Female Singleton Research Articles

Exposing Widow’s Psyche in a Fine Balance: A Study of Rohinton Mistry’s Widow Characters

Indian writers including both male and female novelists generally utilise novels to reveal the psychological conditions of the female sex with the help of their dramatic personas. One such Indian writer is Rohinton Mistry, who unveils the mental states of women through his independent female characters, especially fictional female singletons. Among his numerous works, A Fine Balance is a notable piece that falls into this category. The novel is about the life struggles of the widow heroine Dina Dalal after the death of her husband. Apart from Dina, Mistry has used many widow characters who play minor roles in developing the storyline. The paper aims to exhibit the mental fluctuations of the fictional widows that comprise the widow protagonist Dina Dalal. The investigation with the help of the female characters uncovers the psychological oscillations of the widows due to their singlehood statuses. It unmasks the emotional transpositions, loneliness, fears, regrets, hopelessness and mental instabilities of the widows. The analysis avails the psychoanalytic Literary Theory to support its arguments and to obtain its objectives. With the aid of the select prose narrative, the research brings out Rohinton Mistry’s typical representation of widow characters to have psychological problems because of losing their husbands. Hence, the article projects that despite picturing the fictional widows as persons who are bold and liberating, Mistry has represented them to be psychologically vulnerable rather than presenting them as mentally strong and stable individuals.

Comorbidities in women with polycystic ovary syndrome: a sibling study

Abstract Background Polycystic ovary syndrome (PCOS) has previously been associated with several comorbidities that may have shared genetic, epigenetic, developmental or environmental origins. We analyzed the association between PCOS and several relevant comorbidities while adjusting for early-life biological and socioeconomic conditions, also investigating the extent to which the association is affected by familial risk factors. Methods This total-population register-based cohort study included 857,757 singleton females (333,999 with at least one full sister) born between 1962 and 1980. PCOS and comorbidity diagnoses were measured at age 17-45 years through national hospital register data from 1997 to 2011, and complemented with information on the study subjectś early-life and social characteristics. In the main analysis, sibling fixed effects (FE) models were used to control for all factors that are shared and time-invariant among sisters, thereby testing whether PCOS and examined comorbidities are determined by unobserved familial; environmental, social or genetic factors. Results 9,321 women were diagnosed with PCOS, of whom 15% had obesity, 9% had depression, 8% had anxiety and 4% suffered from sleeping, sexual and eating disorders (SSE). Having PCOS was associated with the odds of obesity increasing nearly 6-fold (adjusted OR (aOR): 5.8 [95%CI:5.5-6.2]). This association was attenuated considerably when accounting for characteristics shared between full sisters (Sister FE: aOR: 4.5 [95% CI: 3.6-5.6]). Among the psychiatric comorbidities, depression (Sister FE: aOR: 1.4 [95% CI: 1.2-1.8]) and anxiety (Sister FE: aOR: 1.5 [95% CI: 1.2-1.8), there was a small decrease in the aORs when also controlling for factors shared between sisters. Conclusions Having been diagnosed with PCOS is associated with an increased risk of obesity and psychiatric comorbidities and a substantial part of this risk can be attributed to factors shared between sisters. Key messages • PCOS is associated with an increased risk of obesity, depression and anxiety. • Among women with PCOS, 16% of the increased risk for obesity, 20% for depression and 29% for anxiety can be attributed to shared family factors between sisters.

P-041 Enhancing Embryos of the Desired Sex in Couples Undergoing PGT-A while Minimizing Embryo Wastage

