Preferences of women for web-based nutritional information in pregnancy

OBJECTIVES

During pregnancy, women are increasingly turning to web-based resources for information. This study examined the use of web-based nutritional information by women during pregnancy and explored their preferences.

STUDY DESIGN

Cross-sectional observational study.

METHODS

Women were enrolled at their convenience from a large maternity hospital. Clinical and sociodemographic details were collected and women's use of web-based resources was assessed using a detailed questionnaire.

RESULTS

Of the 101 women, 41.6% were nulliparous and the mean age was 33.1 years (19-47 years). All women had internet access and only 3% did not own a smartphone. Women derived pregnancy-related nutritional information from a range of online resources, most commonly: What to Expect When You're Expecting (15.1%), Babycenter (12.9%), and Eumom (9.7%). However, 24.7% reported using Google searches. There was minimal use of publically funded or academically supported resources. The features women wanted in a web-based application were recipes (88%), exercise advice (71%), personalized dietary feedback (37%), social features (35%), videos (24%) and cooking demonstrations (23%).

CONCLUSIONS

This survey highlights the risk that pregnant women may get nutritional information from online resources which are not evidence-based. It also identifies features that women want from a web-based nutritional resource.

Perinatal characteristics and obstetric complications in mothers with multiple sclerosis: Record-linkage study

BACKGROUND

Multiple sclerosis (MS) predominantly onsets in women of reproductive age. The possibility of adverse obstetric and perinatal outcomes is a likely source of concern to pregnant women with MS and their clinicians. We aimed to compare the characteristics of the pregnancies of mothers with or without MS.

METHODS

The historical Oxford Record Linkage Study specialised maternity dataset (850,000 people, 1970-1989), with record-linkage between mother and baby, was analysed. The dataset was linked to any prior recorded day-case or inpatient hospital admission episodes back to 1963. The file of mothers' records was searched for a record of MS in either the maternity admission or in a previous admission. The pregnancies and babies of mothers with MS were compared with those of mothers without MS.

RESULTS

There were 181 pregnancies and babies born to 98 mothers with MS. These were compared with 244,573 pregnancies and babies of 124,830 mothers without MS. There was a significant social class gradient with a higher than expected number of cases of MS in the least deprived social classes. Mothers with MS tended to be lighter than other mothers. There were no significant associations between MS and mothers' marital status, history of smoking during the pregnancy, parity, pre-eclampsia, ABO blood group or rhesus group. There were no significant associations with babies' birth weight, and no significant associations with gestational age, being small for gestational age, Caesarian delivery, or forceps delivery. There were no stillbirths, no neonatal deaths, and no postneonatal deaths in the babies born to mothers with MS.

CONCLUSIONS

We hope that our findings will add to the available literature in addressing the understandable anxieties of young women with MS, and reassure them that the characteristics of their pregnancies are generally normal.

Provider adherence to first antenatal care guidelines and risk of pregnancy complications in public sector facilities: a Ghanaian cohort study

BACKGROUND

Guideline utilization aims at improvement in quality of care and better health outcomes. The objective of the current study was to determine the effect of provider complete adherence to the first antenatal care guidelines on the risk of maternal and neonatal complications in a low resource setting.

METHODS

Women delivering in 11 health facilities in the Greater Accra region of Ghana were recruited into a cohort study. Their first antenatal visit records were reviewed to assess providers' adherence to the guidelines, using a thirteen-point checklist. Information on their socio-demographic characteristics and previous pregnancy history was collected. Participants were followed up for 6 weeks post-partum to complete data collection on outcomes. The incidence of maternal and neonatal complications was estimated. The effects of complete adherence on risk of maternal and neonatal complications were estimated and expressed as relative risks (RRs) with their 95% confidence intervals (CI) adjusted for a potential clustering effect of health facilities.

RESULTS

Overall, 926 women were followed up to 6 weeks post-partum. Mean age (SD) of participants was 28.2 (5.4) years. Complete adherence to guidelines pertained to the care of 48.5% of women. Incidence of preterm deliveries, low birth weight, stillbirths and neonatal mortality were 5.3, 6.1, 0.4 and 1.4% respectively. Complete adherence to the guidelines decreased risk of any neonatal complication [0.72 (0.65-0.93); p = 0.01] and delivery complication [0.66 (0.44-0.99), p = 0.04].

