Pre-pregnancy Levels Research Articles

P400. Longitudinal Changes in Attention and Memory in Pregnant and Postpartum Women

Pregnant and postpartum women experience significant physiological changes, yet detailed mental health and cognition studies in this population are scarce. There is limited evidence that cognition, especially memory, declines during pregnancy and may return to pre-pregnancy levels months after delivery. However, these studies have used non-standardized or self-report assessments and often lacked non-pregnant controls. We used a well-validated, computerized cognitive battery to compare pregnant and postpartum cognition in the same cohort.

Maternal lipid profile in pregnancy and embryonic size: a population-based prospective cohort study

BackgroundLipids are crucial for fetal growth and development. Maternal lipid concentrations are associated with fetal growth in the second and third trimester of pregnancy and with birth outcomes. However, it is unknown if this association starts early in pregnancy or arises later during fetal development. The aim of this study was to investigate the association between the maternal lipid profile in early pregnancy and embryonic size.MethodsWe included 1474 women from the Generation R Study, a population based prospective birth cohort. Both embryonic size and the maternal lipid profile were measured between 10 weeks + 1 day and 13 weeks + 6 days gestational age. The maternal lipid profile was defined as total cholesterol, triglycerides (TG), high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), remnant cholesterol, non-high-density (non-HDL-c) lipoprotein cholesterol concentrations and the triglycerides/high-density lipoprotein (TG/HDL-c) ratio. Additionally, maternal glucose concentrations were assessed. Embryonic size was assessed using crown-rump length (CRL) measurements. Associations were studied with linear regression models, adjusted for confounding factors: maternal age, pre-pregnancy body mass index (BMI), parity, educational level, ethnicity, smoking and folic acid supplement use.ResultsTriglycerides and remnant cholesterol concentrations are positively associated with embryonic size (fully adjusted models, 0.17 SDS CRL: 95% CI 0.03; 0.30, and 0.17 SDS: 95% CI 0.04; 0.31 per 1 MoM increase, respectively). These associations were not present in women with normal weight (triglycerides and remnant cholesterol: fully adjusted model, 0.44 SDS: 95% CI 0.15; 0.72). Associations between maternal lipid concentrations and embryonic size were not attenuated after adjustment for glucose concentrations. Total cholesterol, HDL-c, LDL-c, non-HDL-c concentrations and the TG/HDL-c ratio were not associated with embryonic size.ConclusionsHigher triglycerides and remnant cholesterol concentrations in early pregnancy are associated with increased embryonic size, most notably in overweight women.Trial registrationThe study protocol has been approved by the Medical Ethics Committee of the Erasmus University Medical Centre (Erasmus MC), Rotterdam (MEC-2007-413). Written informed consent was obtained from all participants.

Adaptive Text Messaging for Postpartum Risky Drinking: Conceptual Model and Protocol for an Ecological Momentary Assessment Study.

BackgroundRisky drinking is prevalent among women of childbearing age. Although many women reduce their drinking during pregnancy, more than half return to prepregnancy levels during the early postpartum period. Risky drinking in new mothers may be associated with negative child and maternal health outcomes; however, new mothers are unlikely to seek treatment for risky drinking because of stigma and fear of child protective service involvement. SMS text messaging is a promising approach for reaching non–treatment-seeking new mothers at risk because of risky drinking. SMS text messaging interventions (TMIs) are empirically supported for alcohol use, but a tailored intervention for new mothers does not exist. This study aims to fill this gap by developing a just-in-time adaptive TMI for postpartum risky drinking.ObjectiveThe objectives of this paper are to present a preliminary conceptual model of postpartum risky drinking and describe the protocol for conducting an ecological momentary assessment (EMA) study with new mothers to inform the refinement of the conceptual model and development of the TMI.MethodsThis paper presents a preliminary conceptual model of postpartum risky drinking based on the motivational model of alcohol use, social cognitive theory, and temporal self-regulation theory. The model proposes three primary intervention targets: motivation, self-efficacy, and self-regulation. Theoretical and empirical literature in support of the conceptual model is described. The paper also describes procedures for a study that will collect EMA data from 30 participants recruited via social media and the perinatal Central Intake system of New Jersey. Following the baseline assessment, EMA surveys will be sent 5 times per day for 14 days. The assessment instruments and data analysis procedures are described.ResultsRecruitment is scheduled to begin in January 2022 and is anticipated to conclude in March 2022. Study results are estimated to be published in July 2022.ConclusionsThe study findings will enhance our understanding of daily and momentary fluctuations in risk and protective factors for risky drinking during the early postpartum period. The findings will be used to refine the conceptual model and inform the development of the TMI. The next steps for this work include the development of intervention components via an iterative participatory design process and testing of the resulting intervention in a pilot microrandomized trial.International Registered Report Identifier (IRRID)PRR1-10.2196/36849

