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Armed conflict brings about significant health-related consequences to the non-combatant population especially the elderly, women, and children. The consequences for women extend further than battle-related deaths. One important consequence of conflict is the population displacement resulting from individuals and families seeking safety in non-conflict zones. This forced migration places women at risk of gender-based violence during their journey and for this reason the host countries should ensure that the migrants are given access to reproductive health services, including providing emergency contraception and abortion. In the conflict zone, the collapse of all social support, including healthcare services, contribute towards a marked deterioration in the level of care provided to ensure reproductive health and safe motherhood. In addition, the community living the conflict zone is at an increased risk of community infectious disease and poor management of chronic illness. Women and children are almost always innocent victims of war. The international community must act effectively to primarily avoid conflict by sound diplomatic intervention and, when diplomacy fails, reduce the consequences of conflict.

Because of the fear of the use of pharmacological agents, many pregnant women are opting to use alternative management modalities either as primary management or to compliment standard contemporary medical practices. The traditional complementary physical interventions of acupuncture, acupressure, and electrostimulation have a long tradition of use in traditional Chinese medical practice and are advocated for the management of antenatal conditions such as spontaneous miscarriages, gastrointestinal, respiratory, and urinary problems. They have also been advocated as useful to help the process of labour in promoting a cephalic delivery, induction/augmentation of labour and pain relief. Postpartum these modalities have been said to help the secretion and production of milk. While a number of studies, some randomized controlled, have suggested a potential role for these traditional complementary physical interventions, systematic reviews have generally failed to show a definite conclusive beneficial role and all reviews generally suggest the need for further controlled research in the field. Since no adverse effects appear to be associated with the use of these modalities in pregnancy, such modalities of management can be considered but only as an adjuvant to standard pharmacological management after a full clinical assessment has ruled out underlying pathology.

Air travel and long distance travel may have adverse effect on the pregnancy-induced physiology and these effects are more marked among those with pre-existing medical conditions. There are significantly increased risks of deep venous thrombosis, inflight transmission of infections, preterm labour, and other significant obstetric and medical complications that may be exacerbated by the flight and may require emergency care. Transient changes in cardiotocographic tracings during third trimester of pregnancy have been reported following air travel. It has been suggested that pregnant members of the flight crew may be at a slightly higher risk of spontaneous miscarriages. There are no contra-indications for healthy pregnant women on air travel. Those with underlying medical conditions should only embark on long distance travel following consultation with their obstetrician. Pregnant women should be advised to familiarise themselves with the healthcare system in the country/region they will be visiting and draw up an emergency plan of how they will contact the healthcare system at their destination.

To provide an update on the evidence of the effectiveness of acupuncture in treating chronic non-specific low back pain (CNSLBP) based on randomized controlled trials (RCTs) of acupuncture for CNSLBP published between 2006 and 2020. A comprehensive literature search was conducted through the University of Malta website, using the HyDi search engine. The ‘Advanced Search’ option was chosen in order to search for articles that were published in English, and associated with the key words, ‘Chronic’, ‘Acupuncture’, ‘Needle’, ‘Needling’, ‘Non-specific’ and ‘Low Back Pain’, which were entered in their ‘Subject’ field, from the year 2006 till 2020. A comprehensive reading and analysis was done for the search result. Through the use of the HyDi search engine, accessible through the University of Malta, eighteen randomized controlled trials that met the criteria of this study were selected. Through the analysis and comparison of the studies selected for this literature review, there is evidence providing that acupuncture is significantly more effective than current conservative treatment modalities for patients with CNSLBP in reducing pain and improving function.

A paucity of evidence exists on whether the health and social services introduced in Malta for Sub-Saharan African (SSA) migrants have improved perinatal outcomes.Research Aim:This research aimed to compare the sociobiological characteristics and obstetric and perinatal outcomes between SSA migrant women and a local cohort of Maltese women who delivered neonates in Malta.Design:A retrospective comparison of two samples, SSA migrant women and Maltese women utilized the national obstetrics database kept by the Medical and Health Department during 2007–2016. The database had information about 898 SSA mothers (914 neonates) and 36,083 Maltese mothers (36,736 neonates). Statistical comparison was carried out using Pearson’s chi-square test.Results:SSA migrants were significantly more likely to be younger, married, poorly educated, and less likely to smoke cigarettes or abuse illicit drugs. They were statistically more likely to be multiparous and to poorly avail themselves of available antenatal care. Although SSA migrants had a significantly increased risk for perinatal complications, including preeclampsia–eclampsia, threatened preterm labor, placental abruption, intrauterine growth restriction, anemia, infection, hemorrhage, and blood transfusions, the risk for perineal trauma was lower than that for Maltese women. Significantly increased complications in SSA neonates included prematurity, low birth weight, low Apgar scores, respiratory distress syndrome, sepsis, seizures, and increased mortality.Conclusion:Despite the availability of comprehensive free-at-source obstetric healthcare and social support services, the perinatal outcomes of SSA migrants remained substandard when compared to Maltese women. These findings require further investigation of the adequacy and standard of maternity care offered to SSA migrants.

