Early Pregnancy Study Research Articles

Maternal neonatal outcome in relation to placental location, dimensions in early pregnancy

Background: Placenta, which is the vital link between mother and fetus, is critical for maternal neonatal well-being. Its study in early pregnancy may provide information about maternal neonatal disorders. Aim: The study aimed to evaluate the relationship of placental location and dimensions in early pregnancy with maternal neonatal outcomes. Subjects and Methods: Primigravida (801) with singleton pregnancy at 10-weeks gestation and no past/present medical and obstetric disorder had ultrasonography for placental location and dimensions and were followed by ultrasonographic (USG) examination (at 20th week and 30th week), clinically for maternal-neonatal outcome. Statistical analysis was done by Epi 6 software (version 6.0, developed by Centres for Disease Control and Prevention, Atlanta, Georgia, USA) using Chi-square test and Fischer exact test for determining the statistical significance of the observations. P values of 55 cm2 6.8% (13/190), had hypertensive disorders. area 55 cm2 3.7% (7/190) had placental abruption. With thick placenta, 39.2% (58/148), thin, 9.4% (9/96), and normal placenta, 5.2% (29/562) had hypertensive disorders. With thick, 11.5% (17/148), thin 16.7% (16/96), and normal placenta 2.7% (15/562) had placental abruption. With anterior 0.5% (1/200), posterior 14.6% (18/123), fundal placenta 10.55% had preterm births. With anterior 7.5% (15/200), posterior 23.6% (29/123), fundal placenta 18% (58/322) had CS.With placental surface area 55 cm2 14% (28/200) had CS. With thin 27% (25/91), with thick 36.1% (53/148), with normal placenta none had CS for fetal distress. Conclusions: Study of placental location and dimensions in early pregnancy is useful in identifying risks. Keywords: Dimensions, early pregnancy, location, maternal-neonatal outcome, placenta

The onset, recurrence and associated obstetric risk factors for urinary incontinence in the first 18 months after a first birth: an Australian nulliparous cohort study

To investigate the contribution of obstetric risk factors to persistent urinary incontinence (UI) between 4 and 18 months postpartum. Prospective pregnancy cohort. Six metropolitan public hospitals in Victoria, Australia. A total of 1507 nulliparous women recruited to the Maternal Health Study in early pregnancy (≤24 weeks of gestation). Data from hospital records and self-administered questionnaires/telephone interviews at ≤24 and 30-32 weeks of gestation and at 3, 6, 9, 12 and 18 months postpartum analysed using logistic regression. Persistent UI 4-18 months postpartum in women continent before pregnancy. Of the women who were continent before pregnancy, 44% reported UI 4-18 months postpartum, and 25% reported persistent UI (symptoms at multiple follow ups). Compared with spontaneous vaginal birth, women who had a caesarean before labour (adjusted odds ratio [aOR] 0.4, 95% confidence interval [95% CI] 0.2-0.9), in first-stage labour (aOR 0.4, 95% CI 0.2-0.6) or in second-stage labour (aOR 0.4, 95% CI 0.2-1.0) were less likely to report persistent UI 4-18 months postpartum. Prolonged second-stage labour in women who had an operative vaginal birth was associated with increased likelihood of UI (aOR 2.5, 95% CI 1.3-4.6). Compared with women who were continent in pregnancy, women reporting UI in pregnancy had a seven-fold increase in odds of persistent UI (aOR 7.4, 95% CI 5.1-10.7). Persistent UI is common after childbirth and is more likely following prolonged labour in combination with operative vaginal birth. The majority of women reporting persistent UI at 4-18 months postpartum also experienced symptoms in pregnancy.

Female overweight is not associated with a higher embryo euploidy rate in first trimester miscarriages karyotyped by hysteroembryoscopy

Overweight women (body mass index ≥ 25 kg/m(2)) present an embryo euploidy rate in first trimester miscarriages similar to normoweight controls after a selective biopsy and karyotyping of embryo and/or chorion samples taken by hysteroembryoscopy.

