Birth Complications Research Articles

The predictive value of common symptoms in early pregnancy for complications later in pregnancy and at birth.

The aim was to investigate whether common pregnancy-related symptoms-nausea, vomiting, back pain, pelvic girdle pain, pelvic cavity pain, vaginal bleeding, itching of vulva, pregnancy itching, leg cramps, uterine contractions and varicose veins-in the first trimester of pregnancy add to the identification of women at high risk of future pregnancy and birth complications. Survey data linked to national register data. All women booking an appointment for a first prenatal visit in one of 192 randomly selected General Practices in East Denmark in the period April 2015-August 2016. The General Practices included 1491 women to this prospective study. Two outcomes, pregnancy complications and birth complications, were collected from the Danish Medical Birth Register. Among the 1413 included women, 199 (14%) experienced complications in later pregnancy. The most serious complication, miscarriage, was experienced by 65 women (4.6%). Other common pregnancy complications were gestational diabetes mellitus (n=11, 0.8%), gestational hypertension without proteinuria (n=34, 2.4%), mild to moderate preeclampsia (n=34, 2.4%) and gestational itching with effect on liver (n=17, 1.2%). Women who experienced pelvic girdle pain, pelvic cavity pain or vaginal bleeding in the first trimester of pregnancy had a higher risk of pregnancy complications later on in later pregnancy. None of the other examined symptoms showed associations to pregnancy complications. No associations were found between pregnancy-related physical symptoms in first trimester and birth complications. Symptoms in early pregnancy do not add much information about the risk of pregnancy or birth complications, although pain and bleeding may give reason for some concern. This is an important message to women experiencing these common symptoms and to their caregivers.

Birth preparedness and complication readiness practice and associated factors among pregnant women in Central Ethiopia, 2021: A cross-sectional study.

BackgroundBirth preparedness and complication readiness (BP/CR) is an intervention designated by the World Health Organization (WHO) as an essential element of the antenatal (ANC) package with a concept of a global strategy to reduce maternal mortality. In Ethiopia, the proportion of pregnant women preparing for birth and related complications has remained low. Whereas, the need for additional study is indicated to add more evidence to the country’s efforts to end preventable maternal death.MethodsA facility-based cross-sectional study was conducted from March 01 to May 01, 2021. A systematic random sampling technique was applied to recruit 422 pregnant women. Bivariable and multivariable binary logistic regression was fitted to identify factors associated with BP/CR practice. Variables with a p-value ≤ 0.25 on the bivariable analysis were included in multivariable analysis. Adjusted odds ratios (AOR) with the respective 95% confidence interval (CI) and a p-value <0.05 was used to set statistically significant variables in the multivariable analysis.ResultsA total of 414 pregnant women have participated in the study. The overall BP/CR practice level was 44.9% (95% CI: 40.1, 49.7). Preconception care utilization (PCC) (AOR = 2.31; 95% CI:1.38–3.86), urban residents (AOR = 2.00; 95% CI:1.21–3.31), knowledge of BP/CR (AOR = 2.29; 95% CI:1.27–3.47), knowledge of danger signs during pregnancy (AOR = 2.05; 95% CI:1.21–3.47), knowledge of danger signs in newborns (AOR = 2.06; 95% CI:1.21–3.47), starting ANC visits in the 1st and 2nd trimester (AOR = 2.52; 95% CI:1.40–4.52), number of ANC visit ≥ three (AOR = 1.66; 95% CI;1.01–2.74), knowing Expected Date of Delivery (EDD) (AOR = 3.71; 95% CI:2.01–6.82), and joint decision-making on obstetric services (AOR = 3.51; 95% CI;1.99–6.20) were factors significantly associated with BP/CR practice.ConclusionBased on the WHO standard, this study revealed a low level of BP/CR practice among pregnant women, with only less than half of women adequately prepared for childbirth and its complications. Moreover, it has been shown that BP/CR practice is influenced by socio-economic, maternal knowledge, and health service-related factors. Therefore, improving the status of BP/CR practice by expanding awareness creation opportunities, strengthening PCC and early ANC initiation by improving pregnant women’s understanding, and promoting joint decision-making on obstetric services are recommended.

