Maternal Length Research Articles

The evolution of maternity attitudes in Polish society: A longitudinal perspective

Individual attitudes toward motherhood depend on one’s particular culture, values and beliefs. These, however, are usually transformed in the public’s opinion into aspects related to maternity and the image of a child. The negative attitudes toward maternity, in turn, affects the current demographic crisis in many countries in Europe. The study evaluated the changing attitudes toward motherhood in Poland in recent years (2009- -2015) on the basis of the Social Diagnosis longitudinal data. To show family-related behaviour and the changes over time, the author adopted latent mixed models to characterise the two groups of individuals (with a different number of states) at the beginning of the period of observation and to follow their evolution over time. The analysis of the changing propensity of childrearing in Poland seems to be pertinent especially because of the changes in Poland’s new child benefit programme, i.e. extending to one-year the length of maternity and paternity leaves, Family 500+, the first of which entered into force in the analysed period. Hence, the study presents the initial and transition probabilities estimated for five recognized states in two groups of Poles (one with traditional, and the other with more modern attitudes to motherhood). Despite the extension of social benefits, the author observed the negative tendency to childrearing of Polish society in the analysed period of time.

Healthcare burden associated with postpartum hemorrhage after cesarean delivery: a contemporary cohort

Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality and causes significant burden on the health care system. Our objective was to characterize factors associated with healthcare burden among pregnancies complicated with PPH after cesarean delivery using a contemporary cohort. Secondary analysis of the Tranexamic Acid (TXA) for the Prevention of Obstetrical Hemorrhage After Cesarean trial in which prophylactic TXA after cord clamping did not affect trial primary outcome, mortality or transfusion of PRBC. For this secondary analysis, PPH was defined as: EBL > 1000 or receipt of PRBCs in the first 48 hours postpartum (PP). The primary outcome was hospital readmission for ≥ 24 hours within 6 weeks PP or maternal death (a competing outcome). Secondary outcomes were: maternal length of stay after delivery, as well as ICU admission for ≥ 24 hours, thrombotic complications, and postpartum infectious complication within 6 weeks PP (e.g., endometritis, surgical site infection, pelvic abscess). Data was abstracted by trained research nurses. Univariable and multivariable analyses were performed to assess the association between PPH and the primary and secondary outcomes. From March 2018 through July 2021, 10,995 patients were enrolled in the TXA trial, and 9284 (84.4%) had data available for this analysis (950 with PPH and 8334 without). Several baseline characteristics differed between those with or without PPH (Table 1). All factors associated with increased healthcare burden occurred more often in those with PPH versus without PPH, and all, except the primary outcome of readmission for ≥ 24 hours within 6 weeks PP or maternal death, remained associated with PPH after adjusting for confounders (Table 2). PPH after cesarean delivery, defined by > 1 L or PRBC transfusion, is independly associated with a number of indicators of increased healthcare burden. In addition to preventing morbidity and mortality, averting PPH would have a significant effect on health care utilization and maternal burden.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

The impact of nutritional status and maternal behavior on infant growth

<p><strong>Background: </strong>Maternal behaviour during pregnancy is closely related to the condition of the fetus. Malnutrition in pregnant women can cause Low Birth Weight Babies (LBW) and also a decrease in the level of intelligence. The prevalence of stunting in 2021 decreased by 1.6 from 2019, that shows from 27.7% to 24.4%.</p><p><strong>Objectives:</strong> This study aims to determine the impact of nutritional status and maternal behaviour on infant growth in West Jakarta.</p><p><strong>Methods:</strong> This study was a cross-sectional, starting on July 2017 until January 2018. A total of 66 subjects of pregnant women aged 18-35 years chosen to take part in the study from their 37th weeks of pregnancy to delivery. Drinking alcohol, traditional herbs, medicines, and smoking are indicators of maternal behaviour. Maternal IGF-1 concentrations, body weight, body length, and infant heart rate were indicators of infant growth. Chi-Square test and Independent T-Test were used for the statistical analysis.</p><p><strong>Results:</strong> The subjects showed a mean of 26.0±4.8 years old, body height of 154.0±4.9 cm, body weight in third pregnancy of 66.4±11.3 kg, BMI of 22.6±3.7 kg/m<sup>2</sup>, MUAC of 27.2±3.3 cm, and body temperature of 36.2±1.3°C. Maternal behaviour and nutrional status did not significantly affect infant growth (p≥0.05). However, MUAC was a factor that affected to heart rate in infants (p<0.05).</p><p><strong>Conclusions:</strong> Nutritional status is one of indicator that affects to infant growth; therefore, pregnant women need to more attention to keep their nutritional status, nutritional intake and healthy living behaviour during pregnancy.</p>

Association between maternal plasma total antioxidant capacity and dietary antioxidants intake with birth size outcomes.

