Premature Expulsion Research Articles

Gingerol Derivatives as 14α-demethylase Inhibitors: Design and Development of Natural, Safe Antifungals for Immune-compromised Patients

Background: :Currently, clinically used drugs for internal fungal infections have severe side effects. Patients suffering from severe fungal infections and those at a constant risk of developing such infections require long-term administration of safe antifungals.Objective: :This work deals with the design and development of safe, non-toxic antifungals derived from natural compounds for immune-compromised patients, such as HIV patients, who are at a constant risk of developing internal fungal infections.Methods: :Molecular modeling, docking and molecular dynamics simulation studies were performed on the main constituents of ginger and their derivatives to study their capability to inhibit 14α- demethylase enzyme.Results: :Ergosterol is the key component of the fungal cell membrane for its integrity and rigidity, synthesized from lanosterol catalyzed by 14α-demethylase enzyme. In our studies, it is determined that 6-gingerol, 6-paradol, 6-shogaol and their imidazole and triazole derivatives can inhibit the synthesis of ergosterol thus weakening the fungal cell membranes. The triazole derivative of 6-gingerol forms enhanced binding interactions with the active site residues of 14α-demethylase, carries an affinity for catalytically required cofactor heme and forms a stable complex with time without the probability of premature expulsion. Thus, this compound inhibits the formation of ergosterol leading to weakened fungal cell membranes and eventually death of fungal cells.Conclusion: :The triazole derivative of 6-gingerol is recommended as a lead compound for the development of non-toxic antifungals.

ICONE23-1053 OPPORTUNITIES AND NEED TO FURTHER UPGRADE CANDU REACTORS FOR IMPROVED SEVERE ACCIDENT MITIGATION AND REDUCTION OF RISK

Independent deterministic analyses of system response and severe accident progression after a station blackout scenario for CANDU single and multi-unit reactors have unveiled a number of design vulnerabilities that cause uncontrolled pressure boundary ruptures; premature expulsion of coolant from main loops and from the moderator heat sink; direct exposure of core debris and fission product releases to the containment; thermo-mechanical failure of the thin shell Calandria vessel welds; accelerated production of hydrogen with containment boundary failures by steaming as well as by sparsely populated PARS units potentially exposed to high concentration deuterium/hydrogen they are unable to adequately mitigate. A number of design enhancements can however be undertaken to minimize risk from a severe accident by eliminating or avoiding some of the undesirable system responses. Engineered design measures to also avoid some the undesirable accident progression paths have been summarized in the paper. The Canadian regulatory body CNSC prepared a number of design enhancement requests as part of post Fukushima reviews but then accepted measures and submissions that do not meet the public expectations for risk reduction after Fukushima on all counts. Without thoughtful and timely design changes, consequences of a severe core damage in a CANDU reactor can pose risks that are still unacceptable especially after the hype that surrounded the utility 'Stress Tests' and regulatory 'Action Items' that followed Fukushima disaster in 2011. It is stressed that operating CANDU and other similar PHWRs in India are unique; have an enviable safety record; have maintained very high operational loads and the observations in this paper relate to requirements for mitigating a range of potential severe accidents whose probability has been demonstrated to be relatively high given that less than 15000 reactor years of operation have resulted in 3 severe accidents that have caused more off-site damage than ever anticipated. That is something the founding fathers did not consider within the design basis and the current regulating bodies have a difficult time wrapping their head around. Utilities that operate the plants have shown no visible leadership in self assessments; have rejected any attempts to enlighten them and the risk posed by continued operation of these plants can only be minimized by an open discussion of the totality of issues as attempted in this paper.

