral DNA transmission. The following sampling methods were used: (1) in the pregnant woman, when was recruited, in cervix and clinical lesions of the vagina, vulva and perineal region; (2) in the newborn, (a)

Renato L Rombaldi; Eduardo P Serafini; Jovana Mandelli; Edineia Zimmermann; Kamille P Losquiavo



Perinatal care improves the outcome of triplets  

Microsoft Academic Search

Objective: To compare pregnancy complications and neonatal outcome of 85 triplet gestations cared for during the 15 years in a single perinatal unit. Methods: Pregnancies were divided in two groups according to the differences in the management plan and their outcomes were compared. Group I (N=44) consisted of pregnancies cared from 1986 to 1995, using standard model of care: preventive

Snjezana Skrablin; Ivan Kuvacic; Drzislav Kalafatic; Branimir Peter; Snjezana Gveric-Ahmetasevic; Nevena Letica-Protega; Jelena Polak-Babic



Is screening for depression in the perinatal period enough? The co-occurrence of depression, substance abuse, and intimate partner violence in culturally diverse pregnant women.  


Abstract Background: The perinatal period provides unique opportunities to identify and intervene with the co-occurrence of perinatal depression, intimate partner violence (IPV), and substance use problems. Psychosocial screening recommended for women seen in maternal child health settings tends to target single rather than multiple risk factors; there is limited research examining the co-occurrence of these issues especially in racially and ethnically diverse women across the perinatal period. These analyses explore the relationships of sociodemographic, psychosocial, and behavioral characteristics in a large, diverse sample of women. Method: Women receiving perinatal services at routinely scheduled visits, including the 6-week postpartum visit, were recruited from 10 community obstetric/gynecologic clinics. Data were collected on perinatal depression, IPV, maternal substance use, and sociodemographic characteristics by bilingual, bicultural research assistants. Results: A total of 1868 women were screened, 1526 (82%) Latina, 1099 (58.8%) interviewed in Spanish; 20.4% (n=382) screened positive for depressive symptoms based on an Edinburgh Postnatal Depression Scale score of 10 or above, 20.9% reported harmful drinking, 4.3% reported drug use, 23% reported substance use problems, and 3.5% reported current or recent IPV. Women who were Black, Asian, Pacific Islander, or other race/ethnicity had greater odds for depressive symptoms relative to women who were Hispanic or Latino (odds ratio [OR]=1.81, p=0.005). Women reporting substance use problems (OR=2.37, p<0.0001) and IPV (OR=3.98, p<0.0001) had higher odds for depressive symptoms. Conclusion: In a predominately Latina sample, 1 in 5 mothers (20.4%) screened positive for depressive symptoms and over one third (36.7%) reported one or more psychosocial issues during the perinatal period. Screening for multiple risk factors rather than just one can help clinicians tailor interventions for the successful management of psychosocial issues. PMID:23931153

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



Birth weight, maternal weight and childhood leukaemia  

PubMed Central

There is mounting evidence that childhood leukaemia is associated with high birth weight, but few studies have examined the relationship between leukaemia and other perinatal factors that influence birth weight, such as maternal weight or gestational weight gain. This case-cohort study included 916 acute lymphocytic leukaemia (ALL) and 154 acute myeloid leukaemia (AML) cases diagnosed prior to age 10 years between 1985 and 2001 and born in New York State excluding New York City between 1978 and 2001. Controls (n=9686) were selected from the birth cohorts for the same years. Moderate increased risk of both ALL and AML was associated with birth weight 3500?g or more. For ALL, however, there was evidence of effect modification with birth weight and maternal prepregnancy weight. High birth weight was associated with ALL only when the mother was not overweight while heavier maternal weight was associated with ALL only when the infant was not high birth weight. Increased pregnancy-related weight gain was associated with ALL. For AML, birth weight under 3000?g and higher prepregnancy weight were both associated with increased risk. These findings suggest childhood leukaemia may be related to factors influencing abnormal fetal growth patterns.

McLaughlin, C C; Baptiste, M S; Schymura, M J; Nasca, P C; Zdeb, M S



Maternal and infant birth characteristics and hepatoblastoma.  


Hepatoblastoma is a rare embryonal tumor with unknown etiology. The authors conducted a case-cohort study using public health surveillance data sets to examine perinatal risk factors for hepatoblastoma. Hepatoblastoma cases (n = 58) diagnosed between 1985 and 2001 were identified from the New York State Cancer Registry and were matched to electronic birth records for 1985-2001 from New York State, excluding New York City. Controls (n = 6,056) were selected from the birth cohorts for the same years. Having a birth weight less than 1,000 g was associated with a strongly increased risk of hepatoblastoma (relative risk (RR) = 56.9, 95% confidence interval (CI): 24.0, 130.7). After adjustment for birth weight, a moderately increased risk of hepatoblastoma was found for younger maternal age (<20 years vs. 20-29 years: RR = 2.5, 95% CI: 1.0, 5.5), presumptive use of infertility treatment (RR = 9.2, 95% CI: 2.1, 31.5), maternal smoking (RR = 2.1, 95% CI: 1.0, 4.2), and higher maternal prepregnancy body mass index (body mass index of 25-29 vs. 20-24: RR = 2.9, 95% CI: 1.2, 7.6). PMID:16510543

McLaughlin, Colleen C; Baptiste, Mark S; Schymura, Maria J; Nasca, Philip C; Zdeb, Michael S



Birth weight, maternal weight and childhood leukaemia.  


There is mounting evidence that childhood leukaemia is associated with high birth weight, but few studies have examined the relationship between leukaemia and other perinatal factors that influence birth weight, such as maternal weight or gestational weight gain. This case-cohort study included 916 acute lymphocytic leukaemia (ALL) and 154 acute myeloid leukaemia (AML) cases diagnosed prior to age 10 years between 1985 and 2001 and born in New York State excluding New York City between 1978 and 2001. Controls (n=9686) were selected from the birth cohorts for the same years. Moderate increased risk of both ALL and AML was associated with birth weight 3500 g or more. For ALL, however, there was evidence of effect modification with birth weight and maternal prepregnancy weight. High birth weight was associated with ALL only when the mother was not overweight while heavier maternal weight was associated with ALL only when the infant was not high birth weight. Increased pregnancy-related weight gain was associated with ALL. For AML, birth weight under 3000 g and higher prepregnancy weight were both associated with increased risk. These findings suggest childhood leukaemia may be related to factors influencing abnormal fetal growth patterns. PMID:16736025

McLaughlin, C C; Baptiste, M S; Schymura, M J; Nasca, P C; Zdeb, M S



Route of breech delivery and maternal and neonatal outcomes  

Microsoft Academic Search

Objective: To compare maternal and neonatal outcomes in elective cesarean vs. attempted vaginal delivery for breech presentation at or near term. Methods: We reviewed the maternal and neonatal charts of all singleton breech deliveries of at least 35 weeks’ gestation or 2000 g delivered between 1986 and 1997 at our institution. Patients delivered by elective cesarean were compared to those

L Sanchez-Ramos; T. L Wells; C. D Adair; G Arcelin; A. M Kaunitz; D. S Wells



Perinatal care in six eastern Caribbean countries.  


In December, 1981, the Government of the Netherlands conducted evaluation studies of perinatal health care in the 6 Caribbean countries of Antigua, the Bahamas, Barbados, Dominica, Saint Lucia, and St. Vincnet. In recent years, the governments of the 6 countries expressed their concerns about the need to improve perinatal health care and about the limited funds, health facilities, and health manpower available for meeting this need. Data for the studies were collected during visits to the 6 countries and consisted of availble vital statistics and hospital records collected by local physicians and chief nurses. Since 70%-95% of the deliveries in these countries occurred in hospitals, hospital data were used to assess the level of perinatal mortality. Perinatal death rates for the 6 countries ranged from 29/1000 live births to 38/1000 live births. When stillbirths and neonatal death rates were examined separately, there was considerable variation between countries. Stillbirth rates ranged from 23.4-13.6/1000 live births and neonatal death rates ranged from 9.9-22.5/1000 live births. These differences probably reflected classification problems rather than actual differences. Although there was considerable variation in per capita income levels in the 6 countries (US$380-US$2620) these differences did not appear to be associated with differences in perinatal death rates. Average birth weights for the 6 countries ranged from 3000 gm to 3150 gm, and the average for all 6 countries combined was 3100 gm. The incidence of low birth weights (2500 gm or less) ranged from 5.9% in Dominica to 11% in Barbados. The major causes of perinatal death were complications resulting from anoxia or hypoxia, prematurity complications, and neonatal infections. Infants who survive these conditions frequently develop handicaps. Average breastfeeding duration ranged from 1 month in the Bahamas to 7 months in St. Vincent. Bottle feeding is common and generally begins early. Mistaken beliefs about the nutritional inadequacies of breast milk as well as the promotion of formulas contribute toward the relatively low rate and short duration of breastfeeding in these countries. Specific recommendations for improving perinatal health care in each of the 6 countries were provided. Recommendations relevant to most of the countries were 1) to improve the level of health knowledge among the general public, 2) to provide additional training for all health personnel working in the perinatal health care field, 3) to upgrade and improve the maintenance of basic equipment for resuscitating newborns, 4) to promote the early detection and improve the management of jaundice, 5) to distribute free supplies of anti-D-globulin for treating Rh-negative mothers, 6) to develop linkages between perinatal health care facilities and postpartum health care facilities to ensure continuity of care for each infant, 7) to develop a system for detecting and managing high risk pregnancies and infants at high risk, 8) to promote funding for tropical perinatology, and 9) to develop a perinatal technology appropriate to conditions in these countries. PMID:4027454

Boersma, E R



Men in maternal care: evidence from India.  


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

Chattopadhyay, Aparajita



Dynamic influence of maternal and pup traits on maternal care during lactation in an income breeder, the antarctic fur seal.  


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

McDonald, Birgitte I; Goebel, Michael E; Crocker, Daniel E; Costa, Daniel P



The methodological challenges of attempting to compare the safety of home and hospital birth in terms of the risk of perinatal death.  


