Prevalence of Malaria and Associated Factors among Delivering Mothers in Northwest Ethiopia.

BACKGROUND: Malaria is one of the leading causes of morbidity and mortality especially in pregnant women and under-five-year-old children. However, data on the prevalence among delivering mothers, potential fetal transmission, and associated birth outcomes is lacking in Ethiopia. OBJECTIVE: To assess the prevalence of Plasmodium infection from peripheral, placental, and cord blood samples among delivering mothers in Kuch health center, Northwest Ethiopia. METHODS: An institution-based cross-sectional study was conducted among 218 delivering mothers from February to May 2021 in Kuch health center. Data on sociodemographic characteristics and clinical and obstetric history of mothers were collected using a structured questionnaire. Giemsa stained blood films from maternal capillary and placental and umbilical cord blood were examined for plasmodium infection. Data were analyzed using Statistical Package for the Social Sciences version 23 software package. RESULTS: The prevalence of maternal, placental, and umbilical cord malaria was 6.4% (14/218), 2.3% (5/218), and 0.5% (1/218), respectively. Plasmodium falciparum and Plasmodium vivax accounted 3.7% (8/218) and 2.8% (6/218), respectively, in maternal peripheral blood but only Plasmodium falciparum was detected in placental and umbilical cord blood samples. Maternal malaria had significant association with primigravida (χ 2 = 12.611, p = 0.002) and low birth weight (χ 2 = 8.381, p = 0.004). Placental malaria was also significantly associated with low birth weight (χ 2 = 32.255, p ≤ 0.001). CONCLUSION: The prevalence of malaria among delivering mothers was considerable. Maternal peripheral malaria had a significant association with gravidity and birth weight. Placental and umbilical cord malaria also had a significant association with birth weight. Pregnant mothers should be examined for malaria and receive appropriate treatment to prevent adverse birth outcomes.

Sleep, evening light exposure and perceived stress in healthy nulliparous women in the third trimester of pregnancy.

OBJECTIVE: Sleep disturbances are common in pregnancy, and the prevalence increases during the third trimester. The aim of the present study was to assess sleep patterns, sleep behavior and prevalence of insomnia in pregnant women in the third trimester, by comparing them to a group of non-pregnant women. Further, how perceived stress and evening light exposure were linked to sleep characteristics among the pregnant women were examined. METHODS: A total of 61 healthy nulliparous pregnant women in beginning of the third trimester (recruited from 2017 to 2019), and 69 non-pregnant women (recruited in 2018) were included. Sleep was monitored by actigraphy, sleep diaries and the Bergen Insomnia Scale. The stress scales used were the Relationship Satisfaction Scale, the Perceived Stress Scale and the Pre-Sleep Arousal Scale. Total white light exposure three hours prior to bedtime were also assessed. RESULTS: The prevalence of insomnia among the pregnant women was 38%, with a mean score on the Bergen Insomnia Scale of 11.2 (SD = 7.5). The corresponding figures in the comparing group was 51% and 12.3 (SD = 7.7). The pregnant women reported lower sleep efficiency (mean difference 3.8; 95% CI = 0.3, 7.3), longer total sleep time derived from actigraphy (mean difference 59.0 minutes; 95% CI = 23.8, 94.2) and higher exposure to evening light (mean difference 0.7; 95% CI = 0.3, 1.2), compared to the non-pregnant group. The evening light exposure was inversely associated with total sleep time derived from actigraphy (B = -8.1; 95% CI = -14.7, -1.5), and an earlier midpoint of sleep (B = -10.3, 95% CI = -14.7, -5.9). Perceived stressors were unrelated to self-reported and actigraphy assessed sleep. CONCLUSION: In healthy pregnant participants sleep in the third trimester was preserved quite well. Even so, the data suggest that evening light exposure was related to shorter sleep duration among pregnant women.

Prevalence of first adolescent pregnancy and its associated factors in sub-Saharan Africa: A multi-country analysis.

