Assistência pré-natal às usuárias de substâncias psicoativas: dificuldades elencadas pelos profissionais da saúde / Prenatal care for users of psychoactive substances: difficulties listed by health professionals / Atención prenatal a consumidoras de sustancias psicoactivas: dificultades mencionadas por los profesionales de la salud

Objetivo: conhecer as dificuldades elencadas pelos profissionais de saúde na assistência pré-natal às usuárias de substâncias psicoativas. Método: estudo qualitativo, exploratório-descritivo, realizado nas mídias sociais, com profissionais da área da saúde que realizam atendimento pré-natal. A coleta de dados ocorreu de novembro de 2022 a janeiro de 2023 por meio de questionário eletrônico. Os dados foram analisados por meio da análise temática. Protocolo aprovado pelo Comitê de Ética em Pesquisa. Resultados: os profissionais destacam o déficit de conhecimento para abordar este público em específico. A abordagem superficial e condenatória do uso de substâncias pelas políticas públicas corrobora para que os profissionais se sintam preparados em parte para atender essas gestantes. Considerações finais: a capacitação dos profissionais é necessária para superar práticas condenatórias e retrógradas de cuidado que focam unicamente a abstinência; como também, o investimento na capacitação acerca da rede de atenção à saúde, buscando ampliar sua visibilidade e utilização.

Objective: understanding the difficulties listed by health professionals in prenatal care for users of psychoactive substances. Method: this is a qualitative, exploratory-descriptive study carried out on social media with health professionals who provide prenatal care. Data was collected from November 2022 to January 2023 using an electronic questionnaire. The data was analyzed using thematic analysis. Protocol approved by the Research Ethics Committee. Results: the professionals highlight the lack of knowledge to deal with this specific public. The superficial and condemnatory approach to substance use by public policies contributes to making professionals feel partly prepared to deal with these pregnant women. Final considerations: the training of professionals is necessary to overcome condemnatory and retrograde care practices that focus solely on abstinence; and investment in training about the health care network, seeking to increase its visibility and use.

Objetivo: conocer las dificultades mencionadas por los profesionales de la salud en la atención prenatal de las consumidoras de sustancias psicoactivas. Método: estudio cualitativo, exploratorio-descriptivo, realizado en redes sociales, con profesionales de la salud que brindan atención prenatal. La recolección de datos se llevó a cabo de noviembre de 2022 a enero de 2023 a través de un cuestionario electrónico. Los datos se analizaron mediante análisis temático. El protocolo fue aprobado por el Comité de Ética en Investigación. Resultados: los profesionales destacan que les falta el conocimiento para atender a este público específico. El abordaje superficial y condenatorio del consumo de sustancias por parte de las políticas públicas contribuye a que los profesionales se sientan parcialmente preparados para atender a esas gestantes. Consideraciones finales: es necesario capacitar a los profesionales para superar las prácticas asistenciales condenatorias y retrógradas que se centran únicamente en evitar el consumo; e invertir en capacitación sobre la red de atención de salud, para ampliar su visibilidad y uso.

Magnetic resonance imaging of fetal vascular malformations.

Vascular anomalies develop during fetal life and can be detected on prenatal ultrasonography and fetal magnetic resonance imaging. Diagnosis of lymphatic, venous, and arteriovenous malformations, as well as congenital hemangiomas and other congenital vascular tumors, may be challenging. The benign vascular anomalies may be difficult to differentiate from malignancies with a similar appearance. In this manuscript, we present a succinct overview of the congenital vascular anomalies that may present in fetal or neonatal life.

The association of travel burden with prenatal care utilization, what happens after provider-selection.