Maternal antioxidants intake and plasma total antioxidant capacity (TAC) concentration during pregnancy might influence on birth outcomes. This study was conducted to determine the association between dietary antioxidants intake and plasma TAC during pregnancy with birth outcomes. Overall, 220 mother-infant pairs were recruited in the first trimester of pregnancy. Maternal whole blood was collected and TAC was determined by the ELISA kit. Food frequency questionnaire was used to collect information regarding usual dietary intake. Birth size measurements including birth weight, length and head circumference were measured according to standardized protocols. Energy-adjusted intake of beta-carotene in the first trimester of gestation [beta (SE) = 0.0002 (0.00008); p = 0.016] and energy-adjusted intake of vitamin E in third trimester of pregnancy [beta (SE) = -0.31 (0.15); p = 0.046] had significantly positive and negative associations with birth length, respectively. The maternal plasma TAC was positively correlated with birth weight in both unadjusted and adjusted models [beta (SE) = 2.75 (1.35); p = 0.043 and beta (SE) = 3.43 (1.50); p = 0.023, respectively]. In addition, the adjusted model showed a significant positive relationship between the maternal plasma TAC and birth length [beta (SE) = 0.023 (0.009); p = 0.01]. This study showed the positive association of maternal plasma TAC with birth weight and length. Moreover, maternal dietary intake of beta-carotene in the first trimester and vitamin E in the third trimester of pregnancy had significant positive and negative correlations with birth length, respectively.

Maternal Serum Cripto-1 Levels in Pregnancies Complicated with Placenta Previa and Placenta Accreta Spectrum (PAS).

To examine maternal serum Cripto-1 levels in placenta accreta spectrum (PAS) pregnancies and compare them with placenta previa (PP) cases and healthy pregnancies. A prospective case-control study. Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey, from April to September 2021. Sixty singleton pregnant patients with PP complicated with PAS were enrolled, 45 singleton pregnant women with a diagnosis of PP without PAS, and 48 healthy uncomplicated gestational age-matched singleton pregnant women. Cripto-1 levels were determined and evaluated. The median maternal serum concentrations of Cripto-1 were greater in pregnant women with PAS (3.11 ng/mL) than in the PP (2.52 ng/mL) and the control groups (2.01 ng/mL, p<0.001). Based on the Youden index, a 2.557 ng/mL cut-off value of maternal serum Cripto-1 level had a 76.7% sensitivity and 72.1% specificity to diagnose pregnancies complicated with PAS. A negative and statistically significant linear relationship was found between maternal serum Cripto-1 concentration and the gestational week at birth (r= -0.325, p<0.001). A positive and statistically significant linear relationship was found between maternal serum concentrations of Cripto-1 and maternal length of hospital stay after birth (r= 0.320, p<0.001). Serum Cripto-1 levels were significantly increased levels in pregnant women suffering from PAS than in pregnant women with PP and uncomplicated healthy pregnancies. Higher expression of Cripto-1 might be a crucial factor in the pathogenesis of PAS. Abnormal placental implantation, placenta accreta spectrum, Cripto-1, Placenta previa.

