401
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Tutar O, Kocak B, Velidedeoglu M, Baca B, Dikici S, Nurili F, Kantarci F. Small bowel intussusception in a pregnant woman with Peutz-Jeghers Syndrome. Scott Med J 2014; 59:e9-13. [PMID: 24448402 DOI: 10.1177/0036933013519028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Intussusception is the most frequent complication of Peutz-Jeghers Syndrome (PJS), but usually seen in child age. It is a predictable, but infrequent complication in adults with PJS. However, there is no report about intussusception in pregnancy period secondary to Peutz-Jeghers (PJ) polyps in the literature. In this paper, we present a rare intussusception case in a pregnant woman with PJS, which was diagnosed with magnetic resonance imaging, and discuss this condition with a brief literature review.
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Affiliation(s)
- Onur Tutar
- MD, Istanbul University, Cerrahpasa Medical Faculty, Department of Radiology, Istanbul, Turkey
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402
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Timur Taşhan S, Aksoy Derya Y. Traditional practices used by the infertile women to become pregnant and their effects on the quality of life. Int J Nurs Pract 2013; 19:516-22. [PMID: 24093743 DOI: 10.1111/ijn.12094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The present research was planned to determine the traditional practices used by infertile women to become pregnant and their effects on the quality of life. A hospital-based, descriptive and cross-sectional study. Participant Information Forms and SF-36 quality of life scales were applied to 269 women diagnosed as infertile. Some of the infertile women (32.7%) were determined to use a traditional method. The traditional methods used by women included herbal remedies (those edible and drinkable) (87.5%), sitting on the herbal mixtures (8%) and using both practices (4.5%). The SF-36 Mental Health component was determined to be better in infertile women not using traditional practices than those using traditional practices (P < 0.05). Considering the results of the study, health professionals can question women about the traditional practices and guide them about their damages.
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403
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Iuliano AD, Weidle PJ, Brooks JT, Masaba R, Girde S, Ndivo R, Ogindo P, Omolo P, Zeh C, Thomas TK. Neutropenia in HIV-Infected Kenyan Women Receiving Triple Antiretroviral Prophylaxis to Prevent Mother-to-Child HIV Transmission Is Not Associated with Serious Clinical Sequelae. J Int Assoc Provid AIDS Care 2013; 14:261-8. [PMID: 24080477 DOI: 10.1177/2325957413502543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Absolute neutrophil counts (ANCs) are lower in East African adults. To assess the impact of lower ANCs, we reviewed data from HIV-infected Kenyan women receiving antiretroviral therapy antepartum and postpartum. METHODS The Kisumu Breastfeeding Study (KiBS) participants received an antiretroviral regimen from 34 weeks' gestation through 6 months postpartum. Measured ANCs and subsequent illnesses were reviewed. Adverse events (AEs) potentially attributable to neutropenia were identified, and ANCs were graded using the 2004 Division of AIDS table for Grading the Severity of AEs. RESULTS Among 478 women with ≥1 postpartum ANC measured, 298 (62.1%) women met criteria for an AE (<1.3 × 10(9) cells/L). Of those, 38 (12.5%) women experienced a nonlife-threatening illness potentially attributable to neutropenia. CONCLUSION More than half of KiBS women met criteria for neutropenia. The mild clinical experience of most participants with low ANCs supports that these values might be typical for this population and may not result in adverse clinical sequelae.
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Affiliation(s)
- A Danielle Iuliano
- Division of HIV/AIDS Prevention, National Center for HIV, Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Paul J Weidle
- Division of HIV/AIDS Prevention, National Center for HIV, Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - John T Brooks
- Division of HIV/AIDS Prevention, National Center for HIV, Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rose Masaba
- Kenya Medical Research Institute, Kisumu, Kenya
| | - Sonali Girde
- Division of HIV/AIDS Prevention, National Center for HIV, Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA ICF International, Atlanta, GA, USA
| | | | - Paul Ogindo
- Kenya Medical Research Institute, Kisumu, Kenya
| | - Paul Omolo
- Kenya Medical Research Institute, Kisumu, Kenya
| | - Clement Zeh
- Division of HIV/AIDS Prevention, National Center for HIV, Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA Kenya Medical Research Institute (KEMRI)/CDC, Kisumu, Kenya
| | - Timothy K Thomas
- Division of HIV/AIDS Prevention, National Center for HIV, Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA Kenya Medical Research Institute (KEMRI)/CDC, Kisumu, Kenya
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404
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Tzilos G, Hess L, Kao JCW, Zlotnick C. Characteristics of perinatal women seeking treatment for marijuana abuse in a community-based clinic. Arch Womens Ment Health 2013; 16:333-7. [PMID: 23737012 PMCID: PMC3723351 DOI: 10.1007/s00737-013-0358-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 05/20/2013] [Indexed: 11/25/2022]
Abstract
UNLABELLED In the US, marijuana continues to be the most frequently used illicit drug among women of childbearing age, including pregnant and postpartum women. Given the critical window for treatment during the perinatal period, more information is needed about the characteristics of women who abuse marijuana and about their unique needs with the goal of improving clinical services and outcomes for both women and their infants. OBJECTIVES To (1) identify a profile of perinatal women seeking treatment for primarily marijuana abuse and (2) report birth outcomes in a subset of pregnant women with marijuana abuse. METHODS This retrospective clinical chart review study examined 67 adult perinatal women patients (54 % ethnic minority) who attended an inner-city, hospital-affiliated outpatient program specializing in substance abuse treatment for women. Of all pregnant women, 26 % reported positive urine screens during the first trimester, 41 % during the second trimester, and 27 % during the third trimester. While the subset of pregnant women was small, exploratory results suggest that infants whose mothers continued to use marijuana during their pregnancies were born at a lower gestational age than mothers who abstained; t(29) = 2.04, p <0.05. CONCLUSION Identifying potential barriers to treatment could help improve retention in community-based treatment programs during pregnancy and the postpartum period.
