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1.
Eur J Obstet Gynecol Reprod Biol ; 266: 23-30, 2021 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-34560330

RESUMO

OBJECTIVE: Our objective was to examine if US obstetrician-gynecologists (OBGYNs) practice outside of evidenced-based guidelines and use a combination of interventions to prevent spontaneous preterm birth (sPTB). STUDY DESIGN: An electronic survey was distributed to members of the Pregnancy-Related Care Research Network (PRCRN), and also to members of the Society of Maternal-Fetal Medicine (SMFM). The survey consisted of questions regarding physician demographics, and the use of interventions to prevent sPTB in women with 1) a prior sPTB, 2) an incidental short cervix (no prior sPTB), and 3) a history of cervical insufficiency. RESULTS: The PRCRN response rate was 58.6% (283/483) with an additional 143 responses from SMFM members. Among PRCRN responders, 82.7% were general OBGYNs and 17.3% were Maternal-Fetal Medicine subspecialists. Respondents were from all geographic regions of the country; most practiced in a group private practice (42.6%) or academic institution (31.4%). In women with prior sPTB, 45.2% of respondents would consider combination therapy, most commonly weekly intramuscular progesterone (IM-P) and serial cervical length (CL) measurements. If the patient then develops a short cervix, 33.7% would consider adding an ultrasound-indicated cerclage. In women with an incidental short cervix, 66.8% of respondents were likely to recommend single therapy with daily vaginal progesterone (VP). If a patient developed an incidentally dilated cervix, 40.8% of PRCRN respondents would recommend dual therapy, most commonly cerclage + VP, whereas 64.3% of SMFM respondents were likely to continue with VP only. In women with a history of cervical insufficiency, 47% of PRCRN respondents indicated they would consider a combination of IM-P, history-indicated cerclage and serial CL measurements. CONCLUSION: Although not currently supported by evidence-based medicine, combination therapy is commonly being used by U.S. OBGYNs to prevent sPTB in women with risk factors such as prior sPTB, short or dilated cervix or more than one of these risks.

2.
Obstet Gynecol Surv ; 76(8): 493-503, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34449852

RESUMO

Importance: Ten years have passed since the Institute of Medicine (IOM) released its recommendations for gestational weight gain (GWG), based on a woman's prepregnancy body mass index. Despite this, the majority of women do not gain the appropriate gestational weight; most women gain too much weight, and a small but substantial number gain too little. Objective: We review the literature concerning GWG, the opinions and practices of clinicians in managing their patients' weight, and how these practices are perceived by patients. We also review several randomized control trials that investigate the efficacy of clinical intervention in managing GWG. Evidence Acquisition: A literature review search was conducted with no limitations on the number of years searched. Results: The number of clinicians who are aware of and use the IOM recommendations has increased, but the prevalence of inappropriate GWG has not decreased. Clinicians report feeling less than confident in their ability to have an impact on their patients' weight gain, and there are discrepancies between what clinicians and patients report regarding counseling. Many randomized control trials demonstrate a beneficial impact of clinical intervention, highlighting the importance of collaboration and technology to provide educational information and support throughout a pregnancy. Conclusions: Pregnancy provides an opportunity for clinicians to have open and direct conversations with their patients about their weight. Providing clinicians with the tools, skillset, and confidence to assist in the management of GWG is essential to the health of women and their children, and warrants further investigation.


Assuntos
Gerenciamento Clínico , Ganho de Peso na Gestação , Papel do Médico , Guias de Prática Clínica como Assunto/normas , Terapia Comportamental , Aconselhamento , Grupos Étnicos , Feminino , Humanos , National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division , Gravidez , Fatores Raciais , Tecnologia , Estados Unidos/epidemiologia
3.
Am J Primatol ; 83(9): e23315, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34339526

