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Children with autism engage in active play in different ways than children who are neurotypical, but their active play behaviors are not well understood. Research with twins and triplets with autism offers a unique opportunity to gain a clear picture of the play behaviors of children with autism because twins and triplets share many similarities (age, access to toys, etc.). Through semistructured interviews, this descriptive phenomenological study aimed to describe the active play behaviors of 19 twins and triplets with autism from the perspective of their parents (N = 9). The interviews revealed two main themes: (a) parents' descriptions of active play and (b) parents' descriptions of social play. The results reveal the diverse active and social play behaviors of twins and triplets with autism; parents described their children's play behavior when engaging in sensory, indoor, outdoor, and organized play. These results suggest that children with autism may be meeting the definition of active play in nontraditional ways. [ABSTRACT FROM AUTHOR]

Background: Motherhood has been associated with reduced leisure-time physical activity (LTPA) levels. We aim to assess maternal LTPA patterns from preconception to 4 years postpartum. Methods: The study was developed with mothers from the Pelotas 2015 Birth Cohort, Southern Brazil (n = 4273). LTPA data were self-reported for preconception, antenatal, and 3, 12, 24, and 48 months postpartum. Information on LTPA referring to preconception (3 mo before pregnancy) and each gestational trimester was retrospectively collected in perinatal. The prevalence of active mothers was calculated according to recommendations (≥150 min/wk). We described changes in LTPA between follow-ups and estimated the probability of mothers being active according to previous LTPA. We used group-based trajectory analysis to identify patterns of LTPA throughout the follow-ups. Results: The prevalence of active mothers during leisure time decreased in pregnancy and postpartum compared with preconception. At 12 months postpartum, LTPA levels rose again, but at 48 months, the rates of active mothers still had not returned to preconception levels. Prior LTPA engagement was an important determinant of the maintenance of LTPA. Trajectory analysis identified 4 patterns of maternal LTPA, and ∼80% of mothers were allocated to the "always inactive" group. Higher education and income, working outside the home, multiple births, and participating in the PAMELA study intervention were associated with a higher probability of mothers not being included in this predominantly inactive group. Conclusions: Motherhood is associated with declining rates of women meeting physical activity recommendations during pregnancy and early postpartum. [ABSTRACT FROM AUTHOR]

Many clinical trials involve partially clustered data, where some observations belong to a cluster and others can be considered independent. For example, neonatal trials may include infants from single or multiple births. Sample size and analysis methods for these trials have received limited attention. A simulation study was conducted to (1) assess whether existing power formulas based on generalized estimating equations (GEEs) provide an adequate approximation to the power achieved by mixed effects models, and (2) compare the performance of mixed models vs GEEs in estimating the effect of treatment on a continuous outcome. We considered clusters that exist prior to randomization with a maximum cluster size of 2, three methods of randomizing the clustered observations, and simulated datasets with uninformative cluster size and the sample size required to achieve 80% power according to GEE‐based formulas with an independence or exchangeable working correlation structure. The empirical power of the mixed model approach was close to the nominal level when sample size was calculated using the exchangeable GEE formula, but was often too high when the sample size was based on the independence GEE formula. The independence GEE always converged and performed well in all scenarios. Performance of the exchangeable GEE and mixed model was also acceptable under cluster randomization, though under‐coverage and inflated type I error rates could occur with other methods of randomization. Analysis of partially clustered trials using GEEs with an independence working correlation structure may be preferred to avoid the limitations of mixed models and exchangeable GEEs. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Parents of twins appear to be at increased risk of postpartum depression (PPD), yet little is known about the magnitude and timing of onset in the postpartum period compared to singleton parents.We conducted a cohort study using the Danish nationwide health registers. We defined a study population of parents that is, mothers and fathers of all twin and singleton livebirths between 1997 and 2019. Postpartum depression was defined as incident depression diagnosis or a redeemed antidepressant prescription from childbirth through 365 days postpartum. We performed a parametric time‐to‐event analysis based on Poisson regression. The time scale was time since birth, modeled using restricted cubic splines. From this we estimated the hazard ratio (HR) representing the momentary risk, and the cumulative risk ratio (RR) over the first year postpartum, in twin compared to singleton parents.The study population was based on 27,095 twin and 1,350,046 singleton births. In adjusted analyses, the HR of twins compared to singletons was highest around 2 months postpartum (HR 1.28, 95% CI 1.10–1.49) for mothers, and around 6 months (1.20, 95% CI 1.02–1.42) for fathers. The 6 months adjusted cumulative RR of PPD in twins compared to singletons was 1.24 (95% CI 1.10–1.40) for mothers and 1.11 (95% CI 0.95–1.30) for fathers.Twin mothers had increased risk of PPD compared to singleton mothers, which was driven by an immediate increase after childbirth. The risk among twin fathers was not increased immediately after childbirth, but we found slightly elevated risk around 6 months postpartum. This could suggest diverse patterns of PPD symptomatology in twin parents compared to singleton parents and between mothers and fathers. Our findings underline parents of twins as a potentially vulnerable group to PPD and emphasize the need for increased awareness of their mental health. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods Results Conclusion The COVID‐19 pandemic has posed substantial social and economic disruptions that may have had adverse effects on maternal and infant health. This study examines the changes in birth outcomes and prenatal care use during the COVID‐19 pandemic in 2020 and 2021 compared to pre‐pandemic years.Data come from birth certificates from the U.S. Vital Statistics Natality Files. The analytical sample includes 18,678,327 births in the 50 states and Washington, DC between 2017 and 2021. An event study is employed to examine changes in multiple birth outcomes and prenatal care use over years adjusting for demographic/socioeconomic characteristics and state of residence.There were very small changes in birth outcomes during pandemic years in 2020 and 2021. Specifically, low birth weight odds were lower in 2020 (OR = 0.99; 95 CI: 0.98–0.99) but higher in 2021 (OR = 1.03; 95% CI: 1.03–1.04) compared to 2019. C‐section odds were higher in 2021 (OR = 1.01, 95% CI: 1.002–1.008) than in 2019. The mean number of prenatal visits in both 2020 and 2021 relative to 2019 was lower by about 0.3 visits (95% CI: −0.31 to −0.30 in 2021).Overall, there is no evidence of broad pandemic effects on low birth weight and preterm birth in 2020–2021. [ABSTRACT FROM AUTHOR]

In recent decades, the use of assisted reproductive technology (ART) has increased rapidly. To assess the relationship between ART and autism diagnosis, we linked California birth records from 2000 through 2016 with contemporaneous records from the National ART Surveillance System (NASS) and autism caseload records from California's Department of Developmental Services from 2000 through November 2019. All 95 149 birth records that were successfully linked to a NASS record, indicating an ART birth, were matched 1:1 using propensity scores to non-ART births. We calculated the hazard risk ratio for autism diagnosis and the proportions of the relationship between ART conception and autism diagnosis mediated by multiple birth pregnancy and related birth complications. The hazard risk ratio for autism diagnosis following ART compared with non-ART conception is 1.26 (95% CI, 1.17-1.35). Multiple birth, preterm birth, and cesarean delivery jointly mediate 77.9% of the relationship between ART conception and autism diagnosis. Thus, increased use of single embryo transfer in the United States to reduce multiple births and related birth complications may be a strategy to address the risk of autism diagnosis among ART-conceived children. [ABSTRACT FROM AUTHOR]

Objectives: To study the possible associations between advanced maternal age and cesarean section(CS) under the two child policy. Methods: This study used a cohort study from Dongguan People's Hospital in Guangdong Province, China from 2017 to 2020. The cohort was restricted to women aged ≥ 20 who give birth to babies with a gestational age of > 28 weeks and a weight of > 1000 g. Divide the advanced maternal age (AMA) pregnant women into two age groups: 35–39 years old and 40 years old or older age. We analyzed CS rate and CS contribution using the modified Robson classification system. Frequency of cesarean was determined for each group and compared by using χ2 and prevalence ratio. Results: Overall, 47654 women were included, of which 7924 (16.63%) were between the ages of 35 and 39, and 1529 (3.21%) were aged 40 or older. The total CS rate is 40.64%, with 36.10% for mothers aged 20 to 34, 57.90% for women aged 35 to 40, and 64.75% for women aged 40 or older age. In the AMA groups (n = 9453), Robson group 2' was the most common, followed by groups 5 and 10. Women at 40 years or older age were 3 times more likely to undergo a cesarean delivery in Robson group 1', and 1.76 times more likely in group 10. The CS rate in group 2' were statistically significantly higher in the very AMA group. Conclusions: The CS rates increased noticeably with maternal age under the two child policy. Based on the modified Robson classification system, AMA women should pay more attention to primiparous women with single pregnancy, uterine scars, and premature birth in multiple pregnancies. [ABSTRACT FROM AUTHOR]