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Affiliation(s)
- Golfo Tzilos
- Center for Alcohol and Addiction Studies, Alpert Medical School of Brown University, Box G-S121-4, Providence, RI 02912, USA.
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405
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Salam GD, Kumar A, Kar P, Aggarwal S, Husain A, Sharma S. Serum tumor necrosis factor-alpha level in hepatitis E virus-related acute viral hepatitis and fulminant hepatic failure in pregnant women. Hepatol Res 2013; 43:826-35. [PMID: 23279190 DOI: 10.1111/hepr.12028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2012] [Revised: 11/14/2012] [Accepted: 11/19/2012] [Indexed: 12/26/2022]
Abstract
AIM The host response in hepatitis E virus (HEV)-related liver disease of pregnant women is unclear. This study was carried out to evaluate the serum concentration of tumor necrosis factor (TNF)-α in HEV-related acute viral hepatitis (AVH) and fulminant hepatic failure (FHF) in pregnant women in relation to pregnancy outcome. METHODS The study included 262 pregnant and 158 non-pregnant women with jaundice. There were 160 healthy asymptomatic pregnant women and 124 healthy asymptomatic non-pregnant women as controls. The jaundiced patients were classified as AVH or FHF. Serum TNF-α level was assayed by commercially available enzyme-linked immunoassay kits. RESULTS A significantly higher level of TNF-α was observed in HEV-infected pregnant women than non-HEV pregnant women (P < 0.001). TNF-α level was significantly higher in AVH and FHF of HEV-infected pregnant women compared with AVH and FHF of HEV infected non-pregnant women (P = 0.036 and P = 0.010, respectively). The HEV-infected pregnant FHF expired group had significantly higher levels of TNF-α than the non-pregnant FHF expired group (P = 0.025). TNF-α levels were significantly higher in AVH of HEV-infected pregnant women than healthy pregnant controls (P < 0.001). Higher TNF-α levels were observed in HEV-infected women having preterm delivery and low birthweight newborns compared with non-HEV and healthy pregnant women. CONCLUSION Higher serum concentration of TNF-α observed in HEV infected AVH and FHF pregnant cases shows that pregnancy with HEV infection increases TNF-α secretion. TNF-α may be an important factor in the outcomes of pregnancy due to HEV infection.
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Affiliation(s)
- Gyaneshwori Devi Salam
- Department of Obstetrics and Gynecology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
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406
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Abstract
Neuroanaesthetic considerations in non neurosurgical cases are utmost important for the optimal management of such cases. These considerations become even more challenging in patients undergoing emergency surgeries. We have highlighted the neuroanesthetic considerations for three broad categories. The two most important considerations in this type of surgery will be the avoidance of secondary brain insult and maintenance of optimal cerebral perfusion pressure.
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Affiliation(s)
- Tumul Chowdhury
- Department of Anesthesiology, Health Sciences Center, University of Manitoba, Winnipeg, Canada
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407
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Dalar L, Caner H, Eryuksel E, Kosar F. Application of non-invasive mechanical ventilation in an asthmatic pregnant woman in respiratory failure: a case report. J Thorac Dis 2013; 5:97-100. [PMID: 23372957 DOI: 10.3978/j.issn.2072-1439.2012.12.08] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Accepted: 12/25/2012] [Indexed: 11/14/2022]
Abstract
The use of non-invasive mechanical ventilation (NIV) during an asthma attack is controversial. We report a case of a 28-year-old female patient in her 16th week of pregnancy with community-acquired pneumonia who presented during an asthma attack, which led to hypoxic respiratory failure. She was successfully treated using NIV. This case is worth discussing as it includes two clinical conditions in which NIV is often considered contraindicated.