RESUMO

This study was designed to (1) characterize the macronutrient composition of olive baboon (Papio anubis) milk, (2) compare baboon milk composition to that of rhesus macaques (Macaca mulatta), and (3) evaluate the association between the proportion of milk energy derived from protein and relative growth rate within anthropoid primates. A single milk sample was collected from each of eight lactating olive baboons ranging between 47- and 129-days postparturition and six rhesus macaques from 15- to 92-days living at the same institution under identical management conditions. Macronutrient composition (water, fat, protein sugar, and ash) was determined using standard techniques developed at the Nutrition Laboratory at the Smithsonian National Zoological Park. Baboon milk on average contained 86.0% ± 0.6% water, 4.7% ± 0.5% fat, 1.6% ± 0.04% protein, 7.3% ± 0.07% sugar, and 0.165% ± 0.007% ash. Baboon milk gross energy (GE) averaged 0.81 ± 0.04 kcal/g with 51.9% ± 2.6% from fat, 11.8% ± 0.7% from protein, and 36.2% ± 2.0% from sugar. Baboon milk demonstrated strong similarity to milk composition of the closely phylogenetically related rhesus macaque (86.1% ± 0.3% water, 4.1% ± 0.4% fat, 1.69% ± 0.05% protein, 7.71% ± 0.08% sugar, 0.19% ± 0.01% ash, and 0.78 kcal/g). There was no statistical difference between baboon and macaque milk in the proportions of energy from fat, sugar, and protein. Baboon milk can be described as a high sugar, moderate fat, and low protein milk with moderate energy density, which is consistent with their lactation strategy characterized by frequent, on-demand nursing and relatively slow life history compared to nonprimate mammal taxa. The milk energy from protein of both baboon and macaque (12.8% ± 0.3%) milk was intermediate between the protein milk energy of platyrrhine (19.3%-23.2%) and hominoid (8.9%-12.6%) primates, consistent with their relative growth rates also being intermediate. Compared to these cercopithecid monkeys, platyrrhine primates have both higher relative growth rates and higher milk energy from protein, while apes tend to be lower in both.

4.
Vaccine ; 39(35): 4938-4948, 2021 08 16.
Artigo em Inglês | MEDLINE | ID: mdl-34312009

RESUMO

OBJECTIVE: The objectives of this review were to summarize existing data on racial disparities in maternal immunization for influenza in the U.S. and to review the literature on interventions to improve the uptake of the influenza vaccine among Black pregnant women. DATA SOURCES: U.S. survey data on maternal influenza immunization by racial and ethnic group were summarized in narrative form. To review intervention studies, PubMed, CINAHL, EMBASE, and the Cochrane Library databases were searched for English language articles published 2017 to 2021, in addition to studies identified by a previous systematic review. STUDY ELIGIBILITY CRITERIA: Peer-reviewed studies conducted in the U.S. and reporting interventions designed to increase the uptake of the influenza vaccine in pregnancy with study populations including at least 20% of participants identifying as Black were included. STUDY APPRAISAL AND SYNTHESIS METHODS: Studies were grouped and reviewed in a narrative manner according to whether they were conducted in predominantly Black populations or in more racially diverse populations, and whether they tested multicomponent or single-component interventions. RESULTS: A decade of survey data show that Black women in the U.S. consistently have the lowest rate of influenza immunization in pregnancy. Black women report a lower rate of being recommended or offered the vaccine, and provider recommendation is associated with greater vaccine uptake. Intervention studies to increase influenza immunization among Black pregnant women have reported mixed results. Successful interventions include multicomponent practice-based interventions, group prenatal care, and culturally competent patient educational messages. CONCLUSIONS: Racial disparities in maternal uptake of the influenza vaccine are long-standing, but not intractable. More research is needed to test interventions to address this disparity, with a focus on increasing provider recommendation and offer of the vaccine, addressing patients' concerns about vaccine safety and efficacy, improving providers' cultural competence, and building trust between providers and patients.


Assuntos
Vacinas contra Influenza , Influenza Humana , Grupos de Populações Continentais , Feminino , Humanos , Influenza Humana/prevenção & controle , Gravidez , Gestantes , Estados Unidos , Vacinação
5.
Zoo Biol ; 40(3): 192-200, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33705586

RESUMO

We assayed 31 milk samples collected from two African elephant cows housed at the Indianapolis Zoo across lactation (birth to calf age 973 days) for macronutrient composition (water, fat, protein, sugar, gross energy [GE], ash, calcium, and phosphorus). All assays were performed at the Smithsonian National Zoological Park Nutrition Laboratory, Washington, DC (SNZP) using standard methods developed at SNZP. Milk constituents are expressed on a weight-per-weight basis (%) and as a proportion each constituent contributes to milk energy. Calf weights were recorded, and growth rate calculated. The macronutrient composition of the African elephant milk samples was compared to previously published results for Asian elephants using analysis of covariance. African elephant milk is similar to Asian elephant milk, being moderately high in fat and energy and low in sugar. The mean values across lactation (excluding colostrum; n = 28) are 5.6 ± 0.3% crude protein, 3.1 ± 0.3% sugar, 13.0 ± 1.0% fat, and GE of 1.63 ± 0.10 kcal/g. Milk composition did not differ between cows. Milk composition significantly changed over lactation; fat and protein increased, and sugar decreased with calf age, comparable to previously reported data for African and Asian elephant milk. The proportion of milk energy from fat increased and that from sugar decreased over lactation, but the energy from protein was relatively constant. Protein contributed a higher proportion of energy to African elephant milk compared to Asian elephant milk (20.6% vs. 17.0%, p = .001). Despite this, calf growth rate was similar between the species, with the calves in this study gaining about 0.8 kg/day for the first 6 months.


