Greater Number Of Pregnancies Research Articles

Obesity doubled the incidence of preeclampsia but did not worsen the complications of this pathology in pregnant women at the Llano Hospital, at Corrientes, Argentina

Objectives: To evaluate the impact of obesity on the incidence and complications of preeclampsia (PE). Material and methods: Database of 19,699 deliveries. The incidence of PE and its complications was analyzed in relation to body mass index (BMI). Qualitative variables are expressed as percentages and were analyzed with Pearson's chi square; the quantitative ones as mean and SD, and were compared with Student's test and Anova. Differences <0.05 were considered significant. SPSS 20 was used. Results: 703 patients had PE (3.6%); BMI: Mean 23.7±5.8; Classification by BMI: Underweight: 9.2%; Normal: 62.9%; Overweight: 17.4%; Obesity:10.6%; Incidence of PE according to BMI: Low weight: 2.5%; Normal: 2.9%; Overweight: 5.1%; Obesity: 6.0% (p<.0001). Incidence in the variables studied in pregnant women without and with PE were: 3rd trimester hemorrhage: 1 vs 1.4%; premature rupture of membranes (PROM) 10.7 vs 5.9%*; intrauterine growth restriction (IUGR) 3.2 vs 10.1%*; anemia 30 vs 31.2%; previous hypertension (HTN) 2.1 vs 7.2%*; intrauterine mortality 1.8 vs 2.6%; Low Apgar 2.5 vs 4.0%*; preterm 8.6 vs 21.7%*; neonatal death 0.5 vs 1.1%; nulliparous 32.6 vs 47.4%*; smoking 12.1 vs 14.4%; multiple pregnancy 1.5 vs 4.6%*; underweight 6.8 vs 22.9%*; age: 25±6 vs 26±7years*; usual weight 57.8±11.5 vs 63±14 kg*; gestational age by Capurro 38.6±2.4 vs 37.6±2.8*; newborn weight 3274±572 vs 2957±793*; feats 2±2.4 vs 1.9±2.5; deliveries 1.8±2.1 vs 1.7±2.3 (0.003) and total days of hospitalization 7±20 vs 9.6±23 (0.007), respectively. (*p<.0001) Incidence in the variables studied according to BMI in patients without PE: comparing low weight, normal weight, overweight and obesity, significant differences were obtained in PROM, IUGR, previous HTN, low Apgar, nulliparity, low weight of the newborn (RN), gestational age , pregnant age, pregnancies and number of births. The obese women were older and had a greater number of births; but except for the incidence of previous HTN and low Apgar that exceeded those of normal weight, in the rest there was improvement in the weight of the RN, in PROM, IUGR and in anemia as the BMI of the pregnant women increased. Incidence in the variables studied according to BMI in patients with PE: comparing low weight, normal weight, overweight and obesity, significant differences were obtained in PROM, IUGR, nulliparity, low birth weight, pregnant age, pregnant weight, pregnancies and number of births. The EPs with obesity were older, heavier, and had a greater number of pregnancies and births. However, it can be seen that as we go from underweight, normal weight, overweight and obesity, the incidence of: RPM is 15.2; 7.3; 3.4 and 1.7, of RCIU 22.2; 8.9; 12 and 6, and the NB's weight increases: 2687± 802; 2903± 740; 2985± 814 and 3174± 858 respectively. Conclusions: Obesity (10% pregnant women) presented an incidence of PE of 6% vs 2.9% in those of normal weight. Patients with PE compared to normal patients had more perinatal complications except for PROM. Obesity, beyond increasing the incidence of PE, in no case worsened the complications of this pathology.

