Vitamin D, Folate, Vitamin B12, and Iron Status in Pregnant/Postpartum Old Order Anabaptist Women in Southwestern Ontario.

Purpose: To assess vitamin D, folate, vitamin B12, and iron status in Old Order Anabaptist (OOA) pregnant/postpartum women.Methods: Blood was analyzed for plasma 25 hydroxy vitamin D (25(OH)D), red blood cell (RBC) folate, serum vitamin B12, and iron status indicators. Dietary intakes (food and supplements) from 3-day estimated records were compared to Dietary Reference Intakes and Canada's Food Guide (2007).Results: Fifty women participated in this descriptive cross-sectional study. Concentrations of 25(OH)D were low (<50 nmol/L for 20% and < 75 nmol/L for 63%); 42% had total vitamin D intakes < estimated average requirement (EAR). All women had RBC folate above the 1360 mmol/L cut-off. Nineteen percent had folate intakes upper limit. One woman had low serum vitamin B12 (<148 pmol/L); serum vitamin B12 was high (>652 pmol/L) for 24%. None had vitamin B12 intakes

[Early Screening Of Sickle Cell Disease: Knowledge And Behaviors Of Pregnant Women And Health Workers In Burkina Faso]. / Depistage Precoce De La Drepanocytose : Connaissances Et Attitudes De Femmes Enceintes Et d'Agents De La Sante Au Burkina Faso.

OBJECTIVE: Early detection of sickle cell disease significantly reduces sickle cell mortality, but it is not practiced in Burkina Faso where the disease is responsible for significant early mortality. The objective of the study was to analyze the relationship between this finding and the knowledge and attitudes of pregnant women with hemoglobinopathy and health workers. MATERIALS AND METHODS: the study was cross-sectional and conducted in three health districts of Ouagadougou, Burkina Faso, from June 17 to July 31, 2019. Data were collected using a structured individual interview guide. RESULTS: 200 pregnant women with hemoglobinopathy and 50 active health workers had participated in the study. Most women defined sickle cell disease as a bone disease, did not know its transmission mode or the hemoglobin type of their child (ren); 95,4% had never heard of neonatal screening for sickle cell disease. Health workers had limited knowledge of sickle cell disease (16-87%), and only 30% offered neonatal screening to pregnant women with hemoglobinopathy. CONCLUSION: the awareness of the population and training health workers on sickle cell disease, supported by a policy of good access to screening tests, would improve the prognosis of sickle cell disease in Burkina Faso.

OBJECTIF: le dépistage précoce, stratégie ayant amélioré la survie des drépanocytaires, n'est pas pratiquée au Burkina Faso où la maladie est responsable d'une mortalité précoce importante. L'objectif de l'étude était d'analyser la relation entre ce constat et les connaissances et attitudes de femmes gestantes porteuses d'une hémoglobinopathie et des agents de santé. MATÉRIELS & MÉTHODES: l'étude était transversale et conduite dans trois districts sanitaires de Ouagadougou au Burkina Faso, du 17 juin au 31 juillet 2019. Les données étaient recueillies à l'aide d'un guide d'entretien individuel structuré. RÉSULTATS: 200 femmes enceintes porteuses d'une hémoglobinopathie et 50 agents de santé en activité avaient participé à l'étude. La majorité des femmes enquêtées définissait la drépanocytose comme une maladie des os, ne connaissaient pas son mode de transmission, ni le type d'hémoglobine de leur(s) enfant(s) ou n'avaient jamais entendu parler de dépistage néonatal de la drépanocytose. Les agents de santé avaient pour 16 à 87%, des connaissances limitées sur la drépanocytose, 30% seulement proposaient un dépistage néonatal aux femmes enceintes porteuses d'une hémoglobinopathie. CONCLUSION: l'information de la population et la formation des agents de santé sur la drépanocytose, soutenues par l'accès aux tests de dépistage améliorerait le pronostic de la drépanocytose au Burkina Faso.

[Prenatal bonding and effect of recalled maternal overprotection in its development]. / Lien prénatal et effet du vécu de la surprotection maternelle sur son développement.

