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Introduction: In this register‐based study of pregnancies in Denmark, we assessed the associations between maternal age and the risk of fetal aneuploidies (trisomy 21, trisomy 18, trisomy 13, triploidy, monosomy X and other sex chromosome aberrations). Additionally, we aimed to disentangle the maternal age‐related effect on fetal aneuploidies by cases with translocation trisomies and mosaicisms. Material and methods: We followed a nationwide cohort of 542 375 singleton‐pregnant women attending first trimester screening in Denmark between 2008 and 2017 until delivery, miscarriage or termination of pregnancy. We used six maternal age categories and retrieved information on genetically confirmed aneuploidies of the fetus and infant from the national cytogenetic register. Results: We confirmed the known associations between advanced maternal age and higher risk of trisomy 21, 18, 13 and other sex chromosome aberrations, especially in women aged ≥35 years, whereas we found no age‐related associations with triploidy or monosomy X. Cases with translocation trisomies and mosaicisms did not influence the overall reported association between maternal age and aneuploidies. Conclusion: This study provides insight into the accurate risk of fetal aneuploidies that pregnant women of advanced ages encounter. [ABSTRACT FROM AUTHOR]

Objective: This study examined the relationship between parental support and the timing of adolescent mothers' repeat pregnancies. Background: Short interpregnancy timing during adolescence, or an early repeat pregnancy, is a concerning outcome for adolescent mothers because they exacerbate the previous and ongoing adversities of adolescent mothers. Although social support tends to be positive for parenting and well‐being, it is unclear whether social support is protective for when adolescent mothers experience a repeat pregnancy. Parents are the primary source of support for adolescent mothers; thus, it is important to examine their influence on adolescent mothers' experience(s) of repeat pregnancy. Methods: Semi‐Markov multistate models were applied to 20 years of data to examine the relationship between support and timing and risk of subsequent pregnancies for 471 adolescent mothers in the National Longitudinal Study of Youth 1997. Results: This study found that emotional and financial support from parents predicts a higher likelihood of delayed repeat pregnancies, whereas informational support from parents predicts earlier repeat pregnancies for adolescent mothers. Conclusion: The effects of parental support are multifaceted and appear to differentially influence when adolescent mothers experience repeat pregnancies. Implications: Understanding how parental support influences when adolescent mothers experience repeat pregnancy can inform programs that aim to strengthen family support for pregnant and parenting youth. [ABSTRACT FROM AUTHOR]

Abstract Background Rheumatic heart disease (RHD) remains prevalent in the developing world and reproductive-age women are disproportionately affected. It is among the common est cardiac diseases during pregnancy and is associated with poor pregnancy outcomes. Despite its importance among reproductive-age women, there are no local studies that characterize the clinical characteristics, risk of poor pregnancy outcomes and contraception which represents one effective way to prevent unplanned pregnancies in this population. Methods This was a hospital-based descriptive cross-sectional study. Non-pregnant reproductive-age women with echocardiographically diagnosed RHD were consecutively recruited from in- and out-patients units of the Jakaya Kikwete Cardiac Institute (JKCI). A clinical research form was used to gather socio-demographic, clinical characteristics, contraception status and echocardiographic information. The maternal/pregnancy risk class was determined using the modified World Health Organization (WHO) classification of maternal risk. Results Two hundred thirty-eight women of reproductive age with RHD were recruited. The median age (range) was 36 years (15–49). Two-thirds were dyspneic on moderate exertion and 17.2% had New York Heart Association class IV heart failure. A quarter had atrial fibrillation/flutter. On echocardiography, mitral regurgitation was the most common valvular lesion (68.1%), followed by mitral stenosis (66.8%), and 12.2% of participants had reduced left ventricular ejection fraction. Two-thirds (66%) had a high pregnancy risk (class IV) based on the modified WHO classification system. The proportion of participants using contraception was 7.1% and common methods were: bilateral tubal ligation 5 of 17 (29.4%) and hormonal implant (4 of 17). The most common reason for the choice of a method was safety, 10 out of 17 (58.8%). Conclusion The majority of women of reproductive age with RHD in our hospital cohort are at the highest pregnancy risk based on the modified WHO classification and a very small proportion of them are on contraception. These results call for action among clinicians to offer counselling to these patients, educating them on their risk and offering appropriate contraception advice while waiting for definitive interventions.

East Lombok Regency, despite implementing pregnancy health programs, grapples with a persistently high pregnancy risk. This study investigates the disparity between medical and Sasak cultural perspectives on young mothers’ pregnancy risks. Qualitative case study research reveals a conflict between community sociocultural narratives and medical viewpoints. Cultural norms normalize medical narratives, shaping pre-marital reproductive arrangements, body perceptions, and idealized pregnancy concepts. Young mothers, influenced by cultural values, accept pregnancy as a collective social process within the family. The study emphasizes the impact of cultural determinism on shaping perceptions and preferences for young mothers’ pregnancy health, highlighting the need for an integrated approach that bridges medical and cultural perspectives to address and mitigate pregnancy risks effectively.

Background: Rheumatic heart disease (RHD) remains prevalent in the developing world and reproductive-age women are disproportionately affected. It is among the common est cardiac diseases during pregnancy and is associated with poor pregnancy outcomes. Despite its importance among reproductive-age women, there are no local studies that characterize the clinical characteristics, risk of poor pregnancy outcomes and contraception which represents one effective way to prevent unplanned pregnancies in this population. Methods: This was a hospital-based descriptive cross-sectional study. Non-pregnant reproductive-age women with echocardiographically diagnosed RHD were consecutively recruited from in- and out-patients units of the Jakaya Kikwete Cardiac Institute (JKCI). A clinical research form was used to gather socio-demographic, clinical characteristics, contraception status and echocardiographic information. The maternal/pregnancy risk class was determined using the modified World Health Organization (WHO) classification of maternal risk. Results: Two hundred thirty-eight women of reproductive age with RHD were recruited. The median age (range) was 36 years (15–49). Two-thirds were dyspneic on moderate exertion and 17.2% had New York Heart Association class IV heart failure. A quarter had atrial fibrillation/flutter. On echocardiography, mitral regurgitation was the most common valvular lesion (68.1%), followed by mitral stenosis (66.8%), and 12.2% of participants had reduced left ventricular ejection fraction. Two-thirds (66%) had a high pregnancy risk (class IV) based on the modified WHO classification system. The proportion of participants using contraception was 7.1% and common methods were: bilateral tubal ligation 5 of 17 (29.4%) and hormonal implant (4 of 17). The most common reason for the choice of a method was safety, 10 out of 17 (58.8%). Conclusion: The majority of women of reproductive age with RHD in our hospital cohort are at the highest pregnancy risk based on the modified WHO classification and a very small proportion of them are on contraception. These results call for action among clinicians to offer counselling to these patients, educating them on their risk and offering appropriate contraception advice while waiting for definitive interventions. [ABSTRACT FROM AUTHOR]

ObjectivesAn understanding of the relationship between individuals' pregnancy preferences and contraceptive use is essential for appropriate patient-centered counseling and care. We examined the relationship between women's pregnancy preferences and contraceptive use using a new prospective measure, the Desire to Avoid Pregnancy (DAP) scale.Study designAs part of a study examining women's suspicion and confirmation of new pregnancies, we recruited patients aged 15 - 45 from seven reproductive health and primary health facilities in Arizona, New Jersey, New Mexico, South Carolina, and Texas in 2016-2017. We used multivariable logistic, multinomial logistic, and linear regression models to examine the associations among DAP scores (range: 0 - 4) and contraceptive use outcomes and identify factors associated with discordance between DAP and use of contraception.ResultsParticipants with a greater preference to avoid pregnancy had higher odds of contraceptive use (aOR = 1.63, 95% CI: 1.31, 2.04) and used contraceptives more consistently (aβ = 8.9 percentage points, 95% CI: 5.2, 12.7). Nevertheless, 63% of women with low preference to avoid pregnancy reported using a contraceptive method. Higher preference to avoid pregnancy was not associated with type of contraceptive method used: women with the full range of pregnancy preferences reported using all method types.ConclusionWhen measured using a rigorously developed instrument, pregnancy preferences were associated with contraceptive use and consistency of use. However, our findings challenge assumptions that women with the highest preference against pregnancy use more effective methods and that women who might welcome pregnancy do not use contraception.ImplicationsWomen's preferences about pregnancy contribute significantly to their use of contraception. However, health care providers and researchers should consider that contraceptive features besides effectiveness in preventing pregnancy shape contraceptive decision-making and use.

