Prenatal Treatment Research Articles

Gestational cholestyramine treatment protects adult offspring of ApoE-deficient mice against maternal-hypercholesterolemia-induced atherosclerosis.

Perinatal hypercholesterolemia exacerbates the development of atherosclerotic plaques in adult offspring. Here, we aimed to study the effect of maternal treatment with cholestyramine, a lipid-lowering drug, on atherosclerosis development in adult offspring of hypercholesterolemic ApoE-deficient (ApoE-/-) mice. ApoE-/- mice were treated with 3% cholestyramine (CTY) during gestation (G). After weaning, offspring (CTY-G) were fed control diet until sacrificed at 25weeks of age. Atherosclerosis development in the aortic root of offspring was assessed after oil-red-o staining, along with some of predefined atherosclerosis regulators such as LDL and HDL by high-performance liquid chromatography (HPLC), and bile acids (BA) and trimethylamine N-oxide (TMAO) by liquid chromatography-mass spectrometry (LC-MS/MS). In pregnant dams, cholestyramine treatment resulted in significantly lower plasma total- and LDL-cholesterol as well as gallbladder total BA levels. In offspring, both males and females born to treated dams displayed reduced atherosclerotic plaques areas along with less lipid deposition in the aortic root. No significant change in plasma total cholesterol or triglycerides was measured in offspring, but CTY-G males had increased HDL-cholesterol and decreased apolipoproteins B100 to A-I ratio. This latter group also showed reduced gallbladder total and specifically tauro-conjugated bile acid pools, whereas for CTY-G females, hydrophilic plasma tauro-conjugated BA pool was significantly higher. They also benefited from lower plasma TMAO. Prenatal cholestyramine treatment reduces atherosclerosis development in adult offspring of ApoE-/- mice along with modulating the plaques' composition as well as some related biomarkers such as HDL-C, bile acids and TMAO.

Pleiotropic effects of trisomy and pharmacologic modulation on structural, functional, molecular, and genetic systems in a Down syndrome mouse model.

Down syndrome (DS) is characterized by skeletal and brain structural malformations, cognitive impairment, altered hippocampal metabolite concentration and gene expression imbalance. These alterations were usually investigated separately, and the potential rescuing effects of green tea extracts enriched in epigallocatechin-3-gallate (GTE-EGCG) provided disparate results due to different experimental conditions. We overcame these limitations by conducting the first longitudinal controlled experiment evaluating genotype and GTE-EGCG prenatal chronic treatment effects before and after treatment discontinuation. Our findings revealed that the Ts65Dn mouse model reflected the pleiotropic nature of DS, exhibiting brachycephalic skull, ventriculomegaly, neurodevelopmental delay, hyperactivity, and impaired memory robustness with altered hippocampal metabolite concentration and gene expression. GTE-EGCG treatment modulated most systems simultaneously but did not rescue DS phenotypes. On the contrary, the treatment exacerbated trisomic phenotypes including body weight, tibia microarchitecture, neurodevelopment, adult cognition, and metabolite concentration, not supporting the therapeutic use of GTE-EGCG as a prenatal chronic treatment. Our results highlight the importance of longitudinal experiments assessing the co-modulation of multiple systems throughout development when characterizing preclinical models in complex disorders and evaluating the pleiotropic effects and general safety of pharmacological treatments.

Pleiotropic effects of trisomy and pharmacologic modulation on structural, functional, molecular, and genetic systems in a Down syndrome mouse model

Down syndrome (DS) is characterized by skeletal and brain structural malformations, cognitive impairment, altered hippocampal metabolite concentration and gene expression imbalance. These alterations were usually investigated separately, and the potential rescuing effects of green tea extracts enriched in epigallocatechin-3-gallate (GTE-EGCG) provided disparate results due to different experimental conditions. We overcame these limitations by conducting the first longitudinal controlled experiment evaluating genotype and GTE-EGCG prenatal chronic treatment effects before and after treatment discontinuation. Our findings revealed that the Ts65Dn mouse model reflected the pleiotropic nature of DS, exhibiting brachycephalic skull, ventriculomegaly, neurodevelopmental delay, hyperactivity, and impaired memory robustness with altered hippocampal metabolite concentration and gene expression. GTE-EGCG treatment modulated most systems simultaneously but did not rescue DS phenotypes. On the contrary, the treatment exacerbated trisomic phenotypes including body weight, tibia microarchitecture, neurodevelopment, adult cognition, and metabolite concentration, not supporting the therapeutic use of GTE-EGCG as a prenatal chronic treatment. Our results highlight the importance of longitudinal experiments assessing the co-modulation of multiple systems throughout development when characterizing preclinical models in complex disorders and evaluating the pleiotropic effects and general safety of pharmacological treatments.

