Maternal Loss Research Articles

Mitigating the Effects of Maternal Loss on Harbour Seal Pups in Captive Care

Stranded newborn “orphan” harbour seal pups entering captive care are often maintained for some weeks in isolation, mainly as a precaution against the spread of infection. However, this practice raises concerns for the welfare and normal socialisation of pups, who normally spend their first post-natal weeks close to their mothers and other seals. The present study recorded and described the behaviour of six paired orphan pups in rehabilitation up to about five weeks of age, provided with free access to water and haul-out areas. The occurrences of resting, following, nosing and body contacts, and aquatic play were recorded and compared qualitatively and quantitatively with the same behaviours of free-living pups with their mothers. The pups entered the water every day, although more often from about 2.5 weeks of age. They displayed to each other the same behaviours that free-living pups display to their mothers, although they engaged in relatively more physical contact, body nosing, and aquatic play. The study has shown that orphan pups maintained in pairs with free water access can act reciprocally as mother substitutes, thereby promoting species-typical primary socialisation and welfare during their early days of captive care.

Pregnancy monitoring and parturition in dogs

Management of term pregnant dogs is a major and frequent clinical situation in small animal reproductive veterinary practices, and can be challenging. Whether a pregnancy is planned or unplanned, these cases require careful monitoring to prevent maternal distress and neonatal loss. Reproductive system evaluation of female dogs is useful for determination of ovulation during breeding management, pregnancy diagnosis, and for timing of cesarean surgery, among other clinical scenarios. Basic understanding of female dog’s reproductive physiology is mandatory to interpret relevant hormonal assays and other complementary diagnostics such as vaginal cytological evaluation and imaging (ultrasonography and radiography) for clinical decisions. This review covers physiology, diagnostics, and clinical outcomes relevant for pregnancy monitoring and parturition.

An inhalation exposure assessment of Hexafluoroisobutylene in pregnant rats.

Hexafluoroisobutylene (HFIB) is an important compound widely used in semiconductor lithography materials, refrigerants, fluorine coatings, and pharmaceutical intermediates in the fluorination industry. Owing to its toxicity, the occupational exposure in the workplace, especially for pregnant woman is the concern and there is still lack of the data of HFIB toxicity on pregnancy and fetal development. Here, for the first time, we investigated the effects of HFIB on pregnant rats and fetal development. The pregnant rats were exposed to different doses of HFIB (0 ppm, 27.2 ppm, 53.5 ppm, 105.6 ppm) via whole-body inhalation for the period of organogenesis, which from implantation (gestation day 5) to the day prior to scheduled caesarean section (gestation day 19). The results showed that the pregnant rats exposed to 105.6 ppm HFIB displayed systemic toxicity, including a decrease in body weight and food consumption, as well as tracheal inflammation, pulmonary interstitial inflammation and renal tubular swelling. Moreover, reduced fetal and placental weights, delayed ossification, and a reduced number of ossification centers were observed in fetuses delivered by pregnant rats exposed to 105.6 ppm. These effects were attributed to severe maternal weight loss. In addition, it would be useful to note that no whole-body, visceral or skeletal congenital malformations were observed. However, HFIB exposure at 53.5 ppm showed no significant adverse effects on pregnant rats and fetuses. These findings demonstrate that 105.6 ppm HFIB is a toxic concentration, while 53.5 ppm HFIB is the no-observed-adverse-effect concentration (NOAEC) for both pregnancy and fetal development. This study for the first time to provide evidence for the health risk of HFIB exposure on pregnancy and fetal development.

