Maternal Age Research Articles

TRNA-derived RNAs in human milk extracellular vesicles and associations with breastfeeding variables and maternal diet.

To describe tDRs in human milk EVs and their associations with maternal body mass index, age, dietary indices, breastfeeding frequency, season and time of milk collection in a Latina population. We sequenced small RNAs from EVs from 109 mature human milk samples collected at 1 month after delivery in the Southern California Mother's Milk Study. We grouped tDRs using hierarchical clustering and clusters were compared across tDR characteristics. We analyzed associations of tDRs with intrinsic maternal variables (body mass index, age), maternal nutrition (caloric intake, Healthy Eating Index, Dietary Inflammatory Index), and variables related to feeding and milk collection (breastfeeding frequency, season and time of milk collection) using negative binomial models. We identified 338 tDRs expressed in 90% or more of milk EV samples, of which 113 were identified in all samples. tDR-1:26-Gly-CCC-1-M4 accounted for most reads (79%). Pathway analysis revealed a wide array of biological processes and disease mechanisms across the four tDR clusters. tDRs were associated with season of collection, time of collection, breastfeeding frequency, and the dietary inflammatory index. tDRs are abundant in milk EVs and may be sensitive to maternal diet, seasonality, time of day, and breastfeeding frequency.

Socio-economic and geographical inequalities in neonatal mortality rates in Sierra Leone, 2008–2019

BackgroundSierra Leone has reduced neonatal mortality rates(NMR) in recent years. Despite this progress, disparities in newborn survival persist across socio-economic and geographic areas. This study examined the inequalities in neonatal mortality rates in Sierra Leone between 2008 and 2019.MethodsWe utilized data from the Sierra Leone Demographic Health Survey rounds conducted in 2008, 2013, and 2019. We used the World Health Organisation Health Equity Assessment Toolkit to calculate simple measures of inequality (Difference, and Ratio), and complex measures of inequality (Population Attributable Risk, and Population Attributable Fraction). Inequality in neonatal mortality rate was calculated on six stratifiers: maternal age, maternal economic status, maternal level of education, place of residence, sex of the child, and sub-national province.Results Neonatal mortality rate decreased in Sierra Loene from 48.6 deaths per 1,000 live births in 2008 to 29.6 deaths per 1,000 live births in 2019. There was an increase in age-related inequality from a Difference of 0.7 deaths per 1,000 live births in 2008 to 4.3 deaths per 1,000 live births in 2019. Economic inequality decreased from a Difference of 26.8 deaths per 1,000 live births in 2008 to -3.4 deaths per 1,000 live births in 2019. Inequality in education decreased from a Difference of 4.6 deaths per 1,000 live births in 2008 to -4.2 deaths per 1,000 live births in 2019. Inequality increased from a Difference of − 0.5 deaths per 1,000 live births in 2008 to -4.2 deaths per 1,000 live births in 2019 for place of residence. For the child’s sex, the inequality increased from a Difference of − 7.9 deaths per 1,000 live births in 2008 to -11.1 deaths per 1,000 live births in 2019. Provincial inequality increased slightly from a Difference of 14.0 deaths per 1,000 live births in 2008 to 14.4 deaths per 1,000 live births in 2019.ConclusionThe findings show a decline in the national neonatal mortality rate from 2008 to 2019, indicating improvements in healthcare and maternal support. While economic and educational inequalities have decreased, especially in education, sustaining these gains is essential for equitable healthcare access. Despite this progress, inequalities based on age, residence, child’s sex, and province still exist, and have increased between 2008 and 2019. Policymakers should focus on targeted programs for vulnerable age groups and sexes, and develop geographical strategies to ensure uniform improvements in neonatal health.

Pyrroloquinoline-quinone supplementation restores ovarian function and oocyte quality in a mouse model of advanced maternal age.

Natural ovarian aging is one of the major causes for declining fertility in female animals, which has become an insurmountable issue in human reproduction clinics and assisted reproductive technology (ART) procedures. Nevertheless, the molecular basis of oocyte aging remains poorly understood, and feasible improvement strategies are unavailable. In the present study in vivo supplementation of pyrroloquinoline-quinone (PQQ) effectively elevated the fecundity of reproductively aged mice by balancing hormonal secretion, harmonizing the estrus cycle, and eliminating ovarian fibrosis. Moreover, oocyte quality also increased in aged mice after PQQ administration from various aspects, including nuclear and cytoplasmic maturation competency, fertilization capacity and pre-implantation embryonic development potential. Transcriptomic analysis identified target pathways that might mediate PQQ's effects in aged oocytes. Specifically, it was demonstrated that PQQ supplementation restored the mitochondrial dynamics and lysosomal function to remove excessive reactive oxygen species (ROS) and suppress apoptosis in aged oocytes. Jointly, these findings demonstrate PQQ administration is an efficacious method to restore the compromised ovary function and damaged oocyte quality in reproductively aged mice, which might be a potential clinical therapy for women of advanced maternal age with infertility.

