Association of physical activity in the past year and immediately after in vitro fertilization on pregnancy.

OBJECTIVE: To estimate the association of physical activity on in vitro fertilization (IVF). DESIGN: Prospective cohort study. SETTING: Academic infertility clinic. PATIENT(S): Women (n = 121) undergoing nondonor IVF embryo transfer (fresh or frozen). INTERVENTION(S): The women completed a questionnaire on past year physical activity and wore an accelerometer from embryo transfer to serum pregnancy testing. MAIN OUTCOME MEASURE(S): Implantation, intrauterine gestation, and live birth. RESULT(S): Based on self-reported past year physical activity, the adjusted odds of intrauterine gestation was higher among those that had higher continuous active living (odds ratio [OR] 1.96, 95% confidence interval [CI] 1.09-3.50), sports/exercise (OR 1.48, CI 1.02-2.15), and total activity (OR 1.52, 95%CI 1.15-2.01) indices. After embryo transfer, women did almost no vigorous activity (median 0 min/d) as measured by the accelerometer. More of their time was spent in light activity (median 3.0 h/d) and sedentary behaviors (median 9.3 h/d). Accelerometer-measured physical activity and sedentary behavior after embryo transfer were not associated with any IVF outcome. CONCLUSION(S): An active lifestyle in the preceding year favorably impacted the IVF outcome. After embryo transfer, women engaged in mostly light physical activity and sedentary behaviors; therefore, the impact of vigorous physical activity on implantation could not be determined.

Bisphenol A exposure alters developmental gene expression in the fetal rhesus macaque uterus.

Bisphenol A (BPA) exposure results in numerous developmental and functional abnormalities in reproductive organs in rodent models, but limited data are available regarding BPA effects in the primate uterus. To determine if maternal oral BPA exposure affects fetal uterine development in a non-human primate model, pregnant rhesus macaques carrying female fetuses were exposed orally to 400 µg/kg BPA or vehicle control daily from gestation day (GD) 50-100 or GD100-165. Fetal uteri were collected at the completion of treatment (GD100 or GD165); tissue histology, cell proliferation, and expression of estrogen receptor alpha (ERα) and progesterone receptor (PR) were compared to that of controls. Gene expression analysis was conducted using rhesus macaque microarrays. There were no significant differences in histology or in the percentage of cells expressing the proliferation marker Ki-67, ERα, or PR in BPA-exposed uteri compared to controls at GD100 or GD165. Minimal differences in gene expression were observed between BPA-exposed and control GD100 uteri. However, at GD165, BPA-exposed uteri had significant differences in gene expression compared to controls. Several of the altered genes, including HOXA13, WNT4, and WNT5A, are critical for reproductive organ development and/or adult function. We conclude that second or third trimester BPA exposure does not significantly affect fetal uterus development based on morphological, proliferation, and steroid hormone receptor assessments. However, differences in expression of key developmental genes after third trimester exposure suggest that BPA could alter transcriptional signals influencing uterine function later in life.

Healthcare provider accuracy at estimating women's BMI and intent to provide counseling based on appearance alone.

OBJECTIVE: To assess healthcare providers' ability to estimate women's body mass index (BMI) based on physical appearance and determine the prevalence of, and barriers to, weight-related counseling. METHODS: A web-based survey was distributed to healthcare providers ("participants") at a university-based hospital and contained photographs of anonymous women ("photographed women (PW)") as well as questions regarding participant demographics. Participants were asked to estimate BMI category based on physical appearance, state whether they would provide weight-loss counseling for each PW and identify barriers to counseling. RESULTS: One hundred forty-two participants completed the survey. BMI estimations were poor among all participants, with an overall accuracy of only 41% and a large proportion of underestimations. Standardization of PW clothing did not improve accuracy; 41% for own clothing versus 40% for scrubs, P = 0.2. BMI assessments were more accurate for Caucasian versus African American PW (45% versus 36%, P < 0.001) and PW with normal weight (84%) and obesity III (38%) compared to PW with mid-range BMI (P < 0.001). Although the frequency of weight loss counseling was positively associated with PW BMI, participants only intended to counsel 69% of overweight and obese PW. The most commonly cited reason for lack of counseling was time constraints (54%). CONCLUSIONS: Healthcare providers are inaccurate at appearance-based BMI categorization and thus, BMI should be routinely calculated in order to improve identification of those in need of counseling. When appropriately identified, time constraints may prevent practitioners from providing appropriate weight-loss counseling-further complicating the already difficult task of fighting obesity.

Evaluating the Association between Assisted Conception and the Severity of Preeclampsia.

Objective. To investigate the association between assisted conceptions and preeclampsia (PEC), including assessment of severity of disease. Methods. In a prospective case control study, cases were selected from women with preeclampsia and controls from women without preeclampsia. Exposure was defined as assisted conception with intrauterine insemination or in vitro fertilization (IUI or IVF). We assessed the association between exposure and outcome, using Chi square or Fisher's exact tests. Stratified analyses and multivariable logistic regression were used to control for confounders. Results. Preeclampsia was associated with assisted conception after controlling for age and race (AOR 2.2, [1.03-4.72]). All women with preeclampsia who had assisted conceptions demonstrated severe disease and were more likely to have abnormal lab values: AST >45 (AOR = 6.01 [1.63-22.21] P = 0.007), creatinine ≥1 (AOR 2.92 [0.82-10.4], P = 0.09) or platelets <100 (AOR 5.74 [1.00-32.76] P = 0.049), after adjusting for race, age, and multiple gestations. Conclusion. Assisted conceptions are associated with a more severe preeclamptic phenotype.