Follow-up for improving psychological well being for women after a miscarriage

Miscarriage is the premature expulsion of an embryo or fetus from the uterus up to 23 weeks of pregnancy and weighing up to 500 grams. International studies using diagnostic tools have identified that some women suffer from anxiety, depression and grief after miscarriage. Psychological follow-up might detect those women who are at risk of psychological complications following miscarriage. This review is necessary as the evidence is equivocal on the benefits of psychological follow-up after miscarriage. Whether follow-up affects the psychological well being of women following miscarriage. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 December 2011), reference lists of all retrieved papers and contacted professional and lay organisations to obtain any ongoing trials or unpublished data. Randomised controlled trials only. All potential trials for eligibility according to the criteria specified in the protocol by screening the titles and abstracts, retrieving full reports of potentially relevant trials for assessment. All review authors extracted data and checked for accuracy. No studies were published in duplicate. When data were missing and only the abstract was available, we attempted to contact the trial authors. We resolved any disagreement through discussion. Six studies involving 1001 women were included. Three trials compared one counselling session with no counselling. There was no significant difference in psychological well being including anxiety, grief, depression avoidance and self-blame. One trial compared three one-hour counselling sessions with no counselling at four and 12 months. Some subscales showed statistical significance in favour of counselling and some in favour of no counselling. The results for two trials were given in narrative form as data were unavailable for meta-analyses. One trial compared multiple interventions. The other trial compared two counselling sessions with no counselling. Neither study favoured counselling. Evidence is insufficient to demonstrate that psychological support such as counselling is effective post-miscarriage. Further trials should be good quality, adequately-powered using standardised interventions and outcome measures at specific time points. The economic implications and women's satisfaction with psychological follow-up should also be explored in any future study.

From evidence based bioethics to evidence based social policies

In this issue, Norwegian authors demonstrate that causes of early expulsion out the workforce are rooted in childhood. They reconstruct individual biographies in administrative databases linked by an unique national identification number, looking forward 15 years in early adulthood and looking back 20 years till birth with close to negligible loss to follow up. Evidence based bioethics suggest that it is better to live in a country that allows reconstructing biographies in administrative databases then in countries that forbid access by restrictive legislation based on privacy considerations. The benefits of gained knowledge from existing and accessible information are tangible, particularly for the weak and the poor, while the harms of theoretical privacy invasion have not yet materialised. The study shows once again that disadvantage runs in families. Low parental education, parental disability and unstable marital unions predict early disability pensions and premature expulsion out gainful employment. The effect of low parental education is mediated by low education of the index person. However, in a feast of descriptive studies of socio-economic causes of ill health we still face a famine of evaluative intervention studies. An evidence based social policy should be based on effective interventions that are able to break the vicious circles of disability handed down from generation to generation.

AKTIVITAS KONTRASEPSI DAN INTERSEPSI EKSTRAK METANOL DAUN BENALU Dendrophthoe petandra L PADA MENCIT

It had been reported that leaf of Dendrophthoe petandra contained a flavonol glycoside of which quercetion was its aglycone. In-vitro study in the activity of quercetin indicated that quercetin inhibited the activity of sperm hyaluronidase. So it meant quercetin inhibited sperm penetration into cumulus. Other study proved that quercetin inhibited the activity of cytochrome P-450 III A 4 enzyme which catalyzed the reversible hydroxylation of estradiol-17 into estrone and futher into estriol. The elevation of estradiol serum level disturbed gamete and zygote transport in oviduct causing premature expulsion of zygote into uterus. This research was designed to provide information about the anti-fertility activity of methanolic extract of leaf of Dendrophthoe petandra, focused on its contraceptive and interceptive activity. Virgin female Balc-C mice were used as the test animals. Each study had two group of mice which were treated with 150 mg/30 g and 200 mg/30 g extract respectively. Control group were treated with respective vehicle at 1 ml/30 g. statistical analysis of data (p less than 0.05) concluded that the extract had contraceptive and interceptive activity. According to the criterion given by Lee andChi (1985), this methanolic extract had a priority for further study.

Effects of phosphate on the reproductive symbiosis between bitterling and freshwater mussels: implications for conservation

Summary We examined the effects of phosphorus, an important pollutant in fresh waters, on mussels Anodonta anatina and embryos of European bitterling Rhodeus sericeus amarus. These species are involved in an unusual symbiosis, with the fish depositing eggs inside the mussels' gills, where the embryos develop for 3–6 weeks until the larvae leave the mussel. High concentrations of phosphate (500 μg L−1 and higher) caused a significant increase in the rate of premature expulsion and emergence of bitterling embryos from the mussels, with a concomitant increase in fish mortality. At concentrations of 750 μg L−1 and higher, mussels reduced their frequency of ventilation and movements through the substratum. These results have implications for understanding the nature of the symbiosis between the fish and their mussel hosts, showing that mussels have control over bitterling developing in their gills. The premature expulsion of bitterling embryos at high phosphate levels is detrimental to the fish that they harbour. Recommendations for the conservation of bitterling and species of mussels, which are threatened or endangered over parts of their ranges, include reductions in levels of phosphorus in natural habitats and the need for low levels in reintroduction sites for the fish and their mussel hosts.

