Fetal Health Research Articles

Systematic Reviews and Synthesis without Meta-Analysis on Hydrotherapy for Pain Control in Labor

Background: Although there is scientific evidence regarding the use of water immersion during labor, this evidence is primarily focused on the first stage of labor. There is limited scientific evidence on water immersion during the second stage of labor. Objective: The objective of this study was to conduct a comprehensive systematic review and synthesis of contemporary evidence related to water birth, with a specific focus on the second stage of labor. Methods: A systematic review of the scientific literature published between January 2018 and October 2023 was carried out. A synthesis of the results was conducted following the Synthesis without Meta-Analysis (SWiM) guidelines. PubMed, Scopus, and the Cochrane Library were utilized as information sources. The search strategy was designed using the keywords “immersion” and “parturition”, along with their relevant synonyms. Inclusion criteria encompassed studies employing randomized controlled trials (RCTs), systematic reviews, and quantitative and qualitative approaches focusing on pregnant women undergoing water immersion at any stage of the labor process. Results: Eleven articles were selected: two systematic reviews (one quantitative and one qualitative), five cohort studies, one case–control study, one cross-sectional observational study, and two qualitative studies. A thorough assessment of the methodology was performed using several specific tools: the Cochrane RoB 2 (Risk of Bias 2) tool for systematic reviews, JBI Critical Appraisal Checklist for Qualitative Research for qualitative studies, STROBE for observational descriptive studies, and CASPe for qualitative studies. The results provided fundamental insights that will contribute to conceptual standardization regarding the effects of water birth on maternal and fetal health. Additionally, a synthesis of the results was performed concerning types of delivery, analgesia use, pain perception, and maternal satisfaction with the water birth experience. Conclusions: In this study, we conclude that the results regarding delivery types, labor durations, and analgesia use found in the literature, along with statistically significant maternal/fetal effects, are crucial for making recommendations regarding the use of water during labor in any of its stages if the woman desires it safely.

Italian Guidelines for the diagnosis and treatment of Fetal Alcohol Spectrum Disorders: prevention and health promotion.

Alcohol consumption during pregnancy poses significant risks to maternal and fetal health, contributing to a range of adverse outcomes collectively known as Fetal Alcohol Spectrum Disorders (FASD). This article reviews evidence-based preventive strategies aimed at mitigating the detrimental effects of prenatal alcohol exposure. Drawing upon literature from various disciplines, interventions are categorized according to their level of prevention: universal, selective, and indicated. Training of personnel and availability of official guidelines are a pre-requisite for effective prevention. Universal prevention strategies include public health campaigns, educational initiatives, and policy interventions aimed at raising awareness about the risks of prenatal alcohol exposure and promoting abstinence during pregnancy. Integrating alcohol screening and brief intervention protocols into routine prenatal care settings can help identify and support women who may be at risk of alcohol use during pregnancy. Consequently, selective and indicated interventions, identifying drinking women, may provide targeted support to pregnant women at risk. Indicated prevention interventions also encompass treatment and rehabilitation strategies for women with a known alcohol abuse problem or who have already had alcohol-exposed pregnancies. Finally, ethical issues related to the stigma associated with alcohol consumption during pregnancy are highlighted, to be considered for an effective mother and child health promotion.

Italian Guidelines for the diagnosis and treatment of Fetal Alcohol Spectrum Disorders: epidemiology

Fetal alcohol spectrum disorders (FASD) are a significant global challenge characterized by complex diagnosis and research. The diagnostic process is complicated due to overlapping symptoms with other conditions, as well as factors such as maternal nutrition, socioeconomic status, and mental health, which can affect the severity of FASD traits differently in individuals. Risky drinking behaviors are prevalent in young adults, especially those aged 20-24, which coincides with high rates of unplanned pregnancies, increasing the risk of FASD. Specific subpopulations, such as children in care facilities and specialized clinical settings, face higher FASD prevalence. Preventing alcohol consumption during pregnancy is crucial for maternal and fetal well-being. Yet approximately 10% of women worldwide continue to drink during pregnancy, with notably high rates in the European Region. Young adults, especially in countries like Italy, continue to consume alcohol despite legal restrictions, mirroring the drinking patterns of men and raising concerns for fetal health and development. Research findings regarding alcohol’s risks during pregnancy vary, emphasizing the need for increased education on this issue. Ethylglucuronide (EtG) is a reliable biomarker for monitoring alcohol intake during pregnancy, suggesting regular urine examinations throughout each trimester. Proactive education campaigns, particularly in educational institutions, and establishing early diagnosis centers are recommended to address FASD effectively.

