Maternal Population Research Articles

Assessing Needs and Resources for the Home Visiting System in Alabama: A Mixed Methods Approach

The purpose of this article is to describe the initial assessment for the development of a home visiting (HV) system in a state with no existing system. We outline a mixed methods process where the quantitative component was used to identify the communities that possess "at-risk" profiles, and the qualitative component explored the resources and gaps in existing HV services. We employed a mixed methods approach, using six categories of indicators from quantitative secondary data sources to identify "at-risk" profiles for Alabama's 67 counties. A weighted score for each indicator was calculated and counties were ranked. Surveys and focus groups were conducted to further define resources and gaps of existing HV programs. The composite indicator scores identified 13 counties as having the highest level of risk. Five of these 13 communities had no HV home visitation services. Areas of focus for future HV system development include trust, communication, availability, cost, and timeliness. In this assessment related to the Alabama HV system, we used quantitative data to apply criteria to the indicators being measured and qualitative data to supplement the quantitative findings. We examined resources, gaps, program quality, and capacity of the existing HV programs in order to assist in the future development of the HV system and early childhood system. The methods presented in this paper have potential applications beyond HV programs and systems, including broader examinations of complex systems for service provision to the maternal and child health populations.

An AFLP estimation of the outcrossing rate of <i>Spondias tuberosa</i> (Anacardiaceae), an endemic species to the Brazilian semiarid region

The umbu tree (Spondias tuberosa) is one of the most important endemic species to the Brazilian tropical semiarid region. The umbu tree has edible fruits with a peculiar flavor that are consumed in natura or in a semi-industrialized form, such as jams, candies and juices. The majority of endemic species to Brazilian semiarid region have not been studied or sampled to form germ-plasm collections, which increases the risk of losing genetic variability of the adapted species to xerophytic conditions. The aim of this study was to estimate outcrossing rates in S. tuberosa using a multilocus mixed model in order to guide genetic resources and breeding programs of this species. DNA samples were extracted from 92 progenies of umbu trees, which were distributed among 12 families. These trees were planted by seed in 1991 in Petrolina, PE, Brazil. The experimental design was a randomized block, with a total of 42 progenies sampled in three regions. The experimental units were composed by five plants and five replications. The outcrossing rate was estimated by the multilocus model, which is available in the MLTR software, and was based on 17 polymorphic AFLP bands obtained from AAA_CTG and AAA_CTC primer combinations. The observed heterozygotes ranged from 0.147 to 0.499, with a maximum frequency estimated for the AAA_CTC 10 amplicon. The multilocus outcrossing estimation (t(m)) was 0.804 +/- 0.072, while the single-locus (t(s)) was 0.841 +/- 0.079, which suggests that S. tuberosa is predominantly an outcrossing species. The difference between t(m) and t(s) was -0.037 +/- 0.029, which indicates that biparental inbreeding was nearly absent. The mean inbreeding coefficient or fixation index (F) among maternal plants was--0.103 +/- 0.045, and the expected F was 0.108, which indicates that there was no excess of heterozygotes in the maternal population. The outcrossing estimates obtained in the present study indicate that S. tuberosa is an open-pollinated species. Biometrical models applied to this species should therefore take into account the deviation from random outcrossing to estimate genetic parameters and the constitution of broad germplasm samples to preserve the genetic variability of the species. Outcrossing rates based on AFLP and the mixed-mating model should be applied to other studies of plant species in the Brazilian semiarid region.

Clinical and Pharmacogenetic Factors Affecting Neonatal Bilirubinemia Following Atazanavir Treatment of Mothers During Pregnancy