23 Assessing the effects of introducing prophylactic hydrocortisone in extremely low gestational age infants in a tertiary Canadian NICU

Abstract Background Bronchopulmonary dysplasia (BPD) is a common complication of preterm birth. A large trial and a meta-analysis support the early use of physiologic doses of hydrocortisone to reduce the incidence of death or moderate/severe BPD. In 2019, this practice was introduced for all preterm infants &amp;lt;28 weeks gestational age (GA) at our university-affiliated tertiary care NICU. Objectives To determine the effect of prophylactic hydrocortisone on the incidence of survival with mild or no BPD in neonates born &amp;lt;28 weeks GA. Secondary objectives were to compare safety outcomes related to prophylactic hydrocortisone use: late onset sepsis, gastrointestinal perforation, severe intraventricular hemorrhage (IVH) and use of postnatal dexamethasone. Design/Methods We performed a retrospective cohort study of infants born &amp;lt;28 weeks GA admitted to our NICU during 2 epochs, before and after the implementation of prophylactic hydrocortisone. The primary objective was evaluated using logistic regression adjusted for GA. Safety outcomes were compared using chi-square or Fisher’s exact test. Results Epoch 1 included 76 infants and epoch 2 included 71 infants, of whom 63 (88.7%) received prophylactic hydrocortisone. Infants in the two epochs were similar in terms of median (IQR) GA 26.5 (25.0, 27.2) vs 26.7 (25.1, 27.1) weeks GA, mean (SD) weight at admission (882g +/- 212 vs 841g +/- 176), APGAR at 5 minutes, use of antenatal steroids and/or surfactant, and need for intubation at delivery (all p&amp;gt;0.5). Three infants were transferred to another hospital and their BPD status could not be determined. Adjusting for GA, there was a statistically non-significant signal for increased survival with mild or no BPD in epoch 2 (adjusted odds ratio 1.68, 95% CI 0.80, 3.59, p= 0.17) compared to epoch 1. The two epochs had similar incidence of late onset sepsis, gastrointestinal perforation and need for postnatal dexamethasone, however, in epoch 2, fewer infants developed grade 3/4 IVH on head ultrasound within the first two weeks of life (7/71, 9.9%) compared to epoch 1 (21/76, 27.6%, p= 0.01). Conclusion Prophylactic hydrocortisone may be associated with increased survival with mild or no BPD. Safety outcomes in both epochs were similar, but with a significantly decreased incidence of grade 3/4 IVH in the prophylactic hydrocortisone group. Larger cohort studies are required before a clear recommendation for prophylactic hydrocortisone can be made.

Bruno Schulz's 1933 Monograph: On the Hereditary Etiology of Schizophrenia.

In his 1933 article, Bruno Schulz reported a follow-up and reanalysis of the schizophrenic probands and their relatives first studied by Rüdin 20 years earlier that sought to clarify whether schizophrenia was a valid "unit-character" for Mendelian genetic analysis. He proposed a range of subgroupings of probands, particularly traditional subtyping, presence or absence of identifiable causal influences, and outcome. He then compared those subgroupings in several ways, most commonly by the risk for schizophrenia in their siblings and by the level of resemblance among proband-sibling affected pairs. Of his many findings, those of greatest interest included (1) probands with possible and probable physical causes, particularly those with head trauma, had substantially lower risk of illness in siblings, (2) probands with a hebephrenic subtype had a striking elevation of risk for schizophrenia in siblings, (3) probands with psychological causes had higher rates of good outcome, (4) proband-sibling pairs resembled one another for the classical schizophrenic subtypes, and (5) an absence of any cases of schizophrenia in siblings of a small group of schizophrenic probands with birth complications, convulsions, and skull deformities. Schulz used this sample in a fundamentally different way than Rüdin. Rather than seeking for Mendelian transmission patterns, Schulz used family data to evaluate hypothesis about clinical/etiological heterogeneity, thereby presaging many subsequent family studies of psychiatric disorders. While Schulz did not claim to have proved the etiologic heterogeneity of schizophrenia, he raised important questions, still unanswered, about whether schizophrenia is a legitimate "unit-character" appropriate for genetic analysis.

Impact of female obesity and assisted reproduction on uncomplicated pregnancies and healthy births: a study of 428 336 births in Flanders.

