Healthy Women Of Childbearing Age Research Articles

Asymptomatic bacteriuria in users of low-dose combined oral contraceptives

ABSTRACTObjectives To investigate the association between oral contraceptive use and the prevalence of asymptomatic bacteriuria in women.Methods The study was conducted on healthy women of childbearing age who either used low-dose combined oral contraceptives (COCs; cases) or applied the withdrawal method (controls). A positive urine culture with a colony count of more than 105/ml, with the same bacteria on two consecutive specimens, was defined as asymptomatic bacteriuria. Pyuria was defined as the presence of ≥10 leukocytes per mm3 of urine.Results Overall, 369 women in the COC group and 364 in the control group were evaluated. The mean ages of women in the COC group and of controls were 29.9 ± 5.4 years and 30.4 ± 6.0 years, respectively (p = 0.280). Asymptomatic bacteriuria was detected in 2.4% of COC users and 1.9% of the controls (p = 0.633). Pyuria was found in 16% of the cases and 18.1% of the controls (p = 0.441). None of these differences was statistically significant. There was no significant association between duration of COC usage (< 1 year vs. ≥ 1 year) and asymptomatic bacteriuria.Conclusion Use of low-dose COCs (even long-term) does not increase the risk of asymptomatic bacteriuria.

Increase in the prevalence of the MTHFR 677 TT polymorphism in women born since 1959: potential implications for folate requirements

Folate has been recognized to ensure reproductive health and there is a growing body of epidemiological evidence suggesting that the methylenetetrahydrofolate reductase (MTHFR) 677T allele and reduced dietary folate may increase the risk of cervical cancer. The main focus of our survey was to investigate the distribution of the MTHFR C677T polymorphism in relation to women's year of birth and to assess their folate intake and folic acid supplementation. During a 6-months period, 307 healthy women of childbearing age in Catania, Italy, were enrolled in the cross-sectional study. Folate intake was estimated by a semiquantitative food frequency questionnaire and DNA extracted from blood samples for MTHFR C677T genotyping. A TT genotype frequency of 20.5% with an increase in the prevalence of the TT genotype in the cohort of women born since 1959 was shown. The prevalence of inadequate folate intake was 51.5%, significantly higher in non-pregnant women (83.4%) than in pregnant ones (12.3%) with a decrease during the three trimesters of pregnancy (from 25.7 to 5.0%; P=0.013). The use of folic acid supplements improved during the three trimester of pregnancy (from 71.4 to 95.0%; P=0.001). Healthy young women may have higher folate needs due to increasing prevalence of the T allele and reduced folate intake compared with older groups. However, clinicians should be cautious when recommending supplements to women in late pregnancy due to the possible implications in the pregnancy outcome.

Von Willebrand factor antigen and ADAMTS13 activity assay in pregnant women and severe preeclamptic patients

The present study examined von Willebrand factor (vWF) levels and ADAMTS13 activity in pregnant and severe preeclamptic women in order to shed light on the prothrombotic state in severe preeclampsia. Thirty healthy women of childbearing age, 22 second trimester pregnant women, 30 third trimester pregnant women and 10 severe preeclamptic patients were recruited in this study. ADAMTS13 activity was determined by the FRETS-vWF73 assay and vWF antigen (vWF:Ag) levels by an enzyme-linked immunosorbent assay. The results showed that there were statistically significant differences in plasma vWF antigen levels between the severe preeclamptic and third trimester pregnant women, between third and second trimester pregnant women (P<0.05). The third trimester pregnant women had significantly lower plasma ADAMTS13 activity than second trimester pregnant women (P<0.05). Nevertheless, no significant differences in plasma ADAMTS13 activity were found between severe preeclamptic patients and the third trimester pregnant women (P>0.05). In conclusion, plasma ADAMTS13 activity is normal in severe preeclampsia despite the increased vWF:Ag levels. Prothrombotic state is involved in the pathogenesis of severe preeclampsia, as a result of endothelial injury.