Abstract Study question Can we enhance the proportion of euploid embryos of the desired sex for couples undergoing ICSI and PGT-A with sex selection while reducing embryo wastage? Summary answer Using a novel sperm selection technique, we generated higher proportions of embryos and offspring of the desired sex without impairing clinical outcomes or offspring health. What is known already Although controversial, the wish for offspring of a specific sex is common in the U.S. Many couples, particularly those requiring IVF with PGT-A, request a euploid embryo of a specific sex. This is often associated with the generation of more conceptuses of the unwanted sex, resulting in embryo wastage. We propose utilizing a simple and safe sex selection technique (SST) to skew spermatozoa toward the desired sex so that concurrent embryos can be generated in higher proportions. Study design, size, duration Over a 7-year period, ejaculates from male partners of couples (n = 144) undergoing ICSI with PGT-A were processed using SST to enrich spermatozoa for their preferred sex. Standard sperm processing was carried out for couples undergoing ICSI exclusively to assess conceptus aneuploidy, comprising the control group (n = 1,440). The proportion of male and female spermatozoa in the initial and selected specimens, PGT-A results, and ICSI outcomes following frozen embryo transfer (FET) were compared between the two groups. Participants/materials, setting, methods A total of 1,584 couples were treated in 2,723 ICSI cycles. Standard sperm processing was performed for 1,440 couples who did not have offspring sex preferences, comprising the control. For 144 consenting couples, SST was used to enrich spermatozoa for either sex (IRB 1306014043). To confirm sex enrichment and ploidy, ≥1,000 sperm cells were screened by fluorescent in-situ hybridization (FISH) for nine chromosomes. Embryology and PGT-A outcomes were compared between the control and SST cohorts. Main results and the role of chance Couples (n = 1,440) from the control cohort (maternal age, 37.1±4yrs; paternal age, 39.1±6yrs) underwent 2,541 ICSI cycles, yielding an 80.1% fertilization rate (15,901/19,859). PGT-A confirmed that 46.6%(n = 4,479) of conceptuses were female and 53.4%(n = 5,132) were male. These couples achieved 76.2%(866/1136) implantation and 64.9%(737/1136) clinical pregnancy rates, resulting in 624 healthy deliveries (48% female, 52% male). From the study cohort (n = 144), 79 desiring female offspring (maternal age, 37.9±4yrs; paternal age, 40.8±6yrs) obtained an 81.6% sperm sex enrichment. They underwent 98 ICSI cycles, achieving a 76.7%(792/1032) fertilization rate, resulting in a greater proportion of female embryos (79.1%, 351/444) than the control (P<0.05), of which 78.6% (276/351) were euploid. Following FET, 39 couples obtained a 79.5% (31/39) implantation rate, yielding 27 clinical pregnancies with deliveries, thus far, of 16 female singletons, all developing normally. The remaining 65 couples (maternal age, 37.6±3yrs; paternal age, 40.8±5yrs) preferring male offspring obtained 80.8% male sperm enrichment and underwent 84 ICSI cycles, achieving a 74.9%(723/965) fertilization rate with a greater proportion of 79.3%(249/314) male embryos compared with the control (P<0.05), of which 66.3%(165/249) were euploid. Following FET, their implantation rate was 90.0%(36/40), yielding 25 clinical pregnancies that resulted in the deliveries, thus far, of 20 male singletons, all developing normally. Limitations, reasons for caution Although SST does not absolutely grant offspring of a specific sex, it allowed couples to obtain a greater proportion of conceptuses of their preferred genotype. This method does not replace PGT-A for sex selection, but rather enhances the generation of embryos of the desired sex, thereby reducing embryo wastage. Wider implications of the findings We confirmed a significantly higher proportion of conceptuses of the desired sex. Thus far, embryo developmental competence, aneuploidy rates, delivery rates, and offspring health were not impaired by SST-processed spermatozoa. This supports the safety of SST, rendering it effective and ethically palatable. Trial registration number n/a

The clinical performance and population health impact of birthweight-for-gestational age indices at term gestation.

The assessment of birthweight for gestational age and the identification of small- and large-for-gestational age (SGA and LGA) infants remain contentious, despite the recent creation of the Intergrowth 21st Project and World Health Organisation (WHO) birthweight-for-gestational age standards. We carried out a study to identify birthweight-for-gestational age cut-offs, and corresponding population-based, Intergrowth 21st and WHO centiles associated with higher risks of adverse neonatal outcomes, and to evaluate their ability to predict serious neonatal morbidity and neonatal mortality (SNMM) at term gestation. The study population was based on non-anomalous, singleton live births between 37 and 41 weeks' gestation in the United States from 2003 to 2017. SNMM included 5-min Apgar score <4, neonatal seizures, need for assisted ventilation, and neonatal death. Birthweight-specific SNMM was modelled by gestational week using penalised B-splines. The birthweights at which SNMM odds were minimised (and higher by 10%, 50% and 100%) were estimated,and the corresponding population, Intergrowth 21st, and WHO centiles were identified. The clinical performance and population impact of these cut-offs for predicting SNMM were evaluated. The study included 40,179,663 live births and 991,486 SNMM cases. Among female singletons at 39 weeks' gestation, SNMM odds was lowest at 3203 g birthweight, and 10% higher at 2835 g and 3685 g (population centiles 11th and 82nd, Intergrowth centiles 17th and 88th and WHO centiles 15th and 85th). Birthweight cut-offs were poor predictors of SNMM, for example, the cut-offs associated with 10% and 50% higher odds of SNMM among female singletons at 39 weeks' gestation resulted in a sensitivity, specificity, and population attributable fraction of 12.5%, 89.4%, and 2.1%, and 2.9%, 98.4% and 1.3%, respectively. Reference- and standard-based birthweight-for-gestational age indices and centiles perform poorly for predicting adverse neonatal outcomes in individual infants, and their associated population impact is also small.