A novel role for the peritrophic matrix in protecting Leishmania from the hydrolytic activities of the sand fly midgut.

The role of the peritrophic matrix (PM) in the development of Leishmania major infections in a natural vector, Phlebotomus papatasi, was investigated by addition of exogenous chitinase to the bloodmeal, which completely blocked PM formation. Surprisingly, the absence of the PM was associated with the loss of midgut infections. The chitinase was not directly toxic to the parasite, nor were midgut infections lost due to premature expulsion of the bloodmeal. Most parasites were killed in chitinase-treated flies within the first 4 h after feeding. Substantial early killing was also observed in control flies, suggesting that the lack of PM exacerbates lethal conditions which normally exist in the blood-fed midgut. Early parasite mortality was reversed by soybean trypsin inhibitor. Allosamadin, a specific inhibitor of chitinase, led to a thickening of the PM, and also prevented the early parasite mortality seen in infected flies. Susceptibility to gut proteases was extremely high in transitional-stage parasites, while amastigotes and fully transformed promastigotes were relatively resistant. A novel role for the PM in promoting parasite survival is suggested, in which the PM creates a barrier to the rapid diffusion of digestive enzymes, and limits the exposure of parasites to these enzymes during the time when they are especially vulnerable to proteolytic damage.

Rh-erythropoietin stimulates immature reticulocyte release in man.

The pharmacodynamics of single intravenous dosing with recombinant human erthropoietin (rhEPO) was investigated in eight healthy volunteers (150 U/kg, n = 2; 300 U/kg, n = 6) with respect to reticulocyte subdivisions (by fluorescence flow cytometry) and serum ferritin over 6.5 d. The present study shows that bolus rhEPO injection produces an immediate release of high and middle fluorescence (immature) reticulocytes with a high RNA content from the marrow into the circulation, whereas the low fluorescence (more mature) reticulocytes were at first not affected. Serum ferritin decreased markedly within 24 h, reaching a nadir 50% of baseline after 120 h (5 d), with no increase in haemoglobin. Our data suggests that rhEPO triggers premature expulsion of immature reticulocytes from the bone marrow into the circulation independent of its effect in stimulating erythropoiesis and that rhEPO has an effect on serum ferritin concentration which in this dynamic situation is dependent not only on the iron stores.

Plasma 1,25 dihydroxycholecalciferol and its free index are potentiated by ovulation dependent factors and shell formation induced hypocalcemia in the laying hens

The time-course of the changes in blood ionized calcium, and in plasma 1,25 dihydroxycholecalciferol (1,25(OH) 2D 3) concentrations and its free index were studied in hens following suppression and resumption of shell formation and throughout the laying cycle in hens laying hard-shelled eggs, in hens fed a low or normal calcium diet and in hens laying shell-less eggs. The respectives roles of the calcium needs for shell formation and of the reproductive status in regulation of 1,25(OH) 2D 3 production were analysed. Plasma 1,25(OH) 2D 3 decreased 3 hr after suppression of shell formation following premature egg expulsion and remained lower than that of hens laying hard-shelled eggs when premature expulsion of the eggs was continued for several days. Circulating 1,25(OH) 2D 3 tended to increase progressively when shell formation was resumed. Ablation of the parathyroid glands abolished this increase. In hens laying hard-shelled eggs, the plasma 1,25(OH) 2D 3 was higher during the period of shell secretion. Feeding hens a low calcium diet (1.2%) caused a marked increase in the plasma 1,25(OH) 2D 3. Ionized calcium levels tended to show reciprocal changes to plasma 1,25(OH) 2D 3 decreasing when calcification took place and increasing after its suppression. In hypercalcemic hens laying shell-less eggs and fed a 3.5% Ca diet, the plasma 1,25(OH) 2D 3 was at a high level 4 hr after ovulation and diminished thereafter. This additive stimulation does not, therefore, involve the parathyroid gland and may involve hormonal changes induced by ovulation. Vitamin D binding protein (DBP) in the plasma was at a high level in mature hens and was not affected by shell formation. Consequently, the free 1,25(OH) 2D 3 index fluctuated in parallel with total level of this hormone in mature hens. It is concluded that the calcium demand for shell formation modulates, in the short term, plasma 1,25(OH) 2D 3, via the homeostatic regulation of blood calcium by PTH, but that a large part of its increase is independent of PTH and is associated with the endocrine events concomitant with ovulation.