Maternal and Offspring Fatty Acid Desaturase Variants, Prenatal DHA Supplementation, and Dietary n–6:n–3 Fatty Acid Ratio in Relation to Cardiometabolic Health in Mexican Children

BackgroundSingle-nucleotide polymorphisms (SNPs) in fatty acid desaturase (FADS) genes may modify dietary fatty acid requirements and influence cardiometabolic health (CMH). ObjectivesWe evaluated the role of selected variants in maternal and offspring FADS genes on offspring CMH at the age of 11 y and assessed interactions of genotype with diet quality and prenatal docosahexaenoic acid (DHA) supplementation. MethodsWe used data from offspring (n = 203) born to females who participated in a randomized controlled trial of DHA supplementation (400 mg/d) from midgestation to delivery. We generated a metabolic syndrome (MetS) score from body mass index, high-density lipoprotein cholesterol, triglycerides, systolic blood pressure, and fasting glucose and identified 6 distinct haplotypes from 5 offspring FADS SNPs. Dietary n–6 (ω–6):n–3 fatty acid ratios were derived from 24-h recall data (n = 141). We used generalized linear models to test associations of offspring diet and FADS haplotypes with MetS score and interactions of maternal and offspring FADS SNP rs174602 with prenatal treatment group and dietary n–6:n–3 ratio on MetS score. ResultsAssociations between FADS haplotypes and MetS score were null. Offspring SNP rs174602 did not modify the association of prenatal DHA supplementation with MetS score. Among children with TT or TC genotype for SNP rs174602 (n = 88), those in the highest n–6:n–3 ratio tertile (>8.61) had higher MetS score relative to the lowest tertile [<6.67) (Δ= 0.36; 95% confidence interval (CI): 0.03, 0.69]. Among children with CC genotype (n = 53), those in the highest n–6:n–3 ratio tertile had a lower MetS score relative to the lowest tertile (Δ= –0.23; 95% CI: –0.61, 0.16). ConclusionsThere was evidence of an interaction of offspring FADS SNP rs174602 with current dietary polyunsaturated fatty acid intake, but not with prenatal DHA supplementation, on MetS score. Further studies may help to determine the utility of targeted supplementation strategies and dietary recommendations based on genetic profile.

Prenatal diagnosis and in utero treatment of congenital adrenal hyperplasia: An up-to-date comprehensive review.

Congenital adrenal hyperplasia (CAH) is a term that encompasses a wide range of conditions that affect the adrenals. Diagnosis and treatment before birth are important as irreparable birth defects can be avoided, decreasing the need for surgical intervention later in life, especially regarding genitalia anomalies. Although early implementation of dexamethasone in the prenatal treatment of CAH has been controversial, there is recent evidence that this treatment can reduce long-term complications.

Fetal circular shunt in Ebstein's anomaly and non-steroidal anti-inflammatory treatment.

A circular shunt is a poor prognostic factor associated with Ebstein's anomaly. Targeting the constriction of the ductus arteriosus (DA) in order to limit or resolve the circular shunt, has been shown to improve fetal outcomes. Prenatal non-steroidal anti-inflammatory drugs (NSAIDs) have been known to constrict the DA. Recently, prenatal NSAIDs have been used for that purpose in the treatment of circular shunt. Limited research shows that it may be an effective treatment leading to improved fetal outcomes. In this article, we did an extensive review of literature to describe this therapy's effectiveness and outcomes. 82% of fetuses were able to achieve ductal constriction with prenatal NSAID therapy. For fetuses who achieved ductal constriction, fetal demise was less likely (6%) when compared to those who were unable to achieve the same (50%). Of all the fetuses with hydrops, 50% had resoluation of hydrops with prenatal NSAID treatment.

