End Of Pregnancy Research Articles

A qualitative exploration of the reasons and influencing factors for pregnancy termination among young women in Soweto, South Africa: a Socio-ecological perspective

BackgroundPregnancy termination is an essential component of reproductive healthcare. In Southern Africa, an estimated 23% of all pregnancies end in termination of pregnancy, against a backdrop of high rates of unintended pregnancies and unsafe pregnancy terminations, which contributes to maternal morbidity and mortality. Understanding the reasons for pregnancy termination may remain incomplete if seen in isolation of interpersonal (including family, peer, and partner), community, institutional, and public policy factors. This study therefore aimed to use a socio-ecological framework to qualitatively explore, in Soweto, South Africa, i) reasons for pregnancy termination amongst women aged 18–28 years, and ii) factors characterising the decision to terminate.MethodsIn-depth interviews were conducted between February to March 2022 with ten participants of varying parity, who underwent a termination of pregnancy since being enrolled in the Bukhali trial, set in Soweto, South Africa. A semi-structured, in-depth interview guide, based on the socioecological domains, was used. The data was analysed using reflexive thematic analysis, and a deductive approach.ResultsAn application of the socio-ecological framework indicated that the direct reasons to terminate a pregnancy fell into the individual and interpersonal domains of the socioecological framework. Key reasons included financial dependence and insecurity, feeling unready to have a child (again), and a lack of support from family and partners for the participant and their pregnancy. In addition to these reasons, Factors that characterised the participants’ decision experience were identified across all socio-ecological domains and included the availability of social support and (lack of) accessibility to termination services. The COVID-19 pandemic and resultant lockdown policies also indirectly impacted participants’ decisions through detrimental changes in interpersonal support and financial situation.ConclusionsAmongst the South African women included in this study, the decision to terminate a pregnancy was made within a complex structural and social context. Insight into the reasons why women choose to terminate helps to better align legal termination services with women’s needs across multiple sectors, for example by reducing judgement within healthcare settings and improving access to social and mental health support.

Associations of hypertension and antenatal care-seeking with perinatal mortality: A nested case-control study in rural Bangladesh.

Maternal hypertension may be an underrecognized but important risk factor for perinatal death in low resource settings. We investigated the association of maternal hypertension and perinatal mortality in rural Bangladesh. This nested, matched case-control study used data from a 2019 cross-sectional survey and demographic surveillance database in Baliakandi, Bangladesh. We randomly matched each pregnancy ending in perinatal death with five pregnancies in which the neonate survived beyond seven days based on maternal age, education, and wealth quintile. We estimated associations of antenatal care-seeking and self-reported hypertension with perinatal mortality using conditional logistic regression and used median and interquartile ranges to assess the mediation of antenatal care by timing or frequency. Among 191 cases and 934 matched controls, hypertension prevalence was 14.1% among cases and 7.7% among controls. Compared with no diagnosis, the probability of perinatal death was significantly higher among women with a pre-gestational hypertension diagnosis (OR 2.90, 95% CI 1.29, 6.57), but not among women with diagnosis during pregnancy (OR 1.68, 95% CI 0.98, 2.98). We found no association between the number of antenatal care contacts and perinatal death (p = 0.66). Among women with pre-gestational hypertension who experienced a perinatal death, 78% had their first antenatal contact in the sixth or seventh month of gestation. Hypertension was more common among rural women who experience a perinatal death. Greater effort to prevent hypertension prior to conception and provide early maternity care to women with hypertension could improve perinatal outcomes in rural Bangladesh.

Impact of Maternal Pre-Pregnancy Underweight on Cord Blood Metabolome: An Analysis of the Population-Based Survey of Neonates in Pomerania (SNiP).

