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This study evaluated whether IgG avidity measured by chemiluminescent microparticle immunoassay (CMIA) compared with enzyme-linked immunosorbent assay (ELISA) was useful to detect primary T. gondii infection during pregnancy and to estimate the risk for congenital T. gondii infection. One hundred six women with positive tests for T. gondii IgG and T. gondii IgM, comprising 21 women (19.8%) with low (<30%), 6 (5.7%) with borderline (30%–35%), and 79 (74.5%) with high (>35%) IgG avidity measured by ELISA were selected. Their stored sera were used for T. gondii IgG avidity measurements by CMIA. In CMIA, 72 (67.9%) women had low (<50%), 12 (11.3%) had borderline (50%–59.9%), and 22 (20.8%) had high (≥60%) IgG avidity. The ratio of low T. gondii IgG avidity index in CMIA was more than three-fold than that in ELISA. Eighteen (85.7%) of 21 women with ELISA low avidity also had CMIA low avidity, and 26 (96.3%) of 27 women with ELISA low or borderline avidity corresponded to CMIA low or borderline avidity, whereas 21 (26.6%) of 79 women with ELISA high avidity were diagnosed with CMIA low avidity. All three cases with congenital T. gondii infection showed coincidentally low IgG avidity in both methods. A positive correlation in IgG avidity indices was found between of ELISA and CMIA. CMIA for T. gondii avidity measurements compared with ELISA was clinically useful to detect pregnant women at a high risk of developing congenital T. gondii infection. [ABSTRACT FROM AUTHOR]

• Prenatal testing induces elevated anxiety levels among high-risk pregnant women. • The utilization of virtual reality and music during non-stress tests alleviates anxiety and enhances satisfaction among high-risk pregnant women undergoing the procedure. • Virtual reality intervention resulted in a reduction in the duration of reactive non-stress tests. Prenatal tests cause high-risk pregnant women to experience high anxiety levels. This paper investigated the effect of Virtual Reality (VR) and music on anxiety, non-stress test parameters, and satisfaction of high-risk pregnant women undergoing non-stress tests (NSTs). This was a randomized controlled trial. The sample consisted of 102 participants randomized into three groups (VR = 34, music = 34, and control = 34). Maternal anxiety was assessed using the Spielberger State-Trait Anxiety Inventory-S (STAI-S) before and after NSTs. Satisfaction was evaluated using the Visual Analogue Scale (VAS) after NSTs. NST parameters were evaluated after NSTs. The findings were reported based on the Consolidated Standards of Reporting Trials (CONSORT). The VR and music groups had significantly lower mean posttest STAI-S scores than the control group (p <.05). There was no significant difference in NST findings (reactive/nonreactive) between the groups (p >.05). The VR group had a significantly shorter reactive NST duration than the control group (p <.05). The VR and music groups had significantly higher mean VAS-satisfaction scores than the control group (p <.05) Virtual reality and music during NSTs help high-risk pregnant women experience less anxiety and satisfy them more with the procedure. We recommend that obstetric midwives and nurses use these low-cost, simple, and noninvasive methods to reduce anxiety in high-risk pregnant women during prenatal testing. [ABSTRACT FROM AUTHOR]

The association between prenatal exposure to general anaesthesia for maternal surgery during pregnancy and subsequent risk of disruptive or internalising behavioural disorder diagnosis in the child has not been well-defined. A nationwide sample of pregnant women linked to their liveborn infants was evaluated using the Medicaid Analytic eXtract (MAX, 1999–2013). Multivariate matching was used to match each child prenatally exposed to general anaesthesia owing to maternal appendectomy or cholecystectomy during pregnancy with five unexposed children. The primary outcome was diagnosis of a disruptive or internalising behavioural disorder in children. Secondary outcomes included diagnoses for a range of other neuropsychiatric disorders. We matched 34,271 prenatally exposed children with 171,355 unexposed children in the database. Prenatally exposed children were more likely than unexposed children to receive a diagnosis of a disruptive or internalising behavioural disorder (hazard ratio [HR], 1.31; 95% confidence interval [CI], 1.23–1.40). For secondary outcomes, increased hazards of disruptive (HR, 1.32; 95% CI, 1.24–1.41) and internalising (HR, 1.36; 95% CI, 1.20–1.53) behavioural disorders were identified, and also increased hazards of attention-deficit/hyperactivity disorder (HR, 1.32; 95% CI, 1.22–1.43), behavioural disorders (HR, 1.28; 95% CI, 1.14–1.42), developmental speech or language disorders (HR, 1.16; 95% CI, 1.05–1.28), and autism (HR, 1.31; 95% CI, 1.05–1.64). Prenatal exposure to general anaesthesia is associated with a 31% increased risk for a subsequent diagnosis of a disruptive or internalising behavioural disorder in children. Caution is advised when making any clinical decisions regarding care of pregnant women, as avoidance of necessary surgery during pregnancy can have detrimental effects on mothers and their children. [ABSTRACT FROM AUTHOR]

We examined whether women with prenatal mood and anxiety disorders would exhibit differential pro- and anti-inflammatory marker trajectories during the prenatal and postpartum periods compared to women without these disorders. Approximately 179 pregnant women participated in a longitudinal study conducted in two urban areas. Blood samples for inflammatory markers were collected at six study visits. The Structured Clinical Interview for the DSM-IV (SCID) was administered to participants scoring above cutoffs on anxiety and depression. Pregnant women with SCID Axis I diagnoses of mood and/or anxiety disorders were compared to other participants on inflammatory markers. Multilevel modeling tested associations between SCID diagnoses and within-person interleukin (IL)6 and IL10 trajectories. Prenatal SCID diagnoses were associated with linear, quadratic and cubic change in IL6 from prenatal to postpartum timepoints. Women with a prenatal SCID diagnosis had steeper decreases and increases in IL6 during prenatal and postpartum periods. SCID diagnoses were associated with lower IL10 in mid-pregnancy to postpartum (b = −0.078, SE = 0.019; p =.015). Future studies would benefit from a larger sample size and a larger number of participants with SCID diagnoses. Future research should also examine whether different prenatal Axis 1 diagnoses are associated with different patterns of immune response in pregnancy. Pregnant women with prenatal mood and anxiety disorders had greater fluctuations in IL6 across prenatal and postpartum periods and lower IL10 through pregnancy and postpartum. They may have different proinflammatory states that remain after birth without a reciprocal anti-inflammatory response. • Prenatal mood and anxiety disorders are linked to postpartum inflammation. • Women with prenatal SCID diagnoses had greater fluctuations of inflammatory markers. • Lower anti-inflammatory markers in pregnancy associated with prenatal SCID diagnoses [ABSTRACT FROM AUTHOR]

• With an own financial contribution, there is no equal access to fetal aneuploidy screening. • To overcome this inequality, the own contribution of the NIPT should be abandoned. • Since the majority of the parents makes an informed choice, the fear of routinization is redundant. First trimester non-invasive prenatal testing (NIPT) provides pregnant women with a reliable, non-invasive method to screen for fetal aneuploidies. In the Netherlands, there is a nationwide prenatal screening program in which pregnant women and their partners are counseled about their options around 10 weeks of pregnancy. The first trimester and second trimester scan are fully reimbursed but the NIPT has an own financial contribution of €175 per participant, irrespective of type of insurance. The arguments for this own contribution are fear of uncritical use of NIPT or routinization. NIPT has a relatively stable uptake of 51%, against over 95% for second trimester anomaly scan. We aimed to explore the effect of this financial contribution on the decision to opt out of NIPT. We performed a survey among 350 pregnant women undergoing a second trimester anomaly scan in our center, Amsterdam UMC, between January 2021 and April 2022. All pregnant women who declined NIPT in the first trimester, were asked to participate and answered 11–13 questions about the decision-making process, the reasons to opt out and the financial contribution. Information about NIPT was desired in 92% of women and 96% felt sufficiently informed. Most women took the decision not to perform NIPT with their partner and did not experience difficulties in taking this decision. The most important reason to decline NIPT was: "Every child is welcome" (69%). "The test was too expensive" was answered in 12% and was significantly correlated with lower maternal age. Additionally, one in five women (19%) said they would have done NIPT if it had been for free, which was significantly higher in younger women. The own financial contribution plays a role in the decision-making to decline NIPT and partly explains the low uptake in the Netherlands. This suggests that there is no equal access to fetal aneuploidy screening. To overcome this inequality, this own contribution should be abandoned. We speculate that this will have a positive effect on the uptake, which will increase to at least 70% and potentially 94%. [ABSTRACT FROM AUTHOR]