Cesarean Delivery and its Determining Factors: A Hospital-Based Study in Jashore District, Bangladesh

BackgroundThe rising prevalence of cesarean deliveries (CD) is a major public health problem worldwide, especially in Bangladesh. This study aims to investigate the prevalence and factors associated with cesarean deliveries in the Jashore district of Bangladesh. Study designThis cross-sectional study, conducted from December 2022 to February 2023 in Jashore district, Bangladesh, involved face-to-face interviews with 662 mothers during hospital visits. MethodsA pretested, structured, and validated questionnaire was employed to gather information on socioeconomic characteristics, obstetric history, maternal healthcare utilization, and factors influencing the choice of delivery method. Multinomial logistic regression models were employed to assess and predict determining factors influencing cesarean delivery. ResultsThe study revealed a high cesarean delivery (CD) prevalence of 70.5 %, exceeding the WHO-recommended threshold. Key socioeconomic factors associated with increased CD rates included rural residence, younger maternal age (15–20 years), nuclear family structure, and husbands in business. Additionally, private hospital deliveries, a history of previous CD, maternal self-preference, and doctor's influence were significant predictors of CD. The majority of participants believed CD enhances maternal safety (74.6 %) and alleviates pain (74.8 %). ConclusionThe high rate of cesarean deliveries in Jashore highlights the need for public health interventions that improve access to quality maternal care and promote evidence-based decision-making. Reducing unnecessary cesarean procedures, particularly in private hospitals, and enhancing patient education can significantly improve maternal and neonatal health outcomes.

Prenatal air pollutant exposure and preterm birth risk in primiparas of advanced maternal age residing in rural Henan province

ABSTRACT Direct evidence on the impact of air pollution on preterm birth (PTB) among advanced maternal age (AMA) primiparas is limited. This study examined the association between air pollution and PTB among 6,295 AMA primiparas in rural Henan Province. Logistic regression and distributed lag nonlinear models showed that prenatal exposure to carbon monoxide (CO), sulfur dioxide (SO2), nitrogen dioxide (NO2), and fine particulate matter (PM2.5) was associated with an increased PTB risk among AMA primiparas, while ozone (O3) exposure was inversely related to PTB risk (all P < 0.05). Moreover, the vulnerable periods were identified as gestational weeks 1–6 and 22–28. The education level, smoking status, and season of conception significantly modified the association between PTB and air pollution (P interaction < 0.10) among AMA primiparas. These findings emphasize the impact of air pollution on PTB risk in AMA primiparas, highlighting the need for targeted interventions in vulnerable populations.

Longer inter-pregnancy interval is associated with gestational diabetes mellitus recurrence.

This study aimed to evaluate the effect of inter-pregnancy interval (IPI) on the gestational diabetes (GDM) recurrence rate in subsequent pregnancies following an initial pregnancy complicated by GDM. A multicenter retrospective cohort study was conducted. The study included women diagnosed with GDM during their index pregnancy who subsequently delivered between 26 and 42 weeks of gestation from 2005 to 2021. The study population was categorized into 8 groups according to their IPIs: up to 3 months, 3-5 months, 6-11 months, 12-17 months, 18-23 months, 24-35 months, 36-47 months, and over 48 months. We examined the recurrence rate of GDM in the different groups compared to the 18-23 months group that was defined as the reference. Statistical analyses included univariate analyses and multiple logistic regression. Out of 3,532 women that were included in the study, 1776 (50.3%) experienced GDM recurrence in subsequent pregnancy. The recurrence rate was 44.6% for women IPI <6 months, 42.6% for women IPI of 6-11 months, 48.0% for women IPI of 12-17 months, 49.7% for women IPI of 18-23 months, 58.0% for women IPI of 24-47 months and 62.6% for women IPI above 48 months. Multivariable logistic regression revealed that IPIs of 24-47 months and over 48 months were significantly associated with higher recurrence rates as compared to the 18-23 months reference group (adjusted odds ratio [aOR], 95% confidence interval [CI] 1.66 [1.04-2.64] and 3.15 [1.07-9.29], respectively). This analysis also revealed other independent risk factors for GDM recurrence including medication-controlled GDM in the index pregnancy, obesity, maternal age, parity, and gravidity. Longer IPIs (over 24 months) are associated with an increased risk of GDM recurrence in subsequent pregnancies. Clinicians should consider IPI when managing postpartum care and planning future pregnancies for women with a history of GDM.