CONCLUSION

Complete provider adherence to antenatal care guidelines at first antenatal visit influences delivery and neonatal outcomes. While there is the need to explore and understand explanatory mechanisms for these observations, programs that promote complete adherence to guidelines will improve the pregnancy outcomes.

Comparative phenotypic transcriptional characterization of human full-term placenta-derived mesenchymal stromal cells compared to bone marrow-derived mesenchymal stromal cells after differentiation in myogenic medium

Placenta-derived mesenchymal stromal cells (pMSCs) are a very attractive source of MSCs. In this short report we evaluated the expression of phenotypic markers from fetal and maternal pMSCs after exposure to myogenic medium commonly used to differentiate bone marrow MSCs (bmMSCs) to smooth muscle-like cells (SMCs). In order to reveal differences between these different MSC sources, cells were expanded and differentiated to elucidate whether this differentiation protocol facilitated efficient differentiation of SMCs from human pMSCs. We report that TGF-β1, PDGF and ascorbic acid is not sufficient to produce SMCs from pMSCs.

Evaluation and Management of Maternal Cardiac Arrhythmias

Pregnant women often complain of palpitations. The differential diagnosis for new-onset palpitations in pregnancy ranges from benign conditions to life-threatening arrhythmias. Maternal arrhythmias can occur in isolation or in the setting of underlying structural heart disease. Optimal management of maternal cardiac arrhythmias includes identification of the specific arrhythmia, diagnosis of comorbid conditions, and appropriate intervention. In general, management of maternal cardiac arrhythmias is similar to that of the general population. Special consideration must be given as to the effects of medications and procedures on both the mother and fetus to optimize outcomes. The importance of multidisciplinary care with cardiology, obstetrics, and anesthesia is emphasized.

Fetal MRI: incidental findings in the mother

BACKGROUND

Fetal magnetic resonance imaging (MRI) is a routinely used tool in prenatal diagnosis; however, there is a lack of studies evaluating incidental findings observed in the mother.

OBJECTIVE

This study describes and quantifies incidental findings observed in the mother during fetal MRI.

MATERIALS AND METHODS

We reviewed all fetal MRI studies at the University of Minnesota Medical Center from February 2008 to September 2014. Two pediatric radiologists retrospectively conducted a consensus evaluation. The maternal findings were categorized into neurologic, gynecologic, urinary, gastrointestinal and musculoskeletal. Hydronephrosis consistent with the stage of pregnancy was recorded but was not included as an abnormal finding. Abnormal findings were classified into three groups, depending on their clinical significance: level I (low), level II (medium) and level III (high).

RESULTS

We evaluated 332 pregnant patients with a mean age of 29.3 years and a mean gestational age of 29 weeks. Of these, 55.4% had at least 1 incidental finding, for a total of 262 incidental maternal findings. Of the 262 abnormalities, 113 (43.1%) were neurologic, 69 were gynecologic (26.3%), 36 (13.7%) urinary, 24 (9.2%) gastrointestinal and 20 (7.6%) musculoskeletal. Of the 262 incidental findings, 237 (90.5%) were level I, 24 (9.2%) were level II and 1 (0.4%) was level III.

CONCLUSION

Our results suggest that although the vast majority of incidental maternal findings are benign, more significant findings are still encountered and should be expected.

Maternal early pregnancy lipid profile and offspring's lipids and glycaemic control at age 5-6 years: The ABCD study

BACKGROUND & AIMS

Maternal early pregnancy lipid profile might influence offspring's lipids and glycaemic control, through an increased offspring's fat percentage. This explorative study investigates whether maternal early pregnancy lipid profile is associated with offspring's lipids and glycaemic control independently of offspring's fat percentage and if these associations are mediated by offspring's fat percentage. Possible sex differences in these associations are also examined.

METHODS

1133 mother-child pairs of the prospective ABCD-study were included. Maternal non-fasting lipids were collected in early pregnancy: triglycerides, total cholesterol (TC), Apolipoprotein A1 (ApoA1), Apolipoprotein B (ApoB) and free fatty acids (FFA). Fasting triglycerides, TC, high density lipoprotein (HDL), low density lipoprotein (LDL), glucose and C-peptide were assessed in offspring aged 5-6 years and HOMA2-IR was calculated.