Intrauterine growth restriction leads to an altered lipid and amino acid profile in the cord blood at the end of pregnancy. Pre-pregnancy underweight is an early risk factor for impaired fetal growth. The aim of this study was to investigate whether a pre-pregnancy body mass index (ppBMI) of <18.5 kg/m2, as early as at the beginning of pregnancy, is associated with changes in the umbilical cord metabolome. In a sample of the Survey of Neonates in Pomerania (SNIP) birth cohort, the cord blood metabolome of n = 240 newborns of mothers with a ppBMI of <18.5 kg/m2 with n = 208 controls (ppBMI of 18.5-24.9 kg/m2) was measured by NMR spectrometry. A maternal ppBMI of <18.5 kg/m2 was associated with increased concentrations of HDL4 cholesterol, HDL4 phospholipids, VLDL5 cholesterol, HDL 2, and HDL4 Apo-A1, as well as decreased VLDL triglycerides and HDL2 free cholesterol. A ppBMI of <18.5 kg/m2 combined with poor intrauterine growth (a gestational weight gain (GWG) < 25th percentile) was associated with decreased concentrations of total cholesterol; cholesterol transporting lipoproteins (LDL4, LDL6, LDL free cholesterol, and HDL2 free cholesterol); LDL4 Apo-B; total Apo-A2; and HDL3 Apo-A2. In conclusion, maternal underweight at the beginning of pregnancy already results in metabolic changes in the lipid profile in the cord blood, but the pattern changes when poor GWG is followed by pre-pregnancy underweight.

Epigenetic changes regulating the epithelial-mesenchymal transition in human trophoblast differentiation.

The phenotype of human placental extravillous trophoblast (EVT) at the end of pregnancy reflects both first trimester differentiation from villous cytotrophoblast (CTB) and later gestational changes, including loss of proliferative and invasive capacity. Invasion abnormalities are central to two major placental pathologies, preeclampsia and placenta accreta spectrum, so characterization of the corresponding normal processes is crucial. In this report, our gene expression analysis, using purified human CTB and EVT cells, highlights an epithelial-mesenchymal transition (EMT) mechanism underlying CTB-EVT differentiation and provides a trophoblast-specific EMT signature. In parallel, DNA methylation profiling shows that CTB cells, already hypomethylated relative to non-trophoblast cell lineages, show further genome-wide hypomethylation in the transition to EVT. However, a small subgroup of genes undergoes gains of methylation (GOM) in their regulatory regions or gene bodies, associated with differential mRNA expression (DE). Prominent in this GOM-DE group are genes involved in the EMT, including multiple canonical EMT markers and the EMT-linked transcription factor RUNX1, for which we demonstrate a functional role in modulating the migratory and invasive capacities of JEG3 trophoblast cells. This analysis of DE associated with locus-specific GOM, together with functional studies of an important GOM-DE gene, highlights epigenetically regulated genes and pathways acting in human EVT differentiation and invasion, with implications for obstetric disorders in which these processes are dysregulated.

Molar pregnancy: a qualitative study of personal experiences and societal narratives of loss

Background/Aims Molar pregnancy is a rare complication of pregnancy. Patients face surgery, human chorionic gonadotropin monitoring and potentially systemic treatment, resulting in unique support needs. This study's aim was to explore the impacts of gestational trophoblastic disease on embodied and emotional experience. Methods This qualitative study considered stories of molar pregnancy from 20 women in the UK, US, Canada and Australia. These were drawn from 18 publicly available online blogs and eight semi-structured interviews, and analysed thematically. Results Three themes were developed: ‘loss’, describing women's responses to their pregnancy ending; ‘isolation’, comprising ‘rarity’, ‘lack of awareness’ and support seeking; and ‘alienation’, capturing the unfamiliarity of diagnosis, ‘failure’ and barriers to ‘moving forward’. Conclusions Experiences are shaped by wider narratives of ‘typical’ pregnancy. Patient care requires an individualised and responsive approach, and non-specialist practitioners should feel confident in discussing molar pregnancy and have access to up-to-date guidance.

Quality of life and social support during pregnancy in Spanish population. A longitudinal study

BackgroundThe quality of life and social support during pregnancy are two variables influencing the health of pregnants and neonates. The documented impact of these variables on mental health, specifically the risk of depression, is notable. AimTo investigate the evolution of quality of life and social support at the beginning and end of pregnancy in pregnant women, and to examine the relationship between these variables. MethodsThe proposed longitudinal study includes 188 pregnants from a northern region of Spain. Participants were selected through consecutive sampling from September 2021 to April 2023. Quality of life and social support will be assessed in the first and third trimesters of pregnancy using the SF-36 questionnaire and MOS-SSS questionnaire, respectively. FindingsThe questionnaires show strong internal consistency (α = 0.91 and 0.97). Quality of life changes during pregnancy, declining in the physical component and rising in the mental component towards the end. Primiparous women have higher quality of life. Depression risk is 29.8 % in the 1st trimester, dropping to 22.9 % in the 3rd trimester. Social support decreases in the 3rd trimester, particularly among unmarried women. Significant positive correlations exist between quality of life and social support. ConclusionThis study emphasizes notable variations in quality of life and social support during pregnancy, impacting the health of pregnant individuals and neonates. Proposing standardization in monitoring these factors during prenatal check-ups aims to improve the physical and mental health of pregnant individuals and newborns.