Assuntos
Elefantes/fisiologia , Leite/química , Nutrientes/química , Animais , Animais de Zoológico , Feminino
6.
Anal Chem ; 92(15): 10316-10326, 2020 08 04.
Artigo em Inglês | MEDLINE | ID: mdl-32639750

RESUMO

This study significantly expands both the scope and method of identification for construction of a previously reported tandem mass spectral library of 74 human milk oligosaccharides (HMOs) derived from results of combined LC-MS/MS experiments and comprehensive structural analysis of HMOs. In the present work, a hybrid search "bootstrap" identification method was employed that substantially broadens the coverage of milk oligosaccharides and thereby increases utility use of a spectrum library-based method for the rapid tentative identification of all distinguishable glycans in milk. This involved hybrid searching of the previous library, which was itself constructed using the hybrid search of oligosaccharide spectra in the NIST 17 Tandem MS Library. The general approach appears applicable to library construction of other classes of compounds. The coverage of oligosaccharides was significantly extended using milks from a variety of mammals, including bovine, Asian buffalo, African lion, and goat. This new method led to the identification of another 145 oligosaccharides, including an additional 80 HMOs from reanalysis of human milk. The newly identified compounds were added to a freely available mass spectral reference database of 219 milk oligosaccharides. We also provide suggestions to overcome several limitations and pitfalls in the interpretation of spectra of unknown oligosaccharides.


Assuntos
Mamíferos , Leite Humano/química , Leite/química , Oligossacarídeos/química , Bibliotecas de Moléculas Pequenas , Animais , Humanos , Especificidade da Espécie , Espectrometria de Massas em Tandem
7.
Evol Med Public Health ; 2020(1): 60-67, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32382419

RESUMO

Evolution is a fundamental principle in biology; however, it has been neglected in medical education. We argue that an evolutionary perspective is especially important for women's health care providers, as selection will act strongly on reproductive parameters, and the biological costs of female reproduction are generally more resource expensive than for men (e.g. due to gestation and lactation) with greater effects on health and wellbeing. An evolutionary perspective is needed to understand antibiotic resistance, disease and health risks associated with mismatches between our evolved adaptations and current conditions, the importance of the microbiome and the maternal role in how infants acquire and develop their early-life microbiome (vaginal birth, lactation), and the importance of breastmilk as a biochemical signal from mothers to their babies. We present data that obstetrician-gynecologists' views regarding the inclusion of evolution within their training is generally positive, but many barriers are perceived. Requiring coursework in evolutionary biology with an emphasis on evolutionary medicine prior to enrollment in medical school may be a solution.

8.
Am J Primatol ; 82(6): e23131, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32270886

RESUMO

Vitamin D3 (cholecalciferol) is endogenously produced in the skin of primates when exposed to the appropriate wavelengths of ultraviolet light (UV-B). Common marmosets (Callithrix jacchus) maintained indoors require dietary provision of vitamin D3 due to lack of sunlight exposure. The minimum dietary vitamin D3 requirement and the maximum amount of vitamin D3 that can be metabolized by marmosets is unknown. Observations of metabolic bone disease and gastrointestinal malabsorption have led to wide variation in dietary vitamin D3 provision amongst research institutions, with resulting variation in circulating 25-hydroxyvitamin D3 (25(OH)D3 ), the accepted marker for vitamin D sufficiency/deficiency. Multiple studies have reported serum 25(OH)D3 in captive marmosets, but 25(OH)D3 is not the final product of vitamin D3 metabolism. In addition to serum 25(OH)D3, we measured the most physiologically active metabolite, 1,25-dihydroxyvitamin D3 (1,25(OH)2 D3 ), and the less well understood metabolite, 24,25-dihydroxyvitamin D3 (24,25(OH)2 D3 ) to characterize the marmoset's ability to metabolize dietary vitamin D3 . We present vitamin D3 metabolite and related serum chemistry value colony reference ranges in marmosets provided diets with 26,367 (Colony A, N = 113) or 8,888 (Colony B, N = 52) international units (IU) of dietary vitamin D3 per kilogram of dry matter. Colony A marmosets had higher serum 25(OH)D3 (426 ng/ml [SD 200] vs. 215 ng/ml [SD 113]) and 24,25(OH)2 D3 (53 ng/ml [SD 35] vs. 7 ng/ml [SD 5]). There was no difference in serum 1,25(OH)2 D3 between the colonies. Serum 1,25(OH)2 D3 increased and 25(OH)D3 decreased with age, but the effect was weak. Marmosets tightly regulate metabolism of dietary vitamin D3 into the active metabolite 1,25(OH)2 D3 ; excess 25(OH)D3 is metabolized into 24,25(OH)2 D3 . This ability explains the tolerance of high levels of dietary vitamin D3 by marmosets, however, our data suggest that these high dietary levels are not required.