Introduction: The rates of syphilis among pregnant women and infants have increased in recent years, particularly in the U.S. South. Although state policies require prenatal syphilis testing, recent screening rates comparable across Southern states are not known. The purpose of this study is to measure syphilis screening among Medicaid enrollees with delivery in states in the U.S. South.Methods: A total of 6 state-university research partnerships in the U.S. South developed a distributed research network to analyze Medicaid claims data using a common analytic approach for enrollees with delivery in fiscal years 2017-2018 and 2018-2019 (combined N=504,943). In 2020-2021, each state calculated the percentage of enrollees with delivery with a syphilis screen test during the first trimester, third trimester, and at any point during pregnancy. Percentages for those with first-trimester enrollment were compared with the percentages of those who enrolled in Medicaid later in pregnancy.Results: Prenatal syphilis screening during pregnancy ranged from 56% to 91%. Screening was higher among those enrolled in Medicaid during the first trimester than in those enrolled later in pregnancy.Conclusions: Despite state laws requiring syphilis screening during pregnancy, screening was much lower than 100%, and states varied in syphilis screening rates among Medicaid enrollees. Findings indicate that access to Medicaid in the first trimester is associated with higher rates of syphilis screening and that efforts to improve access to screening in practice settings are needed. [ABSTRACT FROM AUTHOR]

Mother-to-child transmission (MTCT) of syphilis remains a leading cause of stillbirth and death among neonates in many developing countries. In 2007, World Health Orgernization launched the global elimination of MTCT (EMTCT) of syphilis. Given the high burden of congenital syphilis, China subsequently released the specific national EMTCT policies and programs to reduce MTCT of syphilis. The congenital syphilis incidence rate per 100,000 live births in China has markedly decreased from 69.9 in 2013 to 11.9 in 2019. However, due to the global pandemic of COVID-19, the current measures for eliminating MTCT of syphilis are greatly challenged. In this article, we summarize the strategies and measures for the EMTCT of syphilis in China in the past 20 years, the remarkable achievements by the policy support under the leadership of the government. In the context of COVID-19 pandemics, strengthening emergency response to the regional outbreaks of COVID-19, adopting safe, rapid, early and high-quality clinical care for 100% of pregnant women to receive prenatal syphilis testing services, ensuring the availability of Benzathine penicillin for the treatment, and strengthening the closed-loop management of pregnant women and newborns infected with syphilis are the key measures to determine the effectiveness of MTCT for syphilis. Lessons from China may be valuable for other countries that are planning to eliminate MTCT of syphilis. [ABSTRACT FROM AUTHOR]

Background: We developed a decision aid (DA) to help pregnant women and their partners make informed decisions about prenatal screening for trisomy. We aimed to determine its usefulness for preparing for decision-making and its acceptability among end-users.Methods: In this mixed-methods pilot study, we recruited participants in three prenatal care settings in Quebec City. Eligible women were over 18 and more than 16 weeks pregnant or had given birth recently. We asked them about the usefulness of the DA using an interview grid based on the Technology Acceptance Model. We performed descriptive statistics and deductive analysis.Results: Thirty-nine dyads or individuals participated in the study. Mean usefulness score was 86.2 ± 13. Most participants found the amount of information in the DA just right (79.5%), balanced (89.7%), and very useful (61.5%). They were less satisfied with the presentation and the values worksheet and suggested different values clarification methods.Conclusion: Rigorous pilot tests of DAs with patients are an important stage in their development before the more formal assessments that precede scaling up the DA in clinical practice.Practice Implications: The next version of the DA will integrate the suggestions of end-users for better decision-making processes about prenatal screening for trisomy. [ABSTRACT FROM AUTHOR]

Objective: There have been substantial medical developments in prenatal anomaly and aneuploidy screening. However, the quality of counseling about these tests tends to lag behind. Additional quality requirements were therefore implemented in the Netherlands in 2017 to optimize this counseling. We compared clients' counseling preferences and experiences before and after implementation of these requirements.Methods: We used the validated 57-item QUOTEprenatal questionnaire, to measure clients' counseling preferences and experiences before and after counseling in 20 obstetric organizations throughout the Netherlands. Clients' preferences and experiences were compared between pregnant women and partners, nulliparous versus multiparous clients and between results of a Dutch survey in 2011 and the current one.Results: Sixty-five counselors and 649 clients (353 pregnant women and 296 partners) participated in this study. Compared to 2011, slightly more clients considered the three QUOTEprenatal components of counseling (client-counselor relationship, health education, and decision-making support) to be either important or very important, especially decision-making support. More clients than in 2011 perceived their needs as being well addressed, with the lowest percentages for decision-making support.Conclusion: Quality requirements seem to benefit the quality of counseling, as perceived by clients.Practical Implications: Counselors should consider tailoring their decision-making support more to clients' needs. [ABSTRACT FROM AUTHOR]

Objective: We examined the potential value of combining ultrasound and non-invasive prenatal screening (NIPS) of maternal blood to screen for major aneuploidies as an early approach before selective fetal reduction from twin pregnancy to singleton.Study Design: The sample was composed of pregnant women with di-chorionic di-amniotic twins who chose to undergo fetal reduction to singleton at 12-24 weeks of gestation. These women were asked to provide a blood sample for cell-free fetal DNA (cffDNA) testing prior to fetal reduction.Results: A total of 24 pregnant women with a twin pregnancy prior to fetal reduction to singleton were enrolled. There were 8 cases with structural anomalies (33.3%) in one twin that dictated fetal reduction. The proportion of patients who underwent selective fetal reduction for fetal abnormalities was larger than in several other studies. The NIPS identified 1 case of Trisomy 13 (4.2%). The other 15 cases (62.5%) had no structural or chromosomal anomalies. The decision to undergo elective reduction of twin pregnancy to singleton was made for social reasons or upon the parents' request. Given the 33% of structural anomalies in the cohort, a cost analysis indicated that this procedure was 6.6-fold less expensive (vs. 4.6-fold with 4% structural anomalies in other publications) than conducting invasive procedures for the entire cohort.Conclusion: The findings suggest that an early anatomical scan and cffDNA can increase the overall safety margin and reduce interventional procedures before elective reduction of twin pregnancy to singleton. However, a larger cohort is needed to confirm these results. [ABSTRACT FROM AUTHOR]

Objective: To generate a self-report instrument to capture clinically relevant variations in expectant parents' caregiving development, specified by how they are preparing to parent an infant with a major congenital anomaly.Methods: Recent literature structured domains to guide item generation. Evaluations by experts and expectant parents led to a refined instrument for field testing. Psychometric testing included exploratory factor analysis, internal consistency, and test-retest reliability.Results: Samples included expert evaluators (n = 9), and expectant parent evaluators (n = 20) and expectant mother field testers (n = 67) with fetal anomaly diagnoses. Preparing to Parent-Act, Relate, Engage (PreP-ARE) resulted from a three factor solution that explained 71.8 % of the total variance, with global Cronbach's α = 0.72, and sub-scales 0.81, 0.65, 0.72 respectively. Cohen's weighted kappa indicated all items were acceptably reliable, with 14 of 19 items showing moderate (≥ 0.41) or good (≥ 0.61) reliability. Convergent validity was found between the maternal antenatal attachment and Act scales (r = 0.39, p = 0.001).Conclusion: This empirically-based instrument was demonstrated to be valid and reliable, and has potential for studying this transitional time.Practice Implications: PreP-ARE could be used to understand patient responses to the diagnosis, level of engagement, readiness to make decisions, and ability to form collaborative partnerships to manage healthcare. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this survey is to evaluate the knowledge of Chinese pregnant women about fetal chromosomal aneuploidy and microdeletion and microduplication syndromes, and Non-invasive prenatal testing (NIPT).Study Design: Written questionnaires were distributed to pregnant women who visited the fetal medicine clinic of the third affiliated hospital of Guangzhou medical university. A total of 330 questionnaires were given. Twenty-two questionnaires with incomplete information were excluded from further analysis. The remaining 308 cases were incorporated into the final analysis. Data were analyzed using IBM SPSS Statistics 26. Comparisons between categorical variables were tested by the use of crosstabs and χ 2 test.Results: Among pregnant women, the recognition of Down syndrome was the highest (93.5 %), followed by maternal serum screening (74.0 %) and NIPT (69.2 %) for chromosomal aneuploidy. The awareness rates of chromosomal microdeletions and microduplications (18.2 %) and monogenic disorders (13.3 %) were the lowest. There were no significant differences in age, education, and conception way between pregnant women (P > 0.05). When asked the opinion on increasing the testing range of NIPT, more than 50 % of pregnant women chose to follow the provider's advice.Conclusion: More than half of pregnant women lacked knowledge of screening methods for fetal chromosomal abnormalities. Less than 20 % of pregnant women knew microdeletion microduplication syndromes. To enhance the understanding of chromosomal abnormalities can ensure that women can actively choose tests rather than passively agreeing to their provider's recommendations so as to avoid missing the optimal prenatal screening time. [ABSTRACT FROM AUTHOR]