This paper identifies a number of methodological difficulties associated with the comparison of home and hospital birth in terms of the risk of perinatal death, and suggests ways in which these problems can be overcome. A review of recent studies suggests that most available data sources are unable to overcome all of these challenges, which is one of the reasons why the debate about whether perinatal death is more likely if a home birth is planned or if a hospital birth is planned has not been satisfactorily resolved. We argue that the debate will be settled only if perinatal mortality data from a sufficiently large number of maternity care providers over a sufficiently long period of time can be pooled and made available for analysis. The pooling of data will bring about its own difficulties due to variations over time and between providers and geographical areas, which would need to be taken into account when analysing pooled data. However, given the impracticality of a randomised controlled trial and the rarity of home birth in most of the Western world, we argue that more effort should be made to pool data for perinatal mortality and other rare pregnancy outcomes, and share them between health providers and researchers. Thus, high-quality analyses could be conducted, allowing all women to make an informed choice about place of birth. However, pooling data from countries or states with very different maternity care systems should be avoided. PMID:22951423

Nove, Andrea; Berrington, Ann; Matthews, Zoë



From planning to practice: building the national network for the surveillance of severe maternal morbidity  

PubMed Central

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.



Maternal and neonatal individual risks and benefits associated with caesarean delivery: multicentre prospective study  

PubMed Central

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.

Carroli, Guillermo; Zavaleta, Nelly; Donner, Allan; Wojdyla, Daniel; Faundes, Anibal; Velazco, Alejandro; Bataglia, Vicente; Langer, Ana; Narvaez, Alberto; Valladares, Eliette; Shah, Archana; Campodonico, Liana; Romero, Mariana; Reynoso, Sofia; de Padua, Karla Simonia; Giordano, Daniel; Kublickas, Marius; Acosta, Arnaldo



Perinatal Responsiveness to Alcohol's Chemosensory Cues as a Function of Prenatal Alcohol Administration during Gestational Days 17–20 in the Rat  

Microsoft Academic Search

Rat fetuses proximal to birth process alcohol-derived cues when the drug is directly delivered into the amniotic fluid. Prior evidence indicates that chemosensory sensation is detected during gestational Day 17 (GD17). In the present study Wistar-derived pregnant females received 0, 1, or 2 g\\/kg\\/day of alcohol (intragastric intubation) during GDs 17–20. Prenatal treatment failed to affect different maternal–fetal and perinatal

Héctor Daniel Dom??nguez; Marcelo Fernando López; Mar??a Gabriela Chotro; Juan Carlos Molina



Is metabolic syndrome X a disorder of the brain with the initiation of low-grade systemic inflammatory events during the perinatal period?  

Microsoft Academic Search

An imbalance between pro- and anti-inflammatory molecules occurs in metabolic syndrome X. High-energy diet, saturated fats and trans-fats during perinatal period could suppress ?6 and ?5 desaturases both in the maternal and fetal tissues, resulting in a decrease in the concentrations of long-chain polyunsaturated fatty acids (LCPUFAs): arachidonic acid (AA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) that have a

Undurti N. Das



Introduction of a qualitative perinatal audit at Muhimbili National Hospital, Dar es Salaam, Tanzania  

Microsoft Academic Search

BACKGROUND: Perinatal death is a devastating experience for the mother and of concern in clinical practice. Regular perinatal audit may identify suboptimal care related to perinatal deaths and thus appropriate measures for its reduction. The aim of this study was to perform a qualitative perinatal audit of intrapartum and early neonatal deaths and propose means of reducing the perinatal mortality

Hussein L. Kidanto; Ingrid Mogren; Jos van Roosmalen; Siriel N. Massawe; Lennarth Nystrom; Gunilla Lindmark



Perinatal malnutrition programs sympathoadrenal and hypothalamic-pituitary-adrenal axis responsiveness to restraint stress in adult male rats.  


In humans, an altered control of cortisol secretion was reported in adult men born with a low birth weight making the hypothalamic-pituitary-adrenal (HPA) axis a possible primary target of early life programming. In rats, we have recently shown that maternal food restriction during late pregnancy induces both an intrauterine growth retardation and an overexposure of fetuses to maternal corticosterone, which disturb the development of the HPA axis in offspring. The first aim of this work was to investigate, in adult male rats, whether perinatal malnutrition has long-lasting effects on the HPA axis activity during both basal and stressful conditions. Moreover, as the HPA axis and sympathetic nervous system are both activated by stress, the second aim of this work was to investigate, in these rats, the adrenomedullary catecholaminergic system under basal and stressful conditions. This study was conducted on 4-month-old male rats malnourished during their perinatal life and on age-matched control animals. Under basal conditions, perinatal malnutrition reduced body weight and plasma corticosteroid-binding globulin (CBG) level but increased mineralocorticoid receptor (MR) gene expression in CA1 hippocampal area. After 30 min of restraint, perinatally malnourished (PM) rats showed increased plasma noradrenaline, adrenocorticotropin hormone (ACTH) and corticosterone concentrations similarly as controls, but calculated plasma-free corticosterone concentration was significantly higher and adrenaline level lower than controls. During the phase of recovery, PM rats showed a rapid return of plasma ACTH and corticosterone concentrations to baseline levels in comparison with controls. These data suggest that in PM rats, an elevation of basal concentrations of corticosterone, in face of reduced CBG and probably increased hippocampal MR lead to a much larger impact of corticosterone on target cells that mediate the negative-feedback mechanism on the activities of both the HPA axis and sympathoadrenal one. PMID:11849373

Lesage, J; Dufourny, L; Laborie, C; Bernet, F; Blondeau, B; Avril, I; Bréant, B; Dupouy, J P



Improving Quality of Care for Maternal and Newborn Health: Prospective Pilot Study of the WHO Safe Childbirth Checklist Program  

PubMed Central

Background Most maternal deaths, intrapartum-related stillbirths, and newborn deaths in low income countries are preventable but simple, effective methods for improving safety in institutional births have not been devised. Checklist-based interventions aid management of complex or neglected tasks and have been shown to reduce harm in healthcare. We hypothesized that implementation of the WHO Safe Childbirth Checklist program, a novel childbirth safety program for institutional births incorporating a 29-item checklist, would increase delivery of essential childbirth practices linked with improved maternal and perinatal health outcomes. Methods and Findings A pilot, pre-post-intervention study was conducted in a sub-district level birth center in Karnataka, India between July and December 2010. We prospectively observed health workers that attended to women and newborns during 499 consecutively enrolled birth events and compared these with observed practices during 795 consecutively enrolled birth events after the introduction of the WHO Safe Childbirth Checklist program. Twenty-nine essential practices that target the major causes of childbirth-related mortality, such as hand hygiene and uterotonic administration, were evaluated. The primary end point was the average rate of successful delivery of essential childbirth practices by health workers. Delivery of essential childbirth-related care practices at each birth event increased from an average of 10 of 29 practices at baseline (95%CI 9.4, 10.1) to an average of 25 of 29 practices afterwards (95%CI 24.6, 25.3; p<0.001). There was significant improvement in the delivery of 28 out of 29 individual practices. No adverse outcomes relating to the intervention occurred. Study limitations are the pre-post design, potential Hawthorne effect, and focus on processes of care versus health outcomes. Conclusions Introduction of the WHO Safe Childbirth Checklist program markedly improved delivery of essential safety practices by health workers. Future study will determine if this program can be implemented at scale and improve health outcomes.

Kodkany, Bhala; Lipsitz, Stuart; Lashoher, Angela; Dziekan, Gerald; Bahl, Rajiv; Merialdi, Mario; Mathai, Matthews; Lemer, Claire; Gawande, Atul



Excessive maternal weight gain patterns in adolescents  

Microsoft Academic Search

The objective of this study was to examine the correlates of excessive maternal weight gain among adolescent mothers in the United States. Data from the Centers for Disease Control & Prevention 2000 natality file were analyzed to examine weight gain among adolescents (?19 years) compared with their older counterparts (?20 years). Using the Institute of Medicine guidelines, we defined excessive

Lajeana D. Howie; Jennifer D. Parker; Kenneth C. Schoendorf



Association of antenatal care with facility delivery and perinatal survival - a population-based study in Bangladesh  

PubMed Central

Background Antenatal Care (ANC) during pregnancy can play an important role in the uptake of evidence-based services vital to the health of women and their infants. Studies report positive effects of ANC on use of facility-based delivery and perinatal mortality. However, most existing studies are limited to cross-sectional surveys with long recall periods, and generally do not include population-based samples. Methods This study was conducted within the Health and Demographic Surveillance System (HDSS) of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) in Matlab, Bangladesh. The HDSS area is divided into an icddr,b service area (SA) where women and children receive care from icddr,b health facilities, and a government SA where people receive care from government facilities. In 2007, a new Maternal, Neonatal, and Child Health (MNCH) program was initiated in the icddr,b SA that strengthened the ongoing maternal and child health services including ANC. We estimated the association of ANC with facility delivery and perinatal mortality using prospectively collected data from 2005 to 2009. Using a before-after study design, we also determined the role of ANC services on reduction of perinatal mortality between the periods before (2005 – 2006) and after (2008–2009) implementation of the MNCH program. Results Antenatal care visits were associated with increased facility-based delivery in the icddr,b and government SAs. In the icddr,b SA, the adjusted odds of perinatal mortality was about 2-times higher (odds ratio (OR) 1.91; 95% confidence intervals (CI): 1.50, 2.42) among women who received ?1 ANC compared to women who received ?3 ANC visits. No such association was observed in the government SA. Controlling for ANC visits substantially reduced the observed effect of the intervention on perinatal mortality (OR 0.64; 95% CI: 0.52, 0.78) to non-significance (OR 0.81; 95% CI: 0.65, 1.01), when comparing cohorts before and after the MNCH program initiation (Sobel test of mediation P < 0.001). Conclusions ANC visits are associated with increased uptake of facility-based delivery and improved perinatal survival in the icddr,b SA. Further testing of the icddr,b approach to simultaneously improving quality of ANC and facility delivery care is needed in the existing health system in Bangladesh and in other low-income countries to maximize health benefits to mothers and newborns.



