Healthy Pregnancy Research Articles

Effects of a behavioral intervention on physical activity, diet, and health-related quality of life in postpartum women with elevated weight: results of the HIPP randomized controlled trial

BackgroundApproaches to improve physical activity (PA), diet, and health-related quality of life (HRQOL) during postpartum in diverse women with elevated weight are needed.MethodsHealth In Pregnancy and Postpartum (HIPP) was a randomized controlled trial that followed African American and white women with overweight or obesity from pregnancy through 12 months postpartum. Participants were randomized to a behavioral intervention grounded in social cognitive theory (n = 112) or standard care (n = 107). From enrollment (≤ 18 weeks gestation) through 6 months postpartum, the intervention group received two in-depth counseling sessions (one each during pregnancy and postpartum), counseling calls, behavioral podcasts, and access to a private Facebook group, while the standard care group received monthly mailings and podcasts focused on healthy pregnancy and infant development. PA (SenseWear armband), diet (ASA24), and HRQOL (SF-12) measurements were obtained from blinded assessors at baseline and 6- and 12-months postpartum. Linear or quantile regression models, depending on conformity to normality assumptions, were used to test differences between behavioral intervention and standard groups in PA outcomes (minutes/day of total PA, light PA, and moderate-to-vigorous intensity PA (MVPA), and total steps/day), dietary outcomes (diet quality and six measures of dietary intake), and HRQOL at 6- and 12-months postpartum, controlling for baseline values, race, parity, weight status, education, maternal age, gestational age, and caloric intake (for most diet models).ResultsThere were no statistically significant differences by group for any PA, diet, or HRQOL outcomes at 6 or 12 months postpartum. Irrespective of group assignment, all PA outcomes improved from pregnancy to postpartum, as did kcals and the mental component of HRQOL. Furthermore, while not statistically significant, virtually all PA outcomes, except MVPA at 12 months, and several dietary outcomes, including diet quality, had patterns favoring the intervention group but with small effect sizes.ConclusionsPostpartum PA, diet, and HRQOL did not differ significantly between women in the behavioral intervention group and those in the standard care group. Given the increased responsibilities and stress that women face during the postpartum period, this appears to be a challenging time to make lifestyle changes.Trial registrationThis trial was registered at ClinicalTrials.gov on 10/09/2014. Identifier: NCT02260518.

The feasibility of integrating an alcohol screening clinical decision support tool into primary care clinical software: a review and Australian key stakeholder study

BackgroundThis study explored the feasibility of integrating a clinical decision support tool into general practice clinical management software in Australia to prompt for alcohol screening among patients who are pregnant or planning a pregnancy. The study aimed to increase understanding of what is an appropriate and acceptable clinical decision support tool, the circumstances when a prompt to use such a screening tool should occur, and the barriers and enablers of successful implementation.MethodsThis feasibility study employed a mixed methods approach and purposive sampling to identify key stakeholders to interview. Participants included vendors of clinical software used in Australian general practice, clinicians in general practice, and relevant others. Data from a literature review and 23 interviews were analysed leading to recommendations which were ‘sense-tested’ by an additional 22 stakeholders.ResultsAlthough there are at least 18 clinical software packages used in Australian general practice, it is feasible to integrate an alcohol screening tool for pregnancy into software for the majority of general practices in Australia. The AUDIT-C alcohol screening tool for pregnancy was widely accepted as suitable for such a purpose. Clinicians suggested the greatest barriers to screening were lack of time within antenatal consultations and insufficient remuneration for longer consultations. Many clinicians saw opportunity for introducing a multifunctional antenatal tool that could incorporate screening and clinical decision support for alcohol, tobacco and other substance use, mental health, domestic and family violence and potentially other areas informing healthy pregnancy. It could also be used opportunistically for preconception screening and counselling. Deployment of the tool could be supported by an education campaign from professional associations.ConclusionThe integration of a tool for screening for alcohol use among women who are pregnant or planning pregnancy into general practice clinical software is feasible; however, a multifunctional antenatal screening tool, incorporating other psychosocial elements, was considered more useful than a stand-alone alcohol screening tool. Codesign is needed with vendors and end-users to develop an acceptable tool that can be widely implemented. Issues with GP renumeration need also to be addressed to encourage alcohol screening pre-pregnancy and in the early months of pregnancy.