A theoretical concern exists that atazanavir (ATV) use during pregnancy may exacerbate physiologic neonatal hyperbilirubinemia. The aim of this substudy was to evaluate patterns of neonatal bilirubin following ATV/ritonavir (RTV) treatment of pregnant mothers and clinical and pharmacogenetic factors that may correlate. The design involved a subanalysis of study AI424182, a multicenter, open-label, prospective, single-arm Phase I study. The study had two treatment arms: (1) ATV/RTV 300/100 mg once daily or (2) ATV/RTV 400/100 mg once daily, both in combination with zidovudine/lamivudine 300/150 mg twice daily. Total bilirubin was assessed at baseline, each visit, and delivery day for mothers and on days 1 (delivery day), 3, 5, and 7 and weeks 2 and 6 for neonates. Blood samples were obtained for UGT1A1 genotyping and ATV cord blood concentration. Bilirubin elevation of any grade occurred in 14/40 neonates (35%). All Grade 3 to 4 bilirubin abnormalities (n=7) occurred after day 14. The pattern of neonatal bilirubin levels reported was consistent with neonatal physiologic elevations of bilirubin. Little correlation was observed between either maternal bilirubin levels over the last 4 weeks of pregnancy (including delivery) or ATV cord concentration and neonatal bilirubin. There was a significant association between UGT1A1 genotype and bilirubin grade in the maternal population (p=0.0006) but not neonates (p=0.49). Neither neonatal UGT1A1 genotype nor cord blood ATV concentration is a good predictor of neonatal hyperbilirubinemia. ATV/RTV treatment of mothers does not appear to exacerbate neonatal physiologic hyperbilirubinemia.

Maternal admixture and population structure in Mexican–Mestizos based on mtDNA haplogroups

The maternal ancestry (mtDNA) has important applications in different research fields, such as evolution, epidemiology, identification, and human population history. This is particularly interesting in Mestizos, which constitute the main population in Mexico (∼93%) resulting from post-Columbian admixture between Spaniards, Amerindians, and African slaves, principally. Consequently, we conducted minisequencing analysis (SNaPshot) of 11 mitochondrial single-nucleotide polymorphisms in 742 Mestizos of 10 populations from different regions in Mexico. The predominant maternal ancestry was Native American (92.9%), including Haplogroups A, B, C, and D (47, 23.7, 15.9, and 6.2%, respectively). Conversely, European and African ancestries were less frequent (5.3 and 1.9%, respectively). The main characteristics of the maternal lineages observed in Mexican-Mestizos comprised the following: 1) contrasting geographic gradient of Haplogroups A and C; 2) increase of European lineages toward the Northwest; 3) low or absent, but homogeneous, African ancestry throughout the Mexican territory; 4) maternal lineages in Mestizos roughly represent the genetic makeup of the surrounding Amerindian groups, particularly toward the Southeast, but not in the North and West; 5) continuity over time of the geographic distribution of Amerindian lineages in Mayas; and 6) low but significant maternal population structure (FST = 2.8%; P = 0.0000). The average ancestry obtained from uniparental systems (mtDNA and Y-chromosome) in Mexican-Mestizos was correlated with previous ancestry estimates based on autosomal systems (genome-wide single-nucleotide polymorphisms and short tandem repeats). Finally, the comparison of paternal and maternal lineages provided additional information concerning the gender bias admixture, mating patterns, and population structure in Mestizos throughout the Mexican territory.

Seasonal variation of birth defects in Norway

BackgroundSeasonal variation in the occurrence of birth defects provides indirect evidence of the causal role of environmental factors, because genetic factors do not exhibit seasonality. AimThis study was undertaken to assess the seasonal variation of birth defects in Norway. MethodsWe conducted a nationwide cross-sectional study of 326,560 births in years 1993–1998, using information from the Medical Birth Registry in Norway. We applied the Lorenz curve and associated Gini index and its 95th percentiles from 10,000 Monte Carlo simulations to identify specific birth defects and birth defect groups with statistically significant seasonal variation. For identified outcomes we applied logistic regression analysis to quantify deviations of risk in high and low peak months. ResultsThe Gini index indicated statistically significant seasonal variation (α = 0.05) for any birth defect, 0.040 (95th percentile = 0.024), respiratory defects, 0.140 (95th percentile = 0.141), and for Down syndrome, 0.148 (95th percentile = 0.126). Based on logistic regression adjusting for maternal age, parity, centrality, population density, and industrial profile, highest risk for respiratory defect was among infants born in March (adjusted odds ratio [OR] 1.82, 95% confidence interval [CI] 1.33–2.50), and for Down syndrome in February (adjusted OR 1.64, 95% CI 1.21–2.22) compared to risks of infants born in other months. ConclusionFindings suggest that environmental factors with seasonal variation play a role in the etiology of respiratory defects and Down syndrome.