Postmenopausal hormone therapy and mortality before and after the Women’s Health Initiative study

Weighing risks and benefits of postmenopausal hormone therapy (HT) has proven a balancing act. We aimed to investigate the association between HT and mortality before and after the 2002 publication from the Women’s Health Initiative (WHI) study. This publication found that the risk of using HT outweighted the benefits, and thus it caused a marked reduction in systemic HT user prevalence. The 2002 WHI publication may also have caused a change in the subsequent HT user profile, as HT is no longer recommended in the prevention of chronic diseases. This cohort study included two populations followed from 1995: A 5% random sample of female singletons from the Danish general population (n = 52,388) and a sample of Danish female twins (n = 15,261). HT use was evaluated in 1995, 2000, 2005, and 2010. The association between HT, education, and mortality was investigated and controlled for potential unobserved familial confounding in a within-pair analysis. Singletons aged 56–75 using systemic HT in 2000 had a lower mortality compared to non-users (hazard ratio (HR) 0.83, 95% confidence interval (CI) 0.78–0.89). In 2005, the mortality was like that of the background population for this age group (HR 1.02, 95% CI 0.94–1.11). Recently postmenopausal twins showed a similar tendency. Systemic HT users, who had switched to local HT by 2005, had a substantially lower mortality than non-users (HR ranging from 0.42 to 0.67 depending on age group). In conclusion, we found that the prevalence of systemic HT use declined after 2002, and systemic HT users’ mortality changed from lower before 2002 to similar to that of the background population after 2002. This indicates that the healthiest users decided to either drop systemic HT or switcted to local HT, as recommendations changed following the WHI publication.

Systemic hormone therapy and dementia: A nested case-control and co-twin control study

ObjectiveThe effect of systemic hormone therapy (HT) on dementia risk is unclear. Our aim was to investigate the association between HT and dementia. Study designThis register-based study consists of a nested case-control study and a co-twin control design, which controls for familial confounding, including shared genetics. Main outcome measuresThrough Danish national registries from 1995 to 2011, we identified: a) 2700 female singletons with incident dementia and 13,492 matched controls; b) 288 female twins with incident dementia and co-twins without dementia. Data on HT and education were retrieved, and analyses were performed using conditional logistic regression and McNemar's χ2-test. HT use decreased dramatically after the Women's Health Initiative study results were published in 2002, and the analyses were stratified accordingly to account for potentially different HT user characteristics. ResultsThe odds ratio (OR) for the association between systemic HT and dementia was 1.05, 95% CI = [0.93–1.19] in singletons and 2.10, 95% CI = [0.99–4.46] in twins. A statistically significant association was found for systemic HT before 2003 in both populations, with an OR of 1.14, 95% CI = [1.01–1.28] in singletons and an OR of 2.20, 95% CI = [1.04–4.65] in twins. ConclusionUsing Danish nationwide registries and controlling for education and for familial factors in a subsample, systemic HT was found to be associated with increased dementia risk if used before 2003, when HT was more commonly prescribed.

Management-related factors in dry cows and their associations with colostrum quantity and quality on a large commercial dairy farm