Influence of the Menstrual Cycle on the Oral Microbial Flora in Women: A Case‐Control Study Including Men as Control Subjects

Changes in the levels of female sex hormones during the menstrual cycle may cause cyclic differences in subgingival bacterial colonization patterns. The purpose of the present study was to test the hypothesis that hormonal changes in the menstrual cycle cause changes in the oral microbiota. Bacterial plaque samples were collected in 20 systemically and periodontally healthy women using no hormonal contraceptives (test group) over a period of 6 weeks. Twenty age-matched systemically and periodontally healthy men were assigned to the control group. Samples were processed by checkerboard DNA-DNA hybridization assay, and 74 species were analyzed. No cyclic pattern of bacterial colonization was identified for any of the 74 species studied in women not using hormonal contraceptives. Aggregatibacter actinomycetemcomitans (previously Actinobacillus actinomycetemcomitans) (Y4) was common at the beginning of menstruation (mean: 32%) and increased during the following 2 weeks (36%) in women (P <0.05). No cyclic differences in bacterial presence were found among the men (P values varied between 0.14 and 0.98). Men presented with significantly higher bacterial counts for 40 of 74 species (P <0.001), including Staphylococcus aureus and Pseudomonas aeruginosa but not Porphyromonas gingivalis (P = 0.15) or Tannerella forsythia (previously T. forsythensis) (P = 0.42). During a menstruation period, cyclic variation in the subgingival microbiota of periodontally healthy women of child-bearing age who were not using oral hormonal contraceptives could not be confirmed. Male control subjects presented with higher levels of many species but also without a cyclic pattern.

Serum Selenium Levels in Healthy Women in Tabriz, Iran

Selenium is of fundamental importance to human health, and selenium deficiency is associated with disease conditions. The objective of this study was to investigate the serum level of selenium in women of childbearing age and postmenopausal women living in Tabriz, Iran. In this cross-sectional study, 60 healthy women of childbearing age and 60 healthy postmenopausal women were studied with the use of biochemical methods (measurement of serum selenium by graphite furnace atomic absorption spectrometry), anthropometric measurements (weight and height), and interviews. The average serum selenium was 76.67 +/- 17.98 microg/L (range, 42.00 to 166.61 microg/L). This level was lower than those reported in other provinces of Iran and some other countries. Sixty-nine women (57.5%) had serum selenium concentrations under 80 microg/L. There was no significant difference in selenium level between the two groups of women. Serum selenium level did not vary with age and body mass index. Some Iranian women are of borderline selenium status and as a consequence are more susceptible to selenium-deficiency diseases. There is a need for community-based programs to encourage people to increase consumption of selenium-rich sources, such as marine foods.

Calculation of red blood cell folate steady state conditions and elimination kinetics after daily supplementation with various folate forms and doses in women of childbearing age

Background: A maternal red blood cell (RBC) folate concentration > 906 nmol/L is thought to be optimal for lowering the risk of neural tube defects (NTDs) in pregnancy. Whereas the appearance of folate in RBCs has been followed during folic acid supplementation, data on elimination kinetics are not yet available.Objective: The aim of our investigation was to estimate the steady state conditions and elimination kinetics of folate in RBCs.Design: Data from 2 randomized, placebo-controlled, double-blind intervention trials were used for kinetic modeling. These studies were performed to investigate the appearance of folate in RBCs in healthy women of childbearing age after different supplementation strategies (study 1: n = 69; 400 μg folic acid/d and 416 μg [6S]-5-methyltetrahydrofolate/d for 24 wk; study 2: n = 21; 800 μg folic acid/d for 16 wk).Results: For RBC folate concentrations, steady state conditions were not reached after 24 (study 1) and 16 (study 2) wk of folate supplementation. However, with the use of these data, we calculated the biological half-life (t1/2) of RBC folate to be ≈8 wk. With the application of pharmacokinetic principles, steady state conditions for RBC folate should be reached after 40 wk (t1/2 × 5).Conclusion: With the use of pharmacokinetic principles, the appearance and elimination kinetics of RBC folate can be calculated on the basis of this t1/2 value.