Ligilactobacillus salivarius V4II-90 eradicates Group B Streptococcus colonisation during pregnancy: a randomised, double-blind, placebo-controlled trial.

Group B Streptococcus (GBS) is the leading cause of bacterial neonatal sepsis. This study aimed to confirm the effect of Ligilactobacillus salivarius V4II-90 on GBS colonisation during pregnancy. A randomised, multicentre, double-blind, placebo-controlled, parallel-group study was conducted in seven hospitals in Madrid, Spain. The sample was broken down into two groups with 20 participants each (n= 40) in order to show reduced GBS colonisation frequency in the probiotic versus the placebo group. Pregnant participants positive for vaginal-rectal colonisation before or during the 13th week of gestation were randomly assigned to either the placebo or the probiotic group. The probiotic, L. salivarius V4II-90 at 1× 109cfu/day was administered for 12 weeks, starting at week 21-23 of gestation. The primary outcome was the percentage of participants with vaginal and/or rectal GBS colonisation at the end of the intervention period (35 weeks of gestation). Secondary outcomes were changes in the microbial composition of vaginal and rectal exudates; premature delivery; premature rupture of membranes; intrapartum antibiotics; new-borns with early or late-onset GBS sepsis; adverse events (AEs); and GBS test results performed at the hospital at week 35 of gestation. Of the 481 participants included, 44 were vaginal-rectal colonised with GBS and randomised. 43 completed the study (20 in the probiotic group and 23 in the placebo group). After intervention, GBS was eradicated in six participants (27%) from the placebo group and in twelve participants (63%) from the probiotic group ( P = 0.030). None of the 185 AEs reported were identified as possibly, probably, or definitely related to the investigational product. In conclusion, oral administration of L. salivarius V4II-90 is a safe and successful strategy to significantly decrease the rates of GBS colonisation at the end of pregnancy and, therefore, to reduce the exposure of subjects and their infants to intrapartum antibiotic prophylaxis. Trial registered at ClinicalTrials.gov: number NCT03669094.

Statutory leave for early pregnancy loss: A comparative study

Pregnancy loss prior to fetal viability is a common experience for women worldwide – 1 in 4 pregnancies end in miscarriage. Increased recognition of the impact of such loss has put the issue of statutory leave in this context on the policy and legislative agenda in an increasing number of jurisdictions. This article seeks to help inform these debates by presenting the findings of a comparative study of jurisdictions which have introduced such leave. From this, the article identifies two main approaches: leave based on the sick leave model and leave based on the compassionate leave model. The article argues that both models have strengths and limitations. What works in each individual jurisdiction will depend, among other factors, on the way in which the jurisdiction in question addresses the issue of leave more broadly. However, regardless of the model adopted, the article argues that some form of statutory leave for miscarriage and other pregnancy loss should be introduced on the basis that such leave serves to reinforce the equality agenda, provides a chance for care and recovery following pregnancy loss, and serves an important expressive and educative goal in ensuring better understanding of the impact of pregnancy loss on those who experience such loss.

Gestational age-specific reference intervals for androgens in pregnancy.

Androgen could impact cervical remodelling during pregnancy, and a higher level is associated with adverse pregnancy outcomes. A population-based gestation age-specific reference interval (RI) of total testosterone (TT), androstenedione (A4), and 17-hydroxyprogesterone (17-OHP) can help to diagnose maternal hyperandrogenism. We enrolled 600 healthy Chinese women to obtain longitudinal serum samples across gestation. The serum androgen profile was measured by liquid chromatography-tandem mass spectrometry. The equations for medians of TT, A4, and 17-OHP were generated by MedCal, and the variances adjusted for 2-level modeling were generated by MLwiN, a system for the specification and analysis of a range of multilevel models. A4 and TT levels increased across the gestation, and they closely correlated with each other (R = 0.90, P=<0.001), whereas 17-OHP level decreased from 5th gestational week to 16th gestational week and then increased afterward towards the end of pregnancy. Women diagnosed with preeclampsia (PE) were found to have a significantly higher level of A4, TT, and 17-OHP when compared with non-PE cases with p ≤0.01, whereas mothers carrying male versus female fetuses have comparable levels of A4, TT, and 17-OHP. The study highlights a methodology for constructing gestational age-specific TT, A4, and 17-OHP levels to provide a better interpretation of results in a cohort of healthy Chinese women. The observation in PE supports previous findings, and the higher levels of TT, A4, and 17-OHP were observed before the onset of PE.

