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Background: Traumatic injuries obtained by pregnant females in motor vehicle collisions present unique treatment challenges for trauma and orthopaedic surgeons. Understanding safety choices in this population can help physicians and public safety advocates in delivering effective and targeted safety messages., Methods: A publicly available, de-identified national data set that documents crash information (NASS-CDS) was examined to identify cohorts of pregnant and non-pregnant vehicle occupants and regression analysis employed to identify factors associated with belt non-use., Results: Pregnant women were found to have significantly lower rates of belt use compared to non-pregnant females (70.0% vs. 90.3%, Rao-Scott Sample Weighted Chi-Square p = 0.0265). Logistic regression identified younger age and sitting in the back seat as associated with lower rates of belt use., Conclusion: Pregnant women wear belts at significantly lower frequencies than non-pregnant women and youth and second row seating increase noncompliance rates. This work suggests the need for targeted intervention strategies to improve belt compliance., Competing Interests: Declaration of competing interest All authors report no conflicts of interest., (Copyright © 2020. Published by Elsevier Inc.)

Background: Parenting self-efficacy has been linked to positive parent and child outcomes however, little research exists on factors that influence parenting self-efficacy among pregnant women with substance use disorders., Objectives: This study explored substance use severity, social support, and family empowerment as predictors of parenting self-efficacy among pregnant women (N = 71) entering SUD treatment., Methods: The study used a quantitative cross-sectional design., Results: Statistically significant positive correlations emerged between social support and parenting self-efficacy as well as family empowerment and parenting self-efficacy. Family empowerment and social support were also correlated. A backward elimination regression analysis revealed family empowerment to be the strongest predictor of parenting self-efficacy. No relationships were found among substance use severity and the study variables., Conclusions: When promoting parenting self-efficacy, both social support and family empowerment are important domains to consider for treatment planning and resource development among pregnant women with substance use disorders.

Female urologists represent an ever-increasing percentage of the work force; more and more of our colleagues will be working through pregnancy. There is a lack of clear and concise advice for pregnant urologists about occupational risks during pregnancy. Urology exposes expectant mothers to potential risks from radiation, teratogenic and cytotoxic drugs, iodine hand scrub, infections, and long working hours. We aim to provide a review of the current evidence and guidance to aid expectant mothers in their decision making. Relevant research articles and up-to-date guidance were reviewed. The millisevert (the average accumulated background radiation dose to an individual for 1 year, exclusive of radon) was used as the main unit of radiation dose. There is no published evidence to date in pregnant clinicians that shows a received radiation dose of more than the recommended dose for a pregnant lady, and no data showing an increased risk of foetal abnormalities in clinicians who continue to screen during pregnancy; however, the data are from small studies. There is strong advice suggesting avoidance of contact with crushed or broken 5α-reductase inhibitor tablets (finasteride and dutasteride), mitomycin and other cytotoxic drugs during pregnancy. Pregnant surgeons should avoid frequent use of iodine hand wash. Good hygiene precautions will protect from many infections along with up-to-date immunisations and use of personal protective equipment for certain cases., (© 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.)

The primary aim of this cross-sectional survey was to assess the total fluid intake (TFI; sum of drinking water and all other fluids) and the intake of water and all other types of beverages in a sample of pregnant and breastfeeding women representative of Java-Island, Indonesia. Therefore, 299 pregnant and 296 breastfeeding women completed a 7-day fluid-specific record. A secondary aim was to estimate the total water intake (TWI; sum of water from fluids and food moisture), and one 24-h recall was performed to determine water intake from food moisture. The median TFI of pregnant and breastfeeding women were 2,250 (1,800-2,800) and 2,360 (1,954-2,968) mL/day, respectively. The largest contributor to TFI was water (72 and 77% for pregnant/breastfeeding women, respectively). Pregnant women to the extent of 42% and 54% of breastfeeding women did not reach the adequate intake (AI) of water from fluids. In pregnant and breastfeeding women, the median water intake from foods was 592 and 613 mL/day, representing 21 and 20% of TWI. Concluding that a high proportion of the pregnant and breastfeeding subjects did not reach the AI of water from fluid, it seems important to put in place actions such as providing education materials and ensuring access to safe water. Moreover, future surveys should dedicate attention to the assessment of fluid intake and hydration status among pregnant and breastfeeding women in other countries., (© 2017 The Author(s) Published by S. Karger AG, Basel.)

Introduction: Studies in different parts of the world indicate that there is high level use of self medication among pregnant women. But there are no scientific evidences on it and factors associated with it in Bahir Dar city administration. The aim of this study was therefore to assess level of self medication and identify factors associated with it among pregnant women attending ANC service at governmental health centers in Bahir Dar city administration., Methods: Institution based cross-sectional study was conducted from June 20-July 10, 2013. Data were collected using structured questionnaire and analyzed using SPSS version 16.0. Back ward logistic regression model was used to assess level of association with self medication practice., Results: A total of 510 pregnant women were included in the study. Of these, 25.1% reported self-medication during the current pregnancy. Self medication during pregnancy was significantly associated with gravida (AOR = 2.1, 95% CI: 1.3-3.4), maternal illness on the date of interview (AOR = 4.8, 95% CI: 2.9-8.0) and location of health facility (AOR = 4.6; 95% CI: 2.9-7.4)., Conclusion: A considerable proportion of pregnant women practiced self-medication during their pregnancy with modern medications or traditional herbs. Mothers who were multi gravida, who had maternal illness on the date of interview and who were attending antenatal care were more likely to practice self medication.

Background/objective: This research was undertaken to determine the oxidative stress and antioxidant status of pregnant northern Nigerian women., Methods: Prospective cohort study. The study was done at General Hospital, Dawakin Kudu LGA, Kano. Kano has a population of 9.2 million and predominantly Muslims. Two hundred consecutive women presenting for antenatal care and 100 apparently normal controls. Ethical approval was obtained. Socio-demographic and clinical information were obtained via interviewer-administered questionnaires from 200 consecutive pregnant women who presented for antenatal care. Serum levels of vitamins A, C, E and malondialdehyde were determined. Data was analyzed with SPSS version 16.0 statistical software. Descriptive statistics was used. Means were compared using analysis of variance (ANOVA). Associations between trimesters and oxidative stress/antioxidant status were tested using chi-square test and p < 0.05 was considered statistically significant., Result: The mean serum vitamin A, E and C levels were 13.39 ± 9.44 µg/dl, 0.35 ± 0.51 mg/dl and 5.99 ± 3.95 µ/dl respectively (below normal limits). The prevalence of vitamins A, C and E deficiency were 65.5%, 79.5% and 51% respectively. The mean serum levels of malondialdehyde was 4.04 ± 0.91 nmol/l (pregnant) and 1.84 ± 0.40 nmol/l (non-pregnant) (p = 0.001). There was strong negative correlation between serum levels of malondialdehyde and vitamins A, C and E., Conclusion: Vitamins A, C, E deficiency and oxidative stress is a problem among Northern Nigeria pregnant women, therefore the value of antioxidant vitamin supplementation should be explored.