Profile of children assisted in a teaching outpatient clinic of developmental disabilities in São Paulo, Brazil

To analyze the epidemiological and clinical profile of patients with developmental disabilities followed in a university clinic in Brazil. Descriptive, retrospective study, based on medical records. Children aged zero to 18 years with developmental problems, firstly evaluated between 2009 and 2018, were included. Patients with missing data or out of the age and time period established were excluded. There were nine losses and 374 patients constituted the final sample. Linear regression models were performed. The mean age at the first assessment was 52.2±39.7 months and the age when the parents perceived the symptoms was 20.9±23.8 months. The most common impairment was motor associated with language delay (28.3%). The interval between the parents' perception and the first consultation was associated with the mothers' education and number of pregnancies. The age at first assessment was associated with the disability type. The number of pregnancies was associated with the child's age when the parents noticed the symptoms and at the first consultation. Parents' recognition of the symptoms occurred early, however, there was a delay until the arrival at the clinic. Higher maternal education was associated with a shorter gap between perception of the developmental disability and consultation. A greater number of pregnancies was associated with a later perception of the developmental delay by the parents as well as a delay in the assessment and a wider interval between them. Motor problems were the most common in younger children, and language complaints in older ones.

Perimenopause and the state of diastolic function of the left ventricle in women

Aim to study the features of the diastolic function of the left ventricle, taking into account the gynecological history in women of perimenopausal age.
 Material and methods. A single-stage cross-sectional study included 75 women aged 45 to 55 years. All women were examined, their anamnesis, including gynecological, was taken and gynecological status was established. Relying on echocardiography data, the women were divided into a group with normal left ventricular diastolic function and a group with diastolic dysfunction. Lipid and carbohydrate metabolism, the concentration of follicle-stimulating hormone were evaluated in all women.
 Results. Study showed that women with detected type 1 diastolic dysfunction were older than women with normal diastolic heart function. In women with diastolic dysfunction, hypertension and negative metabolic indicators were more common; they were characterized by a greater number of pregnancies and abortions, if compared to women with unchanged heart function, in addition, they were more likely to be in early menopause.
 Conclusion. Diastolic dysfunction is widespread in perimenopausal women, which is not always explained by traditional risk factors. There is a relationship between gynecological history and the development of diastolic dysfunction, but the pathogenetic mechanisms underlying this process in women remain unclear.

Reproductive potential repair in men with varicocele

Relevance. In majority of men, varicose veins of the testicle - varicocele - does not cause discomfort and is asymptomatic, and scrotal pain only bothers 10 % of patients. In 2/3 of cases, varicocele is a clinical finding. In this case, varicocele is the most common cause of male infertility. Aim of the study. Recovery of the reproductive potential of patients with varicocele. Materials and Methods. In 219 patients with varicocele, weve carried an ejaculate study out (WHO, 2010) 3, 6, 12 months after surgical treatment of varicocele. We considered the reproductive function restored by normozoospermia in the ejaculate and the onset of pregnancy in the spouse during the follow - up period of 12 months. Results and Discussion. The 2/3 men of the 219 patients with varicocele had ejaculate abnormalities. The age of patients who were diagnosed with pathospermia was 31+11 years. 66 (39.5 %) patients with varicocele had spermatozoa with reduced mobility. After surgical treatment (varicocelectomy according to Marmara), normozoospermia was present almost in every second man. Nevertheless, the number of pregnancies in a married couple was higher than 6 months after varicocelectomy - 24(32.8 %). The surgical method of treatment of varicocele allows to restore the reproductive function of a man in 30 %. In our study, normozoospermia after varicocelectomy was recorded in almost every second patient. Ultrasound changes in the testicle with varicocele are an unfavorable prognosis for the restoration of male fertility. Conclusion. Surgical treatment of varicocele can recover the reproductive potential of almost every second man of reproductive age. Moreover, a greater number of pregnancies six months right after the operation were registered in spouses.