Maternal Liver and Egg Thiamine Concentrations in Walleye from Lake Oahe, South Dakota

Thiamine, vitamin B1, cannot be synthesized by fish. Therefore, developing embryos are reliant on thiamine stores deposited during oogenesis. Thiaminase, which breaks down thiamine in predatory fish, has been suggested as the probable reason for the poor reproductive success in salmonids. Similarly, walleye Sander vitreus reproduction may also be hampered by thiaminase-containing diets. This study documented maternal liver and egg thiamine concentrations of walleye populations from the Cheyenne, Moreau, and Grand rivers of Lake Oahe, South Dakota, USA in 2000, 2001, 2002, and 2004. Thiamine concentrations were generally lowest in the eggs from the Cheyenne River. Free thiamine, thiamine monophosphate, and total thiamine were all significantly lower in eggs from the Cheyenne River compared to the Moreau and Grand Rivers. Maternal liver thiamine pyrophosphate and total thiamine followed a similar pattern. Egg survival to hatch varied significantly between locations, at 30.5%, 41.4%, and 56.8% in the Cheyenne, Moreau, and Grand Rivers, respectively, but was not significantly correlated with any form of egg thiamine. Considerable year-to-year variation was observed when data from the locations were pooled; egg free thiamine, thiamine monophosphate, and total thiamine were significantly higher in 2002. The lowest mean egg total thiamine level of 2.6 nmol/g was recorded in 2000. Liver free thiamine and thiamine monophosphate were weakly, but significantly negatively correlated with egg survival to hatch to hatch. Egg survival to hatch was significantly negatively correlated with maternal length. The results were likely impacted by the unexpected catastrophic loss of walleye forage because of flooding in 2003.

Clinical and economic evaluation of a proteomic biomarker preterm birth risk predictor: cost-effectiveness modeling of prenatal interventions applied to predicted higher-risk pregnancies within a large and diverse cohort

Objectives Preterm birth occurs in more than 10% of U.S. births and is the leading cause of U.S. neonatal deaths, with estimated annual costs exceeding $25 billion USD. Using real-world data, we modeled the potential clinical and economic utility of a prematurity-reduction program comprising screening in a racially and ethnically diverse population with a validated proteomic biomarker risk predictor, followed by case management with or without pharmacological treatment. Methods The ACCORDANT microsimulation model used individual patient data from a prespecified, randomly selected sub-cohort (N = 847) of a multicenter, observational study of U.S. subjects receiving standard obstetric care with masked risk predictor assessment (TREETOP; NCT02787213). All subjects were included in three arms across 500 simulated trials: standard of care (SoC, control); risk predictor/case management comprising increased outreach, education and specialist care (RP-CM, active); and multimodal management (risk predictor/case management with pharmacological treatment) (RP-MM, active). In the active arms, only subjects stratified as higher risk by the predictor were modeled as receiving the intervention, whereas lower-risk subjects received standard care. Higher-risk subjects’ gestational ages at birth were shifted based on published efficacies, and dependent outcomes, calibrated using national datasets, were changed accordingly. Subjects otherwise retained their original TREETOP outcomes. Arms were compared using survival analysis for neonatal and maternal hospital length of stay, bootstrap intervals for neonatal cost, and Fisher’s exact test for neonatal morbidity/mortality (significance, p < .05). Results The model predicted improvements for all outcomes. RP-CM decreased neonatal and maternal hospital stay by 19% (p = .029) and 8.5% (p = .001), respectively; neonatal costs’ point estimate by 16% (p = .098); and moderate-to-severe neonatal morbidity/mortality by 29% (p = .025). RP-MM strengthened observed reductions and significance. Point estimates of benefit did not differ by race/ethnicity. Conclusions Modeled evaluation of a biomarker-based test-and-treat strategy in a diverse population predicts clinically and economically meaningful improvements in neonatal and maternal outcomes.

Evaluation of a clinical protocol for the management of fever in labor among pregnant women at term: A quality-improvement study.

To assess the impact of a quality-improvement initiative designed to increase diagnostic accuracy and adequate management of clinical chorioamnionitis (CC) at a tertiary center. Chorioamnionitis occurs in 1%-13% of term pregnancies and increases maternal and neonatal peripartum complications; often over-diagnosed, it leads to unnecessary investigations and treatments. This was an interrupted time-series study. In September 2017 two interventions were implemented: (1) staff training and (2) standardized clinical protocol for the management of fever in labor. All singleton term pregnancies were included. CC cases were reviewed in the pre-intervention (2015-2016, n= 179) and post-intervention (2017-2018, n= 142) groups. CC criteria based on the American College of Obstetricians and Gynecologists guidelines, antibiotics, maternal and neonatal outcomes, and pathology were compared. A cost-consequence analysis was performed. Incidence of CC decreased from 8.2 to 5.6 per 10 person-year (P< 0.001). This was associated with a significant increase in diagnostic accuracy from 15.7% to 73.2% (P< 0.001). Weight-adjusted tobramycin dosage improved from 8.8% to 69.1% (P< 0.001). Maternal length of hospitalization and readmissions decreased significantly, without affecting neonatal sepsis rate. Interventions decreased yearly hospital costs associated with CC by 23.4%. Standardizing the management of fever in labor significantly increased the diagnostic accuracy of CC and decreased the misuse of antibiotics in term pregnancies. CC costs decreased by 23.4%.

