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There remains a considerable concern among both patients and oncologists that having a live birth (LB) after breast cancer might adversely impact survival. analysis of survival in a national cohort of women with breast cancer diagnosed at age 20–39 years between 1981 and 2017 (n = 5181), and subsequent LB using Scottish Cancer Registry and national maternity records. Cases had at least one subsequent LB, each was matched with up to six unexposed cases without subsequent LB, accounting for guaranteed time bias. In 290 women with a LB after diagnosis, overall survival was increased compared to those who did not have a subsequent LB, HR 0.65 (95%CI 0.50–0.85). Women with subsequent LB who had not had a pregnancy before breast cancer showed increased survival (HR 0.56, 0.38–0.82). There was a progressively greater interaction of subsequent LB with survival with younger age, thus for women aged 20–25 years, HR 0.30 (0.12–0.74) vs. those aged 36–39, HR 0.89 (0.42–1.87). In women with LB within five years of diagnosis, survival was also increased (HR 0.66; 0.49–0.89). Survival following LB was similar to unexposed women by ER status (both positive and negative) and in those known to have been exposed to chemotherapy. This analysis provides further evidence that for the growing number of women who wish to have children after breast cancer, LB does not have a negative impact on overall survival. This finding was confirmed within subgroups, including the youngest women and those not previously pregnant. • The impact of childbirth on survival after breast cancer remains controversial. • National cancer and birth data were used to analyse an unbiased large cohort. • Live birth was associated with improved or similar survival after breast cancer. • This was confirmed by age at diagnosis, previous pregnancy, and ER status. • These findings are reassuring for young women wishing children after breast cancer. [ABSTRACT FROM AUTHOR]

Objective: To evaluate maternal and neonatal outcomes of women with twin pregnancies following a short interpregnancy interval (IPI < 6 months).Study Design: A retrospective computerized database study in a single tertiary medical center between 2005 and 2021. Women who had an index singleton delivery and a subsequent twin gestation in their next pregnancy at the Shaare Zedek Medical Center (SZMC) were included. Maternal and neonatal outcomes of twin pregnancies following a short IPI (<6 months) were compared to those with an optimal IPI (18-48 months). Univariate analysis was followed by multiple logistic regression models; adjusted odds ratios (aORs) and 95 % confidence intervals (CIs) were calculated.Results: During the study period, 2,079 women had an index singleton delivery followed by a twin gestation in their next pregnancy recorded at our medical center; 116 (5.9 %) had a history of short IPI, and 1,057 (50.8 %) had a history of optimal IPI. Women with a history of short IPI had higher rates of preterm labor < 37 weeks and < 34 weeks, NICU admissions and prolonged hospital stay of the first and second fetuses, mechanical ventilation of the first fetus, 1 and 5 Minute Apgar score lower than 7 of the second fetus and lower rates of elective cesarean delivery. An adjusted multivariate analysis showed that a history of short IPI was not an independent risk factor for preterm birth either < 34 weeks or < 37 weeks or for composite adverse neonatal outcome of the first and second twin.Conclusion: Twin pregnancy following a short IPI was not associated with neither preterm labor nor composite adverse neonatal outcome. [ABSTRACT FROM AUTHOR]

Objective: To determine whether the type (intrauterine device or implant) or timing (immediately postpartum vs interval) of postpartum long-acting reversible contraception was associated with a reduction in short interpregnancy interval births.Study Design: We conducted a retrospective cohort study using linked Medicaid claims and birth certificate data from Oregon and South Carolina, 2010 to 2018. Our primary outcome was short interpregnancy interval, defined as repeat pregnancy within 18 months of the index delivery. We determined postpartum contraceptive method and timing of receipt. To assess the association of timing of long acting reversible contraception with short interpregnancy interval, we calculated adjusted probabilities from a logistic regression model incorporating covariate balanced propensity score weights, sociodemographic factors, and clustered at the woman-level.Results: Our study sample included 121,422 births to 97,084 individuals who had more than 1 birth during the study period; 41% had a short interpregnancy interval. A majority of individuals had not received any contraception by 6 months postpartum (68.6%). Overall, 15,477 individuals used long acting reversible contraception postpartum, with the majority receiving interval rather than immediate postpartum long acting reversible contraception (92.9% vs 7.1%). In multivariable analyses, both immediate postpartum (23.0%, 95% CI: 20.5%-25.8%) and interval long acting reversible contraception (15.2%, 95% CI: 14.4%-16.1%) are associated with a lower probability of short interpregnancy interval than short acting methods (42.1%, 95% CI: 41.2%-43.0%).Conclusion: Compared to short-acting methods, receipt of both immediate postpartum and interval long-acting reversible contraception is associated with lower probabilities of a subsequent short interpregnancy interval.Implications: All long acting, reversible contraception, whether placed immediately postpartum or on an interval basis, was associated with a significantly lower probability of a short interpregnancy interval than short acting or no contraceptive method. [ABSTRACT FROM AUTHOR]

Objective: We sought to systematically review the literature on values and preferences regarding contraception among individuals within selected key populations.Study Design: As part of a larger set of reviews on patients' and providers' values and preferences related to contraception globally, we searched ten electronic databases for articles from January 1, 2005 to July 27, 2020. No language restrictions were applied. Data was independently abstracted by two authors and study rigor was assessed using an 8-item measure developed by the Evidence Project for quantitative studies and an adapted CASP checklist for qualitative studies.Results: We identified 12 studies that met our inclusion criteria examining selected key populations, including sex workers, transmasculine individuals, people who inject drugs, or those living in humanitarian contexts. Seven key themes that spoke to values and preferences emerged related to: autonomy, perceived effectiveness and safety, birth spacing and family outcomes, impacts on sexual experience, hormonal effects (e.g. desire for non-hormonal method or perception that the method is more natural as compared to hormonal methods), physical attributes (e.g. appearance and/or ease of use), and stigma. Six studies were of high rigor, five were of moderate rigor, and one was of low rigor. One study described the values and preferences of two of the selected key populations. The research available on the values and preferences of sex workers regarding methods of contraception was limited to female condoms.Conclusion: Consideration of the values and preferences of individuals within selected key populations can inform providers, programme managers and policy makers participating in the delivery of contraceptive care. Contraceptive research among sex workers, transmasculine individuals, people who inject drugs, or those living in humanitarian contexts is quite limited; further research is needed to better understand the values and preferences of these populations. [ABSTRACT FROM AUTHOR]

Medicaid expansion under the Affordable Care Act (ACA) improved access to reproductive health care for low-income women and birthing people who were previously ineligible for Medicaid. We aimed to evaluate if the expansion affected the risk of having a short interpregnancy interval (IPI), a preventable risk factor for adverse pregnancy outcomes. We evaluated parous singleton births to mothers aged 19 or older from U.S. birth certificate data 2009–2018. We estimated the effect of residing in a state that expanded Medicaid access (expansion status determined at 60 days after the prior live birth) on the risk of having a short IPI (<12 months) using difference-in-differences (DID) methods in linear probability models. We stratified the analyses by maternal characteristics and county-level reproductive health care access. Overall risk of short IPI was 14.9% in expansion states and 16.3% in non-expansion states. The expansion was not associated with a significant change in risk of having a short IPI (adjusted mean percentage point change 1.24 [-1.64, 4.12]). Stratified results also did not provide support for an association. ACA Medicaid expansion did not have an impact on risk of short IPI. Preventing short IPI may require more comprehensive policy interventions in addition to health care access. [ABSTRACT FROM AUTHOR]

