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Overweight and obesity during pregnancy is associated with risk of a range of adverse health outcomes. While intervention studies aim to promote behavioral change, little is known about the underlying psychological mechanisms facilitating and hindering change. The aim of this study was to evaluate overweight and obese women's perceptions of making behavior change during pregnancy. We explored beliefs through self-administrated questionnaires (n = 464) and semi-structured face-to-face interviews (n = 26). Questions were designed according to the Health Belief Model. A triangulation protocol was followed to combine quantitative and qualitative data. A total of 269 women (58%) indicated that high gestational weight gain is a concern, with 348 (75%) indicating excessive weight gain is associated with complications during pregnancy or child birth. Women were aware of maternal complications associated with high gestational weight gain, but had more limited awareness of neonatal complications. While most women indicated in questionnaires that healthy eating and physical activity were associated with improved health during pregnancy, they were unable to identify specific benefits at interview. Barriers to making healthy behavior changes were highly individualized, the main barrier being lack of time. While the majority (91%) of women indicated that they would make behavior changes if the change made them feel better, only half felt confident in their ability to do so. Interventions for overweight and obese pregnant women should incorporate education about neonatal health consequences and benefits of healthy behavior change in addition to incorporating strategies to enhance self-efficacy. Keywords Overweight and obesity * Pregnancy * Healthy eating and physical activity * Mixed method research, Introduction Approximately 50% of women in the US [1], Australia [2, 3], and the UK [4] have a body mass index (BMI) [greater than or equal to] 25 kg/ [m.sup.2]. [...]

During embryo implantation and initiation of pregnancy, uterineNK(uNK) cells engage invasive fetal trophoblasts to remodel vessels that conduct blood to the placenta. This partnership, involving uNK cell receptors that recognize HLA-C ligands on trophoblasts, varies the course of human pregnancy because the genes for both receptors and ligands are extraordinarily diverse. Several pregnancy disorders are attributed to insufficient trophoblast invasion and the limitation it imposes on human reproduction. Previously, a particular combination of fetal HLA-C and maternal inhibitory uNK cell receptor was associated with predisposition for preeclampsia. In this issue of the JCI, Hiby and colleagues extend this correlation to recurrent miscarriage and fetal growth restriction, revealing the common mechanism underlying these common pregnancy syndromes. Equally important, they show that mothers with an activating receptor of similar specificity to the inhibitory receptor are less likely to suffer disordered pregnancy., Although glittering prizes for fundamental immunology emerged from the study of lymphocyte responses to genetic polymorphisms within species (1-5), pregnancy is the only situation in which lymphocytes naturally confront another [...]

Objectives. We sought to determine whether differences in the prevalences of 5 specific pregnancy complications or differences in case fatality rates for those complications explained the disproportionate risk of pregnancy-related mortality for Black women compared with White women in the United States. Methods. We used national data sets to calculate prevalence and case-fatality rates among Black and White women for preeclampsia, eclampsia, abruptio placentae, placenta previa, and postpartum hemorrhage for the years 1988 to 1999. Results. Black women did not have significantly greater prevalence rates than White women. However, Black women with these conditions were 2 to 3 times more likely to die from them than were White women. Conclusions. Higher pregnancy-related mortality among Black women from preeclampsia, eclampsia, abruptio placentae, placenta previa, and postpartum hemorrhage is largely attributable to higher case-fatality rates. Reductions in case-fatality rates may be made by defining more precisely the mechanisms that affect complication severity and risk of death, including complex interactions of biology and health services, and then applying this knowledge in designing interventions that improve pregnancy-related outcomes. (Am J Public Health. 2007; 97:247-251. doi:10.2105/AJPH.2005.072975)

