Perinatal hair cortisol concentrations linked to psychological distress and unpredicted birth complications

Maternal well-being and stress during the perinatal period have been hypothesized to influence birth outcomes and the postnatal development of offspring. In the present study, we explored whether hair cortisol concentration (HCC) was related to symptoms of psychological distress during the perinatal period and with unpredicted birth complications (UBCs). Surveys measuring symptoms of perceived stress, state/trait anxiety, and depression were collected from 53 participants (mean age = 31.1, SD = 4.04; 83% Caucasian, 17% other races) during the third trimester and again at two and six months after birth, 24.5% of which reported UBCs. In a subset of participants, we measured HCC in hair samples collected during the third trimester (27-39 weeks) and six months after birth. Compared to participants reporting normal births, those reporting UBCs had significantly elevated composite stress, anxiety, and depression (SAD) scores two months after birth, but scores decreased by six months postpartum. During the third trimester, HCC was positively associated with reported SAD scores, and HCC was elevated in participants reporting birth complications. Logistic regression showed HCC, but not SAD scores, predicted UBCs (p = 0.023, pseudo R2= 19.7%). Repeated measures MANOVA showed HCC varied over the perinatal period depending on both SAD scores reported at two months postpartum and the experience of UBCs; but when SAD scores reported at six months postpartum were included in the model, the association between HCC and SAD scores and the influence of UBCs was diminished. Although generalizability is limited by our relatively small, homogeneous sample, findings support a positive association between reported psychological distress and HCC during pregnancy and at two months postpartum. We also report a novel finding that chronically elevated cortisol concentrations during pregnancy were related to the risk of UBCs and remain elevated through the early postpartum period, suggesting the importance of monitoring both psychological distress and HCC during the perinatal period.

Medical Encounters and Treatment Outcomes in Ironman-Distance Triathlon

PURPOSE

This study aimed to examine the injury and illness characteristics, treatments, and outcomes at elite ultraendurance triathlon events.

METHODS

We quantified participant demographics, injury types, treatments, and disposition for medical encounters at 27 Ironman-distance triathlon championships from 1989 to 2019. We then calculated the likelihood of concurrent medical complaints in each encounter.

RESULTS

We analyzed 10,533 medical encounters among 49,530 race participants for a cumulative incidence of 221.9/1000 participants (95% confidence interval [CI] = 217.7-226.2). Younger (<35 yr; 259.3/1000, 95% CI = 251.6-267.2) and older athletes (70+ yr; 254.0/1000, 95% CI = 217.8-294.4) presented to the medical tent at higher rates than middle-age adults (36-69 yr; 180.1/1000, 95% CI = 175.4-185.0). Female athletes also presented at higher rates when compared with males (243.9/1000, 95% CI = 234.9-253.2 vs 198.0/1000, 95% CI = 193.4-202.6). The most common complaints were dehydration (438.7/1000, 95% CI = 426.2-451.6) and nausea (400.4/1000, 95% CI = 388.4-412.6). Intravenous fluid was the most common treatment (483/1000; 95% CI = 469.8-496.4). Of the athletes who received medical care, 116.7/1000 (95% CI = 110.1-123.4) did not finish the race, and 17.1/1000 (95% CI = 14.7-19.8) required hospital transport. Athletes rarely presented with an isolated medical condition unless their injury was dermatologic or musculoskeletal in nature.

CONCLUSIONS

Ultraendurance triathlon events have high rates of medical encounters among female athletes, as well as both younger and older age categories. Gastrointestinal and exertional-related symptoms are among the most common complaints. Intravenous infusions were the most common treatment after basic medical care. Most athletes entering the medical tent finished the race, and a small percentage were dispatched to the hospital. A more thorough understanding of common medical occurrences, including concurrent presentations and treatments, will allow for improved care and optimal race management.

Clinical presentation of exercise-associated hyponatremia in male and female IRONMAN® triathletes over three decades

PURPOSE

Exercise-associated hyponatremia (EAH) is common in ultra-endurance events and severe cases are more common in females. The purpose of this paper is to compare the clinical presentation of EAH between male and female triathletes in ultra-endurance competitions.