Effectiveness of Prenatal Gentle Yoga on Improvement Level of Depression in Pregnant Women Age &lt;20 and &gt;35 Years

This study aims to analyze the effectiveness of prenatal gentle yoga on depression problems in pregnant women aged &lt;20 and &gt;35 years. This research was carried out at the Bara Baraya Health Center, Antang Health Center, Kapasa Health Center, and Mamajang Health Center. The research design used in this research is Quasi Experiment with a Nonequivalent Control Group Design approach. Sampling used a purposive sampling technique. The instrument used was the Beck Depression Inventory (BDI) questionnaire. The sample in this study consisted of 24 respondents, 12 intervention groups and 12 control groups. Criteria in this research: pregnant women &lt;20 years and &gt;35 years, pregnant women in the II-III trimester with gestational age &gt;=20 to &lt;31 weeks, pregnant women without complications in pregnancy. Results: The mean ranks value for the intervention group was 6.50 in the pre test-mid test and mid test-post test respectively. Meanwhile in the control group the mean ranks value was 5.61 in the pre test-mid test, and the mean ranks value was 4.50 in the mid test-post test. This shows that the intervention group experienced a significant decrease in the level of depression in the BDI – II (Beck Depression Inventory-II) score compared to the control group. And a comparison of post test data from the intervention group and the control group obtained a p-value of 0.005 (&lt;α 0.05) . Conclusion: There was a difference in BDI-II (Beck Depression Inventory -II) scores in the intervention group and the control group after being given Prenatal Gentle Yoga treatment

Identification of Genes Responding to Iron or Choline Treatment for Early-Life Iron Deficiency in the Male Rat Hippocampal Transcriptomes

BackgroundDevelopmental iron deficiency (ID) is associated with long-term cognitive and affective behavioral impairments in humans. Preclinical studies have shown that developmental ID has short- and long-term effects on gene regulation. Prenatal choline supplementation partially rescues early-life ID-induced cognitive deficits in adult male rats. ObjectivesTo identify acute and long-term changes in biological processes regulated by developmental ID and modifiable by choline. MethodsThis study compares the hippocampal transcriptomes of postnatal day (P) 15 iron-deficient (acute) and P65 formerly ID (persistent) rats with or without prenatal choline treatment. Pregnant rats were fed an ID (4 mg/kg Fe) or iron-sufficient (IS) (200 mg/kg Fe) diet from gestational day (G) 2 to P7 with or without choline supplementation (5 g/kg choline) from G11 to G18. Hippocampi were collected from P15 or P65 offspring and analyzed for gene expression by RNA sequencing. ResultsDevelopmental ID-induced changes suggested modified activity of oxidative phosphorylation and fatty acid metabolism. Prenatal choline supplementation induced robust changes in gene expression, particularly in iron-deficient animals, where it partially mitigated the early-life ID-dysregulated genes. Choline supplementation also altered the hippocampal transcriptome in the IS rats, with indications for both beneficial and adverse effects. ConclusionsThis study provided global assessments of gene expression regulated by iron and choline. Our new findings highlight genes responding to iron or choline treatments, including a potentially novel choline-regulated transporter (IPO7), with shared effects on neuroinflammation in the male rat hippocampus.

Pregnancy Induced Hypertension and It’s Associated Factors among Women Attending Delivery Center

Background: Pregnancy-induced hypertension (PIH) is a dangerous condition that can arise during pregnancy and has been associated with a number of negative outcomes for both the mother and the fetus. According to estimates from the World Health Organization, the effects of hypertensive diseases during pregnancy claim the lives of at least one woman every seven minutes. Examining pregnancy-induced hypertension and associated risk factors in women receiving prenatal treatment at Jalalabad Hospital is the aim of this study. Method: During two months, from October 1 to November 30, 2023, a cross-sectional survey was conducted in the maternity hospitals located in Jalalabad. The hospital provided a proportionate amount of the total sample size (620). Using a systematic sampling procedure, study participants were chosen. A p-value of less than 0.05 was deemed statistically noteworthy. Result: Out of a total of 620 pregnant women, only 8% (50/620) of pregnant women had Hypertensive Disorders in Pregnancy (HDP). The average age of the respondent who visited outpatient department of a maternity hospital in Jalalabad was 27.5± 2 years with the majority 42% in years 25-30. The findings from our study indicate that hypertensive disorder in pregnancy has a significant relationship with risk factors such as increasing maternal age (p&lt;0.041), body mass index (BMI) (P&lt;0.007), and family history of hypertension in pregnancy (p&lt;0.026). Whereas other risk factors assessed in our study had no significant association with HDP. Conclusion: The findings of our study highlight the importance of factors including obesity, advancing pregnancy age, and a family history of hypertension as risk factors for HDP. It also emphasizes the necessity of appropriate preconceptional counseling, regular ANC monitoring, and HDP treatment in order to minimize morbidity and death associated with this condition.