BACKGROUND: Birthing people in the United States face numerous challenges when accessing adequate prenatal care (PNC), with transportation being a significant obstacle. Nevertheless, previous studies that relied solely on the distance to the nearest provider cannot differentiate the effects of travel burden on provider selection and care utilization. These may exaggerate the degree of inequality in access and fail to capture perceived travel burden. This study investigated whether travel distances to the initially visited provider, to the predominant PNC provider, and perceived travel burden (measured by the travel disadvantage index (TDI)) are associated with PNC utilization. METHODS: A retrospective cohort of people with live births were identified from South Carolina Medicaid claims files in 2015-2018. Travel distances were calculated using Google Maps. The estimated TDI was derived from local pilot survey data. PNC utilization was measured by PNC initiation and frequency. Repeated measure logistic regression test was utilized for categorical variables and one-way repeated measures ANOVA for continuous variables. Unadjusted and adjusted ordinal logistic regressions with repeated measure were utilized to examine the association of travel burdens with PNC usage. RESULTS: For 25,801 pregnancies among those continuously enrolled in Medicaid, birthing people traveled an average of 24.9 and 24.2 miles to their initial and predominant provider, respectively, with an average TDI of -11.4 (SD, 8.5). Of these pregnancies, 60% initiated PNC in the first trimester, with an average of 8 total visits. Compared to the specialties of initial providers, predominant providers were more likely to be OBGYN-related specialists (81.6% vs. 87.9%, p < .001) and midwives (3.5% vs. 4.3%, p < .001). Multiple regression analysis revealed that every doubling of travel distance was associated with less likelihood to initiate timely PNC (OR: 0.95, p < .001) and a lower visit frequency (OR: 0.85, p < .001), and every doubling of TDI was associated with less likelihood to initiate timely PNC (OR: 0.94, p = .04). CONCLUSIONS: Findings suggest that the association between travel burden and PNC utilization was statistically significant but of limited practical significance.

Childhood PFAS exposure and immunotoxicity: a systematic review and meta-analysis of human studies.

BACKGROUND: Exposure to poly- and perfluoroalkyl substances (PFAS) may affect infant and childhood health through immunosuppression. However, the findings of epidemiological literature examining relationships between prenatal/childhood PFAS exposure and vaccine response and infection in humans are still inconclusive. The aim of this review was to examine the effects of PFAS exposure on vaccine antibody response and infection in humans. METHODS: The MEDLINE/Pubmed database was searched for publications until 1 February 2023 to identify human studies on PFAS exposure and human health. Eligible for inclusion studies had to have an epidemiological study design and must have performed logistic regression analyses of gestational or childhood exposure to PFAS against either antibody levels for pediatric vaccines or the occurrence of children's infectious diseases. Information on baseline exposure to PFAS (in ng/mL), the age of PFAS exposure (gestational or in years), and the outcome was measured, potentially leading to multiple exposure-outcome comparisons within each study was collected. Percentage change and standard errors of antibody titers and occurrence of infectious diseases per doubling of PFAS exposure were calculated, and a quality assessment of each study was performed. RESULTS: Seventeen articles were identified matching the inclusion criteria and were included in the meta-analysis. In general, a small decrease in antibody response and some associations between PFAS exposure and childhood infections were observed. CONCLUSIONS: This meta-analysis summarizes the findings of PFAS effects on infant and childhood immune health. The immunosuppression findings for infections yielded suggestive evidence related to PFAS exposure, particularly PFOS, PFOA, PFHxS, and PFNA but moderate to no evidence regarding antibody titer reduction. SYSTEMATIC REVIEW REGISTRATION: The research protocol of this systematic review is registered and accessible at the Open Science Framework ( https://doi.org/10.17605/OSF.IO/5M2VU ).

Midwives' and Obstetric Physicians' Practices Related to Pregnancy Nutrition Counseling: A Scoping Review.

INTRODUCTION: Dietary intake during pregnancy impacts short- and long-term maternal and fetal health outcomes. Dietary habits are highly individualized and influenced by contextual factors and social determinants of health within each person's lived environment. Midwives and other health care providers are well positioned to facilitate nutrition conversations and interventions with patients related to recommendations and modifications before and during pregnancy. This scoping review synthesizes the literature on perinatal care providers' attitudes and practices related to antenatal nutrition counseling. METHODS: An electronic database literature search was conducted in March 2023 using the following inclusion criteria: English language, published between 1990 and 2023, completed in high-income countries, and evaluated provider practices related to educating pregnancy patients on nutrition. Exclusion criteria included comparison or interventional studies as well as those focused on patient perspectives, specialty diets, comorbidities, or pregnancy complications. Thematic analysis was completed to identify common themes and subthemes across studies related to perinatal care providers' perspectives of pregnancy nutrition. RESULTS: Thirty-six articles were included in the final review. Although providers acknowledged the importance of nutrition for pregnancy outcomes, few reported being able to cover the topic in-depth during antenatal visits. Counseling was usually generalized, limited in scope, and lacked consideration of patient-specific contextual factors such as dietary restrictions, preferences, or access to resources needed to follow recommendations. Provider barriers to comprehensive nutrition counseling included lack of training and time during clinic visits and limited availability of guidelines. DISCUSSION: Multiple gaps in current pregnancy nutrition counseling practices exist. Despite nutrition being viewed by perinatal care providers as an important part of pregnancy, multiple barriers lead to it being overlooked during patient-provider interactions. Contextual factors for both providers and patients contribute to failure of current interventions to consistently and significantly impact dietary habits of pregnant people.