Sociodemographic characteristics of mother’s population and risk of preterm birth in Chile

BackgroundPreterm birth is a global problem in Perinatal and infant Health. Currently is gaining a growing attention. Rates of preterm birth have increased in most countries, producing a dramatic impact on public health. Factors of diverse nature have been associated to these trends.In Chile, preterm birth has increased since 90. Simultaneously, the advanced demographic transition has modified the characteristics of woman population related to maternity.The principal objective of this study is to analyze some sociodemographic characteristics of the maternal population over time, and their possible association to rates of preterm birth. The second aim is to identify groups of mothers at high risk of having a preterm child.MethodsThis population-based study examined all liveborn singletons in Chile from 1991 to 2008; divided in three periods. Preterm birth rates were measured as % births <37 weeks of gestation.Logistic regression assessed the risk of preterm birth associated with mother’s age, parity, and marital status, expressed as crude and adjusted odds ratios.ResultsOver time, rates of preterm birth increased in overall population, especially during the third period (2001–2008). In the same time, characteristics of maternal population changed: significant increase of extreme reproductive ages, significant decrease in parity and increase in mothers living without a partner.Risk of preterm birth remained higher in groups of mothers: <18 and >38 years of age; without a partner; primiparas and grandmultiparas. However, global increase in preterm birth was not explained by the modification of socio demographics characteristics of maternal population.ConclusionsSome socio demographic characteristics remained associated with preterm birth over time. These associations allowed identifying five groups of mothers at higher risk to have a preterm child in the population.Increase in overall preterm birth affected all women, even those considered at “low sociodemographic risk” and the contribution of more recent period (2001–2008) to this increase is greater.Then, studied factors couldn’t explain the increase in preterm birth. Further research will have to consider other factors affecting maternal population that could explain the observed trend of preterm birth.

Neolithic mitochondrial haplogroup H genomes and the genetic origins of Europeans

Haplogroup H dominates present-day Western European mitochondrial DNA variability (>40%), yet was less common (~19%) among Early Neolithic farmers (~5450 BC) and virtually absent in Mesolithic hunter-gatherers. Here we investigate this major component of the maternal population history of modern Europeans and sequence 39 complete haplogroup H mitochondrial genomes from ancient human remains. We then compare this 'real-time' genetic data with cultural changes taking place between the Early Neolithic (~5450 BC) and Bronze Age (~2200 BC) in Central Europe. Our results reveal that the current diversity and distribution of haplogroup H were largely established by the Mid Neolithic (~4000 BC), but with substantial genetic contributions from subsequent pan-European cultures such as the Bell Beakers expanding out of Iberia in the Late Neolithic (~2800 BC). Dated haplogroup H genomes allow us to reconstruct the recent evolutionary history of haplogroup H and reveal a mutation rate 45% higher than current estimates for human mitochondria.

Phthalate exposure in pregnant women and newborns – The urinary metabolite excretion pattern differs distinctly

Some phthalates are endocrine disruptors and reproductive and developmental toxicants. Data on newborn phthalate exposure and elimination characteristics are scarce. We determined 21 urinary phthalate metabolites (indicating exposure to 11 parent phthalates) in two study approaches: in the first approach we collected the urine of 20 healthy newborns at days 2-5 post partum together with 47 urine samples of 7 women during pregnancy. In the second fine tuned approach we collected first urine samples of 9 healthy newborns together with their mother's urine shortly before birth. To ensure full and contamination free collection of the newborns first urines we used special adhesive urine bags for children. All urine samples revealed ubiquitous exposures to phthalates comparable to other populations. Metabolite levels in the newborns first day urine samples were generally lower than in all other samples. However, the newborns urines (both first and day 2-5 urines) showed a metabolite pattern distinctly different from the maternal and general population samples: in the newborns urines the carboxy-metabolites of the long chain phthalates (DEHP, DiNP, DiDP) were the by far dominant metabolites with a relative share in the metabolite spectrum up to 6 times higher than in maternal urine. Oppositely, for the short chain phthalates (DBP, DiBP) oxidized metabolites seemed to be less favored than the simple monoesters in the newborns urines. The skewed metabolite distribution in the newborns urine warrants further investigation in terms of early phthalate metabolism, the quantity of internal phthalate exposure of the fetus/newborn and its possible health effects.

