Nielsen, Tore; Paquette, Tyna
Study objectives: Evaluate the prevalence and phenomenology of dream-associated behaviors affecting pregnant and postpartum mothers. Episodes consist of anxious dreams and nightmares about the new infant that are accompanied by complex behaviors (motor activity, speaking, expressing emotion). Design: Three-group design (postpartum, pregnant, null gravida), self-report, and repeated measures. Setting: Pregnancy and postpartum groups: completion of questionnaires in hospital room within 48 hours of giving birth and home telephone interviews; null gravida group: completion of questionnaires and interview in person or by telephone. Participants: Two hundred seventy-three women in 3 groups: postpartum: n = 202 (mean age = 29.7 ± 4.94 years; 95 primiparas, 107 multiparas); pregnant: n = 50 (mean age = 31.1 ± 5.44 years); null gravida: n = 21 (mean age = 28.5 ± 6.34 years). Interventions: Subjects completed questionnaires about pregnancy and birth factors, personality, and sleep and participated in interviews concerning the prevalence of recent infant dreams and nightmares, associated behaviors, anxiety, depression, and other psychopathologic factors. Measurements and Results: Most women in all groups recalled dreams (88%-91%). Postpartum and pregnant women recalled infant dreams and nightmares with equal prevalence, but more postpartum women reported they contained anxiety (75%) and the infant in peril (73%) than did pregnant women (59%, P < 0.05 and 42%, P < 0.0001). More postpartum (63%) than pregnant (40%) women reported dream-associated behaviors (P < 0.01), but neither group differed from null gravida women (56%). This was due to different distributions over groups of the behavior subtypes. Motor activity was present in twice as many postpartum (57%) as pregnant (24%) or null gravida (25%) women (all P < 0.0001). Expressing emotion was more prevalent among null gravida (56%) than postpartum women (27%) (P < 0.05) but was not different from pregnant women (37
Rosebrock, Laina; Hoxha, Denada; Gollan, Jackie
Reactions to emotional cues, termed affective reactivity, promote adaptation and survival. Shifts in affective reactivity during pregnancy and postpartum may invoke altered responses to environmental and biological changes. The development and testing of affective reactivity tasks, with published normative ratings for use in studies of affective reactivity, has been based on responses provided by healthy college students. A comparison of the healthy norms with ratings provided by peripartum women has yet to be conducted, despite its value in highlighting critical differences in affective reactivity during peripartum phases. This study compared arousal ratings of unpleasant, neutral, pleasant, and threat stimuli from the International Affective Picture System (IAPS; Lang, P.J., Bradley, M.M., Cuthbert, B.N. 2008. International Affective Picture System (IAPS): Affective Ratings of Pictures and Instruction Manual (Technical Report A-8). University of Florida, Gainseville, FL.) between three samples: (a) women measured during pregnancy and again at postpartum, (b) age-matched nonpregnant women, and (c) college-aged women from the normative sample used to test the stimuli. Using mixed-design GLMs, results showed that the pregnant and postpartum women and the age-matched women showed suppressed arousal relative to the college-age women. Additionally, postpartum women showed increased arousal to unpleasant/threat images compared to other types of images. The data suggest that future research on peripartum women should include affective reactivity tasks based on norms reflective of this specific population. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Rosebrock, Laina; Hoxha, Denada; Gollan, Jackie
Reactions to emotional cues, termed affective reactivity, promote adaptation and survival. Shifts in affective reactivity during pregnancy and postpartum may invoke altered responses to environmental and biological changes. The development and testing of affective reactivity tasks, with published normative ratings for use in studies of affective reactivity, has been based on responses provided by healthy college students. A comparison of the healthy norms with ratings provided by peripartum women has yet to be conducted, despite its value in highlighting critical differences in affective reactivity during peripartum phases. This study compared arousal ratings of unpleasant, neutral, pleasant, and threat stimuli from the International Affective Picture System (IAPS; Lang et al., 2008) between three samples: (a) women measured during pregnancy and again at postpartum, (b) age-matched nonpregnant women, and (c) college-aged women from the normative sample used to test the stimuli. Using mixed-design GLMs, results showed that the pregnant and postpartum women and the age-matched women showed suppressed arousal relative to the college-age women. Additionally, postpartum women showed increased arousal to unpleasant/threat images compared to other types of images. The data suggest that future research on peripartum women should include affective reactivity tasks based on norms reflective of this specific population. PMID:25890694
Monastirli, Alexandra; Pasmatzi, Efstathia; Badavanis, George; Tsambaos, Dionysios
Dear Editor, Pityriasis rosea is a common, acute, and self-limiting dermatosis, which is associated with the endogenous systemic reactivation of human herpesvirus (HHV)-6 and/or HHV-7 (1). It predominantly affects individuals of both sexes in their second or third decade of life and is clinically characterized by the occurrence of an initial erythematosquamous plaque followed by the appearance of disseminated similar but smaller lesions one or two weeks later. Several patients develop systemic symptoms such as nausea, anorexia, malaise, headache, fever, arthralgia, and lymphadenopathy that may precede or accompany the eruption; the latter follows the cleavage lines of the trunk creating the configuration of a Christmas tree and spontaneously resolves within 4 to 8 weeks. Mainly based on the nature of the underlying viral reactivation, pityriasis rosea is classified into five different forms (2): 1) Classic and 2) Relapsing (characterized by sporadic and relapsing HHV-6/7 systemic reactivation, respectively), 3) Persistent (persistence of HHV-6/7 viremia), 4) Pediatric (longer activity of HHV-6/7 infection; recent primary infection) and 5) Gestational (HHV-6/7 reactivation and possible intrauterine transmission). Clearly, the inevitable impairment of immune response in pregnancy favors viral reactivation and possibly also the intrauterine transmission of HHV-6/7. Indeed, it is well known and documented that pityriasis rosea more frequently occurs in pregnant women (18%) as compared to the general population (6%) (3). However, the literature concerning the possible effect of pityriasis rosea on the outcome of pregnancy is surprisingly sparse. Only an Italian group, Drago et al (4,5), has systematically investigated the impact of this disorder on pregnant women. They found that 22 out of 61 women (36%) who developed pityriasis rosea during pregnancy had unfavorable outcomes, whereas 8 others miscarried (13%). None of the latter had any risk factors, other than
Celikel, Aysegul; Ustunsoz, Ayfer; Guvenc, Gulten
To determine the vaccination status of pregnant women during pregnancy and factors affecting their vaccination. Immunisation provided through vaccination is one of the most effective ways to reduce or prevent the risks of disease, disability and death. Maternal and newborn health may be protected and morbidity may be decreased through vaccinating pregnant women when necessary. This was a descriptive and cross-sectional survey. This study was conducted in a university hospital in Ankara, Turkey, between 01 March and 31 May 2010. The study was carried out with 198 healthy pregnant women who had completed the 26th week of gestation. Data were collected using the data collection form composed of questions enquiring about the demographic and obstetric features of pregnant women and whether or not they knew that vaccinations could be given during pregnancy, and which vaccines could be used during pregnancy, which vaccine/vaccines they had previously received and the reasons for having been vaccinated or not. Approximately half of the participants had received at least one of the vaccines that may be used in pregnancy (52·0%). The pregnant women received vaccinations for tetanus (47·0%), H1N1 (9·1%), seasonal influenza (3·0%) and hepatitis B (0·5%), respectively. The pregnant women who had been educated about vaccinations had been vaccinated at a statistically significantly higher rate compared with those who had not. This study revealed that pregnant women's knowledge about the required vaccines during pregnancy affected their behaviour towards vaccination. Acquiring knowledge about vaccines that may be used during pregnancy from health personnel is effective to increase vaccination. This result may be interpreted as 'acquired information affects behaviour towards vaccination'. Providing information about immunisation to pregnant women at the antenatal clinic is important in terms of maternal and newborn health. Nurses and midwives working in the antenatal field
Zheng, Shan; Hu, Xiaobin; Wang, Minzhen; Li, Liansheng; Liu, Wu; Da, Zhenqiang; Ma, Yuan; Liu, Peng; Cheng, Ning; Bai, Ya'na
To study the factors of folic acid intake among pregnant women, and to provide the basic dates for improving the effectiveness of folic acid intervention. A cross-section study was conducted both in hospital and household. Anonymous questionnaires were distributed to 2094 women in two counties of Gansu province, who were pregnant at least three months or postpartum within one year. Only 25.4% of 2094 subjects have taken folic acid. Lack of knowledge on folic acid, the age of pregnant women, the history of birth defects, had a check in hospital before pregnant, the degree of education, planned pregnancy and the history of miscarriages were the significant influential factors for whether or not taking folic acid. The history of childbearing and the knowledge on folic are the important factors affecting the use of folic acid supplements. Widely initiating health education on the knowledge of folic acid and advocating family planning in childbearing aged population should be taken as the most important measures. But finding a way of effectively increasing the rate of folic acid intake before pregnancy is a problem still needs to be solved.
Dhaliwal, Jagjit Singh; Lehl, Gurvanit; Sodhi, Sachinjeet K.; Sachdeva, Sonia
Background: The literature is replete with reports that pregnant women have an increased level of periodontal disease as compared with non-pregnant women of the same age. There are many studies correlating the effect of periodontal disease on the adverse pregnancy outcomes. The development of periodontal diseases during pregnancy can be influenced by factors such as preexisting oral conditions, general health, and socio-cultural background. There is very little data studying the effect of socio-demographic factors on the periodontal health of pregnant women. This study evaluated the periodontal status of a sample of pregnant women of Chandigarh and adjoining areas. The study also investigated the relationship between these variables and a series of demographic and clinical variables. Materials and Methods: The participants were 190 pregnant women attending Gynecology and Obstetrics outpatient department of Government Medical College and Hospital, Chandigarh. The participants were examined for their periodontal health and various socio-demographic variables were recorded on performas designed for the purpose of study. Statistical analysis was done. Results: The results revealed that the mean bleeding index scores and probing depth increased with statistical significance when the socio-economic status was lower (P<0.05). No significant differences were found in bleeding index scores and mean probing depth among different categories of profession, education, place of residence, and trimester of pregnancy (P>0.1). The plaque index was not significantly associated with the socio-economic status, profession, place of residence, and trimester of pregnancy (P>0.1). Conclusion: In the population of pregnant women investigated under this study, the clinical and socio-demographic characteristics showed non-significant correlation except socio-economic status which showed statistically significant correlation with bleeding on probing and pocket depth. Further studies may be
Ozer, Ali; Arikan, Deniz Cemgil; Kirecci, Ekrem; Ekerbicer, Hasan Cetin
Background Pregnant women are a target group for receipt of influenza vaccine because there appears to be an elevated mortality and morbidity rate associated with influenza virus infection in pregnant women. The goal of this study is to determine the factors affecting the decisions of pregnant women in Turkey to be vaccinated or not for 2009 H1N1 influenza. Methodology We enrolled 314 of 522 (60.2%) pregnant women who attended to the antenatal clinics of the Medical Faculty of Kahramanmaras Sutcuimam University's Department of Gynecology and Obstetrics between December 23, 2009, and February 1, 2010. We developed a 48-question survey which was completed in a face-to-face interview at the clinic with each pregnant woman. Principal Findings Of the 314 pregnant women, 27.4% were in the first trimester, 33.8% were in the second trimester, and 38.8% were in the third trimester. Twenty-eight pregnant women (8.9%) got vaccinated. Of all the women interviewed, 68.5% stated that they were comfortable with their decisions about the vaccine, 7.3% stated they were not comfortable, and 24.2% stated that they were hesitant about their decisions. The probability of receiving the 2009 H1N1 vaccine was 3.46 times higher among working women than housewives, 1.85 times higher among women who have a child than those who do not, and 1.29 times higher among women with a high-school education or higher than those with only a secondary-school education and below. Correct knowledge about the minimal risks associated with receipt of influenza vaccine were associated with a significant increase in the probability of receiving the 2009 H1N1 vaccine. Conclusions/Significance The number of pregnant women in the study group who received the 2009 H1N1 vaccine was very low (8.9%) and two-thirds of them stated that they were comfortable with their decisions concerning the vaccine. Our results may have implications for public health measures to increase the currently low vaccination rate among
Ishikuro, Mami; Obara, Taku; Metoki, Hirohito; Ohkubo, Takayoshi; Iwama, Noriyuki; Katagiri, Mikiko; Nishigori, Hidekazu; Narikawa, Yoko; Yagihashi, Katsuyo; Kikuya, Masahiro; Yaegashi, Nobuo; Hoshi, Kazuhiko; Suzuki, Masakuni; Kuriyama, Shinichi; Imai, Yutaka
Parity has previously been reported to affect the difference in blood pressure (BP) measured in the office and at home, also known as the white-coat effect, during pregnancy. The objective of this study was to identify possible factors that cause the white-coat effect during pregnancy, focusing on parity. In total, 530 pregnant women (31.3±4.7 years old) who delivered at a maternal clinic were eligible for the study. The association between parity and the white-coat effect (clinic BP compared with home BP) was investigated for each trimester of pregnancy by multivariate analysis of covariance adjusted for age, body mass index, family history of hypertension and smoking habits. The magnitudes of the white-coat effect for systolic BP in the first, second and third trimesters were 4.1±9.8, 3.4±7.1 and 1.8±6.0 mm Hg, respectively and those for diastolic BP were 3.8±7.4, 1.6±5.8 and 2.4±4.9 mm Hg, respectively. Parity was significantly and negatively associated with the white-coat effect for systolic BP in the first trimester of pregnancy (nulliparous women: 5.07±0.61 mm Hg and multiparous women: 2.78±0.74 mm Hg, P=0.02) as well as for diastolic BP in the second and third trimesters of pregnancy. Age, body mass index, family history of hypertension and smoking were not significantly associated with the white-coat effect in any trimester of pregnancy. Parity may have an influence on the white-coat effect in pregnancy; however, the observed effect, on average 1-2 mm Hg, was small.
Taylor, Clare L; Stewart, Robert; Ogden, Jack; Broadbent, Matthew; Pasupathy, Dharmintra; Howard, Louise M
Most women with psychotic disorders and bipolar disorders have children but their pregnancies are at risk of adverse psychiatric and fetal outcome. The extent of modifiable risk factors - both clinical and socio-demographic - is unclear as most studies have used administrative data or recruited from specialist tertiary referral clinics. We therefore aimed to investigate the socio-demographic and clinical characteristics of an epidemiologically representative cohort of pregnant women with affective and non-affective severe mental illness. Women with severe mental illness were identified from a large electronic mental health case register in south London, and a data linkage with national maternity Hospital Episode Statistics identified pregnancies in 2007-2011. Data were extracted using structured fields, text searching and natural language processing applications. Of 456 pregnant women identified, 236 (51.7%) had schizophrenia and related disorders, 220 (48.3%) had affective psychosis or bipolar disorder. Women with schizophrenia and related disorders were younger, less likely to have a partner in pregnancy, more likely to be black, to smoke or misuse substances and had significantly more time in the two years before pregnancy in acute care (inpatient or intensive home treatment) compared with women with affective disorders. Both groups had high levels of domestic abuse in pregnancy (recorded in 18.9%), were from relatively deprived backgrounds and had impaired functioning measured by the Health of the Nation Outcome Scale. Women in the affective group were more likely to stop medication in the first trimester (39% versus 25%) whereas women with non-affective psychoses were more likely to switch medication. A significant proportion of women, particularly those with non-affective psychoses, have modifiable risk factors requiring tailored care to optimize pregnancy outcomes. Mental health professionals need to be mindful of the possibility of pregnancy in women of
Scheelbeek, Pauline F D; Khan, Aneire E; Mojumder, Sontosh; Elliott, Paul; Vineis, Paolo
Coastal areas in Southeast Asia are experiencing high sodium concentrations in drinking water sources that are commonly consumed by local populations. Salinity problems caused by episodic cyclones and subsequent seawater inundations are likely (partly) related to climate change and further exacerbated by changes in upstream river flow and local land-use activities. Dietary (food) sodium plays an important role in the global burden of hypertensive disease. It remains unknown, however, if sodium in drinking water-rather than food-has similar effects on blood pressure and disease risk. In this study, we examined the effect of drinking water sodium on blood pressure of pregnant women: increases in blood pressure in this group could severely affect maternal and fetal health. Data on blood pressure, drinking water source, and personal, lifestyle, and environmental confounders was obtained from 701 normotensive pregnant women residing in coastal Bangladesh. Generalized linear mixed regression models were used to investigate association of systolic and diastolic blood pressure of these-otherwise healthy-women with their water source. After adjustment for confounders, drinkers of tube well and pond water (high saline sources) were found to have significantly higher average systolic (+4.85 and +3.62 mm Hg) and diastolic (+2.30 and +1.72 mm Hg) blood pressures than rainwater drinkers. Drinking water salinity problems are expected to exacerbate in the future, putting millions of coastal people-including pregnant women-at increased risk of hypertension and associated diseases. There is an urgent need to further explore the health risks associated to this understudied environmental health problem and feasibility of possible adaptation strategies. © 2016 American Heart Association, Inc.
Malarewicz, Andrzej; Szymkiewicz, Jadwiga; Rogala, Jerzy
Over the time when the sexual intercourse has been considered merely one of a number of forms of sexual contact, views on sexuality during pregnancy have undergone considerable transformation. A great many of authors emphasise, that the pregnancy is a stimulus for partners to search for ways to maintain mutual emotional bond, close physical affinity and satisfy sexual needs not necessarily finished with an intercourse. The fact, that one of the two partners is pregnant, imposes some restrictions on sexual life. Not rarely, in particular in the first trimester of pregnancy, a female is little interested in sex. It is due to, inter alia, hormonal changes resulting in nausea, fatigue and increased nervosity. These symptoms contribute to general feebleness and reduction of the level of sexual needs and difficulty to become aroused and sexually ready. In spite of that, a lot of women have the need to keep physical and emotional contact with their partners. For a number of couples, pregnancy becomes a stimulus to search for new ways of pleasing each other in love play, that does not necessarily leads with an intercourse. Most studies concerning sexuality during pregnancy focus on observing sexual activity, physiological changes, mutual relationship of partners, analysis of sexual intercourses and investigation of so-called sexual satisfaction. Examination of sexual satisfaction ruchedes the frequency of sexual contacts, intercourses, foreplay, concurrence of orgasms in the two partners, partners' happiness, sexual satisfaction and mutual heartiness. In some researchers' opinion, sexual satisfaction correlates with the feeling of happiness resulting form being pregnant, pregnant woman's feeling still attractive and experience of orgasm. However, some researchers observe reduced sexual activity during pregnancy, except for the second trimester, when sexual activity is similar to the one outside pregnancy. Pregnant women prefer the following types of sexual activity: non
Seneviratne, Sumudu N; Derraik, José G B; Jiang, Yannan; McCowan, Lesley M E; Gusso, Silmara; Cutfield, Wayne S; Hofman, Paul L
There is increasing evidence that the sex of the foetus may alter the maternal metabolic milieu during pregnancy. Following a randomized controlled trial of exercise in overweight and obese pregnant women, we assessed whether the sex of the foetus was associated with changes in maternal metabolism. Data were analysed on 74 randomized participants who completed the trial, including 38 mothers carrying males and 36 mothers carrying females. At 19 weeks of gestation, mothers carrying boys had higher blood glucose concentrations than those carrying girls (5.4 vs 4.9 mmol/l; p = .046). At 36 weeks of gestation, differences were more marked, with blood glucose concentrations 15% higher in mothers carrying females (5.7 vs 5.0 mmol/l; p = .004). In addition, mothers carrying girls had higher concentrations of hs-CRP across pregnancy (5.0 vs 3.6 mg/l; p = .029). Our findings provide further evidence that the sex of the foetus appears to influence maternal metabolism.
Heller, Hanna M; van Straten, Annemieke; de Groot, Christianne J M; Honig, Adriaan
Women in pregnancy and postpartum have an increased vulnerability to develop an affective disorder. Affective disorders in pregnancy are associated with an increased risk of prematurity, dysmaturity (foetal weight below the 10th percentile as determined by ultrasound) and the development of postpartum depressive disorder. Untreated affective disorders and their complications may also result in considerable costs. Recent meta-analyses showed that interventions during pregnancy are less effective than postpartum interventions probably because of high attrition due to the barriers pregnant women experience with attending sessions outside their homes. An internet-based self-help intervention may overcome these barriers as it can be followed at home, and also in one's own time. Such internet interventions showed to be effective for decreasing affective symptoms in general.This randomised clinical trial examines whether an internet-based self-help intervention is effective in the reduction of affective symptoms in pregnancy and postpartum and results in an improvement of the perinatal outcome. We will also determine the cost-effectiveness of the intervention. We will investigate the effectiveness of a 6 week internet-based self-help problem solving treatment (PST) for affective symptoms in pregnancy. We aim to include 286 women with mild to severe affective symptoms who will be randomly assigned to the internet-based intervention or a waiting list control group. Primary outcome measures are affective symptoms and the perinatal outcome. Secondary outcome measures are quality of life, and economic costs. All assessments are based on self-report and will take place at baseline (T0), 10 weeks later (after completion of the intervention (T1), 4 weeks before the expected day of birth (T2), and 6 weeks after delivery (T3). The control group will be measured at the same moments in time. Analysis will be based on the intention-to-treat principle. If shown (cost) effective
Asemi, Zatollah; Samimi, Mansooreh; Siavashani, Mehrnush Amiri; Mazloomi, Maryam; Tabassi, Zohreh; Karamali, Maryam; Jamilian, Mehri; Esmaillzadeh, Ahmad
Background: Pregnancy is associated with unfavorable metabolic profile, which might in turn result in adverse pregnancy outcomes. The current study was designed to evaluate the effects of calcium plus Vitamin D administration on metabolic status and pregnancy outcomes in healthy pregnant women. Methods: This randomized double-blind placebo-controlled clinical trial was performed among 42 pregnant women aged 18–40 years who were at week 25 of gestation. Subjects were randomly allocated to consume either 500 mg calcium-200 IU cholecalciferol supplements (n = 21) or placebo (n = 21) for 9 weeks. Blood samples were obtained at the onset of the study and after 9-week trial to determine related markers. Post-delivery, the newborn's weight, length, and head circumference were measured during the first 24 h after birth. Results: Consumption of calcium-Vitamin D co-supplements resulted in a significant reduction of serum high-sensitivity C-reactive protein levels compared with placebo (−1856.8 ± 2657.7 vs. 707.1 ± 3139.4 μg/mL, P = 0.006). We also found a significant elevation of plasma total antioxidant capacity (89.3 ± 118.0 vs. −9.4 ± 164.9 mmol/L, P = 0.03), serum 25-hydroxyvitamin D (2.5 ± 3.5 vs. −1.7 ± 1.7 ng/mL, P < 0.0001), and calcium levels (0.6 ± 0.6 vs. −0.1 ± 0.4 mg/dL, P < 0.0001). The supplementation led to a significant decrease in diastolic blood pressure (−1.9 ± 8.3 vs. 3.1 ± 5.2 mmHg, P = 0.02) compared with placebo. No significant effect of calcium-Vitamin D co-supplements was seen on other metabolic profiles. We saw no significant change of the co-supplementation on pregnancy outcomes as well. Conclusions: Although calcium-Vitamin D co-supplementation for 9 weeks in pregnant women resulted in improved metabolic profiles, it did not affect pregnancy outcomes. PMID:27076887
Cataldo Oportus, Sylvia; de Paiva Rodrigues, Lilian; Pereira de Godoy, José Maria; Guerreiro Godoy, Maria de Fátima
Aim. The aim of this study was to evaluate the efficacy of lymph drainage to reduce edema of pregnant women. Method. Pregnant women (30 limbs) from the Obstetrics Outpatient Clinic of the Medical School of Santa Casa in São Paulo in the period December 2009 to May 2010 were enrolled in this quantitative, prospective study. The patients, in the 5th to 8th months of gestation, were submitted to one hour of manual lymph drainage of the legs. The volume of the legs was measured by water displacement volumetry before and after one hour of drainage using the Godoy & Godoy manual lymph drainage technique. The paired t-test was used for statistical analysis with an alpha error of 5% being considered significant. Results. Manual lymph drainage significantly reduced swelling of the legs of pregnant women during the day (P = 0.04). Conclusion. Manual lymph drainage helps to reduce limb size during the day of pregnant women.
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Coagulability increases during pregnancy, and thromboembolism can easily occur. Venous thromboembolism is a cause of death in pregnant women, but arterial thrombosis such as ischemic stroke in pregnancy is also not uncommon. In pharmacotherapy for thromboembolism in pregnant women, fetal toxicity and teratogenicity must be carefully considered. As anticoagulants in pregnant women, unfractionated heparin and low-molecular-weight heparin are recommended, but warfarin is not recommended since it has a low molecular weight and crosses the placenta. Various types of new oral anticoagulant drugs have been available in Japan since 2011. However, the Japanese package inserts for these anticoagulants advise quite cautious administration in pregnant women. The guidelines on pregnant women include less information about antiplatelet drugs than anticoagulant drugs. Aspirin may cause teratogenicity and fetal toxicity, and perinatal mortality is increased. However, when low doses of aspirin are administered as antiplatelet therapy, the US Food and Drug Administration has assigned pregnancy category C, and treatment is relatively safe. Neurosurgeons and neurologists commonly encounter pregnant women with thromboembolism, such as ischemic stroke. Up-to-date information and correct selection of drugs are necessary in consultation with specialists in perinatal care.
Jafari, F; Eftekhar, H; Mohammad, K; Fotouhi, A
Background: The need to provide high quality prenatal care services, which take account of women’s views and specifically address their need for information, support and communication, has been advocated and group prenatal care, had been suggested as one of the ways to achieve this objective. The purpose of this study was to examine the impact of group versus individual prenatal care on satisfaction and prenatal care use. Methods: This was a cluster-randomized controlled trial with the health center as the randomization unit that conducted in 2007. Satisfaction was measured through a standardized questionnaire, and the Kotelchuck Adequacy of Prenatal Care Utilization Index was used to measure prenatal care utilization. Results: We recruited 678 women (group prenatal care, (N= 344) and individual prenatal care, (N=334) in the study. Women in group prenatal care model were more satisfied than women in individual prenatal care model in all areas evaluated, including information, communication, co-ordination and quality of care. Group care women were significantly more likely to have adequate prenatal care than individual care women were (OR=1.35 95% CI=1.26–1.44). Conclusions: Group prenatal care was associated with a significant improvement in client satisfaction and prenatal care utilization. This model of care has implications for the planning and provision of prenatal services within public health system, which is moving toward a better quality health care, and increasing use of services. PMID:23113007
Verbeke, Wim; De Bourdeaudhuij, Ilse
This study investigates dietary behaviour and the perceived role of food for health of pregnant versus non-pregnant women. Data were collected between 15 January 2003 and 15 March 2003 in Belgium. One hundred and forty-eight pregnant and 130 non-pregnant women aged between 20 and 40 years completed a self-administered questionnaire about their dietary behaviour and nutritional attitudes. Both sub-samples match with respect to individual factors such as relevant socio-demographics and general food perceptions. Pregnant women report higher consumption of fruits, which results in a better score for fibre intake. They also report higher consumption of beef and dairy products, as well as a higher fat intake. No difference in fish consumption between pregnant and non-pregnant women is observed. In line with recommendations, pregnant women report reduced consumption of food products with heightened safety-related risks, lower use of alcohol and tobacco, and safer food handling practices. Reduced intake of raw vegetables for food safety reasons is not compensated by higher intake of cooked vegetables. Pregnant women also report a lower frequency of moderate physical activity. Most differences in food choice by pregnant versus non-pregnant women pertain to the avoidance of specific, potentially harmful food groups. A substantial share of pregnant women does not follow upon recommendations with respect to alcohol use and exposure to tobacco. Personal medical sources for pregnant women and personal social sources for non-pregnant women are reported as the most attended sources of diet-related information. The perceived role of food for health is not different between pregnant and non-pregnant women, and there were no significant interaction effects between pregnancy and presence of children, which indicates that the observed differences in dietary behaviour can be attributed to the state of being pregnant.
Maral, I; Baykan, Z; Aksakal, F N; Kayikcioglu, F; Bumin, M A
The objectives of this study were to determine the tetanus vaccination status for pregnant women, and to examine the effects of various factors on tetanus toxoid (TT) vaccination coverage during pregnancy in reproductive-age women. Four-hundred and ninety-three postpartum women who had live births at a hospital in Ankara were interviewed and information was collected on the mothers' sociodemographic characteristics, TT vaccination history, and prenatal care during the pregnancy studied. The rates for no vaccination, one-dose vaccination, and two-dose vaccination were 53.3%, 18.9%, and 27.8%, respectively. The vaccinated women (with at least one dose) were significantly younger, of lower parity, and had attended more prenatal care visits than the unvaccinated women. Of the women who attended at least one prenatal care check-up, only about half were vaccinated. Significantly more rural women were vaccinated against tetanus than urban women. Current vaccination rates with TT during pregnancy were found to be well below universal levels. Turkey needs to launch effective mass media campaigns that target urban and suburban populations, and inform and motivate women to request vaccination against tetanus.
Jayasvasti, Kanthika; Kanchanatawan, Buranee
Pregnancy is a crisis in the human life cycle as an important turning point in aspects of anatomical, physiological and psychosocial changes. An unhappy pregnanus could influence the fetal growth and development and sense of maternal competence as well as bonding with the fetus which profoundly affect the nurture of the infant after delivery. The authors'purposes were to study happiness and related factors in pregnant women having antenatal care at King Chulalongkorn Memorial Hospital. Four hundred and thirty-eight pregnant women from the antenatal clinic at King Chulalongkorn Memorial Hospital were randomly selected to complete a set of questionnaires that consisted of personal information, pregnant information, The Oxford Happiness Questionnaire (OHQ), The Maudsley Personality Inventory (MPI) and The Marital Satisfaction Scale (MSS). Prevalence of happiness level was classified by descriptive analysis. Unpaired t-test, ANOVA and Pearson's Product Moment Correlation analyzed related factors to happiness in pregnant woman. Also Stepwise Multiple Regression Analysis was used to define predictive factors for happiness in pregnant women. The sample had a high level of happiness of 57.3%. Significant related factors to happiness were age between 31-35 years, high education level, high individual and family income, having saving deposition, no drug abuse, improved marital relationship, no conflict with relatives, extrovert and stable personality types and no concerns about post-partum body image. Four predictive factors for happiness in pregnant women were extrovert personality, stable personality, high family income and improved marital relationship. Level of happiness in pregnant women could be predicted by type of personality, family income and marital relationship.
Thakur, Achala; Baral, Ratna; Basnet, Pritha; Rai, Rubina; Agrawal, Ajay; Regmi, Mohan Chandra; Uprety, Dhruba Kumar
Asymptomatic bacteriuria is the significant presence of bacteria in urine of an individual without symptoms. The aim of the study is to determine the prevalence of asymptomatic bacteriuria in pregnant women. This study was a prospective study conducted in the department of Obstetrics and Gynaecology at B. P. Koirala Institute of Health Sciences. The duration of the study was six months from January to June 2012. A total of 600 pregnant women were enrolled. All women were clinically identified to have no signs and symptoms of UTI. Clean catch midstream urine sample was collected from each patient into a sterile vial. The urine samples were examined for microscopic and culture sensitivity test. Out of 600 pregnant women, 52 were positive for significant bacteriuria with a prevalence rate of 8.7%. There was a significant difference in prevalence of asymptomatic bacteriuria with respect to trimester (p=0.005). Age did not show any significant difference in the prevalence of asymptomatic bacteriuria (p=0.807). There was not any significant difference in the prevalence of asymptomatic bacteriuria with respect to parity (p=0.864) and booking status (p=0.397). Escherichia coli (35%), Acinetobacter species (15%), Enterococcus species (12%) and Klebsiella pneumoniae (10%) were the common isolates. Most of the isolates were sensitive either to Nitrofurantoin, Norfloxacin or Amikacin. Asymptomatic bacteriuria is common in pregnancy. Urine culture sensitivity should be carried out routinely on all pregnant patients in order to prevent the dangerous complications associated with it.
Aydin, Mustafa; Cayonu, Neval; Kadihasanoglu, Mustafa; Irkilata, Lokman; Atilla, Mustafa Kemal; Kendirci, Muammer
The physiology and anatomy of pregnant women change during pregnancy. Pregnancy is an anatomically and physiologically amended process experienced by women and as a result of these changes, sexual life of pregnant women alters during pregnancy. We aimed to compare sexual functions of pregnant and non-pregnant women. Sexually active 246 pregnant women were included into this cross-sectional controlled study. A total of 210 non-pregnant women were served as control. Both groups were compared in terms of age, gestational age, presence of urinary incontinence, body mass index, and obstetrical history. Sexual functions of the women were evaluated with Female Sexual Function Index (FSFI). Data were analyzed using chi-square, Mann-Whitney U, Fisher's Exact, Shapiro Wilk, Kruskal Wallis and Dunnett's tests where appropriate. The Pvalues < .05 were considered statistically significant. Mean age in both groups were comparable (P = .053). Median total FSFI scores in the pregnant women were significantly lower than those non-pregnant (18.9 vs. 22.7; P < .05). Additionally, the subgroup analyses of the FSFI scores were found that, total FSFI score is significantly lower in the pregnant group compared to non-pregnant group (P < .05). Furthermore, rate of sexual dysfunction in pregnant women was significantly higher than those non-pregnant women (91.08% vs. 67.61%, P = .0001). However, in pregnant women, no meaningful difference in rate of sexual dysfunction was found according to the trimesters (P = .632). Moreover, gravidity and parity exhibited negative impacts on the sexual functions. But number of abortions did not affect sexual function. These data demonstrate that pregnancy significantly diminishes sexual function in women. We believe that, couples need to be counseled regarding the impact of pregnancy on sexual functions.
Mao, Jinyuan; Vanderlelie, Jessica J; Perkins, Anthony V; Redman, Christopher WG; Ahmadi, Kourosh R; Rayman, Margaret P
Background: Low selenium status in pregnancy has been associated with a number of adverse conditions. In nonpregnant populations, the selenium status or response to supplementation has been associated with polymorphisms in dimethylglycine dehydrogenase (DMGDH), selenoprotein P (SEPP1) and the glutathione peroxidases [cytosolic glutathione peroxidase (GPx1) and phospholipid glutathione peroxidase (GPx4)]. Objective: We hypothesized that, in pregnant women, these candidate polymorphisms would be associated with selenium status in early pregnancy, its longitudinal change, and the interindividual response to selenium supplementation at 60 μg/d. Design: With the use of stored samples and data from the United Kingdom Selenium in Pregnancy Intervention (SPRINT) study in 227 pregnant women, we carried out genetic-association studies, testing for associations between selenium status, its longitudinal change, and response to supplementation and common genetic variation in DMGDH (rs921943), SEPP1 (rs3877899 and rs7579), GPx1 (rs1050450) and GPx4 (rs713041). Selenium status was represented by the concentration of whole-blood selenium at 12 and 35 wk of gestation, the concentration of toenail selenium at 16 wk of gestation, and plasma glutathione peroxidase (GPx3) activity at 12 and 35 wk of gestation. Results: Our results showed that DMGDH rs921943 was significantly associated with the whole-blood selenium concentration at 12 wk of gestation (P = 0.032), which explained ≤2.0% of the variance. This association was replicated with the use of toenail selenium (P = 0.043). In unsupplemented women, SEPP1 rs3877899 was significantly associated with the percentage change in whole-blood selenium from 12 to 35 wk of gestation (P = 0.005), which explained 8% of the variance. In supplemented women, SEPP1 rs3877899 was significantly associated with the percentage change in GPx3 activity from 12 to 35 wk of gestation (P = 0.01), which explained 5.3% of the variance. Selenium status was
... waiver of the State plan covering pregnant women, as of March 23, 2010 or December 31, 2013, if higher... 42 Public Health 4 2014-10-01 2014-10-01 false Pregnant women. 435.116 Section 435.116 Public..., AND AMERICAN SAMOA Mandatory Coverage Mandatory Coverage of Pregnant Women, Children Under 19,...
... waiver of the State plan covering pregnant women, as of March 23, 2010 or December 31, 2013, if higher... 42 Public Health 4 2013-10-01 2013-10-01 false Pregnant women. 435.116 Section 435.116 Public..., AND AMERICAN SAMOA Mandatory Coverage Mandatory Coverage of Pregnant Women, Children Under 19,...
Ayisi, J G; Branch, OraLee H; Rafi-Janajreh, A; van Eijk, A M; ter Kuile, F O; Rosen, D H; Kager, P A; Lanar, D E; Barbosa, A; Kaslow, D; Nahlen, B L; Lal, A A
HIV-seropositive pregnant women are more susceptible to malaria than HIV-seronegative women. We assessed whether HIV infection alters maternal and cord plasma malarial antibody responses and the mother-to-infant transfer of malaria antibodies. We determined plasma levels of maternal and cord antibodies [Immunoglobulin (IgG)] to recombinant malarial proteins [merozoite surface protein 1 (MSP-1(19kD)), the erythrocyte binding antigen (EBA-175)], the synthetic peptides [MSP-2, MSP-3, rhoptry associated protein 1 (RAP-1), and the pre-erythrocytic stage, circumsporozoite protein (NANP)(5)] antigenic determinants of Plasmodium falciparum; and tetanus toxoid (TT) by ELISA among samples of 99 HIV-seropositive mothers, 69 of their infants, 102 HIV-seronegative mothers and 62 of their infants. The prevalence of maternal antibodies to the malarial antigenic determinants ranged from 18% on MSP3 to 91% on EBA-175; in cord plasma it ranged from 13% to 91%, respectively. More than 97% of maternal and cord samples had antibodies to TT. In multivariate analysis, HIV infection was only associated with reduced antibodies to (NANP)(5) in maternal (P=0.001) and cord plasma (P=0.001); and reduced mother-to-infant antibody transfer to (NANP)(5) (P=0.012). This effect of HIV was independent of maternal age, gravidity and placental malaria. No consistent HIV-associated differences were observed for other antigenic determinants. An effect of HIV infection was only observed on one malarial antigenic determinant, suggesting that the increased susceptibility to malaria among HIV-infected pregnant women may not be explained on the basis of their reduced antibody response to malaria antigens.
Cao-Lei, L; Elgbeili, G; Massart, R; Laplante, D P; Szyf, M; King, S
Prenatal maternal stress (PNMS) can impact a variety of outcomes in the offspring throughout childhood and persisting into adulthood as shown in human and animal studies. Many of the effects of PNMS on offspring outcomes likely reflect the effects of epigenetic changes, such as DNA methylation, to the fetal genome. However, no animal or human research can determine the extent to which the effects of PNMS on DNA methylation in human offspring is the result of the objective severity of the stressor to the pregnant mother, or her negative appraisal of the stressor or her resulting degree of negative stress. We examined the genome-wide DNA methylation profile in T cells from 34 adolescents whose mothers had rated the 1998 Québec ice storm's consequences as positive or negative (that is, cognitive appraisal). The methylation levels of 2872 CGs differed significantly between adolescents in the positive and negative maternal cognitive appraisal groups. These CGs are affiliated with 1564 different genes and with 408 different biological pathways, which are prominently featured in immune function. Importantly, there was a significant overlap in the differentially methylated CGs or genes and biological pathways that are associated with cognitive appraisal and those associated with objective PNMS as we reported previously. Our study suggests that pregnant women's cognitive appraisals of an independent stressor may have widespread effects on DNA methylation across the entire genome of their unborn children, detectable during adolescence. Therefore, cognitive appraisals could be an important predictor variable to explore in PNMS research.
Cao-Lei, L; Elgbeili, G; Massart, R; Laplante, D P; Szyf, M; King, S
Prenatal maternal stress (PNMS) can impact a variety of outcomes in the offspring throughout childhood and persisting into adulthood as shown in human and animal studies. Many of the effects of PNMS on offspring outcomes likely reflect the effects of epigenetic changes, such as DNA methylation, to the fetal genome. However, no animal or human research can determine the extent to which the effects of PNMS on DNA methylation in human offspring is the result of the objective severity of the stressor to the pregnant mother, or her negative appraisal of the stressor or her resulting degree of negative stress. We examined the genome-wide DNA methylation profile in T cells from 34 adolescents whose mothers had rated the 1998 Québec ice storm's consequences as positive or negative (that is, cognitive appraisal). The methylation levels of 2872 CGs differed significantly between adolescents in the positive and negative maternal cognitive appraisal groups. These CGs are affiliated with 1564 different genes and with 408 different biological pathways, which are prominently featured in immune function. Importantly, there was a significant overlap in the differentially methylated CGs or genes and biological pathways that are associated with cognitive appraisal and those associated with objective PNMS as we reported previously. Our study suggests that pregnant women's cognitive appraisals of an independent stressor may have widespread effects on DNA methylation across the entire genome of their unborn children, detectable during adolescence. Therefore, cognitive appraisals could be an important predictor variable to explore in PNMS research. PMID:25710121
Gaxiola-Robles, Ramón; Bentzen, Rebecca; Zenteno-Savín, Tania; Labrada-Martagón, Vanessa; Castellini, J. Margaret; Celis, Alfredo; O’Hara, Todd; Celina Méndez-Rodríguez, Lía
Seafood provides essential polyunsaturated fatty acids (PUFA) and other nutrients to pregnant women and their fetus(es) while a diet rich in finfish can be a major pathway of monomethyl mercury (MeHg+) exposure. We measured total mercury concentration ([THg]) in hair samples provided by 75 women in Baja California Sur (BCS) to assess its relationship with age, parity, tobacco smoke exposure, and diet based on survey methodologies. Generalized linear models (GLM) were used to explain the possible association of the different variables with [THg] in hair. Median [THg] in hair was 1.52 µgg−1, ranging from 0.12 to 24.19 µgg−1 and varied significantly by segment. Approximately 72% (54/75) of those evaluated exceed 1 µgg−1 [THg] and 8% (6/75) exceed 5 µgg−1 [THg] in hair. Although frequency of fish consumption contributed significantly to explaining hair [THg], fish consumption only explained 43% of [THg] in a GLM incorporating tobacco exposure and body mass index. This study establishes possible relationships among multiple potential sources of exposure and other factors related to [THg] in hair of women in the prenatal period. A more detailed examination of other sources of exposure and factors contributing to [THg] is warranted. PMID:28203532
Gaxiola-Robles, Ramón; Bentzen, Rebecca; Zenteno-Savín, Tania; Labrada-Martagón, Vanessa; Castellini, J Margaret; Celis, Alfredo; O'Hara, Todd; Celina Méndez-Rodríguez, Lía
Seafood provides essential polyunsaturated fatty acids (PUFA) and other nutrients to pregnant women and their fetus(es) while a diet rich in finfish can be a major pathway of monomethyl mercury (MeHg(+)) exposure. We measured total mercury concentration ([THg]) in hair samples provided by 75 women in Baja California Sur (BCS) to assess its relationship with age, parity, tobacco smoke exposure, and diet based on survey methodologies. Generalized linear models (GLM) were used to explain the possible association of the different variables with [THg] in hair. Median [THg] in hair was 1.52 µgg(-1), ranging from 0.12 to 24.19 µgg(-1) and varied significantly by segment. Approximately 72% (54/75) of those evaluated exceed 1 µgg(-1) [THg] and 8% (6/75) exceed 5 µgg(-1) [THg] in hair. Although frequency of fish consumption contributed significantly to explaining hair [THg], fish consumption only explained 43% of [THg] in a GLM incorporating tobacco exposure and body mass index. This study establishes possible relationships among multiple potential sources of exposure and other factors related to [THg] in hair of women in the prenatal period. A more detailed examination of other sources of exposure and factors contributing to [THg] is warranted.
Coutinho, Emília de Carvalho; Silva, Alcione Leite da; Pereira, Carlos Manuel Figueiredo Pereira; Almeida, Alexandra Isabel; Nelas, Paula Alexandra Batista; Parreira, Vitória Barros Castro; Amaral, Maria Odete
This study aimed to assess the care received and the barriers faced by immigrants and Portuguese pregnant women in Portugal. This is an exploratory qualitative study, resorting to applying semi-structured interviews to 60 immigrant and 22 Portuguese women. Content analysis supported by QSR Nvivo10 program was used. The study was approved by an Ethics Committee. The results showed four categories related to affective dimensions-relational, cognitive, technical-instrumental and health care policy for pregnant women. As for the barriers in health care, these were mentioned by some of the expectant mothers, especially immigrant women. Almost all, both immigrant and Portuguese, pregnant women were satisfied with the health care.
Hawkins, Marquis; Kim, Youngdeok; Gabriel, Kelley Pettee; Rockette-Wagner, Bonny Jane; Chasan-Taber, Lisa
Sedentary behavior has been associated with adverse health outcomes among pregnant women; however, few studies have characterized sedentary behavior patterns in this population. We described patterns of accelerometer-determined indicators of sedentary behavior among a national sample of US pregnant (n = 234) women and non-pregnant (n = 1146) women participating in the NHANES 2003-06 cycles. We included women with ≥ 4 days of accelerometer wear of ≥ 10 h/day. A count threshold of < 100 cpm was used to describe sedentary behavior as: 1) total accumulated sedentary time by bout length categories; 2) accumulated sedentary time within discrete bout length categories; 3) mean, median, and usual bout length; and 4) and bout frequency. Both non-pregnant and pregnant women spent up to 60% of their accelerometer wear time in sedentary behavior depending on the minimum bout threshold applied. Sedentary time was higher among pregnant women compared to non-pregnant women when lower bout thresholds (i.e. 10 min or less) were applied. The majority of total sedentary time was accumulated in bouts lasting < 10 min. The women averaged less than two prolonged sedentary bouts (i.e., ≥ 30 min) per day, which accounted for nearly 20% of total accumulated sedentary time. When applying a minimum threshold of at least 15 min, sedentary time increased across pregnancy trimesters, while sedentary time was similar across trimesters when using lower thresholds. These findings provide the first characterization of accelerometer-determined indicators of sedentary behavior in pregnant women. The minimum bout threshold applied influenced estimates of sedentary time and patterns sedentary time accumulation across pregnancy trimesters.
Gesser-Edelsburg, Anat; Shahbari, Nour Abed Elhadi
This study focused on decision-making on terminating pregnancy for Arab Muslim women in Israel who were pregnant with fetuses diagnosed with congenital anomalies. It examined the impact of the doctor-patient interaction on the women's decision, especially in light of social and religious pressures not to terminate under any circumstances. Our goal was to identify perceptions and attitudes of Muslim Arab women who choose to continue their pregnancy following the detection of congenital anomalies in prenatal tests. Specific objectives included (1) To examine the Muslim Arab women's perceptions on genetic testing, and ascertain the reasons for their decision to continue the pregnancy following the detection of a congenital anomaly in the fetus; and (2) To examine risk communication of gynecologists regarding genetic testing and abortions, and regarding the decision of continuing or terminating a pregnancy following detection of a congenital anomaly. The research framework used the constructivist classical qualitative method to understand the experience of women at high risk for congenital anomalies and their experience of how doctors communicate the risk. It showed that the emotional element is no less dominant than religious and social elements. The findings emphasized the disparities between doctors and women regarding emotional involvement (non-directive counselling). The women interviewees (N = 24) felt that this expressed insensitivity. As far as we know, the emotional component has not been raised in previous studies of Muslim women at high risk for congenital defects in their fetus, and therefore comprises a significant contribution of the present study. To mitigate gaps, doctors should take affect into consideration in their communication with patients. It is important for doctors to understand the emotional element in risk communication, both in how they respect women's emotions and in creating an emotional interaction between themselves and the women.
Hodgson, Ian; Plummer, Mary L.; Konopka, Sarah N.; Colvin, Christopher J.; Jonas, Edna; Albertini, Jennifer; Amzel, Anouk; Fogg, Karen P.
Background Despite progress reducing maternal mortality, HIV-related maternal deaths remain high, accounting, for example, for up to 24 percent of all pregnancy-related deaths in sub-Saharan Africa. Antiretroviral therapy (ART) is effective in improving outcomes among HIV-infected pregnant and postpartum women, yet rates of initiation, adherence, and retention remain low. This systematic literature review synthesized evidence about individual and contextual factors affecting ART use among HIV-infected pregnant and postpartum women. Methods Searches were conducted for studies addressing the population (HIV-infected pregnant and postpartum women), intervention (ART), and outcomes of interest (initiation, adherence, and retention). Quantitative and qualitative studies published in English since January 2008 were included. Individual and contextual enablers and barriers to ART use were extracted and organized thematically within a framework of individual, interpersonal, community, and structural categories. Results Thirty-four studies were included in the review. Individual-level factors included both those within and outside a woman’s awareness and control (e.g., commitment to child’s health or age). Individual-level barriers included poor understanding of HIV, ART, and prevention of mother-to-child transmission, and difficulty managing practical demands of ART. At an interpersonal level, disclosure to a spouse and spousal involvement in treatment were associated with improved initiation, adherence, and retention. Fear of negative consequences was a barrier to disclosure. At a community level, stigma was a major barrier. Key structural barriers and enablers were related to health system use and engagement, including access to services and health worker attitudes. Conclusions To be successful, programs seeking to expand access to and continued use of ART by integrating maternal health and HIV services must identify and address the relevant barriers and enablers in
Majchrzycki, Marian; Mrozikiewicz, Przemysław M; Kocur, Piotr; Bartkowiak-Wieczorek, Joanna; Hoffmann, Marcin; Stryła, Wanda; Seremak-Mrozikiewicz, Agnieszka; Grześkowiak, Edmund
Pain of lumbosacral segment of the vertebral column and the pelvis concerns about 45% of all pregnant women. The change of the body posture during pregnancy is the result of gravity centre relocation, which affects the musculosceletal system. Development of the joint, ligament and myofascial dysfunctions, as well as the pain in the lumbosacral segment and the pelvis, are the most common reasons of spine pain. The aim of this review is to present the current state of knowledge about lumbar spine pain in pregnant women with special focus on the pain connected with muscular, joint and ligament disorders. Pregnancy is a serious burden for the female osteo-skeletal system. Lumbar pain with different location and intensification is the negative consequence of the position changes during pregnancy. Pharmacotherapy could be useful only in cases of intensive low back pain, with possible application of small spectrum of drugs that are safe during pregnancy. Physical therapy including manual therapy exercises, massage and techniques of local anesthesia are alternative methods in case of low back pain in pregnant women.
Khan, Muhammad Naseem; Chiumento, Anna; Dherani, Mukesh; Bristow, Katie; Sikander, Siham; Rahman, Atif
The public health significance of maternal mental health is well established. Armed conflicts expose populations to events that could have long-term negative consequences for mental health of pregnant women and their children. This study explores the prevalence and associated risk factors for psychological distress of women during pregnancy, including exposure to past conflict-related potentially traumatic events, in a population exposed to armed conflict in the Swat region of Pakistan. A community-based cross-sectional survey of 349 pregnant women in two union councils in Swat was conducted. Psychological distress was measured using the Self-Reporting Questionnaire (SRQ). Conflict-related potentially traumatic events (PTEs) were measured through an adapted version of the Harvard Trauma Questionnaire. Information was also collected on major life events (Life Events Checklist), social support (Multidimensional Scale of Perceived Social Support), and demographic and socio-economic variables. Prevalence of current psychological distress was 38.1 % (95 % CI: 33.1, 43.3). Psychological distress was significantly associated with three or more potentially traumatic events (PTEs) experienced during the conflict (OR = 2.62, 95 % CI: 1.22, 5.61); three or more major life events in the year following the conflict (OR = 3.25, 95 % CI: 1.82, 5.82) and inversely associated with family support (OR = 0.91, 95 % CI: 0.88, 0.95). This is one of the first community based cross sectional surveys in Swat valley, Pakistan to assess the prevalence of psychological distress during pregnancy in an area affected by conflict. Over a third of women show evidence of significant psychological distress. Exposure to potentially traumatic events remained independently associated with psychological distress 1 year after conflict ended, suggesting that conflict exposure may have long-term impacts upon maternal mental health. Combining this with findings relating to the cumulative
Mahfouz, Ragab A; El-Awady, Waleed S; Dewedar, Ashraf
The aim of the study was to assess the left ventricular (LV) synchronicity in pregnant women and to identify the main determinants of LV dyssynchrony in asymptomatic pregnant women. One hundred sixty-seven pregnant women consecutively and 48 age-matched nonpregnant controls were enrolled. For the assessment of LV systolic dyssynchrony, the standard deviation of the time from QRS onset to peak systolic (Tps-LV- standard deviation [SD]) velocity and the maximal difference of the time from QRS onset to peak systolic velocity (Tps-LV) from 12 segments at the apical views. For the LV diastolic dyssynchrony, the standard deviation of the time from QRS onset to peak diastolic (Tpe-LV-SD) velocity and the maximal difference of the time from QRS onset to peak diastolic velocity (Tpe-LV) were calculated. Both systolic and diastolic dyssynchrony indexes were significantly higher in pregnant women than in the normal controls (Tps-LV; P<.01, Tps-LV-SD; P<.03, Tpe-LV, P<.05 and Tpe-LV-SD; P<.02). A total of 28 (16.8%) of the pregnant women had a dyssynchrony index above the accepted value for LV dyssynchrony (>34.4 msec). There was a significant correlation between LV dyssynchrony indexes with, multiparty, multifetal pregnancies, systolic blood pressure in pregnant women with LV dyssynchrony. Additionally LV dyssynchrony was significantly associated with elevated E/e" and brain natriuretic peptide (BNP). Both systolic synchronicity and diastolic synchronicity were affected in pregnant women compared to nonpregnant women. LV dyssynchrony was significantly correlated with age, multiparity, and BNP level. Early detectable changes in systolic and diastolic synchrony may be present in pregnant women at higher risk of peripartum cardiomyopathy. © 2017, Wiley Periodicals, Inc.
... Digital Press Kit Read the MMWR Science Clips Zika Virus Protecting Pregnant Women and Babies Language: English ( ... Pregnancy Registry (50 US states and DC) Problem Zika infection during pregnancy can cause serious birth defects ...
Romualdi, Daniela; De Cicco, Simona; Gagliano, Donatella; Busacca, Matteo; Campagna, Giuseppe; Lanzone, Antonio; Guido, Maurizio
OBJECTIVE Metformin has been reported to reduce the risk of gestational diabetes (GD) in women with polycystic ovarian syndrome (PCOS). However, little is known about the mechanisms of action of this drug during pregnancy. In the attempt to fill this gap, we performed a prospective longitudinal study providing a detailed examination of glucose and insulin metabolism in pregnant women with PCOS undergoing metformin therapy. RESEARCH DESIGN AND METHODS We enrolled 60 women with PCOS who conceived while undergoing metformin treatment. An oral glucose tolerance test and a euglycemic-hyperinsulinemic clamp were performed at each trimester of gestation in 47 ongoing pregnancies. RESULTS Twenty-two of the study subjects had development of GD despite the treatment. At baseline, insulin sensitivity was comparable between women who had development of GD and women who did not. A progressive decline in this parameter occurred in all subjects, independently of the trimester of GD diagnosis. Insulin secretion was significantly higher during the first trimester in patients with an early failure of metformin treatment. Women with third trimester GD and women with no GD exhibited a significant increase in insulin output as gestation proceeded. All newborns were healthy and only one case of macrosomia was observed. CONCLUSIONS Women with PCOS who enter pregnancy in a condition of severe hyperinsulinemia have development of GD earlier, independently of metformin treatment. The physiologic deterioration of insulin sensitivity is not affected by the drug and does not predict the timing and severity of the glycemic imbalance. Despite the high incidence of GD observed, the drug itself or the intensive monitoring probably accounted for the good neonatal outcome. PMID:23315599
Sheffield, Jeanne S.; Siegel, David; Mirochnick, Mark; Heine, R. Phillips; Nguyen, Christine; Bergman, Kimberly L.; Savic, Rada M.; Long, Jill; Dooley, Kelly E.; Nesin, Mirjana
Clinical pharmacology studies that describe the pharmacokinetics and pharmacodynamics of drugs in pregnant women are critical for informing on the safe and effective use of drugs during pregnancy. That being said, multiple factors have hindered the ability to study drugs in pregnant patients. These include concerns for maternal and fetal safety, ethical considerations, the difficulty in designing appropriate trials to assess the study objectives, and funding limitations. This document summarizes the recommendations of a panel of experts convened by the Division of Microbiology and Infectious Diseases at the National Institute of Allergy and Infectious Diseases, National Institutes of Health. These experts were charged with reviewing the issues related to the development of preclinical and clinical drug studies in pregnant women and to develop strategies for addressing these issues. These findings may also be utilized in the development of future drug studies involving pregnant women and their fetus/neonate. PMID:25425722
Silva, Raimunda Magalhães da; Costa, Milena Silva; Matsue, Regina Yoshie; Sousa, Girliani Silva de; Catrib, Ana Maria Fontenelle; Vieira, Luiza Jane Eyre de Souza
This work uses cartography as a method for mapping the trajectory of primary healthcare provided to pregnant women. The scope of the study comprises 9 Basic Healthcare Units located in the city of Juazeiro do Norte in the State of Ceará. In all, fifteen women in the 37th to 39th week of pregnancy were selected. Interviews were conducted with these women during the period from January to June 2010. The cartographic findings were depicted in stages in the flowchart, which exposed lacunas in prenatal healthcare, such as the low number of oncotic cytology exams conducted and the lack of educational counseling. Nevertheless, in the interviews, a significant number of pregnant women expressed satisfaction with the prenatal care provided. The good relationships developed between the healthcare professionals and the pregnant women were the main reason that led them to continue the treatment. This fact reinforces the importance of dialogue between these two actors for the success of prenatal healthcare.
Ceballos-Martínez, Inés; Sandoval-Jurado, Luis; Jaimes-Mundo, Erika; Medina-Peralta, Gloria; Madera-Gamboa, Joel; Fernández-Arias, Yuri Francisco
To estimate the prevalence of depression in pregnant women, the epidemiological characteristics and associated factors. A cross-comparison, with a sample of 220 pregnant women between 18 and 32 weeks gestation. We excluded patients with depression six months before the current pregnancy. Depressed women were 6.4 %, mean age 26 years and 21.4 % were adolescent. The majority women were high school students (50 %); 71.4 % belong to a low medium socioeconomic status; 21.4 % were without a partner; 35.7 % had depression history in the family and 28.6 % had a history of prior antidepressant treatment. The prevalence of depression in Mexican pregnant women was low. Risk factors associated to depression were young age, low socio-economical status, a lack of a partner, a history of depression in the family.
Abbaszadeh, Fatemeh; Kafaei Atrian, Mahboobe; Masoudi Alavi, Negin; Bagheri, Azam; Sadat, Zohreh; Karimian, Zahra
Background: Quality of life differs for different people in different situations and is related to one's self-satisfaction with life. Quality of life is affected by health status. Objectives: The current study examined the relationship between quality of life and depression in pregnant women in Kashan city. Patients and Methods: A Case - control study was performed on 112 depressed pregnant women (Case Group) and 353 Non-depressed pregnant women (Control Group) who referred to the prenatal health care centers of Kashan University of Medical Sciences .They completed Short Form 36 Health Survey (SF-36) to assess the quality of life and the Beck Depression Inventory to assess the level of depressive symptoms. T-test, chi-square and Pearson correlation coefficient statistical tests were used for data analysis. Results: The findings showed that there was an inverse relationship between quality of life and depression in pregnancy (P = 0.0001). Average scores in all eight domains of quality of life were significantly lower in depressed pregnant women compared to non- depressed women. The strongest relationship was observed between depression and vitality (r =-0.52, P = 0.0001), mental health (r = -0.50, P = 0.001) and social functioning (r =-0.38, P = 0.001). Conclusion: Depressed pregnant women had a lower quality of life. The proper management of depression during pregnancy can improve the quality of life in women. It is recommended that antenatal services integrate screening for depression into routine antenatal care. PMID:25414858
Maiya, Arun G.; Kumar, Pratap; Kamath, Asha
Background and Objectives. Pregnancy triggers a wide range of changes in a woman's body leading to various musculoskeletal dysfunctions. Most commonly reported musculoskeletal discomforts by pregnant women are low back pain and symphysis pubis pain. The culture and the environmental factors may influence the discomforts experienced by a pregnant woman. There is a dearth of literature in India, regarding the common musculoskeletal dysfunctions experienced by a pregnant woman, and hence this study. Method. A questionnaire to identify the musculoskeletal dysfunction was developed; content was validated and was translated to local languages through parallel back translation. 261 primiparous pregnant women participated in the study and filled the questionnaire in their native language. Results. Among the musculoskeletal dysfunctions reported by the pregnant women, 64.6% reported calf muscle cramps, 37.1% reported foot pain, and 33.7% experienced low back pain in their third trimester. In the second trimester, common musculoskeletal dysfunctions experienced by the women were that of calf pain (47.8%), low back pain (42%), and pelvic girdle pain (37%). Conclusion. Musculoskeletal dysfunctions and general discomforts very commonly affect the activities of daily living of pregnant women. Understanding the common discomforts during various trimesters of pregnancy will help to develop a comprehensive program for prevention and cure. PMID:25642349
Ramachandra, Preetha; Maiya, Arun G; Kumar, Pratap; Kamath, Asha
Pregnancy triggers a wide range of changes in a woman's body leading to various musculoskeletal dysfunctions. Most commonly reported musculoskeletal discomforts by pregnant women are low back pain and symphysis pubis pain. The culture and the environmental factors may influence the discomforts experienced by a pregnant woman. There is a dearth of literature in India, regarding the common musculoskeletal dysfunctions experienced by a pregnant woman, and hence this study. A questionnaire to identify the musculoskeletal dysfunction was developed; content was validated and was translated to local languages through parallel back translation. 261 primiparous pregnant women participated in the study and filled the questionnaire in their native language. Among the musculoskeletal dysfunctions reported by the pregnant women, 64.6% reported calf muscle cramps, 37.1% reported foot pain, and 33.7% experienced low back pain in their third trimester. In the second trimester, common musculoskeletal dysfunctions experienced by the women were that of calf pain (47.8%), low back pain (42%), and pelvic girdle pain (37%). Musculoskeletal dysfunctions and general discomforts very commonly affect the activities of daily living of pregnant women. Understanding the common discomforts during various trimesters of pregnancy will help to develop a comprehensive program for prevention and cure.
Mayama, Michinori; Yoshihara, Masato; Uno, Kaname; Tano, Sho; Takeda, Takehiko; Ukai, Mayu; Kishigami, Yasuyuki; Oguchi, Hidenori
The normal range of plasma brain natriuretic peptide (BNP) in pregnant women is still unclear. Moreover, pregnant women experience dynamic body weight changes and suffer from anemia, but effects on maternal BNP have not been investigated. This study aimed to reveal the normal plasma BNP range and examine the effects of physiological changes on BNP among pregnant women. Plasma BNP, hemoglobin, plasma creatinine and BMI were measured in 58 non-pregnant control women and in 773 normal pregnant women at late pregnancy, early postpartum and 1-month postpartum. Mean plasma BNP (in pg/mL) was 11.8 (95% confidence interval: 0-27.5) in non-pregnant women, 17.9 (0-44.7, p<0.001) at late pregnancy, 42.5 (0-112.6, p<0.001) early postpartum and 16.1 (0-43.9, p=0.001) 1-month postpartum. Multiple regression analysis revealed that pre-delivery BNP levels were negatively correlated with BMI (p<0.001) and hemoglobin (p=0.002) and positively correlated with creatinine (p<0.001). Post-delivery BNP was positively associated with body weight change during pregnancy (p=0.001) and post-delivery creatinine (p=0.010) but negatively associated with body weight loss at delivery (p<0.001) and post-delivery hemoglobin (p=0.004). Even normal pregnancy affects plasma BNP, particularly in the early postpartum period, indicative of cardiac stress. Plasma BNP levels are affected by BMI, body weight changes, creatinine and hemoglobin levels; therefore, these factors should be considered when analysing cardiac function and the physiological implications of BNP levels in pregnant women. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
Fauchet, Floris; Treluyer, Jean-Marc; Préta, Laure-Helene; Valade, Elodie; Pannier, Emmanuelle; Urien, Saik; Hirt, Déborah
For the first time, a population approach was used to describe abacavir (ABC) pharmacokinetics in HIV-infected pregnant and nonpregnant women. A total of 266 samples from 150 women were obtained. No covariate effect (from age, body weight, pregnancy, or gestational age) on ABC pharmacokinetics was found. Thus, it seems unnecessary to adapt the ABC dosing regimen during pregnancy.