What is the impact of BMI on uncomplicated pregnancies and healthy births in women who did or did not have medically assisted reproduction (MAR, i.e. ART or hormonal stimulation without manipulation of eggs or embryos) in the Flanders region (Belgium)? Women with a higher BMI who use MAR are at the highest risk of pregnancy and birth complications. Medically assisted reproduction (MAR) is used increasingly worldwide and is associated with increased risk of adverse perinatal outcomes. Obesity is also increasing globally and obese women are more likely to seek MAR since obesity is associated with infertility. When obese women undergo MAR, the risk of adverse outcomes may be enhanced but it is not clear to what extent. We conducted a registry-based study using the data from the Study Centre for Perinatal epidemiology database for years 2009-2015, region of Flanders, Belgium. This included 428 336 women. The average age was 30.0 years (SD 4.78), 194 061 (45.31%) were nulliparous, and 6.3% (n = 26 971) conceived with MAR. We examined the association of BMI and MAR with the following composite primary outcomes: 'uncomplicated pregnancy and birth' and 'healthy baby'. We conducted Poisson regression and adjusted for maternal age, parity, gestational weight gain, smoking and previous caesarean section. In our study, 36.80% (n = 157 623) of women had an uncomplicated pregnancy and birth according to the definition used. The predicted probability of having an uncomplicated pregnancy and birth for women with a BMI of 25 kg/m2 who conceived spontaneously was 0.33 (0.32 to 0.35), while it was 0.28 (0.24 to 0.32) for women who used hormonal stimulation and 0.26 (0.22 to 0.29) for women who used IVF/ICSI. This probability reduced with increasing BMI category for both MAR and non-MAR users. For women with a BMI of 30 kg/m2, the predicted probability of having an uncomplicated pregnancy and birth was 0.28 (0.26 to 0.30) for women who conceived spontaneously, and 0.22 (0.16 to 0.29) and 0.20 (0.14 to 0.26) for women who used hormonal stimulation only or IVF/ICSI, respectively. The predicted probability of having a healthy baby for women with a BMI of 25 kg/m2 who conceived spontaneously was 0.92 (0.91 to 0.93), 0.89 (0.87 to 0.92) for women who used hormonal stimulation only and 0.85 (0.84 to 0.87) for women who used IVF/ICSI. The database did not include data on socio-economic status, pre-pregnancy morbidities and paternal BMI. Subsequently, we could not adjust for these factors in the analysis. Obese women who use MAR are at the highest risk of pregnancy and birth complications. This increase in interventions also has cost and resource implications which is relevant for funding policies. Weight loss interventions prior to MAR seem plausible but their (cost-) effectiveness needs urgent investigation. F.W. received an Erasmus Plus training grant to visit A.B., L.A. and R.D. and conducted this study during this visit. The authors have no competing interest to declare. N/A.

Association of Maternal and Neonatal Birth Outcomes With Subsequent Pediatric Transplants.

We identified maternal and neonatal birth characteristics that were associated with organ or tissue transplants during childhood. We designed a retrospective cohort study of the population of children born between 2006 and 2019 in Quebec, Canada. The exposure included birth complications such as congenital anomaly, neonatal blood transfusion, and oligohydramnios. The main outcome measure was organ or tissue transplantation before 14 y of age. We categorized transplants according to type (major organs versus superficial tissues). To determine the association of birth characteristics with risk of pediatric transplant, we estimated hazard ratios (HRs) and 95% confidence intervals (CIs) using Cox proportional hazards models adjusted for potential confounders. The cohort comprised 1 038 375 children with 7 712 678 person-years of follow-up, including 436 children who had transplants before 14 y of age. Birth complications were predominantly associated with major organ transplants. Congenital anomaly was associated with heart or lung (HR, 10.41; 95% CI, 5.33-20.33) and kidney transplants (HR, 13.69; 95% CI, 7.48-25.06), compared with no anomaly. Neonatal blood transfusion was associated with all major organ transplants, compared with no transfusion. Maternal complications were not as strongly associated with the risk of childhood transplant, although oligohydramnios was associated with 16.84 times (95% CI, 8.09-35.02) the risk of kidney transplant, compared with no oligohydramnios. Adverse birth outcomes such as congenital anomaly, neonatal blood transfusion, and maternal oligohydramnios are associated with a greater risk of transplantation before 14 y of age. Maternal and neonatal birth outcomes may be useful predictors of transplantation.