Implementation of a training program to improve pharmacy services for high-risk neonatal and maternal populations

A training program aimed at increasing pharmacists' role in the care of high-risk maternal, neonatal, and pediatric patients is described. In preparation for the planned expansion of a large Ohio hospital's maternal and neonatal critical care services, the pharmacy department developed a training program to increase the knowledge and skill sets of staff pharmacists, especially those who lacked residency training. The program also supported the department's transition to an integrated patient-centered pharmacy practice model. Clinical practice guidelines, policy statements, and other sources were used to develop a series of 57 one-hour lectures on a wide range of topics in maternal-neonatal critical care. The lectures were delivered one morning each week, every other week, over 30 months, with additional case-based homework assigned; a passing score (80%) on all module examinations and homework assignments was required for continued course participation. Trainees who completed the voluntary program earned a certificate from the department head and continuing-education credit from the Ohio State Board of Pharmacy, and they were eligible to engage in expanded rounding and patient counseling activities. The program appeared to have a positive impact on patient satisfaction and efforts to reduce medication misadventures in the neonatal intensive care unit. The implementation of a training program to educate non-residency-trained pharmacists in selected areas of maternal, neonatal, and pediatric health care helped enable the expansion of pharmacy services to include admission, daily, and discharge counseling.

588: Acceptability of cell free fetal DNA screening in an advanced maternal age population

588: Acceptability of cell free fetal DNA screening in an advanced maternal age population

Exploring the relationship between population density and maternal health coverage

BackgroundDelivering health services to dense populations is more practical than to dispersed populations, other factors constant. This engenders the hypothesis that population density positively affects coverage rates of health services. This hypothesis has been tested indirectly for some services at a local level, but not at a national level.MethodsWe use cross-sectional data to conduct cross-country, OLS regressions at the national level to estimate the relationship between population density and maternal health coverage. We separately estimate the effect of two measures of density on three population-level coverage rates (6 tests in total). Our coverage indicators are the fraction of the maternal population completing four antenatal care visits and the utilization rates of both skilled birth attendants and in-facility delivery. The first density metric we use is the percentage of a population living in an urban area. The second metric, which we denote as a density score, is a relative ranking of countries by population density. The score’s calculation discounts a nation’s uninhabited territory under the assumption those areas are irrelevant to service delivery.ResultsWe find significantly positive relationships between our maternal health indicators and density measures. On average, a one-unit increase in our density score is equivalent to a 0.2% increase in coverage rates.ConclusionsCountries with dispersed populations face higher burdens to achieve multinational coverage targets such as the United Nations’ Millennial Development Goals.

Neighbourhood Income Level and Outcomes of Extremely Preterm Neonates: Protection Conferred by a Universal Health Care System

To determine the impact of neighbourhood income and maternal residence population density on mortality and various morbidities at discharge or transfer from the NICU among extremely preterm neonates (<27 weeks gestation) in Canada.Neighbourhood income level and residential status was derived using a postal code conversion file and census data. Multivariable logistic regression analysis was used to estimate the risk-adjusted odds ratio (AOR) of mortality and survival without major morbidities (chronic lung disease, necrotizing enterocolitis, severe intraventricular hemorrhage, and retinopathy of prematurity) among 2,752 extremely preterm infants admitted to 25 tertiary level neonatal intensive care units in Canada between 2007 and 2008.There were no significant differences between mothers from different neighbourhood income quintiles (Q1 = low; Q5 = high) and neonatal mortality AOR (95% confidence interval): Q1: 1.10 (0.74-1.62), Q2: 1.00 (0.67-1.49), Q3: 1.39 (0.93-2.07), Q4: 1.01 (0.67-1.52), Q5: 1 (reference); or survival without major morbidity: Q1: 1.01 (0.70-1.44), Q2: 0.84 (0.58-1.23), Q3: 0.85 (0.58-1.24), Q4: 0.92 (0.63-1.35), Q5: 1 (reference). There were no significant differences in mortality (AOR 1.14 [0.83-1.57]) or in survival without major morbidity (AOR 0.92 [0.67-1.26]) between infants of mothers residing in sparsely populated areas compared to densely populated areas.Maternal residence in a low-income neighbourhood or sparsely populated area was not associated with higher odds of mortality or survival free of major morbidities in extremely preterm infants.

Neighbourhood income level and outcomes of extremely preterm neonates: protection conferred by a universal health care system.

