The Association between Intertwin Difference in First Trimester Crown-Rump Length, Nuchal Translucency, and Birth Weight Discordance in Twin Pregnancies: A Retrospective Cohort Study.

Background: Discordant birth weight in twins is linked to poor outcomes and predicting this discrepancy may lead to enhanced screening and surveillance. Our purpose was to quantify the relationship between intertwin nuchal translucency (NT) and crown-rump length (CRL) discordance with birth weight discrepancies ≥ 20%. Methods: We conducted a retrospective cohort study of 887 live twin births delivering at a Canadian tertiary care center over a 7-year period who opted for integrated prenatal screening. Categorical data are presented as numbers and percentages, and continuous data are expressed as means and standard deviations. Chi-square tests, Fisher's Exact tests, or T-test were performed as appropriate. We then used published data and receiver operating curves to determine the optimal thresholds for predicting birth weight discordance based on first trimester intertwin NT differences. These values were used in multivariate logistic regression models accounting for known confounders. Results: Roughly 16% of twin pairs exhibited ≥ 20% difference in birth weight. Twin pairs with a CRL discordance greater than 10% have nearly a 4 times greater likelihood of having a birth weight discordance greater than 20% (OR 3.71, CI 2.24-6.14) while controlling for chorionicity, maternal age, gestational age at delivery, maternal body mass index (BMI), and parity. In these models, intertwin NT discordance ≥ 20% (OR 1.16, CI 0.77-1.77) and NT discordance ≥ 14% (OR 1.08, CI 0.73-1.60) were not statistically significant predictors of twin birth weight differences. However, when evaluating the effect of the larger intertwin NT value corresponding to the 95th percentile, an NT difference ≥ 0.9 mm was predictive of birth weight discordance ≥ 20% (OR 2.53, CI 1.21-5.29). Conclusion: Although intertwin CRL and NT discordance measured via ultrasound between 11-14 weeks gestation are related to birth weight discordance, there is uncertainty as to whether twin birth weight differences are related to adverse pregnancy outcomes in this population.

Changes in mood state and recovery-stress perception after an HRV-guided running program in untrained women / Cambios en el estado de ánimo y la percepción del estrés de recuperación después de un programa de carrera guiado por HRV en mujeres sin entrenamiento / Alterações no estado de humor e na percepção do estresse na recuperação após um programa de corrida guiada pela VFC em mulheres não treinadas

To determine the effects of HRV-guided running training on mood state and recovery-stress factors in untrained women. Thirty untrained women were randomized into two groups. The CG performed a pre-defined training program while the HRVG completed their running training regarding the intensity distribution according to the parasympathetic activity. The questionnaires of perception of recovery-stress and mood state were answered pre and post-training. The CG reported reduced emotional stress (-0.8 ± 1.3), conflicts/pressure (-0.8 ± 0.8), and increased sleep quality (0.9 ± 1.1), personal acceptance (0.9 ± 1.6), self-regulation (0.8 ± 1.3), specific recovery mean (0.6 ± 0.9), and total recovery mean (0.4 ± 0.7). The HRVG reported decreased general stress (-0.5 ± 0.8), emotional stress (-0.7 ± 1.2), social stress (-0.8 ± 1.0), lack of energy (-0.8 ± 0.8), general stress mean (-0.5 ± 0.8), and increased self-regulation (0.7 ± 1.1). This group also decreased tension (-2.8 ± 3.7), depression (-2.7 ± 4.2), anger (-2.8 ± 4.4) and fatigue (-2.7 ± 3.7) and TMD (-10.7 ± 14.2). HRVG reduced negative scales of mood state and stress factors that were not observed in the controls