Summary: Background: Despite substantial progress in improving maternal and newborn health, India continues to experience high rates of newborn mortality and stillbirths. One reason may be that many births happen in health facilities that lack advanced services—such as Caesarean section, blood transfusion, or newborn intensive care. Stratification based on pregnancy risk factors is used to guide ‘high-risk’ women to advanced facilities. To assess the utility of risk stratification for guiding the choice of facility, we estimated the frequency of adverse newborn outcomes among women classified as ‘low risk’ in India. Methods: We used the 2019–21 Fifth National Family Health Survey (NFHS-5)—India’s Demographic and Health Survey—which includes modules administered to women aged 15–49 years. In addition to pregnancy history and outcomes, the survey collected a range of risk factors, including biomarkers. We used national obstetric risk guidelines to classify women as ‘high risk’ versus ‘low risk’ and assessed the frequency of stillbirths, newborn deaths, and unplanned Caesarean sections for the respondent’s last pregnancy lasting 7 or more months in the past five years. We calculated the proportion of deliveries occurring at non-hospital facilities in all the Indian states. Findings: Using data from nearly 176,699 recent pregnancies, we found that 46.6% of India’s newborn deaths and 56.3% of stillbirths were among women who were ‘low risk’ according to national guidelines. Women classified as ‘low risk’ had a Caesarean section rate of 8.4% (95% CI 8.1–8.7%), marginally lower than the national average of 10.0% (95% CI 9.8–10.3%). In India as a whole, 32.0% (95% CI 31.5–32.5%) of deliveries occurred in facilities that were likely to lack advanced services. There was substantial variation across the country, with less than 5% non-hospital public facility deliveries in Punjab, Kerala, and Delhi compared to more than 40% in Odisha, Madhya Pradesh, and Rajasthan. Newborn mortality tended to be lower in states with highest hospital delivery rates. Interpretation: Individual risk stratification based on factors identified in pregnancy fails to accurately predict which women will have delivery complications and experience stillbirth and newborn death in India. Thus a determination of ‘low risk’ should not be used to guide women to health facilities lacking key life saving services, including Caesarean section, blood transfusion, and advanced newborn resuscitation and care. Funding: Bill and Melinda Gates Foundation and the World Bank. The findings, interpretations and conclusions expressed in the paper are entirely those of the authors, and do not represent the views of the Gates Foundation or of the World Bank, its Executive Directors, or the countries they represent.

This study describes the sociocultural factors that influence the utilization of antenatal care services among unmarried adolescents aged 16 and below in Akwa Ibom State, Nigeria. A cross-sectional survey design was utilized. A self-designed questionnaire was randomly administered to 621 ever-pregnant unmarried adolescents. Thirty-five in-depth interviews were purposively conducted among unmarried adolescents, skilled and unskilled healthcare providers, and caregivers. Twelve focus group discussions and four life histories were also conducted among unmarried adolescents. Quantitative data were analyzed using descriptive and multivariate logistic regression at p = .05; qualitative data were content analyzed. Poor health provider-patient relations, financial constraints, distant health facilities, and fear of the exchange of babies by health workers influenced antenatal care practices among unmarried adolescents. More than half of the respondents (68.3%) received pregnancy care from faithbased and traditional birth attendants. Antenatal care utilization from orthodox (certified medical) healthcare providers was associated with secondary school education (OR = 7.35, 95% CI [5.83-8.94]), wealthiest households (OR = 6.74, 95% CI [4.34-8.35]) and age at last pregnancy 14-16 (OR = 0.17, 95% CI [0.12-0.27]). There is a need for functional and accessible orthodox healthcare facilities and an increased awareness about antenatal care services among adolescents to reduce delays in antenatal visits and maternal-related health risks through effective policies that could lead to attitudinal change among the populace. [ABSTRACT FROM AUTHOR]

Introduction Local anesthetic systemic toxicity (LAST) is a rare complication of regional anesthesia. Pregnancy is a risk factor due to gestational physiologic changes. Labor and disorders of pregnancy can mask or delay symptoms of LAST, slowing appropriate intervention. This study examines LAST within a larger cohort and identifies features that help distinguish LAST in pregnant women from LAST in nonpregnant patients. Methods The TriNetX database was used to compare pregnant and nonpregnant patients with LAST from 2013 to 2023. Cohorts were matched on age, race, obesity status, diabetes, metabolic disorders, local anesthetic type, and cardiovascular, liver, kidney, and respiratory disease. Outcomes included prodromal symptoms of LAST and symptoms of cardiac and central nervous system excitation and depression. Results Matching occurred for 276 pregnant and 276 nonpregnant patients. Pregnant cohorts had a significantly higher risk of cardiac depression (risk ratio (RR)=1.96 (95% confidence interval (CI): 1.44-2.66), p<0.01) and significantly lower risk of cardiac excitation (RR=0.38 (95% CI: 0.22-0.63), p<0.01), prodromal symptoms (RR=0.17 (95% CI: 0.09-0.33), p<0.01), central nervous system excitation (RR=0.44 (95% CI: 0.21-0.90), p=0.02), and central nervous system depression (RR=0.24 (95% CI: 0.13-0.48), p<0.01) than nonpregnant cohorts. Conclusion Pregnant patients with LAST were more likely to exhibit cardiac depression and less likely to manifest prodromal symptoms, cardiac excitation, and central nervous system excitation and depression than nonpregnant patients. Physiological changes during pregnancy and prompt detection and treatment may explain these differences. These findings highlight the variable nature of LAST and how pregnancy may influence its clinical presentation., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, De Valle et al.)

Objectives: This study examines alcohol consumption and smoking behaviors by pregnancy status and race/ethnicity in order to inform improved interventions designed to assist women of all races to avoid alcohol and tobacco use during pregnancy for their health and to prevent potential fetal exposure. Methods: This retrospective secondary data analysis utilized nationally representative National Health and Nutrition Examination Survey data between 2001 and 2018. Smoking and alcohol use were evaluated by race/ethnicity and pregnancy risk. Sexual behavior, reproductive health, and prescription drug use determined pregnancy risk, categorized as low pregnancy risk, at risk of becoming pregnant, and pregnant. Binary and multinomial multivariable logistic regression were used to examine associations. Results: The final sample consisted of 10,019 women of which 11.8% were Mexican American, 7.7% other Hispanic, 65.5% white, and 15% black (weighted percentages). White low pregnancy risk and pregnancy risk smoked most frequently in respective pregnancy risk groups (p < 0.001). Among pregnant women, smoking prevalence was highest among black women (14.0%, p < 0.01). Pregnancy risk women were more likely to smoke and pregnant women were less likely to smoke compared with low pregnancy risk. Low pregnancy risk and pregnancy risk Hispanics had a lower prevalence of binge drinking, but prevalence decreased less among pregnant Hispanics than other racial/ethnic groups. In adjusted analyses, pregnancy risk black women had more than 2 times the odds of combined smoking and alcohol consumption compared with low pregnancy risk black women. Conclusion: Women who may become pregnant need interventions and improved policy to prevent alcohol use and smoking. Culturally appropriate alcohol and smoking cessation interventions before pregnancy and improved contraception access are needed. [ABSTRACT FROM AUTHOR]