Oocyte donation pregnancies with high fetal-maternal immunogenetic dissimilarity show alterations in the maternal peripheral immunoregulatory response

Oocyte donation (OD) pregnancies result in increased fetal-maternal immunogenetic dissimilarity due to paternal and donor-derived genes. Higher fetal-maternal HLA mismatches are correlated with preeclampsia. Therefore, this study explored the maternal immune response, focusing on regulatory T cells (Tregs), during low versus high allogeneic pregnancies, and healthy versus preeclamptic OD pregnancies. Ten healthy and five preeclamptic OD pregnancies were included. Maternal peripheral blood was collected at different stages of pregnancy. Fetal-maternal HLA mismatches were determined, and immunophenotyping of peripheral blood mononuclear cells was conducted using a 22-colour spectral flow cytometry panel. Cytokines and hormones were detected in maternal plasma using ELISA and Luminex assays. The findings show similarities, but also distinct differences between low and high allogeneic healthy OD pregnancies. Early high allogeneic OD pregnancy showed reduction in Tregs, and CD8+ T cells, alongside lower percentage of effector/memory Tregs expressing PD-1 and Helios. Additionally, high allogeneic OD pregnancies showed increased IL-6 and progesterone in the first trimester. These variations suggest a different mode of immune regulation in early high allogeneic OD pregnancies, possibly to maintain healthy pregnancy. Further comparative analyses revealed reduced CD45RO+CTLA-4+ Tregs and increased latent TGF-β1 and -β2 levels in early preeclamptic compared to healthy OD pregnancy. Late-stage preeclamptic OD pregnancies exhibited higher frequencies of CD45RO+TIGIT+ Tregs and higher levels of TNFα, indicating both a regulatory and pro-inflammatory environment. Overall, this study sheds light on the course of various immunoregulatory key players in OD pregnancy, and expands knowledge on maternal tolerance in this particular type of pregnancy.

Assessment of Placental Antioxidant Defense Markers in Vaccinated and Unvaccinated COVID-19 Third-Trimester Pregnancies

Background: Pregnancy has been identified as a risk factor for severe COVID-19, leading to maternal and neonatal complications. The safety and effects of the SARS-CoV-2 vaccination during pregnancy, particularly on placental function and oxidative stress (OxS), remain underexplored. We investigated the impact of vaccination on third-trimester placental antioxidant defense markers. Methods: Ninety full-term pregnant women were divided into the following groups: vaccinated (n = 27) and unvaccinated (n = 25) COVID-19-positive pregnant women; control subgroups were composed of vaccinated (n = 19) or unvaccinated (n = 19) COVID-19-negative women with a healthy term singleton pregnancy with no signs of COVID-19. Placental samples were collected after delivery. Lipid peroxidation (TBARS), gene expression of HIF-1α, and catalase (CAT), superoxide dismutase-1 (SOD1) and CAT-SOD1 enzymatic activity were measured. Results: COVID-19-positive placentae exhibited significantly higher TBARS and HIF-1α levels compared to controls, regardless of vaccination status. Vaccination significantly increased placental CAT and SOD1 expression and activity in COVID-19-positive women, suggesting enhanced antioxidant defense. Unvaccinated women showed a higher incidence of COVID-19 symptoms and lower antioxidant enzyme activity. Conclusions: SARS-CoV-2 infection induced placental OxS, which is countered by a placental adaptive antioxidant response. Vaccination during pregnancy enhances placental defense, further supporting the safety and benefits of COVID-19 vaccination in preventing complications and protecting fetal development.

Trends in Antenatal Care Engagement among Women in Bangladesh

Background: Antenatal care (ANC) engagement is essential for ensuring healthy pregnancy outcomes by providing timely medical interventions and education to expectant mothers. In Bangladesh, various factors such as socioeconomic status, education level, and access to healthcare services significantly influence antenatal care (ANC) utilization. This study aimed to explore the trends in antenatal care engagement among women in Bangladesh. Methods: This observational cross-sectional study took place over six months at Shaheed Suhrawardy Medical College Hospital in Dhaka, Bangladesh. During this period, 100 women admitted to the Obstetrics and Gynaecology Ward for delivery were purposively selected as participants. Thorough clinical examinations and pertinent investigations were conducted. Data analysis was performed using MS Office tools. Results: In Bangladesh, educated women are more likely to have regular antenatal care (ANC) and make at least four visits. Women over 25 years old tend to attend ANC less frequently, whereas regular attendance is seen in 91.1% of women aged 20-25. Primiparous women had a higher ANC attendance rate at 95.7%, but women with higher parity (≥4) also showed an increased usage of ANC services at 71.4%. Cesarean sections were more prevalent in rural areas at 56.4% compared to 71.0% in urban areas. Regarding neonatal outcomes, 15% of babies were born with low birth weight, and prematurity was observed in 15% of cases. Conclusion: In Bangladesh, a rich tapestry of cultural, educational, and socioeconomic elements plays a pivotal role in shaping the way maternal healthcare is sought. There is a notable disparity in access across urban and rural areas, differences in education levels, preferred treatment facilities, economic standing, and pregnancy experiences.