Influence of Infant and Young Child Feeding Practices (IYCF) on Nutritional Status of Children Aged 6-59 Months in Moheshkhali, Cox’sbazar, Bangladesh: A Cross-Sectional Study

Background: This study addresses the critical issue of malnutrition among under-five children in Moheshkhali, Cox's Bazar, Bangladesh. Despite the alarming rates of stunting, wasting, and underweight in this region, there is a significant lack of localized data on socioeconomic factors, IYCF practices, and overall health status. Understanding these variables is essential for developing effective interventions. Methods: The research involved a cross-sectional study design, where anthropometric measurements were conducted to assess the nutritional status of children aged 6 to 59 months. Maternal education, age, and Body Mass Index (BMI) were also evaluated to explore their impacts on child nutrition. Data were analyzed using standard statistical methods to draw correlations and identify trends. Results: The findings revealed a high prevalence of malnutrition among under-five children, with notable gender disparities in stunting and underweight. The analysis indicated a strong relationship between maternal health indicators—particularly BMI—and child nutritional outcomes. Moreover, inadequate adherence to IYCF practices was observed, with many mothers failing to implement optimal breastfeeding and complementary feeding strategies. Conclusion: The study underscores the urgent need for targeted interventions aimed at improving maternal education and IYCF practices in Moheshkhali. A multi-sectoral approach involving government and non-government organizations is essential to address the malnutrition crisis effectively. Investing in preventive measures and promoting healthy feeding practices are crucial for ensuring the well-being of both mothers and their children.

Air pollution mixture exposure during pregnancy and postpartum psychological functioning: racial/ethnic- and fetal sex-specific associations.

Prenatal air pollution (AP) exposure has been linked to postpartum psychological functioning, impacting health outcomes in both women and children. Extant studies primarily focused on individual pollutants. To assess the association between prenatal exposure to a mixture of seven AP components and postpartum psychological functioning using daily exposure data and data-driven statistical methods. Analyses included 981 women recruited at 24.0 ± 9.9 weeks gestation and followed longitudinally. We estimated prenatal daily exposure levels for constituents of fine particles [elemental carbon (EC), organic carbon (OC), nitrate (NO3-), sulfate (SO42-), ammonium (NH4+)], nitrogen dioxide (NO2), and ozone (O3) using validated global 3-D chemical-transport models and satellite-based hybrid models based on residential addresses. Edinburgh Postnatal Depression Scale (EPDS) was administered to participants to derive a total EPDS score and the subconstruct scores for anhedonia and depressive symptoms. A distributed lag model (DLM) was employed within Bayesian Kernel Machine Regression (BKMR) to develop time-weighted exposure profile for each pollutant. These exposures were then input into a Weighted Quantile Sum (WQS) regression to estimate an overall mixture effect, adjusted for maternal age, education, race/ethnicity, season of delivery, and delivery year. Effect modification by race/ethnicity and fetal sex was also examined. Women were primarily Hispanic (51%) and Black (32%) reporting ≤12 years of education (58%). Prenatal exposure to an AP mixture was significantly associated with increased anhedonia subscale z-scores, particularly in Hispanics (β = 0.07, 95%CI = 0.004-0.13, per unit increase in WQS index). It was also borderline associated with increased total EPDS (β = 0.11, 95%CI = 0.00-0.22) and depressive symptom subscale (β = 0.09, 95%CI = -0.02 to 0.19) z-scores, particularly among Hispanic women who gave birth to a male infant. Sulfate (SO42-), O3 and OC were major contributors to these associations. This study utilizes an advanced data-driven approach to examine the temporally- and mixture-weighted effects of prenatal air pollution exposure on postpartum psychological functioning. We found that exposure to a prenatal air pollution mixture predicted poorer postpartum psychological functioning, particularly anhedonia symptoms in Hispanic women. Findings underscore the importance of considering both exposure mixtures as well as potential modifying factors to better help identify particular pollutants that drive effects and susceptible populations, which can inform more effective intervention strategies.