AIMS The reported frequency of monogenic defects of beta cell function in gestational diabetes (GDM) varies extensively. This study aimed to evaluate the frequency and molecular spectrum of variants in genes associated with monogenic/atypical diabetes in non-obese females of Maltese ethnicity with GDM. METHODS 50 non-obese females who met the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria for diagnosis of GDM and with a first-degree relative with non-autoimmune diabetes were included in this study. Whole exome capture and high throughput sequencing was carried out. Rare sequence variants were filtered, annotated, and prioritised according to the American College for Medical Genetics guidelines. For selected missense variants we explored effects on protein stability and structure through in-silico tools. RESULTS We identified three pathogenic variants in GCK, ABCC8 and HNF1A and several variants of uncertain significance in the cohort. Genotype-phenotype correlations and post-pregnancy follow-up data are described. CONCLUSIONS This study provides the first insight into an underlying monogenic aetiology in non-obese females with GDM from an island population having a high prevalence of diabetes. It suggests that monogenic variants constitute an underestimated cause of diabetes detected in pregnancy, and that careful evaluation of GDM probands to identify monogenic disease subtypes is indicated.

More than 50% of all gynecologic tumors can be classified as rare (defined as an incidence of less than 6 per 100,000 women) and usually have a poor prognosis owing to delayed diagnosis and treatment. In contrast to almost all other common solid tumors, the treatment of rare gynecologic tumors (RGT) is often based on retrospective studies, expert opinion, or extrapolation from other tumor sites with similar histology, leading to difficulty in developing guidelines for clinical practice. Currently, gynecologic cancer research, due to distinct scientific and technological challenges, is lagging behind. Moreover, the overall efforts for addressing these challenges are fragmented across different European countries and indeed, worldwide. The GYNOCARE, COST Action CA18117 (European Network for Gynecological Rare Cancer Research) programme aims to address these challenges by creating a unique network between key stakeholders covering distinct domains from concept to cure: basic research on RGT, biobanking, bridging with industry, and setting up the legal and regulatory requirements for international innovative clinical trials. On this basis, members of this COST Action, (Working Group 1, “Basic and Translational Research on Rare Gynecological Cancer”) have decided to focus their future efforts on the development of new approaches to improve the diagnosis and treatment of RGT. Here, we provide a brief overview of the current state-of-the-art and describe the goals of this COST Action and its future challenges with the aim to stimulate discussion and promote synergy across scientists engaged in the fight against this rare cancer worldwide., peer-reviewed

The problem of adiposity has also become a significant health issue in high-income countries contributing to serious comorbidities that further contribute toward an increase in the human toll of noncommunicable diseases. A familiar interrelationship has been repeatedly reported. This hereditary element has been shown to be an interplay between the genetic makeup of the individual, generally caused by gene polymorphisms, and environmental factors during intrauterine and postpartum life driving metabolic programming through epigenetic processes. The genetic makeup of the individual governs the interrelated control mechanisms involved in controlling energy homeostasis at the cellular level. These control mechanisms are affected by interrelated metabolic, neural, and endocrine factors, especially the neural response of the individual to leptin and insulin levels, and the effect of these hormones on thermogenic energy expenditure and adipogenesis. An understanding of the developmental plasticity involving different mechanisms that alter energy regulation at all levels is important to face the challenges of adipose-preventive medicine in the future.

Pregnant women often resort to herbal medication to ameliorate the disturbing symptoms associated with pregnancy in the mistaken belief that these are safe and carry no potential harmful effects to the developing fetus. Healthcare personnel must be cognizant of the potential adverse side effects of these substances to be able to better advise their patients.

Writing and publishing scientific papers have become requisites for all scientists (researchers and academics alike) to maintain their professional career. The prospects of writing a scientific paper are often regarded as somewhat daunting to the uninitiated. However a universal, well established structure format known as "IMRAD": i.e. Introduction, Methods, Results And Discussion has been established. This paper details this methodology.