Maternal smoking during pregnancy and offspring risk of intellectual disability: a UK-based cohort study.

Background: Observational studies have described associations of maternal smoking during pregnancy with intellectual disability (ID) in the exposed offspring. Whether these results reflect a causal effect or unmeasured confounding is still unclear. Methods: Using a UK-based prospectively collected birth cohort (the Avon Longitudinal Study of Parents and Children) of 13,479 children born between 1991 and 1992, we assessed the relationship between maternal smoking at 18 weeks' gestation and offspring risk of ID, ascertained through multiple sources of linked information including primary care diagnoses and education records. Using confounder-adjusted logistic regression, we performed observational analyses and a negative control analysis that compared maternal with partner smoking in pregnancy under the assumption that if a causal effect were to exist, maternal effect estimates would be of greater magnitude than estimates for partner smoking if the two exposures suffer from comparable biases. Results: In observational analysis, we found an adjusted odds ratio for ID of 0.75 (95% CI = 0.49-1.13) for any maternal smoking and 0.97 (95% CI = 0.71-1.33) per 10-cigarette increase in number of cigarettes smoked per day. In negative control analysis, comparable effect estimates were found for any partner smoking (OR = 0.94; 95% CI = 0.63-1.40) and number of cigarettes smoked per day (OR = 0.94; 95% CI = 0.74-1.20). Conclusions: The results are not consistent with a causal effect of maternal smoking during pregnancy on offspring ID.

Intrauterine growth in chromatinopathies: A long road for better understanding and for improving clinical management.

BACKGROUND: Chromatinopathies are a heterogeneous group of genetic disorders caused by pathogenic variants in genes coding for chromatin state balance proteins. Remarkably, many of these syndromes present unbalanced postnatal growth, both under- and over-, although little has been described in the literature. Fetal growth measurements are common practice in pregnancy management and values within normal ranges indicate proper intrauterine growth progression; on the contrary, abnormalities in intrauterine fetal growth open the discussion of possible pathogenesis affecting growth even in the postnatal period. METHODS: Among the numerous chromatinopathies, we have selected six of the most documented in the literature offering evidence about two fetal overgrowth (Sotos and Weaver syndrome) and four fetal undergrowth syndromes (Bohring Opitz, Cornelia de Lange, Floating-Harbor, and Meier Gorlin syndrome), describing their molecular characteristics, maternal biochemical results and early pregnancy findings, prenatal ultrasound findings, and postnatal characteristics. RESULTS/CONCLUSION: To date, the scarce data in the literature on prenatal findings are few and inconclusive, even though these parameters may contribute to a more rapid and accurate diagnosis, calling for a better and more detailed description of pregnancy findings.

Parental prenatal representations of the child are related to 18-month-old children's social-emotional competence.

Parental representations of the child are linked to positive developmental outcomes in children, but the impact of prenatal representations on early social-emotional development, particularly from fathers, is less understood. This study explores how fathers' and mothers' prenatal representations within two-parent families are associated with early social-emotional development. Prenatal representations of fathers (n = 88) and mothers (n = 92) were assessed between 28 and 32 weeks of gestation using the Working Model of the Child Interview, categorizing them as balanced or nonbalanced. The children's (n = 97; 49.5% girls) social-emotional and behavioral problems and competencies were measured at 18 months using the Brief Infant-Toddler Social and Emotional Assessment. Balanced prenatal representations of both parents were related to higher social-emotional competence in toddlers. However, prenatal representations were not related to social-emotional and behavioral problems. The results highlight the benefits of balanced prenatal representations in promoting early social-emotional competence in children.

Setting a research agenda for examining early risk for elevated cognitive disengagement syndrome symptoms using data from the ABCD cohort.