Effects of prolonged second stage, method of birth, timing of caesarean section and other obstetric risk factors on postnatal urinary incontinence: an Australian nulliparous cohort study

To investigate the contribution of prolonged labour, method of birth, timing of caesarean section and other obstetric risk factors to postpartum urinary incontinence. Prospective pregnancy cohort. Six metropolitan public hospitals in Victoria, Australia. A total of 1507 nulliparous women recruited to the maternal health study in early pregnancy (≤24 weeks). Data from hospital medical records and self-administered questionnaires/telephone interviews at ≤24 and 30-32 weeks of gestation and 3 months postpartum analysed using univariable and multivariable logistic regression. Urinary incontinence 3 months postpartum in women continent before the index pregnancy. Of the women continent before pregnancy, 26% reported new incontinence at 3 months postpartum. Compared with women who had a spontaneous vaginal birth, women who had a caesarean section before labour (adjusted odds ratio [OR] 0.2, 95% CI 0.1-0.5) or in the first stage of labour (adjusted OR 0.2, 95% CI 0.1-0.4) were less likely to be incontinent 3 months postpartum. Adjusted OR for incontinence after caesarean section in the second stage of labour compared with spontaneous vaginal birth was 0.5 (95% CI 0.2-1.0). Prolonged second stage labour was associated with increased likelihood of postpartum incontinence in women who had a spontaneous vaginal birth (adjusted OR 1.9, 95% CI 1.1-3.4) or operative vaginal birth (adjusted OR 1.7, 95% CI 1.0-2.8). In addition to pregnancy itself, physiological changes associated with the second stage of labour appear to play a role in postpartum urinary incontinence.

The association of maternal factors with delayed implantation and the initial rise of urinary human chorionic gonadotrophin

BACKGROUND Late implantation and the pattern of early rise in hCG have been associated with early pregnancy loss. We explored factors that might be predictive of these markers of poor embryonic health in spontaneously conceived pregnancies. METHODS Participants in the North Carolina Early Pregnancy Study collected daily first-morning urine specimens while attempting to conceive. Samples were assayed for estrogen and progesterone metabolites (to identify day of ovulation) and hCG (to detect conception). Data were available for 190 pregnancies, 48 of which ended in early loss (within 6 weeks of the last menstrual period). We used logistic regression to identify characteristics associated with late implantation (≥10 days post-ovulation). For pregnancies surviving at least 6 weeks (n= 142), we used linear mixed models to identify factors associated with variations in hCG rise in the first 7 days from detection. RESULTS Later implantation was associated with current maternal smoking [odds ratio (OR): 5.7; 95% confidence interval (CI): 1.1-30] and with oocytes that were likely to have been fertilized late in their post-ovulatory lifespan (OR: 5.1; CI: 1.9-16). Older women had a faster rise in hCG (P= 0.01), as did women who had relatively late menarche (P for trend = 0.02). Women exposed in utero to diethylstilbestrol showed an unusual pattern of slow initial hCG rise followed by a fast increase, a pattern significantly different from that of unexposed women (P= 0.002). CONCLUSIONS Although limited by small numbers and infrequent exposures, our analyses suggest that a woman's exposures both early in life and at the time of pregnancy may influence early development of the conceptus.

M15.5 Proteinuria in early pregnancy study

M15.5 Proteinuria in early pregnancy study

Effects of early pregnancy loss on hormone levels in the subsequent menstrual cycle

Previous studies of hormone patterns after clinical miscarriage suggest reduced pituitary function. Hormonal effects of very early pregnancy loss (before 6 weeks gestation) have not been described. We used within-woman differences between menstrual cycles in urinary hormone measurements from women in the North Carolina Early Pregnancy Study to describe hormonal changes after very early pregnancy loss (n = 28 early losses; 80 non-conception comparison cycles). We found lower pre-ovulatory luteinising hormone and shorter luteal phase length after very early pregnancy loss, but the differences were non-significant (p > 0.3) and smaller than those reported in the spontaneous miscarriage literature. Consistent with the reduced pituitary function reported post-spontaneous miscarriage, we found a slower rate of oestrogen rise (p = 0.08). There was no evidence of lower mid-luteal steroid levels as has been suggested for post-spontaneous miscarriage cycles. Very early pregnancy losses do not appear to influence subsequent menstrual cycles to the same degree as spontaneous miscarriages.