The Effect of Indomethacin on Eggshell Quality

The objective of the present study was to determine whether indomethacin, an inhibitor of prostaglandin synthesis, could improve shell quality in birds laying a high incidence (>15%) of soft-shelled (SS) and shell-less (SL) eggs and in birds laying exclusively hard-shelled (HS) eggs. Treatments consisted of two injection types, indomethacin or oil (controls), and two injection times, 4 h or 16 h postentrance of the egg into the uterus. Indomethacin delayed oviposition in both HS and SS or SL egg layers, with indomethacin being more effective in delaying oviposition when injected at 16 h as compared with 4 h postentrance of an egg into the uterus. Indomethacin increased shell thickness of the first egg laid following injection in the SS or SL groups but not in the HS groups. Egg weight was not affected by indomethacin injection. It was concluded that indomethacin delayed oviposition and prevented the premature expulsion of some SS or SL eggs. This delay in oviposition resulted in thicker shells of the first egg laid postinjection.

Premature expulsion of the placenta and bovine perinatal mortality

In one study two cases of premature expulsion of the placenta were recorded among 60 supervised calvings (3.3 per cent); both calves died. In a second study, 47 cases were recorded among 332 cases of perinatal mortality (14.2 per cent). The condition was associated with fetal malpresentation and malposture, and mortality either before or during parturition. There was no significant relationship between the occurrence of premature expulsion of the placenta and parity, calving difficulty, previous calving history or the sex of the calf. The condition in cattle is compared with placenta praevia in women.

Effect of Dietary Acetylsalicylic Acid on Eggshell Quality

Acetylsalicylic acid (aspirin) is an inhibitor of prostaglandin synthesis. Many soft-shelled (SS) and shell-less (SL) eggs are laid prematurely. It is hypothesized that prostaglandins may be responsible for the premature expulsion of some SS or SL eggs. The objective of the present study was to determine whether aspirin would reduce the incidence of SS or SL eggs and result in a concomitant increase in hard-shelled (HS) eggs. Layer breeders in their 15th mo of production were divided into groups of high and low incidence SS or SL egg laying and fed either control or rations with .05% aspirin for 4 wk. A decrease (P<.05) in SL egg production occurred in the high incidence group of SS or SL egg layers fed aspirin as compared with controls, but there was no concomitant increase in HS eggs. The production of SS eggs was unaffected by dietary aspirin. It appeared that the aspirin-fed hens of the high incidence group of SS or SL egg layers were attempting to utilize more calcium for shell formation (fewer SL eggs) but at the expense of producing thinner shells for the HS eggs. Aspirin had no effect on the shell quality of HS eggs in the low incidence group of SS or SL egg layers. It was concluded that aspirin can reduce the production of SL eggs, but perhaps due to physiological limitations in calcium mobilization, these aged breeders were not able to convert the SL eggs to HS eggs.

Increases in calbindin D 28K mRNA in the uterus of the domestic fowl induced by sexual maturity and shell formation

Uterine concentrations of calbindin D 28K mRNA were measured in immature pullets and laying hens by dot-blot hybridization using a [ 32P]cRNA probe prepared from the calbindin cDNA. In immature pullets, estrogen increased the calbindin mRNA level and the plasma concentration of 1,25-dihydroxyvitamin D 3 [1,25-(OH) 2D 3]. When testosterone was administered with estrogen there was a further increase in calbindin and its mRNA and an increase in the free 1,25-(OH) 2D 3 index calculated as the ratio of the molar concentrations of total 1,25-(OH) 2D 3 and vitamin D-binding protein (DBP). In laying hens the uterine concentration of calbindin mRNA was low 4 hr after ovulation, but increased most markedly 12 and 18 hr later, when shell calcification took place. Calbindin concentration remained unchanged during the different stages of egg formation but was much higher in laying hens than in pullets treated with sex steroids. Suppression of shell formation by premature expulsion of the egg decreased the concentrations of calbindin mRNA and uterine calbindin and the free 1,25-(OH) 2D 3 index in the plasma. A concomitant increase in calbindin and its mRNA was observed at resumption of shell formation in hens previously laying shell-less eggs. With-drawal of food for 44 hr decreased the uterine concentration of calbindin and its mRNA without a change in the free 1,25-(OH) 2D 3 index in the blood. It is concluded that the synthesis of uterine calbindin is stimulated primarily at sexual maturity and at calcification of the first shell by transcriptional processes. The daily increase in calbindin mRNA associated with shell formation and the absence of a concomitant change in calbindin concentration suggest that post-transcriptional processes exist and that stimuli other than the sex steroid or the 1,25-(OH) 2D 3 are involved in regulation of calbindin synthesis in the uterus.