Prenatal delivery of a therapeutic antisense oligonucleotide achieves broad biodistribution in the brain and ameliorates Angelman syndrome phenotype in mice

Angelman syndrome (AS), an early-onset neurodevelopmental disorder characterized by abnormal gait, intellectual disabilities, and seizures, occurs when the maternal allele of the UBE3A gene is disrupted, since the paternal allele is silenced in neurons by the UBE3A antisense (UBE3A-AS) transcript. Given the importance of early treatment, we hypothesized that prenatal delivery of an antisense oligonucleotide (ASO) would downregulate the murine Ube3a-AS, resulting in increased UBE3A protein and functional rescue. Using a mouse model with a Ube3a-YFP allele that reports on-target ASO activity, we found that in utero, intracranial (IC) injection of the ASO resulted in dose-dependent activation of paternal Ube3a, with broad biodistribution. Accordingly, in utero injection of the ASO in a mouse model of AS also resulted in successful restoration of UBE3A and phenotypic improvements in treated mice on the accelerating rotarod and fear conditioning. Strikingly, even intra-amniotic (IA) injection resulted in systemic biodistribution and high levels of UBE3A reactivation throughout the brain. These findings offer a novel strategy for early treatment of AS using an ASO, with two potential routes of administration in the prenatal window. Beyond AS, successful delivery of a therapeutic ASO into neurons has implications for a clinically feasible prenatal treatment for numerous neurodevelopmental disorders.

Prenatal maternal glucocorticoid exposure modifies sperm miRNA profiles across multiple generations in the guinea-pig.

Maternal stress and glucocorticoid exposure during pregnancy have multigenerational effects on neuroendocrine function and behaviours in offspring. Importantly, effects are transmitted through the paternal lineage. Altered phenotypes are associated with profound differences in transcription and DNA methylation in the brain. In the present study, we hypothesized that maternal prenatal synthetic glucocorticoid (sGC) exposure in the F0 pregnancy will result in differences in miRNA levels in testes germ cells and sperm across multiple generations, and that these changes will associate with modified microRNA (miRNA) profiles and gene expression in the prefrontal cortex (PFC) of subsequent generations. Pregnant guinea-pigs (F0) were treated with multiple courses of the sGC betamethasone (Beta) (1mgkg-1; gestational days 40, 41, 50, 51, 60 and 61) in late gestation. miRNA levels were assessed in testes germ cells and in F2 PFC using the GeneChip miRNA 4.0 Array and candidate miRNA measured in epididymal sperm by quantitative real-time PCR. Maternal Beta exposure did not alter miRNA levels in germ cells derived from the testes of adult male offspring. However, there were significant differences in the levels of four candidate miRNAs in the sperm of F1 and F2 adult males. There were no changes in miRNA levels in the PFC of juvenile F2 female offspring. The present study has identified that maternal Beta exposure leads to altered miRNA levels in sperm that are apparent for at least two generations. The fact that differences were confined to epididymal sperm suggests that the intergenerational effects of Beta may target the epididymis. KEY POINTS: Paternal glucocorticoid exposure prior to conception leads to profound epigenetic changes in the brain and somatic tissues in offspring, and microRNAs (miRNAs) in sperm may mediate these changes. We show that there were significant differences in the miRNA profile of epididymal sperm in two generations following prenatal glucocorticoid exposure that were not observed in germ cells derived from the testes. The epididymis is a probable target for intergenerational programming. The effects of prenatal glucocorticoid treatment may span multiple generations.