Pregnant women and infants are at high risk for complications, hospitalization, and death due to influenza. It is well-established that influenza vaccination during pregnancy reduces rates and severity of illness in women overall. Maternal vaccination also confers antibody protection to infants via both transplacental transfer and breast milk. However, as in the general population, a relatively high proportion of pregnant women and their infants do not achieve protective antibody levels against influenza virus following maternal vaccination. Behavioral factors, particularly maternal weight and stress exposure, may affect initial maternal antibody responses, maintenance of antibody levels over time (i.e., across pregnancy), as well as the efficiency of transplacental antibody transfer to the fetus. Conversely, behavioral interventions including acute exercise and stress reduction can enhance immune protection following vaccination. Such behavioral interventions are particularly appealing in pregnancy because they are safe and non-invasive. The identification of individual risk factors for poor responses to vaccines and the application of appropriate interventions represent important steps towards personalized health care., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Background: Prenatal exposure to methylmercury is associated with adverse neurologic development in children. We examined total blood mercury concentrations and predictors of higher blood mercury concentrations in pregnant and nonpregnant women., Methods: We analyzed data from 1183 pregnant and 5587 nonpregnant women aged 16-49 years from the 1999-2006 National Health and Nutrition Examination Survey (NHANES). We estimated geometric mean blood mercury concentrations and characteristics associated with higher mercury concentrations (≥3.5 μg/L) in crude and adjusted linear and logistic regression models., Results: After adjusting for age and race/ethnicity, geometric mean blood mercury concentrations were clinically similar but significantly lower for pregnant (0.81 μg/L; 95% confidence interval [CI], 0.71-0.91) and nonpregnant women of childbearing age (0.93 μg/L; 95% CI, 0.87-0.99); 94% of pregnant and 89% of nonpregnant women had blood mercury concentrations below 3.5 μg/L. The most significant predictor of higher blood mercury concentrations for both pregnant and nonpregnant women was any seafood consumption vs no consumption in the last 30 days (odds ratio, 18.7; 95% CI, 4.9-71.1; odds ratio, 15.5; 95% CI, 7.5-32.1, respectively). Other characteristics associated with ≥3.5 μg/L blood mercury concentrations were older age (≥35 years), higher education (greater than high school), and higher family income to poverty ratio (3.501+) for both pregnant and nonpregnant women., Conclusion: Pregnancy status was not strongly associated with blood mercury concentrations in women of childbearing age and blood mercury concentrations above the 3.5 μg/L cut were uncommon., (Copyright © 2014 Mosby, Inc. All rights reserved.)

Maternal mortality rates within the United States have reached an all-time high.  Annually, nearly seven hundred women die from pregnancy-related complications, a number of which were highly preventable.  When taking a closer look at these statistics, these deaths disproportionately affect Native American and African American women, making them two to three times more likely to suffer from poorer pregnancy outcomes.  This paper examines the variety of factors that contribute to such a disproportionate maternal mortality rate, including geographic differences, racial and economic inequalities, and the accessibility of healthcare.  Despite attempts to fix these issues, systemic and intrinsic issues persist, and individuals continue to suffer.  This paper highlights the need to address maternal mortality disparities that affect marginalized groups, improved accessibility to healthcare for all, and overall policy reform in order to solve this issue indefinitely.

Aims: The aim of the study is to report the clinical and pharmacological observations from a pregnant patient treated with erlotinib in the second and third trimesters of pregnancy. Methods: Maternal and neonatal blood levels and safety of erlotinib and its metabolites were evaluated. Child development was monitored for 6 years. Results: A 31‐year‐old woman with stage IV lung adenocarcinoma with EGFR exon19 deletion began treatment with erlotinib 150 mg/day at 17 weeks of gestation. Although foetal growth retardation and oligohydramnios were observed at several times during the pregnancy, treatment was continued due to the severity of the maternal presentation, with ongoing foetal monitoring. The foetus seemed to tolerate and recover well without specific interventions. A healthy baby boy was delivered at 37 weeks gestation. The child grew and developed without any obvious issues. At last follow‐up, at age 6 years, he was attending school at a grade appropriate for his age without health or developmental problems. Blood levels of erlotinib were 397–856 ng/mL at 18–37 weeks of gestation and 1190 ng/mL at 8 weeks postpartum. The blood concentration ratios of OSI‐413‐to‐erlotinib ranged from 0.167 to 0.253 at 18–37 weeks of gestation, excluding 24 weeks, and 0.131 at 8 weeks postpartum. The maternal‐to‐foetal transfer rate of erlotinib, OSI‐420 and OSI‐413 were 24.5, 34.8 and 20.3%, respectively. Conclusion: Erlotinib use during the second and third trimester of pregnancy did not seem to cause any untoward effects on the developing foetus, or any long‐lasting effects that could be detected during 6 years of follow‐up of the child. [ABSTRACT FROM AUTHOR]

BACKGROUND: Stress and anxiety during pregnancy are extremely prevalent and are associated with numerous poor outcomes, among the most serious of which are increased rates of preterm birth and low birth weight infants. Research supports that while in-person mindfulness training is effective in reducing pregnancy stress and anxiety, there are barriers limiting accessibility. OBJECTIVE: The aim of this paper is to determine if mindfulness meditation training with the Headspace app is effective for stress and anxiety reduction during pregnancy. METHODS: A longitudinal, single-arm trial was implemented with 20 pregnant women who were instructed to practice meditation via the Headspace app twice per day during the month-long trial. Validated scales were used to measure participants levels of stress and anxiety pre- and postintervention. Physiological measures reflective of stress (heart rate variability and sleep) were collected via the Oura Ring. RESULTS: Statistically significant reductions were found in self-reported levels of stress (P=.005), anxiety (P=.01), and pregnancy anxiety (P

A healthy and balanced diet is a critical requirement for pregnant women as it directly influences both the mother’s and infant’s health. Poor maternal nutrition can lead to pregnancy-related complications with undesirable effects on the fetus. This requirement is equally important for pregnant women with celiac disease (CD) who are already on a gluten-free diet (GFD). Although the GFD is the sole treatment option for CD, it still presents some challenges and confusion for celiac women who wish to conceive. Poorly managed CD has been linked to miscarriages, preterm labor, low birth weight, and stillbirths. Current CD guidelines primarily focus on screening, diagnosis, treatment, and management but lack an evidence-based approach to determine appropriate energy requirements, recommended weight gain during pregnancy, target macronutrient distribution from the diet, the recommended intake of vitamins and minerals from diet and/or supplementation, timing for starting supplementation, and advised portions of gluten-free foods during pregnancy. We recommend and call for the development of such guidelines and/or authoritative papers in the future.

Background: Generalized anxiety disorder (GAD)–characterised by excessive and uncontrollable worry–is the most frequently diagnosed anxiety disorder during pregnancy and the postpartum period. Identification of GAD often relies on assessment of its cardinal feature, pathological worry. The Penn State Worry Questionnaire (PSWQ) is the most robust measure of pathological worry to date but has not been extensively evaluated for use during pregnancy and the postpartum period. This study evaluated the internal consistency, construct validity, and diagnostic accuracy of the PSWQ in a sample of pregnant and postpartum women with and without a principal GAD diagnosis. Methods: One hundred forty-two pregnant and 209 postpartum women participated in this study. Sixty-nine pregnant and 129 postpartum participants met criteria for a principal diagnosis of GAD. Results: The PSWQ demonstrated good internal consistency and converged with measures assessing similar constructs. Pregnant participants with principal GAD scored significantly higher on the PSWQ than those with no psychopathology and postpartum participants with principal GAD scored significantly higher than those with principal mood disorders, other anxiety and related disorders, and no psychopathology. A cut-off score of 55 and 61 or greater was determined for detecting probable GAD during pregnancy and the postpartum period, respectively. Screening accuracy of the PSWQ was also demonstrated. Conclusions: This study underscores the robustness of the PSWQ as a measure of pathological worry and probable GAD and supports its use in the detection and monitoring of clinically significant worry symptoms during pregnancy and postpartum period. [ABSTRACT FROM AUTHOR]