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Affiliation(s)
- Levent Dalar
- Respiratory Intensive Care Unit, Yedikule Teaching Hospital for Pulmonology and Thoracic Surgery, Istanbul, Turkey
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408
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Ishola DA, Permalloo N, Cordery RJ, Anderson SR. Midwives' influenza vaccine uptake and their views on vaccination of pregnant women. J Public Health (Oxf) 2013; 35:570-7. [PMID: 23365262 DOI: 10.1093/pubmed/fds109] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Pregnant women in England are now offered seasonal influenza vaccine. Midwives could be influential in promoting this, but specific information on their views on the policy and their role in its implementation is lacking. METHODS London midwives were surveyed for their views on the new policy and their own vaccine uptake, using an anonymously self-completed semi-structured online survey via a convenience sampling approach. RESULTS In total, 266 midwives responded. Sixty-nine percent agreed with the policy of vaccinating all pregnant women. Seventy-six percent agreed that midwives should routinely advise pregnant women on vaccination, but only 25% felt adequately prepared for this role. Just 28% wished to be vaccinators, due to concerns about increased workload and inadequate training. Forty-three percent received seasonal influenza vaccine themselves. Major reasons for non-uptake were doubts about vaccine necessity (34%), safety (25%) and effectiveness (10%); and poor arrangements for vaccination (11%). Suggested strategies for improving their own uptake included better access to evidence of effectiveness (67%) and improved work-based vaccination (45%). CONCLUSIONS London midwives support influenza vaccination of pregnant women, but are more willing to give advice on, than to administer, the vaccine. Midwives' own influenza vaccine uptake could improve with more information and easier access to vaccination in their workplace.
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Affiliation(s)
- D A Ishola
- Health Protection Agency, London Regional Epidemiology Unit, 151 Buckingham Palace Road, London SW1W 9SZ, UK
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409
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Shibata K, Fukuwatari T, Sasaki S. Nutritional Status of Water-soluble Vitamins Did not Differ According to Intake Levels of Wheat and Wheat Alternatives and Rice and Rice Alternatives as a Staple Food in Pregnant Japanese Women. Nutr Metab Insights 2013; 6:51-7. [PMID: 24812518 PMCID: PMC3999898 DOI: 10.4137/nmi.s12980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The objective of this study was to investigate whether the intake level of a staple food influences the nutritional status of water-soluble vitamins in pregnant Japanese women. Urinary excretion of water-soluble vitamins was used as a biomarker for nutritional assessment. Twenty-four-hour urine samples were collected and vitamin intake was surveyed using a validated self-administered comprehensive diet history questionnaire. Subjects were categorized into bottom, middle, and upper tertiles according to the percentage of total energy intake from wheat and wheat alternatives or rice and rice alternatives. The present study showed that the nutritional status of water-soluble vitamins did not differ with intake level of wheat and wheat alternatives or rice and rice alternatives as a staple food in pregnant Japanese women.
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Affiliation(s)
- Katsumi Shibata
- Department of Nutrition, School of Human Cultures, University of Shiga Prefecture, 2500 Hassaka, Hikone, Shiga Prefecture 522-8533, Japan
| | - Tsutomu Fukuwatari
- Department of Nutrition, School of Human Cultures, University of Shiga Prefecture, 2500 Hassaka, Hikone, Shiga Prefecture 522-8533, Japan
| | - Satoshi Sasaki
- Department of Social and Preventive Epidemiology, School of Public Health, University of Tokyo, 7-3-1 Hongo, Bunkyoku, Tokyo 113-0033, Japan
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410
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Kosgei RJ, Ndavi PM, Ong'ech JO, Abuya JM, Siika AM, Wools-Kaloustian K, Mabeya H, Fojo T, Mwangi A, Reid T, Edginton ME, Carter EJ. Symptom screen: diagnostic usefulness in detecting pulmonary tuberculosis in HIV-infected pregnant women in Kenya. Public Health Action 2011; 1:30-3. [PMID: 26392933 DOI: 10.5588/pha.11.0004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Accepted: 10/06/2011] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To determine the diagnostic usefulness of tuberculosis (TB) symptom screening to detect active pulmonary TB among human immunodeficiency virus (HIV) infected pregnant women in two PMTCT (prevention of mother-to-child transmission) clinics in western Kenya that are supported by the United States Agency for International Development-Academic Model Providing Access to Healthcare partnership. DESIGN Cross-sectional study. Participants were interviewed for TB symptoms with a standardized questionnaire (cough >2 weeks, fever, night sweats, weight loss or failure to gain weight). Those with cough submitted sputum specimens for smear microscopy for acid-fast bacilli and mycobacterial culture. Women at >14 weeks gestation underwent shielded chest radiography (CXR). RESULTS Of 187 HIV-infected women, 38 (20%) were symptom screen-positive. Of these, 21 had a cough for >2 weeks, but all had negative sputum smears and mycobacterial cultures. CXRs were performed in 26 symptomatic women: three were suggestive of TB (1 miliary, 1 infiltrates and 1 cavitary). Of 149 women with a negative symptom screen, 100 had a CXR and seven had a CXR suggestive of TB (1 cavitary, 2 miliary and 4 infiltrates). CONCLUSION This study did not support the utility of isolated symptom screening in identification of TB disease in our PMTCT setting. CXR was useful in identification of TB suspects in both symptomatic and asymptomatic women.