Objective: Catholic Religious and Ethical Directives restrict access to contraception; yet offering contraception during a delivery hospitalization facilitates birth spacing and is a convenient option for patients during the postpartum period. We assessed patient and provider experiences with hospital transparency around postpartum contraceptive care in Illinois Catholic Hospitals.Study Design: We interviewed 44 participants with experience in Illinois Catholic Hospitals: 21 patients, and 23 providers, including clinicians, nurses, doulas, and postpartum program staff. We used an open-ended interview approach, with a semistructured guide focused on postpartum contraceptive care. We conducted interviews by phone between November 2019 and June 2020. We audio-recorded interviews, transcribed them verbatim, and coded transcripts in Dedoose. We developed narrative memos for each code, identifying themes and subthemes. We organized these in a matrix for analysis and present here themes regarding hospital transparency that emerged across interviews.Results: Many patients knew they were delivering in a Catholic hospital; however, few were aware that Catholic policies limited their health care options. Patients expressed a desire for hospitals to be transparent, even "very vocal," about religious restrictions and described consequences of restrictions on patient care. Patients lacked information to make contraceptive decisions, experienced limits on or delays in care, and some lost continuity with trusted providers. Consequences for providers included moral distress in trying to provide care using workarounds such as documenting false medical diagnoses.Conclusions: Religious restrictions on postpartum contraception restrict access, cause unnecessary delays in care, and lead to misdiagnosis and marginalization of contraceptive care. Restrictions also cause moral distress to providers who balance career repercussions and professional integrity with patient needs.Implications: To protect patient autonomy, especially during the vulnerable postpartum period, Catholic hospitals should increase transparency regarding limitations on reproductive health care. Insurers and policy-makers should guarantee that patients have the option to receive care at hospitals without these limitations and facilitate public education about what to expect at Catholic facilities. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study is to show the pre- and postoperative results of transcorporal septal dissection using the balloon technique in complete uterine septums, which is a rare pathology.Study Design: It is a retrospective analysis. In this study 21 patients with a complete uterine septum were included. All patient underwent the transcorporal septal dissection using the balloon technique. Data analysis was based on patient history, surgical reports and telephone contact with the patients and supervising gynecologists.Results: 73% patients with a current desire to become pregnant managed to do so and 75% of them were able to give birth on time. One patient was pregnant at the time of the analysis. In 17 patients the results of the control hysteroscopy were available. In eight patients (47%) a normal cavity was found. In nine cases (53%) a residual septum of 1-2 cm was found, so that an operative hysteroscopy with a residual septum dissection was performed. The operative time was average 30.6 min in the group without laparoscopy and 56.8 min in the group with laparoscopy.Conclusion: The transcorporal septum dissection using the balloon technique is a safe method with a good fertility outcome and requires an experienced surgeon. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the likelihood of a short interpregnancy interval (IPI) resulting in a birth among women covered by Medicaid, as a function of postpartum contraceptive method type.Study Design: We used Medicaid claims and eligibility data to identify women (aged 15-44) who had a Medicaid-financed birth in Delaware in the years 2012-2014 (n = 10,328). Claims were analyzed to determine postpartum contraceptive type within 60 days of the index birth, and linked birth certificates were used to determine the incidence and timing of a subsequent birth through 2018 (regardless of payer). We used logistic regression to analyze the likelihood of having a short IPI following the index birth as a function of postpartum contraceptive type, controlling for preterm births, parity, having a postpartum checkup, and maternal characteristics including age, race, education, and marital status.Results: Compared to patients receiving postpartum long-acting reversible contraceptive methods (LARC), patients with no contraceptive claims had nearly 5 times higher odds (odds ratio [OR] = 4.98, confidence interval [CI] = 3.05-8.13) and those with claims for moderately effective methods (injectable, pill, patch, or ring) had 3.5 times higher odds (OR = 3.51, CI = 2.13-5.77) of a subsequent birth following a short IPI.Conclusions: In a state population of Medicaid-enrolled women, women with claims for postpartum LARC had substantially lower risk of a short IPI resulting in a birth.Implications: Women who received LARC within 60 days postpartum are less likely to experience a short interpregnancy interval resulting in a birth. The evidence suggests that recent state policy changes that make postpartum LARC more accessible to those that desire it will be an effective strategy in helping patients obtain desired birth intervals. [ABSTRACT FROM AUTHOR]

Maternal mortality and morbidity rates have risen significantly, yet little research has focused on how severe maternal morbidity (SMM) is associated with future reproductive health, such as birth spacing or the likelihood of subsequent SMM. This study focuses on the risk of SMM recurrence and the association of interpregnancy intervals with SMM. This population-based, retrospective cohort study used Iowa hospital discharge data longitudinally linked to birth certificate data between 2009 and 2014. To examine recurrence of SMM, crude and adjusted multivariable logistic regression models were generated. The associations between varying interpregnancy intervals and subsequent SMM were examined. Crude, stratified, and adjusted risk ratios and their associated 95% confidence intervals were estimated. A total of 36,190 women were included in this study. Women with SMM in the index delivery had significantly higher odds of SMM in the subsequent delivery (adjusted odds ratio, 8.16; 95% confidence interval, 5.45–12.24) compared with women without SMM. Women with an interpregnancy interval of less than 6 months compared with 18 months or longer were more likely to experience SMM during their subsequent delivery, although the difference was not statistically significant (adjusted odds ratio, 1.41; 95% confidence interval, 0.99, 2.03). This study demonstrates that women who experience SMM are at markedly increased risk of subsequent SMM. Further investigation is necessary to inform optimal interpregnancy interval recommendations based on prior maternal health outcomes. [ABSTRACT FROM AUTHOR]

Objective: To evaluate maternal and neonatal outcomes associated with recurrent short interpregnancy interval (IPI) in women in their third delivery.Methods: A retrospective computerized database study of all women who delivered their first three consecutive deliveries in a single tertiary medical center over 20 years (1999-2019). Maternal and neonatal outcomes of women with recurrent short IPI (<6 months between the 1st and 2nd pregnancy and the 2nd and 3rd pregnancy) were compared to women with recurrent optimal IPI (18-48 months), and to women with a single short IPI (<6 months between the 1st and 2nd pregnancy followed by an optimal IPI of 18-48 months between the 2nd and 3rd pregnancy). Additionally, in the recurrent short IPI groups, outcomes of the 2nd and 3rd pregnancies were compared in order to achieve an ideal adjustment to background characteristics. Univariate analysis was followed by multiple logistic regression models; adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated.Results: During the study period 10,569 women had three consecutive deliveries at our medical center, of those 338 (3.2%) women had recurrent short IPIs, and 1,021 (9.7%) had recurrent optimal IPIs. Recurrent short IPI was associated with a significantly higher risk of maternal anemia (Hb < 10gr%) on admission to labor (aOR 3.4 [95% CI 1.09-10.65], p = 0.04) and higher risk of small for gestational age neonates (aOR 10.4 [95% CI 2.32-46.93], p < 0.01), as compared with women with recurrent optimal IPI and significantly higher rates of low neonatal birth weights (2500 gr) and anemia (Hb < 10gr%) alongside lower rates of operative vaginal deliveries as compared with women with single short IPI followed by an optimal IPI. In the recurrent short IPI groups, the 3rd deliveries had significantly higher rates of in-labor cesarean and anemia (Hb < 10gr%) on admission as compared to their 2nd deliveries.Conclusion: Recurrent short IPI is associated with maternal anemia and small for gestational age neonates. Guiding patients towards prolongation of the IPI should include explanatory comments on these outcomes. [ABSTRACT FROM AUTHOR]

Objectives: To characterize contraceptive counseling experiences among women living with HIV (WLWH) receiving HIV care in Kenya.Study Design: Sexually active, WLWH aged 15 to 49 years were purposively sampled from 109 high-volume HIV Care and Treatment Centers in Kenya between June and September 2016. Cross-sectional surveys were administered to enroll women on a tablet using Open Data Kit. Poisson generalized linear regression models adjusted for facility-level clustering were used to examine cofactors for receiving family planning (FP) counseling with a provider.Results: Overall, 4805 WLWH were enrolled, 60% reported they received FP counseling during the last year, 72% of whom reported they were counseled about benefits of birth spacing and limiting. Most women who received FP counseling were married (64%) and discussed FP with their partner (78%). Use of FP in the last month (adjusted Prevalence Ratio [aPR] = 1.74, 95% confidence interval [CI]: 1.41-2.15, p < 0.001), desire for children in >2 years (aPR = 1.18, 95% CI: 1.09-1.28, p < 0.001), and concern about contraceptive side-effects (aPR = 1.13, 95% CI 1.02-1.25, p < 0.05) were significantly higher among WLWH who received FP counseling compared to those that did not.Conclusions: Over one-third of WLWH did not receiving FP counseling with an HIV care provider during the last year, and counseling was more commonly reported among women who were using FP or desired children in >2 years.Implications: There are missed opportunities for FP counseling in HIV care. FP integration in HIV care could improve FP access and birth spacing or limiting among WLWH. [ABSTRACT FROM AUTHOR]

Comparing individual contributions in a strongly interacting system of stochastic growth processes can be a very difficult problem. This is particularly the case when new growth processes are initiated depending on the state of previous ones and the growth rates of the individual processes are themselves random. We propose a novel technique to deal with such problems and show how it can be applied to a broad range of examples where it produces new insight and surprising results. The method relies on two steps: In the first step, which is highly problem dependent, the growth processes are jointly embedded into continuous time so that their evolutions after initiation become approximately independent while we retain some control over the initiation times. Once such an embedding is achieved, the second step is to apply a Poisson limit theorem that enables a comparison of the state of the processes initiated in a critical window and therefore allows an asymptotic description of the extremal process. In this paper we prove a versatile limit theorem of this type and show how this tool can be applied to obtain novel asymptotic results for a variety of interesting stochastic processes. These include (a) the maximal degree in different types of preferential attachment networks with fitnesses like the well-known Bianconi–Barabási tree and a network model of Dereich, (b) the most successful mutant in branching processes evolving by selection and mutation, and (c) the ratio between the largest and second largest cycles in a random permutation with random cycle weights, which can also be interpreted as a disordered version of Pitman's Chinese restaurant process. [ABSTRACT FROM AUTHOR]

The present paper focuses on the changes undergone by news discourse towards its current multisemiotic, digital nature. It is divided into three main sections; in the first one I will focus on how multimodal/multisemiotic developments have been gradually entrenched in news reporting, from 17th-century woodblock engravings in the early news texts to contemporary convergent journalism, with special reference to the increasing interconnection between verbal output and visuals. Secondly, I will illustrate the shift in topics and methodologies undergone by studies on news discourse particularly over the last few years, with attention to (a) news dissemination and consumer perception (b) the new language(s) of news. Finally, I will present and discuss a pilot case study of multimodality in news reporting, focussing on the coverage by The New York Times of the birth and development of the European Union between 1946 and 2009. The study will attempt to bring to the fore the role played by the dynamic interrelationship between image and verbal text in conveying the news stories and, possibly, the underlying perspective of the newspaper itself when informing readers on the steps leading to the shaping of the EU. • News dissemination has been shaped by historical technological innovations. • Multimodal journalism is rooted in the interplay between verbals and visuals. • Studies on news discourse and transmission have shifted in topics and methodologies. • Co-occurring features in the news output trigger semiotic and pragmatic factors. [ABSTRACT FROM AUTHOR]