A healthy and balanced diet is a critical requirement for pregnant women as it directly influences both the mother's and infant's health. Poor maternal nutrition can lead to pregnancy-related complications with undesirable effects on the fetus. This requirement is equally important for pregnant women with celiac disease (CD) who are already on a gluten-free diet (GFD). Although the GFD is the sole treatment option for CD, it still presents some challenges and confusion for celiac women who wish to conceive. Poorly managed CD has been linked to miscarriages, preterm labor, low birth weight, and stillbirths. Current CD guidelines primarily focus on screening, diagnosis, treatment, and management but lack an evidence-based approach to determine appropriate energy requirements, recommended weight gain during pregnancy, target macronutrient distribution from the diet, the recommended intake of vitamins and minerals from diet and/or supplementation, timing for starting supplementation, and advised portions of gluten-free foods during pregnancy. We recommend and call for the development of such guidelines and/or authoritative papers in the future. [ABSTRACT FROM AUTHOR]

INTRODUCTION: socio-economic status (SES), especially for women, influence access to care. This study aimed to determine the relationship between SES and uptake of malaria intervention by pregnant women and non-pregnant mothers of children under 5 years old in Ibadan, Oyo state, Nigeria. METHODS: this cross-sectional study was conducted at Adeoyo teaching hospital located in Ibadan, Nigeria. The hospital-based study population included consenting mothers. Data were collected using an interviewer-administered modified validated demographic health survey questionnaire. The statistical analysis involved both descriptive (mean, count, frequency) and inferential statistics (Chi-square, logistic regression). Level of statistical significance was set at 0.05. RESULTS: mean age of the study´s total of 1373 respondents was 29 years (SD: 5.2). Of these, 60% (818) were pregnant. The non-pregnant mothers of children under five years old showed a significantly increased odds (OR: 7.55, 95% CI: 3.81, 14.93) for the uptake of malaria intervention. Within the low SES category, women aged 35 years and above were significantly less likely to utilize malaria intervention (OR=0.08; 95% CI: 0.01-0.46; p=0.005) compared to those younger. In the middle SES, women who have one or two children were 3.51 times more likely than women with three or more children to utilize malaria intervention (OR=3.51; 95% CI: 1.67-7.37; p=0.001). CONCLUSION: the findings provide evidence that age, maternal grouping, and parity within the SES category can significantly impact on uptake of malaria interventions. There is a need for strategies to boost the SES of women because they play significant roles in the wellbeing of members of the home.

PURPOSE: This study (1) assessed the psychometric properties of a pregnancy-related COVID worry scale, (2) explored variations in pregnancy-related COVID worry over the course of the pandemic, and (3) examined associations between pregnancy-related COVID worry and depressive symptom severity, and evaluated sleep disturbance as a mediator. METHODS: Data were drawn from an ongoing randomized trial comparing the effectiveness of two enhanced forms of prenatal care. The current analysis includes baseline pre-randomization data collected from participants who enrolled November 2020-November 2021 (n = 201). Participants were pregnant individuals with low income and primarily Latinx. RESULTS: Our 7-item scale was valid and reliable for assessing pregnancy-related COVID worry. Pregnancy-related COVID worry did not vary significantly by any participant characteristic or pandemic stage. Pregnancy-related COVID worry was significantly associated with depressive symptom severity in multivariate analysis (p = .002). For each unit increase on the 10-point pregnancy-related COVID worry scale, the odds of mild-to-severe depression increased by 16% (odds ratio = 1.16, 95% confidence interval 1.02-1.32, p = .02), holding all other variables constant. Sleep disturbance mediated the pregnancy-related COVID worry-depressive symptom relationship (48% of the total effect mediated). CONCLUSIONS: Worry about how COVID may impact their baby, birth, and postpartum experiences was associated with higher depressive symptom severity, partly through its effect on sleep. These findings suggest that interventions related to improving sleep quality among perinatal populations may reduce depressive symptoms. TRIAL REGISTRATION: ClinicalTrials.gov NCT04154423, Engaging Mothers & Babies; Reimagining Antenatal Care for Everyone (EMBRACE) Study.

BackgroundThe development and quality assurance of perinatal eHealth self-monitoring systems is an upcoming area of inquiry in health science. Building patient engagement into eHealth development as a core component has potential to guide process evaluation. Access, 1 attribute of patient engagement, is the focus of study here. Access to eHealth self-monitoring programs has the potential to influence pregnancy health and wellness outcomes. Little is known about how pregnant users' ability to obtain resources is influenced by their own adaptive activities and the mediating activities of eHealth systems during the process of real-world testing of these systems.ObjectiveHere, we examine the patient engagement process of access occurring during the adaptation of eHealth self-monitoring use from a sociomaterial perspective.MethodsIn this mixed methods convergent evaluation design, we interviewed women about perceptions of the adaptation process of using an eHealth self-monitoring system. Deductive analysis was conducted guided by the definition of access as an attribute of patient engagement. After initial qualitative and quantitative data collection and analysis, participants were spilt based on their level of use of the eHealth system (physical wear time of self-monitoring device). Content analysis was then conducted according to user group, using a conceptual matrix developed from ontological perspectives of sociomateriality.ResultsPregnant users' adaptive activities and the mediation activities of the eHealth system represent a cocreation process that resulted in user group-specific characteristics of accessing and using the system. The high- and low-use groups experienced different personal adaptation and eHealth mediation during this process of cocreation. Differences were noted between high- and low-use groups, with the high-use group giving attention to developing skills in recording and interpreting data and the low-use group discussing the manual adding of activities to the system and how the system worked best for them when they used it in their mother tongue.ConclusionsA cocreation process between pregnant users and the eHealth system was identified, illustrating access as a useful core component of perinatal eHealth self-monitoring systems. Researchers and clinicians can observe reasons for why pregnant users access eHealth systems in unique ways based on their personal preferences, habits, and values. Mediation activities of the eHealth system and the different user adaptive activities represent a cocreation process between the users and the eHealth system that is necessary for the personalization of perinatal eHealth systems.

The brain regulates multiple metabolic processes, such as food intake, energy expenditure, insulin secretion, hepatic glucose production, and glucose and fatty acid metabolism in adipose tissue, which are fundamental for the maintenance of energy and glucose homeostasis during lactation and pregnancy. In addition, brain expression has a fundamental impact on the development of maternal behavior. Although brain functions are partly regulated by long noncoding RNAs (lncRNAs), their expression profiles have not been characterized in depth in any ruminant species. We have sequenced the transcriptome of 12 brain tissues from 3 goats that were 1 mo pregnant and 4 nonpregnant goats to investigate their lncRNA expression patterns. Between 4,363 (adenohypophysis) and 4,604 (olfactory bulb) lncRNAs were expressed in brain tissues, leading us to establish a set of 794 already annotated lncRNAs and 5,098 novel lncRNA candidates. The detected lncRNAs shared features with those of other mammals, and tissue-specific lncRNAs were enriched in brain development-related terms. Differential expression analyses between goats that were 1 mo pregnant and nonpregnant goats showed that the lncRNA expression profiles of certain brain regions experience substantial changes associated with early pregnancy (238 lncRNAs are differentially expressed in the olfactory bulb), but others do not. Enrichment analysis showed that differentially expressed lncRNAs from the olfactory bulb are co-expressed with genes previously linked to behavioral changes related to pregnancy. These findings provide a first characterization of the landscape of lncRNA expression in the goat brain and provides valuable clues to understand the molecular events triggered by early pregnancy in the central nervous system. [ABSTRACT FROM AUTHOR]