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Affiliation(s)
- R J Kosgei
- The United States Agency for International Development-Academic Model Providing Access to Healthcare Partnership, Eldoret, Kenya ; University of Nairobi School of Medicine, Nairobi, Kenya
| | - P M Ndavi
- University of Nairobi School of Medicine, Nairobi, Kenya ; Kenyatta National Hospital, Nairobi, Kenya
| | - J O Ong'ech
- University of Nairobi School of Medicine, Nairobi, Kenya ; Kenyatta National Hospital, Nairobi, Kenya
| | - J M Abuya
- The United States Agency for International Development-Academic Model Providing Access to Healthcare Partnership, Eldoret, Kenya ; Moi University School of Medicine, Eldoret, Kenya
| | - A M Siika
- The United States Agency for International Development-Academic Model Providing Access to Healthcare Partnership, Eldoret, Kenya ; Moi University School of Medicine, Eldoret, Kenya
| | - K Wools-Kaloustian
- The United States Agency for International Development-Academic Model Providing Access to Healthcare Partnership, Eldoret, Kenya ; Moi University School of Medicine, Eldoret, Kenya ; Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - H Mabeya
- The United States Agency for International Development-Academic Model Providing Access to Healthcare Partnership, Eldoret, Kenya ; Moi University School of Medicine, Eldoret, Kenya
| | - T Fojo
- Washington University School of Medicine, St Louis, Missouri, USA
| | - A Mwangi
- The United States Agency for International Development-Academic Model Providing Access to Healthcare Partnership, Eldoret, Kenya ; Moi University School of Medicine, Eldoret, Kenya
| | - T Reid
- Operational Research Unit, Médecins Sans Frontières-Operational Centre Brussels, Luxembourg
| | - M E Edginton
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - E J Carter
- The United States Agency for International Development-Academic Model Providing Access to Healthcare Partnership, Eldoret, Kenya ; Moi University School of Medicine, Eldoret, Kenya ; Warren Alpert School of Medicine at Brown University, Providence, Rhode Island, USA
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411
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Barbosa AMP, Dias A, Marini G, Calderon IMP, Witkin S, Rudge MVC. Urinary incontinence and vaginal squeeze pressure two years post-cesarean delivery in primiparous women with previous gestational diabetes mellitus. Clinics (Sao Paulo) 2011; 66:1341-6. [PMID: 21915481 PMCID: PMC3161209 DOI: 10.1590/s1807-59322011000800006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Accepted: 04/26/2011] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To assess the prevalence of urinary incontinence and associated vaginal squeeze pressure in primiparous women with and without previous gestational diabetes mellitus two years post-cesarean delivery. METHODS Primiparous women who delivered by cesarean two years previously were interviewed about the delivery and the occurrence of incontinence. Incontinence was reported by the women and vaginal pressure evaluated by a Perina perineometer. Sixty-three women with gestational diabetes and 98 women without the disease were screened for incontinence and vaginal pressure. Multiple logistic regression models were used to evaluate the independent effects of gestational diabetes. RESULTS The prevalence of gestational incontinence was higher among women with gestational diabetes during their pregnancies (50.8% vs. 31.6%) and two years after a cesarean (44.8% vs. 18.4%). Decreased vaginal pressure was also significantly higher among women with gestational diabetes (53.9% vs. 37.8%). Maternal weight gain and newborn weight were risk factors for decreased vaginal pressure. Maternal age, gestational incontinence and decreased vaginal pressure were risk factors for incontinence two years after a cesarean. In a multivariate logistic model, gestational diabetes was an independent risk factor for gestational incontinence. CONCLUSIONS The prevalence of incontinence and decreased vaginal pressure two years post-cesarean were elevated among women with gestational diabetes compared to women who were normoglycemic during pregnancy. We confirmed an association between gestational diabetes mellitus and a subsequent decrease of vaginal pressure two years post-cesarean. These results may warrant more comprehensive prospective and translational studies.
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412
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Ondersma SJ, Winhusen T, Lewis DF. External pressure, motivation, and treatment outcome among pregnant substance-using women. Drug Alcohol Depend 2010; 107:149-53. [PMID: 19926408 DOI: 10.1016/j.drugalcdep.2009.10.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2009] [Revised: 10/05/2009] [Accepted: 10/06/2009] [Indexed: 11/21/2022]
Abstract
The weight of evidence suggests that legal pressure to enter treatment facilitates retention. However, the extent to which such mandates (a) influence actual levels of substance use, or (b) also facilitate retention among pregnant women, is unclear. Associations between external pressure-defined as self-reported pressure to attend treatment under threat of incarceration, loss of child custody, and/or loss of subsidized housing--and the key outcomes of retention and substance use were therefore examined in a sample of 200 pregnant women receiving community-based substance abuse treatment. The role of external pressure was examined in a series of Cox and GEE regressions, which suggested that external pressure as measured at baseline was associated with decreased risk of dropout (Hazard Ratio=.47, p=.001) and fewer drug-positive urine tests throughout treatment and 12-week follow-up (OR=.48, p=.03). These differences did not appear to be the result of baseline differences between coerced and non-coerced participants in education, legal history, the presence or absence of a substance use disorder, employment, or motivation. The present findings extend the larger literature on external pressure by demonstrating effects on drug use as well as on retention, and among pregnant women.