Delivery decision in pregnant women rescued by ECMO for severe ARDS: a retrospective multicenter cohort study

BackgroundAlthough rarely addressed in the literature, a key question in the care of critically pregnant women with severe acute respiratory distress syndrome (ARDS), especially at the time of extracorporeal membrane oxygenation (ECMO) decision, is whether delivery might substantially improve the mother’s and child’s conditions. This multicenter, retrospective cohort aims to report maternal and fetal short- and long-term outcomes of pregnant women with ECMO-rescued severe ARDS according to the timing of the delivery decision taken before or after ECMO cannulation.MethodsWe included critically ill women with ongoing pregnancy or within 15 days after a maternal/child-rescue-aimed delivery supported by ECMO for a severe ARDS between October 2009 and August 2021 in four ECMO centers. Clinical characteristics, critical care management, complications, and hospital discharge status for both mothers and children were collected. Long-term outcomes and premature birth complications were assessed.ResultsAmong 563 women on venovenous ECMO during the study period, 11 were cannulated during an ongoing pregnancy at a median (range) of 25 (21–29) gestational weeks, and 13 after an emergency delivery performed at 32 (17–39) weeks of gestation. Pre-ECMO PaO2/FiO2 ratio was 57 (26–98) and did not differ between the two groups. Patients on ECMO after delivery reported more major bleeding (46 vs. 18%, p = 0.05) than those with ongoing pregnancy. Overall, the maternal hospital survival was 88%, which was not different between the two groups. Four (36%) of pregnant women had a spontaneous expulsion on ECMO, and fetal survival was higher when ECMO was set after delivery (92% vs. 55%, p = 0.03). Among newborns alive, no severe preterm morbidity or long-term sequelae were reported.ConclusionContinuation of the pregnancy on ECMO support carries a significant risk of fetal death while improving prematurity-related morbidity in alive newborns with no difference in maternal outcomes. Decisions regarding timing, place, and mode of delivery should be taken and regularly (re)assess by a multidisciplinary team in experienced ECMO centers.

Preterm births and deaths: from counting to classification

One in ten babies worldwide is born before completing 37 weeks of gestation, resulting in 15 million preterm births every year.1 Preterm birth and related complications cause 1 million child deaths every year. Many others suffer from prematurity-related morbidities and resultant long-term adverse effects on nutritional status, brain development, and lung functions. The incidence of preterm birth is increasing in many regions of the world.2 However, strategies to prevent preterm birth and improve the evidence-based care of neonates need to recognise that preterm birth is not a single disease but an umbrella term used to describe a health status resulting from a multitude of known and unknown environmental and genetic factors.

Regulation of skeletal muscle protein synthesis in the preterm pig by intermittent leucine pulses during continuous parenteral feeding.

Extrauterine growth restriction is a common complication of preterm birth. Leucine (Leu) is an agonist for the mechanistic target of rapamycin (mTOR) complex 1 (mTORC1) signaling pathway that regulates translation initiation and protein synthesis in skeletal muscle. Previously, we showed that intermittent intravenous pulses of Leu to neonatal pigs born at term receiving continuous enteral nutrition increases muscle protein synthesis and lean mass accretion. Our objective was to determine the impact of intermittent intravenous pulses of Leu on muscle protein anabolism in preterm neonatal pigs administered continuous parenteral nutrition. Following preterm delivery (on day 105 of 115 gestation), pigs were fitted with umbilical artery and jugular vein catheters and provided continuous parenteral nutrition. Four days after birth, pigs were assigned to receive intermittent Leu (1600 µmol kg-1 h-1 ; n = 8) or alanine (1600 µmol kg-1 h-1 ; n = 8) parenteral pulses every 4 h for 28 h. Anabolic signaling and fractional protein synthesis were determined in skeletal muscle. Leu concentration in the longissimus dorsi and gastrocnemius muscles increased in the leucine (LEU) group compared with the alanine (ALA) group (P < 0.0001). Despite the Leu-induced disruption of the Sestrin2·GATOR2 complex, which inhibits mTORC1 activation, in these muscles (P < 0.01), the abundance of mTOR·RagA and mTOR·RagC was not different. Accordingly, mTORC1-dependent activation of 4EBP1, S6K1, eIF4E·eIF4G, and protein synthesis were not different in any muscle between the LEU and ALA groups. Intermittent pulses of Leu do not enhance muscle protein anabolism in preterm pigs supplied continuous parenteral nutrition.