Andersen, Stine Linding; Sørensen, Louise Kolding; Krejbjerg, Anne; Møller, Margrethe; Laurberg, Peter
Maternal iodine requirements increase during pregnancy. Studies performed before the introduction of mandatory iodine fortification of salt in Denmark in 2000 showed that pregnant women with no intake of iodine-containing supplements were moderately iodine-deficient and showed signs of thyroidal stress. We investigated the intake of iodine-containing supplements and urinary iodine excretion in Danish pregnant women after the introduction of iodine fortification of salt. We conducted a cross-sectional study between June and August 2012 in an area of Denmark where iodine deficiency had previously been moderate. Pregnant women coming to Aalborg University Hospital for obstetric ultrasound were recruited consecutively. Participants filled in a questionnaire and handed in a spot urine sample for measurement of iodine and creatinine. Among the pregnant women included (n = 245) 84.1% reported an intake of iodine-containing supplements, and compared with those not taking iodine supplements the median urinary iodine concentration was significantly higher in this group: 109 g/l (25th-75th percentile: 66-191 µg/l). On the other hand, the median urinary iodine concentration was considerably below the recommended level, even for the non-pregnant state in pregnant women with no iodine supplement intake: 68 µg/l (35-93 µg/l), p < 0.001. The majority of pregnant women took iodine-containing supplements, but the subgroup of non-users was still iodine-deficient after the introduction of iodine fortification of salt. Iodine supplement intake during pregnancy in Denmark should be officially recommended. The study was supported by a grant from Musikforlæggerne Agnes og Knut Mørks Fond and from Speciallæge Heinrich Kopps Legat. not relevant.
Filgueiras Meireles, Juliana Fernandes; Neves, Clara Mockdece; Morgado, Fabiane Frota da Rocha; Caputo Ferreira, Maria Elisa
Zika virus presents risk of physical harm to pregnant women, but the fear of infection is also affecting women around the world. There is a gap in the research on Zika virus in the areas involving the impact on the psychosocial well-being of pregnant women. Therefore, this study is aimed at the investigation of the psychosocial adjustment of pregnant women to the risks of Zika virus infection during pregnancy. We investigated 14 pregnant women who were classified in three different groups: six in the first trimester, five in the second trimester and three in the third trimester, aged from 28 to 40 years (33.43 ± 3.76 years). Content analysis was used to interpret data. Our results show that the psychosocial adjustment of participants was significantly negative and included five aspects: (1) negative feelings, (2) changes in family planning, (3) adopting new customs (avoiding places of risk, use of specific clothes and use of repellent), (4) changed attitudes regarding body image and (5) feeling of external demand regarding prevention. The fear of Zika virus infection and all its associated risks have a negative biopsychosocial impact on the pregnant women in this study.
Nguyen, Hang Thanh; Pandolfini, Chiara; Chiodini, Peter; Bonati, Maurizio
Tuberculosis (TB) during pregnancy may lead to severe consequences affecting both mother and child. Prenatal care could be a very good opportunity for TB care, especially for women who have limited access to health services. The aim of this review was to gather and evaluate studies on TB care for pregnant women. We used a combination of the terms "tuberculosis" and "pregnancy", limited to human, to search for published articles. Studies reflecting original data and focusing on TB care for pregnant women were included. All references retrieved were collected using the Reference Manager software (Version 11). Thirty five studies were selected for review and their data showed that diagnosis was often delayed because TB symptoms during pregnancy were not typical. TB prophylaxis and anti-TB therapy appeared to be safe and effective for pregnant women and their babies when suitable follow up and early initiation were present, but the compliance rate to TB prophylaxis is still low due to lack of follow up and referral services. TB care practices in the reviewed studies were in line in principle with the WHO International Standards for Tuberculosis Care (ISTC). Integration of TB care within prenatal care would improve TB diagnosis and treatment for pregnant women. To improve the quality of TB care, it is necessary to develop national level guidelines based on the ISTC with detailed guidelines for pregnant women.
Cuttler, Carrie; Graf, Peter; Pawluski, Jodi L; Galea, Liisa A M
Converging evidence indicates that pregnant women report experiencing problems with memory, but the results of studies using objective measures are ambiguous. The present study investigated potential reason(s) for the discrepancy between findings of subjective and objective memory deficits, as well as potential source(s) of pregnant women's problems with memory. Sixty-one pregnant and 24 nonpregnant women completed a series of memory tests which included field and laboratory measures of prospective memory. Three standardized questionnaires were used to assess subjective aspects of memory. The influence of cortisol, depressed mood, anxiety, physical symptoms, sleep/fatigue, and busyness on pregnancy-related deficits was also examined. The findings revealed objective pregnancy-related deficits on two of the field measures of prospective memory. Pregnancy-related subjective deficits were also detected on all of the questionnaires. In contrast, no objective pregnancy-related deficits were found on the laboratory measures of memory. Increased physical symptoms accounted for one of the objective deficits in memory, while depressed mood and physical symptoms accounted for two of the subjective memory deficits. Collectively, these findings suggest that pregnant women experience everyday life problems with memory that are not readily detected in the laboratory environment. The predominant use of laboratory tests may explain the myriad of previous failures to detect objective deficits in pregnant women's memory. (PsycINFO Database Record (c) 2011 APA, all rights reserved).
Meaney-Delman, Dana; Oduyebo, Titilope; Polen, Kara N D; White, Jennifer L; Bingham, Andrea M; Slavinski, Sally A; Heberlein-Larson, Lea; St George, Kirsten; Rakeman, Jennifer L; Hills, Susan; Olson, Christine K; Adamski, Alys; Culver Barlow, Lauren; Lee, Ellen H; Likos, Anna M; Muñoz, Jorge L; Petersen, Emily E; Dufort, Elizabeth M; Dean, Amy B; Cortese, Margaret M; Santiago, Gilberto A; Bhatnagar, Julu; Powers, Ann M; Zaki, Sherif; Petersen, Lyle R; Jamieson, Denise J; Honein, Margaret A
Zika virus infection during pregnancy is a cause of microcephaly and other fetal brain abnormalities. Reports indicate that the duration of detectable viral RNA in serum after symptom onset is brief. In a recent case report involving a severely affected fetus, Zika virus RNA was detected in maternal serum 10 weeks after symptom onset, longer than the duration of RNA detection in serum previously reported. This report summarizes the clinical and laboratory characteristics of pregnant women with prolonged detection of Zika virus RNA in serum that were reported to the U.S. Zika Pregnancy Registry. Data were obtained from the U.S. Zika Pregnancy Registry, an enhanced surveillance system of pregnant women with laboratory evidence of confirmed or possible Zika virus infection. For this case series, we defined prolonged detection of Zika virus RNA as Zika virus RNA detection in serum by real-time reverse transcription-polymerase chain reaction (RT-PCR) 14 or more days after symptom onset or, for women not reporting signs or symptoms consistent with Zika virus disease (asymptomatic), 21 or more days after last possible exposure to Zika virus. Prolonged Zika virus RNA detection in serum was identified in four symptomatic pregnant women up to 46 days after symptom onset and in one asymptomatic pregnant woman 53 days postexposure. Among the five pregnancies, one pregnancy had evidence of fetal Zika virus infection confirmed by histopathologic examination of fetal tissue, three pregnancies resulted in live births of apparently healthy neonates with no reported abnormalities, and one pregnancy is ongoing. Zika virus RNA was detected in the serum of five pregnant women beyond the previously estimated timeframe. Additional real-time RT-PCR testing of pregnant women might provide more data about prolonged detection of Zika virus RNA and the possible diagnostic, epidemiologic, and clinical implications for pregnant women.
Ewing, Bonnie; Buchholtz, Susan; Rotanz, Richard
Disasters are natural or man-made life-altering events that require preplanning to save lives. Pregnant women are a particularly vulnerable population in such events, because they have special physical and psychosocial needs. Preparations made for labor and birth might have to be drastically altered in the event of an emergency, especially if a woman is separated from her familiar healthcare providers and facilities. The issue of breastfeeding also must be considered in disaster planning for pregnant women, along with occurrences such as food shortages and outbreak of illnesses caused by overcrowding of displaced persons. Recent events such as hurricane Katrina have demonstrated that maternal/child nurses need to become more aware of disaster planning and help to empower pregnant women with knowledge of how to handle their special needs in times of crisis.
Liljestrand, J; Bergström, S; Nieuwenhuis, F; Hederstedt, B
To establish the prevalence of syphilis in pregnant women in Mozambique and evaluate present diagnostic methods, 1468 pregnant women in eight of the country's 10 provinces were examined using the Venereal Disease Research Laboratory (VDRL) test. Positive serum samples were also analysed using the Treponema pallidum haemagglutination (TPHA) assay and one group was also analysed using the fluorescent treponemal antibody absorbed (FTA-ABS) test. The prevalence of VDRL seroreactivity was found to be between 4.5% and 14.6%, whereas the prevalence of treponemal disease as verified by TPHA or FTA-ABS tests was between 1.6% and 9.8%. It is concluded that syphilis is relatively common among pregnant women in Mozambique. The predictive value of a positive VDRL test, when adequately performed, was
Sato, Ana Paula Sayuri; Fujimori, Elizabeth
This study described the nutritional status of 228 pregnant women and the influence of this on birth weight. This is a retrospective study, developed in a health center in the municipality of São Paulo, with data obtained from medical records. Linear regression analysis was carried out. An association was verified between the initial and final nutritional status (p<0.001). The mean of total weight gain in the pregnant women who began the pregnancy underweight was higher compared those who started overweight/obese (p=0.005). Weight gain was insufficient for 43.4% of the pregnant women with adequate initial weight and for 36.4% of all the pregnant women studied. However, 37.1% of those who began the pregnancy overweight/obese finished with excessive weight gain, a condition that ultimately affected almost a quarter of the pregnant women. Anemia and low birth weight were uncommon, however, in the linear regression analysis, birth weight was associated with weight gain (p<0.05). The study highlights the importance of nutritional care before and during pregnancy to promote maternal-infant health.
Ahn, Eric; Nava-Ocampo, Alejandro A.; Koren, Gideon
QUESTION: One of my patients is planning pregnancy and has started taking multivitamin supplements. She is experiencing gastric discomfort. What are the alternatives? ANSWER: Gastric discomfort is usually related to iron intake; pregnant women could use supplements with less iron. Pregnant women need 0.4 to 1.0 mg of folic acid daily. If they have a family history of neural tube defects (NTDs), insulin-dependent diabetes mellitus, or epilepsy, or are currently taking valproic acid, carbamazepine, or antifolates (eg, sulfonamides), they are at intermediate-to-high risk of having babies with NTDs and need 4.0 to 5.0 mg of folic acid daily. PMID:15171671
Yoshitani, Kenji; Inatomi, Yuzuru; Kuwajima, Ken; Ohnishi, Yoshihiko
Stroke during pregnancy is rare, but after occurring, most patients develop serious neurological conditions. Hemorrhagic stroke, including intracerebral hemorrhage and subarachnoid hemorrhage, often requires emergency surgical intervention. In addition to significant maternal physiological changes, the potential for fetal harm should be considered during anesthetic management of these patients. Whether cesarean section or neurosurgical intervention should be prioritized or performed simultaneously in pregnant women with stroke is an important issue. Whether the patients receive general or spinal and epidural anesthesia is another clinically significant issue. Finally neurosurgeons, anesthesiologists, and obstetricians should cooperate to manage pregnant women with stroke.
von Mandach, U; Böni, R; Danko, J; Huch, R; Huch, A
The beta 2-sympathomimetic drug fenoterol (fenoterol hydrobromide, CAS 1944-12-3, Partusisten) is routinely used to inhibit uterine contractions (tocolysis). Investigations of plasma concentrations of those receiving i.v. or oral tocolysis often show different results, both within particular groups of pregnant women and in comparison with non-pregnant persons. The aim of this study was to determine the pharmacokinetics of fenoterol in pregnant women, an important factor which so far had not been known. Four healthy pregnant women with similar weight and gestational age and all with premature labor were administered a continuous intravenous infusion of 4 micrograms fenoterol/min. During and up to 24 hours after the end of the infusion, venous blood samples were taken in order to determine the fenoterol plasma concentrations by radioimmunoassay. From a steady state concentration (css) of 2242 +/- 391 pg/ml (x +/- S.E.), a non-linear two-phased plasma elimination was seen with half-lives t1/2 of 11.40 min and 4.87 h. The area under the plasma concentration-time curve (AUC0-12h) was 6.27 ng/ml x h. The total clearance (Cltot) was 114.8 l/h. These data are nearly the same as the data already known for healthy non-pregnant (male) volunteers. The deviations which are seen in the plasma concentrations in pregnant women in comparison to non-pregnant persons during or after continuous i.v. infusion can therefore not be caused by differences in the pharmacokinetics. Other factors, however, such as body weight and/or gestational age, might influence the results.
Smith, Mary Anne E; MacLaurin, Tanya L
During pregnancy, a woman's immune system is compromised and she is at an increased risk of infection and illness. In particular, the risk of contracting foodborne listeriosis is 20 times greater for pregnant women than for other women of reproductive age. Considering the negative effects of listeriosis on the developing fetus and that more than 380,000 babies were born in Canada in 2010, listeriosis is an important public health concern. And yet, in Canada, it is not clear who is responsible for educating pregnant women on the importance of safe food handling and the avoidance of high-risk foods. Not all women attend prenatal education classes and the circle of care during pregnancy is highly variable. Physicians, however, are very often included in the care circle and may represent a consistent, reliable and trustworthy source of food safety information. At present, only one province has prenatal records that prompt physicians to counsel pregnant women on food safety issues, though all include some assessment of nutrition, diet or supplement use. Improving provincial and territorial prenatal records may be one important way of helping to ensure that critical food safety information is reaching pregnant Canadians.
McMahon, Adrienne B; Arms-Chavez, Clarissa J; Harper, Bridgette D; LoBello, Steven G
It was recently reported that pregnant women were more likely to have minor depression as measured by the Patient Health Questionnaire-8 depression scale (PHQ-8), (as reported by Kroenke and Spitzer (Psychiatr Ann 32(9):1-7, 2002), and Kroenke et al. (J Affect 114(1-3):163-173, 2009)) compared to women who were not pregnant (as reported by Ashley et al. (Arch Womens Ment Health 19(2):395-400, 2015)). The present study is designed to investigate if somatic symptoms (energy level, appetite, sleep) associated with both pregnancy and depression were responsible for this increased prevalence of minor depression. A sample of pregnant women (n = 404) was compared to women who were not pregnant (n = 6754). Both groups scored within the minor depression range on the PHQ-8 and comparisons were based on participants' responses to PHQ-8 items. Results indicate that of the somatic symptoms of depression, only changes in energy level accounted for the elevated prevalence of minor depression among pregnant women compared to women who are not pregnant. Removing the decreased energy item from the score determination reduces the prevalence of minor depression among pregnant women to a level significantly below that of women who are not pregnant. Emotional symptoms such as feeling down and feeling like a failure were less likely to be reported by pregnant women compared to women who were not pregnant. Implications for depression screening during pregnancy are discussed.
Flick, Louise H.; Homan, Sharon M.; Campbell, Claudia; McSweeney, Maryellen; Gallagher, Mary Elizabeth
Abstract Aims This study estimated the prevalence of twenty-two 12-month and lifetime psychiatric disorders in a sample of 744 low-income pregnant women and the frequency that women with psychiatric disorders received treatment. Method To identify psychiatric disorders, the Diagnostic Interview Schedule (DIS) was administered to Medicaid or Medicaid-eligible pregnant women enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). The sample was stratified by the rural or urban location of the WIC sites in southeastern Missouri and the city of St. Louis. Eligible women were enrolled at each site until their numbers were proportional to the racial distribution of African American and Caucasian pregnant women served there. Results The 12-month prevalence of one or more psychiatric disorders was 30.9%. Most common were affective disorders (13.6%), particularly major depressive disorder (8.2%) and bipolar I disorder (5.2%). Only 24.3% of those with a psychiatric disorder reported that they received treatment in the past year. Lifetime prevalence of at least one disorder was 45.6%, with affective disorders being the most frequent (23.5%). Caucasian women were more likely than African Americans to have at least one 12-month disorder, with the difference largely accounted for by nicotine dependence. Higher prevalence of lifetime disorders was also found in Caucasian women, particularly affective disorders and substance use disorders. There were no differences in the prevalence of 12-month or lifetime psychiatric disorders by the urban or rural residence of subjects. Conclusions With nearly one third of pregnant women meeting criteria for a 12-month psychiatric disorder and only one fourth receiving any type of mental health treatment, comprehensive psychiatric screening during pregnancy is needed along with appropriate treatment. PMID:20524895
Devi, Sarita; Mukhopadhyay, Arpita; Dwarkanath, Pratibha; Thomas, Tinku; Crasta, Julian; Thomas, Annamma; Sheela, C N; Hsu, Jean W; Tang, Grace J; Jahoor, Farook; Kurpad, Anura V
Background: Low-quality dietary protein intake and vitamin B-12 deficiency could interact to decrease methionine transmethylation and remethylation rates during pregnancy and may affect epigenetic modifications of the fetal genome.Objective: The objective of this randomized, partially open-labeled intervention trial was to examine the effect of supplemental high-quality protein and vitamin B-12 on third-trimester methionine kinetics in pregnant Indian women with a low vitamin B-12 status.Methods: Pregnant women with low serum vitamin B-12 concentrations (<200 pmol/L) were randomly assigned to 1 of 3 groups: the first group received balanced protein-energy supplementation of 500 mL milk/d plus a 10-μg vitamin B-12 tablet/d (M+B-12 group; n = 30), the second group received milk (500 mL/d) plus a placebo tablet (M+P group; n = 30), and the third group received a placebo tablet alone (P group; n = 33). Third-trimester fasting plasma amino acid kinetics were measured by infusing 1-(13)C,methyl-(2)H3-methionine, ring-(2)H5-phenylalanine, ring-(2)H4-tyrosine,1-(13)C-glycine, and 2,3,3-(2)H3,(15)N-serine in a subset of participants. Placental mRNA expression of genes involved in methionine pathways, placental long interspersed nuclear elements 1 (LINE-1) methylation, and promoter methylation levels of vascular endothelial growth factor (VEGF) were analyzed.Results: Remethylation rates in the M+B-12, M+P, and P groups were 5.1 ± 1.7, 4.1 ± 1.0, and, 5.0 ± 1.4 μmol ⋅ kg(-1) ⋅ h(-1), respectively (P = 0.057), such that the percentage of transmethylation remethylated to methionine tended to be higher in the M+B-12 group (49.5% ± 10.5%) than in the M+P group (42.3% ± 8.4%; P = 0.053) but neither differed from the P group (44.2% ± 8.1%; P > 0.1). Placental mRNA expression, LINE-1, and VEGF promoter methylation did not differ between groups.Conclusions: Combined vitamin B-12 and balanced protein-energy supplementation increased the homocysteine remethylation rate in
Adams, April; Jacobs, Katherine; Vogel, Rachel Isaksson; Lupo, Virginia
Objective Intrahepatic cholestasis of pregnancy (ICP) is a rare liver disorder, usually manifesting in the third trimester and associated with increased perinatal morbidity and mortality. The hallmark laboratory abnormality in ICP is elevated fasting serum bile acids; however, there are limited data on whether a nonfasting state affects a pregnant woman's total bile acids. This study assesses fasting and nonfasting bile acid levels in 10 healthy pregnant women after a standardized glucose load to provide insight into the effects of a glucose load on bile acid profiles. Study Design Pilot prospective cohort analysis of serum bile acids in pregnant women. A total of 10 healthy pregnant women from 28 to 32 weeks' gestation were recruited for the study before undergoing a glucose tolerance test. Total serum bile acids were collected for each subject in the overnight fasting state, and 1 and 3 hours after the 100-g glucose load. Results There was a statistically significant difference between fasting versus 3-hour values. There was no statistically significant difference between fasting versus 1-hour and 1-hour versus 3-hour values. Conclusion There is a difference between fasting and nonfasting total serum bile acids after a 100-g glucose load in healthy pregnant women. PMID:26495178
Rayburn, William F; Bogenschutz, Michael P
Dependence on alcohol, nicotine, or illicit drugs during pregnancy continues to be a problem of major medical, social, and fetal consequences. The purpose of this systematic review was to summarize current experience that pertains to pharmacotherapy for pregnant women with specific chemical addictions. Studies were identified through Medline and HealthSTAR (1979-2003) that linked specific pharmacotherapy with pregnancy. This article reviews the English language literature for clinical studies that link the 2 conditions. In addition, reference lists of all articles that were obtained were evaluated for other potential citations. Pregnant women are excluded systematically from almost all drug trials. Most knowledge about the fetal effects from maternal substance and medication use comes from animal data and from case reports and small clinical series. With the exception of methadone and nicotine replacement, clinical experience with antiaddictive medications in pregnant women is either very limited (alcohol, stimulants) or nonexistent (cannabis, hallucinogens). Antiaddiction medications are important in the treatment of pregnant women with opioid and nicotine dependence and are of growing importance in the treatment of alcohol and stimulant dependence. Future directions will be toward increasing knowledge about current drug therapy and in developing new antiaddiction medications.
... have not been shown to cause harm to pregnant women or their developing babies. If you have your baby before getting your flu shot, you still need to get vaccinated. The flu is spread from person to person. You, or others who care for ...
Usselman, Charlotte W.; Skow, Rachel J.; Matenchuk, Brittany A.; Chari, Radha S.; Julian, Colleen G.; Stickland, Michael K.; Davenport, Margie H.
Muscle sympathetic nerve activity is increased during normotensive pregnancy while mean arterial pressure is maintained or reduced, suggesting baroreflex resetting. We hypothesized spontaneous sympathetic baroreflex gain would be reduced in normotensive pregnant women relative to nonpregnant matched controls. Integrated muscle sympathetic burst incidence and total sympathetic activity (microneurography), blood pressure (Finometer), and R-R interval (ECG) were assessed at rest in 11 pregnant women (33 ± 1 wk gestation, 31 ± 1 yr, prepregnancy BMI: 23.5 ± 0.9 kg/m2) and 11 nonpregnant controls (29 ± 1 yr; BMI: 25.2 ± 1.7 kg/m2). Pregnant women had elevated baseline sympathetic burst incidence (43 ± 2 vs. 33 ± 2 bursts/100 heart beats, P = 0.01) and total sympathetic activity (1,811 ± 148 vs. 1,140 ± 55 au, P < 0.01) relative to controls. Both mean (88 ± 3 vs. 91 ± 2 mmHg, P = 0.4) and diastolic (DBP) (72 ± 3 vs. 73 ± 2 mmHg, P = 0.7) pressures were similar between pregnant and nonpregnant women, respectively, indicating an upward resetting of the baroreflex set point with pregnancy. Baroreflex gain, calculated as the linear relationship between sympathetic burst incidence and DBP, was reduced in pregnant women relative to controls (−3.7 ± 0.5 vs. −5.4 ± 0.5 bursts·100 heart beats−1·mmHg−1, P = 0.03), as was baroreflex gain calculated with total sympathetic activity (−294 ± 24 vs. −210 ± 24 au·100 heart beats−1·mmHg−1; P = 0.03). Cardiovagal baroreflex gain (sequence method) was not different between nonpregnant controls and pregnant women (49 ± 8 vs. 36 ± 8 ms/mmHg; P = 0.2). However, sympathetic (burst incidence) and cardiovagal gains were negatively correlated in pregnant women (R = −0.7; P = 0.02). Together, these data indicate that the influence of the sympathetic nervous system over arterial blood pressure is reduced in normotensive pregnancy, in terms of both long-term and beat-to-beat regulation of arterial pressure
Gharaibeh, M; Al-Ma'aitah, R; Al Jada, N
Although many improvements have been made in the area of women's health in Jordan, women during pregnancy still face many health problems that put their lives at risk. This is evident in the relatively high Maternal Mortality Rate, anaemia, low birth weight and other problems related to their lifestyle practices during pregnancy (Jordanian Ministry of Health 1998). To describe the health-promoting lifestyle behaviours of Jordanian pregnant women. The Maternal Health Promoting Lifestyle Profile (MHPLP), based on the Health Promotion Model, was modified to measure maternal practices. A representative sample of 400 Jordanian pregnant women in their 20th week of gestation or beyond were recruited from five public Maternal and Child Health Centres in the city of Irbid, in the northern part of Jordan. The MHPLP measures six dimensions: physical activity, stress management, self-actualization, nutrition, health responsibility and interpersonal support. Data were analysed by using descriptive analysis. The women reported high scores on health responsibility and self-actualization, moderate scores on interpersonal support and nutrition, and low scores on physical activity and stress management behaviours. CONCLUSIONS AND IMPLICATIONS FOR POLICY, PRACTICE AND RESEARCH: The findings have implications for the quality of care delivered through the maternal and child health services. Health promotion and healthy lifestyle need to be an integral part of health services provided for pregnant women. Further research is needed to develop an instrument that integrates the cultural beliefs relating to lifestyle practices of Jordanian pregnant women mainly in the areas of physical activities and stress management. Policy implications of the findings are discussed.
Bardají, Azucena; Sigauque, Betuel; Bruni, Laia; Romagosa, Cleofé; Sanz, Sergi; Mabunda, Samuel; Mandomando, Inacio; Aponte, John; Sevene, Esperança; Alonso, Pedro L; Menéndez, Clara
There is a widespread notion, based on limited information, that in areas of stable malaria transmission most pregnant women with Plasmodium falciparum infection are asymptomatic. This study aim to characterize the clinical presentation of malaria in African pregnant women and to evaluate the adequacy of case management based on clinical complaints. A hospital-based descriptive study between August 2003 and November 2005 was conducted at the maternity clinic of a rural hospital in Mozambique. All women attending the maternity clinic were invited to participate. A total of 2,330 women made 3,437 eligible visits, 3129 were analysed, the remainder were excluded because diagnostic results were unavailable or they were repeat visits. Women gave a standardized clinical history and had a medical exam. Malaria parasitaemia and haematocrit in capillary blood was determined for all women with signs or symptoms compatible with malaria including: presence and history of fever, arthromyalgias, headache, history of convulsions and pallor. Outcome measure was association of malaria symptoms or signs with positive blood slide for malaria parasitaemia. In 77.4% of visits pregnant women had symptoms suggestive of malaria; 23% (708/3129) were in the first trimester. Malaria parasitaemia was confirmed in 26.9% (842/3129) of visits. Headache, arthromyalgias and history of fever were the most common symptoms (86.5%, 74.8% and 65.4%) presented, but their positive predictive values for malaria parasitaemia were low [28% (27-30), 29% (28-31), and 33% (31-35), respectively]. Symptoms suggestive of malaria were very frequent among pregnant women attending a rural maternity clinic in an area of stable malaria transmission. However, less than a third of them were parasitaemic. In the absence of microscopy or rapid diagnostic tests, a large proportion of women, including those in the first trimester of gestation, would be unnecessarily receiving antimalarial drugs, often those with unknown
Kuizon, M D; Platon, T P; Ancheta, L P; Angeles, J C; Nunez, C B; Macapinlac, M P
The effect of iron supplementation alone or in combination with ascorbic acid as a preventive and or corrective measure against anemia were tested using pregnant women seeking pre-natal consultation at various health centers in Greater Manila Area. One tablet containing 65 mg iron alone or in combination with ascorbic acid per day during a supplementation period which varied from 16.5 to 17.8 weeks maintained initial hemoglobin and hematocrit levels in non-anemic women. Three tablets of the same iron preparation (total of 195 mg iron) daily resulted in significant increases in hemoglobin and hematocrit in anemic women. Ascorbic acid had no apparent beneficial effect. Considering the positive response to iron treatment, it is recommended that a nationwide program of iron supplementation of pregnant Filipinos be undertaken.
Jacyszyn, K; Walas, J; Malinowski, A; Latkowski, T; Cwynar, L
Copper, zinc, and lead concentrations were measured in two groups 72 pregnant women. Twenty-one of them, making up the control group, lived and worked in Wrocław. The other 51 women, the second group, had lived more than five years in Lubin-Polkowice and worked in the local non-ferrous metal plants. They were particularly endangered by their exposure to copper, zinc, and lead concentrations. Pregnancy was normal in all cases. Maternal blood, umbilical cord blood, placenta homogenate, and amniotic fluid were examined by techniques of atom-absorption spectrometry. The metals tested were conspicuously absorbed by placental tissue, but no danger to the pregnant women could be established.
Westreich, Daniel; Rosenberg, Molly; Schwartz, Sheree; Swamy, Geeta
Background HIV-related outcomes may be affected by biological sex and by pregnancy. Including women in general and pregnant women in particular in HIV-related research is important for generalizability of findings. Objective To characterize representation of pregnant and non-pregnant women in HIV-related research conducted in general populations. Data Sources All HIV-related articles published in fifteen journals from January to March of 2011. We selected the top five journals by 2010 impact factor, in internal medicine, infectious diseases, and HIV/AIDS. Study Eligibility Criteria HIV-related studies reporting original research on questions applicable to both men and women of reproductive age were considered; studies were excluded if they did not include individual-level patient data. Study appraisal and synthesis methods. Articles were doubly reviewed and abstracted; discrepancies were resolved through consensus. We recorded proportion of female study participants, whether pregnant women were included or excluded, and other key factors. Results In total, 2014 articles were published during this period. After screening, 259 articles were included as original HIV-related research reporting individual-level data; of these, 226 were determined to be articles relevant to both men and women of reproductive age. In these articles, women were adequately represented within geographic region. The vast majority of published articles, 183/226 (81%), did not mention pregnancy (or related issues); still fewer included pregnant women (n=33), reported numbers of pregnant women (n=19), or analyzed using pregnancy status (n=9). Limitations Data were missing for some key variables, including pregnancy. The time period over which published works were evaluated was relatively short. Conclusions and implications of key findings. The under-reporting and inattention to pregnancy in the HIV literature may reduce policy-makers’ ability to set evidence-based policy around HIV/AIDS care
Westreich, Daniel; Rosenberg, Molly; Schwartz, Sheree; Swamy, Geeta
HIV-related outcomes may be affected by biological sex and by pregnancy. Including women in general and pregnant women in particular in HIV-related research is important for generalizability of findings. To characterize representation of pregnant and non-pregnant women in HIV-related research conducted in general populations. All HIV-related articles published in fifteen journals from January to March of 2011. We selected the top five journals by 2010 impact factor, in internal medicine, infectious diseases, and HIV/AIDS. HIV-related studies reporting original research on questions applicable to both men and women of reproductive age were considered; studies were excluded if they did not include individual-level patient data. Articles were doubly reviewed and abstracted; discrepancies were resolved through consensus. We recorded proportion of female study participants, whether pregnant women were included or excluded, and other key factors. In total, 2014 articles were published during this period. After screening, 259 articles were included as original HIV-related research reporting individual-level data; of these, 226 were determined to be articles relevant to both men and women of reproductive age. In these articles, women were adequately represented within geographic region. The vast majority of published articles, 183/226 (81%), did not mention pregnancy (or related issues); still fewer included pregnant women (n=33), reported numbers of pregnant women (n=19), or analyzed using pregnancy status (n=9). Data were missing for some key variables, including pregnancy. The time period over which published works were evaluated was relatively short. The under-reporting and inattention to pregnancy in the HIV literature may reduce policy-makers' ability to set evidence-based policy around HIV/AIDS care for pregnant women and women of child-bearing age.
Kosenko, E V
The study was designed to analyze the work of women's consultation clinics and maternity homes on antitobacco propaganda among pregnant women. 428 physicians were interviewed. It was shown that 21.7% of physicians at women's consultation clinics and 22.9% of those of maternity homes were constantly engaged in such propaganda activities. The majority of physicians discussed tobacco smoking only in case when the patients had some smoking-associated problems. It was recommended to intensify antitobacco propaganda, to develop the movement under the slogan "Smoking and doctors are incompatible", to raise the responsibility of physicians for health education.
Rasmussen, Mikkel Mylius; Clemmensen, Dorte
Folic acid (FA) deficiency is associated with neural tube defects (NTD). In a non-risk pregnancy, The Danish National Board of Health recommends FA supplementation from planned pregnancy until three months after conception. We explored pregnant women's knowledge about and actual supplementation with FA and related this to education, number of pregnancies and age. Eighty-four consecutive pregnant women with a midwife consultation were included in the period 25-28 August 2008. All filled in a unified questionnaire. 82% had knowledge of FA supplementation and 89% received FA supplementation. 51% followed national recommendations. We found a statistically significant correlation between higher educational level and knowledge about FA supplementation, actual supplementation of FA and FA supplementation in accordance with national recommendations. No statistical associations were found between number of pregnancies or age and any FA-related parameters. Family, friends, general practitioner (GP) and the internet were the main information sources. Correct FA supplementation is quite low; conversely, knowledge about and actual FA supplementation are fairly high. Further intervention is necessary to increase the level of correct FA supplementation. Women with a low educational level--which may herald low socio-economic status--seem to form a suitable target group for information campaigns. Multiple pregnancies or higher age should not be perceived as indicators of a higher information level. Dissemination of information to the pregnant women including family, friends, GPs or the internet is recommended.
Zárate, Arturo; Hernández Valencia, Marcelino; Basurto, Lourdes; Saucedo, Renata
Diabetes type 2 has increased in adult women due to higher frequency of obesity and sedentary lifestyle, and thus cardiovascular diseases have increased. Hyperglycemia control and, collaterally, high blood pressure and dyslipidemia correction are the basis of its therapy. This paper evaluates oral antidiabetic drugs effectiveness and preference. Gestational diabetes is a cause of morbidity and mortality in fetuses and newborns, it has to be timely diagnosed, and needs a strict control, same to diabetes type 1. Gyneco-obstetrical doctor must be alert to diabetes signs and closely work in its therapy.
Llop, Sabrina; Ballester, Ferran; Estarlich, Marisa; Esplugues, Ana; Fernández-Patier, Rosalia; Ramón, Rosa; Marco, Alfredo; Aguirre, Amelia; Sunyer, Jordi; Iñiguez, Carmen; INMA-Valencia cohort
ObjectivesTo describe the degree of annoyance caused by air pollution and noise in pregnant women in a birth cohort; to determine the modifying factors and their relation with exposure to ambient nitrogen dioxide (NO 2). MethodsThe study population was 855 pregnant women in Valencia, Spain. Annoyance caused by air pollution and noise, and explanatory factors were obtained from 786 pregnant women through a questionnaire. NO 2 levels were determined combining measurements at 93 points within the area of study and using geostatistical techniques (kriging). ResultsIn all 7.9% of the women reported high annoyance caused by air pollution and 13.1% high annoyance caused by noise. There was a significant difference in the degree of annoyance due to both air pollution and noise depending on the area where the women lived and their working status. The degree of annoyance correlated better with measured NO 2 at the municipality level (air pollution: r=0.53; noise: r=0.44) than at the individual level (air pollution and noise: r=0.21). On multivariate analysis, being a housewife, higher NO 2 levels and high traffic density were associated with higher degrees of annoyance. ConclusionsThere was a high percentage of women who perceived medium-high annoyance due to noise and air pollution. Annoyance caused by environmental pollutants could lead to some psychological effects, which impair the quality of life, or even physiological ones, which affect prenatal development.
Rehakova, P; Rexhaj, E; Farron, F; Duplain, H
Nowadays, high altitude resorts have become popular destinations for family vacations. Based on a limited number of publications and international guidelines, this article summarizes the effects of high altitude on children and pregnant women. Children also suffer from high altitude-related diseases, however their presentation and clinical significance are different from their adult counterparts. Careful planning of the itinerary with respect to altitude of the overnight stays, access to medical services and potential evacuation routes is the cornerstone of a successful vacation.
In three prenatal clinics in Latin America the average attendance time by pregnant women was 129 minutes but the average time spent with a doctor was only 8-10 minutes. In order to improve prenatal care, providers should analyse what happens during visits. Assessments should be made of the usefulness of the services offered and some thought should be given as to who might best provide them.
Arth, Annelise; Tinker, Sarah; Moore, Cynthia; Canfield, Mark; Agopian, Aj; Reefhuis, Jennita
Neural tube defects (NTDs) include anomalies of the brain (anencephaly and encephalocele) and spine (spina bifida). Even with ongoing mandatory folic acid fortification of enriched cereal grain products, the U.S. Preventive Services Task Force recommends that women of childbearing potential consume a daily supplement containing 400 µg-800 µg of folic acid. Women with a prior NTD-affected pregnancy have an increased risk for having another NTD-affected pregnancy, and if they are planning another pregnancy, the recommendation is that they consume high-dosage folic acid supplements (4.0 mg/day) beginning ≥4 weeks before conception and continuing through the first 12 weeks of pregnancy. To learn whether folic acid supplementation (from multivitamins or single- ingredient supplements) was commonly used during pregnancy by women with a previous NTD-affected pregnancy, supplement use was assessed among a convenience sample of women with a previous NTD-affected pregnancy who participated in the National Birth Defects Prevention Study (NBDPS), a case-control study of major birth defects in the United States. Characteristics of women who previously had an NTD-affected pregnancy and whose index pregnancy (pregnancy included in NBDPS) was either affected by an NTD (N = 17) (i.e., recurrence-cases) or resulted in a live-born infant without a major birth defect (N = 10) (i.e., recurrence-controls) were assessed. Taking a supplement that included folic acid was more common among recurrence-control mothers (80%) than recurrence-case mothers (35%). The recommendation that women should take folic acid supplements just before and during early pregnancy is not being followed by many women and offers an opportunity for NTD prevention, especially among women who are at a higher risk because they have had a previous pregnancy affected by an NTD.
Lindorfer, H; Krebs, M; Kautzky-Willer, A; Bancher-Todesca, D; Sager, M; Gessl, A
In Austria, iodine deficiency has been considered to be eliminated owing to table salt fortification with iodine, but whether this also applies to pregnant women is unclear. Even mild iodine deficiency during gestation may lead to neurocognitive sequelae in the offspring. This is a cross-sectional investigation of urinary iodine excretion in 246 pregnant women (first trimester n=2, second trimester n=53, third trimester n=191, gestational diabetes mellitus n=115, no gestational diabetes mellitus n=131). The iodine content of morning spot urine samples was determined using inductively coupled plasma mass spectrometry. Pregnant women in the Vienna area had a median urinary iodine concentration (UIC) of 87 μg/l. Only 13.8% of the cohort were in the recommended range of 150-249 μg/l, whereas 21.5% had a UIC of 0-49 μg/l, 40.2% had a UIC of 50-99 μg/l and 19.5% had a UIC of 100-149 μg/l. In all, 4.9% had a UIC over 250 μg/l. A total of 137 women of foreign origin had a significantly higher iodine excretion compared with Austrian-born women. Maternal or gestational age had no influence on UIC. Although 79 women on iodine supplementation had a significantly higher iodine concentration compared with women without iodine supplementation (97.3 vs 80.1 μg/l, P=0,006), their UIC was below the recommended range, indicating that doses of 100-150 μg per day are not sufficient to normalize iodine excretion. Sodium and iodine concentrations in the urine were tightly correlated (R=0.539, n=61), suggesting that low intake of iodized salt might contribute to insufficient iodine supply. This study shows that pregnant women in the Vienna area have a potentially clinically significant iodine deficiency and that currently recommended doses of iodine supplementation may not be sufficient.
Szilagyi, A; Szabo, I
Obstetrical and perinatal outcomes in newborns of diabetic pregnant women depend on metabolic control and fetal surveillance during pregnancy. The effects of fetal surveillance on perinatal mortality and morbidity was analyzed in diabetic pregnant women with appropriate glucose control in our regional center for diabetes and pregnancy. 480 deliveries complicated by frank or gestational diabetes occurred in our Department in the period of 1988-1999. Perinatal mortality and morbidity, prevalence of premature deliveries, methods of fetal surveillance, options for respiratory distress syndrome (RDS) profilaxis, cesarean section rate, timing of delivery and its indications and occurrence of malformations have been analyzed. It was found that malformation rate and perinatal mortality may be reduced to even lower level than that of in healthy pregnant women by appropriate glucose control and by using the latest methods of intrauterine fetal surveillance including cardiotocography (non stress test and oxytocin challenge test), doppler fetal artery velocimetry and fetal pulse oximetry. Timing of delivery was needed in 35% of the cases with IDDM and 15% of gestational diabetes due to chronic placental insufficiency. If labour induction was needed before the 38 weeks, amniocentesis was performed to test fetal lung maturity. Direct fetal glucocorticoid administration was used to enhance fetal lung maturation in 14 cases. C-section rate was slightly higher than that of in non diabetic pregnant women. Our perinatal morbidity data (macrosomia, hyperbilirubinemia, hypoglycemia, injuries, infections) are comparable with the data from the literature. Although perinatal mortality with the help of thorough fetal surveillance is even better in diabetic pregnant women than in non diabetic patients, future eye should be focused on factors affecting perinatal morbidity, because it is still higher than in newborns of healthy mothers.
Quinn, Frank A; Reyes-Mendez, Miguel A; Nicholson, Lisa; Compean, Lourdes Puerto; Tavera, Miriam Lugo
Thyroid disorders are common in women of reproductive age, and thyroid dysfunction during pregnancy has been associated with adverse outcomes for mother and child. Thyroid function and thyroid function tests (TFTs) can be influenced by a variety of factors, such as ethnicity, the presence of autoimmune thyroid disease (AITD), dietary iodine intake, pregnancy, and methodological differences. However, no large-scale studies have been published which examine TFTs and prevalence of AITD in Mexican pregnant women and women of reproductive age. TFTs and thyroid autoantibody testing were performed on 660 pregnant and 104 non-pregnant women from Mérida, Yucatán, Mexico. After removal of thyroid autoantibody positive individuals and women with thyroid stimulating hormone (TSH) >4.94 mIU/L, reference intervals were calculated for TFT for non-pregnant women and pregnant women by trimester. Anti-thyroidperoxidase antibodies (TPO-Ab) and/or anti-thyroglobulin antibodies (Tg-Ab) were positive in 14.4% and 13.5% of non-pregnant and pregnant women, respectively. TSH values were significantly higher in women who were positive for TPO-Ab and co-positive for TPO-Ab and Tg-Ab. TSH values were also significantly higher in Tg-Ab positive pregnant women. Other TFTs were not significantly different based on antibody status. Using antibody negative women, reference intervals were determined for TFTs in pregnant (gestational age-specific) and non-pregnant women. Laboratory evidence of AITD is common in this population of Mexican pregnant and non-pregnant women. TFT results and reference intervals are influenced by pregnancy and thyroid autoimmunity. For optimal interpretation of TFT results, gestational age-specific reference intervals established using a local patient population should be used.
Müldner-Nieckowski, Łukasz; Cyranka, Katarzyna; Smiatek-Mazgaj, Bogna; Mielimąka, Michał; Sobański, Jerzy; Rutkowski, Krzysztof
Pregnancy is a major life change for many women. The related biological changes, especially complications in its course and in the course of delivery, carry a risk of developing a variety of psychological problems and mental disorders. However, their treatment is challenging due to the teratogenic effects of most psychoactive drugs and specific requirements for entering different psychotherapeutic programs. Mental disorders during pregnancy are undoubtedly an important issue for both gynecology and psychiatry. There is still a discussion considering the question whether psychotherapy during pregnancy is safe, although no scientifically valid data contradicting the safety of psychotherapy during pregnancy has been published so far. Together with psychotherapy - as a treatment of choice - clinicians approve some other relatively safe treatment methods for psychiatric disorders in pregnant women. Light therapy, limited pharmacotherapy, ECT are included. The goal of this paper is to review current opinions of clinicians and researches concerning possibilities, indications and outcome of psychological treatments as a way to help pregnant women who suffer from different psychiatric conditions, and also because this subject is not yet present in Polish psychiatric journals.
Harville, Emily W.; Xiong, Xu; Buekens, Pierre; Pridjian, Gabriella; Elkind-Hirsch, Karen
Background Although disaster causes distress, many disaster victims do not develop long-term psychopathology. Others report benefits after traumatic experiences (post-traumatic growth). The objective of this study was to examine demographic and hurricane-related predictors of resilience and post-traumatic growth. Methods 222 pregnant southern Louisiana women were interviewed, and 292 postpartum women completed interviews at delivery and eight weeks later. Resilience was measured by scores lower than a non-affected population, using the Edinburgh Depression Scale and the Post-Traumatic Stress Checklist (PCL). Post-traumatic growth was measured by questions about perceived benefits of the storm. Women were asked about their experience of the hurricane, addressing danger, illness/injury, and damage. Chi-square tests and log-Poisson models were used to calculate associations and relative risks (RR) for demographics, hurricane experience, and mental health resilience and perceived benefit. Findings 35% of pregnant and 34% of the postpartum women were resilient from depression, while 56% and 49% were resilient from post-traumatic stress disorder. Resilience was most likely among white women, older women, and women who had a partner. A greater experience of the storm, particularly injury/illness or danger, was associated with lower resilience. Experiencing damage due to the storm was associated with increased report of some perceived benefits. Conclusions Many pregnant and postpartum women are resilient from the mental health consequences of disaster, and perceive benefits after a traumatic experience. Certain aspects of experiencing disaster reduce resilience, but may increase perceived benefit. PMID:20123173
Usmani, K; Moran, E M; Haider, W; Afzal, H; Ahmad, N
Between 1988 and 1991, we treated 595 women with breast cancer in the Breast Disease Section of the Cancer Research Foundation of Pakistan. We report here on 61 patients who were pregnant or lactating. Most patients presented at a late stage of disease because of ignorance, social taboos, or fear of hospitalization and operation. The largest diameter of the breast mass at presentation was 15 cm. Lymph nodes were involved in 70.5% of cases. Multiparity, young marriages, malnutrition, and unhygienic conditions are ripe in the rural environment of Pakistan. No oral contraceptives are used. Modern and conventional methods of treatment did not increase the survival rate of these cancer patients.
Brewster, L M; Taherzadeh, Z; Volger, S; Clark, J F; Rolf, T; Wolf, H; Vanbavel, E; van Montfrans, G A
Black women are at a greater risk to develop hypertension during pregnancy, with a 4.5 times higher rate of fatal preeclampsia than white women. Therefore, it is important to identify factors that may affect this risk. Our group previously proposed that high activity of the central regulatory enzyme of energy metabolism, creatine kinase (CK), may increase ATP-buffering capacity and lead to enhanced vascular contractility and reduced nitric oxide bioavailability. Therefore, we assessed microvascular contractility characteristics in isolated resistance arteries from self-defined black and white normotensive pregnant women using a Mulvany-Halpern myograph. Additionally, morphology was assessed with electron microscopy. Resistance-sized arteries obtained from omentum donated during cesarean sections (11 black women and 20 white women, mean age: 34 yr) studied in series showed similar morphology but significantly greater maximum contractions to norepinephrine (10(-5) M) in blacks [14.0 mN (1.8 SE)] compared with whites [8.9 mN (1.4 SE), P = 0.02]. Furthermore, we found greater residual contractility after the specific CK inhibitor dinitrofluorobenzene (10(-6) M) in black women [55% (6 SE)] compared with white women [28% (4 SE), P = 0.001] and attenuated vasodilation after bradykinin (10(-7) M) in black women [103% (6 SE)] compared with white women [84% (5 SE), P = 0.023], whereas responses to sodium nitroprusside (10(-4) M) and amlodipine (10(-6) M) were similar. We conclude that compared with white women, normotensive pregnant black women display greater resistance artery contractility and evidence of higher vascular CK activity with attenuated nitric oxide synthesis. These findings in normotensives may imply that the black population is at risk for a further incline in pregnancy-related hypertensive disorders.
Taghipour, Ali; Sadat Borghei, Narjes; Latifnejad Roudsari, Robab; Keramat, Afsaneh; Jabbari Nooghabi, Hadi
ABSTRACT Background: Women’s empowerment programs during pregnancy focus primarily on increasing women’s health goals and psychological empowerment has been considered important in most issues related to pregnant mothers’ mental health. Using path analysis, this study aims to examine the direct and indirect components of psychological empowerment of pregnant mothers. Methods: This model-testing study was conducted in Gorgan, northwest of Iran during three months in spring of 2015. Through random cluster sampling, a total number of 160 pregnant women were selected from 10 urban medical centers and clinics as primary centers. We used Spritzer’s Psychological empowerment scale. Suitable sampling based on Nunally and Bernstein was followed in the model. The relationships between the dependent variables were then examined by means of path analysis using Amos 18. Results: The psychological empowerment of pregnant mothers (PEPW) model is impacted by individual factors, such as marriage age and employment, including some subjectively rated factors such as marital satisfaction and experience of violence. The PEPW model was deemed appropriate as optimum conditions indicators of goodness of fit; low index of χ2/df shows little difference between the conceptual model and observed data, while RMSEA value indicated the goodness of fit. Other indicators such as CMIN=0.957, CMIN/DF=0.957, P-CLOSE=0.418, χ2=0.957 and probability level=0.328 the fact that the model is ideal. The mothers’ employment had the highest coefficient in the PEPW path model .731 (0.443, 0.965) bootstrap confidence intervals by 95%, and with a p-value of less than 0.05. Conclusions: The mothers’ employment is the most important factor in psychological empowerment, but it cannot be addressed quickly. Programming to increase marital satisfaction followed by a decrease in family violence and prevention of early marriage are necessary for promotion of psychological empowerment during pregnancy. PMID
Rowley, P T; Loader, S; Sutera, C J; Walden, M
A 45% sample of all pregnancies in Rochester, N.Y. over a five-year period showed that 4.2% of pregnant women had a hemoglobinopathy. Sixty-six percent of these women did not know they had such an abnormality, and 80% did not understand its reproductive significance. Sixty-eight percent of women informed they were positive came for counseling. Fifty-seven percent of counseled women had the baby's father tested. Forty-seven percent of couples at risk offered amniocentesis wanted it. (table; see text) A woman was more likely to want her partner tested if she had a more thorough knowledge of the disease or viewed having an affected child as more burdensome. The partner was more likely to come for testing if the couple were living together than if living apart. Prenatal hemoglobinopathy screening is accepted by providers and pregnant women, at least when expert services are provided at no charge to either. Women and couples use the information provided to pursue their reproductive goals.
Farine, Dan; Seaward, P Gareth
Pregnant women who lie in a supine position may develop syncopal symptoms. However, of those women who become symptomatic, only 2% to 4% have significant aortocaval compression. Even in this small minority of symptomatic women, there is no evidence of fetal compromise. The advice often given to pregnant women to lie on the left side is therefore not relevant. In some women, experiencing a pre-syncopal episode will cause them to avoid lying in the supine position.
Shields, Kristine E; Lyerly, Anne Drapkin
The lack of human data available to inform evidence-based treatment for illness during pregnancy has led to calls for greater inclusion of pregnant women in research, but the extent of their current representation is poorly characterized. Our objective was to measure the current exclusion of pregnant women from industry-sponsored clinical trials as a baseline for future comparison. We compiled data from studies enrolling women of childbearing potential posted on www.ClinicalTrials.gov between 1 October 2011 and 31 January 2012. The review was limited to open United States-based phase IV interventional studies sponsored by the pharmaceutical industry evaluating treatment of conditions that may be experienced by but are not limited to pregnant women and did not involve a medication classified as potentially teratogenic. If there was no mention of pregnancy in the inclusion or exclusion criteria, we contacted a study representative to confirm that pregnant women could be enrolled. Of 558 qualifying industry-sponsored studies, five (1%) were designed specifically for pregnant women. Of 367 phase IV clinical trials with verified inclusion and exclusion criteria, 348 (95%) excluded pregnant women and 19 (5%) did not. We found the exclusion of pregnant women from industry-sponsored clinical trials to be common practice. Moving beyond reflexive exclusion and developing thoughtful criteria for inclusion of pregnant women in clinical research would likely advance the evidence base to inform treatment decisions during pregnancy and lead to better health outcomes for women and children.
Farmakidis, Constantine; Dayal, Ashlesha K.; Lipton, Richard B.
Objective: To characterize demographic and clinical features in pregnant women presenting with acute headache, and to identify clinical features associated with secondary headache. Methods: We conducted a 5-year, single-center, retrospective study of consecutive pregnant women presenting to acute care with headache receiving neurologic consultation. Results: The 140 women had a mean age of 29 ± 6.4 years and often presented in the third trimester (56.4%). Diagnoses were divided into primary (65.0%) and secondary (35.0%) disorders. The most common primary headache disorder was migraine (91.2%) and secondary headache disorders were hypertensive disorders (51.0%). The groups were similar in demographics, gestational ages, and most headache features. In univariate analysis, secondary headaches were associated with a lack of headache history (36.7% vs 13.2%, p = 0.0012), seizures (12.2% vs 0.0%, p = 0.0015), elevated blood pressure (55.1% vs 8.8%, p < 0.0001), fever (8.2% vs 0.0%, p = 0.014), and an abnormal neurologic examination (34.7% vs 16.5%, p = 0.014). In multivariate logistic regression, elevated blood pressure (odds ratio [OR] 17.0, 95% confidence interval [CI] 4.2–56.0) and a lack of headache history (OR 4.9, 95% CI 1.7–14.5) had an increased association with secondary headache, while psychiatric comorbidity (OR 0.13, 95% CI 0.021–0.78) and phonophobia (OR 0.29, 95% CI 0.09–0.91) had a reduced association with secondary headache. Conclusions: Among pregnant women receiving inpatient neurologic consultation, more than one-third have secondary headache. Diagnostic vigilance should be heightened in the absence of a headache history and if seizures, hypertension, or fever are present. Attack features may not adequately distinguish primary vs secondary disorders, and low thresholds for neuroimaging and monitoring for preeclampsia are justified. PMID:26291282
Lavecchia, Melissa; Abenhaim, Haim A
Little is known about outcomes of cardiopulmonary resuscitation (CPR) in pregnancy. The purpose of this study was to determine the prognostic value of pregnancy in women receiving CPR in the emergency department (ED). We conducted a population-based, matched cohort study using the Nationwide Emergency Department Sample (NEDS) from 2006 to 2010. A cohort of pregnant women receiving CPR in the ED was compared to an age-matched cohort of non-pregnant women at a 1:10 ratio. Conditional logistic regression was used to calculate the odds ratio (OR) and corresponding 95% confidence intervals (95% CIs) for variables of interest and survival. Among 8162 women requiring CPR in the ED, we identified 157 pregnant women. Pregnancy was associated with better overall survival of 36.9% compared to 25.9% in non-pregnant women, OR 1.89 (1.32-2.70), p < 0.01. Traumatic injury was identified as a significant predictor of outcome in pregnancy. In non-trauma patients, pregnant women had significantly better odds of surviving CPR than non-pregnant women, OR 2.10 (1.41-3.13), p < 0.01. In cases of trauma, no significant difference was observed between groups. Although further studies are needed, CPR in pregnancy is associated with a better prognosis compared to non-pregnant women, with trauma status being a key factor predicting outcome in the pregnant patient. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Acmaz, Gokhan; Atas, Mustafa; Gulhan, Ahmet; Acmaz, Banu; Atas, Fatma; Aksoy, Huseyin; Zararsiz, Gokmen; Gokce, Gokcen
Gestational diabetes mellitus (GDM) is a risk factor for the development of type II diabetes and it causes maternal and child morbidity. Screening for diabetic retinopathy (DR) is important because patients who develop DR have no symptoms until macular edema and/or proliferative diabetic retinopathy (PDR) are already present. The aim of this study was to determine the early retinal findings of GDM. This study was conducted in a tertiary research center. We conducted a prospective cross-sectional study with 3 groups: Group 1 consisted of 36 pregnant women with GDM, Group 2 consisted of 24 healthy pregnant women, and Group 3 consisted of 38 healthy non-pregnant women of reproductive age. Spectralis optical coherence tomography (OCT) was used for the assessment. Macular, choroid, and retinal nerve fiber layer (RNFL) thicknesses were evaluated in patients with GDM and comparisons were made among pregnant women with GDM, healthy pregnant women, and healthy non-pregnant women for these parameters. The nasal part of the RNFL was significantly thinner in the GDM group than in the healthy pregnant group. None of the patients had retinopathy or macular edema at the time of examination. Decreased nasal part of RNFL thickness may be the first retinal change in patients with GDM. Our study suggests that OCT should be performed for the patients with GDM for detection of early retinal changes associated with GDM.
... html Increasing Numbers of Pregnant Women Also Have Heart Disease Multiple specialists may be needed to care for ... 2017 (HealthDay News) -- Many more American women with heart disease are choosing to have babies, a new study ...
Perquin, D A; Kloet, A; Tans, J T; Witte, G N; Dörr, P J
Three women, aged 27, 32 and 30 years, respectively, suffered from headache, nausea and neurological abnormalities and were found to have an intracranial arteriovenous malformation (AVM). One of them after diagnosis had two pregnancies, both ended by caesarean section with good results. Another woman was 32 weeks pregnant when the AVM manifested itself with a haemorrhage; she recovered well and was delivered by caesarean section. After the AVM proved radiologically to have been obliterated, she delivered after her subsequent pregnancy by the vaginal route with vacuum extraction. The third woman was 15 weeks pregnant when major abnormalities developed. There was a large intracerebral haematoma with break-through to the ventricular system; this patient died. Intracranial haemorrhage during pregnancy is rate. It can result in maternal and foetal morbidity and mortality. It appears that pregnancy does not increase the rate of first cerebral haemorrhage from an AVM. The management of AVM rupture during pregnancy should be based primarily on neurosurgical rather than on obstetric considerations. Close collaboration with a team of neurologists, neurosurgeons, obstetricians and anaesthesiologists is mandatory.
Grau Gandía, S; Martínez Ramón, M A
This review main purpose is to show nursing the present knowledge about cardiopulmonary resuscitation (CPR) in pregnant women because of the scarce information published by Spanish Nursing Publications. The bibliographical research was made using both the Medline (from January 1982 to March 1998) and Index de Enfermería databases. There, we can find 32 references from which only 23 were selected (all of them belong to the Medline database) in spite of 3 chapters that had already been selected from other different books. Although maternal cardiac arrest rarely happens during pregnancy, it is very important for sanitary staff to be familiarized with the specifics thecnics and equipment (ultrasound and cardiotocograph monitoring). This review describes the physiological changes that take place during pregnancy and have an incidence into CPR. The article also includes the conclusions about the checked papers and the peculiarities that have to be taken into account in each CPR, such as the fetal viability evaluation, right CPR position, airway and breathing, desfibrillation, external cardiac compression and use of pharmacologic therapy and intravenous fluids. Moreover, there is a special mention of the perimortem cesarean delivery features: antecedents, foetus-maternals consequences and managements, due to the fact that this surgical operation should be included inside the CPR protocols of the pregnant.
Minkoff, Howard; Paltrow, Lynn M
At times, obstetricians are called upon to assist pregnant women in making clinical choices between options that may selectively disadvantage either the mother or the fetus. If a mother chooses a therapeutic course that disadvantages the fetus the physician may feel distressed. In this paper we argue that the choices made by mothers are almost always in the interests of the fetus, and supported by physicians. When there is disagreement it is often due to poor communication. While acknowledging that the rare circumstances in which the physician and patient wish to pursue different clinical paths can be stressful for the provider, we explain why obstetricians should accept the judgment of their patient in all instances. Finally, we will maintain that positing a choice between maternal and fetal interests is, in fact, creating a false choice, in as much as options are presented as being exclusive, when in fact that is not the case.
Badillo, Priscila; Salgado, Paola; Bravo, Patricia; Guevara, Katherine; Acurio, Jesenia; Gonzalez, Maria Angelica; Oyarzun, Carlos; San Martin, Rody; Escudero, Carlos
We aim to investigate whether overweight/obese pregnant women have elevated plasma levels of adenosine associated with increased consumption of high-calorie food. Sixty women were included. They were divided into lean (n = 23 and n = 12) or overweight/obese (n = 7 and n = 18) non-pregnant and pregnant women, respectively. Clinical records and maternal blood samples were collected after informed consent. A self-reported dietary questionnaire was also completed. Plasma adenosine levels were determined with high-performance liquid chromatography. Biochemical parameters, including glucose, total protein, and lipid profile, were determined using standard colorimetric assays. Adenosine levels were higher in pregnant women than in non-pregnant women (18.7 ± 1.6 vs 10.8 ± 1.3 nM/μg protein, respectively, p < 0.0001). Overweight/obese pregnant women (21.9 ± 2.5 nM/μg protein) exhibited higher adenosine levels than lean pregnant (14.5 ± 1.0 nM/μg protein, p = 0.04) or non-pregnant women (11.7 ± 1.5 nM/μg protein, p = 0.0005). Also, pregnant women with elevated weight gain exhibited higher (26.2 ± 3.7 nM/μg protein) adenosine levels than those with adequate weight gain (14.9 ± 1.4 nM/μg protein, p = 0.03). These differences were not statistically significant compared with those of pregnant women with reduced weight gain (17.4 ± 2.1 nM/μg protein, p = 0.053). Body mass index and adenosine only in pregnant women were positively correlated (r = 0.39, p = 0.02). While, polyunsaturated fatty acid (PUFA) consumption was negatively correlated with plasma adenosine levels only in non-pregnant women (r = -0.33, p = 0.03). Pregnancy is associated with high plasma adenosine levels, which are further elevated in pregnant women who are overweight/obese. High PUFA intake might reduce plasma adenosine levels in non-pregnant women.
DiPietro, Janet A; Voegtline, Kristin M; Costigan, Kathleen A; Aguirre, Frank; Kivlighan, Katie; Chen, Ping
The bidirectional nature of mother-child interaction is widely acknowledged during infancy and childhood. Prevailing models during pregnancy focus on unidirectional influences exerted by the pregnant woman on the developing fetus. Prior work has indicated that the fetus also affects the pregnant woman. Our objective was to determine whether a maternal psychophysiological response to stimulation of the fetus could be isolated. Using a longitudinal design, an airborne auditory stimulus was used to elicit a fetal heart rate and motor response at 24 (n=47) and 36 weeks (n=45) of gestation. Women were blind to condition (stimulus versus sham). Maternal parameters included cardiac (heart rate) and electrodermal (skin conductance) responses. Multilevel modeling of repeated measures with 5 data points per second was used to examine fetal and maternal responses. As expected, compared to a sham condition, the stimulus generated a fetal motor response at both gestational ages, consistent with a mild fetal startle. Fetal stimulation was associated with significant, transient slowing of maternal heart rate coupled with increased skin conductance within 10s of the stimulus at both gestational ages. Nulliparous women showed greater electrodermal responsiveness. The magnitude of the fetal motor response significantly corresponded to the maternal skin conductance response at 5, 10, 15, and 30s following stimulation. Elicited fetal movement exerts an independent influence on the maternal autonomic nervous system. This finding contributes to current models of the dyadic relationship during pregnancy between fetus and pregnant woman. © 2013.
DiPietro, Janet A.; Voegtline, Kristin M.; Costigan, Kathleen A.; Aguirre, Frank; Kivlighan, Katie; Chen, Ping
Objective The bidirectional nature of mother-child interaction is widely acknowledged during infancy and childhood. Prevailing models during pregnancy focus on unidirectional influences exerted by the pregnant woman on the developing fetus. Prior work has indicated that the fetus also affects the pregnant woman. Our objective was to determine whether a maternal psychophysiological response to stimulation of the fetus could be isolated. Methods Using a longitudinal design, an airborne auditory stimulus was used to elicit a fetal heart rate and motor response at 24 (n = 47) and 36 weeks (n = 45) gestation. Women were blind to condition (stimulus versus sham). Maternal parameters included cardiac (heart rate) and electrodermal (skin conductance) responses. Multilevel modeling of repeated measures with 5 data points per second was used to examine fetal and maternal responses. Results As expected, compared to a sham condition, the stimulus generated a fetal motor response at both gestational ages, consistent with a mild fetal startle. Fetal stimulation was associated with significant, transient slowing of maternal heart rate coupled with increased skin conductance within 10 s of the stimulus at both gestational ages. Nulliparous women showed greater electrodermal responsiveness. The magnitude of the fetal motor response significantly corresponded to the maternal skin conductance response at 5, 10, 15, and 30 s following stimulation. Conclusion Elicited fetal movement exerts an independent influence on the maternal autonomic nervous system. This finding contributes to current models of the dyadic relationship during pregnancy between fetus and pregnant woman. PMID:24119937
Fan, Lin; Owusu-Edusei, Kwame; Schillie, Sarah F; Murphy, Trudy V
To describe the antiviral treatment patterns for chronic hepatitis B (CHB) among pregnant and nonpregnant women. Using 2011 MarketScan claims, we calculated the rates of antiviral treatment among women (aged 10-50 years) with CHB. We described the pattern of antiviral treatment during pregnancy and ≥1 month after delivery. We identified 6274 women with CHB during 2011. Among these, 64 of 507 (12.6%) pregnant women and 1151 of 5767 (20.0%) nonpregnant women received antiviral treatment (P < 0.01). Pregnant women were most commonly prescribed tenofovir (73.4%) and lamivudine (21.9%); nonpregnant women were most commonly prescribed tenofovir (50.2%) and entecavir (41.3%) (P < 0.01). Among 48 treated pregnant women with an identifiable delivery date, 16 (33.3%) were prescribed an antiviral before pregnancy and continued treatment for at least one month after delivery; 14 (29.2%) started treatment during the third trimester and continued at least one month after delivery. Among this insured population, pregnant women with CHB received an antiviral significantly less often than nonpregnant women. The most common antiviral prescribed for pregnant women was tenofovir. These data provide a baseline for assessing changes in treatment patterns with anticipated increased use of antivirals to prevent breakthrough perinatal hepatitis B virus infection.
Fan, Lin; Owusu-Edusei, Kwame; Schillie, Sarah F.; Murphy, Trudy V.