OBJECTIVES: Explore the relationship between the recalled bond of pregnant women to their own mothers and the development of prenatal attachment. METHODS: Women with a single-fetal pregnancy who consulted the outpatient service of the maternity "C" ward of the center of maternity and neonatology of Tunis and had perceived fetal movements were included. Maternal-fetal attachment was assessed by the Prenatal Attachment Inventory (PAI), and the Parental Bonding Instrument (PBI) was used to evaluate experienced bond to mother. Socio demographic and clinical data were collected on a pre-established form. RESULTS: Eighty respondents were retained from 95 recruited pregnant women. Their ages ranged from 19 to 44 with an average of 32 years. The rate of primiparity was of 28.7 % and half of pregnancies were identified at risk. The mean score of PAI was 55.3 (ET=10.79). Means scores of PBI "care" dimension and "overprotection" dimension were respectively of 26.26 (ET=5.82) and 17 (ET=6.38). The four types of maternal bonding according to the PBI scores were distributed as follow: affectionate constraint (31.3 %), affectionless control (35 %), optimal bonding (21.3 %) and weak bonding (12.5 %). The two PBI dimensions "care" and "overprotection" were significantly and negatively correlated (P<0.05). The PAI scores were not correlated with the PBI "care" dimension scores but were significantly and negatively correlated with the "overprotection" dimension scores (P<0.,01). In order to better explore this association, the "overprotection" dimension scores were studied according to the 21 items of the PAI. A negative and significant correlation was found only with three of the PAI items: item 12 (P<0;01), 15, and 20 (P<0;05). CONCLUSIONS: Our findings suggest that pregnant women whose mothers showed more overprotective and controlling behaviors could be at risk of developing a weak maternofetal attachment. Further research is needed.

Prenatal exercise and cardiovascular health (PEACH) study: the remote effect of aerobic exercise training on conduit artery and resistance vessel function.

We assessed the impact of a structured lower-limb aerobic exercise training intervention during pregnancy on brachial artery endothelial function, shear rate and patterns, and forearm blood flow and reactive hyperemia. Twenty-seven pregnant women were recruited and randomized into either a control group (n = 11; 31.0 ± 0.7 years), or an exercise intervention group (n = 16; 32.6 ± 0.9 years). The exercise group completed 40 minutes of aerobic exercise (50-70% heart rate reserve) 3-4 times per week, between the second and third trimester of pregnancy. Endothelial function was assessed using flow-mediated dilation (FMD, normalized for shear stress) at pre- (16-20 weeks) and post-intervention (34-36 weeks). The exercise training group experienced an attenuated increase in mean arterial pressure (MAP) relative to the control group (ΔMAP exercise: +2 ± 2 mm Hg vs. control: +7 ± 3 mm Hg; p = 0.044) from pre- to post-intervention. % FMD change corrected for shear stress was not different between groups (p = 0.460); however, the post-occlusion mean flow rate (exercise: 437 ± 32 mL/min vs. control: 364 ± 35 mL/min; p = 0.001) and post-occlusion anterograde flow rate (exercise: 438 ± 32 mL/min vs. control: 364 ± 46 mL/min; p = 0.001) were larger for the exercise training group compared with controls, post-intervention. Although endothelial function was not different between groups, we observed an increase in microcirculatory dilatory capacity, as suggested by the augmented reactive hyperemia in the exercise training group. Registered at ClinicalTrials.gov: NCT02948439. Novelty: Endothelial function was not altered with exercise training during pregnancy. Exercise training did contribute to improved cardiovascular outcomes, which may have been associated with augmented reactive hyperemia, indicative of increased microcirculatory dilatory capacity.

Epidemiology of Chagas disease in pregnant women and congenital transmission of Trypanosoma cruzi in the Americas: systematic review and meta-analysis.

OBJECTIVE: To estimate the prevalence of Chagas disease in pregnant women and the vertical transmission of the disease. METHODS: Observational studies were identified from eight electronic databases, and details on study design, population and prevalence of Chagas disease were extracted. The data were pooled using a random-effects model, and choropleth maps were created based on geopolitical regions and countries. RESULTS: The search identified 7788 articles, of which 50 were eligible. We observed a 9% prevalence of Chagas disease among pregnant women in the Americas (95% confidence interval [CI]: 8-10, I2  = 99.96%). High disease prevalence was identified in pregnant women in South American countries (12%, 95% CI: 11-13), while lower values were identified in pregnant women in North America (2%, 95% CI: 1-3). Countries with medium Human Development Index (HDI) had a higher prevalence of Chagas disease in pregnant women (15%, 95% CI: 13-16, I2  = 99.98%) than countries with high HDI (3%, 95% CI: 2-3). The rate of vertical transmission in the continent was 2% (95% CI: 1-2). The statistical analysis showed that this heterogeneity was explained by the study design, region of the Americas and mean income of the country. CONCLUSION: South and Central American countries have a high prevalence and vertical transmission of Chagas disease. Therefore, systematic screens for this disease during the prenatal period are necessary in addition to the diagnosis and treatment of children at risk for Trypanosoma cruzi infection.