Effects of supportive hemodialysis on the management of a pregnant woman with advanced chronic kidney disease: a case report and literature review

BackgroundPregnancy in women with chronic kidney disease (CKD) is associated with an increased risk of adverse maternal and fetal outcomes, including worsening renal function, hypertension, proteinuria, preeclampsia, preterm delivery, stillbirth, and intrauterine growth restriction. Some pregnant women with CKD may require dialysis after conception. Clinical guidelines provide recommendations for optimal hemodialysis prescription in pregnant women undergoing maintenance hemodialysis for end-stage kidney disease. However, the timing of initiation and optimal doses of hemodialysis for pregnant women with non-dialysis advanced CKD remain uncertain.Case presentationWe describe the case of a 29-year-old woman with a history of CKD for at least 2 years. She was referred to our department with a serum creatinine level of 2.48 mg/dL and an estimated glomerular filtration rate of 20 mL/min/1.73 m2. Because she was found to be pregnant at the initial visit, she was referred to the Department of Obstetrics. At 23 weeks’ gestation, she was admitted due to threatened premature delivery and urinary tract infection, which were managed with ritodrine hydrochloride and antibiotics. Owing to maternal weight loss and asymmetrical fetal growth restriction, daily protein intake was increased from 40 g/day to 60–80 g/day. Additionally, supportive hemodialysis (three times per week) was initiated at 26 weeks’ gestation, and the pre-dialysis blood urea nitrogen (BUN) level was consistently maintained < 40 mg/dL. Consequently, the patient’s weight increased, and fetal growth recovered. Because her blood pressure increased particularly during and after dialysis sessions, dialysis was discontinued at 32 weeks’ gestation. Urinary protein increased to a nephrotic level, and blood pressure was poorly controlled by medication, suggesting the onset of preeclampsia. Thus, a cesarean section was performed at 33 weeks’ gestation, and she delivered a male baby weighing 1449 g. Following childbirth, the patient did not require hemodialysis.ConclusionsSupportive hemodialysis during pregnancy in women with advanced CKD can increase maternal protein intake without elevating BUN levels, leading to improved fetal growth.

From the Everyday to the Extraordinary: Economic Evidence for Queenship in the Chamber Books

ABSTRACT The Tudor Chamber Books (1485–1521) are a useful, underexplored source for examining queenship. In addition to the two queen consorts, Elizabeth of York and her daughter in law, Catherine of Aragon, there is interesting coverage of Margaret and Mary Tudor who became respectively Queen of Scots and Queen of France, as well as the early years of Mary I. This article demonstrates how financial records can shed new light on pivotal moments in a royal woman's life, including childhood, betrothals and weddings, widowhood, joys such as coronation ceremonies and stresses of childbirth and infant (or even maternal) loss. It demonstrates the utility of the Chamber Books themselves and of wider financial sources in charting the lives of royal women and understanding more deeply the rhythms and responsibilities of queenship. This article is part of a research cluster in this issue on the economic power of medieval queens.

Maternal adiposity and perinatal and offspring outcomes: an umbrella review.

Maternal adiposity deleteriously affects obstetrical health and has been associated with long-term adverse consequences in offspring. Here we conducted an umbrella review encompassing 194 observational meta-analyses, 10 Mendelian randomization studies and 748 interventional meta-analyses to appraise the published evidence on the associations between maternal adiposity and perinatal and offspring outcomes. Evidence grading suggested that 17 (8.8%) observational meta-analyses were supported by convincing evidence for 12 outcomes: maternal adiposity was associated with an increased risk of caesarean delivery following labour induction, infant mortality, Apgar score <7 at 1 min, antenatal depression, offspring overweight and obesity, early timing of puberty onset in daughters, attention deficit hyperactivity disorder, cerebral palsy, congenital heart disease and spina bifida (OR/RR ranging from 1.14 to 2.31), as well as increased offspring body fat percent and fat mass (SMD 0.31 and 0.35, respectively). Among these outcomes, interventional meta-analyses supported that maternal weight loss interventions significantly reduced the risk of antenatal depression but not low Apgar scores; these interventions also could not reduce offspring fat mass or body fat percent. Evidence from Mendelian randomization studies supported a causal relationship between maternal adiposity and gestational diabetes mellitus, preeclampsia, birth size and offspring adiposity. Our findings highlight that while observational meta-analyses reveal associations between maternal adiposity and various adverse perinatal and offspring outcomes, convincing, unbiased evidence or support from Mendelian randomization studies is limited. Maternal pre-conceptional and prenatal weight loss interventions can reduce some, but not all, of these adverse effects.