Steroid Profiles and Precursor-to-Product Ratios Are Altered in Pregnant Women with Preeclampsia

Steroid hormone imbalance is associated with the pathogenesis of preeclampsia. However, affected enzymes of steroid metabolism and gene and protein expression in serum and placenta have not been elucidated yet. We aimed to investigate steroid hormone profiles and precursor-to-product ratios in preeclamptic women compared to women with healthy pregnancy (controls) to identify potentially affected steroid hormones and their metabolizing enzymes. Also, we aimed to investigate whether the mRNA expression of these enzymes is different between the study groups and whether levels of serum mRNA expression reflect postnatal placental protein expression. Serum levels of 14 steroid hormones were measured at eight time points throughout pregnancy in nine preeclamptic women and 36 controls. Serum mRNA expression of selected steroid-metabolizing enzymes was assessed, and their protein expression was analyzed in additional nine preeclamptic women. Mean levels of sex steroid and corticosteroid hormones were significantly altered in preeclamptic women. Precursor-to-product ratios of 5α-reductase, aromatase and 11β-hydroxysteroid dehydrogenase 1 were significantly increased, those of steroid 17α-hydroxylase, 17β-hydroxysteroid-dehydrogenase, steroid 11β-hydroxylase and 11β-hydroxysteroid dehydrogenase 2 were significantly decreased. Serum mRNA expression and placenta protein expression were comparable between the groups. Results contribute to understanding the heterogeneity of preeclampsia and can thus promote future research in personalized medicine.

Selective Mutism in the Context of Autism and Bilingualism.

Juan is a 5-year-old boy who has been followed by a developmental-behavioral pediatrician and pediatric neuropsychologist since being diagnosed with language delay and autism spectrum disorder at age 2 years. He is otherwise healthy and was born at term after a healthy pregnancy. His primary language is Spanish, and he has minimal interactions in English. His first words were at 20 months; they were not functional but rather words related to his interests such as "train." He began using 2 to 3-word phrases shortly after but only to request needs. He began speaking in complete sentences at age 4 years.A neuropsychological evaluation was conducted at age 2 years during which Juan demonstrated repetitive behaviors such as hand-flapping, toe-walking, body rocking, and head banging. He displayed sensory seeking behaviors such as rubbing items on his face and close visual inspection. He did not respond to his name and his use of eye contact was inconsistent. He demonstrated rigidity and difficulty transitioning between activities. He did not engage in social reciprocity, and his facial expressions were limited. Minimal spontaneous language was observed, and expressive language largely consisted of echolalia in both languages. Juan was diagnosed with autism spectrum disorder and applied behavior analysis, speech and language therapy, and occupational therapy were recommended.Developmental-behavioral follow-up over the next 2 years noted improvements in behavior, transitions, and social interactions. He participated in early childhood intervention and early childhood special education with significant advances for speech and language in English and Spanish, demonstrating a large vocabulary. At 4 years, parents noted Juan to have reluctance to speak in English. He stopped speaking in English entirely for 3 weeks, though he continued to speak in Spanish. When he resumed speaking in English, it was only with people he knew well (e.g., parents, teachers, babysitter). In clinic, he did not speak to the English-speaking developmental-behavioral pediatrician but spoke in short sentences to the Spanish-speaking neuropsychologist.A repeat neuropsychological evaluation completed at age 5 years revealed that Juan had stopped speaking in English completely, even among those previously deemed "safe." Results were consistent with average cognitive abilities with a strength in verbal skills. Juan's single-word vocabulary in Spanish was exceptionally high. He did not provide expressive responses in English, but his receptive English vocabulary was high average. He responded to English language with nonverbal gestures or spoken language in Spanish. Parents reported Juan to display increased anxiety accompanied by extreme school refusal, behavioral difficulties, and reluctance to leave the home.Given this information, what are your diagnostic considerations and treatment recommendations?