OBJECTIF: Estimer la prévalence de la maladie de Chagas chez les femmes enceintes et la transmission verticale de la maladie. MÉTHODES: Des études d'observation ont été identifiées à partir de huit bases de données électroniques et des détails sur la concept de l'étude, la population et la prévalence de la maladie de Chagas ont été extraits. Les données ont été regroupées à l'aide d'un modèle à effets aléatoires et des cartes choroplèthes ont été créées en fonction des régions et des pays géopolitiques. RÉSULTATS: La recherche a identifié 7.788 articles, dont 50 étaient éligibles. Nous avons observé une prévalence de 9% de la maladie de Chagas chez les femmes enceintes dans les Amériques (intervalle de confiance [IC] à 95%: 8-10, I2 = 99,96%). Une prévalence élevée de la maladie a été identifiée chez les femmes enceintes dans les pays d'Amérique du Sud (12%, IC95%: 11-13), tandis que des valeurs plus faibles ont été identifiées chez les femmes enceintes d'Amérique du Nord (2%, IC95%: 1-3). Les pays à indice de développement humain (IDH) moyen présentaient une prévalence plus élevée de la maladie de Chagas chez les femmes enceintes (15%, IC95%: 13-16, I2 = 99,98%) que les pays à IDH élevé (3%, IC95%: 2 -3). Le taux de transmission verticale sur le continent était de 2% (IC95%: 1-2). L'analyse statistique a montré que cette hétérogénéité s'expliquait par le concept d'étude, la région des Amériques et le revenu moyen du pays. CONCLUSION: Les pays d'Amérique du Sud et d'Amérique centrale ont une prévalence élevée et de transmission verticale de la maladie de Chagas. Par conséquent, des dépistages systématiques de cette maladie pendant la période prénatale sont nécessaires en plus du diagnostic et du traitement des enfants à risque d'infection par Trypanosoma cruzi.

Determination of minimal recording period to assess resting heart rate variability during pregnancy.

Traditionally, resting heart rate variability (rHRV) is measured for 10 min using the last 5 min for analyses (e.g., criterion period). It is unknown whether the measurement period can be shortened in pregnant women as there are currently no established standards. We aimed to compare shorter time segments (e.g., from the 1st to 10th minutes) of the parasympathetic index natural logarithm transformation of root mean square of successive R-R differences (Ln rMSSD) with the criterion period in pregnant and nonpregnant women. Twelve pregnant (age: 30.8 ± 3.4 years; gestational age: 20.1 ± 5.0 weeks) and 15 nonpregnant women (age: 29.8 ± 4.0 years) were included. rHRV was measured using a portable heart rate monitor for 10 min while sitting. Ln rMSSD difference/agreement between shorter time segments and criterion period was analyzed. The result observed between the 4th-5th minutes was the shortest time segment not different from/highly agreed with the criterion period in pregnant women (difference [95% confidence interval (CI)]: -0.10 [-0.22 to 0.02]/bias ± 1.96 × SD: -0.06 [-0.38 to 0.25]). In nonpregnant women, the 2nd-3rd-minute segment was the shortest with similar results (difference [95% CI]: -0.04 [-0.15 to 0.07]/bias ± 1.96 × SD: -0.03 [-0.39 to 0.32]). The Ln rMSSD was found to be stable from the 5th-10th minutes and the 3rd-10th minutes in pregnant and nonpregnant women, respectively. A shortened rHRV assessment can increase its applicability in clinical/exercise-training settings. Novelty Ln rMSSD can be measured for 5 min in pregnant women, with the last 1-min segment analyzed. The last 1-min segment from 3 min can be used for rHRV measurement in nonpregnant women. The shortened rHRV assessment can facilitate its applicability in clinical/exercise-training settings.

Maternity staff immunization coverage against pertussis and maternal vaccination practices: Results of a 2017 cross-sectional survey in five public maternity hospitals.

OBJECTIVES: To conduct an audit of vaccination practices against pertussis in maternity wards to assess immunization practices targeting women, knowledge and awareness among health professionals and their involvement in the vaccination process, and to estimate their vaccine coverage. MATERIALS AND METHODS: 2017 cross-sectional descriptive survey using a data collection sheet of immunization practices targeting women and an anonymous questionnaire for health professionals whose vaccine coverage had been documented by the occupational health service. RESULTS: Five public maternity wards participated: one had a vaccination policy for women; 426 of 822 health professionals completed the questionnaire, 76% (from 50% of all residents to 83% of nurses) declared their vaccination status as up to date. Staff files in occupational health services showed that 69% of 822 health professionals received at least one vaccine booster during adulthood (57% less than 10 years before the survey); documented vaccination coverage rates ranged from 75% for residents to 91% for senior physicians. Occupational physicians and family physicians respectively performed 41% and 34% of vaccinations. While knowledge regarding vaccines was good, only 47% of health professionals declared prescribing them and 18% declared administering the anti-pertussis vaccine "often" or "very often". CONCLUSIONS: Updated data is needed to confirm the reported increase as participating centers are not representative of all birth centers. The active role of health professionals in vaccination-based pertussis prevention needs to be reinforced.