To determine the impact of neighbourhood income and maternal residence population density on mortality and various morbidities at discharge or transfer from the NICU among extremely preterm neonates (<27 weeks gestation) in Canada. Neighbourhood income level and residential status was derived using a postal code conversion file and census data. Multivariable logistic regression analysis was used to estimate the risk-adjusted odds ratio (AOR) of mortality and survival without major morbidities (chronic lung disease, necrotizing enterocolitis, severe intraventricular hemorrhage, and retinopathy of prematurity) among 2,752 extremely preterm infants admitted to 25 tertiary level neonatal intensive care units in Canada between 2007 and 2008. There were no significant differences between mothers from different neighbourhood income quintiles (Q1 = low; Q5 = high) and neonatal mortality AOR (95% confidence interval): Q1: 1.10 (0.74-1.62), Q2: 1.00 (0.67-1.49), Q3: 1.39 (0.93-2.07), Q4: 1.01 (0.67-1.52), Q5: 1 (reference); or survival without major morbidity: Q1: 1.01 (0.70-1.44), Q2: 0.84 (0.58-1.23), Q3: 0.85 (0.58-1.24), Q4: 0.92 (0.63-1.35), Q5: 1 (reference). There were no significant differences in mortality (AOR 1.14 [0.83-1.57]) or in survival without major morbidity (AOR 0.92 [0.67-1.26]) between infants of mothers residing in sparsely populated areas compared to densely populated areas. Maternal residence in a low-income neighbourhood or sparsely populated area was not associated with higher odds of mortality or survival free of major morbidities in extremely preterm infants.

Abstract B48: Design of a feasibility study of breast cancer candidate genes in three ethnic groups.

Abstract The purpose of this presentation is to highlight the design and preliminary recruitment outcomes of a translational feasibility study to investigate the impacts of selected genetic single nucleotide polymorphisms (SNPs) on ethnic disparities in breast cancer subtypes, defined by ER, PR, and Her2 expression, associated with higher breast cancer mortality rates. The study will investigate the frequencies of five SNPs in the 19p13 locus of BRCA1 and two SNPs on chr 5p12 in three ethnic groups: African Americans with Sea Island ancestry (SI; all four grandparents were born in SI geographic regions), African Americans without known Sea Island ancestry (AA; 0 grandparents were born in SI geographic regions), and European Americans (EA). The SI population is an AA subpopulation indigenous to the coastal southeast that has the lowest rates of European genetic admixture of AA tested.(1,2) Comparing risk alleles across these three ethnic groups provides a novel paradigm to assess the extent to which SI ancestry and social processes such as acculturation may be linked to breast cancer subtypes associated with poor prognosis. A protocol has been developed to identify, contact and recruit women recently diagnosed with breast cancer within each ethnic group. Breast cancer cases are initially ascertained through the South Carolina Central Cancer Registry (SCCCR). Recruitment methods encompass steps taken at the SCCCR that include passive consent from the physician of record to contact identified patients, followed by active consent from the identified patients prior to contact by study staff. An investigator-developed algorithm developed to determine SI ancestry of patients, based on geographic ancestry, is administered and eligible participants are asked to complete a telephone-administered survey and to provide a saliva sample for genetic analysis. Recruitment began in June 2012. To date, 23 participants have been recruited, of whom 6 are AA (26%) and 17 are EA (74%), with a mean age of 57.5 years (range =39-77 years). Recruitment will continue until 30 women in each ethnic group are enrolled (total 90 participants). The recruitment process is monitored using a CONSORT diagram. This work will ultimately identify loci for further investigation of breast cancer disparities in other groups and for future development of targeted clinical therapies.

Promoting a Trained MCH Epidemiology Workforce in State Public Health Agencies Through Strategies Developed From Continued Partnerships

