Outcomes of subsequent pregnancy after first pregnancy with early-onset preeclampsia.

PubMed

van Rijn, Bas B; Hoeks, Lette B; Bots, Michiel L; Franx, Arie; Bruinse, Hein W

2006-09-01

The aim of this study was to report outcome of subsequent pregnancy after early-onset preeclampsia in first pregnancy, and to evaluate potential risk factors for recurrence of preeclampsia and preterm delivery. Reproductive follow-up data were obtained for women with a history of early-onset preeclampsia, resulting in delivery before 34 weeks of gestation at the University Medical Center Utrecht, The Netherlands, between July 1993 and September 2002. The relative contributions of demographic data, outcome variables of first pregnancy, and common thrombophilias to the recurrence risk of preeclampsia and preterm delivery in subsequent pregnancy, were estimated by Cox proportional hazard models. Subsequent pregnancy outcome data were available for 120 women. Overall, preeclampsia reoccurred in the second pregnancy in 30 women (25%). However, 6 women delivered before 34 weeks of gestation (5%), 20 women between 34 and 37 weeks of gestation (17%), and 94 women after 37 weeks of gestation (78%). Forty-one women (34%) had an uneventful pregnancy. Recurrence rates for preeclampsia or preterm delivery were not related to severity of first pregnancy complications, including delivery before 28 weeks of gestation, occurrence of hemolysis, elevated liver enzymes, and low platelet count syndrome, small-for-gestational age infants, and to hereditary or acquired thrombophilias. Chronic hypertension was related to a higher recurrence risk of preeclampsia in the second pregnancy (hazard ratio 2.1, 95% CI 1.0-4.4), and smoking was related to a higher recurrence risk of preterm birth (hazard ratio 2.4, 95% CI 1.1-5.6). Outcomes of subsequent pregnancy after first pregnancy with early-onset preeclampsia is generally favorable.

The interrelationship of complement-activation fragments and angiogenesis-related factors in early pregnancy and their association with pre-eclampsia

PubMed Central

Lynch, AM; Murphy, JR; Gibbs, RS; Levine, RJ; Giclas, PC; Salmon, JE; Holers, VM

2016-01-01

Objective To determine the interrelationships during early pregnancy of complement-activation fragments Bb, C3a and sC5b-9, and angiogenesis-related factors placental growth factor (PiGF), soluble fms-like tyrosine kinase-1 (sFlt-1) and soluble endoglin (sEng), and their associations with pre-eclampsia. Design Prospective cohort study. Setting Denver complement study (June 2005–June 2008). Population A total of 668 pregnant women with singleton gestations, recruited between 10 and 15 weeks of gestation. Methods Using univariable and multivariable logistic regression analysis, concentrations of complement-activation fragments and angiogenesis-related factors were compared between 10 and 15 weeks of gestation in women who subsequently did or did not develop pre-eclampsia. Interrelationships between these variables were tested using the non-parametric Spearman rank correlation coefficient. Main outcome measure Pre-eclampsia. The association of complement-activation fragments and angiogenesis-related factors with obesity was also examined. Results The mean (±SD) levels of complement Bb in early pregnancy among women who did and did not develop pre-eclampsia were 0.84 (±0.26) µg/ml and 0.69 (±0.2) µg/ml, respectively (P = 0.001). Concentrations of PiGF were significantly (P = 0.01) lower (31 ± 12 pg/ml) in early pregnancy in the pre-eclamptic group of women, as compared with the normotensive group (39 ± 32 pg/ml). The adjusted odds ratio (AOR) of Bb and PiGF were 2.1 (CI = 1.4–3.1, P < 0.0003) and 0.2 (CI = 0.07–0.7, P = 0.01), respectively. There was no significant difference in the levels of C3a, sC5b-9, sFlt-1 and sEng in early pregnancy among women who developed pre-eclampsia, compared with women who remained normotensive during pregnancy. Higher levels of Bb (P = 0.0001) and C3a (P = 0.03), and lower levels of sFlt-1 (P = 0.0002) and sEng (P = 0.0001) were found among women with obesity, compared with non-obese controls. No meaningful relationships

Ultrasound for fetal assessment in early pregnancy

PubMed Central

Whitworth, Melissa; Bricker, Leanne; Neilson, James P; Dowswell, Therese

2014-01-01

Background Diagnostic ultrasound is a sophisticated electronic technology, which utilises pulses of high frequency sound to produce an image. Diagnostic ultrasound examination may be employed in a variety of specific circumstances during pregnancy such as after clinical complications, or where there are concerns about fetal growth. Because adverse outcomes may also occur in pregnancies without clear risk factors, assumptions have been made that routine ultrasound in all pregnancies will prove beneficial by enabling earlier detection and improved management of pregnancy complications. Routine screening may be planned for early pregnancy, late gestation, or both. The focus of this review is routine early pregnancy ultrasound. Objectives To assess whether routine early pregnancy ultrasound for fetal assessment (i.e. its use as a screening technique) influences the diagnosis of fetal malformations, multiple pregnancies, the rate of clinical interventions, and the incidence of adverse fetal outcome when compared with the selective use of early pregnancy ultrasound (for specific indications). Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (September 2009). Selection criteria Published, unpublished, and ongoing randomised controlled trials that compared outcomes in women who experienced routine versus selective early pregnancy ultrasound (i.e. less than 24 weeks’ gestation). We have included quasi-randomised trials. Data collection and analysis Two review authors independently extracted data for each included study. We used the Review Manager software to enter and analyse data. Main results Routine/revealed ultrasound versus selective ultrasound/concealed: 11 trials including 37505 women. Ultrasound for fetal assessment in early pregnancy reduces the failure to detect multiple pregnancy by 24 weeks’ gestation (risk ratio (RR) 0.07, 95% confidence interval (CI) 0.03 to 0.17). Routine scan is associated with a reduction in

Detection of early pregnancy factor-like activity in women with gestational trophoblastic tumors.

PubMed

Mehta, A R; Shahani, S K

1987-07-01

The presence of immunosuppressive early pregnancy factor (EPF) in the maternal serum has so far been associated with gestation. Its presence in the serum of women with gestational trophoblastic tumors was investigated. The results indicate that while EPF activity was detected in the serum of women with choriocarcinoma, no such activity was detected in the serum of women with hydatidiform mole, leading to the novel use of EPF as a marker to distinguish these two clinical situations. Results of the experiments also suggest that EPF moiety present in the maternal serum during pregnancy may be of different molecular entity than that present in the serum of women with choriocarcinoma.

Cross-Reactivity between Chlamydia trachomatis Heat Shock Protein 10 and Early Pregnancy Factor

PubMed Central

Betsou, Fotini; Borrego, Maria José; Guillaume, Nicolas; Catry, Maria Anjos; Romão, Sandra; Machado-Caetano, J. A.; Sueur, Jean Marie; Mention, Jacques; Faille, Nicole; Orfila, Jeanne

2003-01-01

Chlamydia trachomatis heat shock protein 10 (Chsp10) is associated with chronic genital tract infection with C. trachomatis. Chsp10 is homologous to human chaperonin 10 (Cpn10) and early pregnancy factor (EPF), a form of human Cpn10 that is specifically secreted at the start of pregnancy. We investigated cross-reactions between serum anti-Chsp10 antibodies and anti-EPF antibodies in pregnant and nonpregnant patients. Pregnancy was found to be associated with the presence of anti-EPF antibodies, which are specifically induced in pregnant women with a history of C. trachomatis infection, and with the presence of serum anti-Chsp10 antibodies. We also found that infertility was associated with the presence of anti-Chsp10 and anti-EPF antibodies. The HLA class II haplotype DR8 DQ4 was associated with the presence of anti-Chsp10 antibodies but not of anti-EPF antibodies. PMID:12738647

The Epidermal Growth Factor Receptor Critically Regulates Endometrial Function during Early Pregnancy

PubMed Central

Large, Michael J.; Wetendorf, Margeaux; Lanz, Rainer B.; Hartig, Sean M.; Creighton, Chad J.; Mancini, Michael A.; Kovanci, Ertug; Lee, Kuo-Fen; Threadgill, David W.; Lydon, John P.; Jeong, Jae-Wook; DeMayo, Francesco J.

2014-01-01

Infertility and adverse gynecological outcomes such as preeclampsia and miscarriage represent significant female reproductive health concerns. The spatiotemporal expression of growth factors indicates that they play an important role in pregnancy. The goal of this study is to define the role of the ERBB family of growth factor receptors in endometrial function. Using conditional ablation in mice and siRNA in primary human endometrial stromal cells, we identified the epidermal growth factor receptor (Egfr) to be critical for endometrial function during early pregnancy. While ablation of Her2 or Erbb3 led to only a modest reduction in litter size, mice lacking Egfr expression are severely subfertile. Pregnancy demise occurred shortly after blastocyst implantation due to defects in decidualization including decreased proliferation, cell survival, differentiation and target gene expression. To place Egfr in a genetic regulatory hierarchy, transcriptome analyses was used to compare the gene signatures from mice with conditional ablation of Egfr, wingless-related MMTV integration site 4 (Wnt4) or boneless morphogenic protein 2 (Bmp2); revealing that not only are Bmp2 and Wnt4 key downstream effectors of Egfr, but they also regulate distinct physiological functions. In primary human endometrial stromal cells, marker gene expression, a novel high content image-based approach and phosphokinase array analysis were used to demonstrate that EGFR is a critical regulator of human decidualization. Furthermore, inhibition of EGFR signaling intermediaries WNK1 and AKT1S1, members identified in the kinase array and previously unreported to play a role in the endometrium, also attenuate decidualization. These results demonstrate that EGFR plays an integral role in establishing the cellular context necessary for successful pregnancy via the activation of intricate signaling and transcriptional networks, thereby providing valuable insight into potential therapeutic targets. PMID

Immunohistochemical distribution of early pregnancy factor in ovary, oviduct and placenta of pregnant gilts.

PubMed

Grosso, M C; Bellingeri, R V; Motta, C E; Alustiza, F E; Picco, N Y; Vivas, A B

2015-01-01

Early pregnancy factor (EPF) is an immunosuppressant that promotes maternal immune system tolerance of the allogenic fetus. Little is known about localization of this factor in different tissues and nothing has been reported about localization in swine reproductive and placental tissues. We determined the concentration of EPF in serum of gilts and porcine placenta conditioned medium (PPCM). We also analyzed the expression of EPF in different reproductive tissues of pregnant gilts at 10, 30, 60 and 90 days of pregnancy. EPF concentration in serum and PPCM was determined by western blot and densitometry. EPF expression in reproductive tissue was assessed by immunohistochemistry. The highest concentration of EPF was observed at 30 days in serum and PPCM; the concentration was higher in PPCM than in serum at the stages we evaluated. All reproductive tissues from the gestational stages analyzed showed specific labeling of EPF, but this labeling did not appear in non-pregnant gilts. At 30 days pregnancy, the EPF expression in the ovary was predominantly in follicular lutein cells, probably owing to its function as a luteotrophic factor. In the oviduct, EPF was expressed in unciliated secretory epithelial cells and in the cilia of ciliated cells. In the placenta, EPF was expressed in the fetal portion (mesoderm chorioallantois and epithelium of endoderm). EPF acts as an autocrine and paracrine growth factor for the trophoblast during the peri-implantation period.

Factors affecting retention of early pregnancy in dairy cattle.

PubMed

Starbuck, Melanie J; Dailey, Robert A; Inskeep, E Keith

2004-08-01

Potential factors affecting retention of pregnancy during weeks 5-9 of gestation were studied in dairy cows and heifers (N = 211) on two farms. Cows were examined by ultrasonography for presence of a viable embryo, and sizes of the corpus luteum (CL) and of follicles > or = 5mm were recorded. Blood samples were taken at each examination and assayed for progesterone and estradiol. Overall pregnancy loss was 11.4%. Cows with two CL did not have greater concentrations of progesterone than cows with one CL and they retained fewer pregnancies (P < 0.01; 73% versus 91%). Pregnancy retention was associated positively with concentrations of progesterone and estradiol during week 5 (P < 0.05). Embryos that were lost apparently died before CL regression. Retention of pregnancy declined in cows with high body condition and as age of the cow increased. Pregnancy retention was lower in cows bred to one of four frequently-used service sires (P < 0.05). Days postpartum, milk production, parity, service number, inseminator, synchronization of estrus, diameter of follicles and size of CL did not affect pregnancy retention. In conclusion, retention of pregnancy during placentation varied with concentrations of progesterone and estradiol, age of cow, body condition and service sire.

Isolation, purification and partial characterization of early pregnancy factor (EPF) from sera of pregnant women.

PubMed

Haq, A; Mothi, B A; Al-Hussein, K; Al-Tufail, M; Hollanders, J; Jaroudi, K; Al-Waili, N; Shabani, M

2001-05-29

Early pregnancy factor (EPF) is a pregnancy protein, which is secreted into the maternal serum 12-16 hours after fertilization. It is thought to be an immunosuppressive molecule. EPF is detected in pregnant woman's serum by the rosette inhibition assay (RIA). In this study, EPF was purified from the pregnant woman's sera by using ion exchange chromatography and analyzed by sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE). The proteins which showed a positive result with the RIA, were found to be 35 kDa and 17 kDa molecular weights. The biological activities of these proteins were stable upon heat treatment at 56 degrees C for 30 min. Proteins isolated and purified in this study might be of great significance to the field of human reproduction with particular reference to pregnancy and recurrent abortion.

Alkaline Phosphatase Protects Lipopolysaccharide-Induced Early Pregnancy Defects in Mice

PubMed Central

Lei, Wei; Ni, Hua; Herington, Jennifer; Reese, Jeff; Paria, Bibhash C.

2015-01-01

Excessive cytokine inflammatory response due to chronic or superphysiological level of microbial infection during pregnancy leads to pregnancy complications such as early pregnancy defects/loss and preterm birth. Bacterial toxin lipopolysaccharide (LPS), long recognized as a potent proinflammatory mediator, has been identified as a risk factor for pregnancy complications. Alkaline phosphatase (AP) isozymes have been shown to detoxify LPS by dephosphorylation. In this study, we examined the role of alkaline phosphatase (AP) in mitigating LPS-induced early pregnancy complications in mice. We found that 1) the uterus prior to implantation and implantation sites following embryo implantation produce LPS recognition and dephosphorylation molecules TLR4 and tissue non-specific AP (TNAP) isozyme, respectively; 2) uterine TNAP isozyme dephosphorylates LPS at its sites of production; 3) while LPS administration following embryo implantation elicits proinflammatory cytokine mRNA levels at the embryo implantation sites (EISs) and causes early pregnancy loss, dephosphorylated LPS neither triggers proinflammatory cytokine mRNA levels at the EISs nor induces pregnancy complications; 4) AP isozyme supplementation to accelerate LPS detoxification attenuates LPS-induced pregnancy complications following embryo implantation. These findings suggest that a LPS dephosphorylation strategy using AP isozyme may have a unique therapeutic potential to mitigate LPS- or Gram-negative bacteria-induced pregnancy complications in at-risk women. PMID:25910276

Alkaline phosphatase protects lipopolysaccharide-induced early pregnancy defects in mice.

PubMed

Lei, Wei; Ni, Hua; Herington, Jennifer; Reese, Jeff; Paria, Bibhash C

2015-01-01

Excessive cytokine inflammatory response due to chronic or superphysiological level of microbial infection during pregnancy leads to pregnancy complications such as early pregnancy defects/loss and preterm birth. Bacterial toxin lipopolysaccharide (LPS), long recognized as a potent proinflammatory mediator, has been identified as a risk factor for pregnancy complications. Alkaline phosphatase (AP) isozymes have been shown to detoxify LPS by dephosphorylation. In this study, we examined the role of alkaline phosphatase (AP) in mitigating LPS-induced early pregnancy complications in mice. We found that 1) the uterus prior to implantation and implantation sites following embryo implantation produce LPS recognition and dephosphorylation molecules TLR4 and tissue non-specific AP (TNAP) isozyme, respectively; 2) uterine TNAP isozyme dephosphorylates LPS at its sites of production; 3) while LPS administration following embryo implantation elicits proinflammatory cytokine mRNA levels at the embryo implantation sites (EISs) and causes early pregnancy loss, dephosphorylated LPS neither triggers proinflammatory cytokine mRNA levels at the EISs nor induces pregnancy complications; 4) AP isozyme supplementation to accelerate LPS detoxification attenuates LPS-induced pregnancy complications following embryo implantation. These findings suggest that a LPS dephosphorylation strategy using AP isozyme may have a unique therapeutic potential to mitigate LPS- or Gram-negative bacteria-induced pregnancy complications in at-risk women.

[Early diagnosis of ectopic pregnancy].

PubMed

Belics, Zoran; Gérecz, Balázs; Csákány, M György

2014-07-20

Ectopic pregnancy is a high-risk condition that occurs in 2% of reported pregnancies. This percentage is fivefold higher than that registered in the 1970s. Since 1970 there has been a two-fold increase in the ratio of ectopic pregnancies to all reported pregnancies in Hungary and in 2012 7.4 ectopic pregnancies per thousand registered pregnancies were reported. Recently, the majority (80%) of cases can be diagnosed in early stage, and the related mortality objectively decreased in the past few decades to 3.8/10,000 ectopic pregnancies. If a woman with positive pregnancy test has abdominal pain and/or vaginal bleeding the physician should perform a work-up to safely exclude the possibility of ectopic pregnancy. The basis of diagnosis is ultrasonography, especially vaginal ultrasound examination and measurement of the β-subunit of human chorionic gonadotropin. The ultrasound diagnosis is based on the visualization of an ectopic mass rather than the inability to visualize an intrauterine pregnancy. In some questionable cases the diagnostic uterine curettage or laparoscopy may be useful. The actuality of this topic is justified by practical difficulties in obtaining correct diagnosis, especially in the early gestational time.

Early pregnancy azathioprine use and pregnancy outcomes.

PubMed

Cleary, Brian J; Källén, Bengt

2009-07-01

Azathioprine (AZA) is used during pregnancy by women with inflammatory bowel disease (IBD), other autoimmune disorders, malignancy, and organ transplantation. Previous studies have demonstrated potential risks. The Swedish Medical Birth Register was used to identify 476 women who reported the use of AZA in early pregnancy. The effect of AZA exposure on pregnancy outcomes was studied after adjustment for maternal characteristics that could act as confounders. The most common indication for AZA use was IBD. The rate of congenital malformations was 6.2% in the AZA group and 4.7% among all infants born (adjusted OR: 1.41, 95% CI: 0.98-2.04). An association between early pregnancy AZA exposure and ventricular/atrial septal defects was found (adjusted OR: 3.18, 95% CI: 1.45-6.04). Exposed infants were also more likely to be preterm, to weigh <2500 gm, and to be small for gestational age compared to all infants born. This effect remained for preterm birth and low birth weight when infants of women with IBD but without AZA exposure were used as a comparison group. A trend toward an increased risk of congenital malformations was found among infants of women with IBD using AZA compared to women with IBD not using AZA (adjusted OR: 1.42, 95% CI: 0.93-2.18). Infants exposed to AZA in early pregnancy may be at a moderately increased risk of congenital malformations, specifically ventricular/atrial septal defects. There is also an increased risk of growth restriction and preterm delivery. These associations may be confounded by the severity of maternal illness.

Anti-early pregnancy by PDT

NASA Astrophysics Data System (ADS)

Ding, Ai-Hua; Chen, Hui-Ling

1993-03-01

The effect of laser on anti-early pregnancy in rabbits showed that laser in combination with HPD could induce necrosis of blastocysts and complete absorption. The anti-fertility efficiency of the combined treatment was more effective than that of the He-Ne laser or the HPD treatment alone. The fluorescence spectrum of HPD determined by PNQ3 showed that its affinity to embryonic tissue was about 4 times greater than that to uterine tissue. This may underlie the mechanisms of anti-early pregnancy of the laser. The operation of artificial abortion is a routine method to terminate early pregnancy. Though it is simple and easy, its syndrome and complications can not be absolutely avoided. Many antifertility drugs have been reported, however, they often bring in general reaction. Our present work is to explore a new way of anti-early pregnancy in rabbits by means of the light inhibitory and light sensitive effects of laser. It is a quite safe and painless treatment without expanding and scraping of the uterus.

Compliance with national recommendations for exercise during early pregnancy in a Danish cohort.

PubMed

Broberg, Lotte; Ersbøll, Anne S; Backhausen, Mette G; Damm, Peter; Tabor, Ann; Hegaard, Hanne K

2015-11-27

Exercise during pregnancy is associated with health benefits for both the mother and the fetus, and is therefore recommended in several national guidelines. Only few studies investigate whether these guideline recommendations are met. The aims of this study were 1. To assess the prevalence of pregnant women meeting the Danish recommendations for exercise during early pregnancy, 2. To identify pre-pregnancy factors associated with a lower probability for meeting the recommendations, and 3. To describe which types of exercise pregnant women prefer before and during pregnancy. We conducted a cross-sectional study based on a questionnaire during the first trimester among 7,915 women participating in the prospective Copenhagen Pregnancy Cohort. Associations were estimated by multivariate regression analyses. In early pregnancy, 38 % of the study population met the recommendation for exercise from the Danish Health and Medicines Authority (≥3.5 hours a week). Multiparity, previous miscarriage use of assisted reproductive technology, no engagement in exercise before pregnancy, smoking, pregnancy following assisted reproductive technology, overweight, not understanding Danish language and a low educational level were all factors associated a lower probability for meeting the recommendations. The preferred types of exercise before and during pregnancy were bicycling, brisk walking, running and strength training. The proportion of women engaged in any type of exercise decreased in early pregnancy with the exception of swimming and aquatic exercise. In this cohort, more than one-third met the Danish recommendation for exercise during early pregnancy. Exercise in pregnancy is still an issue to address because the most vulnerable groups of pregnant women do not exercise. This is a cause of concern because it may reflect social inequalities in health and highlights the need for a structural and systematic approach to preconception care and early antenatal counselling.

An outcomes evaluation of an emergency department early pregnancy assessment service and early pregnancy assessment protocol

PubMed Central

Wendt, Kim; Crilly, Julia; May, Chris; Bates, Kym; Saxena, Rakhee

2014-01-01

Background Complications in early pregnancy, such as threatened or actual miscarriage is a common occurrence resulting in many women presenting to the emergency department (ED). Early pregnancy service delivery models described in the literature vary in terms of approach, setting and outcomes. Our objective was to determine outcomes of women who presented to an Australian regional ED with diagnoses consistent with early pregnancy complications following the implementation of an early pregnancy assessment service (EPAS) and early pregnancy assessment protocol (EPAP) in July 2011. Methods A descriptive, comparative (6 months before and after) study was undertaken. Data were extracted from the hospital ED information system and medical healthcare records. Outcome measures included: time to see a clinician, ED length of stay, admission rate, re-presentation rate, hospital admission and types of pathology tests ordered. Results Over the 12 -month period, 584 ED presentations were made to the ED with complications of early pregnancy (268 PRE and 316 POST EPAS–EPAP). Outcomes that improved statistically and clinically following implementation included: time to see a clinician (decreased by 6 min from 35 to 29 min), admission rate (decreased 6% from 14.5% to 8.5%), increase in β-human chorionic gonadotrophin ordering by 10% (up to 80% POST), increase in ultrasound (USS) performed by 10% (up to 73% POST) and increase in pain score documentation by 23% (up to 36% POST). Conclusions The results indicate that patient and service delivery improvements can be achieved following the implementation of targeted service delivery models such as EPAS and EPAP in the ED. PMID:24136123

The role of pregnancy awareness on female sexual function in early gestation.

PubMed

Corbacioglu, Aytul; Bakir, Vuslat Lale; Akbayir, Ozgur; Cilesiz Goksedef, Behiye Pinar; Akca, Aysu

2012-07-01

Female sexual function is negatively influenced by pregnancy due to the physical and emotional changes. Although the most significant effect is seen in the third trimester of pregnancy, a considerable decrease in the frequency of intercourse and sexual desire in the first trimester has also been shown. To investigate the factors that affect sexuality in early pregnancy and the impact of awareness of pregnancy on female sexual function in the first trimester of pregnancy using two self-reported questionnaires. In this cross-sectional study, 130 healthy, married pregnant women who were admitted to the gynecology clinic between the 4th and 10th week of gestation were asked to complete a self-administered questionnaire and the female sexual function index (FSFI). The factors associated with FSFI score and monthly sexual activity frequency in the first trimester, as well as the differences in sexual activity frequency and FSFI scores between the women who were previously aware of their pregnancy and those who were yet unaware of their pregnancy. Women who were unaware of their pregnancy had significantly higher coitus frequency in comparison with the aware group (P = 0.002). Total FSFI score was 21.99 ± 8.13 in the aware group and 24.66 ± 3.76 in the unaware group (P = 0.02). None of the obstetric and sociodemographic variables had an influence on desire and pain scores. Arousal, lubrication, and satisfaction scores were adversely affected by awareness of pregnancy. Orgasm scores were influenced negatively by awareness and positively by love marriage; however, in multivariate linear regression analysis none of these were defined as independent factor for orgasm scores. Overall FSFI scores and monthly frequency of sexual activity were only affected by awareness. The results of this study suggest that in early gestation, awareness of pregnancy is associated with lower female sexual function. Furthermore, obstetric and sociodemographic factors seem to be

Prepregnancy Nutrition and Early Pregnancy Outcomes

PubMed Central

Gaskins, Audrey J.; Toth, Thomas L.; Chavarro, Jorge E.

2015-01-01

Implantation failure and pregnancy loss are estimated to affect up to 75% of fertilized ova; however as of yet there is limited empirical evidence, particularly at the population level, for understanding the environmental determinants of these losses. The purpose of this review is to summarize the current knowledge on prepregnancy nutrition and early pregnancy outcomes with particular focus on the outcome of spontaneous abortion among pregnancies conceived naturally and early pregnancy end points among pregnancies conceived through in vitro fertilization. To date, there is limited evidence to support associations of prepregnancy vitamin D and caffeine intake with pregnancy loss. There is suggestive data supporting a link between a healthy diet and lower risk of pregnancy loss. High folate and minimal to no alcohol intake prior to conception have the most consistent evidence supporting an association with lower risk of pregnancy loss. PMID:26457232

Recent pregnancy trends among early adolescent girls in Japan.

PubMed

Baba, Sachiko; Goto, Aya; Reich, Michael R

2014-01-01

The paper examines recent time trends, explores potentially influential background factors and discusses prevention strategies of pregnancy among girls under 15 years of age in Japan. Using Japanese government data, we first analyzed time trends of early adolescence (<15 years of age) abortion, live birth and child sexual abuse from 2003 to 2010. Second, we analyzed ecological correlations of early adolescent pregnancy (abortion, live birth and stillbirth) with pregnancy in other age groups, child sexual abuse, and indicators of juvenile victimization and juvenile delinquency, using prefectural data. We found that rates of both abortion and live birth in early adolescents have increased since 2005 (annual percent change 5.3% and 2.3%, respectively), despite declining rates in older age groups. The abortion ratio in early adolescence remained the highest among all age groups in Japan. The early adolescent pregnancy rate showed significant correlation with the rates of juvenile victimization of welfare crimes (obscenity, alcohol drinking, smoking and drug use) (Spearman's rank correlation coefficient [rs] = 0.42, P = 0.00) and juvenile delinquency among junior high school students (12-14 years of age) (rs = 0.69, P = 0.00). The observed rise in rates of abortion, live birth and child sexual abuse among early adolescents along with strong ecological correlations of their pregnancy rate with juvenile victimization and delinquency indicators suggests that epidemiological investigation and public health programs at the individual and community levels are needed to address the complex social roots of these trends and to produce effective improvements in early adolescent reproductive health. © 2013 The Authors. Journal of Obstetrics and Gynaecology Research © 2013 Japan Society of Obstetrics and Gynecology.

Maternal depression and physical health problems in early pregnancy: findings of an Australian nulliparous pregnancy cohort study.

PubMed

Perlen, Susan; Woolhouse, Hannah; Gartland, Deirdre; Brown, Stephanie J

2013-03-01

to investigate the relationship between physical health problems and depressive symptoms in early pregnancy. baseline questionnaire, prospective pregnancy cohort study. six metropolitan public maternity hospitals in Victoria, Australia. 1507 nulliparous women recruited in early pregnancy. nine per cent of women (131/1500) scored ≥ 13 on the EPDS indicating probable clinical depression in early pregnancy (mean gestation=15 weeks). The five most commonly reported physical health problems were as follows: exhaustion (86.9%), morning sickness (64.3%), back pain (45.6%), constipation (43.5%) and severe headaches or migraines (29.5%). Women scoring ≥ 13 on the EPDS reported a mean of six physical health problems compared with a mean of 3.5 among women scoring <13 on the EPDS. Women reporting five or more physical health problems had a three-fold increase in likelihood of reporting depressive symptoms (Adj OR=3.13, 95% CI 2.14-4.58) after adjusting for socio-demographic factors, including maternal age. the findings from this large multi-centre study show that women experiencing a greater number of physical health problems are at increased risk of reporting depressive symptoms in early pregnancy. early detection and support for women experiencing physical and psychological health problems in pregnancy is an important aspect of antenatal care. The extent of co-morbid physical and psychological health problems underlines the need for comprehensive primary health care as an integral component of antenatal care. Copyright © 2012 Elsevier Ltd. All rights reserved.

Risk and protective factors in early child development: Results from the All Our Babies (AOB) pregnancy cohort.

PubMed

McDonald, Sheila; Kehler, Heather; Bayrampour, Hamideh; Fraser-Lee, Nonie; Tough, Suzanne

2016-11-01

Understanding factors that protect against early developmental delay among children who are experiencing adversity can inform prevention and early intervention strategies. To identify risk factors for development delay at one year and protective factors for developmental delay in 'at risk' environments (poor maternal mental health and socio-demographic risk). Data was analyzed from 3360 mother-child dyads who participated in the All Our Babies (AOB) pregnancy cohort. Participants completed four questionnaires spanning pregnancy to one year postpartum and provided access to medical records. Risk factors for developmental delay at age one were identified using bivariate methods and multivariable modeling. Protective factors for child development in 'at risk' family environments were identified using bivariate analyses. At one year, 17% of children were developmentally delayed, defined as scoring in the monitoring zone on at least 2 of the 5 developmental domains of the Ages and Stages Questionnaire. Prenatal depression, preterm birth, low community engagement, and non-daily parent-child interaction increased the risk of delay. Protective factors for children in 'at risk' environments included relationship happiness, parenting self-efficacy, community engagement, higher social support, and daily parent-child interaction. The study results suggest that maternal and infant outcomes would be improved, even for vulnerable women, through identification and intervention to address poor mental health and through normalizing engagement with low cost, accessible community resources that can also support parent-child interaction. Copyright © 2016 Elsevier Ltd. All rights reserved.

Risk factors in pregnancy for post-traumatic stress and depression after childbirth.

PubMed

Söderquist, J; Wijma, B; Thorbert, G; Wijma, K

2009-04-01

The objective of this study was to find risk factors in pregnancy for post-traumatic stress and depression 1 month after childbirth. Furthermore, the relation between post-traumatic stress and depression was explored. A prospective longitudinal study. Pregnant women in Linköping and Kalmar, Sweden. A total of 1224 women were assessed in pregnancy, week 12-20 and 32, as well as 1 month postpartum. Post-traumatic stress and depression after delivery were assessed 1 month postpartum. Potential risk factors were assessed in early and late pregnancy. Variables measured during pregnancy were trait anxiety, depression, fear of childbirth, childbirth-related traumatic stress, stress coping capacity, social support, parity, educational level, age, gestation week, parity, educational level, civil status, previous psychological/psychiatric counselling, and previous experience of any traumatic events. Delivery mode was assessed from the medical records. Prevalence of post-traumatic stress (criteria A, B, C, D, E, and F according to DSM-IV) and depression (Beck's depression inventory). One month postpartum, 12 (1.3%) women had post-traumatic stress (met symptom criteria B, C, and D for post-traumatic stress disorder according to Diagnostic and statistical manual of mental disorders, 4th edition [DSM-IV]). The most important risk factors in pregnancy were depression in early pregnancy (OR=16.3), severe fear of childbirth (OR=6.2), and 'pre'-traumatic stress (in view of the forthcoming delivery) in late pregnancy (OR=12.5). The prevalence of depression was 5.6%. Post-traumatic stress and depression were positively related 1 month postpartum and were predicted by mainly the same factors. Risk factors for post-traumatic stress and depression after childbirth can be assessed in early pregnancy. Post-traumatic stress and depression also seem to share the same underlying vulnerability factors.

Screening and treatment for heritable thrombophilia in pregnancy failure: inconsistencies among UK early pregnancy units.

PubMed

Norrie, Gillian; Farquharson, Roy G; Greaves, Mike

2009-01-01

The significance of heritable thrombophilia in pregnancy failure is controversial. We surveyed all UK Early Pregnancy Units and 70% responded. The majority test routinely for heritable thrombophilias; 80%, 76% and 88% undertook at least one screening test in late miscarriage, recurrent miscarriage and placental abruption, respectively. The range of thrombophilias sought is inconsistent: testing for proteins C and S deficiency and F5 R506Q (factor V Leiden) is most prevalent. Detection of heritable thrombophilia frequently leads to administration of antithrombotics in subsequent pregnancies. Thus, thrombophilia testing and use of antithrombotics are widespread in the UK despite controversies regarding the role of heritable thrombophilia in the pathogenesis of pregnancy complications, and the lack of robust evidence for the efficacy of antithrombotic therapy.

Surgical management of early pregnancy failure: history, politics, and safe, cost-effective care.

PubMed

Harris, Lisa H; Dalton, Vanessa K; Johnson, Timothy R B

2007-05-01

Early pregnancy failure and induced abortion are often managed differently, even though safe uterine evacuation is the goal in both. Early pregnancy failure is commonly treated by curettage in operating room settings in anesthetized patients. Induced abortion is most commonly managed by office vacuum aspiration in awake or sedated patients. Medical evidence does not support routine operating room management of early pregnancy failure. This commentary reviews historical origins of these different care standards, explores political factors responsible for their perpetuation, and uses experience at University of Michigan to dramatize the ways in which history, politics, and biomedicine intersect to produce patient care. The University of Michigan initiated office uterine evacuations for early pregnancy failure treatment. Patients previously went to the operating room. These changes required faculty, staff, and resident education. Our efforts blurred the lines between spontaneous and induced abortion management, improved patient care and better utilized hospital resources.

Shifts in color discrimination during early pregnancy.

PubMed

Orbán, Levente L; Dastur, Farhad N

2012-05-25

The present study explores two hypotheses: a) women during early pregnancy should experience increased color discrimination ability, and b) women during early pregnancy should experience shifts in subjective preference away from images of foods that appear either unripe or spoiled. Both of these hypotheses derive from an adaptive view of pregnancy sickness that proposes the function of pregnancy sickness is to decrease the likelihood of ingestion of foods with toxins or teratogens. Changes to color discrimination could be part of a network of perceptual and physiological defenses (e.g., changes to olfaction, nausea, vomiting) that support such a function. Participants included 13 pregnant women and 18 non-pregnant women. Pregnant women scored significantly higher than non-pregnant controls on the Farnsworth-Munsell (FM) 100 Hue Test, an objective test of color discrimination, although no difference was found between groups in preferences for food images at different stages of ripeness or spoilage. These results are the first indication that changes to color discrimination may occur during early pregnancy, and is consistent with the view that pregnancy sickness may function as an adaptive defense mechanism.

Sympathetic activation during early pregnancy in humans

PubMed Central

Jarvis, Sara S; Shibata, Shigeki; Bivens, Tiffany B; Okada, Yoshiyuki; Casey, Brian M; Levine, Benjamin D; Fu, Qi

2012-01-01

Sympathetic activity has been reported to increase in normotensive pregnant women, and to be even greater in women with gestational hypertension and preeclampsia at term. Whether sympathetic overactivity develops early during pregnancy, remaining high throughout gestation, or whether it only occurs at term providing the substrate for hypertensive disorders is unknown. We tested the hypothesis that sympathetic activation occurs early during pregnancy in humans. Eleven healthy women (29 ± 3 (SD) years) without prior hypertensive pregnancies were tested during the mid-luteal phase (PRE) and early pregnancy (EARLY; 6.2 ± 1.2 weeks of gestation). Muscle sympathetic nerve activity (MSNA) and haemodynamics were measured supine, at 30 deg and 60 deg upright tilt for 5 min each. Blood samples were drawn for catecholamines, direct renin, and aldosterone. MSNA was significantly greater during EARLY than PRE (supine: 25 ± 8 vs. 14 ± 8 bursts min−1, 60 deg tilt: 49 ± 14 vs. 40 ± 10 bursts min−1; main effect, P < 0.05). Resting diastolic pressure trended lower (P = 0.09), heart rate was similar, total peripheral resistance decreased (2172 ± 364 vs. 2543 ± 352 dyne s cm−5; P < 0.05), sympathetic vascular transduction was blunted (0.10 ± 0.05 vs. 0.36 ± 0.47 units a.u.−1 min−1; P < 0.01), and both renin (supine: 27.9 ± 6.2 vs. 14.2 ± 8.7 pg ml−1, P < 0.01) and aldosterone (supine: 16.7 ± 14.1 vs. 7.7 ± 6.8 ng ml−1, P = 0.05) were higher during EARLY than PRE. These results suggest that sympathetic activation is a common characteristic of early pregnancy in humans despite reduced diastolic pressure and total peripheral resistance. These observations challenge conventional thinking about blood pressure regulation during pregnancy, showing marked sympathetic activation occurring within the first few weeks of conception, and may provide the substrate for pregnancy induced cardiovascular complications. PMID:22687610

Early Elevations of the Complement Activation Fragment C3a and Adverse Pregnancy Outcomes

PubMed Central

Lynch, Anne M.; Gibbs, Ronald S.; Murphy, James R.; Giclas, Patricia C.; Salmon, Jane E.; Holers, V. Michael

2016-01-01

OBJECTIVE To estimate whether elevations of complement C3a early in pregnancy are predictive of the subsequent development of adverse pregnancy outcomes. METHODS A plasma sample was obtained from each enrolled pregnant woman before 20 weeks of gestation. The cohort (n=1,002) was evaluated for the development of adverse pregnancy outcomes defined as hypertensive diseases of pregnancy (gestational hypertension or preeclampsia), preterm birth (before 37 weeks of gestation), premature rupture of the membranes, pregnancy loss (during the embryonic and fetal period), intrauterine growth restriction, and the composite outcome of any adverse outcome. RESULTS One or more adverse pregnancy outcomes occurred in 211 (21%) of the cohort. The mean levels (ng/mL) of C3a in early pregnancy were significantly (P=<.001) higher among women with one or more adverse outcomes (858±435) compared with women with an uncomplicated pregnancy (741±407). Adjusted for parity and prepregnancy body mass index, women with levels of C3a in the upper quartile in early pregnancy were three times more likely to have an adverse outcome later in pregnancy compared with women in the lowest quartile (95% confidence interval, 1.8–4.8; P<.001). The link between early elevated C3a levels and adverse pregnancy outcomes was driven primarily by individual significant (P<.05) associations of C3a with hypertensive diseases of pregnancy, preterm birth, and premature rupture of the membranes. CONCLUSION Elevated C3a as early as the first trimester of pregnancy is an independent predictive factor for adverse pregnancy outcomes, suggesting that complement-related inflammatory events in pregnancy contribute to the subsequent development of poor outcomes at later stages of pregnancy. PMID:21173647

[Pregnancy-specific beta-glycoprotein in the serum of women with a complicated early pregnancy].

PubMed

Radikov, N

1989-01-01

The author determined pregnancy specific beta 1-glycoprotein in 109 women with threatened early pregnancy as 32 of the women suffered from abortus imminens with several unsuccessful pregnancies in the past as well as 67 women with abortus incipiens with bleeding ex utero. The author established that 87% of women with abortus imminens and preserved pregnancies had values of beta 1-glycoprotein close to those of normal pregnancy for the respective gestational week. 93% of women with abortus incipiens preserved pregnancies till term, but the specific glycoprotein was with in normal ranges. Spontaneous abortion occurred in 7% of women with low values under the 10th percentile. The present study show that examination of pregnancy specific beta 1-glycoprotein in women with threatened early pregnancy is of prognostic significance for the outcome of pregnancy.

Current approaches for assessment and treatment of women with early miscarriage or ectopic pregnancy in Nigeria: a case for dedicated early pregnancy services.

PubMed

Iyoke, C A; Ugwu, O G; Ezugwu, F O; Onah, H E; Agbata, A T; Ajah, L C

2014-01-01

It has been suggested that women with early miscarriage or ectopic pregnancy are best cared for in dedicated units which offer rapid and definitive ultrasonographic and biochemical assessment at the initial review of the patient. To describe the current protocols for the assessment and treatment of women with early miscarriage or ectopic pregnancy as reported by Nigerian Gynecologists, and determine if dedicated early pregnancy services such as Early Pregnancy Assessment Units could be introduced to improve care. A cross-sectional survey of Nigerian Gynecologists attending the 46 th Annual Scientific Conference of the Society of Gynaecology and Obstetrics of Nigeria. This was a questionnaire-based study. Data analysis was by descriptive statistics using Statistical Package for the Social Sciences software, version 17.0 for Windows (IBM Corporation, Armonk, NY, USA). A total of 232 gynecologists working in 52 different secondary and tertiary health facilities participated in the survey. The mean age of the respondents was 42.6 ± 9.1 years (range 28-70 years). The proportion of gynecologists reporting that women with early miscarriage or ectopic pregnancy were first managed within the hospital general emergency room was 92%. The mean reported interval between arrival in hospital and first ultrasound scan was 4.9 ± 1.4 hours (range ½-8 hours). Transvaginal scan was stated as the routine initial imaging investigation by only 17.2% of respondents. Approximately 94.8% of respondents felt that dedicated early pregnancy services were feasible and should be introduced to improve the care of women with early miscarriage and ectopic pregnancy. Reported protocols for managing early miscarriage or ectopic pregnancy in many health facilities in Nigeria appear to engender unnecessary delays and avoidable costs, and dedicated early pregnancy services could be both useful and feasible in addressing these shortcomings in the way women with such conditions are currently managed.

Educational differences in continuing or restarting drinking in early and late pregnancy: role of psychological and physical problems.

PubMed

Pfinder, Manuela; Kunst, Anton E; Feldmann, Reinhold; van Eijsden, Manon; Vrijkotte, Tanja G M

2014-01-01

Many women continue drinking alcohol during pregnancy. This study aimed to describe educational differences in continued drinking in early and late pregnancy and to examine the contribution of psychological and physical factors to the explanation of educational differences. We examined 4,885 women enrolled in the Amsterdam Born Children and their Development study. Information on alcohol intake during pregnancy was based on self-reports at the 16th week of gestation and at 3 months postpartum. Only women who reported alcohol intake before pregnancy were included. Explanatory factors were alcohol intake before pregnancy, psychological problems, and physical problems. The risk of continued drinking in early pregnancy was increased in higher educated women (odds ratio [OR] = 1.41, 95% CI [1.25, 1.60]); in addition, in late pregnancy, higher educated women had an increased risk of restarting (OR = 1.67, 95% CI [1.37, 2.04]) and continuing drinking (OR = 1.77, 95% CI [1.36, 2.30]). The intensity of alcohol intake before pregnancy and all physical and psychological problems together explained 17.1% and 8.8% of the educational differences in continued drinking in early pregnancy, respectively. Higher educated women are more likely to continue drinking during pregnancy. The intensity of alcohol intake before pregnancy and physical and psychological problems contributed to the explanation of continued drinking. However, other factors may play a greater role, such as cultural factors and social norms.

Nutritional factors associated with antenatal depressive symptoms in the early stage of pregnancy among urban South Indian women.

PubMed

Lukose, Ammu; Ramthal, Asha; Thomas, Tinku; Bosch, Ronald; Kurpad, Anura V; Duggan, Christopher; Srinivasan, Krishnamachari

2014-01-01

Many women of reproductive age from developing countries have poor nutritional status, and the prevalence of depression during pregnancy is high. The objective of the present study was to assess the prevalence of antenatal depressive symptoms in early pregnancy, and to identify the demographic and nutritional factors associated with these symptoms in a sample of urban South Indian pregnant women. This cross-sectional study was the baseline assessment of a prospective randomized controlled trial of vitamin B12 supplementation in urban pregnant south Indian women between the ages of 18 and 40 years ( www.clinicaltrials.gov : NCT00641862). 365 women in their first trimester of pregnancy were screened for depressive symptoms at an urban clinic in Karnataka, South India, using the Kessler Psychological Distress Scale (K-10). Nutritional, clinical and biochemical factors were also assessed. Mean (SD) age of the cohort was 22.6 (3.7) years and mean (SD) BMI was 20.4 (3.3) kg/m(2). 121 (33 %) of the women in the 1st trimester had symptoms consistent with depression (K-10 score >6). In multivariate log binomial regression analysis, presence of antenatal depressive symptoms in the first trimester were positively associated with vomiting, prevalence ratio (PR) = 1.54 (95 % CI 1.10, 2.16) and negatively with anemia, PR = 0.67 (95 % CI 0.47, 0.96). Nutrient intakes, serum vitamin B12, methylmalonic acid, homocysteine and red cell folate levels were not associated with measures of depression. Antenatal depressive symptoms in early pregnancy are highly prevalent in urban Indian women and are more common in women with vomiting and without anemia. In this cross-sectional data, blood concentrations of vitamin B12 and folate were not associated with depressive symptoms. The relationship between nutritional status and depressive symptoms may require larger and longitudinal studies.

Early pregnancy factor (EPF) as a marker for detecting subclinical embryonic loss in clomiphene citrate-treated women.

PubMed

Shahani, S K; Moniz, C L; Gokral, J S; Meherji, P K

1995-05-01

A discrepancy exists between the apparently normal ovulation and the pregnancy rates in women treated with clomiphene citrate (CC). Our previous studies have indicated that immuno-suppressive "early pregnancy factor" (EPF) is a novel marker to detect subclinical embryonic loss in infertile women. In the present study EPF was used as a marker to detect subclinical embryonic loss in women treated with CC with/without gonadotropins. In some of the women treated with CC, conception was assisted by artificial insemination with husband's semen (AIH). Our results have indicated that fertilization occurred (EPF + ve) in 47.7% (52/109) of women treated with CC with/without gonadotropins; 13.46% (7/52) retained the fetus and continued pregnancy till full term, whereas 78.9% (41/52) did not retain the fetuses. In the group where after stimulation, conception was assisted by AIH, fertilization was observed in 38.24% (26/68), retention in 11.54% (3/26) but subclinical embryonic loss was observed in 80.8% (21/26) cases. Thus, our results have indicated that subclinical embryonic loss may account for some of the discrepancy observed between the apparently normal ovulation and the pregnancy rates in women treated with clomiphene citrate.

Effect of early pregnancy on the expression of progesterone receptor and progesterone-induced blocking factor in ovine lymph node.

PubMed

Yang, Ling; Zang, Shengqin; Bai, Ying; Yao, Xiaolei; Zhang, Leying

2017-04-15

Lymph nodes are the sites where the immune reaction or suppression takes place. Progesterone (P4) exerts an essential effect of the immunomodulation on the maternal uterus during early pregnancy in ruminants. At present study, the inguinal lymph nodes were obtained at day 16 of non-pregnancy, days 13, 16 and 25 of pregnancy (n = 3 for each group) in ewes, and RT-PCR assay, western blot and immunohistochemistry analysis were used to analyze to the effect of early pregnancy on the expression of P4 receptor (PGR) and progesterone-induced blocking factor (PIBF) in the lymph nodes. Our results showed that the PGR and PIBF mRNA were up-regulated in the lymph nodes in pregnant ewes, and the PGR isoform (60 kDa) and the PIBF variant (75 kDa) were expressed constantly in the lymph nodes. However, there was no expression of the PGR isoform (40 kDa) and the PIBF variant (48 kDa) at day 16 of the estrous cycle. The immunohistochemistry results confirmed that the PGR and PIBF proteins were limited to the subcapsular sinus and trabeculae in the cortex, medullary sinuses, and were localized in the cytoplasm of the specific cells. This paper reports for the first time that early pregnancy exerts its effect on the specific cells in the lymph nodes through P4, which results in the up-regulated expression of the PGR mRNA and 40 kDa isoform, the PIBF mRNA and 48 kDa variant, and is involved in the immunoregulation of the lymph nodes through a cytosolic pathway in ewes. Copyright © 2017 Elsevier Inc. All rights reserved.

Early Pregnancy Diabetes Screening and Diagnosis: Prevalence, Rates of Abnormal Test Results, and Associated Factors.

PubMed

Mission, John F; Catov, Janet; Deihl, Tiffany E; Feghali, Maisa; Scifres, Christina

2017-11-01

To evaluate the prevalence of early diabetes screening in pregnancy, rates of abnormal diabetes test results before 24 weeks of gestation, and factors associated with early diabetes screening. This was a retrospective cohort study of all singleton deliveries from 2012 to 2014 among diverse clinical practices at a large academic medical center. We assessed rates of early (less than 24 weeks of gestation) and routine (at or beyond 24 weeks of gestation) diabetes screening, with abnormal test results defined using the Carpenter-Coustan criteria, a 50-g glucose challenge test result greater than 200 mg/dL, or a hemoglobin A1C level greater than 6.5%. Univariate and multivariate analyses were used to evaluate clinical and demographic determinants of screening and diagnosis. Overall, 1,420 of 11,331 (12.5%) women underwent early screening. Increasing body mass index (BMI) category, race, public insurance, history of gestational diabetes mellitus, a family history of diabetes, and chronic hypertension were associated with early screening. Early screening rates rose with increasing BMI category, but only 268 of 551 (48.6%) of women with class III obesity underwent early screening. Among those screened early, 2.0% of normal-weight women, 4.0% of overweight women, 4.2% of class I obese women, 3.8% of class II obese women, and 9.0% of class III obese women had abnormal early test results (P<.001). Early diabetes screening is used inconsistently, and many women with risk factors do not undergo early screening. A significant proportion of women with class III obesity will test positive for gestational diabetes mellitus before 24 weeks of gestation, and studies are urgently needed to assess the effect of early diabetes screening and diagnosis on perinatal outcomes in high-risk women.

Signs and Symptoms of Early Pregnancy Loss

PubMed Central

Sapra, Katherine J.; Joseph, K.S.; Galea, Sandro; Bates, Lisa M.; Louis, Germaine M. Buck; Ananth, Cande V.

2016-01-01

Approximately one-third of pregnancies end in loss; however, the natural history of early pregnancy loss, including signs and symptoms preceding loss, has yet to be fully described and its underlying mechanisms fully understood. We searched PubMed/MEDLINE and Embase to identify articles with prospective ascertainment of signs and symptoms, including vaginal bleeding, nausea, and vomiting, of pregnancy loss < 20 weeks gestation in spontaneous conceptions to ascertain existing literature on symptomatology of pregnancy loss. Two preconception and 16 pregnancy cohort studies that ascertained information on bleeding and/or nausea/vomiting prior to pregnancy loss ascertainment were included. Data from these studies indicated increased risk of loss with vaginal bleeding and decreased risk of loss with nausea/vomiting, though these studies were mostly comprised of pregnancies surviving into late first trimester. While such associations are biologically plausible, these study designs are subject to bias, given recruitment of women at later gestational ages and reliance on women presenting to care. Reporting symptoms to clinicians and over long periods may introduce reporting error. Data gaps remain regarding (1) relationships between signs and symptoms and losses occurring very early, prior to care entry; (2) empirical testing of whether relationships between signs and symptoms and loss differ across gestational age; (3) whether similar relationships between signs and symptoms and loss are observed in populations using assisted reproductive technologies; (4) the patterning of multiple signs and symptoms in relation to loss; and (5) how hormonal and physiologic adaptions to early pregnancy relate to symptomatology and pregnancy loss. PMID:27342274

Signs and Symptoms of Early Pregnancy Loss.

PubMed

Sapra, Katherine J; Joseph, K S; Galea, Sandro; Bates, Lisa M; Louis, Germaine M Buck; Ananth, Cande V

2017-04-01

Approximately one-third of pregnancies end in loss; however, the natural history of early pregnancy loss, including signs and symptoms preceding loss, has yet to be fully described and its underlying mechanisms fully understood. We searched PubMed/MEDLINE and Embase to identify articles with prospective ascertainment of signs and symptoms, including vaginal bleeding, nausea, and vomiting, of pregnancy loss < 20 weeks gestation in spontaneous conceptions to ascertain existing literature on symptomatology of pregnancy loss. Two preconception and 16 pregnancy cohort studies that ascertained information on bleeding and/or nausea/vomiting prior to pregnancy loss ascertainment were included. Data from these studies indicated increased risk of loss with vaginal bleeding and decreased risk of loss with nausea/vomiting, though these studies were mostly comprised of pregnancies surviving into late first trimester. While such associations are biologically plausible, these study designs are subject to bias, given recruitment of women at later gestational ages and reliance on women presenting to care. Reporting symptoms to clinicians and over long periods may introduce reporting error. Data gaps remain regarding (1) relationships between signs and symptoms and losses occurring very early, prior to care entry; (2) empirical testing of whether relationships between signs and symptoms and loss differ across gestational age; (3) whether similar relationships between signs and symptoms and loss are observed in populations using assisted reproductive technologies; (4) the patterning of multiple signs and symptoms in relation to loss; and (5) how hormonal and physiologic adaptions to early pregnancy relate to symptomatology and pregnancy loss.

Nutrient-gene interactions in early pregnancy: a vascular hypothesis.

PubMed

Steegers-Theunissen, R P M; Steegers, E A P

2003-02-10

It is hypothesized that the following periconceptional and early pregnancy nutrient-gene interactions link vascular-related reproductive complications and cardiovascular diseases in adulthood: (1) Maternal and paternal genetically controlled nutrient status affects the quality of gametes and fertilization capacity; (2) The embryonic genetic constitution, derived from both parents, and the maternal genetically controlled nutrient environment determine embryogenesis and fetal growth; (3) Trophoblast invasion of decidua and spiral arteries is driven by genes derived from both parents as well as by maternal nutritional factors; (4) Angiogenesis, vasculogenesis and vascular function are dependent on the genetic constitution of the embryo, derived from both parents, and the maternal genetically controlled nutritional environment.Early intra-uterine programming of vessels may concern the same (in)dependent determinants of vascular-related complications during pregnancy and cardiovascular diseases in later life.

Human Hsp10 and Early Pregnancy Factor (EPF) and their relationship and involvement in cancer and immunity: current knowledge and perspectives.

PubMed

Corrao, Simona; Campanella, Claudia; Anzalone, Rita; Farina, Felicia; Zummo, Giovanni; Conway de Macario, Everly; Macario, Alberto J L; Cappello, Francesco; La Rocca, Giampiero

2010-01-30

This article is about Hsp10 and its intracellular and extracellular forms focusing on the relationship of the latter with Early Pregnancy Factor and on their roles in cancer and immunity. Cellular physiology and survival are finely regulated and depend on the correct functioning of the entire set of proteins. Misfolded or unfolded proteins can cause deleterious effects and even cell death. The chaperonins Hsp10 and Hsp60 act together inside the mitochondria to assist protein folding. Recent studies demonstrated that these proteins have other roles inside and outside the cell, either together or independently of each other. For example, Hsp10 was found increased in the cytosol of different tumors (although in other tumors it was found decreased). Moreover, Hsp10 localizes extracellularly during pregnancy and is often indicated as Early Pregnancy Factor (EPF), which is released during the first stages of gestation and is involved in the establishment of pregnancy. Various reports show that extracellular Hsp10 and EPF modulate certain aspects of the immune response with anti-inflammatory effects in patients with autoimmune conditions improving clinically after treatment with recombinant Hsp10. Moreover, Hsp10 and EPF are involved in embryonic development, acting as a growth factor, and in cell proliferation/differentiation mechanisms. Therefore, it becomes evident that Hsp10 is not only a co-chaperonin, but an active player in its own right in various cellular functions. In this article, we present an overview of various aspects of Hsp10 and EPF as they participate in physiological and pathological processes such as the antitumor response and autoimmune diseases. Copyright 2009 Elsevier Inc. All rights reserved.

Isolation and purification of an early pregnancy factor-like molecule from culture supernatants obtained from lymphocytes of pregnant women.

PubMed

Aranha, C; Natraj, U; Iyer, K S; Shahani, S

1998-03-01

Our purpose was to determine whether lymphocytes synthesize proteins during pregnancy, to observe whether one of the proteins synthesized has early pregnancy factor (EPF)-like activity and to isolate and purify this molecule from culture supernatants obtained from stimulated lymphocytes of pregnant women. Lymphocyte proliferation assay and 35S-methionine labeling were done to study de novo synthesis of proteins followed by autoradiography to confirm synthesis of proteins. The rosette inhibition assay was used for detection of the EPF-like molecule. Gel filtration on Sephadex G-100 and RPHPLC were used for purification of the EPF-like molecule. The rate of incorporation of 35S-methionine was significantly higher in the lymphocytes of pregnant women compared to those of the control, and autoradiography confirmed the synthesis of proteins during pregnancy. There is a total protein enhancement trend observed during the first trimester that declines toward term. The EPF-like molecule is observed to be synthesized during all the trimesters of pregnancy. This molecule, when purified, showed a single homogeneous biologically active peak. The results indicated that there is an enhancement of existing protein or synthesis of new proteins during pregnancy. The EPF-like molecule is one of the many proteins synthesized and secreted by lymphocytes during pregnancy that, when purified, is biologically active.

Metabolic Profile in Early Pregnancy Is Associated with Offspring Adiposity at 4 Years of Age: The Rhea Pregnancy Cohort Crete, Greece

PubMed Central

Daraki, Vasiliki; Georgiou, Vaggelis; Papavasiliou, Stathis; Chalkiadaki, Georgia; Karahaliou, Marianna; Koinaki, Stella; Sarri, Katerina; Vassilaki, Maria; Kogevinas, Manolis; Chatzi, Leda

2015-01-01

Context Maternal pre-pregnancy obesity may increase the risk of childhood obesity but it is unknown whether other metabolic factors in early pregnancy such as lipid profile and hypertension are associated with offspring cardiometabolic traits. Objective Our objective was to investigate whether fasting lipid, glucose, and insulin levels during early pregnancy and maternal pre-pregnancy weight status, are associated with offspring adiposity measures, lipid levels and blood pressure at preschool age. Design and Methods The study included 618 mother-child pairs of the pregnancy cohort “Rhea” study in Crete, Greece. Pregnant women were recruited at the first prenatal visit (mean: 12weeks, SD: 0.7). A subset of 348 women provided fasting serum samples for glucose and lipid measurements. Outcomes measures were body mass index, abdominal circumference, sum of skinfold thickness, and blood pressure measurements at 4 years of age. A subsample of 525 children provided non-fasting blood samples for lipid measurements. Results Pre-pregnancy overweight/obesity was associated with greater risk of offspring overweight/obesity (RR: 1.83, 95%CI: 1.19, 2.81), central adiposity (RR: 1.97, 95%CI: 1.11, 3.49), and greater fat mass by 5.10mm (95%CI: 2.49, 7.71) at 4 years of age. These associations were more pronounced in girls. An increase of 40mg/dl in fasting serum cholesterol levels in early pregnancy was associated with greater skinfold thickness by 3.30mm (95%CI: 1.41, 5.20) at 4 years of age after adjusting for pre-pregnancy BMI and several other confounders. An increase of 10mmHg in diastolic blood pressure in early pregnancy was associated with increased risk of offspring overweight/obesity (RR: 1.22, 95%CI: 1.03, 1.45), and greater skinfold thickness by 1.71mm (95% CI: 0.57, 2.86) at 4 years of age. Conclusions Metabolic dysregulation in early pregnancy may increase the risk of obesity at preschool age. PMID:25970502

Changes in beverage consumption from pre-pregnancy to early pregnancy in the Norwegian Fit for Delivery study.

PubMed

Skreden, Marianne; Bere, Elling; Sagedal, Linda R; Vistad, Ingvild; Øverby, Nina C

2015-05-01

To describe changes in consumption of different types of beverages from pre-pregnancy to early pregnancy, and to examine associations with maternal age, educational level and BMI. Cross-sectional design. Participants answered an FFQ at inclusion into a randomized controlled trial, the Fit for Delivery (FFD) trial, in median gestational week 15 (range: 9-20), reporting current consumption and in retrospect how often they drank the different beverages pre-pregnancy. Eight local antenatal clinics in southern Norway from September 2009 to February 2013. Five hundred and seventy-five healthy pregnant nulliparous women. Pre-pregnancy, 27 % reported drinking alcohol at least once weekly, compared with none in early pregnancy (P<0.001). The percentage of women drinking coffee (38 % v. 10 %, P<0.001), sugar-sweetened beverages (10 % v. 6 %, P=0.011) and artificially sweetened beverages (12 % v. 9 %, P=0.001) at least daily decreased significantly from pre-pregnancy to early pregnancy, while the percentage of women who reported to drink water (85 % v. 92 %, P<0.001), fruit juice (14 % v. 20 %, P=0.001) and milk (37 % v. 42 %, P=0.001) at least daily increased significantly. From pre-pregnancy to early pregnancy higher educated women reduced their consumption frequency of coffee significantly more than women with lower education. Older women reduced their consumption frequency of coffee and artificially sweetened beverages and increased their consumption frequency of fruit juice and milk significantly more than younger women. There is a significant change in beverage consumption from pre-pregnancy to early pregnancy among Norwegian nulliparous women.

Prevalence and correlates of drinking in early pregnancy among women who stopped drinking on pregnancy recognition.