Neosporosis in Naturally Infected Sheep Herds, a Prospective Cohort Study over Three Years

Background: Neospora caninum is a protozoan parasite and a main cause of abortions in cattle worldwide. However, its role in abortions and decreased fertility in sheep is not completely understood, especially due to the complex, multifactorial etiology of abortions. This study aimed to perform a longitudinal field study to investigate the epidemiology of neosporosis and its effect on fertility in endemic sheep herds. Methods: Serological (IFAT) and clinical (outcome of pregnancy) data from 153 ewe-lambs was collected in four intensive management farms in Israel during three consecutive pregnancies. Results: The seroprevalence in ewe-lambs at different farms varied between 24% and 93%. The overall seroprevalence increased from 50% in ewe-lambs to 96.6% at the end of the third pregnancy. Horizontal infection was observed in all farms, with seroconversion in 59% of seronegative sheep. Abortion rates were lower (p = 0.004) in seropositive ewes in the first pregnancy and not significantly higher in seropositive sheep in consecutive pregnancies. Seropositivity or seroconversion were not associated with abortions or repeated abortions; however, many aborting ewes were removed from the flock. Conclusions: No direct short- or long-term association was found between Neopsora infection and abortions. The variations between flocks and pregnancies suggest a more complex etiology.

Activation of peripheral leukocyte migration before spontaneous labor at term

Leukocytes are induced to migrate into the uterus at parturition, releasing cytokines and chemokines that activate it for delivery. A specific chemotactic signal is required for these actions, and published evidence suggests that it comes from the human fetal membranes and has a time-dependent component (ie, cells obtained at term in labor migrate more than cells obtained at term not yet in labor). The hypothesis that the fetal membrane chemoattractants activate the leukocytes to become responsive for migration was tested. This study aimed to: (1) examine the changes in leukocyte migration-responsiveness longitudinally from the late third trimester, to in labor, to 3 days postpartum; (2) explore the specific week-to-week changes in migration before delivery; (3) define the timing of chemokine receptor expression patterns in leukocytes relative to migration and the changes in cytokine and chemokine concentrations in maternal serum; (4) examine the ability of term fetal membrane-conditioned medium and term maternal serum to increase cell responsiveness; and (5) test the potential of the leukocyte migration assay to predict delivery within 1 week. Leukocyte migration in response to a chemoattractive extract of term human fetal membranes was studied using a modified Boyden chamber. Flow cytometry assessed migrated cell phenotypes. The relationship between the expression of chemokine receptors and migration was tested using quantitative polymerase chain reaction, the bioassay, and regression analyses. Cytokines and chemokines in maternal serum were quantified using multiplex analysis. Conditioned medium from fetal membrane explants and maternal serum were evaluated for their abilities to enhance leukocyte migration using the bioassay. The ability of the bioassay to predict term delivery was assessed using receiver-operating characteristic curve and cost-curve analysis. The number of leukocytes that migrated at term delivery was increased relative to the late third trimester, followed by a significant fall in numbers that migrated at 3 days postpartum (P=.002). The largest increase in migrated cells occurred 1 to 2 weeks before delivery. The messenger RNA abundance of several chemokine receptors increased in peripheral leukocytes at term in labor relative to the third trimester, and this correlated with an increase in migrated cells in 5 of 6 cases (R=0.589 to 0.897; P<.03). The concentrations of several chemokines and cytokines in maternal serum increased with labor onset. Fetal membrane explant-conditioned medium and maternal serum obtained at term labor increased the responsiveness of leukocytes to fetal membrane chemoattractive extract. The bioassay was demonstrated to predict delivery within 7 days with excellent performance characteristics using a cohort prevalence of 71.7% (positive predictive value=96.1%; negative predictive value=58.5%; sensitivity=74.2%; specificity=92.3%; positive likelihood ratio=9.25; and negative likelihood ratio=0.28). A single determination was validated to have a high degree of confidence. Term human fetal membranes release chemoattractants near the end of pregnancy that increase in ability to activate and attract an increasing number of leukocytes as gestation advances.