Contribution of changes in the orexin system and energy sensors in the brain in depressive disorder - a study in an animal model

BackgroundMaternal elevated glucocorticoid levels during pregnancy can affect the developing fetus, permanently altering the structure and function of its brain throughout life. Excessive action of these hormones is known to contribute to psychiatric disorders, including depression.MaterialsThe study was performed in a rat model of depression based on prenatal administration of dexamethasone (DEX) in late pregnancy (0.1 mg/kg, days 14–21). We evaluated the effects of prenatal DEX treatment on the cognition and bioenergetic signaling pathways in the brain of adult male rats, in the frontal cortex and hippocampus, and in response to stress in adulthood, using behavioral and biochemical test batteries.ResultsWe revealed cognitive deficits in rats prenatally treated with DEX. At the molecular level, a decrease in the orexin A and orexin B levels and downregulation of the AMPK-SIRT1-PGC1α transduction pathway in the frontal cortex of these animals were observed. In the hippocampus, a decreased expression of orexin B was found and changes in the MR/GR ratio were demonstrated. Furthermore, an increase in HDAC5 level triggered by the prenatal DEX treatment in both brain structures and a decrease in MeCP2 level in the hippocampus were reported.ConclusionsOur study demonstrated that prenatal DEX treatment is associated with cognitive dysfunction and alterations in various proteins leading to metabolic changes in the frontal cortex, while in the hippocampus adaptation mechanisms were activated. The presented results imply that different pathophysiological metabolic processes may be involved in depression development, which may be useful in the search for novel therapies.

Risk factors for high-stage histological chorioamnionitis among pregnancies with cervical incompetence.

The study aimed to identify predictive risk factor to identify high-stage histological chorioamnionitis (HCA) in pregnancies with cervical incompetence (CIC). A retrospective cohort study was conducted by including 116 pregnant women with cervical incompetence that required prophylactical and therapeutical cerclage. The histopathology examination on placenta was conducted with informed patient consent. All the cases included in this study were divided based on the severity degree of HCA. The demographic characteristic and the parameters related to maternal and fetal outcome were all analyzed. Besides, perioperative parameters of cerclage, including cervical length, cervical morphology, and laboratory indexes were also compared between two groups. Univariate and multivariate logistic regression analysis were used to determine the risk factor of severe chorioamnionitis. Severe HCA was significantly associated with cervical morphology, cerclage indication, cerclage type, and cervical length measured via ultrasound and vaginal examination. After adjusted for confounders, V-type funneling and short cervix was indicated as independent risk factors of severe HCA by multivariate logistic regression analysis, respectively. V-type funneling and short cervix may indicate the elevated risk of high-stage HCA. Due to the negative outcomes related with high-stage HCA, appropriate prenatal treatment would improve the pregnancy outcomes in cerclaged population. To facilitate postpartum treatment, placental histological examination should be routinely recommended to identify the high-stage HCA, especially in high risk pregnancies.

Maternal protein supplementation during mid-gestation improves offspring performance and metabolism in beef cows.

This study examined the impact of maternal protein supplementation during mid-gestation on offspring, considering potential sex-related effects. Forty-three pregnant purebred Tabapuã beef cows (20 female and 23 male fetuses) were collectively managed in a pasture until 100 d of gestation. From 100 to 200 d of gestation, they were randomly assigned to the restricted group [(RES) - basal diet (75% corn silage + 25% sugar cane bagasse + mineral mixture); n = 24] or control group [(CON) - same basal diet + based-plant supplement [40% of crude protein, 3.5g/kg of body weight (BW); n = 19]. From 200 d of gestation until parturition, all cows were equally fed corn silage and mineral mixture. During the cow-calf phase, cows and their calves were maintained in a pasture area. After weaning, calves were individually housed and evaluated during the backgrounding (255 to 320 d), growing 1 (321 to 381 d), and growing 2 (382 to 445 d) phases. Offspring's blood samples were collected at 210 and 445 d of age. Samples of skeletal muscle tissue were collected through biopsies at 7, 30, and 445 d of age. Muscle tissue samples were subjected to reverse-transcription quantitative polymerase chain reaction analysis. Prenatal treatment and offspring's sex (when pertinent) were considered fixed effects. The significance level was set at 5%. At mid-gestation, cows supplemented with protein reached 98% and 92% of their protein and energy requirements, while nonsupplemented cows attained only 30% and 50% of these requirements, respectively. The RES offspring were lighter at birth (27 vs. 31kg), weaning (197 vs. 214kg), and 445 d of age (398 vs. 429kg) (P ≤ 0.05). The CON calves had greater (P < 0.05) morphometric measurements overall. The CON offspring had ~26% greater muscle fiber area (P ≤ 0.01). There was a trend (P = 0.06) for a greater Mechanistic target of rapamycin kinase mRNA expression in the Longissimus thoracis in the CON group at 7 d of age. The Myogenic differentiation 1 expression was greater (P = 0.02) in RES-females. Upregulation of Carnitine palmitoyltransferase 2 was observed in RES offspring at 445 d (P = 0.04). Expression of Fatty acid binding protein 4 (P < 0.001), Peroxisome proliferator-activated receptor gamma (P < 0.001), and Stearoyl-Coenzyme A desaturase (P < 0.001) was upregulated in CON-females. Therefore, protein supplementation during gestation enhances offspring growth and promotes favorable responses to lipogenesis, particularly in females.