RESULTS

After adjustment for covariates, strongest associations were found between maternal TC and offspring's TC (boys β(95%CI) = 0.141 (0.074-0.207); girls β(95%CI) = 0.268 (0.200; 0.336)) and LDL (boys β(95%CI) = 0.114 (0.052; 0.176); girls β(95%CI) = 0.247 (0.181-0.312)), maternal ApoB and offspring's TC (boys β(95%CI) = 0.638 (0.311-0.965); girls β(95%CI) = 1.121 (0.766-1.475)) and LDL (boys β(95%CI) = 0.699 (0.393-1.005); girls β(95%CI) = 1.198 (0.868-1.529)), and maternal ApoA1 and offspring's HDL (only boys β(95%CI) = 0.221 (0.101-0.341)). No significant association was found between maternal lipids and offspring's glycaemic control, and offspring's fat percentage played no mediating role.

CONCLUSIONS

Maternal early pregnancy lipid profile is associated with offspring's lipid profile in childhood, with overall stronger associations in girls. This study provides further evidence that lowering lipid levels during pregnancy might be beneficial for the long term health of the offspring.

Pre-natal exposures and breast tissue composition: findings from a British pre-birth cohort of young women and a systematic review

BACKGROUND

Breast density, the amount of fibroglandular tissue in the adult breast for a women's age and body mass index, is a strong biomarker of susceptibility to breast cancer, which may, like breast cancer risk itself, be influenced by events early in life. In the present study, we investigated the association between pre-natal exposures and breast tissue composition.

METHODS

A sample of 500 young, nulliparous women (aged approximately 21 years) from a U.K. pre-birth cohort underwent a magnetic resonance imaging examination of their breasts to estimate percent water, a measure of the relative amount of fibroglandular tissue equivalent to mammographic percent density. Information on pre-natal exposures was collected throughout the mothers' pregnancy and shortly after delivery. Regression models were used to investigate associations between percent water and pre-natal exposures. Mediation analysis, and a systematic review and meta-analysis of the published literature, were also conducted.

RESULTS

Adjusted percent water in young women was positively associated with maternal height (p for linear trend [p t] = 0.005), maternal mammographic density in middle age (p t = 0.018) and the participant's birth size (p t < 0.001 for birthweight). A 1-SD increment in weight (473 g), length (2.3 cm), head circumference (1.2 cm) and Ponderal Index (4.1 g/cm3) at birth were associated with 3 % (95 % CI 2-5 %), 2 % (95 % CI 0-3 %), 3 % (95 % CI 1-4 %) and 1 % (95 % CI 0-3 %), respectively, increases in mean adjusted percent water. The effect of maternal height on the participants' percent water was partly mediated through birth size, but there was little evidence that the effect of birthweight was primarily mediated via adult body size. The meta-analysis supported the study findings, with breast density being positively associated with birth size.

CONCLUSIONS

These findings provide strong evidence of pre-natal influences on breast tissue composition. The positive association between birth size and relative amount of fibroglandular tissue indicates that breast density and breast cancer risk may share a common pre-natal origin.

Lower maternal serum 25(OH) D in first trimester associated with higher autism risk in Chinese offspring

OBJECTIVE

The aim of this study was to examine the association between maternal serum vitamin D status in first trimester and risk of ASD at age 3-7years in the offspring.

METHODS

Using a case-control design, 68 children diagnosed with ASD and 68 sex and age matched typically-developing children were included. Archived maternal blood samples from the first trimester of pregnancy (11-13weeks gestational age) were identified for those participants. Maternal serum levels of 25 hydroxyvitamin D3 [25(OH) D], unmetabolized folic acid (FA), vitamin B12, homocysteine (HCY) and High Sensitivity C Reactive protein (CRP) were measured from those samples. We examined the associations between those factors in pregnancy and diagnosis of ASD with logistic regression using SPSS.

RESULTS

Mothers in autistic group had significantly lower maternal serum levels of 25(OH) D than in typically-developing group [19.2(IQR: 15.8-22.9)ng/ml vs. 24.3(19.3-27.3)ng/ml, P<0.001], with 55.9% and 29.4% being vitamin D deficient, respectively (P<0.001). Levels of 25(OH) D increased with decreasing severity of ASD as defined by the CARS score (r=-0.302, P<0.001). Maternal first trimester serum levels of 25(OH) D in the lower 3 quartiles (quartile 1, 2, 3) (compared to the highest quartile) was associated with increased odds of ASD diagnosis in offspring [OR (95% CI) Q1: 1.36(0.84-2.58, P=0.25); Q2: 2.68(1.44-4.29, P=0.006); Q3:3.99(2.58-7.12, P<0.001)].