Conocimiento y factores de finalización de la lactancia materna en mujeres de una comunidad en Veracruz, México / Knowledge and factors to stop breastfeeding in women of a community in Veracruz, Mexico / Connaissances et facteurs d'achèvement de l'allaitement maternel chez les femmes d'une communauté à Veracruz, au Mexique / Conhecimento e fatores de conclusâo da amamentaçâo em mulheres de uma comunidade em Veracruz, México

Resumen: Objetivo: Identificar el déficit de conocimiento y los factores de finalización de la lactancia materna en mujeres que acuden al Centro de Salud de Arroyo Blanco en Xalapa, Veracruz. Material y Métodos: Investigación descriptiva, transversal, muestreo no probabilístico a conveniencia en una muestra integrada por 31 mujeres embarazadas. Resultados: El 96.8% menciona tener conocimiento sobre la LM, sin embargo el 12.9% desconoce la técnica adecuada para lactar a su bebé y el 22.6% desconoce la posición correcta de amamantar. Algunos factores de finalización son: poca producción de leche materna (19.4%) y la incorporación a su trabajo (9.7%). Conclusiones: Aunque la mayoría de las mujeres menciona tener el conocimiento sobre la LM, una proporción considerada manifestó tener déficit de conocimiento, ya que desconocen la técnica y posición adecuada para lactar. La información insuficiente sobre la LM, coincide con lo encontrado por Ulunque y cols., los cuales señalan que el conocimiento en las mujeres de su estudio era insuficiente e inadecuado.

Abstract: Objetive: Identify the lack of knowledge and completion factors of breastfeeding in women who come to the Health Center of Arroyo Blanco in Xalapa, Veracruz. Materials and methods: Descriptive, cross-sectional study, non-probabilistic sampling at convenience in a sample composing of 31 pregnant women. Results: Results: 96.8% mentioned having knowledge about breastfeeding. However, 12.9% do not know the proper technique for breastfeeding their baby and 22.6% do not know the correct position to perform it. Some factors of completion are: low breast milk production (19.4%) and incorporation into their work (9.7%). Conclusions: Although most women mentioned having knowledge about BF, a considerate proportion reported having lack of knowledge about it, because they do not know the technique and proper position to breastfeed. Insufficient information on breastfeeding, agrees with what was found by Ulunque et al, who point out that the knowledge about breastfeeding in their study by women was insufficient and inadequate.

Résumé: Objectif: Identifier le manque de connaissances et les facteurs d'achèvement de l'allaitement chez les femmes qui vont au centre de santé d'Arroyo Blanco à Xalapa, Veracruz. Matériel et méthodes: Recherche descriptive, transversale échantillonnage de commodité non-probabilité dans un échantillon constitué de 31 femmes enceintes. Résultats: 96,8% ont déclaré avoir des connaissances en matière d'allaitement. Cependant, 12,9% ne connaissent pas la technique appropriée pour allaiter leur bébé et 22,6% ne connaissent pas la bonne position pour l'exécuter. Certains facteurs d'achèvement sont: une faible production de lait maternel (19,4%) et l'intégration dans leur travail (9,7%). Conclusions: Bien que la plupart des femmes mentionnent avoir des connaissances en matière d'allaitement, une proportion considérée ont déclaré avoir un manque de connaissances à ce sujet, car ils ne connaissent ni la technique ni la position pour allaiter. L'Information insuffisant sur l'allaitement, est d'accord avec les conclusions d'Ulunque et al, qui soulignent que les connaissances sur l'allaitement des femmes dans leur étude étaient insuffisantes et inadéquate.

Resumo: Objetivo: Identificar o déficit de conhecimento e os fatores de completude da amamentaçâo em mulheres atendidas no Centro de Saúde Arroyo Blanco, em Xalapa, Veracruz. Materiais e métodos: Pesquisa descritiva, transversal, amostragem nao probabilística, por conveniência, em uma amostra composta por 31 gestantes. Resultados: 96,8% referiram ter conhecimento sobre a MM, porém 12,9% desconhecem a técnica adequada para amamentar e 22,6% desconhecem a posiçâo correta da amamentaçâo. Alguns fatores de conclusao sao: baixa produçâo de leite materno (19,4%) e incorporaçâo em seu trabalho (9,7%). Conclusao: Embora a maioria das mulheres mencionasse ter conhecimento sobre o AM, uma proporçâo considerou ter déficit de conhecimento, uma vez que desconhecem a técnica e a posiçâo para amamentar. A informaçâo insuficiente sobre o ML, concorda com a encontrada por Ulunque et al., Que indicam que o conhecimento nas mulheres de seu estudo era insuficiente e inadequado.