Lumbopelvic pain associated with catastrophizing and fear‐avoidance beliefs in early pregnancy

To examine and compare levels of catastrophizing, fear-avoidance beliefs, physical ability, and health-related quality of life in women with and without lumbopelvic pain (LP and NLP) in early pregnancy. A cross-sectional study of early pregnancy. Five midwife clinics, one in the center, two in the outskirts of Stockholm, and two in a medium-sized town. Three hundred and twenty-four women in the 19th-21st week of pregnancy. Questionnaires. The Pain Catastrophizing Scale of exaggerated negative thoughts about pain experiences, the Fear-Avoidance Beliefs Questionnaire of beliefs about how physical activity and work affect back pain, the Disability Rating Index of physical ability, and the Nottingham Health Profile to assess health-related quality of life. Two groups were defined: LP (n=141) and NLP (n=183). The Mann-Whitney U-test was used for comparisons. Pregnant women with LP had significantly (p<0.05) higher levels of exaggerated negative thoughts and fear-avoidance beliefs. They also had lower physical ability and health-related quality of life compared to women in the NLP group. It is important to consider exaggerated negative thoughts about pain experiences and fear-avoidance beliefs when treating women with LP during pregnancy and to be aware of the great impact lumbopelvic pain has on women's lives during early pregnancy.

Bayesian Semiparametric Joint Models for Functional Predictors

Motivated by the need to understand and predict early pregnancy loss using hormonal indicators of pregnancy health, this article proposes a semiparametric Bayesian approach for assessing the relationship between functional predictors and a response. A multivariate adaptive spline model is used to describe the functional predictors, and a generalized linear model with a random intercept describes the response. Through specifying the random intercept to follow a Dirichlet process jointly with the random spline coefficients, we obtain a procedure that clusters trajectories according to shape and according to the parameters of the response model for each cluster. This very flexible method allows for the incorporation of covariates in the models for both the response and the trajectory. We apply the method to postovulatory progesterone data from the Early Pregnancy Study and find that the model successfully predicts early pregnancy loss.

Second‐trimester routine ultrasound screening: expectations and experiences in a nationwide Swedish sample

To investigate, in a large nationwide Swedish sample, pregnant women's expectations of the routine second-trimester ultrasound examination, with participants expressing themselves in their own words, and to determine whether they had been given sufficient information about why and how the examination was performed, and about possible risks. We focused specifically on reasons for women not having a positive experience. Of 4600 eligible Swedish-speaking women, 3061 were recruited to the study in early pregnancy, during three 1-week periods spread evenly over 1 year (1999-2000), and these women completed a questionnaire at a mean of 16 weeks' gestation. A follow-up questionnaire at 2 months after delivery was completed by 2730 women. The representativeness of the sample was assessed by comparison with the total Swedish birth cohort of 1999. The most prominent expectation about the up-coming scan was confirmation that the baby was well, followed by confirmation that the pregnancy was real. Detailed information, such as date of delivery and sex of the baby, was mentioned less often, and very few wrote about the examination as an exciting and joyful experience. After the birth, a large majority was satisfied with information about why (88%) and how (87%) the examination was performed, but only 58% said they had received sufficient information about possible risks. 94% had a positive experience of the scan, and those who had not had more ambivalent feelings about their pregnancy. Women with negative feelings about the scan were more often single and of non-Swedish background, and emotional problems were more common in this group. Women's expectations of the routine second-trimester scan differ from those of caregivers, focusing on general reassurance rather than specific information. Level of satisfaction with the scan was high, but information given about risks could be improved. Women with ambivalent or negative feelings about pregnancy may have difficulties enjoying the examination.

Clinical Implications of Increased Congenital Malformations After First Trimester Exposures to Angiotensin-Converting Enzyme Inhibitors

Angiotensin-converting enzyme (ACE) inhibitors are some of the most frequently prescribed antihypertensives in the United States. These agents are contraindicated during the second half of pregnancy because prior studies have demonstrated that use of ACE inhibitors late in pregnancy can cause oligohydramnios, fetal growth restriction, skull defects, infant anuria and renal failure, and death. Interestingly, little was known about the effects of ACE inhibitors when taken early during pregnancy. The purpose of the ACE Inhibitors in Early Pregnancy study was to clarify the safety of the use of ACE inhibitors during pregnancy by conducting an epidemiologic study using a large Medicaid database in which medications prescribed for pregnant women as a part of routine care and infant outcomes were studied. In the study, among 209 infants with first trimester exposure to ACE inhibitors, 7.1% had any major congenital malformation. Compared with 29,096 infants with no exposure to any antihypertensive medication, among whom 2.6% had any major congenital malformation, the adjusted risk of major congenital malformations was increased more than 2-fold. The risks of any congenital malformations and risks of specific organ system malformations, including cardiac malformations, were not increased in 202 infants with first trimester exposure to other antihypertensives when compared with infants with no antihypertensive exposure. Although this was an exploratory study whose findings should be confirmed, there are some important clinical insights that can be drawn from the study's conclusions. Further information on the pregnancy risks of ACE inhibitors and almost every other medication potentially used by pregnant women is needed. Thus, well-controlled studies to identify these risks should be undertaken. Until such information is available, alternative medications to ACE inhibitors should be considered in women of child-bearing age who are pregnant or who are likely to become pregnant while taking the medication.