Impact of healthy pregnancy and lifestyle in mothers on developmental delay in their offspring: a strength-based analysis of a longitudinal study among indigenous children in Australia

IntroductionExtensive literature has investigated the prenatal risk factors of developmental delay in children, with evidence highlighting the impact of prenatal health, mental health, and behavioural factors. While a deficit discourse has underscored Indigenous health research and policies, strengths-based approaches provide an opportunity to reframe this discourse, to illustrate and celebrate the strength and resilience of Australian Indigenous families. As such, this study aimed to identify the protective impact of healthy pregnancy and lifestyle in mothers on developmental delay in Indigenous Australian children; and whether it varies by child birthweight adjusted for gestational age. Further, we also tested whether child birthweight for adjusted gestational age mediates the association between a healthy pregnancy and lifestyle in mothers and developmental delay in their Indigenous offspring.MethodsStrength-based analysis was conducted using data from 8 longitudinal waves of LSIC study in Australia. Random-effect models were used to longitudinally measure the impact of maternal healthy pregnancy and lifestyle on developmental delays in their children between 2008 and 2018. A composite score (ranging from 0 to 3, score = 3 refers to most healthy pregnancy) was created for a healthy pregnancy and lifestyle variable using three criteria − (1) a lack of medical conditions, (2) no substance use including smoking/alcohol/illicit drugs, and (3) intake of iron/folic acid during pregnancy. All models were adjusted for potential covariates.ResultsOf the 780 mother-child dyads analysed, 65.4% of mothers reported healthy pregnancy and lifestyle; while 73.5% of children born with a recommended appropriate birthweight adjusted for gestational age, and 91.4% reported no developmental delays. In children born in the recommended range of appropriate birthweight adjusted for gestational age, healthy pregnancy in mothers (most healthy, aOR: 4.76, 95% CI: 1.12–20.18; and 2nd most healthy, aOR: 4.02, 95% CI: 1.09–14.83) was protective against development delay compared to maternal unhealthy pregnancy. Living in remote areas (vs. major city, and regional) was also found to be protective against developmental delay in those who were born within the recommended range of birthweight adjusted for gestational age. Further, the current study found that child birthweight for adjusted gestational age does not have any mediating effect on the association between healthy pregnancy in mothers and developmental delay in their children.ConclusionThis strengths-based study suggests healthy pregnancy in mothers should be advocated to prevent developmental delay in their offspring in the Australian Indigenous population. The findings also found living in remote areas has a protective effect against developmental delay in Indigenous children who born within the recommended range of birthweight adjusted for gestational age. These findings have implications for challenging and reframing the deficit discourse surrounding Indigenous Australian health research and policymaking. Further studies are needed to investigate the positive relationship between Indigenous Australians’ health and social and emotional well-being (SEWB) and their connection to their country and culture.

Cardiac structural, functional and energetic assessments during and after pregnancy in women with gestational diabetes mellitus, preeclampsia and healthy pregnancy

GDM and preeclampsia are common complications of pregnancy, for which overweight/obesity is a common risk factor. Both conditions are associated with a two-to-four-fold increase in future incident heart failure, which may be linked to early maladaptive myocardial changes. To determine maternal myocardial structural, functional, and energetic responses to pregnancies complicated by gestational diabetes mellitus (GDM) or preeclampsia compared to healthy pregnancies (HP) at third-trimester of pregnancy and twelve-months postpartum. Thirty-eight women with HP, 30 GDM, 20 preeclampsia, 10 non-pregnant controls with overweight (Overweight-NC) and 10 with normal-weight were recruited. Cardiovascular magnetic resonance spectroscopy and imaging were used to define myocardial energetics (phosphocreatine: ATP ratio [PCr/ATP]), left ventricular (LV) volumes, mass, and ejection fraction and global longitudinal shortening (GLS). Pregnancy groups underwent repeat scans twelve-months postpartum, nulliparous-controls were assessed once. During third-trimester, compared to HP, women with either GDM or preeclampsia displayed higher BMI, higher LV-mass (HP:90[85,94]g, GDM:103[96,112], Preeclampsia:118[111,125]g; P=0.001), and lower PCr/ATP (HP:2.2[2.1,2.4], GDM:1.9[1.7,2], Preeclampsia:1.9[1.8,2.1];P=0.0004) and GLS (HP:20[18,21]%, GDM:18[17,19]%, Preeclampsia:16[14,17]%;P=0.01). Post-pregnancy, no group saw significant changes in LV-mass, PCr/ATP or GLS. There were no significant differences in LV-mass, PCr/ATP or GLS between the GDM and preeclampsia groups during or post-pregnancy. Moreover, the Overweight-NC showed no significant differences in LV-mass ( 53[43,63])g, PCr/ATP (2.0[1.8,2.2]) or GLS (-19[17,21]%) compared to GDM or preeclampsia groups during or post-pregnancy. Women with GDM or preeclampsia exhibit similar myocardial phenotypes during pregnancy with persistent subclinical alterations in LV mass, energetics and GLS twelve-months postpartum. These myocardial alterations are similar to those detected in Overweight-NC, potentially suggesting the myocardial changes may predominantly be driven by overweight/obesity.