INTRODUCTION: In low-and middle-income countries, pregnancy-related complications are major causes of death for young women. This study aimed to determine the prevalence of first adolescent pregnancy and its associated factors in sub-Saharan Africa. METHODS: We undertook a secondary analysis of cross-sectional data from Demographic and Health Surveys conducted in 32 sub-Saharan African countries between 2010 and 2018. We calculated the prevalence of first adolescent (aged 15 to 19 years) pregnancy in each country and examined associations between individual and contextual level factors and first adolescent pregnancy. RESULTS: Among all adolescents, Congo experienced the highest prevalence of first adolescent pregnancy (44.3%) and Rwanda the lowest (7.2%). However, among adolescents who had ever had sex, the prevalence ranged from 36.5% in Rwanda to 75.6% in Chad. The odds of first adolescent pregnancy was higher with increasing age, working, being married/cohabiting, having primary education only, early sexual initiation, knowledge of contraceptives, no unmet need for contraception and poorest wealth quintile. By contrast, adolescents who lived in rural areas and in the West African sub-region had lower odds of first adolescent pregnancy. CONCLUSION: The prevalence of adolescent pregnancy in sub-Saharan African countries is high. Understanding the predictors of first adolescent pregnancy can facilitate the development of effective social policies such as family planning and comprehensive sex and relationship education in sub-Saharan Africa and can help ensure healthy lives and promotion of well-being for adolescents and their families and communities.

Association between age at first calving and lactation performance, lactation curve, calving interval, calf birth weight, and dystocia in Holstein dairy cows.

In the present study, records on 115,291 heifers distributed in 113 herds were used to investigate the association between age at the first calving (AFC) and lactation performance, lactation curve, the length of the first calving interval (CI), calf birth weight (CBW), and the incidence of dystocia in Holstein heifers in Iran. Based on the AFC, the heifers were classified into eight classes: AFC of 541 to 690 d, 691 to 720 d, 721 to 750 d, 751 to 780 d, 781 to 810 d, 811 to 840 d, 841 to 900 d, and 901 to 1200 d (AFC1 to AFC8, respectively). Multiple regression mixed models were used to investigate the association between AFC and lactation curve parameters, partial and 305-d lactation performance, 100- and 305-d SCS, and the length of the first calving (CI) interval. The mean (SD) and median AFC across all heifers was 760.2 (74.01) and 750 d, respectively. Of 115,291 heifers included, 28,192 and 7,602 heifers were, respectively, ≤ 720 and > 900 d when calving for the first time. More than 44% of the heifers were at 691 to 750 d (23 to 25 months) of age when calving for the first time. An increased AFC was associated with increased partial and 305-d lactation performance, 100- and 305-d SCS, initial milk yield, milk production at the peak of lactation, upward and downward slopes of the lactation curve. The 305-d fat percentage was associated with AFC; however, there was no association between AFC and 305-d protein percentage. An increased AFC was also associated with decreased milk production persistency, delayed peak time, longer CI, and higher calf birth weight. Compared to heifers calving for the first time between 691 to 780 d (23 to 26 months) of age, both increasing and decreasing AFC were associated with increased risk of dystocia. Controlling AFC is an important management factor in achieving a lower risk of dystocia, higher lactation performance, lower SCS, and shorter length of the calving interval.

Developmental Dysplasia of the Hip: A Review of Etiopathogenesis, Risk Factors, and Genetic Aspects.

As one of the most frequent skeletal anomalies, developmental dysplasia of the hip (DDH) is characterized by a considerable range of pathology, from minor laxity of ligaments in the hip joint to complete luxation. Multifactorial etiology, of which the candidate genes have been studied the most, poses a challenge in understanding this disorder. Candidate gene association studies (CGASs) along with genome-wide association studies (GWASs) and genome-wide linkage analyses (GWLAs) have found numerous genes and loci with susceptible DDH association. Studies put major importance on candidate genes associated with the formation of connective tissue (COL1A1), osteogenesis (PAPPA2, GDF5), chondrogenesis (UQCC1, ASPN) and cell growth, proliferation and differentiation (TGFB1). Recent studies show that epigenetic factors, such as DNA methylation affect gene expression and therefore could play an important role in DDH pathogenesis. This paper reviews all existing risk factors affecting DDH incidence, along with candidate genes associated with genetic or epigenetic etiology of DDH in various studies.

Longitudinal Study of Maternal BMI in Successive Pregnancies.