Twinning costs the dairy industry an estimated $96 million each year. Twin pregnancy occurrence in high-producing dairy cows is primarily a result of multiple ovulations associated with low circulating concentrations of progesterone due to high milk production. The present retrospective observational study aimed to identify associations between (1) previous parity milk yield and subsequent twin birth prevalence, (2) twin birth with same parity milk production and calving interval (CInt), and (3) twin birth and the subsequent twin calving. The final data set included almost 2.9 million US dairy calving and production records between 2001 and 2020. Variables considered were parity, breed, milk production, CInt, calving month, and year. Logistic and linear regression modeling were used to assess the effects of predictors on outcomes. Herd within state was used as a random effect for all regression models. Twin birth probability increased for cows with increased previous parity milk yield independent of breed or parity. Third and greater parity (3+) compared with second parity (2) and all breeds compared with Jerseys were associated with greater twin probability. Calving between April and September that corresponded to conceiving in July through December was associated with greater twin birth probability. Twin births were associated with decreased milk production following the birth event in Holsteins and parity 2 cows and in the calving months between June and September. Surprisingly, twin births in parity 3+ cows were associated with an increased 305-d milk yield. Cows that had a twin birth were more likely to calve twins in the subsequent parity and had a greater risk of having a CInt between 413 and 600 d. The hazard to subsequent calving after single births was greater compared with twin births. These data can be instrumental in guiding research focus on reducing twinning in lactating dairy cows. [ABSTRACT FROM AUTHOR]

Objectives: Very short interpregnancy intervals are associated with negative health outcomes for mothers and children, and pregnancies with very short interpregnancy intervals are more likely to be unintended than pregnancies that are more widely spaced. The objective of this study was to improve understanding of women's motivations regarding pregnancy spacing.Methods: In 2017, we conducted 8 focus group discussions with 49 English- and Spanish-speaking postpartum women in central North Carolina. The groups explored participants' preferences for birth spacing and factors that influenced their decisions. We recorded, transcribed, and coded the discussions and analyzed these data for core themes.Results: Participants' ideas about when and whether to have more children were fluid-some had specific ideas during pregnancy or after delivery that changed over time; others had no definite plans. The primary reason for close birth spacing was to promote their children's having a closer relationship. Reasons for wider spacing included recovery from the previous pregnancy, challenges related to having 2 babies concurrently, and desire to wait for more favorable life circumstances. Participants did not mention health risks to children of short interpregnancy intervals and said that no health care providers discussed these risks with them. They had mixed perspectives about whether this information would influence their own child-spacing preferences but agreed that it should be shared with women to promote informed decision-making.Conclusion: This study adds to limited research regarding the factors that women consider when determining pregnancy spacing. Better understanding of women's motivations can help inform counseling to help women achieve their desired pregnancy spacing. [ABSTRACT FROM AUTHOR]

"A Space Expedition for early elementary and preschool" is a course and a set of activities based on active-inquiry learning. Through the one-day course teachers of young learners are encouraged to create settings for the children to become, and remain, curious and inquisitive. The activities are created with a larger theme project in mind; they can be used in any order, depending on the interests of the learners. The children's role in choosing the topics is essential throughout the course, as the intention is to allow the children to pursue their interests, and hence lead the project forwards. The teachers are encouraged to reflect on personal experiences and ideas together with the children to ensure a feeling of ethos and purpose, and help the children contemplate on their own educational values. All activities and resources used in this course are created by Andøya Space Education. • Allow young learners to realise the excitement of space exploration. • Our children are the space explorers of the future so let us give them the tools. • Most children work best when they can visualize and play their way to knowledge. • Learning with the children eases the pressure on teachers having all the answers. [ABSTRACT FROM AUTHOR]

Objective: Investigate factors associated with symptoms of postpartum depression in mothers from families in social vulnerability.Methods: Information was used from the baseline of a randomized trial to assess a child development program that enrolled 3,242 children < 12 months of age from beneficiary families of the Bolsa Família Program residing in 30 municipalities (counties) in six states of Brazil. The Edinburgh Postnatal Depression Scale (EPDS) was applied to the mothers, and depression was defined as score ≥10. Information on the mother (schooling, age, parity, marital status, skin color, smoking, number of prenatal appointments, and planning of the pregnancy), family (paternal schooling, household crowding, support from the child's father and the family during the pregnancy, and number of children under 7 years living in the household), and infant (sex, gestational age, birthweight, Apgar score, and child's age at the time of the interview) was collected. Prevalence rates for depressive symptoms were calculated with crude and adjusted odds ratios (OR) and 95% confidence intervals (95%CI), using hierarchical logistic regression, in a multilevel model.Results: The analysis included 3,174 mothers with information on EPDS. The interviews were conducted on average 7.9 months (standard deviation= 2.9) after childbirth. Overall prevalence of depressive symptoms was 26.5% (25.0-28.1%). In the adjusted analysis, higher parity was associated with higher odds of postpartum depression (p <0.001). Women with ≥3 previous deliveries showed an odds 84% higher of presenting depressive symptoms (OR= 1.84; 1.43-2.35) than primiparae. Higher maternal and paternal schooling, presence of husband or partner, and having received support from the child's father and the family during the pregnancy were protective factors against postpartum depression.Conclusion: The study showed high prevalence of postpartum depressive symptoms. Promotion of parental education, alongside with the promotion of support to the woman during pregnancy by the child's father and by the family, as well as family planning leading to birth spacing are measures that may help to prevent postpartum depressive symptoms. [ABSTRACT FROM AUTHOR]

Objective: To examine fertility intentions among abortion patients and the potential of abortion for avoiding short birth intervals.Study Design: We used national data from a sample of more than 8000 individuals obtaining abortions in the United States in 2014. We created a measure of fertility intentions based on prior births and responses to an item asking about future childbearing expectations. We identify respondents who reported having a birth in the last 12 months as at risk of a short birth interval. We used simple logistic regression to assess for differences in these measures according to key demographic variables.Results: Most commonly, 39% of patients intended to have (more) children, with similar proportions wanting to delay a first birth (20%) or postpone a second or higher order birth (19%). Some 31% of abortion patients had completed childbearing; they had one or more prior births and did not want to have any more children. Similar proportions of respondents were not sure if they wanted to have children (16%) or did not want to have any children (15%). Among abortion patients who had children, 14% had had a birth in the prior year. We estimate that as many as 77,800 short birth intervals were averted in 2014 because individuals had access to abortion.Conclusions: These findings support the view that abortion allows individuals to plan and space their births according to their reproductive life plans and intentions.Implications: Access to abortion may help thousands of individuals in the United States avoid short birth intervals, potentially leading to improvements in maternal and child health. [ABSTRACT FROM AUTHOR]

Uterotonics are widely used in the pig industry but their effects have not been investigated critically. The objective was to evaluate the effects of oxytocin and carbetocin on farrowing duration, birth interval, farrowing assistance, stillbirth rate, and piglet viability traits by performing a systematic review and a meta-analysis. The search for studies was performed during January 2020 using the PubMed, ISI Web of Science, Science Direct, and Scopus databases. The literature search was conducted using the key words: oxytocin, pig, farrowing, stillbirth, piglet, dose, and carbetocin. Studies which evaluated the effects of oxytocin or carbetocin on farrowing duration, birth interval, stillbirth rate, and farrowing assistance were included in the review. Of 1215 articles, 23 (1.9%) were selected for fulfilling the criteria for inclusion in the present study. A high variety of doses was observed among studies. Oxytocin increased (30%; P < 0.05) the stillborn proportion in the litters compared to control sows. Both oxytocin and carbetocin increased the need of farrowing assistance by 137% (P < 0.01) and 40% (P < 0.05), respectively, compared to control. The use of oxytocin reduced the farrowing duration by 18% and the birth interval by 17%, while carbetocin reduced the same responses by 27 and 23%, respectively (P < 0.01). When used judiciously, uterotonics are a valuable tool to shorten farrowing duration of hyperprolific sows. However, the treatment is not exempt of deleterious effects for piglets and sows. Therefore, the criteria to use these drugs should be based on individual cases and not as part of hormonal protocols for all parturient sows. • Farrowing duration is decreased by oxytocin and carbetocin. • Birth interval is decreased by oxytocin and carbetocin. • Oxytocin increases the stillborn amount. • Oxytocin and carbetocin increases the need of farrowing assistance. • There is no dose standardization in the use of oxytocin or carbetocin. [ABSTRACT FROM AUTHOR]