Nutritional Interventions in Depression and Perinatal Depression  

PubMed Central

Depression is the leading cause of mental disability worldwide. Women who are depressed during pregnancy are at a higher risk for preterm delivery, preeclampsia, birth difficulties, and postpartum depression. The treatment of depression in conventional medicine has focused on physiological factors that lead to impaired neurotransmitter function and treatments to improve neurotransmitter function. Pharmaceutical substances pose risks for pregnant and lactating women, and lower risk options are preferred. Micronutrients, including certain B vitamins, folate, and docosahexaenoic acid (DHA), play a role in the synthesis and absorption of neurotransmitters. Experimental studies suggest that supplementation with specific micronutrients may alleviate depressive symptoms and improve birth outcomes in patients with perinatal depression. Alternative treatments for depression, including nutritional supplements, are an important treatment option for depressive symptoms while limiting potential side effects and treatment costs. This article explores the biological basis of perinatal depression and reviews the potential benefits of non-pharmacological interventions.

Rechenberg, Kaitlyn; Humphries, Debbie



Bisphenol A: Perinatal exposure and body weight  

PubMed Central

Bisphenol A (BPA) is a component of polycarbonate and other plastics including resins that line food and beverage containers. BPA is known to leach from products in contact with food and drink, and is therefore thought to be routinely ingested. In a recent cross sectional study, BPA was detected in urine samples from 92.6% of the US population examined. The potential for BPA to influence body weight is suggested by in vitro studies demonstrating effects of BPA on adipocyte differentiation, lipid accumulation, glucose transport and adiponectin secretion. Data from in vivo studies have revealed dose-dependent and sex dependent effects on body weight in rodents exposed perinatally to BPA. The mechanisms through which perinatal BPA exposure acts to exert persistent effects on body weight and adiposity remain to be determined. Possible targets of BPA action are discussed.

Rubin, Beverly S.; Soto, Ana M.



Erythrocyte disorders in the perinatal period.  


Anemia is a commonly encountered problem in the fetal and neonatal period, and can lead to significant morbidity and mortality. Intrinsic disorders of the erythrocyte, such as the hemoglobinopathies, enzyme deficiencies, and membrane defects are common causes of neonatal anemia. Genetic diseases that lead to decreased erythrocyte production, such as Diamond-Blackfan anemia, Schwachman-Diamond syndrome, and Congential Dyserythropoietic Anemia, are rare causes of perinatal anemia, but are important to recognize as they are often associated with other congenital abnormalities and require specialized treatment. This review focuses on the perinatal presentation and management of intrinsic erythrocyte disorders, as well as on the diagnosis and management of genetic conditions leading to erythrocyte underproduction. PMID:17825683

Steiner, Laurie A; Gallagher, Patrick G



Spontaneous perinatal epidural haemorrhage in a newborn.  


A full-term neonate, born by caesarean section, presents with focal seizures. EEG and cranial ultrasound are normal. MRI of the cerebrum shows an epidural haematoma. Perinatal intracranial haemorrhage in the full-term newborn is an important cause of morbidity and mortality. Most perinatal intracranial haemorrhages are located either subdural or intracerebral, rarely epidural. Epidural haemorrhage is usually a complication of assisted delivery, however it may also occur without forcipal or vacuum extraction, as demonstrated in this case. An epidural haemorrhage should be suspected on clinical findings, even in the absence of an assisted delivery. As cranial ultrasound sonography often misses epidural haemorrhage due to parietal location of the haemorrhage, the diagnosis needs either cerebral CT or MRI. PMID:22665463

Kroon, Elke; Bok, Levinus A; Halbertsma, Feico



Report on Perinatal Statistics for 2002  

Microsoft Academic Search

This report presents information on pregnancy outcomes, together with descriptive social and biological characteristics of mothers giving birth and babies born in Ireland in 2002. In 2002, 60,865 births were notified to the National Perinatal Reporting System. The birth rate for 2002 is estimated at 15.5 per 1,000 population which represents a increase of 12.0 per cent since 1993. Over

Sheelagh Bonham


Report on Perinatal Statistics for 2001  

Microsoft Academic Search

This report presents information on pregnancy outcomes, together with descriptive social and biological characteristics of mothers giving birth and babies born in Ireland in 2001. In 2001, 58,261 births were notified to the National Perinatal Reporting System. The birth rate for 2001 is estimated at 15.1 per 1,000 population which represents a increase of 4.7 per cent since 1992. Over

Sheelagh Bonham


Report on Perinatal Statistics for 2004  

Microsoft Academic Search

This report presents information on pregnancy outcomes, together with descriptive social and biological characteristics of mothers giving birth and babies born in Ireland in 2004. In 2004, 62,406 births were notified to the National Perinatal Reporting System. The birth rate for 2004 is estimated at 15.3 per 1,000 population, an overall increase of 6% in the birth rate of 14.5

Sheelagh Bonham


Perinatal detection of gallstones in siblings.  


Infant and pediatric cholelithiases are well-recognized conditions, thought to be predisposed to by several factors. Fetal cholelithiasis by comparison is a rare finding, and little is known about the natural history and clinical significance of echogenic foci in the fetal gallbladder. The occurrence of fetal gallstones has not been reported among siblings. We report on the first known case of perinatal detection of gallstones in siblings. PMID:20440667

Iroh Tam, Pui-Ying; Angelides, Anastasios



Perinatal predictors of outcome in gastroschisis  

Microsoft Academic Search

Objective:To identify perinatal risk variables predictive of outcome in gastroschisis.Study Design:Gastroschisis cases were collected over a 3-year period from a national database. Risk variables evaluated included gestational age (GA), birth weight, time of birth, admission illness severity (score for neonatal acute physiology-II, SNAP-II) score, and abdominal closure type. Mortality and survival outcomes were analyzed. Multivariate analyses were performed.Result:In all, 239

J A Mills; Y Lin; Y C MacNab; E D Skarsgard; ED Skarsgard



Neoplasms in young dogs after perinatal irradiation  

SciTech Connect

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.

Benjamin, S.A.; Lee, A.C.; Angleton, G.M.; Saunders, W.J.; Miller, G.K.; Williams, J.S.; Brewster, R.D.; Long, R.I.



Perinatal Asphyxia in a Nonhuman Primate Model  

PubMed Central

Perinatal asphyxia is a leading cause of brain injury in neonates, occurring in 2–4 per 1,000 live births, and there are limited treatment options. Because of their similarity to humans, nonhuman primates are ideal for performing preclinical tests of safety and efficacy for neurotherapeutic interventions. We previously developed a primate model of acute perinatal asphyxia using 12–15 min of umbilical cord occlusion. Continuing this research, we have increased cord occlusion time from 15 to 18 min and extended neurodevelopmental follow-up to 9 months. The purpose of this report is to evaluate the increase in morbidity associated with 18 min of asphyxia by comparing indices obtained from colony controls, nonasphyxiated controls and asphyxiated animals. Pigtail macaques were delivered by hysterotomy after 0, 15 or 18 min of cord occlusion, then resuscitated. Over the ensuing 9 months, for each biochemical and physiologic parameters, behavioral and developmental evaluations, and structural and spectroscopic MRI were recorded. At birth, all asphyxiated animals required resuscitation with positive pressure ventilation and exhibited biochemical and clinical characteristics diagnostic of hypoxic-ischemic encephalopathy, including metabolic acidosis and attenuated brain activity. Compared with controls, asphyxiated animals developed long-term physical and cognitive deficits. This preliminary report characterizes the acute and chronic consequences of perinatal asphyxia in a nonhuman primate model, and describes diagnostic imaging tools for quantifying correlates of neonatal brain injury as well as neurodevelopmental tests for evaluating early motor and cognitive outcomes.

Misbe, Elizabeth N. Jacobson; Richards, Todd L.; McPherson, Ronald J.; Burbacher, Thomas M.; Juul, Sandra E.



Congenital and perinatal cytomegalovirus lung infection.  


Abstract Background: Cytomegalovirus (CMV) pneumonitis may be severe, even lethal, following congenital infection or in premature infants with perinatal infection. Objective: To review the epidemiological, pathogenetic, clinical and therapeutic features of prenatal and perinatal CMV lung diseases. Methods: Evaluation of all published papers listed on PubMed describing CMV pneumonitis in infants. Results: CMV is frequent and severe in immunosuppressed infants but infrequent in full-term neonates and occurs more frequently after perinatal than after congenital infection, particularly in premature infants. In premature infants, CMV infection is often protracted and causes a diffuse interstitial pneumonitis leading to fibrosis and bronchopulmonary dysplasia (BPD). Congenital CMV infection should also be considered in newborns with severe acute respiratory distress syndrome and refractory respiratory failure with progression to early chronic lung disease. The association between breast milk-transmitted CMV and development of cystic lung disease and Wilson-Mikity syndrome has also been reported. Data on the efficacy of antiviral therapy for infants with respiratory CMV diseases are lacking and only anecdotal case reports are available. Conclusions: Persistent CMV infection appears to cause a diffuse necrotizing pneumonitis with fibrosis leading to BPD, in both immunocompromised or preterm infants and, less frequently in immunocompetent infants. The role of antiviral therapy remains to be elucidated. PMID:23570320

Coclite, Eleonora; Di Natale, Cecilia; Nigro, Giovanni



Domestic Violence and Perinatal Mental Disorders: A Systematic Review and Meta-Analysis  

PubMed Central

Background Domestic violence in the perinatal period is associated with adverse obstetric outcomes, but evidence is limited on its association with perinatal mental disorders. We aimed to estimate the prevalence and odds of having experienced domestic violence among women with antenatal and postnatal mental disorders (depression and anxiety disorders including post-traumatic stress disorder [PTSD], eating disorders, and psychoses). Methods and Findings We conducted a systematic review and meta-analysis (PROSPERO reference CRD42012002048). Data sources included searches of electronic databases (to 15 February 2013), hand searches, citation tracking, update of a review on victimisation and mental disorder, and expert recommendations. Included studies were peer-reviewed experimental or observational studies that reported on women aged 16 y or older, that assessed the prevalence and/or odds of having experienced domestic violence, and that assessed symptoms of perinatal mental disorder using a validated instrument. Two reviewers screened 1,125 full-text papers, extracted data, and independently appraised study quality. Odds ratios were pooled using meta-analysis. Sixty-seven papers were included. Pooled estimates from longitudinal studies suggest a 3-fold increase in the odds of high levels of depressive symptoms in the postnatal period after having experienced partner violence during pregnancy (odds ratio 3.1, 95% CI 2.7–3.6). Increased odds of having experienced domestic violence among women with high levels of depressive, anxiety, and PTSD symptoms in the antenatal and postnatal periods were consistently reported in cross-sectional studies. No studies were identified on eating disorders or puerperal psychosis. Analyses were limited because of study heterogeneity and lack of data on baseline symptoms, preventing clear findings on causal directionality. Conclusions High levels of symptoms of perinatal depression, anxiety, and PTSD are significantly associated with having experienced domestic violence. High-quality evidence is now needed on how maternity and mental health services should address domestic violence and improve health outcomes for women and their infants in the perinatal period. Please see later in the article for the Editors' Summary

Howard, Louise M.; Oram, Sian; Galley, Helen; Trevillion, Kylee; Feder, Gene



75 FR 12244 - Eunice Kennedy Shriver National Institute of Child Health & Human Development; Notice of Closed...  

Federal Register 2010, 2011, 2012, 2013

...Institute of Child Health & Human Development; Notice of Closed...Institute of Child Health and Human Development Special Emphasis...Contribution to Maternal Pregnancy Physiology and Outcomes in ART. Date...Institute of Child Health and Human Development, NIH, 6100...