Maladaptive cardiomyocyte calcium handling in adult offspring of hypoxic pregnancy: protection by antenatal maternal melatonin.

Chronic fetal hypoxia is one of the most common complications of pregnancy and can programme cardiac abnormalities in adult offspring including ventricular remodelling, diastolic dysfunction and sympathetic dominance. However, the underlying mechanisms at the level of the cardiomyocyte are unknown, preventing the identification of targets for therapeutic intervention. Therefore, we aimed to link echocardiographic data with cardiomyocyte function to reveal cellular mechanism for cardiac dysfunction in rat offspring from hypoxic pregnancy. Further, we investigated the potential of maternal treatment with melatonin as antenatal antioxidant therapy. Wistar rats were randomly allocated into normoxic (21% O2) or hypoxic (13% O2) pregnancy with or without melatonin treatment (5µg/ml; normoxic melatonin in the maternal drinking water from gestational day 6 to 20 (term=22days). After delivery, male and female offspring were maintained to adulthood (16weeks). Cardiomyocytes were isolated from the left and right ventricles, and calcium (Ca2+) handling was investigated in field-stimulated myocytes. Systolic and diastolic function was negatively impacted in male and female offspring of hypoxic pregnancy demonstrating biventricular systolic and diastolic dysfunction and compensatory increases in cardiac output. Ca2+ transients from isolated cardiomyocytes in offspring of both sexes in hypoxic pregnancy displayed diastolic dysfunction with a reduced rate of [Ca2+]i recovery. Cardiac and cardiomyocyte dysfunction in male and female adult offspring was ameliorated by maternal antenatal treatment with melatonin in hypoxic pregnancy. Therefore, cardiomyocyte Ca2+ mishandling provides a cellular mechanism explaining functional deficits in hearts of male and female offspring in pregnancies complicated by chronic fetal hypoxia. KEY POINTS: This study identified significant changes in Ca2+ handling within cardiomyocytes isolated from offspring of hypoxic pregnancy including reduced systolic Ca2+ transients, impaired diastolic recovery of [Ca2+]i and a greater increase in systolic [Ca2+]i amplitude to β-adrenergic stimulation. These changes in cardiomyocyte Ca2+ handling help to explain dysregulation of biventricular systolic and diastolic dysfunction determined by echocardiography. The data show protection against maladaptive cardiomyocyte calcium handling and thereby improvement in cardiac function in adult offspring of hypoxic pregnancy treated with melatonin with doses lower than those recommended for overcoming jet lag in humans. Melatonin treatment alone in healthy pregnancy did cause some alterations in cardiac structure. Therefore, maternal treatment with melatonin should only be given to pregnancies affected by chronic fetal hypoxia.

Reference Levels of Plasma D-dimer for Normal Pregnant and Their Association with Pregnancy Complications: A Single-center Retrospective Analysis

Background: The objective of this study was to extract maternal plasma D-dimer test results from a large medical records dataset and to establish a reference level for pregnant women in our center. This study aimed to investigate the role and efficacy of D-dimer levels for predicting complications in high-risk pregnant women. Methods: The clinical data of 19,117 women who delivered at Wenzhou People’s Hospital between January 1, 2020, and September 30, 2022, were retrospectively analyzed. A total of 74,401 D-dimer test results were extracted from the laboratory information system. Following data screening and matching, 7692 records of D-dimer test results for healthy pregnant women and 19,005 records for pregnant women with complications were selected. D-dimer reference values were calculated for early pregnancy (1–13 weeks gestation), mid-pregnancy (14–27 weeks gestation), late pregnancy (28–36 weeks gestation), and the end of pregnancy (37–41 weeks gestation). A logistic regression model was used to plot receiver operating characteristic (ROC) and determine cut-off values for predicting pregnancy complications in each phase. Results: The mean D-dimer levels in the healthy pregnancy group were 0.56 mg/L in early pregnancy, 1.08 mg/L in mid-pregnancy, 1.48 mg/L in late pregnancy, and 1.89 mg/L at the end of pregnancy. D-dimer levels were greater in the complication group (which contains 11 common pregnancy disorders, including premature rupture of membranes (PRM), gestational diabetes mellitus (GDM), gestational hypertension (GHP), preeclampsia (PE), placental abnormalities, thyroid dysfunction, hemorrhage, thrombophilia, fetal macrosomia, preterm delivery, and infections) than in the healthy group in all pregnancy phases, with statistically significant differences observed in early, medium, and the end of pregnancy. D-dimer levels showed good diagnostic performance in predicting pregnancy complications in early pregnancy (area under the curve (AUC) = 0.71, cut-off value = 0.87, odds ratio: 7.12, 95% confidence interval (CI): 5.41–9.36, p-value = 0.000). Conclusions: The reference range of D-dimer increases with the progression of gestational phases and demonstrates predictive efficacy for high-risk pregnancy complications during early pregnancy.