OBJECTIVE: This longitudinal observational study examined BMI changes between successive pregnancies. METHODS: The computerized medical records of women who attended a large maternity hospital between 2009 and 2017 for their first and second singleton deliveries were analyzed. Women who had their weight first measured after 15 weeks of gestation in either pregnancy were excluded. RESULTS: Of the 9,724 women, the incidence of obesity increased from 11.6% in the first pregnancy to 16.0% in the second. The mean interpregnancy interval was 32.5 ± 15.7 months, and median BMI change was +0.6 kg/m2 (interquartile range 2.2; P < 0.001). Overall, 10.3% (1,006/9,724) developed overweight and 5.9% (571/9,724) developed obesity by the second pregnancy. Of the nulliparas in the overweight category, 20.6% (526/2,558) entered the obesity category. The development of obesity by the second pregnancy was independently associated with a longer interpregnancy interval, formula feeding at hospital discharge, taking antidepressants or anxiolytics, and postnatal depression. Professional/managerial employment was associated with a lower odds ratio of developing obesity. CONCLUSIONS: Maternal obesity increased between the first and second pregnancy, with one-fifth of nulliparas in the overweight category developing obesity. Pregnancy-related factors were identified as predictors of developing obesity. Further research is needed to assess whether interventions targeting these related factors could optimize maternal weight management between pregnancies.

Infertility, Gravidity, and Risk Of Diabetes among High-Risk Women in the Diabetes Prevention Program Outcomes Study.

OBJECTIVE: The extent to which infertility and pregnancy independently increase risk of diabetes and subclinical atherosclerosis is not known. RESEARCH DESIGN AND METHODS: We conducted a secondary analysis of Diabetes Prevention Program (DPP) and the DPP Outcomes Study over a 15-year period. We included women who answered questions about gravidity and infertility at baseline (n = 2085). Infertility was defined as > 1 year of unsuccessful attempts to conceive; thus, women could have histories of infertility as well as pregnancy. Risk of diabetes associated with gravidity and infertility was calculated using Cox proportional hazards models adjusting for age, race/ethnicity, treatment arm, body mass index, and pregnancy during the study. Among women who underwent assessment of coronary artery calcification (CAC) (n = 1337), odds of CAC were calculated using logistic regression models with similar covariates. RESULTS: Among premenopausal women (n = 1075), women with histories of pregnancy and infertility (n = 147; hazard ratio [HR] 1.80; 95% confidence interval [CI] 1.30, 2.49) and women with histories of pregnancy without infertility (n = 736; HR 1.49; 95% CI 1.15, 1.93) had greater diabetes risk than nulligravid women without infertility (n = 173). Premenopausal nulligravid women with histories of infertility had a non-significant elevation in risk, although the number of these women was small (n = 19; HR 1.63; 95% CI 0.88, 3.03). Associations were not observed among postmenopausal women (n = 1010). No associations were observed between infertility or pregnancy with CAC. CONCLUSIONS: Pregnancy, particularly combined with a history of infertility, confers increased risk of diabetes but not CAC among glucose-intolerant premenopausal women.

Does parity affect pregnancy outcomes in the elderly gravida?

PURPOSE: To identify whether older primiparas have more complications than do women who continue to deliver children into their late reproductive age. Patients of at least 35 years of age at delivery were included. Within this cohort, data from primiparous and multiparous women were compared. METHODS: This retrospective study was based on electronic medical records from a single academic center, with more than 7000 deliveries annually. The impact of parity on maternal complications was assessed using a multivariate logistic regression model that adjusted for baseline maternal characteristics and medical history. RESULTS: During the study period, there were 54 283 deliveries in our medical center. A total of 13,982 (25.7%) patients were at least 35 years old at delivery. The rate of twin pregnancy was higher in the primiparous group (1.9%) as compared to the multiparous group (0.8%, 95% CI 0.30-0.64, P < 0.001), as was the incidence of delivery prior to 34 weeks (6.1% of the primiparas versus 2.9% of the multiparas, P < 0.001, OR 2.16, 95% CI 1.75-2.68); hypertensive disorders (3.9% versus 1.7%, P < 0.001, 95% CI 0.33-0.57); diabetes (4.6% versus 3.2%, P = 0.003, 95% CI 0.55-0.88); and IUGR (10.5% versus 4.7%, P < 0.001, 95% CI 0.35-049), respectively. The increased risk for pre-term delivery, hypertensive disorders, diabetes, and IUGR was maintained after logistic regression analysis. CONCLUSION: We found that pregnancy complications typical to older parous women are significantly more common among primiparas, indicating that not only older age, but also having a first child relatively late in the reproductive period contributes to adverse pregnancy outcomes.