Year-end academic review of 2021: Advances in the field of birth defect prevention and control in China as of 2021

Year-end academic review of 2021: Advances in the field of birth defect prevention and control in China as of 2021

Successful Pregnancy Outcome in a Patient with Pompe Disease Receiving Enzyme Replacement Therapy: A Case Report and Review of the Literature

Pregnancy in a woman with Pompe disease should be considered to be high risk and requires close monitoring as pregnancy may worsen symptoms, or cause initial symptoms to progress. Clinical data regarding the use of Enzyme Replacement Therapy (ERT) during pregnancy in Pompe disease is available only for 13 patients and the continuation of ERT during lactation has been reported in only one case. We report a successful pregnancy outcome in a 21 year old primipara with juvenile Pompe disease who continued receiving ERT throughout the pregnancy and lactation. She delivered a healthy full term female infant following caesarean section. She experienced worsening of motor function in the third trimester of pregnancy, but regained motor skills to pre-pregnancy level 6 months following delivery. Breast feeding was continued while on ERT. We also report a second patient in whom the diagnosis of Pompe disease was confirmed 5 years after delivery. In review of history the patient was symptomatic since age 15 years. Review of the literature of the published data of pregnancy in Pompe disease with continuation of ERT did not show any adverse outcome for the fetus. We add to the literature, our experience of continuation of ERT throughout the pregnancy and lactation in a patient with Pompe disease. More data needs to be collected to address the understanding of use of ERT during pregnancy and lactation.

Maternal and foetal outcomes following natural vaginal versus caesarean section (c-section) delivery in women with bleeding disorders and carriers.

Bleeding disorders are uncommon but may pose significant bleeding complications during pregnancy, labour and following delivery for both the woman and the foetus. While many bleeding disorders in women tend to improve in pregnancy, thus decreasing the haemorrhagic risk to the mother at the time of delivery, some do not correct or return quite quickly to their pre-pregnancy levels in the postpartum period. Therefore, specific measures to prevent maternal bleeding and foetal complications during childbirth, are required. The safest method of delivery to reduce morbidity and mortality in these women is controversial. This is an update of a previously published review. To assess the optimal mode of delivery in women with, or carriers of, bleeding disorders. We searched the Cochrane Cystic Fibrosis and Genetic Disorders Coagulopathies Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched the Cochrane Pregnancy and Childbirth Group's Trials Register as well as trials registries and the reference lists of relevant articles and reviews. Date of last search of the Group's Trials Registers: 21 June 2021. Randomised controlled trials and quasi-randomised controlled clinical trials investigating the optimal mode of delivery in women with, or carriers of, any type of bleeding disorder during pregnancy were eligible for the review. No trials matching the selection criteria were eligible for inclusion. No trials matching the selection criteria were eligible for inclusion. The review did not identify any randomised controlled trials investigating the safest mode of delivery and associated maternal and foetal complications during delivery in women with, or carriers of, a bleeding disorder. In the absence of high quality evidence, clinicians need to use their clinical judgement and lower level evidence (e.g. from observational trials, case studies) to decide upon the optimal mode of delivery to ensure the safety of both mother and foetus. Given the ethical considerations, the rarity of the disorders and the low incidence of both maternal and foetal complications, future randomised controlled trials to find the optimal mode of delivery in this population are unlikely to be carried out. Other high quality controlled studies (such as risk allocation designs, sequential design, and parallel cohort design) are needed to investigate the risks and benefits of natural vaginal and caesarean section in this population or extrapolation from other clinical conditions that incur a haemorrhagic risk to the baby, such as platelet alloimmunisation.