A duration of parturition beyond 300 min negatively impacts the health of the sow and the survival of piglets during parturition. Hence, oxytocin is widely used to speed up the parturition. However, oxytocin's negative side effects raise the need of finding alternative treatments such as those already implemented in human medicine. The aim of this study was to evaluate the efficacy of Prostaglandin E2 (PGE2) applied intravaginally (PGE2-V) (1.0 mg) or intramuscularly (PGE2-M) (2.5 mg) to improve the parturition process after expulsion of the fourth piglet compared to a placebo (P–V), which was sterile intravaginal gel or intramuscular oxytocin application (OXY-M) (20 iu) in free farrowing systems.In total, 201 eutocic sows were examined after stratification by parity and random allocation into groups: 54 (P–V), 48 (OXY-M), 50 (PGE2-V), 49 (PGE2-M). Farrowing duration (time between first piglet and last piglet), piglet interval and placenta expulsion duration (time between first and last placenta) were recorded, and each piglet was scored for meconium staining and vitality. Furthermore, stillborn piglets were categorized into ante-partum and intra-partum deaths.Under the present conditions, neither administration of PGE2 nor oxytocin revealed a significant effect on the farrowing process or the vitality of the piglets when compared to untreated sows. Nonetheless, significant differences could be detected between PGE-2 and oxytocin treatments. The duration of farrowing was significantly shorter in oxytocin-treated sows (156 min) compared to sows treated intramuscularly with PGE2 (238 min). Furthermore, the placenta expulsion duration in the OXY-M group (130 min) significantly differed from PGE2-V (198 min) and PGE2-M group (218 min). Although these accelerations of parturition might be considered as a beneficial effect, routine treatment with uterotonic agents after birth of the fourth piglet in free farrowing eutocic sows cannot be recommended, because an overall benefit when compared to untreated sows was not approved. • First study that evaluated efficacy of PGE2 on the birth process in eutocic sows. • Routine treatment with uterotonic agents in free farrowing system not recommended. • Application of an intravaginal uterotonic agent in free farrowing systems is feasible. [ABSTRACT FROM AUTHOR]

• Interval from pregnancy loss to next IVF did not affect chances of conception • Shorter cycle interval post-biochemical or spontaneous vs. medical or surgical loss • Miscarriage type and number embryos transferred affected chance of next pregnancy • Pregnancy chance lower after medical or surgical vs. biochemical or spontaneous loss • Higher chance of live birth with shorter interval to first cycle post-miscarriage Is the interval length between an early pregnancy loss and the following treatment cycle a predictor for achieving clinical pregnancy among IVF patients? This retrospective cohort study of 257 women who reinitiated treatment after first-trimester IVF pregnancy loss was conducted at a tertiary, university-affiliated medical centre between 1 January 2014 to 1 January 2018. Women aged 18–40 years, with normal uterine cavity, who experienced first-trimester pregnancy loss at less than 14 weeks after IVF, were included. Miscarriages were classified as spontaneous, biochemical, medical or surgical. Among 257 women, interval to subsequent IVF treatment was not associated with achieving pregnancy. Patients after biochemical pregnancy (72.7 ± 56.4, median 60 days) or spontaneous miscarriage (97.7 ± 93.1, median 66 days) had shorter intervals to next cycle, compared with medical (111.9 ± 103.2, median 65 days) or surgical (123.4 ± 111.1, median 84 days) (Kaplan–Meier, P = 0.03) miscarriages. Logistic regression analysis showed that the chance of subsequent pregnancy was affected by the number of embryos transferred (P = 0.009) and the type of miscarriage. Medical (P = 0.005) and surgical (P = 0.017) miscarriages were related to lower likelihood of pregnancy compared with biochemical pregnancy (reference group). When pregnancy was achieved in the first post-miscarriage cycle, the chance of live birth increased with shorter intervals (median 57.5 days), whereas second miscarriage was related to longer intervals (median 82.5 days) between miscarriage and subsequent IVF cycle (P = 0.03). On the basis of this cohort, IVF should not be postponed after pregnancy loss, as shorter intervals were associated with greater likelihood of live birth. [ABSTRACT FROM AUTHOR]

Objective: We aimed to evaluate the rates of short interpregnancy interval pregnancies and deliveries among women who receive immediate postpartum LARC.Study Design: We conducted a retrospective cohort study of all women who delivered at Montefiore Medical Center between January 2015 and June 2016 (N = 9561). In this cohort, we identified all repeat deliveries and pregnancies within 18 months of the initial delivery. Using logistic regression models, we compared rates of short interpregnancy interval delivery and pregnancy among recipients of an immediate postpartum IUD, immediate postpartum implant, and no immediate postpartum LARC, adjusting for covariates including patient age, mode of delivery, socioeconomic status, and race.Results: In our cohort, 12.9% of patients received immediate postpartum LARC. The rates of short interpregnancy interval delivery were 3.3% (N = 259/7833) among patients who did not receive immediate postpartum LARC, 1% (N = 6/595) among immediate postpartum IUD recipients, and 0.4% (N = 2/562) among immediate postpartum implant recipients. The rates of short interpregnancy interval pregnancy were 13.8% (N = 1082/7833) among patients who did not receive immediate postpartum LARC, 7.4% (N = 44/595) among immediate postpartum IUD recipients, and 5.2% (N = 29/562) among immediate postpartum implant recipients. Both recipients of immediate postpartum IUDs and immediate postpartum implants had lower rates of short interpregnancy interval delivery and pregnancy compared to patients who did not receive immediate postpartum LARC.Conclusions: This study confirms that women who received immediate postpartum IUDs and implants have lower rates of short interpregnancy interval pregnancies.Implications: Making immediate postpartum LARC widely available is a promising public health approach to help women achieve a longer interpregnancy interval. [ABSTRACT FROM AUTHOR]

In rats, birth timing is affected by changes in the light schedule until the middle of the pregnancy period. This phenomenon can be used to control birth timing in the animal industry and/or clinical fields. However, changes in the light schedule until the middle of the pregnancy period can damage the fetus by affecting the development of the major organs. Thus, we compared birth timing in mice kept under a 12-h light/12-h darkness schedule (L/D) throughout pregnancy with that of mice kept under a light schedule that changed from L/D to constant light (L/L) or constant darkness (D/D) from day 17.5 of pregnancy, the latter phase of the pregnancy period. On average, the pregnancy period was longer in D/D mice (19.9 days) than L/L or L/D mice (19.5 and 19.3 days, respectively, P < 0.05), confirming that light schedule affects birth timing. The average number of newborns was the same in L/L, L/D, and D/D mice (7.5, 7.8, and 7.9, respectively), but the average newborn weight of L/L mice (1.3 g) was lower than that of L/D and D/D mice (both 1.4 g, P < 0.05), indicating that constant light has detrimental effects on fetus growth. However, the percentage of dead newborns was the same between L/L, L/D, and D/D mice (11.1, 10.6, and 3.6%, respectively). The serum progesterone level on day 18.5 of pregnancy in L/D mice was 42.8 ng/ml, lower (P < 0.05) than that of D/D mice (65.3 ng/ml), suggesting that light schedule affects luteolysis. The average pregnancy period of mice lacking a circadian clock kept under D/D conditions from day 17.5 of pregnancy (KO D/D) (20.3 days) was delayed compared with wild-type (WT) D/D mice (P < 0.05). However, the average number of newborns, percentage of births with dead pups, and weight per newborn of KO D/D mice (7.6, 3.6%, and 1.4 g, respectively) were the same as WT mice kept under D/D conditions. A direct effect of the circadian clock on the mechanism(s) regulating birth timing was questionable, as the lighter average weight per KO fetus (0.6 g) versus WT fetus (0.7 g) on day 17.5 of pregnancy might have caused the delay in birth. The range of birth timing in KO D/D mice was the same as that of WT D/D mice, indicating that the circadian clock does not concentrate births at one time. • Changing the light schedule in late pregnancy alters birth timing. • Changing the light schedule decreases progesterone levels before birth. • The circadian clock had no significant effect on birth timing in our study. [ABSTRACT FROM AUTHOR]

• Gujarat, an economically more developed state, had the second-lowest coverage of CFI in the country. • The proportion of children with no immunisation in Gujarat rose from 5% in 2005 to 9% in 2016. • Children whose mothers received increased MCH services have better CFI compared to their counterparts. • Poverty and higher-order births with lower birth interval show a negative effect on the uptake of CFI. • Rural areas and scheduled tribes children in Gujarat have higher CFI than urban areas and other castes. Despite decent progress in Children Full Immunisation (CFI) in India during the last decade, surprisingly, Gujarat, an economically more developed state, had the second-lowest coverage of CFI (50%) in the country, lower than economically less developed states such as Bihar (62%). Further, the proportion of children with no immunisation in Gujarat has risen from 5% in 2005 to 9% in 2016. This paper investigated factors associated with the low level of CFI coverage in Gujarat. The study used two types of datasets: (1) the information on immunisation from 7730 children aged 12–23 months and their mothers from the fourth round of the Gujarat chapter of National Family Health Survey (NFHS 2015–16). (2) A macro (district) level data on both supply and demand-side factors of CFI are compiled from multiple sources. Bivariate and multivariate linear and logistic regression techniques were employed to identify the factors associated with CFI coverage. In Gujarat, during 2015–2016, 50% of children aged 12–23 months did not receive full immunisation. The odds of receiving CFI was higher among children whose mothers had a Maternal and Child Protection (MCP) card (OR: 1.97, 95% CI 1.48–2.60) and those who received "high" maternal health services utilisation (OR: 1.59, 95% CI 1.10–2.26) compared to their counterparts. The odds of receiving CFI was about three times higher among the richest households (OR: 6.50, 95% CI 3.75–11.55) compared to their counterparts in the poorer households. Macro-level analyses suggest that poverty, maternal health care, and higher-order births are defining factors of CFI coverage in Gujarat. In order of importance, focusing on poverty, economic inequalities, pregnancy registration, and maternal health care services utilisation are likely to improve receiving CFI uptake in Gujarat. The disadvantageous position of urban areas and non-scheduled tribes in CFI coverage needs further investigation. [ABSTRACT FROM AUTHOR]