The magnitude and associated factors of postpartum hemorrhage among mothers who delivered at Debre Tabor general hospital 2018.

OBJECTIVE: Since data related to postpartum hemorrhage in Ethiopia is scarce, this study was aimed to assess the magnitude and associated factors of postpartum hemorrhage among mothers who delivered in Debre Tabor general hospital. RESULTS: In this study, one hundred forty-four mothers' charts were reviewed which made the response rate 100%. This study revealed that the magnitude of postpartum hemorrhage was 7.6% (CI 6.2, 9.8). Chi-square test revealed that there was an association between postpartum hemorrhage and gravidity, parity, having antenatal care visit, and the previous history postpartum hemorrhage. This finding confirmed that uterine atony, retained placenta, and genital tract trauma were the most common leading cause of postpartum hemorrhage.

Cognitive Dysfunction Among Primi gravidae Attending an Ante Natal Clinic in Kano, Northwest Nigeria.

Cognitive deficits among pregnant women have been reported, though the evidence is equivocal. Cognitive dysfunction during pregnancy may have negative consequences on maternal and child health.  Yet, very little is known about cognitive function of pregnant women in general and primi gravidae in particular in the area under study. This study aimed to evaluate cognitive function among primi gravidae. About 120 primi gravidae were studied in a large urban hospital in Kano. Mini-Mental State Examination (MMSE) was used to evaluate cognitive function; socio-demographic and clinical data were obtained. Data were processed using IBM SPSS statistics version 20.0. Significant values of P were those < 0.05. The median age of the primi gravidae was 20.0 (3) years; 80 % of them had secondary school education, 88.3 % were in their third trimester of pregnancy and 42.5 % did not have any medical complaints at the time of presentation. The median MMSE score of the primi gravidae was 22.00 (19.0), indicating mild cognitive impairment. Majority of the women (88.3%) had either mild (58.3%) or severe (30%) cognitive dysfunction. The cognitive dysfunction was influenced by level of education (X2 = 11.961, P = 0.003) and type of presenting complaints (X2 = 13.514, P = 0.036). There was significant association between the mild cognitive impairment and level of education (X2 = 11.426, P = 0.022).   This study concluded that the primi gravidae had mild cognitive impairment; with majority (88.3%) of them having cognitive dysfunction, which was significantly associated with level of educational attainment and was influenced by the level of education and presenting complaints.

Disfunciones del suelo pélvico en mujeres primíparas después del parto / Disfunções do assoalho pélvico em primíparas após o parto / Pelvic floor dysfunctions in primiparous women after birth

Objetivo: Estimar la prevalencia de infecciones del tracto urinario (ITU), incontinencia urinaria (IU), incontinencia anal (IA) y dispareunia en mujeres primíparas, e identificar la asociación entre IU y dispareunia con el tipo de parto. Método: Estudio observacional prospectivo realizado con 96 puérperas (72 de parto normal y 24 de parto por cesárea) dos y seis meses después del parto. Los datos fueron recolectados por medio del carnet prenatal, historia clínica y entrevistas con las mujeres entre enero y agosto de 2014 en el Centro de Parto Normal Emergencias y maternidad Municipal Zoraide Eva das Dores, ubicado en el Municipio de Itapecerica da Serra, São Paulo; en centros de salud del municipio mencionado y de los municipios de Juquitiba, São Lourenço y Embú-Guaçú. Resultados: Durante la gestación, 52,1% de las mujeres informaron ITU y 30,2% de ellas, IU. En el segundo y sexto mes después del parto, las prevalencias encontradas fueron: 4,2% y 11,8% de ITU; 17,7% y 11,8% de IU; 8,4% de IA (6,3% con incontinencia de flatos y 2,1% de heces); 2,0% (únicamente incontinencia de flatos; no hubo incontinencia de heces); 48,1% y 17,8% de dispareunia, respectivamente. No hubo asociación estadística entre el tipo de parto y la dispareunia y la IU (p=0,742 y p=0,738; respectivamente). Conclusiones: Las disfunciones del suelo pélvico (DSP) más frecuentes después del parto fueron la IU y la dispareunia. Hubo reducción espontánea de las DPP en el sexto mes después del parto. La identificación prematura de estas enfermedades es de gran importancia para la prevención, diagnóstico y tratamiento de males a la salud física y emocional de la mujer