The prospect of writing a thesis is considered daunting by many but the task is a requisite when embarking into reading for any academic degree. A thesis is a written document following personal research. It is performed to obtain an academic degree or qualification, both at undergraduate and postgraduate level. When writing a thesis, it is imperative that the student follows the universal well-acknowledged structure format known as "IMRAD": i.e. Introduction, Methods, Results and Discussion. A summary of the thesis, known as the 'Abstract', is placed at the beginning of the "IMRAD", while all references cited in the thesis are placed at the very end. The thesis format is similar to a research manuscript prepared for publication in scientific journal, but there are significant differences between the two types of academic works. For example, the liberal use of graphical aides in the form of figures and/or tables enhances the delivery of results. It is essential to ensure that all the literature referred to in the thesis is cited, while paying particular attention to potential plagiarism. When writing a thesis, the student needs to keep in mind three factors: [1] the structure, [2] the substance and [3] the style. Once the student has developed a good plan for thesis layout, then writing becomes greatly faciliated.

Writing for the media is a task faced by many professionals at some point during their academic or clinical life. The style and purpose of writing for the media is strikingly different from that of an academic manuscript. When writing for the media, the author presents information and persuades the mass audience about a particular topic or issue. The author needs to bear in mind that information sent out to the media will make today's story but will be yesterday's news, so time is of the essence. The format of newswriting follows an inverted pyramid structure with the most important message taking center stage at the beginning of the article followed by any additional messages. The use of graphics enhances the message. While embracing the concept of modesty, the author needs to present the newsworthy information in a complete, accurate, efficient and precise manner.

In this ten-year retrospective study we were able to show that Maltese substance-misusing mothers (SMMs) have significantly different socio-biological characteristics from mothers in the general population which seem to impact on neonatal outcomes. Significant differences from the general population were noted in the SMM's age, age at first pregnancy, marital status, educational background, number of cigarettes smoked, number of offspring and weight gained in pregnancy. SMMs booked their pregnancy in hospital later than the general population. On the other hand their infants had a lower mean birth weight and head circumference, had lower Apgar scores, were of lesser gestational age and premature. They were less breast-fed and stayed longer in hospital after their birth.

Background: Most female patients with congenital heart disease (CHD) are becoming pregnant. Maternal CHD can have a negative impact on mother and foetus. This is the first study investigating pregnancy outcomes in Maltese grown-up congenital heart disease (GUCH) patients and one of few to compare these with outcomes in women without heart disease. Methods: Known GUCH pregnancies for the period of 2007-2014 were extracted from our database (GUCH cohort) and cardiovascular outcomes retrieved from hospital notes. A control cohort of 540 pregnancies in women without cardiovascular disease was generated through twenty-fold random matching based on subject age from among all pregnancies in Maltese nationals for the same 8-year period. Obstetric and offspring outcomes were compared between the two cohorts. Results: The GUCH cohort consisted of 27 pregnancies in 24 women. Only 1/27 patients (3.7%) had cardiovascular complications. Elective Caesarean sections were commoner (29.6% vs. 15.4%) and unassisted vaginal deliveries less frequent (51.9% vs. 64.6%) in the GUCH cohort (p=0.02). Obstetric complication rates were similar. GUCH women had smaller babies (median 3030g vs. 3230g; p=0.045) and showed a trend towards more small-for-gestational age babies (18.5% vs. 8.4%; p=0.08) and congenital malformations (7.4% vs. 2.4%; p=0.06). Conclusions: Despite the potential adverse effects of maternal CHD on mother and foetus, most pregnancies are uncomplicated and outcomes comparable to those in women without heart disease, particularly if baseline clinical status is good. Based on our findings, it is being proposed that prospective mothers be counselled about the possibility of having smaller infants., peer-reviewed

Science fiction narratives are regularly used to explore the consequences of contemporary and envisaged future scientific innovations along with the ensuing novel ethical and moral concepts. The television series Star Trek has dealt with aspects of reproductive health, often based on extrapolations from significant real-world breakthroughs in artificial reproductive technology and genetic engineering. This article assesses episodes that addressed such vexing ethical questions as choices affecting pregnancy after rape, advances in obstetrics including surrogate motherhood, and novel delivery techniques designed to protect the health of the mother and baby. However, the most significant ethical challenges may be those involving choices of deliberate genetic enhancements and/or frank physical alterations in non-life-threatening situations. The authors argue that responsible use of the popular science fiction genre, as exemplified by the various Star Trek series, cannot only provide advanced warning of problems and issues that science may eventually unleash but also suggest potential solutions to such problems.