Objective. To describe the antiviral treatment patterns for chronic hepatitis B (CHB) among pregnant and nonpregnant women. Methods. Using 2011 MarketScan claims, we calculated the rates of antiviral treatment among women (aged 10–50 years) with CHB. We described the pattern of antiviral treatment during pregnancy and ≥1 month after delivery. Results. We identified 6274 women with CHB during 2011. Among these, 64 of 507 (12.6%) pregnant women and 1151 of 5767 (20.0%) nonpregnant women received antiviral treatment (P < 0.01). Pregnant women were most commonly prescribed tenofovir (73.4%) and lamivudine (21.9%); nonpregnant women were most commonly prescribed tenofovir (50.2%) and entecavir (41.3%) (P < 0.01). Among 48 treated pregnant women with an identifiable delivery date, 16 (33.3%) were prescribed an antiviral before pregnancy and continued treatment for at least one month after delivery; 14 (29.2%) started treatment during the third trimester and continued at least one month after delivery. Conclusion. Among this insured population, pregnant women with CHB received an antiviral significantly less often than nonpregnant women. The most common antiviral prescribed for pregnant women was tenofovir. These data provide a baseline for assessing changes in treatment patterns with anticipated increased use of antivirals to prevent breakthrough perinatal hepatitis B virus infection. PMID:25548510
Mortazavi, Forough; Akaberi, Arash
Pregnancy adds many sources of concerns to women's daily life worries. Excessive worry can affect maternal physiological and psychological state that influences the pregnancy outcomes. The aim of this study was to validate the Cambridge Worry Scale (CWS) in a sample of Iranian pregnant women. After translation of the CWS, ten experts evaluated the items and added six items to the 17-item scale. In a descriptive cross-sectional study, 405 of pregnant women booked for prenatal care completed the Farsi CWS. We split the sample randomly. Exploratory factor analysis (EFA) was conducted on the first half of the sample to disclose the factorial structure of the 23-item scale. The results of the EFA on the Farsi CWS indicated four factors altogether explained 51.5% of variances. Confirmatory factor analysis (CFA) was done on the second half of the sample. The results of the CFA showed that the model fit our data (chi-square/df = 2.02, RMSEA = 0.071, SRMR = 0.071, CFI = 0.95, and NNFI = 0.94). Cronbach's alpha coefficient for the Farsi CWS was 0.883. The Farsi CWS is a reliable and valid instrument for understanding common pregnancy worries in the third trimester of pregnancy in Iranian women.
Williams, Marissa E; Becker, Suzanna; McKinnon, Margaret C; Wong, Queenie; Cudney, Lauren E; Steiner, Meir; Frey, Benicio N
Postpartum depression (PPD) is associated with debilitating effects on mothers and their infants. A previous history of depression is considered the strongest risk factor for PPD. Depressed individuals recall more negative than positive content and higher levels of stress hormones released during encoding are associated with enhanced recall of emotional stimuli. This study examined the impact of a previous history of major depressive disorder (MDD) and pregnancy on emotional memory. Seventy-seven participants completed the study [44 pregnant women in the second trimester of pregnancy with and without a lifetime history of MDD and 33 non-pregnant women with and without a lifetime history of MDD]. All completed an encoding task and provided salivary cortisol (sCORT) and alpha-amylase (sAA) samples. Participants returned one week later for a surprise incidental recognition memory task. Women with a history of MDD had worse recognition than women without a history of MDD for negative, but not positive images; this effect was independent of sCORT and sAA levels. Pregnancy did not affect emotional memory. Considering that several previous studies found enhanced memory bias for negative content during depressive states, our results suggest that clinical remission may be associated with an opposite cognitive processing of negative emotional content. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Gupta, Lata; Dixit, R
Pregnancy is principally a phenomenon of maternal adaptation to the increasing demands of the growing foetus. Pregnancy causes many visible and invisible changes in human body and it represents one of the best example of selective adaptation in terms of respiratory physiology. To evaluate the changes in dynamic pulmonary function tests in all three trimesters of pregnancy and compare the results between normal pregnant women (case group) and normal non-pregnant women (control group) and also to compare the results of the study with other studies, 50 subjects were selected and divided into two groups, non-pregnant women (n = 20, mean age = 26.5 +/- 2.69 years) and normal pregnant women of all three trimesters (n = 30, mean age = 24.84 +/- 3.00 years). Pulmonary function tests were done by medspiror. Significant decrease in all the parameters of pulmonary function tests like forced vital capacity, forced expiratory volume in one second, peak expiratory flow rate, maximum ventilation volume, were noticed in all trimesters of normal pregnant women as compared to normal non-pregnant women. The data suggest that there is alteration in pulmonary function tests in pregnant women. Continuous Monitoring of pulmonary function tests may prove to be of great value in maternal healthcare as cases of restriction and obstruction in lungs during pregnancy can be identified early and its deterioration can be prevented by proper management.
Ebeigbe, J A; Ebeigbe, P N; Ighoroje, Ada
Pregnancy results in a lot of hormonal changes in the body and the eyes are no exception. These ocular changes could be physiologic, pathologic or a modification of a pre-existing condition. The aim of this study was to determine physiologic ocular changes that are associated with pregnancy in healthy Nigerian women. A total of 100 women were followed longitudinally through out the course of their pregnancy and 6 weeks postpartum. The women were recruited at 8 weeks of pregnancy at the anti-natal clinic in the Department of Obstetrics and Gynecology, University of Benin Teaching Hospital, Nigeria. The women were aged between 20 and 35 years. Tests carried out included visual acuity, ophthalmoscopy, retinoscopy, and tonometry. The tests were carried out in each of the three trimesters of pregnancy and 6 weeks postpartum. There was a fall in intraocular pressure across the trimesters and this was very significant (P<0.0001). Postpartum, the intraocular pressure began to rise. The difference between the third trimester and post-partum values was also statistically significant (P< 0.0001). The difference in visual acuity through out the pregnancy was not significant (P= 0.8477). Although, there was a fall in refractive error across the different trimesters, it was not statistically significant (P=0.3). There was also no difference in the third trimester and the 6 weeks postpartum values of both visual acuity and refractive error. Ocular changes associated with pregnancy are transient and most tend to resolve postpartum, with values returning to near pre-pregnant state.
Kuizon, M D; Natera, M G; Ancheta, L P; Platon, T P; Reyes, G D; Macapinlac, M P
The hemoglobin concentrations during pregnancy in Filipinos belonging to the upper income group, who were prescribed 105 mg elemental iron daily, and who had acceptable levels of transferrin saturation, were examined in an attempt to define normal levels. The hemoglobin concentrations for each trimester followed a Gaussian distribution. The hemoglobin values equal to the mean minus one standard deviation were 11.4 gm/dl for the first trimester and 10.4 gm/dl for the second and third trimesters. Using these values as the lower limits of normal, in one group of pregnant women the prevalence of anemia during the last two trimesters was found lower than that obtained when WHO levels for normal were used. Groups of women with hemoglobin of 10.4 to 10.9 gm/dl (classified anemic by WHO criteria but normal in the present study) and those with 11.0 gm/dl and above could not be distinguished on the basis of their serum ferritin levels nor on the degree of decrease in their hemoglobin concentration during pregnancy. Many subjects in both groups, however, had serum ferritin levels less than 12 ng/ml which indicate poor iron stores. It might be desirable in future studies to determine the hemoglobin cut-off point that will delineate subjects who are both non-anemic and adequate in iron stores using serum ferritin levels as criterion for the latter.
Brasil, Patrícia; Pereira, José P; Moreira, M Elisabeth; Ribeiro Nogueira, Rita M; Damasceno, Luana; Wakimoto, Mayumi; Rabello, Renata S; Valderramos, Stephanie G; Halai, Umme-Aiman; Salles, Tania S; Zin, Andrea A; Horovitz, Dafne; Daltro, Pedro; Boechat, Marcia; Raja Gabaglia, Claudia; Carvalho de Sequeira, Patrícia; Pilotto, José H; Medialdea-Carrera, Raquel; Cotrim da Cunha, Denise; Abreu de Carvalho, Liege M; Pone, Marcos; Machado Siqueira, André; Calvet, Guilherme A; Rodrigues Baião, Ana E; Neves, Elizabeth S; Nassar de Carvalho, Paulo R; Hasue, Renata H; Marschik, Peter B; Einspieler, Christa; Janzen, Carla; Cherry, James D; Bispo de Filippis, Ana M; Nielsen-Saines, Karin
Background Zika virus (ZIKV) has been linked to central nervous system malformations in fetuses. To characterize the spectrum of ZIKV disease in pregnant women and infants, we followed patients in Rio de Janeiro to describe clinical manifestations in mothers and repercussions of acute ZIKV infection in infants. Methods We enrolled pregnant women in whom a rash had developed within the previous 5 days and tested blood and urine specimens for ZIKV by reverse-transcriptase-polymerase-chain-reaction assays. We followed women prospectively to obtain data on pregnancy and infant outcomes. Results A total of 345 women were enrolled from September 2015 through May 2016; of these, 182 women (53%) tested positive for ZIKV in blood, urine, or both. The timing of acute ZIKV infection ranged from 6 to 39 weeks of gestation. Predominant maternal clinical features included a pruritic descending macular or maculopapular rash, arthralgias, conjunctival injection, and headache; 27% had fever (short-term and low-grade). By July 2016, a total of 134 ZIKV-affected pregnancies and 73 ZIKV-unaffected pregnancies had reached completion, with outcomes known for 125 ZIKV-affected and 61 ZIKV-unaffected pregnancies. Infection with chikungunya virus was identified in 42% of women without ZIKV infection versus 3% of women with ZIKV infection (P<0.001). Rates of fetal death were 7% in both groups; overall adverse outcomes were 46% among offspring of ZIKV-positive women versus 11.5% among offspring of ZIKV-negative women (P<0.001). Among 117 live infants born to 116 ZIKV-positive women, 42% were found to have grossly abnormal clinical or brain imaging findings or both, including 4 infants with microcephaly. Adverse outcomes were noted regardless of the trimester during which the women were infected with ZIKV (55% of pregnancies had adverse outcomes after maternal infection in the first trimester, 52% after infection in the second trimester, and 29% after infection in the third trimester
Brasil, P.; Pereira, J.P.; Moreira, M.E.; Nogueira, R.M. Ribeiro; Damasceno, L.; Wakimoto, M.; Rabello, R.S.; Valderramos, S.G.; Halai, U.-A.; Salles, T.S.; Zin, A.A.; Horovitz, D.; Daltro, P.; Boechat, M.; Gabaglia, C. Raja; de Sequeira, P. Carvalho; Pilotto, J.H.; Medialdea-Carrera, R.; da Cunha, D. Cotrim; de Carvalho, L.M. Abreu; Pone, M.; Siqueira, A. Machado; Calvet, G.A.; Baião, A.E. Rodrigues; Neves, E.S.; de Carvalho, P.R. Nassar; Hasue, R.H.; Marschik, P.B.; Einspieler, C.; Janzen, C.; Cherry, J.D.; de Filippis, A.M. Bispo; Nielsen-Saines, K.
BACKGROUND Zika virus (ZIKV) has been linked to central nervous system malformations in fetuses. To characterize the spectrum of ZIKV disease in pregnant women and infants, we followed patients in Rio de Janeiro to describe clinical manifestations in mothers and repercussions of acute ZIKV infection in infants. METHODS We enrolled pregnant women in whom a rash had developed within the previous 5 days and tested blood and urine specimens for ZIKV by reverse-transcriptase–polymerase-chain-reaction assays. We followed women prospectively to obtain data on pregnancy and infant outcomes. RESULTS A total of 345 women were enrolled from September 2015 through May 2016; of these, 182 women (53%) tested positive for ZIKV in blood, urine, or both. The timing of acute ZIKV infection ranged from 6 to 39 weeks of gestation. Predominant maternal clinical features included a pruritic descending macular or maculopapular rash, arthralgias, conjunctival injection, and headache; 27% had fever (short-term and low-grade). By July 2016, a total of 134 ZIKV-affected pregnancies and 73 ZIKV-unaffected pregnancies had reached completion, with outcomes known for 125 ZIKV-affected and 61 ZIKV-unaffected pregnancies. Infection with chikungunya virus was identified in 42% of women without ZIKV infection versus 3% of women with ZIKV infection (P<0.001). Rates of fetal death were 7% in both groups; overall adverse outcomes were 46% among offspring of ZIKV-positive women versus 11.5% among offspring of ZIKV-negative women (P<0.001). Among 117 live infants born to 116 ZIKV-positive women, 42% were found to have grossly abnormal clinical or brain imaging findings or both, including 4 infants with microcephaly. Adverse outcomes were noted regardless of the trimester during which the women were infected with ZIKV (55% of pregnancies had adverse outcomes after maternal infection in the first trimester, 52% after infection in the second trimester, and 29% after infection in the third trimester
Poveda, Gina Ferrer; Carrillo, Katia Sáez; Monje, Marcela Espinoza; Cruz, Carlos Alvarez; Cancino, Apolinaria García
the aim of this research was to determine the prevalence of Helicobacter pylori infection on Chilean pregnant women and its relationship with the appearance and severity of hyperemesis and dyspepsia. quantitative study of prevalence in a transversal cut with variable analysis. The sample was taken from 274 Chilean pregnant women from the Bío Bío province through vein puncture between June and December, 2005. Pregnant women were informed of this study, interviewed and signed an informed consent. The samples were processed using ImmunoComb II Helicobacter pylori IgG kit. Statistical analysis was performed by means of the Statistical Package for Social Sciences (SPSS) Program. out of the total number of pregnant women, 68.6% showed infection by Helicobacter pylori. 79.6% of the total sample had symptoms of dyspepsia, and 72.5% of this group presented Helicobacter pylori infection. 12.4% showed pregnancy hyperemesis; among them, 79.4% were infected with Helicobacter pylori. 73.4% of the pregnant women that showed gastric discomfort during the first three months had Helicobacter pylori infection. 53.7% of them continued with gastric discomfort after the first three months; of those, 95.8% were infected. Helicobacter pylori infection was present only in 1.5% of pregnant women without gastric discomfort. both, gastric discomfort of pregnant women and the continuity of severe symptoms of dyspepsia and hyperemesis after the first three months of gestation are significantly correlated with Helicobacter pylori infection.
Krubiner, Carleigh B; Faden, Ruth R; Cadigan, R Jean; Gilbert, Sappho Z; Henry, Leslie M; Little, Margaret O; Mastroianni, Anna C; Namey, Emily E; Sullivan, Kristen A; Lyerly, Anne D
Concerns about including pregnant women in research have led to a dearth of evidence to guide safe and effective treatment and prevention of HIV in pregnancy. To better understand why these evidence gaps persist and inform guidance for responsible inclusion of pregnant women in the HIV research agenda, we aimed to learn what HIV experts perceive as barriers and constraints to conducting this research. We conducted a series of group and one-on-one consultations with 62 HIV investigators and clinicians to elicit their views and experiences conducting HIV research involving pregnant women. Thematic analysis was used to identify priorities and perceived barriers to HIV research with pregnant women. Experts discussed a breadth of needed research, including safety, efficacy, and appropriate dosing of: newer antiretrovirals for pregnant women, emerging preventive strategies, and treatment for coinfections. Challenges to conducting research on pregnancy and HIV included ethical concerns, such as how to weigh risks and benefits in pregnancy; legal concerns, such as restrictive interpretations of current regulations and liability issues; financial and professional disincentives, including misaligned funder priorities and fear of reputational damage; and analytical and logistical complexities, such as challenges recruiting and retaining pregnant women to sufficiently power analyses. Investigators face numerous challenges to conducting needed HIV research with pregnant women. Advancing such research will require clearer guidance regarding ethical and legal uncertainties; incentives that encourage rather than discourage investigators to undertake such research; and a commitment to earlier development of safety and efficacy data through creative trial designs.
Gandhi, Saurabh V; Walker, Dawn; Milnes, Pete; Mukherjee, Soma; Brown, Brian H; Anumba, Dilly O C
We sought to validate and measure the electrical impedance of the uterine cervix in non-pregnant and pregnant women by spectroscopy. Cervical stromal impedance (CSI) was measured in 50 non-pregnant, 20 1st, 20 2nd and 50 3rd trimester pregnant women. The technique was also validated by comparing in vivo data to a finite element (FE) model of cervical tissue. CSI agreed well with the FE model and was highly reproducible in all study groups. Mean (S.E.) CSI at 4-819 kHz was higher in pregnant (2.78 +/- 0.09 Omega m) compared to non-pregnant (2.38 +/- 0.07, p < 0.01) women, and in the 3rd trimester (3.08 +/- 0.13) compared to non-pregnant (p < 0.01), 1st trimester (2.42 +/- 0.12, p < 0.001) and 2nd trimester (2.20 +/- 0.05, p < 0.001) pregnant women. Measurement of CSI provides a non-invasive method of assessing cervical tissue characteristics. Cervical extracellular matrix synthesis and leukocyte infiltration may account for the increased tissue impedance noted in the 3rd trimester.
Polat, Mehtap; Biberoğlu, Ebru Hacer; Güler, İsmail; Biberoğlu, Ömer Kutay
To examine the relationship of inherited thrombophilia and other thrombotic risk factors with preeclampsia (PE) in a population of pregnant Turkish women. This was a case cross-sectional study in which 70 women with PE and 60 normal pregnant women were studied to find out the frequency of women with risk factors including inherited thrombophilia among preeclamptic cases. Hemoglobin, platelet count, uric acid, vitamin B12, folic acid, copper, homocysteine, plasminogen activator inhibitor-1, fibrinogen, protein S, protein C, activated protein C resistance values show significant differences in women with PE in comparison to women with normal pregnancy. There may be a link between inherited thrombophilia and PE, at least in a sample of Turkish pregnant women. We also propose that the association between thrombophilia and PE is stronger than suggested previously. Furthermore, copper is selectively elevated in women with PE as an independent marker.
Silveira, Marushka Leanne; Pekow, Penelope S.; Dole, Nancy; Markenson, Glenn; Chasan-Taber, Lisa
Objectives Prenatal psychosocial stress has been associated with adverse pregnancy outcomes, even after controlling for known risk factors. This paper aims to evaluate correlates of high perceived stress among Hispanic women, a group with elevated rates of stress during pregnancy. Methods We conducted this analysis among 1426 pregnant Hispanic women using data from Proyecto Buena Salud, a prospective cohort study conducted in Western Massachusetts. Cohen’s Perceived Stress Scale (PSS-14) validated in English and Spanish was administered in early (mean=12.4 wks gestation), mid (mean=21.3 wks gestation) and late (mean=30.8 wks gestation) pregnancy at which time bilingual interviewers collected data on socio-demographic, acculturation, behavioral, and psychosocial factors. High perceived stress was defined as a PSS score>30. Results Young maternal age (odds ratio (OR) =0.6; 95% confidence interval (CI) 0.4-0.9 for <19 vs. 19-23yrs), pre-pregnancy consumption of alcohol (OR=2.2; 95% CI 1.4-3.5 for >12 drinks/mo. vs. none) and smoking (OR=2.2; 95% CI 1.3-3.7 for >10 cigarettes/day vs. none) were associated with high perceived stress during early pregnancy. Furthermore, higher annual household income (OR=0.4; 95% CI 0.1-0.9 for >$30,000 vs. <$15,000), greater number of adults in the household (OR=1.8; 95% CI 1.1-3.0 for ≥3 vs. 1) and language preference (OR=0.6; 95% CI 0.4-0.9 for Spanish vs. English) were associated with high stress during mid-pregnancy. Likewise, annual household income was inversely associated with high stress during late pregnancy. Conclusion Our results have important implications for incorporation of routine screening for psychosocial stress during prenatal visits and implementation of psychosocial counseling services for women at high risk. PMID:23010861
McCabe, Jennifer E; Arndt, Stephan
The objective of this study was to identify demographic and substance abuse trends among pregnant women entering treatment over eleven years. This study compiled the publicly available Treatment Episode Datasets from the Substance Abuse Mental Health Services Administration from 1998 to 2008. Subjects included 1,724,479 women entering publicly funded substance abuse treatment for the first time, 81,818 of whom were pregnant. Compared to non-pregnant women, pregnant women were more likely to be younger, minority, never married, less educated, homeless, and on public-assistance or have no income. Referrals from health care providers (HCPs) among pregnant women entering treatment have stayed consistently low while referrals from the criminal justice system accounted for the largest portion of pregnant women entering treatment. Over the past eleven years, there has been a general decline in alcohol abuse and an increase in drug abuse among women entering treatment; this trend was more pronounced in pregnant women. Unlike their non-pregnant counterparts, pregnant women were more likely to report marijuana, not alcohol, as their primary problem substance as well as other drugs like methamphetamine and cocaine. Over the past eleven years, trends in the demographics and patterns of substance abuse among women have changed; some of these trends were unique to pregnant women. A large proportion of pregnant women entering treatment are referred by the criminal justice system. Knowledge surrounding the demographics and abuse patterns of pregnant women entering treatment can inform HCPs and community programs in their screening and outreach efforts.
Background Occurrence of birth defects (BD) remains an important public health issue. Inadequate knowledge about the defects among prospective mothers could result in delayed interventions. The study determined the knowledge of BD among pregnant women in relation to their socio-demographic profile. Method Four hundred and forty-three (443) pregnant women gave their consent to participate in this study. A researcher-administered questionnaire was used to obtain information on socio-demographic characteristics from the participants and their knowledge about BD. The questionnaire was assessed for test re-test reliability before been administered. The possible scores on the knowledge domain of the questionnaire were categorized into three levels: low knowledge (0–4), moderate knowledge (5–8) and high knowledge (9–12) levels. Data were analyzed using percentages while Spearman’s rank correlation was used to determine the relationship between the knowledge of BD among the participants and their socio-demographic profile. Alpha level was set at p < 0.05. Results A greater proportion of the participants, 235(53.0%) were found in the age range 21 to 30 years, and 234(52.8%) attained secondary level of education. Majority of the participants, 205(46.3%) had high knowledge on the risk factors while 213(48.1%) and 224(50.6%) had moderate overall knowledge and specific knowledge about BD respectively. Most of the participants (48.1%) believed that BD were of supernatural origin. The age, level of education, number of antenatal visits and parity of the participants were not significantly correlated (p > 0.05) with their specific and overall knowledge. Conclusions Particpants generally had moderate knowledge about BD. However, this had no bearing on their socio-demographic profile. The knowledge base about BD seems to be influenced by traditional belief of the participants. This finding should therefore serve as a guide for health care providers while planning
Sato, Mari; Nakamura, Yasuka; Atogami, Fumi; Horiguchi, Ribeka; Tamaki, Raita; Yoshizawa, Toyoko; Oshitani, Hitoshi
Introduction: Pregnant and postpartum women are especially vulnerable to natural disasters. These women suffer from increased risk of physical and mental issues including pregnant related problems. Typhoon Haiyan (Yolanda), which hit the Philippines affected a large number of people and caused devastating damages. During and after the typhoon, pregnant women were forced to live in particularly difficult circumstances. The purpose of this study was to determine concerns and problems regarding public health needs and coping mechanisms among pregnant women during and shortly after the typhoon. Methods: This study employed a cross-sectional design utilizing focus group discussions (FGDs). Participants were 53 women (mean age: 26.6 years old; 42 had children) from four affected communities who were pregnant at the time of the typhoon. FGDs were conducted 4 months after the typhoon, from March 19 to 28, 2014, using semi-structured interviews. Data were analyzed using the qualitative content analysis. Result: Three themes were identified regarding problems and concerns during and after the typhoon: 1) having no ideas what is going to happen during the evacuation, 2) lacking essentials to survive, and 3) being unsure of how to deal with health concerns. Two themes were identified as means of solving issues: 1) finding food for survival and 2) avoiding diseases to save my family. As the pregnant women already had several typhoon experiences without any major problems, they underestimated the catastrophic nature of this typhoon. During the typhoon, the women could not ensure their safety and did not have a strong sense of crisis management. They suffered from hunger, food shortage, and poor sanitation. Moreover, though the women had fear and anxiety regarding their pregnancy, they had no way to resolve these concerns. Pregnant women and their families also suffered from common health problems for which they would usually seek medical services. Under such conditions, the
Sato, Mari; Nakamura, Yasuka; Atogami, Fumi; Horiguchi, Ribeka; Tamaki, Raita; Yoshizawa, Toyoko; Oshitani, Hitoshi
Pregnant and postpartum women are especially vulnerable to natural disasters. These women suffer from increased risk of physical and mental issues including pregnant related problems. Typhoon Haiyan (Yolanda), which hit the Philippines affected a large number of people and caused devastating damages. During and after the typhoon, pregnant women were forced to live in particularly difficult circumstances. The purpose of this study was to determine concerns and problems regarding public health needs and coping mechanisms among pregnant women during and shortly after the typhoon. This study employed a cross-sectional design utilizing focus group discussions (FGDs). Participants were 53 women (mean age: 26.6 years old; 42 had children) from four affected communities who were pregnant at the time of the typhoon. FGDs were conducted 4 months after the typhoon, from March 19 to 28, 2014, using semi-structured interviews. Data were analyzed using the qualitative content analysis. Three themes were identified regarding problems and concerns during and after the typhoon: 1) having no ideas what is going to happen during the evacuation, 2) lacking essentials to survive, and 3) being unsure of how to deal with health concerns. Two themes were identified as means of solving issues: 1) finding food for survival and 2) avoiding diseases to save my family. As the pregnant women already had several typhoon experiences without any major problems, they underestimated the catastrophic nature of this typhoon. During the typhoon, the women could not ensure their safety and did not have a strong sense of crisis management. They suffered from hunger, food shortage, and poor sanitation. Moreover, though the women had fear and anxiety regarding their pregnancy, they had no way to resolve these concerns. Pregnant women and their families also suffered from common health problems for which they would usually seek medical services. Under such conditions, the pregnant woman cooperated with
A new study called "Poor, propertyless, and pregnant" that classified the condition of women in 99 countries found women in Sweden, Finland, and the US to enjoy the best legal and social conditions and the greatest degree of equality with men. The worst discrimination against women occurred in Bangladesh, Mali, Afghanistan, North Yemen, Pakistan, Nigeria, and Saudi Arabia. Women do not have complete equality with men in any country. But over 60% of the world's female population lives in countries where extensive poverty and sexual discrimination have created conditions of deprivation. One of the principal mechanisms that negatively influences the condition of women is early procreation; early and frequent childbirth obliterates women's chances for education and paid employment. Feminization of poverty is becoming universal, largely because a growing proportion of households are headed by women with dependent children. In developed and developing countries alike, working women with families work a double day. Although the struggle for legal and social equality for women takes different forms in different countries, certain basic measures can be applied by all governments. Reforms are needed to give women access to more remunerative jobs, equal property rights, and access to credit. Greater investments are needed in reproductive health and in education and training for women. Governments, employers, and husbands should recognize the social value of childbirth and child rearing. The study is divided into 5 sections, each of which has 4 series of data, so that each country is evaluated on 20 variables. The 5 sections are health, nuptiality and children, education, economic participation, and social equality. In most developed countries women live an average of 7 years longer than men, but in developing countries the difference is only 2 years. Complications of pregnancy and childbirth cause the deaths of over 500,000 women each year and affect another 5 million, mostly
Anisimova, E N; Axamit, L A; Manukhina, E I; Letunova, N Yu; Golikova, A M; Fedotova, T M
The aim of the study was to evaluate the algorithm of safe emergency dental care in pregnant patients. Eighty-five pregnant women aged 20-35 were included in the study. The paper presents elaborated state-of-the-art guidelines for emergency dental care in pregnant patients. Articaine 4% with epinephrine 1:200,000 is recommended as a choice agent for local anesthesia in these patients.
Hinwood, A.L.; Callan, A.C.; Ramalingam, M.; Boyce, M.; Heyworth, J.; McCafferty, P.; Odland, J.Ø.
Recent literature suggests that exposure to low concentrations of heavy metals may affect both maternal and child health. This study aimed to determine the biological heavy metals concentrations of pregnant women as well as environmental and dietary factors that may influence exposure concentrations. One hundred and seventy three pregnant women were recruited from Western Australia, each providing a sample of blood, first morning void urine, residential soil, dust and drinking water samples. Participants also completed a questionnaire which included a food frequency component. All biological and environmental samples were analysed for heavy metals using ICP-MS. Biological and environmental concentrations of lead and mercury were generally low (Median Pb Drinking Water (DW) 0.04 µg/L; Pb soil <3.0 µg/g; Pb dust 16.5 µg/g; Pb blood 3.67 µg/L; Pb urine 0.55; µg/L Hg DW <0.03; Hg soil <1.0 µg/g; Hg dust <1.0 µg/g; Hg blood 0.46 µg/L; Hg urine <0.40 µg/L). Cadmium concentrations were low in environmental samples (Median CdDW 0.02 µg/L; Cdsoil <0.30 ug/g; Cddust <0.30) but elevated in urine samples (Median 0.55 µg/L, creatinine corrected 0.70 µg/g (range <0.2–7.06 µg/g creatinine) compared with other studies of pregnant women. Predictors of increased biological metals concentrations in regression models for blood cadmium were residing in the Great Southern region of Western Australia and not using iron/folic acid supplements and for urinary cadmium was having lower household annual income. However, these factors explained little of the variation in respective biological metals concentrations. The importance of establishing factors that influence low human exposure concentrations is becoming critical in efforts to reduce exposures and hence the potential for adverse health effects. -- Highlights: • Biological heavy metals concentrations in women in their 3rd trimester of pregnancy. • Exposure assessment including environmental, lifestyle and activity
Sousa, Jayra Adrianna da Silva; Corrêa, Rita da Graça Carvalhal Frazão; Aquino, Dorlene Maria Cardoso de; Coutinho, Nair Portela Silva; Silva, Marcos Antonio Custódio Neto da; Nascimento, Maria do Desterro Soares Brandão
Toxoplasmosis is an infection that affects almost a third of the world population. In adults, it is often asymptomatic, although having important manifestation in children- infected by placental transmission. The prenatal is an important moment, requiring actions in women's care during pregnancy, in order to prevent diseases that could compromise the mother and the child's life. This is a descriptive study of qualitative approach aimed to understand the perception of nurses and pregnant women about toxoplasmosis during primary - prenatal care. The study was conducted in five selected primary health care units, in the municipality of São Luis - MA. The sample consisted of 15 nurses working in nursing consultation and 15 pregnant women attended in prenatal care. For data collection, a semi-structured questionnaire and an interview guide covering issues related to knowledge and conduct on toxoplasmosis were used. For analysis, the content analysis technique was used. The answers were transcribed, organized and grouped thematically, where the following categories emerged: knowledge about examination requests; knowledge about toxoplasmosis; guidance during prenatal consultation; knowledge of nurses about the avidity test; procedures and guidelines on reagent cases. Pregnant women showed unawareness about toxoplasmosis and its effects. Nurses, although having basic knowledge about the subject, showed little applicability regarding pregnant women's guidance. The nurse plays an important role in educational activities regarding pregnant women, contributing to the quality of prenatal care. Pregnant women were shown to have some knowledge about toxoplasmosis, although they said they did not have assurance about prevention.
McNeil, Daniel W; Hayes, Sarah E; Randall, Cameron L; Polk, Deborah E; Neiswanger, Kathy; Shaffer, John R; Weyant, Robert J; Foxman, Betsy; Kao, Elizabeth; Crout, Richard J; Chapman, Stella; Brown, Linda J; Maurer, Jennifer L; Marazita, Mary L
Both oral health problems and depression among pregnant women contribute to maternal-infant health outcomes. Little is known, however, about the potential effects of clinically significant depression on the oral health status of pregnant women. The purpose of the present study was to determine the influence of clinically significant depression and rural- or urban-dwelling status on oral health outcomes among pregnant women. Pregnant women (N = 685) in rural (i.e., West Virginia) and urban (i.e., Pittsburgh, PA) areas of northern Appalachia were assessed by calibrated examiners regarding gingivitis, oral hygiene, and DMFT (decayed, missing, and filled teeth), completed the Center for Epidemiologic Studies-Depression Scale (CES-D) and provided demographics. Participants were categorized based on clinically significant depressive symptoms (CES-D ≥ 16) and rural/urban domicile. Women with depression and those living in rural areas had worse oral health on all three indices than their non-depressed and urban counterparts. Depression, particularly among women in rural areas, affects certain oral health indices and represents a modifiable target for intervention. Moreover, treatments designed specifically for rural populations may be of particular utility. Women who are pregnant or planning to become pregnant may benefit from regular depression screenings from their dental and medical health care providers.
Kerker, Bonnie D.; Horwitz, Sarah M.; Leventhal, John M.
Objective: This study's aim was to determine how patients' and providers' characteristics affect hospital providers' decisions to screen pregnant and postpartum women for illicit substances. Methods: A retrospective design was used. Participants included all low-income women (N=1,100) who delivered at an urban teaching hospital over a 12-month…
Kerker, Bonnie D.; Horwitz, Sarah M.; Leventhal, John M.
Objective: This study's aim was to determine how patients' and providers' characteristics affect hospital providers' decisions to screen pregnant and postpartum women for illicit substances. Methods: A retrospective design was used. Participants included all low-income women (N=1,100) who delivered at an urban teaching hospital over a 12-month…
Gao, Ling-Ling; Liu, Xiao Jun; Fu, Bai Ling; Xie, Wen
to examine childbirth fear and identify its predictors among pregnant Chinese women. a cross-sectional descriptive questionnaire survey was conducted in a regional teaching hospital in Guangzhou, China, between October and November 2013. 353 pregnant Chinese women who were at least 18 years old, with a singleton fetus, in the third trimester of pregnancy, not at high risk for complications of pregnancy, and not having had a previous caesarean section. a social-demographic data sheet; the Chinese version of the Childbirth Attitude Questionnaire and the Spielberger׳s State-Trait Anxiety Inventory; and the short form of 32-item Chinese Childbirth Self-Efficacy Inventory. the pregnant Chinese women reported moderate levels of childbirth fear. The pregnant Chinese women who were younger, with lower educational level, not satisfied with their husbands׳ support, and with previous experience of miscarriage reported higher level of childbirth fear. Pregnant women׳s childbirth self-efficacy, state anxiety and trait anxiety were correlated with childbirth fear. The best-fit regression analysis revealed four variables that explained 28% of variance in childbirth fear: trait anxiety, state anxiety, age and previous experience of miscarriage. this study highlighted the connection between childbirth fear, state and trait anxiety, childbirth self-efficacy, age, education and previous miscarriage among pregnant Chinese women. the CAQ was an appropriate method to measure childbirth fear in pregnant Chinese women. The health-care professionals should be sensitive toward issues that could affect levels of childbirth fear in pregnant Chinese women, including age, education and previous miscarriage. Copyright © 2015 Elsevier Ltd. All rights reserved.
Chiga, Sakura; Ohba, Takashi; Miyoshi, Junya; Tanoue, Daisuke; Kawase, Hiromi; Katoh, Takahiko; Katabuchi, Hidetaka
As part of Kumamoto RAINBOW Project, which is a multifaceted implementation for the prevention of premature labor, we investigated pregnant women's oral health status and assessed the effects of dental care and oral hygiene instruction. We examined the oral health status of pregnant women both in the first and the second half of pregnancy in Kumamoto Prefecture from 2012 to 2014. The Community Periodontal Index (CPI) was used to assess the periodontal condition, and women having periodontal pockets with a depth ≥4 mm were defined as suffering from periodontitis. This project covered the cost of dental checkups. Of the 20,702 pregnant women enrolled in this project, 9,527 (46.0%) received dental checkups during the first half of pregnancy. The response rate of dental examinations in Kumamoto City (63.3%), the capital city of Kumamoto Prefecture, was significantly higher than that of the other local areas (32.0%). In Kumamoto City, 4,890 women (83.4%) had dental examinations at the city office when they received a maternal handbook. Three thousand forty-five women (32.0%) had periodontitis. Among 1,605 women who received oral examinations twice at dental clinics, 698 received nonsurgical interventions. Dental interventions significantly decreased the prevalence of periodontitis in pregnant women (55.1% to 45.1%). Dental examinations without interventions also significantly decreased the prevalence of periodontitis (44.6% to 39.9%). Pregnant women living in Kumamoto City had higher rate of visits to dental clinics for checkups than those in other areas. Periodontitis was found in one-third of pregnant women. Not only dental interventions, but also dental examinations improve pregnant women's oral health status.
Bojar, Iwona; Owoc, Alfred; Humeniuk, Ewa; Fronczak, Adam; Walecka, Irena
The objective was to assess the quality of pregnant women's diet in Poland concerning macro-elements and to analyze reasons for low or high quality diets. Five hundred and twelve pregnant women in their 20(th) to 30(th) week of pregnancy took part in the research conducted by means of a 7-day observation of diet. Consumed products were analyzed by means of DIETETYK software developed by the Polish National Food and Nutrition Institute. Obtained macro values were averaged. The results were compared with the recommendations from the World Health Organization, European Union and Polish National Food and Nutrition Institute and analyzed statistically (χ(2) test). The pregnant women consumed an average of 1898 ±380 kcal daily. Average value of macro components supplied with the diet did not deviate from EU and NFNI nutrition recommendations: protein - 72.1 g/person daily, fats overall - 72.8 g, polyunsaturated fatty acids - 10.93 g, cholesterol - 283 mg, carbohydrates - 257 g. The study proved a significant relation between a higher quality diet of pregnant women and tertiary or secondary education (p = 0.05) as well as urban residence (p = 0.01). Pregnant women's diet in Poland is not significantly different from diet quality of pregnant women from other countries. A lower quality diet was observed among women who smoked during pregnancy and lived in rural areas.
Csutak, Adrienne; Steiber, Zita; Tőzsér, József; Jakab, Attila; Berta, András; Silver, David M
Plasminogen activator activity (PAA) in tears of pregnant women was investigated at various gestation times to assess the availability of plasminogen activator for aiding potential corneal wound healing processes during pregnancy. PAA was measured by a spectrophotometric method. The analysis used 91 tear samples from pregnant and non-pregnant women, supplemented with 10 additional tear PAA measurements from non-pregnant women obtained in a previous study. Tear levels of PAA in pregnant women formed a bimodal distribution. Either the tear PAA level was zero or non-zero during pregnancy. When non-zero, the tear PAA level was dissociated from gestation time and not different than non-pregnant and post-pregnant levels. The frequency of occurrence of zero level tear PAA increased with gestation: 16%, 17% and 46% had zero tear PAA in samples taken from women in the first, second and third trimester, respectively. Overall, of the tear samples taken from women during pregnancy, a total of 26% were at zero tear PAA. The remaining tear samples had non-zero tear PAA values throughout gestation equivalent to non-pregnant tear PAA values, suggesting local control of the source of PAA in tears. Given the importance of the plasminogen activator system in tears to wound healing in the cornea, and the high occurrence of zero tear PAA in our sample of pregnant women, elective corneal surgery would be contraindicated. If corneal surgery is nevertheless necessary, the tear PAA level would be worth checking and patients with low level should be closely observed during the postoperative period.
Bourjeily, Ghada; Sharkey, Katherine M; Mazer, Jeffrey; Moore, Robin; Martin, Susan; Millman, Richard
Physiologic changes in the cardiac, respiratory, and renal systems in pregnancy likely impact ventilatory control. Though obstructive sleep apnea and snoring are common in the pregnant population, the predisposition to central respiratory events during sleep and the prevalence of such events is less well studied. The aim of this study was to assess the presence of central apneas during sleep in pregnant women and non-pregnant controls suspected of sleep disordered breathing. Twenty-five pregnant women referred for polysomnography for sleep disordered breathing were compared with non-pregnant controls matched for age, body mass index, gender, and apnea hypopnea index (AHI). Central apnea index was defined as the number of central apneas per hour of sleep, and mixed apnea index was defined as the number of mixed apneas per hour of sleep. Sixty-four percent of pregnant women had a respiratory disturbance index >5 events per hour of sleep. Mean body mass index was 44.1 ± 6.9 kg/m(2) pregnant compared to 44.0 ± 7.3 kg/m(2) in controls. The total number of central apneas observed during sleep in the pregnant group consisted of two central apneas in one patient, and of 98 central apneas in 11 patients in the control group (p = 0.05). Median central apnea index was low in both groups (pregnant 0, interquartile range (IQR) 0, 0 vs. non-pregnant 0, IQR 0, 0.2, p = 0.04). Mixed apnea index was similarly low in both groups. Despite some physiologic changes of pregnancy that impact ventilatory control, the prevalence of central sleep apnea was low in our sample of overweight pregnant women with sleep-disordered breathing.
Giurgescu, Carmen; Zenk, Shannon N; Engeland, Christopher G; Garfield, Lindsey; Templin, Thomas N
African American women are more likely to be exposed to racial discrimination and to experience psychological distress compared with white women. Although studies have shown that social support is positively related to psychological wellbeing, little is known about the potential buffering effect of social support on the relationship between racial discrimination and psychological wellbeing of pregnant women. The purpose of this study was to determine if social support moderates effects of racial discrimination on psychological wellbeing among pregnant African American women. Using a cross-sectional design, 107 African American women between 15 and 26 weeks gestation from an urban university-based midwifery practice completed questionnaires. Women who reported more experiences of racial discrimination also reported lower levels of social support and psychological wellbeing (p <.05). Maternal child nurses should be aware that experiences of racial discrimination have negative effects on psychological wellbeing of pregnant African American women regardless of their levels of social support. However, social support can reduce psychological distress and improve wellbeing of pregnant women. Therefore, nurses need to provide pregnant women with positive and supportive experiences that may improve their psychological wellbeing.
... gov/news/fullstory_162543.html FDA Issues Anesthesia Warning for Pregnant Women, Kids Under 3 A long ... latest published studies, the agency announced that these warnings need to be added to the labels of ...
... news/fullstory_162573.html Pregnant Women Should Avoid Zika-Hit Texas Town: CDC Advisory follows reports of ... border with Mexico, because five cases of local Zika infection have been reported there, U.S. health officials ...
Rakchanok, Noochpoung; Amporn, Dejpitak; Yoshida, Yoshitoku; Harun-Or-Rashid, Md; Sakamoto, Junichi
The aims of this study were to identify dental caries and gingivitis among pregnant women, and to compare it with those in non-pregnant women in Chiang Mai, Thailand. Data were collected from 197 women (94 pregnant and 103 non-pregnant) from June to August, 2008. Dental caries and gingivitis was defined clinically according to the World Health Organization (WHO) diagnostic criteria. Over 74.0% of pregnant women had caries, and 86.2% had gingivitis. There were significant differences between pregnant and non-pregnant women with regard to dental caries (p < 0.001) and gingivitis (p = 0.021). The pregnant women were 2.9 times more likely to suffer from dental caries (95% confidence intervals (CI), 1.6-5.4), and 2.2 times more (95% CI, 1.1-4.7) from gingivitis compared to non-pregnant women. Farmers (Odd ratio (OR), 7.0; 95% CI, 1.8-26.3), high school graduation (OR, 3.0; 95% CI, 1.2-7.3), and universal health insurance coverage (OR, 2.1; 95% CI, 1.0-4.3) were significant predictors for gingivitis. Only high school graduates were found to be significant predictors of dental caries with an OR of 2.8 (95% CI, 1.2-6.3). Poor oral hygiene (OR, 2.2; 95% CI, 0.8-6.5), lack of knowledge (OR, 2.0; 95% CI, 0.6-6.3), and poor oral hygiene habits (OR, 3.0; 95% CI, 1.1-8.6) were important risk factors for dental caries. Similarly, inadequate oral hygiene status (OR, 24.8; 95% CI, 5.5-112.2), and poor oral health habits (OR, 5.2; 95% CI, 1.1-25.2) were found to be significant risk factors for gingivitis among pregnant women indicating, that most women should be trained in proper oral hygiene practices. Community awareness programs should be conducted to increase women's awareness of such hygienic practices.
... 45 Public Welfare 1 2010-10-01 2010-10-01 false Research involving pregnant women or fetuses. 46... PROTECTION OF HUMAN SUBJECTS Additional Protections for Pregnant Women, Human Fetuses and Neonates Involved in Research § 46.204 Research involving pregnant women or fetuses. Pregnant women or fetuses may be...
Liu, Ru; Kuang, Guo-Ping; Luo, Di-Xian; Lu, Xiao-He
AIM To investigate choroidal thickness in pregnant women and compare the measurements with those of normal nonpregnant women. METHODS Using enhanced depth imaging optical coherence tomography (EDI-OCT), choroidal thickness was measured at the fovea and at 1 mm and 3 mm superior, inferior, temporal, and nasal to the fovea in both healthy pregnant women and nonpregnant women. Pearson correlation analysis was performed to evaluate the relationships between subfoveal choroidal thickness (SFCT) and the demographic and ocular parameters. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using fixed-effects model when Meta-analyses were conducted. RESULTS Comparison of choroidal thickness between the groups showed that it was significantly greater in healthy pregnant women's eyes than in normal nonpregnant women's eyes at all locations except at 3 mm superior and 3 mm temporal from the fovea (P<0.05). The mean SFCT was 344.13±50.94 µm in healthy pregnant women's eyes and 315.03±60.57 µm in normal nonpregnant women's eyes, with a statistically significant difference (P=0.008). Pearson correlation analysis showed that age and axial length were significantly related to SFCT in healthy pregnant women, normal nonpregnant women, and all subjects. The results of our cross-sectional study were consistent with the results of the further Meta-analysis, with a pooled weighted mean difference (WMD) of 33.66 µm (95% CI: 26.16 to 41.15) for SFCT. CONCLUSION Our results, along with the comprehensive Meta-analysis, suggest that choroidal thickness in healthy pregnant women is greater than that in normal nonpregnant women. PMID:27588276
Wiley, Kerrie E; Cooper, Spring C; Wood, Nicholas; Leask, Julie
Internationally, pregnant and postpartum women have been the focus of influenza and pertussis immunization campaigns, with differing levels of vaccine acceptance. We used semistructured interviews to explore pregnant women's perspectives on influenza vaccination during pregnancy and postpartum pertussis vaccination. Many women saw pregnancy as a busy time filled with advice on what they "should" and "should not" do to ensure the health of their fetus, and vaccinating themselves was regarded as just one of these tasks needing consideration. Women were more concerned about potential risks to their infants' health before their own. They saw influenza as a disease affecting the mother, whereas they viewed pertussis as a threat to the baby and therefore comparatively more risky. They were thus more likely to intend to vaccinate against pertussis to protect their infant. Framing of vaccination information toward protection of the baby might help increase vaccine uptake among pregnant women.
George, R B; Munro, A; Abdo, I; McKeen, D M; Lehmann, C
The microcirculation is responsible for distribution of blood within tissues, delivery of oxygen and other nutrients, and regulation of blood pressure. The objective of this study was to compare the sublingual microcirculation of pregnant participants to that of comparable non-pregnant volunteers. Two groups of participants were recruited: a group of pregnant, non-laboring women with singleton pregnancies at term gestation and a control group of age-comparable non-pregnant volunteers. A sidestream dark field imaging device was applied to the sublingual mucosal surface obtaining a steady image for at least 20 s duration, in five visual fields. The resultant five video clips per participant were analyzed blindly and at random to prevent coupling between images. The mean microvascular flow index values for each group were compared using a paired t-test. Thirty-seven participants were recruited (19 pregnant, 18 non-pregnant); a single pregnant participant was withdrawn because of technical issues. Baseline characteristics were similar with the exception of weight and body mass index. The mean microvascular flow index was significantly higher in the pregnant group 2.7 ± 0.2 compared to the non-pregnant group 2.5 ± 0.3 (P = 0.021), while the perfused vessel density and proportion of perfused vessels were not significantly different (P = 0.707 and 0.403, respectively). The microvascular flow index of pregnant women is higher than a comparable non-pregnant group, which appears to correlate with the physiological changes of pregnancy. Copyright © 2013 Elsevier Ltd. All rights reserved.
Charkoudian, Nisha; Usselman, Charlotte W; Skow, Rachel J; Staab, Jeffery S; Julian, Colleen Glyde; Stickland, Michael K; Chari, Radha S; Khurana, Rshmi; Davidge, Sandra T; Davenport, Margie H; Steinback, Craig D
Healthy, normotensive human pregnancies are associated with striking increases in both plasma volume and vascular sympathetic nerve activity (SNA). In non-pregnant humans, volume regulatory factors including plasma osmolality, vasopressin and the renin-angiotensin-aldosterone system have important modulatory effects on control of sympathetic outflow. We hypothesized that pregnancy would be associated with changes in the relationships between SNA (measured as muscle SNA) and volume regulating factors, including plasma osmolality, plasma renin activity and arginine vasopressin (AVP). We studied 46 healthy, normotensive young women (23 pregnant and 23 non-pregnant). We measured SNA, arterial pressure, plasma osmolality, plasma renin activity, AVP and other volume regulatory factors in resting, semi-recumbent posture. Pregnant women had significantly higher resting SNA (38 ± 12 vs. non-pregnant: 23 ± 6 bursts/minute), lower osmolality and higher plasma renin activity and aldosterone (all P < 0.05). Group mean values for AVP were not different between groups (4.64 ± 2.57 [non-pregnant] vs. 5.17 ± 2.03 [pregnant], P > 0.05). However, regression analysis detected a significant relationship between individual values for SNA and AVP in pregnant (r = 0.71, P < 0.05) but not non-pregnant women (r = 0.04). No relationships were found for other variables. These data suggest that the link between AVP release and resting SNA becomes stronger in pregnancy, which may contribute importantly to blood pressure regulation in healthy women during pregnancy. Copyright © 2017, American Journal of Physiology-Heart and Circulatory Physiology.
Nien, Jyh Kae; Mazaki-Tovi, Shali; Romero, Roberto; Erez, Offer; Kusanovic, Juan Pedro; Gotsch, Francesca; Pineles, Beth L.; Gomez, Ricardo; Edwin, Samuel; Mazor, Moshe; Espinoza, Jimmy; Yoon, Bo Hyun; Hassan, Sonia S.
Aims Adiponectin is an adipokine that has anti-diabetic, anti-atherogenic, anti-inflammatory and angiogenic properties. This hormone has been implicated in both the physiological adaptation to normal pregnancy and obstetrical complications. The aims of this study were to determine normal maternal plasma concentrations of adiponectin throughout gestation and to explore the relationships between plasma adiponectin concentration, pregnancy, and maternal overweight. Study design A cross-sectional study was designed to include normal pregnant women (normal weight and overweight; 11–42 weeks of gestation), and non-pregnant women. Plasma adiponectin concentration was determined by immunoassay. Non-parametric statistics were used for analysis. Results (1) Adiponectin was detectable in the plasma of all patients; (2) there was no significant difference in the median adiponectin concentrations between pregnant and non-pregnant women; (3) plasma adiponectin concentrations were negatively correlated with gestational age only among normal weight pregnant women; and (4) overweight patients had significantly lower adiponectin concentrations than normal weight women. Conclusion Consistent with the increased insulin resistance and weight gain that occur in pregnancy, adiponectin concentrations were negatively correlated with gestational age. The results of this study and the nomogram herein presented can serve as the basis to explore the relationship between adiponectin and pregnancy complications and facilitate the clinical use of this important adipokine. Condensation Plasma adiponectin concentrations decrease with advancing gestational age only in nonobese women. PMID:17919116
Passey, Megan E; Sanson-Fisher, Rob W; Stirling, Janelle M
To assess support for 12 potential smoking cessation strategies among pregnant Australian Indigenous women and their antenatal care providers. Cross-sectional surveys of staff and women in antenatal services providing care for Indigenous women in the Northern Territory and New South Wales, Australia. Respondents were asked to indicate the extent to which each of a list of possible strategies would be helpful in supporting pregnant Indigenous women to quit smoking. Current smokers (n = 121) were less positive about the potential effectiveness of most of the 12 strategies than the providers (n = 127). For example, family support was considered helpful by 64 % of smokers and 91 % of providers; between 56 and 62 % of smokers considered advice and support from midwives, doctors or Aboriginal Health Workers likely to be helpful, compared to 85-90 % of providers. Rewards for quitting were considered helpful by 63 % of smokers and 56 % of providers, with smokers rating them more highly and providers rating them lower, than most other strategies. Quitline was least popular for both. This study is the first to explore views of pregnant Australian Indigenous women and their antenatal care providers on strategies to support smoking cessation. It has identified strategies which are acceptable to both providers and Indigenous women, and therefore have potential for implementation in routine care. Further research to explore their feasibility in real world settings, uptake by pregnant women and actual impact on smoking outcomes is urgently needed given the high prevalence of smoking among pregnant Indigenous women.
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Doubova Dubova, Svetlana Vladislavovna; Pámanes-González, Verónica; Billings, Deborah L; Torres-Arreola, Laura del Pilar
To assess factors related to partner violence against pregnant women. Data were collected from 383 pregnant women eligible attending five family medicine units of the Mexican institute of social security in Mexico City, Mexico, between September 2003 and August 2004. Data collection was carried out using a questionnaire developed for the study. Of all women interviewed, 120 (31.1%) reported that they had been exposed to psychological and/or physical and/or sexual violence perpetrated by their partners during the current pregnancy; 10% reported combined violence and 21% isolated violence. Psychological violence was most frequently reported (in 93% of the "experienced violence" group). As for their perception of violence there was not found any significant differences between those women who had experienced versus those who did not experience violence. Only about 20% of women had knowledge of centers for women victims of violence. The factors significantly associated with partner violence among pregnant women included: being single (OR=3.02; 95% CI: 1.17;7.83), being unmarried and living with a partner (OR=2.22; 95% CI: 1.11;4.42), history of violence during childhood (OR= 3.08; 95% CI: 1.62;5.85), alcohol consumption by the partner (OR=1.87; 95% CI: 1.02;3.42) and emotional distress among women (OR=4.17; 95% CI: 1.12;15.51). The study results stress other research findings that violence against pregnant Mexican women is still common.
Alhusen, Jeanne L; Wilson, Damali
To explore the perceptions of pregnant women on the experience of intimate partner violence (IPV) as it affects maternal and fetal health. Secondary qualitative content analysis. Individual interviews conducted within three urban obstetric and gynecologic clinics. Our sample included a subset of eight pregnant women experiencing IPV during the current pregnancy. Participants were selected from a larger parent study that included qualitative data from 13 women. We analyzed in-depth individual interview transcripts in which participants discussed how they perceived IPV to affect their health as well as the health of their unborn children. Constant comparative techniques and conventional content analysis methodology were used in analysis. Three themes emerged to illustrate mothers' perceptions of how IPV influenced maternal and fetal outcomes: protection, fetal awareness, and fetal well-being. This analysis provides important insights into concerns that pregnant women experiencing IPV shared about maternal attachment and fetal well-being. Health care providers can use these findings to better assess the physical and psychological concerns of pregnant women experiencing IPV. Further research is needed to better understand how IPV contributes to adverse neonatal outcomes, particularly from a biological perspective. © 2015 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.
Romano, Amy M.
Internet use among pregnant women is common and frequent, while attendance at childbirth education classes appears to be on the decline. This article explores why women turn to the Internet in pregnancy and how Internet use may affect their knowledge, attitudes, and behaviors. It suggests strategies for engaging women's interest in the Internet and describes how doing so may help increase the effectiveness of “traditional” childbirth education while mitigating the potentially overwhelming and confusing aspects of Internet use. PMID:18769519
Chaudhary, Manu; Rench, Marcia A; Baker, Carol J; Singh, Pushpa; Hans, Charoo; Edwards, Morven S
Little is known regarding maternal group B streptococcal (GBS) colonization prevalence and capsular (CPS) serotype distribution among pregnant women in India. The objective of this prospective cohort study was to determine GBS recto-vaginal colonization prevalence in pregnant women at Dr. Ram Manohar Lohia Hospital in Delhi, India. Literature review identified reports from India assessing GBS colonization prevalence in pregnant women. Rectal and vaginal swabs were inoculated into Strep B Carrot Broth (Hardy Diagnostics, Santa Maria, CA) and subcultured onto GBS Detect plates (Hardy Diagnostics, Santa Maria, CA). Isolates were serotyped using ImmuLex Strep-B latex kits (Statens Serum Institut, Copenhagen, Denmark). Thirteen studies were identified citing GBS colonization prevalence during pregnancy as 0.47%-16%. Among 300 pregnant women (mean age: 26.9 years; mean gestation: 34 weeks) enrolled (August 2015 to April 2016), GBS colonization prevalence was 15%. Fifteen percent of women had vaginal only, 29% had rectal only and 56% had both sites colonized. CPS types were Ia (13.3%), Ib (4.4%), II (20%), III (22.2%), V (20%) and VII (6.7%); 13.3% were nontypable. Fetal loss in a prior pregnancy at ≥20-weeks gestation was more common in colonized than noncolonized women (15.6% vs. 3.5%; P = 0.004). Employing recent census data for the birth cohort and estimating that 1%-2% of neonates born to colonized women develop early-onset disease, at least 39,000 cases of early-onset disease may occur yearly in India. Using optimal methods, 15% of third trimester pregnant women in India are GBS colonized. A multivalent vaccine containing 6 CPS types (Ia, Ib, II, III, V and VII) would encompass ~87% of GBS carried by pregnant women in India.
Lim, Kuang Kuay; Chan, Ying Ying; Teh, Chien Huey; Ismail, Hasimah; Yusof, Rafidah; Muhi, Jamail; Lim, Kuang Hock; Foo, Leng Huat
In 2000, legislation on mandatory universal salt iodisation was enacted in Sabah, Malaysia, to reduce the incidence of iodine deficiency disorders among its population. To evaluate the iodine levels among pregnant women from selected rural divisions in Sabah 13 years after the enactment of the universal salt iodisation programme. This cross-sectional study was conducted from 1 May to 30 June, 2013, in three rural divisions of Sabah (the Interior, the West Coast, and Kudat). Data regarding domestic iodised salt use and iodine-containing supplement consumption were obtained from respondents through face-to-face interviews; goitre enlargement was examined through palpation and graded according to the World Health Organization classification. Spot urine samples were also obtained to assess urinary iodine levels by using an in-house modified micromethod. In total, 534 pregnant women participated. The prevalence of goitre was 1.0% (n=5), noted only in the West Coast and Kudat divisions. Although all pregnant women consumed iodised salt, overall median urinary iodine concentration was only 106 μg/L, indicating insufficient iodine intake, with nearly two-thirds of the women (60%) having a median urinary iodine concentrations of <150 μg/L. Pregnant women from the rural divisions in Sabah still exhibit iodine deficiency disorder despite the mandatory universal salt iodisation programme. Iodine supplementation programmes targeting pregnant women are warranted.
Cengiz, Hüseyin; Kanawati, Ammar; Yıldız, Şükrü; Süzen, Sema; Tombul, Tuba
Objective Violence against women, particularly against pregnant women, is increasingly being recognized as a significant problem around the world. Limited studies were found about domestic violence among pregnant women. The aim of this study was to determine the prevalence of domestic violence during pregnancy and the factors affecting it. Material and Methods This prospective study was conducted at the Department of Obstetrics and Gynecology, between January 2012 and April 2013. A total of 1349 pregnant women, irrespective of age and socioeconomic status, were interviewed using a questionnaire in the local language. Results The incidence of domestic violence in this study was 2.37%. The mean age of women who reported violence was 29.06±5.53 years. Age, marriage duration, gravidity, parity, educational level, partner’s educational level, and monthly income exerted no significant influences on women who experienced domestic violence during their pregnancies (p>0.05). Women who resided in the same houses with large extended families were at significantly higher risk of domestic violence during pregnancy in comparison with the pregnant women who lived within a core family (p=0.018). Conclusion Domestic violence during pregnancy is a potential public health problem. Education, improvements in economic autonomy, and society’s attitudes may reduce domestic violence. Health-care providers should increase their awareness of risk factors to protect women from domestic violence. PMID:24976770
This article analyses the school exclusion and subsequent educational inclusion of pregnant young women participating in a course of antenatal and key skills education at an alternative educational setting. It examines the young women's transitions from "failure" in school to "success" in motherhood and re-engagement with…
Perloff, Janet D.
Reviews evidence about health care resources currently available to children and pregnant women in the United States. Evidence suggests that the maldistribution of resources remains a serious threat to health care access for women and children at greatest risk of adverse pregnancy outcomes and child morbidity and mortality. (SLD)
This article analyses the school exclusion and subsequent educational inclusion of pregnant young women participating in a course of antenatal and key skills education at an alternative educational setting. It examines the young women's transitions from "failure" in school to "success" in motherhood and re-engagement with…
May Cripe, Swee; Sanchez, Sixto; Lam, Nelly; Sanchez, Elena; Ojeda, Nely; Tacuri, Silvia; Segura, Carmen; Williams, Michelle A.
Background Migraine and depression are known to be comorbid conditions in non-pregnant women and men. However, the migraine-depression comorbidity among pregnant women, particularly women in developing countries has not been evaluated. Therefore, we evaluated the migraine-depressive symptom relationship in a large cohort of pregnant Peruvian women. Methods Women who delivered singleton infants (N=2,293) at the Instituto Nacional Materno Perinatal, Lima, Peru were interviewed during the postpartum hospital stay. Women were asked questions related to their lifetime and pregnancy experiences with headaches and migraines. Responses to these questions enabled the classification of “probable” and “strict” migraines according to the International Headache Society diagnostic criteria. Depressive symptoms were assessed using the nine-item Patient Health Questionnaire Depression Subset. Logistic regression procedures were used to estimate adjusted odds ratios (AORs) and 95% confidence intervals (CIs). Results Approximately 32% of the women reported a history of migraine, while 41% reported experiencing moderate to severe depressive symptoms during pregnancy. Compared with women without a history of migraine, women with strict migraine had AORs of 2.12 (95% CI 1.54–2.93), 1.85 (95% CI 1.16–2.96) and 2.23 (95% CI 1.08–4.62) for moderate, moderately severe and severe depressive symptoms, respectively. Conclusion This is the first report of a cross-sectional association between migraine and depressive symptoms in pregnant women. If our findings are confirmed, pregnant women with a history of migraine may benefit from increased vigilance for screening and treating depressive symptoms. PMID:19695709
Spera, Anna Maria; Eldin, Tarek Kamal; Tosone, Grazia; Orlando, Raffaele
Hepatitis C virus (HCV) affects about 3% of the world's population, with the highest prevalence in individuals under 40. The prevalence in pregnant women varies with geographical distribution (highest in developing countries). Prevalence also increases in sub-populations of women at high risk for blood-transmitted infections. HCV infection in pregnancy represents a non-negligible problem. However, most of the past antiviral regimens cannot be routinely offered to pregnant or breastfeeding women because of their side effects. We briefly reviewed the issue of treatment of HCV infection in pregnant/breastfeeding women focusing on the effects of the new direct-acting antivirals on fertility, pregnancy and lactation in animal studies and on the potential risk for humans based on the pharmacokinetic properties of each drug. Currently, all new therapy regimens are contraindicated in this setting because of lack of sufficient safety information and adequate measures of contraception are still routinely recommended for female patients of childbearing potential.
Faucette, Azure N; Pawlitz, Michael D; Pei, Bo; Yao, Fayi; Chen, Kang
Children in early infancy do not mount effective antibody responses to many vaccines against commons infectious pathogens, which results in a window of increased susceptibility or severity infections. In addition, vaccine-preventable infections are among the leading causes of morbidity in pregnant women. Immunization during pregnancy can generate maternal immune protection as well as elicit the production and transfer of antibodies cross the placenta and via breastfeeding to provide early infant protection. Several successful vaccines are now recommended to all pregnant women worldwide. However, significant gaps exist in our understanding of the efficacy and safety of other vaccines and in women with conditions associated with increased susceptible to high-risk pregnancies. Public acceptance of maternal immunization remained to be improved. Broader success of maternal immunization will rely on the integration of advances in basic science in vaccine design and evaluation and carefully planned clinical trials that are inclusive to pregnant women. PMID:26366844
de MELO, Simone Cristina Castanho Sabaini; SANTOS, Nathally Claudiane de Souza; de OLIVEIRA, Marcia; SCODRO, Regiane Bertin de Lima; CARDOSO, Rosilene Fressatti; PÁDUA, Rúbia Andreia Falleiros; SILVA, Flavia Teixeira Ribeiro; COSTA, Aline Balandis; CARVALHO, Maria Dalva de Barros; PELLOSO, Sandra Marisa
SUMMARY Introduction: Group B streptococcus (GBS) or Streptococcus agalactiae can colonize the gastrointestinal and genitourinary tracts and has been considered one of the most important risk factors for the development of neonatal disease. The present study evaluated the antimicrobial susceptibility of GBS isolates from pregnant women who were attended at a public health service in Northern Paraná, Brazil. Methods: A descriptive analytical cross-sectional study was performed with 544 pregnant women, at ≥ 35 weeks of gestation. One hundred and thirty-six GBS isolates from pregnant women were tested for antimicrobial susceptibility. Results: All of the GBS isolates showed susceptibility to the drug that is most frequently used for intrapartum prophylaxis: penicillin. Resistance to clindamycin and erythromycin was detected, thus decreasing the options of prophylaxis in women who are allergic to penicillin. Conclusions: Additional studies should be conducted to increase the knowledge of GBS sensitivity profile to antimicrobials in other health centers. PMID:27828624
Davis, Kyle; Goodman, Sherryl H; Leiferman, Jenn; Taylor, Mary; Dimidjian, Sona
Yoga may be well suited for depressed and anxious pregnant women, given reported benefits of meditation and physical activity and pregnant women's preference for nonpharmacological treatments. We randomly assigned 46 pregnant women with symptoms of depression and anxiety to an 8-week yoga intervention or treatment-as-usual (TAU) in order to examine feasibility and preliminary outcomes. Yoga was associated with high levels of credibility and satisfaction as an intervention for depression and anxiety during pregnancy. Participants in both conditions reported significant improvement in symptoms of depression and anxiety over time; and yoga was associated with significantly greater reduction in negative affect as compared to TAU (β = -0.53, SE = 0.20, p = .011). Prenatal yoga was found to be a feasible and acceptable intervention and was associated with reductions in symptoms of anxiety and depression; however, prenatal yoga only significantly outperformed TAU on reduction of negative affect. Published by Elsevier Ltd.