Assuntos
24,25-Di-Hidroxivitamina D 3/sangue , Calcifediol/sangue , Calcitriol/sangue , Callithrix/metabolismo , Fatores Etários , Animais , Animais de Zoológico/metabolismo , Colecalciferol/sangue , Feminino , Masculino , Valores de Referência , Fatores Sexuais
9.
Sci Rep ; 9(1): 12134, 2019 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-31431664

RESUMO

Common marmosets (Callithrix jacchus) are susceptible to intestinal inflammation which leads to chronic diarrhea, weight loss, and vitamin D deficiency. We examined food intake and digestion in three mixed-sex groups of adult marmosets maintained on three commercial base diets. Animals underwent two consecutive 4-day digestion trials. Body mass stayed constant. Feces and diet were assayed for Mn, fat, and gross energy (GE). Apparent digestibility of dry matter (ADDM) was calculated by the total collection method and from dietary and fecal Mn; the methods produced correlated results (r = 0.658, p < 0.001). Apparent digestibility of energy (ADE) was calculated from ADDM and the GE of feces and diet; apparent digestibility of fat (ADfat) was calculated from ADDM and fecal fat. ADDM and ADE varied by diet (p < 0.001). We found poor digesters on all three diets. The concentration of fecal fat was inversely related to ADE (r = -0.729, p < 0.001). High fecal fat (>10%) was associated with ADfat of zero, consistent with lipid malabsorption. Mean digestible energy intake (DEI) was equal to 1.5 the estimated metabolic rate, but varied widely between individuals. The diet with the fewest animals with high fecal fat had the highest mean DEI and most animals above 450 g, suggesting it may be obesogenic.


Assuntos
Callithrix/metabolismo , Dieta , Digestão , Ração Animal , Criação de Animais Domésticos/métodos , Fenômenos Fisiológicos da Nutrição Animal , Animais , Pesquisa Biomédica , Gorduras na Dieta/metabolismo , Fibras na Dieta , Fezes/química , Feminino , Masculino , Modelos Animais , Obesidade/prevenção & controle , Obesidade/veterinária
10.
Zoo Biol ; 38(5): 405-413, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31267587

RESUMO

Hand-rearing and assisted-rearing aardvarks in captivity has become commonplace and has led to success in breeding the species. However, the macronutrient content of aardvark milk past 1 month of age is unknown. A better understanding of aardvark milk composition would enhance captive management efforts. Here, we assayed milk samples from two captive individuals from 2 to 114 days postpartum (N = 21) for dry matter, fat, crude protein, total sugar, ash (total minerals), calcium (Ca), phosphorus (P), and gross energy. The body weight of one calf was measured from birth to weaning. Milk macronutrient composition was compared to that of other Afrotherian species and Xenarthra species with similar diets. Average protein, fat, and sugar concentrations of aardvark milk across lactation were 12.3%, 13.6%, and 2.5%, respectively. Ash averaged 1.9%, with Ca (0.50%) and P (0.35%) accounting for about 45% of total minerals. All measured nutrients increased over lactation except sugar, which decreased. Aardvark milk is high in energy (2.12 kcal/g) mostly derived from fat and protein and little energy from sugar. Calf growth was linear (r2 = 0.995) with a mean gain of 159 g/day, achieving almost 30% of adult weight at weaning. Within Afrotheria, aardvark milk is higher in fat and protein and lower in sugar than elephant milk and more closely resembles the milk of its fellow insectivore, the elephant shrew. Aardvark milk is also similar in composition to milk of insectivorous Xenarthra species (nine-banded armadillo and giant anteater). Aardvark milk composition is consistent with the species' high-protein diet, fast growth, and nursing pattern.


Assuntos
Cingulados , Leite/química , Nutrientes/análise , Animais , Animais de Zoológico , Carboidratos/química , Feminino , Lactação , Proteínas/química
11.
Am J Primatol ; 81(10-11): e22994, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31219214