PubMed

Parackal, S M; Parackal, M K; Harraway, J A

2013-04-01

Women of child bearing age that regularly drink alcohol are at risk for drinking in early pregnancy. Evidence indicates a majority of women stop alcohol consumption on pregnancy recognition. However, there is a dearth of studies reporting on patterns and correlates of drinking in early pregnancy prior to stopping on pregnancy recognition, which the current study aims to address. In 2005, a New Zealand nationwide cross-sectional survey was conducted on a random sample of 1,256 women aged 16-40 years. Data were collected via an interviewer-administered questionnaire using a web-assisted telephone interviewing system. Of the 1,256 women who participated, 127 (10 %) were currently pregnant and 425 women (34 %) were previously pregnant. Half of currently pregnant women and 37 % of previously pregnant women reported that they ceased drinking on recognising pregnancy. Women categorised as "risky drinkers" and those aged 16-24 years had higher odds to drink and binge drink in early pregnancy, compared with non-risky drinkers and women of other age categories respectively. A majority of women stop alcohol consumption on pregnancy recognition but prior to this, drink at levels posing a risk for the developing foetus. Women most at risk for drinking and binge drinking in early pregnancy were younger in age and exhibited risky drinking behaviour prior to pregnancy. A targeted intervention to reduce the risk for an alcohol exposed pregnancy is warranted for sexually active younger women in New Zealand and elsewhere.

Maternal lipid profile during early pregnancy and pregnancy complications and outcomes: the ABCD study.

PubMed

Vrijkotte, Tanja G M; Krukziener, Náthalie; Hutten, Barbara A; Vollebregt, Karlijn C; van Eijsden, Manon; Twickler, Marcel B

2012-11-01

Elevated lipid levels during late pregnancy are associated with complications and adverse outcome for both mother and newborn. However, it is inconclusive whether a disturbed lipid profile during early pregnancy has similar negative associations. Our objective was to investigate whether nonfasting maternal total cholesterol and triglyceride levels during early pregnancy are associated with six major adverse pregnancy outcomes. Data were derived from the Amsterdam Born Children and Their Development (ABCD) cohort study. Random blood samples of nonfasting total cholesterol and triglyceride levels were determined during early gestation (median = 13, interquartile range = 12-14 wk). Outcome measures were pregnancy-induced hypertension (PIH), preeclampsia, preterm birth, small/large for gestational age (SGA/LGA), and child loss. Only nondiabetic women with singleton deliveries were included; the baseline sample consisted of 4008 women. Analysis for PIH and preeclampsia were performed in nulliparous women only (n = 2037). Mean (sd) triglyceride and total cholesterol levels were 1.33 (0.55) and 4.98 (0.87) mmol/liter, respectively. The incidence of pregnancy complications and perinatal outcomes were as follows: PIH, 4.9%; preeclampsia, 3.7%; preterm birth, 5.3%; SGA, 9.3%; LGA, 9.3%; and child loss, 1.4%. After adjustments, every unit increase in triglycerides was linearly associated with an increased risk of PIH [odds ratio (OR) = 1.60, P = 0.021], preeclampsia (OR = 1.69, P = 0.018), LGA (OR = 1.48, P < 0.001), and induced preterm delivery (OR = 1.69, P = 0.006). No associations were found for SGA or child loss. Total cholesterol was not associated with any of the outcome measures. Elevated maternal triglyceride levels measured during early pregnancy are associated with pregnancy complications and adverse pregnancy outcomes. These results suggest that future lifestyle programs in women of reproductive age with a focus on lowering triglyceride levels (i.e. diet, weight

Early menarche and teenager pregnancy as risk factors for morbid obesity among reproductive-age women: A case-control study.

PubMed

Neves, Amanda Gonçalves; Kasawara, Karina Tamy; Godoy-Miranda, Ana Carolina; Oshika, Flávio Hideki; Chaim, Elinton Adami; Surita, Fernanda Garanhani

2017-10-01

The aim of this study was to evaluate potential risk factors, including non-communicable diseases, for morbid obesity in women between 20 and 49 years of age. We performed a case-control study with 110 morbidly obese women and 110 women with adequate weight who were matched by age and with a 1:1 case to control ratio. All women were between 20 to 49 years old and non-menopausal. Possible risk factors were evaluated through a self-report questionnaire assessing socio-demographic, obstetric and gynecological characteristics, presence of non-communicable diseases and habits. Multiple logistic regression was used to estimate the odds ratio with respective confidence intervals. Menarche under 12 years old, teenage pregnancy and lower educational level were shown to be risk factors for morbid obesity among women of reproductive age. Incidences of non-communicable diseases (diabetes, hypertension, dyslipidemia, liver disease, lung disease, thyroid dysfunction, and joint pain) were increased in women with morbid obesity. Early menarche, teenage pregnancy and low education level are risk factors for the occurrence of morbid obesity in women of reproductive age. Some non-communicable diseases were already more prevalent in women with morbid obesity even before 50 years of age.

[A case-control study of factors associated with repeat teen pregnancy based on a sample from a university maternity hospital].

PubMed

Silva, Andréa de Albuquerque Arruda; Coutinho, Isabela C; Katz, Leila; Souza, Alex Sandro Rolland

2013-03-01

Repeat teen pregnancy is a frequent issue and is considered an aggravating factor for increased maternal and fetal morbidity and social problems. The aim of the study was to identify factors associated with repeat teen pregnancy. A case-control study was conducted in 90 postpartum adolescents with more than one pregnancy (cases) and 90 adult women with a history of only one pregnancy during adolescence (controls). Statistical analysis used hierarchical logistic regression with 5% significance. Early sexual initiation (< 15 years), early age at first pregnancy (< 16 years), not raising the children themselves, and low family income (< one minimum wage) were associated with repeat teenage pregnancy, while partner change was inversely associated. Repeat teen pregnancy was mainly associated with reproductive and socioeconomic factors. Partner change appeared as a protective factor. Measures should be adopted during the postpartum period of teenage mothers in order to avoid repeat pregnancy.

Factors associated with pregnancy-associated glycoprotein (PAG) levels in plasma and milk of Holstein cows during early pregnancy and their effect on the accuracy of pregnancy diagnosis.

PubMed

Ricci, A; Carvalho, P D; Amundson, M C; Fourdraine, R H; Vincenti, L; Fricke, P M

2015-04-01

Lactating Holstein cows (n = 141) were synchronized to receive their first timed artificial insemination (TAI). Blood and milk samples were collected 25 and 32 d after TAI, and pregnancy status was determined 32 d after TAI using transrectal ultrasonography. Cows diagnosed pregnant with singletons (n = 48) continued the experiment in which blood and milk samples were collected and pregnancy status was assessed weekly using transrectal ultrasonography from 39 to 102 d after TAI. Plasma and milk samples were assayed for pregnancy-associated glycoprotein (PAG) levels using commercial ELISA kits. Compared to ultrasonography, accuracy was 92% for the plasma PAG ELISA test and 89% for the milk PAG ELISA test 32 d after TAI. Plasma and milk PAG levels for pregnant cows increased from 25 d to an early peak 32 d after TAI. Plasma and milk PAG levels then decreased from 32 d after TAI to a nadir from 53 to 60 d after TAI for the plasma PAG assay and from 46 to 67 d after TAI for the milk PAG assay followed by an increase from 74 to 102 d after TAI. Overall, plasma PAG levels were approximately 2-fold greater compared with milk PAG levels, and primiparous cows had greater PAG levels in plasma and milk compared with multiparous cows. The incidence of pregnancy loss from 32 to 102 d after TAI based on ultrasonography was 13% for cows diagnosed with singleton pregnancies, and plasma and milk PAG levels decreased to nonpregnant levels within 7 to 14 d after pregnancy loss. Both plasma and milk PAG levels were negatively correlated with milk production for both primiparous and multiparous cows. We conclude that stage of gestation, parity, pregnancy loss, and milk production were associated with plasma and milk PAG levels after TAI similarly. Based on plasma and milk PAG profiles, the optimal time to conduct a first pregnancy diagnosis is around 32 d after AI, coinciding with an early peak in PAG levels. Because of the occurrence of pregnancy loss, all pregnant cows should be

Successful treatment algorithm for evaluation of early pregnancy after in vitro fertilization.

PubMed

Cookingham, Lisa Marii; Goossen, Rachel P; Sparks, Amy E T; Van Voorhis, Bradley J; Duran, Eyup Hakan

2015-10-01

To evaluate a prospectively implemented clinical algorithm for early identification of ectopic pregnancy (EP) and heterotopic pregnancy (HP) after assisted reproductive technology (ART). Analysis of prospectively collected data. Academic medical center. All ART-conceived pregnancies between January 1995 and June 2013. Early pregnancy monitoring via clinical algorithm with all pregnancies screened using human chorionic gonadotropin (hCG) levels and reported symptoms, with subsequent early ultrasound evaluation if hCG levels were abnormal or if the patient reported pain or vaginal bleeding. Algorithmic efficiency for diagnosis of EP and HP and their subsequent clinical outcomes using a binary forward stepwise logistic regression model built to determine predictors of early pregnancy failure. Of the 3,904 pregnancies included, the incidence of EP and HP was 0.77% and 0.46%, respectively. The algorithm selected 96.7% and 83.3% of pregnancies diagnosed with EP and HP, respectively, for early ultrasound evaluation, leading to earlier treatment and resolution. Logistic regression revealed that first hCG, second hCG, hCG slope, age, pain, and vaginal bleeding were all independent predictors of early pregnancy failure after ART. Our clinical algorithm for early pregnancy evaluation after ART is effective for identification and prompt intervention of EP and HP without significant over- or misdiagnosis, and avoids the potential catastrophic morbidity associated with delayed diagnosis. Copyright © 2015 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Does tea consumption during early pregnancy have an adverse effect on birth outcomes?

PubMed

Lu, Jin-Hua; He, Jian-Rong; Shen, Song-Ying; Wei, Xue-Ling; Chen, Nian-Nian; Yuan, Ming-Yang; Qiu, Lan; Li, Wei-Dong; Chen, Qiao-Zhu; Hu, Cui-Yue; Xia, Hui-Min; Bartington, Suzanne; Cheng, Kar Keung; Lam, Kin Bong Hubert; Qiu, Xiu

2017-09-01

Tea, a common beverage, has been suggested to exhibit a number of health benefits. However, one of its active ingredients, caffeine, has been associated with preterm birth and low birthweight. We investigated whether tea consumption during early pregnancy is associated with an increased risk of preterm birth and abnormal fetal growth. A total of 8775 pregnant women were included from the Born in Guangzhou Cohort Study. Tea consumption (type, frequency, and strength) during their first trimester and social and demographic factors were obtained by way of questionnaires administered during pregnancy. Information on birth outcomes and complications during pregnancy was obtained from hospital medical records. Overall habitual tea drinking (≥1 serving/week) prevalence among pregnant women was low, at 16%. After adjustment for potential confounding factors (eg, maternal age, educational level, monthly income) tea drinking during early pregnancy was not associated with an increased risk of preterm birth or abnormal fetal growth (small or large for gestational age) (P>.05). We did not identify a consistent association between frequency of tea consumption or tea strength and adverse birth outcomes among Chinese pregnant women with low tea consumption. Our findings suggest that occasional tea drinking during pregnancy is not associated with increased risk of preterm birth or abnormal fetal growth. Given the high overall number of annual births in China, our findings have important public health significance. © 2017 Wiley Periodicals, Inc.

Alternative complement pathway activation fragment Bb in early pregnancy as a predictor of preeclampsia

PubMed Central

Lynch, Anne M.; Murphy, James R.; Byers, Tim; Gibbs, Ronald S.; Neville, Margaret C.; Giclas, Patricia C.; Salmon, Jane E.; Holers, V. Michael

2008-01-01

OBJECTIVE Preeclampsia is a multisystem disease classically defined on the basis of hypertension and proteinuria. As shown in animal studies, complement activation is associated with inflammation in the placenta and adverse pregnancy outcomes. The association between complement activation in humans and adverse pregnancy outcomes is unclear. The purpose of this study was to determine whether elevated levels of the activation fragment Bb in early pregnancy are predictive of preeclampsia. STUDY DESIGN This prospective study of 701 women was conducted in Denver, CO. A single plasma sample was obtained from each woman before 20 weeks’ gestation. The cohort was followed up throughout pregnancy for the development of preeclampsia. Analysis included multivariate logistic regression to adjust for established risk factors for preeclampsia. RESULTS Preeclampsia developed in 4.6% of the cohort. Women with elevated Bb (90th or greater percentile) were substantially more likely to develop preeclampsia than women who had levels less than the 90th percentile (unadjusted relative risk [RR], 3.3, 95% confidence interval [CI] 1.6 to 7, P = .0009). Other significant risk factors for preeclampsia included nulliparity (RR, 2.1, 95% CI, 1–4), a high body mass index (P = .006 for trend), and maternal medical (preexisting maternal hypertension, type 1 diabetes, systemic lupus erythematosus) disease (RR, 4.4, 95% CI, 2–10). Significant risk factors among multiparous women included a history of hypertension in a previous pregnancy (RR, 5, 95% CI, 1.6 to 16) and a change of paternity (RR, 5.1, 95% CI, 1.6 to 15). Adjustment for risk factors did not attenuate the association between an elevated Bb and preeclampsia (adjusted odds ratio [OR], 3.8, 95% CI, 1.6 to 9, P = .002) in the cohort. After removing women with plasma obtained before 10 weeks, the adjusted OR of Bb in the top decile for preeclampsia was 6.1 (95% CI 2.2, 17, P = .0005). CONCLUSION The complement activation product Bb in

Factors associated with residential mobility during pregnancy.

PubMed

Amoah, Doris K; Nolan, Vikki; Relyea, George; Gurney, James G; Yu, Xinhua; Tylavsky, Frances A; Mzayek, Fawaz

2017-09-18

Our objective was to determine the factors associated with residential moving during pregnancy, as it may increase stress during pregnancy and affect birth outcomes. Data were obtained from the Conditions Affecting Neurocognitive Development and Learning in Early Childhood (CANDLE) study. Participants were recruited from December 2006 to June 2011 and included 1,448 pregnant women. The average gestational age at enrollment was 23 weeks. The primary outcome of residential mobility was defined as any change in address during pregnancy. Multivariate regression was used to assess the adjusted associations of factors with residential mobility. Out of 1,448 participants, approximately 9 percent moved between baseline (enrollment) and delivery. After adjusting for covariates, mothers with lower educational attainment [less than high school (adjusted odds ratio [aOR] = 3.74, 95% confidence interval [CI] = 1.78, 7.85) and high school/technical school (aOR = 3.57, 95% CI = 2.01, 6.32) compared to college degree or higher], and shorter length of residence in neighborhood were more likely to have moved compared to other mothers. Length of residence was protective of mobility (aOR = 0.91, 95% CI = 0.86, 0.96 per year). Increased understanding of residential mobility during pregnancy may help improve the health of mothers and their children.

Developmental predictors of inattention-hyperactivity from pregnancy to early childhood.

PubMed

Foulon, Stéphanie; Pingault, Jean-Baptiste; Larroque, Béatrice; Melchior, Maria; Falissard, Bruno; Côté, Sylvana M

2015-01-01

The objective of the study was to characterize the developmental sequence of pre- and postnatal risk factors for inattention-hyperactivity symptoms in preschoolers. Longitudinal data came from a French population based birth cohort study (EDEN; N = 1311 mother-child pairs followed from the pregnancy onwards). Inattention-hyperactivity symptoms were assessed with the Strengths and Difficulties Questionnaire when participating children were 3 years of age. Potential risk factors were classified in four domains (fetal exposures and child somatic characteristics, child temperament, child neurodevelopmental status, psychosocial environment) and four periods (before pregnancy, prenatal/birth, infancy, toddlerhood). Their role as potential moderator or mediator was tested with path analysis to determine the developmental sequence. A low family socioeconomic status before pregnancy was the main environmental risk factor for inattention-hyperactivity symptoms at 3 years, and its effect occurred via two pathways. The first was a risk pathway, where lower SES was associated with higher maternal depression and anxiety during pregnancy; then to higher maternal and child distress and dysregulation in infancy; and in turn to higher levels of inattention-hyperactivity at 3 years. The second was a protective pathway, where higher SES was associated with longer duration of breastfeeding during infancy; then to better child neurodevelopmental status in toddlerhood; and in turn to lower levels of inattention-hyperactivity at 3 years. This study identified psychosocial factors at several developmental periods that represent potential targets for preventing the emergence of inattention-hyperactivity symptoms in early childhood.

Early Pregnancy Diagnosis in Bovines: Current Status and Future Directions

PubMed Central

Gupta, Meenakshi; Singh, Surender; Mohanty, Ashok K.; Singh, Inderjeet

2013-01-01

An early and accurate diagnosis of reproductive dysfunctions or aberrations is crucial to better reproductive management in livestock. High reproductive efficiency is a prerequisite for high life-time production in dairy animals. Early pregnancy diagnosis is key to shorten the calving interval through early identification of open animals and their timely treatment and rebreeding so as to maintain a postpartum barren interval close to 60 days. A buffalo, the most important dairy animal in the Indian subcontinent, is known for problems related to high calving interval, late puberty, and high incidence of anestrus. Lack of reliable cow-side early pregnancy diagnosis methods further aggravates the situation. Several methods of pregnancy diagnosis are being practiced in bovine species, yet none qualifies as the ideal pregnancy diagnosis method due to the inherent limitations of sensitivity, accuracy, specificity, speed, and ease of performing the test. The advancement of molecular techniques like proteomics and their applications in animal research has given a new hope to look for pregnancy biomarker molecules in these animals. This review attempts to examine common pregnancy diagnosis methods available for dairy animals, while assessing the usefulness of the modern technologies in detecting novel pregnancy markers and designing future strategies for research in this area. PMID:24382949

Early pregnancy diagnosis in bovines: current status and future directions.

PubMed

Balhara, Ashok K; Gupta, Meenakshi; Singh, Surender; Mohanty, Ashok K; Singh, Inderjeet

2013-01-01

An early and accurate diagnosis of reproductive dysfunctions or aberrations is crucial to better reproductive management in livestock. High reproductive efficiency is a prerequisite for high life-time production in dairy animals. Early pregnancy diagnosis is key to shorten the calving interval through early identification of open animals and their timely treatment and rebreeding so as to maintain a postpartum barren interval close to 60 days. A buffalo, the most important dairy animal in the Indian subcontinent, is known for problems related to high calving interval, late puberty, and high incidence of anestrus. Lack of reliable cow-side early pregnancy diagnosis methods further aggravates the situation. Several methods of pregnancy diagnosis are being practiced in bovine species, yet none qualifies as the ideal pregnancy diagnosis method due to the inherent limitations of sensitivity, accuracy, specificity, speed, and ease of performing the test. The advancement of molecular techniques like proteomics and their applications in animal research has given a new hope to look for pregnancy biomarker molecules in these animals. This review attempts to examine common pregnancy diagnosis methods available for dairy animals, while assessing the usefulness of the modern technologies in detecting novel pregnancy markers and designing future strategies for research in this area.

Changes in fruit and vegetable consumption habits from pre-pregnancy to early pregnancy among Norwegian women.

PubMed

Skreden, Marianne; Bere, Elling; Sagedal, Linda R; Vistad, Ingvild; Øverby, Nina C

2017-04-04

A healthy diet is important for pregnancy outcome and the current and future health of woman and child. The aims of the study were to explore the changes from pre-pregnancy to early pregnancy in consumption of fruits and vegetables (FV), and to describe associations with maternal educational level, body mass index (BMI) and age. Healthy nulliparous women were included in the Norwegian Fit for Delivery (NFFD) trial from September 2009 to February 2013, recruited from eight antenatal clinics in southern Norway. At inclusion, in median gestational week 15 (range 9-20), 575 participants answered a food frequency questionnaire (FFQ) where they reported consumption of FV, both current intake and recollection of pre-pregnancy intake. Data were analysed using a linear mixed model. The percentage of women consuming FV daily or more frequently in the following categories increased from pre-pregnancy to early pregnancy: vegetables on sandwiches (13 vs. 17%, p <0.01), other vegetables (11 vs. 14%, p = 0.01), fruits (apples, pears, oranges or bananas) (24 vs. 41%, p < 0.01), other fruits and berries (8 vs. 15%, p < 0.01) and fruits and vegetables as snacks (14 vs. 28%, p < 0.01). The percentage of women who reported at least daily consumption of vegetables with dinner (22% at both time points) was stable. A higher proportion of older women increased their consumption of vegetables and fruits as snacks from pre-pregnancy to early pregnancy compared to younger women (p=0.04). We found an increase in the proportion of women consuming FV daily or more frequently from pre-pregnancy to early pregnancy. ClinicalTrials.gov database, NCT01001689 . https://clinicaltrials.gov/ct2/show/NCT01001689?term=NCT01001689&rank=1 .

Decidual vascular changes in early pregnancy as a marker for intrauterine pregnancy.

PubMed

Lichtig, C; Korat, A; Deutch, M; Brandes, J M

1988-09-01

Endometrial vascular changes similar to atherosclerosis of toxemia of pregnancy were described and graded in 217 consecutive endometrial biopsies of known early intrauterine pregnancy. Severe vascular changes were found in 23.5% of cases. Control material consisting of endometrial biopsies of patients with known cases of tubal ectopic pregnancy and various non-pregnancy menstrual disorders showed minimal or no changes except in one case. A parallel study of Aria-Stella phenomenon in 110 cases of uterine pregnancy showed significant changes in only 3.6% of patients. It is obvious that in these cases of positive Arias-Stella findings, the possibility of an extrauterine pregnancy could not be discarded on histologic grounds alone. The authors suggest the use of the vascular changes of the more severe histologic degree as described in this article as a positive or strongly suspicious marker for intrauterine pregnancy whenever this is needed.

Early pregnancy vitamin D status and risk of preeclampsia.

PubMed

Mirzakhani, Hooman; Litonjua, Augusto A; McElrath, Thomas F; O'Connor, George; Lee-Parritz, Aviva; Iverson, Ronald; Macones, George; Strunk, Robert C; Bacharier, Leonard B; Zeiger, Robert; Hollis, Bruce W; Handy, Diane E; Sharma, Amitabh; Laranjo, Nancy; Carey, Vincent; Qiu, Weilliang; Santolini, Marc; Liu, Shikang; Chhabra, Divya; Enquobahrie, Daniel A; Williams, Michelle A; Loscalzo, Joseph; Weiss, Scott T

2016-12-01

Low vitamin D status in pregnancy was proposed as a risk factor of preeclampsia. We assessed the effect of vitamin D supplementation (4,400 vs. 400 IU/day), initiated early in pregnancy (10-18 weeks), on the development of preeclampsia. The effects of serum vitamin D (25-hydroxyvitamin D [25OHD]) levels on preeclampsia incidence at trial entry and in the third trimester (32-38 weeks) were studied. We also conducted a nested case-control study of 157 women to investigate peripheral blood vitamin D-associated gene expression profiles at 10 to 18 weeks in 47 participants who developed preeclampsia. Of 881 women randomized, outcome data were available for 816, with 67 (8.2%) developing preeclampsia. There was no significant difference between treatment (N = 408) or control (N = 408) groups in the incidence of preeclampsia (8.08% vs. 8.33%, respectively; relative risk: 0.97; 95% CI, 0.61-1.53). However, in a cohort analysis and after adjustment for confounders, a significant effect of sufficient vitamin D status (25OHD ≥30 ng/ml) was observed in both early and late pregnancy compared with insufficient levels (25OHD <30 ng/ml) (adjusted odds ratio, 0.28; 95% CI, 0.10-0.96). Differential expression of 348 vitamin D-associated genes (158 upregulated) was found in peripheral blood of women who developed preeclampsia (FDR <0.05 in the Vitamin D Antenatal Asthma Reduction Trial [VDAART]; P < 0.05 in a replication cohort). Functional enrichment and network analyses of this vitamin D-associated gene set suggests several highly functional modules related to systematic inflammatory and immune responses, including some nodes with a high degree of connectivity. Vitamin D supplementation initiated in weeks 10-18 of pregnancy did not reduce preeclampsia incidence in the intention-to-treat paradigm. However, vitamin D levels of 30 ng/ml or higher at trial entry and in late pregnancy were associated with a lower risk of preeclampsia. Differentially expressed vitamin D

[Clinical relevant procedures for early pregnancy diagnosis in the mare].

PubMed

Bostedt, H; Sieme, H; Bartmann, C-P; Handler, J; Sobiraj, A; Wehrend, A

2014-01-01

This review describes stepwise the recto-manual and transrectal ultrasonographic evidence of early pregnancy detection in the horse. The morphological and physiological conditions in the individual phases of early pregnancy are presented in correlation to the potential clinical findings. The importance of embryonic and early foetal losses is presented. Communication and documentation of findings are also addressed. The final section is devoted to the evaluation of the examination effort. In this regard, it is emphasized that the gynaecological examination for the evaluation of the pregnancy status represents a service contract.

Unintended pregnancy amongst an early pregnancy clinic cohort: Identifying opportunities for preventative health interventions.

PubMed

Cheney, Kate; Sim, Kyra A; D'souza, Mario; Pelosi, Marilena; Black, Kirsten I

2016-08-01

A relationship between maternal weight and unintended pregnancy has previously been reported. Researchers have found women who are overweight and obese women are less likely to use contraception, and more likely to have unplanned pregnancies, thus limiting their ability to optimise their health before conception. This study sought to examine the relationship between pregnancy intention and body mass index (BMI) amongst women attending a service managing early pregnancy complications. The cross-sectional descriptive study (n = 550) was conducted from November 2013 to February 2015 in Sydney, Australia. It documented women's pregnancy intention using a self-completed questionnaire incorporating a validated pregnancy intention scale and measuring women's height and weight to calculate their BMI using the WHO classification of anthropometry and adjusting for cut-offs in Asian populations. Socio-demographic characteristics were also documented. The respondents were ethnically diverse with over a third defining themselves as Asian (36%; 196). Forty-four per cent of women (239) had clearly intended their pregnancy, 39% (212) were ambivalent and 18% (99) had not intended to conceive. Forty-nine per cent (263) of women were overweight or obese. No relationship was found between pregnancy intention and BMI. Fewer than half the women with early pregnancy complications clearly intended to be pregnant. Contrary to previous research, pregnancy intention was not associated with maternal weight. Underutilised opportunities for lifestyle and preconception education exist to address the impact of modifiable maternal behaviours on future pregnancies and to provide contraception counselling to those not wishing to conceive. © 2016 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Ultrasound imaging in the management of bleeding and pain in early pregnancy.

PubMed

Knez, Jure; Day, Andrea; Jurkovic, Davor

2014-07-01

Bleeding and pain are experienced by 20% of women during the first trimester of pregnancy. Although most pregnancies complicated by pain and bleeding tend to progress normally, these symptoms are distressing for woman, and they are also associated with an increased risk of miscarriage and ectopic pregnancy. Ultrasound is the first and often the only diagnostic modality that is used to determine location of early pregnancy and to assess its health. Ultrasound is an accurate, safe, painless and relatively inexpensive diagnostic tool, which all contributed to its widespread use in early pregnancy. Pain and bleeding in early pregnancy are sometimes caused by concomitant gynaecological, gastrointestinal, and urological problems, which could also be detected on ultrasound scan. In women with suspected intra-abdominal bleeding, ultrasound scan can be used to detect the presence of blood and provide information about the extent of bleeding. In this chapter, we comprehensively review the use of ultrasound in the diagnosis and management of early pregnancy complications. We include information about the diagnosis of gynaecological and other pelvic abnormalities, which could cause pain or bleeding in pregnancy. We also provide a summary of the current views on the safety of ultrasound in early pregnancy. Copyright © 2014 Elsevier Ltd. All rights reserved.

Factors affecting sexual life during pregnancy in eastern Turkey.

PubMed

Eryilmaz, Gülşen; Ege, Emel; Zincir, Handan

2004-01-01

This is a descriptive and cross-sectional study aiming to determine the factors affecting sexual life in pregnant women. The study was carried out in 238 women in Malatya, Turkey. It was found that 61.4% regarded coitus as a risk during pregnancy, 31.9% did not have any knowledge about this matter. In 81.5% sexual life was affected during pregnancy. The mean frequency of intercourse was 2.02 +/- 0.7/week before pregnancy and decreased to 1.51 +/- 0.6/week during pregnancy. The reasons for this decline are: exhaustion and fatigue (64.3%); waning of sexual desire (55.9%); harmful to the fetus (49.2%); causing abortions in early pregnancy (45%), and inducing preterm labor (34%). There was a significant relationship between changes in sexual life during pregnancy and the duration of marriage (chi2=10.8, p<0.05), education level (chi2=18.1, p<0.05), parity (chi2=11.1, p<0.05), and gravidity (chi2=6.8, p<0.05). The variables such as age, employment status, and number of abortions did not affect sexual life during pregnancy. Copyright 2004 S. Karger AG, Basel

Premenstrual symptoms are associated with psychological and physical symptoms in early pregnancy.

PubMed

Winkel, Susanne; Einsle, Franziska; Wittchen, Hans-Ulrich; Martini, Julia

2013-04-01

The reproductive life of women is characterised by a number of distinct reproductive events and phases (e.g. premenstrual phase, peripartum, perimenopause). The hormonal transitions during these phases are often associated with both psychological and physical symptoms. Associations between these reproductive phases have been shown by numerous studies. However, the relationship between symptoms during the premenstrual phase and during early pregnancy has received little attention thus far, although early pregnancy is a time of dramatic hormonal as well as physical adaptation. Findings are based on a prospective longitudinal study with N = 306 pregnant women (MARI study). Three hundred five women that had menstrual bleeding in the year before pregnancy rated the severity of psychological and physical symptoms during premenstrual phases in the year preceding pregnancy. Besides this, they rated the severity of the same symptoms during early pregnancy (weeks 10 to 12 of gestation). The overall severity of premenstrual symptoms was significantly associated with the overall severity of early pregnancy symptoms (b = 0.4, 95% CI = 0.3-0.5; p < 0.001). The overall severity of early pregnancy symptoms was best predicted by the severity of premenstrual irritability. The best predictor for a particular symptom in early pregnancy mostly was the corresponding premenstrual symptom. The associations between premenstrual and early pregnancy symptoms support the reproductive hormone sensitivity hypothesis that some women are prone to repeatedly experience specific psychological and physical symptoms during different reproductive phases. The findings further imply that the nature of symptoms might be rather consistent between different reproductive phases.

Early prognostic factors of outcomes in monochorionic twin pregnancy: systematic review and meta-analysis.

PubMed

Mackie, Fiona L; Hall, Matthew J; Morris, R Katie; Kilby, Mark D

2018-05-12

Assess ability of first trimester pregnancy related factors (ultrasound measurements, maternal characteristics, biomarkers) to predict complications in monochorionic twin pregnancies DATA SOURCES: MEDLINE, EMBASE, ISI Web of Science, CINAHL, the Cochrane Central Registration of Controlled Trials and Research Registers, and Google Scholar, from inception to 12 May 2017. Grey literature and bibliographies of articles were checked. Studies that reported ultrasound measurements, maternal characteristics, or potential biomarkers, measured in the first trimester in monochorionic diamniotic twin pregnancies, where the potential prognostic ability between the variable and twin-twin transfusion syndrome, growth restriction, or intrauterine fetal death could be assessed. Quality assessment was evaluated using the STROBE checklist by 2 reviewers independently. For meta-analysis, odds ratios using a random effects model, or standardized mean difference were calculated. If a moderate association was found, the prognostic ability was evaluated by calculating the sensitivity and specificity. Risk of heterogeneity was reported as I 2 and publication bias was visually assessed by funnel plots and quantitatively by Egger's test. Forty-eight studies were eligible for inclusion. Twenty meta-analyses could be performed. A moderate association was demonstrated in 3 meta-analyses, between: NT>95th centile in one/both fetuses and TTTS (OR 2.29 [95%CI 1.05, 4.96] I 2 =6.6%, 4 studies, 615 pregnancies); CRL discordance ≥10% and TTTS (OR 2.43 [95%CI 1.13, 5.21] I 2 =14.1%, 3 studies, 708 pregnancies); and maternal ethnicity and TTTS (OR 2.12 [95%CI 1.17, 3.83] I 2 =0.0%, 5 studies, 467 pregnancies), but none demonstrated a prognostic ability for any outcome under investigation. It is not currently possible to predict adverse outcomes in monochorionic twin pregnancies. We have revealed a lack of research investigating first trimester biomarkers in monochorionic twin pregnancies. Different

Developmental Predictors of Inattention-Hyperactivity from Pregnancy to Early Childhood

PubMed Central

Foulon, Stéphanie; Pingault, Jean-Baptiste; Melchior, Maria; Falissard, Bruno; Côté, Sylvana M.

2015-01-01

Objective The objective of the study was to characterize the developmental sequence of pre- and postnatal risk factors for inattention-hyperactivity symptoms in preschoolers. Materials and Methods Longitudinal data came from a French population based birth cohort study (EDEN; N = 1311 mother-child pairs followed from the pregnancy onwards). Inattention-hyperactivity symptoms were assessed with the Strengths and Difficulties Questionnaire when participating children were 3 years of age. Potential risk factors were classified in four domains (fetal exposures and child somatic characteristics, child temperament, child neurodevelopmental status, psychosocial environment) and four periods (before pregnancy, prenatal/birth, infancy, toddlerhood). Their role as potential moderator or mediator was tested with path analysis to determine the developmental sequence. Results A low family socioeconomic status before pregnancy was the main environmental risk factor for inattention-hyperactivity symptoms at 3 years, and its effect occurred via two pathways. The first was a risk pathway, where lower SES was associated with higher maternal depression and anxiety during pregnancy; then to higher maternal and child distress and dysregulation in infancy; and in turn to higher levels of inattention-hyperactivity at 3 years. The second was a protective pathway, where higher SES was associated with longer duration of breastfeeding during infancy; then to better child neurodevelopmental status in toddlerhood; and in turn to lower levels of inattention-hyperactivity at 3 years. Discussion This study identified psychosocial factors at several developmental periods that represent potential targets for preventing the emergence of inattention-hyperactivity symptoms in early childhood. PMID:25938453

Interventions for nausea and vomiting in early pregnancy

PubMed Central

Matthews, Anne; Dowswell, Therese; Haas, David M; Doyle, Mary; O’Mathúna, Dónal P

2014-01-01

Background Nausea, retching and vomiting are very commonly experienced by women in early pregnancy. There are considerable physical and psychological effects on women who experience these symptoms. This is an update of a review of interventions for nausea and vomiting in early pregnancy previously published in 2003. Objectives To assess the effectiveness and safety of all interventions for nausea, vomiting and retching in early pregnancy, up to 20 weeks’ gestation. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (28 May 2010). Selection criteria All randomised controlled trials of any intervention for nausea, vomiting and retching in early pregnancy. We excluded trials of interventions for hyperemesis gravidarum which are covered by another review. We also excluded quasi-randomised trials and trials using a crossover design. Data collection and analysis Four review authors, in pairs, reviewed the eligibility of trials and independently evaluated the risk of bias and extracted the data for included trials. Main results Twenty-seven trials, with 4041 women, met the inclusion criteria. These trials covered many interventions, including acupressure, acustimulation, acupuncture, ginger, vitamin B6 and several antiemetic drugs. We identified no studies of dietary or other lifestyle interventions. Evidence regarding the effectiveness of P6 acupressure, auricular (ear) acupressure and acustimulation of the P6 point was limited. Acupuncture (P6 or traditional) showed no significant benefit to women in pregnancy. The use of ginger products may be helpful to women, but the evidence of effectiveness was limited and not consistent. There was only limited evidence from trials to support the use of pharmacological agents including vitamin B6, and anti-emetic drugs to relieve mild or moderate nausea and vomiting. There was little information on maternal and fetal adverse outcomes and on psychological, social or economic outcomes. We

Decreased endometrial vascularity and receptivity in unexplained recurrent miscarriage patients during midluteal and early pregnancy phases.

PubMed

Tan, Shu-Yin; Hang, Fu; Purvarshi, Gowreesunkur; Li, Min-Qing; Meng, Da-Hua; Huang, Ling-Ling

2015-10-01

To evaluate the predictive value of three-dimensional (3D)-power Doppler sonography on recurrent miscarriage. The study patients were divided into a recurrent miscarriage group (30 cases) and a normal pregnancy group (21 cases). Measurement of endometrial thickness was performed using two-dimensional transvaginal ultrasound in the midluteal phase. The endometrial volume, vascularization index (VI), flow index (FI), and vascularization-flow index (VFI) in midluteal and placenta volume, as well as the VI, FI, and VFI of early pregnancy were measured using Virtual Organ Computer-aided Analysis of 3D-power Doppler ultrasound. Endometrial thickness, endometrial volume, endometrial vascular data, VI, FI, and VFI of the midluteal phase were lower in the recurrent miscarriage group compared with the normal pregnancy group (p < 0.05). Placental volume, VI, and VFI during early pregnancy were lower in the miscarriage group compared with the normal pregnancy group (p < 0.05). There was no significant change in FI between the recurrent miscarriage and control groups during early pregnancy (p > 0.05). The predictive accuracy of endometrial thickness, endometrial volume, VI, FI, and VFI in the midluteal phase, and placenta volume, VI, FI, and VFI in early pregnancy as measured by the receiver operating characteristic curve to predict miscarriage before 12 gestational weeks in participants was 0.681, 0.876, 0.770, 0.720, 0.879, 0.771, 0.907, 0.592, respectively. The 3D-power Doppler ultrasound is a more comprehensive and sensitive method for evaluating endometrial receptivity. Endometrial volume, VI, FI, and VFI in the midluteal phase, as well as VI in early pregnancy, can be considered as predictive factors for recurrent miscarriage. Copyright © 2015. Published by Elsevier B.V.

Risk factors for early miscarriage among Chinese: a hospital-based case-control study.

PubMed

Xu, Guangli; Wu, Yiming; Yang, Liming; Yuan, Lu; Guo, Huafeng; Zhang, Fuqing; Guan, Yichun; Yao, Wu

2014-06-01

To investigate the risk factors for early miscarriage among Chinese women. Hospital-based matched case-control study. Academic medical center and maternal health hospital. 620 women with early miscarriage (less than 13 weeks of gestation) and 1,240 normal pregnant women. Face-to-face questionnaire. Multivariable conditional odds ratio (OR) and 95% confidence interval (CI) to measure risk factors. After adjustment for confounding factors, the following were independently associated with increased risk: history of miscarriage, repeated induced abortion, working night shifts, and frequent staying up late. Vitamin supplementation and regular physical activity reduced the risk of miscarriage. We did not find paternal age, alcohol consumption, or smoking status to be linked with early miscarriage. Our findings suggest that a healthy diet, regular physical activity, and planned pregnancy may be advantageous for women in pre-pregnancy or early pregnancy. Induced abortion, working night shifts, and frequent staying up late were associated with an increased risk of miscarriage. Further work in larger populations is warranted. Copyright © 2014 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Drug use during early pregnancy: cross-sectional analysis from the Childbirth and Health Study in Primary Care in Iceland.

PubMed

Axelsdottir, Thury O; Sigurdsson, Emil L; Gudmundsdottir, Anna M; Kristjansdottir, Hildur; Sigurdsson, Johann A

2014-09-01

To analyse drug use in early pregnancy with special focus on socio-demographic factors associated with psychotropic and analgesic drug use. Cross-sectional study. A total of 1765 women were invited via their local health care centres, and 1111 participated at 11-16 weeks of pregnancy by filling out a postal questionnaire concerning socio-demographic and obstetric background, stressful life events, and drug use. Drug use prior to and early on in pregnancy, socio-demographic factors, smoking, and adverse life events were investigated. Drug categories screened for were psychotropics (collective term for antidepressants, relaxants, and sleep medication), analgesics, hormones, nicotine, vitamins/minerals, and homeopathic medicine. Drug use from the aforementioned drug categories, excluding vitamins/minerals and homeopathic medicine, was reduced by 18% during early pregnancy, compared with six months prior to conception (49% vs. 60%). Psychotropic drug use during early pregnancy was associated with elementary maternal education (p < 0.5), being unemployed (p < 0.001), being single/divorced/separated (p < 0.01), smoking prior to or during pregnancy (p < 0.01), forced to change job/move house (p < 0.001), and psychotropic drug use six months prior to pregnancy (p < 0.001). No items on the stressful life events scale were associated with increased analgesic use, which increased only with multiparity. Use of analgesics and psychotropic drugs seems common in pregnancy. Our results indicate that lack of a support network, stressful life events, and lower status in society may predispose women to more drug use. GPs and midwives responsible for maternity care could take this into account when evaluating risk and gain for women and foetuses in the primary care setting.

The 2011 survey on hypertensive disorders of pregnancy (HDP) in China: prevalence, risk factors, complications, pregnancy and perinatal outcomes.

PubMed

Ye, Chun; Ruan, Yan; Zou, Liying; Li, Guanghui; Li, Changdong; Chen, Yi; Jia, Chaoxia; Megson, Ian L; Wei, Jun; Zhang, Weiyuan

2014-01-01

Hypertensive disorders of pregnancy (HDP) are a group of medical complications in pregnancy and also a risk factor for severe pregnancy outcomes, but it lacks a large-scale epidemiological investigation in recent years. This survey represents a multicenter cross-sectional retrospective study to estimate the prevalence and analyze the risk factors for HDP among the pregnant women who had referred for delivery between January 1st 2011 and December 31st 2011 in China Mainland. A total of 112,386 pregnant women were investigated from 38 secondary and tertiary specialized or general hospitals randomly selected across the country, of which 5,869 had HDP, accounting for 5.22% of all pregnancies. There were significant differences in the prevalence of HDP between geographical regions, in which the North China showed the highest (7.44%) and Central China showed the lowest (1.23%). Of six subtypes of HDP, severe preeclampsia accounted for 39.96%, gestational hypertension for 31.40%, mild preeclampsia for 15.13%, chronic hypertension in pregnancy for 6.00%, preeclampsia superimposed on chronic hypertension for 3.68% and eclampsia for 0.89%. A number of risk factors for HDP were identified, including twin pregnancy, age of >35 years, overweight and obesity, primipara, history of hypertension as well as family history of hypertension and diabetes. The prevalence of pre-term birth, placental abruption and postpartum hemorrhage were significantly higher in women with HDP than those without HDP. The possible risk factors confirmed in this study may be useful for the development of early diagnosis and appropriate treatment of HDP.

The 2011 Survey on Hypertensive Disorders of Pregnancy (HDP) in China: Prevalence, Risk Factors, Complications, Pregnancy and Perinatal Outcomes

PubMed Central

Ye, Chun; Ruan, Yan; Zou, Liying; Li, Guanghui; Li, Changdong; Chen, Yi; Jia, Chaoxia; Megson, Ian L.; Wei, Jun; Zhang, Weiyuan

2014-01-01

Hypertensive disorders of pregnancy (HDP) are a group of medical complications in pregnancy and also a risk factor for severe pregnancy outcomes, but it lacks a large-scale epidemiological investigation in recent years. This survey represents a multicenter cross-sectional retrospective study to estimate the prevalence and analyze the risk factors for HDP among the pregnant women who had referred for delivery between January 1st 2011 and December 31st 2011 in China Mainland. A total of 112,386 pregnant women were investigated from 38 secondary and tertiary specialized or general hospitals randomly selected across the country, of which 5,869 had HDP, accounting for 5.22% of all pregnancies. There were significant differences in the prevalence of HDP between geographical regions, in which the North China showed the highest (7.44%) and Central China showed the lowest (1.23%). Of six subtypes of HDP, severe preeclampsia accounted for 39.96%, gestational hypertension for 31.40%, mild preeclampsia for 15.13%, chronic hypertension in pregnancy for 6.00%, preeclampsia superimposed on chronic hypertension for 3.68% and eclampsia for 0.89%. A number of risk factors for HDP were identified, including twin pregnancy, age of >35 years, overweight and obesity, primipara, history of hypertension as well as family history of hypertension and diabetes. The prevalence of pre-term birth, placental abruption and postpartum hemorrhage were significantly higher in women with HDP than those without HDP. The possible risk factors confirmed in this study may be useful for the development of early diagnosis and appropriate treatment of HDP. PMID:24937406

Inability to have children caused by recurrent HELLP syndrome in early pregnancies - implications for a review of literature.

PubMed

Pawelec, Małgorzata; Karmowski, Andrzej; Karmowski, Mikołaj; Krzemieniewska, Joanna; Kulczycka, Aleksandra; Gabryś, Marian Stanisław; Koryś, Jerzy; Gworys, Bohdan

2013-01-01

This review is inspired by a case of two pregnancies of the same patient complicated by HELLP syndrome, which suggests that there is a predisposition for the occurrence of preeclampsia and HELLP syndrome in early pregnancy. HELLP syndrome, uncommon below the 20th week and rarer still in two consecutive pregnancies, appeared in two pregnancies of the same woman. The aim of our work is to try to understand the cause of heterogeneity of HELLP syndrome and help find a way of prolonging such pregnancies. Recurrent HELLP syndrome in early pregnancy is a form of severe, fulminant preeclampsia. The preceding symptom is a surge in blood pressure. The hypertension becomes resistant to antihypertensive drugs, which indicates that preexisting hypertension is later accompanied by other factors contributing to the rise in blood pressure. Different effects of high dosage of corticosteroids on liver and platelets show that there are different factors responsible for liver damage and for thrombocytopenia. It seems that the symptoms have various origins, so the therapy with one drug only is not sufficiently effective. Nicotine analogues or a plant extract (from rootstock of Eriosema kraussianum) used by South African traditional healers for erectile dysfunction seem to give a chance of prolonging pregnancy and, consequently, having children.

Can women determine the success of early medical termination of pregnancy themselves?

PubMed

Cameron, S T; Glasier, A; Johnstone, A; Dewart, H; Campbell, A

2015-01-01

To determine the outcome of early medical termination of pregnancy (TOP) among women who choose a "self assessment" follow up comprising a self-performed low sensitivity urine pregnancy test with instructions on signs/symptoms that mandate contacting the TOP service. A retrospective review of computer databases of 1726 women choosing self-assessment after early medical TOP (<9 weeks) in the UK. The main outcome measures were (a) number of women choosing self-assessment, (b) contact rates with TOP service and (c) time to presentation with an ongoing pregnancy (failed TOP). Ninety-six percent of women having an early medical TOP and going home to expel the pregnancy chose self-assessment. Two percent of women made unscheduled visits to the TOP service. One hundred and eighty-eight women (11%) telephoned the service about concerns related to complications or the success of treatment. There were eight ongoing pregnancies (0.5%; 95% confidence interval 0.2-0.9%). Four were detected within 4 weeks of treatment; the remainder were not detected until one or more missed menses after the procedure. Most women having an early medical TOP, who go home to expel the pregnancy, choose self-assessment. Relatively few women make unscheduled visits or telephone the TOP service. Most ongoing pregnancies are recognized at an early stage, although late presentation (as with all methods of follow up) does still occur. If women are given clear instructions on how and when to conduct a urine pregnancy test and on signs/symptoms that mandate contacting the TOP service, then they can confirm the success of early medical TOP themselves. Late presentation due to failure to recognize an ongoing pregnancy is rare. Copyright © 2014 Elsevier Inc. All rights reserved.

Serial hCG and progesterone levels to predict early pregnancy outcomes in pregnancies of uncertain viability: A prospective study.

PubMed

Puget, Claire; Joueidi, Yolaine; Bauville, Estelle; Laviolle, Bruno; Bendavid, Claude; Lavoué, Vincent; Le Lous, Maela

2018-01-01

To assess the value of serial hCG and progesterone serum level in the diagnosis of early pregnancy viability. It was a prospective cohort study. Women with a pregnancy of uncertain viability (PUV), defined as the presence of an intra-uterine embryo with a crown-rump length <7mm with no cardiac activity or an intra-uterine gestational sac size <25mm with no visible embryonic structure in a transvaginal ultrasound scan (TVS) were eligible. The diagnosis value of serial plasmatic hCG levels on the first day and 48h after as well as the initial progesterone level were evaluated to diagnose pregnancy viability. Pregnancy viability was assessed by TVS 7 to 14days after inclusion. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of an hCG H48/H0 ratio increase <11% to diagnose an early pregnancy loss were 70.6%, 100%, 100% and 85.3%, respectively. The sensitivity, specificity, PPV and NPV of a 6.2ng/ml progesterone level to diagnose an early pregnancy loss were 20%, 100%, 100% and 65.2%, respectively. The sensitivity, specificity, PPV and NPV of an hCG H48/H0 ratio increase >75% to diagnose a viable pregnancy were 100%, 31%, 45.9% and 100%, respectively. hCG H48/H0 ratio increase <11% was associated with early pregnancy loss in 100% of the cases. hCG H48/H0 ratio increase >75% was associated with 100% of viable pregnancies in 100% of the cases. Serial hCG levels alone permitted an early viability diagnosis within 48h for 41.1% of patients with PUV instead of 7 to 14days with TVS. Copyright © 2017 Elsevier B.V. All rights reserved.

Gestational weight gain as a risk factor for hypertensive disorders of pregnancy.

PubMed

Macdonald-Wallis, Corrie; Tilling, Kate; Fraser, Abigail; Nelson, Scott M; Lawlor, Debbie A

2013-10-01

Pregnancy interventions to limit gestational weight gain (GWG) have been proposed as a means of preventing hypertensive disorders of pregnancy (HDP); however, it is currently unclear whether GWG has a causal influence on the development of HDP. Thus, we aimed to determine whether GWG in early pregnancy is a risk factor for preeclampsia and gestational hypertension and whether GWG precedes the increases in blood pressure in normotensive women across pregnancy. We examined repeat antenatal clinic measurements of weight and blood pressure (median of 12 and 14 per woman, respectively) of 12,522 women in the Avon Longitudinal Study of Parents and Children. Greater prepregnancy weight was associated with an increased risk of gestational hypertension and preeclampsia per 10 kg of prepregnancy weight: odds ratio (OR), 1.80; 95% confidence interval (CI), 1.70-1.91 and OR, 1.71; 95% CI, 1.49-1.95, respectively, for women weighing 90 kg or less before pregnancy; OR, 1.24; 95% CI, 1.03-1.49 and OR, 1.61; 95% CI, 1.18-2.19 for women weighing more than 90 kg. Fully adjusted odds ratios for gestational hypertension and preeclampsia per 200 g per week GWG up to 18 weeks were OR, 1.26; 95% CI, 1.16-1.38 and OR, 1.31; 95% CI, 1.07-1.62. In normotensive women, GWG in early pregnancy was associated positively with blood pressure change in midpregnancy and negatively with blood pressure change in late pregnancy. In all gestational periods, GWG was positively associated with concurrent blood pressure change. However, there was no evidence that blood pressure changes in any period were associated with subsequent GWG. These findings suggest that GWG in early pregnancy may be a potential target for interventions aimed at reducing the risk of HDP. Copyright © 2013 Mosby, Inc. All rights reserved.

Detection of activity similar to that of early pregnancy factor after mating sows with a vasectomized boar.

PubMed

Koch, E; Ellendorff, F

1985-05-01

Incubation of normal pig lymphocytes in serum samples collected from 10 sows immediately before, and at daily intervals after mating with a vasectomized boar significantly elevated the rosette inhibition titre (RIT) of a standard antilymphocyte serum in 6 animals on the first but not on the 2nd and 3rd day after copulation. Infusion of seminal plasma without mating into 5 sows induced an obvious, but not statistically significant, transient rise of titres in 3 pigs. Neither sodium chloride infusion (N = 5), nor sham copulation with diverted penis (N = 5) influenced serum RITs. Porcine seminal plasma showed an inherent rosette-inhibiting property. A depression of rosette formation was evident in a concentration-dependent fashion up to a dilution of 1 in 320. Similarly, preincubation of lymphocytes in serial dilutions of seminal plasma in a non-pregnancy serum sample led to an amplification of the rosette inhibiting capacity of the antilymphocyte serum. Non-specific activation of the eggs to release a signal which induces the production of early pregnancy factor (EPF) or the resorption of seminal plasma components into the blood circulation are considered as possible explanations for the EPF-like activity after mating with a vasectomized boar.

Changes in circulating microRNA levels can be identified as early as day 8 of pregnancy in cattle.

PubMed

Ioannidis, Jason; Donadeu, F Xavier

2017-01-01

Poor reproductive performance remains a major issue in the dairy industry, with low conception rates having a significant impact on milk production through extended calving intervals. A major limiting factor is the lack of reliable methods for early pregnancy diagnosis. Identification of animals within a herd that fail to conceive within 3 weeks after insemination would allow early re-insemination and shorten calving intervals. In a previous study, we found an increase in plasma miR-26a levels in Day 16-pregnant relative to non-pregnant heifers, however changes in miRNA levels that early during pregnancy were very small which likely prevented the identification of robust biomarkers. In this study, we extended our analyses to a wider interval during pregnancy (Days 8 to 60, n = 11 heifers) with the rationale that this may facilitate the identification of additional early pregnancy miRNA biomarkers. Using small RNA sequencing we identified a total of 77 miRNAs that were differentially expressed on Day 60 relative to Day 0 of pregnancy. We selected 14 miRNAs for validation by RT-qPCR and confirmed significant differences in the expression of let-7f, let-7c, miR-30c, miR-101, miR-26a, miR-205 and miR-143 between Days 0 and 60. RT-qPCR profiling throughout Days 0, 8, 16 and 60 of pregnancy showed a distinct increase in circulating levels of miR-26a (3.1-fold, P = 0.046) as early as Day 8 of pregnancy. In summary, in contrast to earlier stages of pregnancy (≤ Day 24), marked differences in the levels of multiple miRNAs can be detected in circulation by Day 60 in cattle. Retrospective analyses showed miR-26a levels to be increased in circulation as early as Day 8, sooner than previously reported in any species, suggesting a biological role for this miRNA in the very early events of pregnancy.

Intrinsic factors associated with pregnancy falls.

PubMed

Wu, Xuefang; Yeoh, Han T

2014-10-01

Approximately 25% to 27% of women sustain a fall during pregnancy, and falls are associated with serious injuries and can affect pregnancy outcomes. The objective of the current study was to identify intrinsic factors associated with pregnancy that may contribute to women's increased risk of falls. A literature search (Medline and Pubmed) identified articles published between January 1980 and June 2013 that measured associations between pregnancy and fall risks, using an existing fall accident investigation framework. The results indicated that physiological, biomechanical, and psychological changes associated with pregnancy may influence the initiation, detection, and recovery phases of falls and increase the risk of falls in this population. Considering the logistic difficulties and ethnic concerns in recruiting pregnant women to participate in this investigation of fall risk factors, identification of these factors could establish effective fall prevention and intervention programs for pregnant women and improve birth outcomes. [Workplace Health Saf 2014;62(10):403-408.]. Copyright 2014, SLACK Incorporated.

The effect of early pregnancy on the formation of obstetric fistula.

PubMed

Browning, Andrew; Mbise, Frederick; Foden, Phil

2017-09-01

To assess the effect of early pregnancy on obstetric fistula. A prospective observational study was conducted among patients with obstetric fistula caused by a long obstructed labor who presented at Selian Lutheran Hospital, Tanzania, or Kitovu Hospital, Uganda, between January 1, 2015, and January 31, 2016. Demographic and clinical variables were evaluated. Among 270 patients, 162 (60.0%) experienced their first pregnancy up to 2 years after menarche (early group) and 108 (40.0%) experienced their first pregnancy more than 2 years after menarche (late group). No significant differences between the early and late groups were found for median age at presentation (30.0 vs 28.0 years), median parity (both 2.0), stillbirth (n=145 [89.5%] vs n=95 [88.0%]), median duration of labor (both 2.0 days), home delivery (n=31 [19.1%] vs n=17 [15.7%]), cesarean delivery (n=79 [48.8%] vs 58 [53.7%]), median time from obstetric fistula formation to presentation (48.0 vs 24.0 months), and obstetric fistula classifications. Obstetric fistula occurred during the first pregnancy in 99 (61.1%) women in the early group and 71 (65.7%) in the late group (P=0.440). Frequency of obstetric fistula during the first pregnancy is not increased among women who experience their first pregnancy within 2 years of menarche. © 2017 International Federation of Gynecology and Obstetrics.

A monoclonal antibody to an early pregnancy factor-induced suppressor factor (EPF-S1) disrupts implantation in mice.

PubMed

Athanasas-Platsis, S; Hoskin, M J; Rolfe, B E; Cavanagh, A C; Morton, H

1995-03-01

The importance of EPF during pregnancy has been established previously but the importance of the EPF-induced suppressor factor EPF-S1 in pregnancy has to date been unaddressed. Investigations were therefore conducted in order to study this. Monoclonal antibodies to EPF-S1 were produced, and one antibody, designated R2T gamma, was characterized. Mated mice were passively immunized with R2T gamma and the effect on implantation determined. Characterization of anti-EPF-S1 R2T gamma revealed that it cross-reacted with EPF-S1 of different MHC restriction but not with EPF or EPF-S2. When injected into mated mice on days 1 to 4, R2T gamma had no effect on pregnancy but when injections continued to day 5, pregnancy was affected; the number of embryos implanted on day 7 were significantly less than the number of corpora lutea counted, signifying embryonic loss. These studies show that anti-EPF-S1 R2T gamma disrupts implantation in mice when injected on days 1 to 5 of pregnancy but not when injected on days 1 to 4, demonstrating that EPF-S1 exerts its effects around the time of implantation.

Self-reported Vitamin Supplementation in Early Pregnancy and Risk of Miscarriage

PubMed Central

Olshan, Andrew F.; Herring, Amy H.; Savitz, David A.; Siega-Riz, Anna Maria; Hartmann, Katherine E.

2009-01-01

Miscarriage is a common and poorly understood adverse pregnancy outcome. In this study, the authors sought to evaluate the relation between self-reported use of prenatal vitamins in early pregnancy and the risk of miscarriage. Between 2000 and 2008, 4,752 US women were prospectively enrolled in Right From the Start. Information about vitamin use was obtained from a first-trimester interview. Discrete-time hazard models were used, candidate confounders were assessed, and the following variables were included in the model: study site, maternal age, gravidity, marital status, education, race/ethnicity, smoking, and use of progesterone in early pregnancy. Approximately 95% of participants reported use of vitamins during early pregnancy. A total of 524 women had a miscarriage. In the final adjusted model, any use of vitamins during pregnancy was associated with decreased odds of miscarriage (odds ratio = 0.43, 95% confidence interval: 0.30, 0.60) in comparison with no exposure. These results should be viewed in the context of a potentially preventive biologic mechanism mitigated by possible confounding by healthy behaviors and practices that are also associated with vitamin supplement use during pregnancy. PMID:19372214

Self-reported vitamin supplementation in early pregnancy and risk of miscarriage.

PubMed

Hasan, Reem; Olshan, Andrew F; Herring, Amy H; Savitz, David A; Siega-Riz, Anna Maria; Hartmann, Katherine E

2009-06-01

Miscarriage is a common and poorly understood adverse pregnancy outcome. In this study, the authors sought to evaluate the relation between self-reported use of prenatal vitamins in early pregnancy and the risk of miscarriage. Between 2000 and 2008, 4,752 US women were prospectively enrolled in Right From the Start. Information about vitamin use was obtained from a first-trimester interview. Discrete-time hazard models were used, candidate confounders were assessed, and the following variables were included in the model: study site, maternal age, gravidity, marital status, education, race/ethnicity, smoking, and use of progesterone in early pregnancy. Approximately 95% of participants reported use of vitamins during early pregnancy. A total of 524 women had a miscarriage. In the final adjusted model, any use of vitamins during pregnancy was associated with decreased odds of miscarriage (odds ratio = 0.43, 95% confidence interval: 0.30, 0.60) in comparison with no exposure. These results should be viewed in the context of a potentially preventive biologic mechanism mitigated by possible confounding by healthy behaviors and practices that are also associated with vitamin supplement use during pregnancy.

Early expression of pregnancy-specific glycoprotein 22 (PSG22) by trophoblast cells modulates angiogenesis in mice.

PubMed

Blois, Sandra M; Tirado-González, Irene; Wu, Julie; Barrientos, Gabriela; Johnson, Briana; Warren, James; Freitag, Nancy; Klapp, Burghard F; Irmak, Ster; Ergun, Suleyman; Dveskler, Gabriela S

2012-06-01

Mouse and human pregnancy-specific glycoproteins (PSG) are known to exert immunomodulatory functions during pregnancy by inducing maternal leukocytes to secrete anti-inflammatory cytokines that promote a tolerogenic decidual microenvironment. Many such anti-inflammatory mediators also function as proangiogenic factors, which, along with the reported association of murine PSG with the uterine vasculature, suggest that PSG may contribute to the vascular adaptations necessary for successful implantation and placental development. We observed that PSG22 is strongly expressed around the embryonic crypt on Gestation Day 5.5, indicating that trophoblast giant cells are the main source of PSG22 during the early stages of pregnancy. PSG22 treatment up-regulated the secretion of transforming growth factor beta 1 and vascular endothelial growth factor A (VEGFA) in murine macrophages, uterine dendritic cells, and natural killer cells. A possible role of PSGs in uteroplacental angiogenesis is further supported by the finding that incubation of endothelial cells with PSG22 resulted in the formation of tubes in the presence and absence of VEGFA. We determined that PSG22, like human PSG1 and murine PSG17 and PSG23, binds to the heparan sulfate chains in syndecans. Therefore, our findings indicate that despite the independent evolution and expansion of human and rodent PSG, members in both families have conserved functions that include their ability to induce anti-inflammatory cytokines and proangiogenic factors as well as to induce the formation of capillary structures by endothelial cells. In summary, our results indicate that PSG22, the most abundant PSG expressed during mouse early pregnancy, is likely a major contributor to the establishment of a successful pregnancy.

Effects of early pregnancy diagnosis by per rectal palpation of the amniotic sac on pregnancy loss in dairy cattle.

PubMed

Romano, Juan E; Fahning, Melvyn L

2013-11-15

To determine effects of per rectal amniotic sac palpation (ASP) for pregnancy diagnosis during early gestation on pregnancy loss in lactating cows. Controlled, randomized block design. 368 pregnant dairy cows. Pregnancy was detected via transrectal ultrasonography (TRUS) at day 29 (day of estrus = day 0), and cows were allocated into a control group (n = 167 cows) and ASP group (180). Control cows were not subjected to pregnancy diagnosis via palpation per rectum. Per rectal ASP was performed between days 34 and 43 by only 1 experienced veterinarian. All cows were reevaluated with TRUS on days 45, 60, and 90. 21 cows were removed because of illness. Pregnancy loss between days 29 and 90 occurred in 44 of 347 (12.7%) cows. Pregnancy loss for the control and ASP groups from days 29 to 90 occurred in 22 of 167 (13.2%) and 22 of 180 (12.2%) cows, respectively. Late embryonic pregnancy loss (days 29 to 45) for the control and ASP groups occurred in 18 (10.8%) and 15 (8.3%) cows, respectively. Early fetal pregnancy loss (days 46 to 60) for the control and ASP groups occurred in 2 of 149 (1.3%) and 6 of 165 (3.6%) cows, respectively, and late fetal pregnancy loss (days 61 to 90) for the same groups occurred in 2 of 147 (1.4%) and 1 of 159 (0.6%) cows, respectively. Pregnancy diagnosis via per rectal ASP during early gestation did not increase pregnancy loss in dairy cattle.