Maternal and child health (MCH) epidemiology has become a major program component of most state Title V MCH programs [1]. MCH epidemiology is ‘‘the systematic collection, analysis and interpretation of population-based and program-specific health and related data in order to assess the distribution and determinants of the health status and needs of the maternal child population for the purpose of planning, implementing, and assessing effective, science-based strategies and promoting policy development’’ [2], a definition derived from the work of others [3]. Increasing ‘‘the proportion of Tribal, State, and local public health agencies that provide or assure comprehensive epidemiology services to support essential public health services[4],’’ including MCH epidemiology, is of national importance and continues to be recognized as a Healthy People objective [4]. Maternal and child health epidemiology capabilities in state and territorial public health agencies have increased over the last decade. According to national surveys, the percentage of jurisdictions reporting substantial epidemiology and surveillance capacity has increased from 35 % in 2001 to 55 % in 2009, and the percentage reporting minimal to no capacity has decreased from 25 % in 2004 to 12 % in 2009 [5]. Moreover, 46 % of jurisdictions have an MCH epidemiologist with a doctoral degree (M.D., Ph.D., and other doctoral degrees), the highest percentage of any public health epidemiology specialty area. This advancement in the MCH workforce occurred because of the strong collaborative efforts of federal public health agencies, academia, and national public health membership organizations [such as the Association of MCH Programs (AMCHP), Council of State and Territorial Epidemiologists (CSTE), and CityMatCH] to bolster MCH epidemiology training at every stage of professional development. The beginnings of these national efforts to promote a trained MCH epidemiology workforce have been described by others [3, 6, 7]. These early efforts included: (1) the Centers for Disease Control and Prevention’s (CDC) MCH epidemiology program (MCHEP) assigning doctoral-prepared career MCH epidemiologists to state and local public health agencies since 1986, with support from the Health Resources and Services Administration’s Maternal and Child Health Bureau (MCHB); and (2) MCHB awarding grants to train existing staff through regional perinatal data projects and continuing education programs such as the Disclaimer The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Association Between Smoking Cessation Interventions During Prenatal Care and Postpartum Relapse: Results from 2004 to 2008 Multi-State PRAMS Data

Cigarette smoking is a serious global public health issue, and is particularly harmful to the maternal and child population. The study aimed to determine if there was an association between smoking cessation intervention during pregnancy and postpartum smoking relapse, and to define a time trend of postpartum smoking relapse after delivery. Data from the 2004-2008 pregnancy risk assessment monitoring systems of Colorado, Maine, Ohio, and Washington were analyzed. Logistic regression was used to define the association between smoking cessation intervention and postpartum smoking relapse, and to identify trend of postpartum smoking relapse. Analyses were done using SAS-Callable SUDAAN v.10.0 and Mplus v.6.0. Among the 2,938 women in the study the relapse rate was 48%. It was 45% among those without intervention, 58% among those who received only counseling, and 57% among those who received both counseling with treatment and/or referral. The rate was 42, 61, and 67% among women whose infants were at 2-3, 4-5, and 6months or more, respectively. Adjusted logistic regression models showed a trend of increased smoking relapse, but did not indicate an association between smoking cessation intervention and smoking relapse. Rates of smoking relapse were high and increased by time after delivery. Smoking cessation intervention during pregnancy may not be successful at preventing postpartum smoking relapse.

Association between pre-eclampsia and locally derived traffic-related air pollution: a retrospective cohort study

BackgroundPre-eclampsia is a common complication of pregnancy and is a major cause of fetal–maternal mortality and morbidity. Despite a number of plausible mechanisms by which air pollutants might contribute to...

Impacts des facteurs maternels sur l’allaitement maternel en réanimation néonatale

Admission at birth to a Neonatal Intensive Care Unit (NICU) complicates breastfeeding especially for preterm babies despite hospital staff trained to encourage breastfeeding. The aim of this study was to find factors related to the mother, the pregnancy or the neonate influencing breastfeeding rate on a NICU. This was a retrospective study including neonatal admissions to the NICU at Antoine-Béclère University Hospital from 1st May 2009 to 30th April 2010. Data was collected from medical notes. The breastfeeding rate (at initiation and at discharge) was analysed with regards to maternal age, method of procreation, type of pregnancy (single or multiple), parity, mode of delivery (vaginal delivery or C-section), birthweight, gestational age and intra-uterine growth restriction (IUGR). The study was based on 460 neonates having complete documentation. The average maternal age was 32 years. Premature infants represented 74.8% of the population (median gestational age=34 weeks) of which 57% were less than 33 weeks (42.6% of all infants, n=196). The median birthweight was 1900 g with 17.6% of IUGR infants. Breastfeeding rate at initiation was 58.7 and 43.9% at discharge (mean admission days: 17.1 [0-180], median=8 days). For infants born of multiple pregnancies (24.3% of the population) 51.6% were born of medically assisted pregnancies (MAP) and 17.6% of spontaneous pregnancies. Breastfeeding rate among these infants was 57.1% at initiation and 45.5% at discharge. It was higher in infants born of MAP at initiation (70.3% versus 55.8% for spontaneous pregnancies, P<0.05) and at discharge (49.5% versus 42.5% for spontaneous pregnancies). For these infants, average maternal age was higher for breastfed infants (33.9 versus 32.1 years for the formula-fed, P<0.05). Breastfeeding rate in infants born to primipares was higher at initiation (64.9% versus 53.6% for multipares, P<0.05) and at discharge (48.5% versus 40.8% for multipares, P<0.05). The rate of infants breastfed was influenced neither by maternal age alone (31.8 ± 5.6 versus 31.4 ± 5.7 years for formula-fed), nor by type of delivery (56.7% for infants born by C-section versus 62.5% for infants born by vaginal delivery), nor gestational age (33.2 ± 4.3 weeks for breastfed, versus 33.4 ± 4.2 weeks for formula-fed infants), nor birthweight (2060 ± 978 g for breastfed versus 2055 ± 909 g for formula-fed infants), nor IUGR (58% versus 58.8% for eutrophes). Our maternal population was different as 16.7% of deliveries were accounted for by MAP, superior to the French average (<10%). We describe for the first time MAP as a positive influencing factor on breastfeeding rates in newborns admitted to a NICU. A better breastfeeding information policy during pregnancy, higher maternal age and increased multiple pregnancies would explain a higher breastfeeding rate among the women who had MAP. An impact of increasing maternal age was found on the rate of breastfed infants born of MAP. Primiparity was also a contributing factor for breastfeeding. Professional formation for all hospital staff concerned would be essential to give out clear and consistent information to families and to encourage support and intimacy throughout hospitalisation as well as at discharge.