Short and long-term exposure to the pesticides fipronil and 2,4-D: Effects on behavior and life history of Daphnia magna

The high levels of contamination in aquatic ecosystems caused by pesticides and the organisms’ consequent continuous exposure to it has made them vulnerable to damage. However, mobile organisms can avoid this continued exposure to contaminants by moving to less disturbed habitats. Therefore, through the use of the Heterogenous Multi-Habitat Assay System (HeMHAS), our objective was to evaluate the ability of Daphnia magna to detect and avoid habitats contaminated by fipronil and 2,4-D, in a spatially connected landscape. Further, the role of contamination by these pesticides, isolated and in mixtures, concerning the colonization of habitats by daphnids was also evaluated. Given that not all organisms successfully escape contamination, the chronic toxicity of the same pesticides using different parameters for D. magna (maternal survival, fecundity and maternal body length) was also evaluated. When evaluating the avoidance response by D. magna exposed to pesticides, there was no preference for the less contaminated areas for both compounds. However, organisms did not move to contaminated zones in the colonization experiments, with no immigration of daphnids to the zones with intermediate and the highest levels of fipronil, nor to the highest concentration of 2,4-D. Finally, the colonization by daphnids was significantly prevented when exposed to a mixture of the pesticides, in which the areas with the highest combinations of pesticide concentrations were not colonized by D. magna. Regarding the long-term chronic effects, negative consequences were observed, particularly for maternal body length, fecundity and maternal survival, due to the exposure to fipronil. Considering that pesticides can limit the areas colonized by organisms by making them unattractive, the risk of local population extinction may be underestimated if only standard endpoints involving forced exposure are studied.

Prenatally diagnosed congenital heart disease: the cost of maternal care

Objective Little is known regarding the effects of a prenatal diagnosis of congenital heart disease (CHD) on the cost of antenatal and delivery care. We sought to compare the maternal costs of care in pregnancies where the fetus or child was diagnosed prenatally vs. postnatally. Methods Costs of maternal care were determined for pregnancies in which the fetus or child was diagnosed with CHD between 1997 and 2012 in the state of Utah. Cases of CHD were identified via a statewide birth defect surveillance program which included data on the timing of diagnosis, maternal demographic and clinical data, and linked to statewide inpatient maternal hospital discharge records. Antenatal testing costs were determined using Medicaid fee estimates and total facility costs were determined for all hospitalizations including delivery. The association of timing of diagnosis of CHD with costs was analyzed using univariable and multivariable models. Results Of 2128 pregnancies included in the study, 36% had a fetus prenatally diagnosed with CHD. The prenatal diagnosis group was more likely to have a termination or stillbirth and were younger at delivery (gestational age 37.3 vs 38.0 weeks, p < .001). Labor induction and cesarean delivery rates were similar between groups. Antenatal testing and delivery hospitalization costs were higher in the prenatal diagnosis group: $5819 vs $4041 (p < .001) and $10,509 vs $7802 (p < .001), respectively. Patients in the prenatal diagnosis group had longer lengths of hospital stays (3.5 vs 2.4 d, p > .001). After controlling for significant differences between the groups, including lesion severity, the prenatal diagnosis remained directly associated with antenatal testing costs (+$1472), maternal hospitalization costs (+$2713), and maternal hospital length of stay (+1.0 d). Conclusion A prenatal diagnosis of fetal CHD was associated with increased prenatal costs, hospitalization costs, and hospital length of stay for affected pregnant patients.