SLO2.1/NALCN Functional Complex Activity in Mouse Myometrial Smooth Muscle Cells During Pregnancy.

At the end of pregnancy, the uterus transitions from a quiescent to a highly contractile state. This is partly due to depolarization of the resting membrane potential in uterine (myometrial) smooth muscle cells (MSMCs). Experiments with human MSMCs showed that the membrane potential is regulated by a functional complex between the sodium (Na+)-activated potassium (K+) channel SLO2.1 and the Na+ Leak Channel Non-Selective (NALCN). In human MSMCs, Na+ entering through NALCN activates SLO2.1, leading to K+ efflux, membrane hyperpolarization (cells become more negative inside), and reduced contractility. Decreased SLO2.1/NALCN activity results in reduced K+ efflux, leading to membrane depolarization, Ca2+ influx via voltage-dependent calcium channels, and increased MSMC contractility. However, all of these experiments were performed with MSMCs isolated from women at term, so the role of the SLO2.1/NALCN complex early in pregnancy was speculative. To address this question here, we examined the role of the SLO2.1/NALCN complex in regulating mouse MSMC membrane potential across pregnancy. We report that Slo2.1 and Nalcn expression change along pregnancy, being more highly expressed in MSMCs from non-pregnant and early pregnant mice than in those from late-pregnant mice. Functional studies revealed that SLO2.1 channels mediate a significant portion of the K+ current in mouse MSMCs, particularly in cells from non-pregnant and early pregnant mice. Activation of SLO2.1 by Na+ influx through NALCN led to membrane hyperpolarization in MSMCs from early pregnancy but not in MSMCs from later pregnancy. Moreover, we found that the NALCN/SLO2.1 complex regulates intracellular Ca2+ responses more in MSMCs from non-pregnant and early pregnancy mice than in MSMCs from late pregnancy. Together, these findings reveal that the SLO2.1/NALCN functional complex is conserved between mouse and humans and functions throughout pregnancy. This work could open avenues for targeted pharmacological interventions in pregnancy-related complications.

Efektifitas Pendamping Minum Tablet Tambah Darah terhadap Kadar Hemoglobin Ibu Hamil di Puskesmas Rappokalling Makassar

Indonesia is one of the countries with the highest MMR in Asia and the 3rd highest in the ASEAN region. MMR in Indonesia, the 2015 SUPAS results were 305/100,000 live births. Pregnant women are declared anemic if hemoglobin (Hb) &lt; 11 mg/L (1) . This study aims to determine the effectiveness of companions taking blood supplement tablets on the hemoglobin levels of pregnant women. The variables to be studied are companions taking Fe tablets and Hb levels of pregnant women. During pregnancy the plasma increases quite large, the hemoglobin and hematocrit concentrations decrease somewhat, during pregnancy the overall blood viscosity decreases, the average hemoglobin concentration at term is 12.5 g/dl and in around 5% of women the concentration is less than 11.0 g/dl, Therefore, a hemoglobin concentration below 11 g/dl, especially at the end of pregnancy, should be considered abnormal and is usually caused by iron deficiency and not due to hypervolemia of pregnancy. This research was conducted at the Rappokalling Makassar Community Health Center, using a non-probability sampling technique using accidental sampling.The results of companions taking blood supplement tablets are effective on the hemoglobin levels of pregnant women with p value = 0.005, therefore, to increase the hemoglobin levels of pregnant women when health workers give blood supplement tablets, it is best to involve husband/family companions as supervisors of taking medication who have previously been educated by health workers.