One suggested approach to improve the reproductive performance of dairy herds is through the targeted management of subgroups of biologically similar animals, such as those with similar probabilities of becoming pregnant, termed pregnancy risk. We aimed to use readily available farm data to develop predictive models of pregnancy risk in dairy cows. Data from a convenience sample of 108 dairy herds in the UK were collated and each herd was randomly allocated, at a ratio of 80:20, to either training or testing data sets. Following data cleaning, there were a total of 78 herds in the training data set and 20 herds in the testing data set. Data were further split by parity into nulliparous, primiparous, and multiparous subsets. An XGBoost model was trained to predict the insemination outcome in each parity subset, with predictors from farm records of breeding, calving and milk recording. Training data comprised 74,511 inseminations in 45,909 nulliparous animals, 86,420 inseminations in 39,439 primiparous animals, and 158,294 inseminations in 32,520 multiparous animals. The final models were evaluated by predicting with the testing data, comprising 31,740 inseminations in 19,647 nulliparous animals, 38,588 inseminations in 16,215 primiparous animals, and 65,049 inseminations in 12,439 multiparous animals. Model discrimination was assessed by calculating the area under receiver operating characteristic curves (AUC); model calibration was assessed by plotting calibration curves and compared across test herds by calculating the expected calibration error (ECE) in each test herd. The models were unable to discriminate between insemination outcomes with high accuracy, with an AUC of 0.63, 0.59 and 0.62 in the nulliparous, primiparous and multiparous subsets, respectively. The models were generally well-calibrated, meaning the model-predicted pregnancy risks were similar to the observed pregnancy risks. The mean (SD) ECE in the test herds was 0.038 (0.023), 0.028 (0.012) and 0.020 (0.008) in the nulliparous, primiparous and multiparous subsets respectively. The predictive models reported here could theoretically be used to identify subgroups of animals with similar pregnancy risk to facilitate targeted reproductive management; or provide information about cows' relative pregnancy risk compared with the herd average, which may support on-farm decision-making. Further research is needed to evaluate the generalizability of these predictive models and understand the source of variation in ECE between herds; however, this study demonstrates that it is possible to accurately predict pregnancy risk in dairy cows using readily available farm data., (The Authors. Published by Elsevier Inc. on behalf of the American Dairy Science Association®. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).)

Objectives: Limited research and guidance on the use of "withdrawal" or coitus interruptus for contraception lead to inconsistent or even inaccurate physician recommendations regarding its use. Consequently, patients rely on online communities to learn about this commonly used contraceptive method. To identify knowledge gaps and concerns between men and women, as well as explore how they use withdrawal, we examined withdrawal-related posts on the popular internet discussion forum, Reddit.Study Design: To explore gendered variations in withdrawal-related Reddit posts, we extracted posts from the gendered forums: "TwoXChromosomes," "Askwomen," "Askmen," and "OneY" between 2010 and 2019 that contained the search terms: "coitus interruptus," "withdrawal," "pull out," "preejaculate," or "precum." We developed an initial codebook with expected codes and augmented it with emerging findings from a random sampling of 10% of posts. We revised iteratively for interrater agreement, after which researchers coded the remaining posts independently.Results: Of 269 withdrawal-related queries, 19% were submitted by men; 81% referenced the contributor's own withdrawal use. Salient domains included: concerns about pregnancy risk (59%), how to effectively use withdrawal (13%), benefits/pleasure from using withdrawal (12%), impact on personal life/relationship (9%), and problems encountered, inclusive of consent (7%). Posts to female-focused forums more frequently inquired about pregnancy risk, while those on male forums more frequently inquired about withdrawal-related logistics (p < 0.001); domains were not associated with contributor gender.Conclusion: Withdrawal-related queries within this Reddit sample are frequently posted by women, the majority of whom want to understand their risk of pregnancy with withdrawal. Research operationalizing withdrawal and more accurately estimating withdrawal-related pregnancy risk is warranted.Implications: Reddit users discuss their personal experiences with withdrawal as contraception, as well as seek advice regarding its use from the online community. Pregnancy risk, logistics of use, and ongoing stigma are salient topics. Further research on pregnancy risk, operationalizing success, and approaches for discussing this behavioral method is warranted. [ABSTRACT FROM AUTHOR]

Two experiments were conducted with Holstein-Friesian cows in the Republic of North Macedonia and with Holstein cows in Kansas. We hypothesized that 1 dose of PGF 2α administered on d 8 (Ov-8×1) instead of d 7 (Ov-7×1) in an Ovsynch program [GnRH-1 (d 0)–7 d–PGF 2α –56 h–GnRH-2–16 h–timed artificial insemination (AI)] would increase the proportion of cows with complete luteolysis compared with controls receiving a single dose on d 7. Cows were treated with Ov-7×1 or with Ov-8×1 in experiment 1 (n = 347), using only a single dose of PGF 2α. In experiment 2 (n = 452), a third treatment was added (Ov-7×2), in which a second dose of PGF 2α was administered on d 8. Progesterone was measured in blood samples collected before the first or only PGF 2α administration and 72 h later before insemination. Complete luteolysis was defined as having occurred when progesterone was ≥1 ng/mL before PGF 2α and ≤0.3 ng/mL 72 h later (time of AI). Follicles and luteal structures were mapped before GnRH-1 and PGF 2α administrations. The results of experiment 1 demonstrated a greater percentage of multiparous cows in OV-8×1 having complete luteal regression compared with multiparous Ov-7×1 cows, whereas treatments were equally effective in primiparous cows, as reflected in the concentrations of progesterone before AI. Furthermore, pregnancy per AI did not differ between treatments. Results in experiment 2 revealed that 99.3% of cows in the Ov-7×2 treatment receiving the second dose of PGF 2α had complete luteolysis, regardless of parity, compared with significantly fewer cows in the Ov-7×1 and Ov-8×1 treatments (91.2 and 90.6%, respectively). Neither concentrations of progesterone, which averaged <0.4 ng/mL at AI, nor pregnancy per AI differed among the 3 treatments. In both experiments, when status of luteal function before PGF 2α treatment was examined [cows with no corpus luteum (CL) before GnRH-1 but which had formed a new CL in response to ovulation after GnRH-1; cows with an older CL (the same CL that was detected before GnRH-1); or cows with both a new and an older CL], treatments did not differ in causing complete luteolysis. Furthermore, complete luteolysis in experiment 2 did not differ regardless of whether cows had 1, 2, or 3 or more CL before PGF 2α administration. Pregnancy per AI did not differ among treatments, indicating that any of the 3 treatments might produce similar pregnancy outcomes with the flexibility of applying either of the 7- or the 8-d treatments. [ABSTRACT FROM AUTHOR]

South African children's long-term health and well-being is jeopardized during their mothers' pregnancies by the intersecting epidemics of HIV, alcohol use, low birth weight (LBW;

Development of bovine estrus synchronization protocols started in the 1970’s. The aim of these protocols has changed progressively from synchronizing estrus to synchronizing ovulation with main goal of performing insemination without heat detection (Timed artificial insemination). The present paper discusses the physiology behind development of these synchronization protocols and reviews of the main protocols used nowadays in dairy herd reproductive management.

Determinants of health in Nepal include access to care, safe food, clean water, mid current technologies in healthcare. Women's health is further affected by the caste system, marriage, domestic and economical violence, and limited education. During pregnancy, stress can have a negative impact on mother and baby's wellbeing. Resilience can strengthen the woman's ability to achieve a healthy pregnancy. The purpose Of this article is to examine resilience in Nepalese women during pregnancy. Much is known on the risks borne by Nepalese childbearing woman; however, minimal data exist on the resilience Of these women toward managing the stressors in pregnancy. [ABSTRACT FROM AUTHOR]

Objectives: Healthy People 2020 establishes objectives for reducing the proportion of pregnancies in the United States that are unintended and for improving contraceptive use. This analysis describes ways to more closely align measurement of contraceptive use with periods of risk for unintended pregnancy using the National Survey of Family Growth (NSFG).Methods: Using the 2011-2015 NSFG we constructed two measures of contraceptive use for women we defined as at risk of an unintended pregnancy: (1) we augmented a measure of recent contraceptive use by recoding non-users according to their method use during their last month of sex in the past 12 months; (2) we augmented use at last sex in the past 12 months by excluding women who were pregnant at last sex. Estimates were compared overall and within 5-year age groups.Results: The augmented measure of recent contraceptive use found fewer women to be using no contraception than the standard measure (7.3% vs 15.4%; p < .001); greater differences were found between the two measures for younger women. When considering contraceptive use at last sex, the augmented measure identified fewer women as using no contraception (15.8% vs 21.0%; p < .001) than the standard measure and more women to be using a most effective method (33.3% vs 31.1%; p = .04) than the standard measure.Conclusions: Aligning periods of unintended pregnancy risk with contraceptive use assessment reduced estimates of no contraceptive use; changes in estimates by method type varied by age.Implications: When assessing contraceptive use for the purpose of unintended pregnancy prevention, researchers may consider the methods described here to further align contraceptive use measurement with periods of unintended pregnancy risk. [ABSTRACT FROM AUTHOR]