Correlates of work productivity and maternal competence after having a baby: the roles of mother-infant bonding and maternal subjective experiences

BackgroundThe law in Lebanon allows new mothers to take up to 10 weeks paid maternity leave, and some private organizations choose to give fathers 2 days of paternity leave in the absence of clear legislation. This falls short of the 6 months recommended for mothers in the literature.MethodsThe sample consisted of 97 Lebanese mothers with children between 6 and 24 months of age. First, we examined correlations between the length of maternity leave and measures of work productivity and maternal sense of competence in their new role as a parent. Second, we explored correlations between the length of maternity leave and mother–child adjustment measures (mother-infant bonding, maternal stress, and parenting guilt). Finally, we looked for predictors of work productivity and maternal sense of competence in demographic variables, mother–child adjustment measures, and partner attachment scores.ResultsResults showed significant correlations between work productivity and maternal sense of competence, irrespective of the length of maternity leave. Regression analyses showed that working for pleasure, mother-infant healthy bonding, and positive subjective experience of being back to work were significant predictors of work productivity, and that maternal stress predicted maternal competence.ConclusionThese findings are discussed within the framework of providing suggestions facilitating mothers’ transition back to work and increasing work productivity after having a baby.

Abstracts from the NIH Office of Research on Women's Health 2022 Annual BIRCWH Meeting:Building Interdisciplinary Research Careers in Women's Health November 2, 2022

Abstracts from the NIH Office of Research on Women's Health 2022 Annual BIRCWH Meeting:Building Interdisciplinary Research Careers in Women's Health November 2, 2022

Neonatal outcomes following intrauterine transfusion for hemolytic disease of the fetus and newborn: a twenty-year service review

Objective The primary objective was to explore perinatal and neonatal outcomes amongst infants who received intrauterine transfusion (IUT) for the management of hemolytic disease of the fetus and newborn (HDFN). The secondary objective was to evaluate the role of key investigations in the fetus at risk of HDFN and assess the relationship with neonatal outcomes. We hypothesized that middle cerebral artery peak systolic velocity (MCA-PSV) and corresponding multiples of the median (MoM) would be predictive of neonatal course. Methods This was a retrospective observational study conducted at a tertiary center in the United Kingdom between January 2000 and August 2020. Trust approval was obtained to conduct this service review. Pregnancies requiring IUT for HDFN were identified using the fetal medicine department database. Inclusion criteria were infants who received IUT for HDFN. 67 pregnancies were eligible for inclusion in the study with 156 IUT events. Data were extracted using healthcare records. Statistical analysis was performed using SPSS version 28.0, data were assessed for normality and Spearman’s correlation analysis was performed with p values < .05 considered significant. Results 67 pregnancies were included in the study which led to the live birth of 68 infants (one twin pregnancy). There were no fetal deaths following IUT. There was one neonatal death due to extreme prematurity following spontaneous vaginal delivery at 23 + 4 weeks gestation, occurring three days following IUT. 97% of infants required admission to the neonatal intensive care unit and 88% required phototherapy. 25% of infants required readmission for red blood cell transfusion due to anemia. There was a significant correlation between maternal anti-D antibody levels and length of neonatal admission r = 0.477, p = .014. MCA-PSV and MoM measured prior to the last IUT had a significant positive correlation with the duration of phototherapy: r = 0.527 (p < .001) and r = 0.313 (p < .05) respectively. Linear regression analysis demonstrated a significant positive relationship between MCA-PSV and corresponding MoM recorded prior to the last IUT with r 2= 0.177 (p = .003) and r 2= 0.101 (p = .029). Conclusion HDFN is an important cause of fetal anemia associated with significant neonatal morbidity. MCA-PSV and MoM may be predictive of neonatal phototherapy requirements. The predictive value of MCA-PSV appears to be dependent on the timing of measurement during the antenatal period and more research is needed. Multicentre collaboration is required to generate a reliable large-scale database to further delineate the value of MCA-PSV and MoM and predict neonatal outcomes in cases of HDFN requiring IUT. This data would assist clinicians in antenatal planning and enable more informed counseling of parents in the antenatal period.