Objetivo: Estimara prevalência de infecção do trato urinário (ITU), incontinência urinária (IU), incontinência anal (IA) e dispareunia em mulheres primíparas e identificar associação entre a dispareunia e IU com o tipo de parto. Método: Estudo observacio nal prospectivo realizado com 96 puérperas (72 de partos normais e 24 cesarianas) com dois e seis meses após o parto. Os dados foram coletados por meio de cartões de pré-natal, prontuários e entrevistas entre janeiro e agosto de 2014 no Centro do Parto Normal do Pronto Socorro e Maternidade Municipal Zoraide Eva das Dores, localizado no Município de Itapecerica da Serra, São Paulo, e em Unidades Básicas de Saúde do município referido e dos Municípios de Juquitiba, São Lourenço e Embú-Guaçú. Resultados: Na gravidez, 52,1% das mulheres referiram ITU e 30,2% delas, IU. No segundo e no sexto mês pós-parto, as prevalências encontradas foram: 4,2% e 11,8% de ITU; 17,7% e 11,8% de IU; 8,4% de IA (6,3% de incontinência de flatos e 2,1% de fezes) e 2,0% (apenas inco ntinência de flatos; não houve incontinência de fezes); e 48,1% e 17,8% de dispareunia, respectivamente. Não houve associação estatística entre o tipo de parto e a dispareunia e a IU (p=0,742 e p=0,738; respectivamente). Conclusão: As disfunções do assoal ho pélvico (DAP) mais frequentes após o parto foram a IU e a dispareunia. Houve redução espontânea das DAP no sexto mês após o parto. A identificação precoce destas morbidades é extremamente importante para a prevenção, diagnóstico e tratamento de agravos à saúde física e emocional da mulher

Objective: To assess the prevalence of the urinary tract infection (UTI), urinary incontinence (UI), anal incontinence (AI) and dyspareunia among primiparous women, as well as to identify the association between dyspareunia and UI and mode of birth. Material and methods: Prospective observational study carried out with 96 post-partum women (72 normal births and 24 caesarean section), two and six months after birth. Data were collected via prenatal cards, medical registers and interviews with women between January and August, 2014, at the Centro do Parto Normal do Pronto Socorro e Maternidade Municipal Zoraide Eva das Dores, located in Itapecerica da Serra, São Paulo, and at Health Centers in the Itapecerica da Serra and the cities of Juquitiba, São Lourenço and Embú-Guaçú. Results: During pregnancy, 52.1% of women reported UTI and 30.2%, UI. Two and six months after birth, there was a prevalence of 4.2% and 11.8% of UTI, 17.7% and 11.8% of UI, 8.4% of AI (6.3% of flatus incontinence and 2.1% of feces) and 2.0% (only flatus incontinence; there was no faecal incontinence); and 48.1% and 17.8% of dyspareunia, respectively. There was no statistical association between the mode of delivery and dyspareunia and UI (p=0.742 and p=0.738; respectively).Conclusions: The most frequent pelvic floor dysfunctions (PFD) after birth were IU and dyspareunia. There was spontaneous reduction of the PFD in the sixth month after birth. The early identification of these diseases is extremely important to prevent, diagnose and treat any harm to women’s physical and emotional health

Prevalence of Low Birth Weight before and after Policy Change to IPTp-SP in Two Selected Hospitals in Southern Nigeria: Eleven-Year Retrospective Analyses.

BACKGROUND: In 2005, Nigeria changed its policy on prevention of malaria in pregnancy to intermittent preventive treatment with sulphadoxine-pyrimethamine (IPTp-SP). Indicators of impact of effective prevention and control of malaria on pregnancy (MIP) are low birth weight (LBW) and maternal anaemia by parity. This study determined the prevalence of LBW for different gravidity groups during periods of pre- and postpolicy change to IPTp-SP. METHODS: Eleven-year data were abstracted from the delivery registers of two hospitals. Study outcomes calculated for both pre- (2000-2004) and post-IPTp-SP-policy (2005-2010) years were prevalence of LBW for different gravidity groups and risk of LBW in primigravidae compared to multigravidae. RESULTS: Out of the 11,496 singleton deliveries recorded within the 11-year period, the prevalence of LBW was significantly higher in primigravidae than in multigravidae for both prepolicy (6.3% versus 4%) and postpolicy (8.6% versus 5.1%) years. The risk of LBW in primigravidae compared to multigravidae increased from 1.62 (1.17-2.23) in the prepolicy years to 1.74 (1.436-2.13) during the postpolicy years. CONCLUSION: The study demonstrated that both the prevalence and risk of LBW remained significantly higher in primigravidae even after the change in policy to IPTp-SP.