Multiple births strain mothers' and families' resources in ways that should highlight preferences for family size, birth spacing, and parity-dependent stopping behavior. Couples with surviving twins reach their target family size sooner than other couples and should be more likely to practice family limitation. Twins are also a greater burden on the mother's time and health, which could lead to postponing the next birth, even among couples who want additional children. We examine these hypotheses by analyzing families with twins in the 1900 and 1910 U.S. Censuses. Using reconstructed birth histories for more than 7 million women in the IPUMS full-count 1900 and 1910 datasets and event-history methods (Kaplan–Meier curves, cure models), we find clear evidence of family limitation following a multiple birth. Couples who had twins or triplets were more likely to stop childbearing, and those who continued having children delayed their next birth. Responses to multiple births were larger in groups previously identified as leaders in the transition to smaller families, and roughly one third of couples stopped after one or two children. We find no evidence that some groups relied primarily on birth spacing to reduce family size while others relied primarily on stopping. [ABSTRACT FROM AUTHOR]

Background: Bottle feeding should be avoided since it interferes with optimal breastfeeding and it causes diarrheal-related morbidity and mortality. Despite the WHO's recommendation that children to avoid bottle feeding, it is still widely practiced in developing countries including our country, Ethiopia. Therefore, this study aimed to assess the spatial variations, and determinants of bottle feeding among children aged 0–23 months using the recent demographic and health survey data for Ethiopia. Methods: A secondary data analysis was conducted using the 2019 Ethiopian mini demographic and health survey data. The total weighted sample of 2067 children aged 0–23 months was included in this study. Spatial analysis was done to identify the hotspot areas of bottle feeding among children in Ethiopia. Multivariable multilevel logistic regression was used to identify predictors of bottle feeding. The spatial analysis was done using ArcGIS 10.7 and Sat Scan 9.6 software. Result: The prevalence of bottle feeding among children aged 0–23 months was 21.52% with 95% CI(19.80%, 23.34%). Age of the child from 6–11 months, and 12–23 months age, having secondary and above education [AOR = 2.09; 95%CI; 1.31, 3.32], being from middle and rich household [AOR = 2.14; 95%CI; 1.37, 3.34] and [AOR = 2.30; 95%CI; 1.46, 3.63], and twin birth [AOR = 8.06; 95%CI; 2.87, 22.58] were significant predictors of bottle feeding. Hotspot areas of bottle feeding were observed in Addis Ababa, Dire Dawa, Harari, and Afar regions of Ethiopia. Conclusion: Bottle feeding practice was found to be spatially clustered in Ethiopia. Education, wealth index, parity, and child's age were significant predictors of bottle feeding. Hotspot areas of bottle feeding were observed in Addis Ababa, Dire Dawa, Harari, and Afar regions. Special attention should be directed towards mothers residing in hotspot areas, educated mothers, mothers of multiple births, and mothers from rich households through community education programs focused on child feeding practices to reduce the practice of bottle-feeding in Ethiopia. [ABSTRACT FROM AUTHOR]

Ovulation rate in many mammalian species is controlled to regulate the numbers of offspring and maximise reproductive success. Pathways that regulate ovulation rate still respond to genetic and environmental factors and show considerable variation within and between species. Genetic segregation, positional cloning, and association studies have discovered numerous mutations and genetic risk factors that contribute to this variation. Notable among the discoveries has been the role of mutations in bone morphogenetic protein 15 (BMP15), growth differentiation factor 9 (GDF9) and bone morphogenetic protein receptor type 1B (BMPR1B) from the intra-ovarian signalling pathway contributing to the evidence that signalling from the oocyte is the key driver in follicle regulation rather than circulating gonadotrophin concentrations. Multiple variants in different domains of BMP15 and GDF9 result in partial or complete loss of function of the proteins providing insights into their functional roles and differential regulation contributing to species differences in ovulation rate. Early success encouraged many more studies in prolific strains of sheep, cattle and goats providing a valuable catalogue of genetic variants of large effect increasing ovulation rate and litter size. More recently, genetic association studies are beginning to identify genetic risk factors with smaller effects. Most genes implicated are from pathways with defined roles in regulation of the ovarian function. However, some genomic regions suggest regulation by novel genes. Continuing genetic and related functional studies will add further to our understanding of the detailed regulation of ovulation rate and litter size with implications for health and animal production systems. Genetic studies have discovered multiple mutations and genetic risk factors that have helped to understand how ovulation rate is controlled in low ovulating species to regulate the numbers of offspring and maximise reproductive success. Most genes identified are from pathways with defined roles in regulation of the ovarian follicle development. Continued genetic studies can continue to improve detailed understanding of the regulation of ovulation rate and litter size with implications for health and animal production systems. Image by G. W. Montgomery. This article belongs to the Collection The biology of the ovary – Honouring the contributions of Ken P McNatty and Rex J Scaramuzzi. [ABSTRACT FROM AUTHOR]

The main purpose of this paper is to consider the multiple birth properties for multi-type Markov branching processes. We first construct a new multi-dimensional Markov process based on the multi-type Markov branching process, which can reveal the multiple birth characteristics. Then the joint probability distribution of multiple birth of multi-type Markov branching process until any time t is obtained by using the new process. Furthermore, the probability distribution of multiple birth until the extinction of the process is also given. [ABSTRACT FROM AUTHOR]

Purpose: Multifetal gestation (MFG) is much more common in pregnancies that utilize assisted reproductive technologies (ART). We assessed how these rates have changed over the previous decade and the impact on live birth rates (LBR). Methods: This retrospective cohort study uses the National Summary Reports of the Society for Assisted Reproductive Technology (SART) from 2014 to 2020. Data points included only autologous cycles. The data were divided into five age groups as reported in the database: < 35, 35–37, 38–40, 41–42, and > 42 years old. Descriptive statistics and a two-tailed T-test were used to determine the trends and statistical significance (p < 0.05). Results: Rates of twin births decreased substantially from 2014 to 2020 for autologous embryo transfers across all age groups and diagnoses. Surprisingly, the overall LBR for autologous IVF cycles decreased at similar rates from 2014 to 2020 in all age groups. The mean number of embryos transferred has dramatically reduced, especially across age groups < 42. Conclusion: Rates of twin and higher-level gestations have decreased substantially over the past decade; the effect correlates with the increased utilization of eSET and PGT. The cause of infertility did not significantly impact the rate of MFG. [ABSTRACT FROM AUTHOR]

• The use of medically assisted reproduction (MAR) has been associated with higher rates of multiple pregnancy. This is due to the use of fertility drugs to stimulate the ovaries, resulting in the release of multiple eggs during a single menstrual cycle, as well as the transfer of multiple embryos. • Changes in IVF procedure strategies, such as single embryo transfer, have contributed significantly to the decline in multiple pregnancies. However, the percentage of multiple pregnancies resulting from first line treatments has remained relatively constant over time. • Despite declining, multiple births resulting from MAR remained about one order of magnitude higher than those resulting from spontaneous pregnancies. Further efforts are needed to reduce multiple pregnancies in infertility treatment. To evaluate the relative impact of different strategies of medically assisted reproduction (MAR), i.e. first line treatment (ovarian stimulation with or without intrauterine insemination) and in vitro fertilization (IVF) procedures (conventional IVF or intracytoplasmic sperm injection), on the risk of multiple births. We utilized the health care utilization databases of the Lombardy region to identify births resulting from MAR between 2007 and 2022. We gathered data on the total number of multiple births and calculated the prevalence rate by dividing the number of multiples by the total number of births. To examine the temporal trend in the proportion of multiple births after MAR over time, a linear regression model was employed separately for different types of techniques and in strata of maternal age. A total of 30,900 births after MAR were included; 4485 (14.5 %) first line treatments and 26,415 (85.5 %) IVF techniques. Overall, 4823 (15.6 %) multiple births were identified. The frequency of multiple births over the study period decreased from 22.0 % in 2007 to 8.7 % in 2022 (p < 0.01). Multiple births from first line treatments were stable ranging from 13.5 % in 2007–2008 to 12.0 % in 2021–2022 (p = 0.29). Multiple births from IVF procedures decreased from 23.8 % in 2007–2008 to 8.4 % in 2021–2022 (p < 0.01). Stratifying for maternal age (i.e. < 35 and ≥ 35 years), the trends remained consistent. The reduction in multiple births has been influenced by changes in IVF strategy and procedures. The decline has been gradual but steady since 2009, when a law restricting embryo freezing was repealed in Italy. In contrast, the proportion of multiple births resulting from first line treatments has remained constant over time. Despite declining, multiple births from MAR remained about one order of magnitude higher than those from spontaneous pregnancies. [ABSTRACT FROM AUTHOR]