[Vulvovaginal candidiasis in pregnant women in the Mère et Enfant Hospital center in Nouakchott, Mauritania]. / Candidoses vulvo-vaginales chez les femmes enceintes au centre hospitalier Mère et Enfant de Nouakchott (Mauritanie).

AIM: To determine the prevalence and the associated risk factors of vulvovaginal candidiasis in pregnant women in Mauritania. PATIENTS AND METHOD: The study was carried out at the laboratory of the Mère et Enfant Center in Nouakchott, from November 1, 2016 to February 5, 2017. It concerned all pregnant women in the third trimester that came to the natal consultation at the gynecology service. These women must have given their informed consent in written form. After completing the survey to collect epidemiological and clinical data, a sample was collected to perform fresh direct examination and culture on Sabouraud-Chloramphenicol media. RESULTS: Two hundred pregnant women were included in the study. Culture on Sabouraud-Chloramphenicol media was positive in 52 patients corresponding to a prevalence of 26%. The germ tube test was positive for 61.5% of isolated Candida. Clinical signs are dominated by leucorrhea (56%), pelvic pain (25%) and vulvar pruritus (11%). Among women with positive culture, 55.76% had received local antifungal treatment in the form of an ovula during pregnancy. CONCLUSION: This study shows that vulvovaginal candidiasis is frequent in pregnant women attending gynecology at the Mère et Enfant Hospital Center in Nouakchott.

[Physiological hydronephrosis in pregnancy: Occurrence and possible causes. An MRI study]. / L'hydronéphrose physiologique durant la grossesse : prévalences et causes possibles. Une étude basée sur l'IRM.

INTRODUCTION: The etiology of the uretero-hydronephrosis in pregnancy is just hypothesis: hormonal or mechanical hypothesis, only investigated by echographic studies. MRI permits to visualize the entirety of the urinary tract, which can be helpful to find out a mechanical cause. METHODOLOGY: We have analysed the MRI of 100 asymptomatic pregnant women. We have determined the number and locations of the uretero-hydronephroses and researched whether there is any relationship between the uretero-hydronephrosis and certain abdominal structures. We focused on the psoas muscle and measured its depth, width and calculated its surface by a reproducible method. RESULTS: The analysis revealed that the uretero-hydronephrosis was predominantly at the right side (63%) and in the majority of the cases limited to the kidney (42%) and/or the proximal third of the ureter (42%). We were able to rule out some proposed etiologies: a compression of the ureter between the uterus and the iliac or ovarian vessels; a protective effect of the left intestinal structures. A link was observed between the psoas muscle and the physiological uretero-hydronephrosis: the ipsilateral psoas muscle seemed smaller in pregnant women presenting a uretero-hydronephrosis. CONCLUSION: We have highlighted a link between a physiological uretero-hydronephrosis during pregnancy and a lesser developped psoas muscle. The hypothesis proposed is that a smaller psoas muscle would have a less protective effect of the ureter due to a lesser development. This study offers a practical conclusion: a left sided uretero-hydronephrosis during pregnancy and/or including the entirety of the ureter is more probably a pathological hydronephrosis. LEVEL OF EVIDENCE: 4.

A Randomized Controlled Clinical Trial Investigating the Effects of Omega-3 Fatty Acids and Vitamin E Co-Supplementation on Biomarkers of Oxidative Stress, Inflammation and Pregnancy Outcomes in Gestational Diabetes.

OBJECTIVES: Limited data are available for assessing the effects of omega-3 fatty acids and vitamin E co-supplementation on metabolic profiles and pregnancy outcomes in gestational diabetes (GDM). This study was designed to determine the effects of omega-3 fatty acids and vitamin E co-supplementation on biomarkers of oxidative stress, inflammation and pregnancy outcomes in women with GDM. METHODS: This randomized, double-blind, placebo-controlled clinical trial was conducted in 60 patients with GDM who were not taking oral hypoglycemic agents. Patients were randomly allocated to intake either 1000 mg omega-3 fatty acids from flaxseed oil plus 400 IU vitamin E supplements (n=30) or placebo (n=30) for 6 weeks. Fasting blood samples were obtained from the women at the beginning of the study and after the 6-week intervention to quantify related markers. RESULTS: After 6 weeks of intervention, omega-3 fatty acids and vitamin E co-supplementation, compared with the placebo, resulted in a significant rise in total antioxidant capacity (TAC) (+187.5±224.9 vs. -32.5±136.1 mmol/L; p<0.001); nitric oxide (NO) (+5.0±7.7 vs. -12.0±28.0 µmol/L; p=0.002) and a significant decrease in plasma malondialdehyde (MDA) concentrations (-0.1±0.9 vs. +0.6±1.4 µmol/L; p=0.03). Co-supplementation with omega-3 fatty acids and vitamin E showed no detectable changes in plasma glutathione and serum high-sensitivity C-reactive protein levels. Joint omega-3 fatty acids and vitamin E supplementation resulted in lower incidences of hyperbilirubinemia in newborns (10.3% vs. 33.3%; p=0.03). CONCLUSIONS: Overall, omega-3 fatty acids and vitamin E co-supplementation for 6 weeks in women with GDM had beneficial effects on plasma TAC, MDA and NO and on the incidence of the newborns' hyperbilirubinemia.