Reproductive potential repair in men with varicocele

Relevance. In majority of men, varicose veins of the testicle - varicocele - does not cause discomfort and is asymptomatic, and scrotal pain only bothers 10 % of patients. In 2/3 of cases, varicocele is a clinical finding. In this case, varicocele is the most common cause of male infertility. Aim of the study. Recovery of the reproductive potential of patients with varicocele. Materials and Methods. In 219 patients with varicocele, weve carried an ejaculate study out (WHO, 2010) 3, 6, 12 months after surgical treatment of varicocele. We considered the reproductive function restored by normozoospermia in the ejaculate and the onset of pregnancy in the spouse during the follow - up period of 12 months. Results and Discussion. The 2/3 men of the 219 patients with varicocele had ejaculate abnormalities. The age of patients who were diagnosed with pathospermia was 31+11 years. 66 (39.5 %) patients with varicocele had spermatozoa with reduced mobility. After surgical treatment (varicocelectomy according to Marmara), normozoospermia was present almost in every second man. Nevertheless, the number of pregnancies in a married couple was higher than 6 months after varicocelectomy - 24(32.8 %). The surgical method of treatment of varicocele allows to restore the reproductive function of a man in 30 %. In our study, normozoospermia after varicocelectomy was recorded in almost every second patient. Ultrasound changes in the testicle with varicocele are an unfavorable prognosis for the restoration of male fertility. Conclusion. Surgical treatment of varicocele can recover the reproductive potential of almost every second man of reproductive age. Moreover, a greater number of pregnancies six months right after the operation were registered in spouses.

Breastfeeding self-efficacy and related factors during early postpartum period

BACKGROUNDBreastfeeding self-efficacy (BSE) could be an indicator of the performance of mothers in breastfeeding during the immediate postpartum time period. The factor most affecting the duration and success of breastfeeding is the self-efficacy perception of the mothers. This study was carried out to determine the BSE and the factors related to it in the early postpartum period. METHODSA cross-sectional study was performed involving 264 mothers. Data were collected by using a questionnaire and the BSE scale (BSES). The questionnaire consisted of questions regarding descriptive characteristics (age, educational status, family type, income level, etc.) and obstetric characteristics regarding pregnancy, delivery and breastfeeding status (number of pregnancies, number of births, type of delivery, planned and desired pregnancy, birth weight, first breast-feeding time after birth, etc.). Simple and multiple linear regression were performed to examine factors related to BSE. RESULTSThe mean BSE score of the mothers participating in the study was 65.20 ± 9.3. Simple and multiple linear regression models indicated that significant determinants of BSE score include having nuclear family type, having social security, a greater number of pregnancies, a greater number of births, the status of antenatal visits in pregnancy, the status of getting information about breastfeeding, and short first breastfeeding time. Getting information about breastfeeding was the most influential factor of BSE (Beta=3.432; 95% CI : 32.771-51.626; p=0.000). CONCLUSIONSIn this study, getting information about breastfeeding was the most influential factor of BSE in the early postpartum period. A woman's level of breastfeeding self-efficacy should be determined during the early postpartum period.

Brentuximab vedotin with chemotherapy in adolescents and young adults (AYAs) with stage III or IV Hodgkin lymphoma: A subgroup analysis from the phase 3 Echelon-1 study.