Introduction: The incidence of Swedish stillbirths has varied little in the past 40 years, with a reported frequency of 400-450 stillbirths/y (approximately 4‰), despite increased information about fetal movement in the media and awareness among healthcare providers. The objectives of this project were to describe the outcome of pregnancies with reduced fetal movement in a Swedish context and to investigate factors associated with poor neonatal outcome in this group.Material and Methods: A retrospective cohort study was performed at Soder Hospital, Stockholm, Sweden. All single pregnancies at the hospital from January 2016 to December 2017 presenting with reduced fetal movement after 22 gestational weeks were included in the study. A composite neonatal outcome was constructed: 5-minute Apgar score ≤7, arterial pH in the umbilical cord ≤7.10, transfer to neonatal care unit for further care or intrauterine fetal death.Results: For women seeking care for reduced fetal movement, the occurrence of composite poor neonatal outcome ranged from 6.2% to 18.4% within different groups. The highest risk for poor neonatal outcome (18.4%) was found in the group of women with a small-for-gestational-age fetus. Another high-risk group (12.8%) was the one comprising women with normal birthweight/large-for-gestational-age fetuses with an in vitro fertilization pregnancy.Conclusions: The highest incidence of poor neonatal outcome among women with reduced fetal movement was found in the groups with small-for-gestational-age fetuses in nulliparous and multiparous women. A routine ultrasound assessment for fetal growth in third trimester is supposedly most efficient to identify undiagnosed small for gestational age. [ABSTRACT FROM AUTHOR]

Introduction and Aims: Few smokers use smoking cessation pharmacotherapies during pregnancy. It is hypothesised that health-care providers' reluctance due to safety concerns contributes to their low use. This study examined the extent of providers' concern regarding smoking cessation pharmacotherapies, relative to other medications in the same and other pregnancy risk categories. Calls made to a teratology information service (MotherSafe, Australia) were taken as a proxy indicator of concern regarding safety during pregnancy.Design and Methods: The primary exposure discussed in 66 687 calls made to MotherSafe between 2001 and 2016 was categorised as nicotine replacement therapy (NRT), bupropion, varenicline or category A (low risk), B1, B2, B3, C, D or X (teratogenic). Separate logistic regression models estimated the odds that calls regarding pharmacotherapies were from providers, relative to medications in the same and other risk categories. Models adjusted for caller remoteness and socio-economic status.Results: Calls regarding bupropion were more likely to be made by providers than calls regarding other medications in its corresponding risk category [B2, adjusted odds ratio (aOR): 2.77, 95% confidence interval (CI) 1.17, 6.59]. Calls about varenicline were also more likely to be from providers than calls regarding other category B3 medications (aOR 95% CI 2.33:1.30, 4.17). Calls regarding NRT were not more or less likely to be from providers than calls regarding other category D medications.Discussion and Conclusions: Providers were more concerned about bupropion and varenicline than other medications within the same pregnancy risk categories. As this overestimation of risk may limit cessation pharmacotherapy use during pregnancy, research investigating strategies for correcting this imbalance is warranted. [ABSTRACT FROM AUTHOR]

Zinpentraxin alfa is a recombinant human pentraxin-2 (PTX-2) developed for the treatment of various fibrotic diseases with the hypothesis that supplementing endogenous PTX-2 levels through intravenous administration should increase its regulatory capacity in circulation and at the site of disease, thereby promoting healing and reducing fibrosis. Zinpentraxin alfa has been studied in various clinical trials, particularly in patients with idiopathic pulmonary fibrosis, where it has demonstrated efficacy in slowing decline in lung function in a phase 2 study. In the present investigation, we summarize findings from 14-day repeat-dose toxicity studies in rats and cynomolgus monkeys supporting early clinical development of zinpentraxin alfa. In addition, we also describe the findings from the embryo-fetal developmental (EFD) studies conducted in rats and rabbits, since the intended fibrosis patient population may include patients of childbearing potential. Zinpentraxin alfa was well tolerated by rats and monkeys in general toxicity studies with no treatment-related adverse effects, as well as by pregnant rats over the same dose range in a definitive EFD study. In contrast, substantial toxicity was observed in a rabbit dose-range-finder EFD study. Zinpentraxin alfa was poorly tolerated by pregnant rabbits and effects on the dams correlated with post-implantation fetal losses. The disparate effects of zinpentraxin alfa on embryo-fetal development between the two species suggests a potential unknown biological function of PTX-2 in pregnancy in the rabbit, which may be relevant to humans. Our findings warrant the consideration for highly effective contraceptive measures to avoid pregnancy in patients enrolled in clinical studies with zinpentraxin alfa. • Zinpentraxin alfa was developed for the treatment of fibrotic diseases. • Well tolerated by rats and monkeys, and rat dams in toxicity studies. • Poorly tolerated by rabbit dams across same doses and exposures. • Maternal toxicity correlated with substantial EFD findings in rabbits. • Findings suggest a potential role for pentraxin-2 in rabbit pregnancy. [ABSTRACT FROM AUTHOR]

Abstract Background In India, where men take most decisions in the family, it is useful that they have adequate knowledge about pregnancy risks during women’s menstrual cycles. Since traditional contraceptive methods are still employed by a large population in India, the knowledge regarding the pregnancy risk during the menstrual cycle is indispensable. This research paper attempts to assess the knowledge among urban men in Uttar Pradesh, India about the fertile window of the menstrual cycle; it also attempts to discover the rationales behind the misconceptions about the concept. Methods This study utilizes the baseline data of the Measurement, Learning, and Evaluation project for the Urban Reproductive Health Initiative in Uttar Pradesh. Descriptive Statistics has been used to assess the prevalence of knowledge among urban men regarding the concept. Using the Discriminant Analysis, we also investigate the rationales behind the misconceptions among urban men about the concept. Results Only one-fifth of the men have the correct knowledge about the concept. Further, we find that education, societal perception, caste, and spousal discussion about the reproductive issues are the primary factors affecting the knowledge about the pregnancy risk during the menstrual cycle. Conclusions There is an urgent need for sex education in the region to make the urban men more educated about the reproductive process of women; this may reduce unwanted births and abortion due to an unwanted pregnancy as well. The study promotes the higher education and motivates couples to discuss the reproductive health issues among them. In this manner, we can provide better reproductive health to the women of urban India.

Introduction: The objective of this study was to examine the outcomes and interventions in pregnant women presenting with a perception of reduced fetal movements (RFM), and to determine if repeated episodes of RFM increase the risk of adverse outcomes.Material and Methods: This was a retrospective cohort study conducted in six NHS hospitals within the Thames Valley network region, UK and one neighboring hospital, an area with approximately 31 000 births annually. All women with a primary presentation of perceived RFM after 24 completed weeks of gestation during the month of October 2016 were included in the study. Prospective records in all units were examined and individual case-notes were reviewed. Pregnancy and neonatal outcomes and their relation with recurrent presentations with RFM were examined using relative risks with 95% CI. The main outcome measures are described. Neonatal outcomes measured were perinatal mortality, neonatal unit admission, abnormal cardiotocography at presentation, a composite severe morbidity outcome of Apgar <7 at 5 minutes or arterial pH <7.0 or encephalopathy, and birthweight. Pregnancy outcomes measured were induction of labor, cesarean section, admission and ultrasound usage rates.Results: In all, 591 women presented with RFM during the month; using annual hospital birth figures, the incidence of RFM was estimated at 22.6% (range 14.9%-32.5%). More than 1 presentation of RFM occurred in 273 (46.2%). All 3 deaths (0.5%) were at the first presentation. More than 1 presentation was associated with higher induction rates (56.0% vs 31.9%), but no increase in any adverse outcomes including small-for-gestational-age.Conclusions: Reduced fetal movements, and recurrent episodes, are common, and lead to considerable resource usage and obstetric intervention. We found no evidence to suggest that recurrent episodes increase pregnancy risk. [ABSTRACT FROM AUTHOR]