Litter reductions reveal a trade-off between offspring size and number in brown bears

Experimental manipulations have revealed positive effects of litter reduction on offspring mass in small mammals, but little is known about this trade-off in large mammals. We examined the determinants of natural litter size variation and quantified the effects of litter size, maternal characteristics, and litter composition on yearling mass using 24 years of data on marked brown bears (Ursus arctos) in Sweden. Infanticide by adult males is a major cause of cub-of-the-year mortality, leading to litter size reductions. Litter size (n = 265) at den emergence ranged from one to four cubs (average, 2.7) and increased with maternal age. Litter size, however, appeared independent of maternal size, population density, interlitter interval, study area, or previous litter sex ratio. Yearling body mass increased with maternal body size but was independent of litter sex ratio. Litter size and yearling mass were negatively correlated, mostly because singletons were about 30 % heavier than yearlings from litters of two to four cubs. In reduced litters, survivors were on average 8 % heavier as yearlings than individuals from intact litters, suggesting that sibling competition reduces growth. Trade-offs between litter size and yearling mass in bears appear similar in magnitude to those found in small mammals.

Population structure of adult female Australian sea lions is driven by fine-scale foraging site fidelity

The Australian sea lion, Neophoca cinerea , one of the world’s rarest otariids, is notable for an asynchronous, aseasonal breeding chronology. Determining the ecological features that shape the genetic structure of marine predators such as Australian sea lions is challenging because their demersal foraging habitat is difficult to observe and quantify. Recent developments in stable isotope screening techniques using milk-dependent pups as proxies for maternal isotope signatures identified temporally stable, alternative (inshore and offshore) foraging ecotypes in adult female Australian sea lions. We combined this technique with mitochondrial DNA (mtDNA) analysis of samples of 40–60% of all pups produced at 17 of the largest South Australian colonies to determine whether ecological specialization in foraging ecotype within and between colonies has shaped maternal population structure within the species. Genetic isolation by distance was apparent at very fine geographical scales with three distinct clusters of colonies that share multiple haplotypes being interspersed with isolated breeding sites. There was no congruence between mtDNA haplotype distribution and foraging ecotypes suggesting that observed behavioural specialization was not maintained along matrilines. We propose that foraging specialization within discrete fine-scale foraging areas and habitats at the individual level limits the dispersive capacity of adult female Australian sea lions which in turn drives population structure. Given this species’ vulnerability to anthropogenic impacts and the high degree of female population structure, determining the extent of male-mediated gene flow in this species is critical. Only then can breeding colony connectivity be established and appropriate management units identified for the species. ► mtDNA and stable isotope data were collected across 17 breeding colonies of Australian sea lions. ► Isolation by distance was significant at 40 km. Alternative foraging ecotypes were present at most sites. ► Fine-scale foraging site fidelity may restrict migratory movement. ► Foraging behaviour is not maintained along matrilines. ► Social learning could maintain foraging behaviour over generations.