7528 Background: Hodgkin lymphoma (HL) is a rare disease that commonly occurs in adolescents and young adults (AYAs) which is typically defined as 15 to 39 years. Given their young age at presentation, key factors in treatment selection include a high cure rate and limiting long-term toxicities. Brentuximab vedotin (Adcetris®; A) is a CD30-directed ADC approved in combination with doxorubicin, vinblastine, and dacarbazine chemotherapy (A+AVD) for adults with previously untreated stage III/IV cHL based on results from the phase 3 ECHELON-1 trial. Recent 5-year data demonstrated a significantly improved PFS per investigator (INV) vs doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) (HR, 0.69; 95% CI, 0.54–0.9; P = 0.003) (Straus 2020). Here we describe key efficacy and safety results for AYA pts enrolled in ECHELON-1. Methods: ECHELON-1 (N = 1334) is a global, open-label, multicenter, randomized trial of pts with previously untreated stage III/IV cHL. A total of 771 AYAs (57.8%) received either A+AVD (n = 396) or ABVD (n = 375) with a PET scan after cycle 2 (PET2). An analysis of PFS (time from randomization to progression or death from any cause) per INV was conducted. Results: After a median follow-up of 60.7 months (95% CI, 60.4-61.0), there was a 36% reduction in the risk of progression or death in AYAs receiving A+AVD vs ABVD (HR 0.64; 95% CI, 0.45-0.92; P = 0.013) with a 5-year PFS of 86.3% vs 79.4%, respectively, similar to the ITT population. The PFS benefit of A+AVD vs ABVD was independent of PET2 status; PET2 positivity (Deauville 4-5) was 6% and 8%, respectively. On the A+AVD arm, 81 AYAs (20%) had at least 1 subsequent anticancer therapy vs 96 AYAs (26%) on the ABVD arm; 26 AYAs (7%) received subsequent high dose chemotherapy and autologous stem cell transplant vs 32 AYAs (9%) on the A+AVD and ABVD arms, respectively. Resolution or improvement of peripheral neuropathy (PN) were similar in both arms; 224 AYAs (88%) on the A+AVD had resolution or improvement of PN vs 133 AYAs (89%) on the ABVD arm. Ongoing PN was predominantly Gr 1 (62%) and Gr 2 (26%), with 8 AYAs (13%) on the A+AVD arm and 1 AYA (5%) on the ABVD arm reporting ongoing Gr 3 PN. Finally, 7 AYAs (1.8%) and 5 AYAs (1.4%) on the A+AVD and ABVD arms, respectively, reported a secondary malignancy. Subsequent pregnancies were reported in female pts (44 A+AVD; 26 ABVD) and partners of male pts (31 A+AVD; 30 ABVD). No stillbirths were reported. All but 1 pt in each arm was < 40. Conclusions: Consistent with the ITT population, AYAs treated with A+AVD compared to ABVD had a durable PFS benefit at this significant 5-year milestone. No impact on the rate of secondary malignancies and a numerically greater number of pregnancies were observed, outcomes of interest to AYAs. Additionally, the majority of PN events improved or resolved over time. A+AVD should be considered a treatment option for AYAs with stage III/IV cHL. Clinical trial information: NCT01712490.

Barriers to Attendance of Prenatal and Well-Child Visits.

Prenatal care (PNC) and well child visit (WCV) attendance are associated with improved health outcomes. We aimed to determine if the factors affecting maternal and child attendance are similar or different. We conducted a retrospective case control study at Virginia Commonwealth University Health System. We used the Adequacy of Prenatal Care Utilization Index and the American Academy of Pediatrics recommendations to assess the adequacy of PNC and WCV attendance, respectively. Mothers with less than 50% visit adherence or initiation after 5 months gestation were eligible as cases and those with 80% or more adherence and initiation before 5 months were eligible as controls. Children in the lowest quintile of adherence were eligible as cases and those with 80% or more adherence were eligible as controls. Cases and controls were randomly selected at a 1:2 ratio from the eligible subjects and frequency matched on birth month. In adjusted analyses, mothers and children who were publicly insured or who were uninsured had higher odds of poor preventive visit attendance. Mothers who experienced intimate partner violence and had more living children were more likely to have poor attendance. Children whose mothers had younger age, greater number of pregnancies and transportation difficulties had poorer attendance. While lack of insurance and public insurance remained significantly associated with both poor PNC and WCV attendance, other factors varied between groups. Expanding eligibility requirements and streamlining enrollment and renewal processes may improve two generations of preventive visit attendance.

Multi-contextual influences on adolescent pregnancy and sexually transmitted infections in the United States

RationaleRates of adolescent pregnancy and sexually transmitted infections (STIs) in the United States remain high. Norms and beliefs about sex and the use of contraception have been identified as potential contributors to these. ObjectiveThe current study examined multi-contextual links between norms and beliefs about sex and contraception, and adolescent pregnancies and STIs. MethodHierarchical linear modeling (HLM) was used to test the study questions in the historical data from Add Health dataset (Wave I, 1994–1995, and Wave II, 1995–1996). Measures of beliefs about sex and contraception were administered to adolescents and their caregivers; pregnancies and STIs were reported by adolescents (N = 13,568; level 1). School-reported data (N = 132; level 2) included sexuality education and prevalence of pregnancies at schools. Community data included the density of family planning providers in each county. ResultsAdolescents negative beliefs about contraception were associated with a higher likelihood of pregnancies and STIs via their association with contraception use. The opposite effect was found for negative beliefs about sex. Parental disapproval of contraception was associated with a decreased likelihood of STIs, but with an increased likelihood of pregnancies. A greater number of pregnancies at school was associated with a greater likelihood of STIs. Unexpectedly, the number of county-level family planning providers was associated with a higher likelihood of STIs. ConclusionAdolescent individual beliefs emerged as the most salient predictors of both pregnancies and STIs.