Maternal loss of 24-hydroxylase causes increased intestinal calcium absorption and hypercalcemia during pregnancy but reduced skeletal resorption during lactation in mice.

Inactivation of 24-hydroxylase (CYP24A1) causes mild hypercalcemia in humans that becomes severe and life-threatening during pregnancy through unclear mechanisms. We studied Cyp24a1 null mice during pregnancy, lactation, and post-weaning. We hypothesized that Cyp24a1 nulls have a much greater increase in calcitriol during pregnancy and lactation, leading to markedly increased intestinal calcium absorption and reduced lactational bone loss. WT and Cyp24a1 null sisters were mated to Cyp24a1+/- males. Timepoints included baseline (BL), late pregnancy (LP), mid-lactation (ML), late lactation (LL), and weekly x4 weeks of post-weaning recovery (R1-4). Assessments included intestinal calcium absorption (IntCaAbs) by gavage of 45Ca, bone mineral content (BMC) by DXA, microCT of femurs, 3-point bending tests of tibias, serum hormones, serum and urine minerals, milk analysis, and intestinal gene expression. At LP, whole body BMC increased equally by ~12% in null and WT. Calcitriol was 2.5-fold higher in nulls vs WT, accompanied by 3-fold increased IntCaAbs, hypercalcemia, hypercalciuria, and 6.5-fold higher FGF23. PTH was suppressed in both. Twenty percent of null dams died during delivery but their serum calcium at LP did not differ from Cyp24a1 nulls that survived. At ML, calcitriol, IntCaAbs, and FGF23 declined in both genotypes but remained higher than BL values in Cyp24a1 nulls. By LL, nulls were still hypercalcemic vs WT, and had lost less mean whole body BMC (11% vs. 21%, P<.02), but by micro-CT there were no differences from WT in cortical or trabecular bone mass. Lactational losses in BMC, cortical thickness, and trabecular number were restored by R4 in both genotypes. In summary, ablation of Cyp24a1 increased IntCaAbs and caused hypercalcemia during pregnancy and lactation, late gestational mortality in some nulls, and reduced lactational BMC loss. Treating women with gestational hypercalcemia from CYP24A1 mutations should focus on reducing calcitriol or IntCaAbs, since increased bone resorption is not the cause.