BACKGROUND: Infants born with a higher birth weight have long been associated with an increased incidence of developing the metabolic syndrome starting from early childhood and persisting into adult life. Such risk factors include genetic tendencies as well as environmental factors. Of these, certain maternal anthropometric characteristics such as obesity or carbohydrate intolerance alter the intrauterine environment to one of nutritional plenty, thus impacting on intrauterine development. This hypernutrition pathway has led to the hypothesis of 'fuel mediated teratogenesis' and an obesogenic environment. AIM: The aim was to identify a relationship across 3 generations relating to body weight and birth weight in order to identify whether a genetic and/or nutritional role are involved in the observed transmission. METHODS/MATERIALS: The study utilized 2 clinical databases. The first consisted of a cohort of 182 women born in 1987 and who delivered a child between 2004-2010 [2nd Generation]. A total of 233 infants were born [3rd Generation]. This was further linked to another database of women who had delivered a child in 1987 [1st Generation]. The birth weight of the 2nd and 3rd generations and the pre-pregnancy body mass index (BMI) of the 1st and 2nd generation were registered as was the development of features of the metabolic syndrome in the 1st generation population. The 1st generation population was subdivided into 2 groups based on the BMI: BMI =25 kg/m2 (n=106). The mean birth weights and pre-pregnancy BMI of the subsequent generations were compared using the student t-test. RESULTS: There was no direct transgenerational link between the first generation BMI and third generation birth weight. Rather, birth weight was directly linked to maternal BMI. Furthermore in this study we also studied the presence of metabolic syndrome in first generation mothers. The presence or absence of metabolic syndrome did not cause any statistically significant difference in the birth weight of 2nd and 3rd generations. CONCLUSIONS: This study supports previous reports that environmental factors play a key role in determining fetal birth weight. Identifying women with a higher pre-pregnancy BMI and educating them with regards to dietary modification in order to reduce body weight prior to pregnancy would contribute towards less adverse outcomes to the mother and her child in both the short and the long term.

Global prevalence increase of diabetes type 2 and gestational diabetes (GDM) has led to increased awareness and screening of pregnant women for GDM. Ideally screening for GDM should be done by an oral glucose tolerance test (oGTT), which is laborious and time consuming. A randomized glucose test incorporated with anthropomorphic characteristics may be an appropriate cost-effective combined clinical and biochemical screening protocol for clinical practice as well as cutting down on oGTTs. A retrospective observational study was performed on a randomized sample of pregnant women who required an OGTT during their pregnancy. Biochemical and anthropomorphic data along with obstetric outcomes were statistically analyzed. Backward stepwise logistic regression and receiver operating characteristics curves were used to obtain a suitable predictor for GDM without an oGTT and formulate a screening protocol. Significant GDM predictive variables were fasting blood glucose () and random blood glucose (). Different RBG and FBG cutoff points with anthropomorphic characteristics were compared to carbohydrate metabolic status to diagnose GDM without oGTT, leading to a screening protocol. A screening protocol incorporating IADPSG diagnostic criteria, BMI, and different RBG and FBG criteria would help predict GDM among high-risk populations earlier and reduce the need for oGTT test., peer-reviewed

OBJECTIVE: To study the current legislation and trends in terminations of pregnancy in the European Union (EU).DESIGN: Data were collected on legislation and statistics for terminations of pregnancy.SETTING: Population-based statistics from the EU member states.POPULATION: Women in reproductive age in the 27 EU member states.METHODS: Information on legislation was collected for all 27 EU member states. Statistical information until 2008 was compiled from international (n = 24) and national sources (n = 17). Statistical data were not available for Austria, Cyprus and Luxembourg.MAIN OUTCOMES MEASURES: Terminations of pregnancy per 1000 women aged 15-49 years.RESULTS: Ireland, Malta and Poland have restrictive legislation. Luxembourg permits termination of pregnancy on physical and mental health indications; Cyprus, Finland, and the UK further include socio-economic indications. In all other EU member states termination of pregnancy can be performed in early pregnancy on a women's request. In general, the rates of termination of pregnancy have declined in recent years. In total, 10.3 terminations were reported per 1000 women aged 15-49 years in the EU in 2008. The rate was 12.3/1000 for countries requiring a legal indication for termination, and 11.0/1000 for countries allowing termination on request. Northern Europe (10.9/1000) and Central and Eastern Europe (10.8/1000) had higher rates than Southern Europe (8.9/1000). Northern Europe, however, had substantially higher rates of termination of pregnancy among teenagers.CONCLUSION: A more consistent and coherent reporting of terminations of pregnancy is needed in the EU. The large variation of termination rates between countries suggests that termination of pregnancy rates may be reduced in some countries without restricting women's access to termination. Sexual education and provision of access to reliable and affordable contraception are essential to achieve low rates of termination of pregnancy.