Effect of dietary factors in pregnancy on risk of pregnancy complications: results from the Norwegian Mother and Child Cohort Study.

PubMed

Meltzer, Helle Margrete; Brantsæter, Anne Lise; Nilsen, Roy M; Magnus, Per; Alexander, Jan; Haugen, Margareta

2011-12-01

There has been a thrilling development , as well as profound changes, in our understanding of the effect of fetal nutrition on the development and health of the child. The Norwegian Mother and Child Cohort Study (MoBa) is an ongoing nationwide population-based pregnancy cohort study that between 1999 and 2008 recruited 90,723 women with 106,981 pregnancies and 108,487 children. The objective of MoBa is to test specific etiologic hypotheses by estimating the association between exposures and diseases with a special focus on disorders that may originate in early life. An important aspect in this regard is maternal diet and nutritional status during pregnancy. Nutritional factors have long been considered to be important determinants of maternal and fetal health, and dietary information is currently being collected in a number of pregnancy cohorts in Europe and the United States. Thus far, pregnancy complications studied in MoBa are preterm birth, preeclampsia, and fetal growth; and the aim of this article is to report results of recently published studies of dietary factors in relation to these outcomes. Numerous studies are planned using MoBa data, and the aim is to add to the knowledge of the interplay between dietary factors, nonnutrients, and toxic dietary substances and epigenetic modulation on fetal development and health later in life.

Early human pregnancy serum cytokine levels predict autoimmunity in offspring.

PubMed

Lindehammer, Sabina Resic; Björck, Sara; Lynch, Kristian; Brundin, Charlotte; Marsal, Karel; Agardh, Daniel; Fex, Malin

2011-09-01

It is generally believed that pregnancy is mediated by a Th2 response, which includes cytokines that promote placental growth and are involved in inducing tolerance to the foetus. If the balance between Th1/and Th2-mediated cytokines is disrupted, systemic and local changes could predispose the foetus to future disease. Therefore, a shift in the Th1/Th2 balance during pregnancy, possibly caused by underlying environmental factors, could be associated with post-partum autoimmune disease in the offspring. Based on this presumption, we used celiac disease as a model to investigate whether autoimmunity is triggered in the foetus during early pregnancy, observed as changes in the mother's cytokine profile. Ten cytokines were measured by electro-chemi-luminescent multiplex ELISA in serum samples obtained from mothers during early pregnancy. Cases included women with children who had developed verified celiac disease before the age of 5, who were compared with other women as matched controls. We observed that 7 out of 10 cytokine levels were significantly increased in our case mothers when compared to controls. Five of these belonged to what is generally known as a Th1-mediated response (TNFα, IFNγ, IL-2, IL-1β and IL-12) and two were Th2 cytokines (IL-13 and IL-10). However, the IL-10 cytokine is known to have features from both arms of the immune system. These results were confirmed in a logistic regression model where five out of the initial seven cytokines remained. This study suggests that increase in Th1 serum cytokines may be associated with celiac disease in offspring.

Inside stories: maternal representations of first time mothers from pre-pregnancy to early pregnancy.

PubMed

Hopkins, Julia; Clarke, David; Cross, Wendy

2014-03-01

According to the psychoanalytical literature, it is during pregnancy that maternal representations of the mother-infant relationship become activated. Midwives who are engaged with the mother and the baby have not drawn upon this concept in their practice. In order for this to happen, it is important to understand better the nature of maternal representations and when they are activated from empirical studies. The research question is: what are the maternal representations of a group of first time mothers from pre-pregnancy, early pregnancy and to the first ultrasound. A narrative approach was used to gain insight into the maternal representations of first time pregnant womens' account of their representations. The analysis method was based on thematic approach. Fifteen women aged between 23 and 38 years. A midwives clinic attached to a tertiary hospital in Melbourne, Australia. First-time pregnant women's maternal representations were activated when a woman begins to plan her pregnancy ('the time is right'), again at the onset of physical changes to her body as a result of conception ('my body is changing'), and at the first early ultrasound at around twelve weeks ('it' is a real baby). Maternal representations are important for the midwife and pregnant women because this concept provides another understanding in relation to the psychological dimension of pregnancy. Copyright © 2013 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Early prediction of hypertension during pregnancy in a low-resource setting.

PubMed

Kumar, Manisha; Gupta, Usha; Bhattacharjee, Jayashree; Singh, Ritu; Singh, Shalini; Goel, Manish; Sharma, Karuna; Rehman, Mujeeb U

2016-02-01

To evaluate the role of maternal factors, biomarkers, and uterine-artery Doppler in the prediction of hypertension during pregnancy. A prospective cohort study was performed between December 2012 and November 2014. All singleton pregnancies between 11 weeks and 13 weeks, 6 days of pregnancy were included. Patients had their body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters), mean arterial pressure, uterine-artery Doppler pulsatility index, and pregnancy-associated plasma protein A (PAPP-A) and free β-human chorionic gonadotropin levels recorded. Any patients diagnosed with hypertension during follow-up were assigned to the case cohort; all other patients were assigned to the control group. Hypertension during pregnancy was observed in 198 (9.7%) of 2042 patients that attended follow-up. The mean BMI, mean arterial pressure, uterine-artery Doppler pulsatility index, and the PAPP-A level at study enrollment were all significantly correlated with the later development of hypertension (P<0.001 for all variables). The combined sensitivity, specificity, positive predictive value, and negative predictive value of using the investigated parameters to predict hypertension was 76%, 80%, 31%, and 93%, respectively. Patient BMI, mean arterial pressure, PAPP-A, and pulsatility index were found to be effective predictors of hypertension during pregnancy. Combining these predictors may be beneficial in selecting individuals for close monitoring and early intervention during pregnancy. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Preconception B-vitamin and homocysteine status, conception, and early pregnancy loss.

PubMed

Ronnenberg, Alayne G; Venners, Scott A; Xu, Xiping; Chen, Changzhong; Wang, Lihua; Guang, Wenwei; Huang, Aiqun; Wang, Xiaobin

2007-08-01

Maternal vitamin status contributes to clinical spontaneous abortion, but the role of B-vitamin and homocysteine status in subclinical early pregnancy loss is unknown. Three-hundred sixty-four textile workers from Anqing, China, who conceived at least once during prospective observation (1996-1998), provided daily urine specimens for up to 1 year, and urinary human chorionic gonadotropin was assayed to detect conception and early pregnancy loss. Homocysteine, folate, and vitamins B6 and B12 were measured in preconception plasma. Relative to women in the lowest quartile of vitamin B6, those in the third and fourth quartiles had higher adjusted proportional hazard ratios of conception (hazard ratio (HR)=2.2, 95% confidence interval (CI): 1.3, 3.4; HR=1.6, 95% CI: 1.1, 2.3, respectively), and the adjusted odds ratio for early pregnancy loss in conceptive cycles was lower in the fourth quartile (odds ratio=0.5, 95% CI: 0.3, 1.0). Women with sufficient vitamin B6 had a higher adjusted hazard ratio of conception (HR=1.4, 95% CI: 1.1, 1.9) and a lower adjusted odds ratio of early pregnancy loss in conceptive cycles (odds ratio=0.7, 95% CI: 0.4, 1.1) than did women with vitamin B6 deficiency. Poor vitamin B6 status appears to decrease the probability of conception and to contribute to the risk of early pregnancy loss in this population.

Early Pregnancy Factor Enhances the Generation and Function of CD4+CD25+ Regulatory T Cells.

PubMed

Chen, Quangang; Zhu, Xiaorong; Chen, Renjin; Liu, Jing; Liu, Peng; Hu, Ankang; Wu, Lianlian; Hua, Hui; Yuan, Honghua

2016-11-01

The mechanisms of fetal semi-allograft acceptance by the mother's immune system have been the target of many immunological studies. Early pregnancy factor (EPF) is a molecule present in the serum of pregnant mammals soon after conception that has been reported to have immunomodulatory effects. In the present study, we aimed to determine whether immune cells such as CD4 + CD25 + regulatory T cells (Tregs) are involved in the suppressive mechanism of EPF. Accordingly, CD4 + CD25 - T cells were isolated from spleens of female C57BL/6 mice and stimulated with anti-CD3 antibody, anti-CD28 antibody and IL-2 in the presence or absence of EPF. Flow cytometry was used to analyze the differentiation of CD4 + CD25 - T cells to CD4 + CD25 + Tregs. We thus found a remarkable rise in the Treg ratio in the EPF-treated cells. Higher mRNA and protein levels of fork head box P3 (Foxp3), a marker of the Treg lineage, were also observed in cells treated with EPF. Furthermore, the effect of EPF on Treg immunosuppressive capacity was evaluated. EPF treatment induced the expression of interleukin-10 and transforming growth factor β1 in Tregs. The suppressive capacity of Tregs was further measured by their capability to inhibit T cell receptor-mediated proliferation of CD4 + CD25 - T cells. We thus found that EPF exposure can enhance the immunosuppressive functions of Tregs. Overall, our data suggest that EPF induces the differentiation of Tregs and increases their immunosuppressive activities, which might be an important mechanism to inhibit immune responses during pregnancy.

[Association between risk factors during maternal pregnancy and the neonatal period and childhood bronchial asthma].

PubMed

Zhang, Hui-Qin; Fan, Rui; Zhang, Jing-Jing; Tao, Xiao-Juan; Sun, Xin

2017-01-01

To study the association of the risk factors during maternal pregnancy and the neonatal period with childhood bronchial asthma. A total of 306 children with asthma (asthma group) and 250 healthy children (control group) were enrolled. Their clinical data during the neonatal period and the maternal data during pregnancy were retrospectively studied. The univariate analysis showed that there were significant differences in the rates of maternal use of antibiotics during pregnancy, use of antibiotics and probiotics during the neonatal period, preterm birth, cesarean section, low birth weight, and breast feeding (>6 months) between the asthma and control groups (P<0.05). The multivariate logistic regression analysis showed that use of antibiotics during pregnancy (OR=3.908, 95%CI: 1.277-11.962), use of antibiotics during neonatal period (OR=24.154, 95%CI: 7.864-74.183), preterm birth (OR=8.535, 95%CI: 2.733-26.652), and cesarean section (OR=4.588, 95%CI: 2.887-7.291) were independent risk factors for childhood asthma. The use of probiotics during the neonatal period (OR=0.014, 95%CI: 0.004-0.046) and breast feeding (>6 months) (OR=0.161, 95%CI: 0.103-0.253) were protective factors for childhood asthma. The early prevention of childhood asthma can be improved by reducing the use of antibiotics during pregnancy, reducing cesarean section, avoiding abuse of antibiotics during the neonatal period, trying breast feeding and taking probiotics in early stage.

High normal blood pressure in early pregnancy also contribute to early onset preeclampsia and severe preeclampsia.

PubMed

He, Dian; Wu, Shaowen; Zhao, Haiping; Zheng, Zihe; Zhang, Weiyuan

2017-11-27

This study was to evaluate effects of high normal blood pressure (HNBP) in early pregnancy on total preeclampsia, early preeclampsia, and severe preeclampsia. We conducted a multicenter, national representative retrospective cohort study. HNBP was defined as systolic blood pressure between 130 and 140 mmHg or diastolic blood pressure between 85 and 90 mmHg. We used multivariable logistic regression to examine the associations of HNBP and the risks of above three types of preeclampsia. We included 58 054 women who were normotensive and nulliparous in early pregnancy. 4 809 (8.3%) fulfilled the definition of having HNBP, 16 682 (28.7%) were in normal blood pressure group, and 36 563 (63.0%) were in optimal blood pressure group. The incidence rates of total preeclampsia, early preeclampsia, and severe preeclampsia were 2.1% (1 217), 0.8% (491), and 1.4% (814), respectively. Compared to having optimal blood pressure, women with HNBP had significantly higher odds of total preeclampsia (odds ratio (OR) = 4.028, 95% confidence interval (CI) 3.377, 4.804), severe preeclampsia (OR = 3.542, 95% CI 2.851, 4.400), and early preeclampsia (OR = 8.163, 95% CI 6.219, 10.715). Our restricted cubic spline results supported the dose-response relationship between continuous blood pressure and the odds ratio of three types of preeclampsia. The fraction of early preeclampsia associated with prehypertension was 58.6%, which was higher than those of total preeclampsia (42.2%) or severe preeclampsia (40.5%). Women in early pregnancy with HNBP more likely develop total preeclampsia, early preeclampsia and severe preeclampsia, compared to those with optimal blood pressure. HNBP contribute more to early preeclampsia than severe preeclampsia. Our study provided robust epidemiological evidences for monitoring HNBP in early pregnancy to reduce the risks of preeclampsia.

Early invasive cervical cancer during pregnancy: different therapeutic options to preserve fertility.

PubMed

Ferraioli, Domenico; Ferriaoli, Domenico; Buenerd, Annie; Marchiolè, Pierangelo; Constantini, Sergio; Venturini, Pier Luigi; Mathevet, Patrice

2012-06-01

Cervical cancer is the second most common cancer diagnosed during pregnancy. Conservative management is possible, and different options should be discussed with patients. The main decision parameters are stage of disease, lymph node status, trimester of pregnancy and wishes of the patient. We reviewed our experience on cases of early-stage cervical cancer discovered during pregnancy and treated with different options of fertility-sparing management. Between 1990 and 2010, 5 patients with early-stage cervical cancer diagnosed during pregnancy were referred to our department for fertility-sparing treatment. The mean age at diagnosis was 28.6 years (range, 26-30 years). The stages of the tumors according to the International Federation of Gynecology and Obstetrics were IA2 in 2 women and IB1 in 3 women. The histological type was squamous carcinoma in 3 cases and adenocarcinoma in 2 cases. All patients willing to preserve their fertility were treated with vaginal radical trachelectomy (VRT) and pelvic lymph nodes dissection (PLN-D). Three procedures were performed in the first trimester: 1 patient was treated with medical abortion and then VRT and PLN-D, 2 patients were submitted to VRT and PLN-D during the first trimester, and 1 patient's case was complicated by spontaneous abortion. One patient was observed during the second trimester (20 weeks of gestation) and treated with VRT and PLN-D during pregnancy. Because this patient had pelvic lymph nodes positive for cancer, a cesarean delivery (CD) with radical hysterectomy and para-aortic lymph nodes dissection was performed followed by chemoradiotherapy. The last patient was evaluated during the third trimester of her pregnancy. Treatment included CD followed by VRT and PLN-D, which was delayed, to allow fetal maturity. Diagnosis of cervical cancer can occur during pregnancy. Different options of fertility-sparing treatment can be discussed on the basis of several factors: tumor stage, gestational age, and the patient

Medication use in early pregnancy-prevalence and determinants of use in a prospective cohort of women.

PubMed

Cleary, Brian J; Butt, Hajeera; Strawbridge, Judith D; Gallagher, Paul J; Fahey, Tom; Murphy, Deirdre J

2010-04-01

To examine the extent, nature and determinants of medication use in early pregnancy. We reviewed early pregnancy medication use, as reported to a midwife at the booking interview, in women delivering between 2000 and 2007 in a large maternity hospital in Dublin, Ireland (n = 61 252). Excluding folic acid, at least one medication was reported in 23 989 (39.2%) pregnancies. Over the counter (OTC) medications were reported in 11 970 (19.5%) pregnancies, illicit drugs or methadone in 545 (0.9%) and herbal medicines/supplements in 352 (0.58%). FDA category D and X medications were reported by 1532 (2.5%) and 1987 (3.2%) women. Asthma, depression and hypertension were among the most commonly reported chronic medical disorders. Medications with potential for foetal harm were reported by 86 (15.7%) women treated for depression and 68 (20%) women treated for hypertension. Factors associated with reporting the use of medications with potential for foetal harm included unplanned pregnancy (adjusted odds ratio [aOR] 1.31, 95% confidence interval [CI] 1.12-1.52), booking at less than 12 weeks gestation (aOR 1.83, 95%CI 1.58-2.13), being above 25 years of age, unemployed (aOR 2.58, 95%CI 2.03-3.29), nulliparous (aOR 1.41; 95%CI 1.22-1.63), single (aOR 1.28; 95%CI 1.06-1.54) or smoking during pregnancy (aOR 1.96, 95%CI 1.67-2.28). Women frequently report medication use in early pregnancy. Women and prescribers need to be aware of the lack of pregnancy safety data for many medications, and the need for pre-pregnancy planning. Prescribers should ensure that optimal medications are used when treating women of childbearing potential with chronic medical disorders.

Arsenic and Immune Response to Infection During Pregnancy and Early Life.

PubMed

Attreed, Sarah E; Navas-Acien, Ana; Heaney, Christopher D

2017-06-01

Arsenic, a known carcinogen and developmental toxicant, is a major threat to global health. While the contribution of arsenic exposure to chronic diseases and adverse pregnancy and birth outcomes is recognized, its ability to impair critical functions of humoral and cell-mediated immunity-including the specific mechanisms in humans-is not well understood. Arsenic has been shown to increase risk of infectious diseases that have significant health implications during pregnancy and early life. Here, we review the latest research on the mechanisms of arsenic-related immune response alterations that could underlie arsenic-associated increased risk of infection during the vulnerable periods of pregnancy and early life. The latest evidence points to alteration of antibody production and transplacental transfer as well as failure of T helper cells to produce IL-2 and proliferate. Critical areas for future research include the effects of arsenic exposure during pregnancy and early life on immune responses to natural infection and the immunogenicity and efficacy of vaccines.

PTSD SYMPTOMS ACROSS PREGNANCY AND EARLY POSTPARTUM AMONG WOMEN WITH LIFETIME PTSD DIAGNOSIS.

PubMed

Muzik, Maria; McGinnis, Ellen W; Bocknek, Erika; Morelen, Diana; Rosenblum, Katherine L; Liberzon, Israel; Seng, Julia; Abelson, James L

2016-07-01

Little is known about trajectories of PTSD symptoms across the peripartum period in women with trauma histories, specifically those who met lifetime PTSD diagnoses prior to pregnancy. The present study seeks to identify factors that influence PTSD symptom load across pregnancy and early postpartum, and study its impact on postpartum adaptation. The current study is a secondary analysis on pregnant women with a Lifetime PTSD diagnosis (N = 319) derived from a larger community sample who were interviewed twice across pregnancy (28 and 35 weeks) and again at 6 weeks postpartum, assessing socioeconomic risks, mental health, past and ongoing trauma exposure, and adaptation to postpartum. Using trajectory analysis, first we examined the natural course of PTSD symptoms based on patterns across peripartum, and found four distinct trajectory groups. Second, we explored factors (demographic, historical, and gestational) that shape the PTSD symptom trajectories, and examined the impact of trajectory membership on maternal postpartum adaptation. We found that child abuse history, demographic risk, and lifetime PTSD symptom count increased pregnancy-onset PTSD risk, whereas gestational PTSD symptom trajectory was best predicted by interim trauma and labor anxiety. Women with the greatest PTSD symptom rise during pregnancy were most likely to suffer postpartum depression and reported greatest bonding impairment with their infants at 6 weeks postpartum. Screening for modifiable risks (interpersonal trauma exposure and labor anxiety) and /or PTSD symptom load during pregnancy appears critical to promote maternal wellbeing. © 2016 Wiley Periodicals, Inc.

PTSD Symptoms across Pregnancy and Early Postpartum Among Women with Lifetime PTSD Diagnosis

PubMed Central

Muzik, Maria; McGinnis, Ellen W.; Bocknek, Erika; Morelen, Diana; Rosenblum, Katherine; Liberzon, Israel; Seng, Julia; Abelson, James L.

2015-01-01

Background Little is known about trajectories of PTSD symptoms across the peripartum period in women with trauma histories, specifically those who met lifetime PTSD diagnoses prior to pregnancy. The present study seeks to identify factors that influence PTSD symptom load across pregnancy and early postpartum, and study its impact on postpartum adaptation. Method The current study is a secondary analysis on pregnant women with a Lifetime PTSD diagnosis (N=319) derived from a larger community sample who were interviewed twice across pregnancy (28 and 35 weeks) and again at 6 weeks postpartum, assessing socioeconomic risks, mental health, past and ongoing trauma exposure, and adaptation to postpartum. Results Using trajectory analysis, first we examined the natural course of PTSD symptoms based on patterns across peripartum, and found 4 distinct trajectory groups. Secondly, we explored factors (demographic, historical, and gestational) that shape the PTSD symptom trajectories, and examined the impact of trajectory membership on maternal postpartum adaptation. We found that child abuse history, demographic risk, and lifetime PTSD symptom count increased pregnancy-onset PTSD risk, whereas gestational PTSD symptom trajectory was best predicted by interim trauma and labor anxiety. Women with the greatest PTSD symptom rise during pregnancy were most likely to suffer postpartum depression and reported greatest bonding impairment with their infants at 6 weeks postpartum. Conclusions Screening for modifiable risks (interpersonal trauma exposure and labor anxiety) and/or PTSD symptom load during pregnancy appears critical to promote maternal wellbeing. PMID:26740305

Risk Factors for Intimate Partner Violence During Pregnancy and Postpartum

PubMed Central

Hellmuth, Julianne C.; Gordon, Kristina Coop; Stuart, Gregory L.; Moore, Todd M.

2012-01-01

Purpose This longitudinal investigation examined potential risk factors for intimate partner violence (IPV) among women during pregnancy and 6 weeks postpartum. Methods A sample of 180 pregnant women was collected in order to investigate 1) whether associations between partner alcohol misuse, partner jealousy, partner suspicion of infidelity, and stress were associated with IPV victimization, 2) the indirect effects of alcohol misuse on these relationships, and 3) factors related to changes in IPV victimization over time. Results At baseline, partner alcohol misuse was associated with each type of IPV victimization and the combination of partner alcohol misuse, partner jealousy, and partner suspicion of infidelity was most strongly associated with severe physical victimization. Partner alcohol misuse mediated the relationship between partner jealousy and psychological and severe physical victimization. At follow-up, partner jealousy and stress were related to women’s psychological victimization and partner alcohol misuse was related to women’s severe physical victimization. Conclusions Findings suggest that partner alcohol misuse is a risk factor for women’s IPV victimization during pregnancy and jealousy and stress may increase risk for some types of IPV. Findings also suggest that intervention should target parents early in pregnancy in order to reduce the risk for future IPV. PMID:23053216

Complementary and alternative medicine use during early pregnancy.

PubMed

Pallivalappila, Abdul Rouf; Stewart, Derek; Shetty, Ashalatha; Pande, Binita; Singh, Rajvir; Mclay, James S

2014-10-01

To determine the prevalence and explore predictors of Complementary and Alternative Medicine (CAM) use during early pregnancy. A questionnaire survey of pregnant women (500) attending for mid trimester scan at the maternity services in Grampian, North-East Scotland. Outcome measures included; CAM used; vitamins and minerals used; independent predictors of use; views and experiences. Descriptive and inferential statistical analysis. The response rate was 66%. Two thirds of respondents (63%) reported using CAM, excluding vitamins and minerals, during early pregnancy. Respondents reported using a total of 28 different CAM modalities, of which oral herbal products were the most common (37% of respondents, 25 different products). The independent predictors of CAM use identified were: use by family and friends (OR 4.1, 95% CI 2.3-7.3, p<0.001); ethnicity (non-white British) (OR 3.4, 95% CI 1.8-6.8, p<0.001); and use prior to pregnancy (OR 2.4, 95% CI 1.2-4.8, p=0.014). In comparison to prescribed medicines, most users were uncertain if CAM were safer (63%), more effective (66%), free from possible adverse effects (46%) or drug-CAM interactions (50%). Despite the majority of respondents being uncertain about their safety and effectiveness, CAM modalities and CAM products are widely used during the early stages of pregnancy in this study population. The role of family and friends rather than health professionals in the decision to use CAM may be of concern and requires further investigation. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Medical abortion in early pregnancy: experience in China.

PubMed

Cheng, Linan

2006-07-01

When medical abortion was first introduced in China, prostaglandins (PGs) were used alone or in combination with Chinese herbs or steroid drugs, but the results were not satisfactory. Mifepristone is now produced in three companies in China and is commonly used with PGs for medical abortion. We performed a Chinese- and English-language literature review of medical abortion in early pregnancy in China. A large multicenter trial conducted in China showed that, when used with a PGF(2alpha) analogue, the complete abortion rate in women given multiple doses of mifepristone (total, 150 mg) was significantly higher than that in women given a single dose of 200 mg of mifepristone. Oral misoprostol (0.6 mg) with mifepristone is now the most commonly used regimen, with a complete abortion rate of over 93%. In China, medical abortion is currently restricted to pregnancies before 49 days, but some hospitals have recently extended the use of medical abortion to pregnancies beyond 49 days. Prolonged bleeding is the main medical abortion side effect and is more likely to occur if the blood levels of human chorionic gonadotrophin fall slowly or when the gestational sac is big. Prescription of testosterone propionate may reduce the duration of bleeding. Over 80% of Chinese women are satisfied with current medical abortion regimens and will choose medical abortion again if they need to terminate a future unwanted pregnancy. Currently, medical abortion is a safe, efficient and acceptable method for the termination of early pregnancy in China.

Purification and partial characterization of an early pregnancy factor-induced suppressor factor (EPF-S1).

PubMed

Rolfe, B A; Athanasas-Platsis, S; Hoskin, M J; Morton, H; Cavanagh, A C

1995-06-01

The immunomodulatory properties of early pregnancy factor (EPF) are mediated through induction of at least two lymphokines, designated EPF-S1 and EPF-S2 (previously estimated M(r) 15,000 and 55,000 respectively). The activity of the former is MHC-restricted while the latter is restricted to a locus (or loci) outside the MHC. The present study established further criteria by which EPF-S1 and EPF-S2 might be distinguished from each other and compared with other suppressor factors. In addition, techniques have been developed to purify EPF-S1 to homogeneity. Congenic mouse strains were used to map the genetic restriction of EPF-S2 in the rosette inhibition test and high performance gel permeation chromatography was used to demonstrate that EPF-S1 induces EPF-S2 but not vice versa. Further studies then focused on isolation of this first component of the cascade, EPF-S1, from immune ascites (from growth in athymic mice of the anti-EPF-S1 producing rat-mouse hybridoma R2T gamma, in which EPF-S1 is complexed to antibody). Techniques used were acidification followed by application to Sep-pak C18 cartridges, high performance cation-exchange chromatography and two reversed-phased HPLC steps on a C3 column. Purified material was analyzed by SDS-PAGE and Edman degradation. Approximately 10 micrograms EPF-S1 were isolated fom 60 ml ascitic fluid. Homogeneity of the purified material was demonstrated by SDS-PAGE, where it ran as a single band of approximate M(r) 12,000 coincident with biological activity. Attempts at Edman degradation indicate that the molecule is N-blocked. Definitive primary characterization of EPF-S1 must await the preparation and isolation of proteolytic fragments of the molecule, but the present studies establish conditions which make such structural analysis possible.

Effect of dietary factors in pregnancy on risk of pregnancy complications: results from the Norwegian Mother and Child Cohort Study1234

PubMed Central

Meltzer, Helle Margrete; Brantsæter, Anne Lise; Nilsen, Roy M; Magnus, Per; Alexander, Jan; Haugen, Margareta

2011-01-01

There has been a thrilling development , as well as profound changes, in our understanding of the effect of fetal nutrition on the development and health of the child. The Norwegian Mother and Child Cohort Study (MoBa) is an ongoing nationwide population-based pregnancy cohort study that between 1999 and 2008 recruited 90,723 women with 106,981 pregnancies and 108,487 children. The objective of MoBa is to test specific etiologic hypotheses by estimating the association between exposures and diseases with a special focus on disorders that may originate in early life. An important aspect in this regard is maternal diet and nutritional status during pregnancy. Nutritional factors have long been considered to be important determinants of maternal and fetal health, and dietary information is currently being collected in a number of pregnancy cohorts in Europe and the United States. Thus far, pregnancy complications studied in MoBa are preterm birth, preeclampsia, and fetal growth; and the aim of this article is to report results of recently published studies of dietary factors in relation to these outcomes. Numerous studies are planned using MoBa data, and the aim is to add to the knowledge of the interplay between dietary factors, nonnutrients, and toxic dietary substances and epigenetic modulation on fetal development and health later in life. PMID:21543541

Predicting risk for childhood asthma by pre-pregnancy, perinatal, and postnatal factors.

PubMed

Wen, Hui-Ju; Chiang, Tung-Liang; Lin, Shio-Jean; Guo, Yue Leon

2015-05-01

Symptoms of atopic disease start early in human life. Predicting risk for childhood asthma by early-life exposure would contribute to disease prevention. A birth cohort study was conducted to investigate early-life risk factors for childhood asthma and to develop a predictive model for the development of asthma. National representative samples of newborn babies were obtained by multistage stratified systematic sampling from the 2005 Taiwan Birth Registry. Information on potential risk factors and children's health was collected by home interview when babies were 6 months old and 5 yr old, respectively. Backward stepwise regression analysis was used to identify the risk factors of childhood asthma for predictive models that were used to calculate the probability of childhood asthma. A total of 19,192 children completed the study satisfactorily. Physician-diagnosed asthma was reported in 6.6% of 5-yr-old children. Pre-pregnancy factors (parental atopy and socioeconomic status), perinatal factors (place of residence, exposure to indoor mold and painting/renovations during pregnancy), and postnatal factors (maternal postpartum depression and the presence of atopic dermatitis before 6 months of age) were chosen for the predictive models, and the highest predicted probability of asthma in 5-yr-old children was 68.1% in boys and 78.1% in girls; the lowest probability in boys and girls was 4.1% and 3.2%, respectively. This investigation provides a technique for predicting risk of childhood asthma that can be used to developing a preventive strategy against asthma. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Circulating Angiogenic Factors and the Risk of Preeclampsia in Systemic Lupus Erythematosus Pregnancies.

PubMed

Leaños-Miranda, Alfredo; Campos-Galicia, Inova; Berumen-Lechuga, María Guadalupe; Molina-Pérez, Carlos José; García-Paleta, Yolanda; Isordia-Salas, Irma; Ramírez-Valenzuela, Karla Leticia

2015-07-01

To investigate whether angiogenic factors are associated with risk of developing preeclampsia in pregnant women with systemic lupus erythematosus (SLE). We performed a nested case-control study within a cohort of SLE women with singleton pregnancies. The study included 42 patients with SLE who eventually developed preeclampsia and 75 normal SLE pregnancies. Serum samples were collected at 4-week intervals (from weeks 12 to 36). Serum samples were analyzed for soluble fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF), and soluble endoglin (sEng). Women destined to develop preeclampsia had lower PlGF levels and higher sFlt-1 and sEng levels, and a higher sFlt-1/PlGF ratio than normal pregnancies. These changes became significant at 12 weeks in patients destined to develop either early onset (< 34 weeks, p ≤ 0.003) or late-onset preeclampsia (≥ 34 weeks, p ≤ 0.02). The risk to develop preeclampsia was higher among patients with PlGF concentration values in the lowest quartile or with sFlt-1 and sEng levels, and sFlt-1/PlGF ratio, in the highest quartile of the normal SLE pregnancies distribution. The OR were higher and appeared earlier in patients destined to develop early onset preeclampsia (OR ≥ 16.2, from Week 12 onward) than in patients who presented preeclampsia later (OR ≥ 8.9, from Week 24 onward). Changes in circulating concentrations of sFlt-1, PlGF, sEng, and the sFlt-1/PlGF ratio precede the onset of preeclampsia in SLE pregnancies. The risk profile of circulating angiogenic factors for developing preeclampsia distinctly evolves depending on whether this condition is manifested earlier or later.

Factors affecting pregnancy length and phases of parturition in Martina Franca jennies.

PubMed

Carluccio, Augusto; Gloria, Alessia; Veronesi, Maria Cristina; De Amicis, Ippolito; Noto, Federico; Contri, Alberto

2015-09-01

The knowledge of normal pregnancy length, duration of parturition stages, and neonatal early adaptation is mandatory for a rationale management of birth, especially in monotocous species with long gestations. This study reports data obtained from a large number of Martina Franca jennies with normal healthy pregnancies and spontaneous eutocic delivery of a mature, healthy, and viable donkey foal. Pregnancy lasts, on average, 371 days, and only the fetal gender significantly determines pregnancy length, with longer gestations observed in jennies bearing male fetuses. Other factors such as the year of foaling, month of ovulation, month of parturition, birth weight of the foal, and age of the jenny did not influence pregnancy length. The first stage of foaling lasted on average 65 minutes, the second stage 19 minutes, and the third stage 58 minutes. The umbilical cord ruptured on average within 16 minutes after birth; the foal stood up in 61 minutes and suckled the colostrum for the first time within 10 minutes after birth and again after 143 minutes of birth; meconium passage occurred, on average, 86 minutes after birth. Although times reported for the process of foaling are similar to data reported for the horse, the times for early neonatal donkey foal adaptation are longer as compared to the horse foal. Copyright © 2015 Elsevier Inc. All rights reserved.

The cellular immunity and oxidative stress markers in early pregnancy loss.

PubMed

Daglar, Korkut; Biberoglu, Ebru; Kirbas, Ayse; Dirican, Aylin Onder; Genc, Metin; Avci, Aslihan; Biberoglu, Kutay

2016-01-01

We investigated whether changes in cellular immunity and oxidative stress in pregnancy have any association with spontaneous miscarriage. Circulating adenosine deaminase (ADA) activity as a marker of cellular immunity and malondialdehyde (MDA) and catalase (CAT), glutathione peroxidase (GPx) as markers of T lymphocyte activation and parameters of oxidative stress and antioxidant defense were compared between 40 women with early pregnancy loss and another 40 women with ungoing healthy pregnancy. Women with miscarriage had higher serum ADA and GPx levels when compared with women with normal pregnancy (p = 0.034 and p < 0.001, respectively). Although serum MDA level was slightly higher in women with miscarriage, the difference was not significant (p = 0.083). CAT levels were alike in both groups. We have demonstrated an increased cellular immunity and perhaps a compensated oxidative stress related to increased antioxidant activation in women with early spontaneous pregnancy loss.

Incidence of Subclinical Hypothyroidism and Hypothyroidism in Early Pregnancy.

PubMed

Akram, Frida Hosseini; Johansson, Bengt; Möllerström, Gunnar; Landgren, Britt-Marie; Stavreus-Evers, Anneli; Skjöldebrand-Sparre, Lottie

2017-11-01

Untreated and subclinical hypothyroidism (SCH) has been associated with adverse pregnancy complications such as increased risk of miscarriage, hypertension, preeclampsia, and preterm delivery. However, in Sweden, screening for thyroid dysfunction during pregnancy is only recommended for women with a high risk of thyroid disease. Therefore, the aim of this study was to determine the incidence of clinical and SCH in women in the first trimester of pregnancy. In this prospective study, 1298 pregnant women were divided into three groups: one unselected general screening group (n = 611), one low-risk group comprising women without risk factors for thyroid disorder (n = 511), and one high-risk group comprising women with an inheritance or suspicion of thyroid disease or undergoing treatment for thyroid disease (n = 88). Serum was obtained up to gestational week 13, and thyrotropin (TSH) was analyzed. The incidences of thyroid dysfunction in the three screening groups were 9.8% in the general screening group, 9.6% in the low-risk group, and 10.2%, p = 0.948, in the high-risk group. In the women with known hypothyroidism on levothyroxine treatment, 50.6% had serum TSH levels above 2.0 mIU/L. High-risk screening is not useful in predicting which women are at risk of thyroid disease in early pregnancy since ∼10% of women with SCH or hypothyroidism could not be diagnosed in this way.

Anemia--prevalence and risk factors in pregnancy.

PubMed

Bencaiova, Gabriela; Burkhardt, Tilo; Breymann, Christian

2012-09-01

To assess the prevalence of decreased iron stores and anemia in pregnant women. To determine whether the risk factors: socio-demographic background, age, BMI, and parity are associated with abnormal hemoglobin concentrations and/or abnormal iron status. A longitudinal study was carried out at the Department of Obstetrics, University Hospital of Zurich to establish the risk factors and prevalence of the decreased iron stores and anemia in early pregnancy. In order to determine the hematological parameters and ferritin levels, venous blood samples of 470 singleton pregnancies between 16 and 20 pregnancy weeks were collected. According to hemoglobin and iron status, the patients were divided into four groups: patients with iron deficiency anemia, patients with decreased iron stores, patients with anemia for other reasons and normal patients. The determinants socio-demographic background, age, BMI and parity were explored using multiple logistic regression analysis. The prevalence of decreased iron stores (ferritin<20 μg/l) was observed in 31.8% of subjects (149/470) and anemia (Hb<110 g/l) in 18.5% (87/470). The prevalence of iron deficiency anemia was higher among women coming from former Yugoslavia and developing countries (p=0.004 and p=0.012). In patients coming from developing countries, a significant increase of anemia for other reasons was observed (p=0.027) and in patients older than 30 years, a significant increase of decreased iron stores (p=0.018). In our study population with low parity, the prevalence of abnormal hemoglobin and abnormal iron status was 50.2% (236/470), and socio-demographic background was the most important risk factor of anemia. Copyright © 2012 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

Anxiety associated with diagnostic uncertainty in early pregnancy.

PubMed

Richardson, A; Raine-Fenning, N; Deb, S; Campbell, B; Vedhara, K

2017-08-01

To determine anxiety levels of women presenting to an early pregnancy assessment unit (EPAU) with abdominal pain and/or vaginal bleeding and to assess how these levels change over time and according to ultrasonographic diagnosis. We undertook a prospective cohort study in an EPAU in a large UK teaching hospital. Women with abdominal pain and/or vaginal bleeding in early pregnancy (< 12 weeks' gestation) presenting for the first time were eligible for inclusion in the study. State anxiety levels were assessed using the standardized short form of Spielberger's state-trait anxiety inventory (STAI) on three occasions (before, immediately after and 48-72 hours after an ultrasound scan). Scores were correlated with ultrasonographic diagnosis. The diagnosis was either certain or uncertain. Certain diagnoses were either positive, i.e. a viable intrauterine pregnancy (IUP), or negative, i.e. a non-viable IUP or ectopic pregnancy. Uncertain diagnoses included pregnancy of unknown location and pregnancy of uncertain viability. Statistical analysis involved mixed ANOVAs and the post-hoc Tukey-Kramer test. A total of 160 women were included in the study. Anxiety levels decreased over time for women with a certain diagnosis (n = 128), even when negative (n = 64), and increased over time for women with an uncertain diagnosis (n = 32). Before the ultrasound examination, anxiety levels were high (STAI value, 21.96 ± 1.11) and there was no significant difference between the five groups. Immediately after the ultrasound examination, anxiety levels were lower in the viable IUP group (n = 64; 7.75 ± 1.13) than in any other group. The difference between the five groups was significant (P < 0.005). After 48-72 hours, women with a certain diagnosis had significantly lower anxiety levels than had those with an uncertain diagnosis (10.77 ± 4.30 vs 22.94 ± 1.65; P < 0.005). The experience of abdominal pain and/or vaginal bleeding in early pregnancy is highly anxiogenic. Following an

Pregnancy at early age is associated with a reduction of progesterone-responsive cells and epithelial Wnt signaling in human breast tissue.

PubMed

Muenst, Simone; Mechera, Robert; Däster, Silvio; Piscuoglio, Salvatore; Ng, Charlotte K Y; Meier-Abt, Fabienne; Weber, Walter P; Soysal, Savas D

2017-04-04

Pregnancy at early age is the most significant modifiable factor which consistently decreases lifetime breast cancer risk. However, the underlying mechanisms haven't been conclusively identified. Studies in mice suggest a reduction in progesterone-receptor (PR) sensitive epithelial cells as well as a downregulation of the Wnt signaling pathway as being one of the main mechanisms for the protective effect of early pregnancy. The aim of our study was to validate these findings in humans. We collected benign breast tissue of 125 women who had been stratified according to age at first pregnancy and the occurrence of subsequent breast cancer, and performed immunohistochemistry for PR, Wnt4 and the Wnt-target Versican. The number of PR positive epithelial cells was significantly lower in the group of women with early pregnancy and no subsequent breast cancer compared to the group of nulliparous women with subsequent invasive breast cancer (p = 0.0135). In women with early pregnancy, expression of Versican and Wnt4 was significantly lower compared to nulliparous women (p = 0.0036 and p = 0.0241 respectively), and Versican expression was also significant lower compared to women with late pregnancy (p < 0.0001). Our results confirm prior observations in mice and suggest a role of downregulation of epithelial Wnt signaling in the protective effect of early pregnancy in humans. This results in a decreased proliferation of stem/progenitor cells; therefore, the Wnt signaling pathway may represent a potential target for breast cancer prevention in humans.

Arsenic and Immune Response to Infection During Pregnancy and Early Life

PubMed Central

Attreed, Sarah E.; Navas-Acien, Ana

2017-01-01

Purpose of Review Arsenic, a known carcinogen and developmental toxicant, is a major threat to global health. While the contribution of arsenic exposure to chronic diseases and adverse pregnancy and birth outcomes is recognized, its ability to impair critical functions of humoral and cell-mediated immunity—including the specific mechanisms in humans—is not well understood. Arsenic has been shown to increase risk of infectious diseases that have significant health implications during pregnancy and early life. Here, we review the latest research on the mechanisms of arsenic-related immune response alterations that could underlie arsenic-associated increased risk of infection during the vulnerable periods of pregnancy and early life. Recent Findings The latest evidence points to alteration of antibody production and transplacental transfer as well as failure of T helper cells to produce IL-2 and proliferate. Summary Critical areas for future research include the effects of arsenic exposure during pregnancy and early life on immune responses to natural infection and the immunogenicity and efficacy of vaccines. PMID:28488132

Physical violence during pregnancy and pregnancy outcomes in Ghana.

PubMed

Pool, Michelle Sharon; Otupiri, Easmon; Owusu-Dabo, Ellis; de Jonge, Ank; Agyemang, Charles

2014-02-15

In pregnancy, violence can have serious health consequences that could affect both mother and child. In Ghana there are limited data on this subject. We sought to assess the relationship between physical violence during pregnancy and pregnancy outcomes (early pregnancy loss, perinatal mortality and neonatal mortality) in Ghana. The 2008 Ghana Demographic and Health Survey data were used. For the domestic violence module, 2563 women were approached of whom 2442 women completed the module. After excluding missing values and applying the weight factor, 1745 women remained. Logistic regression analysis was performed to assess the relationship between physical violence in pregnancy and adverse pregnancy outcomes with adjustments for potential confounders. About five percent of the women experienced violence during their pregnancy. Physical violence in pregnancy was positively associated with perinatal mortality and neonatal mortality, but not with early pregnancy loss. The differences remained largely unchanged after adjustment for age, parity, education level, wealth status, marital status and place of residence: adjusted odds ratios were 2.32; 95% CI: 1.34-4.01 for perinatal mortality, 1.86; 95% CI: 1.05-3.30 for neonatal mortality and 1.16; 95% CI: 0.60-2.24 for early pregnancy loss. Our findings suggest that violence during pregnancy is related to adverse pregnancy outcomes in Ghana. Major efforts are needed to tackle violence during pregnancy. This can be achieved through measures that are directed towards the right target groups. Measures should include education, empowerment and improving socio-economic status of women.

Systematic Review of Chinese Medicine for Miscarriage during Early Pregnancy

PubMed Central

Leung, Ping Chung; Chung, Tony Kwok Hung; Wang, Chi Chiu

2014-01-01

Background. Miscarriage is a very common complication during early pregnancy. So far, clinical therapies have limitation in preventing the early pregnancy loss. Chinese Medicine, regarded as gentle, effective, and safe, has become popular and common as a complementary and alternative treatment for miscarriages. However, the evidence to support its therapeutic efficacy and safety is still very limited. Objectives and Methods. To summarize the clinical application of Chinese Medicine for pregnancy and provide scientific evidence on the efficacy and safety of Chinese medicines for miscarriage, we located all the relevant pieces of literature on the clinical applications of Chinese Medicine for miscarriage and worked out this systematic review. Results. 339,792 pieces of literature were identified, but no placebo was included and only few studies were selected for systematic review and conducted for meta-analysis. A combination of Chinese medicines and Western medicines was more effective than Chinese medicines alone. No specific safety problem was reported, but potential adverse events by certain medicines were identified. Conclusions. Studies vary considerably in design, interventions, and outcome measures; therefore conclusive results remain elusive. Large scales of randomized controlled trials and more scientific evidences are still necessary to confirm the efficacy and safety of Chinese medicines during early pregnancy. PMID:24648851

Neurotrophic Factors and Maternal Nutrition During Pregnancy.

PubMed

Dhobale, M

2017-01-01

Maternal nutrition is one of the major determinants of pregnancy outcome. It has been suggested that reduced intakes or lack of specific nutrients during pregnancy influences the length of gestation, proper placental and fetal growth during pregnancy. Maternal nutrition, particularly micronutrients such as folate and vitamin B 12 , and long-chain polyunsaturated fatty acids (LCPUFA) are the major determinants of the one carbon cycle and are suggested to be at the heart of intrauterine programming of diseases in adult life. LCPUFA play a key role in the normal feto-placental development, as well as in the development and functional maturation of the brain and central nervous system and also regulate the levels of neurotrophic factors. These neurotrophic factors are known to regulate the development of the placenta at the materno-fetal interface and act in a paracrine and endocrine manner. Neurotrophic factors like brain-derived neurotrophic factor and nerve growth factor are proteins involved in angiogenesis and potentiate the placental development. This chapter mainly focuses on micronutrients since they play a main physiological role during pregnancy. © 2017 Elsevier Inc. All rights reserved.

Early pregnancy exposure to feto-toxic medications among out-patients in Malawi.

PubMed

Kabuluzi, Ezereth; Campbell, Malcolm; McGowan, Linda; Chirwa, Ellen; Brabin, Loretta

2014-08-01

To estimate the proportion of women in early pregnancy prescribed potentially feto-toxic medications at an out-patient clinic in Malawi. Over six-months the number of women of child-bearing age attending out-patient clinics and prescribed medicines at Mitundu Community Hospital was derived from the hospital's registry and pharmacy records. Women prescribed potentially feto-toxic medicines (using Food and Drug Administration classifications) by medical assessments were subsequently interviewed and pregnancy tested. Exposure to potentially feto-toxic medications was estimated and differences between pregnant and non-pregnant women were described. Of 8970 female outpatients, 1012 (11.3%; 95% CI: 10.6% to 12%) were prescribed potentially feto-toxic medicines. After excluding 740 as unlikely to be pregnant, 209 women had negative pregnancy tests and 63 were confirmed as pregnant, representing one in 16 of women prescribed contraindicated medicines or between 2.8% and 3.5% of all women attending in early pregnancy. Most medicines were FDA rated C or D. Only 152 (55.9%) of these women had been asked about pregnancy and prescribing practices did not discriminate between pregnant and non-pregnant patients. Assessment and prescribing practices for women attending out-patient clinics who might be in early pregnancy were inadequate, increasing the risk of exposure to potentially feto-toxic medicines.

The impact of nausea and vomiting on women: a burden of early pregnancy.

PubMed

Smith, C; Crowther, C; Beilby, J; Dandeaux, J

2000-11-01

Nausea and vomiting are troublesome symptoms occurring in the first trimester of pregnancy. The aim of this study was to describe the impact these symptoms have on women in early pregnancy by interviewing, using a structured questionnaire, 593 pregnant women presenting with nausea and vomiting in the first trimester of pregnancy. The women were asked to complete the Rhodes index of nausea and vomiting and the MOS 36 Short Form Health Survey (SF-36). Symptoms of nausea and vomiting started early in pregnancy. Nausea was the most troublesome symptom experienced by women, both in its duration and intensity. Low scores for the SF-36 were found for all items, particularly physical functioning, energy and social functioning. The women described substantial effects on working, household duties and parenting activities. Findings from this study suggest nausea and vomiting in early pregnancy has a profound impact on women's general sense of well-being and day to day life activities.

Epidemiologic Tools to Study the Influence of Environmental Factors on Fecundity and Pregnancy-related Outcomes

PubMed Central

Slama, Rémy; Ballester, Ferran; Casas, Maribel; Cordier, Sylvaine; Eggesbø, Merete; Iniguez, Carmen; Nieuwenhuijsen, Mark; Philippat, Claire; Rey, Sylvie; Vandentorren, Stéphanie; Vrijheid, Martine

2014-01-01

Adverse pregnancy outcomes entail a large health burden for the mother and offspring; a part of it might be avoided by better understanding the role of environmental factors in their etiology. Our aims were to review the assessment tools to characterize fecundity troubles and pregnancy-related outcomes in human populations and their sensitivity to environmental factors. For each outcome, we reviewed the possible study designs, main sources of bias, and their suggested cures. In terms of study design, for most pregnancy outcomes, cohorts with recruitment early during or even before pregnancy allow efficient characterization of pregnancy-related events, time-varying confounders, and in utero exposures that may impact birth outcomes and child health. Studies on congenital anomalies require specific designs, assessment of anomalies in medical pregnancy terminations, and, for congenital anomalies diagnosed postnatally, follow-up during several months after birth. Statistical analyses should take into account environmental exposures during the relevant time windows; survival models are an appropriate approach for fecundity, fetal loss, and gestational duration/preterm delivery. Analysis of gestational duration could distinguish pregnancies according to delivery induction (and possibly pregnancy-related conditions). In conclusion, careful design and analysis are required to better characterize environmental effects on human reproduction. PMID:24363355

Epidemiologic tools to study the influence of environmental factors on fecundity and pregnancy-related outcomes.

PubMed

Slama, Rémy; Ballester, Ferran; Casas, Maribel; Cordier, Sylvaine; Eggesbø, Merete; Iniguez, Carmen; Nieuwenhuijsen, Mark; Philippat, Claire; Rey, Sylvie; Vandentorren, Stéphanie; Vrijheid, Martine

2014-01-01

Adverse pregnancy outcomes entail a large health burden for the mother and offspring; a part of it might be avoided by better understanding the role of environmental factors in their etiology. Our aims were to review the assessment tools to characterize fecundity troubles and pregnancy-related outcomes in human populations and their sensitivity to environmental factors. For each outcome, we reviewed the possible study designs, main sources of bias, and their suggested cures. In terms of study design, for most pregnancy outcomes, cohorts with recruitment early during or even before pregnancy allow efficient characterization of pregnancy-related events, time-varying confounders, and in utero exposures that may impact birth outcomes and child health. Studies on congenital anomalies require specific designs, assessment of anomalies in medical pregnancy terminations, and, for congenital anomalies diagnosed postnatally, follow-up during several months after birth. Statistical analyses should take into account environmental exposures during the relevant time windows; survival models are an appropriate approach for fecundity, fetal loss, and gestational duration/preterm delivery. Analysis of gestational duration could distinguish pregnancies according to delivery induction (and possibly pregnancy-related conditions). In conclusion, careful design and analysis are required to better characterize environmental effects on human reproduction.

Termination of pregnancy at very early gestation without visible yolk sac on ultrasound.

PubMed

Heller, Rebecca; Cameron, Sharon

2015-04-01

Requests for termination of pregnancy (TOP) at very early gestation (≤6 weeks) can prove challenging for abortion services as the ultrasound feature usually accepted as definitive evidence of an intrauterine pregnancy (IUP), the presence of a yolk sac within a gestational sac, may not yet be evident. In 2011 the Edinburgh TOP service introduced a protocol permitting women to proceed to treatment without further investigations provided that ultrasound showed the features of an eccentrically placed gestational sac (≥3 mm) with a decidual reaction, and there were no signs, symptoms or risk factors for ectopic pregnancy. A retrospective audit was conducted of outcomes of women presenting for TOP at ≤6 weeks' gestation over a 2-year period using the hospital computerised database. A total of 1155 women presented for TOP with an ultrasound gestational age of ≤6 weeks. Of these, 1030 (89%) had ultrasound evidence of a yolk sac. Eighty-seven women (7.5%) had an eccentrically placed gestational sac with a decidual reaction. All 87 women fulfilled our criteria to proceed to medical TOP, and 66 did so. In the remaining 21 cases, further investigations were performed before they proceeded to medical TOP. Two (0.17%) medical TOPs failed, both in women whose initial ultrasound had shown a yolk sac. Women with ultrasound features consistent with a very early IUP (≥3 mm eccentrically placed gestational sac with a decidual reaction) and without signs, symptoms or risk factors for ectopic pregnancy can proceed directly to medical TOP without the need for delay for further ultrasonography. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Two consecutive pregnancies in early and late stage of amyotrophic lateral sclerosis.

PubMed

Sarafov, Stayko; Doitchinova, Maryana; Karagiozova, Zhvka; Slancheva, Boriana; Dengler, Reinhard; Petri, Susanne; Kollewe, Katja

2009-01-01

There are few reports on pregnancies in sporadic and familial amyotrophic lateral sclerosis (ALS). We report on a young woman with sporadic ALS who gave birth twice during the course of her disease. The first pregnancy occurred 13 months after the onset of symptoms, and one month after diagnosis. The pregnancy was uncomplicated and resulted in vaginal delivery of a healthy boy. Fifteen months later, when she was already bed-ridden, she became pregnant again. She received a percutaneous endoscopic gastrostomy in the 21st gestational week and underwent early Caesarean section in the 34th week of gestation. The child was ventilated for 72 h in a neonatological unit. The patient was tracheotomized and ventilated two months later, i.e. 47 months after symptom onset, and died nine months later from gastrointestinal haemorrhage. Her two children have developed without abnormalities to date. This case confirms that pregnancies in early-stage ALS can develop normally and may result in uncomplicated vaginal delivery. Pregnancies in late stages may be critical for mother and child, and early delivery by Caesarean section may become necessary although neonatal outcome can be good.

Predictive Factors of Plasma HIV Suppression during Pregnancy: A Prospective Cohort Study in Benin

PubMed Central

Ogouyemi-Hounto, Aurore; Azon-Kouanou, Angèle; d'Almeida, Marcelline; Azondékon, Alain; Alao, Marouf J.; Dossou-Gbété, Véronique; Afangnihoun, Aldric; Girard, Pierre-Marie; Cot, Michel; Zannou, Djimon-Marcel

2013-01-01

Objective To investigate the factors associated with HIV1 RNA plasma viral load (pVL) below 40 copies/mL at the third trimester of pregnancy, as part of prevention of mother-to-child transmission (PMTCT) in Benin. Design Sub study of the PACOME clinical trial of malaria prophylaxis in HIV-infected pregnant women, conducted before and after the implementation of the WHO 2009 revised guidelines for PMTCT. Methods HIV-infected women were enrolled in the second trimester of pregnancy. Socio-economic characteristics, HIV history, clinical and biological characteristics were recorded. Malaria prevention and PMTCT involving antiretroviral therapy (ART) for mothers and infants were provided. Logistic regression helped identifying factors associated with virologic suppression at the end of pregnancy. Results Overall 217 third trimester pVLs were available, and 71% showed undetectability. Virologic suppression was more frequent in women enrolled after the change in PMTCT recommendations, advising to start ART at 14 weeks instead of 28 weeks of pregnancy. In multivariate analysis, Fon ethnic group (the predominant ethnic group in the study area), regular job, first and second pregnancy, higher baseline pVL and impaired adherence to ART were negative factors whereas higher weight, higher antenatal care attendance and longer ART duration were favorable factors to achieve virologic suppression. Conclusions This study provides more evidence that ART has to be initiated before the last trimester of pregnancy to achieve an undetectable pVL before delivery. In Benin, new recommendations supporting early initiation were well implemented and, together with a high antenatal care attendance, led to high rate of virologic control. PMID:23555035

Predictive factors of plasma HIV suppression during pregnancy: a prospective cohort study in Benin.

PubMed

Denoeud-Ndam, Lise; Fourcade, Camille; Ogouyemi-Hounto, Aurore; Azon-Kouanou, Angèle; d'Almeida, Marcelline; Azondékon, Alain; Alao, Marouf J; Dossou-Gbété, Véronique; Afangnihoun, Aldric; Girard, Pierre-Marie; Cot, Michel; Zannou, Djimon-Marcel

2013-01-01

To investigate the factors associated with HIV1 RNA plasma viral load (pVL) below 40 copies/mL at the third trimester of pregnancy, as part of prevention of mother-to-child transmission (PMTCT) in Benin. Sub study of the PACOME clinical trial of malaria prophylaxis in HIV-infected pregnant women, conducted before and after the implementation of the WHO 2009 revised guidelines for PMTCT. HIV-infected women were enrolled in the second trimester of pregnancy. Socio-economic characteristics, HIV history, clinical and biological characteristics were recorded. Malaria prevention and PMTCT involving antiretroviral therapy (ART) for mothers and infants were provided. Logistic regression helped identifying factors associated with virologic suppression at the end of pregnancy. Overall 217 third trimester pVLs were available, and 71% showed undetectability. Virologic suppression was more frequent in women enrolled after the change in PMTCT recommendations, advising to start ART at 14 weeks instead of 28 weeks of pregnancy. In multivariate analysis, Fon ethnic group (the predominant ethnic group in the study area), regular job, first and second pregnancy, higher baseline pVL and impaired adherence to ART were negative factors whereas higher weight, higher antenatal care attendance and longer ART duration were favorable factors to achieve virologic suppression. This study provides more evidence that ART has to be initiated before the last trimester of pregnancy to achieve an undetectable pVL before delivery. In Benin, new recommendations supporting early initiation were well implemented and, together with a high antenatal care attendance, led to high rate of virologic control.

Contraceptive Vaccines Targeting Factors Involved in Establishment of Pregnancy

PubMed Central

Lemons, Angela R.; Naz, Rajesh K.

2011-01-01

Problem Current methods of contraception lack specificity and are accompanied with serious side effects. A more specific method of contraception is needed. Contraceptive vaccines can provide most, if not all, the desired characteristics of an ideal contraceptive. Approach This article reviews several factors involved in the establishment of pregnancy, focusing on those that are essential for successful implantation. Factors that are both essential and pregnancy-specific can provide potential targets for contraception. Conclusion Using database search, 76 factors (cytokines/chemokines/growth factors/others) were identified that are involved in various steps of the establishment of pregnancy. Among these factors, three, namely chorionic gonadotropin (CG), leukemia inhibitory factor (LIF), and preimplantation factor (PIF), are found to be unique and exciting molecules. Human CG is a well-known pregnancy-specific protein that has undergone phase I and phase II clinical trials, in women, as a contraceptive vaccine with encouraging results. LIF and PIF are pregnancy-specific and essential for successful implantation. These molecules are intriguing and may provide viable targets for immunocontraception. A multiepitope vaccine combining factors/antigens involved in various steps of the fertilization cascade and pregnancy establishment, may provide a highly immunogenic and efficacious modality for contraception in humans. PMID:21481058

Factors associated with unintended pregnancy in Yamagata, Japan.

PubMed

Goto, Aya; Yasumura, Seiji; Reich, Michael R; Fukao, Akira

2002-04-01

Data on unintended pregnancy are scarce in Japan. The purpose of this study is to examine the association of sociodemographic, reproductive, and other health behavioral factors with unintended pregnancy. A survey was conducted from May through November 1999 in Yamagata, Japan. We distributed anonymous self-administered questionnaires to cervical and breast cancer screening participants aged 35-49 years. There were 564 eligible women, and the number of respondents was 421 (74.6%). The proportion of women who had experienced unintended pregnancy was 46.2%, and 40.1% of them had repeated experiences. Among 312 pre-menopausal married women who did not want to become pregnant, 15.4% were not using any contraception. Factors that were significantly associated with the experience of unintended pregnancy were age of husband being 4 or more years older [Odds ratio (OR) = 1.83], and age at initiation of sexual intercourse (OR = 1.86) and marriage during teens (OR = 11.14). Analysis of 1255 pregnancies that the subjects had experienced showed that 51.2% and 25.9% of mistimed and unwanted pregnancies occurred as a result of no contraceptive use, and 39.5% and 71.1% of these ended in abortions. The number of past unintended pregnancies was significantly (p < 0.001) correlated with the number of pregnancies (r(s) = 0.49), live births 0.20) and abortions (r(s) = 0.63). This is the first epidemiological study in Japan to examine factors associated with unintended pregnancy, and also contraceptive use and pregnancy outcome for each of the unintended pregnancy women had experienced. Unintended pregnancy is not a rare event among our target population, and many unintended pregnancies leading to abortion could be prevented by effective contraceptive use. Results suggest that Yamagata's family planning strategies need to target both the younger and older generations, and address the role of men. A woman's pregnancy history reflecting her past experience of unintended pregnancy could be

Risk factors for early infant mortality in Sarlahi district, Nepal.

PubMed Central

Katz, Joanne; West, Keith P.; Khatry, Subarna K.; Christian, Parul; LeClerq, Steven C.; Pradhan, Elizabeth Kimbrough; Shrestha, Sharada Ram

2003-01-01

OBJECTIVES: Early infant mortality has not declined as rapidly as child mortality in many countries. Identification of risk factors for early infant mortality may help inform the design of intervention strategies. METHODS: Over the period 1994-97, 15,469 live-born, singleton infants in rural Nepal were followed to 24 weeks of age to identify risk factors for mortality within 0-7 days, 8-28 days, and 4-24 weeks after the birth. FINDINGS: In multivariate models, maternal and paternal education reduced mortality between 4 and 24 weeks only: odds ratios (OR) 0.28 (95% confidence interval (CI) = 0.12-0.66) and 0.63 (95% CI = 0.44-0.88), respectively. Miscarriage in the previous pregnancy predicted mortality in the first week of life (OR = 1.98, 95% CI = 1.37-2.87), whereas prior child deaths increased the risk of post-neonatal death (OR = 1.85, 95% CI 1.24-2.75). A larger maternal mid-upper arm circumference reduced the risk of infant death during the first week of life (OR = 0.88, 95% CI = 0.81-0.95). Infants of women who did not receive any tetanus vaccinations during pregnancy or who had severe illness during the third trimester were more likely to die in the neonatal period. Maternal mortality was strongly associated with infant mortality (OR = 6.43, 95% CI = 2.35-17.56 at 0-7 days; OR = 11.73, 95% CI = 3.82-36.00 at 8-28 days; and OR = 51.68, 95% CI = 20.26-131.80 at 4-24 weeks). CONCLUSION: Risk factors for early infant mortality varied with the age of the infant. Factors amenable to intervention included efforts aimed at maternal morbidity and mortality and increased arm circumference during pregnancy. PMID:14758431

Maternal nutritional status in early pregnancy is associated with body water and plasma volume changes in a pregnancy cohort in rural Bangladesh.