6775 Four Cases with the Beckwith-Wiedemann Syndrome Phenotype Caused by GNAS Defects

Abstract Disclosure: T. Urakawa: None. Y. Kanamaru: None. N. Amano: None. A. Uchida: None. J. Shin: None. M. Fukami: None. M. Kagami: None. Background: Beckwith-Wiedemann syndrome (BWS) is an overgrowth disorder with a heterogeneous phenotypic spectrum, including macroglossia (MG), lateralized overgrowth (LO), and hyperinsulinism (HI). According to the BWS clinical scoring system, the consensus statement recommends conducting genetic testing for patients with two or more scores and doing the clinical diagnosis of BWS for patients with four or more scores. The etiologies of BWS consist of methylation abnormalities of differentially methylated regions (DMRs) on 11p15.5, paternal uniparental disomy of chromosome 11 (UPD(11)pat), and maternal loss of function variants of CDKN1C. However, in 20% of BWS cases, the genetic causes remain unclear. Here, we report on four cases of the BWS phenotype with GNAS defects, known to cause pseudohypoparathyroidism (PHP). Case presentation: Case 1 was born at 37 weeks of gestation with birth weight (BW) of 2964 g (+0.8 SD) and birth length (BL) of 50.5 cm (+1.3 SD) and had MG, LO, HI, ear creases (EC), naevus flammeus, umbilical hernia (UH), and postnatal overgrowth (PO) together with intellectual disability (BWS score 9). Case 2 was born at 32 weeks with BW of 1415 g (-1.4 SD) and BL of 40.0 cm (-0.8 SD), showing MG, HI, UH, and PO (BWS score 5). Case 3 was born at 36 weeks with BW of 2366 g (-0.5 SD) and BL of 44.0 cm (-1.1 SD), exhibiting MG, EC, UH, and PO (BWS score 4). Case 4 was born at 36 weeks with BW of 2762 g (+0.6 SD) and BL of 46.0 cm (-0.4 SD), presenting MG and PO (BWS score 2). Cases 3 and 4 showed elevated intact PTH levels. Genetic analysis: Methylation-specific MLPA (MS-MLPA) for multiple DMRs showed abnormal methylation in DMRs on the GNAS locus in cases 1-3, but normal methylation levels in DMRs on 11p15.5. Case 1 had multi-locus imprinting disturbance (MLID) detected by comprehensive methylation analysis (EPIC, Illumina) and a 9pter-9p24.2 deletion identified by array CGH analysis. Case 2 also had MLID together with UPD(20)pat detected by microsatellite marker analysis. Case 3 showed only abnormal methylation in the DMRs on the GNAS locus confirmed by a comprehensive methylation analysis. Case 4 showed no abnormal methylation in the DMRs examined by MS-MLPA and had a pathogenic variant in GNAS (F219L) detected by exome sequencing. Discussion: We identified GNAS defects in four cases with the BWS phenotype. MG and PO were observed in all cases, and other BWS features in each case. Some clinical features observed in 9p terminal deletion syndrome and PHP overlap those in BWS, such as HI, MG, and PO. Therefore, these diseases should be considered as the differential diagnosis of BWS. MLID was identified in two cases, but the methylation status of DMRs on 11p15.5 was normal. The impact of MLID on the BWS phenotype is unknown. Conclusion:GNAS defects can cause the BWS phenotype. Further genetic analysis including GNAS should be considered in cases with the BWS phenotype without 11p15.5 abnormalities. Presentation: 6/2/2024

Association between maternal religious service attendance and pregnancy loss in the United States: a secondary analysis of the Future Families & Child Wellbeing Study.

Accumulating evidence suggests that spirituality and religiosity may be associated with improved health outcomes. However, few studies have examined maternal religiosity as a protective factor for perinatal outcomes. We explored the association between maternal religious attendance and pregnancy loss. Data were drawn from the Future Families & Child Wellbeing Study's first and second waves and medical records (n=1874). Religious attendance was a self-reported response to the question "About how often do you attend religious services?" Pregnancy loss was measured from responses to the second wave survey question, "Since focal child's birth, have you had any miscarriages/abortions/stillbirths?" Logistic regression estimated odds ratios (OR) and 95% confidence intervals (CI) for the association between maternal religious attendance frequency and pregnancy loss, overall and by race. Models were adjusted for sampling weights, religious preference, socioeconomic and behavioral factors. 8% (n=164) of mothers reported having a pregnancy loss. Of those with a pregnancy loss, 28% (n=46) attended services hardly ever and 20% (n=20) attended services once a week or more. Women who attended services more frequently had 58% increased odds of not experiencing a pregnancy loss (OR:1.58;95%CI:1.01,2.48) after adjusting for potential confounding. A post hoc analysis found no difference in pregnancy loss type or subsequent reproductive history based on attendance level. Results suggest that higher maternal religious attendance frequency may be a protective factor for pregnancy loss. Further research is needed to understand the association between maternal religious attendance and mechanisms for pregnancy loss.

Maternal dietary patterns associated with bone density in Chinese lactating women and infants at 6 months postpartum: a prospective study using data from 2018–2019