The Association of Avoidance Coping with Gestational Weight Gain among Pregnant Black Women.

Gestational weight gain (GWG) outside recommended parameters can lead to pregnancy or birth complications. Avoidance coping may influence GWG. We examined the association of avoidance coping with GWG among a sample of 112 pregnant Black women in the Midwest. Participants completed avoidance coping questionnaires at three time points throughout pregnancy. Data were abstracted from medical records for BMI and GWG. Overall, 23.2% gained inadequate weight, 30.4% adequate weight, and 46.4% excess weight. Multinomial logistic regression models indicated associations between avoidance coping and GWG adjusted for covariates. Participants with higher avoidance coping scores at 22-29 weeks' gestation were more likely to experience excess weight gain (odds ratio [OR] = 1.19, 95% CI [1.02, 1.37]). Participants with higher avoidance coping scores at 30-36 weeks' gestation were less likely to experience excess weight gain, (OR = 0.82, 95% CI [0.72, 0.93]). The impact of higher avoidance coping on excess weight gain depends on the time period in pregnancy.

Birth Preparedness and Complication Readiness among Women Within Reproductive Age in Mukura Sub County in Ngora District Eastern Uganda

Ngora district had a total of 3,248 under-five deaths in 2015 (Reproductive maternal newborn and child health report (2015). Ngora Fredica hospital registered 5 maternal deaths on September 6 and 11 in November in 2016. In total 22 maternal deaths in 3 months, 5 deaths are from Nora sub-county with high number of women with morbidity such as foot drop, ill health, maternal exhaustion, and fistulas. The purpose of the study was to assess factors that influence birth preparedness and complications readiness among community women of child-bearing age (15-49 years). Bivariate analysis with an unadjusted odds ratio at a 95% confidence level was performed to determine the factors that were associated with birth preparedness and complication readiness among women within reproductive age. Age (15-19 years COR = 1.68, p-value 0.000), Education level (no formal education COR = 6.1, p-value 0.000), Occupation (housewife not working COR = 4.58, p-value 0.000), Marital status (Single mothers COR = 2.60, p-value 0.000), Number of children (more than 6 children COR = 2.95, p-value 0.000), Distance to the health facility (Not walkable COR = 5.29, p-value 0.000), Cost of transport to the health facility (Not affordable COR = 4.91, p-value 0.010), Perceptions COR = 6.14, p-value 0.000, Knowledge (lack of knowledge on dander signs of birth complications COR = 3.19, p-value 0.000, Practice (not attending ANC COR = 2.95, p-value 0.000) and Practice (delivering from home COR = 3.80, p-value 0.006). Keywords: Birth preparedness, Birth Complication readiness, Reproductive age.

Observing the Maternal Complications and Fetal Morbidity and Mortality of Preterm Birth

Introduction: Preterm labor is one of the clinical events that can change a normal pregnancy into a high-risk one for both the mother and the fetus. Preterm labors are thought to be caused by a combination of factors, including decidual bleeding and uterine deformation. Aim of the Study: The aim of the study was to observe the maternal complications of preterm birth. Methods: This cross-sectional study was conducted at the Department of Obstetrics and Gynecology, Chittagong Medical College Hospital, Bangladesh. The study duration was 6 months, from January to June of 2015. Purposive sampling method was used to select a total of 100 women from those admitted at the study hospital for deliveries according to inclusion and exclusion criteria. Result: Most of the patients were from the third decade of life. Majority (61.0%) patients had multi para. Majority (39.0%) patients were gestational age 34 weeks. More than half (53.0%) had infection, among which urinary tract infection were the most common. Neonatal death was 61%, and most common cause of neonatal death was septicemia, followed by respiratory distress syndrome. Conclusion: Most of the patients were in 3rd decade of life, and did not receive regular antenatal check-up. Infection and pre-eclampsia were the most common maternal complications, while respiratory distress syndrome was the most common perinatal morbidity. Septicemia and respiratory distress syndrome were the most common cause of perinatal death.

