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Copyright of University of Health Sciences Journal of Nursing is the property of Saglik Bilimleri Universitesi and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Congenital heart disease (CHD) is the predominant birth defect. This study aimed to explore the association between maternal cardiovascular health (CVH) and the CHD risk in offspring. Methods: We used the prospective data from the Fujian Birth Cohort Study, collected from March 2019 to December 2022 on pregnant women within 14 weeks of gestation. Overall maternal CVH was assessed by seven CVH metrics (including physical activity, smoking, sleep duration, body mass index, blood pressure, total cholesterol, and fasting plasma glucose), with each metric classified as ideal, intermediate or poor with specific points. Participants were further allocated into high, moderate and low CVH categories based on the cumulative CVH score. The association with offspring CHD was determined with log-binominal regression models. Results: A total of 19810 participants aged 29.7 (SD: 3.9) years were included, with 7846 (39.6%) classified as having high CVH, 10949 (55.3%) as having moderate CVH, and 1015 (5.1%) as having low CVH. The average offspring CHD rate was 2.52%, with rates of 2.35%, 2.52% and 3.84% across the high, moderate and low CVH categories, respectively (P = 0.02). Adjusted relative risks (RRs) of having offspring CHD were 0.64 (95% CI: 0.45-0.90, P = 0.001) for high CVH and 0.67 (95% CI: 0.48-0.93, P = 0.02) for moderate CVH compared to low CVH. For individual metrics, only ideal total cholesterol was significantly associated with lower offspring CHD (RR: 0.73, 95% CI: 0.59-0.83, P = 0.002). Conclusions: Pregnant women of high or moderate CVH categories in early pregnancy had reduced risks of CHD in offspring, compared to those of low CVH. It is important to monitor and improve CVH during pre-pregnancy counseling and early prenatal care. [ABSTRACT FROM AUTHOR]

Copyright of Bagcilar Medical Bulletin / Bağcılar Tıp Bülteni is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Considering the role of fear of childbirth (FOC) in the enhancement of unnecessary cesarean sections (CS), the present study aimed at evaluating the effect of Cognitive-Behavioral Therapy (CBT) and haptonomy on the FOC (as primary outcome) and intended birth method and final birth method (as secondary outcomes) among primigravida women. Methods: This randomized clinical trial was conducted on 99 primigravida women in Tabriz, Iran 2022. Participants were assigned to three groups with a ratio of 1:1:1 using stratified block randomization based on the fear intensity. One of the intervention groups (n = 33) received eight group sessions of CBT from 24 to 28 weeks of gestation and the other intervention group (n = 33) received haptonomy during seven sessions once a week. The control group (n = 33) received routine prenatal care. The Wijma questionnaire was completed by the participants before the intervention, after the intervention at 35–37 weeks of gestation, and after birth. The intended birth method was investigated before and after the intervention at 35–37 weeks of gestation. The final birth method and the reasons for CS were recorded based on the mother's medical profile. The one-way ANOVA was used before the intervention and RMANOVA after the intervention to compare the mean scores of FOC among the three groups. Further, chi-square test was applied to compare the intended and final birth method. Results: The mean (standard deviation: SD) of FOC in the CBT group changed from 74.09 (11.35) at 24–28 weeks of gestation to 46.50 (18.28) at 35–37 weeks and 48.78 (20.64) after birth (P < 0.001). The means (SDs) of FOC in the haptonomy group were 76.81 (13.09), 46.59 (15.81), and 45.09 (20.11), respectively (P < 0.001). The mean (SD) of FOC in the control group decreased from 70.31 (6.71) to 66.56 (18.92) and then, increased to 71.00 (21.14) after birth (P = 0.878). After the intervention, there was no statistically significant difference among the three groups in terms of the intended birth method (P = 0.278), and final birth method (P = 0.107). Conclusion: The findings of the present study revealed that both CBT and haptonomy interventions reduce FOC. Although the desire for vaginal birth and final vaginal birth in the haptonomy group was more than that in the other two groups, there was no statistically significant difference among the three groups. Trial registration: Iranian Registry of Clinical Trials: IRCT20170506033834N9. Date of registration: 02.01.2022. URL: http://en.irct.ir. [ABSTRACT FROM AUTHOR]

Background: Pregnancy and childbirth experience can be important factors for a pleasant relationship between mother and baby. This study assessed the relationship between the pregnancy and birth experience with maternal-fetal attachment (MFA) and mother-child bonding. Methods: A descriptive-analytical study was conducted among 228 pregnant women in Tabriz, Iran February 2022 to March 2023. Using cluster random sampling method, we included 228 women with gestational age 28–36 weeks and followed them up until six weeks postpartum. Data were collected in two stages using the following questionnaires: Pregnancy Experience Scale (hassles and uplifts), Maternal-Fetal Attachment Questionnaire (during the third trimester of pregnancy), Postpartum Bonding Questionnaire, and Childbirth Experience Questionnaire (six weeks postpartum). Data were analyzed using Pearson's correlation test and general linear model. Results: The mean score of MFA was significantly higher among women with feelings of being uplifted during pregnancy [β (95% CI) = 1.14 (0.87 to 1.41); p < 0.001]. However, there was no statistically significant relationship between pregnancy hassles and MFA and mother-child bonding (p > 0.05). Also, there was no statistically significant relationship between childbirth experience and mother-child bonding (p > 0.05). Conclusion: According to the results of this study, pregnancy uplifts have a positive role in improving MFA. Therefore, it is recommended to plan interventions to make pregnancy period a pleasant experience for mothers. [ABSTRACT FROM AUTHOR]