The main objective was to assess the associations of subclinical hypocalcemia (SCH), diagnosed at parturition (SCH-0) and 7 d in milk (SCH-7), with fertility in a herd of grazing dairy cows. Additional objectives were to characterize Ca concentration on 0 and 7 d in milk (DIM), assessing the risk factors for SCH-0 and SCH-7 and also the relationship with health status (metritis, endometritis, subclinical ketosis, and culling). A prospective observational study was carried out in a dairy farm in Argentina. Holstein cows (n = 126) were body condition scored (BCS, 1-5) on -21 ± 3, 0, 7 ± 3, and 28 ± 7 DIM and blood was collected on 0 and 7 ± 3 DIM to determine Ca and ß-hydroxybutyrate concentrations. Calcium concentrations <2.0 and <2.14 mmol/L were used to define SCH-0 and SCH-7, respectively. The associations of SCH with (1) the odds for pregnancy to first service (P1AI) and pregnancy by 100 DIM (P100) were evaluated by logistic models, (2) the services per pregnancy was evaluated by a Poisson regression model, and (3) the hazards of insemination and pregnancy were evaluated with proportional hazards regression models whereas median days from calving to first insemination and to pregnancy were estimated by Kaplan-Meier method. Additionally, Ca concentration was assessed by linear regression models, and the associations of SCH-0 and SCH-7 with the odds for metritis, endometritis, subclinical ketosis, and culling were evaluated by logistic models. Calcium concentrations were similar at 0 and 7 DIM (2.40 vs. 2.41 mmol/L, respectively); they were higher in cows calving in fall than in summer (2.58 vs. 2.24 mmol/L), and they also were higher in primiparous than in multiparous cows (2.53 vs. 2.28 mmol/L, respectively). The proportion of cows having SCH-0 and SCH-7 was 27.3 and 39.3%, respectively. Fall-calving cows had lower odds for SCH- 0 [odds ratio (OR) = 0.31, 95% confidence interval (CI) = 0.12-0.86] than summer-calving cows, multiparous cows had higher odds for SCH-0 (OR = 3.96, 95% CI = 1.09-14.39) than primiparous cows, and cows with prepartum BCS =3.00 had higher odds for SCH-0 (OR = 4.03, 95% CI = 1.17-13.89) than in cows with BCS <3.00. Conversely, parity and prepartum BCS were not important predictors for SCH-7. Surprisingly, SCH-0 was not a risk factor for SCH-7. Cows with SCH-0 had lower odds for P1AI (OR = 0.26, 95% CI = 0.07-0.99) than normocalcemic cows, given that P1AI was 14 versus 38%, respectively. The hazard of first service was not associated with SCH-0 (hazard ratio = 1.03, 95% CI = 0.63-1.70) but cows with SCH-0 had lower hazard of pregnancy (hazard ratio = 0.39, 95% CI = 0.16-0.98) and took 32 d longer to get pregnant (105 vs. 73) than normocalcemic cows. Conversely, SCH-7 was not associated with fertility. Finally, SCH-0 and SCH-7 were associated with the odds for subclinical ketosis and metritis, respectively. In conclusion, SCH-0 but not SCH-7 is associated with reduced fertility in a herd of grazing dairy cows, but both were associated with health status. [ABSTRACT FROM AUTHOR]

The evaluation of thrombotic and pregnancy risks associated with antiphospholipid antibodies (aPL)in individual patients without antiphospholipid syndrome (APS) clinical manifestation is challenging. Our aim is to identify additional risk factors or potential candidate “second hits” for APS clinical events in a large cohort of ethnically diverse aPL-positive patients. We included 219 consecutive aPL-positive patients who attended clinic at our institution. All patients had at least 1 persistent high titer (≥99 percentiles) aPL. Independent risk factors for thrombosis and pregnancy morbidities among patients with positive aPL were evaluated. When assessing risk factors associated with pregnancy morbidities, only female controls of reproductive age (age ≤45) were used. Pearson χ2 analysis and multivariable logistic regression were used to evaluate correlation between different risk factors and clinical manifestations. Of the 219 aPL-positive patients, 120 (54.8%) patients had criteria APS clinical manifestations and 99 patients did not. A total of 46.1% were Caucasian, 26.4% of African descent, 16.9% Hispanic, 1.8% Asian, and 8.7% were unspecified. Among traditional risk factors and signs of endothelial injury, only hypertension demonstrated an independent association with arterial thrombosis (odds ratio [OR] = 3.826, 95% confidence interval [CI]: 1.597-9.167, P = .0026), and lupus anticoagulant (LA) demonstrated an independent association with venous thrombosis (OR = 3.308, 95% CI: 1.544-7.085, P = .0021). None of the evaluated risk factors demonstrated a significant association with pregnancy morbidity. Hypertension is a potential predictor of arterial thrombosis and the presence of LA is a potential predictor of venous thrombosis in aPL-positive patients. [ABSTRACT FROM AUTHOR]

Two experiments were conducted to determine relationships of blood metabolite concentrations, BW, BCS, and rump fat depth with postpartum ovulation and pregnancy risks, as well as their utility in predicting those outcomes in suckled beef cows. In experiment 1, plasma glucose collected 10 and 3 d before AI of suckled beef cows at seven locations did not differ between cows that had resumed estrous cycles (ovulated) before AI compared with anovulatory cows, whereas plasma glucose 3 d before AI was greater (P < 0.01) in cows that became pregnant compared with nonpregnant cows. Serum beta-hydroxybutyrate (BHB) tended (P = 0.09) to be less in ovulatory cows compared with anovulatory cows 10 d before AI, but was unrelated to pregnancy status. Receiveroperator derived true-positive (sensitivity) and false-positive (1--specificity) risks were determined for plasma glucose and serum BHB as predictors for postpartum ovulation and pregnancy status. Serum BHB 3 d before AI produced true-positive and false-positive risks of 82% and 37%, respectively, when predicting ovulatory status before AI. Serum BHB 10 d before AI produced a true-positive and false-positive risks of 92% and 25%, respectively, when predicting pregnancy status. In experiment 2, blood was collected weekly for 12 wk from multiparous suckled beef cows to assess blood metabolite concentrations in addition to concurrent weekly assessments of BW, BCS, and rump fat. When blood metabolites and physical measures were normalized to parturition reflecting changes occurring during the first 6 wk after calving, we observed reduced (P < 0.05) concentrations of serum BHB and NEFA, and greater (P < 0.05) rump fat and BCS in cows that ovulated before first AI, whereas reduced (P < 0.05) plasma glucose was characteristic of cows that became pregnant. When blood metabolites and physical measures were normalized to the onset of the AI program reflecting changes during 6 wk before AI, ovulatory cows had increased (P < 0.05) BCS and lower (P < 0.05) NEFA from 3 to 6 wk before the onset of the AI program compared with anovulatory cows. With all predictor variables in regression models, some multiple correlation coefficients (R2) exceeded 50% when predicting postpartum ovulatory status, but those for predicting pregnancy risk were less than 25%. Although measures of BCS and BHB during 6 wk after calving were related to postpartum ovulation risk, rump fat, glucose, BCS, and NEFA were associated with cows that were ovulatory and pregnant. [ABSTRACT FROM AUTHOR]

A lot of studies use the second-to-fourth digit length ratio (2D:4D) as a biomarker for intrauterine androgen load to predict behavioral and mental health problems. Thus, knowledge of 2D:4D's metric properties, namely reliability and validity, is essential. 2D:4D handscans were available from 149 adolescents (M = 13.32 years, SD = 0.35) and their mothers. For 88 adolescents, there were also primary-school age handscans (M = 7.87 years, SD = 0.68). Prenatal risks for the 1st to 3rd trimesters were recorded during the 3rd trimester of pregnancy (alcohol exposition: meconium biomarker and maternal self-report; nicotine exposition: maternal self-report; maternal depressive symptoms and subjective stress: questionnaires). The 2D:4D ratio was highly stable from childhood to early adolescence. However, both developmental and sex effects were present: The 2D:4D ratio increased with age and was higher in adolescent girls vs. boys. Significant 2D:4D mother-child associations were found for girls. Significant main effects could be found for the prenatal risk factors alcohol (self-report) and nicotine consumption. In line with earlier studies, the 2D:4D biomarker proved to be an inter-individually stable measure with an intra-individual increase from childhood to early adolescence. Sex differences in adolescence and associations with maternal prenatal health behaviour underline the validity of the biomarker. Findings on heritability emphasize the importance of interpreting 2D:4D results in a sex-specific manner. • Prenatal factors can influence child neurodevelopment through foetal programming. • The 2D:4D is a biomarker for intrauterine androgen load and knowledge of 2D:4D's metric properties is essential. • The 2D:4D proved to be an inter-individually stable measure with an intra-individual increase from childhood to adolescence. • Sex differences in adolescence and associations with maternal prenatal health behaviour underline the 2D:4D validity. • Findings on heritability emphasize the importance of interpreting 2D:4D results in a sex-specific manner. [ABSTRACT FROM AUTHOR]