Pregnancy and Lactation in Sprague-Dawley Rats Result in Permanent Reductions of Tibia Trabecular Bone Mineral Density and Structure but Consumption of Red Rooibos Herbal Tea Supports the Partial Recovery.

During pregnancy and lactation, maternal bone mineral density (BMD) is reduced as calcium is mobilized to support offspring bone development. In humans, BMD returns to pre-pregnancy levels shortly after delivery, shifting from a high rate of bone resorption during pregnancy and lactation, into a rapid phase of bone formation post-lactation. This rapid change in bone turnover may provide an opportunity to stimulate a greater gain in BMD and stronger trabecular and cortical structure than present pre-pregnancy. Providing polyphenols present in red rooibos herbal tea may promote such an effect. In vitro, red rooibos polyphenols stimulate osteoblast activity, reduce osteoclastic resorption, and increase mineral production. The study objective was to determine if consuming red rooibos from pre-pregnancy through to 4 months post-lactation resulted in a higher BMD and improved trabecular and cortical bone structure in a commonly used rat model. Female Sprague-Dawley rats (n = 42) were randomized to one of the following groups: PREG TEA (pregnant, received supplemental level of red rooibos in water: ~2.6 g /kg body weight/day in water), PREG WATER (pregnant, received water), or NONPREG CON (age-matched, non-pregnant control, received water) from 2 weeks pre-pregnancy (age 8 weeks) through to 4 months post-lactation. Rats were fed AIN-93G (pre-pregnancy through to the end of lactation) and AIN-93M (post-lactation onwards). BMD and trabecular structure (bone volume fraction, trabecular number, trabecular separation) were improved (p < 0.05) by 1- or 2-months post-lactation when comparing PREG TEA to PREG CON, though neither group recovered to the level of NONPREG CON. Cortical outcomes (cortical area fraction, cortical thickness, tissue mineral density) for PREG TEA and PREG CON were reduced (p < 0.05) following lactation but returned to the level of NONPREG CON by 2-months post-lactation, with the exception of cortical thickness. The lack of recovery of BMD and key outcomes of trabecular bone structure was unexpected. While consumption of red rooibos did not result in stronger bone post-lactation, red rooibos did support the partial recovery of trabecular BMD and bone structure following pregnancy and lactation. The findings also provide insight into the timing and dose of polyphenols to study in future interventions.

Parity-specific motherhood penalties: Long-term impacts of childbirth on women's earnings in Japan.

The issue of motherhood earnings penalty has been well-documented in many Western countries. However, only a few studies discussed how earnings penalty evolves over time and varies across different parity of birth. Moreover, related research in non-Western developed countries is scant. This study contributes to the motherhood penalty literature by examining the long-term impacts (up to 10 years after childbirth) of the first and the second birth on women's employment, work hours, wage rates, and earnings in Japan. It proposes a novel research design based on the event-study approach and fixed effects regressions to quantify the dynamic effects of motherhood resulted from two consecutive birth transitions. Drawing on longitudinal data from the Japanese Panel Survey of Consumers (from 1993 to 2015), our results show that both the first and the second birth trigger short-term earnings penalties by causing a considerable employment slump upon pregnancy. In the long run, while women's employment rates recover, work hours and wage rates remain significantly lower than their pre-pregnancy level, leading to the long-term earnings penalty. More importantly, the long-term negative impacts of childbirth on labor supply and wage rates result mostly from women's first-time rather than the second-time birth transition in Japan. These findings imply that motherhood in Japan imposes long-term penalties on women's earnings, primarily by depressing maternal labor supply after their first-time motherhood transition.

White blood cells in pregnancy: reference intervals for before and after delivery.