Effective vitamin D supplementation among women with gestational diabetes and perinatal outcomes: Results of a clinical trial

BackgroundGestational diabetes mellitus (GDM) is a common clinical condition worldwide that affects the health of women and their offspring. Theaim was to assess whether a protocol of vitamin D supplementation among women with GDM was efficient in increasing vitamin D levels at the end of pregnancy, and to explore whether the supplementation reduced the occurrence of adverse neonatal outcomes among those women. MethodsA controlled clinical trial.Vitamin D was assessed at baseline (< 28 gestational weeks) and after 8 weeks of intervention and categorized as adequate (>30 ng/mL), insufficient (20–29.9 ng/mL), or deficient (<20 ng/mL). Women with insufficiency received 2000 UI daily of vitamin D supplementation and those with deficiency received 7000 UI daily for 8 weeks. The outcomes 25-hydroxyvitamin D [25(OH)D] concentration at 28 weeks, glycemic control, total gestational weight gain, birth weight, and gestational age at birth. Statistical analyses included Chi-squared or Fisher’s exact tests for categorical variables and Kruskall–Wallis test for continuous variables to compare the groups. ResultsAt baseline, 59 pregnant women with GDM allocated to the study group were evaluated at baseline.Vitamin D status changed between the first and second examinations in 70 % of the women investigated. The insufficient and deficient groups showed a tendency towards improvement in glycemic control (p = 0.096). No differences were identified between the groups in terms of the neonatal variables. ConclusionSupplementation was effective in adjusting serum vitamin D levels, and its effect on glycemic control appeared promising in this preliminary investigation.

Influence of leptin administration to pregnant mice on fetal gene expression and adaptation to sweet and fatty food in adult offspring of different sexes.

Elevated leptin in pregnant mice improves metabolism in offspring fed high-calorie diet and its influence may be sex-specific. Molecular mechanisms mediating leptin programming action are unknown. We aimed to investigate programming actions of maternal leptin on the signaling function of the placenta and fetal liver and on adaptation to high-calorie diet in male and female offspring. Female C57BL/6J mice received leptin injections in mid-pregnancy. Gene expression was assessed in placentas and in the fetal brain and liver at the end of pregnancy. Metabolic parameters and gene expression in the liver, brown fat and hypothalamus were assessed in adult male and female offspring that had consumed sweet and fatty diet (SFD: chow, lard, sweet biscuits) for 2 weeks. Females had lower blood levels of leptin, glucose, triglycerides and cholesterol than males. Consuming SFD, females had increased Ucp1 expression in brown fat, while males had accumulated fat, decreased blood triglycerides and liver Fasn expression. Leptin administration to mothers increased Igf1 and Dnmt3b expression in fetal liver, decreased post-weaning growth rate, and increased hypothalamic Crh expression in response to SFD in both sexes. Only in male offspring this administration decreased expression of Fasn and Gck in the mature liver, increased fat mass, blood levels of glucose, triglycerides and cholesterol and Dmnt3a expression in the fetal liver. The results suggest that the influence of maternal leptin on the expression of genes encoding growth factors and DNA methyltransferases in the fetal liver may mediate its programming effect on offspring metabolic phenotypes.

Characteristics and pregnancy outcomes of pregnant women by cancer diagnosis status.

11038 Background: Given the broad exclusion of pregnant patients from clinical trials, limited evidence exists on the impact of cancer diagnoses on pregnancy outcomes. This study aimed to describe patient characteristics and end of pregnancy events among women with and without a cancer diagnosis before pregnancy. Methods: This retrospective claims study used data from the Komodo Research Dataset between 01/01/2016–08/31/2023 to identify adult women with a known gestation of pregnancy record and end of pregnancy outcome. Eligible members needed to be continuously enrolled in medical and prescription drug plans for both 365 days before (baseline) and after the derived pregnancy start (index date). This pregnancy cohort was then stratified according to cancer status, evidenced by any cancer diagnosis during the baseline period, to allow assessment of pregnancy outcomes. Valid pregnancy outcomes included full or preterm live birth and pregnancy loss such as miscarriage, stillbirth, and elective termination. Only the earliest pregnancy observed for each eligible member was analyzed. Results: Among the 1,921,866 pregnant women included in the analyses, only 0.7% (N=12,723) of patients had any cancer diagnosis in the year prior to pregnancy start. Cancer patients were older than non-cancer patients (mean age: 33.8 and 29.2 years, respectively). Commercial medical insurance was more common (67.7% vs. 58.9%) among cancer vs. non-cancer patients and Medicaid enrollment was less common (30.3% vs. 40.6%) upon pregnancy start. The proportion of patients with a live birth was lower among cancer vs. non-cancer patients (59.7% vs. 67.1%), while the proportion with pregnancy loss was higher (31.6% vs. 25.8%). Medicaid enrollment was more common among patients that had a pregnancy loss relative to live birth for both cancer and non-cancer patients (35.5% vs. 27.5% and 45.7% vs. 38.7%, respectively). The proportion of black patients was higher among patients with a pregnancy loss relative to those with live birth in both cohorts (cancer: 11.1% vs. 8.3%; non-cancer: 16.9% vs. 13.7%), while the proportion of white patients was similar for cancer patients with a pregnancy loss vs. live birth (37.4% vs. 37.1%) and the proportion was lower for non-cancer patients (30.4% vs. 34.4%). Conclusions: Preliminary findings suggest pregnancy loss was more common among cancer patients than non-cancer patients. Regardless of cancer status, differences in insurance coverage and race were observed for patients with a live birth relative to patients with pregnancy loss. Additional research should be conducted to identify factors driving differences in pregnancy outcomes, such as in care management by race and ethnicity, particularly among the vulnerable population of cancer patients.