Fetal Health Anxiety: A Validity and Reliability Study of the Turkish Version of the Fetal Health Anxiety Inventory

Fetal Health Anxiety: A Validity and Reliability Study of the Turkish Version of the Fetal Health Anxiety Inventory

Understanding the complex interplay: An in-depth literature review of anemia's impact on maternal and fetal health throughout pregnancy

This comprehensive literature review highlights the intricate dynamics surrounding anemia and its multifaceted implications on maternal and fetal well-being during pregnancy. The analysis spans various factors influencing anemia, encompassing maternal age as a pivotal determinant. The ideal age for pregnancy, between 20-35 years, is explored as a crucial window for minimizing complications, with considerations for both physiological and psychological readiness. Conversely, pregnancies in women under 20 or over 35 are scrutinized for their heightened risks, involving physiological challenges and increased susceptibility to disorders like diabetes and hypertension. The review scrutinizes the role of anemia in precipitating complications such as placenta previa, characterized by abnormal placental implantation and associated with painless vaginal bleeding. Preeclampsia and eclampsia, distinctive hypertensive disorders, are examined, highlighting anemia's potential secondary role through hemolysis. Premature rupture of membranes (PROM) is also investigated, emphasizing anemia's association with disrupted immune responses, potentially contributing to membrane thinning and early rupture. Furthermore, the review explores the link between anemia during pregnancy and postpartum hemorrhage, elucidating the risks posed by reduced oxygen transport and the subsequent impact on uterine contractions. In conclusion, this literature review synthesizes existing knowledge to provide a comprehensive understanding of how anemia intertwines with various pregnancy-related complications, offering insights crucial for improved clinical management and maternal-fetal health outcomes.

IDENTIFICATION OF FACTORS INFLUENCING BIRTH WEIGHT, LENGTH, AND HEAD CIRCUMFERENCE

Newborn size at birth is an important indicator of fetal health, neonatal health, infant survival and childhood morbidity. The aim of our study was to assess and identify factors that significantly influence birth weight, length, and head circumference by performing a post hoc analysis of the data collected during the retrospective-prospective observational cohort study which was conducted at the Clinic for Gynecology and Obstetrics at the University Clinical Centre Kragujevac, Serbia. The influence of potential factors on birth weight, length, and head circumference was evaluated by multiple linear regression analysis. The study included 320 pregnant women and 332 newborns. Four factors had a significant negative effect on birth weight: smoking, twin pregnancy, use of methyldopa and corticosteroids during pregnancy. Smoking, twin pregnancy and corticosteroid use also had a significant negative effect on birth length. Negative effect on fetal head circumference at birth had smoking, use of corticosteroids and antibiotics during pregnancy. Maternal height and gestational age at birth showed a positive influence on fetal anthropometric measurements. Clinicians should pay attention to pregnant women with lower body height, twin pregnancy, who smoke and use corticosteroids, methyldopa and antibiotics.

Serum antibodies against ToRCH agents in pregnant women presenting at a tertiary hospital in Port Harcourt, Nigeria.

ToRCH infections pose a great risk to the fetus and neonates if the mother is actively infected during pregnancy. This may lead to miscarriage, stillbirth, delayed fetal growth and maturation (intrauterine growth retardation), or pre-term delivery. This study aimed to evaluate the prevalence of ToRCH infections in pregnant women in Port Harcourt. Sera from 84 pregnant women between the ages of 16 and 45 were analysed for detectable ToRCH IgM antibodies using the Dia-Pro ToRCH IgM kit. The results from the study showed an IgM seroprevalence rate of 82.1%, with the highest rate of seropositivity obtained among married women (91.0%), Civil servants (92.3%) and women within the age group 25-34 years (92.9%). There was significant relationship between the ToRCH IgM seropositivity and age, marital status and occupational status. The seropositivity of ToRCH agents among pregnant women in Port Harcourt is high, suggesting an acute infection which may adversely affect fetal health. This underscores the need for preventive antenatal screening and universal immunization schemes.