METHODS

Medical records with sodium concentrations (n = 3138) from the IRONMAN® World Championships over the timeframe of 1989-2019 were reviewed for both male (n = 2253) and female (n = 885) competitors. Logistic regression was used to explore the relationships between sex, sodium concentration, and various clinical presentations.

RESULTS

When comparing male and female triathletes, clinical variables found to have a different relationship with sodium concentration include altered mental status (inversely related in males and not related in females), abdominal pain, muscle cramps, hypotension, and tachycardia (directly related in males and not related in females), and vomiting and hypokalemia (not related in males and inversely related in females). Overall, males lost significantly more weight than females, and notably, approximately half of all athletes were dehydrated and lost weight.

CONCLUSIONS

Altered mental status, vomiting, abdominal pain, muscle cramps, hypotension, tachycardia, and hyperkalemia appear to present differently between sexes when comparing hyponatremic to eunatremic athletes. Although overhydration is the most common etiology of hypervolemic hyponatremia, hypovolemic hyponatremia comprises a significant amount of hyponatremic triathletes. Further understanding of how EAH presents helps athletes and medical professionals identify it early and prevent life-threatening complications.

Association of provider advice and gestational weight gain in twin pregnancies: a cross-sectional electronic survey

BACKGROUND

Little is known about patient-provider communication on gestational weight gain among women pregnant with twins, a growing population at high risk for adverse maternal and neonatal outcomes. We examined if women's report of provider advice on gestational weight gain was consistent with the Institute of Medicine (IOM) weight gain guidelines for twin pregnancies, and the association of provider advice on weight gain with women's weight gain during their twin pregnancy.

METHODS

We conducted a cross-sectional survey of 276 women who delivered twins and received prenatal care in the United States. The 2009 IOM provisional weight gain guidelines for twin pregnancies defined whether provider advice on weight gain and women's weight gain were below, within, or above guidelines. Multinomial logistic regression examined associations between provider advice on weight gain with women's weight gain, after adjustment for maternal age, gestational age at delivery, education, parity, twin type, use of assisted reproductive technologies and pre-pregnancy BMI category.

RESULTS

Approximately 30% of women described provider advice on weight gain below the IOM guidelines, 60% within, and 10% above guidelines. Compared to women who reported weight gain advice within guidelines, women who reported advice below guidelines or who reported no advice were 7.1 (95% CI: 3.2, 16.0) and 2.7 (95% CI: 1.3, 5.6) times more likely to gain less than recommended, respectively. Women who reported provider advice above guidelines were 4.6 (95% CI: 1.5, 14.2) times more likely to exceed guidelines.

CONCLUSIONS

Provider advice on gestational weight gain may be an important predictor of women's weight gain during twin pregnancies, highlighting the critical need for accurate provider counseling to optimize health outcomes.

An analysis of postpartum walking balance and the correlations to anthropometry

BACKGROUND

Falls caused by balance issues during pregnancy are quite common, and these issues can continue postpartum, potentially posing a danger to both the mother and baby. While there has been research on changes to walking gait during pregnancy, walking balance in the postpartum period has yet to be examined. Therefore, the aims of this study were to examine if balance changes persist in postpartum and the contribution of anthropometry changes.

METHODS

This was done through longitudinal observational cohort study at 16 and 40 weeks gestation and at four-week intervals postpartum. Balance was measured as lateral center of mass motion during treadmill walking, and recorded with motion capture cameras following anthropometric measurements. Balance variables were statistically analyzed to observe how they changed over time. Hierarchical regression analyses determined correlations between balance and anthropometry.

RESULTS

Balance was observed to improve significantly just following birth. Additionally, there were changes that continued to indicate improvement throughout the postpartum period. Anthropometry changes were significantly, but minimally, correlated with balance changes.