The objective of this observational study was to evaluate the association of management-related factors in dry cows and colostrum quantity and quality in Holstein cows on a large commercial dairy farm. This study was conducted from January 2018 to December 2020 on a commercial dairy farm in Germany, milking approximately 2,500 Holstein cows. Dairy personnel recorded colostrum quantity (n = 7,567) and evaluated colostrum quality in a subsample of animals (n = 2,600) using a digital Brix refractometer. Generalized linear mixed models were constructed to evaluate the association of management-related factors and colostrum quantity and quality. Models were run separately for primiparous or multiparous cows. The outcome variable was either colostrum quantity (kg) or quality (%Brix). Average colostrum quantity was 4.0 ± 2.5 kg, 5.1 ± 3.4 kg, and 5.5 ± 3.5 kg for cows in lactation 1, 2, and ≥3, respectively. In primiparous cows (n = 2,351), colostrum quantity was affected by month of calving (greatest in April = 4.1 kg, and lowest in November = 3.2 kg), sex of the calf (female singleton = 3.50 ± 0.26 kg; male singleton = 3.76 ± 0.27 kg; twins = 2.97 ± 0.66 kg), stillbirth (stillbirth = 3.14 ± 0.39 kg; no stillbirth = 3.68 ± 0.31 kg). In multiparous cows (n = 5,216), colostrum quantity was affected by month of calving (greatest in May = 5.5 kg, and lowest in October = 3.8 kg), calving ease (calving ease 0 = 4.23 ± 0.26 kg; score 1 = 4.77 ± 0.21 kg; score 2 = 4.98 ± 0.22 kg; score 3 = 5.30 ± 0.22 kg), sex of the calf (female singleton = 4.42 ± 0.21 kg; male singleton = 5.00 ± 0.21 kg; twins = 5.03 ± 0.30 kg), stillbirth (stillbirth = 4.24 ± 0.38 kg; no stillbirth = 5.39 ± 0.11 kg), milk yield in previous lactation (+0.1 kg increase for 1,000 kg more milk yield in previous lactation), days spent in the far-off group (0.05 ± 0.003 kg for every day), and days in the close-up pen (0.06 ± 0.010 kg for every day). Average colostrum quality was 25.1 ± 3.4% Brix, 24.7 ± 3.3% Brix, and 27.6 ± 4.4% Brix for cows in lactation 1, 2, and ≥3, respectively. In primiparous cows (n = 817), colostrum quality was affected only by month of calving. Colostrum quality in primiparous cows was greatest in December (26.8%Brix) and lowest in August (23.9% Brix). In multiparous cows (n = 1,783), colostrum quality was affected by parity (lactation 2 = 25.2 ± 2.7% Brix; lactation 3+ = 27.9 ± 2.7%Brix), month of calving (greatest in February = 27.5% Brix, and lowest in August = 25.7% Brix), milk yield in previous lactation, and colostrum quantity. We observed a seasonal pattern for colostrum quantity and quality. Future intervention studies using multiple farms need to elucidate whether management of the photoperiod or length of exposure to close-up diets, or both, can help to optimize colostrum production.

Associations between Prenatal Exposure to Phthalates and Timing of Menarche and Growth and Adiposity into Adulthood: A Twenty-Years Birth Cohort Study.

Phthalates are ubiquitous environmental chemicals with endocrine disrupting properties and potentially obesogenic effects. We hypothesised that antenatal phthalate exposure may influence growth and adiposity patterns in girls through childhood into adolescence. Among 1342 Raine Study singleton females, 462 had maternal serum and at least one outcome available up to 20 years of age. Individuals’ maternal serum collected at 18 and 34 weeks gestation was pooled and analyzed for concentrations of 32 metabolites of 15 phthalate diesters. Cox regression and linear models were used to determine associations between maternal phthalate levels and age at menarche, change in height and weight z-scores between birth and two years, height from birth to 20 years, BMI from two to 20 years, deviation from mid-parental height at age 20 and DEXA scan measures at age 20. Weak negative associations were detected with some phthalate metabolites and change in height and weight z-score during infancy. Weak positive associations between some of the high molecular weight phthalate metabolites and height z-score were detected during childhood. While still within the normal range, age at menarche was slightly delayed in girls with higher prenatal exposure to the higher molecular weight phthalate metabolites. We derived some associations between prenatal phthalate exposure with early growth patterns and age at menarche.

Review of the leucotela species-group of Conura (Hymenoptera: Chalcididae) from Amazon rainforest.

The leucotela species-group of Conura Spinola (Hymenoptera: Chalcididae) was initially proposed to include C. leucotela (Walker 1862) within the subgenus Spilochalcis Thomson. Despite this treatment, the accurate identification of C. leucotela is not possible based on the literature. In this paper, C. leucotela is redescribed and two new species, C. paraleucotela sp. nov. and C. pseudoleucotela sp. nov., are described within the leucotela group, with all the species based on female singletons. Additionally, diagnoses and illustrations are presented for two other unnamed species based on males. The taxonomic concept of the species group is discussed, and new diagnostic characters are proposed. An identification key and illustration of species are provided. The morphology of the coupling mechanism of the propodeum and gaster of some species of the leucotela group and its relation with possible hosts is discussed. A short discussion of rarity of the leucotela group is presented.