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413
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DiClemente RJ, Wingood GM, Rose E, Sales JM, Crosby RA. Evaluation of an HIV/STD sexual risk-reduction intervention for pregnant African American adolescents attending a prenatal clinic in an urban public hospital: preliminary evidence of efficacy. J Pediatr Adolesc Gynecol 2010; 23:32-8. [PMID: 19643646 PMCID: PMC2817990 DOI: 10.1016/j.jpag.2009.05.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Revised: 04/29/2009] [Accepted: 05/12/2009] [Indexed: 11/20/2022]
Abstract
STUDY OBJECTIVE To evaluate an intervention to reduce HIV/STD-associated behaviors and enhance psychosocial mediators for pregnant African-American adolescents. DESIGN A randomized controlled trial. Participants completed baseline and follow-up assessments. SETTING An urban public hospital in the Southeastern U.S. PARTICIPANTS Pregnant African-American adolescents (N=170), 14-20 years of age, attending a prenatal clinic. INTERVENTION Intervention participants received two 4-hr group sessions enhancing self-concept and self-worth, HIV/STD prevention skills, and safer sex practices. Participants in the comparison condition received a 2-hr session on healthy nutrition. MAIN OUTCOME MEASURES Consistent condom use. RESULTS Intervention participants reported greater condom use at last intercourse (adjusted odds ratio=3.9, P=0.05) and consistent condom use (AOR=7.9, P=0.05), higher sexual communication frequency, enhanced ethnic pride, higher self-efficacy to refuse risky sex, and were less likely to fear abandonment as a result of negotiating safer sex. CONCLUSIONS Interventions for pregnant African-American adolescents can enhance condom use and psychosocial mediators.
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Affiliation(s)
- R J DiClemente
- Rollins School of Public Health at Emory University, Atlanta, Georgia 30322, USA
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414
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Wang RY, Jain RB, Wolkin AF, Rubin CH, Needham LL. Serum concentrations of selected persistent organic pollutants in a sample of pregnant females and changes in their concentrations during gestation. Environ Health Perspect 2009; 117:1244-9. [PMID: 19672404 PMCID: PMC2721868 DOI: 10.1289/ehp.0800105] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2008] [Accepted: 03/11/2009] [Indexed: 05/17/2023]
Abstract
OBJECTIVES In this study we evaluated the concentrations of selected persistent organic pollutants in a sample of first-time pregnant females residing in the United States and assessed differences in these concentrations in all pregnant females during gestation. METHODS We reviewed demographic and laboratory data for pregnant females participating in the National Health and Nutrition Examination Survey, including concentrations of 25 polychlorinated biphenyls (PCBs), 6 polychlorinated dibenzo-p-dioxins (PCDDs), 9 polychlorinated dibenzofurans (PCDFs), and 9 organochlorine pesticides. We report serum concentrations for first-time pregnant females (2001-2002; n = 49) and evaluate these concentrations in all pregnant females by trimester (1999-2002; n = 203) using a cross-sectional analysis. RESULTS The chemicals with >or= 60% detection included PCBs (congeners 126, 138/158, 153, 180), PCDDs/PCDFs [1,2,3,4,6,7,8-heptachlorodibenzo-p-dioxin (1234678HpCDD), 1,2,3,6,7,8-hexachlorodibenzo-p-dioxin (123678HxCDD), 1,2,3,4,6,7,8-heptachlorodibenzofuran (1234678HpCDF), 1,1'-(2,2-dichloroethenylidene)-bis(4-chlorobenzene) (p,p'-DDE)], and trans-nonachlor. The geometric mean concentration (95% confidence intervals) for 1234678HpCDD was 15.9 pg/g lipid (5.0-50.6 pg/g); for 123678HxCDD, 9.7 pg/g (5.5-17.1 pg/g); and for 1234678HpCDF, 5.4 pg/g (3.3-8.7 pg/g). The differences in concentrations of these chemicals by trimester were better accounted for with the use of lipid-adjusted units than with whole-weight units; however, the increase in the third-trimester concentration was greater for PCDDs/PCDFs (123678HxCDD, 1234678HpCDF) than for the highest concentration of indicator PCBs (138/158, 153, 180), even after adjusting for potential confounders. CONCLUSION The concentrations of these persistent organic pollutants in a sample of first-time pregnant females living in the United States suggest a decline in exposures to these chemicals since their ban or restricted use and emission. The redistribution of body burden for these and other persistent organic pollutants during pregnancy needs to be more carefully defined to improve the assessment of fetal exposure to them based on maternal serum concentrations. Additional studies are needed to further the understanding of the potential health consequences to the fetus from persistent organic pollutants.