Improvement of autistic-like behaviors in adult rats prenatally exposed to valproic acid through early suppression of orexin receptor.

Autism spectrum disorder (ASD) is a disabling psychiatric disease characterized by impairments in communication and social skills. The pathophysiology of autism is complex and not fully known. Considering the incidence of sleep disorders in individuals with ASD and the important role of orexin in sleep, it is possible to hypothesize that an alteration of the orexinergic system could be implicated in the pathogenesis of autism symptoms. The present study was conducted to investigate the effect of suvorexant [dual orexin receptor antagonists (DORAs)] on autism-like behavior in prenatally valproic acid (VPA)-exposed rats]. Wistar female rats were administered VPA [600 mg/kg, intraperitoneally (i.p.)] or normal saline (10 ml/kg, i.p.; vehicle control) on gestational day 12.5. Thirty-two male offspring were divided into four groups: Control, VPA, Suvorexant+VPA, and VPA+Risperidone. The pups were given suvorexant [20 ml/kg, by mouth/orally (p.o.)] or risperidone (1 ml/kg, p.o.) daily from postnatal day (PND) (40-54). The offspring were tested for repetitive behaviors and cognitive ability with a Y-maze task on PND 55, and social interaction was assessed by play behavior in the open field on PND 56. And anxiety with using the three-chamber social assay on PND 56. In the Y-maze apparatus, spontaneous alteration significantly decreased in the prenatal VPA-treated rats compared to control rats showing autistic-like behavior, and 2-week suvorexant increased the alternation, indicating the beneficial effect of suvorexant. Prenatal treatment with VPA, impaired play behavior (sniffing, grooming, and darting), and increased anxiety-related behavior. Suvorexant treatment attenuated the problems in male offspring's social behavior. Our results showed that suvorexant improved ASD-associated behaviors in the VPA-treated rats, and the orexinergic system may be associated with the pathogenesis of autism symptoms.

Inpatient Growth in Infants Requiring Pharmacologic Treatment for Neonatal Opioid Withdrawal Syndrome.

Aim: To assess inpatient growth parameter trajectories and to identify the type of opioid exposure and treatment characteristics influencing growth parameters of infants admitted to the newborn intensive care unit (NICU) for pharmacological treatment of neonatal opioid withdrawal syndrome (NOWS). Methods: Charts of term infants with NOWS admitted to NICU from 2012 to 2019, who received pharmacologic treatment, were reviewed. Intake (volume: mL/kg/day; calorie: kcal/kg/day) and growth parameter trajectories (weight, head circumference, and length) were analyzed based on the type of prenatal opioid exposure (short-acting opioids (SAOs), long-acting opioids (LAOs), and polysubstance), pharmacologic treatment, and sex. Growth measurement patterns over time were compared between groups using longitudinal mixed-effects models. Results: One hundred nineteen infants were included in the study with median birth weight Z-score of -0.19 at birth and decreased to a median of -0.72 at discharge. Exposure to SAO was associated with an increase in Z-scores nearing discharge across all growth parameters (Z-score for weight p = 0.03). Polysubstance exposure was associated with a decrease in Z-scores for length and head circumference throughout hospitalization. Infants with adjunct clonidine treatment had an increase in Z-score for weight trends. Male infants had a decrease in Z-scores for weight (male -0.96, female -0.59, interaction p = 0.06) and length (male -1.17, female -0.57, interaction p = 0.003) at Day 28. Despite the difference in growth trajectories, intake in terms of amount (mL/kg/day) and calorie intake (kcal/kg/day) was similar based on prenatal exposure, treatment, and sex. Conclusion: Infants with NOWS requiring pharmacologic treatment have a decrease in Z-scores for weight, length, and head circumference at birth and at hospital discharge. Infants with prenatal polysubstance exposure were at particular risk for poorer inpatient growth relative to infants exposed to SAO and LAO, indicated by lower Z-scores for length and occipital frontal circumference (OFC).