CONCLUSIONS

Lower first trimester maternal serum levels of 25(OH) D were associated with increased risk of developing autism in offspring. If these findings are confirmed, this may present an opportunity for prenatal intervention to reduce the risk for ASD.

Effects of Elevated In Ovo Selenium Exposure on Late Stage Development of Xenopus laevis Tadpoles

The effects of elevated in ovo selenium (Se) exposure on late stage larval Xenopus laevis development were investigated. Adult females were fed diets augmented with selenomethionine for 68 days and bred with untreated males to obtain embryos with measured concentrations of 1.6 (control), 10.8, 28.1 and 81.7 μg Se/g dry mass. Embryos were reared under uncontaminated conditions until 50 % of individuals within an aquarium had completed metamorphosis. The highest in ovo Se exposure group exhibited greater froglet body mass and snout to vent length while having a higher proportion of tadpoles at earlier stages of development. No differences were detected among treatment groups for mortality or metamorphic timing during the rearing period. This research suggests that in ovo Se exposure has minimal effect on the survival and development of late stage larval X. laevis in a controlled laboratory environment with adequate food availability.

Setting the global health agenda: The influence of advocates and ideas on political priority for maternal and newborn survival

This study investigates a puzzle concerning global health priorities-why do comparable issues receive differential levels of attention and resources? It considers maternal and neonatal mortality, two high-burden issues that pertain to groups at risk at birth and whose lives could be saved with effective intrapartum care. Why did maternal survival gain status as a global health priority earlier and to a greater degree than newborn survival? Higher mortality and morbidity burdens among newborns and the cost-effectiveness of interventions would seem to predict that issue's earlier and higher prioritization. Yet maternal survival emerged as a priority two decades earlier and had attracted considerably more attention and resources by the close of the Millennium Development Goals era. This study uses replicative process-tracing case studies to examine the emergence and growth of political priority for these two issues, probing reasons for unexpected variance. The study finds that maternal survival's grounding as a social justice issue spurred growth of a strong and diverse advocacy network and aligned the issue with powerful international norms (e.g. expectations to advance women's rights and the Millennium Development Goals), drawing attention and resources to the issue over three decades. Newborn survival's disadvantage stems from its long status as an issue falling under the umbrellas of maternal and child survival but not fully adopted by these networks, and with limited appeal as a public health issue advanced by a small and technically focused network; network expansion and alignment with child survival norms have improved the issue's status in the past few years.

Coverage and inequalities in maternal and child health interventions in Afghanistan

Background

Afghanistan has made considerable gains in improving maternal and child health and survival since 2001. However, socioeconomic and regional inequities may pose a threat to reaching universal coverage of health interventions and further health progress. We explored coverage and socioeconomic inequalities in key life-saving reproductive, maternal, newborn and child health (RMNCH) interventions at the national level and by region in Afghanistan. We also assessed gains in child survival through scaling up effective community-based interventions across wealth groups.

Methods

Using data from the Afghanistan Multiple Indicator Cluster Survey (MICS) 2010/11, we explored 11 interventions that spanned all stages of the continuum of care, including indicators of composite coverage. Asset-based wealth quintiles were constructed using standardised methods, and absolute inequalities were explored using wealth quintile (Q) gaps (Q5-Q1) and the slope index of inequality (SII), while relative inequalities were assessed with ratios (Q5/Q1) and the concentration index (CIX). The lives saved tool (LiST) modeling used to estimate neonatal and post-neonatal deaths averted from scaling up essential community-based interventions by 90 % coverage by 2025. Analyses considered the survey design characteristics and were conducted via STATA version 12.0 and SAS version 9.4.

Results

Our results underscore significant pro-rich socioeconomic absolute and relative inequalities, and mass population deprivation across most all RMNCH interventions studied. The most inequitable are antenatal care with a skilled attendant (ANCS), skilled birth attendance (SBA), and 4 or more antenatal care visits (ANC4) where the richest have between 3.0 and 5.6 times higher coverage relative to the poor, and Q5-Q1 gaps range from 32 % - 65 %. Treatment of sick children and breastfeeding interventions are the most equitably distributed. Across regions, inequalities were highest in the more urbanised East, West and Central regions of the country, while they were lowest in the South and Southeast. About 7700 newborns and 26,000 post-neonates could be saved by scaling up coverage of community outreach interventions to 90 %, with the most gains in the poorest quintiles.