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Affiliation(s)
- Richard Y Wang
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
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415
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Ondersma SJ, Winhusen T, Erickson SJ, Stine SM, Wang Y. Motivation Enhancement Therapy with pregnant substance-abusing women: does baseline motivation moderate efficacy? Drug Alcohol Depend 2009; 101:74-9. [PMID: 19101099 PMCID: PMC2792933 DOI: 10.1016/j.drugalcdep.2008.11.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2008] [Revised: 11/04/2008] [Accepted: 11/04/2008] [Indexed: 11/19/2022]
Abstract
Some evidence suggests that motivational approaches are less efficacious--or even counter-productive--with persons who are relatively motivated at baseline. The present study was conducted to examine whether disordinal moderation by baseline motivation could partially explain negative findings in a previous study [Winhusen, T., Kropp, F., Babcock, D., Hague, D., Erickson, S.J., Renz, C., Rau, L., Lewis, D., Leimberger, J., Somoza, E., 2008. Motivational enhancement therapy to improve treatment utilization and outcome in pregnant substance users. J. Subst. Abuse Treat. 35, 161-173]. Analyses also focused on the relative utility of the University of Rhode Island Change Assessment (URICA) scale, vs. a single goal question as potential moderators of Motivation Enhancement Therapy (MET). Participants were 200 pregnant women presenting for substance abuse treatment at one of four sites. Women were randomly assigned to either a three-session MET condition or treatment as usual (TAU). Generalized Estimating Equations (GEE) revealed no significant moderation effects on drug use at post-treatment. At follow-up, contrary to expectations, participants who had not set a clear quit goal at baseline were less likely to be drug-free if randomized to MET (OR=0.48); participants who did set a clear quit goal were more likely to be drug-free if randomized to MET (OR=2.53). No moderating effects were identified via the URICA. Disordinal moderation of MET efficacy by baseline motivation may have contributed somewhat to the negative results of the [Winhusen, T., Kropp, F., Babcock, D., Hague, D., Erickson, S.J., Renz, C., Rau, L., Lewis, D., Leimberger, J., Somoza, E., 2008. Motivational enhancement therapy to improve treatment utilization and outcome in pregnant substance users. J. Subst. Abuse Treat. 35, 161-173] study, but in the opposite direction expected. A simple question regarding intent to quit may be useful in identifying persons who may differentially respond to motivational interventions. However, moderation effects are unstable, may be best identified with alternate methodologies, and may operate differently among pregnant women.
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Affiliation(s)
- Steven J Ondersma
- Department of Psychiatry & Behavioral Neurosciences, Wayne State University, 2761 E. Jefferson Ave., Detroit, MI 48207, USA.
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416
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Abstract
Pregnant prisoners have health-care needs that are minimally met by prison systems. Many of these mothers have high-risk pregnancies due to the economic and social problems that led them to be incarcerated: poverty, lack of education, inadequate health care, and substance abuse. Lamaze educators and doulas have the opportunity to replicate model programs that provide these women and their children with support, information, and empowering affirmation that improve parenting outcomes and decrease recidivism.
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Affiliation(s)
- Barbara A Hotelling
- BARBARA HOTELLING is an independent childbirth educator and doula in Rochester Hills, Michigan. She has served as president of Lamaze International, president of DONA International, and chair of the Coalition for Improving Maternity Services
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417
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Bradman A, Fenster L, Sjödin A, Jones RS, Patterson DG, Eskenazi B. Polybrominated diphenyl ether levels in the blood of pregnant women living in an agricultural community in California. Environ Health Perspect 2007; 115:71-4. [PMID: 17366822 PMCID: PMC1797836 DOI: 10.1289/ehp.8899] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
BACKGROUND Recent studies have raised concerns about polybrominated diphenyl ether (PBDE) flame retardant exposures to pregnant women and women of child-bearing age in the United States. Few studies have measured PBDEs in immigrant populations. OBJECTIVES Our goal was to characterize levels of seven PBDE congeners, polychlorinated biphenyl (PCB)-153, and polybrominated biphenyl (PBB)-153 in plasma from 24 pregnant women of Mexican descent living in an agricultural community in California. RESULTS The median concentration of the sum of the PBDE congeners was 21 ng/g lipid and ranged from 5.3 to 320 ng/g lipid. Consistent with other studies, 2,2',4,4'-tetrabromodiphenyl ether (BDE-47) was found at the highest concentration (median = 11 ng/g lipid; range, 2.5-205) followed by 2,2',4,4',5-pentabromobiphenyl (BDE-99) (median = 2.9 ng/g lipid; range, 0.5-54), 2,2',4,4',5-pentaBDE (BDE-100) (median = 1.8 ng/g lipid; range, 0.6-44), and 2,2',4,4',5,5'-hexaBDE (BDE-153) (median = 1.5 ng/g lipid; range, 0.4-35). Levels of PCB-153 (median= 4.4 ng/g lipid; range, < 2-75) were lower than U.S. averages and uncorrelated with PBDE levels, suggesting different exposure routes. CONCLUSIONS The overall levels of PBDEs found were lower than levels observed in other U.S. populations, although still higher than those observed previously in Europe or Japan. The upper range of exposure is similar to what has been reported in other U.S. populations. PBDEs have been associated with adverse developmental effects in animals. Future studies are needed to determine the sources and pathways of PBDE exposures and whether these exposures have adverse effects on human health.