PubMed

Gernand, Alison D; Christian, Parul; Schulze, Kerry J; Shaikh, Saijuddin; Labrique, Alain B; Shamim, Abu Ahmed; West, Keith P

2012-06-01

Plasma volume expansion has been associated with fetal growth. Our objective was to examine the associations between maternal nutritional status in early pregnancy and extracellular water (ECW), total body water (TBW), and percentage plasma volume change across pregnancy. In a subsample of 377 pregnant women participating in a cluster-randomized trial of micronutrient supplementation, hemoglobin, hematocrit, and multi-frequency bioelectrical impedance were measured at ~10, 20, and 32 wk of gestation. In early pregnancy, women were short (mean ± SD, 148.9 ± 5.3 cm) and thin (19.5 ± 2.5 kg/m(2)). In mixed-effects multiple regression models, a 1-unit higher BMI at ~10 wk was associated with higher ECW and TBW (0.27 and 0.66 kg per kg/m(2), respectively; P < 0.01) at ~10, ~20, and ~32 wk. Height was also positively associated with ECW and TBW at each time point. Early pregnancy BMI was negatively associated with gains in ECW and TBW (-0.06 and -0.14 kg per kg/m(2), respectively; P < 0.01) from 10 to 20 wk, but not with 20- to 32-wk gains after accounting for weight gain. BMI was positively associated with percentage changes in plasma volume from 20 to 32 wk (0.57% per kg/m(2); P < 0.05). Height was not associated with changes in body water or plasma volume. Women with low BMI and height in early pregnancy have lower ECW and TBW in early, mid, and late pregnancy and lower late pregnancy plasma volume expansion, potentially increasing risk of fetal growth restriction.

Pregnancy Is a Risk Factor for Secondary Focal Segmental Glomerulosclerosis in Women with a History of Very Low Birth Weight

PubMed Central

Tanaka, Mari; Iwanari, Sachio; Tsujimoto, Yasushi; Taniguchi, Keisuke; Hagihara, Koichiro; Fumihara, Daiki; Miki, Syo; Shimoda, Saeko; Ikeda, Masaki; Takeoka, Hiroya

2017-01-01

Low birth weight (LBW) has been known to increase the susceptibility to renal injury in adulthood. A 26-year-old woman developed proteinuria in early pregnancy; she had been born with very LBW. The clinical course was progressive, and an emergency Caesarean section was performed at 36 weeks due to acute kidney injury. A renal biopsy provided a diagnosis of post-adaptive focal segmental glomerulosclerosis. Increased demand for glomerular filtration during early pregnancy appeared to have initiated the renal injury. This report highlights the fact that pregnancy might be a risk factor for renal injury in women born with LBW. PMID:28626180

Pregnancy Is a Risk Factor for Secondary Focal Segmental Glomerulosclerosis in Women with a History of Very Low Birth Weight.

PubMed

Tanaka, Mari; Iwanari, Sachio; Tsujimoto, Yasushi; Taniguchi, Keisuke; Hagihara, Koichiro; Fumihara, Daiki; Miki, Syo; Shimoda, Saeko; Ikeda, Masaki; Takeoka, Hiroya

2017-01-01

Low birth weight (LBW) has been known to increase the susceptibility to renal injury in adulthood. A 26-year-old woman developed proteinuria in early pregnancy; she had been born with very LBW. The clinical course was progressive, and an emergency Caesarean section was performed at 36 weeks due to acute kidney injury. A renal biopsy provided a diagnosis of post-adaptive focal segmental glomerulosclerosis. Increased demand for glomerular filtration during early pregnancy appeared to have initiated the renal injury. This report highlights the fact that pregnancy might be a risk factor for renal injury in women born with LBW.

Improving Outcomes for Teenage Pregnancy and Early Parenthood for Young People in Out-of-Home Care: A Review of the Literature

ERIC Educational Resources Information Center

Mendes, Philip

2009-01-01

Young people leaving out-of-home care are overrepresented among teenage parents. This paper examines the research literature and identifies key factors that contribute to early pregnancy and parenthood for care leavers, the challenges of early parenting and the positive effects of early parenting. The implications for out-of-home care policy and…

Factors Affecting Depression During Pregnancy and the Correlation Between Social Support and Pregnancy Depression.

PubMed

Aktas, Songul; Yesilcicek Calik, Kiymet

2015-09-01

Women are seriously subjected to psychiatric diseases during pregnancy and depression is the most prevailing one among these diseases. There is a relation between the social support and depression in pregnancy whose predisposing factors are genetic, psychological, biological, environmental, and hormonal. This study aimed to determine the frequency of depression symptoms, and its risk factors. Also it studied the correlation between social support and pregnancy depression. This research is a descriptive cross-sectional study. It was conducted on 266 pregnant women selected by simple random method from all pregnant women admitted at the Maternity Hospital of Trabzon, Turkey from May 21 to June 13, 2008. The data were collected with a questionnaire form, the Beck depression inventory (BDI), and the multidimensional scale of perceived social support (MSPSS). The mean BDI score of the pregnant women was 11.12 ± 6.65. According to the BDI, 46.2% of the pregnant women had no depression symptoms, 34.59% of them had mild, 13.91% had moderate, and 4.89% had severe level of depression symptoms. It was found that such factors as the educational level of the pregnant women and their husbands, having an undesired pregnancy, suffering from a chronic disease before pregnancy, presence of pregnancy-related problems, having a child with disability or having relatives whose children had disability, and smoking during pregnancy were the risk factors affecting the severity of the depression symptoms and these results were statistically significant (P < 0.05). On the other hand, the mean MSPSS score was 67.89 ± 14.26 and it was found that the pregnant women got the highest social support from their husbands. It was found that there was a significant correlation between BDI and MSPSS total score and its subscale scores (P < 0.05). According to this study, one-fifth of pregnant women were found to experience depressive symptoms, which require treatment during pregnancy, and the factors

Diagnostic value of the plasmatic ADM level for early ectopic pregnancy.

PubMed

Yan, Qi; Lu, Qi; Tao, Yu; Wang, Yu-Dong; Zhao, Wen-Xia

2015-01-01

To analyze the plasmatic ADM level in early pregnancy and to investigate the diagnostic value of ADM in early ectopic pregnancy (EP). 70 patients with EP who had menopause for 5~8 weeks were included as study group, while 155 women with normal intrauterine pregnancy were also included as control group. The correlation between ADM level and menopause weeks was statistically analyzed and ROC curve was used to identify the diagnostic value of ADM. (1) In 155 cases of normal intrauterine pregnancy, the plasmatic ADM level was increased with menopause weeks in linear relationship, and the correlation coefficient (R) was 0.991 (P<0.05). In 70 patients with EP, no significant increase was found with menopause weeks and no linear relationship can be found between ADM level and menopause weeks in EP group. The correlation coefficient (R) was 0.744 (P>0.05). (2) The multiple of median of plasmatic ADM level in EP group of menopause for 8 weeks was obviously lower than the intrauterine control group (P<0.01). (3) ROC curve was used to analyze the cut-off value of ADM level in the diagnosis of EP, and the area under the ROC curve was 0.523 (P>0.05) regardless of menopause weeks, however, the area under the ROC curve was 0.702 (P<0.05) at 8 weeks after menopause with sensitivity of 53.50% and specificity of 85.00%. Different from normal intrauterine pregnancy, plasmatic ADM level in early EP was relatively lower and no significant increase was found with menopause weeks; further studies are still needed for plasmatic ADM level as an indicator in the early diagnosis of EP.

Early pregnancy in the mare: old concepts revisited.

PubMed

Klein, C

2016-07-01

"Maternal recognition of pregnancy" (MRP) is commonly used to describe the ongoing embryo-maternal communication during early pregnancy that culminates in prevention of luteolysis and ensures ongoing progestin support. The conceptus-derived pregnancy recognition signal has not yet been identified in the mare. Although equine conceptuses produce substantial amounts of estrogens, there is a lack of evidence that estrogens are the pregnancy recognition signal in mares. Conceptus mobility is integral to MRP and is driven by conceptus-derived prostaglandin production. Cessation of conceptus mobility, referred to as fixation, is caused by increases in conceptus size and uterine tone and reduction in sialic acid content of the embryonic capsule. Gene expression profiling of equine preimplantation conceptuses revealed expression of neuraminidase 2 (NEU2), an enzyme that cleaves sialic acid from polysaccharide chains. Furthermore, secretion of NEU2 by conceptuses in vitro was functionally active; it appears therefore, that the conceptus itself regulates sialic acid content through expression of NEU2. Based on gene expression profiling, equine conceptuses express increasing amounts of fibrinogen during early development. Western blot analysis confirmed secretion of fibrinogen into culture medium when conceptuses were cultured in vitro and with immunohistochemistry, the acellular glycoprotein capsule of the conceptus had particularly intense staining for fibrinogen. Therefore, we hypothesize that conceptus-derived fibrinogen interacts with endometrial integrins to promote cessation of conceptus mobility and fixation. Indeed, next generation sequencing analysis of conceptus and endometrial samples 16 d after ovulation revealed that the integrin signaling pathway is significantly enriched in both sample types. Real-time reverse transcription polymerase chain reaction (RT-PCR) confirmed ITGAVB1 as the most abundant integrin receptor in endometrium; fibrinogen has the highest

Factor V Leiden mutation in pregnancy.

PubMed

Cohen, Susan Murphy

2004-01-01

Normal maternal adaptation to pregnancy significantly increases the risk for thrombus formation. Inherited thrombophilias further increase risk for deep venous thrombosis and adverse outcome in pregnancy. Factor V Leiden mutation is the most common inherited thrombophilia, occurring in approximately 5% of the White and 1% of the Black populations. Nurses should be knowledgeable about screening for and diagnosis of factor V Leiden mutation, risk reduction counseling, recommended care of the affected patient, and implications of anticoagulant therapy during the perinatal period.

Association between early pregnancy vitamin D status and changes in serum lipid profiles throughout pregnancy.

PubMed

Lepsch, Jaqueline; Eshriqui, Ilana; Farias, Dayana Rodrigues; Vaz, Juliana S; Cunha Figueiredo, Amanda C; Adegboye, Amanda Rodrigues Amorim; Brito, Alex; Mokhtar, Rana; Allen, Lindsay H; Holick, Michael F; Kac, Gilberto

2017-05-01

To evaluate the associations between first trimester 25-hydroxyvitamin D [25(OH)D] status and changes in high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), total cholesterol (TC), triglyceride (TG) concentrations, TG/HDL-c, and TC/HDL-c ratios throughout pregnancy. We hypothesized that first trimester 25(OH)D inadequacy is associated with lower concentrations of HDL-c and higher LDL-c, TC, TG, TG/HDL-c, and TC/HDL-c ratios throughout pregnancy. A prospective cohort study with 3 visits at 5-13 (baseline), 20-26, and 30-36 gestational weeks, recruited 194 pregnant women attending a public health care center in Rio de Janeiro, Brazil. Plasma 25(OH)D concentrations were measured in the first trimester using liquid chromatography-tandem mass spectrometry. 25(OH)D concentrations were classified as adequate (≥75nmol/L) or inadequate (<75nmol/L). Serum TC, HDL-c, and TG concentrations were measured enzymatically. Crude and adjusted longitudinal linear mixed-effects models were employed to evaluate the association between the first trimester 25(OH)D status and changes in serum lipid concentrations throughout pregnancy. Confounders adjusted for in the multiple analysis were age, homeostatic model assessment (HOMA), early pregnancy BMI, leisure time physical activity before pregnancy, energy intake, and gestational age. At baseline, 69% of the women had inadequate concentrations of 25(OH)D. Women with 25(OH)D inadequacy had higher mean LDL-c than those with adequate concentrations (91.3 vs. 97.5mg/dL; P=0.064) at baseline. TC, HDL-c, LDL-c TG, TG/HDL-c ratios, and TC/HDL-c ratios, increased throughout pregnancy independently of 25(OH)D concentrations (ANOVA for repeated measures P<0.001). The adjusted models showed direct associations between the first trimester 25(OH)D status and changes in TC (β=9.53; 95%CI=1.12-17.94), LDL-c (β=9.99; 95% CI=3.62-16.36) concentrations, and TC/HDL-c ratios (β=0.16; 95% CI=0.01-0.31) throughout

Chronic Exposure to Bisphenol A Affects Uterine Function During Early Pregnancy in Mice

PubMed Central

Davila, Juanmahel; Kannan, Athilakshmi; Flaws, Jodi A.; Bagchi, Milan K.

2016-01-01

Environmental and occupational exposure to bisphenol A (BPA), a chemical widely used in polycarbonate plastics and epoxy resins, has received much attention in female reproductive health due to its widespread toxic effects. Although BPA has been linked to infertility and recurrent miscarriage in women, the impact of its exposure on uterine function during early pregnancy remains unclear. In this study, we addressed the effect of prolonged exposure to an environmental relevant dose of BPA on embryo implantation and establishment of pregnancy. Our studies revealed that treatment of mice with BPA led to improper endometrial epithelial and stromal functions thus affecting embryo implantation and establishment of pregnancy. Upon further analyses, we found that the expression of progesterone receptor (PGR) and its downstream target gene, HAND2 (heart and neural crest derivatives expressed 2), was markedly suppressed in BPA-exposed uterine tissues. Previous studies have shown that HAND2 controls embryo implantation by repressing fibroblast growth factor and the MAPK signaling pathways and inhibiting epithelial proliferation. Interestingly, we observed that down-regulation of PGR and HAND2 expression in uterine stroma upon BPA exposure was associated with enhanced activation of fibroblast growth factor and MAPK signaling in the epithelium, thus contributing to aberrant proliferation and lack of uterine receptivity. Further, the differentiation of endometrial stromal cells to decidual cells, an event critical for the establishment and maintenance of pregnancy, was severely compromised in response to BPA. In summary, our studies revealed that chronic exposure to BPA impairs PGR-HAND2 pathway and adversely affects implantation and the establishment of pregnancy. PMID:27022677

Risk factors for unplanned pregnancy in women with mental illness living in a developing country.

PubMed

du Toit, Elsa; Jordaan, Esme; Niehaus, Dana; Koen, Liezl; Leppanen, Jukka

2018-06-01

Pregnant women in general are at an increased risk of experiencing symptoms of mental illness, and those living in a developing country are even more vulnerable. Research points towards a causal relationship between unplanned pregnancy and perinatal mental illness and suggests that pregnancy planning can aid in reducing the negative impact of mental illness on a woman, her unborn baby, and the rest of the family. In this quantitative, descriptive study, we investigated both socio-demographic factors and variables relating to mental illness itself that may place women at an increased risk of experiencing unplanned pregnancy. Data was gathered at two maternal mental health clinics in Cape Town by means of semi-structured interviews. Univariate analyses of the data revealed five independent key risk factors for unplanned pregnancy: lower levels of education, unmarried status, belonging to the Colored ethnic population, substance use, and having a history of two or more suicide attempts. Some of these factors overlap with findings of similar studies, but others are unique to the specific population (women with mental illness within a developing country). Screening of women based on these risk predictors may pave the way for early interventions and reduce the incidence of unplanned pregnancy and the negative consequences thereof in the South African population.

Malignancy during pregnancy in Japan: an exceptional opportunity for early diagnosis.

PubMed

Sekine, Masayuki; Kobayashi, Yoshiyuki; Tabata, Tsutomu; Sudo, Tamotsu; Nishimura, Ryuichiro; Matsuo, Koji; Grubbs, Brendan H; Enomoto, Takayuki; Ikeda, Tomoaki

2018-02-08

Malignancy during pregnancy has become a significant cause of maternal death in developed countries, likely due to both an older pregnant population, and increases of cervical cancer in younger women. Our aim is to investigate the clinical aspects of malignancy during pregnancy in Japan and to use this information to identify opportunities for earlier detection and treatment. We provided a questionnaire to 1508 secondary or tertiary care hospitals in Japan. We reviewed the clinical characteristics of cases with malignancy during pregnancy for the period of January to December, 2008. From the 760 institutions which responded, we obtained clinical information for 227 unique cases. The questionnaire provided clinical information, including disease site, pregnancy outcome and how the disease was detected. The most common type of malignancy was cervical cancer (n = 162, 71.4%) followed by ovarian (n = 16, 7.0%) and breast cancer (n = 15, 6.6%). Leukemia (n = 7, 3.1%), colon cancer (n = 5, 2.2%), gastric cancer (n = 5, 2.2%), malignant lymphoma (n = 4, 1.8%), thyroid cancer (n = 3, 1.3%), brain cancer (n = 3, 1.3%), endometrial cancer (n = 2, 0.9%), and head and neck cancer (n = 2, 0.9%) accounted for the remaining cases. Overall, gynecological malignancies accounted for 79.3% (95% confidence interval 74.0-84.6) of pregnancy associated malignancies diagnosed in the present study. The majority of cervical cancers, 149 (92.0%) of 162, were diagnosed by a Pap (Papanicolaou) smear during early gestation. Ten (62.5%) of the ovarian cancer cases were diagnosed by ultrasonography during a prenatal checkup or at the time of initial pregnancy diagnosis. Out of 14 breast cancers, only one (7.1%) was diagnosed by screening breast exam. From this study, we reaffirm the clear and significant benefits of prenatal checkups starting at an early gestational age for the detection of gynecological cancers during pregnancy. Conversely, breast

Teenage pregnancy.

PubMed

Molina Cartes, Ramiro; González Araya, Electra

2012-01-01

Teen pregnancy is a social problem not resolved in developing and some developed countries. Adolescent fecundity has become the most exact bio-demographic and health indicator of development. In developing countries that are expected to follow the sexual behaviour patterns of developed countries, without offering the levels of education and services for adolescents, the consequences will be adolescent fecundity and STI prevalence increase. The ignorance about sexuality and reproduction both in parents, teachers and adolescents increases the early initiation of coital relations and of unwanted pregnancies. Extreme poverty and being the son or daughter of an adolescent mother are risk factors of repeating the early pregnancy model. The application of predictive risk criteria in pregnant adolescents to facilitate the rational use of Health Services to diminish the maternal and perinatal mortality is discussed as well as the social factors associated with adolescent pregnancy as socioeconomic levels, structure - types and characteristics of the family, early leaving school, schooling after delivery, female employment, lack of sexual education, parental and family attitudes in different periods of adolescent pregnancy, adolescent decisions on pregnancy and children, unstable partner relationship and adoption as an option. Social consequences are analyzed as: incomplete education, more numerous families, difficulties in maternal role, abandonment by the partner, fewer possibilities of having a stable, qualified and well-paid job, greater difficulty in improving their socioeconomic level and less probability of social advancement, lack of protection of the recognition of the child. Finally, based on evidence, some measures that can reduce adverse consequences on adolescent mothers, fathers and their children are suggested. Copyright © 2012 S. Karger AG, Basel.

[Factors associated with early weaning in a Spanish region].

PubMed

Rius, J M; Ortuño, J; Rivas, C; Maravall, M; Calzado, M A; López, A; Aguar, M; Vento, M

2014-01-01

Breastfeeding has undoubtedly great benefits. Previous studies have foundan early dropout. Only a few studies have investigated related factors. Our aim was to find out on-going breastfeeding rates along the first 12 months after birth and analyse factors associated with early weaning. This is a prospective study including consecutive pairs (mother and newborn) till completion of the required sample. Variables were collected performing a structured program of surveys to the mothers. Bivariate and multivariate analysis of the data was performed. A total of 452 pairs were recruited. It was found that 81% of them started breastfeeding, with a prevalence of breastfeeding of 39% and 21% at 3 and 6 months after birth, respectively. Factors associated with early discontinuation of breastfeeding were: pregnancy induced by assisted reproduction methods (OR=5.58; 95% CI: 2.62-11.91), maternal smoking (OR=1.56; 95% CI: 1.10-2.22), poor maternal expectations about the duration of breastfeeding (OR=2.19; 95% CI: 1.49-3.23), use of nipple shields for breastfeeding (OR=2.57; 95% CI: 1.69-3.90), pacifier use on a regular basis during the first month after delivery (OR=1.39; 95% CI: 1.02-1.91), maternal university educational level (OR=0,59; 95% CI: 0,40-0,88), attending birth preparation programs during pregnancy (OR=0,68; 95% CI: 0,49-0,94), and believing having enough milk output at the time of discharge (OR=0,66; 95% CI: 0,47-0,92). International recommendations about duration of breastfeeding are not achieved in our country because of high rates of early weaning. We describe the known factors involved and other novel factors. The implementation of interventions to increase breastfeeding rates and to prevent early weaning are strongly recommended. Copyright © 2012 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

Natural killer cells and regulatory T cells in early pregnancy loss

PubMed Central

SHARMA, SURENDRA

2015-01-01

Survival of the allogeneic embryo in the uterus depends on the maintenance of immune tolerance at the maternal-fetal interface. The pregnant uterus is replete with activated maternal immune cells. How this immune tolerance is acquired and maintained has been a topic of intense investigation. The key immune cells that predominantly populate the pregnant uterus are natural killer (NK) cells. In normal pregnancy, these cells are not killers, but rather provide a microenvironment that is pregnancy compatible and supports healthy placentation. In placental mammals, an array of highly orchestrated immune elements to support successful pregnancy outcome has been incorporated. This includes active cooperation between maternal immune cells, particularly NK cells, and trophoblast cells. This intricate process is required for placentation, immune regulation and to remodel the blood supply to the fetus. During the past decade, various types of maternal immune cells have been thought to be involved in cross-talk with trophoblasts and in programming immune tolerance. RegulatoryT cells (Tregs) have attracted a great deal of attention in promoting implantation and immune tolerance beyond implantation. However, what has not been fully addressed is how this immune-trophoblast axis breaks down during adverse pregnancy outcomes, particularly early pregnancy loss, and in response to unscheduled inflammation. Intense research efforts have begun to shed light on the roles of NK cells and Tregs in early pregnancy loss, although much remains to be unraveled in order to fully characterize the mechanisms underlying their detrimental activity. An increased understanding of host-environment interactions that lead to the cytotoxic phenotype of these otherwise pregnancy compatible maternal immune cells is important for prediction, prevention and treatment of pregnancy maladies, particularly recurrent pregnancy loss. In this review, we discuss relevant information from experimental and human

Diagnosis and prognosis of early-onset intrahepatic cholestasis of pregnancy: a prospective study.

PubMed

Lin, Jing; Gu, Wei; Hou, Yanyan

2017-11-07

To explore the gestational age of early-onset intrahepatic cholestasis (ICP) of pregnancy, and to analyze the relationship between the clinical biochemical indices and pregnancy outcomes in order to arrive at a reasonable diagnosis and administer appropriate treatment. This is a retrospective clinical study. We selected 47,260 pregnant women who received prenatal care and underwent childbirth at the International Peace Maternity and Child Health Hospital affiliated to Shanghai Jiao Tong University from January 2014 to December 2016 for participating in this study. Of these 47,260 women, 407 developed ICP. To calculate the gestational week cutoff between early- and late-onset ICP by the receiver-operating characteristic (ROC) curve and Youden's index. Two independent samples t tests and chi square test were used to compare the differences in biochemical indices and pregnancy outcomes between the two groups. We found that 34 weeks is the most appropriate cutoff gestational age for the diagnosis of early-onset ICP. Early-onset ICP is characterized by early onset, long disease duration and a higher incidence of preterm labor, fetal distress, and fetal low birth weight compared to late-onset ICP. Thirty-four weeks is the most appropriate cutoff gestational age for the diagnosis of early-onset ICP. And to reduce the adverse pregnancy outcomes in cases of early-onset ICP, we suggest prolonging gestation up to 37 weeks as far as possible before selecting iatrogenic birth.

Is the exposure to antidepressant drugs in early pregnancy a risk factor for spontaneous abortion? A review of available evidences.

PubMed

Santone, Giovanni; Ricchi, Gianmatteo; Rocchetti, David; Tofani, Stefania; Bellantuono, Cesario

2009-01-01

To review studies conducted to establish the risk of spontaneous abortion (SA) in women exposed to antidepressant drugs (ADs) during early pregnancy. By using different search terms, PubMed, Toxline, EMBASE, PsychINFO, and the Cochrane library databases were searched from January 1980 to March 2008, to identify studies assessing the risk of SA in women exposed to different classes of ADs during the first trimester of pregnancy. Ten studies over 21 identified were selected for the analysis. All were performed prospectively and included as control group unexposed women, or exposed to non-teratogenic drugs or to placebo. In seven studies a depressive episode was specified as the reason for which the drug was prescribed, while the time of exposure was in nine. Only three studies over ten selected reported a significant association between an increased rate of SAs and early pregnancy exposure to some ADs. Many methodological flaws in the study design were found in all studies considered. Given this background and a lack of strong evidence on this issue, further prospective and better designed studies are needed to assess the risk of SA in pregnant women exposed to ADs against the risk of an untreated maternal depression.

Dietary fiber intake in early pregnancy and risk of subsequent preeclampsia.

PubMed

Qiu, Chunfang; Coughlin, Kara B; Frederick, Ihunnaya O; Sorensen, Tanya K; Williams, Michelle A

2008-08-01

Substantial epidemiological evidence documents diverse health benefits, including reduced risks of hypertension, associated with diets high in fiber. Few studies, however, have investigated the extent to which dietary fiber intake in early pregnancy is associated with reductions in preeclampsia risk. We assessed the relationship between maternal dietary fiber intake in early pregnancy and risk of preeclampsia. We also evaluated cross-sectional associations of maternal early pregnancy plasma lipid and lipoprotein concentrations with fiber intake. The study population comprised 1,538 pregnant Washington State residents. A 121-item food frequency questionnaire (FFQ) was used to assess maternal dietary intake, 3 months before and during early pregnancy; and generalized linear regression procedures were used to derive relative risk (RR) and 95% confidence intervals (CIs). Dietary total fiber intake was associated with reduced preeclampsia risk. After adjusting for confounders, the RR of preeclampsia for women in the highest (> or =21.2 g/day) vs. the lowest quartile (<11.9 g/day) was 0.28 (95% CI = 0.11-0.75). We observed associations of similar magnitude when the highest vs. the lowest quartiles of water-soluble fiber (RR = 0.30; 95% CI = 0.11-0.86) and insoluble fiber (RR = 0.35; 95% CI = 0.14-0.87) were evaluated. Mean triglyceride concentrations were lower (-11.9 mg/dl, P = 0.02) and high-density lipoprotein cholesterol concentrations were higher (+2.63 mg/dl, P = 0.09) for women in the highest quartile vs. those in the lowest quartile. These findings of reduced preeclampsia risk with higher total fiber intake corroborate an earlier report; and expand the literature by providing evidence, which suggests that dietary fiber may attenuate pregnancy-associated dyslipidemia, an important clinical characteristic of preeclampsia.

Anxiety and depression in women and men from early pregnancy to 3-months postpartum.

PubMed

Figueiredo, Bárbara; Conde, Ana

2011-06-01

To investigate high-anxiety and depression in women and men from early pregnancy to 3-months postpartum, 260 Portuguese couples (N = 520) filled in the State-Anxiety Inventory (STAI-S) and the Edinburgh Post-Natal Depression Scale (EPDS) at the first, second, and third pregnancy trimesters, childbirth, and 3-months postpartum. Rates for high-anxiety (STAI-S ≥ 45) in women (13.1%; 12.2%; 18.2%; 18.6%; 4.7%) and men (10.1%; 8.0%, 7.8%; 8.5%; 4.4%) and for depression (EPDS ≥ 10) in women (20.0%, 19.6%, 17.4%, 17.6%; 11.1%) and men (11.3%; 6.6%; 5.5%; 7.5%; 7.2%) were high. Rates for depression were higher than rates for high-anxiety only in women during early pregnancy and the postpartum, but not at the third pregnancy trimester and childbirth. Rates for high-anxiety and depression were higher in women than in men during pregnancy/childbirth, but not at 3-months postpartum. Rates for high-anxiety but not rates for depression were higher during pregnancy/childbirth compared to 3-months postpartum and only in women. Considering that 15.9% of the parents-to-be were highly anxious and/or depressed during pregnancy-comparing to 9.3% at 3-months postpartum-particular attention should be drawn to both women's and men's mental health early in pregnancy.

Severe physical violence between intimate partners during pregnancy: a risk factor for early cessation of exclusive breast-feeding.

PubMed

Moraes, Claudia L; de Oliveira, Alessandra S D; Reichenheim, Michael E; Lobato, Gustavo

2011-12-01

To investigate the role of severe physical violence during pregnancy (SPVP) between intimate partners in early cessation of exclusive breast-feeding (EBF). A health services survey. The revised Conflict Tactics Scale was used to characterize SPVP; premature breast-feeding cessation was identified using a current status data approach, which was based on the information reported from food recall during the preceding 7 d. The cumulative hazard function was estimated by complementary log-log transformation models, which allowed the ensuing estimation of early breast-feeding cessation rates in different age groups and the ratio of rates of weaning between women exposed and not exposed to violence. Five large public primary health-care facilities of Rio de Janeiro, Brazil. The sample comprised 811 randomly selected mothers of children under 5 months of age who were waiting to be consulted. SPVP is an independent risk factor of cessation of EBF since, after controlling for socio-economic, demographic, reproductive and lifestyle variables, women exposed to violence presented an incidence density that was 31% higher than those who were not exposed (hazard ratio = 1·30, 95% CI 1·01, 1·69). The findings corroborate the hypothesis that SPVP is an important risk factor for EBF. This indicates the need for incentives to adequately train health-care personnel in dealing with lactating women in order to gain a broader view of breast-feeding beyond the biological aspects of lactation, including the maternal psychological dimension.

Evaluation of genes involved in prostaglandin action in equine endometrium during estrous cycle and early pregnancy.

PubMed

Atli, Mehmet O; Kurar, Ercan; Kayis, Seyit A; Aslan, Selim; Semacan, Ahmet; Celik, Sefa; Guzeloglu, Aydin

2010-10-01

The aim was to evaluate expression of genes involved in the biosynthesis of prostaglandins (PTG), Prostaglandin H Synthase-1 (PTGS1) and PTGS2, PGF synthase (PTGFS), and PGE synthase (PTGES), PGF receptor (PTGFR), PGE receptors (PTGER2 and PTGER4), prostaglandin transporter (SLCO2A1) and hydroxyprostaglandin dehydrogenase-15 (HPGD). Endometrial biopsies were obtained from mares on day of ovulation (d0, n=4), late diestrus (LD, n=4), early luteolysis (EL, n=4) and after luteolysis (AL, n=4) during the cycle. Stages of the cycle were confirmed by plasma progesterone concentrations measured daily and ultrasound examinations. Biopsies were also taken on days 14 (P14; n=4), 15 (P15, n=4), 18 (P18, n=4) and 22 (P22; n=4) of pregnancy. Relative mRNA expressions were quantified using real-time RT-PCR. A mixed model was fitted on the normalized data and least significant difference test (α=0.05) was employed. Expression of PTGS1 mRNA was low throughout the estrous cycle and early days of pregnancy, but upregulated on P18 and P22. PTGS2 expression was increased on EL, but it was suppressed by pregnancy on P15, P18, and P22. PTGFS expression was upregulated in both cyclic and pregnant mares compared to d0 and its level was the highest on LD. PTGFR expression was transiently increased on LD and EL and was suppressed during early pregnancy. Both PTGES and PTGER2 expressions were increased on LD, EL, and early pregnancy, but were decreased after the luteolysis in cyclic mares as they remained high on P18 and P22. PTGER4 expression did not change throughout the cycle and early pregnancy. Levels of HPGD and SLCO2A1 were significantly increased only on P22. In conclusion, PTGS2 expression increases around the time of luteolysis and concurrent upregulation of PTGFS and PTGES indicates that equine endometrium has increased capability of PTG production around the time of luteolysis. However, pregnancy reduces PTGS2 expression, but maintains the high levels of PTGES during early

Gestational hypothyroidism: development of mild hypothyroidism in early pregnancy in previously euthyroid women.

PubMed

Hammond, Karen R; Cataldo, Nicholas A; Hubbard, Janice A; Malizia, Beth A; Steinkampf, Michael P

2015-06-01

To determine the proportion of euthyroid women attending a fertility practice who develop hypothyroidism in very early pregnancy (gestational hypothyroidism [GHT]), and to examine the association of GHT with exogenous gonadotropin treatment. Retrospective cohort study. A private reproductive medicine practice. All healthy women (N = 94) with infertility or recurrent pregnancy loss, TSH level <2.5 mIU/L, negative thyroid peroxidase antibodies at initial evaluation, and not taking thyroid medication, who conceived during an 18-month period. Usual fertility care; 30 women who had received exogenous gonadotropins. Serum TSH level at the time of pregnancy detection. Gestational hypothyroidism (TSH ≥ 2.5 mIU/L) developed in 23 of 94 women (24%). The mean increase in serum TSH level from initial evaluation to early pregnancy was 0.45 ± 0.08 [SE] mIU/L. There was a trend toward the association of GHT with use of exogenous gonadotropins. Gestational hypothyroidism was positively associated with initial prepregnancy TSH level. Euthyroid women may develop mild hypothyroidism in early pregnancy, especially after exogenous gonadotropin treatment. Appropriate vigilance will allow for timely levothyroxine treatment. Copyright © 2015 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Prenatal attachment and associated factors during the third trimester of pregnancy in Temuco, Chile.

PubMed

Ossa, Ximena; Bustos, Luis; Fernandez, Lilian

2012-10-01

to estimate the prevalence of poorer prenatal attachment and its association with psycho-affective factors in pregnant women during the third trimester. cross-sectional study in Temuco, La Araucanía Region, Chile. data were collected by structured interview with closed questions for the sociodemographic characterisation of the sample and measurement of six aspects: prenatal attachment, perceived stress, depression, perception of relationship with partner, subjective family support, and obstetric information regarding current and previous pregnancies. 244 pregnant women selected by stratified random sampling in all centres (n=5) of the public health system in Temuco, Chile, with proportional allocation. the prevalence of poorer prenatal attachment was 24.3% (95% confidence interval 19-30%), and this was found to be associated with discontent with the pregnancy, unwanted pregnancy, higher levels of perceived stress, depression and low family support. Religious activity and work were found to modulate the association between poorer prenatal attachment and psycho-affective aspects. The percentage of unplanned pregnancies was high in this study (61.35), and although this does not have a direct influence on poorer prenatal attachment, it is associated with discontent with the pregnancy and unwanted pregnancy. the high proportion of poorer prenatal attachment during the third trimester of pregnancy associated with potentially detectable psychosocial factors means that early diagnosis and timely intervention during prenatal care are an essential challenge for midwives in their work. Any progress that can be made during pregnancy will favour the development of the bonding experience after birth, and thus the balanced development of the child. Copyright © 2011 Elsevier Ltd. All rights reserved.

Vitamin D status in early pregnancy and risk of preeclampsia

PubMed Central

Achkar, Madonna; Dodds, Linda; Giguère, Yves; Forest, Jean-Claude; Armson, B. Anthony; Woolcott, Christy; Agellon, Sherry; Spencer, Anne; Weiler, Hope A.

2016-01-01

OBJECTIVE We sought to examine the association between maternal serum 25-hydroxyvitamin D (25[OH]D) concentration in early pregnancy and the subsequent diagnosis of preeclampsia (PE). STUDY DESIGN This was a nested case-control study from 2 prospective Canadian cohorts conducted in Quebec City, Quebec, and Halifax, Nova Scotia, from 2002 through 2010. Participants were pregnant women (n=169 cases with PE and 1975 controls). Maternal serum was drawn <20 weeks of gestation, and 25(OH)D measurement was performed. Cases were ascertained from medical records. Logistic regression analysis was used to estimate adjusted odds ratios with 95% confidence intervals. RESULTS Women who developed PE had a significantly lower 25(OH)D concentration at a mean gestational age of 14 weeks compared with women in the control group (mean ± SD 25[OH]D 47.2 ± 17.7 vs 52.3 ± 17.2 nmol/L, P < .0001). Women with 25(OH)D <30 nmol/L compared to those with at least 50 nmol/L had a greater risk of developing PE (adjusted odds ratio, 2.23; 95% confidence interval, 1.29–3.83) after adjustment for prepregnancy body mass index, maternal age, smoking, parity, season and year of blood collection, gestational week at blood collection, and cohort site. Exploratory analysis with cubic splines demonstrated a dose-response relationship between maternal 25(OH)D and risk of PE, up to levels around 50 nmol/L, where the association appeared to plateau. CONCLUSION Maternal vitamin D deficiency early in pregnancy defined as 25(OH)D<30 nmol/L may be an independent risk factor for PE. The relevance of vitamin D supplementation for women of child-bearing age should be explored as a strategy for reducing PE and for promoting a healthier pregnancy. PMID:25446694

Early Pregnancy Biochemical Predictors of Gestational Diabetes Mellitus.

PubMed

Powe, Camille E

2017-02-01

Universal oral glucose tolerance-based screening is employed to identify pregnant women with gestational diabetes mellitus (GDM), as treatment of this condition decreases the risk of associated complications. A simple and accurate blood test which identifies women at low or high risk for GDM in the first trimester would have the potential to decrease costs and improve outcomes through prevention or treatment. This review summarizes published data on early pregnancy biomarkers which have been tested as predictors of GDM. A large number of first-trimester biochemical predictors of GDM have been reported, mostly in small case-control studies. These include glycemic markers (fasting glucose, post-load glucose, hemoglobin A1C), inflammatory markers (C-reactive protein, tumor necrosis factor-alpha), insulin resistance markers (fasting insulin, sex hormone-binding globulin), adipocyte-derived markers (adiponectin, leptin), placenta-derived markers (follistatin-like-3, placental growth factor, placental exosomes), and others (e.g., glycosylated fibronectin, soluble (pro)renin receptor, alanine aminotransferase, ferritin). A few large studies suggest that first-trimester fasting glucose or hemoglobin A1C may be useful for identifying women who would benefit from early GDM treatment. To translate the findings from observational studies of first-trimester biomarkers for GDM to clinical practice, trials or cost-effectiveness analyses of screening and treatment strategies based on these novel biomarkers are needed.

COMPLEMENT ACTIVATION FRAGMENT Bb IN EARLY PREGNANCY AND SPONTANEOUS PRETERM BIRTH

PubMed Central

LYNCH, ANNE M.; GIBBS, RONALD S.; MURPHY, JAMES R.; BYERS, TIM; NEVILLE, MARGARET C.; GICLAS, PATRICIA C.; SALMON, JANE E.; VAN HECKE, TRISHA M; MICHAEL HOLERS, V.

2008-01-01

Objective To determine if an elevated level of the complement activation fragment Bb in early pregnancy was associated with spontaneous preterm birth (SPTB) at less than 34 weeks gestation or SPTB between 34 and 37 weeks gestation (late SPTB). Study Design Prospective study of 784 women enrolled at < 20 weeks gestation. Results Following exclusions, 13 women (1.7%) had a SPTB at less than 34 weeks gestation and 25 (3.2%) a SPTB between 34 and 37 weeks gestation. Women with Bb in the top quartile were 4.7 times more likely to have an SPTB less than 34 weeks gestation as compared with women who had levels of Bb in the lower three quartiles (95% CI 1.5 to 14, P = 0.003). There was no association between Bb and late SPTB (RR= 0.8, 95% CI = 0.3 to 2). Conclusions A significant relationship was found between an elevated Bb in early pregnancy and SPTB < 34 weeks gestation. These results suggest that inflammatory events in early pregnancy are part of the pathogenic mechanisms of this condition. PMID:18928972

Identification of serum protein markers for early diagnosis of pregnancy in buffalo.

PubMed

Buragohain, Lukumoni; Nanda, Trilok; Ghosh, Arnab; Ghosh, Mayukh; Kumar, Rajesh; Kumar, Sunil; Gupta, Sambhu Sharan; Bharali, Arpita; Mohanty, Ashok K; Singh, Inderjeet; Balhara, Ashok Kumar

2017-08-01

Improper or delayed pregnancy diagnosis has significant impact over animal production, particularly in buffaloes which inherently suffer from several reproductive inefficiencies. Thus the present study has undertaken to identify serum protein markers pertaining to early pregnancy diagnosis in buffaloes. Serum samples were collected from 10 pregnant Murrah Buffalo heifers at weekly intervals from days 0-35 post-artificial insemination and from 12 inseminated non-pregnant cyclic buffalo heifers on days 0, 7, 14 and 21. Two-dimensional gel electrophoresis and densitometric analysis revealed the presence of five protein spots showing average density fold change of ≥4 during early pregnancy. Mass spectrometry analysis identified these up-regulated proteins as anti-testosterone antibody light chain, apolipoprotein A-II precursor, serum amyloid A, cytokeratin type II, component IV isoform 1, which are have established roles in embryogenesis, but over-expression of the fifth identified protein immunoglobulin lambda light chain in pregnancy has been elucidated as a novel finding in the current study. Further, with bioinformatics analysis, potential antigenic B-cell epitopes were predicted for all these five proteins. An antibody cocktail-based approach involving antibodies against all these five up-regulated entire proteins or their epitopes could be developed for early detection of pregnancy in buffaloes. © 2016 Japanese Society of Animal Science. © 2016 Japanese Society of Animal Science.

Successful diagnosis and treatment of early splenic ectopic pregnancy: A case report.

PubMed

Wu, Lan; Jiang, Xiaoqin; Ni, Juan

2018-04-01

Splenic ectopic pregnancy (SEP), a special abdominal pregnancy, is extremely rare but carries a high risk of potentially uncontrollable, life-threatening intraperitoneal bleeding at early gestation, which is equivalent to the spontaneous rupture of the spleen. Therefore, early diagnosis of SEP is crucial and may avoid life-threatening situation. A 29-year-old G3P2 woman presented with 50 days of amenorrhea and positive serum β-human gonadotropin (β-HCG) was enrolled into the hospital due to the absence of gestational sac located in the uterine cavity. A pan-abdominal ultrasound scan revealed a 2.6 cm ×1.6 cm hyperechoic mass inferior to the spleen with color Doppler signal surrounding and 0.9 cm anechoic inside. The gynecologist found the gestational sac was located in the dorsal pole of the spleen through the exploratory laparoscopy. Total splenectomy was performed uneventfully to avoid the hemorrhage shock. The patient discharged with no complications and normal 1-month follow-up. It highlights that fully understanding of the knowledge about abdominal pregnancy, especially splenic pregnancy, and early imaging study with ultrasonography could reduce or avoid the misdiagnosis and miss-diagnosis of SEP.

Role of MRI in the early diagnosis of tubal ectopic pregnancy.

PubMed

Si, Ming-Jue; Gui, Shuang; Fan, Qin; Han, Hong-Xiu; Zhao, Qian-Qian; Li, Zhi-Xin; Zhao, Jiang-Min

2016-07-01

To determine the role of MRI in the early diagnosis of tubal ectopic pregnancy (EP). Clinical and MRI features of 27 cases of tubal pregnancy were reviewed. A thick-walled gestational sac (GS)-like structure was demonstrated lateral to the uterus in all cases. On T2-weighted images, the thick wall typically exhibited 3 discrete rings in 22 cases (81 %), among which 17 cases (63 %) displayed small vessels and 6 cases (33 %) exhibited small areas of fresh haemorrhage inside the thick wall. The contents demonstrated non-specific liquid in 26 %, papillary solid components in 56 %, and fresh blood or fluid-fluid level in 19 % of the cases. Dilatation of the affected fallopian tube associated with hematosalpinx was demonstrated in 18 cases (67 %) and marked enhancement of the tubal wall was observed in 22 cases (81 %). No correlation was found between the size of the GS and the estimated gestational age (r = 0.056). MRI plays an important role in the early diagnosis and management of tubal pregnancy. The characteristic MRI features include a GS-like structure with a "three rings" appearance on T2-weighted images, presence of solid components in the sac, dilatation of the affected fallopian tube with hematosalpinx, and tubal wall enhancement. • MR imaging has served as a problem-solving procedure in ectopic pregnancy. • MR imaging features can be criteria for early diagnosis of tubal pregnancy. • Detailed assessment of ectopic implantation is necessary for management decision-making.

Healthy Lifestyle During Early Pregnancy and Risk of Gestational Diabetes Mellitus.

PubMed

Badon, Sylvia E; Enquobahrie, Daniel A; Wartko, Paige D; Miller, Raymond S; Qiu, Chunfang; Gelaye, Bizu; Sorensen, Tanya K; Williams, Michelle A

2017-08-01

Previous studies have found associations between individual healthy behaviors and reduced risk of gestational diabetes mellitus (GDM); however, the association of composite healthy lifestyle during pregnancy with GDM has not been examined. Participants in the Omega Study (n = 3,005), a pregnancy cohort study conducted in Washington State (1996-2008), reported information on diet, physical activity, smoking, and stress during early pregnancy. Lifestyle components were dichotomized into healthy/unhealthy and then combined into a total lifestyle score (range, 0-4). Regression models were used to determine relative risk of GDM (n = 140 cases) in relation to healthy lifestyle. Twenty percent of participants had a healthy diet, 66% were physically active, 95% were nonsmokers, and 55% had low stress. Each 1-point increase in lifestyle score was associated with a 21% lower risk of GDM (95% confidence interval: 0.65, 0.96) after adjustment for age, race, and nulliparity. Adjustment for prepregnancy body mass index, prepregnancy physical activity, and prepregnancy smoking attenuated the associations slightly. Associations were similar in normal-weight and overweight/obese women. In this study, a composite measure of healthy lifestyle during early pregnancy was associated with substantially lower GDM risk. Public health messaging and interventions promoting multiple aspects of a healthy lifestyle during early pregnancy should be considered for GDM prevention. © The Author(s) 2017. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Demographic and obstetric factors affecting women's sexual functioning during pregnancy.

PubMed

Abouzari-Gazafroodi, Kobra; Najafi, Fatemeh; Kazemnejad, Ehsan; Rahnama, Parvin; Montazeri, Ali

2015-08-19

Sexual desire and frequency of sexual relationships during pregnancy remains challenging. This study aimed to assess factors that affect women's sexual functioning during pregnancy. This was a cross sectional study carried out at prenatal care clinics of public health services in Iran. An author-designed structured questionnaire including items on socio-demographic characteristics, obstetric history, the current pregnancy, and women's sexual functioning during pregnancy was used to collect data. The generalized linear model was performed in order to find out factors that affect women's sexual functioning during pregnancy. In all, 518 pregnant women participated in the study. The mean age of participants was 26.4 years (SD = 4.7). Overall 309 women (59.7%) scored less than mean on sexual functioning. The results obtained from generalized linear model demonstrated that that lower education, unwanted pregnancy, earlier stage of pregnancy, older age, and longer duration of marriage were the most important factors contributing to disturbed sexual functioning among couples. The findings suggest that sexual function during pregnancy might be disturbed due to several factors. Indeed issues on sexual relationship should be included as part of prenatal care and reproductive health programs for every woman.

Brain-derived neurotrophic factor improves proliferation of endometrial epithelial cells by inhibition of endoplasmic reticulum stress during early pregnancy.

PubMed

Lim, Whasun; Bae, Hyocheol; Bazer, Fuller W; Song, Gwonhwa

2017-12-01

Brain-derived neurotrophic factor (BDNF) is a member of the neurotrophin family binds to two transmembrane receptors; neurotrophic receptor tyrosine kinase 2 (NTRK2) with high affinity and p75 with low affinity. Although BDNF-NTRK2 signaling in the central nervous system is known, signaling in the female reproductive system is unknown. Therefore, we determined effects of BDNF on porcine endometrial luminal epithelial (pLE) cells isolated from Day 12 of pregnancy, as well as expression of BDNF and NTRK2 in endometria of cyclic and pregnant pigs. BDNF-NTRK2 genes were expressed in uterine glandular (GE) and luminal (LE) epithelia during early pregnancy. In addition, their expression in uterine GE and LE decreased with increasing parity of sows. Recombinant BDNF increased proliferation in pLE cells in a dose-dependent, as well as expression of PCNA and Cyclin D1 in nuclei of pLE cells. BDNF also activated phosphorylation of AKT, P70S6K, S6, ERK1/2, JNK, P38 proteins in pLE cells. In addition, cell death resulting from tunicamycin-induced ER stress was prevented when pLE cells were treated with the combination of tunicamycin and BDNF which also decreased cells in the Sub-G 1 phase of the cell cycle. Furthermore, tunicamycin-induced unfolded protein response genes were mostly down-regulated to the basal levels as compared to non-treated pLE cells. Our finding suggests that BDNF acts via NTRK2 to induce development of pLE cells for maintenance of implantation and pregnancy by activating cell signaling via the PI3K and MAPK pathways and by inhibiting ER stress. © 2017 Wiley Periodicals, Inc.

Maternal N-Carbamylglutamate Supply during Early Pregnancy Enhanced Pregnancy Outcomes in Sows through Modulations of Targeted Genes and Metabolism Pathways.

PubMed

Cai, Shuang; Zhu, Jinlong; Zeng, Xiangzhou; Ye, Qianhong; Ye, Changchuan; Mao, Xiangbing; Zhang, Shihai; Qiao, Shiyan; Zeng, Xiangfang

2018-06-13

Reducing pregnancy loss is important for improving reproductive efficiency for both human and mammalian animals. Our previous study demonstrates that maternal N-carbamylglutamate (NCG) supply during early pregnancy enhances embryonic survival in gilts. However, whether maternal NCG supply improves the pregnancy outcomes is still not known. Here we found maternal NCG supply during early pregnancy in sows significantly increased the numbers of total piglets born alive per litter ( P < 0.05) and significantly changed the levels of metabolites in amniotic fluid and serum involved in metabolism of energy, lipid, and glutathione and immunological regulation. The expression of endometrial progesterone receptor membrane component 1 (PGRMC1) was significantly increased by NCG supplementation ( P < 0.05) as well as the expression of PGRMC1, endothelial nitric oxide synthesases (eNOS), and lamin A/C in fetuses and placentae ( P < 0.05). Among the NCG-associated amino acids, arginine and glutamine, markedly increased PGRMC1 and eNOS expression in porcine trophectoderm cells ( P < 0.05), whereas glutamate could stimulate the expression of vimentin and lamin A/C in porcine trophectoderm (pTr) cells ( P < 0.05) and proline stimulated lamin A/C expression ( P < 0.05). Collectively, these data reveal the mechanisms of NCG in reducing early embryo loss. These findings have important implications that NCG has great potential to improve pregnancy outcomes in human and mammalian animals.

Prediction of Maternal Cytomegalovirus Serostatus in Early Pregnancy: A Retrospective Analysis in Western Europe

PubMed Central

Kuessel, Lorenz; Husslein, Heinrich; Marschalek, Julian; Brunner, Julia; Ristl, Robin; Popow-Kraupp, Theresia; Kiss, Herbert

2015-01-01

Background Cytomegalovirus (CMV) is the most prevalent congenital viral infection and thus places an enormous disease burden on newborn infants. Seroprevalence of maternal antibodies to CMV due to CMV exposure prior to pregnancy is currently the most important protective factor against congenital CMV disease. The aim of this study was to identify potential predictors, and to develop and evaluate a risk-predicting model for the maternal CMV serostatus in early pregnancy. Methods Maternal and paternal background information, as well as maternal CMV serostatus in early pregnancy from 882 pregnant women were analyzed. Women were divided into two groups based on their CMV serostatus, and were compared using univariate analysis. To predict serostatus based on epidemiological baseline characteristics, a multiple logistic regression model was calculated using stepwise model selection. Sensitivity and specificity were analyzed using ROC curves. A nomogram based on the model was developed. Results 646 women were CMV seropositive (73.2%), and 236 were seronegative (26.8%). The groups differed significantly with respect to maternal age (p = 0.006), gravidity (p<0.001), parity (p<0.001), use of assisted reproduction techniques (p = 0.018), maternal and paternal migration background (p<0.001), and maternal and paternal education level (p<0.001). ROC evaluation of the selected prediction model revealed an area under the curve of 0.83 (95%CI: 0.8–0.86), yielding sensitivity and specificity values of 0.69 and 0.86, respectively. Conclusion We identified predictors of maternal CMV serostatus in early pregnancy and developed a risk-predicting model based on baseline epidemiological characteristics. Our findings provide easy accessible information that can influence the counseling of pregnant woman in terms of their CMV-associated risk. PMID:26693714

Early pregnancy cerebral venous thrombosis and status epilepticus treated with levetiracetam and lacosamide throughout pregnancy.

PubMed

Ylikotila, Pauli; Ketola, Raimo A; Timonen, Susanna; Malm, Heli; Ruuskanen, Jori O

2015-11-01

Cerebral venous thrombosis (CVT) is an uncommon cause of stroke, accounting to less than 1% of all strokes. We describe a pregnant woman with a massive CVT in early pregnancy, complicated by status epilepticus. The mother was treated with levetiracetam, lacosamide, and enoxaparin throughout pregnancy. A male infant was born on pregnancy week 36, weighing 2.2kg. Both levetiracetam and and lacosamide were present in cord blood in levels similar to those in maternal blood. The infant was partially breast-fed and experienced poor feeding and sleepiness, starting to resolve after two first weeks. Milk samples were drawn 5 days after the delivery and a blood sample from the infant 3 days later. Lacosamide level in milk was low, resulting in an estimated relative infant dose of 1.8% of the maternal weight-adjusted daily dose in a fully breast-fed infant. This is the first case describing lacosamide use during pregnancy and lactation. Copyright © 2015 Elsevier Inc. All rights reserved.

Early pregnancy assessment with transvaginal ultrasound scanning.

PubMed Central

Daya, S; Woods, S; Ward, S; Lappalainen, R; Caco, C

1991-01-01

OBJECTIVE: To establish normal parameters in early pregnancy through transvaginal ultrasonography so that gestational age can be determined and to correlate the sonographic findings with serum human chorionic gonadotropin (hCG) levels calibrated against the first international reference preparation standard. SETTING: Infertility clinic. PATIENTS: Thirty-five women with normal intrauterine pregnancy. INTERVENTIONS: Serial measurement of the serum hCG level and the diameter of the gestational sac through transvaginal ultrasonography. MAIN RESULTS: The gestational sac could not be visualized when the hCG level was less than 1100 IU/L. The average growth rate of the sac was 0.9 mm/d. The threshold values for sac diameter, serum hCG level and gestational age below which the yolk sac was not visible were 3.7 mm, 1900 IU/L and 36 days respectively; the corresponding values above which the yolk sac was always visible were 6.7 mm, 5800 IU/L and 40 days. The threshold values below which cardiac activity was not visible were 8.3 mm, 9200 IU/L and 41 days respectively, and the corresponding values above which cardiac activity was always visible were 14.0 mm, 24,000 IU/L and 46 days. The mean gestational ages and the 95% confidence and prediction intervals were tabulated so that measurement of the gestational sac diameter could be used to estimate gestational age early in normal pregnancy. CONCLUSIONS: Transvaginal ultrasonography enables detection of an intrauterine sac and reliable estimation of gestational age on the basis of sac dimensions before an embryo can be seen. PMID:1993291

The emotional-behavioural functioning of children exposed to maternal depressive symptoms across pregnancy and early childhood: a prospective Australian pregnancy cohort study.

PubMed

Giallo, Rebecca; Woolhouse, Hannah; Gartland, Deirdre; Hiscock, Harriet; Brown, Stephanie

2015-10-01

Children exposed to maternal depression during pregnancy and in the postnatal period are at increased risk of a range of health, wellbeing and development problems. However, few studies have examined the course of maternal depressive symptoms in the perinatal period and beyond on children's wellbeing. The present study aimed to explore the relationship between both the severity and chronicity of maternal depressive symptoms across the early childhood period and children's emotional-behavioural difficulties at 4 years of age. Data from over 1,085 mothers and children participating in a large Australian prospective pregnancy cohort were used. Latent class analysis identified three distinct trajectories of maternal depressive symptoms from pregnancy to 4 years postpartum: (1) no or few symptoms (61%), (2) persistent subclinical symptoms (30%), and (3) increasing and persistently high symptoms (9%). Regression analyses revealed that children of mothers experiencing subclinical and increasing and persistently high symptoms were at least two times more likely to have emotional-behavioural difficulties than children of mothers reporting minimal symptoms, even after accounting for known risk factors for poor outcomes for children. These findings challenge policy makers and health professionals to consider how they can tailor care and support to mothers experiencing a broader spectrum of depressive symptoms across the early childhood period, to maximize opportunities to improve both short-and long-term maternal and child health outcomes.

Association of early maternal hypertriglyceridemia with pregnancy-induced hypertension.

PubMed

Chandi, Anadeep; Sirohiwal, Daya; Malik, Roopa

2015-11-01

Hypertensive diseases are directly responsible for 24 % of maternal deaths in India. A screening method is yet to be discovered to reduce the morbidity and mortality related to it. Serum triglyceride (TG) levels are reported to increase in hypertensive pregnant women. To predict pregnancy-induced hypertension (PIH) by serum triglyceride values. This study is a prospective cohort study that was conducted over three hundred normotensive, primigravida women with singleton pregnancy at 14-20 weeks of gestation. These were divided into two groups on the basis of their TG concentration estimated at 14-20 weeks of gestation. The pregnancy was then followed till delivery and, signs and symptoms of PIH were noted in both the groups. Out of 300 women, 210 women completed the study. Fifty-nine women developed PIH and 151 women remained normotensive. Among 59 women, 45 women had raised TG values i.e., ≥160 mg/dL and 14 women were with normal TG levels i.e., <160 mg/dL. A significant positive correlation was found between serum TG concentration and systolic and diastolic blood pressure. It was observed that a cutoff of 162.50 mg/dL for TG could reliably predict PIH with sensitivity of 76 % and specificity of 85 %. Also, the mothers with hypertriglyceridemia were found to be at higher risk of developing early-onset PIH. Our study supports the evidence that early pregnancy hypertriglyceridemia is associated with an increased risk of PIH.

Factors associated with employment status before and during pregnancy: Implications for studies of pregnancy outcomes.

PubMed

Rocheleau, Carissa M; Bertke, Stephen J; Lawson, Christina C; Romitti, Paul A; Desrosiers, Tania A; Agopian, Aaron J; Bell, Erin; Gilboa, Suzanne M

2017-04-01

Potential confounding or effect modification by employment status is frequently overlooked in pregnancy outcome studies. To characterize how employed and non-employed women differ, we compared demographics, behaviors, and reproductive histories by maternal employment status for 8,343 mothers of control (non-malformed) infants in the National Birth Defects Prevention Study (1997-2007) and developed a multivariable model for employment status anytime during pregnancy and the 3 months before conception. Sixteen factors were independently associated with employment before or during pregnancy, including: maternal age, pre-pregnancy body mass index, pregnancy intention, periconceptional/first trimester smoking and alcohol consumption, and household income. Employment status was significantly associated with many common risk factors for adverse pregnancy outcomes. Pregnancy outcome studies should consider adjustment or stratification by employment status. In studies of occupational exposures, these differences may cause uncontrollable confounding if non-employed women are treated as unexposed instead of excluded from analysis. Am. J. Ind. Med. 60:329-341, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Ectopic pregnancy.

PubMed

Carr, R J; Evans, P

2000-03-01

Ectopic pregnancy occurs in approximately 2% of all pregnancies in the United States, and is the nation's leading cause of first trimester maternal death. Its incidence has increased sixfold in the past 25 years, despite significant improvements in techniques for early diagnosis and management. This article reviews the epidemiology, risk factors, and common clinical presentations of ectopic pregnancy. Both traditional and newly developed strategies for diagnosis and management are described. The primary care physician is in an excellent position to screen for and diagnose ectopic pregnancy, and to counsel patients regarding treatment options and future risks. With the increasing trend toward outpatient nonsurgical management of ectopics, it is expected that the roll of the primary care physician in managing patients with ectopic pregnancy will continue to increase.

Pregnancy, sex and hormonal factors in multiple sclerosis

PubMed Central

Miller, David H; Fazekas, Franz; Montalban, Xavier; Reingold, Stephen C; Trojano, Maria

2014-01-01

Background: Multiple sclerosis (MS) is influenced by pregnancy, sex and hormonal factors. Objectives: A comprehensive understanding of the role of pregnancy, sex and hormonal factors can provide insights into disease mechanisms, and new therapeutic developments and can provide improved patient care and treatment. Methods: Based on an international conference of experts and a comprehensive PubMed search for publications on these areas in MS, we provide a review of what is known about the impact of these factors on disease demographics, etiology, pathophysiology and clinical course and outcomes. Results and conclusions: Recommendations are provided for counseling and management of people with MS before conception, during pregnancy and after delivery. The use of disease-modifying and symptomatic therapies in pregnancy is problematic and such treatments are normally discontinued. Available knowledge about the impact of treatment on the mother, fetus and newborn is discussed. Recommendations for future research to fill knowledge gaps and clarify inconsistencies in available data are made. PMID:24446387

Adolescent pregnancy and associated factors in South African youth.