BackgroundWhite blood cells (WBC) are commonly measured to investigate suspected infection and inflammation in pregnant women, but the pregnancy-specific reference interval is variably reported, increasing diagnostic uncertainty in this high-risk population. It is essential that clinicians can interpret WBC results in the context of normal pregnant physiology, given the huge global burden of infection on maternal mortality.MethodsWe performed a longitudinal, repeated measures population study of 24,318 pregnant women in Oxford, UK, to map the trajectory of WBC between 8-40 weeks of gestation. We defined 95% reference intervals (RI) for total WBC, neutrophils, lymphocytes, eosinophils, basophils, and monocytes for the antenatal and postnatal periods.FindingsWBC were measured 80,637 times over five years. The upper reference limit for total WBC was elevated by 36% in pregnancy (RI 5.7-15.0×109/L), driven by a 55% increase in neutrophils (3.7-11.6×109/L) and 38% increase in monocytes (0.3-1.1×109/L), which remained stable between 8-40 weeks. Lymphocytes were reduced by 36% (1.0-2.9×109/L), while eosinophils and basophils were unchanged. Total WBC was elevated significantly further from the first day after birth (similar regardless of the mode of delivery), which resolved to pre-delivery levels by an average of seven days, and to pre-pregnancy levels by day 21.InterpretationThere are marked changes in WBC in pregnancy, with substantial differences between cell subtypes. WBC are measured frequently in pregnant women in obstetric and non-obstetric settings, and results should be interpreted using a pregnancy-specific RI until delivery, and between days 7-21 after childbirth.FundingNone.

The effect of prepregnancy body mass index on maternal micronutrient status: a meta-analysis

The relationship between prepregnancy body mass index (BMI) and maternal micronutrient status is inconsistent and has not received sufficient attention. This meta-analysis aimed to evaluate the effect of prepregnancy BMI on micronutrient levels in pregnant women. PubMed, Embase, Web of Science, and the Cochrane Library were searched for articles that contained information on micronutrient levels and prepregnancy BMI. A random-effects model was used to determine the association between prepregnancy BMI and maternal micronutrient status. Sixty-one eligible articles were eventually included, with 83,554 participants. Vitamin B12, folate, vitamin D, iron and ferritin were the main micronutrients evaluated in our meta-analysis. Prepregnancy obesity and overweight may lead to an increased risk of micronutrient deficiency, including vitamin B12, folate and vitamin D deficiency, while prepregnancy obesity or overweight may have no significant association with ferritin deficiency. Additionally, the results of the dose–response analyses demonstrated a possible significant inverse correlation between prepregnancy BMI and levels of micronutrient, except for iron and ferritin. Compared with women with normal weight, women who were overweight or obese prepregnancy have lower micronutrient concentrations and are more likely to exhibit micronutrient deficiency during pregnancy, which is harmful to both mothers and neonates.

Lacosamide serum concentrations during pregnancy

Still considered a new ASD, teratogenicity from lacosamide (LCM) exposure during pregnancy is unknown. LCM metabolism through several cytochrome P450 enzymes and minor glucuronidation metabolism in the liver may increase during pregnancy and theoretically lead to lower LCM levels during pregnancy and the risk of increased seizures. Our objective was to determine the impact of pregnancy on serum LCM levels in a series of women with epilepsy (WWE).We identified seven pregnancies with exposure to LCM with at least one level drawn during pregnancy. Patient ages ranged from 18 to 38 years (mean 26.4 years) and total daily doses of LCM ranged from 200 to 600 mg/day. Two patients had increased dose adjustments in response to breakthrough seizures. Dose normalized concentrations (DNC) showed an overall decrease over time through each trimester (p = 0.002) and significantly lower during trimester 2 and 3 (p = 0.001 and p = 0.004, respectively) compared to pre-pregnancy levels. There were no significant changes in seizure frequency and none of the neonates had teratogenic findings at time of birth. We are the first to report a case series on the changes in LCM levels during pregnancy with significant decreased LCM DNC levels during the second and third trimesters in comparison to pre-pregnancy values.

Bone marrow-derived progenitor cells contribute to remodeling of the postpartum uterus.