Predictive value of urine misfolded protein in preeclampsia in twin pregnancies.

To assess the utility of urinary misfolded proteins (MP) in predicting preeclampsia (PE) in high-risk twin pregnancies. A prospective study was conducted on 600 high-risk twin pregnancies at Shanghai First Maternity and Infant Hospital from March to August 2021. Clinical data were collected, and urinary MP levels were measured. Subsequently, fetal outcomes were monitored. The patients were categorized into three groups based on the presence of PE: unaffected PE group, early-onset PE (ePE) group (gestational age < 34weeks), and late-onset PE (lPE) group (gestational age ≥ 34weeks). The predictive value of MP in PE was evaluated using analysis of variance, Chi-square test, and ROC curve analysis. A total of 464 twin pregnancies were included in the study, among which 66 cases (14.2%) developed PE, including 19 cases of ePE (4.1%) and 47 cases (10.1%) of lPE. Significant differences were found in maternal age, pre-pregnancy body mass index (BMI), BMI ≥ 28km/m2, mean systolic blood pressure, diastolic blood pressure, mean arterial pressure (MAP), MAP ≥ 85mmHg, history of PE, history of chronic hypertension, and positive urine protein. The maternal and fetal complications of twin pregnancies with PE were higher than those without PE (P < 0.05). When maternal factors (MF), MAP, and MP were used to predict ePE and lPE alone, the area under the ROC curve of MF was the largest, at 0.739 (95% CI 0.619-0.860) and 0.692 (95% CI 0.603-0.782), respectively. The area under the ROC curve of the combination of the three factors was 0.770 (95% CI 0.703-0.837), higher than that of a single index. In addition, MP predicted the positive predictive value (PPV) and negative predictive value (NPV) of PE from 12 to 15+6 gestational weeks as 57.9% and 89.2%, respectively; from 16 to 27+6 gestational weeks as 36.2% and 89.9%, respectively; and during the 12-27+6 gestational weeks as 42.4% and 92.2%, respectively. The detection of MP in the urine of women with twin pregnancies is a non-invasive and convenient method for predicting PE. If the test result is positive, enhanced monitoring and timely transfer to a superior hospital are necessary. If the test result is negative, it indicates a low risk of developing PE, reducing the need for excessive clinical examination and intervention.

Trends in Postpartum Depression by Race, Ethnicity, and Prepregnancy Body Mass Index

Postpartum depression (PPD) poses significant risks to maternal and child health. Understanding temporal trends is crucial for evaluating prevalence and identifying populations at risk. To evaluate recent trends in PPD and assess how these trends are associated with race, ethnicity, and prepregnancy body mass index (BMI). A serial, cross-sectional analysis using data from the Kaiser Permanente Southern California (KPSC) electronic health records (EHRs), with live and stillbirths at 20 or more weeks of gestation who were KPSC members at the time of delivery between 2010 and 2021. Data were analyzed from July 2022 to August 2023. Self-reported race, ethnicity, and recorded prepregnancy BMI. PPD cases were identified using validated diagnostic codes and prescription records within 12 months postpartum in the KPSC EHRs. Patients with an Edinburgh Postnatal Depression Scale score of 10 or more within 6 months postpartum were further evaluated by a mental health specialist for formal PPD diagnosis. In this study of 442 308 pregnancies, the median (IQR) maternal age at delivery was 31 (27-34) years. The cohort was racially and ethnically diverse, with 62 860 individuals (14.2%) identifying as Asian/Pacific Islander, 231 837 (52.4%) as Hispanic, 33 207 (7.5%) as non-Hispanic Black, 108 201 (24.5%) as non-Hispanic White, 5903 (1.3%) as multiple or other, and 300 (0.1%) unknown. PPD prevalence doubled over the study period, increasing from 9.4% in 2010 to 19.0% in 2021. The largest increases were observed among Asian and Pacific Islander participants (280% increase) and non-Hispanic Black participants (140% increase). PPD rates increased across all BMI categories, particularly among individuals with obesity (class I) and morbid obesity (class II/III). In this cross-sectional study, PPD diagnosis increased significantly across all racial and ethnic groups and BMI categories over the past decade. While rising PPD may reflect improved screening and diagnosis practices, the persistently high rates highlight the need to develop and implement interventions to prevent the condition while expanding efforts to mitigate the impact of PPD on maternal and child health.