Simulated shift work during pregnancy does not impair progeny metabolic outcomes in sheep.

Maternal shift work increases the risk of pregnancy complications, although its effects on progeny health after birth are not clear. We evaluated the impact of a simulated shift work protocol for one-third, two-thirds or all of pregnancy on the metabolic health of sheep progeny. Simulated shift work had no effect on growth, body size, body composition or glucose tolerance in pre-pubertal or young adult progeny. Glucose-stimulated insulin secretion was reduced in adult female progeny and insulin sensitivity was increased in adult female singleton progeny. The results of the present study do not support the hypothesis that maternal shift work exposure impairs metabolic health of progeny in altricial species. Disrupted maternal circadian rhythms, such as those experienced during shift work, are associated with impaired progeny metabolism in rodents. The effects of disrupted maternal circadian rhythms on progeny metabolism have not been assessed in altricial, non-litter bearing species. We therefore assessed postnatal growth from birth to adulthood, as well as body composition, glucose tolerance, insulin secretion and insulin sensitivity, in pre-pubertal and young adult progeny of sheep exposed to control conditions (CON: 10males, 10 females) or to a simulated shift work (SSW) protocol for the first one-third (SSW0-7: 11males, 9 females), the first two-thirds (SSW0-14: 8males, 11 females) or all (SSW0-21: 8males, 13 females) of pregnancy. Progeny growth did not differ between maternal treatments. In pre-pubertal progeny (12-14weeks of age), adiposity, glucose tolerance and insulin secretion during an i.v. glucose tolerance test and insulin sensitivity did not differ between maternal treatments. Similarly, in young adult progeny (12-14months of age), food intake, adiposity and glucose tolerance did not differ between maternal treatments. At this age, however, insulin secretion in response to a glucose bolus was 30% lower in female progeny in the combined SSW groups compared to control females (P=0.031), and insulin sensitivity of SSW0-21singleton females was 236% compared to that of CON singleton female progeny (P=0.025). At least in this model, maternal SSW does not impair progeny metabolic health, with some evidence of greater insulin action in female young adult progeny.

CONCOMITANT FACTORS AFFECTING GESTATION LENGTH AND PERINATAL MORTALITY IN HOLSTEIN-FRIESIAN COWS

The objective of this study was to identify and quantify factors presenting simultaneous moderate or strong influence on gestation length and perinatal mortality (until 4 days postpartum) in Holstein-Frisian dams. The overall gestation length least square mean was 278.2 ± 0.2 days (n = 962). According to the multivariate model (p &lt; 0.001), a shorter gestation length was observed in Holstein-Friesian (–2.0 days) and Red Holstein-Friesian (–3.9 days) breed sires whereas Brown Swiss (2.0 days) and Aberdeen-Angus (2.3 days) breed sires showed a longer gestation length. Primiparous cows and twin pregnancies, as well calving in June and July, shortened gestation length in –1.4, –4.0, –1.9 and –1.8 days, respectively. The perinatal mortality incidence was 7.4% (n = 72) and was more likely to occur in twin pregnancies (p &lt; 0.01) than in pregnancies carrying female (odds ratio = 8.1) or male (odds ratio = 7.9) singletons, as well in primiparous (odds ratio = 2.6) than multiparous dams (p &lt; 0.05). In conclusion, parity and twinning were the major factors which influenced simultaneously gestation length of dams and perinatal mortality incidence. Nevertheless, all studied factors had a significant impact on gestation length and should be considered for reproductive management programs of dairy herds.

Anthropometric characteristics of newborns with Prader-Willi syndrome.

This is a retrospective multicenter nationwide Italian study collecting neonatal anthropometric data of Caucasian subjects with Prader-Willi syndrome (PWS) born from 1988 to 2018. The aim of the study is to provide percentile charts for weight and length of singletons with PWS born between 36 and 42 gestational weeks. We collected the birth weight and birth length of 252 male and 244 female singleton live born infants with both parents of Italian origin and PWS genetically confirmed. Percentile smoothed curves of birth weight and length for gestational age were built through Cole's lambda, mu, sigma method. The data were compared to normal Italian standards. Newborns with PWS showed a lower mean birth weight, by 1/2 kg, and a shorter mean birth length, by 1 cm, than healthy neonates. Females with a 15q11-13 deletion were shorter than those with maternal uniparental maternal disomy of chromosome 15 (p < .0001). The present growth curves may be useful as further traits in supporting a suspicion of PWS in a newborn. Because impaired prenatal growth increases risk of health problems later in life, having neonatal anthropometric standards could be helpful to evaluate possible correlations between the presence or absence of small gestational age and some clinical and metabolic aspects of PWS.