Gravidity, Parity, and Vertebral Dimensions in the Northern Finland Birth Cohort 1966.

STUDY DESIGN: A population-based birth cohort study. OBJECTIVE: To investigate the association between gravidity, parity, and vertebral geometry among middle-aged women. SUMMARY OF BACKGROUND DATA: Vertebral size is a recognized determinant of vertebral fracture risk. Yet, only a few lifestyle factors that influence vertebral size are known. Pregnancy is a labile period that may affect the maternal vertebral size or shape. The lumbar lordosis angle is permanently deepened by pregnancy, but it remains unclear whether vertebral shape or size contribute to this deepened angle. METHODS: We aimed to investigate whether gravidity and parity were associated with vertebral cross-sectional area (CSA) and height ratio (anterior height to posterior height) among 705 middle-aged women from the Northern Finland Birth Cohort 1966. We measured the corpus of their fourth lumbar vertebra using magnetic resonance imaging of the lumbar spine at the age of 46. Gravidity and parity were elicited using a questionnaire also at the age of 46. Linear regression analysis was used with adjustments for body mass index, vertebral CSA (height ratio models), and vertebral height (CSA models). We also ran a subgroup analysis that did not include nulliparous women, and we compared nulliparous women with grand multiparous women. RESULTS: The models found no statistically significant associations between the predictors and outcomes. Crude and adjusted results were highly similar, and the subgroup analyses provided analogous results. CONCLUSION: Pregnancy, or even multiple pregnancies, do not seem to have long-term effects on vertebral geometry. In order to enhance the prevention of vertebral fractures, future studies should aim to reveal more lifestyle determinants of vertebral size. LEVEL OF EVIDENCE: 3.

Prediction of preeclampsia in primigravida in late first trimester using serum placental growth factor alone and by combination model.

We investigated a placental growth factor alone and combined clinical (mean arterial pressure, MAP), biophysical (uterine artery pulsability index, PI) and biochemical (placental growth factor, PLGF) model for predicting preeclampsia in late first trimester. The inclusion criteria was primigravida (<40 years) attending their first hospital visit with singleton pregnancy at 11-14 weeks of gestation. Of the enrolled and followed 291 subjects, 35 (12%) later developed PE (5.8%)/GH (6.2%). An equal number of randomised women with normotensive non-proteinuric course were considered as reference group. For preeclampsia, PLGF alone had detection rate of 40% and 51% with 5% and 10% FPR, respectively. On addition of MAP, the AUC improved to 0.937 for PE. Further, addition of mean PI slightly improved AUC to 0.965. This signifies that a model with all three markers had better prediction of preeclampsia rather than PLGF alone. Impact statement In view of high morbidity and mortality due to hypertensive disorders in pregnancy, there has been extensive research for developing markers to detect/screen the condition in early pregnancy. Several such markers have been tested in their individual capacities and in combination during early pregnancy. Most of these studies have originated from high income countries and focussed mainly on the second trimester of pregnancy. We investigated a placental growth factor alone and combined clinical (mean arterial pressure, MAP), biophysical (uterine artery pulsability index, PI) and biochemical (placental growth factor, PLGF) model for predicting preeclampsia in the first trimester in primigravida (<40 years). A nested case control model was used for our study. For preeclampsia, PLGF alone had detection rate of 40% and 51% with 5% and 10% FPR, respectively. On addition of MAP, the AUC improved to 0.937 for PE. Further, addition of mean PI slightly improved AUC to 0.965. The present study has been done in an Indian subcontinent setting (where maternal mortality related to preeclampsia are even higher) where very limited studies are available for the role of either PLGF or in combinations for prediction of preeclampsia. Our research pointed shows better predictability for PE when a combination of markers is used especially in low-risk nulligravida. These are easy, cheap and non-invasive measurements that can be taken in all women at their first routine antenatal visit.