This cohort study was designed to explore the relationship between maternal dietary patterns (DPs) and bone health in Chinese lactating mothers and infants. We recruited 150 lactating women at 1-month postpartum. The estimated bone mineral density (eBMD) of subjects’ calcanei and the information on dietary intake were collected. After 5-month follow-up, the eBMD of mothers and their infants were measured again. Factor analysis was applied to determine maternal DPs. General linear models were used to evaluate the association between maternal DPs and maternal eBMD loss or infants’ eBMD. With all potential covariates adjusted, Factor 2 (high intake of whole grains, tubers, mixed beans, soybeans and soybean products, seaweeds, and nuts) showed a positive association with the changes of maternal eBMD (β = 0.16, 95 % CI: 0.005, 0.310). Factor 3 (high intake of soft drinks, fried foods, and puffed foods) was inversely correlated with the changes of maternal eBMD (β = –0. 22, 95 % CI: -0.44, 0.00). The changes of maternal eBMD were positively associated with 6-month infants’ eBMD (β = 0.34, 95 % CI: 0.017, 0.652). In conclusion, Factor 2 might contribute to the maintenance of eBMD in lactating women, while Factor 3 could exacerbate maternal eBMD loss. Additionally, the changes of maternal eBMD presented a positive correlation with 6-month infants’ eBMD.

24 - Exploring the impact of maternal weight loss on metabolic function in offspring adipose tissue

24 - Exploring the impact of maternal weight loss on metabolic function in offspring adipose tissue

Exploring the association of hyperhomocysteinemia with early pregnancy losses: A retrospective case-control study in a tertiary clinic in Türkiye.

A disturbance in the metabolism of homocysteine in both the mother and the fetus has been implicated in several placental vasculopathy-related disorders, including pregnancy loss. This study aimed to provide insights into the potential role of homocysteine, Vitamin B12, and folic acid in early pregnancy losses, with a specific focus on the Turkish population. The results of 93 pregnant women who experienced miscarriage between 5 and 14 gestational weeks and 93 healthy pregnant women at the same gestational weeks were compared. The demographic and pregnancy characteristics of all pregnant women were recorded. Vitamin B12, folic acid, and homocysteine levels were measured in serum samples obtained from the groups at similar gestational weeks. In addition, any associations between these biomarkers and different types of pregnancy loss, such as spontaneous abortion and missed abortion, were evaluated. Vitamin B12 and folic acid serum levels were significantly lower in women with miscarriages (P = .019, P < .001, respectively). Homocysteine levels were higher in the patient group (P < .001). Logistic regression analysis showed that a higher homocysteine level was the only predictive factor of miscarriage (P = .001, odds ratio = 0.596); however, folic acid and Vitamin B12 were not predictive factors. There was no significant difference in homocysteine and micronutrient levels between women with missed abortions and women with spontaneous abortions (P > .05). Our results support the continuing evidence of a link between maternal homocysteine levels and fetal loss. However, in exploring the shared pathways in the underlying mechanisms causing the 2 forms of pregnancy loss, maternal blood analysis showed no relationship.

Cumulative adversity and survival in the wild.

Protecting populations contending with co-occurring stressors requires a better understanding of how multiple early-life stressors affect the fitness of natural systems. However, the complexity of such research has limited its advancement and prevented us from answering new questions. In human studies, cumulative risk models predict adult health risk based on early adversity exposure. We apply a similar framework in wild yellow-bellied marmots (Marmota flaviventer). We tested cumulative adversity indices (CAIs) across different adversity types and time windows. All CAIs were associated with decreased pup survival and were well supported. Moderate and acute, but not standardized CAIs were associated with decreased lifespan, supporting the cumulative stress hypothesis and the endurance of early adversity. Multivariate models showed that differences in lifespan were driven by weaning date, precipitation, and maternal loss, but they performed poorly compared with CAI models. We highlight the development, utility, and insights of CAI approaches for ecology and conservation.

Kidney outcomes are altered by preconception weight modulation in rodent mothers with obesity