Evenson, Kelly R.; Moos, Merry-K; Carrier, Kathryn; Siega-Riz, Anna Maria
Objective Physical activity generally declines during pregnancy, but barriers to activity during this time period are not well understood. The objective was to examine barriers to physical activity in a large cohort of pregnant women and to explore these barriers in more depth with qualitative data derived from a separate focus group study using a socioecologic framework. Method A total of 1535 pregnant women (27–30 weeks’ gestation) enrolled in the Pregnancy, Infection, and Nutrition Study were asked an open-ended question about their primary barrier to physical activity; responses were coded into categories according to the socioecologic framework. To further elucidate, 13 focus groups of a total of 58 pregnant women (20–37 weeks’ gestation) were conducted among Hispanic, African American, and White participants. Results Among the 1535 pregnant women participating in the survey, 85% reported an intrapersonal barrier to physical activity, of which almost two-thirds were health related. Only 2% of the women reported their main barrier to physical activity as interpersonal and 3% reported a neighborhood or environmental barrier. These results were supported by the focus group data, overall and by race/ethnicity and body mass index. Although women discussed barriers to physical activity at a variety of levels, the intrapersonal level was the most frequently cited and discussed factor in both studies. Conclusions Since pregnancy may trigger the development of obesity and since physical activity is recommended for healthy pregnant women, it is imperative to promote physical activity in a more relevant way. These quantitative and qualitative studies revealed many barriers to physical activity among pregnant women and some suggestions for interventions. PMID:18478322
Azar, Madona; Stoner, Julie A; Dao, Hanh Dung; Stephens, Lancer; Goodman, Jean R; Maynard, John; Lyons, Timothy J
Minority communities are disproportionately affected by diabetes, and minority women are at an increased risk for glucose intolerance (dysglycemia) during pregnancy. In pregnant American Indian women, the objectives of the study were to use current criteria to estimate the prevalence of first-trimester (Tr1) dysglycemia and second-trimester (Tr2) incidence of gestational diabetes mellitus (GDM) and to explore new candidate measures and identify associated clinical factors. This was a prospective cohort study. In Tr1 we performed a 75-g, 2-hour oral glucose tolerance test (OGTT) and glycated hemoglobin (HbA1c) to determine the following: fasting insulin; homeostasis model assessment of insulin resistance; serum 1,5-anhydroglucitol; noninvasive skin autofluorescence (SCOUT). We defined dysglycemia by American Diabetes Association and Endocrine Society criteria and as HbA1c of 5.7% or greater. In Tr2 in an available subset, we performed a repeat OGTT and SCOUT. Pregnant American Indian women (n = 244 at Tr1; n = 114 at Tr2) participated in the study. The prevalence of dysglycemia at Tr1 and incidence of GDM at Tr2 were measured. At Tr1, one woman had overt diabetes; 36 (15%) had impaired glucose tolerance (American Diabetes Association criteria and/or abnormal HbA1c) and 59 (24%) had GDM-Tr1 (Endocrine Society criteria). Overall, 74 (30%) had some form of dysglycemia. Associated factors were body mass index, hypertension, waist/hip circumferences, SCOUT score, fasting insulin, and homeostasis model assessment of insulin resistance. At Tr2, 114 of the Tr1 cohort underwent a repeat OGTT and SCOUT, and 26 (23%) had GDM. GDM-Tr2 was associated with increased SCOUT scores (P = .029) and Tr1 body mass index, waist/hip circumferences, diastolic blood pressure, fasting insulin, and triglyceride levels. Overall, dysglycemia at Tr1 and/or Tr2 affected 38% of the women. Dysglycemia at some point during pregnancy was common among American Indian women. It was associated with
Stoner, Julie A.; Dao, Hanh Dung; Stephens, Lancer; Goodman, Jean R.; Maynard, John; Lyons, Timothy J.
Context: Minority communities are disproportionately affected by diabetes, and minority women are at an increased risk for glucose intolerance (dysglycemia) during pregnancy. Objectives: In pregnant American Indian women, the objectives of the study were to use current criteria to estimate the prevalence of first-trimester (Tr1) dysglycemia and second-trimester (Tr2) incidence of gestational diabetes mellitus (GDM) and to explore new candidate measures and identify associated clinical factors. Design: This was a prospective cohort study. In Tr1 we performed a 75-g, 2-hour oral glucose tolerance test (OGTT) and glycated hemoglobin (HbA1c) to determine the following: fasting insulin; homeostasis model assessment of insulin resistance; serum 1,5-anhydroglucitol; noninvasive skin autofluorescence (SCOUT). We defined dysglycemia by American Diabetes Association and Endocrine Society criteria and as HbA1c of 5.7% or greater. In Tr2 in an available subset, we performed a repeat OGTT and SCOUT. Participants: Pregnant American Indian women (n = 244 at Tr1; n = 114 at Tr2) participated in the study. Outcomes: The prevalence of dysglycemia at Tr1 and incidence of GDM at Tr2 were measured. Results: At Tr1, one woman had overt diabetes; 36 (15%) had impaired glucose tolerance (American Diabetes Association criteria and/or abnormal HbA1c) and 59 (24%) had GDM-Tr1 (Endocrine Society criteria). Overall, 74 (30%) had some form of dysglycemia. Associated factors were body mass index, hypertension, waist/hip circumferences, SCOUT score, fasting insulin, and homeostasis model assessment of insulin resistance. At Tr2, 114 of the Tr1 cohort underwent a repeat OGTT and SCOUT, and 26 (23%) had GDM. GDM-Tr2 was associated with increased SCOUT scores (P = .029) and Tr1 body mass index, waist/hip circumferences, diastolic blood pressure, fasting insulin, and triglyceride levels. Overall, dysglycemia at Tr1 and/or Tr2 affected 38% of the women. Conclusions: Dysglycemia at some point during
Rizzo, Rachel A; Neumann, Anne M; King, Stella O C; Hoey, Robert F; Finnell, Deborah S; Blondell, Richard D
Opioid-dependent pregnant women are characterized by drug use during pregnancy and deficits in knowledge of newborn care and feeding, and of child development. We assessed parenting skills and concerns among pregnant women in buprenorphine treatment for prescription opioid dependence. We interviewed 32 pregnant women who received buprenorphine treatment for prescription opioid dependence in a primary care setting and administered questionnaires, including the Adult-Adolescent Parenting Inventory version 2 (AAPI-2) and Childhood Experience of Care and Abuse Questionnaire. AAPI-2 scores revealed medium risk of abuse for all five scales: inappropriate expectations of the child, low level of empathy, strong belief in corporal punishment, reversal of parent-child roles, and oppression of children's power and independence. Primary concerns of participants were neonatal abstinence syndrome (NAS) and their child's health. Pregnant women who received buprenorphine for treatment of prescription opioid dependence showed a lack of appropriate parenting skills, but did not express concern about their ability to parent. Our findings suggest a need for nurses to assist prescription opioid-dependent pregnant women in acquiring additional parenting skills, to refer for educational parenting intervention, and to educate patients about NAS.
Rizzo, Rachel A; Neumann, Anne M; King, Stella OC; Hoey, Robert F; Finnell, Deborah S; Blondell, Richard D
Purpose Opioid-dependent pregnant women are characterized by drug use during pregnancy and deficits in knowledge of newborn care and feeding, and of child development. We assessed parenting skills and concerns among pregnant women in buprenorphine treatment for prescription opioid-dependence. Study Design and Methods We interviewed 32 pregnant women who received buprenorphine treatment for prescription opioid dependence in a primary care setting and administered questionnaires, including the Adult-Adolescent Parenting Inventory version 2 (AAPI-2) and Childhood Experience of Care and Abuse Questionnaire. Results AAPI-2 scores revealed medium risk of abuse for all five scales: inappropriate expectations of the child, low level of empathy, strong belief in corporal punishment, reversal of parent-child roles, and oppression of children’s power and independence. Primary concerns of participants were neonatal abstinence syndrome (NAS) and their child’s health. Pregnant women who received buprenorphine for treatment of prescription opioid dependence showed a lack of appropriate parenting skills, but did not express concern about their ability to parent. Clinical Implications Our findings suggest need for nurses to assist prescription opioid-dependent pregnant women in acquiring additional parenting skills, to refer for educational parenting intervention, and to educate patients about NAS. PMID:25137081
Ohida, Takashi; Kaneita, Yoshitaka; Osaki, Yoneatsu; Harano, Satoru; Tanihata, Takeo; Takemura, Shinji; Wada, Kiyoshi; Kanda, Hideyuki; Hayashi, Kenji; Uchiyama, Makoto
Study Objective: Pregnant women suffer from sleep disturbance, which may be aggravated by passive smoking. In this study we investigated the effects of passive smoking on sleep disturbance during pregnancy. Design: Two cross-sectional questionnaire surveys conducted in 2002 and 2006. Setting: Clinical institutions specializing in obstetrics and gynecology that participated in the nationwide surveys: 260 in the 2002 survey and 344 in the 2006 survey. Participants: 16,396 and 19,386 pregnant women in Japan surveyed in 2002 and 2006, respectively. Intervention: N/A. Measurements and Results: Pregnant women exposed to passive smoking were likely to have sleep disturbances, such as subjective insufficient sleep, difficulty in initiating sleep, short sleep duration, and snoring loudly/breathing uncomfortably. Smoking pregnant women had the same sleep disturbances and also experienced excessive daytime sleepiness and early morning awakening. The prevalence of 5 types of sleep disturbance (insufficient sleep, difficulty in initiating sleep, short sleep duration, excessive daytime sleepiness, and snoring loudly/breathing uncomfortably) among nonsmokers with environmental tobacco smoke showed a mean value intermediate between that of active smokers and that of nonsmokers without environmental tobacco smoke. Conclusion: Passive smoking is independently associated with increased sleep disturbance during pregnancy. Citation: Ohida T; Kaneita Y; Osaki Y; Harano S; Tanihata T; Takemura S; Wada K; Kanda H; Hayashi K; Uchiyama M. Is passive smoking associated with sleep disturbance among pregnant women? SLEEP 2007;30(9):1155-1161. PMID:17910387
Rodríguez-Morales, Alfonso J.; Barbella, Rosa A.; Case, Cynthia; Arria, Melissa; Ravelo, Marisela; Perez, Henry; Urdaneta, Oscar; Gervasio, Gloria; Rubio, Nestor; Maldonado, Andrea; Aguilera, Ymora; Viloria, Anna; Blanco, Juan J.; Colina, Magdary; Hernández, Elizabeth; Araujo, Elianet; Cabaniel, Gilberto; Benitez, Jesús; Rifakis, Pedro
Introduction. Intestinal parasitic infections, especially due to helminths, increase anemia in pregnant women. The results of this are low pregnancy weight gain and IUGR, followed by LBW, with its associated greater risks of infection and higher perinatal mortality rates. For these reasons, in the setting of no large previous studies in Venezuela about this problem, a national multicentric study was conducted. Methods. Pregnant women from nine states were studied, a prenatal evaluation with a coproparasitological study. Univariated and multivariated analyses were made to determine risk factors for intestinal parasitosis and related anemia. Results. During 19 months, 1038 pregnant women were included and evaluated. Intestinal parasitosis was evidenced in 73.9%: A lumbricoides 57.0%, T trichiura 36.0%, G lamblia 14.1%, E hystolitica 12.0%, N americanus 8.1%, E vermicularis 6.3%, S stercoralis 3.3%. Relative risk for anemia in those women with intestinal parasitosis was 2.56 (P < .01). Discussion. Intestinal parasitoses could be associated with conditions for development of anemia at pregnancy. These features reflect the need of routine coproparasitological study among pregnant women in rural and endemic zones for intestinal parasites. Further therapeutic and prophylactic protocols are needed. Additional research on pregnant intestinal parasitic infection impact on newborn health is also considered. PMID:17093349
Lane, A; Goodyer, C G; Rab, F; Ashley, J M; Sharma, S; Hodgson, A; Nisker, J
Recent media reports on human studies associating brominated flame retardants (BFRs) in household products in pregnancy with urogenital anomalies in boys and endocrine disruption in both sexes. We sought to explore the perceptions of pregnant women of brominated flame retardant (BFR) exposure, in light of recent media reports on the adverse health effects of BFR exposure prenatally. Pregnant women were recruited for interviews through posters and pamphlets in prenatal clinics, prenatal fairs and community centres. Interviews were audiotaped and transcribed verbatim for Charmaz-based qualitative analysis supported by NVIVO 10™. Theoretical sufficiency was reached after analyzing the interviews of 23 pregnant women. Themes co-constructed were: I-Lack of Awareness of BFRs; II-Factors Influencing BFR Exposure; III-Responsibility; IV-Informed Choice. Almost all participants felt it was difficult to make informed choices to avoid BFRs, and wanted communication from clinicians and regulation from governments regarding decreasing BFR exposure. Pregnant women in Canada may be unaware of the potential risks of exposure to BFRs. Professional organizations and governments should further study risk associated with BFR exposure in pregnancy and provide educational materials for pregnant women and clinicians regarding BFR exposure.
Jamieson, Denise J; Kissin, Dmitry M; Bridges, Carolyn B; Rasmussen, Sonja A
Influenza vaccination is a cornerstone of influenza prevention efforts among pregnant women. Prior to 2005, data from studies conducted on pregnant women were limited, with much of the supporting evidence coming from influenza vaccine studies conducted among nonpregnant, age-matched populations. Since 2005, however, an increasing number of studies have demonstrated the safety and immunogenicity of influenza vaccine for pregnant women, including evidence of maternal transfer of antibody. In addition, the clinical benefit of influenza vaccination, both for the mother and infant, was demonstrated in a landmark randomized clinical trial conducted in Bangladesh. Additional randomized clinical trials with laboratory-confirmed influenza as the primary outcome are underway in countries without a current influenza vaccination program, but such trials are unlikely to be conducted in the United States or other countries that already recommend the vaccination of pregnant women. However, current evidence supports the safety and immunogenicity of inactivated influenza vaccine and its effectiveness in reducing the risk of influenza-related illness among pregnant women. Copyright © 2012 Mosby, Inc. All rights reserved.
Alhusen, Jeanne L.; Rahman, Damali
Objective To explore the perceptions of pregnant women on the experience of intimate partner violence (IPV) as it affects maternal and fetal health. Design Secondary qualitative content analysis. Setting Individual interviews conducted within three urban obstetric and gynecologic clinics Participants Our sample included a subset of eight pregnant women experiencing IPV during the current pregnancy. Participants were selected from a larger parent study that included qualitative data from 13 women. Methods We analyzed in-depth individual interview transcripts in which participants discussed how they perceived IPV to affect their health as well as the health of their unborn children. Constant comparative techniques and conventional content analysis methodology were used in analysis. Results Three themes emerged to illustrate mothers’ perceptions of how IPV influenced maternal and fetal outcomes: protection, fetal awareness, and fetal well-being. Conclusions This analysis provides important insights into concerns that pregnant women experiencing IPV shared about maternal attachment and fetal well-being. Health care providers can use these findings to better assess the physical and psychological concerns of pregnant women experiencing IPV. Further research is needed to better understand how IPV contributes to adverse neonatal outcomes, particularly from a biological perspective. PMID:25651808
Mbule, Marjorie A; Byaruhanga, Yusuf B; Kabahenda, Magaret; Lubowa, Abdulrahman
In spite of intervention efforts, in Uganda, as in other developing countries, high levels of anaemia among pregnant women continue. Anaemia among women of reproductive age (15-49 years) is a matter of national concern. This study was carried out to assess determinants of anaemia in Kiboga district. This was a single cross-sectional, descriptive survey. The anaemia status of the pregnant women was determined by measuring their haemoglobin levels. Possible determinant factors including socio-economic characteristics, knowledge, attitudes, practices and food intake were assessed using a structured questionnaire. Results showed that the prevalence of anaemia among pregnant women in Kiboga district was high enough (63.1%) to be described as a severe public health problem. The uptake and utilisation of the public-health intervention package to combat anaemia in pregnancy was low, with iron/folic acid supplementation at 13.2%, use of intermittent preventive treatment of malaria 45.4%, and use of de-worming medicines 14.5%. Women from households without a functional radio were 2.07 times more likely be anaemic (95%CI, 1.08-3.00) compared with women from households where there was a functional radio. There was little awareness and functional knowledge about anaemia among pregnant women. The high prevalence of anaemia observed in Kiboga district can be attributed to poverty and limited access to nutrition and health education information which lead to low uptake and utilization of the public-health intervention package to combat anaemia in pregnancy.
Lammi-Keefe, C. J.
Background. The 2015–2020 Dietary Guidelines for Americans recommend that pregnant women and women of childbearing ages consume 8–12 oz. of seafood per week. Fish are the major dietary source of omega-3 long chain polyunsaturated fatty acids, which have benefits for the mother and fetus. Methods. In this observational study, we investigated dietary habits of pregnant women in Baton Rouge, Louisiana, USA, to determine if they achieve recommended seafood intake. A print survey, which included commonly consumed foods from protein sources (beef, chicken, pork, and fish), was completed by pregnant women at a single-day hospital convention for expecting families in October 2015. Women (n = 221) chose from six predefined responses to answer how frequently they were consuming each food. Results. Chicken was consumed most frequently (75% of women), followed by beef (71%), pork (65%), and fish (22%), respectively. Consumption frequency for the most consumed fish (catfish, once per month) was similar to or lower than that of the least consumed beef, chicken, and pork foods. Consumption frequency for the most consumed chicken and beef foods was at least once per week. Conclusion. Our data indicate that pregnant women in Louisiana often consume protein sources other than fish and likely fail to meet dietary seafood recommendations. PMID:27504202
Dennis, Alicia Therese
Peripartum cardiomyopathy is a rare but important cause of maternal morbidity and mortality. Women with peripartum cardiomyopathy often present with symptoms and signs of heart failure. The diagnosis of peripartum cardiomyopathy is made after all other causes of heart failure are excluded. Emphasis is on the immediate recognition of an unwell pregnant or recently pregnant woman, early diagnosis with the use of echocardiography, and the correct treatment of heart failure.
Regan, Annette K; Tracey, Lauren; Blyth, Christopher C; Mak, Donna B; Richmond, Peter C; Shellam, Geoffrey; Talbot, Caroline; Effler, Paul V
Influenza vaccination during pregnancy can prevent serious illness in expectant mothers and provide protection to newborns; however, historically uptake has been limited due to a number of factors, including safety concerns. Symptomatic complaints are common during pregnancy and may be mistakenly associated with reactions to trivalent influenza vaccine (TIV). To investigate this, we compared post-vaccination events self-reported by pregnant women to events reported by non-pregnant women receiving TIV. A prospective cohort of 1,086 pregnant women and 314 non-pregnant female healthcare workers (HCWs) who received TIV between March-May 2014 were followed-up seven days post-vaccination to assess local and systemic adverse events following immunisation (AEFIs). Women were surveyed by text message regarding perceived reactions to TIV. Those reporting an AEFI completed an interview by telephone or mobile phone to ascertain details. Logistic regression models adjusting for age and residence were used to compare reactions reported by pregnant women and non-pregnant HCWs. Similar proportions of pregnant women and non-pregnant, female HCWs reported ≥1 reaction following vaccination with TIV (13.0% and 17.3%, respectively; OR = 1.2 [95% CI: 0.8-1.8]). Non-pregnant, female HCWs were more likely to report fever or headache compared to pregnant women (OR: 4.6 [95% CI 2.1-10.3] and OR: 2.2 [95% CI 1.0-4.6], respectively). No other significant differences in reported symptoms were observed. No serious vaccine-associated adverse events were reported, and less than 2% of each group sought medical advice for a reaction. We found no evidence suggesting pregnant women are more likely to report adverse events following influenza vaccination when compared to non-pregnant female HCWs of similar age, and in some cases, pregnant women reported significantly fewer adverse events. These results further support the safety of TIV administered in pregnant women.
Killion, C M
As women and families join the ranks of the homeless in increasing numbers, many women find themselves confronting both pregnancy and homelessness. When pregnancy accompanies the precarious state of homelessness, the need for adequate shelter is not being met during one of the most critical periods of a woman's life. This article focuses on the unique health needs of homeless pregnant women. Detailed accounts of the daily life experiences of African American, Anglo, and Latina homeless pregnant women were derived from an ethnographic study conducted in a large metropolitan area in southern California. Their pregnancies were difficult because normal physiological changes of pregnancy often became pathological, signs of potential complications went unnoticed or unattended, and minor discomforts of pregnancy were exacerbated by the women's environment. Nursing therapeutics that support health maintenance and coping strategies of the women while on the streets or in shelters were explicated.
Introduction Preanalytical errors still constitute the largest source of errors in laboratory work. Proper patient preparation and patient’s knowledge about a particular procedure affects its accuracy and reliability. We hypothesized that most of pregnant women are not well enough informed about the proper procedure for the OGTT. The aims of this study were to investigate: (i) how well pregnant women are informed about the OGTT; (ii) the most common way to inform pregnant women about OGTT and (iii) whether pregnant women’s level of knowledge about the OGTT differ regarding source of information. Materials and methods The anonymous questionnaire was conducted across the country in 23 Croatian primary and secondary healthcare centres. The questionnaire contained 9 questions on certain demographic data and familiarity with OGTT procedure. All 343 participants filled the questionnaire before the first blood draw. Results 42% of the participants demonstrated high and 38% adequate level of knowledge about the OGTT procedure. Majority of participants were informed about the procedure by gynaecologist (56%). The level of knowledge differed among participants with different sources of information (P = 0.030). Further analysis showed that the level of knowledge was lower in pregnant women having received information from their gynaecologist compared to pregnant women who received information from the laboratory staff. Conclusions In general, pregnant women are familiar with OGTT procedure, main source of information about the OGTT procedure is their gynaecologist, but the level of knowledge was higher in women who received information about the OGTT procedure from the laboratory staff. PMID:26110035
Harville, Emily W; Xiong, Xu; Buekens, Pierre; Pridjian, Gabriella; Elkind-Hirsch, Karen
Although disaster causes distress, many disaster victims do not develop long-term psychopathology. Others report benefits after traumatic experiences (posttraumatic growth). The objective of this study was to examine demographic and hurricane-related predictors of resilience and posttraumatic growth. We interviewed 222 pregnant southern Louisiana women and 292 postpartum women completed interviews at delivery and 8 weeks later. Resilience was measured by scores lower than a nonaffected population, using the Edinburgh Depression Scale and the Post-Traumatic Stress Checklist. Posttraumatic growth was measured by questions about perceived benefits of the storm. Women were asked about their experience of the hurricane, addressing danger, illness/injury, and damage. Chi-square tests and log-Poisson models were used to calculate associations and relative risks for demographics, hurricane experience, and mental health resilience and perceived benefit. Thirty-five percent of pregnant and 34% of the postpartum women were resilient from depression, whereas 56% and 49% were resilient from posttraumatic stress disorder. Resilience was most likely among White women, older women, and women who had a partner. A greater experience of the storm, particularly injury/illness or danger, was associated with lower resilience. Experiencing damage because of the storm was associated with increased report of some perceived benefits. Many pregnant and postpartum women are resilient from the mental health consequences of disaster, and perceive benefits after a traumatic experience. Certain aspects of experiencing disaster reduce resilience, but may increase perceived benefit. Copyright 2010 Jacobs Institute of Women
In industrialized countries, the incidence of syphilis has decreased dramatically since the discovery of penicillin in the 1940s. However, syphilis and congenital syphilis are far from eradicated, especially in low- and middle-income countries. Syphilis in pregnant women is a cause of adverse pregnancy outcomes that can be prevented by screening for syphilis and early treatment in pregnancy. Several studies have found screening of pregnant women for syphilis to be a highly cost-effective intervention, even if the prevalence of syphilis is low. Obstacles to universal screening of pregnant women include low awareness of syphilis and low quality of antenatal care and healthcare in general in many low- and middle-income countries. For these settings, we need simpler and more reliable serological tests for syphilis, but we also need to strengthen health services in general to ensure sustainable antenatal care services to ensure sustainability of syphilis screening programmes.
Horney, Jennifer; Zotti, Marianne E.; Williams, Amy; Hsia, Jason
Introduction and Background Women of reproductive age, in particular women who are pregnant or fewer than 6 months postpartum, are uniquely vulnerable to the effects of natural disasters, which may create stressors for caregivers, limit access to prenatal/postpartum care, or interrupt contraception. Traditional approaches (e.g., newborn records, community surveys) to survey women of reproductive age about unmet needs may not be practical after disasters. Finding pregnant or postpartum women is especially challenging because fewer than 5% of women of reproductive age are pregnant or postpartum at any time. Methods From 2009 to 2011, we conducted three pilots of a sampling strategy that aimed to increase the proportion of pregnant and postpartum women of reproductive age who were included in postdisaster reproductive health assessments in Johnston County, North Carolina, after tornadoes, Cobb/Douglas Counties, Georgia, after flooding, and Bertie County, North Carolina, after hurricane-related flooding. Results Using this method, the percentage of pregnant and postpartum women interviewed in each pilot increased from 0.06% to 21%, 8% to 19%, and 9% to 17%, respectively. Conclusion and Discussion Two-stage cluster sampling with referral can be used to increase the proportion of pregnant and postpartum women included in a postdisaster assessment. This strategy may be a promising way to assess unmet needs of pregnant and postpartum women in disaster-affected communities. PMID:22365134
Horney, Jennifer; Zotti, Marianne E; Williams, Amy; Hsia, Jason
Women of reproductive age, in particular women who are pregnant or fewer than 6 months postpartum, are uniquely vulnerable to the effects of natural disasters, which may create stressors for caregivers, limit access to prenatal/postpartum care, or interrupt contraception. Traditional approaches (e.g., newborn records, community surveys) to survey women of reproductive age about unmet needs may not be practical after disasters. Finding pregnant or postpartum women is especially challenging because fewer than 5% of women of reproductive age are pregnant or postpartum at any time. From 2009 to 2011, we conducted three pilots of a sampling strategy that aimed to increase the proportion of pregnant and postpartum women of reproductive age who were included in postdisaster reproductive health assessments in Johnston County, North Carolina, after tornadoes, Cobb/Douglas Counties, Georgia, after flooding, and Bertie County, North Carolina, after hurricane-related flooding. Using this method, the percentage of pregnant and postpartum women interviewed in each pilot increased from 0.06% to 21%, 8% to 19%, and 9% to 17%, respectively. Two-stage cluster sampling with referral can be used to increase the proportion of pregnant and postpartum women included in a postdisaster assessment. This strategy may be a promising way to assess unmet needs of pregnant and postpartum women in disaster-affected communities. Published by Elsevier Inc.
Richard-Lenoble, D; Chandenier, J; Duong, T H
Like antibacterial agents, antiparasite drugs for pregnant women and children must be chosen in function of the stage of pregnancy, age of the child, and expected benefit-risk ratio. While no agent is totally safe, there are few absolute contraindications. Most zones of serious endemic parasite disease are located in developing countries where parasite, bacterial, or viral conditions combined with poor nutrition treatment make it necessary to treat disease in a complex pathogenic environment that weakens pregnant women and children with multiple parasite infections. In both temperate and tropical zones, there have been few real therapeutic advances involving release of new products on the market or development of new indications for existing products. Constant appearance and extension of hematozoa resistance to conventional and even more recent antimalarial agents have prompted research to find new active drugs and long-lasting treatment combinations. Real therapeutic breakthroughs have resulted from the need to develop safe drugs without substantial side-effects for single-dose use in control programs against endemic parasite diseases in mass populations including pregnant women and young children in tropical zones. There are several notable examples in the field of major verminous diseases. Ivermectin is a versatile drug that can be used against filariasis as well as for management of intestinal worms or ectoparasitosis in temperate and tropical countries. Praziquantel is an important advance in platyhelminthiasis, especially bilharziais. Triclabendazole, the latest addition to the benzimidazole family, has shown promise as a substitute for bithionol, that is difficult to procure and not recommended in pregnant women, for treatment distomiasis occurring in pregnant women and children. Other examples include albendazole against giardiasis, nitazoxamide against cryptosporidiosis, artemisinine against bilharziasis, and paramomycine, not recommended in pregnant women
Laenen, Jolien; Roelants, Mathieu; Devlieger, Roland; Vandermeulen, Corinne
Pregnant women have an increased risk for complications and hospitalizations when infected with the influenza virus in the second or third trimester. Additionally, infants under six months of age are most vulnerable when contracting pertussis. Immunization against influenza and pertussis during pregnancy provides protection for mother and neonate against influenza and for neonates against pertussis pending protection through infant immunization. In Belgium, a gradual increase in pertussis cases over the past decade was observed. This study was undertaken to document vaccination coverage for influenza and pertussis and factors related to vaccination status in pregnant women. Two hundred and fifty pregnant women completed a questionnaire during their third trimester. Vaccination data were collected and reasons for non-vaccination were noted as well as socio-demographic data which are known to influence vaccination coverage. A documented vaccination coverage of 42.8% for influenza and 39.2% for pertussis was observed. Taking into account doses which were not documented, but administered according to the expectant mother, coverage for influenza would increase to 62% and for pertussis to 46%. The most important reasons for non-vaccination were the absence of a recommendation by medical staff (9.6%) and delay in vaccination (8.4%). The GP was the most important vaccinator. Pregnant women with a lower education and those with a foreign origin were more vulnerable for non-vaccination. Incomplete documentation is the most important barrier in determining the vaccination status of pregnant women. Immunization during pregnancy needs further integration through vaccination campaigns aimed at both health care providers and pregnant women. Copyright © 2015 Elsevier Ltd. All rights reserved.
Okanishi, Natsuko; Kito, Nobuhiro; Akiyama, Mitoshi; Yamamoto, Masako
Pregnant women often report complaints due to physiological and postural changes. Postural changes during pregnancy may cause low back pain and pelvic girdle pain. This study aimed to compare the characteristics of postural changes in pregnant compared with non-pregnant women. Prospective case-control study. Pregnancy care center. Fifteen women at 17-34 weeks pregnancy comprised the study group, while 10 non-pregnant female volunteers comprised the control group. Standing posture was evaluated in the sagittal plane with static digital pictures. Two angles were measured by image analysis software: (1) between the trunk and pelvis; and (2) between the trunk and lower extremity. Spinal curvature was measured with Spinal Mouse® to calculate the means of sacral inclination, thoracic and lumbar curvature and inclination. The principal components were calculated until eigenvalues surpassed 1. Three distinct factors with eigenvalues of 1.00-2.49 were identified, consistent with lumbosacral spinal curvature and inclination, thoracic spine curvature, and inclination of the body. These factors accounted for 77.2% of the total variance in posture variables. Eleven pregnant women showed postural characteristics of lumbar kyphosis and sacral posterior inclination. Body inclination showed a variety of patterns compared with those in healthy women. Spinal curvature demonstrated a tendency for lumbar kyphosis in pregnant women. Pregnancy may cause changes in spinal curvature and posture, which may in turn lead to relevant symptoms. Our data provide a basis for investigating the effects of spinal curvature and postural changes on symptoms during pregnancy. © 2012 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2012 Nordic Federation of Societies of Obstetrics and Gynecology.
Low-quality dietary protein intake and vitamin B-12 deficiency could interact to decrease methionine transmethylation and remethylation rates during pregnancy, and may affect epigenetic modifications of the fetal genome. The objective of this randomized, partially open-labeled intervention trial was...
Merkx, Astrid; Ausems, Marlein; de Vries, Raymond; Nieuwenhuijze, Marianne J
Gaining too much or too little weight in pregnancy (according to Institute of Medicine (IOM) guidelines) negatively affects both mother and child, but many women find it difficult to manage their gestational weight gain (GWG). Here we describe the use of the intervention mapping protocol to design 'Come On!', an intervention to promote adequate GWG among healthy pregnant women. We used the six steps of intervention mapping: (i) needs assessment; (ii) formulation of change objectives; (iii) selection of theory-based methods and practical strategies; (iv) development of the intervention programme; (v) development of an adoption and implementation plan; and (vi) development of an evaluation plan. A consortium of users and related professionals guided the process of development. As a result of the needs assessment, two goals for the intervention were formulated: (i) helping healthy pregnant women to stay within the IOM guidelines for GWG; and (ii) getting midwives to adequately support the efforts of healthy pregnant women to gain weight within the IOM guidelines. To reach these goals, change objectives and determinants influencing the change objectives were formulated. Theories used were the Transtheoretical Model, Social Cognitive Theory and the Elaboration Likelihood Model. Practical strategies to use the theories were the foundation for the development of 'Come On!', a comprehensive programme that included a tailored Internet programme for pregnant women, training for midwives, an information card for midwives, and a scheduled discussion between the midwife and the pregnant woman during pregnancy. The programme was pre-tested and evaluated in an effect study.
Park, J S
This study examines the decisions of rural pregnant women who sought obstetric care elsewhere, especially in an urban area. The principal data source was the "Patients' Survey of 1988", a nationwide data collection. Among 4091 rural pregnant women, 3090 women left their home counties for obstetric care; 1946 women went to small or medium-sized cities, 645 to large cities. Multivariate techniques were used to examine the factors related to selecting urban obstetric care. The analysis shows that younger, abnormally delivered women were more likely to seek urban obstetrical facilities. In addition, medical insurance, the number of registered cars/1000, the number of general hospitals in the county, and the distance to the nearest large city were positively related to the decision to go to any city. However, distance to the nearest small or medium-sized city had a negatively significant effect on urban obstetrical service utilization. (author's modified)
Gomes, Caroline de Barros; Malta, Maíra Barreto; Martiniano, Ana Carolina de Almeida; Di Bonifácio, Luiza Pereira; Carvalhaes, Maria Antonieta de Barros Leite
To determine the eating behavior of pregnant women assisted by primary health care and to compare it with women at childbearing age in Brazilian capitals. A cross-sectional study conducted on 256 pregnant women in the second trimester of gestation, selected by drawing lots from those assisted by primary health care units of a municipality in the state of São Paulo in 2009/2010. Eating habits were investigated via a questionnaire adapted from the VIGITEL system, consisting of questions about eating habits in general and the frequency and consumption characteristics of food groups/specific foods. For tis comparison, we used the indicators reported by the VIGITEL system for women at childbearing age in Brazilian capitals in 2010. The analyses involved the presentation of frequency distribution and descriptive statistics with comparisons according to the age group. Most patients had breakfast every day (86.7%) and 45.7% habitually exchanged a main meal for a snack once or twice a week. A daily consumption of fruit, raw salad and vegetables was not reported by 48.8%, 41.8% and 55.1% of the women, respectively. Fish was reported to never or almost never be consumed by 64.4% of the pregnant women. At least once a week, 69.9% of them reported the consumption of soda, and 86.4% of wafers/cookies. The comparison between the pregnant women and women at childbearing age in capitals showed a close similar prevalence of overweight, and no difference in the regular consumption of fruit and vegetables. Meat containing excess of fat and whole milk were more consumed by pregnant women, with differences reported in all the age groups analyzed. On the other hand, the pregnant women reported a less regular intake of soft drinks. The actions that need to be performed in prenatal care are various and very important, promoting the consumption of specific foods and providing guidelines about eating behavior, while reinforcing healthy eating habits already present.
Paesano, R; Berlutti, F; Pietropaoli, M; Goolsbee, W; Pacifici, E; Valenti, P
Iron homeostasis in pregnancy compensates for increased iron requirements and in women of child-bearing age for iron loss in menses. Oral administration of ferrous sulfate, prescribed to cure iron deficiency (ID) and ID anemia (IDA), often fails to increase hematological parameters and causes adverse effects. Recently, we demonstrated safety and efficacy of bovine lactoferrin (bLf) in pregnant women suffering from ID/IDA. Two clinical trials were conducted on pregnant and non-pregnant women of child-bearing age suffering from ID/IDA. In both trials, women received oral administration of bLf 100 mg/twice/day (Arm A), or ferrous sulfate 520 mg/day (Arm B). Hematological parameters, serum IL-6 and prohepcidin were assayed before and after therapy. Unlike ferrous sulfate, bLf increased hematological parameters (P less than 0.0001). In pregnant women, bLf decreased serum IL-6 (P less than 0.0001), and increased prohepcidin (P=0.0007). In non-pregnant women bLf did not change the low IL-6 levels while it increased prohepcidin (P less than 0.0001). Ferrous sulfate increased IL-6 (P less than 0.0001) and decreased prohepcidin (P=0.093). bLf established iron homeostasis by modulating serum IL-6 and prohepcidin synthesis, whereas ferrous sulfate increased IL-6 and failed to increase hematological parameters and prohepcidin. bLf is a more effective and safer alternative than ferrous sulfate for treating ID and IDA.
Charles, Alyson M.; Campbell-Stennett, Dianne; Yatich, Nelly; Jolly, Pauline E.
Anemia in pregnancy is a worldwide problem, but it is most prevalent in the developing world. This research project was conducted to determine the predictors of anemia in pregnant women in Westmoreland, Jamaica. A cross-sectional study design was conducted and descriptive, bivariate, and multiple logistic regression analyses were used. Body mass index, Mid-upper arm circumference, and the number of antenatal care visits showed a statistically significant association with anemia. Based on the results, we believe that maintaining a healthy body weight, and frequently visiting an antenatal clinic, will help to lower the prevalence of anemia among pregnant women in Westmoreland. PMID:20526925
Filhol, G; Bernard, P; Quantin, X; Espian-Marcais, C; Ninot, G
Benefits of physical exercise on the physical and psychological health lead to specifics guidelines during pregnancy. For pregnant women, to take part in aerobics exercise (walking, biking) (i.e. 30 minutes, three times per week at 60-90% of the maximal heart rate) and strength training (i.e. one to two times per week) is recommended. Physical exercise programs during pregnancy have shown benefits for preventing and treating complications pregnancy (e.g. gestational diabetes mellitus, overweight). Benefits of exercise and risks associated with sedentary should be widely diffused among pregnant women and prenatal caregivers.
Stoian, Dana; Craciunescu, Mihalea; Timar, Romulus; Schiller, Adalbert; Pater, Liana; Craina, Marius
Thyroid hormones are essential for fetal development. Normal thyroid function in pregnant women adjusts by itself in cases of pregnancy, phenomenon that is deficient in cases of previous maternal thyroid disease. The study group was represented by 120 females, with reproductive age, with known thyroid disease, that had a up to delivery pregnancy. Thyroid ultrasound parameters and functional parameters were follow-up during the 9-month of gestation. The study proposes a mathematical model of predicting the need and the amount of tetraiodothyronine treatment in pregnant women with prevalent thyroid disease.
El Mansouri, B; Rhajaoui, M; Sebti, F; Amarir, F; Laboudi, M; Bchitou, R; Hamad, M; Lyagoubi, M
In Morocco, the seroprevalence of toxoplasmosis in pregnant women living in Rabat, was estimated by analyzing antibodies (IgG, IgM) levels using an ELISA test. The analysis of 2456 serums at the Institut National d'Hygiène showed that the seroprevalence of toxoplasmosis is about 50.6%. According to the questionnaire, the lack of knowledge about this disease and soil contact could be the main causes of toxoplasmosis infection. The use of IgG avidity test has excluded a recent infection in 93.5% of pregnant women with IgM positive sera.
Arch, Joanna J
Relatively little is known about women's anxiety-related treatment preferences and no studies have examined potential differences between pregnant versus non-pregnant women. Treatment credibility and willingness are particularly important to understand regarding exposure-based cognitive behavioral therapy (CBT) and pharmacotherapy, the leading evidence-based treatments. A large U.S. sample of pregnant (n = 377) and matched non-pregnant (n = 399) women (total N = 776) rated overall treatment preferences and treatment credibility, concerns, and willingness to have CBT and pharmacotherapy if suffering from anxiety. Women preferred anxiety-related treatment that included psychotherapy. Preference for psychotherapy alone was stronger among pregnant (74%) than non-pregnant (47%) women, p < .001. In response to treatment descriptions, both groups rated CBT more favorably than pharmacotherapy on treatment willingness, credibility, and concerns, ps < .001, with the magnitude of this preference significantly greater among pregnant than non-pregnant women, ps < .001. Pregnancy status was unrelated to CBT ratings. Treatment credibility and to a lesser extent total concerns mediated the relationship between pregnancy status and pharmacotherapy willingness. Non-pregnant and especially pregnant women rated exposure-based CBT for anxiety more favorably than pharmacotherapy. Pregnancy status predicted general treatment preferences and pharmacotherapy, but not CBT, ratings. Copyright © 2013 Elsevier Ltd. All rights reserved.
Leke, L; Kremp, D
Dietary deficiency in iron and to a lesser extent folic acid is the principle cause of anemia in the world. Reproductive aged women and growing children are the principle groups at risk of anemia. About half of nonpregnant reproductive aged women in tropical countries have hemoglobin levels lower than 12 g/100 ml, the level used by the World Health Organization to define anemia. Nutritional anemia is even more widespread among pregnant and lactating women because of the increased needs for iron during those periods. Pregnant women need almost 500 mg of iron for their increased red blood cell mass, 220 mg for routine iron loss through the urine, bile, sweat, and other routes; 290 mg for the fetus, and almost 25 mg for the placenta. In all, the pregnant women theoretically requires over 1000 mg of iron through diet or bodily reserves. Healthy, well-nourished women have total iron reserves of 2500 mg, but according to published data almost 2/3 of pregnant women even in favorable circumstances end their pregnancies with no remaining iron reserves. In tropical regions the lack of iron reserves is aggravated by parasites and infections, closely spaced pregnancies that do not allow restoration of reserves, and poor dietary availability of iron. Anemia during pregnancy is associated with elevated risks of maternal morbidity and mortality. Fatigue, dyspnea, palpitations and tachycardia, vertigo, loss of appetite and cravings for soil or other inappropriate substances are frequently observed in anemic women. The risks of prematurity and low weight are increased for infants of anemic women. Fetal malformation may be associated with folic acid deficiency. Nutrition education is needed for pregnant women. Local foods may be enriched with iron, and pregnant women may be given iron and vitamin B12 supplements directly. Iron supplements may rapidly increase iron reserves, but they are poorly tolerated by many women. The supplements should be avoided if possible early in the
Nahlen, B L; Akintunde, A; Alakija, T; Nguyen-Dinh, P; Ogunbode, O; Edungbola, L D; Adetoro, O; Breman, J G
To evaluate the efficacy of pyrimethamine on the blood stage (suppressive prophylaxis) and liver stage (causal prophylaxis) of Plasmodium falciparum in pregnant women, in vivo and in vitro field studies were conducted in Ilorin, Nigeria, from Jan 1 to June 30, 1988. For pregnant women with P falciparum infections who received 25 mg of pyrimethamine weekly for suppressive prophylaxis, 67% (59/88) of in vivo and 60% (6/10) of in vitro tests showed pyrimethamine resistance. A second group of parasitaemic and parasite-free pregnant women was enrolled to evaluate the efficacy of pyrimethamine as a primary tissue schizonticide; after receiving a curative dose of chloroquine (25 mg/kg), half the women were given 25 mg of pyrimethamine weekly and half received no prophylaxis. Parasitologic failure rates did not differ between the pyrimethamine-treated (8/34) and the control (11/37) groups during the 16-week follow-up. Thus, pyrimethamine is not effective for suppressive or causal prophylaxis in pregnant women in Ilorin.
Yahaya, M I; Ogunfowokan, A O; Orji, E O
In this study concentration level of calcium, cadmium, copper, iron, magnesium, manganese, nickel, lead and zinc were determined in the amniotic fluid of pregnant women, aged 15 - 45 years enrolled at the Obafemi Awolowo University Teaching Hospitals Complex Ile - Ife. This was with a view to predict the body burden of the metals in the pregnant women and assess the health implications of the toxic elements to the pregnant women and their fetuses. Fifty samples of the amniotic fluid were collected from the pregnant women. The efficiency of extraction of trace metals using conventional wet acid digestion method (CDM) and microwave induced acid digestion method (MWD) was determined by recovery experiments. Levels of trace metals were determined using Atomic Absorption Spectrophotometry. The high percentage recoveries obtained from MWD made it a more efficient method than the CDM and hence its adoption for sample digestion. Statistical analysis of data using descriptive and inferential statistics revealed that age; education and profession have effects on the levels of the trace metals. The mean levels of most of the toxic metals obtained in this study were lower than the recommended limits of trace metals in women whole blood.
Yilmazel, Gülay; Balci, Elçin
The postpartum period is a time of transition for a pregnant woman and her new family. In this period many pregnant women are in search about the family planning methods. But contraceptive options differ depending on women's desires such as cultural and religious believes, partner attitudes, previous contraceptive experiences. This study was conducted to identify status of using a contraceptive method before pregnancy and the factors associated with preferences of contraception in postpartum period. The descriptive research was conducted in a State Hospital March-May 2012 in Turkey. The population of study was formed with 200 pregnant women who applied follow-up pregnant clinics. We took permissions from local authorities and participants. 182 voluntary pregnant women were surveyed. We prepared a 20 item question are form which was asking socio-demographic futures, contraceptives methods before-after delivery and the factors related with using contraceptives after screening literatures related with subject. The 49.5% of women reported that they didn't use any methods before. There was a significant relation between using contraceptives before pregnancy with the idea of using contraceptive during the postpartum period and receiving contraception counseling during pregnancy (p=0.004, p=0.035 respectively). The 86.4% of pregnant implied that they would use a contraceptive method in postpartum period. IUD was the most preferred method. Status of using contraceptive before and receiving contraception counseling in pregnancy were the effective variables on thoughts about using a contraceptive method. To achieve desired goals for maternal and child health in our country health professionals should be more focused on postpartum contraception in antenatal care programs.
Brookfield, Kathleen F; Su, Felice; Elkomy, Mohammed H; Drover, David R; Lyell, Deirdre J; Carvalho, Brendan
Magnesium sulfate is one of the most commonly prescribed intravenous medications in obstetrics. Despite its widespread use, there are limited data about magnesium pharmacokinetics, and magnesium is prescribed empirically without dose adjustment for different indications. The aim of this study was to characterize the pharmacokinetics and placental transfer of magnesium sulfate in pregnant women and to determine key covariates that impact the pharmacokinetics. This is a prospective pharmacokinetic cohort study of pregnant women who were prescribed magnesium sulfate for preeclampsia, preterm labor, or extreme prematurity. Women received a 4-g loading dose and 2 g/h maintenance dose as clinically indicated. Maternal blood samples were obtained before and at multiple time points during and after magnesium administration. Cord blood also was sampled at delivery. A population pharmacokinetic approach that used a nonlinear mixed-effects modeling was used to characterize magnesium disposition. Pharmacokinetic profiles of 111 pregnant women were analyzed. Magnesium clearance was 3.98 L/h in preeclamptic women and 5.88 L/h non-preeclamptic women. Steady-state concentration of magnesium was 7.2 mg/dL in preeclamptic women compared with 5.1 mg/dL in non-preeclamptic women. Maternal weight significantly impacted time to steady state. The ratio of the mean umbilical vein magnesium level to the mean maternal serum magnesium level at the time of delivery was 0.94 ± 0.15. The study accurately characterizes the pharmacokinetics of magnesium administered to pregnant women. Preeclamptic status and maternal weight significantly impact serum magnesium levels. This pharmacokinetic model could be applied to larger cohorts to help tailor magnesium treatment and account for these covariates. Copyright © 2016 Elsevier Inc. All rights reserved.
Lilliecreutz, Caroline; Josefsson, Ann
The aim of the study was to investigate the prevalence of blood and injection phobia in an unselected pregnant population, in order to estimate the need for curative intervention programmes. A cross-sectional study. Antenatal care clinics in the southeast region of Sweden. Sample. In total, 1,606 consecutively registered pregnant women attending their first visit with a midwife. The women were asked to complete the Injection Phobia-Anxiety scale, measuring phobic symptoms. Women who scored>20 on the questionnaire were telephone-interviewed and then diagnosed or dismissed according to the DSM-IV criteria for blood and injection phobia. Main outcome measures. Prevalence of blood and injection phobia according to the DSM-IV. Of 1,529 women who chose to participate (92.5%), 110 women or 7.2% fulfilled the DSM-IV criteria for blood and injection phobia. The mean age of the women was 29.1 years. Blood and injection phobia is hitherto unreported in the literature, but seems to be relatively common and needs to be recognized during pregnancy as it causes a great deal of discomfort and fear among pregnant women. The Injection Phobia-Anxiety scale is suitable as a screening tool in an antenatal care clinic setting.
Audi, Celene Aparecida Ferrari; Segall-Corrêa, Ana M; Santiago, Silvia M; Andrade, Maria da Graça G; Pèrez-Escamila, Rafael
To identify the factors associated with domestic violence against pregnant women. Interviews were conducted with 1,379 pregnant women undergoing antenatal care in basic health care units of the Brazilian Health System, within the municipality of Campinas (Southeastern Brazil). A structured questionnaire on domestic violence, validated in Brazil, was applied between July 2004 and July 2006. The first and second interviews in a cohort study were analyzed. Descriptive and multiple logistic regression analysis of the data were conducted. Psychological violence was reported by 19.1% (n=263) of the total sample of pregnant women and physical/sexual violence was reported by 6.5% (n=89) of them. The factors associated to psychological violence were: adolescent intimate partner (p<0.019) and the pregnant woman had witnessed physical aggression before she was 15 years old (p<0.001). The factors associated to physical/sexual violence were: difficulties encountered by the pregnant woman in attending her antenatal appointments (p<0.014), intimate partner uses drugs (p<0.015) and does not work (p<0.048). The factors associated to psychological and physical/ sexual violence were: low level of education of the interviewee (p<0.013 and p<0.020, respectively), the pregnant woman being responsible for the family (p<0.001 and p=0.017, respectively) pregnant woman had suffered physical aggression during childhood (p<0.029 and p<0.038, respectively), presence of common mental disorder (p<0.001) and intimate partner consumes alcoholic beverage twice or more weekly. (p<0.001). A high prevalence of different categories of domestic violence by an intimate partner during pregnancy was found as well as different factors associated with them. Appropriate mechanisms are necessary, particularly in primary health care, to identify and deal with domestic violence during pregnancy.
Hoek, Janet; Gifford, Heather; Maubach, Ninya; Newcombe, Rhiannon
Objectives Although aware that smoking while pregnant presents serious risks to their unborn children, some women continue to smoke and rationalise their dissonance rather than quit. We explored metaphors women used to frame smoking and quitting, then developed cessation messages that drew on these metaphors and examined the perceived effectiveness of these. Participants We used a two-phase qualitative study. Phase one involved 13 in-depth interviews with women who were smoking (or who had smoked) while pregnant. Phase two comprised 22 in-depth interviews with a new sample drawn from the same population. Analyses Data were analysed using thematic analysis, which promoted theme identification independently of the research protocol. Results Participants often described smoking as a choice, a frame that explicitly asserted control over their behaviour. This stance allowed them to counter-argue messages to quit, and distanced them from the risks they created and faced. Messages tested in phase 2 used strong affective appeals as well as themes that stimulated cognitive reflection. Without exception, the messages depicting unwell or distressed children elicited strong emotional responses, were more powerful cessation stimuli, and elicited fewer counter-arguments. Conclusions Cessation messages that evoke strong affective responses capitalise on the dissonance many women feel when smoking while pregnant and stimulate stronger consideration of quitting. Given the importance of promoting cessation among pregnant women, future campaigns could make greater use of emotional appeals and place less emphasis on informational approaches, which often prompt vigorous counter-arguments. PMID:25431224
De Peyster, A; Willis, W O; Molgaard, C A; MacKendrick, T M; Walker, C
Ascertainment of exposure to cholinesterase-inhibiting pesticides in pregnant subjects is complicated by altered enzyme activity that results from metabolic changes associated with pregnancy. Nevertheless, this study found a high correlation (Pearson chi-square = 13.67, p = .008) between classification of pesticide exposure using self-reported interview information and plasma cholinesterase activity for 203 pregnant women for whom three trimester cholinesterase values were available. All plasma cholinesterase activity values were referenced, by trimester, to a larger sample of 1,050 plasma cholinesterase values from 535 pregnant women. Subjects who lived nearest to agricultural land and who reported that they worked with pesticides in agricultural and other occupations tended to have lower plasma cholinesterase activity than those who reported use of household pesticides only.
Özdemir, Abdurrahman Avar; Ercan Gündemir, Yasemin; Küçük, Mustafa; Yıldıran Sarıca, Deniz; Elgörmüş, Yusuf; Çağ, Yakup; Bilek, Günal
Vitamin D deficiency is a serious health problem although the improvement in socio-economic status in Turkey. The aim of this study was to evaluate the maternal vitamin D status and their effect on neonatal vitamin D status after support program for pregnant women and to detect risk factors for vitamin D deficiency in Bağcılar region in İstanbul. A total of 97 pregnant women and 90 infants were included in this study between January and October 2016. The demographic data, risk factors and daily vitamin intake were recorded. We measured serum levels of vitamin D, calcium, phosphorus and alkaline phosphatase in mothers and their infants. The relationship between their vitamin D levels and risk factors was analyzed. The mean vitamin D level for all women and all infants were found as 14.82 ±11.45 ng/ml and 13.16 ± 7.16 ng/ml, respectively. The number of mothers and infants were significantly higher in deficient group, and their mean vitamin D levels significantly lower (9.02 ± 1.34 ng/ml and 8.80 ± 1.06 ng/ml, respectively) (p < 0.001, p < 0.001). The percent of pregnant women who have received 1000-1200 IU/day of vitamin D was only found as 14.4%. When the mother groups were evaluated in terms of risk factors, there were statistically differences in daily vitamin intake and clothing style (p < 0.001, p < 0.001). Vitamin D deficiency in pregnant women and their infants is still a serious health problem in Turkey, although vitamin D support program has been launched for pregnant women.
Cardemil, Cristina V; Jonas, Anna; Beukes, Anita; Anderson, Raydel; Rota, Paul A; Bankamp, Bettina; Gary, Howard E; Sawadogo, Souleymane; Patel, Sadhna V; Zeko, Sikota; Muroua, Clementine; Gaeb, Esegiel; Wannemuehler, Kathleen; Gerber, Sue; Goodson, James L
Namibia experienced a large measles outbreak starting in 2009, with 38% of reported cases in adults, including women of reproductive age. Population immunity was assessed among pregnant women to determine whether immunization activities were needed in adults to achieve measles elimination in Namibia. A total of 1708 and 2040 specimens sampled from Namibian pregnant women aged 15-44 years who were included in the 2008 and 2010 National HIV Sentinel Survey, respectively, were tested for measles immunoglobulin G antibody. The proportion of women seropositive overall and by 5-year age strata was determined, and factors associated with seropositivity were analyzed by logistic regression, including age, facility type, gravidity, HIV status, and urban/rural setting. Seropositivity in 2008 versus 2010 was compared. In both analysis years, measles seropositivity was lower in 15-19-year-olds (77%) and 20-24-year-olds (85-87%) and higher in 25-44-year-olds (90-94%) (2008, p<0.001; 2010, p<0.001). Overall measles seropositivity did not differ between 2008 (87%) and 2010 (87%) (p=0.7). HIV status did not affect seropositivity. Late in a large measles outbreak, 13% of pregnant women in Namibia, and almost one in four 15-19-year-old pregnant women, remained susceptible to measles. In Namibia, immunization campaigns with measles-containing vaccine should be considered for adults. Published by Elsevier Ltd.
Maine, Gregory T; Stricker, René; Stricker, Reto
Retrospective evaluation of the kinetics of cytomegalovirus (CMV) seroconversion with CMV IgM, IgG, and IgG avidity assays, in a Swiss pregnant women population, has shown that the current published CMV serologic diagnostic algorithms were valid and fit for use. In 19% of the cases analyzed, CMV-specific IgM was detected before IgG.
... Substance Abuse Prevention and Treatment Block Grant § 96.131 Treatment services for pregnant women. (a) The... Director for Substance Abuse Services. (f) The State shall develop effective strategies for monitoring.... Programs which serve an injecting drug abuse population and who receive Block Grant funds shall...
... Substance Abuse Prevention and Treatment Block Grant § 96.131 Treatment services for pregnant women. (a) The... Director for Substance Abuse Services. (f) The State shall develop effective strategies for monitoring.... Programs which serve an injecting drug abuse population and who receive Block Grant funds shall...
... Substance Abuse Prevention and Treatment Block Grant § 96.131 Treatment services for pregnant women. (a) The... Director for Substance Abuse Services. (f) The State shall develop effective strategies for monitoring.... Programs which serve an injecting drug abuse population and who receive Block Grant funds shall...
King, Janet C.; Charlet, Sara
Discusses energy and nutrient requirements of pregnant women with respect to kcal needs and vitamins B-6, folacin, vitamin E, and intake of certain trace elements. Also discusses nutritional needs of the premature infant and the ways of supplying these nutrients. (MA)
Abbasian, Maryam; Chaman, Reza; Amiri, Mohammad; Ajami, Mohammad Esmaeil; Jafari-Koshki, Tohid; Rohani, Hossein; Taghavi-Shahri, Seyed Mahmood; Sadeghi, Erfan; Raei, Mehdi
Background and Objective: Vitamin D deficiency during pregnancy is a worldwide problem. Studies have reported prevalence ranged 18-84% in pregnant women. Receiving adequate calcium and vitamin D during pregnancy period is necessary for calcium homeostasis, fetal growth and bone mineralization. This study was aimed to determine the prevalence of vitamin D deficiency in pregnant women and their neonates in Shahroud city in the northeast Iran. Methods: In this cross-sectional study, 284 pregnant women and their neonates referred to Fatemiyeh Hospital of Shahroud were included. Blood samples of mothers and umbilical cords were collected during the delivery and were sent to laboratory in order to measure calcium and 25-hydroxy vitamin D. Findings: Amounts of Vitamin D insufficiency (20-30 ng/mL) and deficiency (<20 ng/mL) in (mothers, neonates) were found to be (60.2%, 48.9%) and (1.1%, 2.5%) respectively. Calcium deficiency (<8.5 mg/dL) was present in 33.5% of mothers and 25% of neonates. There was a weak correlation between maternal serum and cord blood 25-hydroxy vitamin D (r=0.12, p=0.053). Conclusion: More than half of the mothers and their neonates had some degrees of vitamin D deficiency. It is recommended to evaluate the nutritional status of vitamin D in pregnant women along with public health interventions to be carried out. PMID:27157170
Heberlein, Annemarie; Leggio, Lorenzo; Stichtenoth, Dirk; Hillemacher, Thomas
This article addresses the question of 'best treatment options', which clinicians face when treating pregnant women with alcohol and opioid dependence. Studies show that alcohol consumption is associated with fetal abnormalities and long-term cognitive problems depending on the amount consumed, drinking pattern, and time of gestation. Screening and evaluation of specific interventions are important to reduce alcohol consumption during pregnancy and associated problems in infants. Opioid detoxification is only recommended beyond the first trimester and only in those pregnant women who refuse opioid maintenance therapy. Methadone is the most established treatment of pregnant opioid-dependent women, though recent results indicate some advantages of buprenorphine, slow-release oral methadone and diamorphine compared with methadone. Benzodiazepines seem to be the most recommendable option for managing alcohol withdrawal, and psychosocial interventions succeed in reducing alcohol consumption or in maintaining abstinence in alcohol-dependent pregnant women. Regarding opioid dependence, current results suggest that factors like the health status of the mother, the need for additional medications (e.g. treatment for HIV), comorbid drug dependence, and concurrent drug use need to be considered in order to find the 'best opioid substitute'.
King, Janet C.; Charlet, Sara
Discusses energy and nutrient requirements of pregnant women with respect to kcal needs and vitamins B-6, folacin, vitamin E, and intake of certain trace elements. Also discusses nutritional needs of the premature infant and the ways of supplying these nutrients. (MA)
Caluwaerts, Séverine; Fautsch, Tessy; Lagrou, Daphne; Moreau, Michel; Modet Camara, Alseny; Günther, Stephan; Di Caro, Antonino; Borremans, Benny; Raymond Koundouno, Fara; Akoi Bore, Joseph; Logue, Christopher H; Richter, Martin; Wölfel, Roman; Kuisma, Eeva; Kurth, Andreas; Thomas, Stephen; Burkhardt, Gillian; Erland, Elin; Lionetto, Fanshen; Lledo Weber, Patricia; de la Rosa, Olimpia; Macpherson, Hassan; Van Herp, Michel
We report 2 cases of Ebola viral disease (EVD) in pregnant women who survived, initially with intact pregnancies. Respectively 31-32 days after negativation of the maternal blood EVD-polymerase chain reaction (PCR) both patients delivered a stillborn fetus with persistent EVD-PCR amniotic fluid positivity.
Vidal, Zendy Evelyn Olivo; Rufino, Sergio Cuellar; Tlaxcalteco, Esteban Hernández; Trejo, Cirenia Hernández; Campos, Raúl Martínez; Meza, Mónica Navarro; Rodríguez, Rocío Coutiño; Arroyo-Helguera, Omar
Iodine is an essential element trace for the synthesis of maternal thyroid hormones needed to support normal fetal development; it also acts as an antioxidant directly or induce antioxidant enzymes indirectly. Iodine deficiency and oxidative stress are associated with pregnancy complications. This study aimed to assess the urinary iodine concentration and its relationship with the antioxidant and oxidative stress status during gestation. Pregnant women were consecutively recruited from an obstetric clinic during all gestation trimesters, and urinary iodine concentration, antioxidant, and oxidative stress were determined. Results showed that 70 % of pregnant women have optimal iodine levels (150-200 μg/L), while approximately 30 % showed mild iodine deficiency (50-99 μg/L). Oxidative stress was significantly higher, and the antioxidant status was also compromised as evidenced by decreased total antioxidant status and superoxide dismutase (SOD) activity in pregnant women with mild iodine deficiency than pregnant women with optimal iodine levels. Significant positive correlations were noted between optimal iodine levels and total antioxidant status. Oxidative stress was significantly correlated with mild iodine deficiency. However, no significant correlation was found between iodine levels and SOD and catalase activities. In conclusion, for the first time, these data suggest a correlation between iodine levels and the antioxidant status during pregnancy.
Rostamzadeh Khameneh, Zakieh; Sepehrvand, Nariman; Khalkhali, Hamid-Reza
Background While hepatitis E virus (HEV) mostly causes self-limited disease in general population, it is more severe in pregnant women. Objectives This study aimed to investigate the seroprevalence of anti-HEV IgG among a population of pregnant women in West Azerbaijan of Iran . Patients and Methods One hundred thirty six pregnant women referred to urban health centers of Urmia for pursuing pregnancy-related health services were enrolled in a descriptive, cross-sectional study. Anti-HEV IgG antibody was evaluated using enzyme-linked immunosorbent assay (enzyme-linked immunosorbent assay, ELISA; Dia.Pro; Diagnostic Bioprobes). Results Only five (3.6%) of 136 cases had positive results for anti-HEV IgG. There was no significant difference between age (P=0.88), and income level (P = 0.19) of the two seropositive and seronegative groups. All seropositive cases were from urban areas. Conclusions The seroprevalence of anti-HEV IgG is low in the population of pregnant women in , similar to the rates reported from developed countries. Effective health services and provision of safe water supplies in Urmia may take role in this low prevalence rate. PMID:24348644
Hartriyanti, Yayuk; Suyoto, Perdana S T; Muhammad, Harry F L; Palupi, Ika R
Pregnant women are encouraged to comply with dietary recommendations to meet their own nutritional needs as well as their child. Deficiency of certain nutrients may lead to morbidity of both the mother and child. In this review, information on nutrients intake of pregnant women from studies conducted in Indonesia will be analysed. A literature search of all possible sources of information was conducted. These included (i) electronic databases of PubMed, Elsevier, Science Direct, EBSCO, and Google Scholar; (ii) archives and records of the Ministry of Health; (iii) library collection in institutions such as health polytechnics, local health offices, non-government organisations and universities in Yogyakarta, Central Java, East Java Province; and (iv) articles on pregnant women's nutrient intake conducted in Indonesia in 2000 - 2010. The results were analysed descriptively by comparing them with the Estimated Average Requirements (EAR) value. Two of four studies showed mean energy intake below EAR. Protein intake was lower than EAR only in two studies, while four are in contrary to the EAR. No study showed low fat and carbohydrate intake. A large number of studies reported low average intake of calcium and iron. The reviewed studies suggest that intake of several nutrients by pregnant women in Indonesia is below the EAR.