Neuropsychiatric Aspects of Congenital and Genetic Disorders

Neuropsychiatry is an area of medicine that deals with behavioural issues caused by brain dysfunction. It is found at the intersection of neurology and psychiatry. Individuals with congenital and genetic diseases are more likely to experience neuropsychiatric symptoms (particularly mental retardation), which can lead to considerable disability and a lower quality of life. Developmental delay, intellectual disability, autism spectrum disorders (ASDs), and cognitive dysfunction are the most common symptoms of neuropsychiatric illnesses. Many intellectual developmental abnormalities are caused by complex genetic components (such as attention deficit hyperactivity disorder), pregnancy or birth complications, or environmental variables, among other things. Patients with congenital and genetic diseases with neuropsychiatric indications benefit from a multidisciplinary approach to management. Interdepartmental liaisoning may be advantageous in the absence of a multidisciplinary team.

Pregnancy Complications in Pandemics: Is Pregnancy-Related Anxiety a Possible Physiological Risk Factor?

Background: Birth and pregnancy complications increased by 10.2% during the 2019 coronavirus (COVID-19) pandemic. Pregnant women are at high risk for anxiety, which might trigger physio-logical stress, leading to pregnancy complications. Aim: This study aimed to investigate factors leading to antenatal anxiety during the COVID-19 pandemic. We also aimed to discuss our find-ings with regard to the current literature about pregnancy complications. Methods: This cross-sectional study interviewed 377 pregnant women and assessed anxiety using a validated 7-item general anxiety disorder (GAD-7) scale. Anxiety was related to physiological and demo-graphic parameters. Anxiety was subdivided into pandemic- and pregnancy-related anxiety to minimize results bias. Results: Our results showed that 75.3% of pregnant women were anxious. The mean GAD-7 score was 8.28 ± 5. Linear regression analysis showed that for every increase in the number of previous pregnancies, there was a 1.3 increase in anxiety level (p < 0.001). Women with no previous miscarriages were more anxious (p < 0.001). Surprisingly, pregnant women who were previously infected with COVID-19 were 6% less stressed. Pregnant women with comorbid-ities were more stressed (p < 0.001). Low income (p < 0.001) and age (p < 0.05) were the demo-graphic factors most significantly related to increased anxiety. Conclusions: The prevalence of pregnancy-related anxiety increased threefold in Saudi Arabia due to the COVID-19 pandemic. Healthcare support should be available remotely during pandemics; pregnant women (especially those with comorbidities) should be educated about the risks of infection and complications to prevent anxiety-related complications during pregnancy.

Mekonyumlu Gebeliklerde Doğum Eyleminin ve Sonuçlarının Değerlendirilmesi: Prospektif Kohort Çalışması

Background: The aim of this study was to determine the risk factors for meconium-stained amniotic fluid in a low-risk pregnancy and to evaluate birth complications and neonatal outcomes in deliveries with meconium-stained amniotic fluid (MSAF).&#x0D; Material and Methods: This prospective study was conducted between April 2015 and September 2015 at Ankara Zekai Tahir Burak Women’s Health Education and Research Hospital. 351 women with singleton pregnancies and cephalic position who had reached 37 weeks of gestation were included in the study. Women with known chronic systemic diseases, pregnancy complications, and previous uterine surgery were excluded. 151 cases with MSAF and 200 randomly selected control cases with clear amniotic fluid were included in this study. We compared the two groups in terms of maternal age, gravidity, parity, gestational age, intrapartum maternal fever, body mass index (BMI), duration of labor, cardiotocographic values (CTG), mode of delivery, neonatal outcomes, and admission to the neonatal intensive care unit.&#x0D; Results: In our study, meconium aspiration syndrome (MAS) developed in 2.6% (4/151) of neonates with meconium staining at birth. Gestational age, intrapartum maternal fever and BMI were significantly increased in the MSAF group (p=0.003). The duration of the active phase of labor (cervical dilation from 6 cm to 10 cm) was similar in both groups, and the duration of the second phase of labor was longer in the MSAF group (p=0.002). MSAF was associated with an increased number of abnormal results in cardiotocographic examinations, birth complications, and neonatal outcome (p &lt; 0.001).&#x0D; Conclusion: Deliveries with meconium-stained amniotic fluid are associated with increased morbidity; therefore, intrapartum examinations should be performed more frequently and carefully, and precautions should be taken during labor in collaboration with pediatricians to reduce potential adverse neonatal outcomes.