Patients with congenital heart disease have improved survival rates, and most patients are now expected to survive into adulthood. This improved survival has resulted in increasing numbers of women with congenital heart disease who are of childbearing age. This patient population requires specialized advice on contraception and pregnancy risk. Understanding the unique challenges this population presents is key to providing appropriate care. [ABSTRACT FROM AUTHOR]

Background: In India, where men take most decisions in the family, it is useful that they have adequate knowledge about pregnancy risks during women's menstrual cycles. Since traditional contraceptive methods are still employed by a large population in India, the knowledge regarding the pregnancy risk during the menstrual cycle is indispensable. This research paper attempts to assess the knowledge among urban men in Uttar Pradesh, India about the fertile window of the menstrual cycle; it also attempts to discover the rationales behind the misconceptions about the concept. Methods: This study utilizes the baseline data of the Measurement, Learning, and Evaluation project for the Urban Reproductive Health Initiative in Uttar Pradesh. Descriptive Statistics has been used to assess the prevalence of knowledge among urban men regarding the concept. Using the Discriminant Analysis, we also investigate the rationales behind the misconceptions among urban men about the concept. Results: Only one-fifth of the men have the correct knowledge about the concept. Further, we find that education, societal perception, caste, and spousal discussion about the reproductive issues are the primary factors affecting the knowledge about the pregnancy risk during the menstrual cycle. Conclusions: There is an urgent need for sex education in the region to make the urban men more educated about the reproductive process of women; this may reduce unwanted births and abortion due to an unwanted pregnancy as well. The study promotes the higher education and motivates couples to discuss the reproductive health issues among them. In this manner, we can provide better reproductive health to the women of urban India. [ABSTRACT FROM AUTHOR]

We explore whether young women's perceptions of their sexual partners' childbearing desires contribute to their risk of pregnancy. We used weekly journal data collected from 787 young women to measure their childbearing desires and their perceptions of their partners' childbearing desires. We then conducted hazard modelling to predict pregnancy risk with variables based on interactions between the women's desires and their perceived partners' desires. Models that include perceived partners' desires perform better than one based on women's desires alone. The best model contains three significant predictors: one confirms the importance of pronatal, ambivalent, and indifferent desires for pregnancy risk; one indicates that the perceived partners' antinatal desires reduce women's pregnancy risk; and one suggests that women who both perceive their partners accurately and are in agreement with them have a lower pregnancy risk. The results indicate that perceived partner data can improve prediction and enhance our understanding of pregnancy risk. [ABSTRACT FROM AUTHOR]

Background: Despite substantial progress in improving maternal and newborn health, India continues to experience high rates of newborn mortality and stillbirths. One reason may be that many births happen in health facilities that lack advanced services-such as Caesarean section, blood transfusion, or newborn intensive care. Stratification based on pregnancy risk factors is used to guide 'high-risk' women to advanced facilities. To assess the utility of risk stratification for guiding the choice of facility, we estimated the frequency of adverse newborn outcomes among women classified as 'low risk' in India., Methods: We used the 2019-21 Fifth National Family Health Survey (NFHS-5)-India's Demographic and Health Survey-which includes modules administered to women aged 15-49 years. In addition to pregnancy history and outcomes, the survey collected a range of risk factors, including biomarkers. We used national obstetric risk guidelines to classify women as 'high risk' versus 'low risk' and assessed the frequency of stillbirths, newborn deaths, and unplanned Caesarean sections for the respondent's last pregnancy lasting 7 or more months in the past five years. We calculated the proportion of deliveries occurring at non-hospital facilities in all the Indian states., Findings: Using data from nearly 176,699 recent pregnancies, we found that 46.6% of India's newborn deaths and 56.3% of stillbirths were among women who were 'low risk' according to national guidelines. Women classified as 'low risk' had a Caesarean section rate of 8.4% (95% CI 8.1-8.7%), marginally lower than the national average of 10.0% (95% CI 9.8-10.3%). In India as a whole, 32.0% (95% CI 31.5-32.5%) of deliveries occurred in facilities that were likely to lack advanced services. There was substantial variation across the country, with less than 5% non-hospital public facility deliveries in Punjab, Kerala, and Delhi compared to more than 40% in Odisha, Madhya Pradesh, and Rajasthan. Newborn mortality tended to be lower in states with highest hospital delivery rates., Interpretation: Individual risk stratification based on factors identified in pregnancy fails to accurately predict which women will have delivery complications and experience stillbirth and newborn death in India. Thus a determination of 'low risk' should not be used to guide women to health facilities lacking key life saving services, including Caesarean section, blood transfusion, and advanced newborn resuscitation and care., Funding: Bill and Melinda Gates Foundation and the World Bank. The findings, interpretations and conclusions expressed in the paper are entirely those of the authors, and do not represent the views of the Gates Foundation or of the World Bank, its Executive Directors, or the countries they represent., Competing Interests: Drs. Mickey Chopra, Kevin Croke, Sanam Roder-DeWan, Andrew Sunil Rajkumar, and Margaret E. Kruk hold grants or contracts from the Bill and Melinda Gates Foundation. Several authors (SRD, MC, MAP, ANB, KC, and MEK) received travel funding for a meeting where this paper was initially conceived. Authors declare no other conflicts of interest., (© 2023 The Author(s).)

The objective of this study was to determine the relative importance and contribution of several physiological factors as predictors of pregnancy risk in an Ovsynch (GnRH-1 - 7 d - PGF2α - 56 h - GnRH-2 - 16 h - artificial insemination) timed artificial insemination program: (1) age of the corpus luteum (CL; original CL, new CL, or both in response to GnRH-1) and resulting progesterone concentrations as they affected luteolysis, ovulation after GnRH-2, and pregnancy risk; (2) progesterone concentration before GnRH-1 and GnRH- 2 on subsequent ovulatory response to GnRH-1 and GnRH-2 as well as pregnancy risk; and (3) a combination of these factors in a multivariable logistic regression model to predict pregnancy risk. Original data from 7 published studies were combined including ovulatory responses to both GnRH injections, blood progesterone concentrations before GnRH-1, before PGF2α, and at 48 h after PGF2α, pregnancy per artificial insemination at d 32 and 60 after artificial insemination, and intervening pregnancy loss. Ovulation outcomes were greater at lesser progesterone concentrations after both GnRH injections despite the fact that pregnancy outcomes were greatest when progesterone exceeded 3 ng/mL before GnRH-1 and PGF2α, suggesting that greater progesterone concentration before GnRH-1 and incidence of ovulation act via different mechanisms to improve subsequent fertility. Ovulation after GnRH-2 and subsequent pregnancy outcome were positively related to lesser concentrations of progesterone at 48 h after PGF2α; however, for maximal pregnancy outcome, progesterone should be <0.5 ng/mL. Cows with a CL that also formed a new CL after GnRH-1 had the greatest pregnancy outcome, whereas cows with only a new CL (i.e., anovulatory cows and those at or near estrus without a CL at GnRH-1) had the poorest pregnancy outcome. Pregnancy loss was not affected by CL status during the timed artificial insemination program. Receiver operator curves produced cut points of progesterone concentration that predicted ovulation and pregnancy risk. Selected cut points of progesterone concentration 48 h after PGF2α produced true positive risks greater than 90% and false positive risks less than 25%, thus demonstrating the high predictability of ovulation after GnRH-2 and subsequent pregnancy outcome based on progesterone concentration. We conclude that progesterone concentration is highly predictive of ovulation and pregnancy risk in addition to body condition, size of ovulatory follicle, and parity. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the prevalence of thrombophilia in patients with placenta-mediated pregnancy complications (PMPC).Methods: Patients referred for thrombophilia testing at Odense University Hospital, Denmark, owing to PMPC between January 1, 2010 and December 31, 2014, were included in the present retrospective study. Data collected from patient medical records included the type of PMPC, history of previous thrombosis, and arterial thrombosis risk factors.Results: A total of 103 patients were included in the study; 25 (24.3%) were diagnosed with thrombophilia. Among the study population, factor V Leiden was the most dominant thrombophilia and was diagnosed in 11 (10.7%) patients (compared with 7% prevalence in the general population). The prevalence of all thrombophilias (except prothrombin mutation) was significantly higher in patients with PMPC in comparison with the reported prevalence in the general population.Conclusion: The incidence of thrombophilia was higher in patients with PMPC than in the general population. A positive thrombophilia diagnosis in a patient with PMPC can have significant clinical consequences for future pregnancies. It can also instigate thrombophilia testing among a patient's family members if necessary. Owing to these advantages, continued thrombophilia testing in these patients seems appropriate. [ABSTRACT FROM AUTHOR]