Risk Factors for Birth Asphyxia in Hospital-Delivered Newborns in Dodoma, Tanzania: A Case-Control Study.

Asphyxia at birth remains the leading cause of neonatal morbidity and mortality worldwide, accounting for ∼23% of all neonatal deaths. Although the causes vary from country to country, early identification and treatment of risk factors can improve the situation. To determine the risk factors of birth asphyxia in hospital-delivered neonates in Dodoma, Tanzania. A matched case-control study was conducted from May to July 2017 at Dodoma Region Referral Hospital. Data were collected using a semistructured questionnaire and a standard antenatal care index card. Cases were neonates diagnosed with asphyxia at birth (N = 100), while controls were neonates not diagnosed with asphyxia at birth (N = 300). A binary logistic regression model was used to assess the independent variables associated with birth asphyxia and reported as crude and adjusted odds ratios along with their 95% confidence intervals. A total of 400 newborns and their birth mothers were involved in the study. The average age of the case mothers was 26.9 years (SD = 7.85) and that of the control mothers was 27.24 years (SD = 6.08). Place of residence, anemia, maternal age, prenatal visits attended, use of herbs during labor, previously complicated pregnancy, duration of labor, meconium-stained amniotic fluid, and mode of delivery were predictors of birth asphyxia. The study showed that most predictors of birth asphyxia can be prevented. The results suggest appropriate health education before conception, effective follow-up through prenatal care, early identification and treatment of high-risk pregnant women, and proper monitoring of labor and delivery.

Reproductive neuroendocrine defects programmed by prenatal testosterone treatment between gestational days 60-90 are amplified by postnatal obesity in sheep.

Polycystic ovary syndrome (PCOS) is the leading cause of anovulatory infertility in women of reproductive age, and obesity can increase the severity and development of the PCOS phenotype. Prenatal testosterone (T) treatment between gestational days 30-90 advanced puberty and disrupted the reproductive and metabolic phenotype in female sheep, recapitulating attributes of women with PCOS, with postnatal obesity amplifying its severity. On the other hand, prenatal T treatment from gestational days 60-90 led to a much milder phenotype. We hypothesized that reproductive neuroendocrine defects programmed by prenatal T treatment between gestational days 60-90 are amplified by postnatal obesity in sheep. Suffolk ewes received T propionate (T; 100mg) or corn oil (C; vehicle) twice weekly from gestational days 60-90. At 5months of age, T lambs were assigned to either a maintenance (100% of NRC requirements) or overfed (130% NRC) diet and C lambs were fed the maintenance diet. We compared the timing of puberty (n = 15/group) determined by twice weekly measurement of progesterone concentrations, estradiol positive feedback responsiveness (n = 8/group) determined by assessing LH secretion in response to exogenous estradiol, periovulatory LH dynamics during the second breeding season (n = 8/group) following synchronization with two injections of PGF2α, and progesterone negative feedback (n = 8/group) determined by characterizing LH pulses during the mid-luteal phase between C, T-maintenance and T-overfed groups. Our findings indicate that postnatal obesity: 1) exacerbated reproductive defects and further deteriorated reproductive cyclicity during the second breeding season (adulthood); 2) did not amplify the impairment in estradiol positive feedback in delaying the timing and amplitude of the LH surge, although it reduced the total amount of LH secreted during the preovulatory LH surge; 3) amplified the reduced responsiveness to progesterone negative feedback manifested as an increase in LH pulse amplitude and peak. These observations, in addition to supporting our previous findings that prenatal T treatment results in reproductive neuroendocrine dysfunction and periovulatory disruptions, provide evidence that these neuroendocrine defects programmed between gestational days 60-90 are amplified by postnatal obesity in female sheep.