Prediction of Adverse Pregnancy Outcomes among Women with Type 1 Diabetes

Women with type 1 diabetes are at a greater risk for adverse pregnancy outcomes (APO) compared with the general population, though factors relating to the occurrence of APO have not been well studied. We thus assessed predictors of APO among women with type 1 diabetes. Female participants (n=325; mean baseline age 28, duration 19 years) of a prospective cohort of childhood onset type 1 diabetes were selected for study. Among 320 with pregnancy data available, all pregnancies occurred after study entry (1986-88) for 61 (mean baseline age 21 and duration 14 years). APO were defined as tubal/ectopic pregnancies, spontaneous or induced abortions and stillbirths. Follow-up time was calculated as time in years from study entry to the date of the first adverse pregnancy outcome or date of last live birth for those with normal pregnancies. During 25 years of follow-up, 28 (45.9%) had at least one APO. With the exception of a greater number of total pregnancies in those with an APO (p=0.03), no other univariate differences were observed. In multivariable Cox models, a greater number of pregnancies (HR=1.49, p=0.03), log albumin excretion rate (HR=1.27, p=0.03) and proliferative retinopathy (HR=5.04, p=0.003) predicted APO. In multiple linear regression analyses, the number of pregnancies (β=0.58, p<0.0001) and the presence of proliferative retinopathy (β=0.75, p=0.01) directly predicted number of APO. In analyses excluding induced abortions from the outcome definition (19 adverse events (31.1%)), glomerular filtration rate was the only predictor of any APO (HR=0.98, p=0.08). A greater number of pregnancies (β=0.48, p<0.0001), non-HDL cholesterol (β=0.006, p=0.04), white blood cell count (β=-0.10, p=0.05) and proliferative retinopathy (β=0.74, p=0.02) predicted number of APO. Among women with type 1 diabetes, the presence of microvascular complications relates to both the occurrence and the number of subsequent adverse pregnancy outcomes. Disclosure T. Costacou: None. D. Rubinstein: None. T.J. Orchard: None.

The changing pattern of contraceptive use and pregnancies in four generations of young women.

The aim of this study was to describe contraceptive use and pregnancies and their relationship to socio-economic status (SES) in four generations of young Swedish women. Questionnaires regarding contraceptive use and pregnancies were sent to random samples of 19-year-old women in 1981, 1991, 2001 and 2011 (n=4732). Current contraceptive use was higher in 2001 (78%) (p<0.01) and 2011 (69%) (p<0.05) compared with 1981 (60%) and 1991 (62%). Combined hormonal contraception (CHC) was the most common form of contraception throughout (p<0.0001). The use of long-acting reversible contraception (LARC=implants, intrauterine contraception) and progestogen-only pills increased over time (p<0.01). Mental side effects as a reason for CHC cessation increased over time and was the most common reason for cessation of CHC in 2011 (p<0.001). Contraceptive use was lower in women from low SES areas (p<0.05) in 2011. The percentage of young women who had been pregnant at ≤19years of age was lower (p<0.05) in the assessment from 2001 (7%) than in that in 1991 (13%) and 2011 (12%). The proportion of teenage mothers decreased from 4.4% (1981) to 1.6% (2011) (p<0.01). More women had been pregnant at ≤19years of age in low SES areas than in middle and high SES areas (p<0.05). The lowest pregnancy rate was in the cohort with the highest contraceptive use. Term pregnancies declined over time. A greater number of pregnancies in low SES areas and a change towards lower contraceptive use in low SES areas was recorded in 2011.