Determinar los efectos del entrenamiento de carrera guiado por la VFC sobre el estado de ánimo y los factores de recuperación-estrés en mujeres no entrenadas. Treinta mujeres sin entrenamiento fueron separadas en dos grupos al azar. El GC realizó un programa de entrenamiento predefinido, mientras que el GVFC completó su entrenamiento de carrera con respecto a la distribución de intensidad según la actividad parasimpática. Los cuestionarios de percepción de recuperación-estrés y estado de ánimo se respondieron antes y después del entrenamiento. El GC presentó una reducción del estrés emocional (-0,8 ± 1,3), conflictos / presión (-0,8 ± 0,8) y una mayor calidad del sueño (0,9 ± 1,1), aceptación personal (0,9 ± 1,6), autorregulación (0,8 ± 1,3), media de recuperación específica (0,6 ± 0,9) y media de recuperación total (0,4 ± 0,7). El GVFC presentó una disminución del estrés general (-0,5 ± 0,8), estrés emocional (-0,7 ± 1,2), estrés social (-0,8±1,0), falta de energía (-0,8 ± 0,8), media de estrés general (-0,5 ± 0,8), y aumento de la autorregulación (0,7 ± 1,1). Hubo disminución de la tensión (-2,8 ± 3,7), depresión (-2,7 ± 4,2), ira (-2,8 ± 4,4), fatiga (-2,7 ± 3,7) y TAT (-10,7 ± 14,2) en el GVFC. El GVFC mejoró el estado de ánimo y factores de estrés que no se observaron en los controles

Determinar os efeitos do treinamento de corrida guiado pela VFC sobre o estado de humor e fatores de recuperação-estresse em mulheres não-treinadas. Trinta mulheres não-treinadas foram randomizadas em dois grupos. O GC realizou um programa de treinamento pré-definido, enquanto que o GVFC completou seu treinamento de corrida no que diz respeito à distribuição das intensidade segundo a atividade parassimpática. Os questionários de percepção da recuperação-estresse e estado de humor foram respondidos antes e após o programa de treinamento. O GC apresentou redução do estresse emocional (-0,8 ± 1,3), conflitos/pressão (-0,8 ± 0,8) e uma maior qualidade do sono (0,9 ± 1,1), aceitação pessoal (0,9 ± 1,6), auto-regulação (0,8 ± 1,3), média da recuperação específica (0,6 ± 0,9) e média da recuperação total (0,4 ± 0,7). O GVFC apresentou diminuição do estresse geral (-0,5 ± 0,8), estresse emocional (-0,7 ± 1,2), estresse social (-0,8 ± 1,0), falta de energia (-0,8 ± 0,8), média do estresse geral (-0,5 ± 0,8), e aumento da auto-regulação (0,7 ± 1,1). Houve diminuição da tensão (-2,8 ± 3,7), depressão (-2,7 ± 4,2), raiva (-2,8 ± 4,4), fadiga (-2,7 ± 3,7) e THT (-10,7 ± 14,2) no GVFC. O GVFC reduziu as escalas negativas de humor e fatores de estresse que não foram observados nos controles

Placenta nutrient transport-related gene expression: the impact of maternal obesity and excessive gestational weight gain.

OBJECTIVE: Maternal obesity and excess gestational weight gain (GWG) increase the risk of delivering large infants. This study examined the associations between maternal obesity and GWG on the expression of genes involved in fatty acid, amino acid and glucose transport, and the mechanistic target of rapamycin (mTOR) and insulin signaling axes in the placenta. METHODS: Placenta samples were obtained from lean (n = 11) and obese (n = 10) women. Gene expression in the placenta was measured using polymerase chain reaction. RESULTS: There were no differences in placenta gene expression between the lean and obese women, with the exception of lower expression of mTOR in the women with obesity who delivered male offspring (obese n = 6; lean n = 7). GWG in excess of the upper limit of the body mass index (BMI) specific guidelines was correlated with increased expression of SNAT1 and decreased expression of FABP3, mTOR, IRS1 and IGF1R. CONCLUSIONS: Variations in GWG may alter the expression of genes involved in regulating placental nutrient transport. Future research on placental nutrient transport should account for the sex of the offspring and the percentage of GWG that is gained above the upper limit for the pre-pregnancy BMI.

Unhealthy weight control practices: culprits and clinical recommendations.