SIGNIFICANCE

Many women begin to return to normal activities soon after birth. With women participating in various forms of exercise, potentially rigorous work requirements, and tasks around the home, it is important that they, their medical providers, and employers understand and consider the continued risks of imbalance.

Provider advice on physical activity and nutrition in twin pregnancies: a cross-sectional electronic survey

Background

Health care providers should counsel pregnant patients on physical activity and nutrition to improve pregnancy outcomes. However, little is known about provider advice on these lifestyle behaviors among women pregnant with twins, a growing population at high risk for pregnancy complications. We examined the prevalence and content of provider advice on physical activity and nutrition among women pregnant with twins.

Methods

A cross-sectional electronic survey was administered to 276 women who delivered twins in the past 3 years and received prenatal care in the United States. The proportion of women reporting provider advice on physical activity and nutrition during prenatal visits (yes/no) was assessed and open-ended questions examined the content of provider advice. Bivariate differences in participant characteristics, stratified by provider advice on physical activity and nutrition (yes/no), were assessed. Responses from open-ended questions were examined using a content analysis approach to identify commonly reported advice on physical activity and nutrition.

Results

Approximately 75 and 63% of women reported provider advice on physical activity and nutrition, respectively, during their twin pregnancy. Women who recalled advice on physical activity most commonly reported recommendations to walk at a light to moderate intensity level. However, few women reported physical activity recommendations consistent with current guidelines, and approximately 55% of women reported provider advice to limit or restrict activity during their pregnancy, including bedrest. Nutrition advice was focused on eating a healthy, balanced diet and increasing protein intake. More women reported self-initiating the conversation on physical activity with their provider (40%) compared to nutrition (21%). Despite limited advice, 70% of women reported being satisfied or very satisfied with the information they received from their provider on physical activity or nutrition.

Conclusions

The majority of women reported provider advice on physical activity and nutrition during their twin pregnancies. However, advice was limited in detail, and physical activity levels were commonly restricted, despite the lack of evidence that activity restriction is beneficial during pregnancy. More research is needed to determine the optimal physical activity and dietary patterns in twin pregnancies to facilitate clear and consistent provider counseling on these lifestyle behaviors.

Walking for health during pregnancy: A literature review and considerations for future research

Walking is the most commonly chosen type of physical activity (PA) during pregnancy and provides several health benefits to both mother and child. National initiatives have promoted the importance of walking in general, but little emphasis is directed toward pregnant women, the majority of whom are insufficiently active. Pregnant women face a variety of dynamic barriers to a physically active lifestyle, some of which are more commonly experienced during specific times throughout the pregnancy experience. Walking is unique in that it appears resistant to a number of these barriers that limit other types of PA participation, and it can be meaningfully integrated into some transportation and occupational activities when leisure-time options are unavailable. Preliminary intervention work suggests that walking programs can be effectively adopted into a typical pregnancy lifestyle. However, a great deal of work remains to administer successful pregnancy walking interventions, including developing and using validated methods of PA and walking assessment. This narrative review discusses the unique advantages of walking during pregnancy, provides recommendations for future intervention work, and outlines the need for pregnancy-focused community walking initiatives. Standard search procedures were followed to determine sources from the literature specific to walking during pregnancy for use in each section of this review.

Walking balance on a treadmill changes during pregnancy

BACKGROUND

Altered standing balance during pregnancy has been previously reported. To date, body center of mass (bCOM) motion has not been used to track balance changes in this population. We recently compared three methods to determine the torso center of mass (tCOM) location (via force plate acquired center of pressure calculation, using Pavol surface anthropometry measurements, and a combination of the two) to use in calculating the bCOM during pregnancy.

RESEARCH QUESTION

This current research explored two questions: (1) does walking balance change during pregnancy, and (2) do the methods for identifying tCOM location affect the resulting balance measures?

METHODS

Fifteen pregnant women were recruited to perform 60-second trial of treadmill walking at 4-week intervals from 12 weeks gestation until delivery. Walking balance was measured as bCOM motion within the base of support. Gestation time and anthropometric model (force plate, Pavol, and combination) were repeated-measures independent variables in a general linear mixed model analysis.