Objective: To investigate the rate of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positivity in asymptomatic pregnant women admitted to hospital for delivery in a Turkish pandemic center.Study Design: This prospective cohort study was conducted in Ankara City Hospital between April, 15, 2020 and June, 5, 2020. A total of 206 asymptomatic pregnant women (103 low-risk pregnant women without any defined risk factor and 103 high-risk pregnant women) were screened for SARS-CoV-2 positivity upon admission to hospital for delivery. Detection of SARS-CoV2 in nasopharyngeal and oropharyngeal samples was performed by Real Time Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) method targeting RdRp (RNA dependent RNA polymerase) gene. Two groups were compared in terms of demographic features, clinical characteristics and SARS-CoV-2 positivity.Results: Three of the 206 pregnant women participating in the study had positive RT-PCR tests (1.4 %) and all positive cases were in the high-risk pregnancy group. Although, one case in the high-risk pregnancy group had developed symptoms highly suspicious for COVID-19, two repeated RT-PCR tests were negative. SARS-CoV-2 RT-PCR positivity rate was significantly higher in the high-risk pregnancy group (2.9 % vs 0%, p = 0.04).Conclusion: Healthcare professionals should be cautious in the labor and delivery of high-risk pregnant women during the pandemic period and universal testing for COVID-19 may be considered in selected populations. [ABSTRACT FROM AUTHOR]

Purpose: China has the world's largest burden of hepatitis B virus (HBV) infection. However, there are few studies reported on the latest prevalence of hepatitis B surface antigen (HBsAg) among pregnant women in China. We aimed to assess the prevalence of HBV infection and its associated risk factors among pregnant women in Yunnan, which is a province with relatively high prevalence of blood-borne viruses.Methods: We conducted a cross-sectional study of 15,641 pregnant women who underwent routine antenatal screening for HBsAg in Yunnan between 2013 and 2016. Logistic regression analyses were used to examine the associations between HBV infection and risk factors.Results: Overall, 7.89% (95% confidence interval (CI), 7.47%-8.31%) of the 15,641 pregnant women tested positive for HBsAg. Multivariable logistic regression analysis showed that advanced age (≥35 years old; adjusted odds ratio [aOR], 2.43-2.59), Hani ethnicity (aOR, 1.97; 95% CI, 1.22-3.17), unemployed women (aOR, 1.88; 95% CI, 1.30-2.72), multigravidas (aOR, 1.21; 95% CI, 1.05-1.40), and multiparas (aOR, 1.28; 95% CI, 1.10-1.49) were more likely to be infected with HBV. HBV infection was associated with cesarean section and preterm birth, with aORs of 1.31 (1.17-1.48) and 1.23 (1.00-1.51), respectively. In the subgroup analysis, the association between Hani ethnicity and HBV infection was significantly higher in women aged 35 years or older (aOR = 5.15; 95% CI, 1.51-17.55) than in women younger than 35 years of age (aOR = 1.69; 95% CI, 1.00-2.86).Conclusions: HBV infection among 15,641 pregnant women was of high-intermediate endemicity in Yunnan, China. Advanced age, Hani ethnicity, unemployment, and multigravid and multiparous statuses were associated with an increased prevalence of HBV infection. High-risk pregnant women should be paid more attention during routine antenatal examination. [ABSTRACT FROM AUTHOR]

One stated objective of prenatal screening and diagnosis is the preparation for delivering a baby with medical needs or disability, however, psychosocial outcomes of parents who received a prenatal diagnosis suggest that this objective is not yet realised. Preparation may be complicated by diagnostic and prognostic uncertainty. A prenatal diagnosis that includes significant uncertainty due to the heterogeneous presentations, classifications, causes and outcomes is agenesis of the corpus callosum. As a neuroanatomical anomaly identified in the second or third trimesters, the diagnosis is likely to cause distress for expectant mothers, yet there is limited guidance for holistic support. To begin to address the paucity of research, this hermeneutic phenomenological study sought to explore, and provide a telling of the maternal experience of continuing pregnancy after a prenatal diagnosis of agenesis of the corpus callosum. Through interviews and a series of online, asynchronous and facilitated focus groups, lived experiences during pregnancy from the time of diagnosis to birth were explored with 26 mothers who participated in this international study. Themes were constructed through reflexive thematic analysis to describe the experience of the lived phenomenon. The first theme, Under Threat , included subthemes of The Threat to the Life of the Baby and Threatened Image of the Expected Family. The second theme, Day to Day Toward Adaptation , included subthemes of Holding it Together and Falling Apart, and More Than Information, Searching for Meaning, Hope and Control. To realise the commonly stated objective of prenatal diagnosis, to support maternal preparation, healthcare professionals require awareness of the profound, yet individual experience of prenatal diagnosis to adequately respond and support mothers through their continued pregnancies. Healthcare services should be designed to flexibly respond in a woman- and family-centred manner to reduce the threat and support maternal adaptation after a prenatal diagnosis. • Many mothers recounted a dissociative response to the news of the anomaly. • The diagnosis was experienced as a threat to the life of the baby and expected family. • Mothers engaged many strategies to hold it together, and their falling apart was hidden. • Mothers needed more than information, they searched for meaning, hope and control. • Professionals require awareness of the profound experience of a prenatal diagnosis. [ABSTRACT FROM AUTHOR]

There is much global research interest surrounding the use of cell-free DNA (cfDNA) for liquid biopsies. cfDNA-based non-invasive prenatal testing for foetal chromosomal aneuploidies was the first successful application of cfDNA technology that transformed clinical practice – it has since been rapidly adopted in dozens of countries and is used by millions of pregnant women every year. Prompted by such developments, efforts to use cfDNA in other fields, especially for cancer detection and monitoring have been actively pursued in recent years. Cancer-associated aberrations including single nucleotide mutations, copy number aberrations, aberrations in methylation and alterations in DNA fragmentation patterns have been detected in the cfDNA of patients suffering from a wide variety of cancers. In addition, the analysis of methylation and fragmentomic patterns has enabled the tissue origin of cfDNA to be determined. In this review, different approaches for detecting circulating liver-derived nucleic acids and cancer-associated aberrations, as well as their potential clinical applications for the detection, monitoring and management of hepatocellular carcinoma, will be discussed. [ABSTRACT FROM AUTHOR]

We aimed to determine the correlation between serum alpha-fetoprotein (AFP), the free human chorionic gonadotropin beta subunit (free beta-HCG) in pregnant women during the mid-trimester, and fetal hypospadias, and tried to establish a risk prediction model. A multi-center case-control study was conducted. We divided the fetuses into two groups (69 with fetal hypospadias and 62 without fetal hypospadias). Time-resolved immunofluorescence was used to determine the serum levels of AFP and free beta-HCG. The best cut -value and area under curve (AUC) were determined based on the Receiver operating characteristics (ROC) curve, and the diagnostic value of AFP and free beta-HCG was evaluated. The level of AFP in the study group was 1.14 multiple of Median(MOM), which was higher than in the control group (0.96 MOM); the difference was significant (Z = 2.831, P =.005). Similarly, the free beta-HCG level was 1.30 MOM in the study group, and was also significantly higher than in the control group (0.84 MOM; Z = 3.131, P =.004). We used the AFP and free beta-HCG levels separately to predict fetuses with hypospadias, and the AUCs were 0.644 (95% Confidence interval (CI): 0.5500.737, P =.005) and 0.659 (95% CI: 0.5650.752, P =.002), respectively. According to the ROC curve, the best cut-off values for AFP and free beta-HCG were 0.945 MOM and 1.275 MOM, respectively. When we combined the AFP level with the free beta-HCG level, the AUC was 0.700 (95% CI: 0.610–0.789, P <.001), with a sensitivity of 0.551 and a specificity of 0.855. Combined screening for fetal hypospadias with maternal serum AFP and free beta-HCG levels during the early second trimester has high sensitivity and specificity, which can be used as a new marker. [ABSTRACT FROM AUTHOR]