Conclusions

Afghanistan is a pervasively poor and conflict-prone nation that has only recently experienced a decade of relative stability. Though donor investments during this period have been plentiful and have contributed to rebuilding of health infrastructure in the country, glaring inequities remain. A resolution to scaling up health coverage in insecure and isolated regions, and improving accessibility for the poorest and marginalised populations, should be at the forefront of national policy and programming efforts.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3406-1) contains supplementary material, which is available to authorized users.

An assessment of maternal, newborn and child health implementation studies in Nigeria: implications for evidence informed policymaking and practice

BACKGROUND

The introduction of implementation science into maternal, newborn and child health (MNCH) research has facilitated better methods to improve uptake of research findings into practices. With increase in implementation research related to MNCH world-wide, stronger scientific evidence are now available and have improved MNCH policies in many countries including Nigeria. The purpose of this study was to review MNCH implementation studies undertaken in Nigeria in order to understand the extent the evidence generated informed better policy.

METHODS

This study was a systematic review. A MEDLINE Entrez PubMed search was performed in August 2015 and implementation studies that investigated MNCH in Nigeria from 1966 to 2015 in relation to health policy were sought. Search key words included Nigeria, health policy, maternal, newborn, and child health. Only policy relevant studies that were implementation or intervention research which generated evidence to improve MNCH in Nigeria were eligible and were selected.

RESULTS

A total of 18 relevant studies that fulfilled the study inclusion criteria were identified out of 471 studies found. These studies generated high quality policy relevance evidence relating to task shifting, breastfeeding practices, maternal nutrition, childhood immunization, kangaroo mother care (KMC), prevention of maternal to child transmission of HIV, etc. These indicated significant improvements in maternal health outcomes in localities and health facilities where the studies were undertaken.

CONCLUSION

There is a dire need for more implementation research related to MNCH in low income settings because the priority for improved MNCH outcome is not so much the development of new technologies but solving implementation issues, such as how to scale up and evaluate interventions within complex health systems.

Effects of Chronic Dietary Selenomethionine Exposure on the Visual System of Adult and F1 Generation Zebrafish (Danio rerio)

The effects of chronic dietary selenomethionine (SeMet) exposure on the visual system of adult zebrafish and their progeny were investigated. Adult zebrafish were exposed to measured concentrations of 1.1 (control) and 10.3 µg Se/g dry mass as SeMet for 57 days, then encouraged to breed. Progeny were reared to swim-up and differences in mortality, eye size and visual behaviour were determined. Adult vision was also investigated using behavioural assays. Adults fed the SeMet-spiked diet exhibited significantly fewer positive reactions in the escape response assay when compared to controls. Larvae from adults fed elevated SeMet had smaller eyes and a lower proportion of positive responses in phototaxis, oculomotor and optokinetic response assays compared to controls. These results demonstrate that environmentally relevant elevated dietary SeMet exposure can affect the visual system of both exposed adult zebrafish and their progeny, which could affect fitness and survivability.

The influence of maternal self-objectification, materialism and parenting style on potentially sexualized 'grown up' behaviours and appearance concerns in 5-8year old girls

There is widespread concern about young girls displaying 'grown up' or sexualized behaviours, as well as experiencing body image and appearance concerns that were previously thought to only impact much older girls. The present study examined the influence of three maternal attributes, self-objectification, materialism and parenting style, on sexualized behaviours and appearance concerns in young girls. A sample of 252 Australian mothers of 5-8year old girls reported on the behaviours and appearance concerns observed in their daughters and also completed measures of their own self-objectification, materialism and parenting style. It was found that a significant proportion of young girls were engaging with 'teen' culture, using beauty products and expressing some degree of appearance concern. Maternal self-objectification was related to daughters' engagement in teen culture, use of beauty products and appearance concern. Maternal materialism was related to girls' engagement in teen culture and appearance concern, while an authoritative parenting style was negatively related to girls' use of beauty products. The findings suggest that maternal self-objectification and materialism play a role in the body image and appearance concerns of young girls, and in so doing, identify these maternal attributes as novel potential targets for intervention.