A lactic acid-fermented oat gruel increases non-haem iron absorption from a phytate-rich meal in healthy women of childbearing age

Lactic acid-fermented foods have been shown to increase Fe absorption in human subjects, possibly by lowering pH, activation of phytases, and formation of soluble complexes of Fe and organic acids. We tested the effect of an oat gruel fermented with Lactobacillus plantarum 299v on non-haem Fe absorption from a low-Fe bioavailability meal compared with a pasteurised, fermented oat gruel and non-fermented oat gruels. In a cross-over trial twenty-four healthy women with a mean age of 25 (sd 4) years were served (A) fermented gruel, (B) pasteurised fermented gruel, (C) pH-adjusted non-fermented gruel, and (D) non-fermented gruel with added organic acids. The meals were extrinsically labelled with 55Fe or 59Fe and consumed on 4 consecutive days, for example, in the order ABBA or BAAB followed by CDDC or DCCD in a second period. Fe absorption was determined from isotope activities in blood samples. The fermented gruel with live L. plantarum 299v increased Fe absorption significantly (P < 0.0001) compared with the pasteurised and non-fermented gruels. The lactic acid concentration in the fermented gruel was 19 % higher than in the pasteurised gruel, but the Fe absorption was increased by 50 %. In the gruel with organic acids, the lactic acid concentration was 52 % lower than in the pasteurised gruel, with no difference in Fe absorption. The fermented gruel increased non-haem Fe absorption from a phytate-rich meal in young women, indicating a specific effect of live L. plantarum 299v and not only an effect of the organic acids.

Recurrent vulvovaginal candidiasis

Abstract Recurrent vulvovaginal candidiasis is a prevalent opportunistic mucosal infection, caused predominantly by Candida albicans . This condition affects a significant number of otherwise healthy women of childbearing age, and it causes significant discomfort. Patients who have chronic vulvovaginitis should be thoroughly evaluated to determine the specific etiology and to initiate appropriate therapy. Induction therapy, followed by a maintenance regimen, seems to reduce relapse. Alternative therapies should be considered for recalcitrant cases.

Detection of Antibodies to Human Herpesvirus 8 (HHV-8) among Women of Child-Bearing Age in the Apulia Region (South-Eastern Italy)

In this study the authors investigated the presence of serum antibodies to Human Herpesvirus 8 (HHV-8) in a group of women of child-bearing age in the Apulia region (South Eastern Italy). A seroprevalence of 16.8% was observed, increasing, although non significantly, with the age of the women (10.6% in women between 19 and 25 years, 25.3% in women aging more than 35 years). The presence of antibodies to Hepatitis C Virus (HCV) was significantly associated to the detection of antibodies to HHV-8. Possible mother-to-child transmission of HHV-8 as well as the outcome of fetuses or children born to HHV-8 positive mothers are still a matter of debate. This study, showing the wide diffusion of HHV-8 infection in healthy women of child-bearing age in our geographical area, highlights the urgency of studies aimed to better clarify these relevant topics.

Idiopathic Intracranial Hypertension Presenting With Psychiatric Symptoms

Idiopathic Intracranial Hypertension Presenting With Psychiatric Symptoms

Assessment of diet quality in pregnant women using the Healthy Eating Index

The objectives of this pilot study were to examine the diets of pregnant women and healthy women of childbearing age, to quantify their diets using the US Department of Agriculture Healthy Eating Index (HEI), and to assess the validity of the HEI in pregnancy in terms of macronutrients and micronutrients. Dietary information was prospectively collected from nonpregnant women and pregnant women at 20 to 38 weeks’ gestation using 4-day food records. Diet records were analyzed for nutrient content using computer software and for overall quality using the HEI. Differences between the groups were analyzed statistically using the Student’s t test, descriptive statistics, and χ 2 analysis. The macronutrient composition of the diets and the number of food group servings were similar in both groups. The HEI scores for control (nonpregnant) and pregnant women were similar, 72.6±1.52 and 75.0±0.99, respectively, of a maximum possible score of 100. Pregnant women did not meet daily recommended intakes of micronutrients of concern in pregnancy (calcium, iron, folate) through dietary means. Dietary counseling and nutritional supplements (particularly iron and folate) may be necessary. The HEI was useful in providing a composite measure of dietary intake, but did not discern the need for vitamin and mineral supplements during pregnancy.

The administration of a multivitamin/mineral fortified dairy product improves folate status and reduces plasma homocysteine concentration in women of reproductive age.