RESULTS

There was a significant decrease in walking balance during pregnancy. As gestation progressed, we observed non-linear changes in the bCOM motion within the base of support over time, with some changes starting early in pregnancy and others not starting until late 2^nd trimester. The anthropometric model used to locate the bCOM significantly influences balance measures. The results of this study indicate that the force plate method is more appropriate for locating the tCOM in the anterior and lateral directions.

SIGNIFICANCE

The results of this study will inform clinicians and patients about the gestational stage-associated changes in balance during pregnancy that increase the risk of falling and injury. Researchers should also carefully consider the method for locating the bCOM.

Changes in collegiate ice hockey player anthropometrics and aerobic fitness over 3 decades

Over the past several decades, an increased emphasis on fitness training has emerged among collegiate ice hockey teams, with the objective of improving on-ice performance. However, it is unknown if this increase in training has translated over time into changes in the anthropometric and fitness profiles of collegiate ice hockey players. The purposes of this study were to describe anthropometric (height, weight, body mass index (BMI), percent body fat (%fat)) and aerobic fitness (peak oxygen consumption) characteristics of collegiate ice hockey players over a period of 36 years and to evaluate whether these characteristics differ among player positions. Anthropometric and physiologic data were obtained through preseason fitness testing of players (N = 279) from a National Collegiate Athletic Association Division I men's ice hockey team from the years 1980 through 2015. Changes over time in the anthropometric and physiologic variables were evaluated via regression analysis using linear and polynomial models, and differences among player positions were compared via ANOVA (p < 0.05). Regression analysis revealed that a cubic model best predicted changes in mean height (R² = 0.65), weight (R² = 0.77), and BMI (R² = 0.57), whereas a quadratic model best fit change in %fat by year (R² = 0.30). Little change was observed over time in the anthropometric characteristics. Defensemen were significantly taller than forwards (184.7 ± 12.1 vs. 181.3 ± 5.9 cm) (p = 0.007), and forwards had a higher relative peak oxygen consumption compared with defensemen (58.7 ± 4.7 vs. 57.2 ± 4.4 mL·kg^-1·min^-1) (p = 0.032). No significant differences were observed in %fat or weight by position. Although average player heights and weights fluctuated over time, increased emphasis on fitness training did not affect the athletes' relative aerobic fitness. Differences in height and aerobic fitness levels were observed among player positions.

Associations Among Work-Related and Leisure-Time Physical Activity With Level of Nausea During Pregnancy

Objective

Pregnancy-induced nausea and vomiting are common maladies during early pregnancy and may be related to physical activity (PA). Our objective was to determine relations among work-related PA (work PA), leisure-time physical activity (LTPA), and nausea during the first trimester.

Study design

Online or mailed surveys with questions on pregnancy-related nausea, work PA, and LTPA were completed by 70 women at 15 to 30 months postpartum. Women recalled nausea during the first trimester (none, ≤1 h/d, 2-3 h/d, 4-6 h/d, ≥6 h/d) as well as LTPA frequency, duration, and type. Women also recalled total working hours in their first trimester and percentage of time sitting, standing, and walking at work.

Results

A total of 42 women (60%) were categorized as having high nausea (≥2 h/d). Mann-Whitney U tests showed that women with low nausea had significantly more MET minutes per week of LTPA (P = .05) and hours per week spent standing at work (P = .03). Logistic regression analyses showed standing for ≥20 h/wk at work was related to reduced odds of high nausea (adjusted odds ratio = 0.23; 95% CI = 0.06-0.96), whereas meeting LTPA guidelines was nonsignificantly related to reduced odds.

Conclusion

These findings suggest an inverse relationship between first trimester PA and level of nausea. Further investigation is needed to determine the directionality of these relations.