RESUMO

Milk is inhabited by a community of bacteria and is one of the first postnatal sources of microbial exposure for mammalian young. Bacteria in breast milk may enhance immune development, improve intestinal health, and stimulate the gut-brain axis for infants. Variation in milk microbiome structure (e.g., operational taxonomic unit [OTU] diversity, community composition) may lead to different infant developmental outcomes. Milk microbiome structure may depend on evolutionary processes acting at the host species level and ecological processes occurring over lactation time, among others. We quantified milk microbiomes using 16S rRNA high-throughput sequencing for nine primate species and for six primate mothers sampled over lactation. Our data set included humans (Homo sapiens, Philippines and USA) and eight nonhuman primate species living in captivity (bonobo [Pan paniscus], chimpanzee [Pan troglodytes], western lowland gorilla [Gorilla gorilla gorilla], Bornean orangutan [Pongo pygmaeus], Sumatran orangutan [Pongo abelii], rhesus macaque [Macaca mulatta], owl monkey [Aotus nancymaae]) and in the wild (mantled howler monkey [Alouatta palliata]). For a subset of the data, we paired microbiome data with nutrient and hormone assay results to quantify the effect of milk chemistry on milk microbiomes. We detected a core primate milk microbiome of seven bacterial OTUs indicating a robust relationship between these bacteria and primate species. Milk microbiomes differed among primate species with rhesus macaques, humans and mantled howler monkeys having notably distinct milk microbiomes. Gross energy in milk from protein and fat explained some of the variations in microbiome composition among species. Microbiome composition changed in a predictable manner for three primate mothers over lactation time, suggesting that different bacterial communities may be selected for as the infant ages. Our results contribute to understanding ecological and evolutionary relationships between bacteria and primate hosts, which can have applied benefits for humans and endangered primates in our care.


Assuntos
Microbiota , Leite Humano/microbiologia , Leite/microbiologia , Primatas/microbiologia , Animais , Feminino , Interações entre Hospedeiro e Microrganismos , Humanos , Lactação/fisiologia , Leite/química , Leite Humano/química , Primatas/fisiologia , RNA Ribossômico 16S/genética , Análise de Sequência de DNA , Especificidade da Espécie
12.
J Womens Health (Larchmt) ; 28(11): 1563-1568, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31038373

RESUMO

Background: In 2009, the Institute of Medicine (IOM) published guidance on gestational weight gain (GWG) modified by body mass index (BMI). GWG outside of IOM recommendations negatively affects birth outcomes and child health. This study examined the relationship between BMI, GWG, birth complications, and birth outcomes in a rural, non-Hispanic white population over 10 years. Materials and Methods: We examined maternal BMI, GWG, birth weight, birth complications, and Apgar score in 18,217 term singleton births from medical records at Geisinger, PA from 2006 to 2015. Primary outcomes were GWG, delivery mode, Apgar score, and infant birth weight. Results: A majority of women (74.2%) had GWG outside of recommendations. Prevalence of cesarean delivery was highest for women with GWG above recommendations regardless of BMI. One in five neonates of obese women with GWG above recommendations had Apgar scores below eight. Although most births were normal for gestational age (88%), underweight women who gained below recommendations had the highest percentage of small for gestational age (SGA) births (10.4%) and obese women who gained above recommendations had the highest percentage of large for gestational age (LGA) births (22.2%). Among women with BMIs above 35 kg/m2 and GWG within recommendations, 18.9% of births were LGA. Conclusions: Most pregnant women are not gaining weight within recommendations. GWG outside of IOM recommendations resulted in poorer birth outcomes, particularly in underweight and obese women. Underweight women with GWG below recommendations are at increased risk for SGA neonates. We suggest reducing GWG recommendations for women above 35 kg/m2 to decrease LGA births and pregnancy complications.


Assuntos
Peso ao Nascer , Índice de Massa Corporal , Ganho de Peso na Gestação , Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Adulto , Índice de Apgar , Cesárea/estatística & dados numéricos , Feminino , Humanos , Recém-Nascido , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Pennsylvania , Gravidez , Estudos Retrospectivos , Fatores de Risco , População Rural , Nascimento a Termo , Magreza/epidemiologia
13.
J Womens Health (Larchmt) ; 28(10): 1399-1406, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31038383

RESUMO

Background: Inappropriate gestational weight gain (GWG) is prevalent in the United States. About 20% of women gain below Institute of Medicine (IOM) recommendations; more than 50% gain above. GWG outside of recommendations is linked to poor birth outcomes and health issues for mother and baby. Counseling by health care providers is important to encourage appropriate GWG. Methods: Assess patient recall of counseling regarding GWG, provider knowledge, and opinions about IOM GWG guidance, and GWG outcomes in a subset of women. Cross-sectional, with questionnaires distributed by 8 medical centers across the United States to patients. Questionnaires were distributed to providers and data on maternal body mass index (BMI) and GWG collected at seven sites. Results: A total of 1,157 women returned questionnaires (1,820 maximum possible). A majority at all sites reported a provider discussed their expected GWG with them. Close to half reported that a provider had discussed potential harms from inappropriate GWG. Most of the women (71.2%) considered their obstetrician to be a helpful resource for GWG advice. Most providers (87.5%) reported they were aware of IOM guidelines. As many providers disagreed (18.8%) as agreed (20.8%) that they were successful helping their patients attain appropriate GWG (58.3% were neutral). Physician self-reported confidence was associated with whether they believed they could help their patients avoid excessive GWG. The most common outcome was GWG above recommendations (51.4%). Overweight and obese women were more likely to gain above recommendations. Providers underestimated the proportion of their patients that gained below IOM recommendations (8.5% vs. 18.6%). Conclusions: Providers are aware of the dangers of excessive GWG and a majority of patients report receiving counseling. Providers appear more cognizant of excessive GWG and underestimate inadequate GWG. Most women are not achieving an appropriate GWG, with overweight and obese women especially likely to gain above recommendations.