Maternal and birth risk factors for children screening positive for autism spectrum disorders on M-CHAT-R

This study was carried out to screen children aged 16-30 months, attending pediatric outpatient department of JIPMER, Puducherry, during June to August 2014, for ASD using modified checklist for autism in toddlers-revised (MCHAT-R) and to find association between maternal, birth and postnatal risk factors with risk of ASD. A total of 350 mother-child pairs with children aged between 16 and 30 months were recruited. M-CHAT-R was administered to all mothers to screen for ASD along with risk checklist. Based on screen result children were classified as ASD (high risk) and no ASD (low and medium risk) group. The association between risk factors and screen positivity for ASD was studied using odds ratio. According to our study, 33 (9.4%) screened positive for ASD. Mean age was 21 months. High mean paternal age at birth (P value 0.025), need for resuscitation at birth (OR 3.4, 95% CI 1.47-8.10), NICU stay >12h (OR 4.7, 95% CI 2.26-9.94), late initiation of breastfeeding (OR 3.9, 95% CI 1.83-8.39), neonatal seizures (OR 11.8, 95% CI 5.38-26.25) were associated with screen positivity for ASD. After adjusting for confounding, neonatal seizures, and maternal concern about child development were associated with increased odds of screening positive for ASD whereas exclusive breast feeding in the first 6 months of life is associated with decreased odds. Screening for ASD in children with above risk factors might help in early initiation of remedial interventions.

Temple syndrome: A patient with maternal hetero-UPD14, mixed iso- and hetero-disomy detected by SNP microarray typing of patient-father duos

Temple syndrome (TS, MIM 616222) is an imprinting disorder involving genes within the imprinted region of chromosome 14q32. TS is a genetically complex disorder, which is associated with maternal uniparental disomy of chromosome 14 (UPD14), paternal deletions on chromosome 14, or loss of methylation at the intergenic differentially methylated region (IG-DMR). Here, we describe the case of a patient with maternal hetero-UPD14, mixed iso-/hetero-disomy mechanism identified by a single nucleotide polymorphism (SNP) array analysis of patient-father duos study. The phenotype of our case is similarities to Prader-Willi syndrome (PWS) during infancy and to Russell-Silver syndrome (RSS) during childhood. This SNP array appears to be an effective initial screening tool for patients with nonspecific clinical features suggestive of chromosomal disorders.

Maternal risk exposure during pregnancy and infant birth weight

BACKGROUND

Birth weight is an important determinant of an infant's immediate and future health.

AIM

This study examined associations between selected maternal psychosocial and environmental risk factors during pregnancy and subsequent infant birth weight, utilising data from the South African Birth to Twenty Plus (Bt20+) birth cohort study.

SUBJECTS

Exposure to nine maternal risks were assessed in 1228 women who completed an antenatal questionnaire and whose infants were delivered within a seven-week period.

OUTCOME MEASURES

The outcome of interest was infant birth weight. Birth weight z-scores (BWZ) were calculated using the World Health Organization Child Growth Standards. Bivariate analyses and multiple regression models were used to identify significant risk factors.

RESULTS

The mean infant birth weight was 3139g (SD 486g), with a significant advantage in mean birth weight for male infants of 73g (p=0.008). Being unsure or not wanting the pregnancy was associated with a ~156g reduction in infant birth weight (β=-0.32; 95% CI -0.51; -0.14). Tobacco use during pregnancy was also negatively associated with BWZ (β=-0.32; 95% CI -0.59; -0.05). Exposure to both significant risk factors (tobacco use and pregnancy wantedness) was associated with cumulative reductions in birth weight, particularly among boys.

CONCLUSIONS

This study reinforces the importance of risks related to maternal attitudes and behaviours during pregnancy, namely unwanted pregnancy and tobacco use, which significantly lowered birth weight. Both identified risks are amenable to public health policy and programme intervention.

Obstetric and Perinatal Morbidity in Northern Tasmanian Aboriginal Population: A Retrospective Cohort Study

INTRODUCTION

Aboriginal and Torres Strait Islander women are at increased risk of maternal morbidity and mortality as compared to non-Aboriginals. Similarly, aboriginal babies are at increased risk of low birth weight and infant mortality.

AIM

To investigate the independent association of aboriginality with Tasmanian maternal and neonatal morbidity.

MATERIALS AND METHODS

A retrospective analysis of all the births (gestation more than 20 weeks) from June 2013 to May 2014 was conducted at the Launceston General Hospital, Tasmania. The study compared 66 Aboriginal (4.2% of the total births) to 1477 non-aboriginal births for maternal and neonatal morbidity. Comparisons were made using logistic regression. The outcome measures were maternal and neonatal morbidity.