A significant rise in the use of assisted reproductive technology (ART) has been observed, but concerns about its impact on neonatal outcomes have been considered. The aim of this retrospective cohort study is to determine the association between ART and the risk of neonatal complications and congenital anomalies within a recent time period. This retrospective study enrolled infants born after 20 weeks of gestation at a tertiary hospital in Taiwan between January 2019 and December 2021. The study population was divided into two groups: (1) ART pregnancy group and (2) natural pregnancy group. Maternal and neonatal characteristics, pregnancy complications, and neonatal outcomes were compared between the two groups. Multivariate logistic regression was used to adjust for maternal characteristics, preexisting maternal conditions, pregnancy complications, delivery methods, and infant characteristics. This study enrolled 1770 infants comprising 289 in the ART pregnancy group and 1481 in the natural pregnancy group. The ART pregnancy group showed higher rates of multiple births, preterm births, low birth weights, and longer hospitalization periods. In the stratified analyses that were conducted on singleton births, no significant difference was observed. In the case of multiple births, lower rates of preterm birth, low birth weight, and respiratory support were observed in the ART pregnancy group. After adjusting for maternal and infant characteristics, ART was not considered a significant risk factor for adverse neonatal outcomes, including mortality, complications, and congenital anomalies. Although ART pregnancies were more likely to result in multiple births and furthermore adverse outcomes, ART itself was not associated with an increased risk of poor neonatal outcomes. By implementing measures to control the number of implanted embryos, ensuring appropriate prenatal screening, and providing comprehensive postnatal care, the risks associated with increased multiple pregnancies caused by ART may be reduced. [ABSTRACT FROM AUTHOR]

Litter size plays an essential role in mammalian evolution and is one of the most important factors determining whether an organism is deemed to have a 'slow' or 'fast' life history strategy. Humans are distinct in being classified as having slow life history yet bearing singletons who have completed relatively less growth than other ape neonates. Previous work has proposed that the ancestral primate gave birth to singletons. However, primate litter size has not yet been contextualized within a broad phylogenetic assessment of mammalian life history. We performed a comprehensive investigation of primate litter size using life history data for 155 primate species, and litter size data for an additional 791 boreoeutherian mammals. Litter size and life history traits have strong phylogenetic signal in primates (Pagel's lambda: 0.99, p < 0.001; Blomberg's K: 0.6311. p < 0.001), and litter size is significantly negatively correlated with gestation length (p < 0.001). Our data support that the last common ancestors of both primates and Haplorhini gave birth to multiples (litter size 1.7 and 1.6, respectively). We also find that singleton-bearing pregnancies evolved convergently in multiple primate lineages, including tarsiers and other haplorhines. This study contributes significantly to our understanding of life history and litter size in mammals, and we emphasize the utility of a callitrichid model for investigating the evolution of human reproduction. [ABSTRACT FROM AUTHOR]

Abstract The main purpose of this paper is to consider the multiple birth properties for multi-type Markov branching processes. We first construct a new multi-dimensional Markov process based on the multi-type Markov branching process, which can reveal the multiple birth characteristics. Then the joint probability distribution of multiple birth of multi-type Markov branching process until any time t is obtained by using the new process. Furthermore, the probability distribution of multiple birth until the extinction of the process is also given.

Small ruminants bring unproductive pastures to the economy with products such as meat and milk. Although the management of Hair goats is difficult compared to that of sheep, they make better use of unproductive pastures than sheep. The birth rate of Hair goats is high, but the multiple birth rate is quite low. This study aimed to determine the relationship between the antioxidant paraoxonase-1 (PON-1), and the offspring yield in Hair goats. In the second week of September, 100 females were randomly selected and blood samples were taken 15 days before the introduction of male goats to the herd from both males and females. Blood was taken from the same animals again before starting milking in May. Paraoxonase-1 values were found to be low and significantly different in both sexes in October compared to May. There was a statistical difference (P≤0.05) in PON-1 level in terms of gender and birth type. The PON-1 level of Hair goats that gave birth to twins was like that of male goats and goats with single birth, while it was insignificant between single-birth and infertile goats. It was found that a low PON-1 value was associated with low fertility whereas twin births were closely related to high value of PON-1. PON-1 was found to be important for multiple births (P≤0.05). As a result, it was concluded that the PON-1 level increased the birth rate and offspring yield in Hair goats. [ABSTRACT FROM AUTHOR]

Abstract Background The experiences and challenges associated with breastfeeding multiple births can be considerably more complex than those of singletons. Multiple births refer to the delivery of more than one offspring in a single birth event. Emphasizing the needs and experiences of mothers with multiple births during breastfeeding can enable healthcare providers to design targeted interventions that enhance breastfeeding rates. However, existing breastfeeding and health education resources and practices do not fully meet the needs of women who breastfeed multiples. This review aimed to review and synthesize qualitative studies on the breastfeeding experiences of women with multiple births. Methods A systematic search was conducted in 10 electronic databases for papers published from the inception of the database to March 2024. The Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research was utilized to evaluate the methodological quality of the studies included. The thematic synthesis method of Thomas and Harden was employed to integrate and analyze the included literature to derive new categories and conclusions. Findings Eight studies met the inclusion criteria and quality assessment criteria for this study. Through the integration of their results, four themes were identified: the choice and willingness to breastfeed multiple births; the challenges of breastfeeding multiple births; stage management and individualised adaptation of breastfeeding; and the experience of support. Conclusion Throughout the feeding process from pregnancy to the postpartum period, mothers with multiple births often have predominantly negative experiences with breastfeeding. Consequently, hospitals should create a multidisciplinary follow-up team comprising obstetrics, neonatology, psychology, and community services to offer specialized and personalized support to these women at various stages. Systematic review registration [ https://www.crd.york.ac.uk/PROSPERO/ ], identifier [PROSPERO 2024 CRD42024520348].

Background: Cesarean Section (CS) is the most popular surgery worldwide in obstetric care to save a mother's or the fetus's life. The prevalence of CS delivery in Ethiopia was 0.7% and 1.9% in 2000 and 2016 respectively and its spatial distribution and variation in Ethiopia are limited. This study provides evidence for healthcare providers and pregnant women on the national CS geospatial distribution and variation to promote evidence-based decision-making and improve maternal and neonatal outcomes. Therefore, this study aimed to determine geospatial patterns and individual and community-level factors of CS deliveries in Ethiopia. Method: A secondary data analysis of 5,527 weighted samples of mothers using the 2019 Ethiopian mini demographic and health survey was conducted. The spatial hotspot analysis using Getis-Ord Gi* hot spot analysis of ArcGIS version 10.7.1 was used to show the spatial cluster of CS and multilevel mixed effect logistic regression analyses were employed. Statistical significance was declared at p-value <0.05 and adjusted odds ratio (AOR) with 95% confidence interval (CI) was reported. Result: The prevalence of CS delivery in Ethiopia was 5.4% with 95%CI (4.6%, 6.4%). The spatial autocorrelation shows CS was clustered in Ethiopia (global Moran's index = 1.009, and p-value<0.001). Spatial hotspot indicates CS was prevalent in Addis Ababa, Diredewa, Oromo, and Somali regions. The odds of CS delivery were higher among mothers aged 24–35: AOR = 1.98, 95% CI (1.3, 3.1), and 35–49: AOR = 3.7, 95% CI(2.2, 6.1), live with female household heads: AOR = 1.9, 95% CI (1.2, 3.1), mothers with primary AOR = 1.6, 95% CI (1.07, 2.7), secondary: AOR = 2.4, 95% CI (1.3, 4.25) and higher education: AOR = 2.06, 95% CI (1.03, 4.2), multiple births: AOR = 8.1, 95% CI (3.4, 19.74), mothers in Addis Ababa: AOR = 3.4, 95% CI (1.1, 11.9) and Diredewa: AOR = 7, 95% CI (1.23, 40.7) as compared to their counterparts. Conclusion: In Ethiopia, CS deliveries remain below the World Health Organization estimate with distinct geospatial variation. Geographically, CS delivery is concentrated in urban areas like Addis Ababa and Diredewa, as well as in parts of the Somali and Oromia regions. Maternal age, female household head, Muslim religion, higher educational status, and multiple births at the individual level, and region at the community level were factors of CS delivery in Ethiopia. Therefore, efforts should be geared towards strategies and interventions to ensure fair access to CS delivery in line with WHO recommendations, especially in the regions where the CS delivery rate is below WHO estimates in Tigray, Amhara, Afar, and Benishangul Gumze regions. [ABSTRACT FROM AUTHOR]

Objective To understand the prevalence and trend incidence of neural tube defects (NTDs) in Chongqing from 2007 to 2022, and to provide evidence for comprehensive prevention and control measures. Methods Based on hospital monitoring data, 185 children with NTDs monitored by all birth defects monitoring institutions in Chongqing City from January 2007 to December 2022 were included in the study. They were grouped by year, perinatal gender, maternal permanent residence (urban/rural), maternal age, different regions, and other categories. Chisquare test was used to analyze the differences in the incidence of severe multiple disabling birth defects in different categories, and linear trend test and Joinpoint regression model were used to analyze the change trend. Results From 2007 to 2022, a total of 1 316 934 perinatal births and 185 NTDs were monitored in Chongqing, with an incidence of 1.40/10,000, it was 0.36/10 000(0. 00/10 000 - 2. 45/10 000), 0. 81/10 000(0. 39/10 000 - 2. 42/10 000) and 0. 26/10 000(0. 00/10 000 - 2. 45/10 000) for anencephaly, spina bifidaand encephalocele respectively. The incidence in rural areas was higher than in urban areas (χ² = 11. 38, P < 0. 001). The total incidence of mothers of different age was statistical (χ² = 81.71, P <0.001). The annual incidence of NTDs decreased by 84. 64% from 2. 93/10,000 to 0. 45/10, 000 during this period. There was a gentle decline from 2007 to 2019 (APC = - 10. 85) and a rapid decline from 2019 to 2022 (APC = - 31. 20). Conclusion Annual incidence of NTDs in Chongqing was decreasing over the year. NTDs is prevalent at a low level in Chongqing. [ABSTRACT FROM AUTHOR]

