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An increasingly common question posed by patients antenatally is whether air travel can be considered safe in pregnancy. The aim of this study was to assess whether any agreed standards or policies exist between airlines with respect to flying in pregnancy. Sixty-eight international airlines were surveyed, of whom seventeen (25%) replied. Three of seventeen (17.5%) airlines applied no restrictions at all to pregnant passengers; the remainder applied restrictions to air travel with varying gestations (28 to 36 weeks). A full delivery kit was carried by 5/17 airlines (29%), and some form of training in the management of a delivery was provided to the cabin crew in 12/17 airlines (70%). Experience of in-flight obstetric emergencies was reported by 11/17 airlines (65%). This study highlights a lack of consensus regarding restrictions on air travel in pregnancy. The low response rate also suggests an unwillingness on the part of the airline industry to openly declare their policy on this issue.

A microelectrode was used to measure vaginal pH in a longitudinal study during pregnancy in 30 women, 28 of whom were delivered at term. Excluding pH readings made in the presence of pathogenic organisms, 120 readings were taken. The mean vaginal pH of all subjects was 4.16 (SD 0.41). Analysis of variance showed no significant within-subject variation of pH during pregnancy. Two women had spontaneous preterm deliveries (less than 37 weeks) and their mean vaginal pH during pregnancy was 5.05 and 5.06. Eight women admitted in preterm labour, who then gave birth, had a mean pH of 5.43 (SD 0.94) which was significantly higher than the mean pH of 10 women in labour at term (4.58, SD 0.59). The relation between bacterial growth in vitro and the surrounding pH was also examined. Escherichia coli, a potential pathogen, behaved differently from both Lactobacillus (a commensal organism) and Candida albicans. The clinical observations show a trend towards higher vaginal pH values in association with preterm labour.

Background This longitudinal study examined the profile and pregnancy-related behaviours of women who reported smoking in two successive pregnancies when they presented for prenatal care in a large maternity hospital. Methods Using the hospital electronic medical records, women who delivered two successive singleton pregnancies during the years 2011–15 were analyzed. Standardized data were computerized by a midwife at the first prenatal visit, following delivery and before discharge. Results Over the 5 years, 6647 women delivered twice. Overall 5754 (86.6%) were persistent non-smokers in both pregnancies, 609 (9.2%) were persistent smokers in both pregnancies and between pregnancies 202 (3.0%) quit and 82 (1.2%) started smoking. Compared with persistent non-smokers, persistent smokers had higher rates of reported illicit drug use, alcohol consumption and psychological problems and lower rates of planned pregnancy, folic acid supplementation and breastfeeding in both pregnancies (all P < 0.001). In persistent smokers, folic acid supplementation practices deteriorated and illicit drug use increased in the subsequent pregnancy. Conclusions We found that approximately one in 10 women smoked in two consecutive pregnancies. Furthermore, compared with non-smokers, persistent smokers were more likely to report other health behaviours associated with adverse pregnancy outcomes and may require additional multidisciplinary support. [ABSTRACT FROM AUTHOR]

Background Maternal nutrition is a determinant of pregnancy outcomes. Few studies have evaluated the potential of online nutrition resources to modify behaviour. This randomized controlled trial aimed to determine whether access to a customized evidence-based nutrition website in pregnancy improved neonatal outcomes. Methods Women <18 weeks gestation were recruited at their convenience. The control group received standard care. In addition to standard care, the intervention group received access to an evidence-based nutrition website, customized to the preferences of pregnant women. Results Of the 250 women, there were no differences in characteristics between the two groups. Of the women, 91.0% reported they make a conscious effort currently to eat a healthy diet. However, only 19.6% met dietary requirements for calcium, 13.2% for iron, 2.7% for folate and 2.3% for iodine. The most popular website section was pregnancy nutrition advice but engagement was not sustained. Access to the website was not associated with any improvement in clinical outcomes (P > 0.05). Conclusions We found that provision of a customized website providing nutrition information, did not improve neonatal outcomes. Future studies should explore whether redesign with website interactivity or embedding information on popular digital platforms sustains women's engagement and modifies dietary behaviour. [ABSTRACT FROM AUTHOR]