Background: Little research has examined early life risk for symptoms of cognitive disengagement syndrome (CDS) despite a well-established literature regarding co-occurring outcomes (e.g., attention-deficit/hyperactivity disorder). The current study estimated bivariate associations between early life risk factors and CDS in a large and representative sample of U.S. children. Methods: We conducted secondary analyses of baseline data from the Adolescent Brain Cognitive Development (ABCD) study (N = 8,096 children, 9-10 years old). Birthing parents reported early life risk factors on a developmental history questionnaire, including parental, prenatal, delivery and birth, and developmental milestone information. They also completed the Child Behavior Checklist, which includes a CDS subscale that was dichotomized to estimate the odds of elevated CDS symptoms (i.e., T-score > 70) in children related to risk indices. Results: We observed significantly elevated odds of CDS related to parental risk factors (i.e., unplanned pregnancy, pregnancy awareness after 6 weeks, teenage parenthood), birthing parent illnesses in pregnancy (i.e., severe nausea, proteinuria, pre-eclampsia/toxemia, severe anemia, urinary tract infection), pregnancy complications (i.e., bleeding), prenatal substance exposures (i.e., prescription medication, tobacco, illicit drugs), delivery and birth risk factors (i.e., child blue at delivery, child not breathing, jaundice, incubation after delivery), and late motor and speech milestones in children. Conclusions: Several early-life risk factors were associated with elevated odds of CDS at ages 9-10 years; study design prevents the determination of causality. Further investigation is warranted regarding early life origins of CDS with priority given to risk indices that have upstream commonalities (i.e., that restrict fetal growth, nutrients, and oxygen).

Intrauterine fetal death due to rupture of umbilical vessels: a rare case of furcate cord insertion.

Furcate cord insertion refers to the separation of umbilical vessels before reaching the placenta, where the branching vessels normally attach at the edge of the placental parenchyma or near the placental membranes. This is an extremely rare abnormal umbilical cord insertion. This paper reported a case of a furcate cord insertion, where the rupture of exposed umbilical vessels led to intrauterine fetal death at full term. Through literature review, we analyzed the prenatal ultrasound characteristics and pregnancy outcomes of furcate cord insertions, with the aim to improve detection rates and reduce the risk of adverse pregnancy outcomes.

Prenatal exposure to environmental phenols and phthalates and altered patterns of DNA methylation in childhood.

INTRODUCTION: Epigenetic marks are key biomarkers linking the prenatal environment to health and development. However, DNA methylation associations and persistence of marks for prenatal exposure to multiple Endocrine Disrupting Chemicals (EDCs) in human populations have not been examined in great detail. METHODS: We measured Bisphenol-A (BPA), triclosan, benzophenone-3 (BP3), methyl-paraben, propyl-paraben, and butyl-paraben, as well as 11 phthalate metabolites, in two pregnancy urine samples, at approximately 13 and 26 weeks of gestation in participants of the Center for the Health Assessment of Mothers and Children of Salinas (CHAMACOS) study (N = 309). DNA methylation of cord blood at birth and child peripheral blood at ages 9 and 14 years was measured with 450K and EPIC arrays. Robust linear regression was used to identify differentially methylated probes (DMPs), and comb-p was used to identify differentially methylated regions (DMRs) in association with pregnancy-averaged EDC concentrations. Quantile g-computation was used to assess associations of the whole phenol/phthalate mixture with DMPs and DMRs. RESULTS: Prenatal BPA exposure was associated with 1 CpG among males and Parabens were associated with 10 CpGs among females at Bonferroni-level significance in cord blood. Other suggestive DMPs (unadjusted p-value < 1 × 10-6) and several DMRs associated with the individual phenols and whole mixture were also identified. A total of 10 CpG sites at least suggestively associated with BPA, Triclosan, BP3, Parabens, and the whole mixture in cord blood were found to persist into adolescence in peripheral blood. CONCLUSIONS: We found sex-specific associations between prenatal phenol exposure and DNA methylation, particularly with BPA in males and Parabens in females. Additionally, we found several DMPs that maintained significant associations with prenatal EDC exposures at age 9 and age 14 years.

Possible associations between prenatal exposure to environmental pollutants and neurodevelopmental outcome in children.

