Prior Birth Research Articles

Association of Vaginal Progesterone Treatment With Prevention of Recurrent Preterm Birth

Association of Vaginal Progesterone Treatment With Prevention of Recurrent Preterm Birth

Acculturation, Acculturative Stress, Experience of Discrimination, and Cesarean Birth in Mexican American Women.

Introduction: There is evidence that Mexican Americans are more likely to have cesarean birth than non-Hispanic White Americans. The purpose of this study was to identify factors related to acculturation along with psychological and sociodemographic factors associated with birth mode in a prospective cohort of Mexican American women in Texas. Methods: This secondary analysis included 244 Mexican American pregnant women. Women with a prior cesarean birth were excluded. Variable selection was guided by Berry's Theoretical Framework of Acculturation. Correlations and logistic regression were used to examine relationships and predict risk of cesarean birth. Mediators and moderators were also considered. Results: Eighty women birthed by cesarean. Analytic and parent samples were similar in all demographics. After controlling for parity in logistic regression, greater Spanish language-related acculturative stress (adjusted odds ratio [AOR], 1.06, 95% confidence interval [CI] [1.01, 1.11], p = .028) and experience of discrimination (AOR, 1.18, 95% CI [1.00, 1.38], p = .044) increased the odds of cesarean birth. The relationship between acculturative stress and birth mode was moderated by birth facility. Conclusion: Acculturative stress and discrimination may play a role in birth mode for Mexican American women birthing in Texas. Birth facility and acculturative stress may be interacting in ways that have clinical significance but are yet unexplored.

How Well Do U.S. Primary Care and Obstetrics and Gynecology Clinicians Screen for Pregnancy Complications at Well Woman Visits? A Retrospective Cohort Study.

Pregnancy complications, including pre-eclampsia, gestational diabetes (GDM), and perinatal mood and anxiety disorders (PMADs), impact long-term health. We compared the frequency of screening documentation for pregnancy complications versus a general medical history at well woman visits between providers in primary care and obstetrics and gynecology. We conducted a retrospective cohort study of subjects with at least 1 prior birth who presented for a well woman visit in 2019-2020. Charts were reviewed for documentation of a general medical history (hypertension, diabetes, and mood disorders) versus screening for comparable obstetric complications (pre-eclampsia, GDM, and PMADs). The results were compared using the McNemar and chi-square tests as appropriate. In total, 472 encounters were identified, and 137 met the inclusion criteria. Across specialties, clinicians were significantly more likely to document general medical conditions than pregnancy complications, including hypertensive disorders (odds ratio [OR], 2.45; 95% confidence interval [CI], 1.18 to 5.48), diabetes (OR, 7.67; 95% CI, 3.27 to 22.0), and mood disorders (OR, 10.5; 95% CI, 3.81 to 40.3). Obstetrics and gynecology providers were more likely to document any pregnancy history (OR, 4.50; 95% CI, 1.24 to 16.27); however, they were not significantly more likely to screen for relevant obstetric complications (OR, 2.49; 95% CI, 0.90 to 6.89). Overall, the rate of pregnancy complication documentation was low in primary care and obstetrics and gynecology clinics (8.8 and 19.0%, respectively). Obstetrics and gynecology providers more frequently documented a pregnancy history than those in primary care; however, the rate was low across specialties, and providers reported screening for clinically relevant complications less frequently than for general medical conditions.

Prior childbirth experience and attitude towards subsequent vaginal birth after one caesarean delivery in Lagos, Nigeria: a cross-sectional study