Al-Faris, Nora A
Vitamin D deficiency has emerged as a public health problem worldwide due to its important role in health and disease. The present work is intended to examine prevalence of vitamin D deficiency among pregnant Saudi women and related risk factors. A cross-sectional study was carried out at King Fahad Medical City in Riyadh, Saudi Arabia. Serum 25-hydroxy vitamin D (25(OH)D) was measured by enzyme-linked immunosorbent assay in 160 pregnant women during the first trimester of pregnancy. Socio-demographic, lifestyle and maternal characteristics were collected and vitamin D intake was assessed using a 24-h dietary recall. Weight and height were measured using standardized methods. Vitamin D deficiency (25(OH)D < 50 nmol/L) and insufficiency (25(OH)D = 50-74 nmol/L) were reported in 50% and 43.8% of the study sample, respectively. Median serum 25(OH)D concentration was 49.9 nmol/L. Adequate vitamin D intake (≥600 IU/day) was reported among only 8.1% of pregnant women. Age group, educational level, sun exposure frequency and daytime and daily practice of exercise were significantly associated with vitamin D status. Overall, vitamin D deficiency was common among pregnant Saudi women in Riyadh. Steps should be taken to address the current situation, including increased sunlight exposure, consumption of fatty fish, and vitamin D supplements.
pregnant women in their division worked until 2 weeks before delivery. 12 Afterconvalmesew leave, wome geeamly returned to their work center. according...by circling the number In front of your choice. You may write In an answer If you feel that none of the answers is right for you. Please be honest in
Oni, Olurinde A; Tukur, Jamilu
Poor maternal nutrition, especially in rural settings, adversely affects pregnancy and birth outcomes. In many local communities, pregnant women have food taboos with consequent depletion of vital nutrients. To facilitate early identification and prompt counseling, this study aimed at describing pregnant women who are likely to keep food taboos. Data was collected from 405 pregnant women that attended antenatal care at health facilities in Saki East Local Government of Oyo state, Nigeria. Sociodemographic characteristics of the women were described using means and proportions. Using logistic regression analysis, maternal characteristics significantly associated with adherence to food taboos were identified. The data was analysed using SAS 9.2. Factors associated with food taboos were teen age, primigravidity, low body mass index, lack of formal education, and low monthly family income. Health workers should have a high index of suspicion for food taboos among pregnant women with the identified risk factors.
Njunda, Anna L.; Assob, Jules C.N.; Nsagha, Dickson S.; Kamga, Henri L.; Nde, Peter F.; Yugah, Vuchas C.
Toxoplasmosis is caused by an intracellular protozoan, Toxoplasma gondii, which has a wide geographical distribution. The congenital form results in a gestational form that can present a temporary parasiteamia that will infect the fetus. For this reason early diagnosis in pregnancy is highly desirable, allowing prompt intervention in cases of infection. The aim of this study was to determine the seroprevalence of Toxoplasma gondii antibodies among pregnant women attending the Douala General Hospital. The study was carried out between March and July 2009, whereby 110 pregnant women were tested for IgG and IgM antibodies and information about eating habits and hygienic conditions was collected using a questionnaire. These women's ages ranged from 20–44 years old with an average of 29.9 years; the overall IgG and IgM seroprevalence was 70% and 2.73 % respectively. Seroprevalence was significantly high amongst women who ate raw vegetables (76.39%, P<0.05) and there was a significant trend towards a higher seroprevalence in women who did not have a good source of water (75.58%, P<0.05). This research showed that consumption of raw vegetables and poor quality drinking water are two risk factors associated with Toxoplasma gondii infection amongst pregnant women attending the Douala General Hospital in Cameroon. PMID:28299065
Borghei, Narjes Sadat; Taghipour, Ali; Roudsari, Robab Latifnejad; Keramat, Afsaneh; Noghabi, Hadi Jabbari
Considering that empowering expectant mothers is an important issue to maintain a healthy pregnancy, this study was conducted to evaluate the predictors of empowerment among Iranian pregnant women. This cross sectional study was conducted in Golestan, North of Iran in 2015. A total number of 161 pregnant women were selected through random cluster sampling from urban health centers, using PASS software. The socio-political, educational, and mental-financial predictors of empowerment were measured using a self-structured questionnaire during pregnancy and was analyzed by a linear regression model using SPSS version 16. The findings of linear regression showed that educational dimension of empowerment had the highest coefficient in the regression model, on total empowerment (βeta standardized coefficient [β]=0.696 with DW=1.830 and means error=0). The total empowerment score of pregnant women was controlled by individual factors such as the age of marriage (β-0.228), employment (β-0.210), and educational factors such as participation in prenatal education classes (β-0.246), and moral issues such as sense of spiritual support (β-0.217). By recognizing and observing predictors of empowerment during pregnancy, health care providers can increase women's power over their pregnancy. Educational predictors of empowerment were the most important factors to empower women during pregnancy. The objective of childbirth education classes, therefore, should shift from simply giving information to women, towards giving them appropriate knowledge in order to provide them with empowerment during pregnancy.
Anwar, N; Zaman, N; Nimmi, N; Chowdhury, T A; Khan, M H
There have been an association between systemic diseases and hormonal changes particularly diabetes which has been cited as a risk factor in the progression of periodontitis in pregnant women. The incidence and severity of periodontal diseases are increasing at a higher rate and a common condition in pregnant diabetic women among Bangladeshi population. This cross sectional study included 200 pregnant women who were selected from gynecological department and examined at the dental unit. The clinical parameters used were the Silness and Loe plaque index (PI), gingival scores and periodontal status and any relationship to socio demographic variables (age, occupation, level of education and urban or rural residence) and clinical variables (gestation period, previous pregnancy, type of diabetes and periodontal maintenance) were evaluated. The results showed that these clinical parameters increased concomitantly with an increase in the stage of pregnancy and in women with multiple pregnancies. Increased age, lower level of education, unemployment and patients residing in rural areas were associated with significantly higher gingival scores and periodontal measures. Women with increased age and multiple pregnancies usually have less interest to frequent periodontal maintenance showing a significant statistical relation between an increased age and changes in gingival and periodontal status; however no significant association was found between increased age and plaque index. It is concluded that gingival inflammatory symptoms are aggravated during pregnancy in diabetic women and are related to different clinical and demographic variables.
Tuschy, B; Berlit, S; Hägele, F; Job, H; Sütterlin, M; Kehl, S; Siemer, J
The aim of this study was to evaluate expectations of pregnant women on an ideal maternity hospital. We prospectively performed a survey among 566 pregnant women with regard to their expectations on a perfect hospital for obstetrics. Data collection was accomplished in 3 obstetrical departments in Mannheim, Germany. The questionnaire contained 23 general questions about sociodemographic characteristics and 34 specific questions about the anticipated childbirth. Women who were less than 20 weeks pregnant and women who did not speak German fluently were excluded from this study. In our survey the possibility to get to know midwifes and doctors at information evenings and a guided delivery room tour were defined as very important factors by the interviewed women. Of particular importance was a continuous care by a single midwife and the physical attendance of a family member during childbirth. Furthermore, friendliness of the staff and medical care by paediatricians after childbirth were identified to be important. To some extent, a modern appearance of the ward was also a matter of importance. The medical treatment of mother and the newborn child and the friendliness of the staff have been identified as the most important factors with regard to the expectations of women on an ideal maternity hospital. In addition, a pleasant ambiance of the ward and regular visits by a lactation specialist were named as important. © Georg Thieme Verlag KG Stuttgart · New York.
Gogol', K N; Gotsiridze, E G; Guruli, Z V; Kintraia, N P; Tsaava, F D
Our study revealed that refugee status increases the risks and worsens the outcome of pregnancy among Georgian refugees. 125 Georgian refugee women participated in this study. The study included examinations of the psychological status of expecting mothers, clinical development of pregnancy, complications of labor, functional status of the fetus, and EEG and neuro-ultrasound data of newborns. The control group comprised 125 pregnant women who experienced no stress during pregnancy. An examination of the psycho-emotional status of pregnant refugee women revealed high percentage indicators (82%) for hypochondria, depression, psychopathy, hysteria and psychoastenia in contrast to the control group. The deterioration of psycho-emotional status and biochemical indicators in pregnant refugee women was directly proportional to the worsening of functional and clinical conditions in fetuses. Prolonged stress is the cause of increased morbidity and mortality during pregnancy and child birth in refugee women. Infants born to refugee women also faced increased risks and belong to the group of special premature care and observation.
Bouyou-Akotet, Marielle K; Ionete-Collard, Denisa E; Mabika-Manfoumbi, Modeste; Kendjo, Eric; Matsiegui, Pierre-Blaise; Mavoungou, Elie; Kombila, Maryvonne
Background In areas where malaria is endemic, pregnancy is associated with increased susceptibility to malaria. It is generally agreed that this risk ends with delivery and decreases with the number of pregnancies. Our study aimed to demonstrate relationships between malarial parasitaemia and age, gravidity and anaemia in pregnant women in Libreville, the capital city of Gabon. Methods Peripheral blood was collected from 311 primigravidae and women in their second pregnancy. Thick blood smears were checked, as were the results of haemoglobin electrophoresis. We also looked for the presence of anaemia, fever, and checked whether the volunteers had had chemoprophylaxis. The study was performed in Gabon where malaria transmission is intense and perennial. Results A total of 177 women (57%) had microscopic parasitaemia; 139 (64%)of them were primigravidae, 38 (40%) in their second pregnancy and 180 (64%) were teenagers. The parasites densities were also higher in primigravidae and teenagers. The prevalence of anaemia was 71% and was associated with microscopic Plasmodium falciparum parasitaemia: women with moderate or severe anaemia had higher parasite prevalences and densities. However, the sickle cell trait, fever and the use of chemoprophylaxis did not have a significant association with the presence of P. falciparum. Conclusions These results suggest that the prevalence of malaria and the prevalence of anaemia, whether associated with malaria or not, are higher in pregnant women in Gabon. Primigravidae and young pregnant women are the most susceptible to infection. It is, therefore, urgent to design an effective regimen of malaria prophylaxis for this high risk population. PMID:12919637
Matthews, Jennifer; Huberty, Jennifer L; Leiferman, Jenn A; McClain, Darya; Larkey, Linda K
Depression affects up to 23% of pregnant women and is associated with adverse physical/mental health outcomes for both the mother and baby. Depressed pregnant women may be more likely to engage in unhealthy lifestyle behaviors that contribute to an increased risk for chronic disease. Little is known regarding depressed pregnant women's perceptions, uses of, and interests in complementary health approaches. Study participants (mean age 28.7 ± 6.8; n = 1032) included pregnant women ≥8 weeks gestation who responded to a survey assessing physical and mental health and wellness practices. Of those completing the survey, depressed pregnant women (n = 272) had significantly higher levels of anxiety (P < .001) and stress (P < .001) and had poorer sleep quality (P < .001), mindfulness (P < .001), and social support (P < .001) compared to nondepressed pregnant women (n = 760). A majority (84%) of depressed pregnant women would consider using a complementary health approach for weight and/or stress management during pregnancy, and more than 50% were interested in yoga.
Burst, H V
The issues and concerns of the 85 percent of essentially healthy women who have normal pregnancies and births are reviewed. The importance of their issues in relation to their health care and outcomes is discussed. PMID:3120221
Li, Ling-Jun; Ikram, M. Kamran; Broekman, Leutscher; Cheung, Carol Yim-Lui; Chen, Helen; Gooley, Joshua J.; Soh, Shu-E; Gluckman, Peter; Kwek, Kenneth; Chong, Yap-Seng; Meaney, Michael; Wong, Tien-Yin; Saw, Seang-Mei
Purpose Depression, anxiety, and poor sleep are associated with increased risks of cardiovascular diseases. Previous studies have demonstrated the relationship between negative emotion and retinal microvascular changes among adults, yet no study has been done in pregnant women so far. This study aims to examine the association of antenatal mental health and retinal vascular caliber among Asian pregnant women. Methods Nine hundred and fifty two Asian pregnant women aged 18 to 46 years were included in this study, who were recruited from two Singapore cohort studies, the Growing Up in Singapore Towards Healthy Outcomes (GUSTO) study and the In Vitro Fertilization (IVF) study conducted from 2009 onwards. A total of 835 Asian pregnant women underwent retinal photography at 26 weeks follow up, of whom 800 had gradable photographs. Symptoms of depression, anxiety, and sleep quality were assessed with self-administered questionnaires. Results In multiple linear regression models adjusted for age, ethnicity, household income, pregnancy outcome history, means of conception, hypertension history, diabetes history, cigarette smoking history, mean arterial blood pressure, body mass index, and spherical equivalent, each standard deviation (SD) increase in the Edinburgh Postnatal Depression Scale (EPDS) (4.49 scores) and in the Pittsburgh Sleep Quality Index (PSQI) (2.90 scores) was associated with a 0.80 μm (P = 0.03) and a 1.22 μm (P = 0.01) widening in retinal arteriolar caliber, respectively. Conclusions Our study demonstrates relationships of antenatal depressive symptoms and poor sleep quality with retinal arteriolar widening in pregnant women. Translational Relevance We speculate that this might possibly indicate an effect of antenatal depression and poor sleep on the microcirculation during pregnancy. PMID:24049713
Witczak, Monika; Ferenc, Tomasz; Gulczyńska, Ewa; Nowakowska, Dorota; Łopaczyńska, Dobrosława; Wilczyński, Jan
Pregestational diabetes mellitus (type 1 and type 2) affects about 1% of the obstetric population. In diabetes, persistent hyperglycemia can be a source of DNA damage via overproduction of reactive oxygen species (ROS). Using the cytokinesis-block micronucleus (CBMN) test, we measured the frequencies of micronuclei (MN) per 1000 binucleated (BN) cells in pregnant women (mothers) with type 1 diabetes mellitus (T1DM) and in their newborns. Peripheral blood lymphocytes were collected from 17 pregnant women with T1DM and cord-blood lymphocytes from their 17 newborns. The control group included 40 pregnant women (mothers) without diabetes mellitus (DM) and their 40 newborns. In the group of pregnant women with T1DM, the mean number of MN per 1000 BN cells was 2.35 (±1.07), significantly (p<0.001) higher than in the control group of pregnant women (0.86±0.90). The frequency value in the group of newborns of T1DM mothers was 1.42 (±0.60), significantly (p<0.05) higher than in the corresponding control group (0.67±0.79). The value in the group of mothers with T1DM was significantly (p<0.05) higher than in their newborns. Comparing mothers without DM with their newborns, no significant frequency differences were observed. No significant correlations were observed between MN frequencies in mothers with T1DM and either the frequencies in their newborns, the duration of diabetes, or HbA1C levels. Our results indicate that T1DM is accompanied by increased frequencies of MN in pregnant women and their newborns.
de Bruyn, Maria; Paxton, Susan
With increased availability of antiretroviral therapy, there is an escalating global trend to test all pregnant women for HIV in order to stop perinatal transmission. However, insufficient consideration is given to the impact this may have on the lives of these women and their families. Many women feel pressured into HIV testing during pregnancy, do not receive adequate pre-test counselling or do not give truly informed consent. Some women who test positive experience significantly more discrimination from their partners, families and community members than HIV-positive men do. As a consequence, large numbers of women diagnosed during pregnancy do not tell their husband their status because they fear blame, abandonment or abuse, including physical assault. Women who do disclose their HIV status may face dramatic negative repercussions on their own and their children's wellbeing. Consequently, it is unfair to test women during pregnancy solely or mainly to help prevent perinatal transmission if there are no available support services to protect the women's rights, enable them to live healthy after an HIV-positive diagnosis and engage them in the policies and programmes that affect women's lives. We need to create a climate that encourages HIV testing before pregnancy so that women can make informed reproductive choices. Men must be brought into the testing process through couple counselling before pregnancy and scaling up of voluntary counselling and testing programmes outside the antenatal care setting. In addition, people living with HIV have unique expertise and are very effective as peer counsellors. They have been under-utilised in the health care sector to provide support to newly-diagnosed people and to help eliminate AIDS-related shame and stigma.
Simeone, Regina M; Shapiro-Mendoza, Carrie K; Meaney-Delman, Dana; Petersen, Emily E; Galang, Romeo R; Oduyebo, Titilope; Rivera-Garcia, Brenda; Valencia-Prado, Miguel; Newsome, Kimberly B; Pérez-Padilla, Janice; Williams, Tonya R; Biggerstaff, Matthew; Jamieson, Denise J; Honein, Margaret A
residing in Puerto Rico. As of May 12, 2016, the surveillance systems were monitoring 157 and 122 pregnant women with laboratory evidence of possible Zika virus infection from participating U.S. states and territories, respectively. Tracking and monitoring clinical presentation of Zika virus infection, all prenatal testing, and adverse consequences of Zika virus infection during pregnancy are critical to better characterize the risk for congenital infection, the performance of prenatal diagnostic testing, and the spectrum of adverse congenital outcomes. These data will improve clinical guidance, inform counseling messages for pregnant women, and facilitate planning for clinical and public health services for affected families.
... during pregnancy can result in neonatal abstinence syndrome (NAS). NAS occurs when heroin passes through the placenta to ... weight gain, tremors, diarrhea, vomiting, and possibly death. NAS requires hospitalization and treatment with medication (often morphine) ...
Kayye, Paul T.; Relos, Ruth
This document contains a report from the North Carolina Task Force for the Prevention of Substance Use Among Pregnant Women, a task force established to develop a long-range plan to decrease infant death and disability due to exposure to toxic substances in utero. The executive summary identifies four major problem areas which negatively affect…
... 42 Public Health 4 2010-10-01 2010-10-01 false Qualified pregnant women and children who are not... Categorically Needy Mandatory Coverage of Pregnant Women, Children Under 8, and Newborn Children § 435.116 Qualified pregnant women and children who are not qualified family members. (a) The agency must...
... 42 Public Health 4 2011-10-01 2011-10-01 false Pregnant women eligible for extended coverage. 435... Mandatory Coverage of Special Groups § 435.170 Pregnant women eligible for extended coverage. (a) The agency... pregnancy to women who, while pregnant, applied for, were eligible for, and received Medicaid services on...
... 42 Public Health 4 2013-10-01 2013-10-01 false Pregnant women eligible for extended coverage. 436... ISLANDS Mandatory Coverage of the Categorically Needy § 436.122 Pregnant women eligible for extended... period following termination of pregnancy to women who, while pregnant, applied for, were eligible for...
... 42 Public Health 4 2014-10-01 2014-10-01 false Pregnant women eligible for extended coverage. 436... ISLANDS Mandatory Coverage of the Categorically Needy § 436.122 Pregnant women eligible for extended... period following termination of pregnancy to women who, while pregnant, applied for, were eligible for...
... 42 Public Health 4 2012-10-01 2012-10-01 false Pregnant women eligible for extended coverage. 436... ISLANDS Mandatory Coverage of the Categorically Needy § 436.122 Pregnant women eligible for extended... period following termination of pregnancy to women who, while pregnant, applied for, were eligible for...
... 42 Public Health 4 2012-10-01 2012-10-01 false Pregnant women eligible for extended coverage. 435... Mandatory Coverage of Special Groups § 435.170 Pregnant women eligible for extended coverage. (a) The agency... pregnancy to women who, while pregnant, applied for, were eligible for, and received Medicaid services on...
... 42 Public Health 4 2011-10-01 2011-10-01 false Pregnant women eligible for extended coverage. 436... ISLANDS Mandatory Coverage of the Categorically Needy § 436.122 Pregnant women eligible for extended... period following termination of pregnancy to women who, while pregnant, applied for, were eligible for...
... 42 Public Health 4 2011-10-01 2011-10-01 false Qualified pregnant women and children who are not... Categorically Needy Mandatory Coverage of Pregnant Women, Children Under 8, and Newborn Children § 435.116 Qualified pregnant women and children who are not qualified family members. (a) The agency must provide...
Bautista-Castaño, Inmaculada; Alemán-Perez, Nestor; García-Salvador, Jose Juan; González-Quesada, Alicia; García-Hernández, Jose Angel; Serra-Majem, Lluis
Different epidemiological studies have shown that maternal excess of weight during pregnancy is associated with adverse outcomes of pregnancy, childbirth and morbidity of the neonate. Prevalence of obesity in a pregnant population of Canary Islands is reported here. The group studied was an integrated cohort of all the pregnant women being followed-up at the Materno-Infant University Hospital of the Canarias [Hospital Universitario Materno-Infantil de Canarias; HUMIC] and who concluded their gestation during the year 2008 (n=6693). BMI was measured at the beginning of the pregnancy. 25.0% of the sample of pregnant women were overweight and 17.1% were obese, increasing both with age and not influenced with the educational level. The prevalence of obesity and overweight among pregnant women from the Canary Islands is high. Among the values available from other European countries, only the UK reported values greater than our study sample. Copyright © 2010 Elsevier España, S.L. All rights reserved.
Gay, Cynthia L; Mwapasa, Victor; Murdoch, David M; Kwiek, Jesse J; Fiscus, Susan A; Meshnick, Steven R; Cohen, Myron S
There are limited data on acute HIV infection (AHI) prevalence during pregnancy. Malawian pregnant women admitted in the third trimester and meeting eligibility criteria underwent dual HIV rapid antibody testing. AHI prevalence was retrospectively detected through HIV RNA pooling of seronegative plasma. Among 3,825 pregnant women screened, dual HIV rapid testing indicated that 30.2% were HIV positive, 69.7% were HIV negative, and 0.1% were indeterminate. Sensitivity and specificity of dual rapid testing was 99.0% and 98.7%, respectively. Of 2,666 seronegative specimens, 2,327 had samples available for HIV RNA pooling; 5 women (0.21%) (95% confidence interval, 0.03-0.40%) had AHI with a median peripartum viral load of 1,324,766 copies/mL. Pregnant women are at risk for AHI, warranting counseling of all women and their sexual partners about incident HIV during pregnancy. Dual HIV rapid tests have high sensitivity and specificity. HIV testing should be repeated in the third trimester and/or at delivery.
Kirbas, Ozgur; Biberoglu, Ebru Hacer; Kirbas, Ayse; Daglar, Korkut; Kurmus, Ozge; Danisman, Nuri; Biberoglu, Kutay
Bile acids can induce arrhythmia by altering cardiomyocyte contractility or electrical conduction. The aim of this study was to investigate, by means of QT dispersion parameter detected by simple standard electrocardiogram (ECG), ventricular repolarization changes in pregnant women with and without intrahepatic cholestasis of pregnancy (ICP). In this case-control study including 75 pregnant women with cholestasis and 35 healthy, uncomplicated pregnancy cases, electrocardiographic QT interval durations and QT dispersion (QT-disp) parameters, corrected for the patients' heart rate using the Hodges formula, were investigated. Maximum corrected QT interval values were significantly higher in the severe ICP group than in the control group (p < 0.001) and significantly higher in the severe ICP group than in the mild ICP group (p = 0.01). The values of the mild ICP and control groups were similar. Corrected QT-disp values were also significantly higher in both ICP groups than in the control group and significantly higher in the severe ICP group than in the mild ICP group. Cholestatic diseases predispose patients to cardiovascular complications. Our data clearly demonstrated that QT-disp values were significantly altered in pregnant women with cholestasis when compared to the normal ones. This simple ECG parameter can be used to screen high-risk women, in order to better target counseling regarding lifestyle modifications and to conduct closer follow up and management of women with a history of ICP. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Gay, Cynthia L.; Mwapasa, Victor; Murdoch, David M.; Kwiek, Jesse J.; Fiscus, Susan A.; Meshnick, Steven R.; Cohen, Myron S.
Introduction There are limited data on acute HIV infection (AHI) prevalence during pregnancy. Methods Malawian pregnant women admitted in the third trimester and meeting eligibility criteria underwent dual HIV rapid antibody testing. AHI prevalence was retrospectively detected through HIV RNA pooling of seronegative plasma. Results Among 3825 pregnant women screened, dual HIV rapid testing indicated that 30.2% were HIV positive, 69.7% were HIV negative and 0.1% were indeterminate. Sensitivity and specificity of dual rapid testing was 99.0% and 98.7%, respectively. Of 2666 seronegative specimens, 2327 had samples available for HIV RNA pooling; 5 women (0.21%) (95% CI: 0.03, 0.40%) had AHI with a median peripartum viral load of 1,324,766 copies/mL. Discussion Pregnant women are at risk for AHI, warranting counseling of all women and their sexual partners about incident HIV during pregnancy. Dual HIV rapid tests have high sensitivity and specificity. HIV testing should be repeated in the third trimester and/or at delivery. PMID:20226326
Zheng, Shan; Wang, Minzhen; Bai, Ya'na; Hu, Xiaobin; Zhang, Rongqiang; Du, Wenqi; Li, Liansheng; Li, Jingyu; Cheng, Ning
To investigate the impact of family members and health care providers on the use of folic acid supplements in pregnant women, and to provide basic data for improving the effectiveness of folic acid intervention. A cross-sectional study was conducted in hospitals and households from June to September in 2009. Face-to-face anonymous questionnaires were distributed to 2094 women, who were pregnant at least three months or postpartum in one year, in two counties of Gansu Province. The awareness rate of folic acid was in 62.2% of 2094 pregnant women, and 25.4% of them have taken folic acid. Higher knowledge about folic acid of family members (OR = 0.268, 95% CI 0.208 - 0.346), agreed with taking folic acid by family members (OR = 0.103, 95% CI 0.031 -0.338), and urging pregnant women to take folic acid by family members (OR = 0.147, 95% CI 0.115 - 0.190) were significant predictors for having folic acid taken by pregnant women. Propagating knowledge related to folic acid (OR = 0.252, 95% CI 0.197 - 0.323) and directing pregnant women to use folic acid (OR = 0.168, 95% CI 0.096 - 0.296) by health care providers were also the important predictors for folic acid intake. Family members and health care providers play an important role in affecting the use of folic acid among pregnant women. In order to improve the effectiveness of intervention with folic acid, family members of pregnant women and health care providers should be included into the target population to receive an intensive propaganda campaign on folic acid education to improve the use of folic acid in pregnant women extensively.
Lund, Ingunn Olea; Skurtveit, Svetlana; Engeland, Anders; Furu, Kari; Ravndal, Edle; Handal, Marte
This study describes the use of prescribed drugs among women in opioid maintenance treatment (OMT) prior to, and during, pregnancy. This cohort study was based on data from two nationwide databases: the Medical Birth Registry of Norway and the Norwegian Prescription Database. Norway, 2004-2010. OMT drugs were dispensed to 138 women with 159 pregnancies. All prescription drugs dispensed to women in OMT three months prior to, and during, pregnancy were studied. Amounts of benzodiazepines, z-hypnotics and opioid analgesics dispensed during pregnancy were studied and bivariate analysis was used to study neonatal outcomes of OMT pregnancies with and without such co-medication. The prevalence of prescription drug use by pregnant OMT women was high both during the three-month period prior to (69%), and during (81%), pregnancy. The proportion of pregnant women that was dispensed anti-infectives (48%) and/or drugs acting on the nervous system (45%) during any time in pregnancy was especially high. In 21%, 15% and 13% of the pregnancies the women were dispensed benzodiazepine anxiolytics, opioid analgesics or benzodiazepine hypnotics respectively. Only 5% of the OMT women were dispensed antidepressants. Malformations were significantly more common among children born to mothers in OMT that received co-medication with opioids, benzodiazepines or z-hypnotics. A higher proportion of women in opioid maintenance treatment in Norway use prescription drugs prior to, and during, pregnancy than pregnant women in the general population. Co-medication with drugs with abuse potential may increase the risk of adverse pregnancy outcomes and this need to be further addressed. © 2012 The Authors, Addiction © 2012 Society for the Study of Addiction.
Adeniyi, A A; Ogunbanjo, B O; Sorunke, M E; Onigbinde, O O; Agbaje, M O; Braimoh, M
Good oral health is a fungamental component of pregnant women overall health and quality of life. To determine the proportion of dental services utilisation and the reasons for non utilisation among women receiving antenatal care at the Lagos State University Teaching Hospital (LASUTH). A cross-sectional study of all pregnant women receiving antenatal care in a Nigerian teaching hospital (LASUTH) between July and September 2008 was conducted. The study assessed the women's opinions on regular dental visits, dental visits during pregnancy, the frequency of utilization of oral health services before and during pregnancy and their reasons for non-attendance. Three hundred and forty two (342) pregnant women with age range 18 to 44 years (mean 30.37 +/- 4.5) participated in the study. Only 163 respondents (33.0%) reported ever visiting a dentist, 24 (7.0%) had done so just before or during the present pregnancy. Among the dental clinic attendees the commonest reason for attendance was pain (88 women or 53.9%). Majority (62%) of those who had never visited a dentist attributed their non-attendance to the absence of dental pain. There was a significant relationship between the respondent's age and the utilization of dental services (p < 0.001). The older women had utilised dental services more often than their younger counterparts. Educational level and ethnic grouping were not significantly related to their use of dental services. A high proportion of women receiving antenatal care at LASUTH do not visit the dentist regularly. It is important to provide women in the reproductive age with information on the benefit of regular dental care especially during pregnancy.
Mancuso, Alfredo; De Vivo, Antonio; Fanara, Giusi; Settineri, Salvatore; Giacobbe, Annamaria; Pizzo, Alfonsa
The aim of this study was to investigate the frequency of recall and the content of dreams during pregnancy, as well as their correlation with socio-demographic, obstetric and physician-patients relationship variables, emotional state and duration of labour. A questionnaire, designed to analyse background characteristics, was given to 290 women in the third trimester of gestation. The psychiatric analysis of anxiety and depression was performed using the Hamilton Rating Scale for Anxiety and the Montgomery-Asberg Depression Rating Scale, while dreams were divided into masochistic and pleasant according to Beck's criteria. Oneiric activity was found to be associated with age >or= 35 years, higher family income, higher educational level, and a "satisfactory" physician-patient relationship. Masochistic content was associated with age<35 years, quality of information and frequent thoughts of delivery. Concerning the emotional state, depression levels were higher in women reporting masochistic dreams, while no difference in anxiety levels was found. Labour duration was shorter in the dreamer group and in patients with masochistic dream content. These findings may indicate that, also in pregnancy, the number and the content of dreams are influenced by women's mood and that the evaluation of the oneiric activity might represent a useful tool for clinicians either to investigate the women's emotional state or to predict its repercussions on the course of labour.
Carter, Shannon K; Guittar, Stephanie Gonzalez
previous research has examined emotional labour as an important component of the occupational work of midwives and gynaecological nurses. Fewer studies explore emotion work by women during normal pregnancy and birth, and existing studies emphasise emotion work based on the midwife-woman relationship. This study explores use of emotion work during pregnancy and birth among a sample of women. the study objective is to identify the mechanisms and purposes of emotion work among women during pregnancy and birth. data consist of 18 in-depth interviews with women regarding their pregnancy and birth experiences and seven online pregnancy journals. Data were analysed to identify themes in participant's descriptions of emotion work during pregnancy and birth. participants described four methods of emotion work that included shifting cognitive focus, exerting control, social support and using technology. Participants used emotion work for the four main purposes of maintaining their own and their babies' health, coping with negative events, managing pain, and achieving their desired birth. Although some emotion work was undertaken in relational context with the midwife or partner, much of the emotion work described took place in solitude. social support from midwives or partners was a form of emotion work that facilitated positive interpretations of the birth experience. Published by Elsevier Ltd.
Ogunmodede, Folashade; Jones, Jeffery L.; Scheftel, Joni; ...
Background: Listeriosis is a food-borne disease often associated with ready-to-eat foods. It usually causes mild febrile gastrointestinal illness in immunocompetent persons. In pregnant women, it may cause more severe infection and often crosses the placenta to infect the fetus, resulting in miscarriage, fetal death or neonatal morbidity. Simple precautions during pregnancy can prevent listeriosis. However, many women are unaware of these precautions and listeriosis education is often omitted from prenatal care. Methods: Volunteer pregnant women were recruited to complete a questionnaire to assess their knowledge of listeriosis and its prevention, in two separate studies. One study was a nationalmore » survey of 403 women from throughout the USA, and the other survey was limited to 286 Minnesota residents. Results: In the multi-state survey, 74 of 403 respondents (18%) had some knowledge of listeriosis, compared with 43 of 286 (15%) respondents to the Minnesota survey. The majority of respondents reported hearing about listeriosis from a medical professional. In the multi-state survey, 33% of respondents knew listeriosis could be prevented by not eating delicatessen meats, compared with 17% in the Minnesota survey ( p = 0.01). Similarly, 31% of respondents to the multi-state survey compared with 19% of Minnesota survey respondents knew listeriosis could be prevented by avoiding unpasteurized dairy products (p = 0.05). As for preventive behaviors, 18% of US and 23% of Minnesota respondents reported avoiding delicatessen meats and ready-to-eat foods during pregnancy, whereas 86% and 88%, respectively, avoided unpasteurized dairy products. Conclusions: Most pregnant women have limited knowledge of listeriosis prevention. Even though most respondents avoided eating unpasteurized dairy products, they were unaware of the risk associated with ready-to-eat foods. Improved education of pregnant women regarding the risk and sources of listeriosis in pregnancy is needed.« less
Diouf, A; Kebe, F; Faye, E O; Diallo, D; Ndour Sarr, A; Mboup, S; Diadhiou, F
The epidemiologic and sociodemographic characteristics of human deficiency virus (HIV) infection vary from one country to another. The objective of this study was to determine the prevalence of HIV infection in pregnant women in Dakar and associated factors. Systematic anonymous screening was performed in pregnant women admitted to the maternity ward. Women whose seropositivity was confirmed by Western blot retroviral serology were included. One woman out of four was assigned by simple random selection to the case control group. Over a 24 month period, 12,498 women were tested. 104 were seropositive (44 HIV1, 58HIV2, and 2 HIV1-HIV2 giving a prevalence of 0.8%. Factors associated with HIV1 and HIV2 were different: mean age 21.7 years for HIV1 versus 30.6 for HIV 2 (p = 0.05); origin in Guinea-Bissau for HIV2 (p = 0.001); mean number of pregnancies 2.6 for HIV1 versus 5.9 for HIV2 (p = 0.001); mean parity 1.5 for HIV1 versus 4.5 for HIV2 (p < 0.01); vitality of the conception product in 85.1% for HIV2 versus 67.5% for HIV1 (p = 0.0001). These data confirm the low prevalence of HIV infection in pregnant women, with a predominance for HIV2. The factors identified in associated with virus type suggest a different mode of transmission and/or reduced virulence or HIV2 compared with HIV1. Knowledge of these factors helps orient management strategies, especially in pregnant women.
García-Solís, Pablo; Solís-S, Juan Carlos; García-Gaytán, Ana Cristina; Reyes-Mendoza, Vanessa Amaranta; Robles-Osorio, Ludivina; Hernández-Montiel, Hebert Luis; Leo-Amador, Guillermo Enrique
Iodine nutrition during pregnancy has become an important public health concern because of the deleterious impact of iodine deficiency on brain development during fetal and early postnatal life. Iodine nutrition status can be assessed in a population by the median urinary iodine concentration (UIC). World Health Organization, the United Nations Children's Fund, and the International Council for Iodine Deficiency Disorders have established that a median of UIC between 150 and 249 μg/L in pregnant women indicates an adequate iodine intake. The aim of this study was to assess iodine nutrition status in Mexican pregnant women. Two hundred ninety-four pregnant women receiving prenatal care in the Public Medical Units of the State Ministry of Health for each pregnancy trimester (first, n=60; second, n=103; and third, n=131) in Queretaro, Mexico, were enrolled to assess UIC by the Sandell-Kholtoff method. The median of UIC was 273, 285, and 231 μg/L in the first, second, and third trimesters of gestation, respectively. Globally, the median (range) of UIC was 260 (5-1320) μg/L, and the percentage of samples with UIC below 150 μg/L was 28%. There was no significant difference between the UIC of women using iodine-containing multivitamins compared with those who reported the consumption of noniodized multivitamins (p>0.05). In addition, we found no difference between the UIC of women using iodized table salt compared with those who employed noniodized table salt, with those who did not know whether their table salt was iodized (p>0.05). Based on the median UIC, iodine intake in Queretaro, Mexico, is slightly above requirements during the first two trimesters, and adequate in the third trimester. The wide Mexican universal iodized salt program seems to supply adequate dietary iodine to pregnant women without health insurance in this region. However, regular monitoring of iodine status is recommended during pregnancy throughout Mexico.
The aim of this study was to investigate the experience of birth planning for pregnant women. Research in Australia and overseas has suggested that there are a number of conflicting issues with women's preparation and participation in childbirth. The researcher interviewed forty-two first time mothers in a variety of maternity settings around Victoria to ascertain the importance of birth planning in their approach to childbirth and the ways they went about making their plan and negotiating their needs with health professionals. The data from those interviews demonstrated that the means women used to negotiate their needs for childbirth with health professionals had little influence on their overall pregnancy and birth experience.
Lucas, Faith W
Past research related to pregnancy outcomes has tended to have a bio-medical focus. More recent research has begun to explore possible social and cultural influences on birth outcomes. Qualitative interviews were conducted with 28 pregnant women of Mexican descent in the Texas/Mexico border region to begin to describe the social and cultural contexts of pregnancy of women of Mexican ancestry. Participants' constructions surrounding pregnancy focused on the mother role. Goodness of fit between constructions of the mother role and women's lives and self-concepts resulted in positive or negative feelings about motherhood.
Nordeng, Hedvig; Koren, Gideon; Einarson, Adrienne
Beliefs about medication may impact a woman's decision to take a needed medication during pregnancy. While many women will be faced with decisions regarding medication use during pregnancy, there is a paucity of research on this topic in the literature. To study pregnant women's beliefs about medication and factors that determine those beliefs. A questionnaire was posted at the University of Oslo's Web site for Internet surveys for 5 weeks from mid-September 2008 through October 2008. Seven general statements from the "Beliefs about Medicines" questionnaire and 9 pregnancy-specific statements were used to assess pregnant women's attitudes toward medication use during pregnancy. Other information, such as sociodemographic background and personal medication use during pregnancy, was also collected. A total of 866 pregnant women completed the questionnaire. Most women had a positive attitude toward medication in general, but believed pregnant women should be more restrictive regarding use than nonpregnant women. There was a significant association between women's education, occupation, and attitudes, with less educated women believing that medications in general were harmful and herbal remedies were safe, while women with a higher education were more reluctant to use any medication in pregnancy. Women with health-related occupations were more knowledgeable about the possible risks of untreated illness during pregnancy. There was also an association between pregnant women's attitudes and their use of prescribed penicillins and herbal remedies. Most pregnant women believe that medicines in general are helpful and safe to use. However, they are much more restrictive and unsure about use during pregnancy. Health-care professionals should be aware of such attitudes when advising a woman to take a needed medication during pregnancy.
Bergbom, Ingegerd; Modh, Carin; Lundgren, Ingela; Lindwall, Lillemor
The body of first-time pregnant women is affected in many ways, and the women may not know what to expect. Conversations between women and healthcare personnel about women's bodily experience in early pregnancy can contribute to increased body knowledge, which may have a positive impact in later stages of their pregnancy and in relation to delivery. The aim of the study was to describe first-time pregnant women's experiences of their body in early pregnancy (pregnancy weeks 10-14). Twelve women were asked to draw pictures and answer questions freely about their experiences of their first pregnant body. Hermeneutical text interpretation was used to obtain an overall view of the experiences. A main theme emerged: 'the body is connected to the cycle of life'. This theme comprised five subthemes: 'bodily longing and a sense of ambivalence', 'being doubtful', 'welcoming changes in body and mind', 'feeling inner strength and struggle to find strength' and 'accepting a different body and mind'. This main theme and the subthemes were further interpreted and were understood as an experience of 'me and my body'. The body reminded the women to take care of it and gave rise to positive thoughts. When the body exhibited uncomfortable reactions and sensations, these were taken as evidence of pregnancy, which was also seen positive but it also triggered a sense of dissatisfaction with the body and a feeling of it becoming alien. © 2016 Nordic College of Caring Science.
Nechuta, Sarah; Mudd, Lanay M; Biery, Lynette; Elliott, Michael R; Lepkowski, James M; Paneth, Nigel
We assessed attitudes of a multi-ethnic sample of pregnant women in regard to participation in five data collection procedures planned for use in the National Children's Study. A cross-sectional survey was conducted in nine prenatal clinics in Kent County, Michigan between April and October 2006. Women were approached in clinic waiting rooms at the time of their first prenatal visit and 311 (91.0%) participated. Women were asked about their willingness to participate, and the smallest amount of compensation required for participation in a 45-min in-person interview, a 15-min telephone interview, maternal and infant medical record abstraction, and an infant physical examination. Percentages for willingness to participate were highest for telephone interview (83%), followed by in-person interview (60%), infant examination (57%), and maternal (56%) and infant medical records (54%). About 34-48% of women reported that no compensation would be required for participation by data procedure. Some women reported unwillingness to participate in telephone (9%) or personal (17%) interview, record abstraction (34%) or infant examination (26%), even with compensation. Education greater than high school was associated with increased odds of refusal for infant physical examination, adjusted odds ratio 2.44 [95% confidence interval 1.41, 4.23]. In conclusion, 9-34% of pregnant women, depending on procedure, stated they would not participate in non-invasive research procedures such as medical record abstraction and infant examination, even with compensation. Resistance to these research procedures was especially noted among more highly educated women. Planning for the National Children's Study will have to address potential resistance to research among pregnant women.
Bloom, Tina L; Bullock, Linda F C; Parsons, Lindsay
Rural residence and maternal stress are risk factors for adverse maternal-child health outcomes across the globe, but rural women have been largely overlooked in maternal stress research. We recruited low-income, rural pregnant women for qualitative interviews to explore their stress exposures during pregnancy, reactions to stress, and priorities for stress reduction. We also used quantitative measures (Perceived Stress Scale, Center for Epidemiologic Studies of Depression Scale-Revised, Posttraumatic Stress Disorder Checklist-Civilian, Lifetime Exposure to Violence Scale) to describe stress exposures and reactions. We interviewed 24 pregnant rural women from a Midwestern US state, who were primarily young, white, partnered, and unemployed. Women's predominant stressor was financial stress, compounded by a lack of employment, transportation, and affordable housing options; extended family interdependence; small-town gossip; isolation/loneliness; and boredom. Quantitative measures revealed high levels of global perceived stress, violence exposure, and symptoms of depression and posttraumatic stress disorder among the sample. Women most commonly reported that employment and interventions to increase their employability would most effectively decrease their stress, but faced numerous barriers to education or job training. Tested maternal stress interventions to date include nurse-case management, teaching women stress management techniques, and mind-body interventions. Pregnant women's own priorities for stress-reduction intervention may differ, depending on the population under study. Our findings suggest that rural clinicians should address maternal stress, violence exposure, and mental health symptoms in prenatal care visits and that clinicians and researchers should include the voices of rural women in the conceptualization, design, implementation, and evaluation of maternal stress-reduction interventions.
Does provision of point-of-care CD4 technology and early knowledge of CD4 levels affect early initiation and retention on antiretroviral treatment in HIV-positive pregnant women in the context of Option B+ for PMTCT?
Mangwiro, Alexio-Zambezi; Makomva, Kudzai; Bhattacharya, Antoinette; Bhattacharya, Gaurav; Gotora, Tendai; Owen, Mila; Mushavi, Angela; Mangwanya, Douglas; Zinyowera, Sekesai; Rusakaniko, Simbarashe; Mugurungi, Owen; Zizhou, Simukai; Busumani, William; Masuka, Nyasha
Evidence for Elimination (E4E) is a collaborative project established in 2012 as part of the INSPIRE (INtegrating and Scaling up PMTCT through Implementation REsearch) initiative. E4E is a cluster-randomized trial with 2 arms; Standard of care and "POC Plus" [in which point-of-care (POC) CD4 devices and related counseling support are provided]; aimed at improving retention-in-care of HIV-infected pregnant women and mothers. In November 2013, Zimbabwe adopted Option B+ for HIV-positive pregnant women under which antiretroviral treatment eligibility is no longer based on CD4 count. However, Ministry of Health and Child Care guidelines still require baseline and 6-monthly CD4 testing for treatment monitoring, until viral load testing becomes widely available. Considering the current limited capacity for viral-load testing, the significant investments in CD4 testing already made and the historical reliance on CD4 by health care workers for determining eligibility for antiretroviral treatment, E4E seeks to compare the impact of the provision of POC CD4 technology and early knowledge of CD4 levels on retention-in-care at 12 months, with the current standard of routine, laboratory-based CD4 testing. The study also compares rates of initiation and time-to-initiation between the 2 arms and according to level of maternal CD4 count, the cost of retaining HIV-positive pregnant women in care and the acceptability and feasibility of POC CD4 in the context of Option B+. Outcome measures are derived from routine health systems data. E4E will provide data on POC CD4 testing and retention-in-care associated with Option B+ and serve as an early learning platform to inform implementation of Option B+ in Zimbabwe.
Sydsjö, A; Sydsjö, G
Sick leave rates among pregnant women have been found to vary substantially over time. 8,884 woman delivered at Linköping and Värnamo Women's Clinics in 1978, 1986, 1988, 1992, 1995 and 1997 were studied. Sick leave nearly doubled between 1978 and 1986, and dropped back to the 1978 level in 1997. The somewhat paradoxical findings in our surveys indicate that attitudes, especially as observed in the youngest age groups, together with a sensible adaptation to the prevailing terms of the social security system, may well be the most plausible explanation. Studies on sick leave among women of fertile age should preferably also contain information on the proportion of sick-listed pregnant women, as a small proportion of pregnant women may have a profound impact on sick leave statistics among all insured women of fertile age.
Lee King, Patricia A; Duan, Lei; Amaro, Hortensia
We investigated social vulnerability and behavioral health clinical profiles (symptom severity) of pregnant women with co-occurring disorders, defined as substance abuse, mental illness, and trauma at treatment entry compared to their nonpregnant counterparts and the role of interpersonal abuse in clinical presentation among pregnant women. Our objective was to provide primary health care providers with insight into the needs of pregnant patients with high behavioral health risks to serve them better during the critical window of opportunity for long-term impact. We conducted cross-sectional secondary analysis of baseline data from women enrolled in treatment programs in the Women, Co-occurring Disorders and Violence Study from nine sites across the United States. We used analysis of variance and Cochran-Mantel-Haenszel statistical analyses to compare means and frequencies of social vulnerability indicators and baseline Addiction Severity Index, Brief Symptom Inventory of mental health, and Posttraumatic Stress Diagnostic Scale scores between 152 pregnant and 2,577 nonpregnant women, and between pregnant women with and without current interpersonal abuse. Compared to nonpregnant women, pregnant women evidenced more social vulnerability but better behavioral health clinical profiles at treatment entry. Current interpersonal abuse was associated with increased mental health and trauma symptomatology but not with alcohol or drug abuse severity among pregnant women. The prenatal period is an important time for screening and intervention for factors such as social vulnerability and co-occurring disorders, known to affect pregnancy and infant outcomes; social and behavioral health services are particularly essential among pregnant women with co-occurring disorders.
Fialová, L; Mikulíková, L; Matous-Malbohan, I; Benesová, O; Zwinger, A
Antiphospholipid antibodies (APAs) are characterized as a heterogeneous population of autoantibodies directed against different target antigens, predominantly anionic phospholipids or phospholipid-containing structures. The presence of APAs has been strongly associated with a variety of clinical disorders including adverse pregnancy complications such as spontaneous abortions, pregnancy-induced hypertension, preeclampsia and intrauterine growth retardation. The purpose of this study was to compare the prevalence of anticardiolipin antibodies (ACAs), which are routinely examined, with APAs directed against phosphatidylserine (APS), phosphatidylinositol (API), phosphatidylethanolamine (APE) and phosphatidylcholine (APC) in the sera of pregnant women. We examined 410 serum samples of pregnant women hospitalized in the department for pathological pregnancies. They underwent prenatal biochemical screening of fetal congenital abnormalities in the first and the second trimester of gravidity. Anticardiolipin IgG and IgM were measured using commercial ELISA kits (ImmuLisa Anti-Cardiolipin Antibody), whereas APS, APE, API and APC were determined by our modified ELISA kit. Among 410 pregnant women we found 21 patients (5.1%) positive for ACA IgG (>20 GPL) and 30 patients (7.3%) positive for ACA IgM (>10 MPL). It was found that 7.8% of pregnant women had at least one high-titer APA IgG and 9.8% high-titer APA IgM. One third of ACA IgG or IgM positive sera contained polyspecific autoantibodies reactive to at least two various phospholipids. In the group of IgG ACA positive women, 28.6% patients were positive for APS, 28.6% were positive or moderately positive for API, 23.8% for APC and 19% for APE. In the group of IgM ACA positive women, 33.3% were also positive for APS, 26.7% for APE, 26.7% for API and 23.3% for APC were present. IgG and IgM ACA negative patients exhibited a significantly lower incidence of other APA than the group of ACA positive pregnant women. It still
Rabiepoor, Soheila; Sadeghi, Elham; Sayyadi, Hojjat
This study was aimed to investigate the relationship between spiritual health and physical activity among Iranian pregnant women during 2015. A cross-sectional descriptive-analytic design was adopted. A total number of 411 participants were selected by convenience sampling from Iranian women who regularly attended health centers for prenatal care. Data were collected using demographic questionnaire and Health-Promoting Lifestyle Profile questionnaire, 2nd edition. (Spiritual health and physical activity are two components of health-promoting lifestyle.) The data were analyzed, using descriptive statistics, t test, one-way ANOVA, Pearson's correlation coefficient, and regression. p values <0.05 were considered significant. The mean age of pregnant women was 27.90 ± 6.03 years. Spiritual health had the highest score (25.86 ± 4.7) and physical activity had the lowest score (11.31 ± 3.27), among six Health-Promoting Lifestyle Profile subscales. In fact, there was a statistically significant correlation between spiritual health and physical activity (p = 0.000). According to results, pregnant women have higher spiritual health and lower physical activity scores. There was a statistically significant correlation between spiritual health and physical activity. The findings of this study can be used in prenatal care, midwifery education, and maternal health policies.
Souza, Rodrigo Batista; Trevisol, Daisson José; Schuelter-Trevisol, Fabiana
The aim this study was to determine the in vitro susceptibility to fosfomycin of bacteria isolated from urine samples of pregnant women with urinary tract infection. Samples of urine culture with bacterial growth of pregnant women were collected from clinical laboratories in Tubarão, state of Santa Catarina, Brazil, between September 2012 and May 2013. In the experimental stage, the colonies were tested for sensitivity to fosfomycin by using the Kirby-Bauer method. The following information relating to the samples was also collected: patients' age, colony count, type(s) of identified bacterial(s) and result of the antimicrobial sensitivity test. Student's t-test was used for mean comparison. A total of 134 samples were selected for the study. The age of the subjects ranged from 15 to 40 years (mean 26.7). Escherichia coli (Gram-negative) and Staphylococcus aureus (Gram-positive) were the most commonly identified species. In 89% of cases, the microorganisms were sensitive to fosfomycin. E. coli and S. aureus were the main species of bacteria responsible for urinary tract infections in women in the study area. The most prevalent microorganisms in pregnant women with urinary tract infection were susceptible to fosfomycin.
Malek-mellouli, Monia; Amara, Fethi Ben; Loussaief, Wafa; Reziga, Hédi
Micronutrients or trace elements are minerals essential for growth and development of the body human. To analyze changes in normal pregnancy and during preeclampsia, serum iron and its main proteins: ferritin and soluble transferrin receptors. This is a prospective study of case- control study of 56 pregnant women and 30 non-pregnant women selected as controls. Pregnant women received a quarterly dosing paramètres. The same assays were performed once in controls. The comparative assay of various parameters in normal pregnancy and in control women showed a significant decrease in serum iron from 1 to the third quarter, a slight decline in reserves ferritin in 1st and 2nd quarter increases and becomes significant in the third quarter and an increase of soluble receptors trasferrine during pregnancy, which becomes significant in the third quarter. We noted a disturbance of these parameters in preeclampsia. Iron is essential for fetal development. His involvement in several maternal- fetal complications is not to dismantle .
Brzezińska, Małgorzata; Kucharska, Alicja; Sińska, Beata
Pregnant and breastfeeding women who eat vegetarian are a source of much controversy. This is the result of concern that eliminating some or all animal produce may lead to nutritional deficiencies and thus adversely affect the mother's and child's health. The American Dietetic Association's position is that appropriately planned vegan, lacto-vegetarian and lacto-ovo-vegetarian diets ensure a normal course of pregnancy and lactation. However, in practice the balancing of such a diet can pose certain difficulties, especially for individuals without the necessary experience or knowledge about nutrition. Nutrients to which particular attention needs to be paid to ensure their sufficient supply include: protein (essential amino acids), Omega-3 essential fatty acids, iron and calcium as well as vitamins D and B(12). The proper adherence to recommendations can be attained with a varied diet containing suitable plant products compensating for the nutritional value of the eliminated animal products. Supplementation with vitamin D and vitamin B(12) is also necessary. Research shows that infants born to vegetarian mothers are born at term and have normal birth weight. There is an increased risk of hypospadias in boys. The main difference in the composition of vegetarian mothers' milk compared to non-vegetarians' is lower content of docosahexaenoic acid and higher content of Linoleic and α-Linolenic acid. © 2016 MEDPRESS.
Mulyani, Erry Yudhya; Hardinsyah; Briawan, Dodik; Santoso, Budi Iman
During pregnancy, the body exhibits dynamic changes in fluid composition. More than 50%of women experience nausea and vomiting during the first trimester. Studies of hydration status in pregnant women are limited, and not in tropical countries, like in Indonesia. The objective of this study was to investigate the hydration status and appropriate biomarkers for determination of hydration status in pregnant women in West Jakarta. This study was cross-sectional. A total of 35 pregnant women aged (19-35 years) at the early second trimester of pregnancy was recruited. Urine osmolality, urine specific gravity, and serum osmolality were used to determine hydration status. Subjects then were divided into a hydration group (HG) and a dehydration group (DG). We used independent t tests, chi-square and Spearman rank correlation coefficient to analyse the data. The population was comparably divided between dehydration and hydration groups (57.1% and 42.9%, respectively). The proportions by age, parity, gestational age, height, weight, upper arm circumference, waist circumference, pelvic circumference, body temperature, blood pressure, and fundal height did not differ between groups (p>=0.05). There was a relationship between urine colour and hydration status (p<0.05). Differences in hydration biomarker status (urine osmolality and urine specific gravity) were noted between the groups (p<0.05). Dehydration may be common during pregnancy in tropical Indonesia and can be confirmed by the hydration biomarkers of urinary specific gravity and osmolality. Fluid balance is necessary to prevent health problems and intrauterine growth restriction in pregnant women.
Examining food intake patterns was an important area of study for the NCS because foods are potential vehicles for components that can promote health and for environmental contaminants that can adversely affect health.
Although there has been long-standing reluctance to include pregnant women as clinical trial participants, increasing recognition of profound gaps in research on the safety and efficacy of drugs often prescribed to pregnant women calls into question the practice of routinely excluding them. This article presents compelling reasons for including pregnant women in clinical research, highlights certain regulatory barriers to the inclusion of pregnant women, and proposes that professional societies with expertise in obstetrics and maternal-fetal medicine can be instrumental in hastening the paradigm shift from the systematic exclusion of pregnant women in research to a one of responsible and fair inclusion. Published by Elsevier Inc.
Albrecht, S A; Rankin, M
The purpose of this correlational descriptive study was to assess health behaviors, anxiety levels, and social support of pregnant women, ages 20 to 40, who were without complications and were patients of four private obstetrical practices in a large metropolitan city. Although sampling was a nonprobability approach, various socioeconomic, racial, and religious groups were represented. The three instruments used to test the hypotheses included the State-Trait Anxiety Inventory (STAI), the Personal Resource Questionnaire (PRQ) and a detailed Health Behavior Demographic Questionnaire. Results of the data indicated no significant differences between pregnant smokers' and pregnant nonsmokers' STAI or PRQ scores. Significant positive correlations were revealed between the following variables: Trait anxiety with increased age of pregnancy (r = .77, p = .008); trait anxiety with high educational level (r = .72, p = .001); trait anxiety with state anxiety (r = .64, p = .001); trait anxiety with years married (r = .68, p = .018); trait anxiety with numbers of children (r = .82, p = .005); trait anxiety with high occupation level (r = .68, p = .001), increased age with PRQ support (r = -.88, p = .001); caucasian women examined breast more frequently (r = .47, p = .005); pregnant women who were smokers also were more likely to drink (r = .66, p = .03). Significant negative correlations were: Increased state anxiety with decreased social support (r = -.28, p = .05); higher trait anxiety with lower PRQ (r = -.59, p = .001), and more drinks of alcohol per day with decreased social support (r = .88, p = .04). The study indicated that the subjects who continue to smoke while pregnant were highly educated. All had at least two years of college with 45% having completed graduate school. All were working in managerial or professional jobs. This has implications for nursing interventions focused on enhancing health coping strategies at the workplace and specific health promotion
Lee, Kathryn A; Gay, Caryl L; Alsten, Christopher R
To evaluate the feasibility and efficacy of a home-based cognitive-behavioral training program for sleep during late pregnancy. A nonrandomized quasiexperimental sample of nulliparous women who received the intervention during pregnancy (n=25) was compared with two control groups (n=76 and n=48) from other intervention studies at similar postintervention time points: approximately 1 month before childbirth and 1-2 months after childbirth. The home-based Sleep Enhancement Training System for Pregnancy consisted of 4 weeks of sound-enhanced audio relaxation programs, readings, and daily sleep diaries. Both control groups received dietary recommendations for improving sleep. Sleep duration (total sleep time) and sleep disruption (wake after sleep onset) were measured using wrist actigraphy for a minimum of 48 hours on consecutive weekdays. The intervention group had significantly longer sleep duration and less sleep disruption than both control groups, particularly at the postpartum assessment. Intervention participants slept an average of 430 (95% confidence interval [CI] 397-464) minutes during pregnancy compared with 420 (95% CI 403-438) and 417 (95% CI 395-439) minutes for the two control groups. At the postpartum assessment, the intervention group slept 446 (95% CI 415-478) minutes compared with 390 (95% CI 373-408) and 370 (95% CI 348-393) minutes for those in the control groups. In terms of sleep disruption, women in the intervention group had 16.1% (95% CI 11.9-20.2%) wake after sleep onset during pregnancy, whereas women in the control groups had 13.4% (95% CI 11.2-15.5%) and 20.4% (95% CI 17.7-23.0%). Postpartum, the intervention group had 20.3% (95% CI 16.4-24.1%) wake after sleep onset compared with 26.6% (95% CI 24.5-28.8%) and 28.7% (95% CI 26.0-31.5%) among women in the control groups. Participant feedback about the intervention was generally positive, although intervention adherence was variable. This study provides evidence of the feasibility and
Boggess, Kim A; Urlaub, Diana M; Moos, Merry-K; Polinkovsky, Margaret; El-Khorazaty, Jill; Lorenz, Carol
Racial or ethnic and economic disparities exist in terms of oral diseases among pregnant women and children. The authors hypothesized that women of a racial or ethnic minority have less oral health knowledge than do women not of a racial or ethnic minority. Therefore, the authors conducted a study to assess and compare maternal oral health knowledge and beliefs and to determine if maternal race and ethnicity or other maternal factors contributed to women's knowledge or beliefs. The authors administered a written oral health questionnaire to pregnant women. The authors calculated the participants' knowledge and belief scores on the basis of correct answers or answers supporting positive oral health behaviors. They conducted multivariable analysis of variance to assess associations between oral health knowledge and belief scores and characteristics. The authors enrolled 615 women in the study, and 599 (97.4 percent) completed the questionnaire. Of 599 participants, 573 (95.7 percent) knew that sugar intake is associated with caries. Almost one-half (295 participants [49.2 percent]) did not know that caries and periodontal disease are oral infections. Median (interquartile range) knowledge and belief scores were 6.0 (5.5-7.0) and 6.0 (5.0-7.0), respectively. Hispanic women had median (interquartile range) knowledge and belief scores significantly lower than those of white or African American women (6.0 [4.0-7.0] versus 7.0 [6.0-7.0] versus 7.0 [6.0-7.0], respectively [P < .001]; and 5.0 [4.0-6.0] versus 6.0 [5.0-7.0] versus 6.0 [5.0-7.0], respectively [P < .001]). Multivariable analysis of variance results showed that being of Hispanic ethnicity was associated significantly with a lower knowledge score, and that an education level of eighth grade or less was associated significantly with a lower belief score. Pregnant women have some oral health knowledge. Knowledge varied according to maternal race or ethnicity, and beliefs varied according to maternal education
Ordean, Alice; Kahan, Meldon; Graves, Lisa; Abrahams, Ronald; Boyajian, Talar
Abstract Objective To describe the characteristics of a national cohort of pregnant women on methadone maintenance treatment (MMT) and to provide treatment outcome data for integrated care programs. Design Retrospective chart review. Setting Three different integrated care programs in geographically distinct cities: the Toronto Centre for Substance Use in Pregnancy in Toronto, Ont; the Herzl Family Practice Centre in Montreal, Que; and the Sheway clinic in Vancouver, BC. Participants Pregnant women meeting criteria for opioid dependence and attending an integrated care program between 1997 and 2009. Women were excluded if they were on MMT only for chronic pain. Main outcome measures Patient demographic characteristics, concurrent medical and psychiatric disorders, and substance use outcome data. Results A total of 102 opioid-dependent pregnancies were included. The mean age was 29.7 years and 64% of women were white. Women in Montreal were more likely to have partners and had fewer children. Differences in living and housing situations among the sites tended to resolve by the time of delivery. Almost half of this cohort tested positive for hepatitis C. Women had a high prevalence of depression and anxiety across all sites. Half of this cohort was on MMT before conception and for the other half, MMT was initiated at a mean gestational age of 20.7 weeks, resulting in a mean dose of 82.4 mg at delivery. At the first visit, polysubstance use was common. Prescription opioid use was more frequent in Toronto and heroin use was more prevalent in Vancouver and Montreal. For the entire population, significant reductions were found by the time of delivery for illicit (P < .001) and prescription opioids (P = .001), cocaine (P < .001), marijuana (P = .009), and alcohol use (P < .001). Conclusion Despite geographic differences, all 3 integrated care programs have been associated with significant decreases in substance use in pregnant opioid-dependent women. PMID:24130301
Minozzi, S; Amato, L; Vecchi, S; Davoli, M
The prevalence of opiate use among pregnant women ranges from 1% to 2% to as much as 21%. Heroin crosses the placenta and pregnant opiate dependent women experience a six fold increase in maternal obstetric complications such as low birth weight, toxaemia, 3rd trimester bleeding, malpresentation, puerperal morbidity, fetal distress and meconium aspiration. Neonatal complications include narcotic withdrawal, postnatal growth deficiency, microcephaly, neurobehavioral problems, increased neonatal mortality and a 74-fold increase in sudden infant death syndrome. To assess the effectiveness of any maintenance treatment alone or in combination with psychosocial intervention compared to no intervention, other pharmacological intervention or psychosocial interventions on child health status, neonatal mortality, retaining pregnant women in treatment, and reducing use of substances We searched Cochrane Drugs and Alcohol Group' Register of Trials (June 2007), PubMed (1966 - June 2007), CINAHL (1982- June 2007), reference lists of relevant papers, sources of ongoing trials, conference proceedings, National focal points for drug research. Authors of included studies and experts in the field were contacted. Randomised controlled trials enrolling opiate dependent pregnant women The authors assessed independently the studies for inclusion and methodological quality. Doubts were solved by discussion. We found three trials with 96 pregnant women. Two compared methadone with buprenorphine and one methadone with oral slow morphine. For the women there was no difference in drop out rate RR 1.00 (95% CI 0.41 to 2.44) and use of primary substance RR 2.50 (95% CI 0.11 to 54.87) between methadone and buprenorphine, whereas oral slow morphine seemed superior to methadone in abstaining women from the use of heroin RR 2.40 (95% CI 1.00 to 5.77)For the newborns in one trial buprenorphine performed better than methadone for birth weight WMD -530 gr (95% CI -662 to -397), this result is not
Modh, Carin; Lundgren, Ingela; Bergbom, Ingegerd
Background There are few studies focusing on women's experiences of early pregnancy. Medical and psychological approaches have dominated the research. Taking women's experiences seriously during early pregnancy may prevent future suffering during childbirth. Aim To describe and understand women's first time experiences of early pregnancy. Method Qualitative study using a phenomenological hermeneutic approach. Data were collected via tape-recorded interviews in two antenatal care units in Sweden. Twelve first time pregnant women in week 10–14, aged between 17 and 37 years participated. Results To be in early pregnancy means for the women a life opening both in terms of life affirming and suffering. The central themes are: living in the present and thinking ahead, being in a change of new perspectives and values and being in change to becoming a mother. Conclusions The results have implications for the midwife's encounter with the women during pregnancy. Questions of more existential nature, instead of only focusing the physical aspects of the pregnancy, may lead to an improvement in health condition and a positive experience for the pregnant woman. PMID:21499449
Background Despite the widespread use of medicinal plants in Mali, knowledge about how traditional practitioners (TPs) treat pregnant and lactating women is lacking. Aim of the study The aim of this study was to investigate how traditional practitioners in Mali treat common diseases and ailments during pregnancy. Methods Data was collected through structured interviews of traditional practitioners in one urban (Bamako) and two rural areas (Siby and Dioila) in Mali. The TPs were interviewed about how they treat common diseases and ailments during pregnancy. They were also asked to name harmful plants in pregnancy and plants that could affect breast milk production. In addition, we asked about nine specific medicinal plants commonly used in Mali; Opilia amentacea (syn. Opilia celtidifolia), Ximenia americana, Cola cordifolia, Combretum glutinosum, Parkia biglobosa, Trichilia emetica, Combretum micranthum, Lippia chevalieri and Vepris heterophylla. Results A total of 72 traditional practitioners (64% women, age: 34 to 90 years) were interviewed during an eight week period October 2011 to December 2011. They treated between 1 and 30 pregnant women with medicinal plants per months. We found a relatively high consensus for treatment of pregnant women with common diseases and ailments like nausea and dermatitis. The highest informer consensus was found for the treatment of malaria during pregnancy. TPs generally recommended pregnant women to avoid medicinal plants with bitter tastes like stem and root bark of Khaya senegalensis and Opilia amentacea (syn. Opilia celtidifolia). TPs distinguished between oral (potentially unsafe) and dermal use (safe) of Opilia amentacea (syn. Opilia celtidifolia). Cola cordifolia was used to facilitate labor. Conclusion Experience and knowledge about treatment of pregnant women with medicinal plants was broad among the traditional practitioners in the three investigated regions in Mali. Collaborating with traditional practitioners on the
Meshaka, Riwa; Jeffares, Stephen; Sadrudin, Farah; Huisman, Nicole; Saravanan, Ponnusamy
Patient participation in study design is paramount to design studies that are acceptable to patients. Despite an increase in research involving pregnant women, relatively little is known about the motivational factors that govern their decision to be involved in a clinical trial, compared to other patient groups. To better understand the viewpoints of pregnant women who take part in clinical trials. We chose to use Q-Methodology, a method of exploring the structure of opinions surrounding a topic. We developed a set of 40 statements that encompassed the reasons why pregnant women might want to take part in research and 30 research participants from the PRiDE study (an observational trial investigating the role of micronutrients in gestational diabetes) were asked to rank them in order of agreement. The finished matrices from each participant were compared and analysed to produce capturing viewpoints. About 30 women aged 19-40 involved in the PRiDE study completed the questionnaire. There were two overarching motivators that emerged: a willingness to help medical research and improve our knowledge of medical science, and having a personal connection to the disease, therefore a potential fear of being affected by it. A third, less significant viewpoint, was that of a lack of inconvenience being a motivating factor. Understanding what motivates pregnant women to decide to take part in a research study is valuable and helps researchers maximize their uptake and retention rates when designing a trial involving pregnant women. © 2016 The Authors. Health Expectations Published by John Wiley & Sons Ltd.