Risk Factors for Preeclampsia in Clinical Practice Guidelines: Comparison With the Evidence

(BJOG. 2024;131:46–62. DOI: 10.1111/1471-0528.17320) Preeclampsia affects 2% to 4% of pregnancies globally, with a rising incidence linked to increasing maternal age and body mass. This hypertensive disorder poses significant risks to both maternal and fetal health, making it a key focus of prenatal care through blood pressure and proteinuria screening. Despite the lack of an approved treatment to modify the disease, current best practices involve identifying at-risk women, administering preventative therapy, managing hypertension, and other organ impacts if preeclampsia develops, and ultimately, timing the birth to resolve the condition.

Time Trends in Preeclampsia and Gestational Diabetes in Denmark and Alberta, Canada, 2005 to 2018: A Population-Based Cohort Study

(Acta Obstet Gynecol Scand. 2024;103:266–275. doi: 10.1111/aogs.14703) Preeclampsia (PEC) and gestational diabetes mellitus (GDM) have similar risk factors including increased maternal age and obesity. Both conditions are associated with adverse pregnancy outcomes and long-term health issues for mothers and children, and health care resources could be strained if the prevalence of PEC and GMA are increasing.

Obstetric and neonatal outcomes in the management of twin pregnancies with gestational diabetes using the IADPSG criteria for singleton pregnancies

BackgroundThis study evaluates the effectiveness of the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria, typically applied to singleton pregnancies, in managing gestational diabetes mellitus (GDM) in twin pregnancies. Focusing on a Chinese cohort, it contrasts the clinical outcomes and complications in twin pregnancies with and without GDM.MethodsWe conducted a retrospective cohort study at our hospital from January 2019 to December 2021, including all twin deliveries except those before 28 weeks of gestation, with prior diabetes, or unknown GDM status. GDM was diagnosed using a 75 g oral glucose tolerance test based on the IADPSG criteria, and management involved dietary or insulin interventions. We assessed outcomes such as hypertensive disorders (gestational hypertension, preeclampsia, and eclampsia), membrane rupture, preterm birth, small for gestational age (SGA), large for gestational age (LGA), and neonatal intensive care unit (NICU) admissions.ResultsAmong 1003 twin pregnancies, 21.7% had GDM, with 11.5% receiving insulin. GDM was associated with older maternal age, higher BMI, and a family history of diabetes. Pregnant women with GDM had lower weekly weight gain (0.44 kg/week vs. 0.58 kg/week, p < 0.001) and experienced a higher risk of SGA neonates (aOR = 1.68, 95% CI: 1.06–2.67) and increased NICU admissions (aOR = 1.30, 95% CI: 1.00-1.69) compared to those without GDM. Additionally, dichorionic twins with GDM showed higher risks of SGA and NICU admissions, while monochorionic twins had no significant differences. A U-shaped relationship was identified between weekly weight gain and the rates of SGA and NICU admissions, with the lowest risk observed at a weekly weight gain of 0.75 kg for SGA and 0.57 kg for NICU admissions.ConclusionsApplying singleton-derived IADPSG criteria to twin pregnancies may mitigate some maternal risks but elevates the risk for SGA neonates, suggesting a need for tailored diagnostic and management strategies for twin pregnancies.Trial registrationRetrospectively registered.

Reproductive success and offspring survival decline for female elephant seals past prime age.

Maternal age can influence reproductive success and offspring fitness, but the timing, magnitude and direction of those impacts are not well understood. Evolutionary theory predicts that selection on fertility senescence is stronger than maternal effect senescence, and therefore, the rate of maternal effect senescence will be faster than fertility senescence. We used a 36-year study of northern elephant seals (Mirounga angustirostris) to investigate reproductive senescence. Our dataset included 103,746 sightings of 1203 known-age female northern elephant seals. We hypothesized that fertility (maternal reproductive success), offspring survival and recruitment into the breeding population, and male offspring production would decline with advanced maternal age. Furthermore, we hypothesized that older females would shorten their moulting haul out to allow for more time spent foraging. We found evidence for both fertility and maternal effect senescence, but no evidence for senescence impacting offspring recruitment or sex ratio. Breeding probability declined from 96.4% (95% CI: 94.8%-97.5%) at 11 years old to 89.7% (81.9%-94.3%) at 19 years old, and the probability of offspring survival declined from 30.3% (23.6%-38.0%) at 11 years old to 9.1% (3.2%-22.9%) at 19 years old. The rates of decline for fertility and maternal effect senescence were not different from each other. However, maternal effect senescence had a substantially greater impact on the number of offspring surviving to age 1 compared to fertility senescence. Compared to a hypothetical non-senescent population, maternal effect senescence resulted in 5.3% fewer surviving pups, whereas fertility senescence resulted in only 0.3% fewer pups produced per year. These results are consistent with evolutionary theory predicting weaker selection on maternal effect than fertility senescence. Maternal effect senescence may therefore be more influential on population dynamics than fertility senescence in some systems.