BackgroundPrior caesarean delivery (CD) impacts CD rates in many parts of the world. In low and middle-income countries, few women attempt a trial of labour after caesarean delivery (TOLAC) due to inadequate resources for safe vaginal birth after caesarean delivery (VBAC). The CD rates continue to rise as more women undergo repeat CD. In Nigeria, VBAC rate is low and the contribution of women’s prior childbirth experiences and delivery wishes to this situation deserves further investigation. This study examined the parturient factor in the low VBAC rate to recommend strategies for change.ObjectiveTo describe prior caesarean-related childbirth experiences and attitudes towards subsequent vaginal birth in pregnant women with one previous CD.MethodThis cross-sectional study of antenatal clinic attendees in a tertiary hospital employed the convenience sampling method to recruit 216 consenting women with one previous CD. Structured questionnaires were used to collect information on participants' prior caesarean-related birth experiences, attitudes to vaginal birth in the index pregnancy, future delivery intentions and eventual delivery route. Univariate and bivariate analyses compared delivery wishes based on CD type. SPSS version 22.0 was used for data analysis.ResultsThe modal maternal and gestational age groups were 30–39 years (68.1%) and 29–34 weeks (49.1%) respectively; majorities (60.6%) were secundigravida; 61.6% experienced labour before their CDs while 76.9% had emergency CDs. Complications were documented in 1.4% and 11.1% of mothers and babies respectively. Ninety percent reported a satisfactory overall childbirth experience. A majority (83.3%) preferred TOLAC in the index pregnancy because they desired natural childbirth while 16.7% wanted a repeat CD due to the fear of fetal-maternal complications. The previous CD type and desire for more babies were significantly associated with respondents' preferred mode of delivery (p = 0.001 and 0.023 respectively). Women with previous emergency CD were more likely to prefer vaginal delivery.ConclusionsAntenatal women prefer TOLAC in subsequent pregnancies despite prior satisfactory caesarean-related birth experiences. Adoption of TOLAC in appropriately selected cases will impact women's psyche positively and reduce CD rate.

Association Between Utilization of Digital Prenatal Services and Vaginal Birth After Cesarean.

Digital health services are a promising but understudied method for reducing common barriers to vaginal birth after cesarean (VBAC), including connection to facilities offering labor after cesarean and patient-centered counseling about mode of birth. This study assesses the relationship between use of digital prenatal services and VBAC. In this retrospective cohort study, we analyzed the use of digital prenatal services and mode of birth among users of an employer-sponsored digital women's and family digital health platform. All users had a prior cesarean birth. Users' self-reported data included demographics, medical history, and birth preferences. We used basic descriptive statistics and logistic regression models to assess the association between digital services utilization and VBAC, adjusting for key patient characteristics. Of 271 included users, 44 (16.2%) had a VBAC and 227 (83.8%) had a cesarean birth. Users of both groups were similar in age, race, and ethnicity. Fewer users in the VBAC group (5/44, 11.4%) as compared with the cesarean birth group (62/227, 27.3%) had a prepregnancy body mass index greater than or equal to 30 (P = 0.02). Likewise, more users in the VBAC group preferred vaginal birth (34/44, 77.3% vs 55/227, 24.2%; P < 0.01). In adjusted models, the services associated with VBAC were care advocate appointments (adjusted odds ratio [aOR], 7.67; 95% CI, 1.99-54.4), health care provider appointments (aOR, 1.12; 95% CI, 1.02-1.25), and resource reads (aOR, 1.05, 95% CI, 1.00-1.09). VBAC rates were higher for users who reported the digital health platform influenced aspects of their pregnancy and birth. Reducing cesarean birth rates is a national priority. Digital health services, particularly care coordination and education, are promising for accomplishing this goal through increasing rates of trial of labor after cesarean and subsequent VBAC rates.

Multiple Prior Live Births Are Associated With Cardiac Remodeling and Heart Failure Risk in Women

Greater parity has been associated with cardiovascular disease risk. We sought to find whether the effects on cardiac remodeling and heart failure risk are clear. We examined the association of number of live births with echocardiographic measures of cardiac structure and function in participants of the Framingham Heart Study (FHS) using multivariable linear regression. We next examined the association of parity with incident heart failure with preserved (HFpEF) or reduced (HFrEF) ejection fraction using a Fine-Gray subdistribution hazards model in a pooled analysis of n = 12,635 participants in the FHS, the Cardiovascular Health Study, the Multi-Ethnic Study of Atherosclerosis, and Prevention of Renal and Vascular Endstage Disease. Secondary analyses included major cardiovascular disease, myocardia infarction and stroke. Among n = 3931 FHS participants (mean age 48 ± 13 years), higher numbers of live births were associated with worse left ventricular fractional shortening (multivariable β -1.11 (0.31); P = 0.0005 in ≥ 5 live births vs nulliparous women) and worse cardiac mechanics, including global circumferential strain and longitudinal and radial dyssynchrony (P < 0.01 for all comparing ≥ 5 live births vs nulliparity). When examining HF subtypes, women with ≥ 5 live births were at higher risk of developing future HFrEF compared with nulliparous women (HR 1.93, 95% CI 1.19-3.12; P = 0.008); by contrast, a lower risk of HFpEF was observed (HR 0.58, 95% CI 0.37-0.91; P = 0.02). Greater numbers of live births are associated with worse cardiac structure and function. There was no association with overall HF, but a higher number of live births was associated with greater risk for incident HFrEF.