Objective: To explore the prevalence of asymptomatic SARS-CoV-2 in the maternity population.Study Design: Newham University Hospital based in East London serving a population with the highest death rate secondary to SARS-CoV-2 in the UK, commenced universal screening of all admissions to the Maternity Unit from 22nd April to 5th May, 2020. A proforma was created to capture key patient demographics, indication for admission and presence of SARS-CoV-2 related symptoms at the point of presentation.Results: A total of 180 women with a mean age of 29.9 (SD 7.4) years, at a median gestation of 39 (IQR 37 + 1-40 + 3) weeks underwent universal screening with nasopharyngeal PCR swabs during the two-week period of the study. BAME identity or parity was not associated with the likelihood of a positive result. Seven women (3.9 %, 1.6-7.8) were tested positive for SARS-CoV-2, of whom 6 (3.3 %, 1.2-7.1) were asymptomatic; 85.7 % (42.1-99.6) of the SARS-CoV-2 positive women were asymptomatic. The sensitivity of symptom-driven testing was 14.3 % (0.36-57.87) and specificity was 91.86 % (86.72-95.48) with a positive predictive value of 6.67 % (1.08-31.95) and a negative predictive value of 96.34 % (95.10-97.28).Conclusion: The prevalence of SARS-CoV-2 in the maternity population served by Newham University Hospital was 3.9 %, four weeks after lockdown. Of the women who were found to be SARS-CoV-2 positive, a high proportion (87.9 %) were asymptomatic. These findings support the need for universal testing to enable targeted isolation and robust infectious control measures to mitigate outbreaks of SARS-CoV-2 in maternity units. [ABSTRACT FROM AUTHOR]

Abstract In 2004 the Danish National Board of Health changed its screening recommendations. Since 2005 a first trimester screening for Down syndrome and a prenatal ultrasound screening for congenital anomalies in the second trimester of pregnancy has been offered to all pregnant women. The aim of this study was to describe the prevalence of cleft lip with or without cleft palate and cleft palate in a Danish area and to describe associated anomalies and the development in prenatal diagnosis over time. The study was based on data from the EUROCAT Registry for Funen County. The registry is based on multiple data sources and includes information about live births, fetal deaths with a gestational age >20 weeks and terminations of pregnancy after prenatal diagnosis of severe fetal anomaly. The study included all fetuses/infants out of a population of 182,907 births diagnosed with orofacial clefts born between 1980 and 2014. There were 271 cases diagnosed with cleft lip with or without cleft palate and 127 cases diagnosed with cleft palate, giving a prevalence of 14.8 per 10,000 births for cleft lip with or without cleft palate and 6.9 per 10,000 births for cleft palate. There were no significant changes in prevalence over time for the two anomalies, calculated with and without inclusion of genetic and chromosomal cases. Overall 66 cases were diagnosed prenatally (17% of total). For isolated cleft lip with or without cleft palate none of the 157 cases born before 2005 were diagnosed prenatally compared to 34 of 58 cases (59%) born in 2005–2014 (p < 0.01). The proportion of liveborn infants with multiple congenital anomalies also changed after 2005 with 15% (39/266) of all liveborn infants with orofacial clefts born 1980–2004 having multiple anomalies compared to 7% (7/96) in 2005–2014 (p < 0.05). The implementation of the new screening programme in 2005 has given a major change in prenatal detection rate and reduced the proportion of liveborn infants with orofacial clefts classified as multiple congenital anomaly cases. The prevalence of cleft lip with or without cleft palate was higher than reported from many other countries. [ABSTRACT FROM AUTHOR]

Background: Although the effects of alcohol on metabolic processes in the body have been studied widely, there do not appear to be any previous reports clarifying how substance abuse changes metabolic profiles of pregnant women during the first trimester of pregnancy.Objective: Our aim was to evaluate the effect of substance abuse, especially alcohol use, on the metabolic profile of pregnant women during the first trimester.Study Design: We applied mass spectrometry based non-targeted metabolite profiling of serum collected during routine visit to the hospital between gestational weeks 9 + 0 to 11 + 6 from controls (n = 55), alcohol users (n = 19), drug users (n = 24) and tobacco smokers (n = 40).Results: We observed statistically significantly differences among the study groups in serum levels of glutamate, glutamine, and serotonin (p-values ≤ 0.0001). The serum levels of glutamate were increased in alcohol and drug using mothers when compared to the controls, whereas levels of glutamine were decreased in alcohol and drug using mothers. In addition, serum levels of serotonin were decreased in alcohol using mothers when compared to the controls.Conclusion: The present study shows that alcohol and drug use were associated with increased glutamate, and decreased glutamine levels, and alcohol use is associated with decreased serotonin levels. This study serves as a proof-of-concept that the metabolite profile of human first trimester serum samples could be used to detect alcohol exposure during pregnancy. [ABSTRACT FROM AUTHOR]

Objectives: To examine the costs and outcomes of different screening strategies for Down Syndrome (DS) in singleton pregnancies.Study Design: A decision-analytic model was developed to compare the costs and the outcomes of different prenatal screening strategies. Five strategies were compared for women under 35-year of age: 1A) triple test (TT), 2A); combined test (CT), 3A) Non-invasive Prenatal Screening Test by using cell free fetal DNA (NIPT), 4A) and 5A) NIPT as a second-step screening for high-risk patients detected by either TT, or CT respectively. For women ≥35-year of age, 1B) implementing invasive test (amniocentesis -AC) and 2B) NIPT for all women were compared. Data was analyzed to obtain the outcomes, total costs, the cost per women and the incremental cost-effectiveness ratios (ICERs) for screening strategies.Results: Among the current strategies for women under 35 years old, CT is clearly dominated to TT, as it is more effective and less costly. Although, the current routine practice (2A) is the least-costly strategy, implementing NIPT as a second step screening to high-risk women identified by CT (5A) would be more effective than 2A; leading to a 10.2% increase in the number of detected DS cases and a 96.3% reduction in procedural related losses (PRL). However, its cost to the Social Security Institution that is a public entity would be 17 times higher and increase screening costs by 1.5 times. Strategy 5A would result in an incremental cost effectiveness of 6,873,082 (PPP) US$ when compared to the current one (2A). Strategy 1B-for offering AC to all women ≥35-year of age is dominated over NIPT (2B), as it would detect more DS cases and would be less costly. On the other hand, there would be 206 PRL associated with AC, but NIPT provides clear clinical benefits as there would be no PRL with NIPT.Conclusions: NIPT leads to very high costs despite its high effectiveness in terms of detecting DS cases and avoiding PRL. The cost of NIPT should be decreased, otherwise, only individuals who can afford to pay from out-of-pocket could benefit. We believe that reliable cost-effective prenatal screening policies are essential in countries with low and smiddle income and high birth rates as well. [ABSTRACT FROM AUTHOR]

Background: Prior anxiety and depression have been identified as risk factors for maternal perinatal mental health problems, but other preconception mental disorders have not been prospectively examined. This study investigated prospectively whether women with preconception personality disorder have increased rates of antenatal anxiety and/or depressive symptoms.Methods: 244 women in a population cohort were assessed for personality disorder at age 24 using the Standardised Assessment of Personality. Five to twelve years later, women were screened with the Clinical Interview Schedule, Revised Anxiety Subscale and the Edinburgh Postnatal Depression Scale during the third trimester of 328 pregnancies.Results: Preconception personality disorder was associated with a three-fold increase in the odds of antenatal anxiety symptoms, which remained with adjustment for preconception background factors and preconception common mental disorder (adjusted OR 2.84, 95% CI 1.31-6.15). Preconception personality disorder was associated with doubled odds of antenatal depressive symptoms, however this was attenuated with adjustment for preconception background factors and preconception common mental disorder (adjusted OR 1.98, 95% CI 0.81-4.81).Limitations: Our findings are restricted to pregnant women aged 29-35 years. Anxiety and depression may have been under-identified because they were assessed at a single antenatal time point. Residual confounding of the associations by preconception common mental disorder at other time points may have occurred.Conclusions: Women with personality disorder are at heightened risk of anxiety symptoms in pregnancy, over and above risks associated with prior common mental disorder. This raises a possibility that pregnancy brings particular emotional challenges for women with personality disorders. [ABSTRACT FROM AUTHOR]

Purpose The mechanisms by which gut microbiota contribute to methylmercury metabolism remain unclear. Among a cohort of pregnant mothers, the objectives of our pilot study were to determine (1) associations between gut microbiota and mercury concentrations in biomarkers (stool, hair and cord blood) and (2) the contributions of gut microbial mercury methylation/demethylation to stool methylmercury. Methods Pregnant women (36–39 weeks gestation, n = 17) donated hair and stool specimens, and cord blood was collected for a subset ( n = 7). The diversity of gut microbiota was determined using 16S rRNA gene profiling ( n = 17). For 6 stool samples with highest/lowest methylmercury concentrations, metagenomic whole genome shotgun sequencing was employed to search for the mercury methylation gene ( hgcA ), and two mer operon genes involved in methylmercury detoxification ( merA and merB ). Results Seventeen bacterial genera were significantly correlated (increasing or decreasing) with stool methylmercury, stool inorganic mercury, or hair total mercury; however, aside from one genus, there was no overlap between biomarkers. There were no definitive matches for hgcA or merB , while merA was detected at low concentrations in all six samples. Major conclusions Proportional differences in stool methylmercury were not likely attributed to gut microbiota through methylation/demethylation. Gut microbiota potentially altered methylmercury metabolism using indirect pathways. [ABSTRACT FROM AUTHOR]