Endometrial stem/progenitor cells play a role in postpartum uterine tissue regeneration, but the underlying mechanisms are poorly understood. While circulating bone marrow (BM)-derived cells (BMDCs) contribute to nonhematopoietic endometrial cells, the contribution of BMDCs to postpartum uterus remodeling is unknown. We investigated the contribution of BMDCs to the postpartum uterus using 5-fluorouracil-based nongonadotoxic BM transplant from green fluorescent protein (GFP) donors into wild-type C57BL/6J female mice. Flow cytometry showed an influx of GFP+ cells to the uterus immediately postpartum accounting for 28.7% of total uterine cells, followed by a rapid decrease to prepregnancy levels. The majority of uterine GFP+ cells were CD45+ leukocytes, and the proportion of nonhematopoietic CD45-GFP+ cells peaked on postpartum day (PPD) 1 (17.5%). Immunofluorescence colocalization of GFP with CD45 pan-leukocyte and F4/80 macrophage markers corroborated these findings. GFP+ cells were found mostly in subepithelial stromal location. Importantly, GFP+ cytokeratin-positive epithelial cells were found within the luminal epithelium exclusively on PPD1, demonstrating direct contribution to postpartum re-epithelialization. A subset (3.2%) of GFP+ cells were CD31+CD45- endothelial cells, and found integrated within blood vessel endothelium. Notably, BM-derived GFP+ cells demonstrated preferential proliferation (PCNA+) and apoptosis (TUNEL+) on PPD1 vs resident GFP- cells, suggesting an active role for BMDCs in rapid tissue turnover. Moreover, GFP+ cells gradually acquired cell senescence together with decreased proliferation throughout the postpartum. In conclusion, BM-derived progenitors were found to have a novel nonhematopoietic cellular contribution to postpartum uterus remodeling. This contribution may have an important functional role in physiological as well as pathological postpartum endometrial regeneration.

The effect of pregnancy and the duration of postpartum convalescence on the physical fitness of healthy women: A cohort study of active duty servicewomen receiving 6 weeks versus 12 weeks convalescence.

Pregnancy profoundly affects cardiovascular and musculoskeletal performance requiring up to 12 months for recovery in healthy individuals. To assess the effects of extending postpartum convalescence from 6 to 12 weeks on the physical fitness of Active Duty (AD) soldiers as measured by the Army Physical Fitness Test (APFT) and Body Mass Index (BMI). We conducted a retrospective study of AD soldiers who delivered their singleton pregnancy of ≥ 32weeks gestation at a tertiary medical center. Pre- and post-pregnancy APFT results as well as demographic, pregnancy, and postpartum data were collected. Changes in APFT raw scores, body composition measures, and failure rates across the 6-week and 12-week convalescent cohorts were assessed. Multivariable regressions were utilized to associate risk factors with failure. Four hundred sixty women met inclusion criteria; N = 358 in the 6 week cohort and N = 102 in the 12 week cohort. Demographic variables were similar between the cohorts. APFT failure rates across pregnancy increased more than 3-fold in both groups, but no significant differences were found between groups in the decrement of performance or weight gain. With the combined cohort, multivariable regression analysis showed failure on the postpartum APFT to be independently associated with failure on the pre-pregnancy APFT (OR = 16.92, 95% CI 4.96-57.77), failure on pre-pregnancy BMI (OR = 8.44, 95% CI 2.23-31.92), elevated BMI at 6-8 weeks postpartum (OR = 4.02, 95% CI 1.42-11.35) and not breastfeeding at 2 months (OR = 3.23, 95% CI 1.48-7.02). Within 36 months of delivery date, 75% of women had achieved pre-pregnancy levels of fitness. An additional 6 weeks of convalescence did not adversely affect physical performance or BMI measures in AD Army women following pregnancy. Modifiable factors such as pre- and post-pregnancy conditioning and weight, weight gain in pregnancy and always breastfeeding were found to be significant in recovery of physical fitness postpartum.