Prevalence of prenatal depression and associated factors among HIV-positive women in primary care in Mpumalanga province, South Africa.

This study aimed to assess the prevalence of depressed symptoms and associated factors in prenatal HIV-positive women in primary care facilities in rural South Africa. In a cross-sectional study, 663 HIV-positive prenatal women in 12 community health centres in Mpumalanga province, South Africa, were recruited by systematic sampling (every consecutive patient after HIV post-test counselling). Results indicate that overall, 48.7% [95% CI: 44.8, 52.6] of women during the prenatal period reported depressed mood (scores of ≥ 13 on the Edinburgh Postnatal Depression Scale 10). In multivariate analysis, not being employed, unplanned pregnancy, not having an HIV-positive child, poor antiretroviral therapy adherence, non-condom use at last sex, and intimate partner violence were associated with depressive symptoms. Potential risk factors among HIV-infected prenatal women were identified which could be utilized in interventions. Routine screening for depression may be integrated into prenatal care settings.

Physicians' experiences and views on the role of obstetric ultrasound in rural and urban Rwanda: a qualitative study.

OBJECTIVE: To explore Rwandan physicians' experiences and views on the role of obstetric ultrasound in clinical management of pregnancy, and in situations where maternal and fetal health interests conflict. METHODS: Physicians (n = 19) in public and private health facilities in urban and rural Rwanda were interviewed in 2015 as part of the CROss-Country Ultrasound Study (CROCUS). Data were analysed qualitatively. RESULTS: Ultrasound was described as an important tool in maternity care. Availability and quality of equipment varied across sites, and considerable disparities in obstetric ultrasound utilisation between rural and urban areas were described. The physicians wanted more ultrasound training and saw the potential for midwives to perform basic scans. Information about fetal sex and well-being was described as women's main expectations of ultrasound. Although women's right to autonomy in pregnancy was supported in principle by participating physicians, fetal rights were sometimes seen as needing physician 'protection'. CONCLUSIONS: There appears to be increasing use and demand for obstetric ultrasound in Rwanda, particularly in urban areas. It seems important to monitor this development closely to secure wise and fair allocation of scarce obstetric expertise and resources and to prevent overuse or misuse of ultrasound. Raising awareness about the benefits of all aspects of antenatal care, including ultrasound may be an important step to improve pregnant women's uptake of services. Increased opportunities for formal ultrasound training, including the training of midwives to perform basic scans, seem warranted. Moreover, in parallel with the transition to more medico-technical maternity care, a dialogue about maternal rights to autonomy in pregnancy and childbirth is imperative.

[Maternal knowledge of fetal movements in late pregnancy]. / Évaluation des connaissances des femmes enceintes sur les mouvements actifs fœtaux lors de la visite de terme.

OBJECTIVES: Evaluate knowledge of patients with late pregnancy on active foetal movements. PATIENTS AND METHOD: This prospective study has been carried out with volontary patients during the 41-week of gestation term consultation, with a questionnaire, at the obstetric gynecology departments of St-Etienne Hospital (CHU), Clermont-Ferrand Hospital (CHU), Roanne Hospital (CH) and Firminy Hospital (CH), from July 22nd, 2013 to September 14th, 2014. RESULTS: Few patients (17%) have been seen urgently by an obstetrician or a midwife in case of a decrease of the active foetal movements. Most patients (73.6%) wait 24hours to consult. More than 50% of women have not been informed on this topic before the birth. However, 86.84% of the patients are interested in being informed when they see their doctor. The easiest way would be to count the active foetal movements 3 times a day on a short period. CONCLUSION: There is still a lack of information on the active foetal movements. It remains a difficult topic because its definition is still subjective and the information has no protocol.

Epidemiology of hepatitis E virus infection during pregnancy in Benin.