Background: this study was designed to assess the role of lifestyle and nutritional factors in the aetiology of childhood obesity. Methods: the study was carried out among two study populations of children aged 5-years ( n=206) and 9 years of age ( n=230). the children underwent standard anthropomorphic measurements that were correlated to the social status of the family, physical activity habits and nutritional factors. Results: the prevalence of childhood overweight-obesity in 5-year-old Maltese children was 28.8% in boys and 32.7% in girls; 48.9% and 45.1% respectively at 9 years of age. there was no apparent relationship between childhood obesity and the socioeco - nomic status of the family, but a definite statistically significant negative correlation was noted with breastfeeding in the 5-year-old children. the study suggested a possible positive relationship between childhood obesity and an increase mean passive activity time with a corresponding negative association to mean active physical activity and sleeping times. Obese children appeared to be eating more energy-dense food than their counterparts, though there seems to be an attempt to control for the increased weight by reducing the intake of sweets and snacks. Conclusions: the study suggests that the combination of decreased physical activity and increased energy-dense foods may be contributory towards the development of childhood obesity.

Objective: This study aimed to investigate the role of genetic biomarkers in assessing risk for the eventual development of type 2 diabetes mellitus (T2DM). Methods: Three Maltese women with a history of previous severe GDM and with apparent similar clinical risk factors underwent anthropomorphic and metabolic reassessment 4–7 years post-partum. They were further genotyped for four specific genetic single nucleotide polymorphisms (SNPs) using the qPCR technique for the alleles of SLC2A2 (rs5393A/C), FTO (rs9939609A/T), PCK (rs2071023C/G) and CDKAL1 (rs10946398A/C). Results: While the previous obstetric history of all the caseswas similar, the biological statuswas characterized by an increasing degree of obesity correlating to increasing severity of current carbohydrate intolerance. Genotyping showed that all the tested SNPs were homozygous mutant in the T2DM woman and heterozygous in the impaired glucose tolerance woman. The woman with normal glucose tolerance was shown to be wild type for SLC2A2 (rs5393A/C). Conclusions: There appeared to be an interrelationship between eventual severity of carbohydrate metabolism abnormalities and the genetic allele status. It would appear that the specific allele-scoring can be used to identify further the potential risk of developing T2DM., peer-reviewed

Aims: Childhood obesity has seen an alarming increase in recent decades. This study was designed to assess the role of family history and perinatal programming in the aetiology of childhood obesity in a population known to have a high risk of developing metabolic syndrome. Methodology: The study was carried out among two study populations of children. The first was a population of 206 mixed-gender 5-year-old children; the second of 230 mixed-gender 9-year-old children. The children underwent standard anthropomorphic measurements that were correlated to family history of metabolic syndrome-related illness, the child’s birth weight and a history of breastfeeding in early infant life. Results: No statistically significant correlation was noted with a family history of metabolic syndrome; but a definite (P = 0.04) negative correlation was noted with breastfeeding in the 5-year-old children. Children of low birth weight appeared to retain a lower body weight at five years of age than their higher birth weight counterparts (P = 0.002). The pattern changed to suggest a U-shaped distribution of obesity among the various birth weight groups of children, though statistical significance was noted only for the macrosomic group (P = 0.002). Conclusions: The study confirms the importance of intrauterine and early infant nutrition towards the development of childhood and later obesity. Children of low or high birth weight should be considered at risk and parents are advised actively regarding health lifestyle and nutrition options., peer-reviewed

In the last decade the Maltese population has seen an influx of overseas-born individuals. This has been largely due to Malta’s access to the European Union and the increased intake of refugee immigrants. These immigration trends have resulted in changes in population composition, with the overseas-born population increasing from 17,740 (4.7%) in 1995 to 24,560 (6.1%) in 2005. There has also been an increase in the proportion of births registered in Malta to overseas citizens, including citizens of non-EU Europe (1.1%); the African continent (1.5%); America (0.3%); and Asia (0.8%). About ten per cent of marriages in Malta are between a Maltese spouse and a foreigner. The data suggest that the Maltese population is slowly becoming more cosmopolitan, a trend that is gradually changing the ethnic composition of the Maltese community.