76 FR 12125 - Eunice Kennedy Shriver National Institute of Child Health & Human Development; Notice of Closed...  

Federal Register 2010, 2011, 2012, 2013

...Institute of Child Health & Human Development; Notice of Closed...Institute of Child Health and Human Development Special Emphasis...Contribution to Maternal Pregnancy Physiology and Outcomes in Art. Date...Institute of Child Health and Human Development, NIH, 6100...



Strategic Approach to Improving Maternal Survival in Oman  

PubMed Central

This study of maternal mortality in Oman tries to answer the question: Is the Fifth Millennium Development Goal achievable in Oman or not? In Oman, Maternal Mortality Ratio currently stands at 22.9/100,000, a reduction of 38.9% from its 37.5/100,000 in 2002. This figure suggests that much needs to be done to accelerate progress towards the achievement of the Fifth Millennium Development Goal. Characteristics of 135 Omani women who died during pregnancy, labour or puerperium during the period 1990-2005 were studied. Data related to maternal health in Oman were also scrutinized, e.g. age of first marriage, ante-natal, natal and post-natal care, birth spacing, fertility and perinatal mortality. The study calls for accelerated efforts and renewed commitment to maternal health and recommends a framework for national strategic directions to scale up access to essential interventions to reduce maternal mortality in Oman and move closer to the achievement of the Fifth Millennium Development Goal.

Alshishtawy, Mo'ness M.



Management of maternal obesity prior to and during pregnancy.  


The prevalence of obesity is high and rising worldwide. The greatest prevalence of obesity is found in the western world and in urban developing countries. There is an increased maternal mortality associated with maternal obesity. There are increased risks of most maternal complications in pregnancy including pre-eclampsia, gestational and pre-existing type 2 diabetes mellitus and thromboembolic disorders. There is an increased perinatal mortality associated with maternal obesity; there are increased risks of congenital malformation, fetal macrosomia and indeed risks for the fetus as a child and adult in the years to come. There are increased risks of complications of pregnancy including caesarean section, traumatic delivery and a reduced chance of breastfeeding. Maternal obesity in pregnancy predicts long-term risks for that mother. The management includes increased surveillance for these risks and lifestyle modulation during pregnancy. This includes dietary measures and encouraging modest increase in exercise. Ideally, the mother should achieve closer to an ideal body mass index prior to pregnancy using lifestyle intervention but possibly with pharmacological therapy or bariatric surgery. The ideal weight gain for an obese mother is less than the ideal weight gain for a lean mother. PMID:19945927

Shaikh, H; Robinson, S; Teoh, T G



Role of maternal 5-HT1A receptor in programming offspring emotional and physical development  

PubMed Central

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.

van Velzen, Annelies; Toth, Miklos



Diabetes and Perinatal Mortality in Twin Pregnancies  

PubMed Central

Background Diabetes in pregnancy has been associated with a paradoxically reduced risk of neonatal death in twin pregnancies. Risk “shift” may be a concern in that the reduction in neonatal deaths may be due to an increase in fetal deaths (stillbirths). This study aimed to clarify the impact of diabetes on the risk of perinatal death (neonatal death plus stillbirth) in twin pregnancies. Methods This was a retrospective cohort study of twin births using the largest available dataset on twin births (the U.S. matched multiple birth data 1995-2000; 19,676 neonates from diabetic pregnancies, 541,481 from non-diabetic pregnancies). Cox proportional hazard models were applied to estimate the adjusted hazard ratios (aHR) of perinatal death accounting for twin cluster-level dependence. Results Comparing diabetic versus non-diabetic twin pregnancies, overall perinatal mortality rate was counterintuitively lower [2.1% versus 3.3%, aHR 0.70 (95% confidence intervals 0.63-0.78)]. Individually, both stillbirth and neonatal mortality rates were lower in diabetic pregnancies, but we identified significant differences by gestational age and birth weight. Diabetes was associated with a survival benefit in pregnancies completed before 32 weeks [aHR 0.55 (0.48-0.63)] or with birth weight <1500 g [aHR 0.61 (0.53-0.69)]. In contrast, diabetes was associated with an elevated risk of perinatal death in pregnancies delivered between 32 and 36 weeks [aHR 1.38 (1.10-1.72)] or with birth weight >=2500 g [aHR 2.20 (1.55-3.13)]. Conclusions Diabetes in pregnancy appears to be “protective” against perinatal death in twin pregnancies ending in very preterm or very low birth weight births. Prospective studies are required to clarify whether these patterns of risk are real, or they are artifacts of unmeasured confounders. Additional data correlating these outcomes with the types of diabetes in pregnancy are also needed to distinguish the effects of pre-gestational vs. gestational diabetes.

Luo, Zhong-Cheng; Zhao, Yan-Jun; Ouyang, Fengxiu; Yang, Zu-Jing; Guo, Yu-Na; Zhang, Jun



Effect of multiple micronutrient supplementation during pregnancy on maternal and birth outcomes  

Microsoft Academic Search

Objectives\\/background  Given the widespread prevalence of micronutrient deficiencies in developing countries, supplementation with multiple micronutrients\\u000a rather than iron-folate alone, could be of potential benefit to the mother and the fetus. These benefits could relate to prevention\\u000a of maternal complications and reduction in other adverse pregnancy outcomes such as small-for-gestational age (SGA) births,\\u000a low birth weight, stillbirths, perinatal and neonatal mortality. This

Batool Azra Haider; Mohammad Yawar Yakoob; Zulfiqar A Bhutta



Bisphenol-A exposure during pregnancy and lactation affects maternal behavior in rats  

Microsoft Academic Search

In mammals, endogenous estrogens are crucial for sexual differentiation during the perinatal period, and the modulation in adulthood of many neuroendocrine and behavioral functions involved in reproduction. In rats, the estrogenic environment during pregnancy and lactation affects directly maternal behavior. This experiment was aimed to test whether the exposure to the estrogenic compound bisphenol-A (BPA; 0.040mg\\/kg\\/die, orally) of adult female

Daniele Della Seta; Isabelle Minder; Francesco Dessì-Fulgheri; Francesca Farabollini



Adverse pregnancy outcomes and long-term morbidity after early fetal hypokinesia in maternal smoking pregnancies  

Microsoft Academic Search

Aim  The aim of this study is to evaluate perinatal outcome and subsequent morbidity and neurodevelopment in 10-year-old children\\u000a with fetal hypokinesia intrauterinely verified by ultrasonography in early pregnancy as a pattern of abnormal fetal behavior\\u000a due to maternal chronic smoking. This study revealed significant global fetal hypokinesia as well as head and arm hypokinesia\\u000a in early pregnancy in mothers’ chronic

Dubravko Habek; Melita Kova?evi?



Maternal Health: A Case Study of Rajasthan  

PubMed Central

This case study has used the results of a review of literature to understand the persistence of poor maternal health in Rajasthan, a large state of north India, and to make some conclusions on reasons for the same. The rate of reduction in Rajasthan's maternal mortality ratio (MMR) has been slow, and it has remained at 445 per 1000 livebirths in 2003. The government system provides the bulk of maternal health services. Although the service infrastructure has improved in stages, the availability of maternal health services in rural areas remains poor because of low availability of human resources, especially midwives and clinical specialists, and their non-residence in rural areas. Various national programmes, such as the Family Planning, Child Survival and Safe Motherhood and Reproductive and Child Health (phase 1 and 2), have attempted to improve maternal health; however, they have not made the desired impact either because of an earlier emphasis on ineffective strategies, slow implementation as reflected in the poor use of available resources, or lack of effective ground-level governance, as exemplified by the widespread practice of informally charging users for free services. Thirty-two percent of women delivered in institutions in 2005-2006. A 2006 government scheme to give financial incentives for delivering in government institutions has led to substantial increase in the proportion of institutional deliveries. The availability of safe abortion services is limited, resulting in a large number of informal abortion service providers and unsafe abortions, especially in rural areas. The recent scheme of Janani Suraksha Yojana provides an opportunity to improve maternal and neonatal health, provided the quality issues can be adequately addressed.

Iyengar, Kirti; Gupta, Vikram



Perinatal depression and birth outcomes in a Healthy Start project.  


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

Smith, Megan V; Shao, Lin; Howell, Heather; Lin, Haiqun; Yonkers, Kimberly A



Perinatal and early infantile symptoms in congenital disorders of glycosylation.  


Congenital disorders of glycosylation (CDG) are a rapidly growing family of inborn errors. Screening for CDG in suspected cases is usually performed in the first year of life by serum transferrin isoelectric focusing or mass spectrometry. Based on the transferrin analysis patients can be biochemically diagnosed with a type 1 or type 2 transferrin pattern, and labeled as CDG-I, or CDG-II. The diagnosis of CDG is frequently delayed due to the highly variable phenotype, some cases showing single organ involvement and others mimicking syndromes, like skeletal dysplasia, cutis laxa syndrome, or congenital muscle dystrophy. The aim of our study was to evaluate perinatal abnormalities and early discriminative symptoms in 58 patients consecutively diagnosed with diverse CDG-subtypes. Neonatal findings and clinical features in the first months of life were studied in 36 children with CDG-I and 22 with CDG-II. Maternal complications were found in five, small for gestational age in nine patients. Five children had abnormal neonatal screening results for hypothyroidism. Congenital microcephaly and neonatal seizures were common in CDG-II. Inverted nipples were uncommon with 5 out of 58 children. Dysmorphic features were mostly nonspecific, except for cutis laxa. Early complications included feeding problems, cardiomyopathy, thrombosis, and bleeding. Cases presenting in the neonatal period had the highest mortality rate. Survival in CDG patients is highly dependent on early intervention therapy. We recommend low threshold screening for glycosylation disorders in infants with neurologic symptoms, even in the absence of abnormal fat distribution. Growth retardation and neonatal bleeding increase suspicion for CDG. PMID:23401092

Funke, Simone; Gardeitchik, Thatjana; Kouwenberg, Dorus; Mohamed, Miski; Wortmann, Saskia B; Korsch, Eckhard; Adamowicz, Maciej; Al-Gazali, Lihadh; Wevers, Ron A; Horvath, Adrienne; Lefeber, Dirk J; Morava, Eva



Mothers of IVF twins: the mediating role of employment and social coping resources in maternal stress.  