There is increasing evidence that prenatal stress elevates the risk of children's social–emotional development, but the mechanisms underlying this association are unclear. Home environment provides learning opportunities and stimulation required for children's early development and can be influenced by prenatal maternal stress. This study aimed to examine whether home environment can mediate the association between prenatal stress during the pandemic of coronavirus disease 2019 (COVID-19) and their offspring's social–emotional problems thereafter. A pilot sample was derived from 2020 to 2021 Maternal and Child Health Cohort study (N = 82) with the pregnant women recruited during the COVID-19 lockdown period in 2020. Prenatal stress was assessed using the Perceived Stress Scale. Home environment was measured using the Child Home Nurture Environment Scales. Mother-reported toddler social–emotional problems were assessed at 12 months of age. The mediation model was used for data analysis. The mean scores of social–emotional problems, which include externalizing, internalizing, dysregulation, and competence, were 10.98 (5.08), 14.72 (6.49), 15.15 (6.31), and 36.73 (10.26), respectively. Prenatal stress, home environment, and social–emotional problems were significantly related (P < 0.05). Home environment significantly mediated the association between prenatal stress and social–emotional problems with the indirect effect [95% CI] of 0.06 [0.01, 0.14] for externalizing behaviors, 0.10 [0.00, 0.24] for internalizing behaviors, − 0.15 [− 0.31, − 0.01] for competence, 0.08 [0.01, 0.17] and 0.08 [0.01, 0.21] for dysregulation. These findings suggest that prenatal stress may affect offspring's social–emotional problems through the home environment. Screening for prenatal stress and promoting supportive home environment may be potential strategies for social–emotional problems interventions in children. [ABSTRACT FROM AUTHOR]

Background: Unlike tachyarrhythmias, which are common in pregnancy, there is a paucity of data regarding maternal bradycardias. Our objective was to describe the characteristics, associated conditions, and prognosis of women who develop bradycardia post-partum. Method: We conducted a retrospective chart review of patients referred to the Obstetrical Medicine service at British Columbia Women's Hospital from January 2012 to May 2020 for post-partum maternal bradycardia. Results: Twenty-four patients with post-partum bradycardia were included (age 34.2 ± 4.8 years; heart rate 40.4 ± 8.1 beats per minute; blood pressure 131/72 mm Hg). Sinus bradycardia (79.2%) was the most common rhythm. Dyspnea (29.4%) and chest pain (23.5%) were common symptoms. Mean time to resolution of bradycardia was 3.6 ± 3.8 days. Associated conditions potentially explaining the bradycardia were preeclampsia (54.1%), underlying (16.7%), medications (8.3%), and neuraxial anesthesia (8.3%). Conclusions: Maternal bradycardia is an uncommon condition complicating the post-partum period, that is generally self-limiting, with the majority only require clinical observation. [ABSTRACT FROM AUTHOR]

Marijuana is the most commonly used federally illicit substance among reproductive-age women in the United States. Updated information on marijuana use in this population can inform clinical and public health interventions. Data from the 2013–2019 National Survey on Drug Use and Health was used to report weighted prevalence estimates of marijuana use in the past month, past 2–12 months, and past year among women aged 18–44 years with self-reported pregnancy status. Bivariate analyses and general linear regression models with Poisson distribution using appropriate survey procedures identified factors associated with past-year marijuana use by pregnancy status. Among pregnant women, 4.9% (95% confidence interval [CI]: 4.1–5.6) reported marijuana use in the past month, 10.4% (95% CI: 9.3–11.5) in the past 2–12 months, and 15.2% (95% CI: 13.9–16.6) in the past year. Among nonpregnant women, 11.8% (95% CI: 11.5–12.0) reported marijuana use in the past month, 7.8% (95% CI: 7.6–8.0) in the past 2–12 months, and 19.5% (95% CI: 19.2–19.9) in the past year. After adjusting for sociodemographic characteristics, past-year marijuana use was 2.3–5.1 times more likely among pregnant, and 2.1 to 4.6 times more likely among nonpregnant women who reported past-year tobacco smoking, alcohol use, or other illicit drug use compared to those reporting no substance use. Pregnant and nonpregnant women reporting marijuana use, alone or with other substances, can benefit from substance use screening and treatment facilitation. [ABSTRACT FROM AUTHOR]

Purpose: Pregnant women are vulnerable to Coronavirus Disease 2019 (COVID-19) complications, yet may hesitate to get vaccinated. It is important to identify racial/ethnic and other individual characteristics associated with COVID-19 vaccine acceptance in the United States during pregnancy. Methods: We searched PubMed, Embase, and Web of Science for articles published through January 2023 for keywords/terms related to immunization, COVID-19, and pregnancy, and performed a systematic review and meta-analysis to examine characteristics associated with vaccine acceptance. Results: Of 1,592 articles, 23 met inclusion criteria (focused on pregnant women in the United States, and their willingness or hesitation to vaccinate). Twenty-two of the studies examined receipt of ≥1 COVID-19 vaccine dose and/or intention to vaccinate, while one examined vaccine hesitancy. Vaccine acceptance rates ranged from 7% to 78.3%. Meta-analyses demonstrated that compared with Whites, Hispanics (odds ratios [OR] 0.72; 95% confidence interval [CI] 0.58–0.91) and Blacks (OR 0.44; 95% CI 0.30–0.63) had less COVID-19 vaccine acceptance, while Asians (OR 1.78; 95% CI 1.10–2.88) had greater vaccine acceptance. College graduation or more (OR 3.25; 95% CI 2.53–4.17), receipt or intention to receive the influenza vaccine (OR 3.46; 95% CI 2.22–5.41), and at least part-time employment (OR 2.12; 95% CI 1.66–2.72) were significantly associated with vaccine acceptance. Conclusions: COVID-19 vaccine nonacceptance in pregnant women is associated with Hispanic ethnicity and Black race, while acceptance is associated with Asian race, college education or more, at least part-time employment, and acceptance of the influenza vaccine. Future COVID-19 vaccination campaigns can target identified subgroups of pregnant women who are less likely to accept vaccination. [ABSTRACT FROM AUTHOR]

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IntroductionDaily oral pre-exposure prophylaxis (PrEP) can reduce HIV acquisition. However, prevention effectiveness requires daily adherence prior to and during periods of sexual activity. Little is known about pharmacologic measures of PrEP adherence during pregnancy and postpartum and the factors related to optimal adherence during periods of sexual activity in this population.MethodsBetween August 2019 and October 2021, we enrolled pregnant women without HIV at their first antenatal care visit followed-up through 12 months postpartum. Eligible women ≥16 years old received HIV prevention counselling and were offered oral PrEP (TDF-FTC). We quantified tenofovir-diphosphate (TFV-DP) in dried blood spots in women who reported taking PrEP in the past 30 days (at quarterly follow-up visits). We used regression models with generalized estimating equations to evaluate correlates of TFV-DP (any vs. none, and ≥2 vs. 5/month vs. no sex or

HIV incidence among pregnant and postpartum women remains high in South Africa. Pre-exposure prophylaxis (PrEP) use remains suboptimal in this population, particularly during the postpartum period when women's engagement with routine clinic visits outside PrEP decreases. Key barriers to sustained PrEP use include the need for ongoing contact with the health facility and suboptimal counseling around effective PrEP use. Stepped Care to Optimize PrEP Effectiveness in Pregnant and Postpartum women (SCOPE-PP), is a two-stepped unblinded, individually randomized controlled trial (RCT) that aims to optimize peripartum and postpartum PrEP use by providing a stepped package of evidence-based interventions. We will enroll 650 pregnant women (> 25 weeks pregnant) who access PrEP at a busy antenatal clinic in Cape Town at the time of recruitment and follow them for 15 months. We will enroll and individually randomize pregnant women > 16 years who are not living with HIV who are either on PrEP or interested in starting PrEP during pregnancy. In step 1, we will evaluate the impact of enhanced adherence counselling and biofeedback (using urine tenofovir tests for biofeedback) and rapid PrEP collection (to reduce time required) on PrEP use in early peripartum compared to standard of care (SOC) (n = 325 per arm). The primary outcome is PrEP persistence per urine tenofovir levels and dried blood spots of tenofovir diphosphate (TFV-DP) after 6-months. The second step will enroll and individually randomize participants from Step 1 who discontinue taking PrEP or have poor persistence in Step 1 but want to continue PrEP. Step 2 will test the impact of enhanced counseling and biofeedback plus rapid PrEP collection compared to community PrEP delivery with HIV self-testing on PrEP use (n = up to 325 postpartum women). The primary outcome is PrEP continuation and persistence 6-months following second randomization (~ 9-months postpartum). Finally, we will estimate the cost effectiveness of SCOPE-PP vs. SOC per primary outcomes and disability-adjusted life-years (DALYs) averted in both Step 1 and 2 using micro-costing with trial- and model-based economic evaluation. This study will provide novel insights into optimal strategies for delivering PrEP to peripartum and postpartum women in this high-incidence setting. NCT05322629 : Date of registration: April 12, 2022.