Folate deficiency during the periconceptional period is related to the occurrence and recurrence of neural tube defects. The aim of the study was to assess whether the administration of folic acid and other vitamins and minerals as a fortified dairy product (400 microg per day of folic acid) improves the folate status in women of reproductive age. Plasma and red blood cell folate, plasma vitamin E, B12, total plasma homocysteine, plasma lipid profile, and serum ferritin and transferrin levels were investigated in 31 healthy nonpregnant women receiving 500 mL/day of the fortified dairy product for eight weeks. The women showed a significant increase in plasma levels of folate and vitamin B12 concentrations after four and eight weeks of supplementation. Moreover, we observed an increase in red blood cell folate concentration during the period of the study. Simultaneously, total plasma homocysteine levels decreased significantly during the intervention period. The regular consumption of a folic acid and other vitamins (mainly vitamins B6 and B12) and minerals in a fortified dairy product improves folate status and reduces total plasma homocysteine concentration in healthy women of childbearing age.

Magnesium-induced vasodilation in the dorsal hand vein.

Magnesium affects blood pressure by modulating vascular tone and reactivity. In obstetric patients, magnesium is administered to prevent eclamptic seizures and as a tocolytic to treat preterm labour. Prior to studying vascular sensitivity in women with pre-eclampsia, we sought to determine the effect of magnesium on venous tone in healthy women of childbearing age. Dose-response study. Columbia-Presbyterian Medical Center, New York. Ten healthy non-pregnant women (age range 21-47 years). Vascular response to magnesium sulphate (MgSO4) was measured in a dorsal hand vein using the linear variable differential transformer (LVDT) technique. Complete dose-response curves to MgSO4 (0.0000275-0.088 mmol/min) were determined after 50% preconstriction of the vein with phenylephrine. The ED50 of MgSO4 (dose resulting in 50% of maximal effect, Emax) was determined. Blood samples from the contralateral upper extremity were obtained to assess total plasma magnesium levels at baseline and at the highest infused dose of magnesium. ED50 results are expressed as geometric mean (95% confidence interval, CI). Emax results and magnesium plasma concentrations are expressed as mean [SD]. The ED50 of MgSO4 was 0.000307 mmol/min (95% CI 0.138, 0.666) and Emax was 102% [20%]. Magnesium induces dose-dependent venodilation in healthy women in the absence of systemic haemodynamic effects. The dose resulting in vasodilation using the LVDT/hand vein model is two to three orders of magnitude less than the therapeutic doses of magnesium used for tocolysis or seizure prophylaxis. Studies of the effect of systemically administered therapeutic doses of magnesium on vascular reactivity in pre-eclampsia will be of interest.

The Coraliance study: non-compliant behavior. Results after a 6-month follow-up of patients on oral contraceptives

Objectives This follow-up study was planned to establish the frequency with which women miss their contraceptive pill, and to observe their behavior when they forget it. In those women who changed from a continuous cycle to an interrupted type of cycle, or vice versa, the study also aimed to evaluate the impact of this change on the pattern of omission of pills. Methods The longitudinal, prospective cohort study included healthy women of child-bearing age for whom a change of pill was being prescribed by their gynecologist. Data were recorded during the 6 months preceding inclusion in the study, and for the 6 months of follow-up; the women were asked to complete a diary in which they recorded the number and exact times of pill omission, and their behavior at each omission. Results A total of 617 gynecologists included 3316 women into the study; of these, a group of 2418 (73%) revisited the same gynecologist at follow-up. The groups who either visited the same or a different gynecologist were similar with respect to age, oral contraception type, omission type and frequency. A large non-compliance rate and women's difficulties in maintaining safe contraception after missing a pill were observed in the group with follow-up. Women were never risk-free when they missed a pill; they turned to numerous sources for discordant or conflicting information; 15% of 'not-forgetting' women at the pre-inclusion cycle recorded at least one omission at the last cycle of the 6-month follow-up period. Omission fluctuations during the observational period make it difficult to designate 'forgetful' or 'non-forgetful' classes of women. Administration of the pill in a continuous cycle, and probably 'study' and 'auto-questionnaire' effects, contributed to an improvement in compliance. In the group taking the continuous cycle pill, the omission number slightly decreased, particularly on the first day and week of the cycle, irrespective of the initial cycle type. Conclusions The importance of the phenomenon of non-compliance rate is confirmed as well as women's difficulties in knowing how to maintain contraceptive safety. The continuous cycle regimen is likely to improve women's compliance during the critical period of the cycle.