This study aimed to evaluate associations between prenatal and childhood exposure to phthalates and prenatal exposure to polychlorinated biphenyls (PCBs) and the development of 4-year-old children. Urinary metabolites of five phthalates were measured in women upon delivery, as well as serum concentrations of four PCB congeners. Postnatal phthalate metabolites were measured from children's urine obtained at the time of developmental assessment. The primary outcome was cognitive function as evaluated by the Wechsler Preschool and Primary Scale of Intelligence (WPPSI-III) administered at 4 years. Secondary outcomes were motor function and response to sensory stimuli as evaluated by the Developmental Coordination Disorder Questionnaire (DCDQ) and Short Sensory Profile (SSP) that the mothers filled out, respectively. The study included 57 mother-child pairs. Higher maternal phthalate metabolite concentrations were inversely associated with WPPSI-III scores among boys and not among girls. After using linear regression models and controlling for confounding variables, we found that higher levels of monobenzyl phthalate (MBzP) were the ones associated with lower WPPSI-III scores (p=0.004, 95%CI [-14.18; -3.16]), lower DCDQ scores (p=0.007, 95%CI [-6.08; -1.17] and lower SSP scores (p=0.004, 95%CI [-7.47; -1.79]). No association was found between child urinary phthalate metabolite concentrations or maternal PCB blood concentrations and developmental function. These findings indicate that higher prenatal phthalate metabolite levels may be associated with deficits in neurologic development of young boys.

[Effect of prenatal glucocorticoid therapy on hearing screening in premature infants].

Objective:To explore the effect of prenatal glucocorticoids therapy on hearing screening in premature infants Methods:Data of 693 preterm infants with gestational age of 24-34+6weeks admitted to theJiangxi Maternal and Child Health Hospital within 24 h after birth from June 2022 to June 2023 were retrospectively analyzed. The infants were divided into the DXM group （544 cases） and the non-DXM group （149 cases） based on whether dexamethasone （DXM） was administered prenatally. General data of preterm infants and parturients in two groups were compared, and the effects of different doses and timing of DXM on hearing screening were analyzed. Results:In the terms of preliminary hearing screening. the pass rate of initial hearing screening in DXM group was significantly higher than that in non-DXM group（53.9% vs 35.6%）, with statistical significance（P<0.05）. Further subgroup analysis showed that the passing rate of preliminary hearing screening in adequate prenatal dose（=4 doses） DXM group（58.1%） was significantly higher than that in insufficient group（48.0%） and excessive group（42.4%）, with statistical significance（P<0.05）. Administering DXM 48 hours to 7 days before birth resulted in a higher pass rate for initial hearing screening compared to administration <48 hours or >7 days before birth （56.4% vs. 48.6%）, with a statistically significant difference （P < 0.05）. In terms of re-hearing screening, the pass rate of secondary hearing screening was not significantly correlated with DXM treatment（P>0.05）, but was significantly correlated with gestational age, birth weight, hospital stays, invasive mechanical ventilation, and common neonatal diseases（bronchopulmonary dysplasia, respiratory distress syndrome）（P<0.05）. Among them, bronchopulmonary dysplasia was an independent risk factor forsecondary hearing screening referral（P<0.05）. Conclusion:A single course of adequate dexamethasone use within 48 h-7 d of prenatal has a positive effect on the preliminary hearing screening of preterm infants.

Prevalence and Risk Factors of Prenatal and Postnatal Depressive Symptoms in Babol Pregnancy Mental Health Registry: A Cross-Sectional Study.

BACKGROUND: Prenatal and postnatal depression (PND) is associated with adverse outcomes for mother, fetus, and child. The aim of study was to examine the prevalence and risk factors of prenatal and postnatal depressive symptoms. MATERIALS AND METHODS: This was a cross-sectional and hospital-based survey of 2305 pregnant women and post-partum women (18-48 years) that was registered in the Babol Pregnancy Mental Health Registry (BPMHR) database from June 2020 to March 2021. Two questionnaires, including demographics and depression, were analyzed in this study. Also, the Edinburg Postnatal Depression Scale (EPDS) was used to assess the depressive symptoms. Independent t test and the analysis of variance were used to compare the means. Multiple logistic regressions were used to determine risk factors for depressive symptoms. RESULTS: According to the EPDS scale, the prevalence of depressive symptoms was 19.8% in the pregnant woman group in comparison with the postpartum period (11.6%). Risk factors for antenatal depressive symptoms were parity (women with parity ≥ 4 vs. 1 parity, ß=1.808, P=0.020), two groups of gestational age (gestational age ≤12 weeks vs. 28 weeks, ß=1.562 P=0.030) as well as (gestational age 21-27 weeks vs. 28 weeks (ß=1.586, P=0.033), and high-risk pregnancy (high-risk vs. low-risk pregnancy, ß=1.457, P=0.003). For postnatal depressive symptoms, none of the factors were a significant risk. CONCLUSION: Prenatal and postnatal depressive symptoms should be screened, particularly for women in the first and second trimesters, with high parity, and those with a high-risk pregnancy, as recommended by the present study.