Antioxidants and Pregnancy Complications: Exploring Therapeutic Strategies for Better Outcomes

Pregnancy complications present significant challenges, impacting maternal health and fetal development. Oxidative stress, a key contributor to various pregnancy-related disorders such as preeclampsia, gestational diabetes mellitus (GDM), and preterm birth, has spurred interest in exploring antioxidant interventions. Antioxidants, known for their ability to counteract oxidative damage, have emerged as potential therapeutic agents to mitigate these complications. This paper synthesizes current knowledge on the role of antioxidants in pregnancy, elucidating their mechanisms of action, sources, and impact on oxidative stress-related complications. It examines diverse antioxidant compounds, including vitamins C and E, selenium, and natural phytochemicals, highlighting their potential to modulate oxidative stress pathways and promote maternal-fetal well-being. Furthermore, this paper critically analyzes clinical studies, meta-analyses, and preclinical research exploring the efficacy and safety of antioxidant supplementation during pregnancy. It discusses the complexities surrounding optimal dosages, timing, and formulations of antioxidants, aiming to delineate strategies for their integration into prenatal care. In conclusion, this review provides insights into the promising role of antioxidants as therapeutic strategies to alleviate pregnancy complications associated with oxidative stress. It highlights avenues for future research, advocating for a deeper understanding of antioxidant mechanisms and their optimal utilization in prenatal care to enhance maternal and fetal health outcomes.

Serotonin Transporter-dependent Histone Serotonylation in Placenta Contributes to the Neurodevelopmental Transcriptome

Brain development requires appropriate regulation of serotonin (5-HT) signaling from distinct tissue sources across embryogenesis. At the maternal-fetal interface, the placenta is thought to be an important contributor of offspring brain 5-HT and is critical to overall fetal health. Yet, how placental 5-HT is acquired, and the mechanisms through which 5-HT influences placental functions, are not well understood. Recently, our group identified a novel epigenetic role for 5-HT, in which 5-HT can be added to histone proteins to regulate transcription, a process called H3 serotonylation. Here, we show that H3 serotonylation undergoes dynamic regulation during placental development, corresponding to gene expression changes that are known to influence key metabolic processes. Using transgenic mice, we demonstrate that placental H3 serotonylation is dependent on 5-HT uptake by the serotonin transporter (SERT/SLC6A4). SERT deletion robustly reduces enrichment of H3 serotonylation across the placental genome, and disrupts neurodevelopmental gene networks in early embryonic brain tissues. Thus, these findings suggest a novel role for H3 serotonylation in coordinating placental transcription at the intersection of maternal physiology and offspring brain development.

The relationship between Iranian women’s perception of their birth team’s compliance with medical ethics and their perception of labor pain

BackgroundA safe and satisfactory childbirth experience with the least amount of pain constitutes one of the main domains of reproductive healthcare. The most important aspect of labor pain management is the moral and professional commitment of the health professionals and caregivers involved in creating a pleasant delivery. The present study examines the relationship between Iranian women’s perceptions of their birth team’s compliance with medical ethics and their perception of labor pain.MethodsThis cross-sectional study was conducted on 200 women opting for natural childbirth. The samples were selected by convenience sampling. Three questionnaires, including a demographic information questionnaire, the perception of labor pain questionnaire, and the medical ethics attitude in vaginal delivery questionnaire, were used to collect data. The data were entered into SPSS 22 and analyzed using correlation coefficient and multiple regression tests. The significance level for data analysis was set as less than 0.05.ResultsThe results of the regression analysis showed that among the four principles of medical ethics, only the second and third principles (beneficence and non-maleficence) predicted the perception of labor pain (B = -0.267, P < 0.037). Among the different domains of these principles, the areas of giving the necessary information to the mother (B = -0.199, P = 0.001), respecting the mother’s privacy (B = -0.194, P = 0.001), interaction with the mother (B = -0.287, P = 0.001) and assurance of fetal health (B = -0.492, P = 0.001) were predictors of labor pain perception score.ConclusionsCompliance of the birth team with respecting the mother’s privacy, having friendly interactions with the mother and giving fetal health assurance to the mother can be a predictor of the mother’s decreased perception of labor pain.