Association between a Maternal History of Miscarriages and Birth Defects.

BACKGROUND: Some studies, mainly in the older literature, observed a significant association between miscarriages and birth defects (BDs) occurring in the same sibship. However, few studies examined the BD/miscarriage relationship in depth. In addition nothing has been added to the underlying mechanisms possibly linking both events. The purpose of this work was to identify specific BDs associated with maternal miscarriages. In particular, it examined whether the risk depended on the number of losses, and to suggest the existence of specific factors for each BD/miscarriage association observed. METHODS: The study relied on the Latin American Collaborative Study on Congenital Malformations (ECLAMC) database registries including 26,906 live and stillborn infants with one of 19 selected isolated BDs and 93,853 normal controls. Infants born to primigravid mothers were excluded from the present study. Demographic and reproductive variables were compared between control mothers With and Without previous miscarriages. The number, frequency, and distribution of miscarriages were observed for each BD and controls. A conditional logistic regression was applied to evaluate the miscarriage risk for each BD. RESULTS: Control mothers with previous miscarriages were older, had had more pregnancies, and were less educated. Three risk patterns of miscarriages were observed: a very high risk of miscarriages associated with gastroschisis, omphalocele, and talipes; only one miscarriage associated with spina bifida, and two or more miscarriages associated with hypospadias. CONCLUSION: These three patterns suggest that different factors underly each BD/miscarriage association: infertility for hypospadias, vascular disruption for gastroschisis and talipes, while for spina bifida, the much debated trophoblastic cell residue theory could not be discarded. Birth Defects Research 109:254-261, 2017. © 2017 Wiley Periodicals, Inc.

Pelvic floor muscle strength in primigravidae and non-pregnant nulliparous women: a comparative study.

INTRODUCTION AND HYPOTHESIS: The objective was to evaluate the pelvic floor muscles (PFM) in primigravidae and compare them with those in nonpregnant nulliparous women. METHODS: The sample consisted of 141 women with a mean age of 22.8 years, divided into four groups: 36 nonpregnant nulliparous (C), 31 primigravidae in the first trimester (1T), 42 primigravida in the second trimester (2T), and 32 primigravidae in the third trimester (3T). The participants were examined by digital palpation for pelvic floor muscle contraction using the Modified Oxford Scale, by measuring maximal vaginal squeeze pressure with a vaginal perineometer, and by measuring PFM maximal strength using a vaginal dynamometer. The best value of three maximal strengths was considered for analysis, the Kruskal-Wallis and Mann-Whitney U tests were used and differences were considered significant at p ≤ 0.05. RESULTS: The mean values for group C were 3.2 (digital palpation), 45.6 cmH2O (perineometry), and 11.7 N (dynamometry); for group 1T the corresponding values were 2.5, 21.1 cmH2O, and 8.8 N; for group 2T: 2.8, 22.9 cmH2O, and 7.8 N; and for group 3T: 2.1, 17.3 cmH2O, and 6.8 N. Groups were compared in pairs for digital palpation, perineometry, and dynamometry. There were significant differences between group C and group 1T, and between group C and group 3T. There was a significant difference between group C and group 2T with regard to perineometry and dynamometry, but not digital palpation. Dynamometry demonstrated a difference between groups 1T and 3T, digital palpation between groups 2T and 3T. CONCLUSION: Pelvic floor muscles in primigravidae are not as strong as those in nonpregnant nulliparous women.

Does the number of previous miscarriages influence the incidence of chromosomal aberrations in spontaneous pregnancy loss?

OBJECTIVE: Chromosomal aberrations are a common cause for miscarriage. The purpose of this study was to evaluate factors that influence the frequency of chromosomal abnormalities in miscarriages and provide clinicians with a guideline for management of such cases. METHODS: The study included 170 women who experienced pregnancy loss between the 2004 and 2014. Cytogenetic analysis of products of conception (POC) was routinely performed. RESULTS: Successful cytogenetic analysis was achieved in 144 cases (84%). Of these, 78 cases (54%) had a chromosomal aberration. The incidence of chromosomal aberrations was not statistically significant among patients with 1, 2, 3, 4 or ≥5 previous miscarriages (33.3%, 57.4%, 48.6%, 65.2%, and 59.1%, respectively, p = 0.227). The F/M ratio was similar in normal and abnormal POC karyotypes (1.2:1 and 1.3:1, respectively, p = 0.7). CONCLUSION: Contrary to previous assumptions we did not find correlation between number of previous spontaneous miscarriages a women experienced and chromosomal aberration in her current miscarriage.