Venous thromboembolism and adverse outcomes in highest thromboembolism risk patients compared with those at lower risk

A risk-based institutional protocol for inpatient heparin-based venous thromboembolism prophylaxis in a general obstetrical population previously demonstrated a greater than 2-fold increase in wound hematomas with no change in the frequency of thromboembolism. We sought to compare the rates of thromboembolism and bleeding outcomes in patients at the highest risk for thromboembolism (eg, those with a history of thromboembolism or thrombophilia who require anticoagulation prophylaxis or therapy throughout pregnancy) than low-risk patients. We performed a retrospective cohort study of all deliveries >20 weeks at a single center from 2013-2018. Patients were categorized as high-risk (received outpatient heparin-based prophylaxis or treatment) or low-risk (no outpatient anticoagulation). The primary outcome was newly diagnosed postpartum thromboembolism; the main secondary outcome was wound/perineal hematoma. The outcomes were compared between the high- and low-risk cohorts. Adjusted odds ratios (with 95% confidence intervals) were calculated with the low-risk group as reference. Of 24,303 total deliveries, 395 (1.7%) were high-risk and 23,905 (98.3%) were low-risk. Among the low-risk patients, 8.6% received anticoagulation prophylaxis in accordance with our risk-based inpatient thromboembolism prophylaxis protocol. High-risk patients were more likely to be older and have a higher body mass index, earlier delivery gestational age, medical comorbidities, and pregnancy complications, eg, preeclampsia. Despite outpatient antepartum anticoagulation, high-risk patients had an 11-fold increased risk of thromboembolism (adjusted odds ratio, 11.1 [4.7-26.2]) than low-risk patients. High-risk patients also had significantly more wound/perineal hematomas (adjusted odds ratio, 4.8 [2.7-8.4]), overall wound complications (adjusted odds ratio, 3.0 [2.0-4.4]), blood transfusions, intensive care unit admissions, maternal deaths, and longer maternal lengths of stay. Patients at the highest risk of obstetrical thromboembolism had an 11-fold increased risk of thromboembolism with a more moderate increase (∼5-fold) in postpartum wound and bleeding complications than low-risk patients. This more favorable risk or benefit profile supports current anticoagulation recommendations in high-risk patients.

Obstetric risk in pregnancy interacts with hair cortisone levels to reduce gestational length.

BackgroundMaternal psychological stress has been linked to preterm birth. However, the differential contribution of psychological stress versus stress hormones is not clear. Studies focus primarily on perceived stress and cortisol, with few assessing its inter-convertible hormone cortisone. Furthermore, little is known about the potential moderating roles of obstetric risk and fetal sex in the relationship between maternal stress and gestational length. This gap in knowledge is particularly evident for rural women who typically experience chronic multiple stressors during pregnancy. We explored the relationship of hormonal and psychological stress to gestational length and the effects of obstetric risks and fetal sex on this relationship among Kenyan pregnant women.MethodsThe sample included 130 women recruited between 22 to 28 weeks gestation. They completed a clinical and sociodemographic questionnaire together with the Perceived Stress Scale and provided a hair sample for cortisol and cortisone assay. Women underwent an ultrasound to assess weeks of gestation. At delivery, their pregnancy-related health problems were identified using information extracted from medical records to compile each woman's number of pregnancy risks on the Obstetric Medical Risk Index (OMRI).ResultsPerceived stress and hair cortisol were not significant predictors of gestational length. However, a greater number of obstetric risks on the OMRI was associated with shorter gestational length. This effect was further explained by the interaction between obstetric risk and hair cortisone (B = 0.709, p = 0.02). Hair cortisone levels of mothers who had a shorter gestation were significantly higher in mothers with 2 or more risks on the OMRI but not among mothers with only one or no risks (t = 2.39, p = 0.02). Fetal sex had no relationship to gestational length and also had no moderating effect on the relationship between any stress-related metric and gestational length.ConclusionCortisone levels may increase in anticipation of shorter gestation as a compensatory response to increased obstetric risk. Elevated cortisone may be a more sensitive marker of risk for early delivery than cortisol or psychological stress, with salience for both the male and female fetus.