Infant sex at birth and long-term maternal mortality.

Maternal adaptations may vary by foetal sex. Whether male infants influence long-term mortality in mothers remains uncertain. The objective of the study was to examine whether male infants increase the risk of maternal mortality. This study included pregnant women enrolled at 12 US sites from 1959 to 1966 in the Collaborative Perinatal Project (CPP). Collaborative Perinatal Project records were linked to the National Death Index and the Social Security Master Death File to ascertain deaths until 2016. Foetal sex was determined by infant sex at birth, defined as the total number of male or female infants in pregnancies prior to or during enrolment in the CPP. In secondary analyses, exposure was defined as infant sex at the last CPP delivery. Outcomes included all-cause and underlying causes of mortality. We used Cox proportional hazards models weighted by the number of prior live births and stratified our models by parity and race/ethnicity. Among 48,188 women, 50.8% had a male infant at their last registered CPP pregnancy and 39.0% had a recorded death after a mean follow-up of 47.8 years (SD 10.5 years). No linear association was found between the number of liveborn males and all-cause mortality (primipara women: HR 1.02, 95% CI 0.95, 1.09, multipara women, 1 prior live birth: HR 0.96, 95% CI 0.89, 1.03, multipara women, ≥2 prior live births: HR 0.97, 95% CI 0.85, 1.11). A similar trend was noted for cardiovascular- and cancer-related mortality. At the last delivery, women with a male infant did not have an increased risk of all-cause or cause-specific mortality compared to women with a female infant. These findings were consistent across racial/ethnic groups. Women who give birth to male infants, regardless of number, are not at increased risk of all-cause and cause-specific mortality. These findings suggest that giving birth to male infants may not independently influence the long-term health of women.

Testicular torsion and subsequent testicular function in young men from the general population

Is prior testicular torsion associated with testicular function (semen quality and reproductive hormones) in young men from the general population? In young men from the general population, no differences in semen parameters were observed in those who had experienced testicular torsion compared to controls and observations of higher FSH and lower inhibin B were subtle. Testicular function may be impaired after testicular torsion, but knowledge is sparse and based on studies with small sample sizes and no control group or a less than ideal control group. A cross-sectional population-based study was carried out including 7876 young Danish men with unknown fertility potential, examined from 1996 to 2020. All men (median age 19.0 years) had a physical examination, provided a blood and semen sample, and filled in a questionnaire including information about prior testicular torsion, birth, lifestyle and current and previous diseases. Markers of testicular function, including testis volume, semen parameters and reproductive hormones, were compared between men operated for testicular torsion and controls, using multiple linear regression analyses. The average participation rate was 24% for the entire study period. In total, 57 men (0.72%) were previously operated for testicular torsion (median age at surgery 13.4 years) of which five had only one remaining testicle. Men with prior testicular torsion were more often born preterm (25% versus 9.5% among controls), and they had significantly higher FSH and lower inhibin B levels, and a lower inhibin B/FSH ratio than controls in crude and adjusted models. The association was mainly driven by the subgroup of men who had undergone unilateral orchiectomy. No differences in semen parameters were observed. A limitation is the retrospective self-reported information on testicular torsion. Also, results should be interpreted with caution owing to the high uncertainty of the observed differences. Overall, the results of our study are reassuring for men who have experienced testicular torsion, especially when treated with orchiopexy, for whom reproductive hormone alterations were subtle and without obvious clinical relevance. Our study found no differences in semen parameters, but follow-up studies are needed to assess any long-term consequences for fertility. Financial support was received from the Danish Ministry of Health; the Danish Environmental Protection Agency; the Research fund of Rigshospitalet, Copenhagen University Hospital; the European Union (Contract numbers BMH4-CT96-0314, QLK4-CT-1999-01422, QLK4-CT-2002-00603, FP7/2007-2013, DEER Grant agreement no. 212844); A.P. Møller and wife Chastine Mckinney Møllers Foundation; Svend Andersens Foundation; the Research Fund of the Capital Region of Denmark; and ReproUnion (EU/Interreg). The authors have nothing to declare. N/A.