Background Vaccinating populations against rubella aims to mitigate viral circulation and to ensure that women of childbearing age are immunized to reduce the incidence of congenital rubella syndrome. This study determined the serological statuses of pregnant women in an urban Brazilian population before and after the national rubella immunization campaign that was undertaken in 2008, and it assessed the socio-demographic factors associated with seronegativity. Methods Pregnant women living in Maceió, Alagoas, Brazil, who participated in a municipal prenatal screening program that involved blood tests for rubella, were assessed between June 2007 and May 2012. Socio-demographic factors associated with seronegativity were assessed, including the year of the blood test, categorized as before or after the 2008 immunization campaign, and the women's birth cohorts, the women's ethnicities, the gestational ages at the first prenatal visit, and the women's districts of residence. Results A total of 54,717 capillary blood samples were tested for rubella. The prevalence of pregnant women who were seronegative for rubella declined from 9.4% before the national immunization campaign to 2.8% after the national immunization campaign. Women were more likely to be seronegative for rubella before and after the immunization campaign if they were born between 1990 and 2000 or delayed starting prenatal care. Conclusions The decline in the prevalence of pregnant women who were seronegative for rubella to <5% indicates that the 2008 Brazilian rubella immunization campaign was successful in Maceió. [ABSTRACT FROM AUTHOR]

Background The sensitivity and specificity of noninvasive prenatal testing (NIPT) for detection of sex chromosome aneuploidies (SCAs) compared to common autosomal trisomies are significantly lower. We speculated that in addition to altered maternal X chromosome karyotype, maternal X chromosome copy number variations (CNVs) may also contribute to discordant NIPT SCA results. Methods Clinical NIPT was performed for pregnant women at a single hospital. Copy number variation sequencing (CNV-Seq) was used to identify and quantitate the copy number of maternal X chromosome CNVs for each positive SCA pregnancy. Results Two out of 25 SCA positive NIPT samples had slightly abnormal ChrX/ChrY z-scores and were referred for invasive test confirmation. However, fetal karyotypes were found to be normal. CNV-Seq analysis of the maternal white blood cell DNA archived from the original two NIPT blood samples identified small CNVs spanning the STS gene, which is associated with X-linked ichthyosis. Correcting for the altered plasma levels of X chromosome DNA caused by the two CNVs and, taking into consideration the phenotypic consequences for X-linked disease, both fetuses were diagnosed as normal. Conclusions Maternal DNA sequencing is recommended for all positive NIPT SCA results to avoid unnecessary referral for invasive testing and also to evaluate the risk to the fetus of X-linked disease. [ABSTRACT FROM AUTHOR]

Non-invasive prenatal testing (NIPT) is grounded in the analysis of free circulating fetal DNA (cfDNA) in pregnant women's blood. The rolling out of this screening method was in large part driven by commercial firms, which hoped to reach a huge potential market by offering a test that was expected to be risk-free, reliable, inexpensive, and able to detect a wide range of genetic traits of the future child. To date, most predictions about the scope and uses of NIPT have not materialized: in 2020 NIPT detects only a limited number of genetic anomalies, while results have to be confirmed by amniocentesis. NIPT has become a commercial success. Nevertheless the implementation of NIPT has tended to diverge across different national settings. In countries that already have state-sponsored screening for Down risk, NIPT has been offered by the state health insurance to women defined as "high risk", using a variant of the test that detects only three autosomal aneuploidies: trisomy 21, 13 and 18. These countries effectively regulate the supply of NIPT on grounds of cost-effectiveness and reliability. In countries without state-sponsored screening for Down risk, in contrast, multiple versions of NIPT covering a wider range of birth defects are commonly available on the free market, and purchased by women at low as well as high risk of having an affected child. Market-based healthcare systems tend to present women who can afford to pay for NIPT with a largely unregulated choice of technologies – though reimbursement rules imposed by private insurance providers may serve in effect to regulate use by those consumers who cannot afford to pay for tests from their own pockets. This regulatory divergence is shaped by the presence or absence of prior state-sponsored screening programs for Down risk. • Uses of non -invasive prenatal diagnosis were often shaped by commercial firms. • In spite of its limitations, non -invasive prenatal diagnosis is a marketing success. • There are important national differences in use of non-invasive prenatal diagnosis. • Stratified uses of non -invasive prenatal diagnosis produce situated fetal risks. [ABSTRACT FROM AUTHOR]

Abstract: Background: While depression during pregnancy is one of the strongest risk factors for postnatal depression, it has been comparatively little studied, particularly in sub-Saharan Africa. Methods: Cohort study nested within 4-weekly surveillance of all women of reproductive age to identify pregnancies and collect data on births and deaths in the Kintampo Health Research Centre study area of Ghana. Women were screened for depression during pregnancy using the Patient Health Questionnaire to ascertain DSM-IV major or minor depression. Information on demographic factors, indicators of social and economic disadvantage, and previous obstetric history were also collected which were examined using logistic regression; effect sizes reported as relative risks with 95% confidence intervals. Results: 21,135 pregnant women were screened of whom 20,920 (98.9%) had complete data on potential determinants. 2086 (9.9%, 95% CI: 9.5%–10.3%) had AND. Determinants of AND were: maternal age 30+ years (relative risk [RR], 1.16 (1.06–1.27); never married ([RR] 1.34, (1.14–1.58); lower wealth quintile ([RR], 1.30 (1.13–1.50); unplanned pregnancy ([RR], 1.55 (1.43–1.69); previous pregnancy loss ([RR], 1.30 (1.18–1.43). Limitations: We did not assess women for physical health during pregnancy, and lacked information on some potentially relevant psychosocial factors. Conclusion: Prevalence of antenatal depression, applying clinical criteria, is similar to that seen in high income countries. Factors related to chronic social and economic disadvantage are among the most important co-determinants. Population-level interventions that address these problems among women of reproductive age may be the most effective strategy for reducing the prevalence and impact of depression in pregnancy. [Copyright &y& Elsevier]

Abstract: Immunization against RhD is the major cause of hemolytic disease of the fetus and newborn (HDFN), which causes fetal or neonatal death. The introduction of postnatal immune prophylaxis in the 1960s drastically reduced immunization incidents in pregnant, D-negative women. In several countries, antenatal prophylaxis is combined with postnatal prophylaxis to further minimize the immunization risk. Due to lack of knowledge of the fetal RhD type, antenatal prophylaxis is given to all D-negative women. In the European population, approximately 40% of pregnant women carry a D-negative fetus and are thus at no risk of immunization. Noninvasive fetal RhD genotyping enables antenatal prophylaxis to be targeted to only those women carrying a D-positive fetus to avoid unnecessary treatment. Based on an analysis of cell-free fetal DNA from the plasma of pregnant women, this approach has recently undergone technical improvements and rapid clinical implementation. As a screening assay, the sensitivity is >99.3% from a gestational age of approximately 10–11weeks. In addition, fetal RhD genotyping is widely used to assess the risk of HDFN in anti-D immunized women. [Copyright &y& Elsevier]

Abstract: Objectives: Circulating cell-free fetal DNA (ccffDNA) in maternal plasma is an attractive source for noninvasive prenatal testing (NIPT). The amount of total cell-free DNA significantly increases 24h after venipuncture, leading to a relative decrease of the ccffDNA fraction in the blood sample. In this study, we evaluated the downstream effects of extended processing times on the reliability of aneuploidy detection by massively parallel sequencing (MPS). Design and methods: Whole blood from pregnant women carrying normal and trisomy 21 (T21) fetuses was collected in regular EDTA anti-coagulated tubes and processed within 6h, 24 and 48h after venipuncture. Samples of all three different time points were further analyzed by MPS using Z-score calculation and the percentage of ccffDNA based on X-chromosome reads. Results: Both T21 samples were correctly identified as such at all time-points. However, after 48h, a higher deviation in Z-scores was noticed. Even though the percentage of ccffDNA in a plasma sample has been shown previously to significantly decrease 24h after venipuncture, the percentages based on MPS results did not show a significant decrease after 6, 24 or 48h. Conclusions: The quality and quantity of ccffDNA extracted from plasma samples processed up to 24h after venipuncture are sufficiently high for reliable downstream NIPT analysis by MPS. Furthermore, we show that it is important to determine the percentage of ccffDNA in the fraction of the sample that is actually used for NIPT, as downstream procedures might influence the fetal or maternal fraction. [Copyright &y& Elsevier]