Lower limb venous diameters and haemodynamics during pregnancy and postpartum period in healthy primigravidae.

Objective Analyse venous haemodynamics in healthy primigravidae during pregnancy and in the postpartum. Methods Cohort with primigravidae evaluated in the three trimesters of pregnancy and postpartum. Duplex evaluated venous diameters and reflux; air plethysmography evaluated venous filling index, ejection fraction, residual volume fraction and outflow fraction in both limbs. Results During pregnancy, diameters increased in bilateral common femoral and right infravalvar great saphenous, but returned to first trimester values after delivery. Reflux developed in one woman (5%) in the second trimester and in two more women (15%) in the third trimester. No reflux was detected in postpartum. Bilateral venous filling index was higher during pregnancy. Bilateral ejection fraction and residual volume fraction did not change. Bilateral outflow fraction increased progressively. The right limb outflow fraction in left lateral decubitus was similar. All changes returned to first trimester values after delivery. Conclusions Healthy primigravidae presented changes in lower limbs' veins during pregnancy: diameters in bilateral common femoral and infravalvar great saphenous veins increased; new reflux was developed in 15% of women, but there was no venous hypertension. Calf muscular pump function did not change. All changes returned to first trimester values after delivery.

Impact of female age and nulligravidity on fecundity in an older reproductive age cohort.

OBJECTIVE: To provide female age-related estimates of fecundity and incidence of infertility by history of prior pregnancy among women 30-44 years of age. DESIGN: Prospective, time-to-pregnancy cohort study. SETTING: Not applicable. PATIENT(S): Women, between 30 and 44 years of age, attempting to conceive for ≤3 months, and no known history of infertility, polycystic ovarian syndrome (PCOS), or endometriosis. INTERVENTION(S): Not applicable. MAIN OUTCOME MEASURE(S): Fecundability and incidence of infertility. RESULT(S): Compared to women aged 30-31 years, fecundability was reduced by 14% in women 34-35 years of age (fecundability ratio [FR] 0.86, 95% confidence interval [CI] 0.68-1.08), 19% in women 36-37 years of age (FR 0.81, 95% CI 0.60-1.08, 30% in women 38-39 years of age (FR 0.70, 95% CI 0.48-1.01), 53% in women 40-41 years of age (FR 0.47, 95% CI 0.28-0.78), and 59% in women 42-44 years of age (FR 0.39, 95% CI 0.16-0.93). Fecundability did not differ between women aged 30-31 years and 32-33 years. In general, fecundability and cumulative probability of pregnancy was lower for women who had never had a prior pregnancy. CONCLUSION(S): Women experience a significant reduction in fecundity and increase in the probability of infertility in their late thirties. At any age >30 years, women who have never conceived have a lower probability of achieving a pregnancy. CLINICAL TRIAL REGISTRATION NUMBER: NCT01028365.

Electromyographic activity of the pelvic floor muscles in the third trimester: comparison between primigravidae and secundigravidae.

OBJECTIVE: The objective was to compare the electromyographic activity of pelvic floor muscle (PFM) on third semester between primigravidae and secundigravidae who had previous vaginal delivery. DESIGN: Cross-sectional observational study. SAMPLE: Nineteen primigravidae and 21 secundigravidae between 34'h and 361 gestational weeks were evaluated. MATERIALS AND METHODS: Data collection consisted in assessing the PFMs activity by surface electromyography. MAIN OUTCOME MEASURES: The variables related to electromyographic assessment such peak and average on the rest, maximal voluntary contraction, and sustained contraction. RESULTS: There were no differences on electromyographic activity of PFMs between primigravidae and secondigravidae. However, a significant increase in body mass index and a negative correlation of the newborn weight with the peak value of electromyographic signal during maximal voluntary contraction were observed. CONCLUSIONS: The factors that can change the electromyographic activity pattern during pregnancy can be related to maternal body mass increased and newborn weight.