A Study on Knowledge on Antenatal Care among Mothers Admitted in Obstetric Ward in Dhaka Medical College and Hospital

Introduction: Adequate prenatal treatment is crucial to supporting optimal fetal development, appropriate organogenesis, and a robust immune system in the infant. The nutritional status of the mother has a direct effect on both her own health and the health of her child. Methodology: This was a cross-sectional study conducted at the Obstetric Ward in Dhaka Medical College and Hospital from January 2019 to April 2019, and a total of 150 admitted mothers from the Obstetric Ward enrolled in this study. The data was collected using a pretested, modified questionnaire. The data was inputted and analyzed using the Statistical Package of Social Science (SPSS) software, specifically version 23.0. The study gained ethical clearance from the Institutional Review Board (IRB) of Dhaka Medical College and Hospital in Dhaka, Bangladesh. Objective: The study aimed to assess the knowledge of antenatal care among mothers admitted to the obstetric ward at Dhaka Medical College and Hospital. Results: According to age distribution, 50%, 41.3%, and 8.7% of the respondents belonged to the age groups of 15–25 years, 26–35 years, and 36–45 years, respectively, with a mean age of 26.47 ± 5.652 years. According to the distribution by family type, the majority of the respondents (66%) belonged to the nuclear family and only 34% were in the joint family. The study revealed that the majority of the respondents (25.3%) education was primary, followed by 20% being SSC, 34.7% being HSC, 7.3% being graduates and only 12.7% being illiterate. According to the distribution by profession, 71.3 percent of respondents were housewives and the rest of them, 28.7%, were in service. According to the distribution by residence, most of the respondents (48.7%) were from finished buildings, 10.7% were from semi-pucca buildings and only 40.7% were from other types of residence. Most respondents (73.3%) used sanitary toilets and only 26.7% used non-sanitary toilets. Most of the respondents (82%) were Muslims, 9.3% were Hindus, 4.7% were Christians, 2.7% were Buddhists, and only 1.3% had other religions. Among the respondents, (32.7%) had antenatal clinics available in their community and 67.3% had no antenatal clinics in their community. The majority of the respondents (66%) received antenatal care during pregnancy and 34% did not receive any antenatal care during pregnancy. Most of the respondents (86%) knew that vaccination was important during pregnancy and 14% had no knowledge of the importance of vaccination during pregnancy. Among the respondents, (48.7%) had knowledge of four ANC visits and 51.3% had two visits. The majority of the respondents (82.7%) had a normal mode of delivery and 17.3% had a cesarean section. The majority of the respondents (86.7%) received ANC in the clinic and 13.3% at home. Most of the respondents (88.7%) were more than 18 years old while getting married and 11.3% were less than 18 years old. Most of the respondents (90%) were 20 years old at the birth of their first baby, while 10% were less than 20 years old. The majority of the respondents (61.3%) babies’ birth weight was more than 2.5 kg at birth and 38.7% of respondents’ babies' birth weight was less than 2.5 kg at birth. The majority of the respondents (85.3%) got information from an NGO or hospital, 66% from TV, 0.7% from radio, 1.3% from print media, 6% from billboards, and 21.3% from family physicians. Finally, this study revealed a statistically significant association between the respondent’s knowledge about the toxemia of pregnancy and the age of the respondents (P = 0.001), as well as a highly significant association between the respondent’s sex and the written protocol for universal precaution. (P=0.000). Conclusion: This study revealed that the level of knowledge of the participants regarding antenatal care was moderate. To improve this situation, there is an urgent need for multi-channel awareness.

Placenta accreta spectrum disorder: An updated literature review

Placenta accreta spectrum disorder (PASD) refers to a range of pathological placental adhesions to the uterine wall, previously classified into three subtypes: placenta accreta, placenta increta, and placenta percreta, based on the invasiveness of the villous tissue. This article provides an updated review of the literature on PASD with new insights into the etiopathology of PASD. Recent evidence suggests that extravillous trophoblasts are not overly invasive and that accreta placentation is more likely due to decidualisation failure resulting from blastocyst implantation within a caesarean scar defect (CSD). Previous caesarean delivery has been the most well-known risk factor of PASD, with the increased occurrence of PASD along with the increased number of previous caesarean deliveries. Antenatal identification of PASD is strongly recommended to improve outcomes before the onset of labour or bleeding, so that placental abruption can be avoided. Ultrasonography can identify PASD in the first trimester with good sensitivity and specificity. A standardised approach with a comprehensive multidisciplinary care team is required to manage PASD effectively. The Royal College of Obstetricians and Gynaecologists (RCOG), along with The American College of Obstetricians and Gynaecologists (ACOG), have published guidelines for the best clinical management of PASD. Future research should concentrate on gathering prospective data on the diagnosis and management of PASD in order to assess the association between prenatal imaging, clinical grading, and histology findings. This will lead to more accurate PASD screening, reliable diagnostic criteria, and alternatives to prenatal treatment.