Critical congenital heart disease is the target of postnatal, pulse-oximetry screening; nevertheless, prenatal detection is preferable. Prenatal diagnosis allows for advanced perinatal planning, parental counseling, potential fetal cardiac intervention if indicated, and avoidance of complicated, costly, and at times, risky neonatal transport. The purpose of this study was to investigate a possible association between the occurrence of critical congenital heart disease and pregnancies complicated by maternal comorbidities. We identified all those prenatally and postnatally diagnosed with critical congenital heart disease in Nevada between July 2014 and June 2020. For each identified case of critical congenital heart disease, we assessed each mother's medical history. We divided pregnant women into two groups: 1) those with maternal comorbidities and 2) those without comorbidities. We identified 367 cases of critical congenital heart disease. Of the 367, 229 (62%) occurred in those with maternal comorbidities. Of the 367, 321 (87%) were live-born. Of the 321 live-born, 201 (63%) occurred in those with maternal comorbidities, however, the prevalence of maternal comorbidities in the general pregnancy population is not known. The majority of patients born with critical heart disease were born to mothers with comorbidities versus those without comorbidities for both the total and live-born cohorts (p = 0.00001). Of the 321 live-born, 10 had no prenatal care. Of the 311 with prenatal care, 248 (80%) were prenatally diagnosed. During the study period, there were approximately 210,000 live births in Nevada, for a prevalence of 15.2 (321/210,000) critical congenital cardiac malformations per 10,000 live births. In Nevada, most of those with critical congenital heart disease are products of pregnancies complicated by maternal comorbidities. Further, the state -wide, live-born, critical congenital heart disease prenatal-detection rate was 80%. • Prenatal detection of critical congenital heart disease is preferred to postnatal diagnosis. • The majority of patients born with critical heart disease were born to mothers with comorbidities. • In Nevada, critical congenital heart disease prenatal detection rate is 80%. [ABSTRACT FROM AUTHOR]

The evolution of the diagnosis and management of women with an early pregnancy loss has been a success story. The mortality from ectopic pregnancy has objectively been decreased in the past few decades. However, modern management has resulted in a new set of issues. Over-interpretation of a single ultrasound, misunderstanding of the utility of serial hCG values, and inappropriate use of methotrexate can result in iatrogenic complications. Modern management has successfully improved the diagnosis of ectopic pregnancy before rupture; it should now also focus on ensuring that an intrauterine pregnancy is not interrupted as a result of diagnosis and treatment. This article reviews some of the pitfalls of the modern management of early pregnancy failure and introduces a series of articles on the subject. [ABSTRACT FROM AUTHOR]

Objective: To determine the content of decision-relevant knowledge needed for informed decision-making about (non-) participation in prenatal screening for Down's syndrome (DS), in order to develop a knowledge questionnaire for routine application in large-scale programme evaluations. Methods: A generic list of content domains for knowledge about screening was extracted from the literature. Items reflecting specific knowledge domains were constructed. An expert group of professionals and pregnant women expressed whether domains and items represented decision-relevant information. Results: All presented domains were scored as (very) important. Options when receiving an ‘increased probability for DS’ test result, the meaning of this result, the aim of the screening, and voluntary nature of the test were scored as most important. The condition being screened for, prevalence, and the screening procedure were scored as relatively less important, with a high amount of expert consensus. Conclusion: A knowledge measure for prenatal screening for DS was developed, based on domains and items acquired by expert consensus. Practice implications: This measure of decision-relevant knowledge can be used in routine, large-scale evaluations of the procedure for offering information about prenatal screening for DS. [Copyright &y& Elsevier]

Abstract: Objective: The study aims to describe older women''s self-reported pregnancy-related symptoms, health and use of antenatal services by parity. Study design: The data were collected in a national survey of women who gave birth in one week in England in 2006. A random sample of 4800 participants was drawn via birth registration by the Office for National Statistics. Women were contacted at three months postpartum and a 63% response rate was achieved. Older women''s (35 years or more, n =692) experience of pregnancy-related symptoms and use of antenatal services were compared with those of younger women (<25 years n =336 and 25–34 years, n =1957) using logistic regression (odds ratios (ORs) and 95% confidence intervals (CI)) and adjusting for available confounding factors such as ethnicity, marital status, deprivation and education. Results: The older women had fewer antenatal visits, overnight stays in hospital, and pregnancy-related symptoms than women aged <25 years. Overall, the most common symptoms were nausea 68%, heartburn 62%, and backache 51%. Symptom prevalence varied with age and parity. Compared with women aged <25 years older women were less likely to have vomiting (adjusted OR, 95% CI: 0.49, 0.35-0.70), backache (0.42, 0.32–0.55), and to experience depression (0.58, 0.37–0.90) and more likely to have haemorrhoids (1.81, 1.31–2.47). Compared with women aged 25–34 years they were less likely to have vomiting (0.76, 0.58–0.99) but more likely to have varicose veins (1.39, 1.03–1.88), haemorrhoids (1.60, 1.31–1.96), carpal tunnel syndrome (1.34, 1.03–1.75), and stress incontinence (1.35, 1.05–1.45). Conclusion: Substantial numbers of women reported pregnancy-related symptoms likely to cause discomfort and affect daily life. Older women used antenatal health care less and experienced fewer symptoms but those reported were of the type that are more likely to persist after pregnancy, with the exception of depression, which was most commonly reported by the youngest women. [Copyright &y& Elsevier]

Abstract: Background: This study aims to evaluate the effectiveness of an antenatal psycho-educational intervention to prevent postpartum depression in Mexican women. Method: Pregnant women at high risk for depression were randomized to intervention or a usual care condition. Assessments of depression (SCID, BDI-II) occurred during pregnancy, 6weeks and 4–6months postnatally, and subjective impact of the intervention in the postpartum. Results: Of the 6484 women approached, 377 were eligible and consented to randomization (250 intervention, 127 control). Sixty-eight intervention (27.2%) and 68 (53.5%) control participants completed the three assessment periods. The cumulative incidence of major depression over three time periods was significantly lower (p <0.05) in the intervention (10.7%) than the control group (25%). Repeated-measures analysis of variance showed a significant reduction of BDI-II in both groups, but no significant treatment effect. Even when controlling for initial levels of depressive and anxiety symptoms, a treatment effect on depressive symptoms could not be confirmed, although there was a trend demonstrating that intervention participants with high initial symptoms had a larger reduction of BDI-II. Most participants that completed the intervention reported that it had a medium to great influence on their well-being, depression, current problems, role as mothers and their relationship with the baby. Limitations: Attrition was the most salient methodological problem in this study. Conclusions: This is the first randomized control depression prevention trial in high-risk pregnant Mexican women. Available data are consistent with the possibility that the incidence of depression may have been reduced by the intervention, but differential attrition makes interpretation of the findings difficult. [Copyright &y& Elsevier]

Abstract: Objectives: To examine the reliability of interphase FISH analysis of the main aneuploidies performed on mesenchymal core when prenatal diagnosis was performed on pregnant women with first-trimester fetal abnormalities on ultrasound. Study design: 386 first-trimester prenatal examinations were investigated from chorionic villus samplings for increased nuchal translucencies or other fetal ultrasound abnormalities. Interphase fluorescence in situ hybridization (FISH) for the main aneuploidies (trisomies 13, 18, 21 and gonosomal aneuploidies) was performed on the mesenchymal core of villi. Molecular cytogenetic results were always complemented by conventional cytogenetic results on long-term cultured villi (LTC-villi). Short-term cultured villi (STC-villi) preparations were retrospectively performed only when a chromosomal abnormality was observed with interphase FISH and/or LTC-villi. Results: 88 chromosomal abnormalities (88/386=22.8% of first-trimester diagnoses) which could discuss subsequent abortions were observed after LTC-villi preparations. All cases possibly detectable by interphase FISH were detected. Thus, 85 aneuploidies (85/386=22.0% of first-trimester diagnoses; 85/88=96.6% of chromosomal abnormalities) were detected by interphase FISH, allowing early abortion by curettage before week 14 amenorrhea. No discrepancy occurred between interphase FISH and LTC-villi results for the aneuploidies studied. Three false-negative results (3/386=0.77% of first-trimester diagnoses; 3/88=3.41% of chromosomal abnormalities) were observed with STC-villi. Conclusion: We observed a high rate of false-negative results on cytotrophoblast cells. Conversely, interphase FISH of the main aneuploidies on the mesenchymal core provided rapid and reliable results, and therefore should be preferred to STC-villi in first-trimester prenatal diagnosis performed on pregnant women with fetal abnormalities on ultrasound. [Copyright &y& Elsevier]