Background: The MACF1 gene, found on chromosome 1p34.3, is vital for controlling cytoskeleton dynamics, cell movement, growth, and differentiation. It consists of 101 exons, spanning over 270 kb. The 16p13.11 microduplication syndrome results from the duplication of 16p13.11 chromosome copies and is associated with various neurodevelopmental and physiological abnormalities. Both MACF1 and 16p13.11 microduplication have significant impacts on neural development, potentially leading to nerve damage or neurological diseases. This study presents a unique case of a patient simultaneously experiencing a de novo MACF1 mutation and a hereditary 16p13.11 microduplication, which has not been reported previously. Case presentation: In this report, we describe a Chinese preterm newborn girl exhibiting the typical characteristics of 16.13.11 microduplication syndrome. These features include developmental delay, respiratory issues, feeding problems, muscle weakness, excessive joint movement, and multiple congenital abnormalities. Through whole-exome sequencing, we identified a disease-causing mutation in the MACF1 gene (c.15266T > C / p. Met5089Thr). Additionally, after microarray analysis, we confirmed the presence of a 16p13.11 microduplication (chr16:14,916,289 − 16,315,688), which was inherited from the mother. Conclusions: The patient's clinical presentation, marked by muscle weakness and multiple birth defects, may be attributed to both the de novo MACF1 mutation and the 16p13.11 duplication, which could have further amplified her severe symptoms. Genetic testing for individuals with complex clinical manifestations can offer valuable insights for diagnosis and serve as a reference for genetic counseling for both patients and their families. [ABSTRACT FROM AUTHOR]

Background: Childhood stunting is a major indicator of child malnutrition and a focus area of Global Nutrition Targets for 2025 and Sustainable Development Goals. Risk factors for childhood stunting are well studied and well known and could be used in a risk prediction model for assessing whether a child is stunted or not. However, the selection of child stunting predictor variables is a critical step in the development and performance of any such prediction model. This paper compares the performance of child stunting diagnostic predictive models based on predictor variables selected using a set of variable selection methods. Methods: Firstly, we conducted a subjective review of the literature to identify determinants of child stunting in Sub-Saharan Africa. Secondly, a multivariate logistic regression model of child stunting was fitted using the identified predictors on stunting data among children aged 0–59 months in the Malawi Demographic Health Survey (MDHS 2015–16) data. Thirdly, several reduced multivariable logistic regression models were fitted depending on the predictor variables selected using seven variable selection algorithms, namely backward, forward, stepwise, random forest, Least Absolute Shrinkage and Selection Operator (LASSO), and judgmental. Lastly, for each reduced model, a diagnostic predictive model for the childhood stunting risk score, defined as the child propensity score based on derived coefficients, was calculated for each child. The prediction risk models were assessed using discrimination measures, including area under-receiver operator curve (AUROC), sensitivity and specificity. Results: The review identified 68 predictor variables of child stunting, of which 27 were available in the MDHS 2016–16 data. The common risk factors selected by all the variable selection models include household wealth index, age of the child, household size, type of birth (singleton/multiple births), and birth weight. The best cut-off point on the child stunting risk prediction model was 0.37 based on risk factors determined by the judgmental variable selection method. The model's accuracy was estimated with an AUROC value of 64% (95% CI: 60%-67%) in the test data. For children residing in urban areas, the corresponding AUROC was AUC = 67% (95% CI: 58–76%), as opposed to those in rural areas, AUC = 63% (95% CI: 59–67%). Conclusion: The derived child stunting diagnostic prediction model could be useful as a first screening tool to identify children more likely to be stunted. The identified children could then receive necessary nutritional interventions. [ABSTRACT FROM AUTHOR]

The impact of a major historical event on child and youth development has been of great interest in the study of the life course. This study is focused on assessing the causal effect of the Great Recession on youth disconnection from school and work. Building on the insights offered by the age-period-cohort research, econometric methods, and developmental psychology, we innovatively develop a causal inference strategy that takes advantage of the multiple successive birth cohorts in the National Longitudinal Study of Youth 1997. The causal effect of the Great Recession is defined in terms of counterfactual developmental trajectories and can be identified under the assumption of short-term stable differences between the birth cohorts in the absence of the Great Recession. A meta-analysis aggregates the estimated effects over six between-cohort comparisons. Furthermore, we conduct a sensitivity analysis to assess the potential consequences if the identification assumption is violated. The findings contribute new evidence on how precipitous and pervasive economic hardship may disrupt youth development by gender and class of origin. [ABSTRACT FROM AUTHOR]

Background: The experiences and challenges associated with breastfeeding multiple births can be considerably more complex than those of singletons. Multiple births refer to the delivery of more than one offspring in a single birth event. Emphasizing the needs and experiences of mothers with multiple births during breastfeeding can enable healthcare providers to design targeted interventions that enhance breastfeeding rates. However, existing breastfeeding and health education resources and practices do not fully meet the needs of women who breastfeed multiples. This review aimed to review and synthesize qualitative studies on the breastfeeding experiences of women with multiple births. Methods: A systematic search was conducted in 10 electronic databases for papers published from the inception of the database to March 2024. The Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research was utilized to evaluate the methodological quality of the studies included. The thematic synthesis method of Thomas and Harden was employed to integrate and analyze the included literature to derive new categories and conclusions. Findings: Eight studies met the inclusion criteria and quality assessment criteria for this study. Through the integration of their results, four themes were identified: the choice and willingness to breastfeed multiple births; the challenges of breastfeeding multiple births; stage management and individualised adaptation of breastfeeding; and the experience of support. Conclusion: Throughout the feeding process from pregnancy to the postpartum period, mothers with multiple births often have predominantly negative experiences with breastfeeding. Consequently, hospitals should create a multidisciplinary follow-up team comprising obstetrics, neonatology, psychology, and community services to offer specialized and personalized support to these women at various stages. Systematic review registration: [https://www.crd.york.ac.uk/PROSPERO/], identifier [PROSPERO 2024 CRD42024520348]. [ABSTRACT FROM AUTHOR]

Background: Previous evidence suggests that low-quality embryos may send negative signals to the endometrium and affect the receptivity of the endometrium. This study aimed to evaluate the influence of transferring an additional low-quality embryo with a high-quality embryo on the pregnancy outcome. Methods: A total of 1506 fresh embryo transfer cycles between January 2018 and June 2020 were included. The patients were separated into two groups: a single embryo transfer group (SET, patients receiving a single high-quality embryo) and a double embryo transfer group (DET, patients receiving a high-quality embryo and a low-quality embryo). Main outcome measures including multiple pregnancy rate and live birth rate were discussed. Overall, in the primary analysis, patients who receive an additional low-quality embryo improved the live birth by 8.7% and multiple pregnancy rate by 10.0%. In women aged less than 35 years, compared with SET, DET increased the birth rate by 6.0% but resulted in a 13.5% increase in multiples. Women of 35 years above, adding a low-quality embryo increased the live birth rate by only 2.2% but increased multiples by 14.7%. In patients with one cycle of ET, the same results were obtained. In patients with multiple cycles of ET and adding a low-quality embryo, the live birth rate was similar to SET but with a 14.7% increase in multiples. Conclusions: Compared to DET, we prefer to transfer a high-quality embryo. Nevertheless, in women 35 years or older or in patients with multiple cycles of embryo transfer, adding a low-quality embryo did not significantly improve live birth but increased the multiple rate. [ABSTRACT FROM AUTHOR]