Jones, H.E.; Martin, P.R.; Heil, S.H.; Stine, S.M.; Kaltenbach, K.; Selby, P.; Coyle, M.G.; O’Grady, K.E.; Arria, A.M.; Fischer, G.
This paper addresses common questions that clinicians face when treating pregnant women with opioid dependence. Guidance is provided to aid clinical decision-making, based on both research evidence and the collective clinical experience of the authors which include investigators in the Maternal Opioid Treatment: Human Experimental Research (MOTHER) project. MOTHER is a double-blind, double-dummy, flexible–dosing, parallel-group clinical trial examining the comparative safety and efficacy of methadone and buprenorphine for the opioid dependence treatment among pregnant women and their neonates. The paper begins with a discussion of appropriate assessment during pregnancy, and then addresses clinical management stages, including maintenance medication selection, induction and stabilization, opioid agonist medication management before, during and after delivery, pain management, breast-feeding, and transfer to aftercare. Lastly, other important clinical issues including managing co-occurring psychiatric disorders and medication interactions are discussed. PMID:18248941
de Aguiar, M M; da Silva, H J; Rizzo, J Â; Leite, D F B; Silva Lima, M E P L; Sarinho, E S C
The aim of this study was to systematically review the safety and efficacy of inhaled beclomethasone for asthma treatment in pregnant women. We performed a systematic review in Medline, LILACS and SciELO electronic databases in December 2012. A total of 3433 articles were found by using the keywords asthma, pregnancy and beclomethasone. Among these, 1666 were from Medline, via PubMed, and 1767 were from LILACS and SciELO. Nine of these articles were selected. Only one paper suggested an increased foetal risk for congenital malformations, and one other for offspring endocrine and metabolic disturbances. Data are mostly reassuring, supporting the use of glucocorticoid inhalants during pregnancy, and we found no evidence of inferiority in relation to efficacy and safety of beclomethasone compared to other drugs used in pregnant asthmatic women. Copyright © 2013 SEICAP. Published by Elsevier Espana. All rights reserved.
Shirai, Sayaka; Suzuki, Yayoi; Yoshinaga, Jun; Shiraishi, Hiroaki; Mizumoto, Yoshifumi
Urinary excretion of free and total (free plus conjugated) forms of methyl, ethyl, n-propyl and n-butyl parabens (MP, EP, PP and BP, respectively) and their metabolite p-hydroxybenzoic acid were measured for 111 pregnant Japanese women. Frequent detection of parabens and their metabolite indicated that exposure takes place daily for pregnant Japanese women. The estrogenic potency of PP was 20 times higher than those of the other 3 parabens for the present subjects when both abundance in the urine and the relative estrogenic activity of each compound was considered. Detection of free parabens suggested dermal exposure, probably from their inclusion in personal care products. No statistical association was found between the anogenital index (birth weight-adjusted AGD) of male offspring and the concentrations of any parabens in the urine of the mothers suggesting that the parabens were not apparently estrogenically active at the exposure level of the present subjects. Copyright © 2012 Elsevier Inc. All rights reserved.
Margulies, M; Zin, C; Margulies, N D; Voto, L S
Twenty-four hour noninvasive, automatic and ambulatory control of blood pressure (BP) was carried out on 11 normotensive pregnant women in the third trimester of pregnancy with a Del Mar Avionics Model 1978 Pressurometer III System at 7.5 min intervals during 24 h. The patients kept a detailed record of their activities during those 24 h. BP increased from 9 AM to a peak between 7 and 10 PM. Mean (+/- SD) waking and sleeping values were 110.56 +/- 6.68 mm Hg and 96.5 +/- 10.01 mm Hg, respectively, for systolic BP, and 71.41 +/- 5.35 mm Hg and 62.82 +/- 5.47 mm Hg, respectively, for diastolic BP. There was a significant difference in systolic and diastolic BP between sleeping hours and waking hours. We believe that 24-h control of BP behavior in normotensive pregnant women allows us to adequately diagnose hypertensive disease in pregnancy.
Dhiman, S; Yadav, K; Goswami, D; Das, NG; Baruah, I; Singh, L
Malaria remains a complex problem during the pregnancy, which threatens > 35 millions pregnant women every year. Malaria pathogenesis in pregnancy results in accumulation of infected RBCs in the intervillous spaces causing severe alterations leading to the reduced materno-foetal exchanges. In this article we have revisited the current evidences of clinical implications and overall burden of malaria in pregnancy. Many adverse aftermaths including, low birth weight, intrauterine growth retardation, preterm delivery, stillbirth and anemia were found associated with malaria in pregnant women. Despite of worldwide comprehensive control programmes for malaria in pregnancy, the disease control has been a daunting task everywhere. Socio cultural, economical, lack of awareness and various logistic problems compound the disease in developing countries. Thorough evidence based information and estimates, education and awareness and strengthening of prevention programmes are needed urgently to achieve success in malaria control in pregnancy. PMID:23113116
Sutter, Mary Beth; Gopman, Sarah; Leeman, Lawrence
Pregnant women affected by substance use often encounter barriers to treatment, including housing insecurity, poverty, mental health issues, social stigma, and access to health care. Providers may lack the resources needed to provide quality care. Clinicians offering prenatal care to women with substance use disorder are encouraged to support family-centered, multidisciplinary care to women and their infants, focusing on harm reduction. Collaboration between providers of maternity care, substance abuse treatment, case management, family primary care, and pediatric developmental care can improve outcomes during pregnancy and through the early years of parenting.
Boggess, Kim A.; Urlaub, Diana M.; Moos, Merry-K; Polinkovsky, Margaret; El-Khorazaty, Jill; Lorenz, Carol
Background Racial or ethnic and economic disparities exist in terms of oral diseases among pregnant women and children. The authors hypothesized that women of a racial or ethnic minority have less oral health knowledge than do women not of a racial or ethnic minority. Therefore, the authors conducted a study to assess and compare maternal oral health knowledge and beliefs and to determine if maternal race and ethnicity or other maternal factors contributed to women’s knowledge or beliefs. Methods The authors administered a written oral health questionnaire to pregnant women. The authors calculated the participants’ knowledge and belief scores on the basis of correct answers or answers supporting positive oral health behaviors. They conducted multivariable analysis of variance to assess associations between oral health knowledge and belief scores and characteristics. Results The authors enrolled 615 women in the study, and 599 (97.4 percent) completed the questionnaire. Of 599 participants, 573 (95.7 percent) knew that sugar intake is associated with caries. Almost one-half (295 participants [49.2 percent]) did not know that caries and periodontal disease are oral infections. Median (interquartile range) knowledge and belief scores were 6.0 (5.5–7.0) and 6.0 (5.0–7.0), respectively. Hispanic women had median (interquartile range) knowledge and belief scores significantly lower than those of white or African American women (6.0 [4.0–7.0] versus 7.0 [6.0–7.0] versus 7.0 [6.0–7.0], respectively [P < .001]; and 5.0 [4.0–6.0] versus 6.0 [5.0–7.0] versus 6.0 [5.0–7.0], respectively [P < .001]). Multivariable analysis of variance results showed that being of His-panic ethnicity was associated significantly with a lower knowledge score, and that an education level of eighth grade or less was associated significantly with a lower belief score. Conclusions Pregnant women have some oral health knowledge. Knowledge varied according to maternal race or
Fan, Ling; Zou, Li-ying; Wu, Yu-mei; Zhang, Wei-yuan
To investigate the risk factors associated with abnormal cervical cytology findings in pregnant women. From Sep. 2007 to Sep. 2008, 12,112 pregnant women who underwent their antenatal examinations at 12-36 gestational weeks in Beijing Obstetrics and Gynecology Hospital were enrolled in this study. They were all excluded from the following pathologic obstetrics factors including threatened abortion, premature rupture of membranes or placental previa. Thinprep cytology test (TCT) were given at their first examination, meanwhile, a personal clinic file was established to record her occupation, education, address, family income, nationality, age of first intercourse, number of sex partners, contraception, marriage and pregnancy, current gynecologic diseases, family history of gynecologic tumors, history of gynecologic diseases and smoking and result of pelvic examination. Those risk factors leading to abnormal cervical cytology were analyzed. The complete clinical data were collected from 11 906 cases (98.30%, 11,906/12,112). It was found that 10,354 women were shown with normal TCT result, however, 1134 women (9.52%, 1134/11,906) with atypical squamous cells of undetermined significance (ASCUS), 112 women (0.94%, 112/11,906) with atypical glandular cells of undetermined significance (AGUS), 229 women (1.92%, 229/11,906) with low grade squamous intraepithelial (LSIL), 74 women (0.62%, 74/11,906) with high grade squamous intraepithelial (HSIL). Multiple factorial non-conditioned logistic regression analysis showed that age of first sexual intercourse (OR(ASCUS) = 2.90, OR(AGUS) = 7.32), number of sex partners (OR(ASCUS) = 1.49, OR(AGUS) = 2.02), number of abortion (OR(ASCUS) = 1.68, OR(AGUS) = 3.50) were correlated with ASCUS and AGUS. In LSIL group and HSIL group, age of first sexual intercourse (OR(LSIL) = 6.34, OR(HSIL) = 9.26), number of sex partners (OR(LSIL) = 1.69, OR(HSIL) = 1.65), number of abortion (OR(LSIL) = 1.53, OR(HSIL) = 5.33), smoking (OR(LSIL) = 1
Shieh, Carol; Kravitz, Melva
To explore cognitive, affective, and altruistic dimensions of maternal-fetal attachment in pregnant women who use illicit drugs. Content analysis with deductive and inductive coding methods was used to uncover common themes in each dimension of attachment. A prenatal clinic of a tertiary medical center in the northeastern United States. Forty pregnant women. Inclusion criteria were the following: used illicit drugs after the last menstrual period, had felt fetal movement, and could read and speak English. Women in methadone treatment programs were excluded. Knowing the baby's characteristics and health through fetal movement, acknowledging the fetus as an individual with physical and emotional functions, and knowing the baby by relating the fetus to self and family members are the three major themes in cognitive attachment. Themes in affective attachment include mixing strong affection with guilt and viewing fetal movement as visual and tactile enjoyment but also discomfort. Common themes with conflicting feelings were salient in altruistic attachment, including feeling uncomfortable versus feeling worthwhile, viewing being pregnant as an incentive for lifestyle changes, battling with substance use and concern for fetal health, and alternating between uncertainty and hope in preparing for the baby's arrival. Maternal-fetal attachment is not a phenomenon that is present or absent, but a struggle manifested by guilt, concern, and uncertainty. Without proper treatment and counseling, many women struggle between illicit drug use and development of maternal-fetal attachment.
Gaĭsin, I R; Valeeva, R M; Maksimov, N I; Iskhakova, A S; Khodyrev, L A; Shilina, L V
We examined 150 pregnant women with essential hypertension (EHT), EHT and connective tissue dysplasia (CTD), and healthy. Presence of CTD aggravated clinical picture of EHT and was associated with pronounced cardialgic, neurological, asthenic, vertebrogenic, visceral, and other syndromes. The use of antihypertensive, metabolic (magnesium orotate) drugs, sedative and uroseptic phytotherapy, application of other nondrug measures in conditions of multidisciplinary dynamic support of the gestational period facilitated regress of clinical symptoms of EHT and EHT+CTD, favorable course of pregnancy and successful delivery.
Khaustova, S A; Senyavina, N V; Tonevitsky, A G; Eremina, O V; Pavlovich, S V
The content of low-molecular-weight components in blood serum was studied by tandem mass-spectrometry in pregnant women. Serum metabolic profiles of patients with a grave obstetrical history were detected. The most significant changes were observed for the concentrations of low-molecular-weight substances involved in glucogenesis and β-oxidation processes and in metabolic chains involving carbohydrates, carnitines, amino acids, and lipids.
Nazarpour, Sima; Ramezani Tehrani, Fahimeh; Simbar, Masoumeh; Tohidi, Maryam; Alavi Majd, Hamid; Azizi, Fereidoun
Despite some studies indicating that thyroid antibody positivity during pregnancy has been associated with adverse pregnancy outcomes, evidence regarding the effects of levothyroxine (LT4) treatment of euthyroid/subclinical hypothyroid pregnant women with autoimmune thyroid disease on pregnancy outcome is limited. We aimed to assess whether pregnant women with autoimmune thyroid disease, but without overt thyroid dysfunction are affected by higher rates of adverse pregnancy outcomes. In addition, we aimed to explore whether LT4 treatment improves the pregnancy outcome of affected women. A prospective study was carried out on pregnant women from the first trimester to delivery. The study was conducted among pregnant women receiving prenatal care in centers under coverage of Shahid Beheshti University of Medical Sciences. Of a total of 1746 pregnant women, screened for thyroid dysfunction, 1028 euthyroid TPOAb-negative (TPOAb(-)) and 131 thyroid peroxidase antibody-positive (TPOAb(+)) women without overt thyroid dysfunction entered the second phase of the study. TPOAb(+) women were randomly divided into two groups: group A (n = 65), treated with LT4 and group B (n = 66), received no treatment. The 1028 TPOAb(-) women (group C) served as a normal population control group. Primary outcomes were preterm delivery and miscarriage and secondary outcomes included placenta abruption, still birth, neonatal admission and neonatal TSH levels. Groups B and C displayed a lower rate of preterm deliveries compared with group A (RR = 0.30, 95% CI: 0.1-0.85, P = 0.0229) and (RR = 0.23, shows the percentages of women with TSH values 95% CI: 0.14-0.40, P < 0.001) respectively. There was no statistically significant difference in the rates of preterm labor between groups A and C (RR = 0.79, 95% CI: 0.30-2.09, P = 0.64). The number needed to treat (NNT) for preterm birth was 1.7 (95% CI: 0.039-0.30). Treatment with LT4 decreases the risk of preterm
Pinzón, Diana C; Zamora, Katherine; Martínez, Jorge H; Floréz-López, María E; de Plata, Ana C Aguilar; Mosquera, Mildrey; Ramírez-Vélez, Robinson
There is controversy concerning whether exercise during pregnancy may increase preterm delivery risk and type of delivery. The effect of pregnant Latin-American women engaging in vigorous exercise during the second and third trimester was examined regarding type of delivery and gestational age. This was a secondary analysis of data from a controlled randomized trial for determining the influence of physical exercise on pregnant women's endothelial function. The study included 35 nulliparous women, gestational week 16-20 attending prenatal care at three tertiary hospitals in Colombia, who were randomly assigned to one of two groups. The experimental group engaged in aerobic exercise involving 55 % - 75 % maximum heart rate for 60 min, three times a week for 12 weeks. The control group engaged in their usual physical activity. Maternal weight, height, weight gain, blood pressure and type of delivery were recorded; gender, abdominal and head circumference (cm), weight (g), height (cm), vitality (Apgar score at 1 and 5 min) and gestational age at the time of delivery (in weeks, days) were recorded for the newborn. There was no difference in type of delivery by the end of the 12-week program (p > 0.05), nor regarding newborn anthropometric variables, Apgar score, or maternal variables concerning weight, height, relative weight gain, blood pressure or weeks of gestation (p>0.05). The potential public health benefits of vigorous exercise were enormous. This study supported existing guidelines indicating that Latin-American women may begin or maintain an on-going exercise program during pregnancy. NCT00741312.
Pun, Kunta Devi; Infanti, Jennifer J; Koju, Rajendra; Schei, Berit; Darj, Elisabeth
Globally, knowledge of health sector options to respond to domestic violence during pregnancy is increasing, but this topic is under-investigated in Nepal. This gap affects the provision of adequate antenatal care services and understanding of factors that influence women's willingness and ability to use available services. It is critical to know more about the social norms in a community that promote and prevent women experiencing domestic violence from seeking antenatal care. To explore community perceptions of domestic violence against pregnant women. A qualitative study was conducted in Dhulikhel municipality, involving 41 men and 76 women in 12 focus group discussions in different gender and family role separated groups. The interviews were recorded, transcribed in verbatim, and analyzed using content analysis. A socio-ecological model was used as a theoretical framework to illustrate linkages between individual, relationship, community, and societal influences on perceptions of domestic violence during pregnancy. The community recognized different forms of violence during pregnancy threatening women's physical and psychological health and presenting obstacles to seeking antenatal care. Some types of culturally specific violence were considered particularly harmful, such as pressure to give birth to sons, denial of food, and forcing pregnant women to do hard physical work during pregnancy, which may leave daughters-in-law vulnerable to domestic violence in extended families. A culture where violence is normalized and endurance and family reconciliation are promoted above individual health was perceived to cause women to tolerate and accept the situation. Participants suggested actions and strategies to address continuing violence, which indicated a societal transition toward increased awareness and changing attitudes and practices. Domestic violence during pregnancy needs to be addressed at different levels in Nepal, where women are often dependent on others
Pun, Kunta Devi; Infanti, Jennifer J; Koju, Rajendra; Schei, Berit; Darj, Elisabeth
Background Globally, knowledge of health sector options to respond to domestic violence during pregnancy is increasing, but this topic is under-investigated in Nepal. This gap affects the provision of adequate antenatal care services and understanding of factors that influence women's willingness and ability to use available services. It is critical to know more about the social norms in a community that promote and prevent women experiencing domestic violence from seeking antenatal care. Objective To explore community perceptions of domestic violence against pregnant women. Methods A qualitative study was conducted in Dhulikhel municipality, involving 41 men and 76 women in 12 focus group discussions in different gender and family role separated groups. The interviews were recorded, transcribed in verbatim, and analyzed using content analysis. A socio-ecological model was used as a theoretical framework to illustrate linkages between individual, relationship, community, and societal influences on perceptions of domestic violence during pregnancy. Results The community recognized different forms of violence during pregnancy threatening women's physical and psychological health and presenting obstacles to seeking antenatal care. Some types of culturally specific violence were considered particularly harmful, such as pressure to give birth to sons, denial of food, and forcing pregnant women to do hard physical work during pregnancy, which may leave daughters-in-law vulnerable to domestic violence in extended families. A culture where violence is normalized and endurance and family reconciliation are promoted above individual health was perceived to cause women to tolerate and accept the situation. Participants suggested actions and strategies to address continuing violence, which indicated a societal transition toward increased awareness and changing attitudes and practices. Conclusions Domestic violence during pregnancy needs to be addressed at different levels in
Groth, Susan W.; Morrison-Beedy, Dianne; Meng, Ying
Objective To gain insight into how low-income, pregnant African-American women viewed their weight gain while pregnant and how they managed their weight during pregnancy. Design Descriptive study using three focus groups. Setting Women were recruited from urban prenatal care sites and the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) services in a medium-sized urban Northeastern city. Participants Twenty-six adult, low-income, pregnant African-American women, aged 18–39; the majority were within the first 20 weeks of pregnancy. Methods Three focus groups were conducted utilizing open-ended questions related to pregnancy weight gain. Content analysis was used to analyze the verbatim transcripts. Analysis focused on meaning, intention and context. Groups were compared and contrasted at the within and between group levels to identify themes. Results Four themes were identified that provided insight into how women viewed their pregnancy weight gain and managed weight gain during pregnancy: (a) pregnancy weight gain: no matter how much means a healthy baby; (b) weight retention: it happens; (c) there is a limit: weight gain impact on appearance; and (d) watching and waiting: plans for controlling weight. Conclusion Low-income African-American women, though cognizant of the likelihood of retention of weight following pregnancy, are not focused on limiting their gestational weight gain. The cultural acceptance of a larger body size along with the belief that gaining more weight is indicative of a healthy infant present challenges for interventions to limit excessive gestational weight gain. PMID:22789036
Jeong, Ihnsook; Kim, Jiyun; Im, Sook Bin
The purpose of this study was to develop a financial support program for high-risk pregnant women based on opinions obtained using a questionnaire survey. The program development involved two steps: (1) developing a questionnaire through reviewing previous financial support programs for maternal care and then validating it via professional consultation; and (2) drafting a financial support program. Sixty professionals, 26 high-risk pregnant women, and 100 program implementers completed the questionnaire between August 2014 and October 2014. Based on the obtained professional consultation and survey investigation, the framework of the financial support program was constructed. The suggested recipients were mothers with early labor pains, mothers who have been hospitalized for > 3 weeks, and mothers who used uterine stimulant Pitocin during hospitalization. All hospitalization, medication, and examination costs needed to be supported considering the income level of the recipient. A basic policy for financially supporting high-risk pregnant women has been developed. The efficacy and feasibility of the policy needs to be carefully examined in future studies.
Patil, Avinash S; Sheng, Jessica; Dotters-Katz, Sarah K; Schmoll, Maria S; Onslow, Mitchell; Pierson, Rebecca C
Medication use is common in pregnancy, yet for most medications the optimal formulation and dosage have not been described specifically for pregnant women. Often, adverse effects are only discovered anecdotally or after extensive off-label use occurs. Since pharmacologic research that includes pregnant women is sparse and animal studies are often not applicable to the human fetus, providers must use knowledge of drug behavior and normal physiologic changes of pregnancy to personalize treatment for pregnant women. In this review, we present an overview of the basic concepts of clinical pharmacology: pharmacokinetics, pharmacodynamics, and pharmacogenomics. The normal physiologic changes of pregnancy are presented as a framework to understand alterations in drug behavior. A clinical vignette that addresses 4 pregnancy scenarios involving medications-preterm birth, vaccination, herpes simplex virus infection, and codeine toxicity-is provided to illustrate application of core clinical pharmacologic concepts. Discussion of relevant literature illustrates the challenges of offering individualized pharmacologic therapy in pregnancy. © 2017 by the American College of Nurse-Midwives.
Aydas, A D; Basaranoglu, G; Ozdemir, H; Dooply, S L S; Muhammedoglu, N; Kucuk, S; Saidoglu, L
High incidence of difficult or failed intubation in obstetric patients is still a major problem to challenge anaesthesiologists. Although the probability of difficult intubation is impossible to predict preoperatively, some simple, practical bedside tests may help. This study used five simple tests in an attempt to better evaluate airway changes in pregnant women before and after delivery. Pregnant women from the ASA I-II group who were planning to undergo a normal vaginal delivery were evaluated as to the possibility of experiencing difficult intubation. Mallampati scores, thyromental distance, sternomental distance, mouth opening, and the degree of neck extension were recorded just before delivery and 24 h after delivery. Significant differences were seen in the pre- and post-delivery measurements (p < 0.05). Before delivery, Mallampati scores I, II, III, IV were 35, 24, 2, 0, respectively, and 24 h after delivery became 46, 15, 0, 0, respectively. Within 24 h after delivery, Mallampati scores changed in one-third (n 21, 36.6%) of the patients. Significant differences between the two measurements of thyromental and sternomental distances, mouth opening, and the degree of neck extension confirm difficult airway management in pregnant women.
Auriault, F; Thollon, L; Peres, J; Delotte, J; Kayvantash, K; Brunet, C; Behr, M
This study report documents the development of a finite element (FE) model for analyzing trauma in pregnant women involved in road accidents and help the design of a specific safety device. The model is representative of a 50th percentile pregnant woman at 26 weeks of pregnancy in sitting position. To achieve this, the HUMOS 2 model, which has been validated in a wide range of dynamic tests, was scaled to the morphology of a woman in the 50th percentile and coupled with a model of gravid uterus. During scaling, special attention was paid to the pelvic region which is known to differ considerably in morphological terms between men and women. The gravid uterus model includes a placenta, a fetus, uterosacral ligaments and the amniotic fluid by means of fluid structure interaction formulation. The uterus and the female model were coupled using an original method whereby the growth of an uterus was simulated to compress the abdominal organs in a realistic manner. The model was validated based on experimental tests described in the literature. Additional tests based on abdominal loadings with a seatbelt on Post Mortem Human Surrogates (PMHS) coupled to silicone uterus were also performed. Results highlighted the role of the possible interaction of the fetus in the pregnant woman abdominal response. Experimental corridors taking into account the presence of this fetus could therefore be proposed.
De Lucca, Leidiane; Rodrigues, Fabiane; Jantsch, Letícia B.; Neme, Walter S.; Gallarreta, Francisco M. P.; Gonçalves, Thissiane L.
An oxidative burst occurs during pregnancy due to the large consumption of oxygen in the tissues and an increase in metabolic demands in response to maternal physiological changes and fetal growth. This study aimed to determine the oxidative profile and activity of δ-aminolevulinate dehydratase (δ-ALA-D) in pregnant women who received iron supplementation. Oxidative stress parameters were evaluated in 25 pregnant women with iron supplementation, 25 pregnant women without supplementation and 25 non-pregnant women. The following oxidative stress parameters were evaluated: thiobarbituric acid reactive substances (TBARS), protein thiol groups (P-SH), non-protein thiol levels (NP-SH), vitamin C levels, catalase and δ-ALA-D activity. Markers of oxidative stress and cell damage, such as TBARS in plasma were significantly higher in pregnant women without supplementation. Levels of P-SH, NP-SH and δ-ALA-D activity were significantly lower in pregnant women without supplementation compared to non-pregnant and pregnant women with supplementation, while vitamin C levels were significantly lower in pregnant women without supplementation when compared to non-pregnant women. The increase in the generation of oxidative species and decrease of antioxidants suggest the loss of physiological oxidative balance during normal pregnancy, which was not observed in pregnant women with iron supplementation, suggesting a protective effect of iron against oxidative damage. PMID:27153075
De Lucca, Leidiane; Rodrigues, Fabiane; Jantsch, Letícia B; Neme, Walter S; Gallarreta, Francisco M P; Gonçalves, Thissiane L
An oxidative burst occurs during pregnancy due to the large consumption of oxygen in the tissues and an increase in metabolic demands in response to maternal physiological changes and fetal growth. This study aimed to determine the oxidative profile and activity of δ-aminolevulinate dehydratase (δ-ALA-D) in pregnant women who received iron supplementation. Oxidative stress parameters were evaluated in 25 pregnant women with iron supplementation, 25 pregnant women without supplementation and 25 non-pregnant women. The following oxidative stress parameters were evaluated: thiobarbituric acid reactive substances (TBARS), protein thiol groups (P-SH), non-protein thiol levels (NP-SH), vitamin C levels, catalase and δ-ALA-D activity. Markers of oxidative stress and cell damage, such as TBARS in plasma were significantly higher in pregnant women without supplementation. Levels of P-SH, NP-SH and δ-ALA-D activity were significantly lower in pregnant women without supplementation compared to non-pregnant and pregnant women with supplementation, while vitamin C levels were significantly lower in pregnant women without supplementation when compared to non-pregnant women. The increase in the generation of oxidative species and decrease of antioxidants suggest the loss of physiological oxidative balance during normal pregnancy, which was not observed in pregnant women with iron supplementation, suggesting a protective effect of iron against oxidative damage.
Merino, Francisco J; Martínez-Ruiz, Rocío; Olabarrieta, Iciar; Merino, Paloma; García-Bujalance, Silvia; Gastañaga, Teresa; Flores-Chavez, María
Chagas disease is a chronic and systemic infection caused by Trypanosoma cruzi. According to estimates from WHO, 10 million people are affected by this parasite. In the last years, birthrate among the immigrant women from Latin America settled in the Comunidad Autónoma de Madrid has been increasing, and as T. cruzi can be transmitted from mother to child, in fact 11 cases of congenital Chagas disease have been confirmed. Therefore, the aim of this paper is encouraging improvements in the coverage of the anti-T. cruzi antibodies detection in pregnant women from endemic areas. By this strategy, an active search for infected pregnant women and early detection of her infected newborns could be conducted, and then an early specific treatment could be administrated. Thus, there could be an important contribution to the control of Chagas disease in non-endemic area.
Mathad, Jyoti S.; Gupta, Amita
Tuberculosis is most common during a woman's reproductive years and is a major cause of maternal–child mortality. National guidelines for screening and management vary widely owing to insufficient data. In this article, we review the available data on (1) the global burden of tuberculosis in women of reproductive age; (2) how pregnancy and the postpartum period affect the course of tuberculosis; (3) how to screen and diagnose pregnant and postpartum women for active and latent tuberculosis; (4) the management of active and latent tuberculosis in pregnancy and the postpartum period, including the safety of tuberculosis medications; and (5) infant outcomes. We also include data on HIV/tuberculosis coinfection and drug-resistant tuberculosis. Finally, we highlight research gaps in tuberculosis in pregnant and postpartum women. PMID:22942202
Mathad, Jyoti S; Gupta, Amita
Tuberculosis is most common during a woman's reproductive years and is a major cause of maternal-child mortality. National guidelines for screening and management vary widely owing to insufficient data. In this article, we review the available data on (1) the global burden of tuberculosis in women of reproductive age; (2) how pregnancy and the postpartum period affect the course of tuberculosis; (3) how to screen and diagnose pregnant and postpartum women for active and latent tuberculosis; (4) the management of active and latent tuberculosis in pregnancy and the postpartum period, including the safety of tuberculosis medications; and (5) infant outcomes. We also include data on HIV/tuberculosis coinfection and drug-resistant tuberculosis. Finally, we highlight research gaps in tuberculosis in pregnant and postpartum women.
Stanwood, Nancy L; Bradley, Karen A
Modern intrauterine devices (IUDs) are safe, effective, and reversible, but only 2.1% of U.S. women use IUDs. We aimed to estimate young pregnant women's knowledge of IUDs. We surveyed 190 women, aged 14-25 years, presenting for prenatal or abortion care about their contraceptive history, plans, and knowledge. We asked if they had heard of IUDs and queried them on IUD characteristics. The women were, on average, 20 years old, 27% had education past high school, and 47% had delivered a child. Half were in prenatal care, and 91% had not planned their current pregnancy. Fifty-two percent wished to wait 4 or more years before their next pregnancy, and 27% did not want to be pregnant ever again. Safety and efficacy were the most important factors in choosing a contraceptive method. Fifty percent had heard of IUDs, 71% did not know about IUDs' safety, and 58% did not know about IUDs' efficacy. Respondents who knew of IUDs were older (21 versus 19 years, P<.001) and more likely to be parous (55% versus 39%, P=.04). Young women choosing contraception after a pregnancy would benefit from counseling about the relative safety and effectiveness of IUDs, allowing them to make fully informed contraceptive decisions. II-2.
Gelles, Richard J.
Examined data from Second National Family Violence Survey. Found women under age 25 to be more likely than older women to be both pregnant and to be hit and abused by husbands and partners. Although pregnant women were not particularly vulnerable group, pregnancy did not insulate them from high rates of violence experienced by young women.…
Nguyen, Vinh Quang; Goto, Aya; Nguyen, Tu Van T; Vo, Khoa Tuan; Ta, Tuyet Mai T; Nguyen, Thuy Ninh T; Nguyen, Tien Minh; Ho, My Binh T; Phan, Ngoc Anh T; Vu, Hong Hanh T; Truong, Thuc My; Nguyen, Hung T
Although Vietnam is a region with a plant-based diet that has a high zinc deficiency, epidemiological data showing how this affects pregnant women are limited. This study explores the prevalence of zinc deficiency and possible correlates in pregnant Vietnamese women in Ho Chi Minh City. This was a cross-sectional study conducted at a general hospital in Ho Chi Minh City, Vietnam. All pregnant women who came to their first antenatal care visit from November 2011 to June 2012 were recruited. Those taking a vitamin and/or mineral supplement were excluded. Serum zinc concentrations, determined by a standard colorimetric method, of 10.7 μmol/L-17.5 μmol/L (70.0 g/dL-114 g/dL) were classified as normal and under 10.7 μmol/L (70.0 g/dL) as zinc deficient. In total, 254 pregnant women were invited and 107 (42%) participated. The mean age of participants was 29 years, and mean gestational age was 10 weeks. Median zinc concentration in serum was 13.6 μmol/L, and the prevalence of zinc deficiency was 29% (95% CI=21%-39%). The daily intake of a milk product supplement was the only significant correlate of zinc deficiency of the items investigated (adjusted OR=0.40, 95% CI=0.16-0.99, p=0.049). This is the first study reporting that more than 25% of pregnant Vietnamese women in Ho Chi Minh City are zinc deficient. Further academic and clinical input is needed to confirm the scale of this neglected issue and to investigate the potential of milk product supplementation in this population.
Myers, Kristin M.; Vink, Joy Y.; Wapner, Ronald J.; Hendon, Christine P.
The structural integrity of the cervix in pregnancy is necessary for carrying a pregnancy until term, and the organization of human cervical tissue collagen likely plays an important role in the tissue’s structural function. Collagen fibers in the cervical extracellular matrix exhibit preferential directionality, and this collagen network ultrastructure is hypothesized to reorient and remodel during cervical softening and dilation at time of parturition. Within the cervix, the upper half is substantially loaded during pregnancy and is where the premature funneling starts to happen. To characterize the cervical collagen ultrastructure for the upper half of the human cervix, we imaged whole axial tissue slices from non-pregnant and pregnant women undergoing hysterectomy or cesarean hysterectomy respectively using optical coherence tomography (OCT) and implemented a pixel-wise fiber orientation tracking method to measure the distribution of fiber orientation. The collagen fiber orientation maps show that there are two radial zones and the preferential fiber direction is circumferential in a dominant outer radial zone. The OCT data also reveal that there are two anatomic regions with distinct fiber orientation and dispersion properties. These regions are labeled: Region 1—the posterior and anterior quadrants in the outer radial zone and Region 2—the left and right quadrants in the outer radial zone and all quadrants in the inner radial zone. When comparing samples from nulliparous vs multiparous women, no differences in these fiber properties were noted. Pregnant tissue samples exhibit an overall higher fiber dispersion and more heterogeneous fiber properties within the sample than non-pregnant tissue. Collectively, these OCT data suggest that collagen fiber dispersion and directionality may play a role in cervical remodeling during pregnancy, where distinct remodeling properties exist according to anatomical quadrant. PMID:27898677
The emergence of the novel influenza A (H1N1) pdm09 (pH1N1) strain in 2009 required a coordinated public health response, especially among high-risk populations. Because pregnant women were at increased risk for influenza-related complications and hospitalization compared with the general population, the American College of Obstetricians and Gynecologists and the Advisory Committee on Immunization Practices recommended pregnant women receive both the pH1N1 vaccine and the annual seasonal vaccine during the 2009-10 influenza season as a safe and effective way of protecting both mother and infant. To describe acceptance, predictors, and barriers to influenza vaccination among pregnant women in Massachusetts during the 2009-10 influenza season, the Massachusetts Department of Public Health (MDPH) analyzed data from supplemental influenza questions on the Massachusetts Pregnancy Risk Assessment Monitoring System (PRAMS) survey. The results indicated that 67.5% of residents who had live births in Massachusetts during September 2009-May 2010 received the seasonal vaccine, and 57.6% received the pH1N1 vaccine. Women who were non-Hispanic blacks, aged <25 years, Medicaid beneficiaries, or lived in a household with an income at or below the federal poverty level were significantly less likely to receive the seasonal vaccine. For the pH1N1 vaccine, only being non-Hispanic black was associated with being less likely to have been vaccinated. Vaccination rates were significantly higher among women whose provider offered or recommended the seasonal (75.8%) and pH1N1 (68.1%) vaccines compared with those who did not receive a recommendation (32.4% and 8.6%, respectively). Coverage in Massachusetts was among the highest of 29 PRAMS sites and might have reflected strategic efforts by MDPH to support vaccine education and equity across the state.
Borghei, Narjes Sadat; Taghipour, Ali; Roudsari, Robab Latifnejad; Keramat, Afsaneh; Noghabi, Hadi Jabbari
Introduction Considering that empowering expectant mothers is an important issue to maintain a healthy pregnancy, this study was conducted to evaluate the predictors of empowerment among Iranian pregnant women. Methods This cross sectional study was conducted in Golestan, North of Iran in 2015. A total number of 161 pregnant women were selected through random cluster sampling from urban health centers, using PASS software. The socio-political, educational, and mental-financial predictors of empowerment were measured using a self-structured questionnaire during pregnancy and was analyzed by a linear regression model using SPSS version 16. Results The findings of linear regression showed that educational dimension of empowerment had the highest coefficient in the regression model, on total empowerment (βeta standardized coefficient [β]=0.696 with DW=1.830 and means error=0). The total empowerment score of pregnant women was controlled by individual factors such as the age of marriage (β-0.228), employment (β-0.210), and educational factors such as participation in prenatal education classes (β-0.246), and moral issues such as sense of spiritual support (β-0.217). Conclusion By recognizing and observing predictors of empowerment during pregnancy, health care providers can increase women’s power over their pregnancy. Educational predictors of empowerment were the most important factors to empower women during pregnancy. The objective of childbirth education classes, therefore, should shift from simply giving information to women, towards giving them appropriate knowledge in order to provide them with empowerment during pregnancy. PMID:27790351
Coyne, Sarah M; Liechty, Toni; Collier, Kevin M; Sharp, Aubrey D; Davis, Emilie J; Kroff, Savannah L
Much research has found that exposure to certain types of media portrayals of women can be related to body image concerns among women. The current paper focuses on the impact of certain messages on pregnant and postpartum women. These women are rarely examined in a media research context but are particularly vulnerable to body image concerns. This experimental study involved 192 pregnant or postpartum women who read a magazine containing glamorized media portrayals of pregnant/postpartum women or a control magazine. Pregnant women reported lower body image after only five minutes of exposure to the magazine with pregnant/postpartum women compared to the control group. There was no immediate effect on postpartum women. Implications for the media industry, health professionals, and women are discussed.
Dall'alba, Valesca; Callegari-Jacques, Sidia Maria; Krahe, Cláudio; Bruch, Juliana Paula; Alves, Bruna Cherubini; Barros, Sérgio Gabriel Silva de
Heartburn and regurgitation frequently occur in the third trimester of pregnancy, but their impact on quality of life has not been thoroughly investigated. To measure health-related quality of life of third-trimester pregnant women with heartburn and regurgitation. Methods Data on obstetric history, heartburn and regurgitation frequency and intensity, history of heartburn and regurgitation and health-related quality of life were collected of 82 third-trimester pregnant women. Sixty-two (76%) women had heartburn, and 58 (71%), regurgitation; 20 were asymptomatic. Mean gestational age was 33.8±3.7 weeks; 35 (43%) women had a family history of heartburn and/or regurgitation, and 57 (70%) were asymptomatic before pregnancy. The following quality of life concepts were significantly reduced: physical problems and social functioning for heartburn; physical problems and emotional functioning for regurgitation. There was agreement between heartburn in present and previous pregnancies. Heartburn and/or regurgitation affected health-related quality of life of third trimester pregnant women.
Tayler-Smith, K.; Khogali, M.; Marks, G. B.
Setting: An antenatal clinic serving a population of 47 604 in Nausori, Fiji. Objective: 1) To estimate the prevalence of anaemia, syphilis and hepatitis B in pregnant women attending their first antenatal visit; and 2) to estimate the uptake of treatment for syphilis and for the prevention of hepatitis B transmission in affected individuals. Design: Retrospective review of the clinic register and patient records for the year 2011. Results: The prevalence of anaemia, hepatitis B and syphilis were respectively 22%, 2% and 5%. Among women with syphilis, 78% of those for whom data were available received a complete course of three doses of penicillin during their pregnancy, and 83% of babies born to women with hepatitis B received hepatitis B immunoglobulin. Conclusion: The prevalence of anaemia in pregnant women has declined but remains high, and further research is required to identify the major causes of this condition in Fiji. The prevalence of syphilis has remained static, while hepatitis B has decreased over the past decade. There are some gaps in the implementation of effective interventions to manage these conditions in pregnant women. PMID:26393000
Chen, Yu-Min; Zeng, Jing; Yan, Yue-Rong; Luo, Dan; Huang, Lu; Huang, Hui
To establish the reference intervals of thyroid hormones in normal pregnant women in Chengdu area of China, and to investigate the effects of thyroid autoantibodies on thyroid function in pregnant women. We included 696 pregnant women who had gestation data from June 2013 to March 2014 in Chengdu Women & Children's Central Hospital. Every subject under went questionnaire survey, physical examination, thyroid ultrasound and measurement of thyroid hormone and thyroid autoantibodies. The normal reference intervals were established according to the percentiles (P2.5-P97.5) of the healthy pregnant women in the same trimester. Another 50 non-pregnant women were selected as the control group. Of the 696 pregnant women, 579 subjects had negative thyroid autoantibodies and 117 subjects had positive thyroid autoantibodies. The positive rate of thyroid autoantibodies was 16.81%. Of the 579 subjects with negative thyroid autoantibodies, 257 were in the first trimester, 202 in the second trimester and 120 in the third trimester. In the first trimester of normal pregnancy, the reference intervals of serum thyrotropin (TSH) , free triiodothyronine (FT3) and free thyroxine (FT4) were 0.02-4.03 mIU/L, 3.85-6.27 pmol/L and 11.93-21.04 pmol/L respectively. In the second trimester, the reference intervals of serum TSH, FT3 and FT4 were 0.02-4.05 mIU/L, 3.51-5.82 pmol/L and 11.23-19.22 pmol/L respectively. In the thirdtrimester, the reference intervals for serum TSH, FT3 and FT4 were 0.24-5.41 mIU/L, 3.18-4.97 pmol/L and 11.10-17.00 pmol/L, respectively. When compared with non-pregnant women, the median TSH value was increasingly consisted with the progress of pregnancy period, while the median FT4 and FT3 values were decreasing accordingly. The similar tendencies of TSH, FT3, and FT4 were found in pregnant women with positive thyroid autoantibodies, but the trends were more remarkable when compared with those with negative thyroid autoantibodies. In pregnant women with positive
Giurgescu, Carmen; Kavanaugh, Karen; Norr, Kathleen F.; Dancy, Barbara L.; Twigg, Naomi; McFarlin, Barbara L.; Engeland, Christopher G.; Hennessy, Mary Dawn; White-Traut, Rosemary C.
This research aimed to develop an initial understanding of the stressors, stress responses, and personal resources that impact African American women during pregnancy, potentially leading to preterm birth. Guided by the ecological model, a prospective, mixed-methods, complementarity design was used with 11 pregnant women and 8 of their significant others. Our integrated analysis of quantitative and qualitative data revealed 2 types of stress responses: high stress responses (7 women) and low stress responses (4 women). Patterns of stress responses were seen in psychological stress and cervical remodeling (attenuation or cervical length). All women in the high stress responses group had high depression and/or low psychological well-being and abnormal cervical remodeling at one or both data collection times. All but 1 woman had at least 3 sources of stress (racial, neighborhood, financial, or network). In contrast, 3 of the 4 women in the low stress responses group had only 2 sources of stress (racial, neighborhood, financial, or network) and 1 had none; these women also reported higher perceived support. The findings demonstrate the importance of periodically assessing stress in African American women during pregnancy, particularly related to their support network as well as the positive supports they receive. PMID:23360946
Vasiliauskiene, Ingrida; Milciuviene, Simona; Bendoraitiene, Egle; Narbutaite, Julija; Slabsinskiene, Egle; Andruskeviciene, Vilija
The aim of the study was to determine the efficiency of the applied preventive measures during pregnancy and to improve oral health status to pregnant women. Oral health status of 180 pregnant women was determined according to WHO criteria (WHO: Basic methods, 1997). Dental caries prevalence, DMF-T and DMF-S were evaluated. Gingival status was estimated according to Silness-Loe (GI) index. Women were asked about tooth brushing frequency; oral hygiene was evaluated according to Green-Vermilion (OHI-S) index. Participants were divided into test (89) and control (91) groups. During pregnancy, the following preventive measures were applied to the test group: fluoride varnish applications, mouthrinsing with 0.12% chlorhexine digluconate, professional oral hygiene. Oral health status was evaluated three times during pregnancy. Reduction in dental caries increment of the test group was 56.25% in comparison with the control group. The periodontal status has improved, oral hygiene index (OHI-S) has decreased from 1.48+/-0.05 to 0.94+/-0.06 in the test group, and from 1.49+/-0.06 to 1.9+/-0.06 in the control group. Results of the study showed that selected dental caries preventive measures were effective and significantly improved women's oral health during pregnancy.
Richlin; Cusick; Sullivan; Dildy; Belfort
Objective: To develop normative ranges of maternal arterial oxygen saturation (SpO(2)) for women residing at sea level throughout gestation and postpartum.Materials and Methods: Healthy, nonsmoking, non-laboring pregnant women, with no obstetrical risk factors, were recruited into this longitudinal study performed at The Stamford Hospital (elevation sea level). Maternal SpO(2) was measured in the dominant index finger while breathing room air with a Nelcor N-200 pulse oximeter and DS-100A sensor (Nellcor Puritan Bennett, Pleasanton, CA) at set antepartum (AP) and postpartum (PP) intervals. Oxygen saturation was measured in the following positions: sitting, lying on the left then right side, knee-chest, and supine. Five minutes were allowed between measurements. Measurements were taken at 12, 24, and 36 weeks of gestation and then at 12 weeks postpartum for each patient.Results: Thirty-six patients were initially enrolled. Three were excluded from this study, secondary to loss of follow-up (1), preterm delivery at 35 weeks (1), and complicated placenta previa (1). Of the 33 patients who remained in the study 5 have delivered and undergone postpartum evaluation. SpO(2) values (%) are summarized as mean +/- 2 SD in the Table.Conclusion: Preliminary data in this ongoing descriptive longitudinal study suggest that maternal SpO(2) is at least 97% throughout pregnancy for healthy, non-smoking women residing at sea level. These normative data may be useful in managing pregnant women at risk for hypoxia.
Subramoney, Sreevidya; Gupta, Prakash C
A significantly higher mean hemoglobin level in women smokers in comparison to nonsmokers with a generalized rightward shift of the hemoglobin distribution curve has been reported at the population level. Studies on pregnant women, however, have often associated smoking with decreased hemoglobin levels, although not consistently. We examined whether smokeless tobacco use during pregnancy influenced hemoglobin levels in a population-based cohort of 918 pregnant women in Mumbai, India. Mean hemoglobin levels (Hb) were significantly lower in users (10.00 g/dl) compared with nonusers (10.46 g/dl), p<.000. Anemia (Hb<10 g/dl) was significantly associated with smokeless tobacco in the univariate analysis (OR = 1.7, 95% CI 1.2-2.5). There was no change after adjusting odds ratios for potential confounders in multivariate analysis (OR = 1.7, 95% CI 1.2-2.5). The odds ratios for anemia were adjusted for age of mother, education, socioeconomic status, type of residence, lower body mass index, parity, vegetarian or nonvegetarian food habit, and hemodilution during pregnancy. The results suggest that smokeless tobacco use during pregnancy is associated with lower hemoglobin levels, as has often been observed with cigarette smoking. Smokeless tobacco use is widely prevalent among women in Southeast Asia and is gaining popularity across the world as a safe alternative to smoking. Further exploration and clarification of this association is therefore of considerable importance to public health.
Brantsæter, Anne Lise; Abel, Marianne Hope; Haugen, Margaretha; Meltzer, Helle Margrete
Pregnant women and infants are exceptionally vulnerable to iodine deficiency. The aims of the present study were to estimate iodine intake, to investigate sources of iodine, to identify predictors of low or suboptimal iodine intake (defined as intakes below 100 μg/day and 150 μg/day) in a large population of pregnant Norwegian women and to evaluate iodine status in a sub-population. Iodine intake was calculated based on a validated Food Frequency Questionnaire in the Norwegian Mother and Child Cohort. The median iodine intake was 141 μg/day from food and 166 μg/day from food and supplements. Use of iodine-containing supplements was reported by 31.6%. The main source of iodine from food was dairy products, contributing 67% and 43% in non-supplement and iodine-supplement users, respectively. Of 61,904 women, 16.1% had iodine intake below 100 μg/day, 42.0% had iodine intake below 150 μg/day and only 21.7% reached the WHO/UNICEF/ICCIDD recommendation of 250 μg/day. Dietary behaviors associated with increased risk of low and suboptimal iodine intake were: no use of iodine-containing supplements and low intake of milk/yogurt, seafood and eggs. The median urinary iodine concentration measured in 119 participants (69 μg/L) confirmed insufficient iodine intake. Public health strategies are needed to improve and secure the iodine status of pregnant women in Norway. PMID:23389302
Zhu, Chang-kun; Wang, Fei; Zhou, Yu-mei; Ying, Jun; Chen, Dan-qing
To analyze the maternal outcomes of pregnant women with pernicious placenta previa (PPP). Clinical data of 470 patients with placenta previa admitted in Women's Hospital Zhejiang University School of Medicine from August 2012 to August 2014 were collected and retrospectively analyzed. The patients were divided into pernicious group(n=101) and non-pernicious group(n=369) according to the history of cesarean section and location of placenta attached to the uterine. The general profiles, maternal outcomes of two groups were compared. The age, gravidity and rate of recurrent cavity surgery of pernicious group [(32.5 ± 4.1) y, 3.4 ± 1.2, 28.7%] were higher than those of non-pernicious group [(30.7 ± 4.5) y, 2.1 ± 1.4,13.6%] (P<0.05). The gestational age of pernicious group was (35.6 ± 2.7) weeks, less than that of non-pernicious group [(36.7 ± 2.7) weeks, P<0.001]. Rate of postpartum massive hemorrhage, rate of blood transfusion, rate of placental implantation and hysterectomy in pernicious and non-pernicious group were 29.7%, 35.6%, 27.7%, 11.9% and 8.1%, 10.8%, 5.7%, 0.8%, respectively (P<0.05). Multiple regression analysis showed that placenta accrete was significantly associated with postpartum massive hemorrhage in pernicious group (P<0.05). The awareness of the danger of pregnant women with PPP before operation and paying more attention to antenatal care are key measures to decrease the adverse maternal outcomes of pregnant women with placenta previa.
Tsao, Ying; Creedy, Debra K; Gamble, Jenny
An increasing number of women from other countries, mostly Mainland China and Southeast Asia, are marrying Taiwanese husbands and settling in Taiwan. Immigration, marriage abroad, and pregnancy may be stressful and adversely affect maternal health. Relatively little research has compared the life stress and depressive symptoms of pregnant women of different ethnic groups living in nonmetropolitan areas in Taiwan. This study investigates the levels of life stress and depressive symptoms in pregnant Taiwanese women and Vietnamese "foreign brides" currently living in southern Taiwan. Eligible women in their last trimester of pregnancy who attended their local antenatal clinic were recruited for the study. Participants completed standardized measures, including the Difficult Life Circumstances Scale, Social Support APGAR Scale, and Edinburgh Postnatal Depression Scale. Two hundred thirty-six Taiwanese women and 44 Vietnamese women participated. Major life difficulties for both groups of women were related to their marital relationship, housing, or health problems. Taiwanese participants reported perceiving financial strain more often than their Vietnamese peers, whereas Vietnamese participants reported perceiving greater concerns regarding their children's development and about recent physical abuse than their Taiwanese peers. Furthermore, the Vietnamese participants reported less social support and higher rates of antenatal depression than Taiwanese participants. Clinical nurses and midwives should be sensitive to the particular difficulties and insufficient social support faced by pregnant women from different backgrounds in Taiwan. Women from foreign countries or those under unique challenging circumstances may face a particular risk of adverse outcomes. Identifying stresses informs the development of effective nursing interventions and support activities for new mothers and their families.
Panesar, N S; Li, C Y; Rogers, M S
To establish gestation-related reference intervals for thyroid hormones in a Chinese population. A prospective study with 343 healthy pregnant women (5-41 weeks) and 63 non-pregnant controls. Thyroid stimulating hormone (TSH), free thyroxine (T4) and tri-iodothyronine (T3) (and human chorionic gonadotrophin) were measured by immunoassays. The median, 2.5th and 97.5th percentiles at 4-week intervals were calculated. Data were also analysed for significant trends using ANOVA. Free T3 decreased during pregnancy, whereas free T4 initially increased, peaking between 9-13 weeks and then decreased, the decline becoming significant by week 21. TSH mirrored changes in free T4. The gestation-related reference intervals for thyroid hormones should alleviate the misinterpretation of thyroid function in pregnancy.
Donders, G G
Testing for and treating sexually transmitted diseases (STDs) in pregnant women deserves special attention. Treatment possibilities are limited because of potential risks for the developing fetus, and because effects can differ in pregnant compared with non-pregnant women, re-infection may be missed because of the intrinsic delicacy of contact-tracing during pregnancy and because pregnant women are more reluctant to take the prescribed medication in its full dose, if at all. However, the devastating effects of some of these genital infections far outweigh any potential adverse effects of treatment. Although active syphilis has become a rarity in most Western countries, it is still prevalent in South America, Africa and South-East Asia. Benzathine benzylpenicillin (2.4 million units once or, safer, twice 7 days apart) is the treatment of choice, although patients with syphilis of longer standing require 3 weekly injections as well as extensive investigation into whether there has been any damage due to tertiary syphilis. Despite declining rates of gonorrhea, the relative rate of penicillinase-producing strains is increasing, especially in South-East Asia. The recommended treatment is intramuscular ceftriaxone (125 or 250 mg) or oral cefixime 400 mg. Despite good safety records after accidental use, fluoroquinolones are contraindicated during pregnancy. An alternative to a fluoroquinolone in pregnant women with combined gonorrhea and chlamydial infection is oral azithromycin 1 or 2 g. Azithromycin as a single 1 g dose is also preferable to a 7 day course of erythromycin 500 mg 4 times a day for patients with chlamydial infection. Eradication of Haemophilus ducreyi in patients with chancroid can also be achieved with these regimens or intramuscular ceftriaxone 250 mg. Trichomonas vaginalis, which is often seen as a co-infection, has been linked to an increased risk of preterm birth. Patients infected with this parasite should therefore received metronidazole 500 mg
Lilliecreutz, Caroline; Theodorsson, Elvar; Sydsjö, Gunilla; Josefsson, Ann
Stress and/or anxiety during pregnancy affect maternal and fetal well-being and can cause premature delivery and postnatal pathology in the child. Women suffering from phobias related to blood and injections are prone to high levels of stress, including anxiety and sometimes panic attacks, during pregnancy. Cortisol is amongst the mediators through which the neurohormonal expressions of maternal psychological factors may be transduced to the fetus. The aim of this study was to investigate whether pregnant women suffering from blood and injection phobia have raised cortisol levels or are characterized by unusual diurnal salivary cortisol profiles compared with healthy controls. The sample consisted of 110 pregnant women with blood and injection phobia and 110 pregnant healthy controls. Both groups provided morning and evening saliva samples in weeks 25 and 36 for the assay of cortisol. In gestational week 25, when blood was drawn for the mandatory blood testing, extra blood was taken to analyze corticotrophin-releasing factor, adrenocorticotropic hormone, and cortisol in serum. The diurnal decline in salivary cortisol as well as increased cortisol levels were observed during pregnancy. Pregnant women suffering from blood and injection phobia had a higher output of cortisol compared with women without the phobia (F = 6.25, df = 1, p = 0.014), but no marked difference in the diurnal cortisol rhythm was found between groups. Our findings indicate that untreated blood and injection phobia during pregnancy increases cortisol concentrations. Blood and injection phobia is treatable, and cognitive behavioral therapy can be used. Women with blood and injection phobia during pregnancy therefore need to be recognized and offered treatment without delay in early pregnancy.
Alvarado-Esquivel, Cosme; Hernández-Tinoco, Jesús; Sánchez-Anguiano, Luis Francisco; Ramos-Nevárez, Agar; Cerrillo-Soto, Sandra Margarita; Estrada-Martínez, Sergio; Martínez-Ramírez, Lucio; Pérez-Álamos, Alma Rosa; Guido-Arreola, Carlos Alberto
Cytomegalovirus causes congenital infections all around the world. The seroepidemiology of cytomegalovirus infection in pregnant women in Mexico is largely unknown. We sought to determine the seroprevalence of cytomegalovirus infection in pregnant women in Durango City, Mexico; and to determine seroprevalence association with socio-demographic, clinical and behavioral characteristics of pregnant women. Through a cross-sectional study design, 343 pregnant women were examined for anti-cytomegalovirus IgG and IgM antibodies in Durango City, Mexico. We used a standardized questionnaire to obtain the general characteristics of the pregnant women. Multivariate analysis was performed to determine the association of cytomegalovirus infection with the characteristics of the pregnant women. Anti-CMV IgG and IgM antibodies were detected in 225 (65.6%) and in none of the 343 pregnant women studied, respectively. Multivariate analysis showed that CMV exposure was associated with increasing age (OR = 1.67; 95% CI: 1.01-2.76; P = 0.04). Other women characteristics including socioeconomic status, education, blood transfusion, transplantation, sexual promiscuity and number of previous pregnancies or deliveries did not show an association with CMV exposure. This is the first seroepidemiology study of CMV infection in pregnant women in Mexico. A number of known factors associated with CMV infection were not associated with CMV exposure in the women studied. Further studies to determine routes of CMV infection in pregnant women in Mexico are needed.
Schulze, Marco H; Völker, Fabian M; Lugert, Raimond; Cooper, Paul; Hasenclever, Kai; Groß, Uwe; Pfister, Herbert; Silling, Steffi
Data about the prevalence of human papillomaviruses (HPV) in African women with normal and abnormal cervical cytology are still scarce. Current HPV vaccines contain HPV types, which mainly represent the HPV epidemiology of industrial countries. As further developments of HPV vaccines are going on, it is necessary to regard regional differences in HPV type prevalence to ensure optimal protection by the vaccine. Vaginal swabs of Ghanaian pregnant women, routinely collected before delivery to rule out bacterial infections causing early onset sepsis, were screened for 12 high-risk (HR), 13 probably/possibly (pHR), and 18 low-risk (LR) HPV types. Most pregnant women come for delivery to the hospital. This was considered as appropriate possibility to have an unselected group of women. HPV DNA were detected in 55/165 women (33.3, 95 % CI 26.3-41.1 %). Thirty-four out of fifty-five (61.8, 95 % CI 47.7-74.3 %) of HPV-positive women were infected with HR and/or pHR HPV types. The five most prevalent HR or pHR HPV types were HPV-52 and HPV-67 (7 women each, 4.2, 95 % CI 1.9-8.9 %), HPV-53 (six women, 3.6, 95 % CI 1.5-8.1 %), HPV-45 (five women, 3.0, 95 % CI 1.1-7.3 %), and HPV-18 (four women, 2.4, 95 % CI 0.8-6.5 %), respectively. HPV-16 was found in two women only (1.2, 95 % CI 0.2-4.8 %). Future HPV vaccine research may devote special interest to HPV-67 and HPV-53 provided further studies confirm their high prevalence in the general population of Sub-Saharan African countries. The true carcinogenic potential of HPV-67, which is a member of species alpha9 including HPV-16, and so far categorized as pHR, should be clarified.
Faden, R R; Chwalow, A J; Quaid, K; Chase, G A; Lopes, C; Leonard, C O; Holtzman, N A
We studied the attitudes of 490 pregnant women toward the abortion of defective fetuses. Three hundred of these women were participating in a prenatal screening program for neural tube defects. Although theoretical accounts of the effects of behavior on attitude would suggest that participation in a screening program would affect abortion attitudes, evidence in support of such an association was weak. The overwhelming majority of women, regardless of whether they had participated in the screening program, believed that women are justified in having an abortion in the face of fetal abnormality. There was a sharp increase in the number of screening program participants who said they would have an abortion when the probability of the fetus being affected with a neural tube defect rose from 95 per cent to 100 per cent. PMID:3812832
Reyes, Laura; Garcia, Ronald; Ruiz, Silvia; Dehghan, Mahshid; López-Jaramillo, Patricio
Pre-eclampsia (PE) is one of the leading causes of maternal and perinatal morbidity and mortality worldwide. It has been proposed that, among other risk factors, the nutritional status of women can lead to the endothelial dysfunction that characterizes this entity. The aim of the present study was to compare the nutritional status of women with PE with healthy pregnant and non-pregnant women. A multicenter case-control study was carried out. Between September 2006 and July 2009, 201 women with PE were compared with 201 pregnant, and 201 non-pregnant aged-matched women without cardiovascular or endocrine diseases. A clinical history and physical examination was performed. Fasting blood samples were drawn to measure serum glucose and lipid profile. The nutritional status of participants was assessed using a food frequency questionnaire. The average age of women was 26.6 ± 7.2 years. Compared to healthy pregnant controls, women with PE had a higher body mass index, higher fasting blood glucose levels, higher triglycerides, and lower high-density lipoprotein cholesterol levels. Women with PE had a higher intake of carbohydrates, energy intake and cereal compared to healthy pregnant and non-pregnant controls. A conditional logistic regression demonstrated that carbohydrate and sodium intake are associated with PE development. Diets of women with PE were characterized by higher energy and carbohydrate intake compared to normal pregnant and non-pregnant women. This suggests that higher carbohydrate and sodium intake increases the risk of PE among women in Colombia. © 2012 The Authors. Journal of Obstetrics and Gynaecology Research © 2012 Japan Society of Obstetrics and Gynecology.
Tinker, Sarah C.; Broussard, Cheryl S.; Frey, Meghan T.; Gilboa, Suzanne M.
Objectives Many prescription medications have limited information regarding safety for use during pregnancy. In order to inform research on safer medication use during pregnancy, we examined prescription medication use among women in the United States. Methods We analyzed data from the 1999–2006 National Health and Nutrition Examination Survey (NHANES) to estimate the prevalence of prescription medication use in the past 30 days among pregnant women and non-pregnant women of childbearing age (15–44 years) and to ascertain the most commonly reported prescription medications by women in these groups. We assessed how the most commonly reported medications differed among groups defined by selected demographic characteristics, including age, race/ethnicity, and markers of socioeconomic status. Results Prescription medication use in the past 30 days was reported by 22% of pregnant women and 47% of non-pregnant women of childbearing age. The most commonly reported prescription medications by NHANES participants differed somewhat by pregnancy status; allergy and anti-infective medications were more common among pregnant women, while oral contraceptives were more common among non-pregnant women. Use of prescription medication for asthma and thyroid disorders was reported by both groups. Conclusions Although prescription medication use in the previous 30 days was less common among pregnant women than non-pregnant women, its use was reported among almost 1 in 4 pregnant women. Many of the most common medications reported were for the treatment of chronic medical conditions. Given the potential impact of medications on the developing fetus, our data underscore the importance of understanding the safety of these medications during pregnancy. PMID:25287251
Mathibe-Neke, J M
From a feminist perspective, research on childbirth and women's health is a means to a positive change that is conducted in partnership with women for their benefit. A patient-led National Health System (NHS) (Hillan, 1999) also calls for consultation with patients and the wider public for shaping the current and future health services. This study was aimed at exploring and describing the expectations that pregnant women have regarding antenatal care service by the midwife practitioner. In-depth interviews were conducted in an antenatal unit of an Academic Hospital in Gauteng Povince. Data saturation was reached with a sample of eighteen pregnant women who were conveniently selected. Data analysis ran concurrently with data collection. A manual content analysis as described by Tesch was used. Lincoln and Guba's method of ensuring trustworthiness was adopted (Lincoln & Guba, 1985:328) Literature was undertaken to compare the findings of this study with those of other previous studies. Women displayed several common expectations that led to the saturation of data. It also became apparent from the findings that each woman had varied expectations. There were also some commonalities within the women's expectations. Health care, as the major expectation and a basic human right, appeared to be basically fulfilled, with the exception of interactional characteristics such as the communication of information, guidance, involvement, the understanding and explanation of aspects, freedom of choice, punctuality, individualized care and continuity of care. The conclusions that were reached let to recommendations for nursing practice, education, research and the formulation of guidelines for the midwife practitioner for the implementation of effective antenatal care, based on the identified expectations.