Endometriosis is associated with pregnancy loss: a nationwide historical cohort study

To study whether endometriosis is associated with pregnancy loss and recurrent pregnancy loss (RPL). Nationwide historical cohort study with a nested case-control analysis. National health registers. A total of 29,563 women born between 1957 and 1997 were identified in the national health registers, diagnosed with endometriosis between 1977 and 2017, and age-matched 1:10 with 295,630 women without endometriosis. The number of pregnancy losses was assessed, and data were analyzed with conditional logistic regression. Endometriosis (International Classification of Diseases, 8th Revision, 62530-62539, and International Classification of Diseases, 10th Revision, DN80.0-9). The primary outcomes of interest were the numbers of pregnancy losses categorized as 0, 1, 2, and ≥ 3 losses, unadjusted and adjusted for gravidity, and RPL. The secondary outcome measures were the predefined types of pregnancy losses. Pregnancy loss was defined as the spontaneous demise of a pregnancy until 22 weeks of gestation. Primary RPL was defined as 3 or more consecutive pregnancy losses with no prior live birth or stillbirth, and secondary RPL was defined as 1 or more births followed by 3 or more consecutive losses. A total of 18.9%, 3.9%, and 2.1% of ever-pregnant women with endometriosis had 1, 2, and ≥ 3 pregnancy losses compared with 17.3%, 3.5%, and 1.5% of the women without endometriosis, corresponding to the odds ratios of 1.13 (95% confidence interval, 1.09-1.17), 1.18 (1.10-1.26), and 1.44 (1.31-1.59), respectively. When adjusted also for gravidity, the corresponding results were 1.37 (95% confidence interval, 1.32-1.42), 1.75 (1.62-1.89), and 2.57 (2.31-2.85), respectively. The following predefined subgroups of RPL were positively associated with endometriosis: primary; secondary; secondary after giving birth to a boy; after a complicated delivery; and ≥ 3 pregnancy losses before the age of 30 years. Six endometriosis subgroup analyses found an association between endometriosis and pregnancy loss. These analyses were women diagnosed in the 4 decades between 1977 and 2017, women with adenomyosis, and women with adenomyosis only. This nationwide cohort study found endometriosis to be associated with pregnancy loss and RPL, and the association strengthened with an increasing number of losses.

Factors predictive of preterm birth following history-indicated vaginal cerclage

To determine the predictive value of maternal, antepartum, and operative characteristics for preterm birth (PTB) following history (Hx)-indicated vaginal cerclage. Case-control study of patients undergoing Hx-indicated vaginal cerclage placement at a tertiary center 1/2013-4/2021. Multiple gestations and major fetal anomalies were excluded. Patients were categorized as having term birth or PTB (< 37 wks). Predictive variables (maternal demographics, antepartum characteristics, and operative features) were compared between groups. Bivariate logistic models were used to find potential exposures, which were included for a multivariate logistic model. Receiver operating characteristic (ROC) curve and area under the curve (AUC) were used for assessing model performance. Statistical significance was assessed at a 0.05 level. Of 175 cases analyzed, 89 (51%) had term birth and 86 (49%) a PTB. Patients with higher BMI at cerclage placement (OR 1.07 [95% CI 1.02-1.11]), fewer prior term births (OR 0.60 [CI 0.38-0.93]), and more prior midtrimester losses (OR 2.42 [1.56-3.75]) were more likely to have PTB. In our adjusted multivariable model, BMI at cerclage placement (aOR 1.05 [1.01-1.10]) and number of prior midtrimester losses (aOR 2.23 [1.42-3.48]) remained associated with PTB, but number of prior term births did not (aOR 0.62 [0.39-1.00]). The model including BMI (aOR 1.06 [1.01-1.10]) and prior midtrimester loss (aOR 2.25 [1.44-3.52]) was moderately predictive of PTB (AUC=0.73 [0.65-0.80]). Patients undergoing Hx-indicated cerclage with higher BMI at cerclage placement, fewer prior term births, and greater prior midtrimester losses have an increased risk of PTB. A two factor model was moderately predictive of PTB, which could prove helpful in counseling of future patients eligible for Hx-indicated cerclage.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Number of prior live births is associated with higher arterial stiffness but not its change in older women: the atherosclerosis risk in communities study

Number of prior live births is associated with higher arterial stiffness but not its change in older women: the atherosclerosis risk in communities study

Is Duration of Labor Protective Against Cesarean Scar Niche Formation?