BackgroundOral daily preexposure prophylaxis (PrEP) using emtricitabine (FTC)/tenofovir disoproxil fumarate (TDF) is recommended as standard of care for prevention in individuals at high risk for HIV infection, including pregnant and postpartum cisgender women. FTC/TDF is also active against hepatitis B virus (HBV); however, concern has been raised that providing PrEP to individuals infected with HBV could lead to hepatitis flares and liver injury, especially in the setting of suboptimal PrEP use.MethodsWe conducted a cross-sectional analysis of baseline data from the PrEP in pregnant and postpartum women (PrEP-PP) cohort study from February 2020-March 2022 in one antenatal care clinic in Cape Town, South Africa (SA) to evaluate: (1) the field performance of a point of care test (POCT) (Determine II, Abbott Inc., Japan) for diagnosis of hepatitis B surface antigen (HBsAg) in a maternity setting, (2) the prevalence of HBV in a cohort of pregnant women not living with HIV.ResultsWe enrolled 1194 HIV sero-negative pregnant women at their first antenatal visit. Median age was 26 years (IQR = 22-31 years); 52% were born before 1995 (before universal HBV vaccination had started in South Africa). Median gestational age was 22 weeks (IQR = 16-30 weeks). There were 8 POCT and laboratory confirmed HBV cases among 1194 women. The overall prevalence of 0.67% (95% CI = 0.34-1.32%). In women born before 1995, 8 of 622 women were diagnosed with HBsAg; the prevalence was 1.29% (95% CI = 0.65-2.52%), and in women born in 1995 or after (n = 572); the prevalence was 0% (95% CI = 0.0-0.67%). We confirmed the test results in 99.8% of the rapid HBsAg (Determine II). Sensitivity was 100% (95% CI = 68-100%). Specificity was 100% (95% CI = 99.67-100%).ConclusionThe prevalence of HBV was very low in pregnant women not living with HIV and was only in women born before the HBV vaccine was included in the Expanded Program of Immunization. The Determine II POCT HBsAg showed excellent performance against the laboratory assay. HBV screening should not be a barrier to starting PrEP in the context of high HIV risk communities.

Cisgender women, particularly pregnant and postpartum women in Eastern and Southern Africa, face an unacceptably high risk of HIV acquisition. Oral pre-exposure prophylaxis (PrEP) is an effective HIV prevention intervention that can reduce HIV acquisition and vertical transmission. In this qualitative study, we interviewed 21 postpartum women from Cape Town, South Africa who initiated PrEP during pregnancy and who self-reported low PrEP adherence or missed > 1 PrEP follow-up collection. We identified multiple overlapping barriers to PrEP continuation and/or adherence. Individual factors included forgetting to take PrEP daily, being away from home when PrEP should be taken, anticipated stigma and limited disclosure of PrEP use. Women also reported pill-related factors such as side effects and having to take PrEP in addition to other tablets during pregnancy and the postpartum period. Facility-related barriers included logistics around PrEP collection especially when not in antenatal care, as well as transport and financial barriers.

Background: The goal was to investigate the change of systemic immune inflammation index (SII) in high-risk pregnant women diagnosed with intrahepatic cholestasis of pregnancy (ICP). Methods: Between May 2018 and April 2020, we retrospectively enrolled 218 pregnant women who were followed in our hospital from the first trimester to delivery. We looked at the sociodemographics, laboratory data, SII values, Apgar ratings, and newborn birth weights of pregnant women with ICP. We also compared SII values in the first (SII 1), second (SII 2), and third trimesters (SII 3) between ICP and the control group. Results: In the ICP group, the neutrophil level increased in the second trimester and decreased in the third trimester. The SII 2 was significantly higher in the severe ICP group, and when the SII values of the subgroups were examined, the SII 2 was significantly higher in the severe ICP group. The SII 2 showed a significant cutoff value for ICP with 92% sensitivity and 96% specificity. Again, a positive but weak correlation was found between SII 2 and SII 3 and FBA. When the neonatal outcomes were evaluated between the groups, gestational age at birth, birth weight and Apgar scores at 1 and 5 minutes were significantly lower in the ICP group. Conclusions: The relationship between SII and ICP was investigated for the first time in the literature and a significant cutoff value was found with the SII of the 2nd day. This showed that inflammation occupies an important place in the pathophysiology of cholestasis. [ABSTRACT FROM AUTHOR]

The vaginal microbiota plays a key role in animals' health. Understanding its diversity and composition and associated changes occurring through the reproductive cycle represents valuable knowledge to disclose the mechanisms leading to dysbiosis and eventually to infection. Even if the human vaginal microbiota has been thoroughly studied, scarce research has been conducted on the vaginal microbiota of livestock. In this study, 16S rRNA gene-based sequencing was performed on vaginal samples of ten nulliparous ewes at three different sampling points: before the estrus synchronization protocol (T0), at the time of estrus before mating (Testrus), and the day of the pregnancy diagnosis (Tpreg). Preputial samples from the three males collected pre and post-mating were also analyzed. Firmicutes, Proteobacteria, Bacteroidetes, and Actinobacteria were the most abundant phyla in vaginal samples. The most abundant genera were Porphyromonas, Anaerococcus, and Peptinophilius. Vaginal microbiota biodiversity decreased during pregnancy. Tenericutes (Ureaplasma spp.) increased significantly at Tpreg in both pregnant and nonpregnant ewes. Differences were observed between pregnant and non-pregnant ewes at Tpreg where pregnant ewes had a significantly higher abundance of Actinobacillus spp. and Ureaplasma spp. Ewes that were diagnosed with pregnancy at Tpreg showed a decreased abundance of gram-negative bacteria such as Bacteroidales, Campylobacterales, and Enterobacteriales. In addition, a significant decrease in the relative abundances of genera within Firmicutes, such as Alloicoccus (Lactobacillales), Atopostipes (Lactobacillales), and an uncultured bacteria W5053 from Family XI (Firmicutes, Clostridiales) was observed in non-pregnant ewes at Tpreg. The four most abundant phyla in the rams' prepuce were the same as in the ewes' vagina. The most abundant genus was Corynebacterium. No major differences were observed in the ram's preputial microbiota between pre and post-mating samples. Nevertheless, the differences in the taxonomic composition of ewes' vaginal microbiota between Testrus and Tpreg could be explained by the exposure to the preputial microbiota. This study offers new insights into the effects of several key steps of the ewe's reproductive cycle such as estrus-synchronization protocol, mating, and pregnancy on ovine vaginal microbiota. The knowledge of the microbiota dynamics during the reproductive cycle can help improve the reproductive outcomes of dams by identifying biomarkers and putative probiotics. [ABSTRACT FROM AUTHOR]