Twin pregnancies and births resulting from assisted reproductive technologies have been associated with adverse perinatal outcomes and maternal health complications leading to psychologically complex parenting. In the current study the authors assess the prevalence of clinical levels of maternal stress among mothers of twins resulting from in vitro fertilization and examine the association of social coping resources with three maternal stress sub-scales. During the years 2003-2005, 88 primiparous Israeli mothers of in vitro fertilization-conceived twins provided socio-demographic data during their third trimester of pregnancy, and at 6 months after birth provided data on delivery and medical condition of infants, coping resources (social support and marital quality), and a maternal stress scale. Forty-one percent of the mothers reached a clinically significant level of maternal stress. Social support and maternal employment were the most significant variables associated with experience of the stress in the early stages of adaptation to mothering in vitro fertilization twins. Primiparous mothers of in vitro fertilization twins are vulnerable to maternal stress in early stages of adaptation to the maternal role, some of whom reach clinical levels that may require professional interventions. Unemployed mothers with low social support were the most susceptible to the deleterious effects of in vitro fertilization treatment. PMID:22533899

Baor, Liora; Soskolne, Varda



Changes in adaptability following perinatal morphine exposure in juvenile and adult rats.  


The problem of drug abuse among pregnant women causes a major concern. The aim of the present study was to examine the adaptive consequences of long term maternal morphine exposure in offspring at different postnatal ages, and to see the possibility of compensation, as well. Pregnant rats were treated daily with morphine from the day of mating (on the first two days 5mg/kgs.c. than 10mg/kg) until weaning. Male offspring of dams treated with physiological saline served as control. Behavior in the elevated plus maze (EPM; anxiety) and forced swimming test (FST; depression) as well as adrenocorticotropin and corticosterone hormone levels were measured at postpartum days 23-25 and at adult age. There was only a tendency of spending less time in the open arms of the EPM in morphine treated rats at both ages, thus, the supposed anxiogenic impact of perinatal exposure with morphine needs more focused examination. In response to 5min FST morphine exposed animals spent considerable longer time with floating and shorter time with climbing at both ages which is an expressing sign of depression-like behavior. Perinatal morphine exposure induced a hypoactivity of the stress axis (adrenocorticotropin and corticosterone elevations) to strong stimulus (FST). Our results show that perinatal morphine exposure induces long term depression-like changes. At the same time the reactivity to the stress is failed. These findings on rodents presume that the progenies of morphine users could have lifelong problems in adaptive capability and might be prone to develop psychiatric disorders. PMID:21147096

Klausz, Barbara; Pintér, Ottó; Sobor, Melinda; Gyarmati, Zsuzsa; Fürst, Zsuzsanna; Tímár, Júlia; Zelena, Dóra



The Maternal and Child Health Sites' Practices Regarding HIV Education, Counseling, and Testing of Women of Reproductive Age in Chicago: Barriers to Universal Implementation  

Microsoft Academic Search

Objectives: Women of reproductive age are increasingly at risk for human immunodeficiency virus (HIV) infection. Recent advances in reducing perinatal transmission have resulted in official guidelines on universal HIV education, counseling, and voluntary testing of women of reproductive age, especially pregnant women. This study assesses to what extent the maternal child health (MCH) sites are implementing these guidelines with their

Afsaneh Rahimian; Mary Driscoll; Dean Taylor



Impaired auditory discrimination learning following perinatal nicotine exposure or ?2 nicotinic acetylcholine receptor subunit deletion  

PubMed Central

Maternal smoking during pregnancy can impair performance of the exposed offspring in tasks that require auditory stimulus processing and perception; however, the tobacco component(s) responsible for these effects and the underlying neurobiological mechanisms remain uncertain. In this study, we show that administration of nicotine during mouse perinatal development can impair performance in an auditory discrimination paradigm when the exposed animals are mature. This suggests that nicotine disrupts auditory pathways via nicotinic acetylcholine receptors (nAChRs) that are expressed at an early stage of development. We have also determined that mice which lack nAChRs containing the ?2 subunit (?2* nAChRs) exhibit similarly compromised performance in this task, suggesting that ?2* nAChRs are necessary for normal auditory discrimination or that ?2* nAChRs play a critical role in development of the circuitry required for task performance. In contrast, no effect of perinatal nicotine exposure or ?2 subunit knockout was found on the acquisition and performance of a differential reinforcement of low rate task. This suggests that the auditory discrimination impairments are not a consequence of a general deficit in learning and memory, but may be the result of compromised auditory stimulus processing in the nicotine-exposed and knockout animals.

Horst, Nicole K.; Heath, Christopher J.; Neugebauer, Nichole M.; Kimchi, Eyal Y.; Laubach, Mark; Picciotto, Marina R.



Perinatal outcomes among foreign-born and US-born Chinese Americans, 1995-2000.  


This paper examines nativity differences in adverse perinatal outcomes of Chinese-American mothers. Singleton live births to US-resident Chinese women (150,620 foreign-born, 15,040 US-born) and a random sample of 150,620 non-Hispanic White mothers were selected from 1995 to 2000 national linked birth/infant death certificate files. Associations between maternal nativity status and adverse perinatal outcomes were assessed using multivariable logistic regressions. Compared to US-born Chinese mothers, foreign-born Chinese mothers were less likely to be unmarried, teen mothers, have a non-Hispanic White or other race partner, be rural residents, and more likely to be less educated, or utilize prenatal care inadequately. Controlling for these factors, foreign-born Chinese-American mothers had significantly lower risks for low birth weight, preterm birth, and small-for-gestational age, whereas risks for infant mortality, neonatal mortality, and post-neonatal mortality did not differ significantly from those of infants of US-born Chinese mothers. Chinese Americans exhibited clear nativity differentials for adverse birth outcomes. PMID:18825499

Li, Qing; Keith, Louis G; Kirby, Russell S



Induced abortion as a risk factor for perinatal complications: a review.  

PubMed Central

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.

Bracken, M. B.



Cortical Reorganization of Language Functioning Following Perinatal Left MCA Stroke  

ERIC Educational Resources Information Center

|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…

Tillema, Jan-Mendelt; Byars, Anna W.; Jacola, Lisa M.; Schapiro, Mark B.; Schmithorst, Vince J.; Szaflarski, Jerzy P.; Holland, Scott K.



Perinatal complications and child abuse in a poverty sample  

Microsoft Academic Search

Objective: Perinatal medical illness has been associated with child maltreatment. Using a Child Protective Service (CPS) report as the defining event, this study explores to what extent perinatal morbidity is a risk factor for maltreatment.Method: Medical charts of 206 children ages 0–3 years were reviewed. Data regarding birth history were collected and analyzed in three groups of children: children whose

Marina Zelenko; James Lock; Helena C. Kraemer; Hans Steiner



Measuring perinatal complications: methodologic issues related to gestational age  

Microsoft Academic Search

BACKGROUND: Perinatal outcomes differ by week of gestational age. However, it appears that how measures to examine these outcomes vary among various studies. The current paper explores how perinatal complications are reported and how they might differ when different denominators, numerators, and comparison groups are utilized. CONCLUSION: One issue that can clearly affect absolute rates and trends is how groups

Aaron B. Caughey



Some Animal Models for the Study of Perinatal Asphyxia  

Microsoft Academic Search

Much of our current understanding concerning the pathophysiology of perinatal brain disorders has evolved from animal studies over the past three decades. Fetal and neonatal nonhuman primate, pregnant sheep, lamb, puppy, piglet and immature rodents, all have been important animal models for perinatal brain research. Although no model can be considered Ê?perfect’ in reflecting the variety and complexity of human

Tonse N. K Raju



Cortical Reorganization of Language Functioning Following Perinatal Left MCA Stroke  

ERIC Educational Resources Information Center

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…

Tillema, Jan-Mendelt; Byars, Anna W.; Jacola, Lisa M.; Schapiro, Mark B.; Schmithorst, Vince J.; Szaflarski, Jerzy P.; Holland, Scott K.



Perinatal events and the risk of developing primary sclerosing cholangitis  

Microsoft Academic Search

AIM: To investigate whether perinatal events, intrauterine or postpartum, are associated with the development of primary sclerosing cholangitis (PSC) later in life. METHODS: Birth records from 97 patients with adult PSC in Sweden were reviewed. Information on perinatal events including medications and complications during pregnancy, gestation length, birth weight and length were collected. Two control children of the same sex

Annika Bergquist; Scott M Montgomery; Ulrika Lund; Anders Ekbom; Rolf Olsson; Stefan Lindgren; Hanne Prytz; Rolf Hultcrantz; Ulrika Broomé


Influenza A/H1N1 MF59 adjuvanted vaccine in pregnant women and adverse perinatal outcomes: multicentre study  

PubMed Central

Objective To assess the risk of adverse perinatal events of vaccination of pregnant women with an MF59 adjuvanted vaccine. Design Cross sectional multicentre study. Setting 49 public hospitals in major cities in Argentina, from September 2010 to May 2011. Participants 30?448 mothers (7293 vaccinated) and their 30?769 newborns. Main outcome measure Primary composite outcome of low birth weight, preterm delivery, or fetal or early neonatal death up to seven days postpartum. Results Vaccinated women had a lower risk of the primary composite outcome (7.0% (n=513) v 9.3% (n=2160); adjusted odds ratio 0.80, 95% confidence interval 0.72 to 0.89). The propensity score analysis showed similar results. Adjusted odds ratios for vaccinated women were 0.74 (0.65 to 0.83) for low birth weight, 0.79 (0.69 to 0.90) for preterm delivery, and 0.68 (0.42 to 1.06) for perinatal mortality. These findings were consistent in further subgroup analysis. No significant differences in maternal outcomes were found. Conclusion This large study using primary data collection found that MF59 adjuvanted A/H1N1 influenza vaccine did not result in an increased risk of adverse perinatal events and suggested a lower risk among vaccinated women. These findings should contribute to inform stakeholders and decision makers on the prescription of vaccination against influenza A/H1N1 in pregnant women.