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Affiliation(s)
- Asa Bradman
- Center for Children's Environmental Health Research, School of Public Health, University of California, Berkeley, California 94720-7380, USA.
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418
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Bradman A, Chevrier J, Tager I, Lipsett M, Sedgwick J, Macher J, Vargas AB, Cabrera EB, Camacho JM, Weldon R, Kogut K, Jewell NP, Eskenazi B. Association of housing disrepair indicators with cockroach and rodent infestations in a cohort of pregnant Latina women and their children. Environ Health Perspect 2005; 113:1795-801. [PMID: 16330367 PMCID: PMC1314924 DOI: 10.1289/ehp.7588] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Health burdens associated with poor housing and indoor pest infestations are likely to affect young children in particular, who spend most of their time indoors at home. We completed environmental assessments in 644 homes of pregnant Latina women and their children living in the Salinas Valley, California. High residential densities were common, with 39% of homes housing > 1.5 persons per room. Housing disrepair was also common: 58% of homes had peeling paint, 43% had mold, 25% had water damage, and 11% had rotting wood. Evidence of cockroaches and rodents was present in 60% and 32% of homes, respectively. Compared with representative national survey data from the U.S. Department of Housing and Urban Development, homes in our sample were more likely to have rodents, peeling paint, leaks under sinks, and much higher residential densities. The odds of rodent infestations in homes increased in the presence of peeling paint [odds ratio (OR) 2.1; 95% confidence interval (CI), 1.5-3.1], water damage (OR 1.9; 95% CI, 1.2-2.7), and mold (OR 1.5; 95% CI, 1.0-2.1). The odds of cockroach infestation increased in the presence of peeling paint (OR 3.8; 95% CI, 2.7-5.6), water damage (OR 1.9; 95% CI, 1.2-2.9), or high residential density (OR 2.1; 95% CI, 1.2-3.8). Homes that were less clean than average were more prone to both types of infestations. Pesticides were stored or used in 51% of households, partly to control roach and rodent infestations. These data indicate that adverse housing conditions are common in this community and increase the likelihood of pest infestations and home pesticide use. Interventions to improve housing and promote children's health and safety in this population are needed.
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Affiliation(s)
- Asa Bradman
- Center for Children's Environmental Health Research, School of Public Health, University of California, Berkeley, California 94720-7380, USA.
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419
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Wolff MS, Teitelbaum SL, Lioy PJ, Santella RM, Wang RY, Jones RL, Caldwell KL, Sjödin A, Turner WE, Li W, Georgopoulos P, Berkowitz GS. Exposures among pregnant women near the World Trade Center site on 11 September 2001. Environ Health Perspect 2005; 113:739-48. [PMID: 15929898 PMCID: PMC1257600 DOI: 10.1289/ehp.7694] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2004] [Accepted: 01/27/2005] [Indexed: 05/02/2023]
Abstract
We have characterized environmental exposures among 187 women who were pregnant, were at or near the World Trade Center (WTC) on or soon after 11 September 2001, and are enrolled in a prospective cohort study of health effects. Exposures were assessed by estimating time spent in five zones around the WTC and by developing an exposure index (EI) based on plume reconstruction modeling. The daily reconstructed dust levels were correlated with levels of particulate matter < or = 2.5 microm in aerodynamic diameter (PM2.5; r = 0.68) or PM10 (r = 0.73-0.93) reported from 26 September through 8 October 2001 at four of six sites near the WTC whose data we examined. Biomarkers were measured in a subset. Most (71%) of these women were located within eight blocks of the WTC at 0900 hr on 11 September, and 12 women were in one of the two WTC towers. Daily EIs were determined to be highest immediately after 11 September and became much lower but remained highly variable over the next 4 weeks. The weekly summary EI was associated strongly with women's perception of air quality from week 2 to week 4 after the collapse (p < 0.0001). The highest levels of polycyclic aromatic hydrocarbon-deoxyribonucleic acid (PAH-DNA) adducts were seen among women whose blood was collected sooner after 11 September, but levels showed no significant associations with EI or other potential WTC exposure sources. Lead and cobalt in urine were weakly correlated with sigmaEI, but not among samples collected closest to 11 September. Plasma OC levels were low. The median polychlorinated biphenyl level (sum of congeners 118, 138, 153, 180) was 84 ng/g lipid and had a nonsignificant positive association with sigmaEI (p > 0.05). 1,2,3,4,6,7,8-Heptachlorodibenzodioxin levels (median, 30 pg/g lipid) were similar to levels reported in WTC-exposed firefighters but were not associated with EI. This report indicates intense bystander exposure after the WTC collapse and provides information about nonoccupational exposures among a vulnerable population of pregnant women.