Effects of suppression and resumption of shell formation and parathyroid hormone on uterine calcium-binding protein, carbonic anhydrase activity, and intestinal calcium absorption in hens

The calcium absorption and duodenal and uterine vitamin D-dependent calcium-binding protein (CaBP-28K) levels were decreased in hens when eggshell calcification was suppressed by premature expulsion of the egg. Nevertheless, these levels remained higher than those of immature pullets or pullets treated with estrogen. The resumption of shell formation by hens which had previously laid soft-shell eggs was associated during calcification of the first egg with increases in intestinal Ca absorption, CaBP concentration, and alkaline phosphatase activity. The increase in uterine CaBP concentration preceded the stage of rapid calcium deposition. Uterine carbonic anhydrase activity was increased by sexual maturity but not consistently by shell formation. Ablation of the parathyroids just before the resumption of shell formation suppressed the increases in duodenal calcium absorption and CaBP concentration elicited by egg calcification. In contrast, the increase in CaBP level was maintained in the uterus of parathyroidectomized hens, in spite of the decreased shell deposition. Previous studies indicated that increased uterine CaBP associated with eggshell calcification is not elicited by vitamin D. The present study confirms this observation and also shows that these changes are not elicited by either PTH or sex steroid hormones.

Untersuchungen zur Jahresperiodik der Fortpflanzung beim miinnlichen Kammolch, Triturus cristatus cristatus Laurenti, in Abhiingigkeit von Photoperiode und Wassertemperatur

Under natural photoperiodic conditions and natural water temperatures, the spermatogenesis and testis cycle of Triturus cristatus cristatus exhibits a clear annual periodicity with one reproductive period extending from the end of April to the middle of June. This cycle can be divided into three different phases: 1 ) progression with expulsion of ripe sperma and subsequent spermatocytogenesis ; 2) regeneration with spermiohistogenesis and maximum testis' weight; 3) gonadal resting phase. An advance of gonadal activity in winter with premature expulsion of mature sperm a was only possible in LD 16 : 8 at 20 ± 1°C water temperature; complete spermatogenesis can occur after the middle of February. In the winter and summer, water temperature of 11 ± 1°C combined with long days, LD 12 : 12 , or with short days prevent any gonadal activity. Therefore, water temperature of 20 ± 1°C, combined with long days, are a prerequisite for adequate hypothalamus-hypophysis-gonad-activity. In a year's study with LD 16 : 8 at 20 ± 1°C water temperature, a more or less pronounced spermiahistogenetic activity without expulsion of sperma was observed.

Effect of RMI-12,936 on fertilization and egg transport in the rabbit

The effect of a single subcutaneous injection of 10 mg/kg, 17β-hydroxy-7α-methylandrost-5-en-3-one (RMI-12,936) on ovulation, fertilization and egg transport in rabbits was studied. In vehicle-treated estrous does 24 hr after the ovulation stimulus, all fertilized eggs were recovered from the oviducts. Whereas administration of RMI-12,936, 1 day before ovulation, did not affect the fertilization or the egg transport but the number of unruptured follicles was significantly increased (3.3% in control vs. 25% in RMI-12,936-treated does). When RMI-12,936 was given 3 days before ovulation, a premature expulsion of eggs into the uterus within 24 hr of ovulation was recorded. In addition, there was an increase in the number of unruptured follicles and only 41.9 percent of the ovulated eggs were recovered. Circulating progesterone ( Δ 4P), 20α-dihydroprogesterone (20α-DHP) and testosterone (T) concentrations monitored over a period of 24 hr after ovulation stimulus in RMI-12,936-treated does resulted in a significant increase in serum T. A suppression in Δ 4P and 20α-DHP one day after RMI-12,936 treatment was evident. In contrast, hCG failed to alter the Δ 4P and 20α-DHP levels in those does treated 3 days before with RMI-12,936. When RMI-12,936 results on egg transport were compared with those obtained from does treated with medroxyprogesterone acetate (MPA) or testosterone enanthate (TE), a reduction in the rate of egg recovery and an increase in the number of unruptured follicles in MPA-treated does were observed. It is concluded that RMI-12,936, if given before ovulation, can interrupt pregnancy by accelerating the egg transport without affecting the fertilization.