To describe the fetal death rate of birth defects (including a broad range of specific defects) and to explore the relationship between fetal deaths from birth defects and a broad range of demographic characteristics. Data was derived from the birth defects surveillance system in Hunan Province, China, 2016–2020. Fetal death refers to the intrauterine death of a fetus at any time during the pregnancy, including medical termination of pregnancy. Fetal death rate is the number of fetal deaths per 100 births (including live births and fetal deaths) in a specified group (unit: %). The fetal death rate of birth defects with 95% confidence intervals (CI) was calculated by the log-binomial method. Crude odds ratios (ORs) were calculated to examine the relationship between each demographic characteristic and fetal deaths from birth defects. This study included 847,755 births, and 23,420 birth defects were identified. A total of 11,955 fetal deaths from birth defects were identified, with a fetal death rate of 51.05% (95% CI 50.13–51.96). 15.78% (1887 cases) of fetal deaths from birth defects were at a gestational age of < 20 weeks, 59.05% (7059 cases) were at a gestational age of 20–27 weeks, and 25.17% (3009 cases) were at a gestational age of ≥ 28 weeks. Fetal death rate of birth defects was higher in females than in males (OR = 1.25, 95% CI 1.18–1.32), in rural than in urban areas (OR = 1.43, 95% CI 1.36–1.50), in maternal age 20–24 years (OR = 1.35, 95% CI 1.25–1.47), and ≥ 35 years (OR = 1.19, 95% CI 1.11–1.29) compared to maternal age of 25–29 years, in diagnosed by chromosomal analysis than ultrasound (OR = 6.24, 95% CI 5.15–7.55), and lower in multiple births than in singletons (OR = 0.41, 95% CI 0.36–0.47). The fetal death rate of birth defects increased with the number of previous pregnancies (χ2trend = 49.28, P < 0.01), and decreased with the number of previous deliveries (χ2trend = 4318.91, P < 0.01). Many fetal deaths were associated with birth defects. We found several demographic characteristics associated with fetal deaths from birth defects, which may be related to the severity of the birth defects, economic and medical conditions, and parental attitudes toward birth defects. [ABSTRACT FROM AUTHOR]

Objective: Rare coexistence of disease or pathology Background: Cesarean scar ectopic pregnancy is a rare type of ectopic pregnancy that can result in severe maternal morbidity and mortality. Medical, surgical, and minimally invasive therapies alone or in combination have been described in the literature, but the optimal treatment modality of cesarean scar ectopic pregnancies is unknown. Limited information exists on the course of cesarean scar ectopic pregnancy following treatment with cytotoxic agents. Case Report: We present a case of a woman with a history of multiple cesarean births that was provided with medical abortion for an unintended pregnancy. However, upon follow-up, the patient was found to have a cesarean scar ectopic pregnancy. Following the diagnosis, she was treated by multi-dose systemic methotrexate-leucovorin and with ultrasound-guided intra-gestational sac injection of potassium chloride. After resolution of beta human gonadotropin levels, ultrasound follow-up revealed persistence of residual tissue in the cesarean scar. The patient elected for resection of the residual tissue with operative hysteroscopy. We report a novel hysteroscopic finding after medical treatment of a cesarean scar ectopic pregnancy with intra-gestational sac injection of potassium chloride. Conclusions: Direct visualization of the intra-abdominal cavity and intra-uterine cavity showed that combined medical management with systemic methotrexate and local potassium chloride injection is an effective treatment modality for live cesarean scar ectopic pregnancies, with minimal anatomical harm. Hysteroscopic resection offers a safe and effective approach for removal of persistence of residual tissue. [ABSTRACT FROM AUTHOR]

Polymorphisms identified on the BMPR1B, BMP15, and GDF9 genes tend to increase multiple birth and ovulation rates in sheep. In the planned study, the productivity records of the flocks (approximately 41.000) collected from 2016 to 2022, belonging to the Public Breeding of Kangal Akkaraman Sheep in Sivas province TAGEM/58KAK2012-08 subproject of the Public Animal Breeding National Project, were used. Accordingly, the ear numbers of sheep that gave birth to at least two twins (n=96) and at least two singletons (n=96) were determined from 15 different farms relevant records. According to similar feeding characteristics, environmental variables were grouped as location, year-round feeding type, and seasonal feeding type. DNA groups were genotyped by the PCR-RFLP method for BMPR1B (FecB), BMP15 (FecXB, FecXG, FecXI, FecXH) and GDF9 (FecG) alleles. Accordingly, among the 6 SNPs examined, only the GDF9 gene-FecB SNP was determined polymorphic. Genotypic effect (FecB allele) and environmental effect variables (location, year-round feeding type, seasonal feeding type ) were also examined with a logistic model. It was determined that the relevant alleles and environmental variables did not have a statistically significant effect on the twinning phenotype. According to the results obtained, it was thought that the genes associated with multiple births in Kangal Akkaraman breed may have different variants specific to the breed. In addition, it is suggested that this character, which is affected by multiple genes, should be included in the planned breeding studies by considering the interaction of environmental variables and determining the variation of the related genes. In this respect, it is concluded that our study will guide the sequencing studies and multivariate analyses to be planned. [ABSTRACT FROM AUTHOR]

The objective of this study was to assess the impact of oral progesterone (altrenogest) administered after mating on fertility in goats synchronized during the breeding season. A total of 47 Hair goats were included in the study. A progesterone-impregnated intravaginal sponges were administered for 12 days. On day 10 of intravaginal sponge administration, 480 IU pregnant mare's serum gonadotropin (PMSG) and 0.075 mg cloprostenol were injected intramuscularly to the goats. Animals were exposed to bucks for 12 hours after detection of estrus by the foraging buck. The goats were randomly assigned to two distinct groups: Group 1 (G1, n=23) and Group 2 (G2, n=24). G1 goats were orally administrated 4.4 mg of altrenogest per day for 30 days after mating. G2 goats served as controls. Pregnancy examinations were performed by transrectal ultrasonography on the 30th and 42nd days after mating. Blood samples were taken from one day after mating to 30 days (3-day intervals). Statistical analysis comparing G1 and G2 revealed no significant differences between the groups regarding progesterone concentrations, conception rate, pregnancy rate, lambing rate, multiple birth rate, fecundity, and litter size (p>0.05). In conclusion, this study revealed that oral progesterone use had no impact on fertility parameters. Moreover, further research is warranted to explore the efficacy of various oral progesterone analogs. [ABSTRACT FROM AUTHOR]

Background: Townes-Brocks syndrome (TBS) is a rare genetic disorder characterized by imperforate anus, dysplastic ears, thumb malformations, and other abnormalities. Previous studies have revealed that mutations in the SALL1 gene can disrupt normal development, resulting in the characteristic features of Townes-Brocks syndrome. Spalt-like transcription factors (SALLs) are highly conserved proteins that play important roles in various cellular processes, including embryonic development, cell differentiation, and cell survival. Over 400 different variants or mutations have been reported in the SALL1 gene in individuals with TBS. Most of these variants lead to the formation of premature termination codons (PTCs), also known as nonsense mutations. The majority of these PTCs occur in a specific region of the SALL1 gene called the "hotspot region", which is particularly susceptible to mutation. Methods: In this study, we conducted whole-exome sequencing on a three-generation Chinese family with anorectal malformations. Results: We identified a novel heterozygous mutation (chr16:51175376:c.757 C > T p.Gln253*) in the SALL1 gene. Molecular analysis revealed a heterozygous C to T transition at nucleotide position 757 in exon 2 of the SALL1 (NM_002968) gene. This mutation is predicted to result in the substitution of the Gln253 codon with a premature stop codon (p.Gln253*). The glutamine-rich domain forms a long alpha helix, enabling the mutant protein to interact with the wild-type SALL1 protein. This interaction may result in steric hindrance effects on the wild-type SALL1 protein. Conclusions: Our findings have expanded the mutation database of the SALL1 gene, which is significant for genetic counseling and clinical surveillance in the affected family. Furthermore, our study enhances the understanding of Townes-Brocks syndrome and has the potential to improve its diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Objective: To explore the association between demographic characteristics and perinatal deaths attributable to congenital heart defects (CHDs). Methods: Data were obtained from the Birth Defects Surveillance System of Hunan Province, China, 2016–2020. The surveillance population included fetuses and infants from 28 weeks of gestation to 7 days after birth whose mothers delivered in the surveillance hospitals. Surveillance data included demographic characteristics such as sex, residence, maternal age, and other key information, and were used to calculate the prevalence of CHDs and perinatal mortality rates (PMR) with 95% confidence intervals (CI). Multivariable logistic regression analysis (method: Forward, Wald, α = 0.05) and adjusted odds ratios (ORs) were used to identify factors associated with perinatal deaths attributable to CHDs. Results: This study included 847755 fetuses, and 4161 CHDs were identified, with a prevalence of 0.49% (95%CI: 0.48–0.51). A total of 976 perinatal deaths attributable to CHDs were identified, including 16 (1.64%) early neonatal deaths and 960 (98.36%) stillbirths, with a PMR of 23.46% (95%CI: 21.98–24.93). In stepwise logistic regression analysis, perinatal deaths attributable to CHDs were more common in rural areas than urban areas (OR = 2.21, 95%CI: 1.76–2.78), more common in maternal age <20 years (OR = 2.40, 95%CI: 1.05–5.47), 20–24 years (OR = 2.13, 95%CI: 1.46–3.11) than maternal age of 25–29 years, more common in 2 (OR = 1.60, 95%CI: 1.18–2.18) or 3 (OR = 1.43, 95%CI: 1.01–2.02) or 4 (OR = 1.84, 95%CI: 1.21–2.78) or > = 5 (OR = 2.02, 95%CI: 1.28–3.18) previous pregnancies than the first pregnancy, and more common in CHDs diagnosed in > = 37 gestional weeks (OR = 77.37, 95%CI: 41.37–144.67) or 33–36 gestional weeks (OR = 305.63, 95%CI: 172.61–541.15) or < = 32 gestional weeks (OR = 395.69, 95%CI: 233.23–671.33) than diagnosed in postnatal period (within 7 days), and less common in multiple births than singletons (OR = 0.48, 95%CI: 0.28–0.80). Conclusions: Perinatal deaths were common in CHDs in Hunan in 2016–2020. Several demographic characteristics were associated with perinatal deaths attributable to CHDs, which may be summarized mainly as economic and medical conditions, severity of CHDs, and parental attitudes toward CHDs. [ABSTRACT FROM AUTHOR]