Background Maternal nutrition intakes may influence neonatal birthweight and adiposity; however, inconsistencies within the literature exist. The relationships between maternal dietary intakes in early pregnancy and both birthweight and neonatal adiposity requires elucidation. This study examined the relationship between early pregnancy dietary intakes and subsequent birthweight and neonatal adiposity. Methods Women were recruited at their convenience after sonographic confirmation of a singleton pregnancy. Women completed a Willet food frequency questionnaire evaluating habitual food and nutrient intakes at their first antenatal visit. Neonatal body composition was measured using air-displacement plethysmography. Results Of the 385 mother-neonate dyads, mean maternal age was 30.8 ± 5.3 years, mean Body Mass Index (BMI) was 24.5 ± 4.8 kg/m2 and 41.8% (n = 161) were nulliparous. There were no relationships between maternal food intakes and birthweight (P > 0.05) (n = 385). On multivariable analysis there was a positive relationship between polyunsaturated fat and neonatal fat mass index (FMI) (beta = 0.015, 95% CI = 0.002–0.028, P = 0.04) (n = 80). Conclusion Dietary intakes of polyunsaturated fat in early pregnancy are positively associated with neonatal FMI at birth on multivariable analysis. Further longitudinal studies need to explore this association and the long-term implications for the neonate. [ABSTRACT FROM AUTHOR]

This study aimed to assess the perinatal outcome, especially foetal growth, following the continuation of metformin during the first trimester of pregnancy. All women with polycystic ovary syndrome (PCOS) treated with metformin in the first trimester and who delivered a baby weighing 500 g or more between 2003 and 2005 were studied. Subjects were matched for age and parity with randomly selected controls. The perinatal outcomes studied were: growth parameters, gestational age, congenital defects, hypoglycaemia and neonatal unit admission. Sixty-six pregnancies were compared with 66 controls; all had singleton deliveries. There was no difference in mean birth weight between the metformin and the control groups (p=0.84). The percentage of small (<10th centile) and large (>90th centile) for gestational age babies was lower in the metformin group. In the metformin group, there were no major congenital malformations and 24% of the babies were admitted to the neonatal intensive care unit (NICU) compared with 27% of the babies in the control group (non-significant). Neonatal hypoglycaemia was less common in the metformin group (18.5% vs. 24.5%) and fewer babies required intravenous glucose therapy (6.3% vs. 12%). We found no evidence that the continuation of metformin in the first trimester of pregnancy was associated with an adverse foetal outcome. [ABSTRACT FROM AUTHOR]

The use of body mass index (BMI) for the diagnosis of obesity has limitations, especially when comparing ethnic groups with different body proportions. The aim of this prospective study was to compare maternal body composition in early pregnancy between Caucasian Irish and Indian women. A total of 81 Indian women and 81 Irish Caucasian women were matched for age, parity and BMI. Maternal weight and height were measured, and body composition analysed using bioelectrical impedance. The Irish women were taller and weighed more than the Indian women ( p < 0.001). At any given BMI, the Indian women had a higher total body fat percentage, visceral fat level and high fat percentage than the Irish women ( p == 0.024, 0.001 and 0.001, respectively). Our findings suggest that lower BMI cut-offs should be used for screening for gestational diabetes mellitus in Indian women attending our antenatal services. [ABSTRACT FROM AUTHOR]

The objective of this study was to review the first 50 clinical pregnancies of women with polycystic ovarian syndrome (PCOS) who had ovulation induced either with metformin alone, or in combination with clomifene. The study was confined to women with PCOS attending our infertility service. A register of clinical pregnancies was maintained of women who conceived after metformin therapy. The metformin was continued throughout the first trimester. The outcome of pregnancy was determined by individual chart review. Of the 50 women, 21 conceived with a combination of clomifene and metformin, and 29 with metformin alone. Seven women had a first trimester loss and 43 had a live birth. There were no perinatal deaths, no neonatal seizures and no congenital malformations. There were also no multiple pregnancies. The overall caesarean rate was 37%, and none of the babies had an Apgar score less than 7, at 5 min. This study found no evidence of any adverse clinical effects when metformin is continued in the first trimester of women with PCOS following ovulation induction. There was also no evidence of an increase in the rate of miscarriage or multiple pregnancy. [ABSTRACT FROM AUTHOR]