Hypertensive pregnancy disorder, an under-recognized women specific risk factor for heart failure?

During pregnancy, the maternal cardiovascular (CV) system undergoes major haemodynamic alterations ensuring adequate placental perfusion and a healthy pregnancy course. Hypertensive disorders of pregnancy (HDP) occur in almost 10% of gestations and preeclampsia, a more severe form, in 3-4%. Women with HDP demonstrated impaired myocardial function, biventricular chamber dysfunction and adverse biventricular remodelling. Shortly after delivery, women who experienced HDP express increased risk of classic CV risk factors such as hypertension, renal disease, abnormal lipid profile, and diabetes. Within the first two decades following a HDP, women experience increased rates of heart failure, chronic hypertension, ischaemic heart and cerebral disease. The mechanism underlying the relationship between HDP in younger women and CV disease later in life could be explained by sharing pre-pregnancy CV risk factors or due to a direct impact of HDP on the maternal CV system conferring a state of increased susceptibility to future metabolic or haemodynamic insults. Racial disparities in CV risk and social determinants of health also play an important role in their remote CV risk. Although there is general agreement that women who suffered from HDP should undertake early CV screening to allow appropriate prevention and timely treatment, a screening and intervention protocol has not been standardized due to limited available evidence. In this review, we discuss why women with hypertensive pregnancy may be disproportionately affected by heart failure with preserved ejection fraction and how cardiac remodelling during or after pregnancy may influence its development.

The impact of prenatal exposure to fine particulate matter and its components on maternal and neonatal thyroid function and birth weight: a prospective cohort study.

Maternal and child health has garnered considerable attention recently. The effects of prenatal exposure to PM2.5 and its components on thyroid function in both mothers and fetuses, as well as on offspring birth weight, remain unexplored. This study involved 446 mother-infant pairs from a cohort study in Ma'anshan, China, during 2021-2022. Air pollution data were obtained from the Tracking Air Pollution (TAP) project. Thyroid hormone levels (FT3, FT4, and TSH) were measured in maternal blood samples taken at various pregnancy stages and in cord blood. We employed multiple analytical methods to evaluate the effects of PM2.5 and its components on maternal thyroid function and birth weight z-score (BWz). The GLR analysis reveals that the effect of PM2.5 and its components on BWz differs according to the pregnancy stage and the specific pollutant involved. During the late pregnancy, increased exposure to PM2.5 and specific components (for instance, and ) was correlated with elevated maternal FT4 levels (p < 0.05) and reduced BWz (p < 0.05). QgC results illustrated a notable negative correlation between heightened PM2.5 exposure and BWz in late pregnancy. BKMR analysis confirmed that overall exposure to PM2.5 and its components negatively impacted BWz during the third trimester. Mediation analysis showed that changes in maternal FT4 levels accounted for approximately 8.52%, 8.05%, and 8.13% of the negative effects on BWz from exposure to , and , respectively (p < 0.05). In healthy pregnancies, exposure to PM2.5 and its components during the late pregnancy is linked to alterations in maternal thyroid hormone levels, potentially leading to reduced birth weight. Maternal FT4 levels may mediate the connection between PM2.5 components exposure and reduced the weight of offspring.

Approaching the sterile womb theory in dogs and cats: A multi-technique investigation

The study investigated whether bacterial seeding occurs in utero in dogs and cats using a multi-technique approach, including 16S rRNA gene sequencing, culture, and fluorescence in situ hybridization (FISH). Healthy pregnant bitches and queens (n = 8) undergoing ovariohysterectomy between 30 and 45 days of gestation were included. Placenta and amniotic fluid samples from two foetuses per dam, along with multiple controls (uterine serosa, sampling table, and surgeon's gloves), were collected and analysed.Bacterial sequences were detected in all foetal samples, with no significant differences in intra- and inter-sample diversity (i.e., alpha and beta diversities, respectively) based on sample type or species. However, the surgeon's gloves showed species-specific differences in bacterial composition. After removing control sequences, significant differences based on foeto-maternal units emerged. Moraxella spp. was cultured from the canine placenta with the highest bacterial load, and Burkholderia cepacia was isolated from two feline placentae. FISH showed low bacterial presence in 50 % of placentae without histological signs of inflammation. No bacterial growth was observed in amniotic fluid or control samples.A multi-technique approach, including multiple controls, is essential in studies involving low-biomass samples, as the results of the present study indicated that contamination could mask real bacterial composition of foetal samples. After decontamination, differences were observed based on the foeto-maternal unit.This study confirmed the presence of bacterial DNA in placental and amniotic fluid samples during mid-term, healthy pregnancies in dogs and cats. Bacterial DNA is not equivalent to living bacteria, hence bacterial DNA fragments in the uterus probably originate from the dam but are unlikely to indicate the presence of a resident foetal microbiome.