Assuntos
Ganho de Peso na Gestação , Conhecimentos, Atitudes e Prática em Saúde , Cuidado Pré-Natal , Adulto , Índice de Massa Corporal , Aconselhamento , Estudos Transversais , Feminino , Humanos , Obesidade/complicações , Sobrepeso/complicações , Gravidez , Estudos Prospectivos , Autorrelato , Inquéritos e Questionários , Estados Unidos , Adulto Jovem
14.
PLoS One ; 13(11): e0207186, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30439991

RESUMO

Here we report the first dietary macronutrient and mineral content information for a little-studied yellow baboon group (i.e., the Mchelelo troop) at the Tana River Primate National Reserve, Kenya. We compare forest to savanna samples for this troop found in a partially forested habitat. Observations conducted between 1988 and 1992 determined our list of foods. Subsequently, flora samples, representing 56 species, were collected between April 2008 and March 2009 with nutrient content determined via standard procedures for fiber, gross energy, ash/minerals, crude protein, and crude fat/lipids. Concentrations of specific minerals (calcium, iron, magnesium, manganese, phosphorus, potassium, zinc) were also measured. We predicted forest items would be higher in gross energy and lipids and savanna items higher in crude protein, fiber, and minerals. Our analyses support only the predicted difference in crude protein for savanna items for the overall dataset. In our examination of the top 15 foods, savanna items had significantly higher crude protein, ash, magnesium, and manganese while forest items had higher gross energy. Right-angled mixture triangles show some clustering by location but with substantial overlap in values. Our data provide further indication of the particularity and purposefulness of dietary choices made by primates. They also contribute to the broader discussions of primate nutritional ecology and are a first step towards an examination of macronutrient balancing for this group. Finally, we discuss the impact heavy reliance upon forest products by a "savanna species" may have upon competitors and forest composition. Ultimately, we show that there is still much to be learned about baboon nutrition.


Assuntos
Florestas , Minerais , Nutrientes , Papio cynocephalus , Fenômenos Fisiológicos da Nutrição Animal , Animais , Dieta , Gorduras na Dieta/análise , Fibras na Dieta/análise , Proteínas na Dieta/análise , Comportamento Alimentar , Pradaria , Minerais/análise , Nutrientes/análise
15.
PLoS One ; 13(10): e0204314, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30325919

RESUMO

Spindly Leg Syndrome (SLS) is a persistent animal welfare issue associated with the rearing of amphibians in captivity. We conducted two experiments to investigate the effects of diet, water composition and overfeeding on prevalence of SLS in newly metamorphosed harlequin frogs (Atelopus spp.). In our first experiment, we offered 400 full-sibling tadpoles of Atelopus certus isocaloric diets in treatments of 31%, 37%, 42% and 48% crude protein respectively. Tadpoles fed higher protein diets metamorphosed faster, but the incidence of SLS exceeded 80% in all treatments leading to the conclusion that variation in dietary protein was not responsible for causing SLS. We used 720 full-sibling Atelopus glyphus tadpoles in a second experiment to examine the effects of diet type, water composition and diet ration on SLS. We found that an overall incidence of 58% spindly leg in tadpoles reared in tap water, but reduced to about 10% in water treated by reverse osmosis and then reconstituted. It is possible that the reverse osmosis treatment removed some factor that caused the SLS, or that the reconstitution may have added a mineral lacking in the original tap water. Within tap water treatments, overfeeding tadpoles in tanks increased the incidence of SLS. We recommend further experimental research into this condition to identify the causative factors in the water. Additional research into the nutritional composition of food available to wild tadpoles would be useful in formulating captive diets, that have to date been solely based on surrogate species.