IIt has been theorized that niche formation may be related to insufficient incorporation of the full-thickness of myometrium at the time of hysterotomy closure. We sought to determine if labor per-se, and duration of labor (acting as surrogates for thickness) are associated with the formation of a cesarean scar niche. A case-control study of patients who underwent gynecological ultrasound evaluation for either abnormal uterine bleeding or pelvic pain from 2014-2022, who also had obstetrical records from antecedent term deliveries available at our institution. Cases were women in whom a cesarean scar niche was noted in their ultrasound report; controls were women without a niche. The two groups were subdivided into three subgroups: those who presented for repeat cesarean birth without labor, those who labored < 10 hours, and those who labored for >10 hours. The primary outcome was the relationship between labor duration, number of prior cesarean births, and niche formation. During this period, 2598 patients presented for ultrasound, and 158 (6%) had obstetrical records available for review. Of these, 98 had a niche, and 60 did not. Longer duration of labor was associated with lower risk of niche formation (p< 0.001). Demographics are seen in Table 1. Logistic regression was performed to further query if number of antecedent cesareans plus labor duration better predicted niche formation (Table 2). Those with prior cesareans who labored for >10 hours had lower odds of forming a niche compared to those who labored < 10hours or didn’t labor at all (aOR .023 [0.002-0.218] and .013 [0.001-0.125], respectively). Longer duration of labor as a surrogate for a thinner lower uterine segment at time of cesarean birth, in those with prior cesarean birth, appears protective against niche formation. It is possible that a thinner hysterotomy closure site allows for complete incorporation of all uterine layers, which would be consistent with prior literature supporting this practice as a method of niche prevention.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Trajectories of reproductive transition phase mood disorder from pregnancy to postpartum: A Swiss longitudinal study.

Depressive symptoms are common in the peripartum period and pose a great risk to the well-being of the mother, the infant, and the entire family. Evidence from longitudinal studies suggests that affected women do not constitute one homogeneous group in terms of severity, chronicity, and onset of symptoms. To account for individual differences regarding the longitudinal course of depressive symptoms from pregnancy to the postpartum period, growth mixture models have proven to be useful. We conducted a group-based trajectory modeling analysis to identify perinatal depressive symptom trajectories in a Swiss sample (n = 151). Depressive symptoms were assessed six times, covering nearly 6 months from the third trimester of pregnancy to 3 months postpartum. In addition to determining perinatal depressive symptom trajectories, we aimed to examine whether these trajectories are linked to psychopathological risk factors such as a history of premenstrual syndrome (PMS), anxiety, prenatal stress, and somatic symptoms after delivery that are associated with hormonal fluctuations. The findings revealed three trajectories of perinatal depressive symptoms that were relatively stable over time and differed in symptom load (low, medium, high), as well as one trajectory of decreasing symptoms, with a significant symptom reduction after giving birth. Women with a higher depressive symptom load experienced a greater degree of prior premenstrual symptoms, prenatal anxiety, and birth anxiety, as well as somatic symptoms after delivery. Further research is needed to account for the distinct trajectories of perinatal depressive symptoms in order to provide appropriate care for affected women. A focus on somatic symptoms after delivery and their association with depressive mood is essential to better understand the potential shared etiopathology of reproductive transition phase mood disorders.