Abstract: In Sweden, more than 30 years after the introduction of vaccination for 12-year-old girls and post-partum mothers against rubella and 22 years after the introduction of routine MMR vaccination for all children at the ages of 18 months and 12 years, we have evaluated the rubella IgG activity in antenatal sera. 95.8% (39,890/41,637) of all women had anti-rubella IgG levels ≥10IU/mL. Levels <10IU/mL were more frequent in certain subcohorts: 8.2% (153/1870) of the Swedish women born after the introduction of the programme of childhood vaccination, 7.7% (616/8025) of women born outside the Nordic countries and 10.2% (118/1155) of recent immigrants and refugees to Sweden. In order to attain the goal of protecting the unborn, we propose alternative strategies to be evaluated: routine screening for rubella immunity prior to the first pregnancy, offering individuals with uncertain immunity a booster dose, and/or routine administration of an additional dose of MMR vaccine to all young adults before they leave the educational system. [Copyright &y& Elsevier]

Purpose: To assess the association of antenatal and postnatal social support with postpartum depression (PPD). Methods: We carried out a prospective cohort study of 534 pregnant women between February and September 2007 in Hunan, China. The association between prenatal and postnatal social support with PPD was examined. Results: A total of 103 (19.29%) women had PPD. Women with low prenatal and postnatal social support had higher rates of PPD. For prenatal support, PPD was 28.20% in the lowest quartile versus 9.90% in the highest quartile (adjusted odds ratio [OR]: 3.38, 95% confidence interval [CI]=1.64,6.98). For postnatal support, PPD was 44.10% in the lowest quartile versus 5.40% in the highest quartile (adjusted OR: 9.64, 95% CI=4.09, 22.69). Conclusions: Lower or lack of social support is a risk factor of PPD. The association between postnatal social support and PPD is much stronger than that of prenatal social support. [Copyright &y& Elsevier]

Abstract: Toxoplasmosis acquired during pregnancy exposes the fetus to congenital toxoplasmosis. Avidity tests are commonly used to date time of infection to evaluate the fetal risk and to offer prenatal diagnosis. This study evaluated and compared 2 commercial avidity tests: Platelia™ Toxo IgG Avidity (Bio-Rad, Marnes la Coquette, France) and Liaison® Toxo IgG Avidity II (Diasorin, Saluggia, Italy) kits. In complement, a study of specific IgG and IgM in the 2 systems was carried out. Sensitivity and specificity of the avidity tests were 94.4% and 87.8% for the Liaison® and 91.3% and 98.5% for the Platelia™ methods, respectively. Percentages of complete discrepancies, partial discrepancies, and agreement between both tests were 1.1%, 23.6%, and 75.3%, respectively. Moreover, the combination of both avidity tests may be useful in some cases. Indeed, that strategy permitted to confirm without delay a chronic toxoplasmosis in 23 cases and avoid treatment in these pregnant women. [Copyright &y& Elsevier]

Abstract: Congenital adrenal hyperplasia (CAH) applies to a group of inherited disorders caused by an enzyme deficiency in steroid biosynthesis. The most common form of CAH is 21-hydroxylase deficiency (21-OHD), which in its severe form can cause genital ambiguity in females. Affected females experience virilization both physically and psychologically. Steroid 21-OHD can be diagnosed in utero through molecular genetic analysis of fetal DNA. Appropriate prenatal treatment by dexamethasone administration to the at-risk pregnant mother is effective in reducing genital virilization in the fetus, thus avoiding unnecessary genitoplasty in affected females. Current data from large human studies show that prenatal diagnosis and treatment are safe in the short term for both the fetus and the mother. Preliminary data from long-term studies support these results. [Copyright &y& Elsevier]

Noninvasive prenatal screening tests help identify genetic disorders in a fetus, but their take-up remains low in several countries. Using a regression discontinuity design, we test the causal effect of a policy that eliminated co-payments for noninvasive screening tests in Italy. We identify the treatment effects by a discontinuity in women's eligibility for a free test based on their conception date. We find that the policy increases the probability of women's undergoing noninvasive screening tests by 5.5 percentage points, and the effect varies by socioeconomic status. We do not find evidence of substitution effects with more expensive and riskier invasive diagnostic tests. In addition, the increase in take-up does not affect pregnancy termination or newborn health. We find some evidence of positive effects on mothers' health behaviors during pregnancy as measured by reductions in mothers' weight gain and hospital admissions during pregnancy, but these are statistically significant only at the 10 percent level. [ABSTRACT FROM AUTHOR]

Objectives: We sought to evaluate pregnant women’s knowledge about features of second-trimester screening for Down syndrome and to assess whether knowledge and educational level influence their attitude toward amniocentesis before receiving test results. Methods: Pregnant Caucasian women (n = 300) <35 years old with no personal or family history of Down syndrome were surveyed. Women were randomized to 2 groups. One group of women (n = 150) were surveyed by questionnaire before consultation with specially trained midwives; the other group of women (n = 150) were surveyed after consultation. The questionnaire consisted of 3 sections: 1) participants’ demographic data, 2) knowledge about prenatal screening for Down syndrome, and 3) readiness to undergo amniocentesis if there was an increased risk of Down syndrome. Results: Women surveyed after consultation had greater total knowledge scores than those surveyed before consultation (p < .001). A statistically significant difference in knowledge scores in relation to educational levels was observed only in women who were surveyed before consultation (p = .007). Significantly more women were prepared to accept amniocentesis in the group surveyed after consultation (74%) than before consultation (53%; p < .001). Conclusion: Knowledge gained during a prescreening consultation influenced pregnant women’s attitudes toward further diagnostic investigation. A smaller proportion of women who were indecisive was observed in the group surveyed after prescreening consultation. Indecisiveness was not affected by poor knowledge about screening, but rather by difficulty in knowing how they will feel and what they will do if their screening result is positive. [Copyright &y& Elsevier]

Abstract: Although the diagnosis of congenital CMV infection is still complex, important goals have been achieved in recent years, among which are: the availability of more reliable IgM tests for screening pregnant women whose pre-pregnancy serological status for CMV is unknown, tests to determine the avidity index of anti-CMV IgG, allowing the diagnosis of a primary CMV infection and innovative and traditional virological tests to detect the virus in amniotic fluid. When a woman is found to be IgM-positive, further diagnostic evaluation focused on determining whether this is due to a primary infection should be carried out. Maternal primary infections that were difficult to determine until a few years ago unless documented by seroconversions can now be readily diagnosed from the presence of low/moderate avidity anti-CMV antibody which persists for approximately 18–20 weeks after primary infection. In mothers at risk of transmitting the virus prenatal diagnosis can be performed between 21 and 22 weeks of gestation, and the amniotic fluid represents the pathological material of choice to determine intrauterine virus transmission. At birth or in the first 2/3 weeks of life, it is essential to use appropriate tests for diagnosis of CMV congenital infection. [Copyright &y& Elsevier]

Summary Objective: The objective of this study was to identify whether there is a different pattern of reported offer and uptake of antenatal screening tests across social groups. Design: Prospective cohort study. Setting: Two large maternity hospitals in Northern Ireland. Sample: Women booking for antenatal care were recruited consecutively over a 3-month period commencing 1 September 2003. In total, 711 women were recruited at booking: 359 at Hospital 1 and 352 at Hospital 2. Six hundred and sixty-six women completed both interviews. Methods: Two semi-structured interviews were arranged with consenting participants. The first interview was conducted at the booking appointment, and the second interview took place after 23 weeks of gestation after all screening, including anomaly ultrasound, would have been offered. Main outcome measures: Reported offer and uptake of all screening tests were explored in relation to key sociodemographic indicators: level of education; mother's occupation; partner's occupation; single parent status; car ownership; religious denomination; and Townsend Deprivation Index. Results: With the exception of screening for Down's syndrome and neural tube defects, virtually at[ of the women were offered and underwent screening tests. Further analysis of data from Hospital 1 showed that, after controlling for other sociodemographic factors, women with a lower level of education had a lower odds of reporting Down's syndrome screening being offered Down's syndrome screening. Women having private antenatal care had a higher odds of accepting the offer of a test for Down's syndrome. Conclusions: While the majority of antenatal screening tests are offered to all pregnant women in Northern Ireland, screening for Down's syndrome and NTD reflects a different pattern of offer and uptake. This paper provides evidence of variations in offer and uptake that exist even when it is hospital policy to offer screening to all women. [ABSTRACT FROM AUTHOR]