Assuntos
Ração Animal/análise , Bem-Estar do Animal/estatística & dados numéricos , Bufonidae/crescimento & desenvolvimento , Água/análise , Ração Animal/efeitos adversos , Fenômenos Fisiológicos da Nutrição Animal , Animais , Proteínas na Dieta/efeitos adversos , Incidência , Metamorfose Biológica
16.
BMC Pregnancy Childbirth ; 18(1): 239, 2018 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-29914428

RESUMO

BACKGROUND: In 2009, the Institute of Medicine (IOM) published guidance on gestational weight gain (GWG) modified by maternal pre-pregnancy body mass index (BMI). Estimates indicate that less than half of US pregnant women have GWG within recommendations. This study examined GWG from before (2006-2009) and after (2010-2015) the release of the IOM guidance in a rural, non-Hispanic white population to assess the proportion of women with GWG outside of IOM guidance, whether GWG became more likely to be within IOM guidance after 2010, and identify potential maternal factors associated with GWG outside of recommendations. METHODS: We examined GWG in 18,217 term singleton births between 2006 and 2015 in which maternal pre-pregnancy BMI could be calculated from electronic medical records at Geisinger, PA, and a subset of 12,912 births in which weekly GWG in the third trimester could be calculated. The primary outcome was whether GWG was below, within, or above recommendations based on maternal BMI. The relationships between GWG, maternal BMI, parity, age at conception, gestation length, and maternal blood pressure were examined. RESULTS: GWG declined with increasing maternal BMI, however, more than 50% of overweight and obese women gained above IOM recommendations. About one of five women gained below recommendations (21.3%) with underweight women the most likely to gain below recommendations (33.0%). The proportion of births with usable data increased after 2010, driven by a higher probability of recording maternal weight. However, the proportion of women who gained below, within or above recommendations did not change over the ten years. GWG above recommendations was associated with higher maternal BMI, lower parity, and longer gestation. GWG below recommendations was associated with lower maternal BMI, higher parity, shorter gestation, and younger age at conception. Maternal blood pressure was higher for GWG outside recommendations. CONCLUSIONS: Despite the publication of IOM recommendations in 2009 and an apparent increase in tracking maternal weight after 2010, GWG in this population did not change between 2006 and 2015. A majority of overweight and obese women gained above recommendations. GWG below recommendations continues to occur, and is prevalent among underweight women.


Assuntos
Índice de Massa Corporal , Ganho de Peso na Gestação , Fidelidade a Diretrizes/estatística & dados numéricos , Obesidade/epidemiologia , Adulto , Feminino , Humanos , Mães , National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division , Pennsylvania/epidemiologia , Guias de Prática Clínica como Assunto , Gravidez , Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Estudos Retrospectivos , Fatores de Risco , População Rural , Estados Unidos
17.
Am J Perinatol ; 35(2): 201-208, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28902375

RESUMO

OBJECTIVE: This study sought to assess provider and patient knowledge and beliefs on gestational weight gain (GWG) and exercise during pregnancy, outline current clinical practices and the perceived value of educational tools. STUDY DESIGN: Providers and patients at the George Washington Medical Faculty Associates Obstetricians and Gynecologists clinic were recruited for a voluntary survey. Descriptive statistics of responses were compared and chi-square analysis tested for significant associations. RESULTS: A total of 461 patient and 36 provider questionnaires were analyzed. Providers recommended GWG consistent with the Institute of Medicine guidelines for a "normal" body mass index (82.9%); however, a majority (52.8%) recommended GWG below guidelines for obese women. All providers reported counseling patients on GWG, but only 53.4% of patients reported discussing personal recommendations. About half of providers reported distributing educational materials for GWG (60.0%); however, only 30.6% of patients reported receiving them. African American patients self-reported receiving the highest rates of counseling and educational materials, though a lower rate of recommendations to exercise. Patients perceived educational tools to be more useful than did providers. CONCLUSION: Our findings suggest a gap between provider-patient perceptions regarding counseling and provision of informational materials. Future research should study whether implementing various educational tools might increase the efficacy of current practices.


Assuntos
Exercício Físico , Ganho de Peso na Gestação , Conhecimentos, Atitudes e Prática em Saúde , Cuidado Pré-Natal/métodos , Adolescente , Adulto , Aconselhamento , Feminino , Pessoal de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto/métodos , Gravidez , Complicações na Gravidez , Inquéritos e Questionários , Adulto Jovem
18.
J Matern Fetal Neonatal Med ; 31(21): 2911-2917, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28780891

RESUMO

BACKGROUND: Poor maternal vitamin D status and elevated circulating corticotropin-releasing hormone (CRH) are associated with preterm birth. It is not known if these risk factors are independent or interrelated. Both are associated with inflammation. METHODS: We measured maternal circulating 25-hydroxyvitamin D (25-OH-D) and CRH from 97 samples collected from 15 early-preterm, 31 late-preterm, 21 early-term, and 30 term births. The potential involvement of vitamin D in the regulation of inflammation was evaluated by Q-PCR in human uterine smooth muscle (UTSM) cell line. RESULTS: Maternal 25-OH-D was lowest in early-preterm births (22.9 ± 4.2 ng/ml versus 34.4 ± 1.4 ng/ml; p = .029). Circulating CRH was high in early-preterm births (397 ± 30 pg/ml). Late-preterm (304 ± 13 pg/ml) and early-term births (347 ± 17 pg/ml) were not different from term births (367 ± 19 pg/ml), after accounting for gestational age. Maternal circulating 25-OH-D and CRH were not associated in term births. In preterm births, 25-OH-D below 30 ng/ml was associated with higher CRH. Vitamin D treatment of UTSM significantly reduced mRNA for leptin and IL-6 receptors. Deletion of vitamin D receptor from UTSM promoted the expression of the cox2 inflammatory marker. CONCLUSION: Early-preterm birth showed a syndrome of high maternal CRH and low vitamin D status.