Case-control study of clotting differences using ROTEM testing in pregnant patients with early vaginal bleeding

BackgroundVaginal bleeding in early pregnancy is a common presentation in the Emergency Department (ED), often resulting in pregnancy loss. Hypercoagulability exceeding normal physiological changes may be associated with miscarriage, but conventional clotting tests do not reliably detect this effect. Rotational thromboelastometry (ROTEM), which performs a more comprehensive clotting evaluation, may demonstrate coagulopathic abnormalities contributing to vaginal bleeding and miscarriage in early pregnancy that are not present in normal gestation. ObjectiveThis study aimed to evaluate the relationship between coagulation results from ROTEM testing in patients undergoing active evaluation for possible miscarriage compared to samples taken from asymptomatic patients with healthy pregnancies. Study DesignThis was a prospective case control study from a single center. Patients with chief complaint of vaginal bleeding in early pregnancy (less than 20 weeks) were recruited from the ED for ROTEM testing. These results were compared to healthy pregnant women presenting for routine prenatal care at our hospital’s obstetrical clinic. Crude results were analyzed using t-test for ROTEM measures, and differences were then compared using multiple linear regression, controlling for patient age, race, ethnicity, number of prior pregnancies, and estimated gestational age (EGA) in weeks. ROTEM measurements of interest were the clot formation kinetics using EXTEM, INTEM, and NATEM tracings. ResultsOver the study, 46 patients were recruited from the ED and 51 from the obstetric clinic. Both groups had similar mean ages, and racial and ethnic distribution. ED patients had earlier EGA than OB clinic patients, 7.6 weeks vs. 10.7 weeks, but higher patient age and higher number of prior pregnancies. ROTEM results were not significantly different between groups on univariate analysis except for INTEM CFT and INTEM MCF. After controlling for the patient age and estimated gestational age, no ROTEM result differed between groups. ConclusionIn pregnant patients presenting to the ED with vaginal bleeding before 20 weeks, ROTEM differences were not different in comparison to healthy pregnant patients at the same gestation stage. This suggests that ROTEM clotting profiles may not be useful in the evaluation of vaginal bleeding within this population.

CTNND1 affects trophoblast proliferation and specification during human embryo implantation.

The placenta, serving as the crucial link between maternal and infant, plays a pivotal role in maintaining a healthy pregnancy. Placental dysplasia can lead to various complications, underscoring the importance of understanding trophoblast lineage development. During peri-implantation, the trophectoderm (TE) undergoes differentiation into cytotrophoblast (CTB), syncytiotrophoblast (STB), and extravillous trophoblast (EVT). However, the specification and regulation of human trophoblast lineage during embryo implantation, particularly in the peri-implantation phase, remain to be explored. In this study, we employed a co-culture model of human endometrial cells and native embryos and analyzed the single-cell transcriptomic data of 491 human embryonic trophoblasts during E6 to E10 to identify the key regulatory factors and the lineage differentiation process during peri-implantation. Our data identified four cell subpopulations during the implantation, including a specific transitional state toward the differentiation in which the CTNND1, one crucial component of Wnt signaling pathway activated by cadherins, acted as a crucial factor. Knockdown of CTNND1 impacted the proliferative capacity of trophoblast stem cells (hTSCs), leading to early EVT-like differentiation. Intriguingly, ablation of CTNND1 compromised the terminal differentiation of hTSCs toward both STB or EVT in vitro. Those observations identified the role of cell adhesion-mediated Wnt signaling in hTSC self-renewal, as well as suggest that this signaling pathway controls a transitional state that is crucial for trophoblast lineage specification. These findings contribute valuable insights into trophoblast lineage dynamics and offer a reference for research on placental-related diseases.