Lifestyle and reproductive factors associated with follicular phase length.

Variability in menstrual cycle length, largely determined by variation in follicular phase length, is related to several health outcomes, yet the causes of this variability are incompletely understood. We sought to identify characteristics associated with follicular phase length. We used the North Carolina Early Pregnancy Study to describe factors correlated with timing of ovulation (follicular phase length). Women collected daily urine specimens and recorded vaginal bleeding. Specimens were assayed for estrone 3-glucuronide and pregnanediol 3-glucuronide, which in turn were used to estimate the day of ovulation. All other variables were assessed through interview. Associations with follicular phase length were evaluated using a multiple regression model. We determined follicular phase length for the first cycles of 201 women. Women with a history of miscarriage tended to have shorter follicular phases (2.2 days). Longer duration of oral contraceptive (OC) use and recent OC use (in the last 90 days) were both correlated with longer follicular phase. Occasional marijuana users (up to three times in the last 3 months) had a longer follicular phase than nonusers (3.5 days); the follicular phase in frequent users (more than three times) was almost 2 days longer than that of nonusers. The association between marijuana use and longer follicular phase is consistent with prior rhesus monkey research that shows ovulatory delay or inhibition.

Point: Oral Hypoglycemic Agents Should Not Be Used to Treat Diabetic Pregnant Women

Studies in pregnancy indicate that the most important glucose concentration throughout the day is the peak postprandial glucose response; i.e., it is the highest blood glucose of the day, not the average, that predicts risk of untoward effects. The Diabetes in Early Pregnancy (DIEP) Study was a multicenter, case-controlled trial of type 1 diabetic women compared with healthy control women throughout pregnancy. Along with the primary objective of relating maternal glucose to risk of spontaneous abortions and malformations, they also studied the relationship between maternal postprandial glucose concentrations and risk of neonatal macrosomia (1). The DIEP Study identified 28.5% of infants from diabetic mothers who were above the 90th percentile of infant birth weight. Birth weight correlated positively with first-trimester maternal fasting blood glucose and A1C. When adjusted for fasting blood glucose and A1C, the 1-h postprandial maternal blood glucose concentration in the third trimester was an even stronger predictor of infant birth weight and fetal macrosomia. In addition, they reported that the risk of macrosomia is a continuum. They showed that any postprandial glucose peak was associated with an increased risk of macrosomia above the 10% risk seen in the general population. Combs et al. (2) confirmed the findings of the DIEP Study and added the observation that elevated postprandial glucose was associated with an increased rate of macrosomia when higher maternal postprandial glucose concentrations were observed between weeks 29 and 32 of gestation. In a study of gestational diabetic women who failed a trial of diet and thus required insulin therapy, De Veciana et al. (3) described improved fetal outcome with less risk of neonatal hypoglycemia, macrosomia, and Caesarean delivery in women with gestational diabetes mellitus (GDM) when the women were managed by controlling 1-h postprandial glucose concentrations as opposed to action only based on preprandial glucose concentrations. …

Intolerance to ambient odors at an early stage of pregnancy

Adverse reactions to ambient odorous and pungent substances in daily activities among pregnant women who are half-way through pregnancy, and changes in odor perception at predominantly an early stage of pregnancy motivated the present study of odor intolerance at an early pregnancy stage. Ninety-five women averaging gestational week 11 and 102 non-pregnant women were compared with the Chemical Sensitivity Scale for Sensory Hyperreactivity (CSS-SHR). General environmental intolerance was assessed with items from the Noise Sensitivity Scale that are analogous to the CSS-SHR ("NSS-SHR"). Pregnant women were found to have higher scores on the CSS-SHR, but not on the "NSS-SHR". This suggests an odor intolerance that affects pregnant women's daily activities, which appears not to be due to a general environmental intolerance. The effect size of pregnancy on CSS-SHR score is larger in the present study of early pregnancy than in the previous study of women half-way through pregnancy.