• 42.4% preterms in Italy receive delayed hexavalent vaccine due to parents' concerns. • Parents of preterms vaccinated with Hexyon reported systemic adverse effects as rarer. • We aimed at filling hexavalents safety knowledge gaps in pediatric clinical practice. Recommendations in many countries state that preterm infants (PTIs) should receive the same routine immunization schedule and timing as for full-term births, according to their chronological age. Data regarding hexavalent vaccine safety in PTIs are still limited. We conducted a post-marketing surveillance study of the DTaP2-IPV-HB-Hib vaccine administered to PTIs in Apulia region, Italy. We identified PTIs by selecting the hospital discharge records of infants born between January and June 2017 using the DRG and ICD-9-CM codes for preterm birth, and we matched these data with records included in the regional immunization registry. We analyzed coverage and timeliness of vaccination. To investigate adverse events (AEs) after the first dose, we interviewed via phone the parents of PTIs vaccinated with at least one dose of the DTaP2-IPV-HB-Hib vaccine. At the time of our analysis (31.12.2017), 866/936 (92.5%) PTIs received the first dose of hexavalent vaccine and 539/936 (57.6%) were vaccinated by the third month of age, as recommended; 700/866 (80.8%) received the DTaP2-IPV-HB-Hib vaccine. The parents of 339 PTIs vaccinated with the DTaP2-IPV-HB-Hib vaccine reported local pain as the most common reaction (35.7% of the children). Erythema, swelling, induration and nodule were also reported in about 25% of the children. Systemic adverse events were generally rarer than local reactions. No serious AEs were reported. Our findings showed that more than 40% of PTIs received delayed hexavalent vaccination. This study showed a reassuring safety profile of the vaccine in the preterm population and may be considered as a pilot for further real-world studies. [ABSTRACT FROM AUTHOR]

We present the case of an 8-month-old boy with the repeated recurrence of vesicles from the time of birth and who subsequently manifested psychomotor developmental delay. We retrospectively diagnosed the patient with congenital herpes simplex virus (HSV) infection. Computed tomography showed multiple calcifications in the periventricular white matter and thalami. The bilateral deep white matter showed an abnormally high signal intensity on T2-weighted magnetic resonance imaging. The patient required consecutive, suppressive therapy with valacyclovir to prevent the repeated recurrence of vesicles. This case presented a milder phenotype of congenital HSV infection in comparison to previous reports, and highlights the importance of the careful examination for this disease when neonates present with skin lesions. [ABSTRACT FROM AUTHOR]

The article investigates two interconnected issues: the interaction organization in a family ritual and the modes of small children's participation in it. Focusing on the celebration of a first birthday in Poland, we explore how the different modes of a one-year-old child taking part in the multiparty interaction are collaboratively produced. We present two contrastive cases in terms of differences in space arrangements and children's body control, which are analyzed in relation to their own initiatives and responses. We suggest that the differentiations in their organization correspond to changing social meanings and effects of the whole ritual. • Small child participation in social ritual enhances its social competence. • Spatial arrangements, verbal/nonverbal vocal and body control affect participation. • Child's active participation is subject to the collective work of adult members. • Developmental and communicative competence have less impact on mode of participation. • Adult-child interactions contribute largely to developing child's social competence. [ABSTRACT FROM AUTHOR]

Background: Poor mental health status among both pregnant and postpartum women is commonly reported worldwide. The associations between mental health outcomes and giving birth to the second child since the implementation of China's universal two-child policy have not been identified.Methods: A large-scale based mental health survey was conducted between March 2017 and December 2018 in Suzhou, China. The survey evaluated the symptoms of anxiety, hypomania, depression and poor sleep quality among both pregnant and postpartum women.Results: A total of 3113 questionnaires were collected, the prevalence of anxiety, hypomanic and depressive symptoms and poor sleep quality in our sample were 3.2% (95%CI: 2.6%-3.9%), 51.7% (95%CI: 49.9%-53.4%), 12.4% (95%CI: 11.3%-13.6%) and 37.8% (95%CI: 36.0%-39.5%), respectively. Logistic regression showed that giving birth to the second child was positively associated with women's age, and was negatively correlated with higher educational level and living in rented housing. Women with the second pregnancy or child were positively associated with anxiety symptoms in the whole sample (OR = 1.75, 95%CI: 1.11-2.75) and among prenatal women (OR = 2.11, 95%CI: 1.16-3.83), while it was inversely correlated with depressive symptoms among postpartum women (OR = 0.63, 95%CI: 0.41-0.99).Conclusions: Women giving birth a second time were more prone to have anxiety symptoms among the prenatal women and the whole sample, and less likely to have depressive symptoms among the postpartum women. Efficacious measures and interventions are essential to improve maternal mental health. [ABSTRACT FROM AUTHOR]

• Diaphragm contraction in neonates evoked a sequence of three event-related potentials. • Hiccups can be encoded by the brain as early as ten weeks prior to average time of birth. • Hiccups – frequent in neonates – provide afferent input to the developing brain. Involuntary isolated body movements are prominent in pre-term and full-term infants. Proprioceptive and tactile afferent feedback following limb muscle contractions is associated with somatotopic EEG responses. Involuntary contractions of respiratory muscles, primarily the diaphragm – hiccups – are also frequent throughout the human perinatal period during active behavioural states. Here we tested whether diaphragm contraction provides afferent input to the developing brain, as following limb muscle contraction. In 13 infants on the neonatal ward (30–42 weeks corrected gestational age), we analysed EEG activity (18-electrode recordings in six subjects; 17-electrode recordings in five subjects; 16-electrode recordings in two subjects), time-locked to diaphragm contractions (n = 1316) recorded with a movement transducer affixed to the trunk. All bouts of hiccups occurred during wakefulness or active sleep. Each diaphragm contraction evoked two initial event-related potentials with negativity predominantly across the central region, and a third event-related potential with positivity maximal across the central region. Involuntary contraction of the diaphragm can be encoded by the brain from as early as ten weeks prior to the average time of birth. Hiccups – frequently observed in neonates – can provide afferent input to developing sensory cortices in pre-term and full-term infants. [ABSTRACT FROM AUTHOR]

The aim of this study is to investigate the methodological approach based on active participation of children at every stage of the planning process, from the analysis-synthesis study and design-planning-implementation process to use and monitoring/control stage within the scope of participatory planning approach. Within the scope of this study, Bolu Atatürk Park was used as the sample implementation area, and students from Bolu Mevlana elementary and secondary schools were the sample set. In this framework, an experience process where children are actively involved were followed with the guidance of facilitator and the support of technical staff. It is thought that the research gives children the opportunity to participate in the decisions made regarding their play spaces; in describing and evaluating their environments; in constructing, creating, transforming and reshaping their environment; in gaining a sense of ownership and partnership; in making choices; and in seeing the possibilities. • The design of playgrounds in accordance with child-friendly design principles • Planning and implementation process of playground areas in terms of participation of children • The children were allowed to experience natural children's space during the planning and implementation process. [ABSTRACT FROM AUTHOR]

• The overall concordance of CMV DNA detection in neonatal saliva and urine was 91%. • Compared to urine, positive predictive value of CMV PCR in neonatal saliva was low. • Viral load in saliva was significantly lower in false-positive than in true-positive samples. • For cCMV diagnosis after maternal primary infection urine is the preferred sample. Due to its ease of collection saliva was recently recommended as the preferred specimen, not only for screening, but also for diagnosis of congenital cytomegalovirus (CMV) infection. To compare the diagnostic performance of saliva PCR to urine PCR in infants born to mothers with primary CMV infection during pregnancy. We retrospectively analyzed available data of infants tested for CMV DNA in urine and saliva at birth. PCR was performed with RealStar® CMV-PCR Kit 1.0 (altona Diagnostics). Infectious virus was detected in urine by rapid culture. A total of 133 newborns were eligible for final analysis. Saliva swabs and urine were collected at birth with a time interval of 0–8 days (median 0; IQR 0–1). In 55% of newborns, cord blood was also tested. The overall concordance of saliva and urine PCR was 91% (27 positive, 94 negative). In 12 cases with discordant findings the discrepancy was due to false-negative (n = 2) or false-positive (n = 10) PCR results in saliva. Compared to urine, PCR in saliva showed a positive predictive value of 73%. Viral load in saliva was significantly lower (p < 0.0001; Mann-Whitney test) in the 10 false-positive cases than in the 27 cases with concordantly positive results. Positive CMV PCR results in saliva, especially low positive, have to be confirmed by urine testing. In our opinion detection of CMV by PCR in neonatal urine remains the gold standard for diagnosing congenital CMV infection in infants of mothers with primary infection in pregnancy. [ABSTRACT FROM AUTHOR]