Maternal Metabolic Demands Caused by Pregnancy and Lactation: Association with Productivity and Offspring Phenotype in High-Yielding Dairy Ewes.

Simple SummaryThis study assessed the effects of metabolic load imposed by pregnancy and lactation on productivity and offspring performance in high-yielding dairy sheep. Productivity was assessed in terms of offspring and maternal milk yield, metabolic profile, and body condition. Our results show that maternal productivity and lamb body weight and growth are not compromised by pregnancy and lactation because dairy sheep, when appropriately managed, seem to be able to cover metabolic demands of pregnancy and high milk production without losing productivity.Pregnancy and lactation, especially when concurrent, create a rather metabolically demanding situation in dairy ruminants, but little is known about their effects on offspring phenotype and milk yield. Here, we evaluated the impact of pregnancy and lactation on the metabolic traits and productive performance of Lacaune dairy sheep and their offspring. Productive performance was measured in terms of milk yield, body weight (BW), body condition score (BCS), and size. Productivity was assessed during mid-pregnancy (75 ± 5 d) and late pregnancy (142 ± 4 d) and at 52 ± 5 d in the postpartum period. During pregnancy, high-yielding ewes had higher BW, BCS, plasma glucose, cholesterol, β-OHB, and NEFA than low-yielding ewes, but lower levels of lactate and urea. High-yielding animals had lower BCS after lambing, but their lambs showed greater growth. Productivity during lactation was affected by ewe age and parity: Mature ewes (but not maiden sheep) whose BCS increased steeply during pregnancy yielded more milk in the subsequent lactation than those whose BCS did not increase. Lamb BW and size were positively associated with milk yield in the subsequent lactation. Mature ewes had higher yields than maiden sheep, and mature ewes with multiple pregnancies produced more milk than those with singleton pregnancies. Ewes with male singleton pregnancies also showed higher yield than those with female singletons. These results demonstrate that high-yielding dairy sheep, when appropriately fed and managed, can adequately cover the metabolic demands of pregnancy and high milk production (even when concurrent) without losing productivity.

One size does not fit all: Examining ethnicity in gestational weight gain guidelines

Pregnancy-related metrics vary by race/ethnicity, yet most gestational weight gain (GWG) guidelines are ethnicity-blind. We estimated small-for-gestational age (SGA) risk in a Japanese population, examining GWG adequacy categorized by Institute of Medicine (IOM) and Japanese guidelines in male (N = 192) and female (N = 191) full-term singleton infants. For predicting SGA, IOM guidelines had high sensitivity ( ≥ 0.75), but low specificity ( ≤ 0.25); Japanese guidelines had high specificity ( ≥ 0.80) but low sensitivity ( ≤ 0.50). GWG guidelines’ implicit notions of Caucasian–Americans as optimal may lead to ‘One Size Fits All’ recommendations that can obscure important biocultural factors contributing to maternal child health outcomes.

Case 3: Premature Infant with Anemia and High-Output Cardiac Failure

A female singleton is delivered at 30 6/7 weeks’ gestational age via cesarean for preterm labor and breech presentation. The mother is a 37-year-old grand multipara in her 10th pregnancy. The pregnancy is notable for severe fetal anemia, high-output cardiac failure with normal cardiac anatomy, polyhydramnios, and a placental chorioangioma diagnosed at 26 weeks of gestation. Evaluation for congenital infections is negative. At 25 and 28 weeks’ gestation, the fetus had received in utero red blood cell transfusions for severe fetal anemia. At birth, the infant has respiratory depression requiring intubation and ventilation. Apgar scores are 7, 6, and 8 at 1, 5, and 10 minutes, respectively, and her birthweight is 1,416 g. The neonate is noted to have a protuberant abdomen with significant hepatosplenomegaly, diffuse subcutaneous edema, petechiae, and ecchymoses. The infant requires significant ventilator support for the first few weeks after birth. Chest radiography shows no evidence of pleural or pericardial effusion. Echocardiography shows normal cardiac segmental anatomy with significant biventricular hypertrophy, though blood pressure is maintained. Significant anemia, thrombocytopenia, and coagulopathy are noted over the first days after birth, for which the newborn requires multiple blood products. Profound jaundice necessitates multiple double-volume exchange transfusions. Thrombocytopenia and coagulopathy gradually improve over the first week after birth. However, the infant develops significant cholestasis, reaching a peak direct bilirubin of 12.5 mg/dL (213.8 μmol/L) at 2 weeks of age. The unique constellation of findings in this case, anemia, thrombocytopenia, high-output failure, and cholestasis, presented a broad differential diagnosis. The differential included congenital heart disease and vascular malformations, infectious etiologies, metabolic and genetic disorders, and various renal, hepatic, gastrointestinal, and hematologic pathologies. Sepsis evaluation was performed on admission and …

Association between maternal body mass index in early pregnancy and anorexia nervosa in daughters.