The Fundamentals of Inflammatory Bowel Disease Management in Pregnancy: A Practical Review for the Gastroenterologist.

This narrative review explores the management of Inflammatory Bowel Disease (IBD) during pregnancy, emphasizing its unique challenges to maternal and fetal health, particularly within the Canadian Gastroenterology setting. Seven key principles are highlighted: 1) Preconception counselling, aiming for steroid-free remission confirmed by objective markers, should be routine for female IBD patients. 2) Medication safety, with an eye to future pregnancies, should be addressed upon initiation. Methotrexate and small molecules are contraindicated during pregnancy, while most 5-ASA therapies, biologics, and thiopurines can be continued throughout pregnancy and breastfeeding. Steroids, though not without risks, can be utilized if necessary. 3) Routine monitoring during remission should include serum biomarkers and fecal calprotectin each trimester. 4) Routine endoscopy and imaging are not required, but if indicated, lower GI endoscopy, ultrasound, and unenhanced MRI can be used. Computed tomography and gadolinium enhanced MRI should be avoided. 5) Caesarean section is advised for patients with previous ileal pouch surgeries or active perianal disease, but other patients should follow obstetric indications for delivery. 6) Postpartum period may see more active disease, requiring continued monitoring. Breastfeeding is encouraged, and routine childhood vaccinations are advised, but live vaccinations in the first 6 months warrant detailed review. 7) Complex IBD patients may benefit from a multidisciplinary approach with robust communication between gastroenterologists and obstetricians.

The impact of maternal occupation on children’s health: A mediation analysis using the parametric G-formula

BackgroundPrevious studies have found that maternal occupational choice can directly impact fetal health and mothers’ energy and time available for childcare. Moreover, reduced caregiving time is associated with poorer child health. However, how maternal occupational factors (work nature/income/stress) affect child health has not been fully explored. MethodsData were extracted from China Family Panel Studies (CFPS) from 2014 to 2020. A parametric G-formula Model was constructed to simulate the direct impact of maternal occupational factors (work nature, income, and stress) on child health. Furthermore, we explored their indirect effects mediated by maternal physical health, mental health, or occupational factors for the overall sample and by different age groups of the children. ResultsMaternal work nature and income had positive direct impacts on child health, especially for children whose mothers were employers of budgeted positions. Maternal work stress had a negative direct impact on children's health. Maternal work stress mediated the positive impact of maternal work income (9%). Maternal work stress affected children's health directly for children aged under 6, while for children aged 7–15, it had an indirect impact mediated by maternal physical health (43%), mental health (44%), and income (47%). ConclusionAttention should be paid to maternal occupational factors (especially to work stress) and to the varying care needs of children from their mothers at different ages to improve children's health and prevent the transmission of maternal occupation to children's health.

Up-regulated mRNA expression of VEGFA receptors (FLT1 and KDR) in placentas after assisted reproductive technology fertilization

Placental angiogenesis is a pivotal process for feto-maternal circulation and ensures efficient development of the placenta throughout pregnancy. Many factors during in vitro fertilization and embryo transfer procedures may affect placental gene expression and fetus development. The present study aimed to identify differences in angiogenesis-related gene (VEGFA, FGF2, FLT1, and KDR) expression profiles in placentas after assisted reproductive technology fertilization and natural conception in healthy women. In a case-control study, term placentas were collected from Caucasian women after assisted reproductive technology fertilization (N = 20) and after natural conception in women with uncomplicated pregnancy (N = 9). The mRNA expression in placentas was examined for VEGFA, FGF2, FLT1, and KDR genes by real-time quantitative polymerase chain reaction (RT-qPCR). Group stratification was performed for comparison of investigated genes between the type of embryo transferred (fresh/frozen), place of tissue donation (center/margin), and newborns’ gender (male/female). In the ART placentas, significant down-regulation of VEGFA gene (p = 0.016) and up-regulation of FLT1 (p = 0.026) and KDR (p < 0.001) gene receptors were observed. Genes encoding VEGFA receptors were up-regulated in both fresh (ET) and frozen (FET) embryo transfer groups compared to controls. For the FLT1 gene, a statistically significant difference was observed between the frozen embryo transfer group and the controls (p = 0.032). Relative expression of KDR was significantly higher for both embryo transfer groups compared to controls (p < 0.001) and between ET and FET (p = 0.002). No statistically significant differences were observed between placental expression in different places of tissue donation and newborns’ gender. We observed differences in the placental expression of VEGFA and its receptors FLT1 and KDR in pregnancies after assisted reproductive technology compared to naturally conceived pregnancies. More research is needed to clarify these alterations that may affect placental development and fetal health.