Weekly High-Dose Folic Acid Supplementation Is Effective in Lowering Serum Homocysteine Concentrations in Women

Aims: To compare the efficacy of a weekly high-dose (2,800 µg) folic acid supplement with a daily (400 µg) folic acid supplement in lowering homocysteine concentrations in healthy women of childbearing age. Methods: Free-living healthy women of childbearing age (n = 138) were randomized to receive a weekly (2,800 µg), a daily (400 µg) folic acid supplement, or placebo. Blood samples were collected at baseline and at 12 weeks and analyzed for serum homocysteine and erythrocyte folate. Results: At 12 weeks the mean (95% CI) serum homocysteine concentrations declined significantly (p < 0.05) in women receiving the daily [week 12 – baseline: –1.4 (–2.0, –0.70) µmol/l] and the weekly supplement [–1.3 (–2.1, –0.5) µmol/l] versus placebo [0.0 (–0.5, 0.5) µmol/l]. There was no significant difference between the two folate-treated groups (p > 0.05). At 12 weeks the mean erythrocyte folate concentration increased significantly in both supplemented groups versus placebo (p < 0.001). The increase in erythrocyte folate was significantly greater (p < 0.001) in the daily group than in the weekly group [451 (380, 521) vs. 288 (240, 335) nmol/l]. Conclusion: A weekly high-dose folic acid supplement was as effective as a daily supplement in lowering homocysteine concentrations in healthy women of childbearing age. Further study is needed to determine if weekly folic acid supplementation is effective in lowering homocysteine concentrations in populations with high homocysteine.

Effects of reproductive hormones on experimental vaginal candidiasis.

Vulvovaginal candidiasis (VVC) is an opportunistic mucosal infection caused by Candida albicans that affects large numbers of otherwise healthy women of childbearing age. Acute episodes of VVC often occur during pregnancy and during the luteal phase of the menstrual cycle, when levels of progesterone and estrogen are elevated. Although estrogen-dependent experimental rodent models of C. albicans vaginal infection are used for many applications, the role of reproductive hormones and/or their limits in the acquisition of vaginal candidiasis remain unclear. This study examined the effects of estrogen and progesterone on several aspects of an experimental infection together with relative cell-mediated immune responses. Results showed that while decreasing estrogen concentrations eventually influenced infection-induced vaginal titers of C. albicans and rates of infection in inoculated animals, the experimental infection could not be achieved in mice treated with various concentrations of progesterone alone. Furthermore, progesterone had no effect on (i) the induction and persistence of the infection in the presence of estrogen, (ii) delayed-type hypersensitivity in primary-infected mice, or (iii) the partial protection from a secondary vaginal infection under pseudoestrus conditions. Other results with estrogen showed that a persistent infection could be established with a wide range of C. albicans inocula under supraphysiologic and near-physiologic (at estrus) concentrations of estrogen and that vaginal fungus titers or rates of infection were similar if pseudoestrus was initiated several days before or after inoculation. However, the pseudoestrus state had to be maintained for the infection to persist. Finally, estrogen was found to reduce the ability of vaginal epithelial cells to inhibit the growth of C. albicans. These results suggest that estrogen, but not progesterone, is an important factor in hormone-associated susceptibility to C. albicans vaginitis.

Sjögren autoantibodies modify neonatal cardiac function via M 1 muscarinic acetylcholine receptor activation

Isolated congenital heart block may be associated with primary Sjögren syndrome. In this work we describe circulating antibodies in the sera of primary Sjögren syndrome patients that are able to interact with neonatal myocardium by activating muscarinic acetylcholine receptors of M 1 subtype. We report on the presence of autoantibodies against the second extracellular loop of human M 1 muscarinic acetylcholine receptors in primary Sjögren syndrome mothers whose children have congenital heart block using a synthetic peptide in indirect immunofluorescence technique. Autoantibodies from primary Sjögren syndrome patients gave positive image on neonatal atria but not on adult atria slices. The synthetic M 1 peptide selectively abrogated indirect immunofluorescence recognition. The primary Sjögren syndrome–immunoglobulin G also displayed an ‘agonist like’ activity modifying the intracellular events associated with muscarinic acetylcholine receptor activation. The mechanism appears to occur secondarily to stimulation of phosphoinositides turnover via phospholipase C activation. This, in turn, triggers cascade reactions involving calcium/calmodulin and leads to activation of nitric oxide synthase and soluble guanylate cyclase. All of these effects were selectively blunted by pirenzepine and neutralized by M 1 synthetic peptide. These biological effects were not obtained using adult instead of neonatal rat atria and neither occurred with the sera of normal healthy women of childbearing age. It could be concluded that antibodies against neonatal M 1 muscarinic acetylcholine receptor may be another serum factor to be considered in the pathophysiology of the development of congenital heart block associated with primary Sjögren syndrome mothers.