OBJECTIVES: Hepatitis E virus (HEV) is the cause of enterically transmitted non-A, non-C hepatitis (an infection that is particularly severe during pregnancy) in tropical and subtropical countries. As there are no published data concerning the prevalence of HEV antibodies in Benin, their presence was investigated in pregnant women undergoing routine HIV screening in a rural area in northern Benin and in pregnant women with acute non-A, non-C hepatitis. METHODS: A total of 278 serum samples were collected from asymptomatic pregnant women in 2011 were tested for HEV and hepatitis A virus (HAV) antibodies, and the HEV IgM-positive samples were further tested for HEV-RNA. A further seven samples of pregnant women with acute non-A, non-C hepatitis collected during episodes of acute hepatitis in 2005 were also analysed. RESULTS: Of the 278 samples collected in 2011, 16.19% were positive for HEV IgG and 1.44% for HEV IgM (none positive for HEV-RNA), and 99.64% were positive for total HAV antibodies (none positive for HAV IgM). Six of the seven samples collected in 2005 were positive for HEV IgG and IgM, and two were also positive for HEV-RNA. CONCLUSIONS: The circulation of HEV infection is significant among pregnant women in Benin, in whom the consequences may be fatal.

[Preventive withdrawal from work, psychosocial work demands and major depressive symptoms]. / Retrait préventif du travail, exposition aux contraintes psychosociales au travail et symptômes dépressifs majeurs.

AIM: Our study objectives were as follows: assess exposure to psychosocial work demands among working pregnant women and women on preventive withdrawal from work; and measure the association between psychosocial work demands and major depressive symptoms, according to time of withdrawal from work. METHODOLOGY: Karasek's abbreviated scale was used to measure psychosocial work demands (Job strain and "Iso-strain") and CES-D scale (Center for Epidemiological Studies Depression Scale) was used to measure major depressive symptoms (CES-D score≥23), at 24-26 weeks of pregnancy, among 3043 pregnant women in Montreal (Quebec) who worked at paid jobs at least 15 h/week and at least four consecutive weeks since the beginning of their pregnancy. Multivariate logistic regression models were built. RESULTS: At 24-26 weeks of pregnancy, 31.4% (956/3043) of pregnant women were on preventive withdrawal from work. They were more in "high-strain" (31.1% vs. 21.1%) and "Iso-strain" groups (21.0% vs. 14.2%) than those who continued to work (P<0.0001). The prevalence of major depressive symptoms was higher in women on preventive withdrawal from work (10.8%; CI 95%: 8.9 to 12.9) compared to working women (7.1%; CI 95%: 6.1-8.3). After adjustment for personal and professional risk factors, "Iso-strain" remained significantly associated with major depressive symptoms in working women (adjusted OR=1.75; CI 95%: [1.05 to 2.92]) and women on preventive withdrawal from work, regardless of duration of activity before withdrawal: 4 to 12 weeks (adjusted OR=2.72; CI 95%: [1.19-6.12]), 13 to 20 weeks (adjusted OR=3.51; CI 95%: [1.54-7.97]), and ≥21 weeks (adjusted OR=2.39; CI 95%: [1.10-5.20]). CONCLUSION: Psychosocial work demands are an important risk factor for the mental health of pregnant workers and require that preventive actions be put forward.

Group B Streptococci serotype distribution in pregnant women in Ghana: assessment of potential coverage through future vaccines.

OBJECTIVE: Group B streptococcal (GBS) colonization of pregnant women can lead to subsequent infection of the new-born and potentially fatal invasive disease. Data on GBS colonization prevalence and serotype distribution from Africa are scarce, although GBS-related infections are estimated to contribute substantially to infant mortality. In recent years, GBS vaccine candidates provided promising results in phase I and II clinical trials. We aimed to assess the prevalence and serotype distribution of GBS in Ghana since this knowledge is a prerequisite for future evaluation of vaccine trials. METHODS: This double-centre study was conducted in one rural and one urban hospital in central Ghana, West Africa. Women in late pregnancy (≥35 weeks of gestation) attending the antenatal care clinic (ANC) provided recto-vaginal swabs for GBS testing. GBS isolates were analysed for serotype and antibiotic susceptibility. GBS-positive women were treated with intrapartum antibiotic prophylaxis (IAP) according to current guidelines of the Center for Disease Control and Prevention (CDC). RESULTS: In total, 519 women were recruited at both study sites, recto-vaginal swabs were taken from 509. The overall prevalence of GBS was 19.1% (18.1% in rural Pramso and 23.1% in urban Kumasi, restrospectively). Capsular polysaccharide serotype (CPS) Ia accounted for the most frequent serotype beyond all isolates (28.1%), followed by serotype V (27.1%) and III (21.9%). No resistance to Penicillin was found, resistances to second line antibiotics clindamycin and erythromycin were 3.1% and 1%, respectively. DISCUSSION: Group B Streptococcus serotype distribution in Ghana is similar to that worldwide, but variations in prevalence of certain serotypes between the urban and rural study site were high. Antibiotic resistance of GBS strains was surprisingly low in this study.