Physiologic responses to running with a jogging stroller

The purpose of this study was to assess the effect of running with a jogging stroller (JS) on oxygen consumption (VO2), heart rate (HR), and rating of perceived exertion (RPE). This study included 2 parts: Part 1 involved participants (N=15) running on an indoor track and Part 2 involved participants (N=12) running on a paved greenway. All participants completed 6, one-mile trials randomized over 2 visits: 3 were completed at a predetermined pace (160.8 m·min (- 1)) without a JS (NoJS), with 11.36 kg in the JS (JS1), and 22.72 kg in the JS (JS2) and 3 were self-paced and included NoJS, JS1, and JS2. VO2 and HR were measured using a portable metabolic system and telemetry. Repeated measures ANOVAs were used to determine differences among conditions. Part 1, there were no differences in VO2 across conditions, but HR and RPE were significantly higher (P<0.05) during the JS trials compared to the NoJS trials. Part 2, VO2 and RPE during JS trials were higher than NoJS trials (P<0.05). No significant differences were found in HR. The results indicate that it is feasible to run while pushing a JS with minimal increases in exertion compared to running without a JS.

Accuracy of physical activity monitors in pregnant women

PURPOSE

To determine the step count accuracy of three pedometers and one accelerometer in pregnant women during treadmill walking.

METHODS

Participants were 30 women in the second or third trimester (20-34 wk) who were screened for pregnancy-related risk factors. Each participant was fitted with a belt containing three physical activity monitors: Yamax Digiwalker SW-200 (DW), New Lifestyles NL 2000 (NL), and GT3X ActiGraph accelerometer (ACT). The Omron HJ-720ITC (HJ) was placed in the pants' front pocket. Participants walked at 54, 67, 80, and 94 m · min for 2 min each. Actual steps were determined by an investigator using a hand-tally counter. The mean percent of steps recorded was calculated for each device at each speed and compared. Pearson correlations were used to determine the effect of body mass index and tilt angle on pedometer accuracy.

RESULTS

There was a significant interaction between speed and device (F9,20 = 7.574, P < 0.001). Across all speeds, the NL and HJ had the lowest error. The ACT and DW underestimated the actual steps taken, particularly at the slower walking speeds. At 54 m · min, the ACT averaged 77.5% of steps and the DW averaged 56.9% of steps. Significant differences in the mean percent of steps recorded were found between devices at all speeds. Body mass index was only significantly correlated with percent of steps recorded by the NL, and there were no significant correlations between steps recorded and tilt angle.

CONCLUSIONS

In pregnant women, the ACT and DW had more error than the NL and HJ. On the basis of these results, the NL and HJ should be considered for use in further research studies and physical activity programs that focus on walking during pregnancy.

Different tissue responses for iodine and iodide in rat thyroid and mammary glands

This research describes the effects of short-term elemental iodine (I2) and iodide (I-) replacement on thyroid glands and mammary glands of iodine-deficient (ID) Sprague-Dawley female rats. Iodine deficiency causes atypical tissue and physiologic changes in both glands. Tissue histopathology and the endocrine metabolic parameters, such as serum TT4, tissue and body weights, and vaginal smears, are compared. A moderate reduction in thyroid size from the ID control (IDC) was noted with both I- and I2, whereas serum total thyroxine approached the normal control with both I- and I2, but was lower in IDC. Thyroid gland IDC hyperplasia was reduced modestly with I2, but eliminated with I-. Lobular hyperplasia of the mammary glands decreased with I2 and increased with I- when compared with the IDC; extraductal secretions remained the same as IDC with I2, but increased with I-; and periductal fibrosis was markedly reduced with I2, but remained severe with I-. Thus, orally administered I2 or I- in trace doses with similar iodine availability caused different histopathological and endocrine patterns in thyroid and mammary glands of ID rats. The significance of this is that replacement therapy with various forms of iodine are tissue-specific.

Private security's challenge to police chiefs

The author discusses why police chiefs who have not yet given thought to developing a security partnership agenda should begin now. Partnerships, he says, should be cultivated between public police and private security.

Breaking with tradition

The author discusses why healthcare security directors need to find more creative and innovative ways of providing cost-efficient services. Non-traditional partnerships, he notes, are needed.