255 Leucine Supplementation During Continuous Feeding Enhances Lean Growth in a Preterm Piglet Model

Abstract Extrauterine growth restriction is a common complication of preterm birth and is associated with reduced lean growth and long-term morbidities. We previously showed that intermittent pulses of leucine during continuous orogastric feeding increases mTORC1 signaling to protein synthesis in skeletal muscle of neonatal pigs born at term. The objective of this study was to determine the extent to which leucine pulses during continuous feeding would promote lean growth by enhancing mTORC1 signaling in a preterm piglet model. Pigs delivered by cesarean section at 105 d gestation were continuously fed a protein and energy balanced milk-replacer diet [195 kcal ME and 13.5 g protein (kg body weight; BW)-1·d-1)]. Pigs (n=11-12) were randomly assigned to Leucine (LEU) or Alanine (ALA, isonitrogenous control) groups and treatments were administered as a pulse (1.6 mmol·kg BW-1·h-1) for 1 h every 4 h for 21 d. Body composition was determined by DXA and indices of amino acid signaling and mTORC1 activation were determined postprandially, 60 min after initiation of the last pulse. LEU pigs had a 10% greater average daily gain (ADG) (P &amp;lt; 0.05) than ALA pigs. Total lean mass tended to be greater (+13%; P &amp;lt; 0.06) in LEU compared with ALA, and longissimus dorsi muscle weight was 17% heavier in LEU than ALA pigs (P=0.01). Indices of mTORC1 activation, i.e., phosphorylation of S6K1 and 4EBP1 and abundance of the eIF4E-eIF4G complex, were increased in longissimus dorsi and gastrocnemius muscle of LEU compared with ALA pigs (P &amp;lt; 0.05). These results show that leucine supplementation during continuous feeding enhances mTORC1-activated translation initiation in skeletal muscle leading to an increase in muscle mass and lean growth in a preterm piglet model. Research was supported by NIH and USDA.

Obstetric Simulation Training to Breech Delivery, Shoulder Dystocia, Forceps, and Vacuum Experience

OBJECTIVES: This study aimed to create a simulation model in shoulder dystocia, breech delivery, and vacuum forceps applications, and to show the effect of education on the knowledge-skill level of the individuals involved. STUDY DESIGN: This prospective cohort research was conducted among assistant doctors and midwives. The course was held in the simulation center by creating 4 different scenarios. The steps of each maneuver were determined separately. Performance was evaluated on a five-point Likert-type scale between 1-5 points before and after training. A higher score was considered higher proficiency in the subject. RESULTS: Of the participants in the study, 51.4% (n=19) of 37 were doctors. The post-training scores obtained from each step of the shoulder dystocia maneuvers, breech birth maneuver, forceps application, and vacuum application were statistically significantly higher than the pre-training scores (p&lt;0.001). The change in the post-training skill scores of the physicians was significantly higher than that of the midwives (p&lt;0.001). Post-training, 67.9% of the participants thought that the simulation training was a great help in transforming their theoretical knowledge into practice. CONCLUSION: Breech delivery, shoulder dystocia, forceps, and vacuum applications are difficult subjects to education in obstetrics. In these pieces of training, simulation should be used as a training method in obstetric education and integrated into the curriculum. We believe that giving and disseminating an effective and accessible simulation protocol to healthcare professionals can reduce birth complications.

Alcohol exposure prior to pregnancy-does hazardous consumption affect placenta- and inflammatory-mediated pregnancy outcomes? A Swedish population-based cohort study.