This study assessed the trends in twin births and their survival in Bangladesh by analyzing over a quarter million live births during 1970–2018, pooled from all eight rounds of the Bangladesh Demographic and Health Survey. In these five decades, the twinning rate increased by 1.5 times, from 5.8 to 8.6 twins per 1000 maternities. The decadal twinning rates varied across maternal age, parity, body mass index, household wealth index, and geographic region. The gap in decadal neonatal, infant, and under-five cumulative survival probability between singleton and multiple births was found to be closing, using Kaplan-Meier curves. Child mortality decreased by 80% and 60% in singleton and multiple births respectively. However, the absolute size of child mortality in multiple births remained six times higher than in singletons and was concentrated in the neonatal period. The share of multiple births surged in all types of child mortality. We predict a further and faster rise in multiple births in the coming decades in the face of upward trends in maternal age overlapping with higher parities, education, career prospects, contraceptive use, and the future demand-supply of assisted reproductive technology. A particular focus on the improvement of perinatal and neonatal care with wider availability is warranted. Otherwise, increased multiple births might raise child mortality and create public health challenges. [ABSTRACT FROM AUTHOR]

Reciprocal IVF is a route to parenthood that, for the first time, allows cis two-mother families (and other couples in which both partners have a uterus and egg stores) to 'share' biological parenthood. This family form offers a valuable opportunity for researchers to examine experiences of gestational and genetic motherhood within the same family, and this article is the first to take a sociological approach to exploring kinship within this emerging family form. Drawing upon interview data with 14 two-mother families (28 mothers) who have conceived via reciprocal IVF, we show that mothers hold complex, creative and sometimes contradictory understandings of the 'multiple motherhoods' within their family (i.e. genetic, epigenetic and gestational motherhood). Overall, mothers took an active and strategic approach to constructing kinship within their family, and these findings have theoretical, empirical and clinical implications. [ABSTRACT FROM AUTHOR]

Purpose: The association between birth order and adverse perinatal outcomes has been well studied in twin pregnancies. However, little is known about the differences in immediate perinatal outcomes as well as long‐term hospitalization of the offspring in triplet pregnancies according to their birth order. As such, we aimed to assess the differences in immediate perinatal outcomes and long‐term hospitalizations among triplets by their birth order. Methods: In a retrospective hospital‐based cohort study, immediate perinatal outcomes and long‐term hospitalizations were compared among triplet siblings according to their birth order. Deliveries occurred between the years 1991 and 2021 in a tertiary medical center. The study groups were followed until 18 years of age for cardiovascular, respiratory, neurological, and infection‐related hospitalizations. Generalized estimation equation (GEE) models were used to control for confounders. Kaplan–Meier survival curves were used to compare cumulative long‐term hospitalization incidences and Cox proportional hazards models were performed to control for confounders. Results: The study included 117 triplet deliveries. Rates of small for gestational age (SGA) infants increased linearly by birth order (6.0%, 7.7%, and 15.4% for the first, second, and third siblings, respectively; p‐value for trends = 0.035). Using a GEE model controlling for maternal age, being born third in a triplet pregnancy was independently associated with SGA (third vs. first sibling, adjusted OR 3.0, 95% CI 1.38–6.59, p = 0.005). No significant differences in cardiovascular, respiratory, neurological, and infection‐related hospitalizations were noted among the first, second, and third siblings. Likewise, using Kaplan–Meier survival analyses, no significant differences in the cumulative incidence of long‐term pediatric hospitalizations were noted between the siblings. In Cox proportional hazards models, controlling for weight and gender, birth order in a triplet pregnancy did not exhibit an association with long‐term hospitalizations of the offspring. Conclusion: Despite the association between birth order and SGA, birth order in triplets does not seem to have an impact on the risk for long‐term offspring hospitalization. [ABSTRACT FROM AUTHOR]

Background: Assessing the cost-effectiveness of interventions targeting childhood excess weight requires estimates of the hazards of transitioning between weight status categories. Current estimates are based on studies characterized by insufficient sample sizes, a lack of national representativeness, and untested assumptions. Objectives: We sought to (1) estimate transition probabilities and hazard ratios for transitioning between childhood weight status categories, (2) test the validity of the underlying assumption in the literature that transitions between childhood bodyweight categories are time-homogeneous, (3) account for complex sampling procedures when deriving nationally representative transition estimates, and (4) explore the impact of child, maternal, and sociodemographic characteristics. Methods: We applied a multistate transition modeling approach accounting for complex survey design to UK Millennium Cohort Study (MCS) data to predict transition probabilities and hazard ratios for weight status movements for children aged 3–17. Surveys were conducted at ages 3 (wave 2 in 2004), 5 (wave 3 in 2006), 7 (wave 4 in 2008), 11 (wave 5 in 2012), 14 (wave 6 in 2015), and 17 (wave 7 in 2018) years. We derived datasets that included repeated body mass index measurements across waves after excluding multiple births and children with missing or implausible bodyweight records. To account for the stratified cluster sample design of the MCS, we incorporated survey weights and jackknife replicates of survey weights. Using a validation dataset from the MCS, we tested the validity of our models. Finally, we estimated the relationships between state transitions and child, maternal, and sociodemographic factors. Results: The datasets for our primary analysis consisted of 10,399 children for waves 2–3, 10,729 for waves 3–4, 9685 for waves 4–5, 8593 for waves 5–6, and 7085 for waves 6–7. All datasets consisted of roughly equal splits of boys and girls. Under the assumption of time-heterogeneous transition rates (our base-case model), younger children (ages 3–5 and 5–7 years) had significantly higher annual transition probabilities of moving from healthy weight to overweight (0.033, 95% confidence interval [CI] 0.026–0.041, and 0.027, 95% CI 0.021–0.033, respectively) compared to older children (0.015, 95% CI 0.012–0.018, at ages 7–11; 0.018, 95% CI 0.013–0.023, at ages 11–14; and 0.018, 95% CI 0.013–0.025 at ages 14–17 years). However, the resolution of unhealthy weight was more strongly age-dependent than transitions from healthy weight to non-healthy weight states. Transition hazards differed by child, maternal, and sociodemographic factors. Conclusions: Our models generated estimates of bodyweight status transitions in a representative UK childhood population. Compared to our scenario models (i.e., time-homogeneous transition rates), our base-case model fits the observed data best, indicating a non-time-homogeneous pattern in transitions between bodyweight categories during childhood. Transition hazards varied significantly by age and across subpopulations, suggesting that conducting subgroup-specific cost-effectiveness analyses of childhood weight management interventions will optimize decision-making. [ABSTRACT FROM AUTHOR]

Background: The 2016 Patient-Oriented Strategy Encompassing IndividualizeD Oocyte Number (POSEIDON) criteria redefined the poor responders as low prognosis patients. The embryo transfer strategy for POSEIDON patients remained to be addressed. This study aimed to investigate the optimized number of embryos to transfer for unexpected low-prognosis patients (POSEIDON Group 1 and Group 2) with blastocyst transfer in their first frozen cycle. Methods: A retrospective cohort study of 2970 patients who underwent frozen-thawed embryo transfer (FET) between January 2018 and December 2021. Patients from POSEIDON Group 1 (N = 219) and Group 2 (N = 135) who underwent blastocyst transfer in their first FET cycles were included and divided into the elective single embryo transfer (eSET) group and the double embryo transfer (DET) group. Results: For POSEIDON Group 1, the live birth rate per embryo transfer of the DET group was slightly higher than the eSET group (52.17% vs 46.15%, OR 0.786, 95% CI 0.462–1.337, P = 0.374; adjusted OR (aOR) 0.622, 95% CI 0.340–1.140, P = 0.124), while a significant increase of 20.00% in the multiple birth rate was shown. For Group 2, higher live birth rates were observed in the DET group compared to the eSET group (38.46% vs 20.48%, OR 0.412, 95% CI 0.190–0.892, P = 0.024; aOR 0.358, 95% CI 0.155–0.828, P = 0.016). The difference in the multiple birth rate was 20.00% without statistical significance. Univariate and multivariate analyses revealed that age (OR 0.759, 95% CI.624–0.922, P = 0.006 and OR 0.751, 95% CI 0.605–0.932, P = 0.009) and the number of transferred embryos (OR 0.412, 95% CI 0.190–0.892, P = 0.024 and OR 0.367, 95% CI 0.161–0.840, P = 0.018) were significant variables for the live birth rate in POSEIDON Group 2. Conclusions: The findings in the present study showed that eSET was preferred in the first frozen cycle for POSEIDON Group 1 to avoid unnecessary risks. Double embryo transfer strategy could be considered to improve the success rate for POSEIDON Group 2 with caution. Further stratification by age is needed for a more scientific discussion about the embryo transfer strategy for POSEIDON patients. [ABSTRACT FROM AUTHOR]