Preoccupation with weight status and a desire to lose weight appears common. Many individuals seek "magic bullet" approaches to weight loss and waive the risks of using these products. In this paper, we review the challenges of weight maintenance, highlight some unhealthy weight control practices, and discuss the futility and potential danger of unregulated weight control agents. Novel clinical strategies are discussed that health care providers may use to triage patients with obesity in an attempt to make ethical and personalized treatment decisions.

Maternal-fetal nutrient transport in pregnancy pathologies: the role of the placenta.

Appropriate in utero growth is essential for offspring development and is a critical contributor to long-term health. Fetal growth is largely dictated by the availability of nutrients in maternal circulation and the ability of these nutrients to be transported into fetal circulation via the placenta. Substrate flux across placental gradients is dependent on the accessibility and activity of nutrient-specific transporters. Changes in the expression and activity of these transporters is implicated in cases of restricted and excessive fetal growth, and may represent a control mechanism by which fetal growth rate attempts to match availability of nutrients in maternal circulation. This review provides an overview of placenta nutrient transport with an emphasis on macro-nutrient transporters. It highlights the changes in expression and activity of these transporters associated with common pregnancy pathologies, including intrauterine growth restriction, macrosomia, diabetes and obesity, as well as the potential impact of maternal diet. Molecular signaling pathways linking maternal nutrient availability and placenta nutrient transport are discussed. How sexual dimorphism affects fetal growth strategies and the placenta's response to an altered intrauterine environment is considered. Further knowledge in this area may be the first step in the development of targeted interventions to help optimize fetal growth.

Validity of SC-StepRx pedometer-derived moderate and vigorous physical activity during treadmill walking and running in a heterogeneous sample of children and youth.

BACKGROUND: The purpose of this study was to determine the validity of the SC-StepRx pedometer to assess moderate and vigorous physical activity during treadmill walking and running in a heterogeneous sample of children and youth aged 10-17 years. METHODS: Physical activity intensity assessed via indirect calorimetry served as the criterion standard. A convenience sample of 40 participants (20 boys, 20 girls) wore 6 SC-StepRx pedometers, 2 ActiGraph GT3X accelerometers, 2 Actical accelerometers, 1 Walk4Life MVP pedometer and 1 NL-1000 pedometer while walking/running at speeds approximating 2, 3, 4, 6 and 7 METs. Associations between indirect calorimetry and each activity monitor were assessed using linear regression analyses in SAS 9.2. RESULTS: Estimates of moderate and vigorous physical activity from all monitors were significantly associated with the criterion standard of indirect calorimetry. The strongest associations with the criterion measure were observed for the SC-StepRx with moderate/vigorous thresholds of 110/130 steps•minute(-1), and the NL-1000 (R2 = 0.82, p <0.05). The SC-StepRx with moderate/vigorous thresholds of 110/130 steps•minute(-1) also exhibited the highest combined sensitivity (92.9%) and specificity (96.5%) for correctly identifying a bout of moderate-to-vigorous physical activity. CONCLUSIONS: This study demonstrates that the SC-StepRx pedometer is a valid tool for the measurement of moderate and vigorous physical activity in children and youth.

Gastroschisis: antenatal sonographic predictors of adverse neonatal outcome.

OBJECTIVES: The aim of this review was to identify clinically significant ultrasound predictors of adverse neonatal outcome in fetal gastroschisis. METHODS: A quasi-systematic review was conducted in PubMed and Ovid using the key terms "gastroschisis," "predictors," "outcome," and "ultrasound." RESULTS: A total of 18 papers were included. The most common sonographic predictors were intra-abdominal bowel dilatation (IABD), intrauterine growth restriction (IUGR), and bowel dilatation not otherwise specified (NOS). Three ultrasound markers were consistently found to be statistically insignificant with respect to predicting adverse outcome including abdominal circumference, stomach herniation and dilatation, and extra-abdominal bowel dilatation (EABD). CONCLUSIONS: Gastroschisis is associated with several comorbidities, yet there is much discrepancy in the literature regarding which specific ultrasound markers best predict adverse neonatal outcomes. Future research should include prospective trials with larger sample sizes and use well-defined and consistent definitions of the adverse outcomes investigated with consideration given to IABD.