Purpose: We examined the association between interpregnancy intervals (IPIs) and stillbirth (defined as fetal death ≥20 weeks), as both short and long IPIs have been associated with adverse perinatal outcomes. Prior pregnancy loss is also a known risk factor for stillbirth, and women who suffer a prior loss often have shorter IPIs. For these reasons, we also sought to quantify the proportion of the association between prior pregnancy loss and subsequent stillbirth risk that may be attributed to a short IPI.Methods: We used data from the Stillbirth Collaborative Research Network, a multisite case-control study conducted in 2006-2008, restricted to singleton pregnancies among multiparous or multigravid women (985 controls and 291 cases). We accounted for complex sample design and nonparticipation with weighted multivariable logistic regression.Results: In the adjusted models, IPIs <6 months, as compared with a reference of 18-23 months, were associated with increased odds of stillbirth (aOR 1.6, 95% CI: 0.8, 3.4). Long IPIs (60-100 months) were also associated with an increased odds of stillbirth (aOR 2.4, 95% CI: 1.2, 4.5). After control for covariates, about one-fifth (21.2%) of the association of prior pregnancy loss (stillbirth, ectopic pregnancy, molar pregnancy, or spontaneous abortion) and stillbirth may be attributable to a short IPI.Conclusions: Our results suggest that women who experience a prior pregnancy loss may benefit from additional counseling on adequate birth spacing to reduce subsequent stillbirth risk. [ABSTRACT FROM AUTHOR]

To ascertain whether adverse pregnancy outcomes at first pregnancy influence subsequent interpregnancy intervals (IPIs) and whether the size of this effect varies with IPI distribution We included 251,892 mothers who gave birth to their first two singletons in Western Australia, from 1980 to 2015. Using quantile regression, we investigated whether gestational diabetes, hypertension, or preeclampsia in the first pregnancy influenced IPI to subsequent pregnancy and whether effects were consistent across the IPI distribution. We considered intervals at the 25th centile of the distribution as 'short' and the 75th centile as 'long'. The average IPI was 26.6 mo. It was 0.56 mo (95% CI: 0.25–0.88 mo) and 1.12 mo (95% CI: 0.56 – 1.68 mo) longer after preeclampsia, and gestational hypertension respectively. There was insufficient evidence to suggest that the association between previous pregnancy complications and IPI differed by the extent of the interval. However, associations with marital status, race/ethnicity and stillbirth contributed to either shortening or prolonging IPIs differently across the distribution of IPI. Mothers with preeclampsia and gestational hypertension had slightly longer subsequent IPIs than mothers whose pregnancies were not complicated by these conditions. However, the extent of the delay was small (<2 mo). [ABSTRACT FROM AUTHOR]

• Second generation migrants with a high fertility have larger families. • Decisions about when to have a first child are not influenced by cultural norms. • Second generation migrants tend to abandon economically costly cultural norms. • Fertility norms operate partly through religion and selection of a non-native partner. I analyze the interplay between culture and economic incentives in decision-making. To this end, I study fertility timing decisions of second generation migrant women to France and the US. While I confirm that originating from a high fertility country correlates to having larger families, I also find that it does not predict earlier entry into motherhood. I propose a model that rationalizes these findings in which decisions are the result of a trade-off between an economic cost-benefit analysis and a cultural norm. The model predicts that decisions with a higher cost of deviation from the economic optimum should be less prone to cultural influence. This is consistent with substantial evidence showing that the timing of the first birth bears much larger costs for mothers in terms of labor market outcomes than that of subsequent births. [ABSTRACT FROM AUTHOR]

• Inadequate colostrum consumption increases preweaning mortality. • Piglets with standing time >5 min had lower colostrum consumption. • Sows with a low litter birth weight had low colostrum yield. • High mortality was found for piglets with colostrum consumption < 400 g. Inadequate colostrum consumption increases preweaning mortality and reduces body weight gain. The aim of the present study was to determine which factors influence piglet colostrum consumption and to study their relationship with the piglet survival and growth in tropical climates. At birth, 1018 piglets from 1 to 7 parity sows were monitored for heart rate, blood oxygen saturation, blood glucose concentration, birth order, birth interval, sex, standing time, integrity of the umbilical cord and rectal temperature 24 h after birth (RT24h). Piglets were weighed at birth and postnatal days 1 and 21. The mortality rate of piglets was determined on day 21 of lactation. On average, individual colostrum consumption was 426 g. Litters with less than 12 piglets born alive, a low birth weight (BWB), birth order greater than 9 or standing time greater than 5 min had significantly lower colostrum consumption (P < 0.001) compared to those with a greater number of piglets born alive, higher BWB and shorter standing time. Sows with a low litter birth weight had low colostrum yield (P < 0.001). High mortality at postnatal day 21 was found for piglets with colostrum consumption less than 400 g and RT24h less than 38.5 °C (P < 0.05). Moreover, piglets with colostrum consumption less than 400 g and low BWB had reduced average daily weight gain (P < 0.001). In conclusion, the number of piglets born alive, BWB, RT24h, birth order and standing time influenced piglet colostrum consumption, with litter birth weight representing the most influential factor for colostrum yield in a tropical climate. [ABSTRACT FROM AUTHOR]

Clinical prediction and especially prevention of abnormal birth timing, particularly pre-term, is poor. The cervix plays a key role in birth timing; it first serves as a rigid barrier to protect the developing fetus, then becomes the pathway to delivery of that fetus. Imaging biomarkers to define this remodeling process could provide insights to improve prediction of birth timing and elucidate novel targets for preventive therapies. Quantitative ultrasound (QUS) approaches that appear promising for this purpose include shear wave speed (SWS) estimation to quantify softness, as well as parameters based on backscattered power, such as the mean backscattered power difference (mBSPD) and specific attenuation coefficient (SAC), to quantify the organization of tissue microstructure. Invasive studies in rodents demonstrated that as pregnancy advances, cervical microstructure disorganizes as tissue softness and compliance increase. Our non-invasive studies in pregnant women and rhesus macaques suggested that QUS can detect these microstructural changes in vivo. Our previous study in the same cohort showed a progressive decline in SWS during pregnancy, consistent with increasing tissue softness, and we hypothesized that backscatter parameters would also decrease, consistent with increasing microstructural disorganization. In this study, we analyzed the mBSPD and SAC in the cervices of rhesus macaques (n = 18). We found that both mBSPD and SAC decreased throughout pregnancy (p < 0.001 for both parameters) and that the former appears to be a more reliable biomarker. In summary, biomarkers that can characterize tissue microstructural organization are promising for comprehensive characterization of cervical remodeling in pregnancy. [ABSTRACT FROM AUTHOR]

Abstract We investigated whether maternal dietary nitrate supplementation, leading to nitric oxide (NO) formation, would affect duration of farrowing, levels of asphyxiation, vitality of piglets at birth and/or loss of potential viable piglets in the form of stillbirth and pre-weaning mortality. Data were collected from 190 crossbred (Yorkshire x Dutch Landrace) sows, which were allocated, balanced for parity, to six dietary nitrate levels (0, 0.03, 0.06, 0.09, 0.12 or 0.15% of nitrate). Sow received the lactational diet containing nitrate from approximately 7 days before farrowing until 5 days after farrowing. Blood acid-base parameters (pH, p O 2 , p CO 2 , BE ecf , HCO 3 , sO 2 and lactate) and nitrate concentration were determined in umbilical cord blood. The farrowing process was video recorded and later analysed for total duration of farrowing, piglet birth interval, piglet vitality was scored and piglet latency to stand right after birth. Placentas were collected after expulsion during and after farrowing. Placenta length and width were measured and placental color scores were assessed based on redness of the placenta. The probability of a higher vitality score of piglets (being more vital) linearly increased with increasing levels of maternal dietary nitrate. This higher vitality score however, was not reflected by changes in the blood acid-base parameters in umbilical cord blood, except for a tendency for a higher p O 2 with increasing levels of nitrate, which could have been caused by a quicker onset of respiration or an increased blood flow to the piglets during birth. Placenta width increased with increasing levels of maternal dietary nitrate, but no effect on placenta length and redness was found. Neither duration of farrowing nor birth interval were affected by maternal dietary nitrate level. In conclusion, maternal nitrate supplementation may affect piglet vitality via vasodilatation (placental characteristics) rather than an increase in exercise efficiency (duration of farrowing). Highlights • Duration of farrowing was not affected by nitrate supplementation. • p O 2 in umbilical cord blood tended to increase with increasing dosage of nitrate. • Placenta width increased with increasing levels of sow nitrate supplementation. • Piglet vitality increased linearly with increasing levels of supplemented nitrate. [ABSTRACT FROM AUTHOR]