Hu sheep (HS), a breed of sheep carrying the FecB mutation gene, is known for its "year-round estrus and multiple births" and is an ideal model for studying the high fecundity mechanisms of livestock. Through analyzing and comparing the genomic selection features of Hu sheep and other sheep breeds, we identified a series of candidate genes that may play a role in Hu sheep's high fecundity mechanisms. In this study, we conducted whole-genome resequencing on six breeds and screened key mutations significantly correlated with high reproductive traits in sheep. Notably, the CC2D1B gene was selected by the fixation index (FST) and the cross-population composite likelihood ratio (XP-CLR) methods in HS and other five breeds. It was worth noting that the CC2D1B gene in HS was different from that in other sheep breeds, and seven missense mutations have been identified. Furthermore, the linkage disequilibrium (LD) analysis revealed a strong linkage disequilibrium in this specific gene region. Subsequently, by performing different grouping based on FecB genotypes in Hu sheep, genome-wide selective signal analysis screened several genes related to reproduction, such as BMPR1B and PPM1K. Besides, FST analysis identified functional genes related to reproductive traits, including RHEB, HSPA2, PPP1CC, HVCN1, and CCDC63. Additionally, a missense mutation was found in the CCDC63 gene and the haplotype was different between the high reproduction (HR) group and low reproduction (LR) group in HS. In summary, we discovered genetic differentiation among six distinct breeding sheep breeds at the whole genome level. Additionally, we identified a set of genes which were associated with reproductive performance in Hu sheep and visualized how these genes differed in different breeds. These findings laid a theoretical foundation for understanding genetic mechanisms behind high prolific traits in sheep. [ABSTRACT FROM AUTHOR]

Purpose: After living with the COVID-19 pandemic for more than 2 years, the impact of lockdown measures on preterm birth rates is inconsistent according to data from different countries. In this study, rates of preterm-born infants during the time of COVID-19-related lockdowns were analyzed in a tertiary perinatal center at Munich University, Germany. Methods: We analyzed the number of preterm births, infants, and stillbirths before 37 weeks of gestation during the German COVID-19 lockdown period compared to the same time periods in the years 2018 and 2019 combined. Additionally, we expanded the analysis to Pre- and Post-Lockdown Periods in 2020 compared to the respective control periods in the years 2018 and 2019. Results: Our database shows a reduction in the rate of preterm infants during the COVID-19 lockdown period (18.6%) compared to the combined control periods in 2018 and 2019 (23.2%, p = 0.027). This was mainly based on a reduced rate of preterm multiples during the lockdown period (12.8% vs. 28.9%, p = 0.003) followed by a reversed effect showing a threefold rise in multiple births after the lockdown. In singletons, the rate of preterm births was not reduced during the lockdown. The rate of stillbirths was not affected by the lockdown measures as compared to the control period (0.9% vs. 0.7%, p = 0.750). Conclusion: During the COVID-19 pandemic lockdown period, we found a reduced rate of preterm-born infants compared to a combined control period in the years 2018 and 2019 in our large tertiary University Center in Germany. Due to the predominant reduction in preterm multiples, we postulate that less physical activity might have led to the protective effect by lockdown measures. [ABSTRACT FROM AUTHOR]

Although racial disparities in criminal justice contact are long‐standing and the subject of continuing public debate, few studies have linked early‐life social conditions to racial disparities in arrest over the life course and in changing times. In this article, we advance and test a theoretical model of racial inequality in long‐term arrest histories on a representative sample of nearly 1,000 individuals from multiple birth cohorts in the Project on Human Development in Chicago Neighborhoods. Large Black–White disparities in arrests from ages 10 to 40 arise from racial inequalities in exposure to cumulative childhood advantages and disadvantages rather than from race‐specific effects. Smaller but meaningful Hispanic–White gaps follow a similar pattern, and the same explanations of racial disparities hold across different offense types and across birth cohorts who came of age at different times during 1995 to 2021. These findings indicate that inequalities in early‐life structural factors, which themselves are historically shaped, trigger processes of cumulative advantage and disadvantage that produce racial disparities in arrests over the life course and that persist across different points in contemporary history. [ABSTRACT FROM AUTHOR]

Introduction: There has been increased use of both induction of labor (IOL) and cesarean section for women with term pregnancies in many high‐income countries, and a trend toward birth at earlier gestational ages. Existing evidence regarding the association between IOL and cesarean section for term pregnancies is mixed and conflicting, and little evidence is available on the differential effect at each week of gestation, stratified by parity. Material and methods: To explore the association between IOL and primary cesarean section for singleton cephalic pregnancies at term, compared with two definitions of expectant management (first: at or beyond the week of gestation at birth following IOL; and secondary: only beyond the week of gestation at birth following IOL), we performed analyses of population‐based historical cohort data on women who gave birth in one Australian state (Queensland), between July 1, 2012 and June 30, 2018. Women who gave birth before 37+0 or after 41+6 weeks of gestation, had stillbirths, no‐labor, multiple births (twins or triplets), non‐cephalic presentation at birth, a previous cesarean section, or missing data on included variables were excluded. Four sub‐datasets were created for each week at birth (37–40). Unadjusted relative risk, adjusted relative risk using modified Poisson regression, and their 95% confidence intervals were calculated in each sub‐dataset. Analyses were stratified by parity (nulliparas vs. parous women with a previous vaginal birth). Sensitivity analyses were conducted by limiting to women with low‐risk pregnancies. Results: A total of 239 094 women were included in the analysis, 36.7% of whom gave birth following IOL. The likelihood of primary cesarean section following IOL in a Queensland population‐based cohort was significantly higher at 38 and 39 weeks, compared with expectant management up to 41+6 weeks, for both nulliparas and paras with singleton cephalic pregnancies, regardless of risk status of pregnancy and definition of expectant management. No significant difference was found for nulliparas at 37 and 40 weeks; and for paras at 40 weeks. Conclusions: Future studies are suggested to investigate further the association between IOL and other maternal and neonatal outcomes at each week of gestation in different maternal populations, before making any recommendation. [ABSTRACT FROM AUTHOR]

To study the contribution of ovulation induction and ovarian stimulation, in vitro fertilization (IVF), and unassisted conception to the increase in national plural births in the United States, a significant contributor to adverse maternal and infant health outcomes. National and IVF-assisted plural birth data were derived from the Centers for Disease Control and Prevention's National Vital Statistics System (1967–2021, after introduction of Clomiphene Citrate in the United States) and the National Assisted Reproductive Technology Surveillance System (1997–2021), respectively. Not applicable. Not applicable. Not applicable. In addition to IVF-assisted plural births, the contributions of unassisted conception to plural births among women aged <35 and ≥35 years were estimated using plural birth rates from 1949–1966 and a Bayesian logistic model with race and age as independent variables. The contribution of ovulation induction and ovarian stimulation was estimated as the difference between national plural births and IVF-assisted and unassisted counterparts. From 1967–2021, the national twin birth rate increased 1.7-fold to a 2014 high (33.9/1,000 live births), then declined to 31.2/1,000 live births; the triplet and higher order birth rate increased 6.7-fold to a 1998 high (1.9/1,000 live births), then declined to 0.8/1,000 live births. In 2021, the contribution of unassisted conception among women aged <35 years to the national plural births was 56.1%, followed by ovulation induction and ovarian stimulation (19.5%), unassisted conception among women aged ≥35 years (16.8%), and IVF (7.6%). During 2009–2021, the contribution of ovulation induction and ovarian stimulation has remained stable, the contribution of unassisted conception among women aged <35 and ≥35 years has increased, and the contribution of IVF has decreased. Ovulation induction and ovarian stimulation are leading iatrogenic contributors to plural births. They are, therefore, targets for intervention to reduce the adverse maternal and infant health outcomes associated with plural births. Maternal age of ≥35 years is a significant contributor to the national plural birth increase. [ABSTRACT FROM AUTHOR]