Exploring pregnant individuals’ counseling needs regarding urgent imaging to rule out pulmonary embolism

BackgroundComputed tomography pulmonary angiogram and lung scintigraphy with ventilation/perfusion scan are needed to diagnose pulmonary embolism (PE) in pregnancy. Their associated ionizing radiation doses are considered safe in pregnancy. A standardized patient information tool may improve patient counseling and reduce testing hesitancy. ObjectivesIn this context, we sought to address 1) what patients want to know before undergoing these tests and 2) how they want the information to be provided to them. MethodsWe used a qualitative descriptive methodology. We recruited pregnant participants at the McGill University Health Center in Montreal, Canada. Structured interviews explored information needs about PE and diagnostic imaging for PE. The interview transcripts’ themes were analyzed with a hybrid deductive and inductive approach. ResultsOf 21 individuals approached, 20 consented to participate. Four had been previously investigated for PE. Participants requested information about the risks associated with PE and radiation and their effects on maternal and fetal health. They preferred for radiation doses to be presented in comparison with known radiation thresholds for fetal harm. They suggested that a written tool should be developed using an accessible language. Participants also indicated that the tool would be integrated into their decision-making process, emphasizing a lower risk tolerance for their fetus than for themselves. ConclusionThis single-center group of pregnant patients wished to be informed about the risks of PE and radiation associated with imaging. A written tool could help put information into context and facilitate decision making. These new insights may be used to inform counseling.

The protective association of dairy intake and the adverse impact of iron on gestational diabetes risk.

Background: Gestational diabetes (GDM) is a pregnancy-related glucose intolerance with significant implications for maternal and fetal health. Calcium is essential for insulin secretion and metabolism, while iron intake may also impact GDM. This case-control study was conducted to investigate the relationship between calcium and iron intake with the risk of GDM. Methods: GDM was defined as Fasting Blood Sugar>92mg/dL or 75g Oral-Glucose-Tolerance-Test 120-minutes>153mg/dL. A 168-Item food-frequency-questionnaire was used to collect dietary calcium and iron intake from 24-40 weeks of gestation. The impact of total iron, red, processed/unprocessed meat consumption, calcium, and dairy intake on GDM were investigated. Results: A total of 229 GDM and 205 non-GDM women (18-45 years) participated. GDM group had higher pre-pregnancy weight, weight gain, and pre-pregnancy BMI. Across all models, GDM risk significantly increased in the third and fourth quartiles of iron intake. The fourth quartile had an Odds Ratio (OR) of 2.68 (CI 95%, 4.89-1.56; P<0.001) compared to the reference. Heme-iron consumption in the fourth quartiles increased GDM risk. In the second calcium intake model, ORs for the second, third, and fourth quartiles were 0.51 (CI 95%, 0.91-0.25), 0.43 (CI 95%, 0.77-0.24), and 0.35 (CI 95%, 0.63-0.19), respectively (P<0.001 all), reducing GDM risk by 50-65% compared to the first quartile. Dairy consumption in all quartiles of the first and second models was associated with lower GDM risk. Conclusions: Consumption of heme-iron through red and processed meat associated with an increased chance of developing GDM. Dairy intake reduces the chances of developing GDM in pregnant women.