RESULTS

Significantly higher number of aboriginal women (49% vs 19%; OR 4.15 90%CI 2.52- 6.85) smoked and used illicit drugs (15% vs 2%; OR 9.24; 95%CI 4.28-19.96) than the non-aboriginal women (both p<0.001). Maternal morbidity was not significantly different between aboriginal compared to non-aboriginal women (OR 0.64; 95%CI 0.36-1.14; p=0.13; adjusted OR 1.00; 95%CI 0.52-1.93; p=0.99). Factors positively associated with maternal morbidity included: age (OR 1.28; 95%CI 1.13-1.46; p<0.01) and BMI (OR 1.50; 95%CI 1.33-1.70; p<0.01). The unadjusted OR of neonatal morbidity for aboriginality was 1.98 (95%CI 1.17-3.34; p=0.01) and adjusted was 1.45 (95%CI 0.77-2.72; p=0.25). Factors positively associated with neonatal morbidity included smoking (OR 2.24; 95%CI 1.59-3.14; p<0.01), illicit drug use 95%CI 1.49-(OR 3.26; 95%CI 1.49-7.13; p <0.01), hypertension (OR 2.49; 95%CI 1.61-3.84; p<0.01) and diabetes (OR 1.92; 95%CI 1.33-2.78; p<0.01).

CONCLUSION

The composite Aboriginal maternal morbidity does not differ, however the increased rates of smoking and illicit drug use are largely responsible for neonatal morbidity. Along with strengthening strategies to decrease medical comorbidities in aboriginals, we recommend intensifying smoking and illicit drug cessation programs.

Peromyscus as a model system for understanding the regulation of maternal behavior

The genus Peromyscus has been used as a model system for understanding maternal behavior because of the diversity of reproductive strategies within this genus. This review will describe the ecological factors that determine litter size and litter quality in polygynous species such as Peromyscus leucopus and Peromyscus maniculatus. We will also outline the physiological and social factors regulating maternal care in Peromyscus californicus, a monogamous and biparental species. Because biparental care is relatively rare in mammals, most research in P. californicus has focused on understanding the biology of paternal care while less research has focused on understanding maternal care. As a result, the social, sensory, and hormonal cues used to coordinate parental care between male and female P. californicus have been relatively well-studied. However, less is known about the physiology of maternal care in P. californicus and in other Peromyscus species. The diversity of the genus Peromyscus provides the potential for future research to continue to examine how variation in social systems has shaped the mechanisms that underlie maternal care.

Diagnostic and prognostic value of molecular and serological investigation of human parvovirus B19 infection during pregnancy

To define diagnostic and prognostic markers of parvovirus B19 (B19V) fetal infection, two groups were investigated: 1) pregnant women with specific symptoms or contacts with symptomatic households (n=37); 2) mothers with pathological ultrasound findings and the relevant fetus at the time of prenatal diagnosis (n=16). In the first group, diagnosis of B19V infection was achieved using IgM detection in 29/37 (78.3%) of patients, while B19V DNA was detected in 36/37 (97.3%) of infected women. In the second group, intrauterine infection was investigated by amniocentesis (n=5), cordocentesis (n=3) or both (n=5). Median B19V DNA load in amniotic fluid was 8.2x107 copies/ml and in fetal blood was 2x109 copies/ml. Maternal blood was positive for B19V DNA (median 3.8x104 copies/ml) in 14/16 (87.5%) women examined. At time of fetal US investigation, all mothers were B19V IgG positive and B19V IgM were detected in 10/16 (62.5%), while fetal B19V IgG and IgM were detected in 1/8 (12.5%) and 5/8 (62.5%), respectively. Phylogenetic analysis revealed that all B19V maternal and fetal strains belonged to genotype 1A. Diagnosis of maternal, fetal and neonatal B19V infection should be based on both IgM and DNA detection. Prognostic markers of congenital B19V infection need to be defined.

MATERNAL AND NEONATAL OUTCOMES OF HISTOLOGICAL CHORIOAMNIONITIS

BACKGROUND

Clinical Chorioamnionitis contributes to maternal and neonatal morbidity and mortality but the effect of histological chorioamnionitis is sparse in our environment.

AIM

To determine the maternal and neonatal outcomes of histological chorioamnionitis amongst pregnant women and their babies.