PubMed

Mchunu, G; Peltzer, K; Tutshana, B; Seutlwadi, L

2012-12-01

Adolescent pregnancy, occurring in girls aged 10-19 years, remains a serious health and social problem worldwide, and has been associated with numerous risk factors evident in the young people's family, peer, school, and neighbourhood contexts. To assess the prevalence of adolescent pregnancy and associated factors in the South African context, as part of a population-based household survey that formed part of an evaluation of the impact of loveLife, South Africa's national HIV prevention campaign for young people. A cross-sectional population-based household survey was conducted using a multi-stage stratified cluster sampling approach. The total sample included 3123 participants, aged 18-24, 54.6% men and 45.4% women, from four of nine provinces in South Africa (Eastern Cape, Gauteng, KwaZulu-Natal and Mpumalanga). Among female youth 19.2% said that they had an adolescent pregnancy, while 5.8% of male youth indicated that they had impregnated a girl when they were an adolescent (12-19 years), 16.2% of the women indicated that they ever had an unwanted pregnancy and 6.7% had ever terminated a pregnancy. In multivariable analysis among women it was found that being employed or unemployed, greater poverty, having higher sexually permissive attitudes and scoring higher on the contraceptive or the condom use index was associated with adolescent pregnancy, and among men wanting the pregnancy and having a sense of the future were associated with adolescent pregnancy. Adolescent pregnancy was found to be high in this sample of South African youth. Multiple factors contributing to adolescent pregnancy have been identified which can be used in targeting young people on the prevention of adolescent pregnancy.

The relationship between maternal serum iron and zinc levels and their nutritional intakes in early pregnancy with gestational diabetes.

PubMed

Behboudi-Gandevani, Samira; Safary, Kolsum; Moghaddam-Banaem, Lida; Lamyian, Minoor; Goshtasebi, Azita; Goshtasbi, Azita; Alian-Moghaddam, Narges

2013-07-01

The aim of this study was to investigate the association between maternal iron/zinc serum levels and their nutritional intake in early pregnancy with gestational diabetes. The maternal serum zinc/iron levels were measured in 1,033 healthy singleton pregnant women aged 20-35 between 14 and 20 weeks of gestation, within two groups: namely, normal and gestational diabetes, and participants were followed up to 24-28 weeks of gestation. Food frequency questionnaire was used to assess nutritional intakes of iron/zinc. The main outcome was gestational diabetes screened with the 50-g glucose challenge test and diagnosed with oral glucose tolerance test at 24-28 weeks of gestation. Gestational diabetes occurred in 72 (6.96 %) of 1,033 women in study. There was a statistical relationship between early pregnancy maternal serum iron and gestational diabetes, mean (SD), 143.8 (48.7) vs. 112.5 (83.5) μg/dl, P value of <0.0001. There was no statistical significant difference in zinc levels and iron/zinc nutritional intake between groups. The results remained unchanged after using regression model for adjustment of potential risk factors with an adjusted OR of 1.006 (95 % CI 1.002 to 1.009; P = 0.001) for early pregnancy maternal serum iron to cause gestational diabetes. The receiver-operator characteristic curve identified that a maternal serum iron above 100 μg/dl in early pregnancy is the optimum cutoff value for predicting gestational diabetes, which showed a sensitivity and specificity of 80.6 and 50.7 %, respectively. In conclusion, high maternal serum iron in early pregnancy could increase the risk of gestational diabetes. Also, it could be used as a sensitive and specific predictor for gestational diabetes.

Sexual abuse in childhood and adolescence and the risk of early pregnancy among women ages 18-22.

PubMed

Young, Maria-Elena D; Deardorff, Julianna; Ozer, Emily; Lahiff, Maureen

2011-09-01

This clinic- and community-based study of young women investigated the relationship between previous sexual abuse and early pregnancy, examining the effect of the developmental period in which sexual abuse occurred and type of sexual abuse, while also providing methodological advances in the assessment of distinctive sexual abuse and its sequelae. Secondary data analysis using Cox proportional hazards models was conducted to determine the association between sexual abuse in childhood, in adolescence, or both, and risk of early pregnancy among 1,790 young women. In addition, this study examined the type of sexual abuse that occurred during each period. As compared with women with no history of sexual abuse, women who experienced sexual abuse only in childhood had a 20% greater hazard of pregnancy; women who experienced sexual abuse only in adolescence had a 30% greater hazard of pregnancy; and women who experienced sexual abuse in both childhood and adolescence had an 80% greater hazard of pregnancy. Across these periods, attempted rape and rape were associated with an increased hazard of pregnancy. The association between sexual abuse and pregnancy was mediated by age at first intercourse and moderated by a woman's education level. This study provides evidence that both the developmental timing and the type of sexual abuse contributes to an increased risk for early pregnancy. The study findings indicate that sexual abuse leads to an earlier age of first sexual intercourse, which in turn increases the likelihood of an early pregnancy. Women with higher educational attainment are less likely to experience early pregnancy as a result of abuse. Copyright © 2011 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Complement activation fragment Bb in early pregnancy and spontaneous preterm birth.

PubMed

Lynch, Anne M; Gibbs, Ronald S; Murphy, James R; Byers, Tim; Neville, Margaret C; Giclas, Patricia C; Salmon, Jane E; Van Hecke, Trisha M; Holers, V Michael

2008-10-01

The objective of this study was to determine whether an elevated level of the complement activation fragment Bb in early pregnancy was associated with spontaneous preterm birth (SPTB) at less than 34 weeks' gestation or SPTB between 34 and 37 weeks' gestation (late SPTB). This was a prospective study of 784 women enrolled at less than 20 weeks' gestation. Following exclusions, 13 women (1.7%) had a SPTB at less than 34 weeks' gestation and 25 (3.2%) a SPTB between 34 and 37 weeks' gestation. Women with Bb in the top quartile were 4.7 times more likely to have an SPTB less than 34 weeks' gestation as compared with women who had levels of Bb in the lower 3 quartiles (95% confidence interval [CI] 1.5-14, P = .003). There was no association between Bb and late SPTB (relative risk 0.8, 95% CI 0.3-2). A significant relationship was found between an elevated Bb in early pregnancy and SPTB less than 34 weeks' gestation. These results suggest that inflammatory events in early pregnancy are part of the pathogenic mechanisms of this condition.

Comparison of accuracy of pregnancy-associated glycoprotein (PAG) concentration in blood and milk for early pregnancy diagnosis in cows.

PubMed

Gajewski, Z; Petrajtis-Gołobów, M; Melo de Sousa, N; Beckers, J F; Pawliński, B; Wehrend, A

2014-12-01

The aim of this study was to compare two methods of early pregnancy diagnosis by determining pregnancy-associated glycoprotein (PAG) concentration in blood and PAG concentration in milk. Blood and milk samples were obtained on days 0 (AI day), 14, 21, 28, 35, 49, 63, 77, 91 and 105 of gestation from 60 lactating Holstein Frisian cows from one herd, carrying live fetuses. To determine PAG concentration a specific RIA system (RIA-706) was used. PAG concentration in blood and milk increased after 28 days of pregnancy, with blood concentrations being significantly higher than in milk. However, the accuracy of both tests at this time point was similar (sensitivity: 92 % in blood, 93 % in milk; specificity 53 % and 60 % respectively). None of the tests were able to detect open cows properly at this stage. On day 35 of gestation sensitivity (100 % for blood, 97 % for milk) and specificity (100 % for blood, 100 % for milk) were high enough to be used for reliable pregnancy diagnosis. The accuracy (sensitivity and specificity) for PAG concentrations in blood and milk for the rest of the study was 100 %. Our investigation shows that PAG determination in milk is a stress-free and non-invasive method for early pregnancy diagnosis in cattle.

Predicting adverse obstetric outcome after early pregnancy events and complications: a review.

PubMed

van Oppenraaij, R H F; Jauniaux, E; Christiansen, O B; Horcajadas, J A; Farquharson, R G; Exalto, N

2009-01-01

BACKGROUND The aim was to evaluate the impact of early pregnancy events and complications as predictors of adverse obstetric outcome. METHODS We conducted a literature review on the impact of first trimester complications in previous and index pregnancies using Medline and Cochrane databases covering the period 1980-2008. RESULTS Clinically relevant associations of adverse outcome in the subsequent pregnancy with an odds ratio (OR) > 2.0 after complications in a previous pregnancy are the risk of perinatal death after a single previous miscarriage, the risk of very preterm delivery (VPTD) after two or more miscarriages, the risk of placenta praevia, premature preterm rupture of membranes, VPTD and low birthweight (LBW) after recurrent miscarriage and the risk of VPTD after two or more termination of pregnancy. Clinically relevant associations of adverse obstetric outcome in the ongoing pregnancy with an OR > 2.0 after complications in the index pregnancy are the risk of LBW and very low birthweight (VLBW) after a threatened miscarriage, the risk of pregnancy-induced hypertension, pre-eclampsia, placental abruption, preterm delivery (PTD), small for gestational age and low 5-min Apgar score after detection of an intrauterine haematoma, the risk of VPTD and intrauterine growth restriction after a crown-rump length discrepancy, the risk of VPTD, LBW and VLBW after a vanishing twin phenomenon and the risk of PTD, LBW and low 5-min Apgar score in a pregnancy complicated by severe hyperemesis gravidarum. CONCLUSIONS Data from our literature review indicate, by finding significant associations, that specific early pregnancy events and complications are predictors for subsequent adverse obstetric and perinatal outcome. Though, some of these associations are based on limited or small uncontrolled studies. Larger population-based controlled studies are needed to confirm these findings. Nevertheless, identification of these risks will improve obstetric care.

Psychometric Evaluation of the Ford Insomnia Response to Stress Test (FIRST) in Early Pregnancy.

PubMed

Gelaye, Bizu; Zhong, Qiu-Yue; Barrios, Yasmin V; Redline, Susan; Drake, Christopher L; Williams, Michelle A

2016-04-15

To evaluate the construct validity and factor structure of the Spanish-language version of the Ford Insomnia Response to Stress Test questionnaire (FIRST-S) when used in early pregnancy. A cohort of 647 women were interviewed at ≤ 16 weeks of gestation to collect information regarding lifestyle, demographic, and sleep characteristics. The factorial structure of the FIRST-S was tested through exploratory and confirmatory factor analyses (EFA and CFA). Internal consistency and construct validity were also assessed by evaluating the association between the FIRST-S with symptoms of depression, anxiety, and sleep quality. Item response theory (IRT) analyses were conducted to complement classical test theory (CTT) analytic approaches. The mean score of the FIRST-S was 13.8 (range: 9-33). The results of the EFA showed that the FIRST-S contained a one-factor solution that accounted for 69.8% of the variance. The FIRST-S items showed good internal consistency (Cronbach α = 0.81). CFA results corroborated the one-factor structure finding from the EFA; and yielded measures indicating goodness of fit (comparative fit index of 0.902) and accuracy (root mean square error of approximation of 0.057). The FIRST-S had good construct validity as demonstrated by statistically significant associations of FIRST-S scores with sleep quality, antepartum depression and anxiety symptoms. Finally, results from IRT analyses suggested excellent item infit and outfit measures. The FIRST-S was found to have good construct validity and internal consistency for assessing vulnerability to insomnia during early pregnancy. © 2016 American Academy of Sleep Medicine.

Association of risk factors with smoking during pregnancy among women of childbearing age: an epidemiological field study in Turkey.

PubMed

Nur, Naim

2017-01-01

Smoking during pregnancy is an important risk factor for maternal and infant health that is preventable. This study aimed to investigate the risk factors associated with smoking behavior during pregnancy. A household-based probability sample survey of 1,510 women was conducted in the center of the city of Sivas, Turkey, between September 2013 and May 2014. The prevalence of smoking during pregnancy was estimated according to independent variables by means of regression analysis. The prevalence of smoking during pregnancy was 16.5%. Logistic regression showed that being at a relatively young age (odds ratio, OR = 1.92, P = 0.025 for 15-24 age group; and OR = 2.45, P = 0.001 for 25-34 age group), having a low educational level (OR = 1.76, P = 0.032), being unmarried (OR = 1.48, P = 0.002) and living in an extended family (OR = 1.98, P = 0.009) were the factors associated with the risk of smoking during pregnancy. Systematic attention should be paid to socioeconomic inequalities, to support women towards quitting smoking before or at an early stage of their pregnancies. Younger women and particularly those in lower socioeconomic groups should be targeted. This will lead to better pregnancy status, especially among young women.

The role of thyroid hormone in trophoblast function, early pregnancy maintenance, and fetal neurodevelopment.

PubMed

Ohara, Noriyuki; Tsujino, Taro; Maruo, Takeshi

2004-11-01

To review the literature on the roles of thyroid hormone in trophoblast function, early pregnancy maintenance, and fetal neurodevelopment. MEDLINE was searched for English-language papers published from 1971 to 2003, using the key words "brain," "hypothyroidism," "placenta," "pregnancy," "threatened abortion," "thyroid hormone," "thyroid hormone receptor," "thyroid hormone replacement therapy," "thyroid hormone-responsive gene," and "trophoblast." Transplacental transfer of thyroid hormone occurs before the onset of fetal thyroid hormone secretion. Thyroid hormone receptors and iodothyronine deiodinases are present in the placenta and the fetal central nervous system early in pregnancy, and thyroid hormone plays a crucial role both in trophoblast function and fetal neurodevelopment. Maternal hypothyroxinemia is associated with a high rate of spontaneous abortion and long-term neuropsychological deficits in children born of hypothyroid mothers. Maternal iodine deficiency also causes a wide spectrum of neuropsychological disorders in children, ranging from subclinical deficits in cognitive motor and auditory functions to hypothyroid-induced cognitive impairment in infants. However, these conditions are preventable when iodine supplementation is initiated before the second trimester. Although thyroid hormone replacement therapy is effective for reducing the adverse effects complicated by maternal hypothyroidism, the appropriate dose of thyroid hormone is mandatory in protecting the early stage of pregnancy. Close monitoring of maternal thyroid hormone status and ensuring adequate maternal thyroid hormone levels in early pregnancy are of great importance to prevent miscarriage and neuropsychological deficits in infants.

Pre-Pregnancy BMI, Gestational Weight Gain, and the Risk of Hypertensive Disorders of Pregnancy: A Cohort Study in Wuhan, China.

PubMed

Zhou, Aifen; Xiong, Chao; Hu, Ronghua; Zhang, Yiming; Bassig, Bryan A; Triche, Elizabeth; Yang, Shaoping; Qiu, Lin; Zhang, Yaqi; Yao, Cong; Xu, Shunqing; Wang, Youjie; Xia, Wei; Qian, Zhengmin; Zheng, Tongzhang; Zhang, Bin

2015-01-01

Hypertensive disorders of pregnancy (HDP) are major causes of maternal death worldwide and the risk factors are not fully understood. Few studies have investigated the risk factors for HDP among Chinese women. A cohort study involving 84,656 women was conducted to investigate pre-pregnancy BMI, total gestational weight gain (GWG), and GWG during early pregnancy as risk factors for HDP among Chinese women. The study was conducted between 2011-2013 in Wuhan, China, utilizing data from the Maternal and Children Healthcare Information Tracking System of Wuhan. A total of 84,656 women with a live singleton pregnancy were included. Multiple unconditional logistic regression was conducted to evaluate associations between putative risk factors and HDP. Women who were overweight or obese before pregnancy had an elevated risk of developing HDP (overweight: OR = 2.66, 95% CI = 2.32-3.05; obese: OR = 5.53, 95% CI = 4.28-7.13) compared to their normal weight counterparts. Women with total GWG above the Institute of Medicine (IOM) recommendation had an adjusted OR of 1.72 (95% CI = 1.54-1.93) for HDP compared to women who had GWG within the IOM recommendation. Women with gestational BMI gain >10 kg/m2 during pregnancy had an adjusted OR of 3.35 (95% CI = 2.89-3.89) for HDP, compared to women with a gestational BMI gain <5 kg/m2. The increased risk of HDP was also observed among women with higher early pregnancy (up to 18 weeks of pregnancy) GWG (>600g/wk: adjusted OR = 1.48, 95% CI = 1.19-1.84). The results from this study show that maternal pre-pregnancy BMI, early GWG, and total GWG are positively associated with the risk of HDP. Weight control efforts before and during pregnancy may help to reduce the risk of HDP.

Ultrasonographically documented early pregnancy loss in an Asian elephant (Elephas maximus).

PubMed

Lueders, Imke; Drews, Barbara; Niemuller, Cheryl; Gray, Charlie; Rich, Peter; Fickel, Jörns; Wibbelt, Gudrun; Göritz, Frank; Hildebrandt, Thomas B

2010-01-01

Early embryonic resorption or fetal loss is known to occur occasionally in captive elephants; however, this has mostly been reported anecdotally. The present study documents the case of a 24-year-old, multiparous Asian elephant cow that suffered embryonic death and resorption at around 18 weeks of gestation. From ovulation onwards, this female was sonographically examined 58 times. Blood was collected twice weekly for progestagen determination via enzyme immunoassay. On Day 42 after ovulation, a small quantity of fluid was detected in the uterine horn, which typically indicates the presence of a developing conceptus. Repeated inspections followed what appeared to be a normal pregnancy until Day 116. However, on Day 124, signs of embryonic life were absent. Progestagen concentrations started declining two weeks later, reaching baseline levels one month after embryonic death. Retrospectively, ultrasound examination revealed several abnormalities in the uterine horn. Besides an existing leiomyoma, multiple small cystic structures had formed in the endometrium at the implantation site and later in the placenta. These pathological findings were considered as possible contributors to the early pregnancy failure. PCR for endotheliotropic elephant herpes virus (EEHV) (which had occurred previously in the herd) as well as serology for other infectious organisms known to cause abortion in domestic animals did not yield any positive results. Although no definitive reason was found for this pregnancy to abort, this ultrasonographically and endocrinologically documented study of an early pregnancy loss provides important insights into the resorption process in Asian elephants.

Association of increased S100A8 serum protein with early pregnancy loss.

PubMed

Nair, Rohini R; Khanna, Anuradha; Singh, Kiran

2015-02-01

The contribution of systemic S100A8 protein in menstrual cycle, pregnancy, and early pregnancy loss (EPL) is not known. Altered expression of S100A8 in maternal decidua is associated with recurrent early pregnancy loss. The objective of this study was to investigate the systemic level of S100A8 in different phases of menstrual cycle, different trimester of pregnancy, and in EPL. Level of S100A8 was investigated in serum samples of the subjects through enzyme-linked immunosorbent assay (ELISA). S100A8 levels were elevated during proliferative phase of menstrual cycle. We found no statistical difference in S100A8 level in different trimester of pregnancy. S100A8 level was found to be significantly elevated in patients with EPL. This is the first study evaluating the systemic level of S100A8 predicting its role during menstrual cycle and pregnancy. It opens a new perspective in which S100A8 can be used as a prognostic marker for EPL. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

The use of iloprost in early pregnancy in patients with pulmonary arterial hypertension.

PubMed

Elliot, C A; Stewart, P; Webster, V J; Mills, G H; Hutchinson, S P; Howarth, E S; Bu'lock, F A; Lawson, R A; Armstrong, I J; Kiely, D G

2005-07-01

In patients with pulmonary hypertension, pregnancy is associated with a high risk of maternal death. Such patients are counselled to avoid pregnancy, or if it occurs, are offered early interruption. Some patients, however, decide to continue with their pregnancy and others may present with symptoms for the first time whilst pregnant. Pulmonary vasodilator therapy provides a treatment option for these high-risk patients. The present study describes three patients with pulmonary arterial hypertension of various aetiologies who were treated with the prostacyclin analogue iloprost during pregnancy, and the post-partum period. Nebulised iloprost commenced as early as 8 weeks of gestation and patients were admitted to hospital between 24-36 weeks of gestation. All pregnancies were completed with a duration of between 25-36 weeks and all deliveries were by caesarean section under local anaesthetic. All patients delivered children free from congenital abnormalities, and there was no post-partum maternal or infant mortality. In conclusion, although pregnancy is strongly advised against in those with pulmonary hypertension, the current authors have achieved a successful outcome for mother and foetus with a multidisciplinary approach and targeted pulmonary vascular therapy.

Positive feelings during pregnancy, early feeding practices, and infant health.

PubMed

McManus, Melissa A; Khalessi, Ali A; Lin, Joyce; Ashraf, Jahanzeb; Reich, Stephanie M

2017-05-01

Early parenting practices, such as infant feeding, can affect children's physical health. Additionally, negative prenatal maternal affect can influence feeding choices, such as breast-feeding, and can have a detrimental effect on children's health. Little is known, however, about the contribution of positive maternal affect during pregnancy on feeding practices and children's health. This study explored whether positive prenatal feelings influenced children's health during the first 18 months, and whether early feeding practices mediated the relationship between these two variables. Low-income, ethnically diverse, primiparous women (n = 114) reported their feelings of pregnancy uplifts and hassles during their third trimester. These women were interviewed again at 2, 4, 6, 9, 12, and 18 months post-partum about their feeding practices. A retrospective audit of their infants' medical charts was completed from birth to 18 months. Using structural equation modeling, having more uplifts than hassles during pregnancy was associated with longer breast-feeding duration and greater adherence to recommended schedules for introducing fruits and vegetables, solids, and baby cereal. These feeding practices were linked to better child health outcomes, including reduced risk of upper respiratory tract infections, conjunctivitis, otitis media, and thrush. Positive maternal feelings during pregnancy were associated with better feeding practices, and these better feeding practices were associated with fewer common childhood illnesses. Helping expectant women focus on the positive aspects of their pregnancy may lead to postnatal care methods that are fiscally advantageous, preventive of detrimental postnatal choices, and medically beneficial for children. © 2016 Japan Pediatric Society.

Long-term Recall of Pregnancy-related Events.

PubMed

Chin, Helen B; Baird, Donna D; McConnaughey, D Robert; Weinberg, Clarice R; Wilcox, Allen J; Jukic, Anne Marie

2017-07-01

Early-life factors can be associated with future health outcomes and are often measured by maternal recall. We used data from the North Carolina Early Pregnancy Study and Follow-up to characterize long-term maternal recall. We used data from the Early Pregnancy Study as the gold standard to evaluate the accuracy of prepregnancy weight, early pregnancy behaviors, symptoms and duration of pregnancy, and child's birthweight reported at follow-up, for 109 women whose study pregnancies had resulted in a live birth. Most (81%) participants reported a prepregnancy weight at follow-up that correctly classified them by BMI category. Women reported experiencing pregnancy symptoms later at follow-up than what they reported in the Early Pregnancy Study. Accuracy of reporting of early pregnancy behaviors varied based on exposure. Overall, women who had abstained from a behavior were more likely to be classified correctly. Sensitivity of reporting was 0.14 for antibiotics, 0.30 for wine, 0.71 for brewed coffee, and 0.82 for vitamins. Most misclassification at follow-up was due to false-negative reporting. Among women who gave birth to singletons, 94% could report their child's correct birthweight within ½ pound and 86% could report duration of pregnancy within 7 days at follow-up. Self-report of prepregnancy weight, duration of pregnancy, and child's birthweight after almost 30 years was good, whereas self-reported pregnancy-related exposures resulted in higher levels of reporting error. Social desirability appeared to influence women's report of their behaviors at follow-up. Self-reported assessment of confidence in the recalled information was unrelated to accuracy.

Pregnancy Complications

MedlinePlus

... care provider will likely test your urine in early pregnancy to see if this is the case and ... and body-mass index before pregnancy or in early pregnancy and found that obesity during pregnancy is associated ...

Sleep disordered breathing in pregnancy.

PubMed

Izci Balserak, Bilgay

2015-12-01

Sleep disordered breathing (SDB) is common and the severity increases as pregnancy progresses.Frequent snoring, older age and high pre-pregnancy body mass index (>25 kg⋅m(-2)) could be reliable indicators for SDB in early pregnancy.SDB screening tools, including questionnaires, used in the nonpregnant population have poor predictive ability in pregnancy.Accumulating evidence suggests that SDB during pregnancy may be associated with increased risk of adverse pregnancy outcomes, including gestational diabetes and pre-eclampsia. However, the results should be interpreted cautiously because several studies failed to adjust for potential maternal confounders and have other study limitations.There are no pregnancy-specific practice guidelines for SDB treatment. Many clinicians and practices follow recommendations for the treatment in the general population. Women with pre-existing SDB might need to be reassessed, particularly after the sixth month of pregnancy, because symptoms can worsen with nasal congestion and weight gain. To highlight the prevalence and severity of sleep disordered breathing (SDB) in the pregnant population.To inform readers about risk factors for SDB in pregnancy.To explore the impact of SDB on adverse maternal and fetal outcomes, and biological pathways for associated adverse maternal and fetal outcomes.To introduce current management options for SDB in pregnancy, including medical and behavioural approaches. Sleep disordered breathing (SDB) is very common during pregnancy, and is most likely explained by hormonal, physiological and physical changes. Maternal obesity, one of the major risk factors for SDB, together with physiological changes in pregnancy may predispose women to develop SDB. SDB has been associated with poor maternal and fetal outcomes. Thus, early identification, diagnosis and treatment of SDB are important in pregnancy. This article reviews the pregnancy-related changes affecting the severity of SDB, the epidemiology and the

Sleep disordered breathing in pregnancy

PubMed Central

2015-01-01

Key points Sleep disordered breathing (SDB) is common and the severity increases as pregnancy progresses. Frequent snoring, older age and high pre-pregnancy body mass index (>25 kg⋅m−2) could be reliable indicators for SDB in early pregnancy. SDB screening tools, including questionnaires, used in the nonpregnant population have poor predictive ability in pregnancy. Accumulating evidence suggests that SDB during pregnancy may be associated with increased risk of adverse pregnancy outcomes, including gestational diabetes and pre-eclampsia. However, the results should be interpreted cautiously because several studies failed to adjust for potential maternal confounders and have other study limitations. There are no pregnancy-specific practice guidelines for SDB treatment. Many clinicians and practices follow recommendations for the treatment in the general population. Women with pre-existing SDB might need to be reassessed, particularly after the sixth month of pregnancy, because symptoms can worsen with nasal congestion and weight gain. Educational aims To highlight the prevalence and severity of sleep disordered breathing (SDB) in the pregnant population. To inform readers about risk factors for SDB in pregnancy. To explore the impact of SDB on adverse maternal and fetal outcomes, and biological pathways for associated adverse maternal and fetal outcomes. To introduce current management options for SDB in pregnancy, including medical and behavioural approaches. Sleep disordered breathing (SDB) is very common during pregnancy, and is most likely explained by hormonal, physiological and physical changes. Maternal obesity, one of the major risk factors for SDB, together with physiological changes in pregnancy may predispose women to develop SDB. SDB has been associated with poor maternal and fetal outcomes. Thus, early identification, diagnosis and treatment of SDB are important in pregnancy. This article reviews the pregnancy-related changes affecting the

Qualitative Evaluation of Historical and Relational Factors Influencing Pregnancy and Sexually Transmitted Infection Risks in Foster Youth

PubMed Central

Ahrens, Kym R.; Spencer, Renee; Bonnar, Mavis; Coatney, Alexis; Hall, Tyson

2016-01-01

Purpose To explore how attitudes, norms, behaviors, responses to early life experiences, and protective factors influence pregnancy and sexually transmitted infection risks from the perspectives of current and former foster youth to inform the development of prevention strategies. Methods We conducted semi-structured individual qualitative interviews with a diverse sample of 22 current/former foster youth aged 15–21 years (63% female; average age = 18.6 years). We then used Theoretical Thematic Analysis to systematically analyze the data for key themes related to sexual health in four categories: 1) norms and attitudes, 2) responses to early life experiences, 3) protective factors, and 4) youth-driven intervention ideas. Results Participants reported a range of sexual experience levels, varied sexual orientations, and also reported varied life experiences prior to and during foster care. We detected several norms and attitudes that likely contribute to risks of early pregnancies and sexually transmitted infections. These included that one can tell by looking whether a partner is trustworthy or has a sexually transmitted infection, that condoms aren’t necessary with long-term or infrequent partners or if birth control is used, and that teen pregnancy is an inevitable event. With respect to responses to early life experiences, youth frequently described difficulties dealing with strong emotions in the context of romantic and/or sexual relationships; many attributed these difficulties to early experiences with biological family members or in foster care. Participants linked emotion regulation difficulties with struggles in trust appraisal, effective communication, and impulsive behaviors. Youth also described a variety of protective factors that they felt helped them prevent sexual risk behaviors or improved their lives in other respects. Finally, participants endorsed factors likely to improve intervention acceptability and efficacy, including an open, non

Vitamin D, the placenta and early pregnancy: effects on trophoblast function.

PubMed

Ganguly, Ankana; Tamblyn, Jennifer A; Finn-Sell, Sarah; Chan, Shiao-Y; Westwood, Melissa; Gupta, Janesh; Kilby, Mark D; Gross, Stephane R; Hewison, Martin

2018-02-01

Pregnancy is associated with significant changes in vitamin D metabolism, notably increased maternal serum levels of active vitamin D, 1,25-dihydroxyvitamin (1,25(OH) 2 D). This appears to be due primarily to increased renal activity of the enzyme 25-hydroxyvitamin D-1α-hydroxylase (CYP27B1) that catalyzes synthesis of 1,25(OH) 2 D, but CYP27B1 expression is also prominent in both the maternal decidua and fetal trophoblast components of the placenta. The precise function of placental synthesis of 1,25(OH) 2 D remains unclear, but is likely to involve localized tissue-specific responses with both decidua and trophoblast also expressing the vitamin D receptor (VDR) for 1,25(OH) 2 D. We have previously described immunomodulatory responses to 1,25(OH) 2 D by diverse populations of VDR-expressing cells within the decidua. The aim of the current review is to detail the role of vitamin D in pregnancy from a trophoblast perspective, with particular emphasis on the potential role of 1,25(OH) 2 D as a regulator of trophoblast invasion in early pregnancy. Vitamin D deficiency is common in pregnant women, and a wide range of studies have linked low vitamin D status to adverse events in pregnancy. To date, most of these studies have focused on adverse events later in pregnancy, but the current review will explore the potential impact of vitamin D on early pregnancy, and how this may influence implantation and miscarriage. © 2018 Society for Endocrinology.

The Lin28/Let-7 System in Early Human Embryonic Tissue and Ectopic Pregnancy

PubMed Central

Steffani, Liliana; Martínez, Sebastián; Monterde, Mercedes; Ferri, Blanca; Núñez, Maria Jose; AinhoaRomero-Espinós; Zamora, Omar; Gurrea, Marta; Sangiao-Alvarellos, Susana; Vega, Olivia; Simón, Carlos; Pellicer, Antonio; Tena-Sempere, Manuel

2014-01-01

Our objective was to determine the expression of the elements of the Lin28/Let-7 system, and related microRNAs (miRNAs), in early stages of human placentation and ectopic pregnancy, as a means to assess the potential role of this molecular hub in the pathogenesis of ectopic gestation. Seventeen patients suffering from tubal ectopic pregnancy (cases) and forty-three women with normal on-going gestation that desired voluntary termination of pregnancy (VTOP; controls) were recruited for the study. Embryonic tissues were subjected to RNA extraction and quantitative PCR analyses for LIN28B, Let-7a, miR-132, miR-145 and mir-323-3p were performed. Our results demonstrate that the expression of LIN28B mRNA was barely detectable in embryonic tissue from early stages of gestation and sharply increased thereafter to plateau between gestational weeks 7–9. In contrast, expression levels of Let-7, mir-132 and mir-145 were high in embryonic tissue from early gestations (≤6-weeks) and abruptly declined thereafter, especially for Let-7. Opposite trends were detected for mir-323-3p. Embryonic expression of LIN28B mRNA was higher in early stages (≤6-weeks) of ectopic pregnancy than in normal gestation. In contrast, Let-7a expression was significantly lower in early ectopic pregnancies, while miR-132 and miR-145 levels were not altered. Expression of mir-323-3p was also suppressed in ectopic embryonic tissue. We are the first to document reciprocal changes in the expression profiles of the gene encoding the RNA-binding protein, LIN28B, and the related miRNAs, Let-7a, mir-132 and mir-145, in early stages of human placentation. This finding suggests the potential involvement of LIN28B/Let-7 (de)regulated pathways in the pathophysiology of ectopic pregnancy in humans. PMID:24498170

Comfort with motherhood in late pregnancy facilitates maternal role attainment in early postpartum.

PubMed

Nakamura, Yasuka; Takeishi, Yoko; Ito, Naoko; Ito, Mizuki; Atogami, Fumi; Yoshizawa, Toyoko

2015-01-01

Quality of life, comfort, and wellbeing during pregnancy are essential for every country in the world. Pregnancy is considered a preparation period for becoming a mother. Maternal role development, including confidence and satisfaction as a mother, is important in the transition to motherhood. Negative psychosocial affect, such as increased anxiety and distress, during pregnancy adversely influences the childbirth experience and childcare, which contributes to postpartum depression. However, the impact of positive feelings on the maternal role development remains unclear. Therefore, the study purpose was to clarify the relationship between comfort in late pregnancy and maternal role attainment and childcare during early postpartum. We designed a descriptive, longitudinal, correlational study by using the Prenatal Comfort Scale, the Postpartum Maternal Role Confidence Scale, and the Postpartum Maternal Satisfaction Scale. Among 339 participants who had received care at a university hospital located in Sendai city in Japan, 215 subjects completed the longitudinal study by answering a questionnaire for the respective Scale late in their pregnancy or during early postpartum. The subjects consisted of 114 primipara (32.0 ± 5.4 years) and 101 multipara (33.4 ± 4.9 years). In primipara, comfort with motherhood was significantly correlated with maternal confidence regarding knowledge and childcare skills and maternal satisfaction. In multipara, comfort in late pregnancy was related to maternal confidence and satisfaction. Positive affect was related to maternal confidence and maternal satisfaction in early postpartum. Therefore, a prenatal nursing intervention helps women become more comfortable with impending motherhood, thereby promoting maternal role attainment after delivery.

Teen Pregnancy Risk Factors Among Young Women of Diverse Sexual Orientations.

PubMed

Charlton, Brittany M; Roberts, Andrea L; Rosario, Margaret; Katz-Wise, Sabra L; Calzo, Jerel P; Spiegelman, Donna; Austin, S Bryn

2018-04-01

Young women who are sexual minorities (eg, bisexual and lesbian) are approximately twice as likely as those who are heterosexual to have a teen pregnancy. Therefore, we hypothesized that risk factors for teen pregnancy would vary across sexual orientation groups and that other potential risk factors exist that are unique to sexual minorities. We used multivariable log-binomial models gathered from 7120 young women in the longitudinal cohort known as the Growing Up Today Study to examine the following potential teen pregnancy risk factors: childhood maltreatment, bullying victimization and perpetration, and gender nonconformity. Among sexual minorities, we also examined the following: sexual minority developmental milestones, sexual orientation-related stress, sexual minority outness, and lesbian, gay, and bisexual social activity involvement. Childhood maltreatment and bullying were significant teen pregnancy risk factors among all participants. After adjusting for childhood maltreatment and bullying, the sexual orientation-related teen pregnancy disparities were attenuated; these risk factors explained 45% of the disparity. Among sexual minorities, reaching sexual minority developmental milestones earlier was also associated with an increased teen pregnancy risk. The higher teen pregnancy prevalence among sexual minorities compared with heterosexuals in this cohort was partially explained by childhood maltreatment and bullying, which may, in part, stem from sexual orientation-related discrimination. Teen pregnancy prevention efforts that are focused on risk factors more common among young women who are sexual minorities (eg, childhood maltreatment, bullying) can help to reduce the existing sexual orientation-related teen pregnancy disparity. Copyright © 2018 by the American Academy of Pediatrics.

Early pregnancy angiogenic markers and spontaneous abortion: an Odense Child Cohort study.

PubMed

Andersen, Louise B; Dechend, Ralf; Karumanchi, S Ananth; Nielsen, Jan; Joergensen, Jan S; Jensen, Tina K; Christesen, Henrik T

2016-11-01

Spontaneous abortion is the most commonly observed adverse pregnancy outcome. The angiogenic factors soluble Fms-like kinase 1 and placental growth factor are critical for normal pregnancy and may be associated to spontaneous abortion. We investigated the association between maternal serum concentrations of soluble Fms-like kinase 1 and placental growth factor, and subsequent spontaneous abortion. In the prospective observational Odense Child Cohort, 1676 pregnant women donated serum in early pregnancy, gestational week <22 (median 83 days of gestation, interquartile range 71-103). Concentrations of soluble Fms-like kinase 1 and placental growth factor were determined with novel automated assays. Spontaneous abortion was defined as complete or incomplete spontaneous abortion, missed abortion, or blighted ovum <22+0 gestational weeks, and the prevalence was 3.52% (59 cases). The time-dependent effect of maternal serum concentrations of soluble Fms-like kinase 1 and placental growth factor on subsequent late first-trimester or second-trimester spontaneous abortion (n = 59) was evaluated using a Cox proportional hazards regression model, adjusting for body mass index, parity, season of blood sampling, and age. Furthermore, receiver operating characteristics were employed to identify predictive values and optimal cut-off values. In the adjusted Cox regression analysis, increasing continuous concentrations of both soluble Fms-like kinase 1 and placental growth factor were significantly associated with a decreased hazard ratio for spontaneous abortion: soluble Fms-like kinase 1, 0.996 (95% confidence interval, 0.995-0.997), and placental growth factor, 0.89 (95% confidence interval, 0.86-0.93). When analyzed by receiver operating characteristic cut-offs, women with soluble Fms-like kinase 1 <742 pg/mL had an odds ratio for spontaneous abortion of 12.1 (95% confidence interval, 6.64-22.2), positive predictive value of 11.70%, negative predictive value of 98

Effect of maternal smoking cessation before and during early pregnancy on fetal and childhood growth.

PubMed

Suzuki, Kohta; Sato, Miri; Zheng, Wei; Shinohara, Ryoji; Yokomichi, Hiroshi; Yamagata, Zentaro

2014-01-01

Maternal smoking during pregnancy is a major cause of intrauterine growth restriction and childhood obesity, but only a few studies have examined the association of smoking cessation before and during pregnancy with fetal and childhood growth. We examined this association in a prospective cohort study in Japan. Our study included children born between 1991 and 2006 and their mothers. Using a questionnaire, maternal smoking status was recorded at pregnancy. The anthropometric data of the children were collected during a medical check-up at age 3 years. Multiple linear and logistic regression models were used for data analysis stratified by sex. In total, 2663 mothers reported their smoking status during early pregnancy, and data were collected from 2230 (83.7%) children at age 3 years. Maternal smoking during pregnancy was associated with a significant reduction in birth weight (approximately 120-150 g). Body mass index at age 3 years was significantly higher among boys born to smoking mothers than among boys born to nonsmoking mothers. Maternal smoking during pregnancy was associated with overweight at age 3 years among boys (adjusted odds ratio, 2.4; 95% CI, 1.03-5.4). However, among women who stopped smoking in early pregnancy, there was no increase in the risks of a small for gestational age birth or childhood overweight at age 3 years. Children born to mothers who stopped smoking before or during early pregnancy had appropriate fetal and childhood growth.

[Risk factors in the living environment of early spontaneous abortion pregnant women].

PubMed

Liu, Xin-yan; Bian, Xu-ming; Han, Jing-xiu; Cao, Zhao-jin; Fan, Guang-sheng; Zhang, Chao; Zhang, Wen-li; Zhang, Shu-zhen; Sun, Xiao-guang

2007-10-01

To study the relationship between early spontaneous abortion and living environment, and explore the risk factors of spontaneous abortion. We conducted analysis based on the interview of 200 spontaneous abortion cases and the matched control (age +/- 2 years) by using multifactor Logistic regression analysis. The proportions of watching TV > or =10 hours/week, operating computer > or =45 hours/week, using copycat, microwave oven and mobile phone, electromagnetism equipment near the dwell or work place, e. g. switch room < or =50 m and launching tower < or =500 m in the cases are significantly higher than those in the controls in single factor analysis (all P < 0.05). After adjusted the effect of other risk factors by multifactor analysis, using microwave oven and mobile phone, contacting abnormal smell of fitment material > or =3 months, having emotional stress during the first term of pregnancy and spontaneous abortion history were significantly associated with risk of spontaneous abortion. The odds ratios of these risk factors were 2.23 and 4.63, respectively. Using microwave oven and mobile phone, contacting abnormal smell of fitment material > or =3 months, having emotional stress during the first term of pregnancy, and spontaneous abortion history are risk factors of early spontaneous abortion.

EVALUATION OF THE EFFECTS OF METHANOL DURING EARLY PREGNANCY IN THE RAT

EPA Science Inventory

Recent attention to methanol (MeOH) as a potential alternative fuel prompted an evaluation of the chemical's effects during very early pregnancy. ats were dosed by gavage during Days 1-8 of pregnancy at 0, 1.6, 2.4 or 3.2 g MeOH/kg/day. roups of animals were killed on Days 9, 11 ...

[Relations between hypertensive disorders in pregnancy and subsequent risk of early-term birth: a birth cohort study].

PubMed

Li, F Y; Yan, S Q; Huang, K; Mao, L J; Pan, W J; Ge, X; Han, Y; Hao, J H; Tao, F B

2017-12-10

Objective: To evaluate the relations between hypertensive disorders (HDP) in pregnancy and early-term birth. Methods: A total of 3 474 pregnant women were consecutively recruited. Demographic information was collected in early pregnancy. HDP was diagnosed in the first, second and third trimesters, respectively. On the basis of precise evaluation on gestation age, early-term birth was defined as gestational age of 37-38 weeks+6 days. Logistic regression models were conducted to examine the associations between HDP and early-term birth. Results: The current study included 3 260 pregnant women, with the rates of HDP, pregnancy-induced hypertension syndrome and pre-eclampsia as 6.0% ( n =194), 4.2% ( n =137) and 1.8% ( n =57), respectively. After controlling for potential confounders, no significant differences between pregnancy-induced hypertension syndrome and earlyterm birth ( OR =1.49, 95% CI : 0.94-2.36) were found. Pre-eclampsia appeared to have increased the risk of early-term birth ( OR =4.46, 95% CI : 2.09-9.54). Conclusion: Pre-eclampsia could significantly increase the risk of early-term birth. This finding suggested that early detection and intervention programs were helpful in reducing the risk of early-term birth.

Are female orphans at risk for early marriage, early sexual debut, and teen pregnancy? Evidence from sub-Saharan Africa.

PubMed

Palermo, Tia; Peterman, Amber

2009-06-01

Female orphans are widely cited as being at risk for early marriage, early childbearing, and risky sexual behavior; however, to date no studies have examined these linkages using population-level data across multiple countries. This study draws from recent Demographic and Health Surveys from ten sub-Saharan African countries to examine the relationship between orphanhood status and measures of early marriage, early sexual debut, and teen pregnancy among adolescent girls aged 15 to 17. Results indicate that, overall, little association is found between orphanhood and early marriage or teen pregnancy, whereas evidence from seven countries supports associations between orphanhood and early sexual debut. Findings are sensitive to the use of multivariate models, type of orphan, and country setting. Orphanhood status alone may not be a sufficient targeting mechanism for addressing these outcomes in many countries; a broader, multidimensional targeting scheme including orphan type, schooling, and poverty measures would be more robust in identifying and aiding young women at risk.

Physical, sexual and social health factors associated with the trajectories of maternal depressive symptoms from pregnancy to 4 years postpartum.

PubMed

Giallo, Rebecca; Pilkington, Pamela; McDonald, Ellie; Gartland, Deirdre; Woolhouse, Hannah; Brown, Stephanie

2017-07-01

Few studies have examined the course of maternal depressive across pregnancy and early parenthood. The aim of this study was to identify the physical, sexual and social health factors associated with the trajectories of maternal depressive symptoms from pregnancy to 4 years postpartum. Data were drawn from 1102 women participating in the Maternal Health Study, a prospective pregnancy cohort study in Melbourne, Australia. Self-administered questionnaires were completed at baseline (<24 weeks gestation), and at 3-, 6-, 12-, and 18 months, and 4 years postpartum. Latent class analysis modelling identified three distinct classes representing women who experienced minimal depressive symptoms (58.4%), subclinical symptoms (32.7%), and persistently high symptoms from pregnancy to 4 years postpartum (9.0%). Risk factors for subclinical and persistently high depressive symptoms were having migrated from a non-English speaking country, not being in paid employment during pregnancy, history of childhood physical abuse, history of depressive symptoms, partner relationship problems during pregnancy, exhaustion at 3 months postpartum, three or more sexual health problems at 3 months postpartum, and fear of a partner since birth at 6 months postpartum. This study highlights the complexity of the relationships between emotional, physical, sexual and social health, and underscores the need for health professionals to ask women about their physical and sexual health, and consider the impact on their mental health throughout pregnancy and the early postpartum.

Normal pregnancy is associated with an increase in thrombin generation from the very early stages of the first trimester.

PubMed

Bagot, C N; Leishman, E; Onyiaodike, C C; Jordan, F; Freeman, D J

2017-09-01

Pregnancy is a hypercoagulable state associated with an increased risk of venous thrombosis, which begins during the first trimester, but the exact time of onset is unknown. Thrombin generation, a laboratory marker of thrombosis risk, increases during normal pregnancy but it is unclear exactly how early this increase occurs. We assessed thrombin generation by Calibrated Automated Thrombography in women undergoing natural cycle in vitro fertilization, who subsequently gave birth at term following a normal pregnancy (n=22). Blood samples were taken just prior to conception and repeated five times during very early pregnancy, up to Day 59 estimated gestation. Mean Endogenous Thrombin Potential (ETP), peak thrombin generation and Velocity Index (VI) increased significantly from pre-pregnancy to Day 43 gestation (p=0.024-0.0004). This change persisted to Day 59 gestation. The mean of the percentage change from baseline, accounting for inter-individual variation, in ETP, peak thrombin and VI increased significantly from pre-pregnancy to Day 32 gestation (p=0.0351-<0.0001) with the mean increase from baseline persisting to Day 59 gestation. Thrombin generation increases significantly during the very early stages of normal pregnancy when compared to the pre-pregnancy state. The increased risk of venous thrombosis therefore likely begins very early in a woman's pregnancy, suggesting that women considered clinically to be at high thrombotic risk should start thromboprophylaxis as early as possible after a positive pregnancy test. Copyright © 2017 Elsevier Ltd. All rights reserved.

Severe subarachnoid hemorrhage associated with cerebral venous thrombosis in early pregnancy: a case report.

PubMed

Yamamoto, Junkoh; Kakeda, Shingo; Takahashi, Mayu; Idei, Masaru; Nakano, Yoshiteru; Soejima, Yoshiteru; Saito, Takeshi; Akiba, Daisuke; Shibata, Eiji; Korogi, Yukunori; Nishizawa, Shigeru

2013-12-01

Cerebral venous thrombosis (CVT) rarely induces subarachnoid hemorrhage (SAH). During late pregnancy and puerperium, CVT is an uncommon but important cause of stroke. However, severe SAH resulting from CVT is extremely rare during early pregnancy. We report on a rare case of severe SAH due to CVT, and discuss the potential pitfalls of CVT diagnosis in early pregnancy. A 32-year-old pregnant woman (9th week of pregnancy) presented with slight head dullness. Initial magnetic resonance imaging (MRI) revealed focal, abnormal signal intensity in the left thalamus. Nine days later, the patient developed a generalized seizure and severe SAH was detected with computed tomography (CT) scan. MRI and cerebral angiography revealed a completely thrombosed superior sagittal sinus, vein of Galen, straight sinus, and right transverse sinus. Transvaginal sonography indicated a missed abortion. The day after admission, the patient presented again with a progressive loss of consciousness and signs of herniation. The patient underwent emergency decompressive craniotomy, followed by intrauterine curettage. Two months later, she made an excellent recovery except for a slight visual field defect. A rare case of severe SAH due to CVT is reported, with emphasis on the potential pitfalls of CVT diagnosis in early pregnancy. Copyright © 2013 Elsevier Inc. All rights reserved.

Maternal pre-pregnancy body mass index and circulating microRNAs in pregnancy.

PubMed

Enquobahrie, Daniel A; Wander, Pandora L; Tadesse, Mahlet G; Qiu, Chunfang; Holzman, Claudia; Williams, Michelle A

Maternal pre-pregnancy overweight and obese status has been associated with a number of pregnancy complications and adverse offspring outcomes. Mechanisms for observed associations, however, are largely unknown. We investigated associations of pre-pregnancy body mass index with early-mid pregnancy epigenetic biomarkers, circulating microRNAs. Peripheral blood was collected from participants (16-27 weeks gestation) of two multi-racial pregnancy cohorts, the Omega Study and the Pregnancy Outcomes and Community Health Study. Plasma miRNA expression was characterised using epigenome-wide (319 miRNAs) profiling among 20 pregnant women in each cohort. Cohort-specific linear regression models that included the predictor (pre-pregnancy body mass index), the outcome (microRNA expression), and adjustment factors (maternal age, gestational age at blood collection, and race) were fit. Expression of 27 miRNAs was positively associated with pre-pregnancy body mass index in both cohorts (p-values <0.05). A number of these differentially expressed miRNAs have previously been associated with adipogenesis (e.g. let-7d*, miR-103-2*, -130b, -146b-5-p, -29c, and -26b). Identified miRNAs as well as their experimentally validated targets participate in pathways that involve organismal injury, reproductive system disease, connective tissue disorders, cancer, cellular development, growth and proliferation. Pre-pregnancy body mass index is associated with circulating miRNAs in early-mid pregnancy. Published by Elsevier Ltd.

Vitamin D Deficiency Prevalence and Predictors in Early Pregnancy among Arab Women

PubMed Central

Al-Musharaf, Sara; Fouda, Mona A.; Turkestani, Iqbal Z.; Al-Ajlan, Abdulrahman; Sabico, Shaun; Alnaami, Abdullah M.; Hussain, Syed Danish; Alraqebah, Buthaynah; Al-Serehi, Amal; Alshingetti, Naemah M.; Al-Daghri, Nasser; McTernan, Philip G; Wimalawansa, Sunil J.

2018-01-01

Data regarding the prevalence and predictors of vitamin D deficiency during early pregnancy are limited. This study aims to fill this gap. A total of 578 Saudi women in their 1st trimester of pregnancy were recruited between January 2014 and December 2015 from three tertiary care antenatal clinics in Riyadh, Saudi Arabia. Information collected includes socio-economic, anthropometric, and biochemical data, including serum vitamin D (25(OH)D) levels, intake of calcium and vitamin D, physical activity, and sun exposure indices. Pregnant women with 25(OH)D levels <50 nmol/L were considered vitamin D deficient. The majority of participants (n = 468 (81%)) were vitamin D deficient. High levels of indoor activity, whole body clothing, multiparity, total cholesterol/HDL ratio(>3.5), low HDL-cholesterol, and living in West Riyadh were significant independent predictors for vitamin D deficiency, with odds ratios (ORs) (95% confidence interval) of 25.4 (5.5–117.3), 17.8 (2.3–138.5), 4.0 (1.7–9.5), 3.3 (1.4–7.9), 2.8 (1.2–6.4), and 2.0 (1.1–3.5), respectively. Factors like increased physical activity, sun exposure at noon, sunrise or sunset, high educational status, and residence in North Riyadh were protective against vitamin D deficiency with ORs 0.2 (0.1–0.5); 0.2 (0.1–0.6); 0.3 (0.1–0.9); and 0.4 (0.2–0.8), respectively. All ORs were adjusted for age, BMI, sun exposure, parity, summer season, vitamin D intake, multivitamin intake, physical activity, education, employment, living in the north, and coverage with clothing. In conclusion, the prevalence of vitamin D deficiency among Saudi women during early pregnancy was high (81%). Timely detection and appropriate supplementation with adequate amounts of vitamin D should reduce the risks of vitamin D deficiency and its complications during pregnancy. PMID:29662044

Prevalence of depressive disorders and related factors in women in the first trimester of their pregnancies in Erzurum, Turkey.

PubMed

Akçalı Aslan, Puren; Aydın, Nazan; Yazıcı, Esra; Aksoy, Ayse Nur; Kirkan, Tulay Sati; Daloglu, Gokhan Ali

2014-12-01

Depression is the most frequently seen mental disease in the pregnancy period. The first trimester of pregnancy is important in terms of its effects on both the fetus and on the mother. This study has researched the prevalence of depression in women in the first trimester of their pregnancies in Erzurum, which is a large province in the Eastern region of Turkey. The study participants were 463 pregnant women who were in the first trimester of their pregnancy. Screening was primarily carried out using the Edinburgh Postnatal Depression Scale (EPDS), and Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV)-Clinical Version (SCID-I) was applied to those participants with a score of 12 points and higher. To assess the risk factors, a sociodemographic data form was completed by the authors. The total depressive disorder rate was 16.8% in women in the first trimester of their pregnancies (12.3% major depressive disorder, 1.5% double depression, 2.6% minor depressive disorder and 0.4% dysthymia). A history of mental disease, mental disease suffered during a previous pregnancy, exposure to violence in the present pregnancy, an unplanned pregnancy and spouse's unemployment were predictors for depressive disorders. It is important to identify the risk groups for the early recognition of depression in pregnancy. Developing depression screening programs can be useful for early diagnosis and therapy. © The Author(s) 2014.

Calcium supplementation commencing before or early in pregnancy, or food fortification with calcium, for preventing hypertensive disorders of pregnancy.

PubMed

Hofmeyr, G Justus; Manyame, Sarah

2017-09-26

Pre-eclampsia is considerably more prevalent in low- than high-income countries. One possible explanation for this discrepancy is dietary differences, particularly calcium deficiency. Calcium supplementation in the second half of pregnancy reduces the serious consequences of pre-eclampsia and is recommended by the World Health Organization (WHO) for women with low dietary calcium intake, but has limited effect on the overall risk of pre-eclampsia. It is important to establish whether calcium supplementation before and in early pregnancy has added benefit. Such evidence would be justification for population-level fortification of staple foods with calcium. To determine the effect of calcium supplementation or food fortification with calcium, commenced before or early in pregnancy and continued at least until mid-pregnancy, on pre-eclampsia and other hypertensive disorders, maternal morbidity and mortality, as well as fetal and neonatal outcomes. We searched the Cochrane Pregnancy and Childbirth Trials Register (10 August 2017), PubMed (29 June 2017), ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (10 August 2017) and reference lists of retrieved studies. Randomised controlled trials of calcium supplementation or food fortification which include women of child bearing age not yet pregnant, or in early pregnancy. Cluster-RCTs, quasi-RCTs and trials published in abstract form only would have been eligible for inclusion in this review but none were identified. Cross-over designs are not appropriate for this intervention.The scope of this review is to consider interventions including calcium supplementation with or without additional supplements or treatments, compared with placebo or no intervention. Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. This review is based on one RCT (involving 60 women) which looked at calcium plus additional supplements

Predictive factors for the methotrexate treatment outcome in ectopic pregnancy: A comparative study of 400 cases.

PubMed

Bonin, Lucie; Pedreiro, Cécile; Moret, Stéphanie; Chene, Gautier; Gaucherand, Pascal; Lamblin, Géry

2017-01-01

We sought to evaluate the global success rate of intramuscular methotrexate for the treatment of ectopic pregnancy, identify factors predictive of treatment success or failure, and study methotrexate tolerability in a large patient cohort. For this single-center retrospective observational study, we retrieved the records of all women who had a clinically or echographically confirmed ectopic pregnancy with a Fernandez score <13 and who were treated according to a 1mg/kg intramuscular single-dose methotrexate protocol. Medical treatment failure was defined by an obligation to proceed to laparoscopy. Needing a second injection was not considered to be medical treatment failure. Between February 2008 and November 2013 (69 months), 400 women received methotrexate for ectopic pregnancy. The medical treatment protocol was effective for 314 patients, i.e., an overall success rate of 78.5%. A single methotrexate dose was sufficient for 63.5% of the women and a second dose was successful for 73.2% of the remaining women. The medical treatment success rate fell as initial hCG levels climbed. The main factors associated with methotrexate failure included day (D) 0, D4 and D7 hCG levels, pretherapeutic blood progesterone, hematosalpinx at D0 and pain at D7. Early favorable kinetics of hCG levels was predictive of success. Methotrexate treatment was successful in 90% of women who had D0 hCG <1000IU/l. Methotrexate tolerability was good, with only 9% of the women reporting non-severe adverse effects. The fertility rate with delivery after medical treatment for ectopic pregnancy was 80.7%. In this study, we showed that an initial hCG value <1000IU/l and favorable early HCG kinetics were predictive factors for the successful medical treatment of ectopic pregnancy by methotrexate, and hematosalpinx and pretherapeutic blood progesterone >5ng/ml at diagnosis were predictive of its failure. We also confirmed good tolerability for single-dose methotrexate protocols. Copyright �

Maternal cardiac metabolism in pregnancy

PubMed Central

Liu, Laura X.; Arany, Zolt

2014-01-01

Pregnancy causes dramatic physiological changes in the expectant mother. The placenta, mostly foetal in origin, invades maternal uterine tissue early in pregnancy and unleashes a barrage of hormones and other factors. This foetal ‘invasion’ profoundly reprogrammes maternal physiology, affecting nearly every organ, including the heart and its metabolism. We briefly review here maternal systemic metabolic changes during pregnancy and cardiac metabolism in general. We then discuss changes in cardiac haemodynamic during pregnancy and review what is known about maternal cardiac metabolism during pregnancy. Lastly, we discuss cardiac diseases during pregnancy, including peripartum cardiomyopathy, and the potential contribution of aberrant cardiac metabolism to disease aetiology. PMID:24448314

The association of factor V leiden mutation with recurrent pregnancy loss.

PubMed

Kashif, Sumreen; Kashif, Muhammad Ali; Saeed, Anjum

2015-11-01

To determine the association of factor V Leiden mutation with recurrent pregnancy loss. The case-control study was conducted at the Department of Haematology, Armed Forces Institute of Pathology, Rawalpindi, Pakistan, from January to June 2012, and comprised women of 18 to 45 years of age who had a history of recurrent pregnancy loss, and controls with no history of pregnancy loss. All the subjects belonged to Punjabi ethnic group. Three ml blood was taken from cases and controls and deoxyribonucleic acid was extracted. In order to identify Factor V Leiden mutation, polymerase chain reaction method was utilised combined with the amplification refractory mutation system. Data was analysed using SPSS 17. Of the 112 subjects, 56(50%) were in each of the two groups. The presence of factor V Leiden mutation among the cases was 3(5.4%) while it was absent among the controls. The mutation was significantly associated with recurrent pregnancy loss (p=0.017).Recurrent pregnancy loss was higher in cases than controls (p=0.001). Factor V Leiden mutation, Recurrent pregnancy loss, PCR (Polymerase chain reaction).

Warburg-like Glycolysis and Lactate Shuttle in Mouse Decidua during Early Pregnancy*

PubMed Central

Zuo, Ru-Juan; Gu, Xiao-Wei; Qi, Qian-Rong; Wang, Tong-Song; Zhao, Xu-Yu; Liu, Ji-Long; Yang, Zeng-Ming

2015-01-01

Decidualization is an essential process of maternal endometrial stromal cells to support pregnancy. Although it is known that enhanced glucose influx is critical for decidualization, the underlying mechanism in regulating glucose metabolism in decidua remains insufficiently understood. Here, we demonstrate that aerobic glycolysis-related genes and factors are all substantially induced during decidualization, indicating the existence of Warburg-like glycolysis in decidua. In vitro, progesterone activates hypoxia-inducible factor 1α (Hif1α) and c-Myc through Pi3k-Akt signaling pathway to maintain aerobic glycolysis in decidualizing cells. Knocking down of pyruvate kinase M2 (Pkm2) attenuates the induction of decidual marker gene. Decidual formation in vivo is also impaired by glycolysis inhibitor 3-bromopyruvate. Besides, lactate exporter monocarboxylate transporter 4 (Mct4) is induced in newly formed decidual cells, whereas lactate importer Mct1 and proliferation marker Ki-67 are complementarily located in the surrounding undifferentiated cells, which are supposed to consume lactate for proliferation. Hif1α activation is required for lactate-dependent proliferation of the undifferentiated cells. Inhibition of lactate flux leads to compromised decidualization and decelerated lactate-dependent proliferation. In summary, we reveal that Warburg-like glycolysis and local lactate shuttle are activated in decidua and play important roles for supporting early pregnancy. PMID:26178372

Pre-Pregnancy BMI, Gestational Weight Gain, and the Risk of Hypertensive Disorders of Pregnancy: A Cohort Study in Wuhan, China

PubMed Central

Hu, Ronghua; Zhang, Yiming; Bassig, Bryan A.; Triche, Elizabeth; Yang, Shaoping; Qiu, Lin; Zhang, Yaqi; Yao, Cong; Xu, Shunqing; Wang, Youjie; Xia, Wei; Qian, Zhengmin; Zheng, Tongzhang; Zhang, Bin

2015-01-01

Background Hypertensive disorders of pregnancy (HDP) are major causes of maternal death worldwide and the risk factors are not fully understood. Few studies have investigated the risk factors for HDP among Chinese women. A cohort study involving 84,656 women was conducted to investigate pre-pregnancy BMI, total gestational weight gain (GWG), and GWG during early pregnancy as risk factors for HDP among Chinese women. Methods The study was conducted between 2011–2013 in Wuhan, China, utilizing data from the Maternal and Children Healthcare Information Tracking System of Wuhan. A total of 84,656 women with a live singleton pregnancy were included. Multiple unconditional logistic regression was conducted to evaluate associations between putative risk factors and HDP. Results Women who were overweight or obese before pregnancy had an elevated risk of developing HDP (overweight: OR = 2.66, 95% CI = 2.32–3.05; obese: OR = 5.53, 95% CI = 4.28–7.13) compared to their normal weight counterparts. Women with total GWG above the Institute of Medicine (IOM) recommendation had an adjusted OR of 1.72 (95% CI = 1.54–1.93) for HDP compared to women who had GWG within the IOM recommendation. Women with gestational BMI gain >10 kg/m2 during pregnancy had an adjusted OR of 3.35 (95% CI = 2.89–3.89) for HDP, compared to women with a gestational BMI gain <5 kg/m2. The increased risk of HDP was also observed among women with higher early pregnancy (up to 18 weeks of pregnancy) GWG (>600g/wk: adjusted OR = 1.48, 95% CI = 1.19–1.84). Conclusion The results from this study show that maternal pre-pregnancy BMI, early GWG, and total GWG are positively associated with the risk of HDP. Weight control efforts before and during pregnancy may help to reduce the risk of HDP. PMID:26305565

Chronic exposure to bisphenol a impairs progesterone receptor-mediated signaling in the uterus during early pregnancy

PubMed Central

Li, Quanxi; Davila, Juanmahel; Bagchi, Milan K.; Bagchi, Indrani C.