Nutrient intakes and telomere length of cell-free circulating DNA from amniotic fluid: findings from the Mamma & Bambino cohort

Pregnancy represents a crucial period in which several exposures—and especially maternal diet—might shape children’s health. Thus, identifying how maternal dietary intakes early affect biological aging in children represents a public health mission. We aimed to assess the relationship between maternal intake of nutrients in early pregnancy and telomere length of cell-free circulating DNA (cfDNA) from amniotic fluid. We used data and samples from the ongoing prospective “Mamma & Bambino” study, which recruits mother–child pairs from Catania at the first prenatal visit. Maternal nutrient intakes were assessed using a Food Frequency Questionnaire, while relative telomere length of cfDNA was assessed by real-time polymerase chain reaction. Our analysis included 174 mother–child pairs. The intakes of iron, vitamin B1, and magnesium were positively correlated with relative telomere length (p-values < 0.05). However, only the intake of magnesium was positively associated with relative telomere length, after applying a linear regression model (β = 0.002; SE = 0.001; p = 0.024). Magnesium deficiency was negatively associated with relative telomere length after adjusting for the same covariates (β = −0.467; SE = 0.176; p = 0.009). To our knowledge, this is the first evidence of a positive relationship between maternal nutrient intake and telomere length of cfDNA. Further efforts are needed for deeply investigating the effect of maternal dietary intakes on telomere length, in order to develop effective public health strategies.

Interaction between maternal dietary fat intake, breast milk omega-3 fatty acids and infant growth during the first year of life.

Long chain fatty acids (LCFA) of human milk (HM) might be associated with different patterns of weight gain in infancy. This study aims to examine the interaction between maternal dietary fat intake, breast milk content of docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) with infant growth during the first year of life. This longitudinal study was conducted among 215 Iranian mother-infant pairs. The infants were followed up from birth to 12 months of age. Trained healthcare providers measured infant anthropometrics including weight, length and head circumference at birth, 2, 4, 6 and 12 months of age. Breast hind milk samples were collected in the morning through hand expression between 6 and 12 weeks postpartum. Maternal dietary intake was assessed using a 3-day dietary record. Linear mixed effects models were performed to determine the interaction between maternal dietary fat intake, the breast milk content of EPA and DHA with infant growth. Further adjustments were applied for potential confounders. Mean and standard deviation (SD) of maternal age and body mass index were 29.70 (5.24) years and 24.47 (4.42)kg/m2 , respectively. Mean (SD) of infant birth weight was 3177.50 (413.20)g, and 50% were boys. An inverse interaction existed between maternal dietary fat intake and breast milk EPA with infant 4-month weight (β: -366.2, P-value: 0.01). We found a significant association of maternal dietary fat intake and infant 6-month weight (β: 22.5, P-value: 0.04). An inverse interaction was documented between maternal dietary fat intake and breast milk DHA with infant weight at 12-month of age (β: -95.3, P-value: 0.02). We found a significant association between maternal dietary fat intake and infant length at 12-month (β: 0.06, P-value: 0.02). We found an inverse interaction between maternal dietary fat intake and breast milk omega-3 fatty acids with infant weight at 4 and 12 months of age. Although longer follow-up of growth indices is recommended, these findings suggest functional relevance of HM composition to infant growth.

A Comprehensive Analysis of the Costs of Severe Maternal Morbidity.

The objectives of this study were to include readmissions and physician costs in the estimates of total costs of severe maternal morbidity (SMM), to consider the effect of SMM on maternal length of stay (LOS), and to examine these for the more restricted definition of SMM that excludes transfusion-only cases. California linked birth certificate-patient discharge data for 2009 through 2011 (n=1,262,862) with complete costs and LOS were used in a secondary data analysis. Cost-to-charge ratios were used to estimate costs from charges, adjusting for inflation. Physician payments were estimated from the mean payments for specific diagnosis-related groups. Generalized linear models estimated the association between SMM and costs and LOS. Excluding readmissions and physician costs, SMM was associated with a 60% increase in hospital costs (marginal effect [ME] $3,550) and a 33% increase in LOS (ME 0.9days). These increased to 70% (ME $5,806) and 46% (ME 1.3days) when physician costs and readmissions were included. The effects of SMM were roughly one-half as large for patients who only required a blood transfusion (49% [ME $4,056] and 31% [ME 0.9days]) as for patients who had another indicator for SMM (93% [ME $7,664] and 62% [ME 1.7days]). Postpartum hospital readmissions and physician costs are important and previously unreported contributors to the costs of SMM. Excess costs and LOS associated with SMM vary considerably by indication. Cost effects were larger than the LOS effects, indicating that SMM increases treatment intensity beyond increasing LOS, and decreasing SMM may have broader health and cost benefits than previously understood.