Intersectional socioeconomic disparities in continuous smoking through pregnancy among pre-pregnant smokers in Sweden between 2006 and 2016.

BACKGROUND: While well-established associations exist between socioeconomic conditions and smoking during pregnancy (SDP), less is known about social disparities in the risk of continuous SDP. Intersectional analyses that consider multiple social factors simultaneously can offer valuable insight for planning smoking cessation interventions. METHODS: We include all 146,222 pregnancies in Sweden between 2006 and 2016 where the mother smoked at three months before pregnancy. The outcome was continuous SDP defined as self-reported smoking in the third trimester. Exposures were age, education, migration status and civil status. We examined all exposures in a mutually adjusted unidimensional analysis and in an intersectional model including 36 possible combinations. We present ORs with 95% Confidence Intervals, and the Area Under the Curve (AUC) as a measure of discriminatory accuracy (DA). RESULTS: In our study, education status was the factor most strongly associated to continuous SDP among women who smoked at three months before pregnancy. In the unidimensional analysis women with low and middle education had ORs for continuous SDP of 6.92 (95%CI 6.63-7.22) and 3.06 (95%CI 2.94-3.18) respectively compared to women with high education. In the intersectional analysis, odds of continuous SDP were 17.50 (95%CI 14.56-21.03) for married women born in Sweden aged ≥ 35 years with low education, compared to the reference group of married women born in Sweden aged 25-34 with high education. AUC-values were 0.658 and 0.660 for the unidimensional and intersectional models, respectively. CONCLUSION: The unidimensional and intersectional analyses showed that low education status increases odds of continuous SDP but that in isolation education status is insufficient to identify the women at highest odds of continuous SDP. Interventions targeted to social groups should be preceded by intersectional analyses but further research is needed before recommending intensified smoking cessation to specific social groups.

Evaluation of an Embedded Health Psychologist Intervention for Obstetric Patients With Adverse Childhood Experiences.

BACKGROUND: Screening for adverse childhood experiences (ACEs) and resilience in pregnancy is a promising practice for mitigating ACEs-related health complications. Yet, the best follow-up for pregnant patients with high ACEs and/or low resilience has not been established. OBJECTIVE: This study evaluates referrals to and participation in an embedded health psychologist (EHP) intervention for pregnant patients with ACEs and/or low resilience. MATERIALS AND METHODS: Patients in 3 Kaiser Permanente Northern California medical centers with ACEs who had also received resilience screening during standard prenatal care and who were participating in an EHP intervention were included (N = 910). The authors used multivariable logistic regression to examine whether ACEs (0, 1-2, 3+) and resilience (high vs low) were associated with referrals to and participation in EHP intervention. They also evaluated the impact of EHP intervention through clinician (N = 53) and patient (N = 51) surveys. RESULTS: Patients with 3+ vs 0 ACEs were more likely to receive an EHP referral (adjusted odds ratio [aOR] = 2.89, 95% confidence interval [CI]: 1.93-4.33) and were more likely to participate in EHP intervention (aOR = 2.85, 95% CI: 1.87-4.36). Those with low vs high resilience were also more likely to receive an EHP referral (aOR = 1.86, 95% CI: 1.32-2.62) and participate in EHP (aOR = 1.71, 95% CI: 1.19-2.44). When ACEs and resilience were combined, those with high ACEs and low resilience had the greatest odds of referrals and participation. Patients and clinicians reported positive experiences with EHP intervention. CONCLUSION: Patients with higher ACEs and lower resilience scores were more likely to be referred to and participate in EHP intervention, suggesting that at-risk patients can be successfully linked with a health psychologist when accessible within obstetric care.

The Influence of Maternal Hypoxia and Buspirone during Pregnancy on Cognitive Abilities and a Stress Response in Adult Male Offspring.

Spatial learning, memory, and reactivity of the hypothalamic-pituitary-adrenocortical system (HPA axis) were studied in adult male rats, whose mothers during pregnancy were subjected to acute moderate normobaric hypoxia, or repeated injections of buspirone, an agonist of type 1A serotonergic receptors (5HT1A), or their combination. Prenatal treatment with buspirone in rats with prenatal hypoxia impaired learning ability during the first day of 5-day training. A decrease in the effectiveness of long-term memory in comparison with short-term memory was revealed in two groups of rats: prenatal treatment with buspirone in combination with hypoxia and injection of physiological saline without hypoxia. The effectiveness of long-term memory and the level of corticosterone in response to stress did not differ between the groups, which can indicate adaptation of the 5HT1A receptor and the HPA axis to the prenatal buspirone and normobaric hypoxia during ontogeny.