Identification of potential missed opportunities for human papillomavirus (HPV) vaccination in women referred to an academic colposcopy clinic for evaluation of abnormal cervical cytology

abstractObjective: To identify possible predictors of missed opportunities for human papillomavirus (HPV) counseling and vaccination prior to presentation at an academic colposcopy clinic. Materials and Methods: We examined the characteristics of 638 vaccinated and 1,024 unvaccinated age-eligible patients using data from a patient registry of women presenting for colposcopic evaluation between 2/26/2007 and 3/10/2014 who were aged 26 or less at presentation. Demographics, smoking history, pregnancy history, sexually transmitted infections (STIs), sexual history, contraception use, immunosuppression, and medical problems were compared between HPV vaccinated and unvaccinated women. Multivariable logistic regression models included age, race, language, marital status, insurance type, lifetime number of sexual partners, other medical illnesses, number of pregnancies, contraception use, history of STIs, and smoking history to determine predictors of HPV vaccination. Results: In multivariable analysis, race, marital status, and language were not significantly associated with HPV vaccination. Women with fewer pregnancies were more likely to be vaccinated (p-trend <0 .0001). Vaccinated women were more likely to have other medical illnesses (OR=1.44, 95% CI=1.13–1.83) and be aware of their HPV status (OR=1.75, 95% CI= 1.40–2.18). Conclusions: In this study, greater number of pregnancies was associated with lower vaccination rates as compared to women who had never been pregnant. Reproductive health visits, such as postpartum and family planning visits, represent an ideal opportunity to educate women about HPV and the importance of vaccination, and should be an area of focus to improve current HPV vaccination rates.

Association between HIV infection and bone mineral density in climacteric women

A cross-sectional study was conducted with the purpose of evaluating bone mineral density in HIV seropositive and seronegative climacteric women. HIV infection was negatively associated with bone mineral density in the lumbar spine To assess bone mineral density (BMD) and its associated factors in HIV seropositive and seronegative climacteric women A cross-sectional study with 537 women (273 HIV seropositive and 264 HIV seronegative) aged between 40 and 60 years old receiving follow-up care at two hospitals in Brazil. A questionnaire on clinical and sociodemographic characteristics was completed. Laboratory tests were performed, and BMD was measured at the lumbar spine and hip. Statistical analysis was carried out by Yates and Pearson chi-squared tests, Mann-Whitney test, and multiple linear regression. The mean age was 47.7 years in HIV-seropositive women, and 75 % had nadir CD4 above 200, and 77.8 % had viral load below the detection limit. The mean age in the HIV-seronegative women was 49.8 years. The prevalence of low spinal BMD was 14.6 % in the HIV-seropositive and 4.6 % in the HIV-seronegative women (p < 0.01). The prevalence of low BMD at the femoral neck was 5.6 % in HIV-seropositive and 3.3 % in the HIV-seronegative women (p = 0.38). Multiple analyses showed that the factors associated with lower BMD at the spine were being postmenopausal and being HIV-seropositive. Being overweight was associated with a higher BMD. At the femoral neck, factors associated with lower BMD were being postmenopausal and being white. Being overweight and having a greater number of pregnancies were associated with higher BMD CONCLUSIONS: HIV-seropositive women on long-term antiretroviral treatment and in good immunological conditions exhibited low BMD in the spine (L1-L4). However, BMD in the femoral neck was similar to non-infected women.

Hormone-related factors and post-menopausal onset depression: Results from KNHANES (2010–2012)