Bayesian Adaptive Regression Splines for Hierarchical Data

This article considers methodology for hierarchical functional data analysis, motivated by studies of reproductive hormone profiles in the menstrual cycle. Current methods standardize the cycle lengths and ignore the timing of ovulation within the cycle, both of which are biologically informative. Methods are needed that avoid standardization, while flexibly incorporating information on covariates and the timing of reference events, such as ovulation and onset of menses. In addition, it is necessary to account for within-woman dependency when data are collected for multiple cycles. We propose an approach based on a hierarchical generalization of Bayesian multivariate adaptive regression splines. Our formulation allows for an unknown set of basis functions characterizing the population-averaged and woman-specific trajectories in relation to covariates. A reversible jump Markov chain Monte Carlo algorithm is developed for posterior computation. Applying the methods to data from the North Carolina Early Pregnancy Study, we investigate differences in urinary progesterone profiles between conception and nonconception cycles.

Lipoprotein metabolism of pregnant women is associated with both their genetic polymorphisms and those of their newborn children

To explore whether the placenta contributes to the lipoprotein metabolism of pregnant women, we took advantage of the fact that placental proteins are encoded from the fetal genome and examined the associations between lipids of 525 pregnant women and the presence, in their newborns, of genetic polymorphisms of LPL and apolipoprotein E (APOE), two genes expressed in placenta. After adjustment for maternal polymorphisms, newborn LPL*S447X was associated with lower triglycerides (-21 +/- 9 mg/dl), lower LDL-cholesterol (LDL-C; -12 +/- 5 mg/dl), lower apoB (-14 +/- 4 mg/dl), higher HDL-C (5 +/- 2 mg/dl), and higher apoA-I (9 +/- 4 mg/dl) in their mothers; newborn LPL*N291S was associated with higher maternal triglycerides (114 +/- 31 mg/dl); and newborn APOE*E2 (compared to E3E3) was associated with higher maternal LDL-C (14 +/- 6 mg/dl) and higher maternal apoB (14 +/- 5 mg/dl). These associations (all P < 0.05) were independent of polymorphisms carried by the mothers and of lipid concentrations in newborns and were similar in amplitude to the associations between maternal polymorphisms and maternal lipids. Such findings support the active role of placental LPL and APOE in the metabolism of maternal lipoproteins and suggest that fetal genes may modulate the risk for problems related to maternal dyslipidemia (preeclampsia, pancreatitis, and future cardiovascular disease).

Elevated Pregnancy Losses at High and Low Extremes of Maternal Glucose in Early Normal and Diabetic Pregnancy

Early pregnancy losses increase with marked hyperglycemia in diabetic pregnancy. However, mean loss rates do not differ from those of nondiabetic pregnancy. This observation might be explained by increased fetal losses at the extremes of glycemia in diabetic and nondiabetic pregnancy. To test this hypothesis, we examined relationships of proximate measures of prior glycemia, glycated protein and fructosamine, to pregnancy loss. A total of 389 diabetic and 429 nondiabetic pregnant subjects participated in the Diabetes In Early Pregnancy study. Glycated protein and fructosamine measurements were standardized as multiples of control values for each center (Z score). The logarithm of odds of pregnancy loss were plotted against Z scores and tested by logistic models. Mean pregnancy loss rates were 12% in diabetic and 13% in normal pregnancies. However, over six intervals of glycated protein in diabetic pregnancy, fetal loss rates at the upper and lower extremes (24 and 33%, respectively) were approximately threefold higher than the four intervening rates (8-14%). The odds ratio of pregnancy loss for these extreme intervals to the intervening intervals is 3.0 (P = 0.01). Nondiabetic losses showed a similar pattern. In confirmation, logit pregnancy losses were increased in a J-shaped curve at the glycemic extremes in normal (P < 0.019) and diabetic (P < 0.015) pregnancy. The upper glycemic extreme in diabetic pregnancy was two- to fivefold higher than in control pregnancy. Pregnancy losses are increased at the extremes of glycemia in both normal and diabetic pregnancy but at higher levels in diabetic pregnancy. The data suggest defensive adaptations against hyperglycemia in diabetic pregnancy.