Obesity increases the risk of chronic kidney disease. We have previously demonstrated the benefits of preconception maternal weight loss on fertility and pregnancy outcomes in a mouse model of maternal obesity. Here, we elucidate if preconception weight loss, either by diet modification or the glucose-like peptide 1 agonist liraglutide, used in the treatment of diabetes and obesity, improves maternal kidney outcomes in late gestation. C57BL/6 female mice were fed either a high-fat-diet (HFD) or a chow (control) diet for 8 weeks. To induce pre-pregnancy weight loss, HFD-fed dams were switched to chow diet (HFD-C) or administered liraglutide (0.3 mg/kg subcutaneous) whilst continuing on HFD (HFD-L). Liraglutide was discontinued one week prior to mating. HFD-V mice continued on HFD, with saline injections. A group of HFD-fed dams were ‘diet switched’ to chow after conception (post-conception, HFD-PC). Maternal body weight and glucose tolerance were measured: (1) preconception and (2) during late gestation followed by blood, urine and kidney collection. Serum creatinine, urinary creatinine and albumin, kidney tissue gene expression and protein were measured. In the preconception period, HFD-L and HFD-C mothers have lower urine albumin:creatinine ratios (UACR) and fatty acid synthase (FAS) protein expression (P < 0.005 vs. HFD-V). At late gestation, kidneys of HFD-V and HFD-PC dams have increased gene expression of insulin receptor and FAS (P < 0.05) and higher UACR compared to controls (P < 0.01). In the HFD-PC group, kidneys show increased mRNA and protein expression of metabolic and oxidative stress markers (FAS, 8-OHdG vs. control, P < 0.05, P < 0.0001 respectively). The preconception intervention groups with liraglutide, or diet change show reduced oxidative stress (protein expression of 8-OHdG, P < 0.05 vs. HFD), mRNA and protein expression of FAS (P < 0.05 vs. HFD), protein expression of fibrosis markers (collagen IV, fibronectin vs. HFD, P < 0.05), and UACR (P < 0.05 vs. HFD). This study suggests that preconception weight loss benefits maternal kidney health during pregnancy, superior to diet intervention once already pregnant.

Trial and error − Outcome of breech presentation depending on birth mode and root cause analysis of severe adverse events

ObjectivesThe debate about the safest birth mode for breech presentation at term remains unresolved. The comparison of a vaginal breech birth (VBB) with an elective caesarean section (CS) regarding fetal outcomes favors the CS. However, the question of whether attempting a VBB is associated with poorer fetal outcomes is examined in this study. Additionally, the study evaluates factors contributing to a successful VBB and illustrates possible errors in VBB management.Study design: We performed a retrospective analysis of term breech births over 15 years in a Perinatal Center Level I regarding fetal, maternal, and obstetric outcomes by comparing successful with unsuccessful VBB attempt and all attempted VBB vs. CS including a multivariate analysis of predictors for a successful VBB. A root cause analysis of severe adverse events (SAE) was conducted to evaluate factors leading to poorer fetal outcomes in VBB. ResultsOf 863 breech cases, in 78 % a CS was performed and in 22 % a VBB was attempted, with 57 % succeeding. Comparing successful with unsuccessful VBB attempts, successful VBB showed significantly lower maternal blood loss (p < 0.001) but poorer umbilical arterial pH (UApH) (p < 0.001), while other fetal outcome parameters showed no significant differences. Predictive factors for a successful VBB attempt were a body mass index (BMI) below 30.0 kg/m2 (p = 0.010) and multiparity (p = 0.003). Comparing all attempted VBB to CS, maternal blood loss was significantly higher in CS (p < 0.001), while fetal outcomes were significantly worse in VBB attempts, included poorer Apgar scores (p < 0.001), poorer UApH values (p < 0.001), higher transfer rate to the Neonatal Intensive Care Unit (NICU) (p < 0.001) and higher rate of respiratory support in the first 24 h (p = 0.003). ConclusionThe failed attempt of VBB indicates significantly worse UApH without lower Apgar scores or higher transfer rate to the NICU. The likelihood of a successful VBB is 9% lower with obesity and 2.5 times higher in multiparous women. Attempting a VBB should include detailed pre-labor counseling, regarding predictive success factors, an experienced team, and consistent management during birth.

Impacts of Maternal Nutrition on Sow Performance and Potential Positive Effects on Piglet Performance.