Clinical Evaluation of an Ayurvedic Preparation “Sangfer” for the Treatment of Anemia in Pregnant Women: An Open-labeled Clinical Study

Background: Iron deficiency during pregnancy is one of the primary causes of anemia in infants and young children. Ithas a negative impact on maternal and fetal health throughout pregnancy with higher likelihood of adverse maternal andfetal outcomes. Maternal iron supplementation is a critical tool to address the global problem of iron deficiency and preventits negative consequences. Method: An open-label non-comparative prospective clinical trial was carried out to evaluatethe effectiveness of “Sangfer” liquid in 16 pregnant women with anemia. “Sangfer” is a polyherbal Ayurvedic proprietarymedication containing elemental iron and zinc and four medicinal herbs viz. Withania somnifera, Emblica officinalis, Asparagusracemosus and Pueraria tuberosa. The aim of the study was to examine its efficacy and safety in treating anemia in pregnantwomen. The dose administered was 10 mL twice daily after food for 12 weeks (84 days). Patients were evaluated at screening(Visit 1 at Day 0), baseline (Visit 2 at Day 1) and during follow-ups (Visit 3 at Day 28, Visit 4 at Day 56 and Visit 5 atDay 84). Results: There was a significant increase in mean hemoglobin levels from 8.08% at Day 1 to 11.19% at the finalvisit at Day 84. The anemia sign and symptom scores also significantly reduced from Day 1 to different follow-up visits.The mean Physician Global Assessment (PGA) score was found to reduce from 1.0 at Day 1 to 0.0 at the final follow-upvisit. Conclusion: “Sangfer” is highly effective for the treatment of anemia during pregnancy. No adverse effects includingserious adverse effects were observed during the study period.

Ultrasound blood flow characteristics changes in fetal umbilical artery thrombosis: A retrospective analysis.

Umbilical artery thrombosis (UAT) is extremely uncommon and leads to adverse perinatal outcomes. Hypercoagulation of blood in pregnant women is suspected to be an important risk for UAT. Ultrasound is an effective way to detect thrombosis. The mother can monitor her own fetal health using ultrasound, which enables her to take preventative action in case of emergency. To investigate ultrasonic blood signal after UAT in the umbilical artery, and evaluate the relationship between hypercoagulability and UAT. We described a case of a newly formed UAT with markedly altered ultrasonic indices of umbilical artery blood flow, and retrospectively studied it with 18 UAT patients confirmed by histopathology from October 2019 and March 2023 in Xiamen Women and Children's Hospital. Patients' information was collected from medical archives, including maternal clinical data, neonatal outcomes, pathological findings and ultrasonic indices of umbilical artery blood flow, such as systolic-diastolic duration ratio (S/D), resistance index (RI), pulsatility index (PI) and peak systolic velocity (PSV). Ultrasound and coagulation indices were analyzed with matched samples t-test and Wilcoxon rank sum test using the statistical packages in R (version 4.2.1) including car (version 3.1-0) and stats (version 4.2.1), and visualized by ggplot2 package (version 3.3.6). A patient with normal findings in second and third-trimester routine ultrasound scan developed UAT with severe changes in ultrasonic indices of umbilical artery blood flow (within 2.5th of reference ranges) in a short period of time. Statistical analysis of umbilical artery blood flow ultrasound indices for 19 patients with UAT showed that the decrease in S/D, RI, and PI and increase of PSV during the disease process was greater than that of non-UAT. All 18 patients delivered in our hospital showed characteristic manifestations of UAT on histological examination after delivery, most of which (16/18) showed umbilical cord abnormalities, with 15 umbilical cord torsion and 1 pseudoknot. Coagulation parameters were not significantly changed in UAT patients compared with normal pregnancy women. Significant changes in ultrasound indicators after UAT were demonstrated. PSV can play important roles in the diagnosis of UAT. Hypercoagulability alone is not sufficient for the occurrence of UAT.

Management of monogenic diabetes in pregnancy: A narrative review.