Evaluating the duration of labor in patients undergoing TOLAC

To examine labor differences in patients that had an uncomplicated vaginal birth after cesarean (VBAC) and patients that had a complicated VBAC or failed trial of labor after cesarean (TOLAC). This was a secondary analysis of patients at ≥ 37 weeks’ gestation with a history of one prior cesarean section, no prior vaginal births that underwent a TOLAC (N=5274) from the Consortium of Safe Labor (2002-2008). Length of labor was compared between patients that had an uncomplicated VBAC and patients that had a complicated VBAC or failed TOLAC. A complicated VBAC was defined as patients that had an estimated blood loss (EBL) of greater than 1000 mL, neonatal intensive care unit (NICU) admission, 5-minute APGAR score < 7, or 3rd or 4th degree laceration. A failed TOLAC was defined as a patient that had an intrapartum repeat cesarean section. Weibull-based accelerated failure time regression model was used to examine the interval censored time of cervical dilation from 1 cm to the next by calculating median (5th- 95th percentile) transverse times (hour). A Cox regression model was used to evaluate the length of the second stage. Of the 5274 patients that underwent a TOLAC, an uncomplicated VBAC occurred in 1400 (26.5%), a complicated VBAC occurred in 194 (3.7%) of patients and a failed TOLAC occurred in 3680 (72.2%) patients. Patients that had uncomplicated VBAC had a tendency for shorter laboring time with progression from 1-6 cm taking 8 hours (IQR 2.4-15.9) compared to 13.7 hours (IQR 4.1-27.1) in patients that had a complicated VBAC or failed TOLAC (p=.10). Compared to patients that had an uncomplicated VBAC, patients that had a complicated VBAC or failed TOLAC (HR 0.67, 0.95% CI 0.57-0.79), older patients (HR 0.97; 0.95% CI 0.96-0.98), and patients that used an epidural (HR 0.71; 0.95% CI 0.62-0.81) were more likely experience a longer second stage. Although not statistically significant, a longer duration in the first and second stage of labor may increase the risk of having a complicated VBAC or failed TOLAC.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Risk of recurrent preterm birth following spontaneous immature and extreme preterm birth in the Netherlands

Spontaneous preterm birth (sPTB) has proven to be an important risk factor for recurrent sPTB, yet the lower limit of gestational age of prior birth is not well defined. In this study, we assessed the risk of recurrent sPTB following immature and extreme preterm birth between 16+0 - 27+6 weeks and we assessed the relationship between the interpregnancy interval and the recurrent risk.

Factors associated with successful vaginal birth after cesarean section among mothers who gave birth in Ambo town, Oromia, Central Ethiopia, a case-control study.

While Trial of labour after previous cesarean section for women with no contraindication for vaginal delivery is an important strategy to reduce short- and long-term morbidity related with repeated cesarean section, the rate of cesarean section and repeated cesarean section with its complication are increasing. The objective of the study was to assess factors associated with successful vaginal birth among women with previous cesarean delivery in public hospitals of Ambo town in 2019. A case-control study was conducted in Ambo public Hospitals in 2019. A total of 243 clients were included, of which 81 clients were cases and 162 clients were controls with controls to cases ratio of 2. A Lottery method was applied to select the controls and cases were selected consecutively. Bivariate, followed by multivariate analyses, were conducted with 95% CI and p-value <0.05 to identify factors associated with successful vaginal birth after cesarean delivery. Parity three and four(AOR = 3.45, 95%CI(1.16, 10.229), labour monitoring with partograph (AOR= 4.77, 95%CI: 1.65,13.88), prior vaginal birth after caesareans (AOR = 5.68, 95%CI:1.44,22.46), occiput-posterior position (AOR = 0.109, 95%CI: (0.02, 0.49), duration of labour after admission less than 8 hours (AOR = 4.57, 95%CI: 1.92,10.85) and artificial rupture of membrane (AOR = 5.02 95%CI: 1.67,15.06) were factors significantly associated with successful vaginal birth after previous cesarean section. The study shows that parity, duration of labour, previous history of successful vaginal birth after cesarean section, artificial rupture of membrane, and partograph monitoring of labour were associated with successful vaginal birth after previous cesarean section. All Women with a history of cesarean section should be counselled and encouraged to undergo a trial of labour as long as it is not contraindicated.

Reproductive factors and metabolic syndrome among Chinese women aged 40 years and older.

The aim of this study is to explore the relationship between reproductive variables and the prevalence of metabolic syndrome (MetS) and its components among Chinese women aged 40 years and older. A cross-sectional study was conducted among 4453 women aged 40 years and older in Guangxi, China. The associations between women's reproductive factors and MetS were analyzed using a logistic regression model. The prevalence of MetS was 23.9% in this population. Women with MetS were mostly older, more likely to be postmenopausal, and had higher parity. Compared to women with one prior live birth, those with three or more live births had the highest odds of having MetS (odds ratio [OR]=1.56; 95% CI, 1.23-1.99). Similarly, compared to premenopausal women, postmenopausal participants had higher odds of having MetS (OR=1.86; 95% CI, 1.49-2.31). No associations were observed between MetS and abortion or with age at menarche. Our study suggests that multiparity and menopausal status may be associated with the development of MetS. The inconsistency seen in epidemiological research to date calls for further investigation.