Association between maternal dental periapical infections and pregnancy outcomes: results from a cross-sectional study in Malawi.

OBJECTIVES: Maternal infections are associated with intrauterine growth restriction (IUGR) and preterm birth (PTB). Dental infections are common in low-income settings, but their contribution to adverse pregnancy outcomes is unknown. We studied the epidemiology of dental periapical infections among pregnant women and their association to foetal growth restriction and the duration of pregnancy in a rural sub-Saharan African population. METHODS: This was a cross-sectional study on the association between maternal dental periapical infections and birth outcomes, in Malawi, Africa. We assessed oral health clinically and radiologically among recently delivered women with known duration of pregnancy and measured birthweight (BW), length and head circumference of their infants. RESULTS: Of 1024 analysed participants, 23.5% had periapical infections. Mean duration of pregnancy was 39.4 weeks, BW 2979 g and length 49.7 cm. Women with periapical infection had mean (95% CI) pregnancy duration 0.4 weeks (0.1-0.8) shorter and delivered infants with 79 g (13-145) lower BW and 0.5 cm (0.2-0.9) shorter neonatal length than women without periapical infection. The incidence of PTB was 10.0% among women with periapical infection and 7.3% among those without (adjusted difference 3.5%, 95% CI -1.1-8.1%). Corresponding prevalences for stunting were 20.9% and 14.2% (adjusted difference 9.0%, 95% CI 2.7%-15.2%). The population-attributable risk fraction attributable to periapical infection was 9.7% for PTB and 12.8% for stunting. CONCLUSIONS: Periapical infection was associated with shorter pregnancy duration and IUGR in the study area; interventions addressing this risk factor may improve birth outcomes in low-income settings.

[Not Available]. / À l'ère de l'automédication, que savent les femmes enceintes des anti-inflammatoires ?

OBJECTIVE: Non-steroidal anti-inflammatory drugs (NSAIDs) are contraindicated in pregnancy because of the many foetalmaternal complications they can induce. Yet, NSAIDs can be massively found in family medicine cabinets and they are over the-counter drugs for most of them. Because of the actual trend of empowerment and public authorities encouraging self-medication, NSAIDs might be used. Our aim was to assess pregnant women's knowledge of NSAIDs. STUDY DESIGN: A descriptive study, through the distribution of 330 questionnaires to all pregnant women consulting at the Teaching hospital of Saint-Etienne, during a week, from February 11(th), 2014 to 19(th), 2014. RESULTS: The answering rate was 96.4%. Around 46% of pregnant women declared self-medicating. More than 1 in 3 women considered NSAIDs without danger starting from their 6th month of pregnancy. Eighty-six percent of women recognized ibuprofen as belonging to NSAISs. However, 1 in 2 women didn't consider Rhinadvil® (ibuprofene/pseudoephedrine) as such and approximately 40% for Aspegic® (lysine acetylsalicylate) and Aspirin® (acetylsalicylic acid). Danger's perception varied according to the galenic and the trade name: 60% of them thought that Rhinadvil® was without risks and around 1 in 2 women thought the same for Aspirin® and Aspegic®. Eighty-six per cent of women recognized ibuprofen as belonging to NSAIDs. However, 1 in 2 women didn't consider Rhinadvil® as such and approximately 40% for Apegic® and Aspirin®. CONCLUSION: Pregnant women's knowledge of NSAIDs is not satisfactory. They are not aware of their danger and do not know how to recognize them. Yet, self-medication is rising and its accessibility is made easier. A work on prevention and information is therefore essential.

Risk factors for Chagas disease among pregnant women in El Salvador.

OBJECTIVES: To determine the seroprevalence of Chagas disease among pregnant women and estimate the risk factors for Chagas disease during pregnancies. METHODS: Community-based serological tests on Trypanosoma cruzi and structured interviews on socio-demographic and socio-economic status were conducted with pregnant women registered at three health centres in Sonsonate province, El Salvador. RESULTS: Of 797 pregnant women participating in the study, 29 (3.6%) were infected with Chagas disease. None had clinical symptoms. The results of bivariate analyses showed the significant association between seropositivity and maternal age ≥35 years, anaemia, illiteracy, having no formal school education and having knowledge on Chagas disease (P < 0.05). The results of multivariate analysis indicate that age ≥35 years and anaemia were significantly associated with being infected with Chagas disease among pregnant women (OR = 3.541 and 5.197, respectively). CONCLUSION: We recommend that the national Chagas disease control programme be better coordinated with the national maternal and child health programme to introduce blood screening for T. cruzi during antenatal visits. If financial constraint allows systematic blood screening to be only partially implemented, resources should be focused on pregnant women ≥35 years and women who have anaemia.