Pregnancy is an important period in which mother-infant attachment begins, includes bio-psychological changes, and has physical and psychological effects on the future life of the fetus. This study aims to evaluate the prenatal attachment levels of Syrian refugee and Turkish mothers in Turkey and to determine the variables that affect these. This cross-sectional study conducted in the obstetric outpatient clinics with 397 pregnant women 197 Syrian and 200 native women. Inclusion criteria were a pregnancy of at least 20 weeks, no communication or mental disorders, no chronic diseases, no diagnosis of high-risk pregnancy, literacy in the pregnant Turkish women, Turkish language proficiency in the pregnant Syrian women, and residence in Turkey for at least three years. Data were collected using a Sociodemographic form and The Prenatal Attachment Inventory (PAI). The data were analyzed by conducting independent t-tests, and hierarchical multiple linear regression analysis. The mean prenatal attachment score of Turkish pregnant women (61.79 ± 8.55) was higher than Syrian women (48.38 ± 10.39) (p <.05). Education level, pre-pregnancy counseling, regular checkup, support from spouses, relatives, and friends, and being a refugee of pregnant women were determined as predictors of prenatal attachment. The results showed that 67 percent of the total variance in the prenatal attachment levels could be explained in model 2 (F = 35.524, R2 variation =.673, p =.001). The low prenatal attachment level of Syrian pregnant women was a result of the detrimental impacts of being a refugee on pregnancy. The integration of transcultural knowledge, culture-specific perspectives, and cross-cultural theories into clinical practices is essential for immigrant women. [ABSTRACT FROM AUTHOR]

Copyright of Revista Bioetica is the property of Conselho Federal de Medicina and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction (1): The COVID-19 pandemic led to changes in healthcare during pregnancy, childbirth and puerperium. The objective of this study was to know the impact of visit restrictions, PCR performance and use of masks on delivery and puerperium care. Methods (2): A descriptive cross-sectional study was carried out. A survey was used to assess the impact of COVID-19-related measures on women who had given birth in hospitals in the Region of Murcia, Spain, between March 2020 and February 2022. Results (3): The final sample size was 434 women. The average scores were 4.27 for dimension 1 (Visit restrictions), 4.15 for dimension 2 (PCR testing) and 3.98 for dimension 3 (Mask use). More specifically, we found that the restriction of visits was considered a positive measure for the establishment of the mother–newborn bond (mean score 4.37) and that the use of masks at the time of delivery should have been made more flexible (mean score 4.7). Conclusions (4): The policy of restricting hospital visits during the pandemic caused by COVID-19 has been considered beneficial by mothers, who expressed that they did not feel lonely during their hospital stay. [ABSTRACT FROM AUTHOR]

Introduction: Thyroid dysfunction is one of the most common endocrine disorder affecting women of reproductive age group including pregnancy. There are a few reports of prevalence of hypothyroidism during pregnancy from India with prevalence rate ranging from 4.8% to 11%, Subclinical Hypothyroidism is as high as 13.5 % women. Aim & Objective: To study the incidence of sub clinical hypothyroidism during pregnancy and its outcome both in fetus and mother. Material & Method: This prospective study with 50 patients has been conducted from October 2019 to September 2021, in the department of obstetrics and gynecology at VIMSAR Burla after getting clearance from the institutional ethical committee. Observation: The Incidence of subclinical hypothyroidism was found to be 0.58%. The Common association with maternal complications were preeclampsia (4%), preterm labour (22%), and anti partum haemorrhage (2%).The most common association with neonatal complication observed were low birth weight, intra uterine growth retardation, poor APGAR score, RDS and perinatal deaths. Conclusion: Subclinical hypothyroidism requires special consideration because pregnancy induces major changes in thyroid function and maternal thyroid disease can have adverse effect on pregnancy and fetus. Replacement therapy with L-thyroxin is the treatment of choice in hypothyroidism and subclinical hypothyroidism. [ABSTRACT FROM AUTHOR]

The crosstalk between maternal stress exposure and fetal development may be mediated by epigenetic mechanisms, including DNA methylation (DNAm). To address this matter, we collect 32 cord blood samples from low-income Brazilian pregnant adolescents participants of a pilot randomized clinical intervention study (ClinicalTrials.gov, Identifier: NCT02807818). We hypothesized that the association between the intervention and infant neurodevelopmental outcomes at 12 months of age would be mediated by DNAm. First, we searched genome methylation differences between cases and controls using different approaches, as well as differences in age acceleration (AA), represented by the difference of methylation age and birth age. According to an adjusted p-value ≤ 0.05 we identified 3090 differentially methylated positions- CpG sites (DMPs), 21 differentially methylated regions (DMRs) and one comethylated module weakly preserved between groups. The intervention group presented a smaller AA compared to the control group (p = 0.025). A logistic regression controlled by sex and with gestational age indicated a coefficient of −0.35 towards intervention group (p = 0.016) considering AA. A higher cognitive domain score from Bayley III scale was observed in the intervention group at 12 months of age. Then, we performed a potential causal mediation analysis selecting only DMPs highly associated with the cognitive domain (adj. R2 > 0.4), DMRs and CpGs of hub genes from the weakly preserved comethylated module and epigenetic clock as raw values. DMPs in STXBP6, and PF4 DMR, mediated the association between the maternal intervention and the cognitive domain at 12 months of age. In conclusion, DNAm in different sites and regions mediated the association between intervention and cognitive outcome. [ABSTRACT FROM AUTHOR]

