[Violence Against Staff in Delivery Rooms - Results of an Online-Survey and Structured Interviews in Obstetric Clinics in Berlin]. / Gewalt gegen Kreißsaalpersonal ­ Ergebnisse einer Online-Befragung und von Leitfadeninterviews an Berliner Geburtskliniken.

INTRODUCTION: Violence against medical staff is a known problem in emergency departments. Nevertheless, there is little empirical data about physical and verbal violence against staff members in delivery rooms in Germany. METHODS: This study comprises both quantitative and qualitative analyses. For the quantitative part, midwives and doctors working in delivery rooms in Berlin were asked to fill out a questionnaire about their experiences with violence within the last 6 months; this survey was completed between 15 November 2019 and 15 February 2020. For the qualitative part, structured interviews were conducted to investigate individual experiences of violence in more detail. RESULTS: Out of 173 participants in total, 148 (86%) reported to have experienced verbal violence and 82 (47%) reported to have experienced physical violence. Midwives and younger staff seem to be more often affected by violence. 70% of the participants did not feel sufficiently prepared for situations of violence. In a total of 36 interviews, the participants specifically named communicative problems, too high expectations of the pregnant women and their companion, as well as language barrier and cultural differences as reasons for furthering violence. CONCLUSION: Violence against staff is a relevant problem in delivery rooms in Berlin. Participants would welcome training to deal with violence and professional help for coming to terms with experiences of violence. Improved information about pregnancy and delivery, institutionalized translation, and more staff could possibly help to decrease frequency of violence.

Sex-specific epigenetic alterations of the hypothalamic Agrp-Pomc system do not explain 'diabesity' in the offspring of high-fat diet (HFD) overfed maternal rats.

Maternal high-fat diet (HFD) overfeeding pre- and during pregnancy and lactation may 'program' a 'diabesity' predisposition in the offspring, for inconclusive reasons. Acquired alterations of the hypothalamic promoter methylation and mRNA expression of the satiety neurohormone Pomc are possibly of critical importance here. We investigated within one developmental approach, including male and female rats, the sex-specific DNA methylation pattern and corresponding mRNA expression of both Pomc and its endogenous functional antagonist Agrp in the hypothalamus of adult HFD offspring. Obesity and diabetic disturbances occurred in both male and female HFD offspring, accompanied by altered Pomc promoter methylation pattern. However, this was not related to significant Pomc mRNA expression alterations. In contrast, male-specific alterations of Agrp promoter methylation were found, even associated with reduced mRNA expression of this orexigenic/anabolic Pomc antagonist. In conclusion, acquired epigenetic alterations of the hypothalamic Agrp-Pomc system hardly explain the 'diabesity' phenotype in HFD offspring, while distinct vulnerability and functionality of Agrp promoter and related genomic regions methylation should be further investigated.

Hypothalamic insulin receptor expression and DNA promoter methylation are sex-specifically altered in adult offspring of high-fat diet (HFD)-overfed mother rats.

Maternal overnutrition around reproduction has been shown to increase the offspring's risk for "diabesity," mediated by altered hypothalamic neuropeptide expression. In this report, a possible contribution of altered hypothalamic sensing capacity for the peripheral satiety signals glucose, insulin and leptin will be addressed, taking into account potential sex differences. Specifically, we evaluated the effects a maternal high-fat diet (HFD) overfeeding has in rats pre- and during pregnancy and lactation on the hypothalamic gene expression patterns of insulin and leptin receptors (InsR, ObRb) and glucose transporter 3 (Glut3) as well as DNA methylation in the offspring at adult age (day 200 of life). Maternal HFD consumption resulted in a metabolic syndrome phenotype, i.e., obesity, hyperleptinemia, hyperinsulinemia, impaired glucose tolerance and increased homeostatic model assessment of insulin resistance. Interestingly, in turn, insulin resistance was more pronounced in male offspring, accompanied by decreased hypothalamic InsR-mRNA. This was linked with hypermethylation of an activating transcription factor binding site within the hypothalamic InsR promoter. The degree of methylation correlated inversely with respective InsR expression, while InsR expression itself was inversely related to phenotypic "diabesity." Expression of ObRb and Glut3 mRNA was not significantly changed. In conclusion, sex-specific alterations of hypothalamic InsR expression and DNA promoter methylation in adult offspring of HFD-overfed dams may lead to hypothalamic insulin resistance and "diabesity," with males predisposed to this epigenetic malprogramming.

[Folic Acid Intake Among Women in Berlin According to Their Socio-Economic Status]. / Folsäure-Einnahme bei Berliner Frauen in Abhängigkeit vom sozioökonomischen Status.