Does advanced maternal age confer a survival advantage to infants born at early gestation?  

PubMed Central

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.



Prenatal and perinatal risk factors of schizophrenia.  


Schizophrenia could be considered the most severe of all psychiatric disorders. It shows a heterogeneous clinical picture and presents an etiopathogenesis that is not cleared sufficiently. Even if the etiopathogenesis remains a puzzle, there is a scientific consensus that it is an expression of interaction between genotype and environmental factors. In the present article, following a study of literature and the accumulated evidence, the role of prenatal and perinatal factors in the development of schizophrenia will be revised and synthesized. We think that better knowledge of the risk factors could be helpful not only for better comprehension of the pathogenesis but especially to optimize interventions for prevention of the disorder. PMID:22646662

Meli, Giampiero; Ottl, Birgit; Paladini, Angela; Cataldi, Luigi



Use of Wigglesworth pathophysiological classification for perinatal mortality in Malaysia.  

PubMed Central

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.

Amar, H. S.; Maimunah, A. H.; Wong, S. L.



Antenatal care packages with reduced visits and perinatal mortality: a secondary analysis of the WHO Antenatal Care Trial  

PubMed Central

Background In 2001, the WHO Antenatal Care Trial (WHOACT) concluded that an antenatal care package of evidence-based screening, therapeutic interventions and education across four antenatal visits for low-risk women was not inferior to standard antenatal care and may reduce cost. However, an updated Cochrane review in 2010 identified an increased risk of perinatal mortality of borderline statistical significance in three cluster-randomized trials (including the WHOACT) in developing countries. We conducted a secondary analysis of the WHOACT data to determine the relationship between the reduced visits, goal-oriented antenatal care package and perinatal mortality. Methods Exploratory analyses were conducted to assess the effect of baseline risk and timing of perinatal death. Women were stratified by baseline risk to assess differences between intervention and control groups. We used linear modeling and Poisson regression to determine the relative risk of fetal death, neonatal death and perinatal mortality by gestational age. Results 12,568 women attended the 27 intervention clinics and 11,958 women attended the 26 control clinics. 6,160 women were high risk and 18,365 women were low risk. There were 161 fetal deaths (1.4%) in the intervention group compared to 119 fetal deaths in the control group (1.1%) with an increased overall adjusted relative risk of fetal death (Adjusted RR 1.27; 95% CI 1.03, 1.58). This was attributable to an increased relative risk of fetal death between 32 and 36 weeks of gestation (Adjusted RR 2.24; 95% CI 1.42, 3.53) which was statistically significant for high and low risk groups. Conclusion It is plausible the increased risk of fetal death between 32 and 36 weeks gestation could be due to reduced number of visits, however heterogeneity in study populations or differences in quality of care and timing of visits could also be playing a role. Monitoring maternal, fetal and neonatal outcomes when implementing antenatal care protocols is essential. Implementing reduced visit antenatal care packages demands careful monitoring of maternal and perinatal outcomes, especially fetal death.



Development of a Linked Perinatal Data Resource From State Administrative and Community-Based Program Data.  


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

Hall, Eric S; Goyal, Neera K; Ammerman, Robert T; Miller, Megan M; Jones, David E; Short, Jodie A; Van Ginkel, Judith B



Maternal behavior in cattle  

Microsoft Academic Search

We provide a critical summary of the literature on maternal behavior in cattle. The studies we review increase our basic understanding of this behavior and provide insights into practical problems in cattle production. When domesticated cattle are permitted to rear their young, the behaviors associated with maternal care are for the most part similar to those observed in wild ungulates.

Marina A. G. von Keyserlingk; Daniel M. Weary



Confidential inquiry into perinatal mortality in the Lower Rio Grande Valley, 1988  

Microsoft Academic Search

A review of 1985 neonatal death statistics in the Lower Rio Grande Valley of Texas revealed an excessive perinatal death rate among Hispanics compared to Anglos. In order to identify factors contributing to perinatal mortality in the region and to determine if existing perinatal services were adequate, a confidential inquiry into each 1988 perinatal death was performed.^ Medical risk factors

Beryl Craig Vallejo



An Exploratory Study of the Psychological Impact and Clinical Care of Perinatal Loss  

Microsoft Academic Search

Perinatal loss is a unique and potentially traumatizing experience that can leave bereaved parents struggling with a host of mental health difficulties. In this exploratory study of the predictors and mental health outcomes associated with perinatal loss, we examined a cohort of women who experienced a perinatal loss within the previous 5 years. Results suggest perinatal loss is associated with

Shannon M. Bennett; Brett T. Litz; Shira Maguen; Jill T. Ehrenreich



Lesser than diabetes hyperglycemia in pregnancy is related to perinatal mortality: a cohort study in Brazil  

PubMed Central

Background Gestational diabetes related morbidity increases along the continuum of the glycemic spectrum. Perinatal mortality, as a complication of gestational diabetes, has been little investigated. In early studies, an association was found, but in more recent ones it has not been confirmed. The Brazilian Study of Gestational Diabetes, a cohort of untreated pregnant women enrolled in the early 1990's, offers a unique opportunity to investigate this question. Thus, our objective is to evaluate whether perinatal mortality increases in a continuum across the maternal glycemic spectrum. Methods We prospectively enrolled and followed 4401 pregnant women attending general prenatal care clinics in six Brazilian state capitals, without history of diabetes outside of pregnancy, through to birth, and their offspring through the early neonatal period. Women answered a structured questionnaire and underwent a standardized 2-hour 75-g oral glucose tolerance test (OGTT). Obstetric care was maintained according to local protocols. We obtained antenatal, delivery and neonatal data from hospital records. Odds ratios (OR) were estimated using logistic regression. Results We ascertained 97 perinatal deaths (67 fetal and 31 early neonatal). Odds of dying increased according to glucose levels, statistically significantly so only for women delivering at gestational age ?34 weeks (p < 0.05 for glycemia-gestational age interaction). ORs for a 1 standard deviation difference in glucose, when analyzed continuously, were for fasting 1.47 (95% CI 1.12, 1.92); 1-h 1.55 (95% CI 1.15, 2.07); and 2-h 1.53 (95% CI 1.15, 2.02). The adjusted OR for IADPSG criteria gestational diabetes was 2.21 (95% CI 1.15, 4.27); and for WHO criteria gestational diabetes, 3.10 (95% CI 1.39, 6.88). Conclusions In settings of limited detection and treatment of gestational diabetes mellitus, women across a spectrum of lesser than diabetes hyperglycemia, experienced a continuous rise in perinatal death with increasing levels of glycemia after 34 weeks of pregnancy. Current GDM diagnostic criteria identified this increased risk of mortality.



The Effect of Maternal Thrombophilia on Placental Abruption: Histologic Correlates  

PubMed Central

Objective To determine if the histology of placental abruption differs by maternal thrombophilia status. Study design This was a multicenter, case-control study of women with abruption and delivering at ?20 weeks’ gestation, collected as part of the ongoing New Jersey-Placental Abruption Study. Women were identified by clinical criteria of abruption. Maternal blood was collected postpartum and tested for anticardiolipin antibodies, and mutations in the Factor V Leiden and prothrombin genes. Cases were comprised of women with an abruption and a positive thrombophilia screen. Controls were comprised of women with an abruption and a negative thrombophilia screen. All placental histology was systematically reviewed by two perinatal pathologists, blinded to the abruption status. Results A total of 135 women with placental abruption were identified, of which 63.0% (n=85) had at least one diagnosed maternal thrombophilia. There were increases in the rates of meconium-stained membranes (7.9% versus 2.1%, P=0.015) and decidual necrosis (4.5% versus 2.1%, P=0.023) when a maternal thrombophilia was diagnosed. Although there was no difference in the overall presence of infarcts between the 2 groups (27.0% versus 38.3%, P=0.064), the presence of an old infarct was more common among women with a positive thrombophilia screen (83.3% versus 44.4%, P=0.003). Conclusion Placental abruption with a positive maternal thrombophilia screen is associated with higher rates of old placental infarcts and decidual necrosis compared with abruption when thrombophilia is not diagnosed. These lesions suggest a chronic etiology of placental abruption in the presence of a maternal thrombophilia.

Kinzler, Wendy L.; Prasad, Vinay; Ananth, Cande V.



Parental and Perinatal Correlates of Neonatal Behaviors.  

ERIC Educational Resources Information Center

|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…

Standley, Kay


Care for perinatal illness in rural Nepal: a descriptive study with cross-sectional and qualitative components  

PubMed Central

Background Maternal, perinatal and neonatal mortality rates remain high in rural areas of developing countries. Most deliveries take place at home and care-seeking behaviour is often delayed. We report on a combined quantitative and qualitative study of care seeking obstacles and practices relating to perinatal illness in rural Makwanpur district, Nepal, with particular emphasis on consultation strategies. Methods The analysis included a survey of 8798 women who reported a birth in the previous two years [of whom 3557 reported illness in their pregnancy], on 30 case studies of perinatal morbidity and mortality, and on 43 focus group discussions with mothers, other family members and health workers. Results Early pregnancy was often concealed, preparation for birth was minimal and trained attendance at birth was uncommon. Family members were favoured attendants, particularly mothers-in-law. The most common recalled maternal complications were prolonged labour, postpartum haemorrhage and retained placenta. Neonatal death, though less definable, was often associated with cessation of suckling and shortness of breath. Many home-based care practices for maternal and neonatal illness were described. Self-medication was common. There were delays in recognising and acting on danger signs, and in seeking care beyond the household, in which the cultural requirement for maternal seclusion, and the perceived expense of care, played a part. Of the 760 women who sought care at a government facility, 70% took more than 12 hours from the decision to seek help to actual consultation. Consultation was primarily with traditional healers, who were key actors in the ascription of causation. Use of the government primary health care system was limited: the most common source of allopathic care was the district hospital. Conclusions Major obstacles to seeking care were: a limited capacity to recognise danger signs; the need to watch and wait; and an overwhelming preference to treat illness within the community. Safer motherhood and newborn care programmes in rural communities, must address both community and health facility care to have an impact on morbidity and mortality. The roles of community actors such as mothers-in-law, husbands, local healers and pharmacies, and increased access to properly trained birth attendants need to be addressed if delays in reaching health facilities are to be shortened.