Introduction: In this study, we investigated the maternal severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection's effect on newborn hearing loss. Methods: Thirty-nine newborns whose mother's SARS-CoV-2 real time-polymerase chain reaction test was positive at the time of parturition were included in this study. Another 39 newborns who were born from healthy pregnancies were selected as the control group. Neonates with risk factors for hearing loss determined by the American Academy of Pediatrics Joint Committee on Infant Hearing 2007 and those with ear pathology were excluded. The newborn hearing screening was done with auditory brainstem response (ABR) test. Second ABR test (ABR-2) was performed on newborns who failed the 1st test (ABR-1). The third ABR test (ABR-3) was performed on newborns who failed the second ABR test (ABR-2). The screening results were analyzed statistically. Results: In the control group, a total of 6 (15.4%) newborns failed ABR-1, five newborns in one ear (3 right, 2 left), and one newborn in both ears. In the study group, a total of 14 (35.9%) newborns failed ABR-1, 11 newborns from both ears and 3 (2 right, 1 left) newborns from one ear. ABR-1 results were significantly worse in the study group's neonates (p=0.038). In addition, the rate of involvement of both ears was higher in the study group (p=0.018; p<0.05). 1 (16.7%) newborn in the control group and 2 (14.3%) newborns in the study group failed the ABR-2 in both ears. There was no statistically significant difference according to the ABR-2 test (p=0.681; p>0.05). All babies passed the ABR-3. Conclusion: There was a significant relationship between neonatal hearing loss and maternal SARS-CoV-2 infection. This hearing loss is usually bilateral and temporary. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Medical Biochemistry is the property of Society of Medical Biochemists of Serbia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Paideia (0103863X) is the property of Paideia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Turkiye Klinikleri Journal of Nursing Sciences is the property of Turkiye Klinikleri and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Extensão em Foco is the property of Universidade Federal do Parana and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Turkiye Klinikleri Journal of Health Sciences / Türkiye Klinikleri Sağlık Bilimleri Dergisi is the property of Turkiye Klinikleri and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: To describe the ontogeny of the immune system and the adaptive mechanisms of the immune system in the neonatal period, with an emphasis on transplacental antibody transport and breastfeeding. Source of data: Non-systematic literature review in the PubMed database. Summary of the findings: The last two decades have witnessed a great advance in the knowledge of the immune system since conception. Several investigation tools have provided insight on phenomena that were previously inadequately understood. Still expanding, the functional and molecular investigation of various aspects of the immune system will make it possible to understand how intra-uterus maternal-fetal exchanges, the maternal microbiota interacting with the fetus and newborn, and the acquisition of immunological competence occur in healthy and disease scenarios. Conclusions: In-depth knowledge of the development of the immune system and of the adaptive mechanisms that allow a safer transition to the extrauterine environment are fundamental components of optimizing maternal and young infant vaccination, as well as the strategies associated with full postnatal development, and the early diagnosis and treatment of innate errors of immunity. [ABSTRACT FROM AUTHOR]

Copyright of Revista Gaucha de Enfermagem is the property of Revista Gaucha de Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Enfermagem em Foco is the property of Conselho Federal de Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Habanera de Ciencias Médicas is the property of Universidad de Ciencias Medicas de La Habana and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: This study was conducted to examine the relationships among the perceptions and practice of taegyo (a traditional set of practices and beliefs related to healthy fetal development) and maternal-fetal attachment in pregnant women. Methods: The participants were 136 pregnant women who visited a public health center or maternity hospital for prenatal care. The collected data were analyzed using descriptive statistics, the t-test, analysis of varience, and Pearson correlation coefficients with SPSS version 22.0. Results: The mean age of the pregnant women was 32.24±3.99 years. The mean scores for perceptions of taegyo, practice of taegyo, and maternal-fetal attachment were 3.96±0.53, 3.74±0.64, and 3.94±0.49, respectively. Perceptions of taegyo were significantly correlated with the practice of taegyo (r=.72, p<.001), and maternal-fetal attachment (r=.55, p<.001). A significant correlation was also found between the practice of taegyo and maternal-fetal attachment (r=.65, p<.001). Conclusion: Perceptions of taegyo affected the practice of taegyo, and had a positive effect on maternal-fetal attachment. These findings suggest that primary care nurses at hospitals and public health centers should provide nursing intervention programs to improve the perceptions of taegyo, the practice of taegyo, and maternal-fetal attachment. [ABSTRACT FROM AUTHOR]

Objectives: understand the structure and content of the maternal representations of Mexican teenagers during their first pregnancy. Methods: a study was carried out with qualitative methodology based on the concept of maternal representation and the theory of social representations with 30 adolescents who attended prenatal control at the Civil Hospital of Guadalajara "Fray Antonio Alcalde", in Jalisco, Mexico. The participants were interviewed with the consent of their tutors. Classical content analysis techniques were used to obtain codes and thematic categories to develop a conceptual map that explains maternal representations. Results: the maternal representation was identified: "Pregnant but reunited, a legitimated bad decision", which was composed of social meanings towards adolescent pregnancy, family dynamics, expectations towards motherhood, and the feelings experienced by the adolescent during the pregnancy. The content of the representations was heterogeneous for most of the identified categories; however, it is identified that the desire for pregnancy guides the expectations of the adolescent about her future way of being as a mother. Conclusions: the desire of women for pregnancy, the level of participation of the couple, and the social meanings of adolescent pregnancy, have an outstanding role in the development of models of maternal representations. [ABSTRACT FROM AUTHOR]