The objectives of this review are to identify the nutritional challenges faced by modern sows and present potential solutions to mitigate excessive maternal tissue loss and reproductive failure as it relates to recent genetic improvements. Current feeding programs have limitations to support the rapid genetic improvements in reproductive performance for modern sows. Since 2012, both litter size at birth and fetal weight have increased by 2.26 pigs per litter and 0.22 kg per piglet, respectively, thereby increasing the nutrient needs for sows during gestation and lactation. Prediction models generated in this review predict that modern sows would need 31% more lysine during gestation when compared with current feeding programs. Physiological challenges facing modern sows are also addressed in this review. High oxidative stress, pelvic organ prolapse, and lameness can directly affect the sow, whereas these physiological challenges can have negative impacts on colostrum and milk quality. In response, there is growing interest in investigating the functional roles of select bioactive compounds as feed additives to mitigate the severity of these challenges. Selenium sources, catechins, and select plant extracts have been utilized to reduce oxidative stress, calcium chloride and phytase have been used to mitigate pelvic organ prolapse and lameness, algae and yeast derivatives have been used to improve colostrum and milk quality, and fiber sources and probiotics have been commonly utilized to improve sow intestinal health. Collectively, this review demonstrates the unique challenges associated with managing the feeding programs for modern sows and the opportunities for revision of the amino acid requirements as well as the use of select bioactive compounds to improve reproductive performance.

THE CONTRIBUTION OF BREAST-FEEDING TO THE DEPURATION OF DDE

The presence of persistent organic halogens (POHs) in maternal plasma and milk has been recognized since the 1970s. Yet, the presence of these compounds in human milk poses a still undetermined risk to the health of mother and child. The vertical transfer of POHs during either pregnancy or after birth during breast-feeding remains a concern. The paucity of data on maternal plasma contaminant levels before and after long periods of breast-feeding poses a serious problem for researchers attempting to model contaminant changes in maternal plasma and contaminant transfer via milk to the baby. This issue is of clinical concern since there is inadequate data to model infant exposure to POHs, leading to uninformed decisions about risks and benefits of breast-feeding. To address this issue we carried out a longitudinal analysis of the association between maternal plasma p,p'-DDE (1,1-dichloro-2,2- bis(p-chlorophenyl) ethylene) load and breast-feeding duration and parity. This pesticide residue was chosen because it is both an ubiquitous and abundant POH. The women recruited for the study were 34.4 + 2.8 yr and had breast-fed an average of 2.1 children a total of 64.6 + 32.6 weeks when they were sampled at the end of the study. A questionnaire was used to determine the mother's breast-feeding activity. We found that the women had very low levels of p,p'-DDE in their plasma and milk compared to other populations in the world and that the trend in Canada towards lower contaminant loads has been sustained in our study population. The regression of change in plasma p,p'-DDE with breast-feeding duration is significant (p &lt; 0.01, F = 15.80, and n=12). We found that maternal plasma p,p'-DDE levels changed by 0.0057 μg/L for every week of breast-feeding. Thus, women breast-feeding their infants lost, on average, 30 μg of this contaminant per week. These results suggest that maternal depuration of p,p'-DDE via breast-feeding is a significant cause of maternal contaminant loss and contaminant accumulation in the baby.

Words, Wounds and Pre-oedipal Oneness: Maryse Condé’s Le Cœur à rire et à pleurer

This essay reads Maryse Condé’s 1999 récit d’enfance, Le Cœur à rire et à pleurer, as a “generational text”; a text that is both about the unresolved and ambivalent feelings aroused by writing about the dead mother, and also about this loss as the site and source of (literary) generation. Le Cœur defiantly rewrites the classic narrative of Antillean matrifocality, and yet, although the mother’s death is relegated to a single line, maternal loss suffuses the entire narrative. Moreover, the text is a reflection on language, writing and literature more generally, and can be read as an exploration of the painful transition from preoedipal to symbolic. Words in this text are destructive entities that wound and distort all relationships, but especially the relationship with the mother, igniting a sustained yearning to return to the security of the prelinguistic pre-oedipal.