Conjoined twinning is a relatively rare event in any community, with a rate of 1.58 per 100,000 maternities reported in the EUROCAT database. The present study reviews the historical records for conjoined twins born in a closed Central Mediterranean archipelago population with particular reference to the last three decades. While the natural monozygotic twinning rates in the Maltese Islands corresponds to that reported from other communities, the incidence of conjoined twinning in the Maltese Islands has been shown by the present study to be significantly 2.5-times higher than that reported by the remaining EUROCAT contributors. The rate reported from the Maltese Islands by this review is 3.98 per 100,000 maternities.

The Maltese population traditionally harbours Roman Catholic beliefs that have been gradually secularised. The present study sets out to quantify the consequences of more liberal sexual attitudes in this community.We reviewed the reproductive and sexual health indicators reported from Malta and from other selected European countries. We then analysed the findings of a questionnaire study which was carried out among 200 Maltese and 2200 other European individuals to investigate various aspects of their sexual history.A greater proportion of Maltese births occur in teenagers but the out-of-wedlock maternity rate in Malta appears to be the third lowest in Europe. However, the rate appears to have nearly trebled over seven years. Sexually transmitted infections rates in Maltese are either similar to or lower than those reported from the other European countries. The Maltese reported a higher mean age at first intercourse and a lower mean number of sexual partners mainly in women aged over 35 years. They received an earlier sexual education but they still predominantly resorted to unreliable contraception methods at their first sexual encounter.The study confirms that sexual behaviour has changed. The educational support to deal with these altered practices is in place but still needs to be reinforced.

Prematurity remains one of the main causes of neonatal mortality and morbidity even in countries that have welldeveloped comprehensive maternity and neonatal services. Objective: A review of the epidemiology and the short-term complications arising from natural or iatrogenic prematurity in modern practice is necessary to assess the true import of this obstetric complication. Methodology: All deliveries with known gestational age at delivery in the Maltese Islands during the period 1999–2006 were included in the study (23,073 maternities with a total of 23,422 births). These maternities included a total of 1279 delivered at a documented 36 or less completed weeks of gestation. Results: During the period under review the prematurity rate amounted to 6.2% of all maternities. Iatrogrenic-induced births accounted for 33.9% of the total. A premature birth was statistically more likely to occur in women at their extremes of reproductive life ( 17 years: OR = 1.16; or 30 years: OR = 1.44: p < 0.0001), or who gave a history of multiparity (Para 3+: OR = 1.56: p = 0.008) or previous recurrent miscarriage (OR = 1.79: p = 0.008) or fetal loss (OR = 3.17: p < 0.0001). The current pregnancy was statistically more likely to be a multiple pregnancy (OR = 13.52: p < 0.0001) or be complicated by hypertension (OR = 2.62: p < 0.0001), pre-existing (OR = 7.50: p < 0.0001) or gestational (OR = 2.4: p < 0.0001) diabetes, or antenatal bleeding (OR = 9.22: p < 0.0001). Premature births were statistically more likely to deliver by Caesarean section (OR = 2.13: p < 0.0001). The stillbirth and neonatal mortality is significantly higher (OR = 73.0: p < 0.0001) in premature births; while the premature infant is very much more likely to require resuscitation and life support interventions (low 5 min Apgar score: OR = 36.5: p < 0.0001). The neonatal period of the premature infant is fraught with risks of significant serious complications such as respiratory distress syndrome (OR = 9.14: p < 0.0001), hyperbilirubinaemia (OR = 16.0: p < 0.0001) and sepsis (OR = 16.0: p < 0.0001). Conclusions: The short-term morto-morbidity and the long-term morbidity associated with preterm births necessitates a determined drive to identify those pregnant women at risk so that proactive intervention management can be instituted.

Background: The incidence rates of cervical carcinoma are closely associated with the degree of promiscuous sexu- ality experienced by a population. Methods: The study reviews the registered incidence and mortality data of this malignancy in the Maltese population and relates the observed trends to the increasing sexual promiscuity and HPV infections experienced by the population. Results: The observed recent fall in malignancy rates have been offset by an apparent rise in premalignant conditions identi- fied by the cervical screening program in force on the Islands. Much of the observed rise in premalignant conditions appears to be related to the influence of HPV cervical infection. Conclusions: Strict vigilance to identify potentially malignant conditions and institute timely treatment remains the corner- stone for maintaining control of this disease. The introduction of protective vaccines against HPV should serve to reduce the size of the problem further.