Physical activity in the early postpartum period in primiparous women

Little is known about early postpartum physical activity (PA). ObjectivesWe aimed to describe PA amount and types and compare moderate-vigorous PA (MVPA) at 12–25 (T1) and 33–46 days (T2) postpartum. DesignCross-sectional study. MethodsParticipants, primiparas delivered vaginally, wore wrist accelerometers and completed questionnaires. Median and interquartile range (IQR) describe minutes/day of PA intensities in total minutes, 5- and 10-minute bouts. Wilcoxon Signed Rank test compared MVPA. Results577 (age: 28.3 (SD: 5.1)) had accelerometry or questionnaire at either time-point. 405 had accelerometry at both time-points. Median (IQR) total minutes/day for light, moderate, vigorous and MVPA were 295.8 (256.1–331.7), 54.6 (40–72.7), 0.4 (0.2–0.8), and 55.5 (40.4–74.3), respectively, at T1 and 329 (289.4–367.1), 63.6 (46.9–82.2), 0.6 (0.3–1.3), and 64.5 (47–84.8), respectively, at T2. Median (IQR) minutes/day for MVPA in 5- and 10-minute bouts were 1.6 (0–5.5) and 0 (0–3.8) at T1, and 3 (0–9.2) and 0 (0–5.5) at T2. At T1, 75% (406/541) and at T2, 72.4% (397/548) reported non-impact activities. At T1, 4% and at T2, 13% reported impact/straining activities. MVPA was greater at T2 than T1 (p < 0.0001) with medians (IQR) of: total: 64.7 (47–84.6) vs 56.5 (41–74.9) minutes; 5-minute bouts: 3 (0–9.8) vs 1.7 (0–5.6) minutes; and 10-minute bouts: 1.3(0–6) vs 0(0–3.8) minutes. ConclusionsWomen had high daily MVPA, though MVPA in bouts remained low. Significant increases in MVPA from T1 to T2 were small, few women reported impact/straining activities. Realistic return to pre-pregnancy PA levels should recognize the relative lack of sustained/strenuous activity in early postpartum.

Multidisciplinary, biopsychosocial factors contributing to return to running and running related stress urinary incontinence in postpartum women

ObjectivesTo examine contributory factors behind postpartum return-to-running and return to pre-pregnancy running level, in addition to risk factors for postpartum running-related stress urinary incontinence (SUI).Methods881 postpartum women completed an online...

Obstetric and long-term graft outcomes in pregnant kidney transplant recipients: A single-center experience.

Kidney transplantation (KT) is the best option for many women with end-stage renal disease desiring pregnancy. The aim of this study was to investigate obstetric and graft outcomes among KT recipient women in our center. Maternal and fetal data were assessed in 29 pregnancies of 18 female KT recipients. Each patient was matched with two controls without pregnancy history for factors known to affect graft function. According to pre-pregnancy levels, serum creatinine and eGFR slope in the gestational and postpartum periods were calculated as percentages. The main maternal and fetal complications were preeclampsia (38%) and preterm births (38%), respectively. Pregnancy (odds ratio [OR]: 5.09; p=.02), proteinuria in the third trimester (OR: 5.52; p=.02), proteinuria in postpartum third months (OR: 7.4; p=.008) and stable creatinine levels in the first 6months of pregnancy (OR: 11.25 p=.03) were associated with graft dysfunction. Postpartum first year eGFR decline (-16.8% vs. -6.7%; p=.04) and second-year eGFR decline (-18.5% vs. -8.3%; p=.04) were significantly higher in the pregnancy group than those matched controls. Pregnancy after KT is associated with high rates of maternal and fetal complications. The sustained decline of eGFR may suggest an increased risk of graft loss compared to recipients with similar clinical characteristics.

Changes in alcohol consumption during pregnancy and over the transition towards parenthood

ObjectiveTo examine pre- to postnatal changes in drinking for women and men and assess the role of education level in these changes. BackgroundThe transition towards parenthood can contribute to significant shifts in alcohol consumption for women and men. Research has generally focused on pregnancy and short-term changes following childbirth, usually for mothers only. Socio-economic variation in the impact of childbirth and return to drinking postnatally is similarly understudied. MethodLongitudinal alcohol consumption data for 2470 individuals (1248 female) who were pregnant, or the partner of a pregnant woman, were obtained from a representative, Australian survey for three years prior and following birth.Piecewise regression models, including an education-x-time interaction, assessed changes in drinking quantity and frequency. ResultsFemale usual quantity and frequency significantly declined during pregnancy, followed by significant postnatal increases in quantity, approaching pre-pregnancy levels, with similar trends across education levels. Male usual quantity increased following childbirth, save for those men with a high-school education. Having an undergraduate degree was associated with a significant postnatal increase in drinking frequency. ConclusionFurther awareness of the risks associated with male-partner drinking could provide substantial public health benefits. Successful facilitation and implementation of interventions and harm reduction strategies for harmful drinking over the pre- to postnatal period could benefit from further consideration of socioeconomic status and education level, particularly for men.