Byline: Suzanne B. Zane (1), Burney A. Kieke (2), Juliette S. Kendrick (3), Carol Bruce (1) Keywords: pregnancy; ectopic; maternal; surveillance; incidence Abstract: Objectives: Ectopic pregnancy is a common condition with significant health consequences complications are a major cause of maternal mortality in the United States. Accurate ascertainment of the number of ectopic pregnancies occurring in the United States has been dramatically affected by changing medical practices, causing estimates based on hospital data to be falsely low. This study was performed to identify nationally representative data on ectopic pregnancies and determine overlap of these data, to calculate the annual weighted number of ectopic pregnancies and confidence intervals for these estimates, and to determine barriers to estimation of ectopic pregnancy incidence. Methods: To assess whether a national estimate of the incidence of ectopic pregnancy could be calculated, we analyzed 1992--99 data from the six nationally representative data sets that include information on ectopic pregnancy. We examined relevant data in each data set and assessed whether any combination of data sets could be used to estimate ectopic pregnancy incidence. We calculated weighted estimates and 95% confidence intervals for hospitalizations, outpatient surgeries, outpatient medical procedures, and physician visits for and self-reports of ectopic pregnancy. Results: Small sample sizes severely limited calculation of estimates of ectopic pregnancy. Data needed for assessing multiple counting was not available consistently. The likelihood of multiple counting of cases was substantial when data set counts were combined. Conclusions: A reliable incidence rate for ectopic pregnancy in the United States could not be estimated from existing nationally representative data sources. Major advances in diagnosis and treatment of ectopic pregnancy have affected surveillance in two ways: inpatient hospital treatment of ectopic pregnancy has decreased, and multiple health care visits for a single ectopic pregnancy have increased. Alternate means of surveillance are needed to improve understanding of risk factors and trends for ectopic pregnancy, and we recommend examination of the databases of public and private insurance systems and managed care systems. Similar alternate means of surveillance may be needed for other health conditions with comparable changes in management of care. Author Affiliation: (1) Maternal Health Team, Maternal and Infant Health Branch, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia (2) Statistics and Computer Resources Branch, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia (3) Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia Article History: Registration Date: 04/10/2004

Byline: Carol A. Hickey (1), Martha Kreauter (3), Janet Bronstein (2), Victoria Johnson (2), Sandre F. McNeal (1), Dorothy S. Harshbarger (4), L. Albert Woolbright (4) Keywords: Low prenatal weight gain; WIC; body mass index; interpregnancy intervals; tobacco; anemia; prenatal care Abstract: Objective: To determine the association of maternal and prenatal WIC program participation characteristics with low prenatal weight gain among adult women delivering liveborn, singleton infants at term. Methods: WIC program data for 19,017 Black and White Alabama women delivering in 1994 were linked with birth certificate files to examine the association of anthropometric, demographic, reproductive, hematologic, behavioral and program participation characteristics with low prenatal weight gain. Results: One third (31.0%) had low prenatal weight gain as defined by the Institute of Medicine. The incidence of low weight gain was increased among women who had &lt 12 years of education, were single, Black, anemic, had low or normal pre-pregnancy body mass index (BMI), increased parity, interpregnancy intervals a$? 24 months, used tobacco or alcohol, or entered prenatal care or WIC programs after the first trimester. After adjusting for selected maternal characteristics, the adjusted odds ratios (AOR) for low weight gain were increased with short interpregnancy intervals (AOR 1.21 to 2.20) tobacco use (AOR 1.16 to 1.40), anemia (AOR 1.20 to 1.25), and second trimester entry into prenatal care (AOR 1.14 to 1.20) the size of the AORs and 95% confidence intervals varied by BMI and racial subgroup. Conclusions: The results of this study suggest that WIC interventions targeting low prenatal weight gain be focused on risk factors present not only during pregnancy, but during the pre- and interconceptional periods as well. Interventions should target low BMI, tobacco use, and anemia, and include attention to nutrition screening and risk reduction among women in postpartum and family planning clinic settings. Author Affiliation: (1) Department of Maternal and Child Health, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, 35294-0022 (2) Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama (3) Division of WIC, Bureau of Family Health Services, USA (4) Alabama Department of Public Health, Center for Health Statistics, Montgomery, Alabama Article History: Registration Date: 30/09/2004