Goodman, Karen J; O'Rourke, Kathleen; Day, R Sue; Wang, Constance; Redlinger, Thomas; Campos, Armando; de la Rosa, Jose Manuel
Helicobacter pylori infection causes chronic digestive diseases that disproportionately affect Hispanics and other immigrant groups in the United States. Information on the epidemiology of H. pylori infection in pregnant women who reside along the U.S.-Mexico border is critical to understanding the dynamics of current H. pylori transmission patterns within families along the border. We describe the epidemiology of H. pylori infection in pregnant women recruited from Women, Infants, and Children (WIC) clinics in El Paso, Texas, and Mexican Social Security Institute maternal-child clinics in Ciudad Juarez, Mexico, from April 1998 to October 2000. We interviewed participants regarding environmental factors and tested their serum for IgG antibodies. We used logistic regression to estimate associations between environmental exposures and the odds of H. pylori prevalence. Definitive serological tests were available from 751 women. Seroprevalence was 74% in Juarez women and 56% in El Paso women. Prevalence increased with age, crowding, poor sanitation, and residence in Mexico, decreased with education, and was not associated with the woman's number of living children. In the U.S.-Mexico border region, women of reproductive age have a high prevalence of H. pylori infection, apparently related to poor socioeconomic conditions.
Shrestha, S; Tuladhar, N R; Basnyat, S; Acharya, G P; Shrestha, P; Kumar, P
Vaginitis is the most prevalent disorder among the pregnant women. The objective of this study was to find out the prevalence of common types of vaginitis among the pregnant women visiting Paropakar Maternity and Women's Hospital in Kathmandu. Among 200 pregnant women included in the study, 78 (39.0%) had vaginitis. Of total 78 positive cases of vaginitis, 29.5% had candidiasis, 52.6% bacterial vaginosis and 1.3% trichomoniasis. Approximately 83% had monomicrobial infection and 16.7% had polymicrobial infection. Vaginitis was common in the age group of 20 to 29 years (41.8%) and 30-39 years (40.0%). Ethnically, Indo-Aryans (40.2%) were mostly infected. The infection rate was the highest among illiterate women (47.6%) and least among the women having education above secondary (23.0%). The positive infection rate was higher in women from rural area (45.2%) than those from urban area (37.3%). Nearly half of the women with agriculture occupation (48.4%) had vaginitis. Vaginitis was common in women with third pregnancy (52.6%). Among 78 vaginitis cases, 53 (67.9%) were asymptomatic cases.
Stoĭkova, V; Ivanov, S; Mazneĭkova, V; Tsoncheva, A
Preeclampsia is one of the most common and severe pregnancy complications, which ethiology remains unclear. It is certain that endothelial dysfunction plays a key role in the development of preeclampsia. Homocysteine is an important independent cardiovascular risk factor, which might induce the endothelial dysfunction observed in preeclampsia. 26 pregnant women--14 with preeclampsia (group 1) and 12 healthy term pregnant controls (group 2) were enrolled in the study between December 2003 and August 2004. Six of the women in this group had a superimposed preeclampsia. The mean homocysteine level in the first group was 11,04 mol/l, while in the control group it was 6,24 micromol/l (p < 0.05). The women with a severe preeclampsia had a significantly higher serum homocysteine levels than those with mild form (F = 0.025). Seven of the patients (50%) gave birth before 34th weeks of gestation. The study finds a link between the serum homocysteine as an endothelial dysfunction marker and the development of preeclampsia and a relation between the severity of preeclampsia and the degree of the elevation of the serum homocysteine levels.
Peñacoba-Puente, Cecilia; Carmona-Monge, Francisco Javier; Marín-Morales, Dolores; Écija Gallardo, Carmen
To analyze the change of childbirth expectations over the course of pregnancy as well as their relation to socio-demographic and clinical variables. The study of expectations in pregnant women is gaining more interest from a biopsychosocial approach because of its consequences on pregnant women's wellbeing. To our knowledge there are no previous studies analyzing the evolution of childbirth expectations over the course of pregnancy. Longitudinal study (first trimester and third trimester). Women were evaluated for childbirth expectations in their first trimester (n=285) and third trimester (n=122) of pregnancy. They also completed questionnaires collecting socio-demographic information. Childbirth expectations appear to remain more or less stable over the course of pregnancy, although they tend to become slightly negative at the end of gestation, specifically referring to personal control and delivery circumstances. Multiparity and planned pregnancy are associated with higher positive expectations. It seems essential to explore and to try to adjust childbirth expectations to more realistic ones, in order for them to be fulfilled. Midwives and other maternity healthcare providers play a key role in this regard. Copyright © 2015 Elsevier Inc. All rights reserved.
de Vasconcellos Piscoya, Maria Dilma Bezerra; de Alencar Ximenes, Ricardo Arraes; da Silva, Genivaldo Moura; Jamelli, Sílvia Regina; Coutinho, Sônia Bechara
OBJECTIVE: The main objective of this study was to investigate the risk factors associated with periodontitis in pregnant women. METHODS: This study was conducted in two stages. In Stage 1, a cross-sectional study was conducted to determine the prevalence of periodontitis among 810 women treated at the maternity ward of a university hospital. In Stage 2, the factors associated with periodontitis were investigated in two groups of pregnant women: 90 with periodontitis and 720 without. A hierarchized approach to the evaluation of the risk factors was used in the analysis, and the independent variables related to periodontitis were grouped into two levels: 1) socio-demographic variables; 2a) variables related to nutritional status, smoking, and number of pregnancies; and 2b) variables related to oral hygiene. Periodontitis was defined as a probing depth ≥4 mm and an attachment loss ≥3 mm at the same site in four or more teeth. A logistic regression analysis was also performed. RESULTS: The prevalence of periodontitis in this sample was 11%. The variables that remained in the final multivariate model with the hierarchized approach were schooling, family income, smoking, body mass index, and bacterial plaque. CONCLUSION: The factors identified underscore the social nature of the disease, as periodontitis was associated with socioeconomic, demographic status, and poor oral hygiene. PMID:22249477
Simões, Mafalda; Marques, Catarina; Gonçalves, Ana; Pereira, Ana Paula; Correia, Joaquim; Castela, João; Guerreiro, Cristina
The iatrogenic risk of HIV vertical transmission, calculated in initial epidemiologic studies, seemed to counterindicate invasive prenatal diagnosis (PND) procedures. The implementation of highly active antiretroviral therapy (HAART) represented a turning point in PND management, owing to a rapid and effective reduction of maternal viral load (VL). In the present study, we identified cases of vertical transmission in HIV-infected pregnant women who did amniocentesis in the second trimester of pregnancy (n = 27), from 1996 to 2011. We divided our sample into Group A--women under HAART when submitted to amniocentesis (n = 20) and Group B--women without antiretroviral therapy before amniocentesis (n = 7). We had 1 case of vertical transmission in Group B. Preconceptional or early first trimester HIV serology is essential to avoid performing an amniocentesis without antiretroviral therapy or viral suppression. When there is an indication for amniocentesis in an HIV-infected pregnant woman, it should be done if the patient is on HAART and, if possible, when VL is undetectable. Nowadays, with combined first trimester screening test to select pregnancies with high risk of aneuploidies, advanced maternal age is a less frequent indication to perform PND invasive procedures, representing an outstanding gain in prenatal diagnosis of this population.
Galvao, Tais F.; Silva, Marcus T.; Zimmermann, Ivan R.; Lopes, Luiz Antonio B.; Bernardo, Eneida F.; Pereira, Mauricio G.
Objective. To assess the effects of the inactivated influenza virus vaccine on influenza outcomes in pregnant women and their infants. Methods. We performed a systematic review of the literature. We searched for randomized controlled trials and cohort studies in the MEDLINE, Embase, and other relevant databases (inception to September 2013). Two researchers selected studies and extracted the data independently. We used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to assess the quality of the evidence. Results. We included eight studies out of 1,967 retrieved records. Influenza vaccination in pregnant women significantly reduced the incidence of influenza-like illness in mothers and their infants when compared with control groups (high-quality evidence) and reduced the incidence of laboratory-confirmed influenza in infants (moderate-quality evidence). No difference was found with regard to influenza-like illness with fever higher than 38°C (moderate-quality evidence) or upper respiratory infection (very-low-quality evidence) in mothers and infants. Conclusions. Maternal vaccination against influenza was shown to prevent influenza-like illness in women and infants; no differences were found for other outcomes. As the quality of evidence was not high overall, further research is needed to increase confidence and could possibly change these estimates. PMID:24971194
Wang, Yinsong; Tan, Mingguang; Huang, Zongzhi; Sheng, Liqin; Ge, Yongxin; Zhang, Hongde; Jiang, Mingli; Zhang, Guilin
Diabetes mellitus is characterized by hyperglycemia and is closely related to trace elements. Quite a few pregnant women suffer from impaired glucose tolerance (IGT) or gestational diabetes mellitus (GDM). Investigation of the changes of elemental contents in serum of the pregnant women with IGT and GDM is significant in the etiological research and cure of the diseases. In the present work, the elements Cu, Zn, Ca, Sr, Mg, P, Fe, and Al in the serum of pregnant women were determined. The elemental contents in different experimental groups were compared. Also, the correlation between elemental contents and gestational period was observed. The results showed that compared with normal pregnant women, the Cu contents in serum of pregnant women with GDM increased, but Zn contents had a decreasing trend. In addition, for all pregnant women, the Ca contents in serum had an obvious inverse correlation with gestational period.
Reberte, Luciana Magnoni; Hoga, Luiza Akiko Komura; Gomes, Ana Luisa Zaniboni
This study aimed to describe the production process of an educational booklet focusing on health promotion of pregnant women. The action research method was used in this process composed of the following steps: choice of the content based on the needs of pregnant women, creation of illustrations, content preparation based on scientific literature, validation of the material by experts and pregnant women. This work resulted in the final version of the booklet, which was entitled "Celebrating life: our commitment with the health promotion of pregnant women". Active participation of health professionals and pregnant women through dialogue and collective strategy permeated the process of development of the booklet. The opinions of pregnant women and experts who considered the booklet enriching and enlightening justify the use of it as an additional resource of educational activities carried out during the prenatal care.
Ifesanya, Joy U; Ifesanya, Adeleke O; Asuzu, Michael C; Oke, Gbemisola A
The need to attain and maintain good oral hygiene among pregnant women cannot be over emphasized as periodontal diseases in pregnancy have been linked with poor pregnancy outcomes. This study assessed the variables that affect oral hygiene status among pregnant women in a south-western Nigerian locality. Four hundred and five pregnant Nigerian women were assessed for their oral hygiene status using the Oral Hygiene Index-Simplified. Demographic and pregnancy statistics were also obtained and the relationships between these and oral hygiene status were determined. The mean age was 25.35 ± 5.02 years. Most of the women (96.0%) had never visited a dentist or any other oral health care provider and only 12.5% of those who had been attended by dental care givers have ever had professional dental cleaning. The oral hygiene status appeared to worsen as parity increased (p=0.047) while the use of the toothbrush and paste was associated with good oral hygiene (p=0.007). Higher education was associated with use of the tooth brush and paste (p=0.046) and good oral hygiene (p= 0.001). The positive effect of education on oral hygiene practices is highlighted in this study. However there is still need for proper health enlightenment in this population with regards to use of the available oral health care facilities.
Spera, Anna Maria; Eldin, Tarek Kamal; Tosone, Grazia; Orlando, Raffaele
Hepatitis C virus (HCV) affects about 3% of the world’s population, with the highest prevalence in individuals under 40. The prevalence in pregnant women varies with geographical distribution (highest in developing countries). Prevalence also increases in sub-populations of women at high risk for blood-transmitted infections. HCV infection in pregnancy represents a non-negligible problem. However, most of the past antiviral regimens cannot be routinely offered to pregnant or breastfeeding women because of their side effects. We briefly reviewed the issue of treatment of HCV infection in pregnant/breastfeeding women focusing on the effects of the new direct-acting antivirals on fertility, pregnancy and lactation in animal studies and on the potential risk for humans based on the pharmacokinetic properties of each drug. Currently, all new therapy regimens are contraindicated in this setting because of lack of sufficient safety information and adequate measures of contraception are still routinely recommended for female patients of childbearing potential. PMID:27134703
Background The purpose of this study was compare of daily iron supplementation in three time frames- daily, weekly and three time weekly supplementation in preventing anemia in healthy pregnant women. Method The present study was a prospective simply randomized clinical trial. During January 2006- January 2008, 150 healthy pregnant women without anemia, in their 16th week of pregnancy were randomly allocated into three equal groups. The first group (n = 50) received a 50 mg-ferrous sulfate tablet daily, second group (n = 50) received a 50 mg-ferrous sulfate tablet three times a week, and the third group (n = 50) received two 50 mg-ferrous sulfate tablets (100 mg) weekly, respectively for 12 consecutive weeks. Serum hemoglobin, ferritin, and iron were measured before and after the supplementation. Paired t and ANOVA tests were used as appropriated. Results There were no significant differences between the pre- and post-treatment hemoglobin levels with iron supplementation in the three group (P = 0.518, P = 0.276, respectively). The mean serum iron level before and after treatment with iron supplementation in the three groups was not statistically significant (P = 0.962, P = 0.970, respectively). Although the mean serum ferritin level before and after treatment with iron supplementation was statistically significant in the three groups, no significant differences were found comparing the three groups (P = 0.827, P = 0.635 respectively). Conclusions This results suggested, three times a week or weekly iron supplementation is as effective as daily supplementation for healthy pregnant women without anemia. Trial Registration ISRCTN: IRCT201101093820N1 PMID:22026956
Woolcott, Christy G; Giguère, Yves; Weiler, Hope A; Spencer, Anne; Forest, Jean-Claude; Armson, B Anthony; Dodds, Linda
Evidence suggests a beneficial effect of vitamin D on perinatal health; however, low vitamin D status is prevalent in pregnant women and neonates. The objective was to determine factors that are associated with vitamin D status of mothers in early pregnancy and neonates. The study comprised 1,635 pregnant women from Quebec City and Halifax, Canada, 2002-2010. Vitamin D status was based on the concentration of 25-hydroxy-vitamin D [25(OH)D] determined with a chemiluminescence immunoassay in maternal sera collected at a median of 15 weeks' gestation and in neonatal cord sera at delivery. A questionnaire with information on potential determinants was completed midpregnancy. A total of 44.8% of mothers and 24.4% of neonates had 25(OH)D concentrations <50 nmol/L. Adjusted mean (95% confidence interval) maternal 25(OH)D levels were higher in summer than in winter by 16.1 nmol/L (13.6-18.7), and in those in the highest versus the lowest category of education by 6.1 nmol/L (0.5-11.8), in BMI <25 kg/m2 versus BMI ≥35 kg/m2 by 8.2 nmol/L (4.0-12.3), and in the highest versus the lowest physical activity category by up to 9.5 nmol/L (2.9-16.1). Determinants of neonatal 25(OH)D levels were similar but also included maternal age, dairy intake, supplement use and 25(OH)D level. This study suggests that vitamin D status of pregnant women and/or neonates might be improved through supplementation, adequate dairy intake, a move towards a healthy pre-pregnancy body weight, and participation in physical activity. Controlled studies are needed to determine the effectiveness of interventions aimed at these factors.
Teixeira, Selma Villas Boas; Moura, Maria Aparecida Vasconcelos; Silva, Leila Rangel da; Queiroz, Ana Beatriz Azevedo; Souza, Kleyde Ventura de; Albuquerque, Leônidas Netto
Analyzing the elements that compose the environment of pregnant women who have experienced intimate partner violence in the light of Levine's Nursing Theory. A qualitative, descriptive study conducted from September to January 2012, with nine pregnant women in a Municipal Health Center in Rio de Janeiro. The interviews were semi-structured and individual. The theoretical framework was based on Levine's Nursing Theory. Thematic analysis evidenced the elements that composed the external environment, such as violence perpetrated by intimate partners before and during pregnancy, violence in childhood and adolescence, alcohol consumption and drug use by the partner, unemployment, low education and economic dependency, which affected health and posed risks to the pregnancy. Violence perpetrated by an intimate partner was the main external factor that influenced the internal environment with repercussions on health. This theory represents a tool in nursing care which will aid in detecting cases and the fight against violence.
Gunnarsdottir, Ingibjorg; Tryggvadottir, Ellen Alma; Birgisdottir, Bryndis Eva; Halldorsson, Thorhallur Ingi; Medek, Helga; Geirsson, Reynir Tomas
Nutrition in pregnancy may affect growth, development and health of the child in the short and long term. We aimed to assess diet and nutrient intake among pregnant women in the capital area and evaluate differences in dietary intake between women who were overweight/obese and normal weight before pregnancy. Pregnant women aged 18-40 years (n=183) living in the capital area kept four day weighed food records to assess diet and nutrient intake in the 19th-24th week of pregnancy (n=98 with body mass index (BMI) <25 kg/m2; n=46 with BMI 25-29.9 kg/m2 and n=39 with BMI ≥30 kg/m2). Only 20% of the women consumed the minimum recommended 25 g/day of dietary fibers. The contribution of added sugar to the total energy intake was on average 12% (SD ± 5%). About one-fourth appeared not to meet requirements for iodine, vitamin D and DHA (docosahexaenoic acid). No overconsumption of vitamins and minerals from food or supplements was observed. Higher median intake of milk and dairy products (346 g/day vs. 258 g/day, p<0.05), soft drinks (200 g/day vs. 122 g/day, p<0.05), as well as chips and popcorn (13 g/day vs. 0 g/day, p<0,05) was observed among women with BMI ≥30 kg/m2 compared with women of normal weight before pregnancy (BMI <25 kg/m2). Dietary habits and choices among women require enhanced consideration both before and in pregnancy, particularly among those who are obese. Sub-optimal consumption of iodine, vitamin D and DHA, was seen among up to a quarter of the pregnant women. pregnancy, nutrition, dietary intake, essential fatty acids, iodine, vitamin D, folic acid. Correspondence: Ingibjorg Gunnarsdottir, email@example.com.
... women and fetuses involved in observational research. 26.304 Section 26.304 Protection of Environment... Protections for Pregnant Women and Fetuses Involved as Subjects in Observational Research Conducted or Supported by EPA § 26.304 Additional protections for pregnant women and fetuses involved in...
Zufarova, Sh A
Pregnant women with pyelonephritis (PN) and glomerulonephritis (GN) were shown to have response to the therapy in accordance with level of kidney functional activity. The women with PN and GN have the treatment efficacy higher with Kidney Functional Reserve KFR > 10% and from 5 to 10% and practically absent in pregnant women with KFR < 5% (Kidney functional reserve).
... 42 Public Health 4 2014-10-01 2014-10-01 false Pregnant women eligible for extended coverage. 435... Groups § 435.170 Pregnant women eligible for extended coverage. (a) The agency must provide categorically needy Medicaid eligibility for an extended period following termination of pregnancy to women who, while...
... 42 Public Health 4 2013-10-01 2013-10-01 false Pregnant women eligible for extended coverage. 435... Groups § 435.170 Pregnant women eligible for extended coverage. (a) The agency must provide categorically needy Medicaid eligibility for an extended period following termination of pregnancy to women who, while...
... women and fetuses involved in observational research. 26.304 Section 26.304 Protection of Environment... Protections for Pregnant Women and Fetuses Involved as Subjects in Observational Research Conducted or Supported by EPA § 26.304 Additional protections for pregnant women and fetuses involved in observational...
... women and fetuses involved in observational research. 26.304 Section 26.304 Protection of Environment... Protections for Pregnant Women and Fetuses Involved as Subjects in Observational Research Conducted or Supported by EPA § 26.304 Additional protections for pregnant women and fetuses involved in...
... women and fetuses involved in observational research. 26.304 Section 26.304 Protection of Environment... Protections for Pregnant Women and Fetuses Involved as Subjects in Observational Research Conducted or Supported by EPA § 26.304 Additional protections for pregnant women and fetuses involved in...
Fialová, L; Mikulíková, L; Malbohan, I; Benesová, O; Stípek, S; Zima, T; Zwinger, A
Oxidized low density lipoproteins (oxLDL) formed in vivo induce a humoral immune response. Oxidative modification of LDL renders it immunogenic and a heterogeneous population of specific anti-oxLDL antibodies is produced. These antibodies could represent a biological marker of oxidative stress and serve as markers of atherosclerosis. Autoantibodies against oxLDL (oLAb) have been detected in human subjects practically of every age. oLAb also appear in the blood of pregnant women. Some studies have shown that the levels of antibodies to oxLDL were elevated in women with established preeclampsia. The present study was aimed to estimate the oLAb IgG levels in the first and second trimester of pregnancy. Furthermore, we estimated the correlation between maternal serum (MS) levels of oLAb and alpha-1-fetoprotein (MS AFP), human chorionic gonadotrophin (MS HCG) and trophoblast-specific-beta-1-glycoprotein (MS SP1), because these proteins are determined as a part of prenatal biochemical screening for fetal congenital abnormalities. Our study deals with the oLAb changes in women with pregnancy-induced hypertension. We also investigated the correlation between oLAb IgG and anticardiolipin antibodies IgG (ACA) in the serum of pregnant women. We examined 40 pregnant women attending Institute for Mother and Child Care for their antenatal care as outpatients. Routine blood samplings between the 9-13th week of pregnancy and 16-18th week of pregnancy were performed as a part of biochemical prenatal screening for fetal congenital abnormalities (Group 1). Their mean age was 27 +/- 4.1 years. Furthermore, we examined 26 women in the second or third trimester with pregnancy-induced hypertension (Group 2). Group 2 was compared with 49 pregnant women in the second or third trimester who were normotensive (Group 3). We used commercial standardized ELISA kits for determination of oLAb IgG, ACA IgG, MS AFP and MS HCG, MS SP1 was analyzed by single radial immunodiffusion. We did not find
Strelnikova, A I; Tsirkin, V I; Krysova, A V; Hlybova, S V; Dmitrieva, S L
Acetylcholine (5.5×10(-10)-5.5×10(-6)M) accelerated erythrocyte agglutination in men, non-pregnant women in follicular phase of the menstrual cycle, and pregnant women in the first trimester. The effect was blocked with atropine (5.5×10(-6)M). Acetylcholine had no effect on the rate of erythrocyte agglutination in non-pregnant women in the luteal phase and pregnant women in the second and third trimesters, which coincided with the development of myometrium refractoriness to acetylcholine in pregnant women. The results indicate that erythrocytes can reflect M-cholinoreactivity of internal organs.
Holusková, I; Lubušký, M; Studničková, M; Procházka, M
The aim of this review is to give comprehensive summary of erythrocyte alloimunization of pregnant women, laboratory dignostics and clinical importance. Review. University Hospital Olomouc, Transfusion Department, Department of Obstetrics and Gynecology. Based on literature analysis using database search engines PubMed, Google Scholar, Ovid in field of erythrocyte antibodies, laboratory diagnostics and clinical importance up-to-date knowledge. Erythrocyte alloimunization anti-D antibodies decreases in connection with the introduction of immunoprofylaxis. Immunization of non RhD antibodies with impossibility using of immunoprofylaxis remains still clinical problem.
Counsilman, J J; Mackay, E V
A survey of postpartum women in Brisbane revealed that many gave up smoking just before or shortly after becoming pregnant, and that many of the remainder reduced their rate of consumption. Husbands who smoked showed no comparable changes in behaviour. Thus apparently many couples were aware of the dangers to the fetus of active smoking by the woman, but not of the dangers of her passive inhalation of smoke. Other significant findings included (i) increasing rates of consumption during successive pregnancies, (ii) high degrees of conformity for most habits (e.g. use of filters), and (iii) stronger addiction and earlier starting ages among heavy smokers than light smokers.
Giurgescu, Carmen; Murn, Nicole L.
Depression during pregnancy is common, and pregnant African American (AA) women are more likely to experience depressive symptoms compared with pregnant non-Hispanic white women. This study explored AA women’s experience of church attendance, church member support, depressive symptoms, and psychological well-being at 15–25 weeks’ gestation. Nurses need to be aware of the importance of church support and encourage clergy and church members to be supportive of pregnant women. PMID:27119803
Côté-Arsenault, Denise; Schwartz, Katharine; Krowchuk, Heidi; McCoy, Thomas P
To test the feasibility and acceptability of a caring-based nurse home visit intervention for women pregnant after perinatal loss (PAL), the goal of which was to provide a safe, supportive environment, normalize the pregnancy after loss, reduce anxiety and depression through stress reduction skills, and facilitate prenatal attachment. This mixed methods study was conducted in two phases: Phase I, to determine the components of the intervention, and Phase II, a randomized trial that used the revised intervention components. Pregnant women with a history of at least one perinatal loss (9 in Phase I and 24 in Phase II) were recruited from obstetrical practices. Phase II sample size was adequate to detect group differences. Background measures of demographics, obstetrical history, and meaning of past losses were collected at baseline. Measured at three points across pregnancy were threat appraisal of pregnancy; and emotional states: anxiety (pregnancy, state, trait), depression, self mastery, prenatal attachment, and satisfaction with social support. The caring-based nurse home visit intervention included activities aimed to reduce anxiety and promote prenatal attachment. The control group were sent pregnancy information booklets that coincided with their gestational age. Qualitative and quantitative evaluations were obtained. In Phase I, 8 women received the intervention; in Phase II, 13 received the intervention and 11 were in the control group. No baseline between-group differences were found. The intervention group had significantly higher satisfaction with social support over time. Women's evaluations were very positive; home visits were rated most liked and helpful. They appreciated a knowledgeable nurse who knew their story, listened, normalized the PAL experience, and was there with nonjudgmental support. The intervention is both feasible and acceptable. Most women felt that they could reduce their own anxiety using the tools and skills they were provided
Osime, Odaburhine E; Ese-Onakewhor, Joseph U; Kolade, Samson O
To report on the changes in fibrinolytic activity in human immunodeficiency virus (HIV) infected pregnant women who are undergoing highly active antiretroviral therapy (HAART). Blood was collected from 50 HIV positive women on HAART (test subjects), and 50 HIV positive women not on HAART (controls). These women were attending the prevention of mother to child clinic (PMTCT) of the University of Benin Teaching Hospital, Benin City, Nigeria from January to June 2014. Standard manual techniques were used to estimate plasma fibrinogen concentration (PFC), euglobulin lysis time (ELT), packed cell volume (PCV), and plasma viscosity (PV). The mean ± standard error of mean (SEM) of PFC was 4.02±0.13 g/l and ELT from the test subjects was 378±15 mins was significantly higher (p<0.05) compared with the control subjects (PFC 3.46±0.12 g/l and ELT 267±9.0 mins). The PCV or hematocrit values in the test subject was 29.1±0.38%, which was significantly lower (p<0.05) compared with the control subject (31.3±0.43%). The PV in the test subject was 1.76±0.02 mPa/s, while the control subjects was higher (1.73±0.02 mPa/s). This increase was not statistically significant (p>0.05). There were differences in the various parameters investigated when the various trimesters were compared. These differences did not, however, follow a particular pattern. Highly active antiretroviral therapy can cause changes in fibrinolytic activity that may predispose pregnant women to hyperfibrinogenemia and anemia.
Oral health may plan an important role in the general health of adolescents who are pregnant and parenting. However, little is known about the socio-behavioral and environmental experiences that may affect the adolescent woman's oral health and quality of life. The purpose of this study was to explore oral health experiences among adolescent women who were pregnant and parenting. This was a qualitative descriptive study. Twenty-four adolescent women who were pregnant and parenting, 14-18 years of age, who read and spoke English and were enrolled in an alternative school-based program. Manifest and latent content analysis were conducted by hand with data from face-to-face interviews, observations, field notes, and reflective journaling. Member checks confirmed credibility of the qualitative findings. Four themes emerged from the oral health data: perceptions, knowledge and practices, myths and misconceptions, and values. Nurses may play a key role in improving the oral health status of adolescents who are pregnant and parenting. Oral health should be a routine part of every general health assessment. Copyright © 2012 Elsevier Ltd. All rights reserved.
Bojar, Iwona; Owoc, Alfred; Humeniuk, Ewa; Wierzba, Waldemar; Fronczak, Adam
Women's daily nutrition should include proper amounts of vitamins, ingredients and fluids. The shortage or surplus of any ingredient can negatively affect the health condition of a mother or hera baby. The objective of the study was to assess the quality of the diet of pregnant wome in Poland against the World Health Organization (WHO) and European Union (EU) recommendations concerning requirements for vitamins and minerals. 512 pregnant women in their 20(th) -30(th) week of pregnancy took part in the research conducted by the means of observation of a 7-day diet. Consumed products were analyzed by the means of DIETETYK software developed by the Polish National Food and Nutrition Institute (NFNI). Obtained micro- values were averaged. The results were compared with the recommendations of the WHO UE and NFN and analyzed statistically (test Chi(2)). A lower consumption than 400 g/day of fruit and vegetables in the diets was found in 4.68% of pregnant women. Mean values for vitamins: D - 2.64 ug/person, B6 - 1.76 mg/person and folic acid - 1603 ug/person, as well as average values for mineral components: calcium 689 mg/person, magnesium 255 mg/person, iron - 10.1 mg/person, zinc - 9.2 mg/person were also lower than daily recommended values. Daily level for sodium, phosphorus and vitamin A were exceeded. Results indicate insufficient knowledge of pregnant women about proper nutrition during pregnancy. Supplementing most vitamins and mineral components, beginning with a first pregnancy trimester, is necessary. Women at childbearing age must be educated about the necessity for proper nutrition during and before a pregnancy.
Wilder, Christine; Lewis, Daniel; Winhusen, Theresa
Increasing use of opioids has led to an increase in the number of pregnant and postpartum women in medication assisted treatment (MAT) for opioid use disorder. We (1) conducted a systematic review of published literature on MAT discontinuation (methadone and buprenorphine) in pregnant and postpartum women and (2) determined methadone discontinuation rates in a retrospective cohort (2006-2013) of pregnant and postpartum women in a university affiliated methadone clinic. We found limited generalizable literature reports of discontinuation rates, with a range of prenatal discontinuation rates from 0 to 33% and rates which spanned various prenatal and postnatal periods from 26 to 64%. In our cohort of 229 women, 251 pregnancies were reported, with a prenatal methadone discontinuation rate of 11.0%. Based on a Cox proportional hazards model controlling for age, pregnancy outcome, and duration of treatment prior to delivery, the probability of methadone discontinuation at or before 6 months postpartum was 56.0%. Duration of methadone treatment prior to delivery was inversely associated with risk for postpartum discontinuation of treatment (HR = 0.98, 95% CI (0.96, 0.99)). We conclude that the postpartum period is a time of increased risk for discontinuation of MAT. More accurate assessment of rates of pre- and postpartum MAT discontinuation, as well as further investigation of factors affecting these rates, is warranted. Development and testing of interventions to encourage early prenatal enrollment in MAT and improve postnatal retention in MAT would benefit pregnant women and new mothers with opioid use disorder. Published by Elsevier Ireland Ltd.
Chou, C S; Lin, L Y; Chen, K M; Lai, S C
The study was to determine the seroprevalence of toxoplasmosis in the sera of pregnant women in central Taiwan and to investigate the levels of cytokine in the sera of pregnant women with Toxoplasma gondii infection. The 220 blood samples were collected from pregnant women. The haematological parameters of peripheral blood were analysed by a haematology analyser. Serum samples of the pregnant women were analysed by a commercially available anti-T. gondii IgM/IgG antibody enzyme-linked immunosorbent assay (ELISA) kit and FlowCytomix assays. Six (2.7%) of the sera samples had IgM anti-T. gondii antibodies, and twenty (9.1%) had T. gondii IgG seropositive. All six IgM seropositive samples had low IgG avidity, indicative of acute infection. Total white blood cells and eosinophils were statistically significantly increased (p<0.05) in pregnant women with T. gondii infection, as compared with healthy pregnant women. Th1 cytokines IFN-γ, IL-1β, IL-2 and IL-12 p70, and Th2 cytokines IL-10 in pregnant women with T. gondii IgM/IgG seropositive were significantly increased (p<0.05), as compared with healthy pregnant women. These results showed that both of Th1 and Th2 cytokines play an important role in the toxoplasmosis of pregnant women.
Kuru, U; Turan, O; Kuru, N; Saglam, Z; Ceylan, Y; Nurluoglu, M; Agacfidan, A
A total of 5,366 pregnant Turkish women were screened for hepatitis B surface antigen (HBsAg) and 225 (4.2%) of them were found to be positive. Hepatitis B e antigen (HBeAg) was detected in 6.2% of HBsAg-positive pregnant women. the overall prevalence of HBsAg and antibody to HBsAg (anti-HBs) among the spouses, previous children, mothers and first degree relatives of the HBsAg-positive pregnant women was 56%, 49%, 79% and 74% respectively. The prevalence of HBsAg is thus high in pregnant Turkish women with familial clustering of hepatitis B virus infection.
Heminger, Christina L; Schindler-Ruwisch, Jennifer M; Abroms, Lorien C
Background Smoking during pregnancy has deleterious health effects for the fetus and mother. Given the high risks associated with smoking in pregnancy, smoking cessation programs that are designed specifically for pregnant smokers are needed. This paper summarizes the current landscape of mHealth cessation programs aimed at pregnant smokers and where available reviews evidence to support their use. Methods A search strategy was conducted in June–August 2015 to identify mHealth programs with at least one component or activity that was explicitly directed at smoking cessation assistance for pregnant women. The search for text messaging programs and applications included keyword searches within public health and medical databases of peer-reviewed literature, Google Play/iTunes stores, and gray literature via Google. Results Five unique short message service programs and two mobile applications were identified and reviewed. Little evidence was identified to support their use. Common tools and features identified included the ability to set your quit date, ability to track smoking status, ability to get help during cravings, referral to quitline, and tailored content for the individual participant. The theoretical approach utilized was varied, and approximately half of the programs included pregnancy-related content, in addition to cessation content. With one exception, the mHealth programs identified were found to have low enrollment. Conclusion Globally, there are a handful of applications and text-based mHealth programs available for pregnant smokers. Future studies are needed that examine the efficacy of such programs, as well as strategies to best promote enrollment. PMID:27110146
Askari, Sahar Ghale; Khatbasreh, Masomeh; Ehrampoush, Mohammad Hassan; Sheikhha, Mohammad Hassan; Eslami, Hadi; Taghavi, Mahmoud; Shahrokhi, Samira; Andishmand, Sodeh
The process of industrialization and lifestyle changes have gradually exposed human societies to a larger number of environmental risk factors, which may cause hormonal abnormalities and congenital anomalies. The current study aimed to investigate the relationship between environmental factors and hormonal abnormalities among pregnant women in Yazd, Iran. A hundred participants were randomly selected from among a group of pregnant women. According to the screening tests (AFP, free β-HCG, uE3, PAPP-A, and inhibin-A) performed at the genome clinic in Yazd in 2016, the risk of Down Syndrome (DS) was sufficiently high in this group of pregnant women from which the participants were selected. A questionnaire was used to collect data on the degree of the participants' exposure to pesticides at home, use of canned and fast foods, and consumption of greenhouse fruits. The collected data were analyzed by One-way ANOVA and Kruskal-Wallis Test. The mean of Multiple of Median (MoM) for inhibin-A was significantly higher among pregnant women who often or always used pesticides at home (p=0.047). The mean MoM for free β-HCG was significantly higher among pregnant women who often or always used canned foods (p=0.024). Finally, the mean MoM for uE3 (1.85±1.30) was significantly higher among pregnant women who never consumed greenhouse fruits (p=0.003). It can be concluded that it is possible to reduce environmental exposures affecting hormonal abnormalities among pregnant women by improving nutritional patterns, minimizing the use of pesticides at home, and reducing the intake of canned foods and greenhouse fruits. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
Harlap, Susan; Davies, A. Michael
Associations between previous induced abortion and demographic and health factors in pregnancy were measured in 9 874 women who gave birth and who had been interviewed during pregnancy. Previous abortion was most rare among women having their first baby and increased with increasing birth order up to the fourth, thereafter decreasing. It was positively correlated with maternal age and negatively with age at marriage. There was no effect of years of schooling, when other variables were taken into account, but there were significant differences between ethnic groups, abortion being commonest among Jewish women from North African countries and more prevalent in those from western and Asian countries than in the second-generation Israel-born or in Arab women. Women who reported abortions were less likely to be strict as regards religious observance and less likely to have had a previous stillbirth or child death, other variables being equal. They were more likely to be smokers or former smokers and to be delivered of their babies in certain obstetric units. They more often reported vomiting, bleeding, and medication in early pregnancy. On the other hand, there was no significant association with diabetes, anaemia, blood groups, or season of birth. The findings show that women reporting previous induced abortions differ significantly from other pregnant women in a wide range of demographic and health characteristics. Such women may also be biased for complications of pregnancy and outcome, particularly if selected from a clinic population. Observations that indicate a deleterious effect of induced abortions on subsequent pregnancy outcomes must therefore be interpreted with considerable caution. PMID:1083303
Schuster, K; Bailey, L B; Dimperio, D; Mahan, C S
The relationship between the vitamin B6 status of 180 pregnant women and the incidence and degree of morning sickness experienced during the first trimester was investigated. There were no significant differences in plasma pyridoxal 5'-phosphate (PLP), erythrocyte aspartate aminotransferase (AspAT) activity, and stimulation of erythrocyte AspAT activity by exogenous PLP between subjects who experienced morning sickness and those who did not. No relationship was found between these indicators of vitamin B6 status and the degree of morning sickness experienced by this group during early pregnancy. There were no differences in the number of women who experienced morning sickness or in the number with different degrees of sickness when plasma levels of PLP, erythrocyte AspAT activity or stimulation by PLP were divided into upper and lower 50th percentile groups and compared. Therefore these data show no relationship between vitamin B6 status and the incidence or degree of morning sickness.
O'Byrne, E M; Carriere, B T; Sorensen, L; Segaloff, A; Schwabe, C; Steinetz, B G
Immunoreactive relaxin was measured in plasma samples obtained from human volunteers utilizing the RIA procedure of Sherwood et al., as modified by O'Byrne and Steinetz for heterologous plasma samples. Immunoreactive hormone was not detected in samples obtained from men, and only rarely in plasma of nonpregnant women. Immunoreactive relaxin was present as early as the fourth week of pregnancy and was detectable throughout the course of gestation. Immunoreactive relaxin tended to be higher early in pregnancy, and there was no peak just before parturition as occurs in many other species. Our results are at variance with those of Bryant and coworkers, who reported high levels of immunoreactive relaxin in men and nonpregnant as well as pregnant women. The possible reasons for this discrepancy are presented.
This study set out to (1) estimate the prevalence of three forms of feeding intention among 2,178 pregnant women in six of Hong Kong's regional hospitals and (2) identify the associated demographic, socioeconomic, obstetric and relational correlates. The research design was exploratory, cross-sectional, and quantitative. The Chinese version of a self-administered questionnaire was used to collect the demographic, socio-economic, and obstetric characteristics of the women. Couples' relationships were investigated using the Dyadic Adjustment Scale. All women in the second trimester of their pregnancies who attended the target antenatal clinics within the data collection period of December 2004 to December 2006 were recruited. The prevalence rates of breastfeeding, mixed feeding and artificial feeding were 53.9%, 14.8%, and 31.3%, respectively. Women who had been born in Hong Kong, lived in accommodation that was > or = 300 feet(2) (approximately 30 m(2)), had made an early antenatal booking, had a planned pregnancy, were experiencing their first pregnancy, and had a lower level of conflict with their partners were significantly more likely to opt for breastfeeding. Women who had been born in Hong Kong and already had children were significantly more likely to choose mixed feeding, compared with the artificial group in a multinomial logistic regression model. These findings suggest that effective promotion of breastfeeding during the prenatal period must target the correlates of feeding intention.
Käser, Annina K.; Arguin, Paul M.; Chiodini, Peter L.; Smith, Valerie; Delmont, Jean; Jiménez, Beatriz C.; Färnert, Anna; Kimura, Mikio; Ramharter, Michael; Grobusch, Martin P.; Schlagenhauf, Patricia
Summary Background Data on imported malaria in pregnant women are scarce. Method A retrospective, descriptive study of pooled data on imported malaria in pregnancy was done, using data from 1977 to 2014 from 8 different collaborators in Europe, the United States and Japan. Most cases were from the period 1991–2014. National malaria reference centresas well as specialists on this topic were asked to search their archives for cases of imported malaria in pregnancy. A total of 632 cases were collated, providing information on Plasmodium species, region of acquisition, nationality, country of residence, reason for travel, age, gestational age, prophylactic measures and treatment used, as well as on complications and outcomes in mother and child. Results Datasets from some sources were incomplete. The predominant Plasmodium species was P. falciparum in 72% of cases. Among the 543 cases where information on the use of chemoprophylaxis was known, 471 (74.5%) did not use chemoprophylaxis or used incorrect or incomplete chemoprophylaxis. The main reason for travelling was “visiting friends and relatives” VFR (48.6%) and overall, most cases of malaria were imported from West Africa (85.9%). Severe anaemia was the most frequent complication in the mother. Data on offspring outcome was limited, but spontaneous abortion was a frequently reported foetal outcome (n = 14). A total of 50 different variants of malaria treatment regimens were reported. Conclusion Imported cases of malaria in pregnancy are mainly P. falciparum acquired in sub-Saharan Africa. Malaria prevention and treatment in pregnant travellers is a challenge for travel medicine due to few data on medication safety and maternal and foetal outcomes. International, collaborative efforts are needed to capture standardized data on imported malaria cases in pregnant women. PMID:26227740
Rasmussen, Mette; Heitmann, Berit Lilienthal; Tønnesen, Hanne
Background: Smoking is considered the most important preventable risk factor in relation to the development of complications during pregnancy and delivery. The aim of this study was to evaluate the effectiveness of an intensive 6-week gold standard programme (GSP) on pregnant women in real life. Methods: This was a prospective cohort study based on data from a national Danish registry on smoking cessation interventions. The study population included 10,682 women of a fertile age. The pregnancy status of the study population was identified using the National Patient Registry. Results: The response rate to follow up was 76%. The continuous abstinence rate for both pregnant and non-pregnant smokers was 24–32%. The following prognostic factors for continuous abstinence were identified: programme format (individual/group), older age, heavy smoking, compliance with the programme, health professional recommendation, and being a disadvantaged smoker. Conclusions: The GSP seems to be as effective among pregnant smokers as among non-pregnant smoking women. Due to the relatively high effect and clinical significance, the GSP would be an attractive element in smoking cessation intervention among pregnant women. PMID:23959083
Petousis-Harris, Helen; Walls, Tony; Watson, Donna; Paynter, Janine; Graham, Patricia; Turner, Nikki
Objectives Actively recruit and intensively follow pregnant women receiving a dose of acellular pertussis vaccine for 4 weeks after vaccination. Design and settings A prospective observational study conducted in 2 New Zealand regions. Participants Women in their 28th–38th week of pregnancy, recruited from primary care and antenatal clinics at the time of Tdap administration. Telephone interviews were conducted at 48 h and 4 weeks postvaccination. Main outcomes measures Outcomes were injection site reactions, systemic symptoms and serious adverse events (SAEs). Where available, data have been classified and reported according to Brighton Collaboration definitions. Results 793 women participated with 27.9% receiving trivalent inactivated influenza vaccine concomitantly. 79% of participants reported mild or moderate pain and 2.6% severe pain. Any swelling was reported by 7.6%, induration by 12.0% (collected from 1 site only, n=326), and erythema by 5.8% of participants. Fever was reported by 17 (2.1%) participants, 14 of these occurred within 24 h. Headache, dizziness, nausea, myalgia or arthralgia was reported by <4% of participants, respectively, and fatigue by 8.4%. During the study period, there were 115 adverse events in 113 participants, most of which were minor. At the end of the reporting period, 31 events were classified as serious (eg, obstetric bleeding, hypertension, infection, tachycardia, preterm labour, exacerbation of pre-existing condition and pre-eclampsia). All had variable onset time from vaccination. There were two perinatal deaths. Clinician assessment of all SAEs found none likely to be vaccine related. Conclusions Vaccination with Tdap in pregnant women was well tolerated with no SAE likely to be caused by the vaccine. Trial registration number ACTRN12613001045707. PMID:27091823
Messerer, L; Bouzbid, S; Gourbdji, E; Mansouri, R; Bachi, F
The aim of the study was to estimate the seroprevalence and risk factors of toxoplasmosis in pregnant women in the department of Annaba, Algeria. We performed a cross-sectional study with analytical purposes. The study was collaboration between the laboratory of Parasitology-Mycology, Faculty of Medicine of Annaba and Parasite Biology Department at the Pasteur Institute of Algeria. A total of 1028 pregnant women who underwent prenatal diagnosis/visit were included over a period of 4 years from January 2006 to December 2009. Immunoglobulin G and M were assayed, using the microparticle enzyme method. The avidity test was used to determine the date of contamination according to age of pregnancy. Search for the parasite was made by inoculation of the placenta and cord blood in white mice. The study compared mother-to-child serological profiles using Western Blot (WB) IgG and IgM. Direct (not well-cooked meat) and indirect (presence of cat, gardening) indicators were recorded to search for parasite exposure. Seroprevalence was 47.8 % (95 % CI: 44.8 to 51.0) and the rate of active toxoplasmosis was 1.1 % (95 % CI 0.6 to 1.8). According to their immune status, this was the first serology for 41 % (CI95 %: 38.0-44.0) of women; 12 % (CI95 %: 10.5-14.6) of primiparous women had only one serology test during their entire pregnancy. Major risk factors were consumption of poorly-cooked meat and exposure to cats. Toxoplasmosis during pregnancy is a serious issue and an effective prevention program is needed. Copyright © 2014 Elsevier Masson SAS. All rights reserved.
Fischer, G; Johnson, R E; Eder, H; Jagsch, R; Peternell, A; Weninger, M; Langer, M; Aschauer, H N
To assess the maternal and fetal acceptability of buprenorphine and neonatal abstinence syndrome (NAS) in children born to buprenorphine-maintained mothers. Open-label, flexible dosing, inpatient induction with outpatient maintenance, conducted at the University of Vienna within the existing pregnancy and drug addiction program. Fifteen opioid-dependent pregnant women. Sublingual buprenorphine tablets (1-10 mg/day). Mothers: withdrawal symptoms (Wang Scale), nicotine dependence (Fagerström Scale: FTQ) and urinalysis. Neonates: birth outcome and NAS (Finnegan Scale). All subjects were opioid-, nicotine- and cannabis-dependent. Buprenorphine was well tolerated during induction (Wang Score < or = 4) and illicit opioid use was negligible (91% opioid-negative). All maternal, fetal and neonatal safety laboratory measures were within normal limits or not of clinical significance. Mean birth outcome measures including gestational age at delivery (39.6 +/- 1.5 weeks), Apgar scores (1 min = 8.9; 5 min = 9.9; and 10 min = 10), birth weight (3049 +/- 346 g), length (49.8 +/- 1.9 cm) and head circumference (34.1 +/- 1.8 cm) were within normal limits. The NAS was absent, mild (without treatment) and moderate (with treatment) in eight, four and three neonates, respectively. The mean duration of NAS was 1.1 days. Buprenorphine appears to be well accepted by mother and fetus, and associated with a low incidence of NAS. Further investigation of buprenorphine as a maintenance agent for opioid-dependent pregnant women is needed.
Ramirez-Cacho, William A; Strickland, Lisa; Beraun, Cristina; Meng, Chen; Rayburn, William F
The objective of this study was to determine whether medical students' attendance at a clinic designed for pregnant substance users would yield changes in their attitudes toward the special needs of this population. This prospective study involved 104 consecutive third-year students rotating on our obstetrics-gynecology clerkship. Students were assigned to attend either a half day prenatal clinic designed specifically for women with substance use disorders during the first 4 weeks (study group) or during the second 4 weeks (control group). Each answered a confidential 24-question survey (using a 5-point scale from "strongly agree" to "strongly disagree"), dealing with comfort levels and attitudes, at the beginning and midway points of the 8-week clerkship. Student t tests were used for comparisons of averaged scores. At the beginning of the clerkship, no differences were found between the study (n = 52) and control groups (n = 52) in their responses to the survey. Regardless of gender, students who attended the clinic reported they became more comfortable in talking with patients about their substance use (P < .001) and more nonjudgmental in treating these patients (P < .02). Compared with before the clerkship, the control group became less comfortable in talking with these patients about their habits (P < .01), less aware about the prevalence of substance abuse during pregnancy (P < .02), and less aware about the efficacy of counselors (P < .05). Medical students became more comfortable and better informed about pregnant women with substance use disorders after attending a clinic dedicated toward this population's special needs.
Wilder, Christine M; Winhusen, Theresa
Opioid misuse during pregnancy is associated with negative outcomes for both mother and fetus due not only to the physiological effects of the drug but also to the associated social, medical and mental health problems that accompany illicit drug use. An interdisciplinary approach to the treatment of opioid use disorder during pregnancy is most effective. Ideally, obstetric and substance use treatment are co-located and ancillary support services are readily available. Medication-assisted treatment with methadone or buprenorphine is intrinsic to evidence-based care for the opioid-using pregnant woman. Women who are not stabilized on an opioid maintenance medication experience high rates of relapse and worse outcomes. Methadone has been the mainstay of maintenance treatment for nearly 50 years, but recent research has found that both methadone and buprenorphine maintenance treatments significantly improve maternal, fetal and neonatal outcomes. Although methadone remains the current standard of care, the field is beginning to move towards buprenorphine maintenance as a first-line treatment for pregnant women with opioid use disorder, because of its greater availability and evidence of better neonatal outcomes than methadone. However, there is some evidence that treatment dropout may be greater with buprenorphine relative to methadone.
Fledderjohann, Jasmine; Vellakkal, Sukumar; Stuckler, David
Promoting breastfeeding is major maternal and child health goal in India. It is unclear whether mothers receive additional food needed to support healthy breastfeeding. Using the latest National Family and Health Survey (2005-2006), we applied multilevel linear regression models to document correlates of nutrition for (n = 20,764) breastfeeding women. We then compared consumption of pulses, eggs, meat, fish, dairy, fruit, and vegetables across a sample of breastfeeding, non-breastfeeding/pregnant (NBP), and pregnant women (n = 3,409) matched within households and five-year age bands. We tested whether breastfeeding women had greater advantages in the 18 high-focus states of India's National Rural Health Mission (NRHM). Vegetarianism, caste, and religion were the strongest predictors of breastfeeding women's nutrition. Breastfeeding women had no nutritional advantage compared to NBP women, and were disadvantaged in their consumption of milk (b = -0.14) in low-focus states. Pregnant women were similarly disadvantaged in their consumption of milk in low-focus states (b = -0.32), but consumed vegetables more frequently (b = 0.12) than NBP women in high-focus states. Breastfeeding women do not receive nutritional advantages compared to NBP women. Targeted effort is needed to assess and improve nutritional adequacy for breastfeeding Indian women. Copyright © 2015 The Authors. Published by Elsevier B.V. All rights reserved.
Fledderjohann, Jasmine; Vellakkal, Sukumar; Stuckler, David
Objective Promoting breastfeeding is major maternal and child health goal in India. It is unclear whether mothers receive additional food needed to support healthy breastfeeding. Methods Using the latest National Family and Health Survey (2005–2006), we applied multilevel linear regression models to document correlates of nutrition for (n = 20,764) breastfeeding women. We then compared consumption of pulses, eggs, meat, fish, dairy, fruit, and vegetables across a sample of breastfeeding, non-breastfeeding/pregnant (NBP), and pregnant women (n = 3,409) matched within households and five-year age bands. We tested whether breastfeeding women had greater advantages in the 18 high-focus states of India's National Rural Health Mission (NRHM). Results Vegetarianism, caste, and religion were the strongest predictors of breastfeeding women's nutrition. Breastfeeding women had no nutritional advantage compared to NBP women, and were disadvantaged in their consumption of milk (b = −0.14) in low-focus states. Pregnant women were similarly disadvantaged in their consumption of milk in low-focus states (b = −0.32), but consumed vegetables more frequently (b = 0.12) than NBP women in high-focus states. Conclusions Breastfeeding women do not receive nutritional advantages compared to NBP women. Targeted effort is needed to assess and improve nutritional adequacy for breastfeeding Indian women. PMID:26826049
Harm, Sarah K; Yazer, Mark H; Waters, Jonathan H
The objective of this study was to determine if there are differences in common red blood cell (RBC) indices and platelet concentrations during pregnancy and to establish if any observed differences in these parameters were based on the patient's ethnicity. From an electronic perinatal database which stores laboratory and clinical information on a large number of births at a regional hospital specializing in obstetrical care, RBC index and platelet concentration data were retrospectively analyzed at various time points throughout pregnancy. RBC index data was collected from 8,277 pregnant women (5,802 Caucasian pregnant women and 2,475 non-Caucasian pregnant women). Platelet concentration data was available from 8252 pregnant women (5,784 Caucasian pregnant women and 2,468 non-Caucasian pregnant women). Hemoglobin (HGB) levels were significantly higher amongst Caucasian women compared to non-Caucasian women (P at least <0.01) starting at 27 weeks gestation and proceeding until term. There was no significant difference in the mean PLT counts between Caucasian and non-Caucasian pregnant women at any point during gestation. There are ethnic differences in HGB levels, but not the platelet concentrations, during pregnancy. Based on this finding it would be reasonable to conduct formal prospective studies to determine the clinical significance of this difference and to establish the threshold for diagnosing gestational anemia, especially in pregnant non-Caucasian women.
This paper examines the net effect of women's autonomy on their pregnancy intention status among currently pregnant Bangladeshi women. This study is based on data from the Bangladesh Demographic Health Survey, 2007 (BDHS). A subset of interviews from currently pregnant women (718) were extracted from 10,146 married women of reproductive age. The BDHS 2007 used a pre-tested, structured questionnaire to collect sociodemographic, women's empowerment, and pregnancy information. Associations between unintended pregnancy and explanatory variables were assessed using bivariate analysis. Logistic regression was used to assess the net effect of women's autonomy on current pregnancy intention status after controlling for other variables. Results indicate that women's autonomy is a significant predictor of unintended pregnancy after adjusting for other factors. A unit increase in the autonomy scale decreases the odds of unintended pregnancy by 16%. Besides autonomy, our results also indicate that current age, number of children ever born, age at marriage, religion, media access, and contraceptive use exert strong influences over unintended pregnancy. Women who have ever used contraceptives are 82% more likely to classify their current pregnancies as unintended compared with women who are non-users of contraceptives. Improvement in women's autonomy and effective and efficient use of contraceptives may reduce unintended pregnancies as well as improve reproductive health outcomes.
Cechim, Petrolina Libana; Perdomini, Fernanda Rosa Indriunas; Quaresma, Lisiane Moitin
This is an exploratory study based on a qualitative approach. The objective was to investigate why HIV positive pregnant women do not follow the treatment which is recommended by the Health Ministry during the prenatal period. The individuals participating of this investigation were seven HIV positive women who, during their pregnancy, did not follow the prophylaxis treatment currently recommended. The data were collected by means of semi-structured interviews. Categories based on what these individuals reported were then stipulated and the results showed that women are in a vulnerable position regarding the negotiation of safe sex with their partners. Moreover, low social and economical conditions and lack of affection lead women to become victims of HIV/AIDS.
Mahanta, Lipi B; Roy, Tanusree Deb; Dutta, Rongmili Gogoi; Devi, Arundhuti
Pregnancy is a critical time in the course of life, having both health and social impacts for individuals, family, and society. The prevalence of undernutrition among pregnant women in a rural area of Assam, India, was examined using anthropometric and biochemical assessments. Key socioeconomic factors that affect nutritional status were examined. A cross-sectional study with a sample of 285 women from all three trimesters was done. The results found that 48% of the women were below normal for Body Mass Index (BMI), indicating a high level of undernutrition. The age of the mother and husband's occupation showed a strong positive correlation with BMI, while family size and income level showed a negative correlation. The results of the biochemical analysis showed that 62% of the women were anemic, and copper and zinc levels were 29% and 12% below normal levels, respectively. The study findings indicate that undernutrition is far higher than national and global standards.
Bascuñán, Karla A.; Valenzuela, Rodrigo; Chamorro, Rodrigo; Valencia, Alejandra; Barrera, Cynthia; Puigrredon, Claudia; Sandoval, Jorge; Valenzuela, Alfonso
Chilean diets are characterized by a low supply of n-3 polyunsaturated fatty acids (n-3 PUFA), which are critical nutrients during pregnancy and lactation, because of their role in brain and visual development. DHA is the most relevant n-3 PUFA in this period. We evaluated the dietary n-3 PUFA intake and erythrocyte phospholipids n-3 PUFA in Chilean pregnant women. Eighty healthy pregnant women (20–36 years old) in the 3rd–6th month of pregnancy were included in the study. Dietary assessment was done applying a food frequency questionnaire, and data were analyzed through the Food Processor SQL® software. Fatty acids of erythrocyte phospholipids were assessed by gas-liquid chromatography. Diet composition was high in saturated fat, low in mono- and PUFA, high in n-6 PUFA (linoleic acid) and low in n-3 PUFA (alpha-linolenic acid and DHA), with imbalance in the n-6/n-3 PUFA ratio. Similar results were observed for fatty acids from erythrocyte phospholipids. The sample of Chilean pregnant women showed high consumption of saturated fat and low consumption of n-3 PUFA, which is reflected in the low DHA content of erythrocyte phospholipids. Imbalance between n-6/n-3 PUFA could negatively affect fetal development. New strategies are necessary to improve n-3 PUFA intake throughout pregnancy and breast feeding periods. Furthermore, it is necessary to develop dietary interventions to improve the quality of consumed foods with particular emphasis on n-3 PUFA. PMID:25386693
Yang, Li-Juan; Zhu, Dong-Ning; Dang, Yan-Ling; Zhao, Xiong
Patients with condyloma acuminata (CA) during pregnancy represent a special risk group. The outcomes of many treatment methods for such cases are not satisfactory. The purpose of the present study was to evaluate the treatment outcome and safety of cryotherapy combined with proanthocyanidins (PCs) for CA in pregnant women. In this study, 46 pregnant women with CA were treated with cryotherapy combined with PCs. The lesions were sprayed with liquid nitrogen until the color of the wart changed from flesh colored to purple. A PC-containing formulation was then sprayed onto a non-woven fabric or single-layer gauze and applied to the affected area. The PC treatment was applied for 20 min, 2 or 3 times per day. All patients were followed up at 1 and 3 months. No visible warts remained after the cryotherapy and PC treatment. At the 1-month follow-up, only 1 case of recurrence was identified. At 3 months, 5 cases of recurrence were identified, and the recurrence rate was 10.9%. The satisfaction rate of the patients was 94% at 1 month and 87% at 3 months after treatment. All pregnancies resulted in healthy live births without delivery complications. Cryotherapy combined with PCs is indicated to be a safe and effective procedure and may serve as a treatment option for pregnant women with CA.
YANG, LI-JUAN; ZHU, DONG-NING; DANG, YAN-LING; ZHAO, XIONG
Patients with condyloma acuminata (CA) during pregnancy represent a special risk group. The outcomes of many treatment methods for such cases are not satisfactory. The purpose of the present study was to evaluate the treatment outcome and safety of cryotherapy combined with proanthocyanidins (PCs) for CA in pregnant women. In this study, 46 pregnant women with CA were treated with cryotherapy combined with PCs. The lesions were sprayed with liquid nitrogen until the color of the wart changed from flesh colored to purple. A PC-containing formulation was then sprayed onto a non-woven fabric or single-layer gauze and applied to the affected area. The PC treatment was applied for 20 min, 2 or 3 times per day. All patients were followed up at 1 and 3 months. No visible warts remained after the cryotherapy and PC treatment. At the 1-month follow-up, only 1 case of recurrence was identified. At 3 months, 5 cases of recurrence were identified, and the recurrence rate was 10.9%. The satisfaction rate of the patients was 94% at 1 month and 87% at 3 months after treatment. All pregnancies resulted in healthy live births without delivery complications. Cryotherapy combined with PCs is indicated to be a safe and effective procedure and may serve as a treatment option for pregnant women with CA. PMID:27284325
Chang, Mei-Wei; Brown, Roger; Nitzke, Susan; Smith, Barbara; Eghtedary, Kobra
This study investigated the mediating roles of sleep and depression on the relationships between stress, fat intake, and fruit and vegetable intake among low-income overweight and obese pregnant women by trimesters. Participants (N = 213) completed a self-administered survey including stress (exogenous variable), depression, sleep (mediators), fat intake, and fruit and vegetable intake (endogenous variables). Path analysis was performed to compare mediation effects among pregnant women in each trimester. Consistently across three trimesters, stress was related to depression but not sleep duration, night time sleep disturbance, sleep quality, sleep latency or fat intake. Sleep duration was not associated with depression. Depending on trimester, night time sleep disturbance, sleep quality, and sleep latency were related to depression; night time sleep disturbance and depression affected fat intake; stress influenced fruit and vegetable intake. Sleep duration, sleep disturbance, sleep quality, sleep latency and depression did not mediate the relationships between stress, fat intake, and fruit and vegetable intake in the second and third trimesters. However, depression mediated the relationship between stress and fat intake in the first trimester. Stress management interventions may help low-income overweight and obese pregnant women decrease depressive symptoms and therefore contribute to overall nutritional health.
Adachi, Yoshimi; Iso, Hiroyasu; Shen, Junyi; Ban, Kanami; Fukui, On; Hashimoto, Hiroyuki; Nakashima, Takako; Morishige, Kenichiro; Saijo, Tatuyoshi
In April 2008, specialization in gynecology and obstetrics departments was introduced in the Sennan area of Osaka prefecture in Japan that aimed at solving the problems of regional provisions of obstetrics services (e.g., shortage of obstetricians, overworking of obstetricians, and provision of specialist maternity services for high-risk pregnancies). Under this specialization, the gynecology and obstetrics departments in two city hospitals were combined and reconstructed into two centers, i.e., the gynecological care center in Kaizuka City Hospital and the prenatal care center in Izumisano City Hospital. This paper investigates to what extent and how this specialization affected pregnant women's choices of the prenatal care center and other maternity institutions. We used birth certificate data of 15,927 newborns from the Sennan area between April 1, 2007 and March 30, 2010, for Before and After Analysis to examine changes in pregnant women's choices of maternity institutions before and after the specialization was instituted. Our results indicated that this specialization scheme was, to some extent, successful on the basis of providing maternity services for high-risk pregnancies at the prenatal care center (i.e., Izumisano City Hospital) and having created a positive effect by pregnant women to other facilities in the nearby area.
Background This study was undertaken to characterize the vaginal microbiota throughout normal human pregnancy using sequence-based techniques. We compared the vaginal microbial composition of non-pregnant patients with a group of pregnant women who delivered at term. Results A retrospective case–control longitudinal study was designed and included non-pregnant women (n = 32) and pregnant women who delivered at term (38 to 42 weeks) without complications (n = 22). Serial samples of vaginal fluid were collected from both non-pregnant and pregnant patients. A 16S rRNA gene sequence-based survey was conducted using pyrosequencing to characterize the structure and stability of the vaginal microbiota. Linear mixed effects models and generalized estimating equations were used to identify the phylotypes whose relative abundance was different between the two study groups. The vaginal microbiota of normal pregnant women was different from that of non-pregnant women (higher abundance of Lactobacillus vaginalis, L. crispatus, L. gasseri and L. jensenii and lower abundance of 22 other phylotypes in pregnant women). Bacterial community state type (CST) IV-B or CST IV-A characterized by high relative abundance of species of genus Atopobium as well as the presence of Prevotella, Sneathia, Gardnerella, Ruminococcaceae, Parvimonas, Mobiluncus and other taxa previously shown to be associated with bacterial vaginosis were less frequent in normal pregnancy. The stability of the vaginal microbiota of pregnant women was higher than that of non-pregnant women; however, during normal pregnancy, bacterial communities shift almost exclusively from one CST dominated by Lactobacillus spp. to another CST dominated by Lactobacillus spp. Conclusion We report the first longitudinal study of the vaginal microbiota in normal pregnancy. Differences in the composition and stability of the microbial community between pregnant and non-pregnant women were observed. Lactobacillus spp. were the
Shomer, Einat; Katzenell, Sarah; Zipori, Yaniv; Rebibo-Sabbah, Annie; Brenner, Benjamin; Aharon, Anat
Microvesicles including exosomes and microparticles, participate in the placental-maternal crosstalk in normal pregnancies and gestational vascular complications (GVC). Low molecular weight heparin (LMWH) is known to reduce the risk of placenta-mediated pregnancy complications. This study was aimed to characterize microvesicles of pregnant women receiving LMWH and explore microvesicle involvement in trophoblast and endothelial cell function. Microvesicles were isolated from blood samples obtained from non-pregnant women, healthy pregnant women (HP) and pregnant woman treated with LMWH. Microvesicle protein contents were assessed by protein array and ELISA. Microvesicle effects on early stage trophoblasts, term trophoblasts and endothelial cell migration, angiogenesis and apoptosis were evaluated. Microvesicles derived from the group treated with LMWH contained higher levels of several proangiogenic proteins compared to those of HP women. Exposure of endothelial cells to circulating microvesicles derived from HP and LMWH treated groups induced significantly higher cell migration and branch tube formation compared to untreated cells. The effect of microvesicles from HP- and LMWH groups on early-stage trophoblast migration was similar. Microvesicles derived from these two study groups significantly decreased early-stage trophoblast apoptosis, while microvesicles derived from the HP-group (but not from the LMWH-group) significantly increased the term trophoblast apoptosis (TUNEL assay) compared to untreated cells. Therapy with LMWH affects patients' microvesicle content, leading to normalization of invasion, angiogenesis activity and survival of endothelial and trophoblast cells in vitro. The effects of LMWH on microvesicles may point to an additional mechanism of heparin action in high-risk pregnancy. Copyright © 2015 Elsevier Ltd. All rights reserved.