The Role of the Intrauterine and Perinatal Environment in Cerebral Palsy

Author Disclosure Drs Paneth, Korzeniewski, and Hong did not disclose any relationships relevant to this article. After completing this article, readers should be able to: 1. Discuss the prevalence of cerebral palsy (CP) in school-aged children. 2. Describe the role of neuroimaging in CP. 3. Describe the impact of ventilatory practices in low-birthweight infants on the risk of CP. 4. Delineate the role of infection and fetal inflammation in pregnancy in the development of CP. The special importance of CP to clinicians whose practices encompass pregnancy and the perinatal or neonatal period is that no other neurodevelopmental disorder bears as close a causal relationship to the hazards of intrauterine and perinatal life. Although the strength of that relationship has been exaggerated at times, especially in relation to obstetric trauma and birth asphyxia, there can be no serious doubt that adverse events in pregnancy and the perinatal period do occasionally damage the fetal or neonatal brain. A distinctive feature of brain damage produced between early gestation and infancy is destruction of cerebral white matter or extrapyramidal tracts, thereby producing a clinical syndrome in which disturbance of motor control is a prominent and probably a necessary feature. Depending on the nature and extent of the insult, the motor disorder may be predominantly spastic, dyskinetic, or ataxic and may involve all four limbs (quadriplegia), one side (hemiplegia), or be most prominent in the legs (diplegia). CP severe enough to be recognized as a disability is found in about 1 in 500 school-age children in most developed countries, with little variation between countries or over the past 30 years. (1) Because CP often is accompanied by other neurodevelopmental disabilities, particularly seizure disorders, varying degrees of mental retardation, blindness, or deafness, affected children constitute the single largest group of children in the population who have major disabilities. (2) More …

Recruitment for a community-based study of early pregnancy: the Right From The Start study.

Despite the high incidence of spontaneous abortion, little is known about its causes, in part because of the challenge of assembling a large cohort of women in early pregnancy for prospective study. We describe the effectiveness of recruitment strategies used in Right From The Start (RFTS), a prospective, community-based study of spontaneous abortion. Between December 2000 and September 2002, 803 pregnant women enrolled in RFTS, 103 of whom were recruited while trying to conceive. The mean gestational age at enrollment was 52 days, with 25% of the cohort enrolling before 6 completed weeks' gestation. Participants recruited directly from the community typically enrolled earlier in their pregnancies (mean of 44 days) and accounted for 24% of the total cohort and 83% of all participants who were recruited while trying to conceive. Posting brochures in drug stores and targeted mailings to new homeowners were the most effective community recruitment strategies. Recruitment at private and public prenatal care sites accounted for 57% and 19% of the participants respectively. Recruitment from public clinics required direct contact by RFTS staff and yielded women who enrolled at later gestational ages (mean of 58 days), but was valuable for inclusion of minorities and lower income women with less favourable health behaviours. Although intensive, diverse efforts were required, when recruitment efforts were maximised, we successfully recruited over 10% of the estimated number of pregnant women in the community.

Leptin and phospholipid-esterified docosahexaenoic acid concentrations in plasma of women: observations during pregnancy and lactation.

The n-3 fatty acid status changes during pregnancy and lactation. Plasma leptin concentrations and gene expression have been related to n-3 fatty acids. To investigate the relation between plasma leptin concentration and the docosahexaenoic acid (22:6n-3) content of plasma phospholipids during early pregnancy and the postpartum period. Leptin (radioimmunoassay) and the phospholipid fatty acid profile (capillary gas-liquid chromatography) were measured in plasma of women during two independent longitudinal observational studies. Dietary intake of n-3 fatty acids was also determined. Within the first 10 weeks after the last menstrual period, an almost parallel increase in leptin concentration and the 22:6n-3 content (mg/l and % wt/wt) of plasma phospholipids was seen (study 1, n = 21). During the postpartum period (study 2, n = 57), leptin levels decreased quickly, preceding the changes in 22:6n-3 concentrations. During both studies, leptin concentrations did not consistently relate to dietary intake of n-3 fatty acids or to 22:6n-3 concentrations in plasma phospholipids. Before and during early pregnancy (study 1), significant positive associations between leptin levels and the total amount of phospholipid-associated fatty acids were found. No such association was seen during late pregnancy or the postpartum period (study 2). The postpartum decrease in leptin levels did not differ between lactating and non-lactating women. Not the 22:6n-3 content, but the total amount of phospholipid-associated fatty acids was related to plasma leptin concentration, before and during early pregnancy but not during late pregnancy and the postpartum period.