• Behavioral and life history strategies of Calanus spp. are evolved in a high-resolution model. • At low predation risk, the influences of food-availability and temperature dominated. • All model species evolved similar strategies to counter elevated predation risk. • Modest predation risk was countered by behavioral plasticity (diel vertical migration) • Evolution of (smaller) body sizes was predicted at higher predation risk levels. Strong seasonality of resources and predation risk act as bottom-up and top-down selection pressures in high-latitudes, under which numerous behavioral and life history strategies evolve. Although such seasonal strategies are well-documented among high-latitude marine zooplankton, it is difficult to separate the role of bottom-up and top-down selection pressures in the evolution of seasonal strategies. Here, we present a model that allows partitioning of bottom-up (i.e. food availability and temperature) and top-down (i.e. visual predation risk) selection pressures to study how behavioral and life history strategies of high-latitude copepods evolve. In the model, timing, amplitude and ontogenetic trajectories of diel and seasonal vertical migrations (DVM and SVM) were defined as behavioral strategies. Body size, generation time and birth time comprised the life history strategy. Numerous combinations of behavioral and life history strategies were hardwired to copepods representing three model species. In a given model environment, strategies were evaluated for growth, survival and reproductive performances using a fitness estimate, which was heuristically maximized using a Genetic Algorithm. Model simulations were performed in three seasonality regimes representing various levels of visual predation risk from low- to high-Arctic. At lower visual predation risk, species-specific behavioral and life history strategies were largely influenced by food availability and temperature. As visual predation risk increased, the influence of bottom-up selection pressures diminished, and irrespective of the modelled latitude, all model species employed largely similar strategies to counter the predation risk. Modest increase of visual predation risk stimulated the diel vertical migration behavior. Further increase of visual predation risk was associated with decrease of body size, which created a significant impact on the observed behavioral and life history strategies through allometric processes. Our findings suggest that top-down selection pressures play a significant role in the evolution of behavioral and life history strategies of high-latitude copepods. [ABSTRACT FROM AUTHOR]

Carbetocin is an oxytocin-like compound with long acting properties that has recently been introduced to both human and domestic animal obstetrics. The aims of the present study were to evaluate the effects of carbetocin administration after the first piglet was born on farrowing duration, birth interval, colostrum consumption and vitality index in newborn piglets. In total, 186 sows and their offspring (n = 2611 piglets) were distributed into three groups: 1) CONTROL: sows were allowed to farrow naturally (n = 66); 2) OXY: sows were administered oxytocin 20 IU intramuscularly after the first piglet was born (n = 62); and 3) CARBE: sows were administered carbetocin 0.6 μg/kg intramuscularly after the first piglet was born (n = 58). The reproductive data of sows including farrowing duration, total number of piglets born per litter (TB), number of piglets born alive per litter (BA), proportion of stillborn piglets per litter (SB) and proportion of mummified fetuses per litter (MF) were recorded. Piglet vitality index including skin colour, integrity of the umbilical cord, heart rate, blood oxygen saturation, screaming score, udder stimulation score, movement capacity and number of completed circles around enclosure were determined. Birth weights of the piglets were measured immediately at birth and again at 24 h thereafter to determine the individual colostrum intake of the piglets. On average, the farrowing duration, birth interval and BA were 188.0 ± 95.7 min, 12.5 ± 18.3 min, and 12.3 ± 2.9 piglets per litter, respectively. The farrowing duration of the sows was reduced in CARBE group (151.2 ± 11.9 min) compared to OXY (180.2 ± 11.5 min, P = 0.003) and CONTROL (227.7 ± 11.2 min, P < 0.001) groups. Birth interval of piglets in all categories of birth weight in the CARBE group was shorter than those in the CONTROL group (P < 0.05). However, the colostrum yield of sows in CARBE group (2398 ± 133 g) was lower than CONTROL and OXY groups (3371 ± 125 g and 3549 ± 128 g, respectively; P < 0.001). Similarly, colostrum intake of piglets in the CONTROL and OXY groups was higher than in the CARBE group (276.4 ± 11.0 g, 286.4 ± 13.6 g and 225.3 ± 14.0 g, respectively; P < 0.05). The percentage of stillborn piglets in CARBE was higher than OXY (8.7 ± 1.1% vs 5.3 ± 1.1%, P < 0.05) but did not differ significantly compared to CONTROL (7.5 ± 1.1%, P > 0.05). The piglet movement capacity in CONTROL was lower than CARBE group (1.36 vs 1.48, P < 0.05) but was not different compared to OXY group (1.40, P > 0.05). In conclusion, administration of carbetocin after the birth of the first piglet reduced the farrowing duration of sows, but increased the number of stillborn piglets and reduced the colostrum yield of sows. • Sows (n = 58) were administered carbetocin intramuscularly after the first piglet was born. • Farrowing duration was reduced in CARBE (151 min) compared to CONTROL (228 min) groups. • The colostrum yield of sows in CARBE was lower than CONTROL groups. • The piglet movement capacity in CONTROL was lower than CARBE groups. • The percentage of stillborn piglets in CARBE was higher than OXY groups. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the article was to examine the association between short interpregnancy intervals and adverse outcomes by maternal age among U.S. women.Methods: Using publicly available natality files for 2013-2016 singleton births, we compared the risks of preterm birth, gestational diabetes, gestational hypertension, and maternal morbidity (delivery-related complications) for less than 6-month, 6 to 11-month, and 12 to 17-month to 18- to 23-month interpregnancy intervals, overall and by maternal age. Models adjusted for maternal demographics, conditions, and behaviors.Results: Among 2,365,219 births, adjusted risk ratios (aRR) for preterm birth overall for intervals less than 6, 6-11, and 12-17 months were 1.62 (95% confidence interval: 1.60, 1.65), 1.16 (1.15, 1.18), and 1.03 (1.02, 1.05), respectively, compared with 18-23 months. Intervals less than 6, 6-11, and 12-17 months were significantly protective overall for gestational diabetes (aRR range: 0.89-0.98), gestational hypertension (aRR range: 0.93-0.95), and maternal morbidity (aRR range: 0.93-1.08). All aRRs attenuated or remained flat with increasing maternal age.Conclusion: Interpregnancy intervals less than 18 months showed different patterns of association for preterm birth compared with maternal outcomes, overall and across age. This suggests that increasing maternal age may have discordant effects on associations between short interpregnancy interval and adverse perinatal and maternal outcomes. [ABSTRACT FROM AUTHOR]

Abstract Introduction Factors that occur between consecutive pregnancies may influence repeated excessive gestational weight gain (GWG) and infants born large-for-gestational age (LGA). We examined interpregnancy interval, weight retention, and GWG in women's first pregnancy as predictors of excessive GWG and LGA in women's second pregnancy. Methods We used data from women's first two live births during the First Baby Study, a 3-year prospective observational cohort of first-time mothers (N = 549). GWG was calculated as weight at delivery minus prepregnancy weight for first and second pregnancies and categorized using the Institute of Medicine guidelines. Weight retention at 6 and 12 months and interpregnancy interval (time from first live birth to conception of second infant) were quantified. Infants were considered LGA if birthweight was in the 90th percentile or greater for gestational age. Results Many women (51.7%) exceeded GWG recommendations in both pregnancies. Women who exceeded guidelines in their first pregnancy had a 5.08 greater odds (p <.01) for exceeding guidelines in their second pregnancy, compared with women who did not exceed guidelines in their first pregnancy. Interpregnancy interval and weight retention had no association with exceeding guidelines in women's second pregnancy. Exceeding guidelines in women's first pregnancy resulted in a 4.48 greater odds (p <.01) of first-born infants being LGA, and exceeding guidelines in women's second pregnancy resulted in a 1.82 greater odds of second-born infants being large-for-gestational age (p =.02), compared with women who met guidelines in their first or second pregnancy, respectively. Conclusions Exceeding GWG guidelines in women's first pregnancy predicted exceeding guidelines in their second pregnancy, independent of interpregnancy interval and weight retention. [ABSTRACT FROM AUTHOR]

Objectives: To understand how having or being denied an abortion affects the likelihood of trying to become pregnant, overall pregnancy rates, and the rate and timing of an intended pregnancy in the future.Study Design: The Turnaway Study is a prospective cohort study of women who received or were denied a wanted abortion. Women were recruited from one of 30 US abortion facilities. We examined subsequent intended pregnancy among those who presented just under the facility's gestational limit and received an abortion (Near-Limit Abortion Group, n=413) and those who presented for abortion just beyond the facility's gestational limit, were denied an abortion and went on to parent the child (Parenting Turnaways, n=146). First, we modeled the probability of trying to become pregnant using multivariable mixed-effects logistic regression. We then used Cox proportional-hazards models to compare overall pregnancy rates and intended pregnancy rates over 5 years.Results: Parenting Turnaways had lower predicted probabilities of reporting trying to become pregnant in the first 1.5 years after birth/abortion than the Near-Limit Abortion Group. They also had lower pregnancy rates overall [40.4 per 100 woman-years vs. 53.5 per 100 woman-years, adjusted hazards ratio (aHR)=0.69, 95% confidence interval (CI): 0.54-0.89]. The 5-year intended pregnancy rate was low among both groups, but compared to the Near-Limit Abortion Group, Parenting Turnaways had a lower intended pregnancy rate (2.2 per 100 woman-years vs. 7.5 per 100 woman-years, aHR=0.29, 95% CI: 0.10-0.85).Conclusion: Being able to obtain a wanted abortion may enable women to have an intended pregnancy later.Implications: Ensuring that women can obtain an abortion for an unwanted pregnancy may enable them to have a subsequent pregnancy when they are ready to have a baby. [ABSTRACT FROM AUTHOR]