2016-01-01

Environmental and occupational exposure to endocrine disrupting chemicals (EDCs) is a major threat to female reproductive health. Bisphenol A (BPA), an environmental toxicant that is commonly found in polycarbonate plastics and epoxy resins, has received much attention due to its estrogenic activity and high risk of chronic exposure in human. Whereas BPA has been linked to infertility and recurrent miscarriage in women, the impact of its exposure on uterine function during early pregnancy remains unclear. In a recent publication in Endocrinology, we demonstrated that prolonged exposure to an environmental relevant dose of BPA disrupts progesterone receptor-regulated uterine functions, thus affecting uterine receptivity for embryo implantation and decidua morphogenesis, two critical events for establishment and maintenance of early pregnancy. In particular we reported a marked impairment of progesterone receptor (PGR) expression and its downstream effector HAND2 in the uterine stromal cells in response to chronic BPA exposure. In an earlier study we have shown that HAND2 controls embryo implantation by repressing fibroblast growth factor (FGF) expression and the MAP kinase signaling pathway, thus inhibiting epithelial proliferation. Interestingly we observed that downregulation of PGR and HAND2 expression in uterine stroma upon BPA exposure was associated with an enhanced activation of FGFR and MAPK signaling, aberrant proliferation, and lack of uterine receptivity in the epithelium. In addition, the proliferation and differentiation of endometrial stromal cells to decidual cells, an event critical for the maintenance of early pregnancy, was severely compromised in response to BPA. This research highlight will provide an overview of our findings and discuss the potential mechanisms by which chronic BPA impairs PGR-HAND2 pathway and adversely affects implantation and the establishment of pregnancy. PMID:28239613

Socio-economic, environmental and nutritional characteristics of urban and rural South Indian women in early pregnancy: findings from the South Asian Birth Cohort (START).

PubMed

Dwarkanath, Pratibha; Vasudevan, Anil; Thomas, Tinku; Anand, Sonia S; Desai, Dipika; Gupta, Milan; Menezes, Gladys; Kurpad, Anura V; Srinivasan, Krishnamachari

2018-06-01

High frequency of low birth weight (LBW) is observed in rural compared with urban Indian women. Since maternal BMI is known to be associated with pregnancy outcomes, the present study aimed to investigate factors associated with BMI in early pregnancy of urban and rural South Indian women. Prospective observational cohort. A hospital-based study conducted at an urban and a rural health centre in Karnataka State. Pregnant women (n 843) aged 18-40 years recruited in early pregnancy from whom detailed sociodemographic, environmental, anthropometric and dietary intake information was collected. A high proportion of low BMI (32 v. 26 %, P<0·000) and anaemia (48 v. 23 %, P<0·000) was observed in the rural v. the urban cohort. Rural women were younger, had lower body weight, tended to be shorter and less educated. They lived in poor housing conditions, had less access to piped water and good sanitation, used unrefined fuel for cooking and had lower standard of living score. The age (β=0·21, 95 % CI 0·14, 0·29), education level of their spouse (β=1·36, 95 % CI 0·71, 2·71) and fat intake (β=1·24, 95 % CI 0·20, 2·28) were positively associated with BMI in urban women. Our findings indicate that risk factors associated with BMI in early pregnancy are different in rural and urban settings. It is important to study population-specific risk factors in relation to perinatal health.

Lower inter-partum interval and unhealthy life-style factors are inversely associated with n-3 essential fatty acids changes during pregnancy: a prospective cohort with Brazilian women.

PubMed

Pinto, Thatiana J P; Farias, Dayana R; Rebelo, Fernanda; Lepsch, Jaqueline; Vaz, Juliana S; Moreira, Júlia D; Cunha, Geraldo M; Kac, Gilberto

2015-01-01

To analyze serum fatty acids concentrations during healthy pregnancy and evaluate whether socioeconomic, demographic, obstetric, nutritional, anthropometric and lifestyle factors are associated with their longitudinal changes. A prospective cohort of 225 pregnant women was followed in the 5th-13th, 20th-26th and 30th-36th weeks of gestation. Serum samples were collected in each trimester of pregnancy and analyzed to determine the fatty acids composition using a high-throughput robotic direct methylation method coupled with fast gas-liquid chromatography. The independent variables comprised the subjects' socioeconomic and demographic status, obstetric history, early pregnancy body mass index (BMI), dietary and lifestyle parameters. Analyses were performed using linear mixed-effects models. The overall absolute concentrations of fatty acids increased from the 1st to the 2nd trimester and slightly increased from the 2nd to the 3rd trimester. Early pregnancy BMI, inter-partum interval and weekly fish intake were the factors associated with changes in eicosapentaenoic + docosahexaenoic acids (EPA+DHA) and total n-3 polyunsaturated fatty acids (PUFAs). Early pregnancy BMI, age and monthly per-capita income were inversely associated with the changes in the n-6/n-3 ratio. Alcohol consumption was positively associated with the n-6/n-3 ratio. Early pregnancy BMI was positively associated with EPA+DHA and total n-3 PUFAs, while presenting a reduced weekly fish intake and a lower inter-partum interval were associated with lower levels of n-3 PUFAs. A lower per-capita family income and a drinking habit were factors that were positively associated with a higher n-6/n-3 ratio.

Effect of early pregnancy diagnosis by per rectum amniotic sac palpation on pregnancy loss, calving rates, and abnormalities in newborn dairy calves.

PubMed

Romano, Juan E; Bryan, Kelsey; Ramos, Roney S; Velez, Juan; Pinedo, Pablo

2016-02-01

The objectives of the present study were to evaluate the effect of per rectal amniotic sac palpation (ASP) for pregnancy diagnosis during the late embryonic period on pregnancy loss, calving rates, and abnormalities in newborn calves. A controlled, randomized, blocked, blind experiment containing 680 lactating pregnant dairy cows with a viable embryo diagnosed by transrectal ultrasonography was performed. Two dairy operation sites (farm A and farm B) were selected. At each farm, the cows were randomly divided into control (CON) and ASP groups. The CON group was not subjected to pregnancy diagnosis via per rectum palpation. The ASP examinations were performed by one experienced veterinarian between Days 34 and 45 after breeding. All cows were reevaluated by transrectal ultrasonography only between 2 and 4 weeks later. Two calving rates were calculated: calving rate 1 (cows that calved from the initial number of pregnant cows) and calving rate 2 (cows that calved from cows pregnant at reexamination). In farm A, the percentages of early pregnancy loss were 11.5% (19 of 165) and 13.2% (24 of 182) for the CON and the ASP groups, respectively (P = 0.64). In farm B, the percentage of early pregnancy loss was 11.2% (19 of 170) for the CON group and 8.8% (14 of 159; P = 0.48) for the ASP group. In farm A, the percentage of late pregnancy loss was 7.6% (11 of 145) for the CON group and 5.5% (8 of 155; P = 0.39) for the ASP group. In farm B, the percentage of late pregnancy loss was 3.7% (5 of 137) for the CON group and 6.3% (8 of 127; P = 0.32) for the ASP group. In farm A, early pregnancy loss was higher than late pregnancy loss (12.4% vs. 6.3%; P = 0.01), and in farm B, the same tendency was detected (10.0% vs. 4.9%, for early and late pregnancy loss, respectively; P = 0.02). In farm A, calving rate 1 was 81.2% (134 of 165) for the CON group and 80.8% (147 of 182; P = 0.92) for the ASP group. Calving rate 2 for the same groups was 92.4% (134 of 145) and 94.8% (147 of 155

Evaluation of serum concentrations of tumor necrosis factor (TNF)-α, interleukin (IL)-2, IL-10, and nitric oxide (NO) during the estrous cycle, early pregnancy and abortion in goats.

PubMed

Chen, Youwang; Lv, Wenting; Jia, Jingliang; Wang, Jiantao; Yang, Jianhui

2016-11-01

The aim of this study was to establish the serum concentrations, ranges, and trends of Th1 type cytokine (tumor necrosis factor (TNF)-α and interleukin (IL)-2), Th2 type cytokine (IL-10), and nitric oxide (NO) during the estrous cycle, early pregnancy and abortion in goats. Boer goats (n=25) having symptoms of normal estrous cycles were selected, 20 were mated and 15 conceived a pregnancy, and the remaining five were not mated and served as estrous controls. On the Day 60 of pregnancy, all 15 pregnant goats were induced to abort the pregnancy by intramuscular injection of prostaglandin (PG). Serum samples were collected on Days 1, 7, 14, and 19 of the estrous cycle, at Days 0, 10, 20, 30, 40, 50, and 60 of pregnancy, and at Days 1, 3, 8, 10 over the period when abortion were occurring. Results of the present study indicated that during the estrous cycle the balance between Th1 and Th2 cytokines slightly shifted toward Th1 cytokine production (TNF-α and IL-2). The NO may have a direct positive role in inducing a Th1 response. During early pregnancy, TNF-α and IL-2 serum concentrations markedly increased from Days 0 to 10, and gradually decreased from Days 10 to 60, while IL-10 and NO serum concentrations remained elevated from Days 0 to 60. The increased concentrations of IL-10 and decreased concentrations of TNF-α and IL-2 are characteristic of a Th2-enhanced response, which may be related to increased concentrations of NO. These changes may be essential to maintain a normal pregnancy. In addition, the serum concentrations of TNF-α, IL-2 and NO at Days 1, 3, 8 and 10 of the period of induced abortion were markedly greater than that on Day 60 of pregnancy. Conversely, IL-10 concentrations at these four time points of abortion were markedly less than that on Day 60 of pregnancy. After abortion, the Th2 response shifted to a Th1-enhanced response. Thus, NO concentrations increase and the Th1-enhanced response may function synergistically to be involved in

Associations of early pregnancy sleep duration with trimester-specific blood pressures and hypertensive disorders in pregnancy.

PubMed

Williams, Michelle A; Miller, Raymond S; Qiu, Chunfang; Cripe, Swee May; Gelaye, Bizu; Enquobahrie, Daniel

2010-10-01

We evaluated the influence of maternal self-reported habitual sleep duration during early pregnancy on blood pressure (BP) levels and risk of hypertensive disorders of pregnancy. Prospective cohort study. Clinic-based study. A cohort of 1,272 healthy, pregnant women. We abstracted maternal antenatal BP values from medical records and estimated mean BP differences across hours of sleep categories in regression models, using generalized estimating equations. Odds ratios (OR) and 95% confidence intervals (95% CIs) for pregnancy induced hypertension (PIH) and preeclampsia (PE) in relation to long and short sleep duration were estimated. Mean 1st and 2nd trimester systolic (S) and diastolic (D) BP values were similar among women reporting to be short sleepers (< or = 6 h) vs. women reporting to sleep 9 hours. However, both short and long sleep duration in early pregnancy were associated with increased mean 3rd trimester SBP and DBP. For example, mean 3rd trimester SBP was 3.72, and 2.43 mm Hg higher for women reporting < or = 6 h and 7-8 h sleep, respectively, compared with women reporting 9 h of sleep. Mean 3rd trimester SBP was 4.21 mm Hg higher for women reporting long sleep (> or = 10 h) vs. the reference group. Short and long sleep durations were associated with increased risks of PIH and PE. The ORs for very short (< 5 h) and long (> or = 10 h) sleepers were 9.52 (95% CI 1.83 to 49.40) and 2.45 (95% CI 0.74 to 8.15) for PE. Our findings are consistent with a larger literature that documents elevated blood pressure and increased risks of hypertension with short and long sleep duration.

The decidua of preeclamptic-like BPH/5 mice exhibits an exaggerated inflammatory response during early pregnancy

PubMed Central

Heyward, CY; Sones, JL; Lob, HE; Yuen, LC; Abbott, KE; Huang, W; Begun, ZR; Butler, SD; August, A; Leifer, CA; Davisson, RL

2017-01-01

Preeclampsia is a devastating complication of pregnancy characterized by late-gestation hypertension and proteinuria. Because the only definitive treatment is delivery of the fetus and placenta, preeclampsia contributes to increased morbidity and mortality of both mother and fetus. The BPH/5 mouse model, which spontaneously develops a syndrome strikingly similar to preeclampsia, displays excessive inflammation and suppression of inflammation improves pregnancy outcomes. During early pregnancy, decidual macrophages play an important role in promoting maternal tolerance to fetal antigens and regulating tissue remodeling, two functions that are critical for normal placental development. BPH/5 pregnancies are characterized by abnormal placentation; therefore, we hypothesized that macrophage localization and/or function is altered during early pregnancy at the site of placental formation (the decidua) compared to C57BL/6 controls. At early gestation time points, before the onset of maternal hypertension or proteinuria, there was a reduction in the number of macrophages in BPH/5 decidua and a concomitant increase in activated T cells compared to C57BL/6. BPH/5 decidua also exhibited decreased expression of the immunosuppressive cytokine, IL-10, and increased expression of pro-inflammatory, inducible nitric oxide synthase (iNOS). Together, these data suggest that a reduction in decidual macrophages during pregnancy is associated with immune activation in BPH/5 mice, inadequate placental development and may contribute to adverse pregnancy outcomes in this model. PMID:28432903

Does Father Absence Place Daughters at Special Risk for Early Sexual Activity and Teenage Pregnancy?

PubMed Central

Ellis, Bruce J.; Bates, John E.; Dodge, Kenneth A.; Fergusson, David M.; Horwood, L. John; Pettit, Gregory S.; Woodward, Lianne

2009-01-01

The impact of father absence on early sexual activity and teenage pregnancy was investigated in longitudinal studies in the United States (N = 242) and New Zealand (N = 520), in which community samples of girls were followed prospectively from early in life (5 years) to approximately age 18. Greater exposure to father absence was strongly associated with elevated risk for early sexual activity and adolescent pregnancy. This elevated risk was either not explained (in the U.S. study) or only partly explained (in the New Zealand study) by familial, ecological, and personal disadvantages associated with father absence. After controlling for covariates, there was stronger and more consistent evidence of effects of father absence on early sexual activity and teenage pregnancy than on other behavioral or mental health problems or academic achievement Effects of father absence are discussed in terms of life-course adversity, evolutionary psychology, social learning, and behavior genetic models. PMID:12795391

Risk factors for neonatal thyroid dysfunction in pregnancies complicated by Graves' disease.

PubMed

Uenaka, Mizuki; Tanimura, Kenji; Tairaku, Shinya; Morioka, Ichiro; Ebina, Yasuhiko; Yamada, Hideto

2014-06-01

To determine the factors related to adverse pregnancy outcomes and neonatal thyroid dysfunction in pregnancies complicated by Graves' disease. Thirty-five pregnancies complicated by Graves' disease were divided into two groups: adverse pregnancy outcome (n=15) and no adverse pregnancy outcome (n=20). Adverse pregnancy outcomes included spontaneous abortion, stillbirth, premature delivery, fetal growth restriction, and pregnancy-induced hypertension. The 31 pregnancies resulting in live births were also divided into two groups: neonatal thyroid dysfunction (n=9) and normal neonatal thyroid function (n=22). Serum levels of thyroid-stimulating hormone (TSH), free thyroxine (FT4), TSH-receptor antibody (TRAb), the duration of hyperthyroidism in pregnancy, doses of antithyroid medication, and the duration of maternal antithyroid medication throughout pregnancy were compared. There were no significant differences in these factors between pregnancies with an adverse pregnancy outcome and those with no adverse pregnancy outcome. However, serum levels of FT4, TRAb, the duration of hyperthyroidism in pregnancy, the maximum daily dose of antithyroid medication, and the total dose of antithyroid medication were significantly different between pregnancies with neonatal thyroid dysfunction and those with normal neonatal thyroid function. Multivariate logistic regression analysis showed that the FT4 level in mothers was a significant factor related to the development of neonatal thyroid dysfunction (odds ratio 28.84, 95% confidence interval 1.65-503.62, p<0.05). Graves' disease activity in women of childbearing age should be well controlled prior to conception. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Factors across the life course predict women's change in smoking behaviour during pregnancy and in midlife: results from the National Child Development Study.

PubMed

Schoenaker, Danielle A J M; Ploubidis, George B; Goodman, Alissa; Mishra, Gita D

2017-12-01

Tobacco smoking before, during and after pregnancy remains one of the few preventable factors associated with poor health outcomes for mothers and their children. We investigate predictors across the life course for change in smoking behaviour during pregnancy and whether this change predicts smoking status in midlife. Data were from the National Child Development Study (1958 British birth cohort). We included female cohort members who reported a first pregnancy up to age 33 years. Among 1468 women who smoked before pregnancy, we examined predictors reported in childhood (age 11 years), adolescence (age 16 years) and early adulthood (age 23 years) of change in smoking behaviour from 12 months before to during pregnancy using log-binomial regression. The association between change in smoking behaviour during pregnancy and smoking status in midlife (age 55 years) was examined while adjusting for predictors across the life course. Among prepregnancy smokers (39%), 26% reduced and 35% quit smoking during pregnancy. Parental smoking and lower social class during childhood, and early adulthood lower social class, depression, early smoking initiation, high smoking intensity, living with a smoker, no pregnancy planning and early motherhood were associated with lower probability of smoking reduction or cessation in pregnancy. Compared with women who smoked before and during pregnancy, women who reduced or quit were two times more likely to be non-smoker at age 55 years (95% CI 1.76 to 2.20). Findings from this population-based birth cohort study lend support for smoking cessation strategies that target those at risk at various stages across the life course. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

18 Percent of Pregnant Women Drink Alcohol during Early Pregnancy

MedlinePlus

National Survey on Drug Use and Health The NSDUH Report Data Spotlight September 9, 2013 18 Percent of Pregnant VA60 Women Drink Alcohol during Early Pregnancy Women who drink alcohol while pregnant increase the risk that their infants will have physical, learning, and/ ...

Lifestyle patterns in early pregnancy linked to gestational diabetes mellitus diagnoses when using IADPSG criteria. The St Carlos gestational study.

PubMed

Ruiz-Gracia, Teresa; Duran, Alejandra; Fuentes, Manuel; Rubio, Miguel A; Runkle, Isabelle; Carrera, Evelyn F; Torrejón, María J; Bordiú, Elena; Valle, Laura Del; García de la Torre, Nuria; Bedia, Ana R; Montañez, Carmen; Familiar, Cristina; Calle-Pascual, Alfonso L

2016-06-01

Early-pregnancy lifestyle (EPL) could influence the development of gestational diabetes mellitus(GDM), depending on the diagnostic criteria used. We studied EPL in 1750 pregnant women using Carpenter-Coustan criteria(CCc), and in 1526 with the International Association of Diabetes and Pregnancy Study Groups criteria(IADPSGc). GDM risk factors were assessed in women between 24 and 28 weeks of gestational age during two consecutive years. A semiquantitative frequent-food-consumption questionnaire was used to evaluate lifestyle during pregnancy. Multiple logistic regression analysis was conducted to assess GDM risk with different lifestyle patterns. Using IADPSGc, the GDM ORs (95%CI) for intake/week were: nuts >3 times: 0.59 (0.39-0.91; p < 0.015), refined cereals ≤1 serving: 0.72(0.58-0.89; p < 0.003), juices <4 servings: 0.77 (0.62-0.95; p < 0.017), cookies and pastries <4 servings: 0.71(0.57-0.89; p < 0.003) as compared to opposite habits. No significant nutritional patterns were found to be significant using CCc. The OR (95%CI) for GDM with none of the four risk patterns as compared to having three-four risk factors was 0.21(0.07-0.62; p < 0.005), remaining significant after stratification by BMI, age, obstetric events, parity and family history. The multiple logistic regression model including nutritional categories and pregestational BMI, age, obstetric history, parity, personal/family history, had an area under the curve(AUC) of the receiver operating curve(ROC) for the probability to predict GDM of 0.66 (CI 95%: 0.63-0.69; p < 0.001). Our study is the first to identify four early-pregnancy nutritional patterns associated with the GDM when using IADPSGc. Adherence to a low-risk nutritional pattern from early pregnancy on could be an effective strategy for GDM prevention. Copyright © 2015 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Environmental Tobacco Smoke: Relationship to Early Pregnancy Discomforts.

PubMed

Hung, Hui-Jung; Chen, Chiu-Ying; Wang, Shu-Li; Wu, Trong-Neng; Lee, Chiu-Hsiang; Cheng, Shi-Yann

2017-05-01

We assessed environmental tobacco smoke (ETS) and examined its association with pregnancy discomforts. We used structured questionnaires to interview a convenience sample of 139 pregnant women (8-20 weeks of gestation) recruited from 2 hospitals in central Taiwan. We found that 84% of the participants experienced ETS exposure in their households, workplaces, and/or public areas. Bivariate analyses showed the severity of pregnancy discomforts in the participants exposed to a high level of ETS was higher than that in those exposed to a low level of ETS. We found the discomfort symptoms of thirst, heartburn, lower abdominal pain, frequent urination, and depression to be significantly associated with ETS exposure. There also was a dose-response relationship between ETS exposure and discomfort. In addition, the presence of at least 4 out of those 5 symptoms served as a signal for raising women's self-awareness to avoid ETS hazards. Our study provides empirical evidence of an adverse relationship between ETS exposure and early pregnancy discomforts. The exposure to ETS in pregnant women remains high, and health education programs targeting this population should enhance their self-awareness to the discomforts related to ETS exposure and prompt them to adopt prevention strategies.

Early pregnancy vaginal microbiome trends and preterm birth.

PubMed

Stout, Molly J; Zhou, Yanjiao; Wylie, Kristine M; Tarr, Phillip I; Macones, George A; Tuuli, Methodius G

2017-09-01

, diversity, and evenness during pregnancy (P < .01). This change occurred between the first and second trimesters. Within-subject comparisons across pregnancy showed that preterm birth is associated with increased vaginal microbiome instability compared to term birth. No distinct taxa were associated with preterm birth. In a predominantly African-American population, a significant decrease of vaginal microbial community richness and diversity is associated with preterm birth. The timing of this suppression appears early in pregnancy, between the first and second trimesters, suggesting that early gestation may be an ecologically important time for events that ordain subsequent term and preterm birth outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

Predictive value of serum β-hCG for early pregnancy outcomes among women with recurrent spontaneous abortion.

PubMed

Liu, Yinglin; Liu, Yukun; Li, Xuejiao; Jiao, Xuedan; Zhang, Rui; Zhang, Jianping

2016-10-01

To examine peak serum levels of the β-subunit of human chorionic gonadotropin (β-hCG) for prediction of early pregnancy outcomes among women with recurrent spontaneous abortion (RSA). In a retrospective study, the medical records of pregnant women with a history of RSA treated at Sun Yat-sen Memorial Hospital, China, between January 2011 and July 2013 were reviewed. Serum β-hCG had been measured twice weekly from 5 to 13weeks of pregnancy, and pregnancy was monitored by transvaginal ultrasonography to 13(+6)weeks. Optimal cutoff for peak β-hCG level was determined by receiver operator characteristic curve analysis and Youden index. Women were divided into four groups on the basis of optimal peak β-hCG cutoff and pregnancy outcome (pregnancy at 13weeks or spontaneous abortion). Peak β-hCG levels and length of pregnancy at this peak were examined. Overall, 1240 patients were included. The optimal cutoff value of peak β-hCG was 88 468IU/L, with a sensitivity, specificity, positive predictive value, and negative predictive value for successful pregnancy of 95.6%, 88.0%, 95.6%, and 89.0%, respectively. A faster rise in β-hCG, higher peak β-hCG, and longer pregnancy length at peak β-hCG were associated with successful early pregnancy. A cutoff value of serum β-hCG of 88 000IU/L could be used to predict early pregnancy outcomes for women with a history of RSA. Copyright © 2016. Published by Elsevier Ireland Ltd.

Factors influencing utilization of intermittent preventive treatment for pregnancy in the Gushegu district, Ghana, 2013

PubMed Central

Stephen, Atasige Awin-irigu; Wurapa, Frederick; Afari, Edwin Andrew; Sackey, Samuel Oko; Malm, Keaziah Laurencia; Nyarko, Kofi Mensah

2016-01-01

Introduction The coverage of adequate (≥2 doses) IPTp-SP in Ghana is below the national target of 80% and that is a threat to reducing the incidence of malaria in pregnancy. The primary objective of the study was to determine the client and facility related factors associated with adequate uptake of IPTp-SP and suggest approaches for increased uptake. Methods A cross sectional study was conducted among ANC clients and staff in Gushegu, questionnaires was administered to 330 conveniently sampled nursing mothers and all ANC staff present. A checklist and observation were used to collect health facility data. Data was analyzed descriptively and associations between the related factors and adequate uptake of IPTp-SP were determined. Results A total of 91.5% and 8.5% of respondents took adequate (≥2doses) and inadequate (≤1dose) IPTp-SP respectively. 85.4% respondents were early first ANC attendance and 80% were multiple gravidae. Mean ANC visits was 5.0 (standard deviation = 2.2). The key determinants for inadequate uptake of IPTp were Unemployment [OR= 4.9 95% CI (1.9-13.1], single gravidae [OR= 3.4 95% CI (1.5-7.6)] and late first ANC visit [OR= 6.8 95% CI (3.0-15.4)]. DOT practice, good staff attitude and health talk at the facility were observed and confirmed by ANC clients as satisfactory. adequate uptake of SP among respondents was high. Majorities were unemployed, have had multiple pregnancies and made early first ANC visits. Unemployment and late first ANC visits are significantly associated with taking inadequate SP dose. Conclusion Adequate uptake of SP among respondents was high. Majorities were unemployed, have had multiple pregnancies and made early first ANC visits. Unemployment and late first ANC visits are significantly associated with taking inadequate SP dose. PMID:28149434

Factors influencing utilization of intermittent preventive treatment for pregnancy in the Gushegu district, Ghana, 2013.

PubMed

Stephen, Atasige Awin-Irigu; Wurapa, Frederick; Afari, Edwin Andrew; Sackey, Samuel Oko; Malm, Keaziah Laurencia; Nyarko, Kofi Mensah

2016-01-01

The coverage of adequate (≥2 doses) IPTp-SP in Ghana is below the national target of 80% and that is a threat to reducing the incidence of malaria in pregnancy. The primary objective of the study was to determine the client and facility related factors associated with adequate uptake of IPTp-SP and suggest approaches for increased uptake. A cross sectional study was conducted among ANC clients and staff in Gushegu, questionnaires was administered to 330 conveniently sampled nursing mothers and all ANC staff present. A checklist and observation were used to collect health facility data. Data was analyzed descriptively and associations between the related factors and adequate uptake of IPTp-SP were determined. A total of 91.5% and 8.5% of respondents took adequate (≥2doses) and inadequate (≤1dose) IPTp-SP respectively. 85.4% respondents were early first ANC attendance and 80% were multiple gravidae. Mean ANC visits was 5.0 (standard deviation = 2.2). The key determinants for inadequate uptake of IPTp were Unemployment [OR= 4.9 95% CI (1.9-13.1], single gravidae [OR= 3.4 95% CI (1.5-7.6)] and late first ANC visit [OR= 6.8 95% CI (3.0-15.4)]. DOT practice, good staff attitude and health talk at the facility were observed and confirmed by ANC clients as satisfactory. adequate uptake of SP among respondents was high. Majorities were unemployed, have had multiple pregnancies and made early first ANC visits. Unemployment and late first ANC visits are significantly associated with taking inadequate SP dose. Adequate uptake of SP among respondents was high. Majorities were unemployed, have had multiple pregnancies and made early first ANC visits. Unemployment and late first ANC visits are significantly associated with taking inadequate SP dose.

Effects of early pregnancy BMI, mid-gestational weight gain, glucose and lipid levels in pregnancy on offspring's birth weight and subcutaneous fat: a population-based cohort study.

PubMed

Sommer, Christine; Sletner, Line; Mørkrid, Kjersti; Jenum, Anne Karen; Birkeland, Kåre Inge

2015-04-03

Maternal glucose and lipid levels are associated with neonatal anthropometry of the offspring, also independently of maternal body mass index (BMI). Gestational weight gain, however, is often not accounted for. The objective was to explore whether the effects of maternal glucose and lipid levels on offspring's birth weight and subcutaneous fat were independent of early pregnancy BMI and mid-gestational weight gain. In a population-based, multi-ethnic, prospective cohort of 699 women and their offspring, maternal anthropometrics were collected in gestational week 15 and 28. Maternal fasting plasma lipids, fasting and 2-hour glucose post 75 g glucose load, were collected in gestational week 28. Maternal risk factors were standardized using z-scores. Outcomes were neonatal birth weight and sum of skinfolds in four different regions. Mean (standard deviation) birth weight was 3491 ± 498 g and mean sum of skinfolds was 18.2 ± 3.9 mm. Maternal fasting glucose and HDL-cholesterol were predictors of birth weight, and fasting and 2-hour glucose were predictors of neonatal sum of skinfolds, independently of weight gain as well as early pregnancy BMI, gestational week at inclusion, maternal age, parity, smoking status, ethnic origin, gestational age and offspring's sex. However, weight gain was the strongest independent predictor of both birth weight and neonatal sum of skinfolds, with a 0.21 kg/week increased weight gain giving a 110.7 (95% confidence interval 76.6-144.9) g heavier neonate, and with 0.72 (0.38-1.06) mm larger sum of skinfolds. The effect size of mother's early pregnancy BMI on birth weight was higher in non-Europeans than in Europeans. Maternal fasting glucose and HDL-cholesterol were predictors of offspring's birth weight, and fasting and 2-hour glucose were predictors of neonatal sum of skinfolds, independently of weight gain. Mid-gestational weight gain was a stronger predictor of both birth weight and neonatal sum of skinfolds than early

ATRAZINE EFFECTS ON EARLY PREGNANCY AND IMPLANATION IN THE RAT

EPA Science Inventory

Atrazine Effects on Early Pregnancy and Implantation in the Rat.
A.M. Cummings, B.E. Rhodes*, and R.L. Cooper*.
Reproductive Toxicology Division, NHEERL, USEPA, Research Triangle Park, NC
Atrazine (ATR), an herbicide, can induce mammary tumors in rats. ATR can also sup...

Hyperglycosylated human chorionic gonadotropin as an early predictor of pregnancy outcomes after in vitro fertilization.

PubMed

Chuan, Sandy; Homer, Michael; Pandian, Raj; Conway, Deirdre; Garzo, Gabriel; Yeo, Lisa; Su, H Irene

2014-02-01

To determine whether serum hyperglycosylated human chorionic gonadotropin (hhCG) measured as early as 9 days after egg retrieval can predict ongoing pregnancies after in vitro fertilization and fresh embryo transfer (IVF-ET). Cohort Academic assisted reproduction center. Consecutive patients undergoing IVF-ET INTERVENTION(S): Serum hhCG and hCG levels measured 9 (D9) and 16 (D16) days after egg retrieval Ongoing pregnancy beyond 9 weeks of gestation. Ongoing pregnancy (62 of 112 participants) was associated with higher D9 levels of hhCG and hCG. However, hhCG was detectable in all D9 OP samples, while hCG was detectable in only 22%. A D9 hhCG level of >110 pg/mL was 96% specific for an ongoing pregnancy, yielding a positive predictive value of 94%. Compared with the D9 hCG levels, hhCG was more sensitive and had a larger area under the curve (0.87 vs. 0.67, respectively). The diagnostic test characteristics were similar between the D16 hhCG and hCG levels. In patients undergoing assisted reproduction, a test to detect pregnancy early and predict outcomes is highly desirable, and hhCG is detectable in serum 9 days after egg retrieval IVF-ET cycles. In this early assessment, hhCG was superior to traditional hCG and highly predictive of ongoing pregnancies. Copyright © 2014 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Prevalence of anemia and micronutrient deficiencies in early pregnancy in rural Bangladesh, the MINIMat trial.

PubMed

Lindström, Emma; Hossain, Mohammad B; Lönnerdal, Bo; Raqib, Rubhana; El Arifeen, Shams; Ekström, Eva-Charlotte

2011-01-01

To describe the prevalence of anemia and micronutrient deficiencies as well as their determinants in early pregnancy. Baseline data from a population-based randomized intervention trial. The study was conducted in Matlab, a sub-district in rural Bangladesh from 1 January to 31 December 2002. Pregnant women (n= 740) were enrolled in approximately week 14 in pregnancy. Data were collected using questionnaires, physical examinations and laboratory analyses of blood samples for concentrations of hemoglobin, ferritin, zinc, folate and vitamin B-12. Covariates associated with anemia and micronutrient deficiencies in bivariate analyses were evaluated in multivariate logistic regression models adjusting for potential confounders. Anemia was present in 28% of the women, 55% were zinc deficient, 46% were vitamin B-12 deficient and 18% were folate deficient. Anemia was not associated with iron deficiency but rather with vitamin B-12 deficiency. Infestation with Ascaris was highly prevalent (67%) and associated with both folate and vitamin B-12 deficiency. Anemia and micronutrient deficiencies all varied significantly with season. The high prevalences of zinc and vitamin B-12 deficiencies in early pregnancy are a concern, as it could lead to adverse pregnancy outcomes and increased health risks for both mother and child. The prevalence of iron deficiency was low, but as this was during early pregnancy, the women might develop iron deficiency and consequently iron deficiency anemia as the pregnancy progresses. © 2010 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2010 Nordic Federation of Societies of Obstetrics and Gynecology.

Epidemiological investigation of risk factors of the pregnant women with early spontaneous abortion in Beijing.

PubMed

Zhou, Li-Ying; Zhang, Hong-Xia; Lan, Yong-Lian; Li, Ying; Liang, Yu; Yu, Lan; Ma, Yan-Min; Jia, Chan-Wei; Wang, Shu-Yu

2017-05-01

To determine the risk factors of the pregnant women with early spontaneous abortion in Beijing. A total of 34,417 cases of pregnant women were participated in the survey from January 2000 to December 2013. A questionnaire was informed to each woman. The content of questionnaire includes four parts: general condition, obstetrical history, past history and family history, and living environment and habits. The mental condition was evaluated with Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS). A total of 32,296 questionnaires were collected. The spontaneous abortion rate in the total sample was 3.0%. There was no significant difference between the normal pregnancy group and spontaneous abortion group in terms of general condition, obstetrical and past history (P>0.05). Significant differences between the two groups were found in terms of decoration during pregnancy, keeping pets, near mobile communication base station within 100 m around the residence, drinking during pregnancy, having a cold during pregnancy and SAS (P<0.05). Having a cold during pregnancy, decoration during pregnancy, near mobile communication base station within 100 m around the residence, keeping pets and high SAS were determined the independent risk factors of spontaneous abortion by Logistic regression analysis. Having a cold during pregnancy, decoration, keeping pets, near mobile communication base station within 100 m around the residence and high SAS are the independent risk factors of spontaneous abortion in Beijing.

Onset of bell's palsy in late pregnancy and early puerperium is associated with worse long-term outcomes.

PubMed

Phillips, Katie M; Heiser, Alyssa; Gaudin, Robert; Hadlock, Tessa A; Jowett, Nate

2017-12-01

The incidence of Bell's palsy (BP) is elevated in the late phases of pregnancy. Controversy exists as to whether pregnancy is a risk factor for worse outcomes in BP, and whether such outcomes are the result of factors intrinsic to pregnancy or the tendency to withhold medical therapy in this cohort. Long-term facial function outcomes in cases of pregnancy-associated BP (PABP) were compared against outcomes in cases affecting nonpregnant adult women of child-bearing age by a blinded expert using the electronic clinician-graded facial function scale (eFACE) facial grading system. Fifty-one pregnancy-associated cases and 58 nonpregnancy-associated cases were included. Among patients who received early corticosteroid therapy, significantly worse static, synkinesis, and composite facial function eFACE scores were demonstrated among cases of PABP compared to nonpregnancy-associated cases (static median = 86 vs. 92.5, P = 0.005; synkinesis median = 79 vs. 86, P = 0.007; composite median = 78 vs. 84, P = 0.023). Among those not treated with corticosteroids, significantly worse dynamic and composite facial function eFACE scores were demonstrated in cases of PABP compared to those for nonpregnancy-associated cases (dynamic median = 74 vs. 92.5, P = 0.038; composite median = 73 vs. 86.5, P = 0.038). A trend toward improved outcomes was demonstrated within both groups for those treated with corticosteroids compared to those who were not. In comparison to cases unrelated to pregnancy, late-term PABP is associated with worse long-term outcomes to a degree that cannot solely be explained by differences in medical therapy. 4. Laryngoscope, 127:2854-2859, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

The impact of pregnancy on physical activity level.

PubMed

Fell, Deshayne B; Joseph, K S; Armson, B Anthony; Dodds, Linda

2009-09-01

The purpose of this study was to compare women's levels of physical activity during early pregnancy and during the year before pregnancy, and to identify characteristics associated with discontinuing sports and exercise among women previously active during the year before pregnancy. Data collected from 1,737 women enrolled in a prospective cohort study and who had no contraindications for exercise were included in this analysis. Measures of physical activity (including household and care-giving activities, active living and sports and exercise activities) during early pregnancy were compared to the year before pregnancy. Log binomial regression was used to identify factors associated with discontinuing sports and exercise during pregnancy. There was a statistically significant decrease in all summary measures of physical activity during early pregnancy. The largest decreases were observed in sports and exercise activity. Among women active before pregnancy, age <35 years, multiparity, less than university education, pre-pregnancy body mass index (BMI) > or = 30 kg/m(2) and lower levels of pre-pregnancy exercise were associated with discontinuing sports and exercise activities during pregnancy. Most women reduced their physical activity level during the first 20 weeks of pregnancy compared with their level of activity during the year prior to pregnancy, particularly for sports and exercise, although a small proportion of women in this study actually increased their activity in this area during early pregnancy. Participation in sports and exercise activity during pregnancy is potentially modifiable and could favorably impact perinatal health and maternal post-partum weight. The results of this study suggests that pregnancy is an event that leads to a decrease in physical activity.

Risk Factors for Pregnancy and Childbearing in Single Young Women: Evidence from the Australian Longitudinal Study on Women's Health

ERIC Educational Resources Information Center

Miller-Lewis, Lauren R.; Wade, Tracey D.; Lee, Christina

2005-01-01

This study investigated psychosocial predictors of early pregnancy and childbearing in single young women, consistent with the Eriksonian developmental perspective. Two mail-out surveys assessing reproductive behaviour and sociodemographic, education/competence, psychosocial well-being, and aspiration factors were completed 4 years apart by 2635…

The decidua of preeclamptic-like BPH/5 mice exhibits an exaggerated inflammatory response during early pregnancy.

PubMed

Heyward, C Y; Sones, J L; Lob, H E; Yuen, L C; Abbott, K E; Huang, W; Begun, Z R; Butler, S D; August, A; Leifer, C A; Davisson, R L

2017-04-01

Preeclampsia is a devastating complication of pregnancy characterized by late-gestation hypertension and proteinuria. Because the only definitive treatment is delivery of the fetus and placenta, preeclampsia contributes to increased morbidity and mortality of both mother and fetus. The BPH/5 mouse model, which spontaneously develops a syndrome strikingly similar to preeclampsia, displays excessive inflammation and suppression of inflammation improves pregnancy outcomes. During early pregnancy, decidual macrophages play an important role in promoting maternal tolerance to fetal antigens and regulating tissue remodeling, two functions that are critical for normal placental development. BPH/5 pregnancies are characterized by abnormal placentation; therefore, we hypothesized that macrophage localization and/or function is altered during early pregnancy at the site of placental formation (the decidua) compared to C57BL/6 controls. At early gestation time points, before the onset of maternal hypertension or proteinuria, there was a reduction in the number of macrophages in BPH/5 decidua and a concomitant increase in activated T cells compared with C57BL/6. BPH/5 decidua also exhibited decreased expression of the immunosuppressive cytokine, IL-10, and increased expression of pro-inflammatory, inducible nitric oxide synthase. Together, these data suggest that a reduction in decidual macrophages during pregnancy is associated with immune activation in BPH/5 mice, inadequate placental development and may contribute to adverse pregnancy outcomes in this model. Copyright © 2017 Elsevier B.V. All rights reserved.

Milk consumption during pregnancy increases birth weight, a risk factor for the development of diseases of civilization.

PubMed

Melnik, Bodo C; John, Swen Malte; Schmitz, Gerd

2015-01-16

Antenatal dietary lifestyle intervention and nutrition during pregnancy and early postnatal life are important for appropriate lifelong metabolic programming. Epidemiological evidence underlines the crucial role of increased birth weight as a risk factor for the development of chronic diseases of civilization such as obesity, diabetes and cancer. Obstetricians and general practitioners usually recommend milk consumption during pregnancy as a nutrient enriched in valuable proteins and calcium for bone growth. However, milk is not just a simple nutrient, but has been recognized to function as an endocrine signaling system promoting anabolism and postnatal growth by activating the nutrient-sensitive kinase mTORC1. Moreover, pasteurized cow's milk transfers biologically active exosomal microRNAs into the systemic circulation of the milk consumer apparently affecting more than 11,000 human genes including the mTORC1-signaling pathway. This review provides literature evidence and evidence derived from translational research that milk consumption during pregnancy increases gestational, placental, fetal and birth weight. Increased birth weight is a risk factor for the development of diseases of civilization thus involving key disciplines of medicine. With regard to the presented evidence we suggest that dietary recommendations promoting milk consumption during pregnancy have to be re-evaluated.

Prevalence of Urinary Incontinence During Pregnancy and Associated Risk Factors.

PubMed

Dinç, Ayten

2017-07-04

To investigate the prevalence of urinary incontinence during pregnancy and associated risk factors. The study is a cross-sectional and descriptive study. A questionnaire was conducted with a total of 750 pregnant women about their urinary incontinence complaints between April and December 2013. The prevalence of urinary incontinence during pregnancy was 300 in 750 (40%). Stress urinary incontinence was the most common type of incontinence during pregnancy. 41.7% of nulliparous women, 38% of primipara women, and 20.3% of multipara women experienced urinary incontinence. Among women reporting UI, 29.3% experienced leakage a few times a day and the amount of leakage was generally (59.7%) moderate. Factors significantly associated with urinary incontinence included age group, gestational age, parity, previous urinary incontinence, constipation, mode of delivery at last childbirth, previous urinary tract infection, body mass index during pregnancy. But on multivariable analysis, the risk factors for urinary incontinence during pregnancy were previous urinary tract infection (OR = 3.8, 95%CI 1.5-9.3), constipation (OR 3.1, 95%CI 1.7-5.6) and gestational age (OR 0.5, 95%CI 0.3-0.9). As a result of this study, urinary incontinence is a common condition during pregnancy. Results would help the design of more intensive training programs to prevent incontinence during pregnancy by increasing the awareness about urinary incontinence of healthcare staff engaging in the care of pregnant women. © 2017 John Wiley & Sons Australia, Ltd.

The effect of depression symptoms and social support on black-white differences in health-related quality of life in early pregnancy: the health status in pregnancy (HIP) study.

PubMed

Liu, Li; Setse, Rosanna; Grogan, Ruby; Powe, Neil R; Nicholson, Wanda K

2013-06-03

Lower physical and social functioning in pregnancy has been linked to an increased risk of preterm delivery and low birth weight infants, butt few studies have examined racial differences in pregnant women's perception of their functioning. Even fewer studies have elucidated the demographic and clinical factors contributing to racial differences in functioning. Our objective was to determine whether there are racial differences in health-related quality of life (HRQoL) in early pregnancy; and if so, to identify the contributions of socio-demographic characteristics, depression symptoms, social support and clinical factors to these differences. Cross-sectional study of 175 women in early pregnancy attending prenatal clinics in urban setting. In multivariate analysis, we assessed the independent relation of black race (compared to white) to HRQoL scores from the eight domains of the Medical Outcomes (SF-36) SURVEY: Physical Functioning, Role-Physical, Bodily Pain, Vitality, General Health, Social Functioning, Role-Emotional, and Mental Health. We compared socio-demographic and clinical factors and depression symptoms between black and white women and assessed the relative importance of these factors in explaining racial differences in physical and social functioning. Black women comprised 59% of the sample; white women comprised 41%. Before adjustment, black women had scores that were 14 points lower in Physical Function and Bodily Pain, 8 points lower in General Health, 4 points lower in Vitality and 7 points lower in Social Functioning. After adjustment for depression symptoms, social support and clinical factors, black women still had HRQoL scores that were 4 to 10 points lower than white women, but the differences were no longer statistically significant. Level of social support and payment source accounted for most of the variation in Physical Functioning, Bodily Pain and General Health. Social support accounted for most of the differences in Vitality and Social

What is to blame for postnatal pelvic floor dysfunction in primiparous women-Pre-pregnancy or intrapartum risk factors?

PubMed

Durnea, Constantin M; Khashan, Ali S; Kenny, Louise C; Durnea, Uliana A; Dornan, James C; O'Sullivan, Suzanne M; O'Reilly, Barry A

2017-07-01

The aetiology of pelvic floor dysfunction (PFD) is still poorly understood. However childbearing is recognized as a major risk factor. To elucidate the natural history of PFD by investigating the impact of the mode of delivery on postnatal pelvic floor dysfunction in primiparas, when PFD existing before the first pregnancy is taken into consideration. 4P-study (Prevalence and Predictors of Pelvic floor dysfunction in Primips) is a prospective cohort study, nested within the Screening for Pregnancy Endpoints (SCOPE) study set in a tertiary referral teaching hospital with 9000 deliveries annually. Established and proposed risk factors for urinary, fecal, prolapse and sexual dysfunction and the severity of symptoms for each of these outcomes were assessed using the Australian Pelvic Floor Questionnaire in 1482 nulliparous women, who each completed the questionnaire in early pregnancy. Of these, 1060 (72%) repeated the questionnaire 12 months postpartum.Outcomes were analyzed using multivariate ordinal logistic regression. Significant (p<0.05) risk factors for postpartum PFD were pre-pregnancy presence of similar symptoms Odds Ratio (OR) (5.0-30.0), smoking (OR 2.2-4.6), recurrent UTI (OR 2.2-17.3), high hip circumference (OR1.4-1.6), vigorous exercising (OR 3.1-17.9), induction of labor (OR 1.5-2.3), forceps delivery (OR 1.8-8.8), and 3rd degree perineal tear (OR 2.4-2.7). Cesarean section was associated with a lower risk of stress urinary incontinence (OR 0.3-0.5). Other common pre-pregnancy significant (p<0.05) risk factors for various PFD types prior to the first pregnancy were: diagnosed depression - (OR 1.6-2.1), high BMI (OR 3.1), strenuous exercising (OR 1.3-2.2), recurrent UTI (OR 1.5-2.5) and lower educational achievement (OR 1.5-1.6). Pre-pregnancy PFD was mainly associated with modifiable risk factors such as smoking and exercising. The main risk factor for postpartum PFD was the presence of similar symptoms prior to pregnancy, followed by anthropometric

Early life risk factors and their cumulative effects as predictors of overweight in Spanish children.

PubMed

Iguacel, Isabel; Escartín, Laura; Fernández-Alvira, Juan M; Iglesia, Iris; Labayen, Idoia; Moreno, Luis A; Samper, María Pilar; Rodríguez, Gerardo

2018-05-01

To explore early life risk factors of overweight/obesity at age 6 years and their cumulative effects on overweight/obesity at ages 2, 4 and 6 years. Altogether 1031 Spanish children were evaluated at birth and during a 6-year follow-up. Early life risk factors included: parental overweight/obesity, parental origin/ethnicity, maternal smoking during pregnancy, gestational weight gain, gestational age, birth weight, caesarean section, breastfeeding practices and rapid infant weight gain collected via hospital records. Cumulative effects were assessed by adding up those early risk factors that significantly increased the risk of overweight/obesity. We conducted binary logistic regression models. Rapid infant weight gain (OR 2.29, 99% CI 1.54-3.42), maternal overweight/obesity (OR 1.93, 99% CI 1.27-2.92), paternal overweight/obesity (OR 2.17, 99% CI 1.44-3.28), Latin American/Roma origin (OR 3.20, 99% CI 1.60-6.39) and smoking during pregnancy (OR 1.61, 99% CI 1.01-2.59) remained significant after adjusting for confounders. A higher number of early life risk factors accumulated was associated with overweight/obesity at age 6 years but not at age 2 and 4 years. Rapid infant weight gain, parental overweight/obesity, maternal smoking and origin/ethnicity predict childhood overweight/obesity and present cumulative effects. Monitoring children with rapid weight gain and supporting a healthy parental weight are important for childhood obesity prevention.

Signs and symptoms associated with early pregnancy loss: findings from a population-based preconception cohort.

PubMed

Sapra, K J; Buck Louis, G M; Sundaram, R; Joseph, K S; Bates, L M; Galea, S; Ananth, C V

2016-04-01

What is the relationship between signs and symptoms of early pregnancy and pregnancy loss <20 weeks' gestation? Vaginal bleeding is associated with increased incidence of early pregnancy loss, with more severe bleeding and bleeding accompanied by lower abdominal cramping associated with greater incidence of loss; conversely, vomiting is associated with decreased incidence of early pregnancy loss, even in the setting of vaginal bleeding, while nausea alone is not. Two previous cohort studies with preconception enrollment suggested that bleeding is associated with loss while nausea is inversely associated with loss though these studies were limited by small study size and reporting after loss ascertainment. No prior preconception cohort study has examined multiple signs and symptoms in relation to pregnancy loss. Population-based preconception cohort of 501 couples discontinuing contraception to try for pregnancy in 16 counties in Michigan and Texas, USA. Participants were followed daily until positive home pregnancy test or 12 months of trying without an hCG pregnancy; women who became pregnant were followed daily from 2 to 7 weeks post-conception. Three hundred and forty-seven women had a positive home pregnancy test denoting hCG pregnancy. Three hundred and forty-one women remained after excluding ineligible pregnancies. Women recorded daily from 2 to 7 weeks post-conception their signs and symptoms, including vaginal bleeding (none, spotting, light, moderate and heavy), lower abdominal cramping, nausea and vomiting. Pregnancy losses were ascertained by a subsequent negative home pregnancy test, clinical confirmation or onset of menses, depending on gestational age at loss; time-to-loss was measured in days post-conception. Cumulative incidence functions and 95% confidence intervals (CIs) were constructed for each sign or symptom, and hazard ratios (HRs) and 95% CIs for presence compared with absence of signs or symptoms were estimated using Cox proportional

Signs and symptoms associated with early pregnancy loss: findings from a population-based preconception cohort

PubMed Central

Sapra, K.J.; Buck Louis, G.M.; Sundaram, R.; Joseph, K.S.; Bates, L.M.; Galea, S.; Ananth, C.V.

2016-01-01

STUDY QUESTION What is the relationship between signs and symptoms of early pregnancy and pregnancy loss <20 weeks' gestation? SUMMARY ANSWER Vaginal bleeding is associated with increased incidence of early pregnancy loss, with more severe bleeding and bleeding accompanied by lower abdominal cramping associated with greater incidence of loss; conversely, vomiting is associated with decreased incidence of early pregnancy loss, even in the setting of vaginal bleeding, while nausea alone is not. WHAT IS KNOWN ALREADY Two previous cohort studies with preconception enrollment suggested that bleeding is associated with loss while nausea is inversely associated with loss though these studies were limited by small study size and reporting after loss ascertainment. No prior preconception cohort study has examined multiple signs and symptoms in relation to pregnancy loss. STUDY DESIGN, SIZE, DURATION Population-based preconception cohort of 501 couples discontinuing contraception to try for pregnancy in 16 counties in Michigan and Texas, USA. Participants were followed daily until positive home pregnancy test or 12 months of trying without an hCG pregnancy; women who became pregnant were followed daily from 2 to 7 weeks post-conception. PARTICIPANTS, SETTING, METHODS Three hundred and forty-seven women had a positive home pregnancy test denoting hCG pregnancy. Three hundred and forty-one women remained after excluding ineligible pregnancies. Women recorded daily from 2 to 7 weeks post-conception their signs and symptoms, including vaginal bleeding (none, spotting, light, moderate and heavy), lower abdominal cramping, nausea and vomiting. Pregnancy losses were ascertained by a subsequent negative home pregnancy test, clinical confirmation or onset of menses, depending on gestational age at loss; time-to-loss was measured in days post-conception. Cumulative incidence functions and 95% confidence intervals (CIs) were constructed for each sign or symptom, and hazard ratios (HRs

Adverse effects of falciparum and vivax malaria and the safety of antimalarial treatment in early pregnancy: a population-based study.

PubMed

McGready, R; Lee, S J; Wiladphaingern, J; Ashley, E A; Rijken, M J; Boel, M; Simpson, J A; Paw, M K; Pimanpanarak, M; Mu, Oh; Singhasivanon, P; White, N J; Nosten, F H

2012-05-01

The effects of malaria and its treatment in the first trimester of pregnancy remain an area of concern. We aimed to assess the outcome of malaria-exposed and malaria-unexposed first-trimester pregnancies of women from the Thai-Burmese border and compare outcomes after chloroquine-based, quinine-based, or artemisinin-based treatments. We analysed all antenatal records of women in the first trimester of pregnancy attending Shoklo Malaria Research Unit antenatal clinics from May 12, 1986, to Oct 31, 2010. Women without malaria in pregnancy were compared with those who had a single episode of malaria in the first trimester. The association between malaria and miscarriage was estimated using multivariable logistic regression. Of 48,426 pregnant women, 17,613 (36%) met the inclusion criteria: 16,668 (95%) had no malaria during the pregnancy and 945 (5%) had a single episode in the first trimester. The odds of miscarriage increased in women with asymptomatic malaria (adjusted odds ratio 2·70, 95% CI 2·04-3·59) and symptomatic malaria (3·99, 3·10-5·13), and were similar for Plasmodium falciparum and Plasmodium vivax. Other risk factors for miscarriage included smoking, maternal age, previous miscarriage, and non-malaria febrile illness. In women with malaria, additional risk factors for miscarriage included severe or hyperparasitaemic malaria (adjusted odds ratio 3·63, 95% CI 1·15-11·46) and parasitaemia (1·49, 1·25-1·78 for each ten-fold increase in parasitaemia). Higher gestational age at the time of infection was protective (adjusted odds ratio 0·86, 95% CI 0·81-0·91). The risk of miscarriage was similar for women treated with chloroquine (92 [26%] of 354), quinine (95 [27%) of 355), or artesunate (20 [31%] of 64; p=0·71). Adverse effects related to antimalarial treatment were not observed. A single episode of falciparum or vivax malaria in the first trimester of pregnancy can cause miscarriage. No additional toxic effects associated with artesunate

Pre-pregnancy obesity and maternal nutritional biomarker status during pregnancy: a factor analysis.

PubMed

Tomedi, Laura E; Chang, Chung-Chou H; Newby, P K; Evans, Rhobert W; Luther, James F; Wisner, Katherine L; Bodnar, Lisa M

2013-08-01

Pre-pregnancy obesity has been associated with adverse birth outcomes. Poor essential fatty acid (EFA) and micronutrient status during pregnancy may contribute to these associations. We assessed the associations between pre-pregnancy BMI and nutritional patterns of maternal micronutrient and EFA status during mid-pregnancy. A cross-sectional analysis from a prospective cohort study. Women provided non-fasting blood samples at ≥ 20 weeks’ gestation that were assayed for red cell EFA; plasma folate, homocysteine and ascorbic acid; and serum retinol, 25-hydroxyvitamin D, a-tocopherol, soluble transferrin receptors and carotenoids. These nutritional biomarkers were employed in a factor analysis and three patterns were derived: EFA, Micronutrients and Carotenoids. The Antidepressant Use During Pregnancy Study, Pittsburgh, PA, USA. Pregnant women (n 129). After adjustment for parity, race/ethnicity and age, obese pregnant women were 3.0 (95% CI 1.1, 7.7) times more likely to be in the lowest tertile of the EFA pattern and 4.5 (95% CI 1.7, 12.3) times more likely to be in the lowest tertile of the Carotenoid pattern compared with their lean counterparts. We found no association between pre-pregnancy obesity and the Micronutrient pattern after confounder adjustment. Our results suggest that obese pregnant women have diminished EFA and carotenoid concentrations.

A Novel early pregnancy assessment unit/Gynaecology assessment unit dashboard: An experience from a UK district general hospital.

PubMed

Wahba, K; Shah, A; Hill, K; Hosni, M M

2015-01-01

The establishment of early pregnancy assessment units (EPAUs)/Gynaecology assessment units (GAUs) started more than 20 years ago in the UK to decrease hospital admissions of patients with early pregnancy problems. However, there are still wide variations in the quality of services provided by these units. The objective of this study was to create a method that can be used for continuous assessment of these units on a regular basis. We designed a dashboard covering all aspects of EPAU/GAU activities depending upon the early pregnancy unit association guidelines, and the department of health data and statistics. The EPAU/GAU dashboard has been used successfully in the early assessment pregnancy unit of Yeovil District hospital for few years and is still implemented until now. It is an excellent tool for continuous audit. It is a simple method that should be adopted by different EPAUs/GAUs for their objective assessment in order to improve the services provided by these units.

Risk of glucose intolerance and gestational diabetes mellitus in relation to maternal habitual snoring during early pregnancy.

PubMed

Qiu, Chunfang; Lawrence, Wayne; Gelaye, Bizu; Stoner, Lee; Frederick, Ihunnaya O; Enquobahrie, Daniel A; Sorensen, Tanya K; Williams, Michelle A

2017-01-01

Obstructive sleep apnea (OSA) or habitual snoring is known to be associated with impaired glucose tolerance and type 2 diabetes among both men and non-pregnant women. We examined the association of habitual snoring during early pregnancy with risk of impaired glucose tolerance (IGT) and gestational diabetes mellitus (GDM). A cohort of 1,579 women was interviewed during early pregnancy. We collected information about snoring frequency during early pregnancy. Results from screening and diagnostic tests for IGT and GDM were abstracted from medical records. Multivariate logistic regression models were fitted to estimate odds ratios (OR) and 95% confidence intervals (95% CI) of IGT and GDM associated with snoring in early pregnancy. Overall, women who snored "most or all of the time" had a 2.1-fold increased odds of IGT (OR 2.10; 95% CI 1.31-3.35) and a 2.5-fold increased odds of GDM (OR 2.50; 95% CI 1.34-4.67) as compared with women who never snored. Compared with lean women (pre-pregnancy body mass index (BMI) <25 kg/m2) who did not snore, lean snorers had a 2-fold increased odds of GDM (OR = 1.99, 95% CI: 1.07-3.68). The odds of GDM risk was particularly elevated among overweight women (BMI ≥ 25 kg/m2) who snored (OR = 5.01; 95% CI 2.71-9.26). However, there was no evidence of an interaction between overweight and snoring with GDM risk (p-value = 0.144). These findings, if confirmed, may have important implications for tailoring prenatal care for overweight pregnant women, and /or those with a history of habitual snoring in early pregnancy.

Does the presence of a Caesarean section scar affect implantation site and early pregnancy outcome in women attending an early pregnancy assessment unit?

PubMed

Naji, O; Wynants, L; Smith, A; Abdallah, Y; Saso, S; Stalder, C; Van Huffel, S; Ghaem-Maghami, S; Van Calster, B; Timmerman, D; Bourne, T

2013-06-01

Are there any differences in the location and distance to the internal cervical ostium of the implantation site of the intrauterine gestation sacs, early pregnancy symptoms and pregnancy outcome at 12 weeks gestation between women with and without a previous Caesarean section (CS)? The presence of a CS scar affects the site of implantation, and the distance between implantation site and the scar is related to the risk of spontaneous abortion. WHAT IS KNOWN ALREADY?: Little is known about the impact of a CS scar on implantation other than the risk of Caesarean scar pregnancy (CSP). Furthermore, there is a paucity of information on how the proximity of implantation to the scar impacts on pregnancy outcome in the first trimester. A prospective cohort study conducted over 15 months in the early pregnancy unit of a London Teaching Hospital. Three hundred and eighty women underwent a transvaginal scan at 6-11 weeks of gestation. A total of 170 women had undergone ≥1 CS, and 210 women had no history of CS. The 380 women were recruited as consecutive non-selected cases. The relationship between the implanted sac and the CS scar was assessed by quantifiable measures and by subjective impression. Logistic regression analysis was used to determine the influence of the presence of a CS scar on pregnancy outcome. The final outcome of the study was the viability of the pregnancy at 12 weeks. Implantation was most frequently posterior (53%) in the CS group and fundal in the non-CS group (42%). Gestation sac implantation was 8.7 mm lower in the CS group (95% confidence interval (CI) 6.7-10.7, P < 0.0001). Presenting complaints differed in women with and without a previous CS (P = 0.0009). More frequent vaginal bleeding [73 versus 55%, difference -18, 95% CI (-27 to -8%] yet no clearly increased spontaneous abortion rates were noted in the CS group compared with the non-CS group (adjusted odds ratio = 1.1, 95% CI 0.6-1.9, P = 0.74). Subjective impression showed that in eight

Factors Associated with Pregnancy among Married Adolescents in Nepal: Secondary Analysis of the National Demographic and Health Surveys from 2001 to 2011

PubMed Central

Pradhan, Rina; Wynter, Karen; Fisher, Jane

2018-01-01

Pregnancy-related morbidity and mortality are much more prevalent among adolescents than adults, particularly in low-income settings. Little is known about risk factors for pregnancy among adolescents in Nepal, but setting-specific evidence is needed to inform interventions. This study aimed to describe the prevalence, and identify factors associated with pregnancy among adolescents in Nepal between 2001 and 2011. Secondary analyses of Nepal Demographic Health Surveys (NDHS) data from 2001, 2006, and 2011 were completed. The outcome was any pregnancy or birth among married adolescents; prevalence was calculated for each survey year. Although the rate of marriage among adolescent women in Nepal decreased significantly from 2001 to 2011, prevalence of pregnancy and birth among married adolescent women in Nepal remains high (average 56%) in Nepal, and increased significantly between 2001 and 2011. Regression analyses of this outcome indicate higher risk was associated with living in the least resourced region, early sexual debut, and older husband. Despite national efforts to reduce pregnancies among married adolescent women in Nepal, prevalence remains high. Integrated, cross-sectoral prevention efforts are required. Poverty reduction and infrastructure improvements may lead to lower rates of adolescent pregnancy. PMID:29385771

Factors Associated with Young Adults’ Pregnancy Likelihood

PubMed Central

Kitsantas, Panagiota; Lindley, Lisa L.; Wu, Huichuan

2014-01-01

OBJECTIVES While progress has been made to reduce adolescent pregnancies in the United States, rates of unplanned pregnancy among young adults (18–29 years) remain high. In this study, we assessed factors associated with perceived likelihood of pregnancy (likelihood of getting pregnant/getting partner pregnant in the next year) among sexually experienced young adults who were not trying to get pregnant and had ever used contraceptives. METHODS We conducted a secondary analysis of 660 young adults, 18–29 years old in the United States, from the cross-sectional National Survey of Reproductive and Contraceptive Knowledge. Logistic regression and classification tree analyses were conducted to generate profiles of young adults most likely to report anticipating a pregnancy in the next year. RESULTS Nearly one-third (32%) of young adults indicated they believed they had at least some likelihood of becoming pregnant in the next year. Young adults who believed that avoiding pregnancy was not very important were most likely to report pregnancy likelihood (odds ratio [OR], 5.21; 95% CI, 2.80–9.69), as were young adults for whom avoiding a pregnancy was important but not satisfied with their current contraceptive method (OR, 3.93; 95% CI, 1.67–9.24), attended religious services frequently (OR, 3.0; 95% CI, 1.52–5.94), were uninsured (OR, 2.63; 95% CI, 1.31–5.26), and were likely to have unprotected sex in the next three months (OR, 1.77; 95% CI, 1.04–3.01). DISCUSSION These results may help guide future research and the development of pregnancy prevention interventions targeting sexually experienced young adults. PMID:25782849

Does adenosine deaminase activity play a role in the early diagnosis of ectopic pregnancy?