Comparison of the Effectiveness of Different Assisted Reproductive Techniques (ART) in Couples with Unexplained Infertility

Introduction Unexplained infertility, impacting 10-30% of couples, remains a significant challenge due to the absence of identifiable etiologies, complicating treatment decisions. Assisted reproductive technologies (ART) like IVF, IUI, and ICSI have become primary interventions, though their efficacy varies across patient subgroups. Objective of this StudyThis study aims to evaluate the clinical efficacy of IVF, IUI, and ICSI in managing unexplained infertility, considering patient demographics and prior ART outcomes, to guide evidence-based clinical decision-making. Matherials and methods A detailed literature search was undertaken across PubMed, Web of Science, and Embase to locate research on the adverse effects of monoclonal antibodies used in asthma management. The search covered English-language studies from the start of each database up to 2024. To ensure comprehensiveness, additional relevant studies were found by examining the reference lists of selected articles. Aim of the KnowledgeThe research seeks to clarify ART effectiveness in unexplained infertility, identifying optimal scenarios for each treatment type and assessing advancements that enhance reproductive outcomes while minimizing risks. ConclusionsThe analysis suggests IVF as the most effective option for complex cases, especially in advanced maternal age, though it involves higher risks. IUI is a lower-risk, cost-effective initial treatment, while ICSI is indicated for male factor infertility. Tailored ART strategies based on individual reproductive profiles are essential. SummaryThis study underscores the need for individualized ART approaches in unexplained infertility. IVF remains highly effective for challenging cases, while IUI and ICSI provide viable alternatives depending on patient-specific factors. Future research should aim to refine ART protocols to optimize success rates and minimize associated risks.

Pregnancy Outcomes of Elderly Primigravidae in a Tertiary Hospital in West Africa: A Retrospective Cohort Study.

Elderly primigravidae refers to women who become pregnant for the first time from age 35 years and above. Advanced maternal age is a known risk factor for numerous maternal and perinatal complications. This study sought to determine pregnancy outcomes of elderly primigravidae at the Korle-Bu Teaching Hospital (KBTH). A retrospective cohort study was conducted. Women who had their first delivery at KBTH from January 1, 2015 to December 31, 2017 had their demographic and obstetrics and gynecology history and maternal and fetal outcomes retrieved from the department's electronic database. Women aged 35 years or more who had their first delivery within the study period constituted the exposed, whereas those between 20 and 34 were considered unexposed. Modified Poisson regression with robust error variance estimation and the log link function between the sociodemographic and obstetric factors and maternal and fetal outcomes to estimate adjusted risk ratios (aRRs) and 95% CI were used. Of 29,243 total deliveries, elderly primigravidae constituted 1.81% (530/29,243). Maternal outcomes associated with elderly primigravidae were increased incidence of Caesarean section or instrument delivery (aRR [95% CI] = 1.73 [1.56-1.92]) and prolonged length of stay in hospital (aRR [95% CI] = 1.14 [1.06-1.23]). Fetal outcome associated with the elderly primigravidae was stillbirth (aRR [95% CI] = 1.91 [1.25-2.91]). Elderly primigravidae therefore require more intensive monitoring, even in the absence of any obvious maternal complications. These findings will help in counseling and in the shared decision-making for delivery of elderly primigravidae.

New perinatal mental health conditions diagnosed during COVID-19: a population-based, retrospective cohort study of birthing people in Ontario.