This randomized controlled trial was conducted on 80 Iranian pregnant women with unplanned pregnancy. The participants were randomly assigned to two groups of intervention and control. The intervention group received one to three sessions of individual counseling and six sessions of group counseling each week in six consecutive weeks, and the control group received routine care. The Edinburgh Postnatal Depression Scale and the Spielberger State-Trait Anxiety Inventory were completed by the participants before and 4 weeks after the intervention. There was no significant difference between groups in terms of socio-demographic characteristics, and the baseline depression and anxiety scores (P > 0.05). The depression and anxiety scales were completed before and 4 weeks after the intervention. The mean scores of depression, state anxiety, and trait anxiety were significantly lower in the counseling group than in the control group 4 weeks after the end of intervention. It is recommended that counseling should be provided for women with unplanned pregnancy. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Advanced Nursing (John Wiley & Sons, Inc.) is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Aquichan is the property of Universidad de la Sabana and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The association between low levels of alcohol consumption during pregnancy and children's health remains unclear because of the difficulty in ruling out residual genetic and environmental confounding factors. In this study, using a within-family sibling fixed effects design, we sought to examine the association between low prenatal alcohol exposures (PAE) and children's overall psychosocial behavior in a Japanese cohort. Methods: We used maternal and sibling data from the Japanese Study of Stratification, Health, Income and Neighborhood 2012-2013. Households were recruited from the Tokyo metropolitan area through clustered random sampling. Children under 18 years old who have siblings (n = 1,600) and their mothers were selected. PAE status was retrospectively measured, and classified by binominal and continuous measurements. Outcome measures of children's psychosocial behavior were assessed with the Child Behavior Checklist T-score. Results: Low PAE was significantly associated with the offspring's anxiety problems (β = 1.54, 95%CI = 0.26, 2.82) and internalizing problems (β = 2.73, 95%CI = 0.87, 4.60), and marginally significant with the offspring's total problem scores (β = 2.34, 95%CI = −0.24, 4.92). There was no significant difference in PAE between boys and girls when it comes to behavioral problems. Conclusions: Low PAE was associated with children's anxiety, internalizing problems and overall problems, taking into account possible unobserved genetic and environmental confounding influences. [ABSTRACT FROM AUTHOR]

Copyright of Journal of International Obstetrics & Gynecology is the property of TianJin Medical Information Center and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: Maternal-fetal attachment in a pregnant woman is important for her health and for her child's emotional stability. This study was done to identify the contribution of maternal fatigue, social support, and Taegyo to maternal-fetal attachment based on a survey of pregnant women. Methods: The study was a descriptive correlation study. Participants were 211 from two women's health clinic centers. Data were analyzed using t-test, ANOVA, Pearson correlation coefficients and stepwise multiple regression. Results: Mean scores for maternal-fetal attachment, Taegyo, maternal fatigue, and social support were 93.74 (range 25-125), 64.76 (17-85), 24.12 (10-40), and 54.43 (22-132), respectively. There were significant differences in maternal-fetal attachment according to parity, breast feeding experience, and putting prenatal education into practice. Multiple regression analysis showed that the key determinants of maternal-fetal attachment, were Taegyo (β=.67), maternal fatigue (β=.21), and social support (β=.13), and these explained 55% of the total variance of attachment. Conclusion: The results suggest a need to encourage Taegyo in prenatal management program and provide methods for fatigue resolution and promotion of social support. [ABSTRACT FROM AUTHOR]

Copyright of Der Gynäkologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der Gynäkologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der Gynäkologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim: To study obstetricians’ attitudes in Finnish antenatal screening units concerning fetal sex determination without medical indication. Methods: A structured questionnaire to all delivery units (n = 37) and the main outpatient screening units (n = 18) in the country. Results: The majority of units made fetal sex determination without medical indication at patient’s request during the second-trimester ultrasonographic screening. This examination was seen to have consequences for maternal—fetal attachment, but it was also considered medically useless and sometimes harmful. Only three out of the responding 32 units maintained quality control of the examination. A false diagnosis resulted extremely seldom in any litigation process. Conclusions: More precise guidelines are needed for fetal sex determination in healthcare organisation. [ABSTRACT FROM PUBLISHER]

Background: Actions taken after a stillbirth can affect long-term psychological morbidity. Our objective was to study how infant bonding and maternal actions after stillbirth are associated with ensuing depressive symptoms. Methods: Using the population-based Swedish Medical Birth Register, we identified all 380 Swedish-speaking women who gave birth to singleton stillborn infants in Sweden in 1991. Of these, 314 (83%) completed a postal questionnaire 3 years after the stillbirth. Items included actions taken to bond with the baby and demographics. The association between care-related factors and later maternal depressive symptoms was quantified using relative risks estimated using multivariable regression. Results: We observed an almost sevenfold increased risk of depressive symptoms for mothers who reported not being with their babies as long as they wished (adjusted risk ratio [RR] 6.9, 95% CI 2.4–19.8). Compared with women who became pregnant again within 6 months, those with no later pregnancy were at higher risk of depressive symptoms (adjusted RR 2.8, 95% CI 0.9–8.4). In addition, compared with women who experienced a stillbirth in their first pregnancy, stillbirth occurring with an infant who was third in the birth order was related to a twofold risk of elevated depressive symptoms (adjusted RR 2.2, 95% CI 0.8–6.4). Furthermore, stillbirth occurring in a fourth or later pregnancy was associated with an almost sevenfold risk of depressive symptomatology (adjusted RR 6.7, 95% CI 2.2–20.5). No evidence of an association was found between other care-related actions and subsequent maternal depressive symptoms. Conclusions: Our results suggest that a mother being with the stillborn baby for as long as desired and the birth order of the stillbirth may influence her later depressive symptomatology. Compared with mothers who became pregnant again within 6 months, those who did not have a subsequent pregnancy were at higher risk of depressive symptoms at 3 years’ follow-up. (BIRTH 35:2 June 2008) [ABSTRACT FROM AUTHOR]