PubMed

Turkmen, G G; Karçaaltıncaba, D; Isık, H; Fidancı, V; Kaayalp, D; Tımur, H; Batıoglu, S

2016-01-01

Early diagnosis of ectopic pregnancy (EP) is important due to life-threatening consequences in the first trimester of pregnancy. In this study we aimed to investigate the role of adenosine deaminase (ADA) activity in the prediction of EP. Forty-one patients with unruptured ectopic pregnancy comprised the case group and forty-two first trimester pregnant women with shown foetal heart beating in ultrasound comprised the control group. The mean ADA level in EP (10.9 ± 3.0 IU/L) was higher than that in control group (9.2 ± 3.6 IU/L) (p = 0.018). Receiver operating characteristics or ROC curve identified ADA value of 10.95 IU/L as optimal threshold for the prediction of EP with 56% sensitivity and 67% specificity. High ADA levels are valuable in the early diagnosis of EP. However more comprehensive studies are required.

Treatment of Nausea and Vomiting in Pregnancy: Factors Associated with ED Revisits

PubMed Central

Sharp, Brian R.; Sharp, Kristen M.; Patterson, Brian; Dooley-Hash, Suzanne

2016-01-01

Introduction Nausea and vomiting in pregnancy (NVP) is a condition that commonly affects women in the first trimester of pregnancy. Despite frequently leading to emergency department (ED) visits, little evidence exists to characterize the nature of ED visits or to guide its treatment in the ED. Our objectives were to evaluate the treatment of NVP in the ED and to identify factors that predict return visits to the ED for NVP. Methods We conducted a retrospective database analysis using the electronic medical record from a single, large academic hospital. Demographic and treatment variables were collected using a chart review of 113 ED patient visits with a billing diagnosis of “nausea and vomiting in pregnancy” or “hyperemesis gravidarum.” Logistic regression analysis was used with a primary outcome of return visit to the ED for the same diagnoses. Results There was wide treatment variability of nausea and vomiting in pregnancy patients in the ED. Of the 113 patient visits, 38 (33.6%) had a return ED visit for NVP. High gravidity (OR 1.31, 95% CI [1.06–1.61]), high parity (OR 1.50 95% CI [1.12–2.00]), and early gestational age (OR 0.74 95% CI [0.60–0.90]) were associated with an increase in return ED visits in univariate logistic regression models, while only early gestational age (OR 0.74 95% CI [0.59–0.91]) was associated with increased return ED visits in a multiple regression model. Admission to the hospital was found to decrease the likelihood of return ED visits (p=0.002). Conclusion NVP can be difficult to manage and has a high ED return visit rate. Optimizing care with aggressive, standardized treatment in the ED and upon discharge, particularly if factors predictive of return ED visits are present, may improve quality of care and reduce ED utilization for this condition. PMID:27625723

Medically complex pregnancies and early breastfeeding behaviors: a retrospective analysis.

PubMed

Kozhimannil, Katy B; Jou, Judy; Attanasio, Laura B; Joarnt, Lauren K; McGovern, Patricia

2014-01-01

Breastfeeding is beneficial for women and infants, and medical contraindications are rare. Prenatal and labor-related complications may hinder breastfeeding, but supportive hospital practices may encourage women who intend to breastfeed. We measured the relationship between having a complex pregnancy (entering pregnancy with hypertension, diabetes, or obesity) and early infant feeding, accounting for breastfeeding intentions and supportive hospital practices. We performed a retrospective analysis of data from a nationally-representative survey of women who gave birth in 2011-2012 in a US hospital (N = 2400). We used logistic regression to examine the relationship between pregnancy complexity and breastfeeding. Self-reported prepregnancy diabetes or hypertension, gestational diabetes, or obesity indicated a complex pregnancy. The outcome was feeding status 1 week postpartum; any breastfeeding was evaluated among women intending to breastfeed (N = 1990), and exclusive breastfeeding among women who intended to exclusively breastfeed (N = 1418). We also tested whether breastfeeding intentions or supportive hospital practices mediated the relationship between pregnancy complexity and infant feeding status. More than 33% of women had a complex pregnancy; these women had 30% lower odds of intending to breastfeed (AOR = 0.71; 95% CI, 0.52-0.98). Rates of intention to exclusively breastfeed were similar for women with and without complex pregnancies. Women who intended to breastfeed had similar rates of any breastfeeding 1 week postpartum regardless of pregnancy complexity, but complexity was associated with >30% lower odds of exclusive breastfeeding 1 week among women who intended to exclusively breastfeed (AOR = 0.68; 95% CI, 0.47-0.98). Supportive hospital practices were strongly associated with higher odds of any or exclusive breastfeeding 1 week postpartum (AOR = 4.03; 95% CI, 1.81-8.94; and AOR = 2.68; 95% CI, 1.70-4.23, respectively). Improving clinical and hospital

FACTORS ASSOCIATED WITH PREGNANCY AMONG UNMARRIED WOMEN IN MALAYSIA.

PubMed

Zain, Norhasmah Mohd; Low, Wah Yun; Othman, Sajaratulnisah

2015-05-01

Pregnancy among unmarried women may have negative social and health implications in Malaysia. The number of pregnancies among unmarried women has increased in Malaysia, but the socio-demographic profile of these women is unclear. This study aims to evaluate the characteristics of unmarried pregnant women and the factors associated with unmarried pregnancies among young women in Malaysia. We conducted a cross sectional study at six hospitals and six women's shelters in Peninsular Malaysia during 2011-2012. Unmarried pregnant women were compared with married pregnant women. Participants were interviewed using a structured questionnaire asking for socio-demographic data, family background, risky sexual behavior, social support and pregnancy details. A total of 484 women (239 unmarried and 245 married) were included in the study. Most unmarried subjects were adolescents, from urban areas, from a low socioeconomic group, and lived with parents prior to pregnancy. Age (OR=0.67; 95% CI: 0.61-0.74), studying status (OR=17.33; 95% CI: 2.65-113.19), alcohol use (OR=40.46; 95% CI: 2.51-652.38) exposure to pornographic material (OR=13.48; 95% CI: 3.24-56.01), contraceptive use (OR=0.20; 95% CI: 0.08-0.51), and social support (OR=0.90; 95% CI: 0.86-0.94) were all associated with unmarried pregnancy. These factors need to be considered when.designing an intervention program.

Use of Antihistamine Medications During Early Pregnancy and Isolated Major Malformations

PubMed Central

Gilboa, Suzanne M.; Strickland, Matthew J.; Olshan, Andrew F.; Werler, Martha M.; Correa, Adolfo

2013-01-01

BACKGROUND Antihistamines are commonly used during pregnancy. There is little evidence that they have teratogenic effects, but there are knowledge gaps with respect to newer products, as well as the relationship between specific antihistamines and specific birth defects. METHODS Using the National Birth Defects Prevention Study (1997-2003), the authors examined associations between maternal use of 14 antihistamines during early pregnancy and 26 isolated major birth defects. A Bayesian analysis incorporating prior knowledge about the relationships between the antihistamines, birth defects, and measured covariates was conducted. RESULTS Of the 364 associations investigated, 24 had 95% posterior intervals excluding 1.0. All 24 associations were positive; 23 associations were of weak to moderate magnitude (posterior odds ratio [OR] < 3.0) and one was strong (OR > 6.0) but very imprecise. Of the 24 associations, 20 were with non-cardiac defects. Eight associations involved the antihistamine diphenhydramine. CONCLUSIONS The results of this study generally were consistent with no association between birth defects and antihistamine use during early pregnancy. Several of the findings might warrant further investigation, although the observed elevated associations should be interpreted in the context of the number of associations investigated and the analysis of retrospective, self-reported data. PMID:19161158

Maternal-foetal attachment during early pregnancy in Taiwanese women pregnant by in vitro fertilization.

PubMed

Kuo, Pi-Chao; Bowers, Beverly; Chen, Yueh-Chih; Chen, Chung-Hey; Tzeng, Ya-Ling; Lee, Maw-Sheng

2013-11-01

The aim of this study was to investigate maternal-foetal attachment at 9, 12 and 20 weeks gestation and to identify factors that influenced maternal-foetal attachment in Taiwanese women who conceived by in vitro fertilization. Development of maternal-foetal attachment is an important part of taking on the maternal role. However, evidence about maternal-foetal attachment after assisted conception is inconclusive. A longitudinal design with repeated measures. A prospective, longitudinal design with repeated measures was used. Over an 18-month period in 2006-2008, a convenience sample of 160 women who conceived after undergoing successful in vitro fertilization were recruited from a major infertility care centre in Taiwan. Data were collected by self-reported measures, including: (1) Maternal-Foetal Attachment Scale; (2) Symptoms Checklist; (3) Pregnancy-related Anxiety Scale; (4) Social Support Apgar; (5) Chinese childbearing attitude Questionnaire; and (6) Awareness of Foetus Scale. The selected instruments to measure each variable were administered to participants at 9, 12 and 20 weeks gestation. Maternal-foetal attachment increased as pregnancy progressed from 9 to 20 weeks gestation. General linear mixed model showed predictors of maternal-foetal attachment included Chinese childbearing attitude, awareness of the foetus, and social support. Health provider awareness of cultural influences on the development of early maternal-foetal attachment of women pregnant by in vitro fertilization is needed. Prenatal education in early pregnancy might incorporate more information about foetal development to allow the mother to visualize her unborn child. Providing social support for women who were conceived by in vitro fertilization is beneficial to the development of maternal-foetal attachment. © 2013 Blackwell Publishing Ltd.

Early Pregnancy Weight Gain Exerts the Strongest Effect on Birth Weight, Posing a Critical Time to Prevent Childhood Obesity.

PubMed

Broskey, Nicholas T; Wang, Peng; Li, Nan; Leng, Junhong; Li, Weiqin; Wang, Leishen; Gilmore, L Anne; Hu, Gang; Redman, Leanne M

2017-09-01

Gestational weight gain (GWG) is associated with infant birth weight and childhood obesity; however, the patterns of GWG on infant birth weight are poorly understood. This analysis in 16,218 mother-child dyads from Tianjin, China, determined the risk of infant size at birth according to GWG occurring throughout the first and second trimester (early GWG) or during the third trimester (late GWG), according to maternal prepregnancy BMI and the 2009 Institute of Medicine recommendations. Excessive GWG in early and late pregnancy had an increased risk for large-for-gestational-age (LGA) infants (odds ratio [OR]: 2.4; 95% confidence interval [CI]: 1.5-4.0, P < 0.001). Regardless of prepregnancy BMI, excessive GWG early in pregnancy (< 24 weeks) was associated with an increased risk of LGA infants (OR: 2.5; 95% CI: 2.1-3.1, P < 0.001), and inadequate early GWG was associated with a higher risk of small-for-gestational-age (SGA) infants (OR: 1.4; 95% CI: 1.2-1.7, P < 0.001). The pattern of GWG early in pregnancy, regardless of GWG later in pregnancy, had the greatest impact on infant size at birth. Interventions initiated early in pregnancy may facilitate better adherence to the GWG guidelines and minimize the risk of LGA and SGA infants, a potential precursor for childhood obesity. © 2017 The Obesity Society.

Early-life exposure to air pollutants and adverse pregnancy outcomes: protocol for a prospective cohort study in Beijing

PubMed Central

Song, Jing; Wei, Ling; Ma, Ying; Tian, Ning; Huang, Shi Yun; Dai, Yin Mei; Zhao, Li Hong; Kong, Yuan Yuan

2017-01-01

Introduction The association between early exposure to ambient air pollution and adverse pregnancy outcomes in China is unclear. This study will assess the risk of early-life exposure to air pollutants in Beijing and explore the viability of 8-hydroxydeoxyguanosine (8-OHdG) as a biological indicator to assess oxidative stress induced by early-life exposure to air pollution. Methods and analysis Here, 2500 women with singleton pregnancies and their infants will be recruited from the Beijing Obstetrics and Gynecology Hospital. We will collect nine types of biological samples, including maternal serum, urine, placental tissue, umbilical cord tissue and umbilical cord blood during all three trimesters. The air pollution data (particulate matter (PM)2.5, PM10 and similar factors) will be recorded at official fixed-site monitoring stations closest to where the pregnant women live. We plan to assess the effect of air pollutants on adverse pregnancy outcomes and infant respiratory and circulatory disease using Cox regression and competitive risk analysis and explore possible critical windows of exposure during pregnancy using daily pollutant concentrations averaged over various periods of pregnancy combined with individual activity and physiological parameters. Maternal and umbilical cord blood samples (1000 samples) will be randomly selected for 8-OHdG assays to assess the correlation between exposures to air pollutants and oxidative stress. We will determine whether air pollutant exposure or 8-OHdG levels are associated with adverse pregnancy outcomes. SPSS and SAS statistical software will be used for data analysis. Cox regression and competing risk analysis will be used to compute the HR and population attributable risk. Ethics and dissemination This research protocol has already been approved by the Medical Ethics Committee of Beijing Obstetrics and Gynecology Hospital. Written informed consent will be obtained from all study participants prior to enrolment. The

Early-life exposure to air pollutants and adverse pregnancy outcomes: protocol for a prospective cohort study in Beijing.

PubMed

Song, Jing; Chen, Yi; Wei, Ling; Ma, Ying; Tian, Ning; Huang, Shi Yun; Dai, Yin Mei; Zhao, Li Hong; Kong, Yuan Yuan

2017-09-03

The association between early exposure to ambient air pollution and adverse pregnancy outcomes in China is unclear. This study will assess the risk of early-life exposure to air pollutants in Beijing and explore the viability of 8-hydroxydeoxyguanosine (8-OHdG) as a biological indicator to assess oxidative stress induced by early-life exposure to air pollution. Here , 2500 women with singleton pregnancies and their infants will be recruited from the Beijing Obstetrics and Gynecology Hospital. We will collect nine types of biological samples, including maternal serum, urine, placental tissue, umbilical cord tissue and umbilical cord blood during all three trimesters. The air pollution data (particulate matter (PM)2.5, PM10 and similar factors) will be recorded at official fixed-site monitoring stations closest to where the pregnant women live. We plan to assess the effect of air pollutants on adverse pregnancy outcomes and infant respiratory and circulatory disease using Cox regression and competitive risk analysis and explore possible critical windows of exposure during pregnancy using daily pollutant concentrations averaged over various periods of pregnancy combined with individual activity and physiological parameters. Maternal and umbilical cord blood samples (1000 samples) will be randomly selected for 8-OHdG assays to assess the correlation between exposures to air pollutants and oxidative stress. We will determine whether air pollutant exposure or 8-OHdG levels are associated with adverse pregnancy outcomes. SPSS and SAS statistical software will be used for data analysis. Cox regression and competing risk analysis will be used to compute the HR and population attributable risk. This research protocol has already been approved by the Medical Ethics Committee of Beijing Obstetrics and Gynecology Hospital. Written informed consent will be obtained from all study participants prior to enrolment. The results will be published in peer-reviewed journals or

Oxytocin and tumor necrosis factor alpha stimulate expression of prostaglandin E2 synthase and secretion of prostaglandin E2 by luminal epithelial cells of the porcine endometrium during early pregnancy.

PubMed

Waclawik, Agnieszka; Blitek, Agnieszka; Ziecik, Adam J

2010-10-01

Oxytocin (OXT) and tumor necrosis factor α (TNF) have been implicated in the control of luteolysis by stimulating endometrial secretion of luteolytic prostaglandin F(2α) (PGF(2α)). Nevertheless, OXT concentration in porcine uterine lumen increases markedly on days 11-12 of pregnancy, and TNF is expressed in endometrium during pregnancy. The objective of the study was to determine the effect of OXT and TNF on expression of the enzymes involved in PG synthesis: PG-endoperoxide synthase 2 (PTGS2), PGE(2) synthase (mPGES-1) and PGF synthase, and PGE(2) receptor (PTGER2), as well as on PG secretion by endometrial luminal epithelial cells (LECs) on days 11-12 of the estrous cycle and pregnancy. LECs isolated from gilts on days 11-12 of the estrous cycle (n=8) and pregnancy (n=7) were treated with OXT (100  nmol/l) and TNF (0.6  nmol/l) for 24  h. OXT increased PTGS2 mRNA and mPGES-1 protein contents, as well as PGE(2) secretion but only on days 11-12 of pregnancy. TNF stimulated PTGS2 and mPGES-1 mRNA, as well as mPGES-1 protein expression and PGE(2) release on days 11-12 of pregnancy and the estrous cycle. In addition, expressions of PTGER2 and PTGER4 were determined in corpus luteum (CL). Abundance of PTGER2 mRNA and PTGER4 protein in CL was upregulated on day 14 of pregnancy versus day 14 of the estrous cycle. This study indicates that TNF and OXT regulate PGE(2) synthesis in LECs during early pregnancy. PGE(2) secreted by LECs, after reaching ovaries, could have a luteoprotective effect through luteal PTGER2 and PTGER4, or may directly promote uterine function and conceptus development.

The effect of exposure to hypergravity on pregnant rat dams, pregnancy outcome and early neonatal development

NASA Astrophysics Data System (ADS)

Ladd, B.; Nguon, K.; Sajdel-Sulkowska, E. M.

2006-01-01

We previously reported that hypergravity exposure affects food intake and mass gain during pregnancy. In the present study, we explored the hypothesis that changes in maternal body mass in hypergravity-exposed pregnant rat dams affect pregnancy outcome and early offspring development. Furthermore, we hypothesized that the changes observed at 1.5G will be magnified at higher gravity and by exposure during critical developmental periods. To test this hypothesis, we compared maternal body mass gain, food consumption, birth outcome and early offspring development between Sprague Dawley rat dams exposed to graded (1.5 1.75G) chronic hypergravity (HG) or rotation (rotational control, RC) on a 24-ft centrifuge for 22.5 h starting on gestational day (G) 10 with dams housed under identical conditions but not exposed to hypergravity (SC). We also compared maternal body mass, food consumption, birth outcome and early offspring development between rat dams exposed to 1.65G during different stages of pregnancy and nursing. Exposure to hypergravity resulted in transient loss in body mass and prolonged decrease in food consumption in HG dams, but the changes observed at 1.5G were not magnified at 1.65G or 1.75G. On the other hand RC dams gained more mass and consumed more food than SC dams. Exposure to hypergravity also affected pregnancy outcome as evidenced by decreased litter size, lowered neonatal mass at birth, and higher neonatal mortality; pregnancy outcome was not affected in RC dams. Neonatal changes evidenced by impaired righting response observed at 1.5G was magnified at higher gravity and was dependent on the period of hypergravity exposure. On the other hand, righting response was improved in RC neonates. Hypergravity exposure during early postpartum affected the food consumption of nursing mothers and affected early survival of their offspring. The changes observed in dams and neonates appear to be due to hypergravity exposure since animals exposed to the rotation

Diabetes in pregnancy among indigenous women in Australia, Canada, New Zealand and the United States: a systematic review of the evidence for screening in early pregnancy

PubMed Central

Chamberlain, Catherine; McNamara, Bridgette; Williams, Emily D; Yore, Daniel; Oldenburg, Brian; Oats, Jeremy; Eades, Sandra

2013-01-01

Recently proposed international guidelines for screening for gestational diabetes mellitus (GDM) recommend additional screening in early pregnancy for sub-populations at a high risk of type 2 diabetes mellitus (T2DM), such as indigenous women. However, there are criteria that should be met to ensure the benefits outweigh the risks of population-based screening. This review examines the published evidence for early screening for indigenous women as related to these criteria. Any publications were included that referred to diabetes in pregnancy among indigenous women in Australia, Canada, New Zealand and the United States (n = 145). The risk of bias was appraised. There is sufficient evidence describing the epidemiology of diabetes in pregnancy, demonstrating that it imposes a significant disease burden on indigenous women and their infants at birth and across the lifecourse (n = 120 studies). Women with pre-existing T2DM have a higher risk than women who develop GDM during pregnancy. However, there was insufficient evidence to address the remaining five criteria, including the following: understanding current screening practice and rates (n = 7); acceptability of GDM screening (n = 0); efficacy and cost of screening for GDM (n = 3); availability of effective treatment after diagnosis (n = 6); and effective systems for follow-up after pregnancy (n = 5). Given the impact of diabetes in pregnancy, particularly undiagnosed T2DM, GDM screening in early pregnancy offers potential benefits for indigenous women. However, researchers, policy makers and clinicians must work together with communities to develop effective strategies for implementation and minimizing the potential risks. Evidence of effective strategies for primary prevention, GDM treatment and follow-up after pregnancy are urgently needed. Copyright © 2013 John Wiley & Sons, Ltd. PMID:23315909

Thin mother, obese child? A review of early risk factors for obesity in offspring.

PubMed

Tabibzadeh, Pantea; Mewes, Ricarda

2016-09-01

The huge percentages of persons with obesity in many countries constitute a public health crisis. The severe consequences of obesity for physical health and emotional wellbeing already emerge in childhood. Therefore, the acknowledgment of early risk factors is essential to provide recommendations for prevention strategies. This review outlines the current state of research concerning early risk factors for obesity, that is, factors that even contribute to later obesity of the offspring during gestation. In this regard, this review specifically addresses the link between restricted eating behavior of the mother and obesity in her offspring. We systematically searched for articles in PsychINFO, PsychINDEX, MEDLINE, PubMed, MEDPILOT, and Web of Science, and we identified additional studies in bibliographies. Although some risk factors (e.g., short period of breastfeeding, gestational diabetes, and high maternal BMI) have a vast evidence base, others (e.g., restricted eating behavior and second-hand smoking) are insufficiently studied. Physical activity and diet programs in pregnancy can reduce not only the occurrence of gestational diabetes, but also the risk of inappropriate weight gain. As smoking during pregnancy and inappropriate eating behavior are associated with lower education, psychoeducation, for instance in sex education classes, could be easily conceivable.

Factors predicting early postpartum glucose intolerance in Japanese women with gestational diabetes mellitus: decision-curve analysis.

PubMed

Kondo, M; Nagao, Y; Mahbub, M H; Tanabe, T; Tanizawa, Y

2018-04-29

To identify factors predicting early postpartum glucose intolerance in Japanese women with gestational diabetes mellitus, using decision-curve analysis. A retrospective cohort study was performed. The participants were 123 Japanese women with gestational diabetes who underwent 75-g oral glucose tolerance tests at 8-12 weeks after delivery. They were divided into a glucose intolerance and a normal glucose tolerance group based on postpartum oral glucose tolerance test results. Analysis of the pregnancy oral glucose tolerance test results showed predictive factors for postpartum glucose intolerance. We also evaluated the clinical usefulness of the prediction model based on decision-curve analysis. Of 123 women, 78 (63.4%) had normoglycaemia and 45 (36.6%) had glucose intolerance. Multivariable logistic regression analysis showed insulinogenic index/fasting immunoreactive insulin and summation of glucose levels, assessed during pregnancy oral glucose tolerance tests (total glucose), to be independent risk factors for postpartum glucose intolerance. Evaluating the regression models, the best discrimination (area under the curve 0.725) was obtained using the basic model (i.e. age, family history of diabetes, BMI ≥25 kg/m 2 and use of insulin during pregnancy) plus insulinogenic index/fasting immunoreactive insulin <1.1. Decision-curve analysis showed that combining insulinogenic index/fasting immunoreactive insulin <1.1 with basic clinical information resulted in superior net benefits for prediction of postpartum glucose intolerance. Insulinogenic index/fasting immunoreactive insulin calculated using oral glucose tolerance test results during pregnancy is potentially useful for predicting early postpartum glucose intolerance in Japanese women with gestational diabetes. © 2018 Diabetes UK.

Provider knowledge, attitudes and treatment preferences for early pregnancy failure

PubMed Central

Dalton, Vanessa K.; Harris, Lisa H.; Gold, Katherine J.; Kane-Low, Lisa; Schulkin, Jay; Guire, Ken; Fendrick, A. Mark

2010-01-01

Objective To describe health care provider knowledge, attitudes and treatment preferences for early pregnancy failure (EPF). Study Design We surveyed 976 obstetrician/gynecologists, midwives and family medicine practitioners on their knowledge and attitudes toward treatment options for EPF, and barriers to adopting misoprostol and office uterine evacuations. We used descriptive statistics to compare practices by provider specialty and logistic regression to identify associations between provider factors and treatment practices. Results Seventy percent of providers have not used misoprostol and 91% have not used an office uterine evacuation to treat EPF in the past 6 months. Beliefs about safety and patient preferences, and prior induced abortion training were significantly associated with use of both of these treatments. Conclusions Increasing education and training on the use of misoprostol and office uterine evacuation, and clarifying patient treatment preferences may increase the willingness of providers to adopt new practices for EPF treatment. PMID:20227674

Maternal hCG concentrations in early IVF pregnancies: associations with number of cells in the Day 2 embryo and oocytes retrieved.

PubMed

Tanbo, T G; Eskild, A

2015-12-01

Do number of cells in the transferred cleavage stage embryo and number of oocytes retrieved for IVF influence maternal hCG concentrations in early pregnancies? Compared with transfer of a 2-cell embryo, transfer of a 4-cell embryo results in higher hCG concentrations on Day 12 after transfer, and more than 20 oocytes retrieved were associated with low hCG concentrations. Maternal hCG concentration in very early pregnancy varies considerably among women, but is likely to be an indicator of time since implantation of the embryo into the endometrium, in addition to number and function of trophoblast cells. We followed 1047 pregnancies after IVF/ICSI from oocyte retrieval until Day 12 after embryo transfer. Women were recruited in Norway during the years 2005-2013. Successful pregnancies after transfer of one single embryo that had been cultured for 2 days were included. Maternal hCG was quantified on Day 12 after embryo transfer by chemiluminescence immunoassay, which measures intact hCG and the free β-hCG chain. Information on a successful pregnancy, defined as birth after >16 weeks, was obtained by linkage to the Medical Birth Registry of Norway. Transfer of a 4-cell embryo resulted in higher maternal hCG concentrations compared with transfer of a 2-cell embryo (134.8 versus 87.8 IU/l, P < 0.05). A high number of oocytes retrieved (>20) was associated with low hCG concentrations (P < 0.05). The factors studied explain a limited part of the total variation of hCG concentrations in early pregnancy. Although embryo transfer was performed at the same time after fertilization, we do not know the exact time of implantation. A further limitation to our study is that the number of pregnancies after transfer of a 2-cell embryo was small (27 cases). Number of cells in the transferred embryo and number of oocytes retrieved may influence the conditions and timing for embryo implantation in different ways and thereby influence maternal hCG concentrations. Such knowledge may be

The role of magnesium and thyroid function in early pregnancy after in-vitro fertilization (IVF): New aspects in endocrine physiology.

PubMed

Stuefer, Sibilla; Moncayo, Helga; Moncayo, Roy

2015-06-01

The initiation of a pregnancy is a process that requires adequate energetic support. Recent observations at our Institution suggest a central role of magnesium in this situation. The aim of this study was to evaluate magnesium, zinc, selenium and thyroid function as well as anti-Müllerian hormone in early pregnancy following in-vitro fertilization as compared to spontaneous successful pregnancies. A successful outcome of pregnancy after IVF treatment was associated with 2 parameters: higher levels of anti-Müllerian hormone as well as higher levels of magnesium in the pre-stimulation blood sample. These two parameters, however, showed no correlation. Spontaneous pregnancies as well as pregnancies after IVF show a fall of magnesium levels at 2-3 weeks of gestation. This drop of magnesium concentration is larger following IVF as compared to spontaneous pregnancies. Parallel to these changes TSH levels showed an increase in early IVF-pregnancy. At this time point we also observed a positive correlation between fT4 and TSH. This was not observed in spontaneous pregnancies. Thyroid antibodies showed no correlation to outcomes. In connection with the initiation of pregnancy following ovarian stimulation dynamic changes of magnesium and TSH levels can be observed. A positive correlation was found between fT4 and TSH in IVF pregnancies. In spontaneous pregnancies smaller increases of TSH levels are related to higher magnesium levels. We propose that magnesium plays a role in early pregnancy as well as in pregnancy success independently from anti-Müllerian hormone. Neither thyroid hormones nor thyroid antibodies were related to outcome.

Adaptation to Pregnancy, Birth and Early Parenting: A Preliminary View.

ERIC Educational Resources Information Center

Eichler, Lois S.; And Others

The normal course of family adaptation to pregnancy, birth, and early parenting is examined in this study, and variables predictive of difficulties in family adjustment during this period are investigated. Subjects were 89 married couples and 9 women whose husbands did not participate. The women had a mean age of 28 years; 46 were pregnant for the…

Peanut allergy: is maternal transmission of antigens during pregnancy and breastfeeding a risk factor?

PubMed

DesRoches, A; Infante-Rivard, C; Paradis, L; Paradis, J; Haddad, E

2010-01-01

Peanut allergy is an important public health problem in western countries. However, the risk factors associated with this allergy remain uncertain. To determine whether the consumption of peanuts during pregnancy and breastfeeding is a risk factor for peanut allergy in infants. We enrolled 403 infants in a case-control study. The cases were infants aged 18 months or less with a diagnosis of peanut allergy based on a history of clinical reaction after exposure to peanuts and the presence of peanut-specific immunoglobulin E. Controls were age-matched infants with no known clinical history or signs of atopic disease. The mothers of the children filled out a detailed questionnaire about maternal diet during pregnancy and breastfeeding, the infant's diet, the presence of peanut products in the infant's environment, and family history of atopy. The mean (SD) age of cases was 1.23 (0.03) years. The groups were comparable in terms of the rate and duration of breastfeeding. However, the reported consumption of peanuts during pregnancy and breastfeeding was higher in the case group and associated with an increased risk of peanut allergy in offspring (odds ratio [OR], 4.22 [95% confidence interval [CI], 1.57-11.30 and OR, 2.28 [95% CI, 1.31-3.97] for pregnancy and breastfeeding, respectively). Overall, the infants with peanut allergy did not seem to be more exposed to peanut products in their environment than the controls. Early exposure to peanut allergens, whether in utero or through human breast milk, seems to increase the risk of developing peanut allergy.

Does Father Absence Place Daughters at Special Risk for Early Sexual Activity and Teenage Pregnancy?

ERIC Educational Resources Information Center

Ellis, Bruce J.; Bates, John E.; Dodge, Kenneth A.; Fergusson, David M.; Horwood, L. John; Pettit, Gregory S.; Woodward, Lianne

2003-01-01

Longitudinal studies in two countries investigated impact of father absence on girls' early sexual activity (ESA) and teenage pregnancy. Findings indicated that greater exposure to father absence strongly related to elevated ESA and adolescent pregnancy risk. Elevated risk was not explained (U.S. sample) or only partly explained (New Zealand…

Is alcohol binge drinking in early and late pregnancy associated with behavioural and emotional development at age 7 years?

PubMed

Niclasen, Janni; Andersen, Anne-Marie Nybo; Strandberg-Larsen, Katrine; Teasdale, Thomas William

2014-12-01

The purpose of this study was to investigate associations of maternal binge drinking in early and late pregnancy with child behavioural and emotional development at age seven. It was hypothesised that late exposure is associated with more negative outcomes than early exposure. Differences were expected on the continuous outcome measures, but not on above cutoff scale scores. Data were derived from the Danish National Birth Cohort. Three exposure groups were defined according to binge drinking from three interviews regarding binge episodes in early, middle and late pregnancy. A 'no binge' group included women with no binge episodes reported in any of the interviews, the 'early bingers' reported episodes in the first interview only, and the 'late bingers' in the last part of pregnancy only. The outcome measure was the Strengths and Difficulties Questionnaire (SDQ) used as continuous externalising/internalising scores and above cutoff hyperactivity/inattention, conduct, emotional and peer problems scores. Only women with full information concerning binge drinking from the three interviews, together with full-scale SDQ information on their children at age seven and being term-born, were included in the study (N = 37,315). After adjustment for maternal education, psychiatric diagnoses, age and smoking, children exposed to binge drinking in early and late pregnancy had significantly higher mean externalizing scores at age seven than unexposed children, an effect albeit much less for early binge drinking (relative change in mean 1.02, CI 1.00-1.05) than for late binge drinking (relative change in mean 1.21, CI 1.04-1.42). No associations were observed for any of the above cutoff outcomes. Exposure to binge drinking in early and late pregnancy is associated with elevated externalising scores, particularly so in late pregnancy. No increased risk for any of the above cutoff scale scores was observed.

Hypertension in Pregnancy is a Risk Factor for Peripheral Arterial Disease Decades after Pregnancy

PubMed Central

Weissgerber, Tracey L.; Turner, Stephen T.; Bailey, Kent R.; Mosley, Thomas H.; Kardia, Sharon L. R.; Wiste, Heather J.; Miller, Virginia M.; Kullo, Iftikhar J.; Garovic, Vesna D.

2013-01-01

Background An ankle-brachial index (ABI) (the ratio of ankle to brachial artery systolic blood pressure) value ≤0.9 identifies patients with peripheral arterial disease (PAD) and elevated cardiovascular event risk. This study examined whether women with a history of hypertension in pregnancy are more likely to have an ABI ≤0.9 decades after pregnancy. Methods and Results ABI was measured in nulliparous women (n=144), and women with a history of normotensive (n=1,272) or hypertensive (n=281) pregnancies who participated in the Genetic Epidemiology Network of Arteriopathy (GENOA) study [non-Hispanic white (39%) and black (61%) women, 60 (mean) ± 10 (SD) years of age]. Relationships between PAD and pregnancy history were examined by logistic regression. Compared to women with a history of normotensive pregnancy, women with a history of hypertensive pregnancy had greater odds of PAD (1.61 (odds ratio); 1.04–2.49 (95% confidence interval), p=0.03, adjusted for age, race, height and heart rate). Additional adjustment for ever smoking, hypertension, diabetes, dyslipidemia, a family history of hypertension or coronary heart disease, body mass index and education did not attenuate this relationship (1.63; 1.02–2.62, p=0.04). PAD risk did not differ between women with a history of normotensive pregnancy and nulliparous women (1.06; 0.52–2.14, p=0.87). Conclusions Hypertension in pregnancy is an independent risk factor for PAD decades after pregnancy after adjusting for race, age, height, heart rate, ever smoking, hypertension, diabetes, dyslipidemia, a family history of hypertension or coronary heart disease, body mass index and education. PMID:23659871

Factors Associated with Unwanted Pregnancy among Adolescents in Russia.

PubMed

Panova, O V; Kulikov, A M; Berchtold, A; Suris, J C

2016-10-01

To identify social and behavioral factors associated with unintended pregnancy among adolescents in Russia. Cross-sectional. The investigation group consisted of 145 adolescents aged 15-19 years admitted to a youth-friendly clinic for induced abortion. The control group consisted of 77 sexually active never pregnant adolescent girls of similar age admitted for other reasons. Both groups completed a self-administered questionnaire about their occupation, educational level of their mother, family structure and socioeconomic status, relationship with their mother, sexual behavior, and substance use. Factors associated with unintended pregnancy. In the bivariate analysis pregnant adolescents tended to have a lower educational level, to live in a nonintact family, to prefer stronger alcohol drinks, and to have a younger age at sexual debut and more frequent sexual intercourse. In the log-linear model six factors appeared to be directly linked to pregnancy: mother's lower education, alcohol consumption, nonintact family structure, low academic grades, higher frequency of sexual intercourse, and lower age at sexual debut. Although the issue of unwanted pregnancy and possible ways to prevent it should be kept in mind in the psychosocial assessment of any adolescent, the results of our study suggest that some adolescents are at increased risk of unwanted pregnancy. This group includes adolescent girls with low educational attainment, living in a disrupted family, and reporting other risk behaviors. These adolescents might specially benefit from specific preventive programs to reduce the number of adverse outcomes. Copyright © 2016 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Burden of malaria in early pregnancy: a neglected problem?

PubMed

Huynh, Bich-Tram; Cottrell, Gilles; Cot, Michel; Briand, Valérie

2015-02-15

According to the current World Health Organization guidelines, the drug prevention of malaria during pregnancy does not adequately cover the first trimester of gestation in high-transmission areas. Although the pathophysiological mechanisms of early infections are not completely understood yet, a review of the most recent studies on the topic suggests that their consequences are serious in terms of maternal anemia and low birth weight. Consequently, there is a need to focus on the awareness of women in a period hard to access, to develop safe drugs to be used in the first trimester, and to consider preconceptional interventions in teenage girls, such as a new malaria vaccine to be used in pregnancy. © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Relationship between inflammatory biomarkers and depressive symptoms during late pregnancy and the early postpartum period: a longitudinal study.

PubMed

Simpson, William; Steiner, Meir; Coote, Marg; Frey, Benicio N

2016-01-01

Perinatal depressive symptoms often co-occur with other inflammatory morbidities of pregnancy. The goals of our study were 1) to examine whether changes in inflammatory markers from the third trimester of pregnancy to 12 weeks postpartum were associated with changes in depressive symptoms; 2) to examine whether third trimester inflammatory markers alone were predictive of postpartum depressive symptoms; and 3) to examine the relationship between inflammatory markers and depressive symptoms during the third trimester of pregnancy and at 12 weeks postpartum. Thirty-three healthy pregnant women were recruited from the Women's Health Concerns Clinic at St. Joseph's Healthcare in Hamilton, Canada. The impact of depressive symptoms on the levels of interleukin (IL)-6, IL-10, tumor necrosis factor alpha (TNF-α), and C-reactive protein (CRP) at the third trimester of pregnancy, at 12 weeks postpartum, and across time was assessed using linear and mixed-model regression. Regression analysis revealed no significant association between depressive symptoms and any of the candidate biomarkers during pregnancy, at 12 weeks postpartum, or over time. Pregnancy depressive symptoms (p > 0.001), IL-6 (p = 0.025), and IL-10 (p = 0.006) were significant predictors of postpartum Edinburgh Perinatal Depression Scale (EPDS) score. Our study supports previous reports from the literature showing no relationship between inflammatory biomarkers and depressive symptoms during late pregnancy, early postpartum, or across time. Our study is the first to observe an association between late pregnancy levels of IL-6 and IL-10 and postpartum depressive symptoms. Further studies with larger samples are required to confirm these findings.

Factors influencing repeated teenage pregnancy: a review and meta-analysis.

PubMed

Maravilla, Joemer C; Betts, Kim S; Couto E Cruz, Camila; Alati, Rosa

2017-11-01

Existing evidence of predictors of repeated teenage pregnancy has not been assessed rigorously. This systematic review provides a comprehensive evaluation of protective and risk factors that are associated with repeated teenage pregnancy through a metaanalytical consensus. We used PubMed, EMBASE, CINAHL, ProQuest, PsychINFO, ScienceDirect, Scopus, and Web of Science databases from 1997-2015 and the reference list of other relevant research papers and related reviews. Eligibility criteria included (1) epidemiologic studies that analyzed factors associated with repeated pregnancy or birth among adolescents <20 years of age who were nulliparous or experienced at least 1 pregnancy, and (2) experimental studies with an observational component that was adjusted for the intervention. We performed narrative synthesis of study characteristics, participant characteristics, study results, and quality assessment. We also conducted random-effects and quality-effects metaanalyses with meta-regression to obtain pooled odds ratios of identified factors and to determine sources of between-study heterogeneity. Twenty-six eligible epidemiologic studies, most from the United States (n=24), showed >47 factors with no evidence of publication bias for each metaanalysis. Use of contraception (pooled odds ratio, 0.60; 95% confidence interval, 0.35-1.02), particularly long-acting reversible contraceptives (pooled odds ratio, 0.19; 95% confidence interval, 0.08-0.45), considerably reduced repeated teenage pregnancy risk. Among studies about contraception, the number of follow-up visits (adjusted coefficient, 0.72; P=.102) and country of study (unadjusted coefficient, 2.57; permuted P=.071) explained between-study heterogeneity. Education-related factors, which included higher level of education (pooled odds ratio, 0.74; 95% confidence interval, 0.60-0.91) and school continuation (pooled odds ratio, 0.53; 95% confidence interval, 0.33-0.84), were found to be protective. Conversely, depression

[Assessment of thyroid function in women treated for vomiting in early pregnancy].

PubMed

Makowska, Beata; Preis, Krzysztof; Swiatkowska-Freund, Małgorzata; Leszczyńska, Katarzyna

2005-08-01

Hyperthyroidism does not influence procreation ability significantly, but very often causes complications of the course of pregnancy and increases neonatal morbidity and mortality in newborns. Nausea and vomiting in the first trimester of pregnancy are very common complaints in these patients. The aim of the study was to prove, that assessment of the thyroid hormones in every vomiting woman in the first trimester allows to start the proper treatment of hyperthyreosis as early as possible and improves the prognosis. Authors analyzed 22 pregnant women treated for vomiting during the first trimester in the Department of Obstetrics and 5 women treated in the Outpatient Clinic. In none of them hormonal dysfunction was diagnosed before pregnancy. In 21 patients free thyroxine (fT4) in serum was assessed. In 8 cases (38%) hyperthyreosis was diagnosed. Except the routine anti vomiting treatment, they received a beta-blocker 30 mg per day. It allowed to avoid hospitalization in three pregnant women treated in the outpatient clinic. Two patients, who had earlier two spontaneous abortions, delivered healthy babies. 1. The beta-blocker in treatment gives very good results and allows to avoid hospitalization in patients with hyperthyroidism and hyper emesis gravidarum. 2. In some patients vomiting may be the only symptom of sub clinical hyperthyroidism in early pregnancy. Assessment of the thyroid hormones levels and adequate treatment may give these women a chance for a healthy child.

Does binge drinking during early pregnancy increase the risk of psychomotor deficits?

PubMed

Kesmodel, Ulrik Schiøler; Bay, Bjørn; Wimberley, Theresa; Eriksen, Hanne-Lise F; Mortensen, Erik Lykke

2013-07-01

The potential effects of binge drinking during pregnancy on child motor function have only been assessed in a few, small studies. We aimed to examine the effects of binge alcohol consumption during early pregnancy, including number of binge episodes and timing of binge drinking, on child motor function at age 5. We performed a prospective follow-up study of 678 women and their children sampled from the Danish National Birth Cohort based on maternal alcohol consumption during pregnancy. At 5 years of age, the children were tested with the Movement Assessment Battery for Children. Parental education, maternal IQ, prenatal maternal smoking, the child's age at testing, sex of child, and tester were considered core confounders, while the full model also controlled for prenatal maternal average alcohol intake, maternal age and prepregnancy body mass index, parity, home environment, postnatal parental smoking, health status, participation in organized sport, and indicators for hearing and vision impairment. There were no systematic or significant differences in motor function between children of mothers reporting isolated episodes of binge drinking and children of mothers with no binge episodes. No association was observed with respect to the number of binge episodes (maximum of 12) and timing of binge drinking. In this study, we found no systematic association between isolated episodes of binge drinking during early pregnancy and child motor function at age 5. Copyright © 2013 by the Research Society on Alcoholism.

Parental Family Stress during Pregnancy and Cognitive Functioning in Early Childhood: The Generation R Study

ERIC Educational Resources Information Center

Henrichs, Jens; Schenk, Jacqueline J.; Kok, Rianne; Ftitache, Bouchra; Schmidt, Henk G.; Hofman, Albert; Jaddoe, Vincent W. V.; Verhulst, Frank C.; Tiemeier, Henning

2011-01-01

We investigated whether parental family stress during pregnancy is associated with cognitive functioning in early childhood in a population-based cohort (n = 3139). Family stress was assessed using the Family Assessment Device at the 20th week of pregnancy and was reported by mothers and fathers. Mothers completed the MacArthur Communicative…

Changes in the Vaginal Microenvironment with Metronidazole Treatment for Bacterial Vaginosis in Early Pregnancy

PubMed Central

Balkus, Jennifer; Agnew, Kathy; Lawler, Richard; Hitti, Jane

2009-01-01

Abstract Objective Bacterial vaginosis (BV) is associated with preterm delivery, but there is little evidence that treatment improves pregnancy outcomes. We examined whether oral or vaginal metronidazole treatment for BV in early pregnancy was more effective in restoring the normal vaginal environment. Methods This was a randomized controlled trial comparing oral and intravaginal metronidazole for treatment of BV in early pregnancy (<20 weeks). Vaginal samples collected at baseline and 4 weeks after treatment were evaluated using gram stain, culture, colorimetric detection of sialidase, and immunoassay for measurement of proinflammatory cytokines interleukins-1β, -6, -8 (IL-1β, IL-6, IL-8) and secretory leukocyte protease inhibitor (SLPI). We compared the effect of treatment between groups (using chi-square and t test) and within individuals (McNemar's test). Results Of 126 subjects, 108 (86%) completed follow-up (55 oral, 53 intravaginal). Of the study population, 34% achieved therapeutic cure, and this was not different between treatment groups. BV-associated bacteria were significantly reduced in both groups, but few subjects regained colonization with protective lactobacilli. Among women who achieved therapeutic cure, the level of IL-1β dropped significantly (p < 0.001) and SLPI increased (p = 0.003). More women in the vaginal treatment group had undetectable sialidase after treatment (p = 0.013). Conclusions Treatment with oral or intravaginal metronidazole in early pregnancy reduced colonization with BV-associated bacteria but was not effective in achieving therapeutic cure or in restoring healthy vaginal lactobacilli. PMID:19951217

[Single center survey of the relationship between pregnancy anemia and prepregnancy lifestyle].

PubMed

Akase, Tomoko; Hihara, Emiko; Uematsu, Kazuko; Kodaka, Masanobu; Akase, Tomohide; Tashiro, Shin-Ichi

2008-07-01

Physiologically, anemia often occurs during pregnancy because of an increase in circulating plasma volume. Pregnancy anemia is found prenatally in 50-75% of women. Based on the present survey performed in our obstetrics and gynecology ward, 52% of women experienced anemia during their pregnancy. This suggests that normal physiological changes due to pregnancy alone are not the only factors contributing to pregnancy anemia. Therefore to study the influence of lifestyle on pregnancy anemia, we investigated prepregnancy lifestyles on the assumption that the accumulation of several factors over a long period is usually the cause of anemia. The present results suggest that (i) the probability of anemia is slight in late pregnancy, if a normal Hb concentration is maintained in early pregnancy; (ii) the menstrual cycle is involved in the onset of anemia during early pregnancy; (iii) the number of meals taken and the level of alcohol consumption influence Hb concentration in late pregnancy. We believe that these findings provide a useful information source for advising patients on avoiding pregnancy anemia, which we can also use as guidance for outpatients at puberty. In conclusion, to prevent pregnancy anemia it is important to keep a regular menstrual cycle before pregnancy, and to take 3 meals/day and abstain from alcohol before and during pregnancy.

"These are not good things for other people to know": how rural Tanzanian women's experiences of pregnancy loss and early neonatal death may impact survey data quality.

PubMed

Haws, Rachel A; Mashasi, Irene; Mrisho, Mwifadhi; Schellenberg, Joanna Armstrong; Darmstadt, Gary L; Winch, Peter J

2010-11-01

Little research in low-income countries has compared the social and cultural ramifications of loss in childbearing, yet the social experience of pregnancy loss and early neonatal death may affect demographers' ability to measure their incidence. Ninety-five qualitative reproductive narratives were collected from 50 women in rural southern Tanzania who had recently suffered infertility, miscarriage, stillbirth or early neonatal death. An additional 31 interviews with new mothers and female elders were used to assess childbearing norms and social consequences of loss in childbearing. We found that like pregnancy, stillbirth and early neonatal death are hidden because they heighten women's vulnerability to social and physical harm, and women's discourse and behaviors are under strong social control. To protect themselves from sorcery, spiritual interference, and gossip--as well as stigma should a spontaneous loss be viewed as an induced abortion--women conceal pregnancies and are advised not to mourn or grieve for "immature" (late-term) losses. Twelve of 30 respondents with pregnancy losses had been accused of inducing an abortion; 3 of these had been subsequently divorced. Incommensurability between Western biomedical and local categories of reproductive loss also complicates measurement of losses. Similar gender inequalities and understandings of pregnancy and reproductive loss in other low-resource settings likely result in underreporting of these losses elsewhere. Cultural, terminological, and methodological factors that contribute to inaccurate measurement of stillbirth and early neonatal death must be considered in designing surveys and other research methods to measure pregnancy, stillbirth, and other sensitive reproductive events. Copyright © 2010 Elsevier Ltd. All rights reserved.

Validity of a food frequency questionnaire to estimate long-chain polyunsaturated fatty acid intake among Japanese women in early and late pregnancy.

PubMed

Kobayashi, Minatsu; Jwa, Seung Chik; Ogawa, Kohei; Morisaki, Naho; Fujiwara, Takeo

2017-01-01

The relative validity of food frequency questionnaires for estimating long-chain polyunsaturated fatty acid (LC-PUFA) intake among pregnant Japanese women is currently unclear. The aim of this study was to verify the external validity of a food frequency questionnaire, originally developed for non-pregnant adults, to assess the dietary intake of LC-PUFA using dietary records and serum phospholipid levels among Japanese women in early and late pregnancy. A validation study involving 188 participants in early pregnancy and 169 participants in late pregnancy was conducted. Intake LC-PUFA was estimated using a food frequency questionnaire and evaluated using a 3-day dietary record and serum phospholipid concentrations in both early and late pregnancy. The food frequency questionnaire provided estimates of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) intake with higher precision than dietary records in both early and late pregnancy. Significant correlations were observed for LC-PUFA intake estimated using dietary records in both early and late pregnancy, particularly for EPA and DHA (correlation coefficients ranged from 0.34 to 0.40, p < 0.0001). Similarly, high correlations for EPA and DHA in serum phospholipid composition were also observed in both early and late pregnancy (correlation coefficients ranged 0.27 to 0.34, p < 0.0001). Our findings suggest that the food frequency questionnaire, which was originally designed for non-pregnant adults and was evaluated in this study against dietary records and biological markers, has good validity for assessing LC-PUFA intake, especially EPA and DHA intake, among Japanese women in early and late pregnancy. Copyright © 2016 The Authors. Production and hosting by Elsevier B.V. All rights reserved.

Repeat Pregnancy among Urban Adolescents: Sociodemographic, Family, and Health Factors.

ERIC Educational Resources Information Center

Coard, Stephanie Irby; Nitz, Katherine; Felice, Marianne E.

2000-01-01

Examines sociodemographic, family, and health factors associated with repeat pregnancy in a clinical sample of urban, first-time mothers. Results indicate that postpartum contraceptive method was associated with repeat pregnancy at year one; contraceptive use, maternal age, history of miscarriages, and postpartum contraceptive method were…

[Studies of termination of early pregnancy with Bromo-Geraminum].

PubMed

Hou, Z K; Liu, D G; Kao, F S; Chen, S L

1984-08-01

The authors introduced 3 ml of 2-3% Bromo-Geraminum (BG) solution into the uterine cavities to induce abortion in 356 early pregnant women from March 1979 through June 1980. The success rate in the termination of early pregnancy was 80.1% and even 96.5% in those who had been pregnant for less than 5 weeks. The mean abortion time was 40.9 porn 19.7 hours. It was noticed that the blood HCG level dropped dramatically after introducing into the uterine cavity. It has been demonstrated experimentally and clinically that this method is effective, safe, simple, and inexpensive and that the normal menstrual cycle recovers very soon without side effects.

Birth defects after use of antithyroid drugs in early pregnancy: a Swedish nationwide study.

PubMed

Andersen, Stine Linding; Lönn, Stefan; Vestergaard, Peter; Törring, Ove

2017-10-01

Antithyroid drugs (ATDs) may have teratogenic effects, but more evidence is needed on the risk and types of birth defects after the use of methimazole (MMI) and propylthiouracil (PTU). This study aimed to evaluate the association between the use of ATDs in early pregnancy and birth defects. Swedish nationwide register-based cohort study. The study included 684 340 children live-born in Sweden from 2006 to 2012. Exposure groups defined by maternal ATD use in early pregnancy were MMI ( n  = 162); PTU ( n  = 218); MMI and PTU ( n  = 66); ATD before or after, but not in pregnancy ( n  = 1551) and non-exposed (never ATD ( n  = 682 343)). Outcome was cumulative incidence of birth defects diagnosed before two years of age. The cumulative incidence of birth defects was not significantly different in children exposed to MMI (6.8%, P  = 0.6) or PTU (6.4%, P  = 0.4) vs non-exposed (8.0%). For subtypes of birth defects, MMI was associated with an increased incidence of septal heart defects ( P  = 0.02). PTU was associated with ear ( P  = 0.005) and obstructive urinary system malformations ( P  = 0.006). A case of choanal atresia was observed after exposure to both MMI and PTU. The incidence of birth defects in children born to mothers who received ATD before or after, but not in pregnancy, was 8.8% and not significantly different from non-exposed ( P  = 0.3), MMI exposed ( P  = 0.4) or PTU exposed ( P  = 0.2). MMI and PTU were associated with subtypes of birth defects previously reported, but the frequency of ATD exposure in early pregnancy was low and severe malformations described in the MMI embryopathy were rarely observed. © 2017 European Society of Endocrinology.

Perceived Financial Satisfaction, Health Related Quality of Life and depressive Symptoms in Early Pregnancy.

PubMed

Sahrakorpi, Niina; Koivusalo, Saila B; Eriksson, Johan G; Kautiainen, Hannu; Stach-Lempinen, Beata; Roine, Risto P

2017-07-01

Objectives To assess the associations of perceived financial satisfaction and health-related quality of life (HRQoL) and depressive symptoms in an unselected pregnant population in early pregnancy. Methods 750 consecutive pregnant women attending the first communal ultrasound examination before gestational week 14 were invited to participate. Questionnaires assessing HRQoL (15D), depressive symptoms (Edinburgh Depression Scale, EPDS), medical, obstetric, and socioeconomic status were handed out. The participants were divided into three groups according to their satisfaction with their financial status, (unsatisfied, somewhat satisfied, and satisfied). Main outcome measures were 15D and EPDS-scores and dimensions of HRQoL. Results 325 (43,3%) questionnaires were returned. The mean 15D-score for HRQoL was 0,926 (SD 0,056). The financially unsatisfied women had lower HRQoL than women in more satisfied groups (0.906, 0.923 and 0.931, p = 0.012). The result remained significant, even after adjusting for age and education(p = 0.032). The unsatisfied women had a higher mean body mass index (BMI) (25.4, 24.4 and 23.2 kg/m 2 , p for linearity = 0.002), were more often smokers, (13 vs. 4 and 3%, p = 0.029), and had experienced at least one abortion (18, 14 and 7%, p = 0.017). Dimensions of depression, distress and sleep explained the differences between the groups. 27% of unsatisfied women scored EPDS ≥10 points suggesting increased risk of depression. Conclusions Financial satisfaction in early pregnancy associates with HRQoL and risk of perinatal depressive symptoms. Unsatisfied women more often have risk factors for unfavourable pregnancy outcomes which may influence the later health and wellbeing of the mother and child.

HYPERGLYCOSYLATED HUMAN CHORIONIC GONADOTROPIN AS AN EARLY PREDICTOR OF PREGNANCY OUTCOMES AFTER IN VITRO FERTILIZATION

PubMed Central

Chuan, Sandy; Homer, Michael; Pandian, Raj; Conway, Deirdre; Garzo, Gabriel; Yeo, Lisa; Su, H. Irene

2014-01-01

Objective To determine if hyperglycosylated hCG (hhCG), produced by invasive trophoblasts, measured as early as 9 days after egg retrieval can predict ongoing pregnancies (OP) after in vitro fertilization and fresh embryo transfer (IVF-ET). Design Cohort Setting Academic ART center Patients Consecutive patients undergoing IVF-ET Interventions Serum hhCG and hCG levels measured 9 (D9) and 16 (D16) days after egg retrieval Outcome Ongoing pregnancy (OP) beyond 9 weeks of gestation Results OP (62 of 112 participants) was associated with higher D9 levels of hhCG and hCG However, hhCG was detectable in all D9 OP samples, while hCG was detectable in only 22%. D9 hhCG levels >110 pg/mL was 96% specific for OP, yielding a positive predictive value of 95%. Compared to D9 hCG levels, hhCG was more sensitive and had a larger area under the curve (0.87 vs. 0.67). Diagnostic test characteristics were similar between D16 hhCG and hCG levels. Conclusions In patients undergoing assisted reproduction, a test to detect pregnancy early and predict outcomes is highly desirable. HhCG is detectable in serum 9 days after egg retrieval IVF-ET cycles. At this early assessment, hhCG is superior to traditional hCG and highly predictive of ongoing pregnancies. PMID:24355054

Pregnancy-associated glycoprotein (PAG) concentration in plasma and milk samples for early pregnancy diagnosis in Lacaune dairy sheep.

PubMed

El Amiri, B; Sousa, N M; Alvarez Oxiley, A; Hadarbach, D; Beckers, J F

2015-04-01

In the present study, four RIA systems (RIA-1 to -4) based on two antisera raised against ovine pregnancy-associated glycoproteins (ovPAGs), combined with an ovine or a bovine PAG tracer were used to measure PAG concentrations in plasma and milk samples of dairy ewes. Blood and milk samples were collected on different days of gestation: 0, 18, 20, 22, 25, 28, 32, 42, and 49. From day 20 onward, the PAG in plasma could be detected in all pregnant ewes using the four RIA systems. By using milk, except for RIA-1, the other systems showed a sensitivity of 100% from day 28 of gestation onward. In plasma, PAG concentrations were higher in multiple than in single pregnancies, while no clear relationship was observed in milk. In conclusion, milk is a good alternative to plasma for early pregnancy diagnosis in sheep from day 28 to day 42. Copyright © 2014 Elsevier Ltd. All rights reserved.

Correlates of poor mental health in early pregnancy in obese European women.

PubMed

Sattler, Matteo C; Jelsma, Judith G M; Bogaerts, Annick; Simmons, David; Desoye, Gernot; Corcoy, Rosa; Adelantado, Juan M; Kautzky-Willer, Alexandra; Harreiter, Jürgen; van Assche, Frans A; Devlieger, Roland; Jans, Goele; Galjaard, Sander; Hill, David; Damm, Peter; Mathiesen, Elisabeth R; Wender-Ozegowska, Ewa; Zawiejska, Agnieszka; Blumska, Kinga; Lapolla, Annunziata; Dalfrà, Maria G; Bertolotto, Alessandra; Dunne, Fidelma; Jensen, Dorte M; Andersen, Lise Lotte T; Snoek, Frank J; van Poppel, Mireille N M

2017-12-04

Depression during pregnancy is associated with higher maternal morbidity and mortality, and subsequent possible adverse effects on the cognitive, emotional and behavioral development of the child. The aim of the study was to identify maternal characteristics associated with poor mental health, in a group of overweight/obese pregnant women in nine European countries, and thus, to contribute to better recognition and intervention for maternal depression. In this cross-sectional observational study, baseline data from early pregnancy (< 20 weeks) of the DALI (Vitamin D and Lifestyle Intervention for gestational diabetes mellitus prevention) study were analyzed. Maternal mental health was assessed with the World Health Organization Well-Being Index (WHO-5). Women were classified as having a low (WHO-5 ≤ 50) or high wellbeing. A total of 735 pregnant women were included. The prevalence of having a low wellbeing was 27.2%, 95% CI [24.0, 30.4]. Multivariate analysis showed independent associations between low wellbeing and European ethnicity, OR = .44, 95% CI [.25, .77], shift work, OR = 1.81, 95% CI [1.11, 2.93], insufficient sleep, OR = 3.30, 95% CI [1.96, 5.55], self-efficacy, OR = .95, 95% CI [.92, .98], social support, OR = .94, 95% CI [.90, .99], and pregnancy-related worries (socioeconomic: OR = 1.08, 95% CI [1.02, 1.15]; health: OR = 1.06, 95% CI [1.01, 1.11]; relationship: OR = 1.17, 95% CI [1.05, 1.31]). Mental health problems are common in European overweight/obese pregnant women. The identified correlates might help in early recognition and subsequent treatment of poor mental health problems during pregnancy. This is important to reduce the unfavorable effects of poor mental health on pregnancy outcomes. ISRCTN70595832 , 02.12.2011.

Maternal depression from early pregnancy to 4 years postpartum in a prospective pregnancy cohort study: implications for primary health care.

PubMed

Woolhouse, H; Gartland, D; Mensah, F; Brown, S J

2015-02-01

To describe the prevalence of maternal depression from pregnancy to 4 years postpartum, and the risk factors for depressive symptoms at 4 years postpartum. Prospective pregnancy cohort study of nulliparous women. Melbourne, Australia. In all, 1507 women completed baseline data in pregnancy (mean gestation 15 weeks). Women were recruited from six public hospitals. Questionnaires were completed at recruitment and 3, 6, 12 and 18 months postpartum, and 4 years postpartum. Scores ≥13 on the Edinburgh Postnatal Depression Scale were used to indicate depressive symptoms. Almost one in three women reported depressive symptoms at least once in the first 4 years after birth. The prevalence of depressive symptoms at 4 years postpartum was 14.5%, and was higher than at any time-point in the first 12 months postpartum. Women with one child at 4 years postpartum were more likely to report depressive symptoms at this time compared with women with subsequent children (22.9 versus 11.3%), and this association remained significant in adjusted models (Adjusted odds ratio 1.71, 95% confidence interval 1.12-2.63). Maternal depression is more common at 4 years postpartum than at any time in the first 12 months postpartum, and women with one child at 4 years postpartum report significantly higher levels of depressive symptoms than women with subsequent children. There is a need for scaling up of current services to extend surveillance of maternal mental health to cover the early years of parenting. © 2014 Royal College of Obstetricians and Gynaecologists.