Pregnant individuals' information needs and intention to vaccinate their children with routine and COVID-19 vaccines: Findings from a cross-sectional survey.

The current study assessed pregnant individuals' intention to accept routine and COVID-19 vaccines for their baby after birth, and to identify key demographic (e.g., age) and nondemographic characteristics (e.g., prior birth) associated with vaccination intention. The authors conducted a cross-sectional survey with pregnant individuals attending prenatal practices affiliated with a large academic medical center and two rural county health departments in the southeastern United States. The survey included 11 questions and was self-administered by pregnant individuals in clinic settings. The final analysis included responses from 443 pregnant individuals. Only 67% of pregnant individuals planned to vaccinate their baby with all recommended routine vaccines; an additional 22% reported having questions about recommendations. Only 35% of pregnant individuals said they would vaccinate their baby as soon as possible with a COVID-19 vaccine. Younger pregnant individuals and those identifying as Black or African American had lower routine and COVID-19 vaccination intention. Routine vaccination, but not COVID-19 vaccination intention, was associated with familiarity with routine vaccination schedule, trimester of pregnancy, Hispanic ethnicity, history of prior birth, and having access to a computer. Study findings support differential tailoring of future interventions targeting pregnant individuals to promote routine and COVID-19 vaccines for children.

Exploring the experiences of pregnant women in the U.S. during the first year of the Covid-19 pandemic.

In this paper, we integrate the stress process model with symbolic interactionism to frame our analysis of interviews with 35 women who were pregnant and/or gave birth during the first year of the Covid-19 pandemic. We detail three stressors, highlight their variation, and discuss how they coped with these stressors. Women reported having to navigate contradictory information about the public health crisis, but Black participants simultaneously endured added strain from a heightened awareness of racialized violence. To cope with an overabundance of precarious and contradictory messages, some women sought out information (i.e., information gatherers), others eschewed information (i.e., information avoiders), and most established protective "bubbles." Next, women experienced disruptions in pregnancy rituals but coped by reframing their expectations. This stressor, however, was less acute for women with a prior birth. Third, women shared feelings of social isolation and reduced social support, which were intensified if pregnancy complications occurred. Women coped by relying on telecommunication and at-home monitoring devices. Our study shows how pregnant women experienced and coped through adversity to mitigate stressors amid pandemonium.

Impact of pumpkin seeds supplementation on anemia in antenatal mothers at Andhra Pradesh, India.

Anemia during pregnancy causes 40% of maternal fatalities in underdeveloped nations, according to statistics from the WHO. Pregnant women should meet the requirements for various nutrients, notably micronutrients, to ensure a better pregnancy outcome in the future. Cucurbita moschata (Pumpkin) seeds contain a variety of compounds, such as m-carboxyphenylalanine, amino butyrate, and citrulline, as well as a number of other amino acids. It has a wide variety of biological activity such as antioxidant, anticancer, anti-inflammatory etc. However, the community's use of pumpkin seeds is still limited. The present study was aimed to assess the impact of supplementation of pumpkin seeds on anemia among antenatal mothers in relation to Demographic and obstetric variables at Amalapuram Mandal, East Godavari district, Andhra Pradesh. In the third stage of the study, antenatal mothers' pre- and post-test scores for indicators of anaemia, pica, nail health, level of activity, heart rate, capillary refill, nutritional status, extremities, and level of hunger were compared. According to age, education, occupation, monthly income, and information source, the data demonstrates that according to three prenatal moms' consumption of pumpkin seeds in the morning, three in the afternoon, and one in the evening. The data available indicates that, of the 5 prenatal moms, 2 displayed symptoms of anemia with respect to the length of the menstrual cycle, the volume of menstrual flow, and the method of the previous delivery. Additionally, it was discovered that three of the pregnant mothers had appropriate hemoglobin levels and three of them had inadequate levels based on their past deliveries, menstrual flow volume, and cycle length. It also revealed that there is no discernible relationship between pregnant mothers in Amalapuram Mandal's diet of dry fruits and nuts and menstrual cycle length, flow volume, or method of prior birth.