Background: Low socio‐economic status is associated with poor birth outcomes, however, few studies on this topic have been conducted in South Africa. We determined associations between socio‐demographic variables of pregnant women and birth outcome in their offspring. Methods: This study was nested in a prospective cohort study conducted at an antenatal clinic at a regional hospital in Bloemfontein, South Africa. Questionnaires on socio‐demographic information were completed on 682 pregnant women in a structured interview. Post‐delivery, 331 participants provided the Road to Health Booklets for 347 infants, in which birth data were recorded. Associations between socio‐demographic variables and birth outcome (defined as premature delivery or low length‐for‐age or low weight‐for‐length at birth) were investigated. Logistic regression with backward selection (p < 0.05) was used to select independent factors that were significantly associated with birth outcome. Variables with a p‐value of <0.15 on bivariate analysis were considered for inclusion in the model. Results: Poor birth outcome was observed in 36.3% (116/320) of women. The odds of experiencing poor birth outcome were lower for women who owned a stove versus those who did not (OR 0.11, 95% CI: 0.02–0.67), and higher for women with grade 8–10 (OR 5.84, 95% CI: 1.90–17.91) or grade 10–12 (OR 4.33, 95% CI: 1.50–12.49) as their highest level of education versus tertiary education. The odds of experiencing poor birth outcomes were also higher for those employed part‐time (OR 2.55, 95% CI: 1.10–5.93) versus full‐time and/or self‐employed. Conclusion: Our findings confirm that the presence of basic amenities such as a stove, better education and employment improve the chances of better birth outcomes. Early screening of pregnant women for the identification of socio‐demographic risk factors that may impact on birth outcome is recommended. [ABSTRACT FROM AUTHOR]

Background: The development of connective tissue in the fetus during the ruminant gestation period increases the need for vitamin C, which is then further increased by the course of pregnancy and lactation. As pregnancy and lactation develop, free radicals and MDA produced as a result of oxidative stress interact with functional groups in the cell, resulting in cell damage. The oxidant/antioxidant balance at this time can be calculated using the total antioxidant status, total oxidant status and oxidative status index values. This study aimed to investigate the effect of two different doses of vitamin C on oxidative stress indicators in late gestation, early and late lactation ewes and their offspring. Methods: In the study, 48 ewes of the German Meat Merino and Akkaraman breeds that were developed by crossbreeding were employed. After breeding, four groups were formed from pregnant and non-pregnant ewes. Negative Pregnancy Control group was formed from non-pregnant ewes. Positive Pregnancy Control, Positive Pregnancy Practice 1 and Positive Pregnancy Practice 2 groups were formed from pregnant ewes. After the 90th day of pregnancy, ewes in the Negative Pregnancy Control and Positive Pregnancy Control groups received saline (0.9% NaCl, 2.5 ml) injections every week concurrently with the other pregnant groups until delivery. From the 90th day of pregnancy until birth, sheep participating in Positive Pregnancy Practices 1 and 2 received weekly injections of vitamin C (625 mg/CA, 2.5 ml and 1250 mg/CA, 5 ml, respectively). Result: In the study, no statistically significant difference was found in serum MDA, TAS, TOS and OSI levels between late pregnancy, lactation and born lambs. While none of the pregnant ewes in this study aborted, vitamin C injection significantly decreased postnatal lamb mortality. This showed that vitamin C helped pregnant ewes feel less stressed throughout pregnancy and helped lower postnatal lamb mortality. In pregnant ewes, AO-effective vitamin C supplementation has been shown to have possible beneficial effects on both maternal and offspring health, whereby the number of stillbirths was reduced by vitamin C supplementation, especially in Positive Pregnancy Practice 2 lambs. [ABSTRACT FROM AUTHOR]

Background: Acute appendicitis is the most common nonobstetric cause of acute abdomen in pregnant women. In this study, we aimed to evaluate pregnant patients who were operated on for acute appendicitis in our center, which has a large pregnant population, in the light of the literature. Materials and Methods: The data of patients operated on for acute appendicitis between November 2015 and August 2022 were retrospectively examined and recorded electronically. The patients' complaints, physical examination findings, radiological data, operation type, and pathological data were recorded and examined in the light of the literature. Results: The average age of 37 patients who underwent appendectomy was 27.7 (20-42) years. In these patients, acute appendicitis was diagnosed most frequently in the 2nd trimester (48.6%). The most common presenting complaint of the patients was abdominal pain, and the most common physical examination finding was abdominal tenderness. Considering the admission time of the patients, it was observed that a delay of more than 24 hours increased the risk of perforation. Although the most common histopathological finding was acute appendicitis, malignancy was detected in one patient and enterobius vermicularis was detected in another. Conclusions: Acute appendicitis should be kept in mind in patients with new-onset right lower quadrant abdominal pain during pregnancy. Because delay in diagnosis and therefore surgery causes serious morbidity and mortality for both the fetus and the mother. [ABSTRACT FROM AUTHOR]

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IntroductionPre-exposure prophylaxis (PrEP) is a safe and effective prevention strategy to reduce women's risk of HIV in pregnancy and postpartum. Effective PrEP protection requires daily PrEP adherence, but little is known about maternal PrEP continuation and factors that influence PrEP use.MethodsThe PrEP in pregnancy and postpartum (PrEP-PP) study enrolled consenting pregnant, HIV-negative women at first antenatal care (ANC) visit with follow-up through 12 months postpartum. Eligible and consenting women and girls ≥16 years received HIV prevention counselling and were offered PrEP. Interviewers collected socio-demographic and behavioural data from participants at each visit. We analysed the proportion of women who initiated PrEP and the proportion who continued PrEP after 3 months with associated correlates by estimating the prevalence ratio adjusting for a priori confounders.ResultsBetween August 2019 and October 2021, we enrolled 1201 pregnant women (median gestation 21 weeks; age 26 years); 84% of women initiated PrEP at their first ANC visit (n = 1014); 55% were married or cohabiting. Overall, 66% of women on PrEP returned for a repeat prescription at 1 month; 58% returned at 3 months (n = 493 of 844). Almost one-half of women on PrEP reported a side effect at 1 month, mostly nausea/vomiting. Women on PrEP in the first and second trimesters had higher odds of reporting side effects (aOR 2.61; 95% CI 1.17-5.84) versus postpartum women. Women who reported side effects continued with PrEP less than those who did not report side effects (aPR = 0.87; 95% CI 0.77-0.97). Women with ≥1 previous pregnancy (aPR = 0.76; 95% CI 0.57-1.01) or were postpartum (aPR 0.85; 95% CI 0.75-0.97) were less likely to continue PrEP compared to women who were primigravid or pregnant. Women who reported having an HIV+ partner (aPR = 1.45; 95% CI 1.13-1.85) or high HIV risk perception (aPR = 1.20, 95% CI = 1.01-1.41) were more likely to continue on PrEP than those who had HIV-negative partners or low risk perception.ConclusionsPrEP initiation and early continuation were high in this setting, compared to other studies in women. Being postpartum and experiencing side effects were associated with lower PrEP continuation, presenting opportunities for counselling on early transient side effects. Interventions for postpartum women on PrEP are needed.

Climate change is accelerating the intensity and frequency of wildfires globally. Understanding how wildfire smoke (WS) may lead to adverse pregnancy outcomes and alterations in placental function via biological mechanisms is critical to mitigate the harms of exposure. We aim to review the literature surrounding WS, placental biology, biological mechanisms underlying adverse pregnancy outcomes as well as interventions and strategies to avoid WS exposure in pregnancy. This review includes epidemiologic and experimental laboratory-based studies of WS, air pollution, particulate matter (PM), and other chemicals related to combustion in relation to obstetric outcomes and placental biology. We summarized the available clinical, animal, and placental studies with WS and other combustion products such as tobacco, diesel, and wood smoke. Additionally, we reviewed current recommendations for prevention of WS exposure. We found that there is limited data specific to WS; however, studies on air pollution and other combustion sources suggest a link to inflammation, oxidative stress, endocrine disruption, DNA damage, telomere shortening, epigenetic changes, as well as metabolic, vascular, and endothelial dysregulation in the maternal-fetal unit. These alterations in placental biology contribute to adverse obstetric outcomes that disproportionally affect the most vulnerable. Limiting time outdoors, wearing N95 respirator face masks and using high quality indoor air filters during wildfire events reduces exposure to related environmental exposures and may mitigate morbidities attributable to WS.