To assess the impact of three-dimensional (3D) versus two-dimensional (2D) ultrasound (US) on maternal–fetal bonding. Prospective randomized pilot study among low risk women with singleton fetuses in the second and third trimester. Dependent on the randomization pattern, US was commenced either with 2D US or 3D US and the effects were recorded with standardized questionnaires. Sixty patients were included. Although the quality of 2D US, assessed by the examinator, was superior to 3D US, maternal recognition was higher with 3-D US ( P = 0.004). With 2D US, nulliparous patients had significantly more difficulties visualizing the fetus, than multiparous ( P = 0.03). However, the maternal preference of 3D US had no significant impact on maternal–fetal bonding. Ultrasound had no significant effect on maternal–fetal bonding. Three-dimensional images may facilitate recognition of the fetus, but 3D US did not have higher impact on maternal–fetal bonding. This finding may be a reason not to consider 3D ultrasound for routine scanning. [ABSTRACT FROM AUTHOR]

Objective: To assess the fetal outcome of three hypertensive women exposed to amlodipine. 5 mg/day, in the first trimester of pregnancy. Case 1: The patient was treated with amlodipine until 7 weeks of gestation. She was also exposed to levosulpiride, aluminum hydroxide gel, magnesium carbonate, and Ginkgo biloba. At 38+3 weeks of pregnancy, she delivered a 3750 g healthy female baby, and restarted taking amlodipine, 5 mg/day, while exclusively breastfeeding her daughter. At three months of age, the infant was healthy. Case 2: The patient was treated with amlodipine from 2+2 to 3+4 weeks of pregnancy. Her treatment was modified to atenolol until the week 6+4 weeks, when she declined any antihypertensive treatment. At 39+4 weeks of pregnancy, the patient delivered a 2600 g baby. At 20 months old, the baby presented with intellectual delay and weakness in the left arm and hand grasp. These neurological alterations were not attributed to her exposure to amlodipine early in utero. Case 3: The patient was treated with amlodipine from 7+6 to 12 weeks of pregnancy. She was also taking sucralfate and lorazepam. At 12 weeks of amenorrhea, ultrasound revealed a 15.3 mm, single fetal pole in the gestational sac without cardiac activity. She underwent dilatation and evacuation of a dead embryo. Conclusion: As reported with other calcium-channel blockers, amlodipine does not appear to be teratogenic and it appears to be compatible with breastfeeding. [ABSTRACT FROM AUTHOR]

Objective To identify associations between cocaine exposure during pregnancy and medical conditions in newborn infants from birth through hospital discharge. Design Multisite, prospective, randomized study. Setting Brown University, University of Miami, University of Tennessee (Memphis), and Wayne State University. Subjects A total of 717 cocaine-exposed infants and 7442 nonexposed infants. Main Outcome Measures Results of physical examination and conditions observed during hospitalization. Results Cocaine-exposed infants were about 1.2 weeks younger, weighed 536 g less, measured 2.6 cm shorter, and had head circumference 1.5 cm smaller than nonexposed infants (all P<.001). Results did not confirm previously reported abnormalities. Central and autonomic nervous system symptoms were more frequent in the exposed group: jittery/tremors (adjusted odds ratio, 2.17; 99% confidence interval, 1.44-3.29), high-pitched cry (2.44; 1.06-5.66), irritability (1.81; 1.18-2.80), excessive suck (3.58; 1.63-7.88), hyperalertness (7.78; 1.72-35.06), and autonomic instability (2.64; 1.17-5.95). No differences were detected in organ systems by ultrasound examination. Exposed infants had more infections (3.09; 1.76-5.45), including hepatitis (13.46; 7.46-24.29), syphilis (8.84; 3.74-20.88), and human immunodeficiency virus exposure (12.37; 2.20-69.51); were less often breastfed (0.26; 0.15-0.44); had more child protective services referrals (48.92; 28.77-83.20); and were more often not living with their biological mother (18.70; 10.53-33.20). Conclusions Central and autonomic nervous system symptoms were more frequent in the exposed cohort and persisted in an adjusted analysis. They were usually transient and may be a true cocaine effect. Abnormal anatomic outcomes previously reported were not confirmed. Increased infections, particularly sexually transmitted diseases, pose a serious public health challenge. Exposure increased involvement of child protective services and out-of-home placement. [ABSTRACT FROM AUTHOR]