Cows managed for extended lactation go through several estruses before rebreeding. The aims of this study were (1) to quantify the effect of the first 8 estruses after calving on milk yield, milking frequency, and estrous behavioral activity, and (2) to determine the effects of early lactation live weight gain (LWG) as an indication of energy balance on milk yield, plasma insulin-like growth factor 1 (IGF-1) concentration, estrous behavioral activity, interval from calving to first estrus, between-estrus intervals, and pregnancy risk. Milk yield, live weight, and estrous behavioral activity were measured daily in 62 Holstein cows, 17 primiparous and 45 multiparous, managed for an 18-mo calving interval. Blood plasma obtained at wk 3, 5, 12, and 24 after calving was analyzed for IGF-1. Estrus was detected by use of milk progesterone profiles combined with visual observations (i.e., mounting behavior and other). The cows were divided into 2 groups: the cows having a negative LWG in each of the first 5 wk post-partum and the cows having a positive LWG in at least 1 of the first 5 wk after calving. The results indicate a similar decrease of 0.56 kg of milk per day of estrus during each of the 8 consecutive estruses. The activity level was 17 ± 1 movements per hour higher during the 8 estruses compared with the basic activity level. More cows expressed mounting behavior at estrus 8 than at estrus 2 (63.3 and 45.9%, respectively). The negative LWG cows had lower IGF-1 and higher milk production than the positive LWG cows. Both LWG groups had similar interval from calving to first estrus, on average 55 d. To conclude, the decrease in milk yield during estrus is marginal and similar in consecutive estruses. Moreover, estrous behavior is more highly expressed in the later estruses compared with the earlier estruses. Reproductive parameters (frequency of mounting, pregnancy risk, interval to first estrus, and between-estrus intervals) were not influenced by the live weight change during early lactation. [ABSTRACT FROM AUTHOR]

Objectives To analyze data from recent Demographic and Health Surveys (DHS) conducted in 21 low- and middle-income countries (LMICs) to examine patterns of interpregnancy intervals, unmet need, pregnancy risk and family planning method use and method mix among women 0–23 months postpartum. Study design Secondary analysis of postpartum women aged 15–49 years in 22 DHS surveys from 21 LMICs conducted between 2005 and 2012. We applied an adapted unmet need definition for postpartum women to look at prospective fertility preferences. We also constructed a new composite pregnancy risk indicator for postpartum women who have been sexually active since their last birth. Results In 9 of 22 surveys, 50% or more of nonfirst births occur at interpregnancy intervals that are too short. Overall prospective unmet need for family planning by postpartum women has not changed demonstrably since a 2001 analysis and is universally high: 61% of all postpartum women across the 21 countries have an unmet need for family planning. In 10 of 22 surveys, pregnancy risk rises steadily throughout the 2 years after birth. In the remaining 12 surveys, the risk of pregnancy peaks at 6–11 months after birth. Even when postpartum women are using family planning, they rely overwhelmingly on short-acting methods (51–96% in 21 of 22 surveys). Conclusion Our approach of estimating pregnancy risk by postpartum timing confirms a high probability for pregnancies to be less than optimally spaced within 2 years of a prior birth and suggests that special consideration is needed to effectively reach this population with the right messages and services. Implications Using recent, multicountry data for women within 2 years postpartum in LMICs, this paper updates existing estimates of high prospective unmet need for family planning and presents a new composite pregnancy risk analysis based on postpartum women’s actual practices to demonstrate the magnitude of missed opportunities for programmatic intervention for the postpartum population. [ABSTRACT FROM AUTHOR]

The reported prevalence of antiphospholipid antibodies in women with a chief complaint of pregnancy loss varies, as does the risk of adverse outcomes in subsequent pregnancies. Our objectives were to assess the prevalence of antiphospholipid antibodies meeting revised Sapporo thresholds among women presenting with a chief complaint of pregnancy loss and risks in subsequent pregnancies for these women. We examined a retrospective cohort of patients presenting with a chief complaint of pregnancy loss between 2003 and 2012. Antiphospholipid antibodies were assessed at the providers’ discretion, and patients were considered positive if they met the revised Sapporo criteria. Patient data were obtained by review of the medical records. 338/390 women (86.7%) presented with a chief complaint of pregnancy loss and had testing for antiphospholipid antibodies. 19/338 women (5.6%) persistently tested positive for at least one antiphospholipid antibody. Seven women who tested positive had isolated recurrent early pregnancy loss ≤10 weeks, and 12 women who tested positive had venous thromboembolism (VTE), systemic lupus erythematosus (SLE), delivery <34 weeks for pre-eclampsia, and/or placental insufficiency, or fetal demise >10 weeks. Subsequent pregnancy outcomes were available for 13 patients. Compared with women with recurrent early pregnancy loss alone, subsequent obstetric morbidity was significantly more likely in those patients with a history of SLE and/or VTE ( p = 0.048). We conclude that the prevalence of positive antiphospholipid antibodies in women with a chief complaint of pregnancy loss and without autoimmune disease or prior thrombosis is low and that among these women, subsequent pregnancy outcomes are largely favorable. [ABSTRACT FROM AUTHOR]

Objective: To evaluate longitudinal care needs and health service access among mother–infant pairs after adolescent pregnancy. Methods: In a case–control study, data were analyzed from primiparous adolescent and adult mother–infant pairs who delivered at Reunion Island University Hospital, France, between January 2004 and December 2006, and were followed-up from maternity discharge until December 2011. Infant outcomes were hospitalization during the first 2years of life, hospital access for “non-medical” reasons, and neuropsychiatric care. Maternal outcomes were number of pregnancies and childbirths, rapid repeat pregnancy (RRP) rate, pregnancy morbidities, and use of health services. Results: Data from 476 cases and 476 controls were analyzed. Adolescent and control offspring did not differ in the measured outcomes. Adolescent and control mothers had, respectively, 2.4±1.3 and 1.9±1.1 pregnancies; 1.9±0.8 and 1.6±0.7 childbirths; and RRP rates of 7.6% and 2.7% (all P <0.001). Adolescents had less pregnancy-related pathologies at the index pregnancy and more frequently had natural deliveries (P <0.05). Younger mothers exhibited higher rates (19.7% versus 6.9%, P =0.001) of care for psychosocial reasons (suicide attempt, acute alcohol or drug intoxication, road accident, psychiatric problems, physical abuse). Conclusion: Concerns arise from the long-term psychosocial risk among adolescent mothers. [ABSTRACT FROM AUTHOR]

Many different definitions of the construct of motivational ambivalence have appeared in the literature on reproductive health. Using a theoretical framework in which motivational ambivalence is defined as an interaction between positive and negative pregnancy desires, we propose two hypotheses. The first is that positive and negative pregnancy desires independently predict the risk of an unplanned pregnancy. The second is that ambivalence and three related constructs that are also based on the interaction between positive and negative desires are each important predictors of pregnancy risk. We use weekly journal data collected from a US sample of 1,003 women aged 18–19 years and conduct hazard model analysis to test our hypotheses. Using both dummy and continuous predictors, we report results that confirm both hypotheses. The proposed interaction framework has demonstrated validity, compares favourably with previously reported alternative approaches, and incorporates a set of constructs that have potential importance for further research directed at the prevention of unplanned pregnancy. [ABSTRACT FROM AUTHOR]