INTRODUCTION: The intake of folic acid before and during pregnancy is known to reduce the risk of neural tube defects. Many pregnant women do take folic acid at some point during their pregnancy. Very few of them start taking supplements before conception as recommended. The aim of this study was to find out more about the supplementation behavior among pregnant women and postpartum women in Berlin. METHODS: Pregnant women and postpartum women were asked to anonymously fill in a questionnaire about potential folic acid intake. We conducted a logistic regression analysis to identify independent predictors of folic acid intake during pregnancy. RESULTS: 90.7% (n=1069) of women did take folic acid at some point during their pregnancy, 37.8% (n=445) before conception as advised. Women are more likely to take folic acid before conception when they have planned their pregnancy, when they are better educated, earn more money and are older. Non-German(-speaking) women took significantly less folic acid than German women. Education, income and planning of the pregnancy were identified as independent predictors of folic acid intake prior to conception. CONCLUSION: Almost two thirds of pregnant women do not take folic acid when they need it most, especially those women who do not make much money, are not well educated, are young, and/or have not planned their pregnancy. Additionally, the supplementation rate is lower among non-German women and/or women who do not speak any German.

Influence of sunflower seed oil or baby lotion on the skin barrier function of newborns: A pilot study.

BACKGROUND: Skin care influences skin barrier function during the first postnatal weeks. Although the use of natural oils in preterms has been investigated, there are currently no data comparing the effect of sunflower oil to an emollient on barrier development in healthy term newborns. METHODS: In a prospective, randomized clinical study, 50 healthy full-term newborns aged ≤72 h were randomly assigned to two groups: group baby lotion (L, n=22) and sunflower seed oil (SSO, n=24). The skin barrier function was evaluated in three anatomical areas (front, abdomen, and thigh) by noninvasive assessment of transepidermal water loss (TEWL), stratum corneum hydration (SCH), sebum, and skin pH at inclusion and after five weeks. RESULTS: In both groups, skin pH decreased and SCH increased statistically significantly in all measured areas at W5 compared to baseline. TEWL decreased statistically significantly on the forearm in both groups, on the upper leg in group L, and on the abdomen in group SSO. CONCLUSIONS: Both skin care regimes did not harm skin barrier function adaptation in healthy term neonates during the first five weeks of life.

Avoiding the prenatal programming effects of glucocorticoids: are there alternative treatments for the induction of antenatal lung maturation?

BACKGROUND: The long-term outcomes of antenatal glucocorticoids (GCs) vary between reports, and have generated controversy in terms of repeated and single-course events, causing irreversible effects on endocrine set points. AIM: This study aimed to assess the effects of alternative therapeutic agents other than synthetic glucocorticoid GC administration for fetal lung maturation. METHODS: A review of literature from PubMed, EMBASE, Cochrane Library, and Google Scholar was conducted to assess the use of alternative therapies to synthetic GCs using recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA). End points included the rates of respiratory distress syndrome (RDS), mRNA expression for pneumocyte type II, concentration of surfactant proteins in alveolar lavage, morphological differences, histological proof of lung maturation, and angiogenesis or quantification of the surfactant pool. RESULTS: In all 41 studies examined, we found that ambroxol showed positive effects on lung maturation, but it has yet to be analyzed with sufficient significance in humans. Interleukins and TNF-alpha produce accelerated lung maturation, but have only been evaluated in basic research/experimental studies. Growth factors promote structural and functional growth in all phases of lung maturation, but little is known about their reciprocal effects and exact mechanisms as therapeutics. Thyroid releasing hormone or vitamin A cause detrimental side effects or were less effective for lung maturation. CONCLUSIONS: The efficacy and safety of these alternative agents are differentiated and none up to now can be recommended as an alternative to GCs.

Does docosahexaenoic acid (DHA) status in pregnancy have any impact on postnatal growth? Six-year follow-up of a prospective randomized double-blind monocenter study on low-dose DHA supplements.

Fetuses and breastfed children depend on the maternal docosahexaenoic acid (DHA) supply, which might have long-lasting consequences. We studied the growth of 6-year-old children whose mothers received supplemental DHA from midpregnancy to 3 months after delivery. One hundred and forty-four pregnant women had been randomized to receive one of three vitamin-mineral supplements, one supplying an additional 200 mg/day DHA. Of the original sample, 120 children were measured at age 6 years with standardized methods. As one objective of the follow-up was to investigate the DHA influence on normal growth, the DHA group was compared with the pooled controls after exclusion of five premature infants. The weight, length, body mass index (BMI), head circumference, and skin-fold thickness at 6 years were similar in the 41 children of the DHA group and the 74 controls. Longitudinally, the BMI z-scores of the DHA group increased up at a later age than that of the controls. We found a highly significant negative correlation between height at 6 years and the increase in red blood cell DHA concentration of mothers from 22 to 37 weeks of pregnancy. We conclude that DHA supplements during midpregnancy corrected a low maternal DHA status (which correlated with children's height) and was favorable in regard to the BMI development up to 6 years.