We aimed to determine the incidence of mental health diagnoses and associated health and social risk factors among perinatal people in three different COVID-19 phases. We conducted a population-based, retrospective cohort study using linked administrative datasets. We included persons with live, in-hospital births in Ontario, Canada from January 1 to March 31 in 2019, 2021, or 2022 (three phases relative to COVID-19 with different public health policy measures). We excluded people with prior mental health diagnoses. We used diagnostic codes to identify new onset of depression, anxiety, or adjustment disorder in the antenatal and postpartum period. We developed multivariable, modified Poisson models to examine associations between sociodemographic and clinical factors and new mental health diagnoses in each phase. There were 72,242 people in our cohort. Antenatal mental health diagnoses were significantly higher in 2021 (aRR = 1.32; CI = 1.20-1.46) and 2022 (aRR = 1.22; CI = 1.11-1.35) versus 2019. Postpartum diagnoses were significantly greater in 2021 (aRR = 1.16; CI = 1.08-1.25) versus 2019. Antenatal diagnoses were associated with birth year, previous stillbirth, pre-existing hypertension, multiparity, residential instability, and ethnocultural diversity. Postpartum diagnoses were associated with birth year, maternal age, multiparity, care provider profession, assisted reproductive technology, birthing mode, pre-existing hypertension, intensive care admission, hospital readmission, residential instability, and ethnocultural diversity. Family physicians increasingly made mental health diagnoses in 2021 and 2022. Increased incidence of perinatal mental health diagnoses during COVID-19 suggests complex dynamics involving pandemic and health and social risk factors. This study was registered with Clinicaltrials.gov (NCT05663762) on December 21, 2022.

Determination of Minor and Trace Elements in Breast Milk of Lactating Mothers in Early Lactation from Tehran, Iran Using Neutron Activation Analysis Method.

This study aimed to evaluate the concentrations of both essential and non-essential elements in the breast milk of lactating mothers from Tehran, Iran, during the colostrum period. Neutron activation analysis (NAA) was used to measure the element concentrations. Additionally, the study assessed how these element concentrations were influenced by maternal factors such as age and economic status. Breast milk samples were collected from 95 lactating mothers, aged 18 to 41, during the early lactation phase, specifically within the colostrum period (2-7 days postpartum). The colostrum milk samples were freeze-dried, powdered, and irradiated at the Tehran Research Reactor for neutron activation analysis (NAA). This method was used to measure the concentrations of essential elements-calcium (Ca), potassium (K), sodium (Na), chlorine (Cl), and iodine (I)-as well as non-essential elements-aluminum (Al), bromine (Br), and rubidium (Rb). Descriptive statistics, including mean, median, maximum, minimum, and standard deviation, were calculated for each element. Statistical analyses, such as Pearson's correlation, were performed to assess relationships between the concentrations of various elements. Additionally, t-tests and p-values were employed to evaluate differences in element levels across maternal age groups (17-34 years vs. 35-45 years) and economic status (high/middle vs. low). The mean concentrations of the elements in dry breast milk powder samples were: Al = 6.9mg/kg, Br = 11.9mg/kg, Ca = 2.757mg/g, Cl = 7.836mg/g, I = 1.22mg/kg, K = 5.853mg/g, Na = 4.932mg/g, and Rb = 3.69mg/kg. Significant correlations were found between element pairs, such as Na-Cl, Br-Cl, Na-Br, Rb-K, and I-Cl. Maternal age significantly influenced bromine concentrations, with older mothers showing 22% higher Br levels (p = 0.038), while calcium levels were 15% lower but not statistically significant (p = 0.20). Maternal economic status significantly impacted calcium and potassium concentrations, with higher levels observed in mothers from better economic conditions (p = 0.02 and p = 0.025, respectively). This study highlights the elemental composition of breast milk samples of lactating mothers in Tehran and shows that maternal factors, such as age and economic status, can significantly influence the concentrations of specific elements in breast milk.

Analysis of medico-legal claims related to deliveries: Caesarean section vs. vaginal delivery.