The etiology of anorexia nervosa is poorly understood. Although genetic factors play a major role, maternal factors, and obstetric complications are possible environmental causes. We investigated the association between maternal overweight and obesity in early pregnancy and risk of anorexia nervosa in daughters. A retrospective cohort study including all live singleton females born in Sweden from 1992 through 2002. Anorexia nervosa diagnosis was identified by using the nation-wide Swedish Patient and Cause of Death Registers. Multivariable Cox hazards regression was used to estimate adjusted hazard ratios (aHRs) and 95% CIs, adjusting for confounders. Stratified Cox regressions were applied to data on siblings to adjust for unmeasured familial confounding. Among 486,688 live singleton females, 2,414 (0.50%) were diagnosed with anorexia nervosa through 2012. The aHR of anorexia nervosa decreased linearly by maternal BMI (p-value for trend < .001). When compared with daughters of normal weight mothers (body mass index [BMI] 18.5-24.9), aHRs (95%CI) of anorexia nervosa were 0.74 (0.65-0.84) in daughters of overweight mothers (BMI 25-29.9) and 0.61 (0.47-0.78) in daughters of mothers with obesity Grade I (BMI 30-34.9). In sibling control analysis, no associations were observed between maternal BMI and aHRs of anorexia nervosa in offspring. The rate of anorexia nervosa decreased with maternal overweight and obesity in a dose-response manner. However, the sibling control analysis suggests that these findings are not consistent with causals effects of maternal BMI on anorexia nervosa in offspring.

Handedness and the Corpus Callosum: A Review and Further Analyses of Discordant Twins

Handedness effects with respect to regional corpus callosum (CC) anatomy remain open to question. Midsagittal CC tracings were obtained from structural MRIs in 21 female monozygotic twin pairs with discordant handedness (MZHd). The CC was divided into 99 percentile widths which were grouped into seven regions based on Denenberg’s (1989, 1991b) factor analysis. Results showed that left handed (LH) twins had significantly larger regional widths in CC region W22–39 compared to right handed (RH) twins, an effect present in 19/21 MZHd pairs. Cross-study analyses revealed CC W22–39 to have the highest variation across female singletons (Cowell et al., 1992, 1993). In the adjacent genu region (W3–18), CC size did not differ between RH and LH twins. However, when twins were reclassified according to handedness direction and consistency to form consistent RH, non-consistent RH, consistent LH and non-consistent LH groups, patterns of CC size in W3–18 closely matched those of singleton women (Cowell et al., 1993). Namely, CC W3–18 was larger in consistent compared to non-consistent RHs. Results support a claim that CC region W22–39, interconnecting premotor cortex in females, provides for environmentally influenced components of handedness, given the difference within MZHd twin pairs. By contrast, CC W3–18, connecting prefrontal cortex, was sensitive to direction and consistency of handedness, both in twins and singletons, a result consistent with combined genetic and environmental effects. Findings highlight the significance of MZHd twin studies in elucidating the developmental mechanisms underpinning structure–function asymmetry, cortical interconnectivity and neurodevelopmental bases of left hand preference.

Maternal polycystic ovarian syndrome and early offspring development.