Association between the peripartum maternal and fetal telomere lengths and mitochondrial DNA copy numbers and preeclampsia: a prospective case–control study

PurposeTo explore changes in telomere length (TL) and mitochondrial copy number (mtDNA-CN) in preeclampsia (PE) and to evaluate the combined effect of maternal TL and mtDNA-CN on PE risk.MethodsA case–control study of 471 subjects (130 PE cases and 341 age frequency matched controls with gestational age rank from 24 to 42 weeks) was conducted in Nanjing Drum Tower Hospital, Jiangsu Province of China. Relative telomere length (RTL) and mtDNA-CN were measured using quantitative polymerase chain reaction (qPCR), and PE risk was compared between groups by logistic regression analyses.ResultsPE patients displayed longer RTL (0.48 versus 0.30) and higher mtDNA-CN (3.02 versus 2.00) in maternal blood as well as longer RTL (0.61 versus 0.35) but lower mtDNA-CN (1.69 versus 5.49) in cord blood (all p < 0.001). Exercise during pregnancy exerted an obvious effect of maternal telomere length prolongation. Multiparous women with folic acid intake during early pregnancy and those who delivered vaginally showed longer telomere length, while those factors imposed no or opposite effect on RTL in PE cases. Furthermore, RTL and mtDNA-CN were positively correlated in controls (in maternal blood r = 0.18, p < 0.01; in cord blood r = 0.19, p < 0.001), but this correlation was disrupted in PE patients in both maternal blood and cord blood. Longer maternal RTL and higher mtDNA-CN were associated with a higher risk of PE, and the ROC curve of RTL and mtDNA-CN for predicting PE risk presented an AUC of 0.755 (95% CI: 0.698–0.812).ConclusionsThe interaction of TL and mtDNA-CN may play an important role in the pathogenesis of PE and could be a potential biomarker of PE risk.

Maternal and obstetric outcomes of listeria pregnancy: insights from a national cohort

Objective We sought to evaluate and describe the maternal and obstetric morbidity associated with Listeria infection in pregnancy. Methods Retrospective cohort of pregnant women using the 2007-2018 National Inpatient Sample. Pregnant women with discharge diagnosis codes consistent with Listeria infection were identified. Outcomes of deliveries complicated by Listeria infection were compared to those of delivery without this infection. The primary outcome was a composite of severe maternal morbidity. Secondary outcomes included components of the composite, maternal length of stay, mode of delivery, stillbirth, and preterm delivery. Results We identified 134 maternity associated hospitalizations for Listeria (weighted national estimate 666), of which 72 (weighted national estimate of 358) were delivery admissions. Delivery admissions complicated by Listeria resulted in higher rates of severe maternal morbidity than those without, (30.9% vs. 1.6%, p<.001). In adjusted analyses, women with Listeria had 21.2-fold higher risk of severe maternal morbidity (95% CI: 14.0, 31.9) when compared to those without Listeria. Specifically, Listeria delivery admissions had higher rates of acute respiratory distress syndrome (2.8% vs. 0.1%, p<.001), mechanical ventilation (1.4% vs. 0.0%, p<.001), sepsis (28.1% vs. 0.1%, p<.001), and shock (1.4% vs. 0.0%, p<.001). Listeria delivery admissions also had higher rates of preterm birth (61.3% vs. 7.7%, p < 0.001) and stillbirth (13.5% vs. 0.7%, p<.001). Women hospitalized or delivered with Listeria infection were also more likely to have a cesarean delivery (57.9% vs. 32.9, p<.001) and the average length of stay for women with Listeria was also longer (4.0 days vs. 2.3 days, p<.001). Conclusions Women with Listeria infection in pregnancy have higher rates of severe maternal morbidity, specifically increased risk of sepsis, septic shock, and acute respiratory distress syndrome. Among delivery hospitalizations, these women also have higher rates of preterm birth and stillbirth.