BackgroundAlthough hypotheses have been proposed regarding the biological mechanisms of hormonal fluctuations in mood disorders, few epidemiological studies have addressed this issue. The aim of this study was to examine the association between hormone-related life events and postmenopausal depression. MethodsOf 13,918 women who participated in the Korean National Health and Nutrition Examination Survey (KNHANES) V, a total of 4869 post-menopausal women who had completed information on depression onset age and additional reproductive factors were included in the analysis. A multivariate logistic regression was applied to calculate the odds ratios between reproductive factors and post-menopausal onset depression. ResultsA total of 276 women (5.7%) were diagnosed with depression after menopause. Longer reproductive years were associated with a reduced risk of depression (for more than 35 reproductive years: OR=0.41, 95% CI: 0.27–0.62, P-trend<0.001). Similarly, a later age of menopause (52 years and older) corresponded to a decreased risk of depression (OR=0.35, 95% CI: 0.22–0.55) compared to the women with a menopausal age younger than 46 years. Greater numbers of pregnancies and exogenous hormone use were also associated with increased risk of depression. LimitationsAll data were collected from interviews using questionnaires. There may be some inaccuracies in recall of lifetime reproductive events, but women generally recalled their hormonal events correctly. ConclusionEarly menopause and the use of exogenous hormones were associated with the risk of post-menopausal depression. Clinicians should closely monitor and consider further screening for depressed women who undergo early menopause or those with exogenous hormone use.

The prevalence of overactive bladder syndrome and urinary incontinence in a Turkish women population; associated risk factors and effect on Quality of life.

To investigate the prevalence and risk factors of overactive bladder syndrome and urinary incontinence in Turkish women; furthermore, to assess the impact on the quality of life. A cross-sectional, epidemiological study was carried out in women of reproductive age to define overactive bladder syndrome, urinary incontinence, ICIQ-SF score and medical care seeking. The women's average age was 34.4 ± 5.26 years. The prevalence of UI was 26.9%. Stress UI was the predominant form. The prevalence of UI increased with age, BMI, number of pregnancies and children delivered. The prevalence of OAB was 20.7%. Women with OAB were older and had greater number of pregnancies than women without OAB. History of nocturnal enuresis was a significant risk factor for OAB and UUI. Women with MUI had more frequent and more abundant leakage of urine. 10.7% of women sought medical care for their condition. Although prevalence estimates differ across studies, the available evidence indicates that UI and OAB are highly prevalent conditions among women. UI had negative effect on QoL, but only severely-affected women sought medical care. Public health and clinical management programs are needed to determine diagnosis and management of these social problems.

Pregnancy outcomes of women with failure to retain rubella immunity

Objective: We sought to explore the clinical variables associated with the loss of rubella immunity during pregnancy and to determine if these changes are linked to obstetrical complications.Methods: This is a case-control study in which women were identified whose rubella antibody titers were equivocal or non-immune and compared to those who had retained immunity. Two hundred and eighty-five cases were identified and compared to the same number of controls using Student’s t test, Mann–Whitney U-test or Fisher’s exact test. Univariate and multivariate logistic regressions were employed.Results: Subjects with diminished immunity were more likely to have public insurance and higher gravidity with a trend toward increased tobacco use. Diminished rubella immunity was not associated with adverse obstetrical outcomes, including preterm birth and pre-eclampsia and is likely not a risk factor for these pregnancy outcomes.Conclusion: While no adverse pregnancy outcomes were associated with a loss of rubella immunity, women with greater number of pregnancies appear to lose their immunity to rubella. This relationship needs to be explored further and if proven, revaccination prior to pregnancy may need to be addressed.

Effects of progestagen exposure duration on estrus synchronization and conception rates of crossbreed ewes undergoing fixed time artificial insemination

Synchronization of estrus and ovulation are of paramount importance in modern livestock improvement programs. These methods are critical for assisted reproduction technologies, including artificial insemination and embryo transfer, that can increase productivity. In the current study, subcutaneous implants containing norgestomet were placed for long (14 days), medium (9 days), and short (5 days) periods of time in 70 crossbred ewes undergoing fixed-time artificial insemination. The resulting effects on estrus synchronization and conception rates were subsequently evaluated. Among the synchronized ewes, 85.7% (60/70) underwent estrus over a period of 72 h after progestagen treatment ceased. The shortest mean interval between withdrawal of the device and onset of estrus (34.2 ± 8.9 h) was observed in the G14 days of P4 group (p < 0.05). The conception rate of the G14 days of P4 group was statistically higher than that of the other groups (83.3% vs. 60.9% vs. 47.8%; p < 0.05). In conclusion, 14 days of norgestomet treatment produced higher conception rates and a greater number of pregnancies at the beginning of the breeding season.