Serum ionized magnesium and calcium in women after menopause: inverse relation of estrogen with ionized magnesium

Objective: To study the serum concentrations of the sex steroid hormones and free divalent cations Mg 2+ and Ca 2+ in healthy women at or past menopause and to compare them with the serum concentrations of healthy, cycling women of child-bearing age at different stages of the menstrual cycle. Design: Controlled clinical study. Setting: An academic medical center. Patient(s): Women of varying age and duration of menopause, and healthy, cycling women. Intervention(s): None. Main Outcome Measure(s): Serum levels of the sex steroids (estrogen, progesterone, and testosterone) and of Ca 2+ and Mg 2+ were measured in menopausal and postmenopausal women, and in healthy, cycling women at five different stages of the menstrual cycle. Result(s): The Mg 2+ and total Mg levels of the postmenopausal women were inversely related to the serum level of estrogen and were similar to the levels present during the early follicular phase of healthy women of child-bearing age. The Ca 2+ level was unrelated to the sex steroid hormones present, but it was increased compared with that of younger women in both the follicular phase and the luteal phase. Conclusion(s): Serum levels of Mg 2+ and total Mg were inversely correlated with the estrogen concentration in menopausal women. Serum levels of Ca 2+ were significantly elevated in menopausal women compared with younger women, but the ratio of Ca 2+ to Mg 2+, a measure of cardiovascular problems, was not elevated in the postmenopausal women.

Estimation of group B streptococcus type III polysaccharide-specific antibody concentrations in human sera is antigen dependent.

The presence of immunoglobulin G (IgG) antibodies against group B streptococcus (GBS) type III polysaccharide (PS) has been correlated with protection against GBS disease. The GBS type III PS is structurally similar to the pneumococcal type 14 PS, differing only in the presence of sialic acid residues. Four different preparations of GBS type III PS were evaluated for their specificity in enzyme-linked immunosorbent assay (ELISA): free PS, free PS mixed with methylated human serum albumin (mHSA), PS conjugated to biotin and PS conjugated to human serum albumin. Three groups of human sera were used to evaluate these PS preparations: sera from recipients of a GBS PS vaccine, sera from women receiving a GBS type III PS-tetanus toxoid conjugate vaccine, and sera from nonimmunized healthy women of childbearing age. Estimated antibody concentrations were different depending on the PS preparation used. Using any of the four preparations, we were able to measure </=0.05 micrograms of IgG antibody to the GBS type III PS per ml. The specificity of the assay was determined by competitive inhibition with homologous and heterologous PS. The pneumococcal type 14 PS did not inhibit binding of antibody to the native GBS type III PS in sera from adults receiving the GBS PS vaccine or in sera from nonimmunized adults (except serum G9). The pneumococcal type 14 PS inhibited 50% in sera from recipients of GBS type III conjugate vaccine and in serum G9 when GBS type III PS conjugated to biotin or to HSA was used as antigen in ELISA. These data show that free GBS type III PS or PS mixed with mHSA is a sensitive and specific antigen for ELISA and that conjugation can alter the antigenic specificity of a PS.

The Constipation Assessment Scale for Pregnancy

To determine the reliability and validity of the Constipation Assessment Scale (CAS) during pregnancy. Survey. The assessment tool was administered first to a group of healthy women of childbearing age in a school of nursing and then to pregnant women in their physicians' offices. A nonrandom sample of 16 nonpregnant women of childbearing age and 30 women pregnant 28 weeks or longer, 15 of whom had low-risk pregnancies and 15 of whom had high-risk pregnancies. The test-retest reliability, content validity, and internal consistency of the CAS were determined. An expert panel review found a calculated percentage of agreement for content validity of .75 and a Cohen's kappa of .714. Test-retest reliability based on 16 nursing students yielded high positive correlations ranging from rH = .84 to rH = .92. Internal consistency of the CAS for pregnancy based on the 30 surveys indicated an alpha coefficient of .82. The CAS for pregnancy was found to be reliable and valid within the context of this study. Future studies designed to identify potential therapeutic interventions for constipation during pregnancy could use the CAS for pregnancy as a measurement instrument.