An outbreak of acute encephalopathy occurred in pregnant ewes and their newborn lambs associated with consumption of Talisia esculenta fruits and bark. Clinical signs in 5 adult pregnant ewes included drooling, bloat, tachypnea, depression, ataxia, body shaking, difficulty in rising, and recumbency. Three neonatal lambs born to some of those ewes had similar clinical signs. No significant gross abnormalities were observed on autopsy. Histologically, neuronal necrosis, axonal and dendritic swelling, and loss of Purkinje neurons were observed in the cerebellum. The observation of similar neurologic clinical signs and lesions in pregnant ewes and their neonatal lambs suggests that the toxic principle of T. esculenta crosses the placenta and reaches the fetus.

Objective: This study was conducted to evaluate the exercise attitudes of women of reproductive age during pregnancy. Method: The descriptive study was conducted with 326 women who applied to the gynecology outpatient clinics of a state hospital between September and November 2023. Data were collected with the ''Personal Information Form'' and ''Exercise Attitudes in Pregnant Women Scale''. Statistical analyses were analyzed at p

Background: Vaccination serves as an efficient primary means of control for infectious diseases. However, in the case of the COVID-19 pandemic, pregnant women within the United States had the lowest rates of COVID-19 vaccination and reported the lowest intent to vaccinate. Objectives: To explore the decision-making process for COVID-19 vaccination for people pregnant during the pandemic. Design: A secondary analysis of data from a mixed-methods study that examined the impact of COVID-19 on experiences of prenatal care, birth support, and delivery in the Southern United States. Methods: This study used a descriptive phenomenological approach to thematically analyze in-depth interviews (n = 20) with adult women who were pregnant by January 2020 and had their prenatal care and delivery during the pandemic beginning in March 2020. The transcripts were de-identified, coded, and thematically analyzed to saturation to identify drivers of COVID-19 vaccine decision-making based on COVID-19 vaccination status and timing. Comparative analyses were conducted to assess differences in decision-making processes based on race/ethnicity and parity. Participants also completed a sociodemographic survey that included their COVID-19 vaccination status. Results: Two themes emerged, the weighing of parallel risks and priorities from different sources resulting in vaccine decisional conflict and the need to reconcile that conflict via multiple strategies. All participants weighed priorities and risks from multiple areas of their lives and described internal conflict around vaccination. Participants described tailoring decisions to household dynamics, reconciling public and private values around vaccination, and the impact of their identities on the decision-making process. While many described concerns over vaccine safety and fetal health, uniquely, many highlighted weighing the impact of prior pregnancy loss history, with some choosing other preventive measures like social distancing or mask-wearing, which they deemed less risky. Conclusion: Pregnant people make complex COVID-19 vaccination decisions, which must be considered in future vaccine messaging and advocacy for this group. [ABSTRACT FROM AUTHOR]

Background: Congenital antithrombin deficiency is an autosomal dominant disease that results in deep venous thrombosis and pulmonary embolism, which is mainly caused by mutations in the antithrombin gene (SERPINC1). Since SERPINC1 is highly susceptible to alterations, severe structural and functional changes that promote thrombosis may occur. Clinical presentations vary from different alterations. We report a pregnant case with novel mutation in SERPINC1 presenting transient antithrombin deficiency and multiple venous thromboembolisms. Case presentation: We report a case of a 36-year-old pregnant patient who was diagnosed with congenital antithrombin deficiency for carrying a novel heterozygous mutation, NM_000488:exon5:c.T9 38 C:p. M313T in SERPINC1 presenting transient antithrombin deficiency and multiple venous thromboembolisms. Thrombolytic with alteplase and anticoagulant therapies with low-molecular-weight heparin and warfarin were administrated. After confirming the genetic analysis and the termination of pregnancy, rivaroxaban was administrated, and the thrombosis reduced. Conclusions: Our study enriched the mutation database of SERPINC1 gene, provided some new theoretical basis for gene diagnosis and genetic counseling of patients with transient antithrombin deficiency. While it still needs for subsequent exploration of molecular pathogenesis. [ABSTRACT FROM AUTHOR]

Background: Although an association between maternal nutritional intake and developmental delays in children has been demonstrated, the association of the timing of meal intake and development delays remains unclear. We examined the association between breakfast intake frequency before and during pregnancy and developmental delay in children. Methods: Of the pregnant women who participated in the Tohoku Medical Megabank Project Three-Generation Cohort Study, 7491 answered the required questions and were analyzed. The frequency of breakfast intake from pre- to early pregnancy and from early to mid-pregnancy was classified into four groups: daily, and 5–6, 3–4, and 0–2 times/week. Child developmental delays at age 2 and 3.5 years were assessed using the Ages & Stages Questionnaire, Third Edition. Logistic regression models were constructed to examine the association between breakfast intake frequency in pregnant women and developmental delays in children aged 2 and 3.5 years. Results: The proportion of pregnant women who had breakfast daily was 78.1% in pre- to early pregnancy, and 82.2% in early to mid-pregnancy. The proportion of children with developmental delays was 14.7% and 13.4% at age 2 and 3.5 years, respectively. Compared with the risk in children of women who had breakfast daily from pre- to early pregnancy, children of women who had breakfast 0–2 times/week had a higher risk of developmental delays at 2 years of age: odds ratio (OR) 1.30, (95% confidence interval [CI], 1.02–1.66). The risk of developmental delays at age 2 years increased in the children of women who had breakfast 0–2 times/week in early to mid- pregnancy: OR 1.75 (95% CI, 1.32–2.32). The risk of developmental delays at age 3.5 years did not increase in the children of women who had breakfast 0–2 times/week from pre- to early and early to mid-pregnancy: OR 1.06 (95% CI, 0.81–1.39 and OR 1.15 (95% CI 0.84–1.57), respectively. Conclusion: For women with a low frequency of breakfast intake from pre- to mid-pregnancy there was an association with developmental delays in their children at age 2, but not at 3.5 years. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study is to evaluate the effect size of core stabilization exercise for prenatal and postnatal women through measures of urinary symptoms, voiding function, pelvic floor muscle strength and endurance, quality of life, and pain scores. Design: The PubMed, Embase, Cochrane Library, and Scopus databases were searched. Randomized controlled trials were selected and subjected to meta-analysis and risk of bias assessment. Results: Ten randomized controlled trials were selected, and 720 participants were included. Ten articles using seven outcomes were analyzed. Relative to the control groups, the core stabilization exercise groups exhibited superior results for urinary symptoms (standardized mean difference = −0.65, 95% confidence interval = −0.97 to 0.33), pelvic floor muscle strength (standardized mean difference = 0.96, 95% confidence interval = 0.53 to 1.39), pelvic floor muscle endurance (standardized mean difference = 0.71, 95% confidence interval = 0.26 to 1.16), quality of life (standardized mean difference = −0.9, 95% confidence interval = −1.23 to 0.58), transverse muscle strength (standardized mean difference =−0.45, 95% confidenceinterval =−0.9 to –0.01), and voiding function (standardized mean difference = −1.07, 95% confidence interval = −1.87 to 0.28). Conclusions: Core stabilization exercises are safe and beneficial for alleviating urinary symptoms, improving quality of life, strengthening pelvic floor muscles, and improving transverse muscle function in prenatal and postnatal women with urinary incontinence. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: The aim of our study is to examine the changes in core muscle functions during pregnancy. Methods: Our study was carried out in 67 primigravida pregnant women. Superficial electromyography (EMG) and non-invasive 2D/3D ultrasonography (USG) were used to evaluate core muscle (diaphragm, transversus abdominus [TA], internal oblique [IO]–external oblique [EO] muscles, pelvic floor muscles, multifidus) function during pregnancy. Pelvic floor muscle strength was also measured by a digital palpation method (PERFECT system). USG was used to measure expected fetal weight and the diastasis recti (DR) distance. Mann–Whitney U test was used to show changes in trimesters in the core muscles, and Spearman correlation analysis was used to determine the relationship. Results: In the third trimester, an nonsignificant increase in EMG parameters was observed in all of the core muscles. Although a statistically significant decrease was observed in muscle thickness values measured by EO and IO USG in the third trimester, DR was found to increase at all levels (p < 0.005). When we evaluated both trimesters and all pregnant women together, no relationship was found between all core muscles and pelvic floor muscles in the data evaluated by EMG and USG. We found a negative correlation in USG values between fetal weight and IO and the upper part of the rectus abdominus muscle, and a positive correlation between the EMG data of the EO and rectus abdominus muscles. Conclusions: In women, the coactivation relationship between the core muscles may disappear during pregnancy. As the trimesters progress during pregnancy, a decrease in thickness and an increase in muscle activity can be observed in the core muscles. Pregnant women can be given exercise training for core muscles for protection in both the prenatal and postnatal periods. But more research needs to be done. [ABSTRACT FROM AUTHOR]