Objective To explore the clinical characteristics of multiple-birth preterm infants with necrotizing enterocolitis (NEC) and examine the effects of multiple births on clinical manifestations and outcomes of NEC infants. Methods In this retrospective study, 234 premature infants with NEC admitted to Shanghai Children's Hospital from July 2014 to June 2021 were included as research objects, among which 79 were multiple premature infants with NEC and 155 were single premature infants with NEC, According to the presence of single/multiple birth, they were divided into two groups of singleton (group A, n = 155) and multiple-birth (group B, n = 79). Twin group of vaginal delivery was divided into primary birth (group C, n = 9 and secondary birth (group D, n = 4) based upon birth order. Twin group was also assigned into two groups of higher birth weight (group E, n = 20) and lower birth weight (group F n = 45. And twin group was divided into two groups of concordant twins (CT, group G, n = 42 and discordant twins (DT, group H, n = 26). The latter group was further divided into DT with higher birth weight (group l, n = 5 and DT with lower birth weight (group J,n= 21). Demographic profiles (birth weight, gestational age & birth mode), clinical data (time of NEC onset, laboratory results & Bell stage), treatment (medical or surgical, intestinal perforation & extent of disease) and outcomes (postoperative complications & in-hospital mortality) were recorded. Results Seventy-nine cases of multiple preterm NEC infants were recruited, including 75 twins and 4 triplets. Seventy-five preterm NEC twins had a mean gestational age of 31. 60 weeks and a mean birth weight of 1 476.51 gram. Bell stage was 1 (n= 35), II (n = 21) and III n = 19 Eighteen cases (24%) underwent operation. As compared with group A, NEC infants in group B had a lower birth weight [1618.77 ± 481.30) g. (1 479.34 ±376.88) g, P = 0.016], higher rates of cesarean delivery [84(54.2%) vs. 65 (82.3%), P < 0.001 ] and assisted reproductive technology [11(7.1%) vs. 21 (26.6%) P < 0.001 ]. However, no differences existed in demographic profiles, clinical manifestations, laboratory results, Bell stage, surgery or outcomes (P > 0.05). There was no significant effect of birth order on demographic profiles, clinical manifestations, laboratory results, Bell stage, surgery or outcomes (P > 0.05) As compared with group E, group F had a lower birth weight [(1677.65 ±458.23) gus. (1382.89±300.81) g,P=0.019], lower WBC count [(12.31 ±4.22) ts. (9.13 plus/minus 4.01) * 109/L P = 0.023], greater intestinal lesion [5(45.4%) ts.0(0.0%), P = 0.002 ] and more postoperative complications [11(100%) 18. 3 (42.9%), P = 0.011 ] No difference existed in demographic profiles, clinical manifestations, other laboratory results, Bell stage, surgery or in-hospital mortality (P > 0.05). As compared with group G, group J had a greater gestational age [(30.95±2.44), (32.71 ±2.30) week, P = 0.027 ] and a higher rate of cesarean delivery [30 (71.4%) ts. 20 (95.2%) P = 0.045) rfloor. However, no differences existed in demographic profiles, clinical manifestations, laboratory results, Bell stage, surgery or outcomes (P > 0.05) Conclusions Multiple-birth NEC infants have no greater severity of Bell stage, more surgery, greater extent of intestinal lesion, more postoperative complications or higher in-hospital mortality. Twins with lower birth weight are prone to greater extent of intestinal lesion and more postoperative complications. However, birth order and discordance of twins have no significant effect on disease severity, surgery or in-hospital mortality. [ABSTRACT FROM AUTHOR]

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Objective International guidelines recommend that preterm infants should be supported to maintain their serum electrolytes within "normal" ranges. In term babies, cord blood values differed in pathological pregnancies from healthy ones. Study Design We examined cord blood sodium, chloride, potassium, glucose, and creatinine to derive maturity-related reference intervals. We examined associations with gestational age, delivery mode, singleton versus multiple, and prenatal maternal adverse conditions. We compared preterm cord values to term, and to adult reference ranges. Results There were 591 infants, 537 preterm and 54 term. Preterm cord glucose levels were steady (3.7 ± 1.1 mmol/L), while sodium, chloride, and creatinine increased over GA by 0.17, 0.14 mmol/L/week, and 1.07 µmol/L/week, respectively (p < 0.003). Average preterm cord potassium and chloride were higher than the term (p < 0.05). Compared with adult reference intervals, cord preterm reference intervals were higher for chloride (100–111 vs. 98–106 mmol/L), lower for creatinine (29–84 vs. 62–115 µmol/L), and more variable for potassium (2.7–7.9 vs. 3.5–5.0 mmol/L) and sodium (130–141 vs. 136–145 mmol/L). Cesarean section was associated with higher potassium and lower glucose, multiple births with higher chloride and creatinine and lower glucose, and SGA with lower glucose. Conclusion Cord blood values varied across the GA range with increases in sodium, chloride, and creatinine, while glucose remained steady. Average preterm reference values were higher than term values for potassium and chloride. Preterm reference values differed from published adults' reference values. The changes across GA and by delivery mode, SGA, and being a multiple, which may have direct implications for neonatal care and fluid management. Key Points Cord blood electrolyte, creatinine, and glucose values vary across neonatal gestational age. Average preterm cord values of potassium and chloride were higher than term values. Cord reference values differ by delivery mode, growth, and multiple impacting neonatal care decisions. [ABSTRACT FROM AUTHOR]

In our ongoing project, which focuses on the introgression of Booroola/FecB gene and the myostatin (MSTN) gene into purebred Moghani sheep, we assessed the performance of second-generation Moghani crossbreds such as second crossbreds (F2) and initial backcross generation (BC1). These crossbreds were generated through different mating systems, including in-breeding, outcrossing, first paternal backcrossing (PBC1), and first maternal backcrossing (MBC1). Notably, F2 strains exhibited lean tail, woolly fleece and a higher percentage of white coat color compared to BC1. The impact of mating systems and birth types on pre-weaning survival rates was found to be statistically significant (P < 0.0001), with singleton offspring resulting from paternal backcross showing a particularly substantial effect. The F2 crossbred lambs carrying the Booroola gene did not show a statistically significant difference in survivability compared to those carrying the MSTN gene, implying the Booroola prolificacy gene had no significant impact on survival outcomes. However, the occurrence of multiple births had a significant negative impact on lamb survival (P < 0.0001). The PBC1 sheep strains, specifically Texel Tamlet ram strains carrying the MSTN mutation, exhibited superior growth rates compared to others (P < 0.05). Interestingly, the MSTN mutation in the homozygous variant genotype significantly impacts growth rate before weaning compared to other genotypes and pure Moghani sheep (P < 0.05). In conclusion, this study objectively underscores the pivotal role of genetic factors, specifically through strategic mating systems like paternal backcrossing, in enhancing desired traits and growth rates in Moghani sheep, thereby contributing valuable insights to the field of sheep breeding programs. [ABSTRACT FROM AUTHOR]

Purpose: Our study aimed to investigate the best time to manage hydrosalpinx to improve pregnancy outcomes during in vitro fertilization–embryo transfer (IVF–ET). Methods: Patients with hydrosalpinx who received IVF treatment were analyzed retrospectively. And two groups were included to compare the effects of different timing treatment of hydrosalpinx on IVF pregnancy outcomes, "Proximal Tubal Occlusion First Group" (Group Ligation-COH) and "Oocyte Retrieval First Group" (Group COH-Ligation). The main outcome measures included: ovarian response indexes, laboratory indexes and clinical pregnancy outcomes. Univariate and multivariate Logistic regression analysis was performed for outcome indicators, and the odds ratios (OR) and 95% confidence interval (CI) were used. Results: A total of 1490 patients were included (n = 976 Ligation-COH and n = 514 COH-Ligation). The Gn starting dose and MII rate in group Ligation-COH were significantly higher than those in group COH-Ligation (203.33 ± 58.20 vs. 203.33 ± 58.20, 81.58% vs. 80.28%, P < 0.05). The number of oocytes obtained and the number of available D3 embryos in group COH-Ligation were higher than those in group Ligation-COH (15.10 ± 7.58 vs. 13.45 ± 6.42, 10.92 ± 5.81 vs. 9.94 ± 5.15, P < 0.05). Although the number of ET cycles per IVF cycle in group COH-Ligation was higher than that in group Ligation-COH (1.88 ± 1.00 vs. 1.48 ± 0.70, P < 0.05), the biochemical pregnancy rate, clinical pregnancy rate, multiple pregnancy rate, live birth rate and cumulative live birth rate in group Ligation-COH were significantly higher than those in group COH-Ligation (60.83% vs. 46.27% for biochemical pregnancy, 55.69% vs. 38.5% for clinical pregnancy, 26.18% vs. 17.74% for multiple pregnancy, 47.08% vs. 25.26% for live birth, 69.47% vs. 47.47% for cumulative live birth, P < 0.05), and the miscarriage rate in group Ligation-COH was lower than that in group COH-Ligation (10.47% vs. 17.20 for early abortion, 4.49% vs. 15.86% for late abortion, P < 0.05). In logistic regression analysis, after adjustment for age and multiple factors, the above results were still statistically significant differences (P < 0.001). For elderly patients, the clinical pregnancy rate, multiple birth rate and live birth rate in group Ligation-COH were also higher than those in group COH-Ligation (P < 0.001). No significant differences were detected for patients with diminished ovarian reserve. Conclusions: For the choice of ligation operation time, we recommend that patients choose tubal ligation first and then ovulation induction and oocyte retrieval treatment. [ABSTRACT FROM AUTHOR]