Is maternal polycystic ovarian syndrome (PCOS) associated with developmental delays in offspring? Offspring of mothers with PCOS were at higher risk of failure on the Ages and Stages Questionnaire (ASQ). There is growing evidence that offspring of mothers with PCOS may be at higher risk for developmental disorders due to potential exposure to hyperandrogenism and insulin resistance. Few studies exist regarding maternal PCOS and early childhood development in the USA. The Upstate KIDS Study is a population-based prospective cohort study of infants born between 2008 and 2010 in New York State (excluding New York City), originally designed to study-and finding no impact of-infertility treatment exposure on child development. Children were followed up to 36 months of age. In all, 4453 mothers completed one or more developmental screening instruments for 5388 children (35.5% twins) up to 36 months of age. In our study, 458 mothers (10.3%) reported a healthcare provider's diagnosis of PCOS, as well as the related treatment received, on the baseline study questionnaire. Parents completed the ASQ on their child's development at 4, 8, 12, 18, 24, 30 and 36 months of age to assess fine motor, gross motor, communication, personal-social functioning and problem-solving cognitive domains. We used generalized linear mixed models to estimate odds ratios (OR) between PCOS diagnosis and failures in the ASQ adjusted for maternal age, race, BMI, education, marital status, smoking, alcohol consumption, diabetes, insurance and plurality. Diagnosis of PCOS was associated with increased risk of the offspring failing the fine motor domain (adjusted odds ratio (aOR) = 1.77; 95% CI: 1.09, 2.89), largely driven by higher risk in female singletons (aOR = 2.23; 1.16, 4.29). Twins of mothers with PCOS had higher risk of failing the communication (aOR = 1.94; 1.19, 3.18) and personal-social functioning (aOR = 1.76; 1.12, 2.77) domains compared to twins born to mothers without PCOS. Compared to offspring of women without PCOS, offspring of women who reported receiving no treatment for their PCOS had a stronger association with failing the ASQ (aOR = 1.68; 0.95, 2.75) than the association among offspring of women who reported PCOS treatment (aOR = 1.16; 0.79, 1.73). Further study is needed to confirm the role of maternal PCOS in early offspring development with provider-validated diagnosis of PCOS. If confirmed, these findings suggest that offspring of women with PCOS may be at increased risk for developmental delay. Supported by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD; contracts HHSN275201200005C, #HHSN267200700019C). Authors have no competing interests to declare. Not applicable.

Tykes, Toddlers, Teens, and Twins of Robust Mothers: Do the Offspring of Twinning Mothers Share in Their Mother’s Robust Phenotype?

ABSTRACTWomen who bear twins may possess a robust phenotype compared to non-twinning mothers. We examine mortality patterns for the singleton offspring of mothers of twins compared to the offspring of non-twinning mothers to determine whether they share the hypothesized robust phenotype of their mothers. Using data from the Utah Population Database, we show that both male and female singleton offspring of twinning mothers experience a survival disadvantage prior to age 5, no survival benefit or penalty between ages 5 and 49, and—for males only—a statistically significant survival advantage after age 50. We further examine the survival effects on singletons born before and after a twinset. We observe a survival disadvantage in early life for singleton offspring of twinning mothers born after the twinset for both sexes. In addition, we find a significant survival advantage at older ages in certain categories of male singleton offspring—a likely reflection of mortality selection. The findings suggest that while bearing twins may reflect a robust maternal phenotype, the toll of bearing twins may disadvantage subsequent offspring, especially during infancy.

Polock index of 16 887 singleton neonates in different gestational age in Shenzhen City

Objective To establish the Polock indexes (PI) of singleton neonates in different gestational age (GA), so as to provide a reference data for evaluating physical fullness and symmetry in neonates at birth. Methods A total of 16 887 live singleton neonates at 27-42 weeks of GA from two hospitals were measured at birth by site survey method using cluster samples by a cross sectional time in Shenzhen City, from 2013 to 2015 in this study, to establish PI of singleton neonates in different GA. Results The PI mean and the percentile curves(3rd, 10th, 25th, 50th, 75th, 90th, 97th )of singleton neonates at 27-42 weeks of GA (male, female, and unisex three groups) were established in 2015 in Shenzhen, China.The fullness and nutrition status of neonates at birth can be evaluated by these PI curves.According to the 3rd, 10th, 25th-75th, 90th, 97th curves, the down, mid down, middle, mid upper, upper levels were divided in turn.When the PI values>97th curve it was overweighted or fatty.When the PI values<3rd curve it was malnutrition.The lowest values of PI were at 27 weeks of GA, and the highest values appeared at 42 weeks of GA.The PI values were increasing with GA growth, which indicated that the GA increased the body density and fullness.The 50th percentile curve of male PI was higher than that of the female, and the male ratio increased by 61.2-89.5 at the gestational age of 27-34 weeks; between 35 and 42 weeks of fetal age, males increased by 104.8-149.1, which had a statistical difference (P<0.001). Conclusions The PI of singleton neonates rises with GA increase, which shows the GA increases the body density and fullness.PI is higher in male than in female singleton neonates. Key words: Different gestational age; Singleton; Infant, newborn; Polock index