An essential element in achieving a successful birth process is the size of the infant and its relationship to the birth canal. The maternal anthropomorphic characteristics of height and weight are determinant in establishing birth canal adequacy and infant size. The present study assesses the risk element of these two factors on obstetric performance in a Mediterranean population characterised by a relatively short stature and a high prevalence of the Metabolic Syndrome. Obese women have been shown to have pregnancies which are more likely to be complicated by hypertension and diabetes when compared to their leaner counterparts. They were more likely to be delivered by Caesarean section and vaginal delivery was more likely to be complicated by shoulder dystocia. The infants born to these mothers were heavier and were more likely to suffer from respiratory distress in the neonatal period. The short stature woman similarly had a greater likelihood of requiring Caesarean delivery in spite of having a tendency to infants with smaller birth weights than their taller counterparts. The study confirms that the maternal body habitus remains an obstetric risk consideration that needs to be addressed when deciding on management of delivery.

The interplay of various nutrients provided to the developing foetus determines the growth potential of the conceptus. This study assessed the inter-relationship between these nutrients in a Mediterranean population including 1062 pregnant, previously non-diabetic women. These underwent an oral glucose tolerance test (oGTT) and were accordingly classified into gestational hyperglycaemic and normoglycaemic groups. Fasting insulin, HbA1c, and lipid profiles were further assessed, and the anthropomorphic characteristics of the mother and child at birth were measured. Lipid profiles were compared between the two groups and related to the biological characteristics of the mother and child at birth. Gestational hyperglycaemia was significantly associated with elevated triglycerides (P

Screening and diagnostic criteria for gestational diabetes (GDM) are inconsistent across Europe, and the development of a uniform GDM screening strategy is necessary. Such a strategy would create opportunities for more women to receive timely treatment for GDM. Developing a consensus on screening for GDM in Europe is challenging, as populations are diverse and healthcare delivery systems also differ. The European Board & College of Obstetrics and Gynaecology (EBCOG) has responded to this challenge by appointing a steering committee, including members of the EBCOG and the Diabetic Pregnancy Study Group (DPSG) associated with the EASD, to develop a proposal for the use of uniform diagnostic criteria for GDM in Europe. A proposal has been developed and has now been approved by the Council of the EBCOG. The current proposal is to screen for overt diabetes at the first prenatal contact using cut-off values for diabetes outside pregnancy, with particular efforts made to screen high-risk groups. When screening for GDM is performed at 24 weeks' gestation or later, the proposal is now to use the 75 g OGTT with the new WHO diagnostic criteria for GDM. However, more research is necessary to evaluate the best GDM screening strategy for different populations in Europe. Therefore, no clear recommendation has been made on whether a universal one-step, two-step or a risk-factor-based screening approach should be used. The use of the same WHO diagnostic GDM criteria across Europe will be an important step towards uniformity.

The problem of childhood adiposity has reached epidemic proportions in many parts of the world and has become a public health challenge. Obesity co-morbidities are expected to increase progressively in line with the recent observed increase in childhood adiposity. Unless a solution is found, adiposity trends will escalate increasing mortality . To date the understanding of why this is happening is rudimentary and it seems that no coherent and effective methods have been developed to overcome this condition. Biological influences, parental influences and societal influences need all to be addressed if childhood adiposity is to be managed appropriately. Effective policies and programmes are needed at both global and national levels in order to address childhood adiposity. In light of these findings this paper explores the literature to provide a comprehensive understanding of the cause and effect in childhood adiposity. This paper also provides recommendations and possible solutions/methods of intervention for what could be considered a National epidemic.

The use of illicit drugs has increased disturbingly in the last decades, this increase being reflected by an increase in the number of female drug abusers who present in the pregnant state. A total of 47 cases of current or past heroine abuse (0.24% of total maternities) were delivered at the Karin Grech Maternity Unit of St. Luke's Teaching Hospital in Malta. The socio-biological characteristics of these women were assessed and compared to similar parameters in the remaining pregnant population. These women have been shown to be generally of a younger age

Any screening programme must be sufficiently cost-effective and applicable to conditions where early intervention can alter the disease progression. Gestational diabetes (GDM) qualifies as a condition amenable to screening since timely intervention can alter the development of short and long-term complications in both the mother and child. While the gold standard for screening remains the 75 g oral glucose tolerance test, it is essential that conformity in diagnostic cut-off criteria is generally agreed upon and should be based on outcome clinical indicators rather than statistical or economic indicators. A clear clinical sub-division classification of GDM based on the severity of the condition also needs to be universally defined. The 2013 WHO guidelines serve to establish a general consensus, though it is accepted that further studies need be performed to confirm some of the proposals.