Comparative analysis of the application with the combination of CMA and karyotype in routine and late amniocentesis.

PURPOSE: This is a retrospective comparative study. We aimed to analyze the results of karyotype and chromosomal microarray analysis (CMA) of amniotic fluid across different gestational weeks and evaluate the clinical value in prenatal diagnosis, particularly in the late pregnancies. METHODS: Samples from 580 pregnant women of 18-23 weeks of gestation (mid-gestation group) and 196 pregnant women of 24-32 weeks of gestation (late group) were performed both standard G-band karyotype analysis and CMA. RESULTS: Among the 580 pregnant women in the routine group, the most common indications were positive Down's screening (213/580, 36.7%), followed by advanced maternal age (196/580, 33.8%); while fetal structural anomalies on ultrasonography were the top reason for amniocentesis in the late group (56/196, 28.6%). In the routine group, the total detection rate was 12.1% (70/580), of which 4.1% (24/580) were identified by karyotype analysis and 11.2% (65/580) by CMA. The total detection rate was 15.3% (30/196) in the late group, of which 5.1% (10/196) were detected by karyotype analysis, and 14.3% (28/196) by CMA. CONCLUSION: Karyotype analysis and CMA are complementary in detecting chromosomal abnormalities. Amniotic cavity puncture in the karyotype analysis in 18-23 weeks of gestation and 24-32 weeks of gestation is safe and effective, more obvious effect on the latter.

Patient-Provider Trust as a Key Component of Prenatal Screening for Adverse Childhood Experiences (ACES): A Concept Analysis.

INTRODUCTION: The concept of patient-provider trust in prenatal adverse childhood experiences (ACEs) screening remains unexplored. This concept analysis illuminates the role of trust in prenatal ACE screening to improve patient-provider relationships, increase patient uptake of ACE screening, and ensure that ACE screening is implemented in a strengths-based, trauma-informed way. METHODS: A concept analysis was conducted using the Rodgers' evolutionary method to define the antecedents, attributes, and consequences of this construct. The databases searched were PubMed, PsychInfo, and Scopus between 2010 and 2021. A total of 389 articles were retrieved using the search terms prenatal, adverse childhood experiences screening, adverse childhood experiences, and adverse childhood experiences questionnaire. Included articles for detailed review contained prenatal screening, trauma screening (ACE or other), trust or building trust between patient and health care provider, patient engagement, and shared decision making. Excluded articles were those not in the context of prenatal care and that were exclusively about screening with no discussion about the patient-provider relationship or patient perspectives. A total of 32 articles were reviewed for this concept analysis. RESULTS: We define trust in prenatal ACE screening as a network of evidence-based attributes that include the timing of the screening, patient familiarity with the health care provider, cultural competence, demystifying trauma, open dialogue between the patient and health care provider, and patient comfort and respect. DISCUSSION: This concept analysis elucidates the importance of ACE screening and provides suggestions for establishing trust in the context of prenatal ACE screening. Results give insight and general guidance for health care providers looking to implement ACE screening in a trauma-informed way. Further research is needed to evaluate pregnant patients' attitudes toward ACE screening and how a health care provider's trauma history might influence their care. More inquiry is needed to understand the racial, ethnic, and cultural barriers to ACE screening.

[Analysis of Prenatal Ultrasound Manifestations in 15 Cases of Cantrell Syndrome]. / Cantrell综合征15ä¾‹äº§å‰è¶ å£°è¡¨çŽ°åˆ†æž.