Abstract: Sixty pregnant women with clinical signs of rubella and specific rubella antibodies were studied between January 1999 and December 2002 in order to determine the intrauterine rubella transmission rate and the presence of the virus in amniotic fluid and fetal tissues by nested PCR. Thirty-three patients presented rubella before 12 weeks of gestation and 27 after 12 weeks. Gestational age at the time of acute rubella was determined on the basis of the date of last menstruation and the first trimester ultrasound scan. Thirteen patients with clinical features of rubella before 12 weeks of gestation were submitted to amniocentesis. Three products of conception were analyzed. The presence of the rubella virus was determined by nested PCR. IgM and IgG antibodies were analyzed in neonatal samples at birth and at 3 months of age using a capture immunoassay. Newborn follow-up was based on the presence of congenital rubella syndrome-compatible defects, anti-rubella antibodies, echocardiographic alterations, brainstem evoked response audiometry, and ophthalmological pathology. Five miscarriages and four fetal deaths were observed in the group of patients presenting clinical features before 12 weeks of gestation. IgM antibodies were detected in seven neonates at birth and at 3 months of age. Deafness was observed in three cases and pigmentary retinopathy in one case. Fourteen of the 16 samples (13 amniotic fluid and 3 fetal tissue samples) submitted to virological analysis tested positive. Four fetal deaths, five miscarriages (one with negative virology) and seven newborns with anti-rubella IgM at birth and/or at 3 months age were observed in the group with rubella before 12 weeks of gestation. There were three cases in which virological analysis of the amniotic fluid samples was positive (infected) while the newborn showed no signs of congenital rubella syndrome and anti-rubella IgM were absent. When maternal rubella occurred after 12 weeks of gestation, no fetal or neonatal rubella signs were observed. Eradication of congenital rubella syndrome is possible since vaccination campaigns continue and all services related to the health care of children, adolescents and women have become aware of the significance of the problem and are collaborating. All pregnant women in Brazil should be screened for the rubella antibody and the susceptible group should be vaccinated after giving birth. [Copyright &y& Elsevier]

Abstract: Objectives: : To investigate whether amniotic fluid concentrations of non protein bound iron (NPBI) vary with growth in healthy fetuses and also offer a reference curve in the second trimester of pregnancy. Design and methods: : Amniotic fluid concentrations of NPBI were measured by HPLC in 118 women with physiological singleton pregnancies, who underwent amniocentesis for fetal karyotype between weeks 15 and 18 of gestation. Results: : NPBI increased progressively from weeks 14–15 to weeks 15–16, peaking at 17–18 weeks of gestation. NPBI values regressed positively with gestational age (GA). Multiple linear regression analysis between NPBI, as dependent variable, and various fetal parameters, as independent variables, showed a statistically significant regression coefficient with GA, bi-parietal diameter and transverse cerebellar diameter. Conclusions: : The present data constitutes the first quantification of NPBI concentrations in amniotic fluid under physiological conditions. Correlations with GA and ultrasound fetal biometry suggest that NPBI may play a role in fetal growth. [Copyright &y& Elsevier]

Since the 1960s, prenatal diagnosis techniques have been developed in industrialized countries. There is no therapeutic treatment for most of the diagnosed foetuses and the only solution medicine can offer is abortion; therefore, the techniques might seem controversial. Here, I aim to explore why some prenatal diagnosis and screening techniques are widely used when pregnant women are often ambivalent about them. This article draws on previous sociological work, accounts of health practitioners and a case study of the diffusion of Down''s Syndrome prenatal diagnosis in France. It argues that numerous factors, other than the demand of the users, can contribute to speed up the diffusion of a technique. [Copyright &y& Elsevier]

This experimental study investigates an intervention designed to increase rates of antenatal screening uptake in those intending to undergo antenatal screening. Eighty-eight pregnant women intending to undergo prenatal screening were alternately allocated to standard care or asked to write a simple plan for attending or making an appointment. Twenty-five (63%) in the intervention group made an action plan. There was no difference in uptake of screening between the intervention group and the control group, nor between those making an action plan and the control group. Within the intervention group, those making an action plan had higher screening uptake (21/25, 84%) than those not making one (7/15, 47%; CI95 difference=8–66%, P=0.017). Asking women who intend to undergo screening to make an action plan does not increase screening uptake. This result raises doubts about introducing simple action plans in a clinical situation as an effective means of changing behaviour. [Copyright &y& Elsevier]

Objective: Ultrasound is a widespread noninvasive method of prenatal diagnosis. The detection of fetal abnormalities can provoke anxiety, which needs coping. The coping process of pregnant women with different risk conditions for fetal abnormality were studied in a longitudinal design and compared with a nonrisk control group of women with healthy uncomplicated pregnancies. Methods: The coping strategies of women (n=664) during the second trimester were assessed with a questionnaire [Heim E, Augustiny KF, Blaser A, Schaffner L. Berner Bewa¨ltigungsformen (BEFO) Handbuch. Bern: Huber, 1991]. Data were collected at three points in time: immediately before the ultrasound scanning for fetal malformation, at 5–6 and 10–12 weeks after the prenatal ultrasound examination. Questionnaires were also used to collect information about sociodemographic data, anxiety, pregnancy data and personality. Results: The analysis of the coping strategies of women with high-risk pregnancies (n=497) and as well of these with no-risk conditions in the control group (n=167) revealed three different factors of coping: Factor I: positive emotional attitude/distance, Factor II: negative emotional attitude/disapproval and Factor III: active coping. At all three points in time, Factor I correlated significantly with anxiety decrease, Factor II with increase and Factor III did not correlate with anxiety at all. Conclusions: Women with risk-pregnancies used coping strategies similar to those women in the control-group. Different spectrums of coping strategies corresponded significantly to increasing or decreasing anxiety. These women with high levels of anxiety, especially, should be offered sensitive care or psychotherapeutic counseling, as their coping processes did not lead to successful coping in the form of a reduction in anxiety. [Copyright &y& Elsevier]

Non-Invasive Prenatal Testing (NIPT) for common fetal aneuploidies is rapidly increasing in India for both naturally conceived pregnancies and pregnancies conceived by assisted reproductive technologies (ART). This study aims to establish the very first next generation sequencing (NGS) laboratory for NIPT in an Indian hospital using the Ion Torrent platform to provide a complete in-house solution for pregnant women. In brief, all plasma DNA samples (both control and test groups) were converted to genomic DNA libraries using Fragment Library Kit (Thermo Fisher Scientific, Cat. No. 4471252) with Ion Xpress Barcode-Adapters mix (Thermo Fisher Scientific, Cat. No. 4471250) using our laboratory developed protocol. The libraries were then quantified using Qubit dsDNA HS (high sensitivity) Assay Kit, (Thermo Fisher Scientific) and diluted to equimolar amounts before pooling. The Ion Chef System (Thermo Fisher Scientific), as part of the workflow, was used for automated template preparation and loading the sequencing chip. Thereafter, low-pass whole-genome sequencing was done using the ion semiconductor sequencer Ion S5 System (Thermo Fisher Scientific,) to achieve at least 5 million sequence reads. In the dry-lab, the sequenced reads were aligned to the reference human genome (UCSC hg19) locally and their BAM files were generated. The euploid BAM files from the training set of samples were assigned to NIPT reference group and their aligned reads were partitioned into 50,000 bp bins. The number of reads in each bin becomes the unit for comparison with the test samples. GC corrections were performed based on the average coverage of genomic regions having a similar GC-content to correct the coverage differences between bins having a different GC percentage. In this validation study, the standard Z-score prediction models returned a value between -3 and +3 for all the chromosomes, indicating that there is no trisomy present. The scores for aneuploidy samples all showed a value above 4. The z-score refers to the number of standard deviations from the mean of a reference data set and in all molecular counting approaches, a z-score of more than 4 is considered a positive result. The algorithm was blindly tested on a cohort of 100 known samples, of which the 12 were T21, eight were T18, four were T13 and 76 were from euploid pregnancies. Our algorithm correctly called all euploid and aneuploid cases. For all aneuploidies, z scores were above a value of 4. Interestingly, accurate detection of aneuploidy was also noted at foetal fraction as low as 3.2%. Therefore, based on our findings, our algorithm is expected to be sensitive and specific for up to 99.9% of pregnancies with one of the three common trisomies. Based on the high performance of our NIPT test in validation studies, testing has commenced at Lifeline Hospital, including pregnancies conceived by ART. Clinical performance is currently under evaluation to derive positive predictive value (PPV) and negative predictive value (NPV) for each trisomy. [ABSTRACT FROM AUTHOR]