Inflammatory signalling during the perinatal period: Implications for short- and long-term disease risk

During pregnancy and the postpartum, there are dynamic fluctuations in steroid and peptide hormone levels as well as inflammatory signalling. These changes are required for a healthy pregnancy and can persist well beyond the postpartum. Many of the same hormone and inflammatory signalling changes observed during the perinatal period also play a role in symptoms related to autoimmune disorders, psychiatric disorders, and perhaps neurodegenerative disease later in life. In this review, we outline hormonal and immunological shifts linked to pregnancy and the postpartum and discuss the possible role of these shifts in increasing psychiatric, neurodegenerative disease risk and autoimmune symptoms during and following pregnancy. Furthermore, we discuss how key variables such as the number of births (parity) and sex of the fetus can influence inflammatory signalling, and possibly future disease risk, but are not often studied. We conclude by discussing the importance of studying female experiences such as pregnancy and parenting on physiology and disease.

Influence of Socioeconomic Factors and Nutritional Advice on Diet Quality in Women of Reproductive Age: A FIGO-DQS Assessment.

Nutritional knowledge, attitudes, and practice are important ways of assuring a healthy pregnancy start, which can be shaped during the pre-pregnancy period by the intervention of healthcare providers. In this cross-sectional study, the main objective was to explore contextual determinants of diet quality in women of fertile age, including socioeconomic factors and sources of information. Data on socioeconomic background, sources of nutritional advice, and determinants of food choices were collected through an anonymous web-based questionnaire completed by 465 women. Diet quality was assessed with the International Federation of Gynaecology and Obstetrics diet quality score (FIGO-DQS). Better food choices (OR = 1.73; 95% CI: 1.16-2.51), higher knowledge level (OR = 1.66; 95% CI: 1.119-2.466), and healthcare advice (OR = 1.70, 95% CI: 1.119-2.466) increased the chances of having a better diet. Both healthcare providers (β = 0.503, p = 0.018) and determinants of food choices (β = 0.520, p = 0.011) had a significant influence on the FIGO score, although the advice provided by the healthcare professionals did not yield a significant influence on the determinants of food choices (β = 0.310, p = 0.125); Conclusions: Knowledge had a mediator effect on the impact of healthcare guidance on nutrition practices, but it does not fully explain the adherence to healthy lifestyle choices.

Autonomy and prevention: From conflicting to complementary aims of prenatal screening.

From an ethical point of view, there is an important distinction between two types of prenatal screening. The first of these targets maternal or foetal conditions (e.g., infectious diseases, blood group sensitization) where early detection allows for interventions that improve the chances of a healthy pregnancy outcome. The second screens for foetal conditions such as Down syndrome, where a timely diagnosis in most cases only allows for a choice between preparation for a child with special needs or termination of the pregnancy. Whereas the former makes an easy fit with the prevention aim of most other population screening programmes, the latter does not. In order to steer clear from a possible eugenic reading of its aim, a wide international consensus has emerged for the view that prenatal screening of this type should have the atypical aim of helping women (couples) to make autonomous reproductive choices, rather than reducing the birth prevalence of the relevant disorders. However, keeping these types of prenatal screening apart may become increasingly difficult given the development of tests, such as the Non-Invasive Prenatal Test, which cannot only be used for both types of screening but may also lead to interconnected findings on both sides of the divide. This makes it an urgent question: What the aim or aims of this new hybrid screening should be? As neither 'prevention' nor 'autonomy' will do, we argue for a normative framework that gives both aims their due, while recognizing the tensions between them.

Penguatan Peran Suami pada Masa Kehamilan Istri di Posyandu Krisan Cianjur

Sukanagalih is one of the villages located in Pacet District, Cianjur Regency, West Java and is one of the villages fostered by Binawan University. The problem of pregnant women with Chronic Energy Deficiency (KEK) still occurs in Cianjur Regency. The problem of KEK needs to be handled and given attention by related parties. The role of the family, especially the husband, can affect the health of pregnant women. Based on this, community service was carried out with the main target being pregnant women by involving cadres from the Krisan Posyandu. In this activity, the husbands of pregnant women were involved to be given education related to pregnancy and how to prepare food during pregnancy. By involving husbands, it is hoped that the mother will have a healthy pregnancy and will give birth to a healthy baby. This community service aims to provide education and involve husbands regarding the scope of pregnancy and the provision of nutritious food for pregnant women using food and herbal local. The stages of community service activities carried out are continued potential surveys, implementation of educational activities and cooking competitions, as well as evaluation and reporting. Based on the survey results, to expand the benefits of the activity, education participants are not only limited to pregnant women and their husbands but also other residents who live in the area. Providing education to residents has increased the knowledge of the participants. Before the education was carried out, the average level of knowledge was 47.70 and after being given education it increased to 85.31. In addition, the cooking competition activities that were carried out have made residents more creative in utilizing local food ingredients and herbs into various types of food and drinks. Seeing the results obtained, residents of Sukanagalih Village have the potential to be given further assistance.