Smoking among partners of non-smoking pregnant women has been linked to adverse pregnancy outcome, including low birthweight. Paternal smoking also increases the risk of infant respiratory infections and sudden infant death syndrome, irrespective of maternal smoking status. Furthermore, men's smoking habits are probably one of the strongest influences on the extent to which women are able to quit smoking in pregnancy and maintain cessation post birth. In four focus group discussions, male smokers whose partners were pregnant discussed their beliefs about passive smoking in pregnancy, the barriers they perceived to quitting in pregnancy and their preparedness to support maternal cessation. Men were largely unaware that their own smoking could pose a specific risk to the fetus, but when pregnant women are smokers, men believed their own smoking habits were unimportant. For men, barriers to quitting during their partners' pregnancy were: lack of understanding as to how passive smoking can affect the fetus, including a belief that the fetus is 'protected' inside its mother; lack of motivation to quit early in pregnancy due to the baby not being 'real'; and concern about stress-induced marital discord associated with cigarette withdrawal. These findings are discussed with regard to messages and strategies which may influence men to quit during their partners' pregnancy. Key words - smoking, passive smoking, pregnancy

A doctor recounts the ordeal of waiting for his wife to deliver triplets that have been diagnosed to have the high likelihood of contracting infections or even dying prematurely. This was to occur after a failed delivery of twin daughters years earlier. The couple was on a fertility drug regimen. Happily, the triplet babies were successfully delivered and grew to become lively boys a year after., After losing premature twins, the author and his wife faced an even greater ordeal: a triple pregnancy Like many two-career couples, my wife and I had put off starting a [...]

Scatchard analysis of the binding of 125I, and transferrin receptor (TR) immunoreactivity measurement in pregnant diabetic mothers to determine the influence of fetal iron demand on placental TR reveal that fetal iron demand affects the modulation of placental TR expression and results in fetal hypoxia, hyperinsulinemia and high erythropoiesis. Placental syncytiotrophoblastic TR expression increases and corresponds to low cord serum ferritin levels, indicating that the fetus uses high placental iron transport and mobilizes fetal iron stores to increase erythropoiesis. TR staining reveals that fetal hyperinsulinemia plays a primary or secondary role in TR expression.

Objectives. The effects of antepartum urinary tract infection on adverse maternal and perinatal outcomes were examined. Antepartum urinary tract infection has been previously implicated as a risk factor for numerous outcomes. Methods. Crude and multivariable analyses were performed with a perinatal registry cohort of 25 746 mother/infant pairs. Results. Elevated risks were observed for exposure to urinary tract infection and low birthweight, prematurity, preterm low birthweight, premature labor, hypertension/preeclampsia, maternal anemia, and amnionitis. Urinary tract infection was associated with perinatal death only among subjects 20 to 29 years of age. Conclusions. These findings underscore the importance of antepartum urine screening to identify patients at risk for adverse outcomes. (Am J Public Health. 1994;84: 405-410), Women who have urinary tract infections while pregnant may have an increased chance of delivering low-birthweight and premature infants. Urinary tract infections are caused by gram-negative bacteria and have symptoms that include burning and pain while urinating. The medical records of 25,746 women were studied to see if any correlation could be made between urinary tract infections and the health of their children at birth. Of these women, 1988 had urinary tract infections during pregnancy. Those with urinary tract infections had a higher percentage of low-birthweight, premature and pre-term low-birthweight infants. Premature birth due to urinary tract infection may account for the low birthweight of infants, meaning that the infection may induce premature labor rather than growth retardation of the infant.

Delayed recognition of pregnancy was observed in two patients with anorexia nervosa. The detection of conception at weeks 25 and 26, respectively, was incidental. Both patients were amenorrheic before conception. Both patients experienced the eating disorder-related feelings of bloated bellies, nausea, lassitude and weakness, but ignored the possibility of pregnancy. Pregnancy in eating-disordered patients is rare and extremely complicated. Early detection and medical follow-up are essential to avoid the risks of complications.

Becoming a midwife involves taking responsibility in many areas, including monitoring the health of mother and fetus during pregnancy and labour, ensuring safe delivery of the baby, support for the [...]