Background The World Health Organization recommends that women take 400 µg of folate supplementation daily throughout pregnancy. We examined the relationship between total folate intake from the diet and supplements at the first prenatal visit and haematological indices at this visit and subsequently. Methods Women were recruited at their convenience and in addition to clinical and sociodemographic details, detailed questionnaires on dietary intakes and supplementation consumption were completed under supervision. A full blood count and serum and red blood cell (RBC) folate levels were taken. Results Of the 502 women studied, 97.5% had inadequate total dietary folate intake at the first visit, but, 98.2% were taking folic acid (FA) supplementation. Only 1.8% (n = 9) had anaemia at their first visit (with no case of macrocytosis). Subsequently, 212 women had a further Hb sample in the third trimester and 8.5% (n = 18) were anaemic and 43.4% (89/205) were anaemic postnatally. There was a relationship between the development of anaemia postnatally and lower RBC folate levels at the first visit (P = 0.02). Conclusions In a country where FA food fortification remains voluntary, these findings support the recommendation that women should start FA supplementation before pregnancy and continue FA after the first trimester. [ABSTRACT FROM AUTHOR]

Objectives: During pregnancy, women are increasingly turning to web-based resources for information. This study examined the use of web-based nutritional information by women during pregnancy and explored their preferences. Study design: Cross-sectional observational study. Methods: Women were enrolled at their convenience from a large maternity hospital. Clinical and sociodemographic details were collected and women's use of web-based resources was assessed using a detailed questionnaire. Results: Of the 101 women, 41.6% were nulliparous and the mean age was 33.1 years (19-47 years). All women had internet access and only 3% did not own a smartphone. Women derived pregnancy-related nutritional information from a range of online resources, most commonly: What to Expect When You're Expecting (15.1%), Babycenter (12.9%), and Eumom (9.7%). However, 24.7% reported using Google searches. There was minimal use of publically funded or academically supported resources. The features women wanted in a web-based application were recipes (88%), exercise advice (71%), personalized dietary feedback (37%), social features (35%), videos (24%) and cooking demonstrations (23%). Conclusions: This survey highlights the risk that pregnant women may get nutritional information from online resources which are not evidence-based. It also identifies features that women want from a web-based nutritional resource. [ABSTRACT FROM AUTHOR]

Objective: Maternal body composition influences the outcome of pregnancy for both mother and baby. The use of a surrogate marker of body composition, body mass index, has limitations. Recent studies have explored the use of bioelectrical impedance analysis to directly measure body composition because it is safe and practical during pregnancy. Data on the repeatability of multifrequency bioelectrical impedance analysis during pregnancy are limited. The objective of this study was to evaluate the repeatability of body composition parameters using advanced bioelectrical impedance analysis in a pregnant population. Methods: We used the eight-electrode multifrequency Tanita MC180 MA bioelectrical impedance analysis system (Tokyo, Japan). Double measurements (two minutes apart) of maternal body composition were performed under standardized conditions in 20 women. All measurements were performed by the same researcher. Bland-Altman plots were created for the body composition parameters to determine repeatability. Results: The mean difference (± SD) for body mass index was 0.03 (± 0.23) kg/m2, for total body fat mass 0.01 (± 0.52) kg and for total body fat-free mass -0.05 (± 0.41) kg. The coefficients for repeatability ranged from 0.8 - 2.5% for all the body composition parameters studied. Discussion: This study demonstrated that the measurement of body composition parameters using advanced bioelectrical impedance analysis is reproducible in pregnancy. [ABSTRACT FROM AUTHOR]