Objectives: To explore women's responses to PATH questions (Pregnancy Attitudes, Timing and How important is pregnancy prevention) about hypothetical pregnancies and associations with contraceptive method selection among individuals who present as new contraceptive clients and desire to prevent pregnancy for at least 1 year.Study Design: The HER Salt Lake Contraceptive Initiative provided no-cost contraception to new contraceptive clients for 1 year at family planning health centers in Salt Lake County. Those who wanted to avoid pregnancy for at least 1 year and completed the enrollment survey are included in the current study. We used Poisson regression to explore the association between survey-adapted PATH questions and contraceptive method selection.Results: Based on an analytic sample of 3121 individuals, we found pregnancy timing and happiness about hypothetical pregnancies to be associated with method selection. Clients who report plans to wait more than 5 years [prevalence rate (PR) 1.14; 95% confidence interval (CI) 1.05-1.24], those who never wanted to become pregnant (PR 1.16; 95% CI 1.07-1.26) or those who were uncertain (PR=1.19; 95% CI 1.09-1.30) were all more likely to select IUDs and implants than women who reported wanting to become pregnant within 5 years. Greater happiness was associated with lower chance of choosing an IUD or implant (PR 0.98; 95% CI 0.96-0.999). Expressed importance of pregnancy prevention was not significantly associated with any specific contraceptive choice.Conclusions: Pregnancy intentions and happiness about a hypothetical pregnancy were independently associated with selection of IUDs and implants.Implications: Pregnancy attitudes, plans and emotions inform clients' contraceptive needs and behaviors. Client-centered contraceptive care may benefit from a more nuanced PATH approach rather than relying on a single time-oriented question about pregnancy intention. [ABSTRACT FROM AUTHOR]

Highlights • Neuronal differentiation "timing" can have non-molecular effect on development of neuronal connections. • Three potential scenarios where neurogenetic "timing" influences axon guidance are discussed. • These mechanisms are rarely tested experimentally, but may serve to increase phenotypic diversity in neurons. Abstract Neurogenesis proceeds like a continuous wave, in which each type of neurons is produced over a few days to several days. During this protracted time window, early-born and late-born neurons are sequentially produced with a considerable time lag. Even if they are identical in their genetic and molecular specifications, they could develop different characteristics under the influences of the timing of their birth. In this review, we discuss the potential influences of "timing" as a generic parameter affecting neuronal differentiation, particularly on axon guidance and connections. These ideas have rarely been tested experimentally, but may provide a new strategy by which phenotypic diversity is increased in neurons. [ABSTRACT FROM AUTHOR]

Abstract Rationale Psychological stress-induced cortisol elevations appear to contribute to preterm birth. Yet, some studies suggest that the biological ramifications of racial discrimination-associated stress are unique and may involve development of decreased glucocorticoid sensitivity despite normalized cortisol levels. Objective In this study, we examined the effects of racial discrimination on maternal cortisol output, leukocyte glucocorticoid sensitivity, and the degree of correspondence between cortisol levels and birth timing in an African American cohort. Method A generally healthy prospective cohort was enrolled at 28–32 weeks gestation (n = 91). The Experiences of Discrimination scale was administered, whole blood collected, and plasma cortisol levels, cytokine levels, and leukocyte counts quantified for examination of patterns of endogenous feedback. Results Racial discrimination in the mid-tertile was associated with greater maternal cortisol levels than the bottom tertile among women reporting internalizing responses (b* = 0.68, p = 0.001). Decreased leukocyte glucocorticoid sensitivity was witnessed at greater frequencies of experiences of racial discrimination, as evidenced by decreased correspondence between maternal cortisol levels and plasma IL-8 levels, monocyte counts, and lymphocyte counts (p values ≤ 0.043). The association between maternal cortisol levels and birth timing differed by discrimination tertile (p values ≤ 0.005), with greater cortisol levels predictive of earlier birth among women without (b* = −0.59, p < 0.001) but not with racial discrimination (p s ≥ 0.497). Conclusion We provide novel evidence of decreased glucocorticoid sensitivity at increasing frequency of exposure to racial discrimination. Our findings suggest that the biology of preterm birth may depend upon racial discriminatory exposures, favoring pathways dependent upon glucocorticoid-induced increases in leukocyte tissue surveillance versus glucocorticoid resistance-associated inflammatory aberrations at increasing levels of exposure. Precision approaches to prenatal care are sorely needed to combat preterm birth, particularly among African American women, with efforts dependent upon further research examining the pathways contributing to the syndrome dependent upon the totality of an individual's exposures. Highlights • Racial discrimination predicts lower maternal leukocyte glucocorticoid sensitivity. • Elevated cortisol levels predict earlier birth in women without past discrimination. • Findings suggest biology of preterm birth may be unique based on prior exposures. [ABSTRACT FROM AUTHOR]

Objectives: Postpartum family planning (PPFP) is essential for maternal and newborn health but is often not systematically addressed before or after childbirth. This article describes the development and field-testing of a PPFP counseling tool to support providers and women.Methods: Participatory action research involving women, men, providers, policymakers, researchers, and contraceptive experts from Burkina Faso and the Democratic Republic of Congo.Results: The tool consists of an A4-size flipchart with illustrations on the client side and clinical information and counseling tips on the provider side, and can be used during visits of the antenatal-delivery-postnatal care continuum. Qualitative results suggest that the tool is easily understandable, user-friendly, relevant, and useful with regard to providing PPFP information to clients, and respectful of clients' rights and choices. It may have a positive influence on clients' attitudes towards PPFP and their decision to use contraception.Conclusions: The tool holds promise in guiding a systematic discussion on birth spacing options among providers and clients. Its impact on contraceptive uptake requires further research.Practice Implications: If proven effective, the tool could be disseminated to Ministries of Health and local, regional, and global partners to strengthen national family planning and maternal and child health strategies in low-resource countries. [ABSTRACT FROM AUTHOR]

Across human societies infants receive care from both their mothers and others. Reproductive cooperation raises two important questions: how does allocare benefit mothers and infants, and why do caretakers help mothers when they could spend their time in other, perhaps more valuable ways? We use behavioral and biological data from three small-scale societies to evaluate 1) how allocare affects a nursing mother's time, 2) whether a mother's birth interval length, surviving fertility and infant weight vary as a function of the childcare help that she receives, and 3) the opportunity cost for helpers to spend time caring for children. Across our hunter-gatherer and agricultural samples we find that on average mothers provide 57% of the direct care that an infant receives and allocaretakers 43% (±20%). Model results show that for every 10% increase in allocare the probability that a mother engages in direct care diminishes by 25%, a potential savings of an estimated 165 kcals per day. While allocare has a significant immediate impact on mother's time, no detectable effect on delayed fitness measures (birth interval and surviving fertility) or on infant weight status was evident. Cross culturally we find that other than mothers, siblings spend the most time caretaking infants, and they do so without compromising the time that they might otherwise spend in play, economic activities or education. The low opportunity cost for children to help offers an alternative explanation why juveniles are common caretakers in many societies, even in the absence of delayed indirect fitness benefits. While we expect specific patterns to vary cross culturally, these results point to the importance of infant allocare and its immediate time benefits for mothers to maintain flexibility in balancing the competing demands to support both older and younger children. [ABSTRACT FROM AUTHOR]

Background The relationship between unintended pregnancy and interpregnancy interval (IPI) across maternal age is not clear. Methods Using data from the National Survey of Family Growth, we estimated the percentages of pregnancies that were unintended among IPI groups (<6, 6–11, 12–17, 18–23, 24+ months) by maternal age at last live birth (15–19, 20–24, 25–29, 30–44 years). Results Approximately 40% of pregnancies were unintended and 36% followed an IPI<18 months. Within each maternal age group, the percentage of pregnancies that were unintended decreased as IPI increased. Conclusion Unintended pregnancies are associated with shorter IPI across the reproductive age spectrum. [ABSTRACT FROM AUTHOR]

Purpose: One-third of all pregnancies in the United States are conceived within 18 months of a prior live birth. Preventing unintended pregnancies may help to decrease the prevalence of pregnancies with these short interpregnancy intervals. However, data on factors associated with pregnancy intention among women who have had short birth intervals are sparse. Pregnancy Risk Assessment Monitoring System data were used to further evaluate these associations.Methods: Because only Mississippi and Tennessee Pregnancy Risk Assessment Monitoring System include a survey question about birth interval length, this analysis was limited to women from those states who recently had a short birth interval (n = 384). Pregnancy intention and demographic, lifestyle, and reproductive data were obtained from surveys and birth certificates. Logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs).Results: Nearly 76% of women with short birth intervals reported their pregnancy as unintended. Women who were non-Hispanic black or consumed alcohol during pregnancy had statistically significant increased odds of reporting the pregnancy with a short birth interval as being unintended (OR = 3.98; 95% CI: 1.73-9.16 and OR = 10.56; 95% CI: 1.80-61.83, respectively).Conclusions: Although all women should be counseled on postpartum contraceptive use, findings suggest that important subpopulations of women may benefit from more targeted counseling during prenatal care visits and the immediate postpartum hospital stay regarding the importance of using contraception to not only better space pregnancies but also prevent unintended pregnancies. [ABSTRACT FROM AUTHOR]