Taylor, Caroline M; Golding, Jean; Hibbeln, Joseph; Emond, Alan M
Lead is a widespread environmental toxin. The behaviour and academic performance of children can be adversely affected even at low blood lead levels (BLL) of 5-10 µg/dl. An important contribution to the infant's lead load is provided by maternal transfer during pregnancy. Our aim was to determine BLL in a large cohort of pregnant women in the UK and to identify the factors that contribute to BLL in pregnant women. Pregnant women resident in the Avon area of the UK were enrolled in the Avon Longitudinal Study of Parents and Children (ALSPAC) in 1991-1992. Whole blood samples were collected at median gestational age of 11 weeks and analysed by inductively coupled plasma dynamic reaction cell mass spectrometry (n = 4285). Self-completion postal questionnaires were used to collect data during pregnancy on lifestyle, diet and other environmental exposures. Statistical analysis was carried out with SPSS v19. The mean±SD BLL was 3.67±1.47 (median 3.41, range 0.41-19.14) µg/dl. Higher educational qualification was found to be one of the strongest independent predictor of BLL in an adjusted backwards stepwise logistic regression to predict maternal BLL <5 or ≥5 µg/dl (odds ratio 1.26, 95% confidence interval 1.12-1.42; p<0.001). Other predictive factors included cigarette smoking, alcohol and coffee drinking, and heating the home with a coal fire, with some evidence for iron and calcium intake having protective effects. The mean BLL in this group of pregnant women is higher than has been found in similar populations in developed countries. The finding that high education attainment was independently associated with higher BLL was unexpected and currently unexplained. Reduction in maternal lead levels can best be undertaken by reducing intake of the social drugs cigarettes, alcohol and caffeine, although further investigation of the effect of calcium on lead levels is needed.
Tiwari, Amit Kumar Mani; Mahdi, Abbas Ali; Zahra, Fatima; Sharma, Sudarshna; Negi, Mahendra Pal Singh
To correlate blood lead levels (BLLs) and oxidative stress parameters in pregnant anemic women. A total of 175 pregnant women were found suitable and included for this study. Following WHO criteria, 50 each were identified as non-anemic, mild anemic and moderate anemic and 25 were severe anemic. The age of all study subjects ranged from 24-41 years. At admission, BLLs and oxidative stress parameters were estimated as per standard protocols and subjected with ANOVA, Pearson correlation analysis and cluster analysis. Results showed significantly (p < 0.01) high BLLs, zinc protoporphyrin (ZPP), oxidized glutathione (GSSG), lipid peroxide (LPO) levels while low delta aminolevulinic acid dehydratase (δ-ALAD), iron (Fe), selenium (Se), zinc (Zn), haemoglobin (Hb), haematocrit (Hct), mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC), red blood cell (RBC) count, reduced glutathione (GSH), superoxide dismutase (SOD), catalase (CAT) and total antioxidant capacity (TAC) in all groups of anemic pregnant women as compared with non anemic pregnant women. In all groups of pregnant women, BLLs showed significant (p < 0.01) and direct association with ZPP, GSSG and LPO while inverse relation with δ-ALAD, Fe, Se, Zn, Hb, Hct, MCV, MCH, MCHC, RBC, GSH, SOD, CAT and TAC. Study concluded that low BLLs perturb oxidant-antioxidant balance and negatively affected hematological parameters which may eventually Pb to Fe deficiency anemia during pregnancy.
Lorenzo-Pouso, A I; Pérez-Sayáns, M; Suárez-Quintanilla, J A; González-Palanca, S
An association has been found between oral health problems and obstetric complications during pregnancy. The main aim of this study was to assess the perception by pregnant women on their oral health and related habits and beliefs. A questionnaire was designed in order to obtain information from 96 pregnant women attending the Valdeorras Local Hospital and the primary health dental practice in the Valle Inclan Health Center. It was found that many pregnant women perceived they were suffering from some kind of problem affecting their mouth. It was shown that pregnant women had adequate habits regarding oral health, but they believed that their pregnancy would implicitly cause them to have mouth problems. Pregnant women are able to understand the impact of their oral health on their general well-being and the health of their unborn child. It has been detected that a series of habits and beliefs would ideally need to be acted upon in order to reduce health problems. Copyright © 2017 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.
Cheung, K; El Marroun, H; Elfrink, M E; Jaddoe, V W V; Visser, L E; Stricker, B H Ch
Several studies have been conducted to assess determinants affecting the performance or accuracy of self-reports. These studies are often not focused on pregnant women, or medical records were used as a data source where it is unclear if medications have been dispensed. Therefore, our objective was to evaluate the concordance between self-reported medication data and pharmacy records among pregnant women and its determinants. We conducted a population-based cohort study within the Generation R study, in 2637 pregnant women. The concordance between self-reported medication data and pharmacy records was calculated for different therapeutic classes using Yule's Y. We evaluated a number of variables as determinant of discordance between both sources through univariate and multivariate logistic regression analysis. The concordance between self-reports and pharmacy records was moderate to good for medications used for chronic conditions, such as selective serotonin reuptake inhibitors or anti-asthmatic medications (0.88 and 0.68, respectively). Medications that are used occasionally, such as antibiotics, had a lower concordance (0.51). Women with a Turkish or other non-Western background were more likely to demonstrate discordance between pharmacy records and self-reported data compared with women with a Dutch background (Turkish: odds ratio, 1.63; 95% confidence interval, 1.16-2.29; other non-Western: odds ratio, 1.33; 95% confidence interval, 1.03-1.71). Further research is needed to assess how the cultural or ethnic differences may affect the concordance or discordance between both medication sources. The results of this study showed that the use of multiple sources is needed to have a good estimation of the medication use during pregnancy. Copyright © 2017 John Wiley & Sons, Ltd.
Dindo, Lilian; Elmore, Alexis; O'Hara, Michael; Stuart, Scott
Depression during pregnancy is highly prevalent and is associated with increased risk of a variety of negative psychological and medical outcomes in both mothers and offspring. Antenatal depression often co-occurs with significant anxiety, potentially exacerbating morbidities for women and their children. However, screening during the antenatal period is frequently limited to assessment of depression so that other significant comorbid disorders may be missed. Follow-up assessment by clinicians has similarly focused primarily on detection of depressive symptoms. Anxiety, obsessive compulsive disorder, and post-traumatic stress disorder, among others, often go undetected in perinatal care settings, even when depression is identified. Failing to recognize these comorbid diagnoses may lead to inadequate treatment or only partial alleviation of distress. Consequently, screening for and assessment of comorbid disorders is warranted. In this study, 382 pregnant women (M age = 25.8 [SD = 5.3] years, 85.0% Caucasian) receiving care at a university hospital clinic and Maternal Mental Health Care centers in eastern Iowa and who screened positive for depression on the Beck Depression Inventory completed the Structured Clinical Interview for DSM-IV to assess comorbid mental health symptoms and diagnoses. Overall, findings demonstrate high rates of anxiety disorders among women both with and without current major depression, although depressed women reported higher rates of generalized anxiety disorder and post-traumatic stress disorder. Notably, however, incidence-specific symptoms were comparable across groups. Routine screening of both anxiety and depression during pregnancy should be conducted.
Micieli, Mariella; Votino, Carmela; Visconti, Federica; Quaresima, Paola; Torti, Carlo
Currently, the only efficient way to prevent human Cytomegalovirus (HCMV) infection in pregnancy is primary prophylaxis through hygienic measures. So, we evaluated knowledge of HCMV and its prevention in a group of pregnant women. An anonymous questionnaire with multiple-choice answers was administered to all pregnant women who were followed up at the Obstetrics and Gynecology Unit of “Pugliese-Ciaccio Hospital,” a third-level hospital in Catanzaro (Southern Italy), from November 2015 to March 2016. Previously prescribed serology results for HCMV were also evaluated. Three hundred and fifty women participated in the study and the results clearly demonstrated that knowledge of pregnant women about HCMV is poor. Moreover, prescribed screening procedures need to be optimized, since one out of three pregnant women has not been tested for HCMV or the screening was not performed adequately. For this reason, it is important to implement informative campaign in both pregnant women and providing physicians. PMID:28831237
Sehati Shafayi, Fahimeh; Akef, Maryam; Sadegi, Homayoon; sallakh Niknazhad, Akram
Introduction Hypertension is the most common medical problem affecting pregnant women during pregnancy contributing to one third of substantial maternal mortality and varieties of fetal and neonatal health problems, while representing health status of a society. This study aimed to investigate the links between a healthy life style and developing hypertension during pregnancy in order to improve healthier behaviors. Methods In a case-control study from October 2009 to April 2010, physical activity and nutritional practices of two groups of pregnant women (220 in each group) with gestational age of 20 weeks or more, single pregnancy, without any previous medical disorders were compared. Samples in case group had pregnancy induced hypertension. Data were collected using a two-part questionnaire after obtaining informed written consents from mothers before enrollment; later the data were analyzed using the SPSS 13 and Stata software. Results Women in two groups did not differ regarding their socioeconomic characteristics. There were no significant differences in nutritional practices and level of physical activity in pregnant women of study groups; mean score of physical activity was 54.6±14.8 in test and 57.3±15.0 in control group (P=0.06) and it was 72.9±10.3 and 73.719.5 about nutritional habits in test and control group respectively. Mean pre-pregnancy BMI was higher in case group (P=0.02); these women also had a higher percentage of previous prenatal mortality and history of hypertension. Conclusion Results state that health during pregnancy is relevant to healthy life style especially preconceptional period; therefore employing proper strategies to improve women knowledge and attitude of the important dimensions of healthy life considering good and healthy diet and active life seem to solve the problem; this needs to unite all health workers to set proper educational programs and courses and support of health policy makers. PMID:24250984
Healy, C Mary; Rench, Marcia A; Montesinos, Diana P; Ng, Nancy; Swaim, Laurie S
Tetanus, diphtheria and acellular pertussis (Tdap) and influenza vaccination is recommended during each pregnancy but uptake is suboptimal. We evaluated knowledge and acceptance of vaccination recommendations among pregnant women. Prospective, convenience survey of pregnant women presenting for antenatal care at the Pavilion for Women, Texas Children's Hospital, Houston, and their healthcare providers. 796 of 825 (96.5%) of women and 63 of 87 (72.4%) providers completed surveys. Mean age of pregnant women was 30.2 (18-45) years. Self-identified race/ethnicity was 45% white, 26% Hispanic, 13% black, 12% Asian and 4% other. Most women had college degrees (84%) and private health insurance (83%). Mean gestation was 28.5 weeks with 4.8%, 37.8% and 57.4%, in the 1st, 2nd and 3rd trimesters, respectively. Women used various sources for pregnancy information (personal contacts, providers, print, audiovisual and online media) but 89.1% cited a provider as their most trusted source, predominantly (85.8%) their physician. 668 (84%) knew vaccines are recommended during pregnancy, specifically influenza (77%) and Tdap (61%) vaccines. 659 (83%) were willing to receive vaccines if recommended by their physician. Factors impacting vaccination decisions included safety for baby, safety for mother and sufficient information, scoring 4.7, 4.5 and 4.2, respectively, on a 5-point scale; less important were additional visit time (2.6), cost (1.9) or needle phobia (1). Women surveyed in the 3rd trimester showed greater acceptance than those earlier in gestation (87% vs 78%; P0.003). Maternal education, ethnicity, insurance, multiple gestation or history of serious illness in a prior infant did not affect willingness to receive vaccines. Pregnant women are willing to accept vaccination in pregnancy if recommended by their physician and if sufficient discussion of safety and rationale occurs. Strong physician recommendation, as reported for pediatric vaccination, is essential to
Roldán, Jakeline Calle; Acuña, Cecilia; Ríos, Paulina
Document and analyze Ecuador's experience using active community case-finding for uptake of pregnant and postpartum women in Ecuador. A cross-sectional descriptive study was conducted of information obtained on active community case-finding of pregnant and postpartum women in the catchment areas of 200 primary care facilities of Ecuador's Ministry of Public Health. Visits were made to 460 451 homes in 20 provinces; 15 622 pregnant women and 4 014 postpartum women were identified. Of the pregnant women, 89% (13 875) had had at least one prenatal check-up, while 70% of postpartum women (4 014) had had at least one post-delivery or post-caesarean check-up. Potential risk was identified in 29% of pregnant women (4 601). Orellana and Sucumbíos provinces had the lowest percentages of pregnant women with at least one prenatal check-up and the lowest percentages of postpartum women with at least one postpartum checkup. A total of 3 951 brigades were formed at the national level for this activity. Active community case-finding was valuable in identifying pregnant and postpartum women who had not been captured by the health system, especially to detect their risk status, in addition to the advantages of participatory uptake, especially with support from universities with health majors. Low coverage for postpartum check-ups underscores the importance of learning why women do not receive this care. Similar experiences need to be systematized to improve the process.
Melzer, Katarina; Heydenreich, Juliane; Schutz, Yves; Renaud, Anne; Kayser, Bengt; Mäder, Urs
“Metabolic Equivalent” (MET) represents a standard amount of oxygen consumed by the body under resting conditions, and is defined as 3.5 mL O2/kg × min or ~1 kcal/kg × h. It is used to express the energy cost of physical activity in multiples of MET. However, universal application of the 1-MET standard was questioned in previous studies, because it does not apply well to all individuals. Height, weight and resting metabolic rate (RMR, measured by indirect calorimetry) were measured in adolescent males (n = 50) and females (n = 50), women during pregnancy (gestation week 35–41, n = 46), women 24–53 weeks postpartum (n = 27), and active men (n = 30), and were compared to values predicted by the 1-MET standard. The RMR of adolescent males (1.28 kcal/kg × h) was significantly higher than that of adolescent females (1.11 kcal/kg × h), with or without the effects of puberty stage and physical activity levels. The RMR of the pregnant and post-pregnant subjects were not significantly different. The RMR of the active normal weight (0.92 kcal/kg × h) and overweight (0.89 kcal/kg × h) adult males were significantly lower than the 1-MET value. It follows that the 1-MET standard is inadequate for use not only in adult men and women, but also in adolescents and physically active men. It is therefore recommended that practitioners estimate RMR with equations taking into account individual characteristics, such as sex, age and Body Mass Index, and not rely on the 1-MET standard. PMID:27447667
Oliveira, Tenilson Amaral; Bersusa, Ana Aparecida Sanches; Santos, Tatiana Fiorelli Dos; Aquino, Márcia Maria Auxiliadora de; Mariani Neto, Corintio
Objective The purpose of this study was to evaluate the perinatal outcomes in pregnant women who use illicit drugs. Methods A retrospective observational study of patients who, at the time of delivery, were sent to or who spontaneously sought a public maternity hospital in the eastern area of São Paulo city. We compared the perinatal outcomes of two distinct groups of pregnant women - illicit drugs users and non-users - that gave birth in the same period and analyzed the obstetric and neonatal variables. We used Student's t-test to calculate the averages among the groups, and the Chi-square test or Fisher's exact test to compare categorical data from each group. Results We analyzed 166 women (83 users and 83 non-users) in both groups with a mean of age of 26 years. Ninety-five percent of the drug users would use crack or pure cocaine alone or associated with other psychoactive substances during pregnancy. Approximately half of the users group made no prenatal visit, compared with 2.4% in the non-users group (p < 0.001). Low birth weight (2,620 g versus 3,333 g on average, p < 0.001) and maternal syphilis (15.7% versus 0%, p < 0.001) were associated with the use of these illicit drugs. Conclusions The use of illicit drugs, mainly crack cocaine, represents an important perinatal risk. Any medical intervention in this population should combine adherence to prenatal care with strategies for reducing maternal exposure to illicit drugs.
Parra-Cabrera, Socorro; Stein, Aryeh D; Wang, Meng; Martorell, Reynaldo; Rivera, Juan; Ramakrishnan, Usha
Nutritional demands for docosahexaenoic acid (DHA) are high during pregnancy. Diets low in DHA and long-chain polyunsaturated fatty-acids (LC-PUFA) in pregnancy are associated with poorer DHA status and slower reestablishment of maternal stores. To assess intakes of LC-PUFA among urban pregnant women in Central Mexico, we conducted a cross-sectional survey in Prenatal Clinic at the General Hospital No. 1 of the Mexican Society Security Institute, Cuernavaca, Morelos, Mexico. We ascertained intakes over past three months of 110 food items using a food frequency questionnaire developed for this population. Among 1364 pregnant women 18-35 years of age (mean age 26.2 ± 4.7 years) who were interviewed at 18-22 weeks gestation, median (inter-quartile range) daily intakes of linoleic acid, alpha-linolenic acid (LA), arachidonic acid, eicosapentaenoic acid and DHA were 17.6 (13.6; 22.2) g, 1.4 (1.0; 2.0) g, 137 (102; 174) mg, 18 (10; 38) mg, and 55 (37; 99) mg respectively. The median ratio of n-6 to n-3 PUFA was 11.8:1. The main dietary contributions to DHA intake were eggs, chicken, and fresh canned fish. Intakes of PUFAs were higher among women who had completed high school (p<0.01). We conclude that intakes of DHA were much lower than recommended values; the high n-6 to n-3 ratio suggests a suboptimal balance of these PUFAs. Very few sources of DHA are commonly eaten. © 2010 Blackwell Publishing Ltd.
Shafaie, Fahimeh Sehhatie; Mirghafourvand, Mojgan; Rahmati, Mahbubeh; Nouri, Parviz; Bagherinia, Marzieh
The aim of this study was to determine the relationship between the psychological status of pregnant women with perceived social support. In this cross-sectional study, 372 Iranian women were selected randomly via a two-stage cluster sampling method at the third trimester of pregnancy in healthcare centers of Tabriz-Iran. Data were collected using the socio-demographic characteristics questionnaire, perceived social support (PRQ-85) and the short form of depression, anxiety, and stress (DASS-21). The statistical tests including Spearman's correlation, Mann-Whitney, Kruskal Wallis, and linear regression model were used for data. The mean (SD) score of perceived social support 131.5 (18.9) with a range of 25-175 was achieved. In terms of the scale of mental health, median (25-75 percentile) of the score of anxiety 4.0 (3.0-7.0), depression 1.0 (0.0-6.0), and stress 8.0 (0.6-10.0) was achieved. There was a significant negative correlation between perceived social support with anxiety (r = -.355, p < .001), depression (r = -.541, p < .001), and stress in women (r = -.302, p < .001). The results of this study showed that social support affects the mental state of women in the third trimester of pregnancy and the levels of anxiety, depression, and stress decrease in pregnant women with increasing of social support.
Stoecker, B J; Abebe, Y; Hubbs-Tait, L; Kennedy, T S; Gibson, R S; Arbide, I; Teshome, A; Westcott, J; Krebs, N F; Hambidge, K M
The relation between zinc status and cognitive function was examined in a cross-sectional study in the Sidama area of Southern Ethiopia. Pregnant women >24 weeks of gestation from three adjacent rural villages volunteered to participate. Mean (s.d.) plasma zinc of 99 women was 6.97 (1.07) mumol/l (below the cutoff of 7.6 mumol/l indicative of zinc deficiency at this stage of gestation). The Raven's Coloured Progressive Matrices (CPM) test was administered individually. Scores for the Raven's scale A, which is the simplest scale, ranged from 4 to 10 of a possible 12. Women with plasma zinc <7.6 mumol/l had significantly lower Raven's CPM scale A scores than women with plasma zinc concentrations >7.6 mumol/l. Plasma zinc and maternal age and education predicted 17% of the variation in Raven's CPM scale A scores. We conclude that zinc deficiency is a major factor affecting cognition in these pregnant women.
Eszes, Noémi; Bikov, András; Lázár, Zsófia; Bohács, Anikó; Müller, Veronika; Stenczer, Balázs; Rigó, János; Losonczy, György; Horváth, Ildikó; Tamási, Lilla
Asthma is a common chronic disease complicating pregnancy with a risk for perinatal complications. Control of airway inflammation in the asthmatic pregnancy improves pregnancy outcomes. Our aim was to evaluate pH of exhaled breath condensate (EBC), a non-invasive method for the assessment of asthmatic airway inflammation, in healthy and asthmatic pregnancies. Cross-sectional study. Hungarian university clinics. Seventeen healthy pregnant women, 21 asthmatic pregnant women, 23 healthy non-pregnant women and 22 asthmatic non-pregnant women. EBC samples were collected using a portable condenser, EBC pH was measured after argon deaeration. EBC pH. EBC pH (mean ± SD) of healthy non-pregnant and asthmatic non-pregnant women was similar (7.75 ± 0.27 vs. 7.54 ± 0.57; p = 0.118), probably indicating an optimal control of airway inflammation in asthmatic women. On the other hand, EBC pH was higher in healthy pregnant women compared with healthy non-pregnant women (8.02 ± 0.43 vs. 7.75 ± 0.27; p = 0.017). Higher EBC pH accompanying healthy pregnancy was absent in asthmatic pregnant patients whose EBC pH was lower (7.65 ± 0.38) than that of healthy pregnant women (p = 0.006), and it was similar to that in asthmatic and healthy non-pregnant women (p = 0.470 and p = 0.300, respectively). The EBC pH in asthmatic pregnant women correlated positively with birthweight (r = 0.49, p = 0.047) and negatively with forced vital capacity (r = 0.45, p = 0.039). EBC pH was not related to blood pH. EBC pH is higher in healthy pregnant women but not in asthmatic pregnant women compared with data from healthy non-pregnant women, indicating that oxidative inflammatory processes induced by asthma may compromise the regulatory mechanisms causing alkaline pH in the airways during pregnancy. © 2013 The Authors Acta Obstetricia et Gynecologica Scandinavica © 2013 Nordic Federation of Societies of Obstetrics and Gynecology.
Katirayi, Leila; Namadingo, Hazel; Phiri, Mafayo; Bobrow, Emily A; Ahimbisibwe, Allan; Berhan, Aida Yemane; Buono, Nicole; Moland, Karen Marie; Tylleskär, Thorkild
Introduction The implementation of lifelong antiretroviral treatment (ART) for all pregnant women (Option B+) in Malawi has resulted in a significant increase in the number of HIV-positive pregnant women initiating treatment. However, research has highlighted the challenge of retaining newly initiated women in care. This study explores barriers and facilitators that affect a woman's decision to initiate and to adhere to Option B+. Methods A total of 39 in-depth interviews and 16 focus group discussions were conducted. Eligible women were ≥18 years old, living with HIV and either pregnant and receiving antenatal care from a study site or had delivered a child within the last 18 months, breastfed their child and received services at one of the study sites. Eligible women were identified by healthcare workers (HCWs) in the antenatal clinic and ART unit. Focus groups were also conducted with HCWs employed in these departments. Qualitative data were analyzed using Maxqda version 10 (VERBI Software, Berlin, Germany). Results The general perception towards the drug regimen used in Option B+ was positive; women reported fewer side effects and acknowledged the positive benefits of ART. Women felt hopeful about prolonging their life and having an HIV-uninfected baby, yet grappled with the fact that ART is a lifelong commitment. Women and HCWs discussed challenges with the counselling services for prevention of mother-to-child HIV transmission under the new Option B+ guidelines, and many women struggled with initiating ART on the same day as learning their HIV status. Women wanted to discuss their circumstances with their husbands first, receive a CD4 count and obtain an HIV test at another facility to confirm their HIV status. HCWs expressed concern that women might just agree to take the drugs to please them. HCWs also discussed concerns around loss to follow-up and drug resistance. Conclusions Although Option B+ has significantly increased the number of women initiating
Díaz-Olavarrieta, Claudia; Wilson, Kate S; García, Sandra G; Revollo, Rita; Richmond, Kara; Paz, Francisco; Chavez, Lorena P
Intimate partner violence (IPV) and sexually transmitted infections (STI) are epidemics that disproportionately affect women. This study determined IPV prevalence and the association between IPV and positive syphilis tests among pregnant women attending antenatal clinics in three provinces in Bolivia. We administered structured questionnaires to women after syphilis testing. The questionnaire included sociodemographic variables and four questions form the modified version of the Abuse Assessment Screen (AAS) to assess physical and sexual violence. Of 6002 women who completed the violence questionnaire and had a syphilis test, 20.4% (n=1227) reported physical or sexual abuse or both committed by their partner in the past year. Prevalence of positive syphilis tests was twice as high among women who reported IPV (8%) than among women who did not (4%) (p<0.01). Women's age (younger), education level (lower), occupation as homemaker, being in a consensual union, more previous pregnancies, lower economic status, and language spoken at home (Spanish and an indigenous language), as well as history of IPV in the past 12 months, were significantly associated with positive syphilis tests in bivariate analysis. History of IPV remained significantly associated with positive syphilis tests in multivariate analysis (OR 1.59, 95% CI 1.23-2.07). In addition, low education among women's partners and having at least one previous pregnancy were positively associated with IPV in multivariate analysis. There is a significant association between history of partner violence and a positive syphilis test among pregnant women, suggesting that syphilis can be an important negative health consequence of IPV. Bolivia's new maternal and infant health program in antenatal clinics, which includes universal syphilis screening, should also provide screening and follow-up care for IPV.
Lai, Florence Y; Dover, Douglas C; Lee, Bonita; Fonseca, Kevin; Solomon, Natalia; Plitt, Sabrina S; Jaipaul, Joy; Tipples, Graham A; Charlton, Carmen L
Rubella IgG levels for 157,763 pregnant women residing in Alberta between 2009 and 2012 were analyzed. As there have been no reported cases of indigenous rubella infection in Canada since 2005, there has been a lack of naturally acquired immunity, and the current prenatal population depends almost entirely on vaccine induced immunity for protection. Rubella antibody levels are significantly lower in younger maternal cohorts with 16.8% of those born prior to universal vaccination programs (1971-1980), and 33.8% of those born after (1981-1990) having IgG levels that are not considered protective (<15 IU/mL). Analysis across pregnancies showed only 35.0% of women responded with a 4-fold increase in antibody levels following post-natal vaccination. Additionally, 41.2% of women with antibody levels <15 IU/mL had previously received 2 doses of rubella containing vaccine. These discordant interpretations generate a great deal of confusion for laboratorians and physicians alike, and result in significant patient follow-up by Public Health teams. To assess the current antibody levels in the prenatal population, latent class modeling was employed to generate a two class fit model representing women with an antibody response to rubella, and women without an antibody response. The declining level of vaccine-induced antibodies in our population is disconcerting, and a combined approach from the laboratory and Public Health may be required to provide appropriate follow up for women who are truly susceptible to rubella infection.
Willcox, Jane C; Campbell, Karen J; McCarthy, Elizabeth A; Lappas, Martha; Ball, Kylie; Crawford, David; Shub, Alexis; Wilkinson, Shelley A
Promoting healthy gestational weight gain (GWG) is important for preventing obstetric and perinatal morbidity, along with obesity in both mother and child. Provision of GWG guidelines by health professionals predicts women meeting GWG guidelines. Research concerning women's GWG information sources is limited. This study assessed pregnant women's sources of GWG information and how, where and which women seek GWG information. Consecutive women (n = 1032) received a mailed questionnaire after their first antenatal visit to a public maternity hospital in Melbourne, Australia. Recalled provision of GWG guidelines by doctors and midwives, recalled provided GWG goals, and the obtaining of GWG information and information sources were assessed. Participants (n = 368; 35.7% response) averaged 32.5 years of age and 20.8 weeks gestation, with 33.7% speaking a language other than English. One in ten women recalled receiving GWG guidelines from doctors or midwives, of which half were consistent with Institute of Medicine guidelines. More than half the women (55.4%) had actively sought GWG information. Nulliparous (OR 7.07, 95% CI = 3.91-12.81) and obese (OR 1.96, 95% CI = 1.05-3.65) women were more likely to seek information. Underweight (OR 0.29, 95% CI = 0.09-0.97) women and those working part time (OR 0.52, 95% CI = 0.28-0.97) were less likely to seek information. Most frequently reported GWG sources included the internet (82.7%), books (55.4%) and friends (51.5%). The single most important sources were identified as the internet (32.8%), general practitioners (16.9%) and books (14.9%). More than half of women were seeking GWG guidance and were more likely to consult non-clinician sources. The small numbers given GWG targets, and the dominance of non-clinical information sources, reinforces that an important opportunity to provide evidence based advice and guidance in the antenatal care setting is currently being missed.
Al-Mayahie, Sareaa M G
Vaginal Escherichia coli is a reservoir along the fecal-vaginal-urinary/neonatal course of transmission in extraintestinal E. coli infections. They also causes genital tract infections especially vaginitis, so that detection of their antibiotic resistance is an important approach to control these infections. One important mechanism of resistance is ESBL production by Enterobacteriaceae especially Klebsiella spp. and Escherichia coli, which is now a worldwide problem that limits therapeutic options. Sixty one vaginal E. coli isolates from pregnant and non-pregnant women, were detected phenotypically and genotypically for ESBL production. Most of pregnant and non-pregnant women's isolates, were resistant to cefotaxime (100% vs. 81.5%, respectively) and more than half of them to ceftazidime (56.5% vs. 71.0%, respectively). One hundred percent each, 52.1% vs. 68.4%, and 73.9% vs. 60.5%%, were ESBL producers by screening, confirmatory, and PCR tests, respectively. Pregnant women's isolates had: CTX-M- (69.5%), SHV- and OXA-type (each 4.3%) ESBLs. Only one isolate (4.3%) had two types of ESBLs. All 16 CTX-M-positive (100%) isolates had CTX-M-1. Non-pregnant women's isolates were predominated by SHV and CTX-M -type (44.7% vs. 39.4%, respectively), followed by OXA- (15.7%), and TEM-type (2.6%). Of these isolates, 42.1% had two types of ESBL genes. All 15 CTX-M-positive (100%) isolates had CTX-M-1. Pregnant and non-pregnant women's isolates differed significantly (P≤ 0.05) regarding the expression of SHV- (4.3% vs. 44.7%, respectively) and CTX-M-type (69.5% vs. 39.4%, respectively) ESBLs. In both, CTX-M-1 was the predominant CTX-M group (each 100%). All of the isolates were susceptible to imipenem and meropenem, while the highest rate of resistance was against β-lactams. Multidrug resistance was noted in 56.2% of ESBL-producing isolates. Ggenital tracts of pregnant and non-pregnant women represent different environments for propagation of ESBL-producing E. coli. In Iraq
Resch, Stephen; Altice, Frederick L; Paltiel, A David
Antiretroviral therapy (ART) initiated on a prenatal basis in HIV-infected pregnant women is a highly effective method for preventing mother-to-child HIV transmission. We developed a decision analytic model to project the clinical and economic outcomes of alternative HIV screening strategies (voluntary prenatal screening [VPS], routine prenatal screening [RPS], and mandatory newborn screening [MNS]) for a high-risk population of incarcerated pregnant women. Data for the decision model came from the HIV voluntary counseling and testing program at Connecticut's sole correctional facility for women and a comprehensive anonymously linked serosurvey of all inmates who entered the facility during the 2-year period beginning in October 1994. Based on serosurvey results, in the absence of any HIV screening program, 2.5 cases of pediatric HIV infection would be expected per 1000 pregnancies. Multiplied by the discounted lifetime cost per case of $247,000, this translates to a cost of $624 per testing-eligible prison entrant. Entrants were considered eligible if they were pregnant and their HIV status was unknown. MNS would save money, cost $364 per eligible entrant, and simultaneously reduce the rate of infections to 1.1 per 1000 pregnancies. Doing both MNS and RPS is most effective in reducing the rate of new infections (down to 0.2 per 1000 pregnancies). It would, however, increase costs to $430 per eligible entrant. This would result in an incremental cost of $73,603 per additional pediatric HIV case averted when compared with MNS alone. If mandatory newborn testing was not considered a feasible option, RPS would dominate VPS and would be cost-saving compared with no screening. RPS compares favorably with alternative uses of HIV prevention and treatment resources. In correctional facilities where voluntary newborn screening is already in place, our findings show that there remains a small marginal benefit to be realized from switching to RPS. In settings where HIV
Ali, Nurshad; Blaszkewicz, Meinolf; Al Nahid, Abdullah; Rahman, Mustafizur; Degen, Gisela H
The trichothecene mycotoxin deoxynivalenol (DON) is a contaminant of crops worldwide and known to cause adverse health effects in exposed animals and humans. A small survey reported the presence of DON in maize samples in Bangladesh, but these data are insufficient to assess human exposure, and also, biomonitoring data are still scarce. The present study applied biomarker analysis to investigate the DON exposure of pregnant women in Bangladesh. Urine samples were collected from pregnant women living in a rural (n = 32) and in a suburban (n = 22) area of the country. Urines were subjected to enzymatic hydrolysis of glucuronic acid conjugates and to immunoaffinity column clean-up prior to LC-MS/MS analysis of DON and its de-epoxy metabolite DOM-1. The limits of detection (LOD) for DON and DOM-1 in urine were 0.16 ng/mL and 0.10 ng/mL, respectively. DOM-1 was not detected in any of the urines, whilst DON was detectable in 52% of the samples at levels ranging from 0.18-7.16 ng/mL and a mean DON concentration of 0.86 ± 1.57 ng/mL or 2.14 ± 4.74 ng/mg creatinine. A significant difference in mean urinary DON levels was found between the rural (0.47 ± 0.73 ng/mL) and suburban (1.44 ± 2.20 ng/mL) cohort, which may be related to different food habits in the two cohorts. Analysis of food consumption data for the participants did not show significant correlations between their intake of typical staple foods and DON levels in urine. The biomarker concentrations found and published urinary excretion rates for DON were used to estimate daily mycotoxin intake in the cohort: the mean DON intake was 0.05 µg/kg b.w., and the maximum intake was 0.46 µg/kg b.w., values lower than the tolerable daily intake of 1 µg/kg b.w. These first results indicate a low dietary exposure of pregnant women in Bangladesh to DON. Nonetheless, further biomonitoring studies in children and in adult cohorts from other parts of the country are of interest to gain more insight into DON exposure in the
Audi, Celene Aparecida Ferrari; Corrêa, Ana Maria Segall; Turato, Egberto Ribeiro; Santiago, Silvia Maria; Andrade, Maria da Graça Garcia; Rodrigues, Maria Socorro Pereira
This study sought to compare the perception of domestic violence of women, victims of this kind of violence, with the perception of pregnant women, victims or not of domestic violence, as well as to search for elements allowing for the planning and execution of a cohort study on domestic violence among pregnant women. A qualitative exploratory research was conducted using the technique of convenience sampling for selecting a focal group. The subjects were twenty four women divided into two groups: (1) thirteen women from a follow-up group from a Referral Center for victims of domestic violence, and (2) eleven pregnant women that were participating in the pre-natal care program in a primary care unit, selected independently of suffering domestic violence or not. The data collected were transcribed, conceptually decoded and qualified for qualitative analysis. The contents of the women's discourse were analyzed on the basis of thematic categories. It was observed that domestic violence was perceived in a similar way by both studied groups, independently from the fact of having or not experienced a situation of this kind. The understanding and discussion of the topics proposed for the groups allowed developing a more appropriate approach to the studied women. The way the questions were formulated in the questionnaire was considered of easy understanding by both groups of women.
Samandari, Ghazaleh; Martin, Sandra L; Kupper, Lawrence L; Schiro, Sharon; Norwood, Tammy; Avery, Matt
The purpose of this study is to estimate rates of suicide and homicide death among pregnant, postpartum and non-pregnant/non-postpartum women ages 14-44, and to determine comparative rates of violent death for pregnant and/or postpartum women compared to non-pregnant/non-postpartum women. North Carolina surveillance and vital statistics data from 2004 to 2006 were used to examine whether pregnant or postpartum women have higher (or lower) rates of suicide and homicide compared to other reproductive-aged women. The suicide rate for pregnant women was 27% of the rate for non-pregnant/non-postpartum women (rate ratio= 0.27, 95% CI = 0.11-0.66), and the suicide rate for postpartum women was 54% of the rate for non-pregnant/non-postpartum women (rate ratio = 0.54, 95% CI = 0.31-0.95). Homicide rates also were lower for pregnant and postpartum women, with the homicide rate for pregnant women being 73% of the rate for non-pregnant/non-postpartum women (rate ratio = 0.73, 95% CI = 0.39-1.37), and the homicide rate for postpartum women being half the rate for non-pregnant/non-postpartum women (rate ratio = 0.50, 95% CI = 0.26-0.98). Although pregnant and postpartum women are at risk for homicide and suicide death, the highest risk group is non-pregnant/non-postpartum women. Violence prevention efforts should target all women of reproductive age, and pay particular attention to non-pregnant/non-postpartum women, who may have less access to health care services than pregnant and postpartum women.
M'Cormack, Fredanna A. D.; Drolet, Judy C.
Introduction: Iron deficiency anemia prevalence of pregnant Sierra Leone women currently is reported to be 59.7%. Anemia is considered to be a direct cause of 3-7% of maternal deaths and an indirect cause of 20-40% of maternal deaths. This study explores knowledge, attitudes, and behaviors of urban pregnant Sierra Leone women regarding anemia.…
... 42 Public Health 4 2010-10-01 2010-10-01 false Qualified pregnant women and children who are not... women and children who are not qualified family members. (a) The Medicaid agency must provide Medicaid to a pregnant woman whose pregnancy has been medically verified and who— (1) Would be eligible for...
Whittemore, Kate; Tate, Anna; Illescas, Alex; Saffa, Alhaji; Collins, Austin; Varma, Jay K.
We surveyed women in New York, New York, USA, who were in areas with active Zika virus transmission while pregnant. Of 99 women who were US residents, 30 were unaware of the government travel advisory to areas with active Zika virus transmission while pregnant, and 37 were unaware of their pregnancies during travel. PMID:27855041
... 42 Public Health 4 2011-10-01 2011-10-01 false Qualified pregnant women and children who are not... women and children who are not qualified family members. (a) The Medicaid agency must provide Medicaid to a pregnant woman whose pregnancy has been medically verified and who— (1) Would be eligible for an...
Fairbrother, Nichole; Hutton, Eileen K.; Stoll, Kathrin; Hall, Wendy; Kluka, Sandy
Although fatigue is a common experience for pregnant women and new mothers, few measures of fatigue have been validated for use with this population. To address this gap, the authors assessed psychometric properties of the Multidimensional Assessment of Fatigue (MAF) scale, which was used in 2 independent samples of pregnant women. Results…
Whittemore, Kate; Tate, Anna; Illescas, Alex; Saffa, Alhaji; Collins, Austin; Varma, Jay K; Vora, Neil M
We surveyed women in New York, New York, USA, who were in areas with active Zika virus transmission while pregnant. Of 99 women who were US residents, 30 were unaware of the government travel advisory to areas with active Zika virus transmission while pregnant, and 37 were unaware of their pregnancies during travel.
Kim, Deborah Rubin; Wang, Eileen
In our studies of transcranial magnetic stimulation in pregnant women with major depressive disorder, two subjects had an episode of supine hypotensive syndrome and one subject had an episode of dizziness without hypotension. Prevention of the supine hypotensive syndrome in pregnant women receiving transcranial magnetic stimulation is described.
Laken, Marilyn Poland; Hutchins, Ellen
According to current estimates, approximately 5.5 percent of all American pregnant women use an illicit drug during pregnancy. National concern for drug-exposed infants prompted interest in the needs of substance using pregnant women and in the development of drug treatment programs for them. A total of 147 comprehensive programs have been funded…
... 42 Public Health 4 2014-10-01 2014-10-01 false Qualified pregnant women and children who are not... women and children who are not qualified family members. (a) The Medicaid agency must provide Medicaid to a pregnant woman whose pregnancy has been medically verified and who— (1) Would be eligible for...
... 42 Public Health 4 2012-10-01 2012-10-01 false Qualified pregnant women and children who are not... women and children who are not qualified family members. (a) The Medicaid agency must provide Medicaid to a pregnant woman whose pregnancy has been medically verified and who— (1) Would be eligible for...
... 42 Public Health 4 2013-10-01 2013-10-01 false Qualified pregnant women and children who are not... women and children who are not qualified family members. (a) The Medicaid agency must provide Medicaid to a pregnant woman whose pregnancy has been medically verified and who— (1) Would be eligible for...
Amari-Omaka, Lois Nnenna; Obande-Ogbuinya, Nkiru Edith
The purpose of this study was to determine sources of malaria information among pregnant women in Ebonyi state and implications for malaria education. The cross sectional research design was adopted and stratified sampling technique was used to select a total of five hundred and four (504) pregnant women from 12 hospitals in the state. A self…
Fairbrother, Nichole; Hutton, Eileen K.; Stoll, Kathrin; Hall, Wendy; Kluka, Sandy
Although fatigue is a common experience for pregnant women and new mothers, few measures of fatigue have been validated for use with this population. To address this gap, the authors assessed psychometric properties of the Multidimensional Assessment of Fatigue (MAF) scale, which was used in 2 independent samples of pregnant women. Results…
Tansarli, G S; Skalidis, T; Legakis, N J; Falagas, M E
Bacterial vaginosis (BV), candidiasis, and trichomoniasis were the three established types of vaginal conditions until aerobic vaginitis (AV) was defined in the early 2000s. We sought to study the prevalence of abnormal vaginal flora (AVF) with inflammation in our hospital and to correlate it with AV. We prospectively collected vaginal smear specimens originated from symptomatic women who were examined at Iaso Obstetrics, Gynecology and Children's Hospital of Athens from April 2014 until September 2015. Amsel's criteria were used for the diagnosis of BV. The presence of leukocytes and lactobacillary grade were evaluated to classify a condition as AVF with inflammation; subsequently, bacterial cultures were performed. A total of 761 women were included. Five hundred and seventy-nine women were diagnosed with candidiasis, BV, trichomoniasis, or other types of vaginitis in which no pathogenic bacterial growth occurred in cultures. One hundred and eighty-two women (23.9 %) were diagnosed with AVF with inflammation (116 non-pregnant, 66 pregnant). Escherichia coli was the most common pathogen among these women (non-pregnant: 45.7 %, pregnant: 34.8 %). Other common pathogens were Group-B-Streptococcus (non-pregnant: 20.7 %, pregnant: 22.7 % respectively), Enterococcus faecalis (14.7 %, 18.2 %), and Klebsiella pneumoniae (6.9 %, 12.1 %). The prevalence of AVF with inflammation may be high. Since inflammation criteria were applied, most cases of BV were eliminated and the majority of cases of AVF are AV. Therefore, clinicians should include AV in the differential diagnosis of vaginitis, while microbiologists should take into account the growth of aerobic bacteria in vaginal cultures originating from women with microscopic findings of AV.
Machado, Fernanda Campos; Cesar, Dionéia Evangelista; Assis, Amanda Vervloet Dutra Agostinho; Diniz, Cláudio Galuppo; Ribeiro, Rosangela Almeida
The aim of this study was to use the fluorescence in situ hybridization (FISH) technique to test the hypothesis of qualitative and quantitative differences of 8 periodontopathogens between pregnant and non-pregnant women. This cross-sectional study included 20 pregnant women in their second trimester of pregnancy and 20 non-pregnant women. Probing depth, bleeding on probing, clinical attachment level, and presence of calculus were recorded. Subgingival plaque samples were collected and the FISH technique identified the presence and numbers of Aggregatibacter actinomycetemcomitans, Tannerella forsythia, Campylobacter rectus, Porphyromonas gingivalis, Treponema denticola, Fusobacterium nucleatum, Prevotella intermedia and Prevotella nigrescens. The Mann-Whitney U-test was applied to compare the data between the two groups. The mean age, ethnicity, marital status, education, and economic level in both groups were similar. The clinical parameters showed no significant differences between pregnant and non-pregnant women. The numbers of subgingival periodontopathogens were not found to be significantly different between groups, despite the higher mean counts of P. intermedia in pregnant women. Colonization patterns of the different bacteria most commonly associated with periodontal disease were not different in the subgingival plaque of pregnant and non-pregnant women.
Yoo, Jae Young; Rho, Mina; You, Young-Ah; Kwon, Eun Jin; Kim, Min-Hye; Kym, Sungmin; Jee, Young-Koo; Kim, Yoon-Keun; Kim, Young Ju
Recent evidence has indicated that bacteria-derived extracellular vesicles (EVs) are important for host–microbe communication. The aims of the present study were to evaluate whether bacteria-derived EVs are excreted via the urinary tract and to compare the composition of bacteria-derived EVs in the urine of pregnant and non-pregnant women. Seventy-three non-pregnant and seventy-four pregnant women were enrolled from Dankook University and Ewha Womans University hospitals. DNA was extracted from urine EVs after EV isolation using the differential centrifugation method. 16S ribosomal RNA (16S rRNA) gene sequencing was performed using high-throughput 454 pyrosequencing after amplification of the V1–V3 region of the 16S rDNA. The composition of 13 taxa differed significantly between the pregnant and non-pregnant women. At the genus level, Bacillus spp. EVs were more significantly enriched in the urine of the pregnant women than in that of the non-pregnant women (45.61% vs 0.12%, respectively). However, Pseudomonas spp. EVs were more dominant in non-pregnant women than in pregnant women (13.2% vs 4.09%, respectively). Regarding the compositional difference between pregnant women with normal and preterm delivery, EVs derived from Ureaplasma spp. and the family Veillonellaceae (including Megasphaera spp.) were more abundant in the urine of preterm-delivered women than in that of women with normal deliveries. Taken together, these data showed that Bacillus spp. EVs predominate in the urine of pregnant women, whereas Pseudomonas spp. EVs predominate in the urine of non-pregnant women; this suggests that Bacillus spp. EVs might have an important role in the maintenance of pregnancy. PMID:26846451
Yoo, Jae Young; Rho, Mina; You, Young-Ah; Kwon, Eun Jin; Kim, Min-Hye; Kym, Sungmin; Jee, Young-Koo; Kim, Yoon-Keun; Kim, Young Ju
Recent evidence has indicated that bacteria-derived extracellular vesicles (EVs) are important for host-microbe communication. The aims of the present study were to evaluate whether bacteria-derived EVs are excreted via the urinary tract and to compare the composition of bacteria-derived EVs in the urine of pregnant and non-pregnant women. Seventy-three non-pregnant and seventy-four pregnant women were enrolled from Dankook University and Ewha Womans University hospitals. DNA was extracted from urine EVs after EV isolation using the differential centrifugation method. 16S ribosomal RNA (16S rRNA) gene sequencing was performed using high-throughput 454 pyrosequencing after amplification of the V1-V3 region of the 16S rDNA. The composition of 13 taxa differed significantly between the pregnant and non-pregnant women. At the genus level, Bacillus spp. EVs were more significantly enriched in the urine of the pregnant women than in that of the non-pregnant women (45.61% vs 0.12%, respectively). However, Pseudomonas spp. EVs were more dominant in non-pregnant women than in pregnant women (13.2% vs 4.09%, respectively). Regarding the compositional difference between pregnant women with normal and preterm delivery, EVs derived from Ureaplasma spp. and the family Veillonellaceae (including Megasphaera spp.) were more abundant in the urine of preterm-delivered women than in that of women with normal deliveries. Taken together, these data showed that Bacillus spp. EVs predominate in the urine of pregnant women, whereas Pseudomonas spp. EVs predominate in the urine of non-pregnant women; this suggests that Bacillus spp. EVs might have an important role in the maintenance of pregnancy.
Abdelgadir, M A; Khalid, A R; Ashmaig, A L; Ibrahim, A R M; Ahmed, A-Aziz M; Adam, I
A cross-sectional study was conducted between August and September 2010 at the antenatal care clinic of the Araba Waeshreen Hospital (Geizera), central Sudan. Sociodemographic, medical, obstetric and use of pica information were gathered. Body mass index (BMI) was calculated. Haemoglobin levels were measured and blood films and stools were examined for malaria and schistosomiasis. Out of the 292 women, 119 (40.8%) had anaemia (HB < 11 g/dl); eight (2.7%) had severe anaemia (HB < 7 g/dl). One patient had a positive blood film for malaria. A total of 38 (13.0%) out of the 292 pregnant women had S. mansoni infections. While age, parity, gestational age, education, occupation, interpregnancy interval and BMI were not associated with anaemia, pica (OR = 1.7, 95% CI = 1.0-2.9, p = 0.02) and S. mansoni infections (OR = 2.8, 95% CI = 1.2-6.7, p = 0.01) were significantly associated with anaemia using univariate and multivariate analyses. The high prevalence of anaemia among these women needs to be controlled through preventive measurement of S. mansoni infections and health education to prevent practising pica.
Alhusen, Jeanne L; Frohman, N; Purcell, Genevieve
Intimate partner violence (IPV) during pregnancy is a major public health issue with significant implications for maternal mental health. Less studied is the association between IPV during pregnancy and suicidal ideation. This study reports the prevalence and correlates of suicidal ideation among low-income pregnant women receiving prenatal care at a university obstetrical clinic from February 2009 to March 2010. We performed a cross-sectional analysis of 166 women surveyed between 24 and 28 weeks of gestation using the Edinburgh Postnatal Depression Scale (EPDS) and the Abuse Assessment Screen (AAS). Multiple logistic regression identified factors associated with antenatal suicidal ideation. The prevalence of suicidal ideation was 22.89 %. In the fully adjusted model, antenatal depressive symptomatology (OR = 17.04; 95 % CI 2.10-38.27) and experiencing IPV (OR = 9.37; 95 % CI 3.41-25.75) were significantly associated with an increased risk of antenatal suicidal ideation. The prevalence of antenatal suicidal ideation in the current study was higher than other population-based samples though this sample was predominantly single, low-income, and 19 % experienced IPV during pregnancy. Given the strong association of antenatal suicidal ideation, depressive symptomatology, and IPV, health care providers are urged to identify those women at risk so that antenatal care can be tailored to best support optimal maternal and neonatal outcomes.
Lawrence, Herenia P; Cidro, Jaime; Isaac-Mann, Sonia; Peressini, Sabrina; Maar, Marion; Schroth, Robert J; Gordon, Janet N; Hoffman-Goetz, Laurie; Broughton, John R; Jamieson, Lisa
This study assessed links between racism and oral health outcomes among pregnant Canadian Aboriginal women. Baseline data were analyzed for 541 First Nations (94.6%) and Métis (5.4%) women in an early childhood caries preventive trial conducted in urban and on-reserve communities in Ontario and Manitoba. One-third of participants experienced racism in the past year determined by the Measure of Indigenous Racism Experience. In logistic regressions, outcomes significantly associated with incidents of racism included: wearing dentures, off-reserve dental care, asked to pay for dental services, perceived need for preventive care, flossing more than once daily, having fewer than 21 natural teeth, fear of going to dentist, never received orthodontic treatment and perceived impact of oral conditions on quality of life. In the context of dental care, racism experienced by Aboriginal women can be a barrier to accessing services. Programs and policies should address racism's insidious effects on both mothers' and children's oral health outcomes.
Tugut, N; Tirkes, D; Demirel, G
The aim of the study was to identify knowledge and fear related to childbirth and the postpartum period in pregnant women. The sample consisted of 114 pregnant women. It was determined that pregnant women had insufficient levels of knowledge related to childbirth and the postpartum period. The Fear of Childbirth and Postpartum Anxiety Scale score for childbirth and the postpartum period related to 'fear regarding the action of childbirth', was found to be the highest. The highest causes for concern were determined to be 'infant-related anxiety' and 'fear regarding infant and puerperal health'. No statistically significant correlation was observed between the perceived sufficiency of the knowledge of pregnant women in terms of maintaining their own health and care, and their mean childbirth and postpartum period concern score. These findings indicate that the level of concern among pregnant women with relation to the postpartum period and childbirth is rather high.
Kim, Deborah R; Hantsoo, Liisa; Thase, Michael E; Sammel, Mary; Epperson, C Neill
Pregnant women with major depressive disorder (MDD) report that psychotherapy is a more acceptable treatment than pharmacotherapy. However, although results of several studies suggest that psychotherapy is an effective treatment for pregnant women, logistical barriers-including cost and traveling for weekly visits-can limit real-world utility. We hypothesized that computer-assisted cognitive behavior therapy (CCBT) would be both acceptable and would significantly decrease depressive symptoms in pregnant women with MDD. As a preliminary test of this hypothesis, we treated 10 pregnant women with MDD using a standardized CCBT protocol. The pilot results were very promising, with 80% of participants showing treatment response and 60% showing remission after only eight sessions of CCBT. A larger, randomized controlled trial of CCBT in pregnant women with MDD is warranted.
Ozturk, Perihan; Kıran, Hakan; Kurutas, Ergul Belge; Mulayim, Kamil; Avcı, Fazıl
Striae gravidarum is a form of scarring on the skin observed during pregnancy and can cause serious cosmetic problems. Striae gravidarum may be influenced by hormonal changes, although the etiology is not clear. The aim of this study was to investigate whether body mass index (BMI) and serum collagenase-2 levels in pregnant women are related to the development of striae gravidarum. Thirty pregnant women with striae, 30 pregnant women without striae, and 32 health controls were enrolled in the study. BMI and serum collagenase-2 levels were measured in the participants. Pregnant women with striae gravidarum had increased serum collagenase-2 and BMI levels when compared to pregnant women without striae gravidarum and healthy controls (P < 0.05). The increase in serum collagenase-2 levels was related to the development of striae gravidarum alone, or secondary to BMI increase. © 2016 Wiley Periodicals, Inc.
Aliyu, Muktar H.; Blevins, Meridith; Megazzini, Karen M.; Parrish, Deidra D.; Audet, Carolyn M.; Chan, Naomi; Odoh, Chisom; Gebi, Usman I.; Muhammad, Mukhtar Y.; Shepherd, Bryan E.; Wester, C. William; Vermund, Sten H.
Background We examined antiretroviral therapy (ART) initiation and retention by sex and pregnancy status in rural Nigeria. Methods We studied HIV-infected ART-naïve patients aged ≥15 years entering care from June 2009 to September 2013. We calculated the probability of early ART initiation and cumulative incidence of loss to follow-up (LTFU) during the first year of ART, and examined the association between LTFU and sex/pregnancy using Cox regression. Results The cohort included 3813 ART-naïve HIV-infected adults (2594 women [68.0%], 273 [11.8%] of them pregnant). The proportion of pregnant clients initiating ART within 90 days of enrollment (78.0%, 213/273) was higher than among non-pregnant women (54.3%,1261/2321) or men (53.0%, 650/1219), both p<0.001. Pregnant women initiated ART sooner than non-pregnant women and men (median [IQR] days from enrollment to ART initiation for pregnant women=7 days [0–21] vs 14 days [7–49] for non-pregnant women and 14 days [7–42] for men; p<0.001). Cumulative incidence of LTFU during the first year post-ART initiation was high and did not differ by sex and pregnancy status. Persons who were unemployed, bedridden, had higher CD4+ counts, and/or in earlier WHO clinical stages were more likely to be LTFU. Conclusions Pregnant women with HIV in rural Nigeria were more likely to initiate ART but were no more likely to be retained in care. Our findings underscore the importance of effective retention strategies across all patient groups, regardless of sex and pregnancy status. PMID:26012740
Gandhi, Preeti; Farrell, Tom
To study the outcomes of two-stage GDM screening of morbidly obese women in our obstetric unit and to evaluate the diagnostic performance of 20-week oral glucose tolerance test (OGTT) values in predicting or excluding late onset GDM. A retrospective study in which 190 pregnant women with BMI ≥40 had two-stage screening: a 75g OGTT is performed at 20 weeks and repeated at 28 weeks if the 20-week OGTT was normal. Receiver operating characteristic (ROC) curves for 20-week OGTT values were constructed in order to obtain an optimal cut-off value of fasting and/or 2-h glucose at 20 weeks from which GDM could be predicted or excluded at 28 weeks. Sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were determined for each of the fasting and 2-h post-load glucose values at 20 weeks. Forty six (24%) women were diagnosed with GDM. Thirty-two (70%) were diagnosed at 20 weeks and 14 (30%) at 28 weeks. The 2-h cut-off value of ≥6mmol/l at the 20-week OGTT had a negative likelihood ratio of 0.12 to predict GDM at 28 weeks. The low negative likelihood ratio reduces the probability of detecting GDM at 28 weeks from 9% (pre-test probability) to 1% (post-test probability). Nearly 70% of the women were diagnosed with GDM at 20 weeks, which gives an early opportunity to treat maternal hyperglycaemia with consequent health benefits. A 2-h cut-off glucose value of 6mmol/l at 20 weeks OGTT has a low negative likelihood ratio which virtually excludes GDM at 28 weeks. Hence women with a 2h value of <6mmol/l at 20 weeks can avoid a repeat 28 week OGTT test. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
Colbers, Angela; Best, Brookie; Schalkwijk, Stein; Wang, Jiajia; Stek, Alice; Hidalgo Tenorio, Carmen; Hawkins, David; Taylor, Graham; Kreitchmann, Regis; Burchett, Sandra; Haberl, Annette; Kabeya, Kabamba; van Kasteren, Marjo; Smith, Elizabeth; Capparelli, Edmund; Burger, David; Mirochnick, Mark
Objective. To describe the pharmacokinetics of maraviroc in human immunodeficiency virus (HIV)–infected women during pregnancy and post partum. Methods. HIV-infected pregnant women receiving maraviroc as part of clinical care had intensive steady-state 12-hour pharmacokinetic profiles performed during the third trimester and ≥2 weeks after delivery. Cord blood samples and matching maternal blood samples were taken at delivery. The data were collected in 2 studies: P1026 (United States) and PANNA (Europe). Pharmacokinetic parameters were calculated. Results. Eighteen women were included in the analysis. Most women (12; 67%) received 150 mg of maraviroc twice daily with a protease inhibitor, 2 (11%) received 300 mg twice daily without a protease inhibitor, and 4 (22%) had an alternative regimen. The geometric mean ratios for third-trimester versus postpartum maraviroc were 0.72 (90% confidence interval, .60–.88) for the area under the curve over a dosing interval (AUCtau) and 0.70 (0.58–0.85) for the maximum maraviroc concentration. Only 1 patient showed a trough concentration (Ctrough) below the suggested target of 50 ng/mL, both during pregnancy and post partum. The median ratio of maraviroc cord blood to maternal blood was 0.33 (range, 0.03–0.56). The viral load close to delivery was <50 copies/mL in 13 women (76%). All children were HIV negative at testing. Conclusions. Overall maraviroc exposure during pregnancy was decreased, with a reduction in AUCtau and maximum concentration of about 30%. Ctrough was reduced by 15% but exceeded the minimum Ctrough target concentration. Therefore, the standard adult dose seems sufficient in pregnancy. Clinical Trials Registration. NCT00825929 and NCT000422890. PMID:26202768
Neriishi, Kazuo; Monzen, Yoshio; Okamoto, Naomasa
We conducted a review of literature related to radiation effects on pregnant women, fetuses, and children from the perspective of epidemiology, pathology, and radiobiology. During 8-25 weeks post-conception the central nervous system is particularly sensitive to radiation. Fetal doses in excess of 100 mGy can result in some reduction of IQ (intelligence quotient). Fetal doses in the range of 1000 mGy can lead to severe mental retardation and microcephaly, particularly during 8-15 weeks and to a lesser extent 16-25 weeks after conception. Recent studies of cancers and chromosome aberrations indicated less radiosensitivity in prenatally exposed A-bomb survivors compared with postnatally exposed survivors, for which we provide possible hypotheses as an explanation.
Smíšková, Dita; Karpíšková, Renata; Džupová, Olga; Marešová, Vilma
Listeria monocytogenes is ubiquitous in nature, being commonly present in faecal flora of otherwise healthy human population or animals. Clinical manifestation of listeria infection may vary widely from mild to invasive, life-threatening disease. In an immunocompromised host, a rather serious course should be expected. Due to cell-mediated immune insufficiency associated with pregnancy even a short bacteraemia in pregnant women can result in transplacental infection. Most listeria infections are sporadic but outbreaks may occur. An outbreak of listeriosis in the Czech Republic in the autumn of 2006 and winter of 2007 was associated with an increased incidence of perinatal listeriosis. More information on listeriosis prevention in pregnancy should be given and each febrile episode during pregnancy should be carefully examined. Early treatment of listeriosis reduces the risk of vertical transmission.
Koren, Gideon; Madjunkova, Svetlana; Maltepe, Caroline
Since the thalidomide disaster, medicine is practised as if every drug is teratogenic, when in fact very few medications are. Pregnant women are often ready to refuse treatment even for life-threatening conditions owing to misinformation and misperceptions about fetal risks. How can I reassure my patients and prevent misinformation from affecting their treatment? Physicians must provide evidence-based counseling to their patients. For example, antihistamines for morning sickness have been proven safe in numerous studies, but are commonly the subject of media reports overstating the risks to the fetus. Family physicians and obstetricians must take an active role in preventing pregnant patients from being misinformed. Copyright© the College of Family Physicians of Canada.
Lopez, William D; Seng, Julia S
The prevalence of posttraumatic stress disorder (PTSD) in the United States is higher among pregnant women than women generally. PTSD is related to adverse birth outcomes via physiological and behavioral alterations, such as smoking. We utilize salivary cortisol measures to examine how traumatic stress, smoking and the hypothalamic-pituitary-adrenal axis interact. Pregnant women (n =395) gave cortisol specimens as part of a cohort study of PTSD and pregnancy at three health systems in the Midwestern United States. Women were divided into three groups: nonsmokers, quitters (who stopped smoking during pregnancy), and pregnancy smokers. Mean cortisol values at three points, sociodemographics, trauma history, and PTSD were compared across groups. We assessed the association of smoking group and PTSD with late afternoon cortisol levels. Smokers, quitters, and nonsmokers differed on demographic risk factors and PTSD symptom load. Late afternoon and bedtime cortisol measures were significantly positively correlated with smoking in pregnancy, with smokers with PTSD presenting the highest cortisol levels. Regression analysis showed that smoking in pregnancy was associated with higher late afternoon cortisol in an additive manner with PTSD symptoms. Smoking appears to have a different relationship with cortisol level for those with and without PTSD. This is the first study to show additive effects of smoking and PTSD on cortisol levels in pregnant women. Since high cortisol, smoking, and PTSD have been shown to adversely affect perinatal outcomes, and since those continuing to smoke in pregnancy had the highest PTSD symptom load, PTSD-specific smoking cessation programs in maternity settings are warranted. PMID:24926909
Tyer-Viola, Lynda A; Duffy, Mary E
This paper is a report of the development and initial psychometric evaluation of the Pregnant Women with HIV Attitude Scale. Previous research has identified that attitudes toward persons with HIV/AIDS have been judgmental and could affect clinical care and outcomes. Stigma towards persons with HIV has persisted as a barrier to nursing care globally. Women are more vulnerable during pregnancy. An instrument to specifically measure obstetric care provider's attitudes toward this population is needed to target identified gaps in providing respectful care. Existing literature and instruments were analysed and two existing measures, the Attitudes about People with HIV Scale and the Attitudes toward Women with HIV Scale, were combined to create an initial item pool to address attitudes toward HIV-positive pregnant women. The data were collected in 2003 with obstetric nurses attending a national conference in the United States of America (N = 210). Content validity was used for item pool development and principal component analysis and analysis of variance were used to determine construct validity. Reliability was analysed using Cronbach's Alpha. The new measure demonstrated high internal consistency (alpha estimates = 0.89). Principal component analysis yielded a two-component structure that accounted for 45% of the total variance: Mothering-Choice (alpha estimates = 0.89) and Sympathy-Rights (alpha estimates = 0.72). These data provided initial evidence of the psychometric properties of the Pregnant Women with HIV Attitude Scale. Further analysis is required of the validity of the constructs of this scale and its reliability with various obstetric care providers.
Dooley, Kelly E.; Denti, Paolo; Martinson, Neil; Cohn, Silvia; Mashabela, Fildah; Hoffmann, Jennifer; Haas, David W.; Hull, Jennifer; Msandiwa, Regina; Castel, Sandra; Wiesner, Lubbe; Chaisson, Richard E.; McIlleron, Helen