Context Proposed federal legislation would require physicians to inform women seeking abortions at 20 or more weeks after fertilization that the fetus feels pain and to offer anesthesia administered directly to the fetus. This article examines whether a fetus feels pain and if so, whether safe and effective techniques exist for providing direct fetal anesthesia or analgesia in the context of therapeutic procedures or abortion. Evidence Acquisition Systematic search of PubMed for English-language articles focusing on human studies related to fetal pain, anesthesia, and analgesia. Included articles studied fetuses of less than 30 weeks’ gestational age or specifically addressed fetal pain perception or nociception. Articles were reviewed for additional references. The search was performed without date limitations and was current as of June 6, 2005. Evidence Synthesis Pain perception requires conscious recognition or awareness of a noxious stimulus. Neither withdrawal reflexes nor hormonal stress responses to invasive procedures prove the existence of fetal pain, because they can be elicited by nonpainful stimuli and occur without conscious cortical processing. Fetal awareness of noxious stimuli requires functional thalamocortical connections. Thalamocortical fibers begin appearing between 23 to 30 weeks’ gestational age, while electroencephalography suggests the capacity for functional pain perception in preterm neonates probably does not exist before 29 or 30 weeks. For fetal surgery, women may receive general anesthesia and/or analgesics intended for placental transfer, and parenteral opioids may be administered to the fetus under direct or sonographic visualization. In these circumstances, administration of anesthesia and analgesia serves purposes unrelated to reduction of fetal pain, including inhibition of fetal movement, prevention of fetal hormonal stress responses, and induction of uterine atony. Conclusions Evidence regarding the capacity for fetal pain is limited but indicates that fetal perception of pain is unlikely before the third trimester. Little or no evidence addresses the effectiveness of direct fetal anesthetic or analgesic techniques. Similarly, limited or no data exist on the safety of such techniques for pregnant women in the context of abortion. Anesthetic techniques currently used during fetal surgery are not directly applicable to abortion procedures. [ABSTRACT FROM AUTHOR]

Presents an editorial regarding the accumulating evidence for prenatal nutritional origins of mental disorders. Reference to a study that reports an association between prenatal exposure to severe maternal nutritional deficiency and risk for schizophrenia in adulthood; Association of prenatal nutritional deficiency in intrauterine development with risk for postnatal psychiatric disorder in offspring; Role played by prenatal folate deficiency in risk for neural tube defects.

Context Schizophrenia is a common major mental disorder. Intrauterine nutritional deficiency may increase the risk of schizophrenia. The main evidence comes from studies of the 1944-1945 Dutch Hunger Winter when a sharp and time-limited decline in food intake occurred. The most exposed cohort conceived during the famine showed a 2-fold increased risk of schizophrenia. Objective To determine whether those who endured a massive 1959-1961 famine in China experienced similar results. Design, Setting, and Participants The risk of schizophrenia was examined in the Wuhu region of Anhui, one of the most affected provinces. Rates were compared among those born before, during, and after the famine years. Wuhu and its surrounding 6 counties are served by a single psychiatric hospital. All psychiatric case records for the years 1971 through 2001 were examined, and clinical and sociodemographic information on patients with schizophrenia was extracted by researchers who were blinded to the nature of exposure. Data on number of births and deaths in the famine years were available, and cumulative mortality was estimated from later demographic surveys. Main Outcome Measures Evidence of famine was verified, and unadjusted and mortality-adjusted relative risks of schizophrenia were calculated. Results The birth rates (per 1000) in Anhui decreased approximately 80% during the famine years from 28.28 in 1958 and 20.97 in 1959 to 8.61 in 1960 and 11.06 in 1961. Among births that occurred during the famine years, the adjusted risk of developing schizophrenia in later life increased significantly, from 0.84% in 1959 to 2.15% in 1960 and 1.81% in 1961. The mortality-adjusted relative risk was 2.30 (95% confidence interval, 1.99-2.65) for those born in 1960 and 1.93 (95% confidence interval, 1.68-2.23) for those born in 1961. Conclusion Our findings replicate the Dutch data for a separate racial group and show that prenatal exposure to famine increases risk of schizophrenia in later life. [ABSTRACT FROM AUTHOR]

Context Tobacco increases the risk of systemic diseases, and it has adverse effects on pregnancy. However, only indirect data have been published on a possible genotoxic effect on pregnancy in humans. Objectives To determine whether maternal smoking has a genotoxic effect on amniotic cells, expressed as an increased chromosomal instability, and to analyze whether any chromosomal regions are especially affected by exposure to tobacco. Design, Setting, and Patients In this prospective study, amniocytes were obtained by routine amniocentesis for prenatal diagnosis from 25 controls and 25 women who smoke (≥10 cigarettes/d for ≥10 years), who were asked to fill out a smoking questionnaire concerning their smoking habits. Chromosomal instability was analyzed in blinded fashion by 2 independent observers in routine chromosome spreads. Breakpoints implicated in chromosomal abnormalities were identified by G-banding. Main Outcome Measures Association between maternal smoking and increased chromosomal instability in amniotic fluid cells, expressed as chromosomal lesions (gaps and breaks) and structural chromosomal abnormalities. Results Comparison of cytogenetic data between smokers and nonsmokers (controls) showed important differences for the proportion of structural chromosomal abnormalities (smokers: 12.1% [96/793]; controls: 3.5% [26/752]; P = .002) and to a lesser degree for the proportion of metaphases with chromosomal instability (smokers: 10.5% [262/2492]; controls: 8.0% [210/2637]; P = .04), and for the proportion of chromosomal lesions (smokers: 15.7% [391/2492]; controls: 10.1% [267/2637]; P = .045). Statistical analysis of the 689 breakpoints detected showed that band 11q23, which is a band commonly implicated in hematopoietic malignancies, was the chromosomal region most affected by tobacco. Conclusions Our findings show that smoking 10 or more cigarettes per day for at least 10 years and during pregnancy is associated with increased chromosom... [ABSTRACT FROM AUTHOR]