Pregnancy in women with monogenic diabetes is potentially complex, with significant implications for both maternal and fetal health. Among these, maturity-onset diabetes of the young (MODY) stands out as a prevalent monogenic diabetes subtype frequently encountered in clinical practice. Each subtype of MODY requires a distinct approach tailored to the pregnancy, diverging from management strategies in non-pregnant individuals. Glucokinase MODY (GCK-MODY) typically does not require treatment outside of pregnancy, but special considerations arise when a woman with GCK-MODY becomes pregnant. The glycemic targets in GCK-MODY pregnancies are not exclusively dictated by the maternal/paternal MODY genotype but are also influenced by the genotype of the developing fetus. During pregnancy, the choice between sulfonylurea or insulin for treating hepatocyte nuclear factor 1-alpha (HNF1A)-MODY and HNF4A-MODY depends on the mother's specific circumstances and the available expertise. Management of other rarer MODY subtypes is individualized, with decisions made on a case-by-case basis. Therefore, a collaborative approach involving expert diabetes and obstetric teams is crucial for the comprehensive management of MODY pregnancies.

Women's attitudes towards disclosure of genetic information in pregnancy with varying levels of penetrance.

Chromosomal-microarray-analysis (CMA) may reveal susceptibility-loci (SL) of varied penetrance for autism-spectrum-disorder (ASD) and other neurodevelopmental conditions. Attitudes of women/parents to disclosure of SL during pregnancy are understudied. A multiple-choice questionnaire was distributed to postpartum women. Data were collected on women's interest to receive prenatal genetic information with various levels of penetrance. Women's (n=941) disclosure choices were dependent on the magnitude of risk: approximately 70% supported disclosure of either full or 40% penetrance, 53% supported disclosure at a 20% risk threshold, and 40% supported disclosure at 10% or less. Although most women supported, rejected or were indecisive about disclosure consistently across all risk levels, nearly one-quarter (24%) varied their responses based on penetrance, and this was associated with religiosity, education, parity and concern about fetal health (p-values<0.04). Among those who varied their choices, the risk threshold was lower among secular women (20%) than among ultraorthodox women (40%). In a multivariable analysis, ultraorthodox women were much less likely to vary their choices on ASD disclosure compared with secular women (aOR=0.37, p<0.001). Women's attitudes toward disclosure are influenced by the level of risk and their individual characteristics. We therefore encourage engaging women/couples in disclosure decisions regarding uncertain and probabilistic results from prenatal genomic tests.

Occurrence of Imipenem-Resistant Uropathogenic Escherichia coli in Pregnant Women: An Insight into Their Virulence Profile and Clonal Structure.

Uropathogenic Escherichia coli (UPEC) is the predominant pathogen in Urinary Tract Infection (UTI) in pregnant and non-pregnant women. Limited studies were initiated to explore UPEC from pregnant women with respect to imipenem resistance, pathogenicity, and their clonal lineage. In this study, imipenem resistance, phylogenetic background, virulence-associated genes, and clonal characteristics in UPECs isolated from pregnant and non-pregnant cohorts were investigated. E. coli was identified biochemically from urine culture-positive samples from pregnant and non-pregnant women. Carbapenem (meropenem, ertapenem, imipenem) susceptibility was determined by Kirby-Bauer disk diffusion test. The pathogenic determinants were identified by PCR. MEGA 11 was used to interpret clonal lineages from MLST. GraphPad Prism 8.0 and SPSS 26.0 were used for statistical interpretation. Results indicated highest resistance against imipenem compared to meropenem and ertapenem in UPECs isolated from pregnant (UPECp; 63.89%) and non-pregnant (UPECnp; 87.88%) women. Although phylogroup E was predominant in both imipenem-resistant isolates, acquisition of virulence factors was higher among UPECnp than UPECp. Akin to this observation, the presence of PAI III536 and PAI IV536 was statistically significant (p < 0.05) in the former. MLST analysis revealed similar clonal lineages between UPECnp and UPECp, which showed an overall occurrence of ST405 followed by ST101, ST410, ST131, and ST1195 in UPECnp and ST167 in UPECp, respectively, with frequent occurrence of CC131, CC405. Therefore, imipenem-resistant UPECp although discrete with respect to their virulence determinants when compared to UPECnp shared similar STs and CCs, which implied common evolutionary history. Thus, empiric treatment must be restricted in UTIs to especially protect maternal and fetal health.