Corticogenesis and folding process of the neopallium in the South American plains vizcacha, Lagostomus maximus.

The plains vizcacha, Lagostomus maximus, is a precocial hystricomorph rodent with a gyrencephalic brain. This work aimed to perform a time-lapse analysis of the embryonic brain cortical development in the plains vizcacha to establish a species-specific temporal window for corticogenesis and the gyrencephaly onset. Additionally, a comparative examination with evolutionarily related rodents was conducted. Embryos from 40embryonic days (ED) until the end of pregnancy ( 154 ED) were evaluated. The neuroanatomical examination determined transverse sulci at 80ED and rostral lateral and caudal intraparietal sulci around 95ED. Histological examination of corticogenesis showed emergence of the subplate at 43ED and expansion of the subventricular zone (SVZ) and its division into inner and outer SVZs around 54ED. The neocortical layers formation followed an inside-to-outside spatiotemporal gradient beginning with the emergence of layers VI and V at 68ED and establishing the final six neocortical layers around 100ED. A progressive increment of gyrencephalization index (GI) from 1.005±0.003 around 70ED, which reflects a smooth cortex, up to 1.07±0.009 at the end of gestation, reflecting a gyrencephalic neuroanatomy, was determined. Contrarily, the minimum cortical thickness (MCT) progressively decreased from 61ED up to the end of gestation. These results show that the decrease in the cortical thickness, which enables the onset of neocortical invaginations, occurs together with the expansion and subdivision of the SVZ. The temporal comparison of corticogenesis in plains vizcacha with that in relative species reflects a prenatal long process compared with other rodents that may give an evolutionary advantage to L. maximus as a precocial species.

Hematological parameters of healthy pregnant women in three trimesters compared with parameters of non-pregnant women

Anemia is a public health problem, especially in developing countries. All over the world iron deficiency is the main cause of anemia, especially during pregnancy. Pregnant women belong to the most vulnerable population group in Iraq.The objective: to determine the impact of pregnancy on hematological parameters and to compare the hematological indicators in different periods of gestation with the indicators of non-pregnant women.Materials and methods. The study was conducted over a three-month period at Baghdad hospitals and medical centers, including Baghdad Teaching Hospital, Al-Karam Hospital, and a health center in Al-Dorrah and Al-Shaab, Baghdad province, from September 1 to December 1, 2022. 60 pregnant women, 20 persons in each trimester, and 25 non-pregnant women (control) aged 18–35 years were included in the study. All participants were examined for hematological parameters: hemoglobin, erythrocytes, packed cell volume (PCV), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), measured of the concentration of hemoglobin in red blood cells (MCHC) and determined the level of iron in the blood (serum iron – SI, total iron binding capacity – TIBC, transferrin saturation – TS and serum ferritin – SF).Results. A significant decrease in the hematological indicators of pregnant women in the first trimester of pregnancy compared to non-pregnant women was established – hemoglobin, erythrocytes, PCV, MCH, MCHC. The dynamics of the decrease in the level of these parameters increases in the second trimester, and also progressively decreases in the third trimester, which leads to anemia.Starting from the first trimester and during the second and third trimesters, a decrease in the level of serum iron, transferrin saturation and serum ferritin was found in pregnant women compared to non-pregnant women, but the level of TIBC increased. During the second trimester, the need for iron begins to increase and continues to growth until the end of pregnancy. In addition, these research results indicate the importance of iron deficiency in the development of iron deficiency anemia.Conclusions. During pregnancy, anemia and a decrease in the level of some hematological parameters were determined, which progresses with increasing gestational age and is less compared to that in non-pregnant women. A decrease in the level of iron in the blood serum was established from the first to the third trimester of pregnancy. The severity of anemia is related to many factors, especially age, education level, low income, type of diet and parity.