The Iranian National Health Service (NHS) suggested that gynecologists face a higher risk of medicolegal claims, with a significant number of claims being related to delivery events. This study aimed to investigate the factors associated with delivery related claims. In this cross-sectional study, we conducted an analysis of medico-legal documents which related to complications during delivery events and presented to Iranian Medical Legal Organization spanning from March 2018 to February 2020. A total of 227 legal prosecutions that were initiated by patients or, in cases where that wasn't possible, by their families, were included in the study and all of them were evaluated in commission with experienced professionals. The data collection phase occurred between February 2023 and May 2023. The collected data encompassed various aspects, including patient characteristics mode of delivery, reasons for claims, hospital type, accused party, the occurrence of instrumental delivery and the final disposition of the claims (paid claims or closed claims). Paid claims represent successful lawsuits where the healthcare provider or their insurer made a financial settlement to the patient. Closed claims encompass those that were either denied or dismissed. Chi-square or t-tests were employed to compare factors between paid claims and closed claims. In this study, it was observed that vaginal delivery was performed in 51.1% of the claims, whereas 48.9% underwent a caesarean section.. Approximately half of the claims were against obstetrician-gynecologists, and 33% of the claims against other providers were against midwives.. The majority of complaints were related to perinatal mortality (34.8%) and neonatal asphyxia (18.5%). In 58.1% of cases, no malpractice was identified, while 41.9% resulted in paid claims. Also, there were no significant differences between the paid claims and closed claims groups in several factors, such as the type of hospital (P = 0.904), maternal age (P = 0.157), type of delivery (P = 0.080), and accused party (P = 0.168). However, the number of instrumental deliveries (13.8% of vaginal deliveries) and the reasons for claims, exhibited significant differences between the two claims (P = 0.021, P<0.001 respectively). This study found that maternal complications were more common in caesarean sections, while neonatal claims were more prevalent in vaginal deliveries. The study recommended public health interventions to reduce the overall prevalence of delivery-related claims.

Family Socioeconomic Status and Neurodevelopment Among Patients With Dextro-Transposition of the Great Arteries

Data are limited on the longitudinal implications of socioeconomic status (SES) for neurodevelopmental outcomes among persons with complex congenital heart disease (CHD). To examine the association of family SES, maternal educational level, and maternal IQ with the neurodevelopment of individuals with dextro-transposition of the great arteries (d-TGA) from age 1 to 16 years and to identify how SES-related disparities change with age. This cohort study analyzed data of participants enrolled in the Boston Circulatory Arrest Study, a randomized clinical trial conducted in Boston, Massachusetts, from 1988 to 1992. Participants were infants with d-TGA who underwent arterial switch operation and, after operation, underwent in-person neurodevelopmental status evaluations at ages 1, 4, 8, and 16 years. Analyses were conducted from April 2021 to August 2024. Mean Hollingshead scores at birth, age 1 year, and age 4 years were used to assign participants to SES tertiles (lowest, middle, or highest). Age-appropriate neurodevelopmental outcomes assessed at 4 study time points (ages 1, 4, 8, and 16 years) via in-person administration of a range of well-validated measures. Standardized neurodevelopmental composite scores from each evaluation were derived from principal component analysis and compared across SES tertiles, adjusting for birth and medical characteristics. These scores were used to categorize the sample into latent classes; patient and medical factors for a 3-class model were used to estimate latent class using multinomial regression. The sample included 164 patients with d-TGA (123 males [75%]; mean [SD] gestational age at birth, 39.8 [1.2] weeks; 3 with Asian [2%], 6 with Black [4%], 5 with Hispanic [3%], and 146 with White [89%] race and ethnicity) and their mothers (mean [SD] age at birth, 28.5 [5.2] years). Lower SES tertile was associated with worse scores on most individual neurodevelopmental tests and worse neurodevelopmental composite scores at ages 4, 8, and 16 years. For example, mean (SD) neurodevelopmental composite scores at age 4 years were -0.49 [0.83] for lowest, 0.00 [0.81] for middle, and 0.47 [1.10] for highest SES tertile (F2 = 15.5; P < .001). When measured at consecutive time points, differences between SES tertiles were of similar magnitude. A latent class analysis produced 2- and 3-class models representing patients with stable (103 [64%] and 85 [53%]), improving (20 [13%]), and declining (57 [36%] and 55 [34%]) neurodevelopmental status. Those experiencing declines in neurodevelopmental status were more likely to have younger maternal age at childbirth (26.6 [5.1] vs 29.6 [4.9] and 29.1 [5.1] years; P = .002), lower maternal IQ (91.0 [14.1] vs 100.1 [11.1] and 96.2 [11.0]; P < .001), and lower SES (35.2 [10.8] vs 40.9 [9.9] and 35.8 [10.1]; P = .003) compared with those with stable or improving status. This cohort study of individuals with d-TGA found an association between lower family SES and worse neurodevelopmental outcomes in childhood and continuing throughout adolescence as well as greater decline in neurodevelopmental status over time. Effective strategies are needed to improve access to neurodevelopmental monitoring and intervention services for children with CHD from lower socioeconomic backgrounds.