Background: The utility of procalcitonin to identify obstetric sepsis is unknown. Objective: To calculate the mean (range) procalcitonin in pregnancy among healthy women not in labor (group 1), healthy women in labor (group 2), and women with preterm prelabor rupture of membranes (PPROM) without clinical chorioamnionitis (group 3). Search Strategy: NLM PubMed, Elsevier Embase, and Wiley Cochrane Central Register of Controlled Trials from inception to February 21, 2022. Selection Criteria: Ten or more pregnant women with procalcitonin reported at more than 20 weeks of pregnancy, with information on labor, PPROM, and infection. Exclusions were major medical comorbidities. Data Collection and Analysis: Each abstract and full‐text review was independently reviewed by the same two authors. Quality was reviewed using the Newcastle‐Ottawa Scale. A meta‐analysis was performed using a random effects model. Main Results: The systematic review included 25 studies: 10 (40%) of good quality and 15 (60%) of poor quality. The meta‐analysis included 21 studies. Mean procalcitonin in group 1 was 0.092 ng/mL (range 0.036–0.049 ng/mL), in group 2 it was 0.130 ng/mL (range 0.049–0.259 ng/mL), and in group 3 it was 0.345 ng/mL (range 0.005–1.292 ng/mL). Conclusions: Among healthy pregnant women not in labor, procalcitonin levels are comparable to those in non‐pregnant adults and may be useful in identifying infection. Procalcitonin levels in other groups overlap abnormal values of procalcitonin in non‐pregnant adults, and may not discriminate infection among women in labor or with obstetric comorbidities. Prospero: CRD42020157376, registered 4/28/2020. Synopsis: Although limited data are published, procalcitonin levels in healthy pregnant women without complications are comparable with those in non‐pregnant adults. [ABSTRACT FROM AUTHOR]

Background: There are major health benefits of physical exercise during pregnancy for the mother and newborn. On the other hand, physical inactivity during pregnancy is varied around the world, but it is more common during the third trimester of pregnancy. A positive attitude toward antenatal exercise can reduce physical inactivity. Objectives: To identify the barriers that prevent pregnant women from doing physical exercise. To find out the association between the barriers and pregnant women's characteristics. Methods: A descriptive cross-sectional study design was used to assess pregnant women's barriers to physical exercise during pregnancy. Non probability (purposive sample) was used to collect the data from (200) pregnant women. The questionnaire consisted of ten questions for barriers and ten questions for practices. Results: The higher percentage of women's age was (20-29) years; they graduated from primary school. More than one-third of them have two to three living children. Most of them stated a lack of information or training on physical exercise during pregnancy is the most common barrier, and only (37%) pregnant women practice antenatal exercise. Conclusion: The perceived barriers to physical exercise during pregnancy are a lack of information or training, a lack of family support, a lack of time, and the fear that it may be harmful to the fetus. Pregnant women need encouragement to perform prenatal exercise and facilitate the overcoming barriers. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to determine the impact of evidence-based educational materials and access to local resources on physical activity (PA) levels, beliefs, and motivation (including self-efficacy) regarding PA during pregnancy in a rural setting. Methods: Information on PA levels (step counts, Pregnancy Physical Activity Questionnaire) and beliefs and motivation regarding PA (main surveys: Exercise Beliefs Questionnaire, Protection Motivation Theory and Health Action Process Approach) were collected between 8 and 16 weeks gestation. Women from a rural community were randomly assigned to the PA group (PAG, n = 38) or control group (n = 32). The PAG participants received an evidence-based educational brochure and access (at no charge to them) to local fitness facilities. At approximately 34 to 37 weeks gestation, baseline assessments were repeated. Results: Sedentary time was significantly different between groups over time, with control participants increasing sedentary time and PAG participants decreasing sedentary time (P = .04). Sixteen women (42%) in the PAG utilized the resources provided (prenatal yoga being utilized most). Postintervention, there was a significant group x time interaction for Perceived Self-Efficacy scores; scores in the PAG remained consistent with baseline values, whereas scores in the control group decreased (P = .03). Conclusions: The intervention reduced sedentary time and maintained self-efficacy scores during pregnancy. [ABSTRACT FROM AUTHOR]

Background and objectivePublished works have discussed the pharmacokinetic interactions of drugs with pregnancy, but none comprehensively identify all the approved United States Food and Drug Administration (FDA) and European Medicines Administration (EMA) drugs that have a pregnancy-related intervention. The objective of this systematic review is to comprehensively identify medications that have clinically meaningful interventions due to pharmacokinetic reasons.MethodsAn in-depth search of clinical data using the PDR3D: Reed Tech Navigator™ for Drug Labels was conducted from 1 June to 12 August 2022. The PDR3D was analyzed using the search terms “pregnant” and “pregnancy” within the proper label section. Regarding the US labels, the terms were searched under the “dosage and administration” section, whereas with the EU labels, the terms were searched within the “posology and method of administration” section. If a finding was discovered within the search, the rest of the label was analyzed for further information. Clinical relevance was based on whether an intervention was needed.ResultsUsing the search strategy, 139 US and 20 EU medications were found to have clinically meaningful interventions in pregnancy. The most common explanations for clinical relevance included hepatic metabolism, protein binding, renal elimination, and P-gp influence. Of the US labels: 40 were found to undergo hepatic metabolism, 11 were found to be influenced by renal elimination, 12 were found to be influenced by protein binding, 7 were found to be influenced by P-gp, and the remaining drugs required further research. Of the EU labels: 11 were found to undergo hepatic metabolism, 3 were found to be influenced by renal elimination, 3 were found to be influenced by protein binding, 1 was found to be influenced by P-gp, and the remaining drugs required further research.ConclusionThis comprehensive review of clinically relevant interventions in pregnancy will potentially aid in the treatment of pregnant females when they are undergoing therapy, provide intervention and dosing guidance for physicians, and save time for prescribers and pharmacists. Advances in non-clinical predictions for pregnancy dosing may guide the need for a future clinical evaluation.