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Affiliation(s)
- Mary S Wolff
- Mount Sinai School of Medicine, New York, New York 10029, USA.
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420
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Wang CJ, Yen CF, Lee CL, Soong YK. Minilaparoscopic cystectomy and appendectomy in late second trimester. JSLS 2002; 6:373-5. [PMID: 12500839 PMCID: PMC3043439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Laparoscopic ovarian cystectomy and appendectomy during the early second trimester have been widely reported. However, the use of both procedures in advanced gestation is rare. We propose a minilaparoscopic approach for performing these 2 procedures in a woman 24-weeks pregnant. METHODS We describe the case and laparoscopic management of acute abdominal pain at the 24th week of pregnancy. Microlaparoscopy under ultrasound guidance was used for the first trocar insertion to prevent injury to the uterus. It was followed by minilaparoscopic ovarian cystectomy and appendectomy. RESULTS Premature contractions occurred after the operation, but they were controlled with a single tocolytic agent, and an apparently healthy female baby was born uneventfully via Cesarean delivery at 41 weeks of gestation. CONCLUSION Minilaparoscopic ovarian cystectomy and appendectomy can be carried out in the late second trimester without serious sequela.
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Affiliation(s)
- Chin-Jung Wang
- Division of Gynecologic Endoscopy, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Tao-Yuan, Taiwan
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421
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Hwang S, Lee E, Yoon J, Yoon BK, Lee JH, Choi D. Effects of electric stimulation on bovine oocyte activation and embryo development in intracytoplasmic sperm injection procedure. J Assist Reprod Genet 2000; 17:310-4. [PMID: 11042826 PMCID: PMC3455396 DOI: 10.1023/a:1009496726343] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE This study was carried out to investigate the efficacy of electric stimulation before and/or after intracytoplasmic sperm injection (ICSI) on bovine oocyte activation and embryo development. METHODS The oocytes were treated with electric shock before (B), before and after (B&A), and after (A) sperm injection. In each group, sham ICSI (ICSI-s) was performed to exclude the effect of parthenogenesis (B ICSI-s, B&A ICSI-s, and A ICSI-s). An electric pulse was applied with a single direct current (DC) pulse (0.8 kV/cm, 70 microseconds). RESULTS One pronucleus (PN) formation in the B&A ICSI-s group was slightly higher than that found in B and B&A ICSI group; however, the difference was not significant. Two PN formation in B&A ICSI group was higher than that found in sham ICSI groups (P < 0.05). There were no differences among treatment groups in the cleavage rate; however, morulae and blastocyst formation in the B&A embryos was significantly higher than that of other groups (P < 0.05) and got pregnant. CONCLUSIONS Electric stimulation before and after injection was an effective method in inducing bovine oocyte activation and in sustaining embryo development to the morulae and blastocyst stage.
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Affiliation(s)
- S Hwang
- Infertility Clinic, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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422
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Baines MG, Billingsley KA, De Fougerolles AR, Duclos AJ, Olney HJ, Pomerantz DK, Gendron RL. Evaluation of the role of exogenous pathogens on the incidence of embryo loss during early pregnancy in mice. J Reprod Immunol 1994; 26:17-30. [PMID: 8040834 PMCID: PMC7127243 DOI: 10.1016/0165-0378(93)00863-o] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The mating of CBA/j female mice (H2k) by DBA/2j male mice (H2d) typically results in an elevated incidence of spontaneous embryo loss thus providing an ideal genetically controlled laboratory model for the study of the factors causing early embryo loss during pregnancy. There is now considerable data on the cells and factors involved in fetal resorption but little is known about the events which activate this process. While the activation of the maternal response to the fetal implant could have endogenous or genetic origins, a role for exogenous factors including microbial pathogens could also be involved. In order to investigate these possibilities, the reproductive success of CBA/j female x DBA/2j male matings in a conventional animal care facility were compared with matings in a specific pathogen free (SPF) animal facility. All animals housed under these conditions were routinely screened by immunoassay and culture, for the presence of a number of viral and bacterial pathogens of mice. The incidence of spontaneous embryo loss in specific pathogen free CBA female mice mated by DBA and other male strains was found to be virtually identical to that of CBA female mice infected with multiple viral pathogens and housed under otherwise identical conditions (non-SPF). However, the numbers of implantation per pregnancy was significantly greater in an SPF facility. Therefore, exposure of mating mice to exogenous viral and bacterial pathogens did not appear to alter the overall incidence of spontaneous embryo resorption. It was concluded that the immunomodulatory effects of infection by common murine pathogens neither augmented nor reduced post-implantation embryo losses.
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Affiliation(s)
- M G Baines
- McGill University, Department of Microbiology, Montreal, Quebec, Canada
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