Determinants of Breast Appearance and Aging in Identical Twins

Appearance, aging, and disorders of the breast are multifactorial. There are intrinsic, patient-specific characteristics, such as breast growth during puberty and propensity for breast cancer, which are primarily inherited. There are also environmental factors, which can be potentially controlled. Monozygotic twins provide an excellent research opportunity to examine the role of extrinsic factors in subjects with identical genetic predispositions. The authors investigate the role and significance of various environmental and acquired factors on breast aesthetics. Identical female twins were recruited during the Twins Days Festival in Twinsburg, Ohio, in 2009 and 2010. After consent was obtained, enrolled subjects completed a comprehensive survey on their medical and personal history. Standardized digital photographs were taken by medical photographers. Sixteen aesthetic breast features were subjectively rated by 6 plastic surgery residents blinded to the survey results. These ratings were then analyzed against survey data to determine the significance of different exogenous factors on breast appearance. A total of 161 pairs of identical female twins (n = 322) with a mean (SD) age of 47.6 (14.5) years were recruited. Twins who moisturized their skin daily had significantly fewer rhytids (P = .002). Twins who received hormone replacement therapy after menopause had more attractive breast shape, size, projection, areolar shape, and areolar size (P < .03). However, twins who had a higher body mass index, greater number of pregnancies, and larger cup sizes had significantly less attractive breasts (P < .05). Twins who smoked cigarettes and consumed alcohol also had significantly less attractive breasts (P < .05). Twins who breastfed had less attractive areolar size and shape but better skin quality than their counterparts who never breastfed (P < .03). Finally, there was a significantly higher incidence of breast pain in twins who primarily slept on their sides compared with twins who primarily slept on their backs (P < .008). This study implicates several environmental factors that significantly affect the aesthetic quality of breasts.

Association of number of live births with left ventricular structure and function. The Multi-Ethnic Study of Atherosclerosis (MESA)

Pregnancy is associated with marked maternal cardiovascular/hemodynamic changes. A greater number of pregnancies may be associated with long-term subclinical changes in left ventricular (LV) remodeling. Among 2,234 white, black, Hispanic, and Chinese women (mean age 62 years) in the MESA, we used linear regression to relate live births and cardiac magnetic resonance imaging LV measures. Covariates included age, ethnicity, height, income, education, birth country, smoking, menopause, and oral contraceptive duration. Models were additionally adjusted for potential mediators: systolic blood pressure, antihypertensive use, total/high-density lipoprotein cholesterol, triglycerides, diabetes, and body mass index. We performed sensitivity analyses excluding 763 women in the lowest socioeconomic group: annual income <$25,000 and lower high school level of education. With each live birth, LV mass increased 1.26 g; LV end-diastolic volume, 0.74 mL; and LV end-systolic volume, 0.45 mL; LV ejection fraction decreased 0.18% (P trend <0.05). Changes were most notable for the category of women with ≥5 pregnancies. Upon adjustment for potential biologic mediators, live births remained positively associated with LV mass and end-systolic volume. Live births remained significantly associated with LV end-systolic, end-diastolic volumes, and LV mass (P trend ≤0.02) after excluding women in the lowest socioeconomic group. Number of live births is associated with key LV structural and functional measures in middle to older ages, even after adjustment for sociodemographic factors and cardiovascular disease risk factors. Hemodynamic changes during pregnancy may be associated with cardiac structure/function beyond childbearing years.

Unmet need for publicly funded family planning in region IV

Unmet need for family planning results in higher rates of unintended pregnancies, shorter birth spacing intervals, higher abortion rates, and a greater number of pregnancies. Unmet need may be caused by lack of services, fewer contraceptive options offered, high out-of-pocket costs of methods, low understanding of options and proper use and low use of effective long-acting methods. By examining trend data in the southeast compared to national data, program decision-makers can monitor unmet need and take steps to improve service delivery that will reduce unintended pregnancies and lead ultimately to better health outcomes for women and the children they eventually may bear.