Dietary CP and digestion kinetics influence BW loss, litter weight gain, and reproduction by affecting postprandial amino acid metabolism in lactating sows

To avoid a high body protein mobilization in modern lean sows during lactation, an adequate dietary amino acid (AA) supply and an efficient AA utilization are crucial. This study evaluated the effects of dietary CP and in vitro protein digestion kinetics on changes in sow body condition, litter weight gain, milk composition, blood metabolites, protein utilization efficiency and subsequent reproductive performance. We hypothesized that a slower digestion of dietary protein would improve AA availability and utilization. In total, 110 multiparous sows were fed one of four lactation diets in a 2 × 2 factorial design, with two CP concentrations: 140 g/kg vs 180 g/kg, and two protein digestion kinetics, expressed as a percentage of slow protein (in vitro degradation between 30 and 240 min): 8 vs 16% of total protein. Feeding sows the high CP diets reduced sow weight loss (Δ = 7.6 kg, P < 0.01), estimated body fat loss (Δ = 2.6 kg, P = 0.02), and estimated body protein loss (Δ = 1.0 kg, P = 0.08), but only at a high percentage of slow protein. A higher percentage of slow protein increased litter weight gain throughout lactation (Δ = 2.6 kg, P = 0.04) regardless of CP concentrations, whereas a higher CP only increased litter weight gain during week 3 of lactation (Δ = 1.2 kg, P = 0.01). On Day 15 postfarrowing, serial blood samples were taken from a subsample of sows fed with the high CP diets. In these sows, a high percentage of slow protein resulted in higher plasma AA concentrations at 150 and 180 min after feeding (Δ = 0.89, P = 0.02, Δ = 0.78, P = 0.03, mmol/L, respectively) and lower increases in urea at 90 and 120 min after feeding (Δ = 0.67, P = 0.04, Δ = 0.70, P = 0.03, mmol/L, respectively). The higher dietary CP concentration increased total nitrogen loss to the environment (Δ = 604 g, P < 0.01) with a reduction of protein efficiency (Δ = 14.8%, P < 0.01). In the next farrowing, a higher percentage of slow protein increased subsequent liveborn litter size (Δ = 0.7, P < 0.05). In conclusion, feeding sows with a high dietary CP concentration alleviated maternal weight loss during lactation when the dietary protein digestion rate was slower, but lowered protein efficiency. A slower protein digestion improved litter weight gain, possibly by reducing AA oxidation and improving plasma AA availability, thus, improving protein efficiency.

Umbilical Cord Blood Collection During Cesarean Section: Effect on Maternal Blood Loss and Morbidity [ID 2683610

INTRODUCTION: Umbilical cord blood collection (UCBC) for stem-cell banking is routinely performed during cesarean sections (CS). Few studies have examined the maternal effect. This study's objective is to evaluate whether UCBC during CS is associated with increased maternal blood loss and morbidity. METHODS: This was a single-center retrospective cohort study of primary CS (PCS) in 2021. Exclusion criteria were age less than 18, multifetal gestation, gestational age less than 34 weeks, emergency, and infection. Data were compared between participants with and without UCBC during PCS. Extensive demographic data was collected and compared. The primary outcome was quantitative blood loss (QBL). Secondary outcomes were operative time, hemorrhage medication usage, and blood transfusion (BT). RESULTS: Eight hundred two PCS were reviewed, and 191 were excluded. Of the remaining 611, UCBC was attempted in 151 (24.7%). The UCBC cohort had higher gestational age (39.1 versus 38.7; P=.007), were less often in labor (P=.004) or on magnesium (P=.022), and were more likely to be scheduled (P=.002). Quantitative blood loss was higher with UCBC (1,091.5 versus 1,007.5 mL; P=.075). In non-labored PCS, the QBL difference was statistically significant (941.8 versus 798 mL; P=.034). Umbilical cord blood collection was associated with increased operative time (62.4 versus 56.8 minutes; P&lt;.001) and postoperative BT (7.2% versus 3.3%; P=.036). There were no associations between UCBC and usage of hemorrhage medications. CONCLUSION: Umbilical cord blood collection increases QBL in nonlabored PCS. Umbilical cord blood collection increases operative time and postoperative BT in PCS. Patients should be appropriately counseled and selected for UCBC based on hemorrhage risk factors.