Mesko, Natasha; Osrin, David; Tamang, Suresh; Shrestha, Bhim P; Manandhar, Dharma S; Manandhar, Madan; Standing, Hilary; Costello, Anthony M de L



Associations between perinatal factors and adiponectin and leptin in 9-year-old Mexican-American children.  


What is already known about this subject Mexican-American children are at particularly high risk of obesity. Features of the perinatal environment, including maternal nutrition, anthropometry, glucose tolerance and growth rate during infancy are implicated in programming of obesity in the offspring. What this study adds Greater rate of weight or length gain in the first 6 months of life is associated with lower 9-year child adiponectin levels, adjusting for 9-year child BMI. Nine-year-old child adipokine levels are strongly related to those of their mothers'. OBJECTIVES: To (i) determine whether perinatal factors (including maternal anthropometry and nutrition and early life growth measures) are associated with adiponectin and leptin levels in 9-year-old children, and (ii) assess relationships between adiponectin, leptin and concurrent lipid profile in these children. METHODS: We measured plasma adiponectin and leptin for 146 mothers-9-year-old child pairs from the ongoing longitudinal birth cohort followed by the Center for the Health Assessment of Mothers and Children of Salinas. Data on perinatal factors, including sociodemographics, maternal anthropometry and nutrition, and early life child growth were collected during pregnancy, birth and 6-month visits. RESULTS: Greater rate of weight and length gain during the first 6 months of life were associated with lower adiponectin in 9-year-olds (??=?-2.0, P?=?0.04; ??=?-8.2, P?=?0.02, respectively) adjusting for child body mass index (BMI). We found no associations between child adipokine levels and either maternal calorie, protein, total fat, saturated fat, fibre, sugar-sweetened beverage consumption during pregnancy or children's concurrent sugar-sweetened beverage and fast food intake. Lipid profile in 9-year-old children closely reflected adiponectin but not leptin levels after adjustment for child BMI. Additionally, we report that child adipokine levels were closely related to their mothers' levels at the 9-year visit. CONCLUSION: Overall, our results support the hypothesis that early life factors may contribute to altered adipokine levels in children. PMID:23325579

Volberg, Vitaly; Harley, Kim G; Aguilar, Raul S; Rosas, Lisa G; Huen, Karen; Yousefi, Paul; Davé, Veronica; Phan, Nguyet; Lustig, Robert H; Eskenazi, Brenda; Holland, Nina



The maternal autopsy  

PubMed Central

Careful study of reports prepared for the Confidential Enquiries into Maternal Deaths in England and Wales has made it clear that many maternal autopsy reports are not as informative as they might be. This is, in part at least, because no pathologist who does not work in a maternity unit can expect to see more than a handful of such deaths in a working lifetime. This paper describes briefly the particular features to look for at autopsy, stresses the importance of taking adequate material for histology and discusses some of the more significant histological findings, both of conditions which cause death and of those commonly associated with it. Images

Rushton, DI; Dawson, IMP



Distribution of maternity units and spatial access to specialised care for women delivering before 32 weeks of gestation in Europe.  


Survival and quality of life are improved for very preterm babies when delivery occurs in a maternity unit with on-site neonatal intensive care (level III unit). We investigated the impact of distance on the probability of delivering in such a unit for births before 32 weeks of gestation from 9 European regions with diverse perinatal health systems (the MOSAIC cohort). We analysed distances between women's homes, and the nearest level III in population quartiles, adjusting for maternal and pregnancy characteristics. Living farther away from a level III reduced access to specialised care everywhere; in some regions women residing in the fourth quartile were half as likely to deliver in level III units as those in the first. To improve regionalized perinatal care the spatial location of level III units should be taken into account. PMID:20083421

Pilkington, Hugo; Blondel, Béatrice; Papiernik, Emile; Cuttini, Marina; Charreire, Hélène; Maier, Rolf F; Petrou, Stavros; Combier, Evelyne; Künzel, Wolfgang; Bréart, Gérard; Zeitlin, Jennifer



Victimization and perpetration among perinatal substance abusers.  


This study examined associations between demographic, psychiatric, substance abuse, and childhood abuse variables and past 30-day victimization and perpetration among 77 perinatal substance abusers. Victimization rates were 70% emotional, 34% physical, 29% sexual, and 42% personal freedom violations. For perpetration, incidence was 71% emotional, 25% physical, 5% sexual, and 9% personal freedom violations. Through univariate regression, Addiction Severity Index (ASI) psychiatric and drug composite scores, childhood physical abuse, borderline personality disorder (BPD) and post-traumatic stress disorder (PTSD) were found to significantly predict victimization. In contrast, ASI psychiatric and drug composite scores, BPD, PTSD, and aggressive-sadistic and antisocial personality disorders were found to significantly predict perpetration. In multiple regression models, ASI drug and psychiatric composite scores accounted for the majority of the variance for both victimization and perpetration, suggesting that women with high ASI scores should be queried about their involvement in abusive acts at time of admission to drug treatment. PMID:14675508

Haller, Deborah L; Miles, Donna R



Hyperthermia, inflammation, and perinatal brain injury.  


Hyperthermia at the time of or following a hypoxic-ischemic insult has been associated with adverse neurodevelopmental outcome. Moreover, an elevation in temperature during labor has been associated with a variety of other adverse neurologic sequelae such as neonatal seizures, encephalopathy, stroke, and cerebral palsy. These outcomes may be secondary to a number of deleterious effects of hyperthermia including an increase in cellular metabolic rate and cerebral blood flow alteration, release of excitotoxic products such as free radicals and glutamate, and hemostatic changes. There is also an association between chorioamnionitis at the time of delivery and cerebral palsy, which is thought to be secondary to cytokine-mediated injury. We review experimental and human studies demonstrating a link between hyperthermia and perinatal brain injury. PMID:23683657

Kasdorf, Ericalyn; Perlman, Jeffrey M



[Oxytocin administration during labor. Results from the 2010 French National Perinatal Survey.  


OBJECTIVES: To estimate the frequency of oxytocin administration during labor, in all women in labor, in low-risk women, and in women with a previous cesarean delivery. Our objectives were also to identify characteristics of women and of maternity units associated with this practice in France. POPULATION AND METHOD: Analysis of the 2010 French Perinatal Survey data (n=14,681 women who delivered in continental France). The frequency of oxytocin administration during labor was estimated in all women in labor (n=12,845) and in low-risk women (n=9798). The independent associations between oxytocin administration during labor and characteristics of women and units were quantified with multivariate logistic regression modeling. RESULTS: Sixty-four percent of laboring women received oxytocin during labor, and 58% of women with a spontaneous onset of labor. In the population of low-risk women with spontaneous labor and epidural, nulliparity and over-weight, as well as the private status and small size of the maternity unit, were independently associated with a more frequent administration of oxytocin during labor. CONCLUSION: Oxytocin administration during labor is very frequent in France, probably beyond classical indications. PMID:23570744

Belghiti, J; Coulm, B; Kayem, G; Blondel, B; Deneux-Tharaux, C



Maternal hair--an appropriate matrix for detecting maternal exposure to pesticides during pregnancy.  


The detection of exposure of pregnant women to toxicants in the environment is important because these compounds can be harmful to the health of the woman and her fetus. The aim of this study was to analyze for pesticides/herbicides in paired maternal hair and blood samples to determine the most appropriate matrix for detecting maternal exposure to these compounds. A total of 449 pregnant women were prospectively recruited at midgestation from an agricultural site in the Philippines where a preliminary survey indicated significant use at home and on the farm of the following compounds: propoxur, cyfluthrin, chlorpyrifos, cypermethrin, pretilachlor, bioallethrin, malathion, diazinon, and transfluthrin. Paired maternal hair and blood samples were obtained from each subject upon recruitment into the study (midgestation) and at birth and were analyzed for the above compounds, as well as lindane and DDT [1,1,1-trichloro-2-2-bis(p-chlorophenyl) ethane], and some of their known metabolites by gas chromatography/mass spectrometry. The highest exposure rate was seen for propoxur and bioallethrin and maternal hair analysis provided the highest detection rate for these two compounds, compared to blood, at both time periods: (1) At midgestation, 10.5% positive for propoxur in hair compared to 0.7% in blood (P<0.001) and for bioallethrin, 11.9% positive in hair compared to 0% in blood (P < or = 0.001), and (2) at birth, 11.8% positive for propoxur in hair compared to 4% in blood (P < or = 0.001) and for bioallethrin, 7.8% in hair compared to 0% in blood (P < or = 0.001). A small number of maternal hair samples were also positive for malathion, chlorpyrifos, pretilachlor, and DDT. Only a few of the pesticide metabolites were detected, principally 3-phenoxybenzoic acid, malathion monocarboxylic acid, and DDE [1,1,dichloro-2-2-bis(p-chlorophenyl)ethylene], and they were mostly found in maternal blood. There was a significant association between the use of the home spray pesticide, Baygon, and propoxur in maternal hair at birth (P=0.001) and between the use of a slow-burning mosquito coil and the presence of bioallethrin in maternal hair at midgestation and at birth (P=0.001, P < or = 0.041, respectively). There is significant exposure of the pregnant woman to pesticides, particularly to pesticides that are used at home. Our study demonstrates the advantages of analyzing maternal hair as a readily available biologic matrix for studying maternal exposure to toxicants in the environment, compared to blood. For propoxur, there was a 3- to 15-fold higher detection rate of the pesticide in maternal hair as compared to blood. As for the other pesticides, bioallethrin, malathion, chlorpyrifos, and DDT were exclusively found in maternal hair compared to blood. On the other hand, pesticide metabolites were infrequently found in maternal hair or maternal blood. Pesticides in blood most likely represent acute exposure, whereas pesticides in hair represent past and/or concurrent exposure. The high sensitivity, wide window of exposure, availability, and ease of hair collection are distinct advantages in using hair to detect exposure to pesticides among pregnant women. However, pesticides in maternal hair may also be secondary to passive exposure and therefore not truly representative of the internal pesticide dose. Finally, the analysis of maternal hair for pesticides as an index of maternal exposure to pesticides in the environment allows the institution of measures to prevent further exposure during pregnancy. PMID:16584725

Ostrea, Enrique M; Villanueva-Uy, Esterlita; Bielawski, Dawn M; Posecion, Norberto C; Corrion, Melissa L; Jin, Yan; Janisse, James J; Ager, Joel W



Maternal and foetal risk factor and complication with immediate outcome during hospital stay of very low birth weight babies.  