Context Currently, fetal point mutations cannot be reliably analyzed from circulatory fetal DNA in maternal plasma, due to the predominance of maternal DNA sequences. However, analysis of circulatory fetal DNA sequences in maternal plasma have been shown to selectively enrich for fetal DNA molecules on the basis of a smaller molecular size than maternal DNA. Objective To examine the prenatal analysis of 4 common β-thalassemia point mutations: IVSI-1, IVSI-6, IVSI-110, and codon 39. Design, Setting, and Patients A total of 32 maternal blood samples were collected at 10 to 12 weeks of gestation (mean, 10.7 weeks) between February 15, 2003, and February 25, 2004, in Bari, Italy, from women with risk for β-thalassemia in their newborns immediately prior to chorionic villous sampling. Samples in which the father and mother did not carry the same mutation were examined. Circulatory DNA was size-fractionated by gel electrophoresis and polymerase chain reaction (PCR) amplified with a peptide-nucleic-acid clamp, which suppresses amplification of the normal maternal allele. Presence of the paternal mutant allele was detected by allele-specific real-time PCR. Main Outcome Measure Detection of paternally inherited β-globin gene point mutations. Results Presence or absence of the paternal mutant allele was correctly determined in 6 (86%) of 7 cases with the IVSI-1 mutation, 4 (100%) of 4 with the IVSI-6 mutation, 5 (100%) of 5 with the IVSI-110 mutation, and 13 (81%) of 16 with the codon 39 mutation. One false-positive test result was scored for the IVSI-1 mutation. Two cases with the codon 39 mutation were classified as uncertain and 1 case was excluded due to lack of a diagnostic test result at the time of analysis. These results yielded an overall sensitivity of 100% and specificity of 93.8%, with classified cases removed. Conclusion Our recently described technique of the size-fractionation of circulatory DNA in maternal plasma may be potentially useful f... [ABSTRACT FROM AUTHOR]

Context Perinatal arterial ischemic stroke (PAS) is a common cause of hemiplegic cerebral palsy. Risk factors for this condition have not been clearly defined. Objective To determine maternal and infant characteristics associated with PAS. Design, Setting, and Patients Case-control study nested within the cohort of all 199 176 infants born from 1997 through 2002 in the Kaiser Permanente Medical Care Program, a managed care organization providing care for more than 3 million residents of northern California. Case patients were confirmed by review of brain imaging and medical records (n = 40). Three controls per case were randomly selected from the study population. Main Outcome Measure Association of maternal and infant complications with risk of PAS. Results The population prevalence of PAS was 20 per 100 000 live births. The majority (85%) of infants with PAS were delivered at term. The following prepartum and intrapartum factors were more common among case than control infants: primiparity (73% vs 44%, P = .002), fetal heart rate abnormality (46% vs 14%, P<.001), emergency cesarean delivery (35% vs 13%, P = .002), chorioamnionitis (27% vs 11%, P = .03), prolonged rupture of membranes (26% vs 7%, P = .002), prolonged second stage of labor (25% vs 4%, P<.001), vacuum extraction (24% vs 11%, P = .04), cord abnormality (22% vs 6%, P = .01), preeclampsia (19% vs 5%, P = .01), and oligohydramnios (14% vs 3%, P = .01). Risk factors independently associated with PAS on multivariate analysis were history of infertility (odds ratio [OR], 7.5; 95% confidence interval [CI], 1.3-45.0), preeclampsia (OR, 5.3; 95% CI, 1.3-22.0), prolonged rupture of membranes (OR, 3.8; 95% CI, 1.1-12.8), and chorioamnionitis (OR, 3.4; 95% CI, 1.1-10.5). The rate of PAS increased dramatically when multiple risk factors were present. Conclusions Perinatal arterial ischemic stroke in infants is associated with several independent maternal risk factors. How these complications, along with t... [ABSTRACT FROM AUTHOR]

Background Many women of reproductive age are employed in industries involving exposure to organic solvents. Animal toxicological studies and human case reports demonstrate that high exposure to solvents causes neurodevelopmental toxicity in exposed offspring. Data from occupationally exposed women and their children are few. Objective To compare the cognitive, language, and motor performance and the behavioral achievements of children whose mothers were exposed occupationally to organic solvents during pregnancy with those of a matched unexposed control group. Participants Thirty-two pregnant women occupationally exposed to organic solvents were recruited during pregnancy and followed up. Their offspring (age range, 3-9 years) were tested for cognitive functioning (IQ), language, visual-motor functioning, and behavioral functioning and were compared with a matched unexposed control group that was recruited and tested in a similar manner. Examiners were blinded to the exposure status. Results Mothers occupationally exposed to organic solvents did not differ significantly from matched controls in demographic variables. After controlling for potential confounding because of maternal IQ and maternal education, children exposed in utero to organic solvents obtained lower scores on subtests of intellectual, language, motor, and neurobehavioral functioning. Conclusions In utero exposure to organic solvents is associated with poorer performance on some specific subtle measures of neurocognitive function, language, and behavior. Reducing exposure in pregnancy is merited until more refined risk assessment is possible. Further studies that address exposure to specific solvents, dose, and gestational timing of exposure are needed. [ABSTRACT FROM AUTHOR]