Assuntos
Hormônio Liberador da Corticotropina/sangue , Nascimento Prematuro/sangue , Vitamina D/análogos & derivados , Adulto , Linhagem Celular , Ciclo-Oxigenase 2/metabolismo , Feminino , Humanos , Miométrio/metabolismo , Projetos Piloto , Gravidez , Receptores de Interleucina-6/metabolismo , Receptores para Leptina/metabolismo , Vitamina D/sangue
19.
J Womens Health (Larchmt) ; 26(11): 1169-1175, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-28604154

RESUMO

OBJECTIVE: Assess obstetrician-gynecologists' knowledge and counseling practices regarding gestational weight gain (GWG). MATERIALS AND METHODS: Questionnaire studies were conducted in 2012 and 2014 sent to practicing obstetrician-gynecologists. RESULTS: Response rates were 111/236 (47%) and 206/474 (43.5%). The majority of respondents agreed (50.0%) or strongly agreed (26.6%) that excessive GWG is a major health concern, often or always calculate the body mass index (BMI) of their patients (79.1%), and use BMI to modify their weight gain recommendations (78.5%). The physicians reported that, on average, 7.8% of pregnant patients gained too little weight, 47.3% gained an appropriate amount, and 45.1% gained too much. A greater proportion of patients with private insurance was associated with physician perception of fewer gaining excessive weight (r = -0.205, n = 198, p = 0.004), whereas high proportions with Medicaid or uninsured were positively correlated with a perception of excessive GWG (r = 0.206 and 0.187, n = 198, p = 0.004 and 0.008, respectively). A majority of physicians (55.1%) were not confident in their ability to affect their patients' prenatal weight gain. Confident physicians exhibited more appropriate practice efforts (e.g., use prepregnancy BMI; 83.6% vs. 74.8%, p = 0.009) and were more likely to inform their patients about the increased risk of pregnancy complications (90.8% vs. 69.7%, p = 0.001) and possible harms to their baby (76.9% vs. 61.0%, p = 0.001) from excessive GWG. CONCLUSIONS: Study participants perceived excessive GWG to be a significant problem, but had low confidence in their ability to address it.


Assuntos
Aconselhamento , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde , Padrões de Prática Médica , Ganho de Peso , Adulto , Índice de Massa Corporal , Feminino , Humanos , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Gravidez , Complicações na Gravidez , Inquéritos e Questionários , Ganho de Peso/fisiologia
20.
Reprod Sci ; 24(11): 1482-1492, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-28322134

RESUMO

Almost every part of our body has a coevolved microbial community. The expressed microbial genes comprise the various microbiomes that play important roles in normal physiology and development. The various microbiomes are separate, yet often connected, with the species composition of one affecting others. The female reproductive system microbiomes (eg, vaginal, placental, and mammary/milk) remain less well explored than the gut microbiome although they comprise a large proportion of the female microbial network. This review examines the evidence for interconnectivity between the female reproductive microbiomes, other maternal microbiomes, and developing infant microbiomes and the potential roles of each in health and disease. Disruptions in maternal microbiomes may be linked to pregnancy complications and maternal, fetal, and neonatal health. The diversity of the vaginal microbiome's makeup, which appears to vary across ethnicity, has led researchers to reconsider the idea of a "healthy" or "normal" vaginal microbial community. Less is known about the possible placental microbiome, although an association between the placenta's bacterial makeup and preterm labor and other pregnancy complications is being investigated. The mammary/milk microbiome appears to be influenced by maternal characteristics and may play a role in inoculating the infant but may also be affected by the infant's oral microbiome. Probiotic therapies such as "vaginal seeding" offer potential health benefits but require more rigorous testing. Exploring the reproductive microbiomes in detail and pairing this information with an individual's detailed medical history will provide a more complete picture of the status and importance of the microbial network to health.


Assuntos
Microbiota , Leite Humano/microbiologia , Placenta/microbiologia , Reprodução , Vagina/microbiologia , Animais , Feminino , Humanos , Recém-Nascido , Masculino , Microbiota/fisiologia , Leite Humano/fisiologia , Placenta/fisiologia , Gravidez , Reprodução/fisiologia , Vagina/fisiologia
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