DESIGN OF THE STUDY

Cross sectional longitudinal study.

SETTING

Jos University Teaching Hospital (JUTH), Jos, Nigeria.

METHODOLOGY

Parturients were interviewed and examined as well as had their placenta examined histologically for chorioamnionitis. They and their babies were followed up for 6 weeks after delivery to monitor for any complications that may arise.

RESULTS

A total of 148 parturients were enrolled from the labour ward of Jos University Teaching Hospital and of these 90 (60.8%) had histologic chorioamnionitis (HCA). As regards outcome, 9(10%) with histologic chorioamnionitis as well as 5(8.62%) of those without HCA had premature delivery. Low birth weight occurred in 12(13.33%) and 6(10.34 %) of those with HCA and without HCA respectively. In all, 1(1.47%) and 1(2.56%) of women with HCA and without HCA correspondingly had neonatal sepsis. Puerperal sepsis occurred in 2(2.94%) of those with HCA and 2(5.13%) of those without HCA.

CONCLUSION

Our study has demonstrated that histological chorioamnionitis had no adverse maternal or neonatal effect. There is the need for more studies investigating the cause and the implication of histological chorioamnionitis.

Ambient air pollution and adverse birth outcomes: Differences by maternal comorbidities

BACKGROUND

Prenatal exposure to ambient air pollution has been associated with adverse birth outcomes, but the potential modifying effect of maternal comorbidities remains understudied. Our objective was to investigate whether associations between prenatal air pollution exposures and birth outcomes differ by maternal comorbidities.

METHODS

A total of 818,400 singleton live births were identified in the province of Ontario, Canada from 2005 to 2012. We assigned exposures to fine particulate matter (PM2.5), nitrogen dioxide (NO2) and ozone (O3) to maternal residences during pregnancy. We evaluated potential effect modification by maternal comorbidities (i.e. asthma, hypertension, pre-existing diabetes mellitus, heart disease, gestational diabetes and preeclampsia) on the associations between prenatal air pollution and preterm birth, term low birth weight and small for gestational age.

RESULTS

Interquartile range (IQR) increases in PM2.5 (2μg/m(3)), NO2 (9ppb) and O3 (5ppb) over the entire pregnancy were associated with a 4% (95% CI: 2.4-5.6%), 8.4% (95% CI: 5.5-10.3%) and 2% (95% CI: 0.5-4.1%) increase in the odds of preterm birth, respectively. Increases of 10.6% (95% CI: 0.2-2.1%) and 23.8% (95% CI: 5.5-44.8%) in the odds of preterm birth were observed among women with pre-existing diabetes while the increases were of 3.8% (95% CI: 2.2-5.4%) and 6.5% (95% CI: 3.7-8.4%) among women without this condition for pregnancy exposure to PM2.5 and NO2, respectively (Pint<0.01). The increase in the odds of preterm birth for exposure to PM2.5 during pregnancy was higher among women with preeclampsia (8.3%, 95% CI: 0.8-16.4%) than among women without (3.6%, 95% CI: 1.8-5.3%) (Pint=0.04). A stronger increase in the odds of preterm birth was found for exposure to O3 during pregnancy among asthmatic women (12.0%, 95% CI: 3.5-21.1%) compared to non-asthmatic women (2.0%, 95% CI: 0.1-3.5%) (Pint<0.01). We did not find statistically significant effect modification for the other outcomes investigated.

CONCLUSIONS

Findings of this study suggest that associations of ambient air pollution with preterm birth are stronger among women with pre-existing diabetes, asthma, and preeclampsia.

Genetic and neuroendocrine regulation of the postpartum brain

Changes in expression of hundreds of genes occur during the production and function of the maternal brain that support a wide range of processes. In this review, we synthesize findings from four microarray studies of different maternal brain regions and identify a core group of 700 maternal genes that show significant expression changes across multiple regions. With those maternal genes, we provide new insights into reward-related pathways (maternal bonding), postpartum depression, social behaviors, mental health disorders, and nervous system plasticity/developmental events. We also integrate the new genes into well-studied maternal signaling pathways, including those for prolactin, oxytocin/vasopressin, endogenous opioids, and steroid receptors (estradiol, progesterone, cortisol). A newer transcriptional regulation model for the maternal brain is provided that incorporates recent work on maternal microRNAs. We also compare the top 700 genes with other maternal gene expression studies. Together, we highlight new genes and new directions for studies on the postpartum brain.