Objective To evaluate the prevalence of hepatitis C virus (HCV) infection in children with perinatal human immunodeficiency virus (HIV) infection. Design Cross-sectional substudy. Setting Multicenter study from 41 sites in the United States. Patients Children with perinatal HIV infection were randomly selected from a large, long-term, follow-up protocol. Main Outcome Measure Hepatitis C infection was defined as having positive test results on both HCV antibody and HCV RNA assays. Results Five hundred thirty children enrolled in the substudy; definitive HCV test results were available for 525 children. Eighty-three percent were of a minority race or ethnicity.They were equally distributed by sex, had a median age of 10.7 years, and were relatively healthy, with 75% having CD4+ lymphocyte counts greater than 500 cells/mm3. Eight of 525 children (1.5%; 95% confidence interval [CI], 0.7%-3.0%) infected with HIV were coinfected with HCV. In contrast, the rate of HCV infection in a serosurvey of more than 2700 children aged 6 to 11 years from the National Health and Nutrition Examination Survey was 0.2% (95% CI, 0.04%-0.6%). In our study, there were no differences between children coinfected with HIV and HCV and those without HCV infection in terms of demographic characteristics, CD4+ or CD8+ T-lymphocyte counts, HIV 1 RNA levels, preterm or mode of delivery, or liver disease; however, the number of children coinfected with HIV and HCV was small. Conclusion While HCV prevalence infection rates are low in children with perinatal HIV infection, they are 8 to 10 times higher than reported in HCV serosurveys of children in the United States. [ABSTRACT FROM AUTHOR]

Context Maternal hypothyroidism and hyperthyroidism have deleterious effects on the outcome of pregnancy. While the effects of thyroid hormone (TH) deprivation on the fetus, independently from that on the mother, can be studied in infants with congenital hypothyroidism, this is not the case in those with fetal thyrotoxicosis. Objective To study the effects of TH excess on fetuses carried by mothers with resistance to TH (RTH) who are euthyroid despite high TH levels but who may carry normal fetuses that are exposed to high maternal hormone levels. Design, Setting, and Participants Retrospective study of 167 members of an Azorean family with RTH. Affected individuals had the RTH phenotype (high serum concentration of free thyroxine and triiodothyronine without suppressed thyrotropin) confirmed by genotyping to identify the Arg243→Gln mutation in the TH receptor β gene. Main Outcome Measures Pregnancy outcome of affected mothers vs that of unaffected mothers carrying fetuses conceived by affected fathers, as well as that of unaffected first-degree relatives and outcomes from the general island population. Comparison of birth weights and blood concentrations of thyrotropin (TSH) obtained during routine neonatal screening of infants born to these 3 groups. Results Thirty-six couples with complete information belonged to 1 of 3 groups: affected mothers (n = 9), affected fathers (n = 9), and unaffected relatives (n = 18). Mean miscarriage rates were 22.9%, 2.0%, and 4.4%, respectively (χ2 = 8.66, P = .01). Affected mothers had an increased rate of miscarriage (z = 3.10, P = .002, by Wilcoxon rank-sum test). They had marginally higher than expected numbers of affected offspring, ie, 20 affected and 11 unaffected children (P = .07), while affected fathers had 15 affected and 12 unaffected children (P = .35). Unaffected infants born to affected mothers were significantly smaller than affected infants, having a mean SD score for gestational ag... [ABSTRACT FROM AUTHOR]

Background Extensive evidence now supports a statistical association between prenatal smoking and increased risk for antisocial outcomes in offspring. Though this statistical link may signal a causal association, commentators have urged caution in interpreting findings because of the likelihood of confounding. Methods We used data from the Environmental Risk Longitudinal Twin Study, a representative British sample of 1116 twin pairs studied at ages 5 and 7 years, to assess associations between prenatal smoking and early childhood conduct problems net of the effects of both heritable and environmental risks for child antisocial outcomes. Results Prenatal smoking showed a strong, dose-response relationship with child conduct problems at ages 5 and 7 years. Around half of this association was attributable to correlated genetic effects. Mothers who smoked during pregnancy differed from other mothers in a number of ways. They were more likely to be antisocial, had children with more antisocial men, were bringing up their children in more disadvantaged circumstances, and were more likely to have had depression. Controlling for antisocial behavior in both parents, depression in mothers, family disadvantage, and genetic influences, estimates for the effects of prenatal smoking were reduced by between 75% and the entire initial effects. Conclusions Observed associations between prenatal smoking and childhood conduct problems are likely to be heavily confounded with other known risks for children's behavioral development. As a result, tests of any causal influence of prenatal smoking must await findings from experimental studies. [ABSTRACT FROM AUTHOR]

Discusses the controversy surrounding keepsake photos of fetal images made with 3-dimensional ultrasound that expectant parents can purchase. The issues of doctors' offices providing nonmedical services, businesses offering the mementos made by noncertified personnel, and fees; Stance of the American Institute of Ultrasound in Medicine for the appropriate use of ultrasound; Indication that a task force is studying the legal, ethical, and professional implications of the keepsake photos; The position of physicians and other professionals on the issue, including Joshua Copel, Lawrence Platt, Delores Pretorius, Jeffrey Ecker, Michael Goldrich, and Robert Wolfson; Concern about the effect of Doppler ultrasound on the fetus; Status of ultrasound machines as prescription devices, according to the U.S. Food and Drug Administration; Consumer demand for the keepsakes; The positive benefits from fetal photos; Information about Geddes Keepsake Inc.

A response to a letter to the editor is presented regarding a study by Saint Clair and colleagues on the rates of adult schizophrenia in China.

Presents a study involving a 43-year-old woman who had a complex partial seizure in the seventh month of pregnancy with simultaneous fetal heart rate monitoring. Identification of fetal heart rate decelerations; Indication of fetal distress; Association of maternal partial seizures with fetal distress.