Distinct cytokine profiles in late pregnancy in Ugandan people with HIV

During pregnancy, multiple immune regulatory mechanisms establish an immune-tolerant environment for the allogeneic fetus, including cellular signals called cytokines that modify immune responses. However, the impact of maternal HIV infection on these responses is incompletely characterized. We analyzed paired maternal and umbilical cord plasma collected during labor from 147 people with HIV taking antiretroviral therapy and 142 HIV-uninfected comparators. Though cytokine concentrations were overall similar between groups, using Partial Least Squares Discriminant Analysis we identified distinct cytokine profiles in each group, driven by higher IL-5 and lower IL-8 and MIP-1α levels in pregnant people with HIV and higher RANTES and E-selectin in HIV-unexposed umbilical cord plasma (P-value < 0.01). Furthermore, maternal RANTES, SDF-α, gro α\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\mathrm{\\alpha }$$\\end{document}-KC, IL-6, and IP-10 levels differed significantly by HIV serostatus (P < 0.01). Although global maternal and umbilical cord cytokine profiles differed significantly (P < 0.01), umbilical cord plasma profiles were similar by maternal HIV serostatus. We demonstrate that HIV infection is associated with a distinct maternal plasma cytokine profile which is not transferred across the placenta, indicating a placental role in coordinating local inflammatory response. Furthermore, maternal cytokine profiles in people with HIV suggest an incomplete shift from Th2 to Th1 immune phenotype at the end of pregnancy.

Targeting strategies for balanced energy and protein (BEP) supplementation in pregnancy: study protocol for the TARGET-BEP cluster-randomized controlled trial in rural Bangladesh

BackgroundThe World Health Organization (WHO) recommends balanced energy and protein (BEP) supplementation be provided to all pregnant women living in undernourished populations, usually defined as having a prevalence > 20% of underweight women, to reduce the risk of stillbirths and small-for-gestational-age neonates. Few geographies meet this threshold, however, and a large proportion of undernourished women and those with inadequate gestational weight gain could miss benefiting from BEP. This study compares the effectiveness of individual targeting approaches for supplementation with micronutrient-fortified BEP vs. multiple micronutrient supplements (MMS) alone as control in pregnancy in improving birth outcomes.MethodsThe TARGET-BEP study is a four-arm, cluster-randomized controlled trial conducted in rural northwestern Bangladesh. Eligible participants are married women aged 15–35 years old identified early in pregnancy using a community-wide, monthly, urine-test-based pregnancy detection system. Beginning at 12–14 weeks of gestation, women in the study area comprising 240 predefined sectors are randomly assigned to one of four intervention arms, with sector serving as the unit of randomization. The interventions involving daily supplementation through end of pregnancy are as follows: (1) MMS (control); (2) BEP; (3) targeted BEP for those with pre-pregnancy body mass index (BMI) < 18.5 kg/m2 and MMS for others; (4) targeted BEP for those with pre-pregnancy BMI < 18.5 kg/m2, MMS for others, and women with inadequate gestational weight gain switched from MMS to BEP until the end of pregnancy. Primary outcomes include birth weight, low birth weight (< 2500 g), and small for gestational age, defined using the 10th percentile of the INTERGROWTH-21st reference, for live-born infants measured within 72 h of birth. Project-hired local female staff visit pregnant women monthly to deliver the assigned supplements, monitor adherence biweekly, and assess weight regularly during pregnancy. Trained data collectors conduct pregnancy outcome assessment and measure newborn anthropometry in the facility or home depending on the place of birth.DiscussionThis study will assess the effectiveness of targeted balanced energy and protein supplementation to improve birth outcomes among pregnant women in rural Bangladesh and similar settings.Trial registrationClinicalTrials.gov NCT05576207. Registered on October 5th, 2022.