Objective: Cantrell syndrome, a rare congenital disorder, is characterized by a unique collection of defects on the midline abdominal wall, the lower sternum, the anterior diaphragm, and the diaphragmatic pericardium in addition to some form of intracardiac defect. So far, most of the reports on fetuses with Cantrell syndrome worldwide are either case reports or literature reviews, and few comprehensive studies on fetuses with Cantrell syndrome have been reported, especially in domestic literature. This study aims to provide a detailed analysis of 15 cases of Cantrell syndrome fetuses, focusing on their prenatal ultrasound manifestations and postnatal examination outcomes. Methods: A retrospective analysis was conducted with 15 cases of fetuses diagnosed with Cantrell syndrome via prenatal ultrasound examinations between March 2018 and July 2023. Ultrasound examinations were performed in accordance with the Guidelines for Obstetric Ultrasound in China, including first-trimester fetal ultrasound scan and routine second-trimester fetal ultrasound scan. Gestational age was evaluated and nuchal translucency (NT) was measured during first-trimester fetal ultrasound scan at 11 to 13+6 weeks. The diagnostic criterion for NT thickening was NT≥3.0 mm and the screening of severe fetal structural malformations was performed, including the screening of the head, the neck, the thorax, the abdominal content, the abdominal wall, the limbs and other structures. During routine second-trimester fetal ultrasound scan, the fetal biometry was assessed and an anatomy survey was performed. Post-induction and postnatal outcomes of fetuses diagnosed with Cantrell syndrome by prenatal ultrasound were followed up by postnatal observation, inquiries with the electronic medical record system, or telephone follow-up. The prenatal ultrasound imaging manifestations and features of the fetuses with Cantrell syndrome, as well as their post-induction or postnatal examination results were comprehensively summarized and analyzed. Results: The study involved pregnant women of the average age of 30.1±3.5 years, with ultrasound diagnoses made between 11 to 26 weeks of gestation (mean: 13.4±4.0 weeks). Among the 15 cases, there were 10 singleton pregnancies and 5 cases of one twin in a pair of twins. These twins comprised 3 monochorionic diamniotic twins and 2 dichorionic diamniotic twins, with Cantrell syndrome present in one of the twins in all 5 cases. Thirteen cases were diagnosed by fetal ultrasound scan conducted in the first trimester, with 10 being singleton pregnancies and 3 being twin pregnancies (1 monochorionic diamniotic twins and 2 dichorionic diamniotic twins). One case was missed in the first-trimester ultrasound scan, resulting in a missed diagnosis rate of 7.1%. Two cases were diagnosed in second-trimester fetal ultrasound scan, both involving monochorionic diamniotic twins. One case was a referral from another hospital at 19 weeks, while the other was initially not diagnosed for Cantrell syndrome and was diagnosed at 26 weeks. Prenatal ultrasound examinations revealed a consistent pattern of abnormalities across all 15 fetuses, including manifestations of ectopic cordis combined with abdominal protrusion mass. Specifically, 4 cases were diagnosed with omphalocele, 4 with gastroschisis, and the remaining 7 had uncertain coverage of the membrane on the surface of the abdominal protrusion mass. Six fetuses had complete ectopic cordis, while nine had partial ectopic cordis. Fetal echocardiography was performed in 5 cases, revealing intracardiac malformations in 4 cases (80%). Notably, 2 cases were diagnosed in the second trimester, including one with right ventricular hypoplasia accompanied by interventricular septal defect and another with double outlet right ventricle accompanied by interventricular septal defect. Additionally, 2 cases were diagnosed in the first trimester, one with single atrium and single ventricle, and the other with complete transposition of the great arteries. Of the 15 cases of fetuses with Cantrell syndrome, 13 (86.7%) exhibited concomitant malformations in other systems. These included 7 cases of spinal malformations, 4 limb abnormalities, 3 umbilical cord abnormalities, 2 central nervous system malformations, 1 facial malformation, and 2 fetal hydrops. Spinal malformations were the most prevalent concomitant malformation, accounting for 46.7% of all cases. Among the 14 fetuses undergoing NT examination, 7 (50%) had increased NT, and 5 of them had cystic hygroma. All 10 singleton pregnancies underwent induced abortion, and the appearance of the induced fetuses was consistent with the prenatal ultrasound manifestations. In the twin pregnancies, 2 cases experienced intrauterine fetal death, while 2 underwent selective reduction. Notably, 3 of these cases exhibited postnatal appearances consistent with prenatal ultrasound manifestation, while 1 case showed an indistinct appearance after selective reduction during delivery. One case was lost to follow-up. Genetic testing was conducted for 4 induced fetuses, none of which yielded any relevant pathogenic or potentially pathogenic variants. Conclusion: In conclusion, Cantrell syndrome manifests prenatally with ectopic cordis combined with abdominal protrusion mass, often accompanied by intracardiac malformations and other concomitant malformations. While most cases can be diagnosed in the first trimester, there remains the possibility of missed diagnoses, which underscores the importance of close follow-up in the second trimester.