Pre-pregnancy serum complement C3 level is a predictor of preterm birth for pregnancies with systemic lupus erythematosus

BackgroundThis study aimed to clarify predictors of preterm birth in pregnancy of women with systemic lupus erythematosus (SLE). We investigated the predictors of preterm birth before pregnancy from the perspective of the importance of preconception care.MethodsWe analysed fetal outcomes of 108 pregnancies in 74 SLE patients in a retrospective study. We compared pre-pregnancy clinical characteristics and disease activity in these women between the preterm birth and full-term birth groups to select predictive factors for preterm birth before pregnancy.ResultsEighty-three of 108 pregnancies resulted in live births, of which 27 (25.0%) were preterm births. Pre-pregnancy serum complement 3 (C3) level was significantly lower in the preterm birth group (77.0 mg/dl) than the full-term birth group (87.5 mg/dl) (P = 0.029). Multivariate analysis identified history of lupus nephritis (odds ratio: 5.734, 95% CI 1.568–21.010, P = 0.008) and low C3 level (< 85 mg/dl) at pre-pregnancy (odds ratio 4.498, 95% CI 1.296–15.616, P = 0.018) as risk factors for preterm birth. The greater the number of these risk factors, the higher was the preterm birth rate (P = 0.0007). In the case of SLEDAI score ≤ 4, the preterm birth rate was higher in the pre-pregnancy low C3 group (< 85 mg/dl) (42.1%) than in the high C3 group (C3 ≥ 85 mg/dl) (14.7%) (P = 0.018).ConclusionFor patients with a history of LN, treatment management focusing on pre-pregnancy serum complement levels is very important.

Does the birth of a child still prompt a marriage? A comparison of Austria, France, Germany and Hungary

ABSTRACT Austria, France, Germany, and Hungary are four neighbouring European societies all with conservative welfare regimes, yet with distinct institutional and structural features. We investigate how these differences shape a particular example of culturally contingent behaviour: cohabiting couples’ marriage behaviour when they have a child. Based on a discussion of relevant differences in family policy, legal frames and normative contexts, we develop hypotheses on country-specific marriage patterns. We test these hypotheses using longitudinal data from the Generations and Gender Programme (GGP) and the German Family Panel (pairfam). A number of relevant covariates were harmonized in order to be able to control for potential confounders which may affect the fertility process as well as marriage formation. Using discrete-time event history analysis, we observe robust differences in the effects of fertility on the marriage rate of cohabiting couples between the four countries. Pregnancy increases the marriage rate in Austria, Germany and Hungary, whereas no significant effect of fertility is found for France. After childbirth, the transition rate drops to its pre-pregnancy level in Austria and Germany and even below that in Hungary. Our findings point to a critical role of the socio-cultural context in which couples make relevant decisions about their private lives.

Physical Activity and Sitting Time From 16 to 24Weeks of Pregnancy to 12, 24, and 48Months Postpartum: Findings From the 2015 Pelotas (Brazil) Birth Cohort Study.

Physical activity levels decrease during pregnancy, and the time course of return to prepregnancy levels is unclear. This study aimed to describe changes in leisure-time physical activity (LTPA) and sitting time from 16 to 24weeks of pregnancy to 12, 24, and 48months postpartum in women with different education levels in Brazil. Data from 4000 mothers of children enrolled in the 2015 Pelotas (Brazil) Birth Cohort were analyzed. The women were interviewed between 16 and 24weeks of pregnancy and when their children were aged 12, 24, and 48months. The LTPA and sitting time were self-reported. Only 15.7% of the women reported any LTPA during pregnancy; this declined to 7.9% at 12months postpartum; it was 16.8% at 24months and 23.2% at 48months. On average, participants spent a mean (SD) of 6.4 (3.9), 4.2 (3.2), 4.3 (3.3), and 4.4 (3.3) hours per day sitting during pregnancy, and at 12, 24, and 48months after the birth, respectively. Both any LTPA and high sitting (8+ h/d) were consistently higher among women with higher education. After 24months postpartum, LTPA levels had returned to or exceeded pregnancy levels, but sitting time remained lower than during pregnancy.