Further Studies With Hens Producing a High Incidence of Non-Calcified or Partially Calcified Egg Shells

Two experiments were conducted in which physical and chemical comparisons were made between hens producing a high or low percentage (40 and 4, respectively) of ultra-thin shell (UTS) or shell-less (SL) eggs to obtain information related to the cause of shell-less eggs. No difference was observed in the weight of the hen, egg, ovary or oviduct or in serum calcium or sodium between the UTS-SL hens and control hens. The hens producing a high incidence of shell-less and ultra-thin shell eggs (UTS-SL hens) consumed 2.6 grams less feed per hen per day, and the specific gravity of hard shell eggs was only slightly lower than that of controls. The mixed excreta of the UTS-SL hens contained significantly less sodium and potassium, and 15% more calcium than did the control hens. Tibia weight, breaking strength and ash was significantly greater in the UTS-SL hens. No difference was observed in calcium content of the isthmus and magnum but the uterus of the UTS-SL hens contained a significantly higher percent calcium than that of the control birds. Percent fat in the uterus was significantly increased. Percent fat was significantly increased in the liver (Exp. 1) of UTS-SL birds in Experiment 1 and numerically lower in Experiment 2.It was concluded that the inability of the UTS-SL hens to continuously produce eggs with normal shells is not due to a failure of the hen to absorb calcium from the digestive tract, transport it to the blood, bone or uterus but to the hens inability to utilize calcium at the actual site of egg shell formation or premature expulsion.

Intrauterine degeneration of embryos in IUD-bearing mice.

The effect of a unilaterally placed silk IUD on the fate of mouse embryos was investigated. In sham-operated controls examined at 72 and 96 hours after conception blastocysts were observed along both uterine horns and no polymorphonuclear leucocytes (PMNLs) were seen in the lumina of either of the horns or the oviducts. In contrast all IUD-bearing animals showed large masses of PMNLs surrounding the IUD and extending toward the uterine and ovarian extremities of the horn. Embryos were present in either the oviducts (tube-locked) or in the cranial portions of the uterine horns surrounded by PMNLs. Progressive signs of embryonic degeneration were observed. Possible modes of action of the IUD including premature expulsion of embryos through the cervix and cclusion by PMNLs are discussed.

The possible mode of action of prostaglandins: XI. Clomiphene citrate and the reversal of luteolytic or abortifacient efficacy of prostagland in F2a in rats

A single injection of prostaglandin F2a (PGF2a), 2.0 mg/kg bw, on day 10 of pregnancy resulted in luteal regression followed by resorption of fetuses and placentae. However, when the same regimen of PGF2a was scheduled on day 18, premature evacuation of the uterine content by 72 hr followed. A simultaneous regimen of clomiphene citrate at an antiestrogenic dose level concurrently with PGF2a consistently prevented either termination of pregnancy or premature expulsion of fetuses. The antifertility or abortifacient efficacy of PGF2a in rats is discussed.

FAMILIAL TRENDS IN LOW BIRTH WEIGHT

The reproductive performance of sisters and sisters-in-law of 185 women who had delivered “light-for-dates” and “premature expulsion” low birth weight infants was studied. Percentile birth weights were compared taking into account length of gestation, fetal sex, and the height, weight, parity, and smoking habits of the mother. Sisters of women who had delivered light-for-dates babies had lighter babies than the general population, their sisters-in-law, or the sisters of women in the premature expulsion group. These other groups, however, had the expected distribution of percentile birth weights. Data on familial trends in smoking habits and unknown gestation are also presented. The results are consistent with the theory that the mother9s own intrauterine experience affects her reproductive performance but could also be explained by shared family learning experience of as yet unidentified microsocial factors related to pregnancy performance.