Epidemiological observations have suggested a relationship between type 2 diabetes and a low or high birth weight. However, there are many confounding variables and problems with retrospective data collection. The study of women with gestational diabetes mellitus (GDM), who are likely to develop type 2 diabetes in the future, may help clarify these observations. Women diagnosed as suffering from GDM (n=162) were included in the study if their own birth weight data were available. The birth-weight distribution of the general population was obtained from published data for the same period. A family history of diabetes prevalence was assessed from medical records for the 162 GDM subjects, and by direct interview of 250 non-diabetic pregnant controls. The birth-weight distribution of women with GDM, when normalized to that of the general population, showed a statistically significant U-shape with a greater proportion of GDM women having low (1000–2000 g) or high (>4500 g) birth weight. Compared to non-diabetic pregnant controls, a statistically higher proportion of GDM women had a maternal family history of diabetes; the mean birth weight of these women was also statistically higher than that of GDM women with no family history of diabetes. No such differences were noted among women with a paternal family history. These data suggest that the intrauterine millieur Interieur, whether one of nutritional deprivation or one of nutritional plenty, results in changes in pancreatic development and peripheral response to insulin that may lead to adult-onset GDM and type 2 diabetes. Genetic predisposition, unless determined by mitrochondrial genetic material, does not apparently have any part in determining birth weight.

This study was carried out to quantify secular trends in seasonal variation in births in Malta, a small Mediterranean country where the vast proportion of births occur in wedlock due to a predominantly Roman Catholic population. It also related such variations to seasonal variation in marriages. Annual seasonal peaks of marriages and births were analysed over the period 1950–1996 by X11 ARIMA. A significant peak in marriages (n=111,932) in the third quarter of the year was found for almost the entire period under study. This was paralleled by a peak in births (n=299,558) for the period 1970–1996, which lagged after the peak in marriages by 13–14 months. For the period 1994–1996, when monthly data for monthly pregnancies were available by pregnancy order, the peak in births was caused by first pregnancies only. Seasonal patterns in births occur almost universally due to cultural and/or biometeorological factors. The best known patterns include those of the southern United States, where births decline in April and May, and in northern Europe, where births peak in March and April. In Malta, the late summer peak in births appears to be due to a practical and planned approach by Maltese couples to contraceptive planning, probably influenced by the Roman Catholic ethos and social pressures, with unprotected intercourse occurring only after marriage. In Malta, birth control, albeit by so-called natural methods, was introduced in the 1960s. Prior to this period, births peaked towards the beginning/end of the year, and this may be the more natural seasonality of births in Malta., peer-reviewed

Syndromic adiposity appears to have a predisposition to run in families suggesting a hereditary element in its transmission. Purely genetic defects and DNA sequence variants have been directly associated with the development of adiposity; however, these account for a very small proportion of cases. A stronger association has been made between the intrauterine and early childhood nutritional environment of the foetus and young child and the predisposition of childhood and subsequent adulthood obesity. The nutritional environments include both a situation of nutritional deprivation or excess working through the interplay of epigenetic changes, and pancreatic and hypothalamic development. This is further compounded by the nutritional and lifestyle attitudes of the particular at-risk family. Adiposity prevention measures must include reenforced intervention strategies stating with lifestyle education schemes during pregnancy followed through until infancy and early childhood especially in those families/individuals identified as being at a risk of developing significant adiposity.

The Mediterranean region is generally characterized by a patriarchal society that generally predisposes towards a higher prevalence of spouse abuse. The prevalence of domestic spouse abuse in a central Mediterranean closed island community was assessed to approximate 11.7% of the pregnant population. The abuse varied from psychological to physical abuse. There was a strong history of experience of domestic violence/abuse during childhood in both the victim and perpetrator suggesting that a “circle of abuse” may play a role in some cases. The socio-biological characteristics of the victim did not appear to statistically predispose towards a higher risk for domestic abuse, though single mothers were statistically more likely to report a history of domestic abuse. Abused women were more likely to smoke cigarettes during pregnancy than their counterparts. The perpetrator was statistically more likely to be unemployed, and smoke cigarettes and drink alcohol. There were no statistical correlation between a history of spouse abuse and educational level attained by both the victim and perpetrator. A history of domestic abuse appears to have an adverse effect on the pregnancy with a higher risk of premature birth and its attendant complications; although it is difficult to ascertain how much the reported poor obstetric outcome is a direct effect of violence itself or to other associated adverse social or biological co-factors. About a third of the women interviewed were unaware of the domestic violence services being offered in their community emphasizing the need of an information drive. The antenatal period, with the distribution of leaflets and antenatal classes, is an opportune time to promote the support services available in the community.