Alcohol consumption during pregnancy is related to severe birth complications such as low birthweight, preterm birth and birth defects. During the last decade, the Alcohol Use Disorders Identification Test (AUDIT) has been used as a screening tool in Swedish maternal healthcare units to identify hazardous, pre-pregnancy alcohol use. However, evaluation of the screening with AUDIT, as well as adverse maternal or neonatal outcomes, has not been assessed at a national level. This was a population-based cohort study of 530 458 births from 2013 to 2018 using demographic, reproductive and maternal health data from the Swedish Pregnancy Register. Self-reported alcohol consumption in the year before pregnancy, measured as AUDIT scores, was categorized into moderate (6-13 points) and high-risk (14-40 points) consumption, with low-risk (0-5 points) consumption as the reference group. Associations with pregnancy- and birth outcomes were explored with logistic regressions using generalized estimating equation models, adjusting for maternal and socioeconomic characteristics. Estimates are presented as adjusted odds ratios (aORs) with 95% confidence intervals (CIs). High-risk and moderate pre-pregnancy alcohol consumption was associated with preeclampsia, preterm birth and birth of an infant small for gestational age (SGA), but these associations were nonsignificant after adjustments. Prior moderate-risk (aOR 1.29, 95% CI 1.17-1.42) and high-risk consumption (aOR 1.62, 95% CI 1.17-2.25) increased the likelihood of intrapartum and neonatal infections. Apart from identifying hazardous alcohol consumption prior to pregnancy and the offer of counseling, screening with the AUDIT in early pregnancy indicates a high risk of inflammatory-/placenta-mediated pregnancy and birth outcomes. For most outcomes, AUDIT was not an independent contributor when adjusting for confounding factors. Hazardous alcohol use prior to pregnancy was independently linked to intrapartum and neonatal infections; conditions associated with morbidity and long-term sequalae. These associations may be explained by alcohol-induced changes in the maternal or fetal immune system in early pregnancy or persistent alcohol intake during pregnancy, or may depend on unidentified confounding factors.

BLOSSoM: Improving Human Milk Provision in Preterm Infants Through Texting Support.

Introduction:Mother’s own milk (MOM) reduces complications of preterm birth. Despite high initiation rates of expression, half of preterm infants do not receive MOM at discharge. Frequent outreach and a short message service (SMS) have improved MOM provision in term dyads. We aimed to improve MOM provision rate from 61% to >80% by implementing standardized lactation education and Breastfeeding & Lactation Outreach via SMS Supporting Mothers (BLOSSoM).Methods:The baseline period was June 2019 to April 2020. A multidisciplinary team implemented PDSA cycles: education/documentation (standardized lactation education and education documentation, May 2020–April 2021), and BLOSSoM (SMS program providing educational texts/videos, reminders, 2-way communication with neonatal intensive care unit (NICU) lactation, May 2021–December 2021). The primary outcome was MOM provision at NICU discharge/transfer for infants younger than 34 weeks, as analyzed on the SPC chart. BLOSSoM participants evaluated the program using a 5-point Likert scale.Results:Demographic and clinical characteristics were unchanged among the three periods. However, the monthly MOM provision rate improved from 61% to 81%. Eighty-seven percent of BLOSSoM participants completed the evaluation with 83% rating the program most supportive, 78% rating the videos as the most helpful, followed by team check-ins (54%) and 2-way texting (24%).Conclusions:Using a multidisciplinary approach, we improved the monthly MOM provision rate at discharge/transfer for preterm infants. SMS providing educational texts/media and 2-way communication supporting lactating NICU mothers was critical to our success. Providing another method of communication through SMS was well accepted and valued by the majority.

Recovery of pelvic floor muscle strength and endurance 6 and 12 months postpartum in primiparous women—a prospective cohort study

Introduction and hypothesisTo date there has been scant knowledge on the natural recovery of the pelvic floor muscles (PFMs) after childbirth. The aims of the present study were to investigate whether PFM variables at 6 and 12 months postpartum had returned to mid-pregnancy levels and assess risk factors for reduced recovery at 12 months postpartum.MethodsThis was a prospective cohort study following 235 nulliparous pregnant women from mid-pregnancy to 12 months postpartum. Vaginal resting pressure (VRP), PFM strength and endurance were assessed by manometry at 22 weeks, 6 and 12 months postpartum. Multiple linear regression was used to address factors influencing PFM variables beyond birth mode.ResultsCesarean section was protective for change in PFM variables. From mid-pregnancy to 12 months postpartum there was a 20% reduction in VRP (p<0.001) and a 7.5 % reduction in PFM strength (p=0.007), and an increase of 9% in PFM endurance (p=0.002) in the normal vaginal birth. The instrumental vaginal group had a decline in VRP of 21% (p<0.001) and PFM strength of 15% (p=0.011), but no significant change in PFM endurance. Higher BMI at 12 months postpartum, longer second stage of labor, and major tears of the levator ani muscle had a negative influence on the PFM recovery beyond delivery mode.ConclusionsAt 12 months postpartum following vaginal delivery, the PFMs are not fully recovered compared with mid-pregnancy values. More follow-up physical therapy may be warranted in the postpartum period, especially for women with complicated vaginal births and higher BMI.