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

Mannan, M A; Jahan, N; Dey, S K; Uddin, M F; Ahmed, S



The Coalition for Improving Maternity Services: Evidence Basis for the Ten Steps of Mother-Friendly Care  

PubMed Central

One factor explaining why women choose unnecessary high-tech births is their lack of knowledge of the research. Presenting research in Lamaze class can be difficult; however, teaching tools described in this article may help facilitate evidence-based discussions. The recently published Journal of Perinatal Education supplement issue written by the Coalition for Improving Maternity Services Expert Work Group gives Lamaze educators a rich resource to pass along to expectant parents.

Hotelling, Barbara A.



Maternal Adherence to the Zidovudine Regimen for HIV-Exposed Infants to Prevent HIV Infection: A Preliminary Study  

Microsoft Academic Search

ABSTRACT. Objective. To describe the extent of ad- herence to the recommended neonatal zidovudine (ZDV) regimen administered to infants who have been exposed to the human immunodeficiency virus (HIV) to prevent mother-to-child transmission of HIV and to determine which maternal factors are associated with compliance. Methods. HIV-infected women,(n,87) who were participating in a larger study of perinatal transmission at 3

Penelope A. Demas; Mayris P. Webber; Drph Ellie E. Schoenbaum; Jeremy Weedon; Janis Mcwayne; Mph Elizabeth Enriquez; Mahrukh Bamji; Genevieve Lambert; Donald M. Thea


[Perinatal clomiphene citrate treatment changes sexual orientations of male mice].  


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

He, Feng-Qin; Zhang, Heng-Rui



Effect of n-3 long chain polyunsaturated fatty acids during the perinatal period on later body composition.  


A systematic review to identify studies reporting the effects of n-3 long chain polyunsaturated fatty acids (LCPUFA) intake, during pregnancy and postnatally, on infants and young children's body composition was performed. A structured search strategy was performed in the MEDLINE (PubMed), EMBASE, and LILACS databases. Inclusion and exclusion criteria were defined according to the research question. Only those studies addressing the relationship between n-3 LCPUFA exposure during the perinatal period and later adiposity measured in terms of weight, height, body mass index (BMI), skinfold thickness and/or circumferences were included regardless of the study design. Studies quality was scored and were thereafter categorised into those reporting on maternal intake of n-3 LCPUFA during pregnancy or lactation (6 publications) or on infant's n-3 LCPUFA intake (7 publications). Two studies showed inverse associations between maternal n-3 LCPUFA intake and children's later body composition (lower adiposity, BMI or body weight), two showed direct associations and no effects were observed in the remaining two studies. Among those studies focusing on n-3 LCPUFA intake through enriched infant formulas; three observed no effect on later body composition and two showed higher weight and adiposity with increased amounts of n-3 LCPUFA. Reversely, in two studies weight and fat mass decreased. In conclusion, reported body composition differences in infants and young children were not clearly explained by perinatal n-3 LCPUFA intake via supplemented formulas, breastfeeding or maternal intakes of n-3 LCPUFA during pregnancy and lactation. Associated operational mechanisms including n-3 LCPUFA doses and sources applied are not sufficiently explained and therefore no conclusions could be made. PMID:22591886

Rodríguez, G; Iglesia, I; Bel-Serrat, S; Moreno, L A



Perinatal considerations in the hospital disaster management process.  


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

Orlando, Susan; Danna, Denise; Giarratano, Gloria; Prepas, Robbie; Johnson, Cheri Barker


Social and professional support needs of families after perinatal loss.  


Perinatal loss has been associated with depression, anxiety, obsessive-compulsive disorder, suicide, marital conflict, and post-traumatic stress disorder. Nurses may provide professional support through teaching, role modeling, encouragement, counseling, problem solving, and other interventions. Nurses also may encourage more effective social support by helping significant others to provide willing, well-intentioned action that will produce a positive response in the bereaved couple. Interventions to increase professional and social support after perinatal loss are described. PMID:16227519

Hutti, Marianne H


Biomagnetism in perinatal medicine. Our experience in Greece.  


This is a report on our experience in the application of biomagnetism in perinatal medicine. We provide a brief description of our research work in fetal magnetoencephalography and fetal magnetocardiography in normal, preeclamptic and IUGR pregnancies, together with hemodynamics of the umbilical cord and uterine arteries, providing a new approach to biomagnetism as a non invasive imaging modality in the investigation of perinatal complications. PMID:17447637

Kotini, A; Anastasiadis, A N; Koutlaki, N; Tamiolakis, D; Anninos, P; Anastasiadis, P



Emerging roles of social work in perinatal services.  


Perinatal social work is a recent field of practice with expanding opportunities and responsibilities for social workers in direct practice, research and education. This paper discusses the emergence of high technology in the perinatal field and the specialization of social work knowledge, skills and roles which are developing in tandem with bio-medical advances. The need to reconcile compelling needs for preventive social work practice with those of specialization are examined. PMID:2094959

Walther, V N



Dissimilar Pattern of Perinatal Drug Abuse in the Philippines  

Microsoft Academic Search

Aim: To determine the pattern of perinatal drug abuse in the Philip- pines. Method: Three hundred ninety-three mother\\/infant dyads from the nurseries of 7 perinatal centers in Metropolitan Manila were enrolled in the study. Meconium was collected from the in- fants and analyzed for cocaine, opiate, cannabinoid and metham- phetamine by radioimmunoassay. Results: Eighty-nine infants (22.6%) were positive for drugs;

Enrique M. Ostrea; Randy Prescilla; Edwina Tan; Emilio Hernandez; Gloria Baens Ramirez; Herminia L. Cifra; Ma. Luisa Manlapaz


The Association Between Depression and Diabetes in the Perinatal Period  

Microsoft Academic Search

Both depression and diabetes are common in the perinatal period and result in serious consequences for mother and fetus. Although\\u000a the association between depression and diabetes is well established, few studies have examined the association between these\\u000a disorders during the perinatal period, when the etiology of depression and diabetes may differ from other periods over the\\u000a life course. This article

Laura J. Rasmussen-Torvik; Bernard L. Harlow



A nested case-control study of maternal-neonatal transmission of hepatitis B virus in a Chinese population  

PubMed Central

AIM: To examine the determinants of maternal-neonatal transmission of hepatitis B virus (HBV). METHODS: A nested case-control study was conducted in Changsha, Hunan, People’s Republic of China from January 1, 2005 to September 31, 2006. To avoid potential maternal blood contamination, we collected vein blood of newborns immediately after birth and before initial hepatitis B vaccination to determine the HBV infection status of the newborn. For each HBsAg-positive infant, one HBsAg-negative infant born to an HBsAg-positive mother was matched by hospital at birth (same), gender (same), and date of birth (within 1 mo). A face-to-face interview was conducted to collect clinical and epidemiological data. Conditional logistic regression analysis was used to estimate the independent effects of various determinants on maternal-neonatal transmission of HBV. RESULTS: A total of 141 HBsAg-positive infants and 141 individually matched HBsAg-negative infants were included in the final analysis. Maternal first-degree family history of HBV infection, intrahepatic cholestasis, and premature rupture of membranes were risk factors for perinatal transmission of HBV, whereas systematic treatment and HBV immunoglobulin injections for mothers with HBV infection were protective factors for maternal-neonatal transmission of HBV, after adjustment for potential confounding factors. CONCLUSION: For HBsAg-positive mothers, systematic treatment, HBV immunoglobulin administration, and controlling intrahepatic cholestasis and pregnancy complications may reduce the incidence of perinatal transmission of HBV.

Chen, Li-Zhang; Zhou, Wen-Qi; Zhao, Shu-Shan; Liu, Zhi-Yu; Wen, Shi-Wu



[Long-term cerebral effects of perinatal inflammation].  


Perinatal inflammation can lead to fetal/neonatal inflammatory syndrome, a risk factor for brain lesions, especially in the white matter. Perinatal inflammation is associated with increased incidence of cerebral palsy in humans and animal models and there is a strong relationship with increased incidence of autism and schizophrenia in humans. Perinatal inflammation causes acute microglial and astroglial activation, blood-brain barrier dysfunction, and disrupts oligodendrocyte maturation leading to hypomyelination. Inflammation also sensitizes the brain to additional perinatal insults, including hypoxia-ischemia. Furthermore, long after the primary cause of inflammation has resolved, gliosis may also persist and predispose to neurodegenerative diseases including Alzheimer's and Parkinson's disease, but this relation is still hypothetical. Finding of acute and chronic changes in brain structure and function due to perinatal inflammation highlights the need for treatments. As gliosis appears to be involved in the acute and chronic effects of perinatal inflammation, modulating the glial phenotype may be an effective strategy to prevent damage to the brain. PMID:22885003

Chhor, V; Schang, A-L; Favrais, G; Fleiss, B; Gressens, P



Safety of non-medically led primary maternity care models: a critical review of the international literature.  


The Australian government has announced major reforms with the move to a primary maternity care model. The direction of the reforms remains contentious; with the Australian Medical Association warning that the introduction of non-medically led services will compromise current high standards in maternity services and threaten the safety of mothers and babies. The purpose of this paper is to conduct a critical review of the literature to determine whether there is convincing evidence to support the safety of non-medically led models of primary maternity care. Twenty-two non-randomised international studies were included representing midwifery-led care, birth centre care and home birth. Comparative outcome measurements included: perinatal mortality; perinatal morbidity; rates of medical intervention in labour; and antenatal and intrapartum referral and transfer rates. Findings support those of the three Cochrane reviews, that there is sufficient international evidence to support the conclusion of no differenc