Stress experienced by pregnant women can influence pregnancy outcomes and place pregnant women at greater risk for illness. Stress during pregnancy can also put women at increased risk for preterm birth, low birth weight, and hypertension. Furthermore, babies exposed to prenatal maternal stress could have later physical, intellectual, and behavioral difficulties. It is important to note that racial or ethnic minority pregnant women appear to have challenging pregnancy outcomes that are not associated with stress. [ABSTRACT FROM AUTHOR]

Objective: To assess the long-term impact of implementation intention formation in reducing consultations for emergency contraception and pregnancy testing among teenage women. Design: Teenage women visiting a family planning clinic were randomly assigned to implementation intention versus control conditions. Main outcome measures: Objective measures of consultation outcomes were obtained from clinic records at 2-year follow-up (N = 227). Results: Rates of consultation for emergency contraception and pregnancy testing in the implementation intentions condition were 19% and 33% lower, respectively, compared to the rates observed in the control condition. Pregnancy rates were 43% lower. Intervention participants who consulted for emergency contraception and pregnancy testing at baseline were more than twice as likely to change to consulting for contraceptive supplies over the follow-up period compared to equivalent control participants (19% vs. 9%). Conclusion: The impact of implementation intention formation on reducing pregnancy risk among teenagers is durable over 2 years. Implementation intentions were successful in changing behavior among precisely those participants who were at greatest risk of becoming pregnant. [ABSTRACT FROM AUTHOR]

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Pregnant women's perception of risk may influence their health behaviors during pregnancy; however, no validated instrument exists to measure those perceptions. The purpose of this study was to refine a new instrument, the Perception of Pregnancy Risk Questionnaire (PPRQ), and conduct psychometric assessment of the final 9-item version. Reliability and validity were assessed using a sample of 199 women in the third trimester of pregnancy. Exploratory factor analysis resulted in a two-factor solution. Evidence of construct validity was demonstrated using the known-groups technique and through convergent validity. Ratings of pregnancy risk correlated with state anxiety level, providing evidence of concurrent validity. The PPRQ had high internal consistency reliability and excellent test–retest reliability. © 2009 Wiley Periodicals, Inc. Res Nurs Health 32:493–503, 2009 [ABSTRACT FROM AUTHOR]

Abstract: Background: Advance provision of emergency contraception (EC) has increased use but not impacted on pregnancy or abortion rates. Here we describe young women''s EC use and experiences of unprotected sex to explore why this difference occurs. Methods: In-depth interviews with twenty 20-year-old women from eastern Scotland. Results: The majority (16) had used EC; 10 reported some experience of unprotected sex. EC use followed contraceptive failure and unexpected or unplanned, but not frequent, unprotected sex. Acknowledging the need for EC requires recognition of pregnancy risk. Those reporting frequent unprotected sex misperceived their pregnancy risk and did not use EC. This group was from socially disadvantaged backgrounds, and all became pregnant. Conclusions: EC remains an important “backup” contraceptive and should continue to be widely available. With high levels of unprotected sex, nonuse of EC and unintended pregnancies, further efforts are required to improve the sexual and reproductive health outcomes of disadvantaged young women. [Copyright &y& Elsevier]

Abstract: Purpose: This study investigates the predictors of rapid repeat pregnancy (subsequent pregnancy within 24 months of previous pregnancy outcome) in a sample of urban adolescents. Methods: Adolescents aged 12–19 years (N = 354) who were predominantly African-American (94.1%) completed individual interviews during pregnancy and at 24 months postpartum. Logistic regression was used to determine the relationship among mental health factors, behavioral factors, and negative life experiences in the prediction of rapid repeat pregnancy. Results: Of the adolescents, 42% (n = 147) of adolescents reported a rapid repeat pregnancy. Baseline reports of later age at menarche (12.43 vs. 11.91; p = .003) and a greater likelihood of aggression were significantly associated with having a rapid repeat pregnancy within 24 months. Age at menarche and self-reported aggression contributed independently to the prediction of a closely spaced second pregnancy (p < .05). Conclusions: It is suggested that pubertal onset and individual mental health as it relates to measures of aggression should be considered when developing programs targeting adolescents at highest risk for rapid repeat pregnancy. [Copyright &y& Elsevier]

Individuals typically believe that they are less likely than the average person to experience negative events. Such “unrealistic optimism” (UO) has been assessed in two ways: directly (via a single question, requiring comparison of own risk to that of the average person) and indirectly (via separate questions about own risk and that of the average person). The study examined the equivalence of the direct and indirect measures of female students' UO for unwanted pregnancy. Participants (N?=?120) answered questions about their own risk, that of the average female student, and their own risk relative to that of the average female student; responses and response times were recorded. There was only a moderate association between direct- and indirect-UO. Direct-UO was strongly associated with estimate of own risk, but only moderately associated with estimate of the average student's risk. Response times for the comparative risk and own risk questions did not differ, but participants took significantly longer to answer the question about average student's risk. The results suggest that the two measures of UO are not equivalent, but, rather, that individuals answering a comparative risk question focus mainly on their own risk, at the expense of that of the average person. [ABSTRACT FROM AUTHOR]

The object of the study was to evaluate the research designs of social support interventions for prevention of low birth weight (LBW). A literature search of published articles identified 12 randomized controlled trials of social support to prevent LBW birth. These were evaluated using specific methodological criteria for effective intervention research. Only one study showed a significant reduction in LBW. However, none of the studies met all of the proposed criteria for rigorous intervention research. It is premature to conclude that social support interventions are ineffective in preventing LBW. Specific recommendations for future intervention research design are outlined. [ABSTRACT FROM AUTHOR]

Background: The incidence of Fetal Alcohol Syndrome (FAS) has been estimated at 1 to 3 per 1000 live births. Fetal Alcohol Spectrum Disorders (FASD) (which include FAS) are estimated to occur in about 1 in 100 births. Cessation of drinking during pregnancy can improve the outcome even if the unborn child is already affected. For individuals born with FASD, an early diagnosis appears to be a protective factor against secondary disabilities. A quick screening tool to identify newborn children at risk has been elusive. Methods: A simple descriptive presentation is offered that shows where 36 individuals with FASD were found from among the many patterns and amounts of prenatal alcohol use that were reported by a sample of 1439 pregnant women whose offspring were later e-amined within the first 7 years of life. Results: Individuals with FASD (i.e., those with FAS, fetal alcohol effects, alcohol-related neurodevelopmental disorder) were found within two aggregates of alcohol scores that together recommend a set of three to four alcohol questions. Within this derivation sample, one scoring of the questions yields almost 78% sensitivity and 97% specificity for FASD. Another scoring of the same instrument yields 100% sensitivity with 90% specificity. Conclusions: These new data may facilitate early identification of offspring who may be most in need of early intervention, namely those born with FASD. [ABSTRACT FROM AUTHOR]

This paper presents a test of a multivariate model designed to predict the pregnancy risk- taking behavior of a sample of adolescent females. Pregnancy risk is conceptualized as the frequency with which adolescents engage in sexual intercourse without the use of an effective contraceptive method. This model, known generally as the Fishbein model of behavior prediction, led to the hypothesis that an adolescent female's sexual and contraceptive behavior can be predicted from a linear combination of her attitudes toward performing that behavior and her normative beliefs, weighted by her motivation to comply with those norms. Analyses of data drawn from a sample of 244 female adolescents ages 13 to 18 yielded mixed support for the model. Whereas attitudes and parental norms, weighted by motivation to comply, are strongly related to both measures of contraceptive use, none of the variables are related to the frequency of sexual intercourse. Peer norms are only weakly related to any of the pregnancy-risk behavioral measures. The departure of these findings from those of previous tests of the Fishbein model is discussed, including methods and subject variance factors. Previous tests of the model have also focused on predicting behavioral intentions as opposed to actual behavior. That certain elements of the Fishbein model were found to be predictive of adolescent pregnancy-risk behavior, despite the significant differences in methodology, adds weight to the generalizability of the model and its potential usefulness for generating a clearer understanding of adolescent behavior. [ABSTRACT FROM AUTHOR]

Project Taking Charge is an abstinence-based intervention program for early adolescents designed to delay sexual intercourse and prevent teen pregnant. This article reports the evaluation results of a 6-month follow-up study involving adolescents from two of the original three program sites. Many of the knowledge gains found at posttest were retained at follow-up. In addition, program participants were less likely than comparison subjects to report the initiation of sexual intercourse within the 6 months following the program. [ABSTRACT FROM AUTHOR]