Non-identical distribution pattern of epidermal growth factor and platelet-derived growth factor in the mouse uterus during the oestrous cycle and early pregnancy.

PubMed

Jaber, L; Kan, F W

1998-10-01

In the present study, we examined by immunohistochemistry the cell-specific distribution of epidermal growth factor (EGF) and platelet-derived growth factor (PDGF) in the mouse uterus during the oestrous cycle and throughout the first 7 days of pregnancy. Paraffin-embedded tissue samples were immunostained using the avidin-biotin peroxidase technique and then examined by light microscopy. Our results showed that immunostaining for EGF was detected in the stroma but not in the luminal or glandular epithelium. A high concentration of EGF was detected in the stroma around the time of embryo implantation at days 3, 4 and 5 of pregnancy. The implanted embryo at day 7 of gestation showed immunostaining for EGF between the ectoderm and endoderm layers. The cell distribution pattern for PDGF was found to be different from that observed with EGF. Luminal and glandular epithelia displayed PDGF immunostaining throughout the first 7 days of pregnancy, with the highest intensity at days 4 and 5 of gestation. In contrast, no immunostaining was observed in the luminal and glandular epithelia at post-oestrus, dioestrus and pro-oestrus stages. However, a weak reaction started to appear at oestrus. The embryo at the blastocyst stage displayed a strong immunoreaction for antibody against PDGF. In addition, the decidual boundary zone surrounding the implanted embryo at days 5, 6 and 7 of gestation also showed an immunostaining for PDGF. The present observations demonstrate clearly the presence of EGF and PDGF in the mouse uterus in high concentrations at the peri-implantation period. Thus, our results, together with what is known about the effect of EGF and PDGF in controlling the growth, differentiation and activation of a variety of cell types, suggest a possible role for these growth factors during the preparation of the endometrium for implantation in controlling the proliferation activity of stromal and/or epithelial cells.

Early Childhood Adversity and Pregnancy Outcomes

PubMed Central

Smith, Megan V.; Gotman, Nathan; Yonkers, Kimberly A.

2016-01-01

Objectives To examine the association between adverse childhood experiences (ACEs) and pregnancy outcomes; to explore mediators of this association including psychiatric illness and health habits. Methods Exposure to ACEs was determined by the Early Trauma Inventory Self Report Short Form; psychiatric diagnoses were generated by the Composite International Diagnostic Interview administered in a cohort of 2303 pregnant women. Linear regression and structural equation modeling bootstrapping approaches tested for multiple mediators. Results Each additional ACE decreased birth weight by 16.33 g and decreased gestational age by 0.063. Smoking was the strongest mediator of the effect on gestational age. Conclusions ACEs have an enduring effect on maternal reproductive health, as manifested by mothers’ delivery of offspring that were of reduced birth weight and shorter gestational age. PMID:26762511

Intrauterine adhesions as a risk factor for failed first-trimester pregnancy termination.

PubMed

Luk, Janelle; Allen, Rebecca H; Schantz-Dunn, Julianna; Goldberg, Alisa B

2007-10-01

Risk factors for failed first-trimester surgical abortion include endometrial distortion caused by leiomyomas, uterine anomalies and malposition and cervical stenosis. This report introduces intrauterine adhesions as an additional risk factor. A multiparous woman presented for pregnancy termination at 6 weeks' gestation. Three suction-curettage attempts failed to remove what appeared to be an intrauterine pregnancy. Rising beta-hCG levels and concern for an interstitial ectopic pregnancy prompted a diagnostic laparoscopy and exploratory laparotomy without the identification of an ectopic pregnancy. After methotrexate treatment failed, the patient underwent ultrasound-guided hysteroscopy and suction curettage using a cannula with a whistle-cut aperture for the successful removal of a pregnancy implanted behind intrauterine adhesions. Intrauterine adhesions are a cause of failed surgical abortion. Ultrasound-guided hysteroscopy may be required for diagnosis.

[IDENTIFICATION OF CAUSES OF EARLY PREGNANCY LOSSES ACCORDING TO HYSTOMORPHOLOGIC FEATURES].

PubMed

Gotsiridze, K; Kintraia, N; Pailodze, M; Gogia, T; Tsaava, F

2017-01-01

Retrospective analysis of the early spontaneous abortions has been conducted (486 cases). Histomorphologic analysis of the curettage material contents erveledinvolutive-regressive developmental chsnges in 108 (22,28%) cases, in 370 cases (77.78%) pathologic changes, like inflammatory changes of deciduas and chorionic villis in 302 cases (80.2%), pathologic prematurity of chorionic vili in 48 cases (12.6%), hydatidiform mole in 28 cases (7.4%). As most cases of pregnancy loss has been reported at 7-9 weeks /172 cases/, we compared histomorphologic data revealed at 7-8 (71 cases) weeks to 5-6 (135 cases) and 10-12 weeks of gestation. Morphologic research data confimed, that at 7-8 weeks compared to 5-6 weeks leading reason ofpregnancy loss was inflammatory changes (OR-1,584), what can be cause of 110 pregnancy losses at 1000 pregnant women (AR-0.11). Data comparing7-9 weeks to 10-12 weeks pregnancy losses, confirm the priority of pathologic immaturity (OR-1,279) and hydatidiform mole (OR-1,557) and could be the risk of 100 cases of pregnancy termination at 1000 pregnant women (AR-0.10).Existing results are of great importance for the preconceptional preparation of women.

Finasteride use during pregnancy and early neonatal outcome: a case report.

PubMed

AlSaad, Doua; Lee, Ben H; Al-Obaidly, Sawsan

2018-06-01

The use of antiandrogen drugs such as finasteride during pregnancy may carry the risk of birth defects, especially hypospadias. We report a 39-year-old woman, with 5 weeks unplanned pregnancy, the patient conceived while receiving daily dose of finasteride 2.5 mg for treatment of alopecia. The patient's partner was concurrently using finasteride for the same purpose. Ultrasound scans including detailed anatomy were normal throughout pregnancy and the fetal gender was detected to be male. The patient had her delivery at 38 +5 weeks' gestation, by elective cesarean section, a male infant with a weight of 3.58 kg and Apgar score of 9 and 10 at 1 and 5-min, respectively. The infant was healthy with no obvious dysmorphic features. In this case report, maternal use of finasteride in early pregnancy was not associated with external genitalia abnormalities of a male baby. Moreover, maternal exposure to the semen of partner who received finasteride did not adversely affect the short term neonatal outcomes. However, absence of apparent neonatal adverse effects in a single case report does not indicate safety of use. Population-based long term neonatal outcomes are yet to be established.

Determinants of adolescent pregnancy in sub-Saharan Africa: a systematic review.

PubMed

Yakubu, Ibrahim; Salisu, Waliu Jawula

2018-01-27

Adolescent pregnancy has been persistently high in sub-Saharan Africa. The objective of this review is to identify factors influencing adolescent pregnancies in sub-Saharan Africa in order to design appropriate intervention program. A search in MEDLINE, Scopus, Web of science, and Google Scholar databases with the following keywords: determinants, factors, reasons, sociocultural factors, adolescent pregnancy, unintended pregnancies, and sub- Saharan Africa. Qualitative and cross-sectional studies intended to assess factors influencing adolescent pregnancies as the primary outcome variable in sub- Saharan Africa were included. Our search was limited to, articles published from the year 2000 to 2017 in English. Twenty-four (24) original articles met the inclusion criteria. The study identified Sociocultural, environmental and Economic factors (Peer influence, unwanted sexual advances from adult males, coercive sexual relations, unequal gender power relations, poverty, religion, early marriage, lack of parental counseling and guidance, parental neglect, absence of affordable or free education, lack of comprehensive sexuality education, non-use of contraceptives, male's responsibility to buy condoms, early sexual debut and inappropriate forms of recreation). Individual factors (excessive use of alcohol, substance abuse, educational status, low self-esteem, and inability to resist sexual temptation, curiosity, and cell phone usage). Health service-related factors (cost of contraceptives, Inadequate and unskilled health workers, long waiting time and lack of privacy at clinics, lack of comprehensive sexuality education, misconceptions about contraceptives, and non-friendly adolescent reproductive services,) as influencing adolescent pregnancies in Sub-Saharan Africa CONCLUSION: High levels of adolescent pregnancies in Sub-Saharan Africa is attributable to multiple factors. Our study, however, categorized these factors into three major themes; sociocultural and economic

Psychosocial factors associated with early initiation and frequency of antenatal care (ANC) visits in a rural and urban setting in South Africa: a cross-sectional survey.

PubMed

Muhwava, Lorrein Shamiso; Morojele, Neo; London, Leslie

2016-01-25

Late booking and infrequent antenatal care (ANC) are common but avoidable patient-related risk factors for maternal deaths in South Africa. The aim of the study was to examine the association of psychosocial factors with early initiation of ANC and adequate frequency of attendance of ANC clinics among women in an urban and rural location in South Africa. Data from a 2006 cross-sectional household survey of 363 women from the rural Western Cape and 466 women from urban Gauteng provinces of South Africa for risk of alcohol-exposed pregnancy were analysed. We examined associations between psychosocial variables (self-esteem, cultural influences, religiosity, social capital, social support, pregnancy desire (wanted versus unwanted pregnancy), partner characteristics and mental health) and both early ANC first visit (before 16 weeks) and adequate frequency of ANC visits (4 or more visits) for respondents' last pregnancy. Overall prevalence among urban women of early ANC initiation was 46% and 84% for adequate ANC frequency. Overall prevalence among rural women of early ANC initiation was 45% and 78% for adequate ANC frequency. After adjusting for clustering, psychosocial factors associated with early ANC initiation in the urban site were being employed (OR 1.6; 95% CI 1.0-2.5) and wanted pregnancy (OR 1.8; 95% CI 1.1-3.0). For the rural site, early ANC initiation was significantly associated with being married (OR 1.93; 95% CI 1.0-3.6) but inversely associated with high religiosity (OR 0.5; 95% CI 0.3-0.8). Adequate frequency of ANC attendance in the rural site was associated with wanted pregnancy (OR 4.2; 95% CI 1.9-9.3) and the father of the child being present in the respondent's life (OR 3.0; 95% CI 1.0-9.0) but inversely associated with having a previous miscarriage (OR 0.4; 95% CI 0.2-0.8). There were no significant associations between adequate ANC attendance and the psychosocial factors in the urban site. The majority of women from both sites attended ANC

Baseline Demographic, Anthropometric, Psychosocial, and Behavioral Characteristics of Rural, Southern Women in Early Pregnancy.

PubMed

Thomson, Jessica L; Tussing-Humphreys, Lisa M; Goodman, Melissa H; Olender, Sarah

2016-09-01

Objectives Beginning life in a healthy uterine environment is essential for future well-being, particularly as it relates to chronic disease risk. Baseline (early pregnancy) demographic, anthropometric (height and weight), psychosocial (depression and perceived stress), and behavioral (diet and exercise) characteristics of rural, Southern, pregnant women enrolled in a maternal, infant, and early childhood home visiting program are described. Methods Participants included 82 women early in their second trimester of pregnancy and residing in three Lower Mississippi Delta counties in the United States. Baseline data were collected through direct measurement and surveys. Results Participants were primarily African American (96 %), young (mean age = 23 years), single (93 %), and received Medicaid (92 %). Mean gestational age was 18 weeks, 67 % of participants were overweight or obese before becoming pregnant, and 16 % tested positive for major depression. Participants were sedentary (mean minutes of moderate intensity physical activity/week = 30), had low diet quality (mean Healthy Eating Index-2010 total score = 43 points), with only 38, 4, and 7 % meeting recommendations for saturated fat, fiber, and sodium intakes, respectively. Conclusions for Practice In the Lower Mississippi Delta, there is a need for interventions that are designed to help women achieve optimal GWG by improving their diet quality and increasing the amount of physical activity performed during pregnancy. Researchers also should consider addressing barriers to changing health behaviors during pregnancy that may be unique to this region of the United States.

Biomonitoring of human fetal exposure to environmental chemicals in early pregnancy.

PubMed

Cooke, Gerard M

2014-01-01

The first trimester of human fetal life, a period of extremely rapid development of physiological systems, represents the most rapid growth phase in human life. Interference in the establishment of organ systems may result in abnormal development that may be manifest immediately or programmed for later abnormal function. Exposure to environmental chemicals may be affecting development at these early stages, and yet there is limited knowledge of the quantities and identities of the chemicals to which the fetus is exposed during early pregnancy. Clearly, opportunities for assessing fetal chemical exposure directly are extremely limited. Hence, this review describes indirect means of assessing fetal exposure in early pregnancy to chemicals that are considered disrupters of development. Consideration is given to such matrices as maternal hair, fingernails, urine, saliva, sweat, breast milk, amniotic fluid and blood, and fetal matrices such as cord blood, cord tissue, meconium, placenta, and fetal liver. More than 150 articles that presented data from chemical analysis of human maternal and fetal tissues and fluids were reviewed. Priority was given to articles where chemical analysis was conducted in more than one matrix. Where correlations between maternal and fetal matrices were determined, these articles were included and are highlighted, as these may provide the basis for future investigations of early fetal exposure. The determination of fetal chemical exposure, at the time of rapid human growth and development, will greatly assist regulatory agencies in risk assessments and establishment of advisories for risk management concerning environmental chemicals.

A Novel Use of Three-dimensional High-frequency Ultrasonography for Early Pregnancy Characterization in the Mouse.

PubMed

Peavey, Mary C; Reynolds, Corey L; Szwarc, Maria M; Gibbons, William E; Valdes, Cecilia T; DeMayo, Francesco J; Lydon, John P

2017-10-24

High-frequency ultrasonography (HFUS) is a common method to non-invasively monitor the real-time development of the human fetus in utero. The mouse is routinely used as an in vivo model to study embryo implantation and pregnancy progression. Unfortunately, such murine studies require pregnancy interruption to enable follow-up phenotypic analysis. To address this issue, we used three-dimensional (3-D) reconstruction of HFUS imaging data for early detection and characterization of murine embryo implantation sites and their individual developmental progression in utero. Combining HFUS imaging with 3-D reconstruction and modeling, we were able to accurately quantify embryo implantation site number as well as monitor developmental progression in pregnant C57BL6J/129S mice from 5.5 days post coitus (d.p.c.) through to 9.5 d.p.c. with the use of a transducer. Measurements included: number, location, and volume of implantation sites as well as inter-implantation site spacing; embryo viability was assessed by cardiac activity monitoring. In the immediate post-implantation period (5.5 to 8.5 d.p.c.), 3-D reconstruction of the gravid uterus in both mesh and solid overlay format enabled visual representation of the developing pregnancies within each uterine horn. As genetically engineered mice continue to be used to characterize female reproductive phenotypes derived from uterine dysfunction, this method offers a new approach to detect, quantify, and characterize early implantation events in vivo. This novel use of 3-D HFUS imaging demonstrates the ability to successfully detect, visualize, and characterize embryo-implantation sites during early murine pregnancy in a non-invasive manner. The technology offers a significant improvement over current methods, which rely on the interruption of pregnancies for gross tissue and histopathologic characterization. Here we use a video and text format to describe how to successfully perform ultrasounds of early murine pregnancy to

Early neonatal mortality in twin pregnancy: Findings from 60 low- and middle-income countries.

PubMed

Bellizzi, Saverio; Sobel, Howard; Betran, Ana Pilar; Temmerman, Marleen

2018-06-01

Around the world, the incidence of multiple pregnancies reaches its peak in the Central African countries and often represents an increased risk of death for women and children because of higher rates of obstetrical complications and poor management skills in those countries. We sought to assess the association between twins and early neonatal mortality compared with singleton pregnancies. We also assessed the role of skilled birth attendant and mode of delivery on early neonatal mortality in twin pregnancies. We conducted a secondary analysis of individual level data from 60 nationally-representative Demographic and Health Surveys including 521 867 singleton and 14 312 twin births. We investigated the occurrence of deaths within the first week of life in twins compared to singletons and the effect of place and attendance at birth; also, the role of caesarean sections against vaginal births was examined, globally and after countries stratification per caesarean sections rates. A multi-level logistic regression was used accounting for homogeneity within country, and homogeneity within twin pairs. Early neonatal mortality among twins was significantly higher when compared to singleton neonates (adjusted odds ratio (aOR) 7.6; 95% confidence interval (CI) = 7.0-8.3) in these 60 countries. Early neonatal mortality was also higher among twins than singletons when adjusting for birth weight in a subgroup analysis of those countries with data on birth weight (n = 20; less than 20% of missing values) (aOR = 2.8; 95% CI = 2.2-3.5). For countries with high rates (>15%) of caesarean sections (CS), twins delivered vaginally in health facility had a statistically significant (aOR = 4.8; 95% CI = 2.4-9.4) increased risk of early neonatal mortality compared to twins delivered through caesarean sections. Home twin births without SBA was associated with increased mortality compared with delivering at home with SBA (aOR = 1.3; 95% CI = 1.0-1.8) and

Ultrasonographic diagnosis of early pregnancy in cattle using different ultrasound systems.

PubMed

Racewicz, Przemysław; Sickinger, Marlene; Włodarek, Jan; Jaśkowski, Jędrzej M

2016-06-16

To evaluate the efficiency of different ultrasound devices in achieving an early diagnosis of pregnancy in dairy herds. A total of 1976 Holstein Friesian cows and heifers were artificially inseminated (AI) according to the herd manager's regime. Pregnancy diagnostics were performed between day 26 and 35 after AI using six different types of ultrasound systems (linear vs. sector scanners). Manual rectal palpation between day 45 and 60 after AI was used as the gold standard for pregnancy diagnostics. Sensitivity (SENS), specificity (SPEC), positive (PPV) and negative predictive value (NPV) and diagnostic accuracy (ACC) of the diagnostic measures were determined. Average SENS was 82% (range 67.7-95.2%) with a mean SPEC of 73% (range 50.0-81.0%). ACC was 78.2% with a minimum of 64.6% and a maximum of 89.4%, depending on the ultrasound system. The PPV (ratio of the number of pregnant cows with a positive examination result to the number of cows actually pregnant) was 80.8% (range 59.1-88.1%), whereas the NPV (defined as the ratio of the number of cows correctly diagnosed negative to the number of cows actually open) was 74.4% (72.3-91.9%). Significant differences for these parameters were found depending on the ultrasound system used (p ≤ 0.01; Cramer's V. = 0.14). Regardless of the ultrasound device used, early pregnancy diagnostics between day 26 and 35 show a moderate diagnostic efficiency. Comparing the accuracy of the different devices, there may be a significant influence of type and technical parameters. Even though ultrasound systems with mechanical sector probes are not as convenient to use as systems with linear probes, according to this study, sector scanners are a reasonable alternative.

Adolescent Stress, Coping, and Academic Persistence in Rural Appalachia: The Unacknowledged Import of Early Adolescent Pregnancy.

ERIC Educational Resources Information Center

Lange, Linda; Bickel, Robert

This paper examines pregnancy in early adolescence, among West Virginia females aged 10-14, as it relates to local economic and social contexts. Although research on adolescent pregnancy is substantial, it is generally limited to the experiences of older adolescents and premised on assumptions of methodological individualism--that the correlates…

Pregnancy and delivery in women with von Willebrand's disease and different von Willebrand factor mutations.

PubMed

Castaman, Giancarlo; Tosetto, Alberto; Rodeghiero, Francesco

2010-06-01

Pregnancy in von Willebrand's disease may carry a significant risk of bleeding. Information on changes in factor VIII and von Willebrand factor and pregnancy outcome in relation to von Willebrand factor gene mutations are very scanty. We examined biological response to desmopressin, changes in factor VIII and von Willebrand factor and pregnancy outcome in a cohort of 23 women with von Willebrand's disease characterized at molecular level and prospectively followed during 2000-2007. Thirty-one pregnancies occurred during the study period. Remarkably, similar changes of factor VIII and von Willebrand factor were observed after desmopressin and during pregnancy in nine women with R854Q, R1374H, V1665E, V1822G and C2362F mutations. Women with von Willebrand's disease and R1205H and C1130F mutations (17 pregnancies in 12 women) had only a slight increase of factor VIII and von Willebrand factor during pregnancy while their response to desmopressin was marked but short-lived. For these women, two to three desmopressin administrations within the first 48 hours were sufficient to successfully manage vaginal delivery. Two women with recessive von Willebrand's disease due to compound heterozygosity for different gene mutations had a spontaneous, major increase in factor VIII while von Willebrand factor remained severely reduced. Desmopressin increased factor VIII and was clinically useful in the first case, while a factor VIII/von Willebrand factor concentrate was required in the second patient not responsive to the compound. Factor VIII/von Willebrand factor concentrate was also required for two women with type 2 A von Willebrand's disease with V1665E mutations who had no von Willebrand factor activity change during pregnancy. In one of them, delayed bleeding occurred 15 days later requiring treatment with Factor VIII/von Willebrand factor concentrate. No miscarriages or stillbirths occurred. Close follow-up and detailed guidelines for the management of parturition have

Childhood obesity is associated with maternal smoking in pregnancy.

PubMed

Toschke, André Michael; Koletzko, Berthold; Slikker, William; Hermann, Monika; von Kries, Rüdiger

2002-08-01

Overweight and obesity are major public health issues. Childhood obesity often persists throughout adulthood. Recently a higher prevalence of obesity in adults whose mothers smoked during pregnancy was reported. The aim of this study was to assess whether this association is also detectable in pre-school children in a different setting and to identify the critical period for intrauterine exposure to inhaled smoke products in pregnancy. We analysed questionnaire data on early feeding and lifestyle factors of 8,765 German children aged 5.00 to 6.99 years. Obesity was defined as a body mass index >97th percentile. The prevalence estimates for obesity were: mother never smoked 2.8% (95% CI 2.4%-3.2%), smoked after pregnancy only 1.6% (95%CI 0.4%-4.1%), smoked throughout pregnancy 6.2% (95% CI 4.5%-8.3%), smoked before pregnancy, but not throughout 4.5% (95%CI 3.6%-5.7%). These associations could not be explained by confounding due to a number of constitutional, sociodemographic and lifestyle factors. The unadjusted/adjusted odds ratios were: smoked during pregnancy: 2.32 (95% CI 1.63%-3.30%)/1.92 (95% CI 1.29%-2.86%); smoked before, but not throughout pregnancy: 1.67 (95%CI 1.26%-2.22%)/1.74 (95%CI 1.29%-2.34%). the association of maternal smoking in pregnancy and obesity was also detectable in children at school entry. Since smoking after pregnancy was not associated with childhood obesity, intrauterine exposure rather than family lifestyle factors associated with smoking appears to be instrumental. There appears to be a role for early intrauterine exposure.

Upregulation of zinc absorption matches increases in physiological requirements for zinc in women consuming high-or-moderate-phytate diets during late pregnancy and early lactation

USDA-ARS?s Scientific Manuscript database

Objectives: To determine the roles of host and dietary factors in matching increases in physiological requirements for zinc (Zn) during late pregnancy and early lactation in women whose major dietary staple is maize with and without phytate reduction. Methods: Subjects were 22 indigenous Guatemalan ...

Isolation and purification of an early pregnancy factor-like molecule from culture supernatants obtained from lymphocytes of pregnant women: II. Identification of the molecule as a Fc-receptor-like molecule: a preliminary report.

PubMed

Aranha, C; Bordekar, A; Shahani, S

1998-11-01

Early pregnancy factor (EPF)-like activity from culture supernatants obtained from stimulated lymphocytes of pregnant women was characterized and identified. The enzyme-linked immunosorbent assay depending on the presence of "Fc" receptors on bovine spermatozoa was used to identify the EPF-like molecule purified by gel filtration and reverse-phase high-performance liquid chromatography. The results indicated that the crude lymphocyte culture supernatant, the EPF-positive G IV fraction obtained on gel filtration, and the EPF-positive reverse-phase high-performance liquid chromatography protein readily bound with the different concentrations of aggregated human gamma-globulin in a manner similar to that in which the standard control of aggregated human gamma-globulin binds to the bovine spermatozoa. EPF-like activity synthesized and secreted by lymphocytes during pregnancy may be a Fc-receptor-like molecule.

Time-lapse culture with morphokinetic embryo selection improves pregnancy and live birth chances and reduces early pregnancy loss: a meta-analysis.

PubMed

Pribenszky, Csaba; Nilselid, Anna-Maria; Montag, Markus

2017-11-01

Embryo evaluation and selection is fundamental in clinical IVF. Time-lapse follow-up of embryo development comprises undisturbed culture and the application of the visual information to support embryo evaluation. A meta-analysis of randomized controlled trials was carried out to study whether time-lapse monitoring with the prospective use of a morphokinetic algorithm for selection of embryos improves overall clinical outcome (pregnancy, early pregnancy loss, stillbirth and live birth rate) compared with embryo selection based on single time-point morphology in IVF cycles. The meta-analysis of five randomized controlled trials (n = 1637) showed that the application of time-lapse monitoring was associated with a significantly higher ongoing clinical pregnancy rate (51.0% versus 39.9%), with a pooled odds ratio of 1.542 (P < 0.001), significantly lower early pregnancy loss (15.3% versus 21.3%; OR: 0.662; P = 0.019) and a significantly increased live birth rate (44.2% versus 31.3%; OR 1.668; P = 0.009). Difference in stillbirth was not significant between groups (4.7% versus 2.4%). Quality of the evidence was moderate to low owing to inconsistencies across the studies. Selective application and variability were also limitations. Although time-lapse is shown to significantly improve overall clinical outcome, further high-quality evidence is needed before universal conclusions can be drawn. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

The value of multidisciplinary team meetings within an early pregnancy assessment unit.

PubMed

Bharathan, Rasiah; Farag, Mena; Hayes, Kevin

2016-08-01

This is the first study to ascertain the value of multidisciplinary team (MDT) meetings within an early pregnancy assessment unit (EPAU). Our national telephone survey identified that in the United Kingdom, overall 37% of EPAU utilise regular MDT meetings. Secondary and tertiary hospitals are just as likely to hold regular MDT meetings. The participants in our interview study expressed the principal benefits of regular MDT meetings as communication, education and effective stress management. The perceived additional benefits included improved care quality, better patient experience and enhanced team cohesion. During the meetings, at least, one representative from every tier of staffing was present. The caseload of the MDT meeting comprised ectopic pregnancies and pregnancies of unknown location. We propose a number of research studies, which would build on this study. Such efforts will help enhance the effectiveness of the MDT-based EPAU service.

Pregnancy-related maternal risk factors of attention-deficit hyperactivity disorder: a case-control study.

PubMed

Amiri, Shahrokh; Malek, Ayyoub; Sadegfard, Majid; Abdi, Salman

2012-01-01

Background. The etiology of attention-deficit hyperactivity disorder (ADHD) is complex.This study was conducted to evaluate the pregnancy-related maternal risk factors of ADHD. Methods. 164 ADHD children attending to Child and Adolescent Psychiatric Clinics compared with 166 normal children selected in a random-cluster method from primary schools. ADHD rating scale and clinical interview based on Schedule for Affective disorders and Schizophrenia for School-Aged Children (K-SADS) were used to diagnose ADHD cases and to select the control group. Results. The mean maternal age at pregnancy, duration of pregnancy, and the mean paternal age were alike in two groups. The ADHD children's mothers compared with those of control group had higher frequencies of somatic diseases, psychiatric disorders, and alcohol and cigarette exposure during the pregnancies (P < 0.01). Also birth by cesarean section was more common among mothers of ADHD children (P < 0.001). These factors plus trauma to the abdomen during pregnancy were significantly predictors of ADHD in children. Conclusions. Some pregnancy-related maternal factors may be considered as environmental risk factors for ADHD. Each of these factors considered in our study as a risk factor needs to be tested and confirmed through next methodologically appropriate researches in this field.

Molar Pregnancy

MedlinePlus

... including a rare form of cancer — and requires early treatment. Symptoms A molar pregnancy may seem like a normal pregnancy at first, but most molar pregnancies cause specific signs and symptoms, including: Dark brown to bright red ...

Identifying factors that influence pregnancy intentions: evidence from South Africa and Malawi.

PubMed

Evens, Emily; Tolley, Elizabeth; Headley, Jennifer; McCarraher, Donna R; Hartmann, Miriam; Mtimkulu, Vuyelwa T; Manenzhe, Kgahlisho Nozibele; Hamela, Gloria; Zulu, Fatima

2015-01-01

In developing-country settings, pregnancy intentions are often assessed using a series of questions from the Demographic and Health Surveys, yet research conducted in several countries yields conflicting results regarding these questions' ability to predict pregnancy. Conducted in Malawi and South Africa, this study identified individual, partner and societal factors that influence desire for pregnancy, and women's ability to achieve their intentions. Data come from interviews and focus-group discussions conducted prior to the FEM-PrEP HIV-prevention trial with women from communities at high risk of HIV infection. Cultural norms regarding contraceptive use and childbearing influenced both women's desire for pregnancy and ability to achieve those goals. Partner's expectations for pregnancy, financial concerns, family composition and contraceptive experiences were additional influences. Actively planning for pregnancy was not a salient concept to the majority of participants. Results support the call for a multidimensional measure of pregnancy intention that reflects the variety of factors that influence intentions, highlight the fluid nature of many women's reproductive health decision making and challenge the notion that all fertility decisions are the result of conscious action. Additional work on how women's plans for pregnancy are achieved would be programmatically more useful than current measures of intention.

Increased planned delivery contributes to declining rates of pregnancy hypertension in Australia: a population-based record linkage study.

PubMed

Roberts, Christine L; Algert, Charles S; Morris, Jonathan M; Ford, Jane B

2015-10-05

Since the 1990s, pregnancy hypertension rates have declined in some countries, but not all. Increasing rates of early planned delivery (before the due date) have been hypothesised as the reason for the decline. The aim of this study was to explore whether early planned delivery can partly explain the declining pregnancy hypertension rates in Australia. Population-based record linkage study utilising linked birth and hospital records. A cohort of 1,076,122 deliveries in New South Wales, Australia, 2001-2012. Pregnancy hypertension (including gestational hypertension, pre-eclampsia and eclampsia) was the main outcome; pre-eclampsia was a secondary outcome. From 2001 to 2012, pregnancy hypertension rates declined by 22%, from 9.9% to 7.7%, and pre-eclampsia by 27%, from 3.3% to 2.4% (trend p<0.0001). At the same time, planned deliveries increased: prelabour caesarean section by 43% (12.9-18.4%) and labour inductions by 10% (24.8-27.2%). Many maternal risk factors for pregnancy hypertension significantly increased (p<0.01) over the study period including nulliparity, age ≥35 years, diabetes, overweight and obesity, and use of assisted reproductive technologies; some risk factors decreased including multifetal pregnancies, age <20 years, autoimmune diseases and previous pregnancy hypertension. Given these changes in risk factors, the pregnancy hypertension rate was predicted to increase to 10.5%. Examination of annual gestational age distributions showed that pregnancy hypertension rates actually declined from 38 weeks gestation and were steepest from 41 weeks; at least 36% of the decrease could be attributed to planned deliveries. The risk factors for pregnancy hypertension were also risk factors for planned delivery. It appears that an unanticipated consequence of increasing early planned deliveries is a decline in the incidence of pregnancy hypertension. Women with risk factors for hypertension were relatively more likely to be selected for early delivery

Early pregnancy diagnosis in sheep using near-infrared spectroscopy on blood plasma.

PubMed

Andueza, Donato; Alabart, José L; Lahoz, Belén; Muñoz, Fernando; Folch, José

2014-02-01

The objective of this study was to evaluate the ability of near-infrared reflectance spectroscopy (NIRS) to discriminate between pregnant and nonpregnant ewes in early stages of pregnancy after artificial insemination (AI) from blood plasma. Samples were collected using jugular puncture at 18 and 25 days after AI from 188 Rasa Aragonesa and Ansotana ewes. Plasma samples were analyzed for pregnancy-associated glycoprotein (PAG) and progesterone (P4) using ELISA commercial kits. The spectra of plasma samples were recorded in the visible and near-infrared ranges. The performance of these tests were compared, using as criterion standard the pregnancy status determined using transabdominal ultrasonography at 45 days after AI. Pregnancy rate was 47.9% (90/188). At Day 18, sensitivity was similar in NIRS and P4 tests (98.9% vs. 100%; not significant) and greater than PAG (32.2%; both P < 0.001). Specificity was similar in NIRS and PAG tests (both 100%) and greater than that of P4 (84.7%; P < 0.001). At Day 25, sensitivity and specificity of NIRS and PAG were both 100%. It can be concluded that NIRS was an accurate method of diagnosis of pregnancy at Days 18 and 25 after AI in ewes. Copyright © 2014 Elsevier Inc. All rights reserved.

Interferon-τ increases BoLA-I for implantation during early pregnancy in dairy cows.

PubMed

Zhu, Zhe; Li, Binbin; Wu, Yue; Wang, Xiao; Deng, GanZhen

2017-11-10

Interferon-τ (IFN-τ) signals pregnancy recognition in ruminants. We investigated the effects of IFN-τ produced by embryo trophoblastic cells (ETCs) on expression of bovine leukocyte antigen-I (BoLA-I), a bovine analogue of human MHC-I, in endometrial luminal epithelial cells (EECs) during early pregnancy in dairy cows. Expression of IFN-τ and BoLA-I was increased in endometrial tissues during early pregnancy. Expression of the anti-inflammatory cytokine IL-10 was increased in endometrial tissues, while expression of the pro-inflammatory cytokine IL-6 was decreased, indicating immunosuppression. Progesterone increased IFN-τ expression in EECs. IFN-τ increased p-STAT1 and p-STAT3 levels in EECs, but reduced TRAF3 levels. In addition, IFN-τ increased expression of BoLA-I and IL-10, but decreased expression of IL-6 in EECs. These results indicate that IFN-τ enables stable implantation in dairy cows by increasing expression of BoLA-I, and by immunosuppression mediated by increased IL-10 and decreased IL-6 expression.

Interferon-τ increases BoLA-I for implantation during early pregnancy in dairy cows

PubMed Central

Zhu, Zhe; Li, Binbin; Wu, Yue; Wang, Xiao; Deng, GanZhen

2017-01-01

Interferon-τ (IFN-τ) signals pregnancy recognition in ruminants. We investigated the effects of IFN-τ produced by embryo trophoblastic cells (ETCs) on expression of bovine leukocyte antigen-I (BoLA-I), a bovine analogue of human MHC-I, in endometrial luminal epithelial cells (EECs) during early pregnancy in dairy cows. Expression of IFN-τ and BoLA-I was increased in endometrial tissues during early pregnancy. Expression of the anti-inflammatory cytokine IL-10 was increased in endometrial tissues, while expression of the pro-inflammatory cytokine IL-6 was decreased, indicating immunosuppression. Progesterone increased IFN-τ expression in EECs. IFN-τ increased p-STAT1 and p-STAT3 levels in EECs, but reduced TRAF3 levels. In addition, IFN-τ increased expression of BoLA-I and IL-10, but decreased expression of IL-6 in EECs. These results indicate that IFN-τ enables stable implantation in dairy cows by increasing expression of BoLA-I, and by immunosuppression mediated by increased IL-10 and decreased IL-6 expression. PMID:29221114

Impact of Pre-Pregnancy BMI on B Vitamin and Inflammatory Status in Early Pregnancy: An Observational Cohort Study

PubMed Central

Bjørke-Monsen, Anne-Lise; Ulvik, Arve; Nilsen, Roy M.; Midttun, Øivind; Roth, Christine; Magnus, Per; Stoltenberg, Camilla; Vollset, Stein Emil; Reichborn-Kjennerud, Ted; Ueland, Per Magne

2016-01-01

Maternal nutrition and inflammation have been suggested as mediators in the development of various adverse pregnancy outcomes associated with maternal obesity. We have investigated the relation between pre-pregnancy BMI, B vitamin status, and inflammatory markers in a group of healthy pregnant women. Cobalamin, folate, pyridoxal 5′-phosphate, and riboflavin; and the metabolic markers homocysteine, methylmalonic acid, and 3-hydroxykynurenine/xanthurenic acid ratio (HK/XA); and markers of cellular inflammation, neopterin and kynurenine/tryptophan ratio (KTR) were determined in pregnancy week 18 and related to pre-pregnancy body mass index (BMI), in 2797 women from the Norwegian Mother and Child Cohort Study (MoBa). Pre-pregnancy BMI was inversely related to folate, cobalamin, pyridoxal 5′-phosphate (PLP), and riboflavin (p < 0.001), and associated with increased neopterin and KTR levels (p < 0.001). Inflammation seemed to be an independent predictor of low vitamin B6 status, as verified by low PLP and high HK/XA ratio. A high pre-pregnancy BMI is a risk factor for low B vitamin status and increased cellular inflammation. As an optimal micronutrient status is vital for normal fetal development, the observed lower B vitamin levels may contribute to adverse pregnancy outcomes associated with maternal obesity and B vitamin status should be assessed in women with high BMI before they get pregnant. PMID:27916904

Vasodilator factors in the systemic and local adaptations to pregnancy

PubMed Central

Valdes, Gloria; Kaufmann, Peter; Corthorn, Jenny; Erices, Rafaela; Brosnihan, K Bridget; Joyner-Grantham, JaNae

2009-01-01

We postulate that an orchestrated network composed of various vasodilatory systems participates in the systemic and local hemodynamic adaptations in pregnancy. The temporal patterns of increase in the circulating and urinary levels of five vasodilator factors/systems, prostacyclin, nitric oxide, kallikrein, angiotensin-(1–7) and VEGF, in normal pregnant women and animals, as well as the changes observed in preeclamptic pregnancies support their functional role in maintaining normotension by opposing the vasoconstrictor systems. In addition, the expression of these vasodilators in the different trophoblastic subtypes in various species supports their role in the transformation of the uterine arteries. Moreover, their expression in the fetal endothelium and in the syncytiotrophoblast in humans, rats and guinea-pigs, favour their participation in maintaining the uteroplacental circulation. The findings that sustain the functional associations of the various vasodilators, and their participation by endocrine, paracrine and autocrine regulation of the systemic and local vasoactive changes of pregnancy are abundant and compelling. However, further elucidation of the role of the various players is hampered by methodological problems. Among these difficulties is the complexity of the interactions between the different factors, the likelihood that experimental alterations induced in one system may be compensated by the other players of the network, and the possibility that data obtained by manipulating single factors in vitro or in animal studies may be difficult to translate to the human. In addition, the impossibility of sampling the uteroplacental interface along normal pregnancy precludes obtaining longitudinal profiles of the various players. Nevertheless, the possibility of improving maternal blood pressure regulation, trophoblast invasion and uteroplacental flow by enhancing vasodilation (e.g. L-arginine, NO donors, VEGF transfection) deserves unravelling the

Safety of Tenofovir Use During Pregnancy: Early Growth Outcomes in HIV-Exposed Uninfected Infants

PubMed Central

SIBERRY, George K.; WILLIAMS, Paige L.; MENDEZ, Hermann; SEAGE, George R.; JACOBSON, Denise L.; HAZRA, Rohan; RICH, Kenneth C.; GRINER, Raymond; TASSIOPOULOS, Katherine; KACANEK, Deborah; MOFENSON, Lynne M.; MILLER, Tracie; DiMEGLIO, Linda A.; WATTS, D. Heather

2012-01-01

Objective To evaluate the association of tenofovir disoproxil fumarate (TDF) use during pregnancy with early growth parameters in HIV-exposed, uninfected (HEU) infants. Design US-based prospective cohort study of HEU children to examine potential adverse effects of prenatal TDF exposure. Methods We evaluated the association of maternal TDF use during pregnancy with small for gestational age (SGA); low birth weight (LBW, <2.5kg); weight-for-age z-scores (WAZ), length-forage z-scores (LAZ) and head circumference-for-age (HCAZ) z-scores at newborn visit; and LAZ, HCAZ, and WAZ at age one year. Logistic regression models for LBW and SGA were fit, adjusting for maternal and sociodemographic factors. Adjusted linear regression models were used to evaluate LAZ, WAZ and HCAZ by TDF exposure. Results Of 2029 enrolled children with maternal antiretroviral information, TDF was used by 449 (21%) HIV-infected mothers, increasing from 14% in 2003 to 43% in 2010. There was no difference between those exposed to combination regimens with versus without TDF for SGA, LBW, and newborn LAZ and HCAZ. However, at age one year, infants exposed to combination regimens with TDF had significantly lower adjusted mean LAZ and HCAZ than those without TDF (LAZ: −0.17 vs. −0.03, p=0.04; HCAZ: 0.17 vs. 0.42, p=0.02). Conclusions TDF use during pregnancy was not associated with increased risk for LBW or SGA. The slightly lower mean LAZ and HCAZ observed at age one year in TDF-exposed infants are of uncertain significance but underscore the need for additional studies of growth outcomes after TDF use during pregnancy. PMID:22382151

Maternal TSH level and TPOAb status in early pregnancy and their relationship to the risk of gestational diabetes mellitus.

PubMed

Ying, Hao; Tang, Yu-Ping; Bao, Yi-Rong; Su, Xiu-Juan; Cai, XueYa; Li, Yu-Hong; Wang, De-Fen

2016-12-01

Subclinical hypothyroidism is common in pregnant women and often related to adverse pregnancy outcomes, but its relationship with gestational diabetes remains controversial. In particular, the impact of thyroperoxidase antibodies status on the relationship between subclinical hypothyroidism and gestational diabetes is not clear. We investigated the association between combined thyroid stimulating hormone (TSH) level and thyroperoxidase antibodies status in early pregnancy (<20 weeks of gestation) and gestational diabetes mellitus. A total of 7084 pregnant women met the inclusion criteria, which included thyroperoxidase antibodies-positive subclinical hypothyroidism [TSH(H)TPOAb(+)] (n = 78), thyroperoxidase antibodies-negative subclinical hypothyroidism [TSH(H)TPOAb(-)] (n = 281), thyroperoxidase antibodies-positive euthyroidism [TSH(N)TPOAb(+)] (n = 648), and thyroperoxidase antibodies-negative euthyroidism [TSH(N)TPOAb(-)] (n = 6077). Of the 7084 cases included in our study, 1141 cases were diagnosed with gestational diabetes mellitus at 24-28 weeks of pregnancy. The prevalence of gestational diabetes mellitus in TSH(N)TPOAb(-), TSH(H)TPOAb(-), TSH(N)TPOAb(+), and TSH(H)TPOAb(+) was 14.65, 19.57, 24.85, and 46.15 %, respectively. Compared with TSH(N)TPOAb(-) women, the risk of gestational diabetes mellitus was increased in all other groups of women in early pregnancy. After dividing early pregnancy into first and second trimesters, we found that TSH(H)TPOAb(-) women in the first trimester do not show this increase. Our study suggests that subclinical hypothyroidism and thyroperoxidase antibodies-positive euthyroidism in early pregnancy are associated with an increased risk of gestational diabetes mellitus.

Factors related to the continuation of employment during pregnancy among Japanese women.

PubMed

Matsuzaki, Masayo; Haruna, Megumi; Ota, Erika; Murayama, Ryoko; Murashima, Sachiyo

2011-12-01

To determine the relationship between the working situation (full-time housewife, stopped working during pregnancy, or currently employed) and the lifestyle factors, reasons for stopping work during pregnancy, and effects of working conditions in order to identify the factors that are related to the continuation of employment among pregnant Japanese women. In a cross-sectional study, a questionnaire was administered to pregnant women who visited an obstetrics clinic in a Tokyo suburb for an outpatient medical check-up during July and August 2004. The data of 530 healthy pregnant women were analyzed. The pregnant women who stopped working during their pregnancy had lower mental health scores than the full-time housewives and employed pregnant women. In each trimester, the employed pregnant women reported a shorter daytime sleep duration than the pregnant women who stopped working during their pregnancy and the full-time housewives. The reasons for stopping work during pregnancy were categorized as somatic symptoms due to pregnancy, working conditions, and a sense of values or social reasons. The employed women in the third trimester more often reported the availability of, and access to, a rest area in their company, compared to those in the first and second trimesters. The lifestyle factors of the pregnant women were different, based on their work situation. In particular, the employed pregnant women had a shorter daytime sleep duration. The pregnant women who stopped working during their pregnancy could have benefited from mental health support. In addition, the reasons for stopping work during pregnancy were different in the three trimesters. A flexible system is needed for working women that adapts to the physical changes that occur during pregnancy. © 2011 The Authors. Japan Journal of Nursing Science © 2011 Japan Academy of Nursing Science.

Adolescent pregnancy outcomes and risk factors in Malaysia.

PubMed

Omar, Khairani; Hasim, Suriati; Muhammad, Noor Azimah; Jaffar, Aida; Hashim, Syahnaz Mohd; Siraj, Harlina Halizah

2010-12-01

To assess the outcomes and risk factors of adolescent pregnancies in 2 major hospitals in Malaysia. We conducted a case-control study of pregnant girls aged 10 through 19 years. The controls were women aged 20 through 35 years who did not become pregnant in their adolescence. Cases and controls were matched for parity and place of delivery. Data were collected from questionnaires and the hospitals' medical records. The study included 102 cases and 102 controls. There were significant associations between adolescent pregnancy and low education level, low socioeconomic status, being raised by a single parent, not engaging in extracurricular school activities, engaging in unsupervised activities with peers after school, and substance abuse (P<0.05 for all); being anemic, being unsure of the expected delivery date, and having few antenatal visits and a late delivery booking; and low Apgar scores and perinatal complications. Adolescent pregnancies are high-risk pregnancies. Better sexual health strategies are required to address the associated complications. Copyright © 2010 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Hyperthyroidism in pregnancy.

PubMed

Mestman, Jorge H

2012-10-01

Successful outcome in pregnancy hyperthyroidism depends on the cause, interpretation of laboratory tests, and careful use of antithyroid drug (ATD) therapy. Planning of a pregnancy in a woman with active or past history of Graves' hyperthyroidism is mandatory in order to avoid complications. Fetal health may be affected by three factors: poor control of maternal hyperthyroidism, titer of maternal TRAb, and inappropriate use of ATD. Careful assessment of thyroid function through pregnancy and evaluation of fetal development by ultrasonography is the cornerstone for a successful outcome. In a subgroup of women previously treated with ablation therapy, those whose serum TSRAb titers remained elevated, are at risk of having a fetus/neonate with Graves' hyperthyroidism. Use of ATD during lactation is well tolerated, if recommended guidelines are followed. Women during their childbearing age with active Graves' hyperthyroidism should plan their pregnancy. Causes of hyperthyroidism in pregnancy include Graves' disease or autonomous adenoma, and transient gestational thyrotoxicosis as a consequence of excessive production of human chroionic gonadotropin by the placenta. Careful interpretation of thyroid function tests and frequent adjustment of ATD is of utmost importance in the outcome of pregnancy. Graves' hyperthyroidism may relapse early in pregnancy or at the end of the first year postpartum.

Successful Pregnancy in a Patient with Combined Deficiency of Factor V and Factor VIII.

PubMed

El Adib, Ahmed Ghassan; Majdi, Farah; Dilai, Mohamed Othmane; Asmouki, Hamid; Bassir, Ahlam; Harou, Karam; Soumani, Abderraouf; Younous, Said; Mahmal, Lahoucine

2014-01-01

Inherited combined factor V and factor VIII deficiency (F5F8D) is autosomal recessive transmission disorder. Epistaxis, postsurgical bleeding, and menorrhagia are the most common symptoms. The risk of miscarriage and placental abruption is consequent. We report a case of successful pregnancy in a patient with F5F8D. 20-year-old woman, born of consanguineous parents, third gestate, first parity, two miscarriages, admitted for child birth of a spontaneous pregnancy estimated at 38 weeks and was diagnosed with F5F8D. At admission, patient was hemodynamically stable, with good obstetric conditions. The biologic results showed low levels of PT (52%), factor V (7%), and factor VIII (5%), and the activated partial thromboplastin time was prolonged (68,6%). Parturient was admitted in intensive care unit, maternal and fetal monitoring was performed. Fresh frozen plasma (FFP) and factor VIII concentrates were perfused at the induction of labor. Analgesia used fentanyl titration. The delivery gave birth to a newborn male, with Apgar 10/10 and 3000 g. The puerperium was simple without any important bleeding. Laboratory tests for the newborn were acceptable. Little literature is available on this subject and there are no guidelines available concerning pregnancy; we chose to prescribe a combination of factor VIII concentrate and FFP in pre-, per- and postpartum. The same protocol was successfully used in a patient before dental extraction and prostatectomy. Vaginal delivery is possible, as our case. Management by multidisciplinary team is recommended.

[Obesity and cardiometabolic risk factors during pregnancy].

PubMed

Callegari, Sandra Beatriz Mangucci; de Resende, Elisabete Aparecida Mantovani Rodrigues; Barbosa Neto, Octávio; Rodrigues, Virmondes; de Oliveira, Eduardo Mangucci; Borges, Maria de Fátima

2014-10-01

To assess cardiometabolic risk factors during normal pregnancy and the influence of maternal obesity on them. This study included 25 healthy pregnant women with a single pregnancy and a gestational age of less than twenty weeks. Longitudinal analysis of blood pressure, body weight, body mass index (BMI), serum concentrations of leptin, adiponectin, cortisol, total cholesterol and fractions, triglycerides, uric acid, fasting glucose, oral glucose tolerance test, HOMA-IR and insulin/glucose ratio was performed each trimester during pregnancy. In order to evaluate the impact of obesity, pregnant women were divided into two groups based on BMI for the first quarter of pregnancy: Gpn for pregnant women with BMI<25 kg/m2 and Gso for BMI≥25 kg/m2. One-Way ANOVA for repeated measurements or Friedman test and Student-t or Mann-Whitney tests for statistical comparisons and Pearson correlations test were used for statistical analysis. The mean values for the first quarter of pregnancy for the following parameters were: age: 22 years; weight: 66.3 kg and BMI 26.4 kg/m2, with 20.2 and 30.7 kg/m2 for the Gpn and Gso groups, respectively. Mean weight gain during pregnancy was ±12.7 kg with 10.3 kg for the Gso group and 15.2 kg for the Gpn group. Regarding plasma determinations, cortisol, uric acid and lipid profile increased during all trimesters of pregnancy, except for HDL-cholesterol, which did not change. Blood pressure, insulin and HOMA-IR only increased in the third quarter of pregnancy. The Gso group tended to gain more weight and to show higher concentrations of leptin, total cholesterol, LDL-cholesterol, VLDL-cholesterol, TG, glucose, insulin, HOMA-IR, besides lower HDL-cholesterol and greater diastolic blood pressure in the 3rd quarter of pregnancy. Three pregnant women developed gestational hypertension, presented prepregnancy obesity, excessive weight gain, hyperleptinemia and an insulin/glucose ratio greater than two. Weight and BMI were positively correlated with

[Obesity and cardiometabolic risk factors during pregnancy.

PubMed

Callegari, Sandra Beatriz Mangucci; Resende, Elisabete Aparecida Mantovani Rodrigues de; Barbosa Neto, Octávio; Rodrigues Junior, Virmondes; Oliveira, Eduardo Mangucci de; Borges, Maria de Fátima

2014-10-03

To assess cardiometabolic risk factors during normal pregnancy and the influence of maternal obesity on them. This study included 25 healthy pregnant women with a single pregnancy and a gestational age of less than twenty weeks. Longitudinal analysis of blood pressure, body weight, body mass index (BMI), serum concentrations of leptin, adiponectin, cortisol, total cholesterol and fractions, triglycerides, uric acid, fasting glucose, oral glucose tolerance test, HOMA-IR and insulin/glucose ratio was performed each trimester during pregnancy. In order to evaluate the impact of obesity, pregnant women were divided into two groups based on BMI for the first quarter of pregnancy: Gpn for pregnant women with BMI<25 kg/m2 and Gso for BMI≥25 kg/m2. One-Way ANOVA for repeated measurements or Friedman test and Student-t or Mann-Whitney tests for statistical comparisons and Pearson correlations test were used for statistical analysis. The mean values for the first quarter of pregnancy for the following parameters were: age: 22 years; weight: 66.3 kg and BMI 26.4 kg/m2, with 20.2 and 30.7 kg/m2 for the Gpn and Gso groups, respectively. Mean weight gain during pregnancy was ±12.7 kg with 10.3 kg for the Gso group and 15.2 kg for the Gpn group. Regarding plasma determinations, cortisol, uric acid and lipid profile increased during all trimesters of pregnancy, except for HDL-cholesterol, which did not change. Blood pressure, insulin and HOMA-IR only increased in the third quarter of pregnancy. The Gso group tended to gain more weight and to show higher concentrations of leptin, total cholesterol, LDL-cholesterol, VLDL-cholesterol, TG, glucose, insulin, HOMA-IR, besides lower HDL-cholesterol and greater diastolic blood pressure in the 3rd quarter of pregnancy. Three pregnant women developed gestational hypertension, presented prepregnancy obesity, excessive weight gain, hyperleptinemia and an insulin/glucose ratio greater than two. Weight and BMI were positively correlated with

Measurement of the uterus and gestation sac by ultrasound in early normal and abnormal pregnancy.

PubMed

Chandra, M; Evans, L J; Duff, G B

1981-01-14

Uterine volumes measured by two different ultrasonic methods, and gestation sac volumes in early normal pregnancy are reported. The results obtained for uterine volume measurements are compared. Methods using measurements obtained from only a longitudinal scan were simpler but slightly less accurate. Uterine volumes were also calculated in a series of patients with pregnancy complicated by threatened abortion. The accuracy of the prediction of the outcome of the pregnancy, based solely on uterine volume was 71 percent. Uterine volume measurement is most useful in identifying cases of missed abortion where the period of gestation is known.

Paternal factor V Leiden and recurrent pregnancy loss: a new concept behind fetal genetics?

PubMed

Udry, S; Aranda, F M; Latino, J O; de Larrañaga, G F

2014-05-01

In up to 50% of couples affected by recurrent pregnancy loss, no identifiable cause is established. Fetal and maternal factors may be equally important in the establishment and maintenance of the placental/maternal arteriovenous anastomoses. Therefore,the inheritance of thrombophilia-related genes may be an important factor in the pathophysiology of recurrent pregnancy loss. Most of the research on recurrent pregnancy loss and thrombophilia has focused on maternal factors, but little is known about the paternal contribution. On that basis, we studied the association between inherited paternal thrombophilias and recurrent pregnancy loss in a narrowly selective group of 42 Argentine males from couples that presented without any known risk factors for recurrent pregnancy loss. The genotypic distributions of factor (F) V Leiden and prothrombin G20210A among cases were compared with those from a reference group composed of 200 Argentine men. We found a significant difference in the distribution of FV Leiden between both groups (16.7% vs. 3.0%), but no difference was found in the distribution of prothrombin G20210A (2.4% vs.2.0%). Those couples with paternal FV Leiden carriage would be six times more likely to experience recurrent pregnancy loss despite no other apparent cause (OR = 6.47; 95% CI, 2.06–20.39). We found evidence of an association between the paternal carriage of FV Leiden and the predisposition to recurrent pregnancy loss, thereby supporting the hypothesis that genetic contributions from both parents are essential factors in the development of this obstetric disorder.

Fetal bilateral renal agenesis, phocomelia, and single umbilical artery associated with cocaine abuse in early pregnancy.

PubMed

Kashiwagi, Maki; Chaoui, Rabih; Stallmach, Thomas; Hürlimann, Sandra; Lauper, Urs; Hebisch, Gundula

2003-11-01

Maternal cocaine abuse in pregnancy is associated with complications such as intrauterine growth retardation, abruptio placentae, and preterm delivery. We report what is, to our knowledge, the first published observation of fetal bilateral renal agenesis associated with a vascular disruption syndrome comprising upper limb reduction defect and a single umbilical artery following maternal cocaine abuse in early pregnancy. This constellation in a fetus aborted at 18 weeks extends the spectrum of complications possibly associated with cocaine abuse in pregnancy. Copyright 2003 Wiley-Liss, Inc.

Characteristics related to early secondary amenorrhoea and pregnancy among women diagnosed with systemic lupus erythematosus: an analysis using the GOAL study.

PubMed

Knight, Jessica H; Howards, Penelope P; Spencer, Jessica B; Tsagaris, Katina C; Lim, Sam S

2016-01-01

Systemic lupus erythematosus (SLE) disproportionately affects women and often develops during their reproductive years. Research suggests that some women who receive cyclophosphamide as treatment for SLE experience earlier decline in menstrual function, but reproductive health among women with SLE who have not taken this drug is less well understood. This study aims to better understand the relation between SLE and reproduction by assessing early secondary amenorrhoea and pregnancy in women treated with and without cyclophosphamide from a population-based cohort with large numbers of African-Americans. Female patients with SLE, ages 20-40 at time of diagnosis, who were 40 years or older at the time of the survey were included in this analysis (N=147). Participants in the Georgians Organized Against Lupus (GOAL) study were asked about their reproductive histories including early secondary amenorrhoea, defined as loss of menstruation before age 40. Women who were cyclophosphamide naïve had an increased prevalence of early secondary amenorrhoea compared with population estimates, 13-17% compared with 1-5%. Factors associated with early secondary amenorrhoea in women not treated with cyclophosphamide were marital status and receipt of a kidney transplant. Treatment with cyclophosphamide doubled the prevalence after adjustment for patient characteristics. Over 88% of women reported being pregnant at least once, and about 83% of these had a child, but the majority of pregnancies occurred before diagnosis. SLE diagnosed in early adulthood may affect women's reproductive health even if they are not treated with cyclophosphamide. Better understanding of other factors related to reproductive health in this population will improve clinicians' and patients' abilities to make treatment and family planning decisions.

Characteristics related to early secondary amenorrhoea and pregnancy among women diagnosed with systemic lupus erythematosus: an analysis using the GOAL study

PubMed Central

Knight, Jessica H; Howards, Penelope P; Spencer, Jessica B; Tsagaris, Katina C; Lim, Sam S

2016-01-01

Objective Systemic lupus erythematosus (SLE) disproportionately affects women and often develops during their reproductive years. Research suggests that some women who receive cyclophosphamide as treatment for SLE experience earlier decline in menstrual function, but reproductive health among women with SLE who have not taken this drug is less well understood. This study aims to better understand the relation between SLE and reproduction by assessing early secondary amenorrhoea and pregnancy in women treated with and without cyclophosphamide from a population-based cohort with large numbers of African-Americans. Methods Female patients with SLE, ages 20–40 at time of diagnosis, who were 40 years or older at the time of the survey were included in this analysis (N=147). Participants in the Georgians Organized Against Lupus (GOAL) study were asked about their reproductive histories including early secondary amenorrhoea, defined as loss of menstruation before age 40. Results Women who were cyclophosphamide naïve had an increased prevalence of early secondary amenorrhoea compared with population estimates, 13–17% compared with 1–5%. Factors associated with early secondary amenorrhoea in women not treated with cyclophosphamide were marital status and receipt of a kidney transplant. Treatment with cyclophosphamide doubled the prevalence after adjustment for patient characteristics. Over 88% of women reported being pregnant at least once, and about 83% of these had a child, but the majority of pregnancies occurred before diagnosis. Conclusions SLE diagnosed in early adulthood may affect women's reproductive health even if they are not treated with cyclophosphamide. Better understanding of other factors related to reproductive health in this population will improve clinicians' and patients' abilities to make treatment and family planning decisions. PMID:27752335

Diverse functions of HBEGF during pregnancy.

PubMed

Jessmon, Philip; Leach, Richard E; Armant, D Randall

2009-12-01

The establishment of pregnancy requires an intimate physical interaction and a molecular dialogue between the conceptus and the maternal reproductive tract that commences at implantation and continues until the placenta is formed and fully functional. Failure of the regulatory processes that ensure the fidelity of this relationship can precipitate a catastrophic pregnancy loss. One of the earliest identified molecular mediators of blastocyst implantation is heparin-binding epidermal growth factor (EGF)-like growth factor (HBEGF), which signals between the endometrium and implanting trophoblast cells to synchronize their corresponding developmental programs. HBEGF expression by trophoblast cells of the developing placenta appears to regulate extravillous differentiation and provide cytoprotection in a sometimes-hostile environment. This versatile member of the EGF signaling system will be examined in light of its associations with key events during early pregnancy.

Prevalence of unintended pregnancy and its associated factors among sexually active never-married youth in Shanghai.

PubMed

He, Huan; Blum, Robert W

2013-11-01

This study was conducted to determine the prevalence and the associated factors for unintended pregnancy among never-married sexually active youth (15-24 years old) in Shanghai. Using a probability sample (n = 765, including 502 males and 263 females) from 2006, we estimated prevalence of unintended pregnancy involvement for females and males by demographic factors and its associations with contextual and behavioural factors, guided by a social-ecological framework. Weighted proportion analyses estimated that 13.8% of females and 17.7% of males had been involved in an unintended pregnancy, and 99.0% and 90.5% of such pregnancies were reported to have ended in abortion by females and males, respectively. Controlling for sexual behaviour factors and residence history, multivariate hazard analyses with Weibull functions found increased hazard among older female youth (19-21 vs. 15-18 years old) but decreased hazard among older male youth (15-18 vs. 19-21/22-24 years old) as compared with the younger groups. Parallel analyses of unintended pregnancy's associations with contextual factors by sex also suggested that female unintended pregnancy involvement was more likely to be associated with family factors (family living arrangements and maternal education), while unintended pregnancy involvement among males was only associated with school factors (school climate and sex education on pregnancy) and perceived neighbourhood contraceptive services access. Sexually active and never-married youth are at considerable risk of unintended pregnancy and abortion in Shanghai. Age- and sex-specific strategies will be needed if China is going to be successful in addressing unintended pregnancy. © 2013 The Authors. Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians).