Time to initiation of antenatal care and its predictors among pregnant women in Ethiopia: a multilevel mixed-effects acceleration failure time model.

OBJECTIVE: To assess the time to initiation of antenatal care (ANC) and its predictors among pregnant women in Ethiopia. DESIGN: Retrospective follow-up study using secondary data from the 2019 Ethiopian Mini-Demographic and Health Survey. SETTING AND PARTICIPANTS: 2933 women aged 15-49 years who had ANC visits during their current or most recent pregnancy within the 5 years prior to the survey were included in this study. Women who attended prenatal appointments but whose gestational age was unknown at the first prenatal visit were excluded from the study. OUTCOME MEASURES: Participants were interviewed about the gestational age in months at which they made the first ANC visit. Multivariable mixed-effects survival regression was fitted to identify factors associated with the time to initiation of ANC. RESULTS: In this study, the estimated mean survival time of pregnant women to initiate the first ANC visit in Ethiopia was found to be 6.8 months (95% CI: 6.68, 6.95). Women whose last birth was a caesarean section (adjusted acceleration factor (AAF)=0.75; 95% CI: 0.61, 0.93) and women with higher education (AAF)=0.69; 95% CI: 0.50, 0.95) had a shorter time to initiate ANC early in the first trimester of pregnancy. However, being grand multiparous (AAF=1.31; 95% CI: 1.05, 1.63), being previously in a union (AAF=1.47; 95% CI: 1.07, 2.00), having a home birth (AAF=1.35; 95% CI: 1.13, 1.61) and living in a rural area (AAF=1.25; 95% CI: 1.03, 1.52) were the impediments to early ANC initiation. CONCLUSION: Women in this study area sought their initial ANC far later than what the WHO recommended. Therefore, healthcare providers should collaborate with community health workers to provide home-based care in order to encourage prompt ANC among hard-to-reach populations, such as rural residents and those giving birth at home.

Ultrasound imaging of core muscles activity in multiparous women with vaginal laxity: a cross-sectional study.

Vaginal laxity (VL) is a common condition among multiparous women, especially those who have delivered vaginally. Since pelvic floor muscles (PFMs) work synergistically with other core muscles, physical therapy protocols that aim to treat VL should train the PFMs in combination with other core muscles. To investigate the activity of core muscles in multiparous women with and without VL, and its relation to sexual function. An observational, cross-sectional study. The study included 100 multiparous women, who were divided into two groups according to their scores on the vaginal laxity questionnaire (VLQ). Women who scored between 1 and 3 on the VLQ were categorized as having VL (n = 48), while those who scored between 5 and 7 were placed in the control group (n = 52). The primary outcomes were PFM displacement, diaphragmatic excursion, transversus abdominis activation ratio, and lumbar multifidus thickness measured by ultrasound imaging. The secondary outcome was sexual functioning, evaluated using the Arabic female sexual function index (ArFSFI). The VL group had significantly lower PFM displacement (mean difference (MD) - 0.42; 95% confidence interval (CI) - 0.49 to - 0.33; p = 0.001), diaphragmatic excursion (MD - 2.75; 95% CI - 2.95 to - 2.55; p = 0.001), lumbar multifidus thickness (MD - 10.08; 95% CI - 14.32 to - 5.82; p = 0.02), and ArFSFI scores (MD - 9.2; 95% CI - 10.59 to - 7.81; p = 0.001) in comparison to the control group (p < 0.05). Nevertheless, the transversus abdominis activation ratio demonstrated no significant difference between the two groups (MD 0.06; 95% CI - 0.05 to 0.17; p = 0.33). Multiparous women with VL had significantly lower PFM displacement, diaphragmatic excursion, lumbar multifidus thickness, and sexual function index scores than women in the control group. The only exception was transversus abdominis activation, which did not differ significantly between the VL and control groups.

Breastfeeding in primiparous women with congenital heart disease - a register study.

BACKGROUND: The number of pregnant women with congenital heart disease (CHD) is rising, and the disease poses increased risks of cardiovascular and obstetric complications during pregnancy, potentially impacting breastfeeding success. This study aimed to investigate breastfeeding in primiparous women with CHD compared to primiparous women without CHD, and to examine potential hindering factors for breastfeeding in women with CHD. METHODS: The data were gathered between 2014 and 2019 and obtained by merging the Swedish Congenital Heart Disease Register (SWEDCON) with the Swedish Pregnancy Register. Primiparous women ≥ 18 years of age with CHD (n = 578) were matched by age and municipality to 3049 women without CHD, giving birth after 22 gestational weeks. Multivariable logistic regression analysis was used to identify factors associated with non-breastfeeding in women with CHD. RESULTS: Fewer women with CHD breastfed than women without CHD two days (94% vs. 97%, p = 0.001) and four weeks after birth (84% vs. 89%, p = 0.006). When all women were analysed, having CHD was associated with non-breastfeeding at both two days and four weeks after birth. For women with CHD, body mass index (BMI) ≥ 30 (OR 3.1; 95% CI 1.4, 7.3), preterm birth (OR 6.4; 95% CI 2.1, 19.0), self-reported history of psychiatric illness (OR 2.4; 95% CI 1.2, 5.1), small for gestational age (OR 4.2; 95% CI 1.4, 12.2), and New York Heart Association Stages of Heart Failure class II - III (OR 6.0; 95% CI 1.4, 26.7) were associated with non-breastfeeding two days after birth. Four weeks after birth, factors associated with non-breastfeeding were BMI ≥ 30 (OR 4.3; 95% CI 2.1, 9.0), self-reported history of psychiatric illness (OR 2.2; 95% CI 1.2, 4.2), and preterm birth (OR 8.9; 95% CI 2.8, 27.9). CONCLUSIONS: The study shows that most women with CHD breastfeed, however, at a slightly lower proportion compared to women without CHD. In addition, factors related to the heart disease were not associated with non-breastfeeding four weeks after birth. Since preterm birth, BMI ≥ 30, and psychiatric illness are associated with non-breastfeeding, healthcare professionals should provide greater support to women with CHD having these conditions.

Temporal disposition of pelvic girdle, vagina and vulva in relation to urovagina in cycling and pregnant-postpartum cows.

Urovagina (UV) is less studied in cows. The vaginal contents, constrictor vestibule muscle activity, circulating progesterone, pelvic girdle, vagina and vulva angles were compared on Days 0 and 14 within and between UV (UV group; n = 36) and normal (N group; n = 36) cows. The oestrous duration was compared among the groups. Parameters for various UV severities were also compared. Another set of pregnant-postpartum cows (P-PP group; n = 31) underwent monthly evaluations for UV and the angles from the third month of pregnancy until the second month postpartum. The effect of age, parity and body condition score on UV severities on Day 0, and parity on angles in the P-PP group was evaluated. Different variables were correlated in different groups. The UV group was repeat breeder, exhibited prolonged oestrus and reduced progesterone on Day 14. The latter increased with UV severity on Day 0. On Day 14, severe form of UV was more prevalent. The UV severity increased with parity. In the UV group, a cranioventral pelvic girdle on Day 0 became more cranioventral on Day 14 and was correlated with the vagina moving from a caudodorsal position on Day 0 to a cranioventral position on Day 14. In the P-PP group, the pelvic girdle and vagina remained caudodorsal and UV was undetectable throughout the study. Vagina and vulva displayed a parity-by-month interaction in the P-PP group. To summarize, the UV characteristics were influenced by the oestrous cycle stage, pelvic girdle angles, and parity.

Split weaning improves pregnancy rate and embryo survival in sows mated in lactation.

Increasing piglet weaning age while maintaining the reproductive efficiency of the breeding herd depends on the ability to stimulate sows to ovulate during lactation without reducing subsequent pregnancy rates and litter sizes. The aim of this study was to determine if a reduction in piglet suckling load, either prior to or immediately after mating in lactation, altered ovarian follicle development and increased embryo survival to day 30 of gestation. Fifty-nine multiparous Large White x Landrace sows were allocated to one of three treatments; litter size maintained at 11 piglets (control); litter size reduced to seven piglets on day 18 of lactation (split wean (SW)); or litter size reduced to seven piglets at expression of lactation oestrus (oestrus split wean (OES SW)). The percentage of sows that expressed lactation oestrus did not differ between treatments (79.7 %; P > 0.05) and split weaning had minimal effects on ovarian follicle development. Pregnancy rates were higher for SW and OES SW sows, compared to control sows. Embryo survival to day 30 of gestation was higher for SW sows (73.7 %) compared with control (56.4 %) and OES SW sows (49.5 %; P < 0.05). In summary, weaning a portion of the litter prior to mating in lactation improved pregnancy rates and embryo survival.

Predictive modelling of deviation from expected milk yield in transition cows on automatic milking systems.

The transition period is a pivotal time in the production cycle of the dairy cow. It is estimated that between 30% and 50% of all cows experience metabolic or infectious disease during this time. One of the most common and economically consequential effects of disease during the transition period is a reduction in early lactation milk production. This has led to the utilisation of deviation from expected milk yield in early lactation as a proxy measure for transition health. However, to date, this analysis has been used exclusively for the retrospective assessment of transition cow health. Statistical models capable of predicting deviations from expected milk yield may allow producers to proactively manage animals predicted to suffer negative deviations in early lactation milk production. The objective of this retrospective cohort study was first, to explore the accuracy with which cow-level production and behaviour data collected on automatic milking systems (AMS) from 1-3 days in milk (DIM) can predict deviation from expected 30-day cumulative milk yield in multiparous cows. And second, to assess the accuracy with which predicted yield deviations can classify cows into groups which may facilitate improved transition management. Production, rumination, and physical activity data from 31 commercial AMS were accessed. A 3-step analytical procedure was then conducted. In Step 1, expected cumulative yield for 1-30 DIM for each individual cow-lactation was calculated using a mixed effect linear model. In Step 2, 30-Day Yield Deviation (YD) was calculated as the difference between observed and expected cumulative yield. Lactations were then assigned to one of three groups based on their YD, RED Group (0% YD). In Step 3, yield, rumination, and physical activity data from days 1-3 in lactation were used to predict YD using machine learning models. Following external validation, YD was predicted across the test data set with a mean absolute error of 9%. Categorisation of animals suffering large negative deviations (RED group) was achieved with a specificity of 99%, sensitivity of 35%, and balanced accuracy of 67%. Our results suggest that milk yield, rumination and physical activity patterns expressed by dairy cows from 1-3 DIM have utility in the prediction of deviation from expected 30-day cumulative yield. However, these predictions currently lack the sensitivity required to classify cows reliably and completely into groups which may facilitate improved transition cow management.

The Concentration of Lactoferrin in Breast Milk Correlates with Maternal Body Mass Index and Parity.

Background: Lactoferrin (LF) is a multifunctional glycoprotein found in human milk and body fluids, which has been shown to play a vital role in regulating the immunity and supporting the intestinal health of infants. Aim: This study evaluated the association between maternal/parturient factors and LF concentration in the breast milk of Chinese mothers. Methods: 207 breast milk samples were collected from healthy mothers with in the first year of lactation. Maternal and parturient information was collected for these participants through questionnaires. The content of lactoferrin in breast milk was detected by liquid chromatography, and macronutrient concentration in breast milk was measured by human milk analyzer in only 109 samples. Results: Our findings demonstrated that the LF content was much higher within the first month of lactation than it was after that period (p < 0.05). When compared with normal and lean mothers, the LF content of obese mothers was considerably higher (p < 0.05). The parity and LF content showed a favorable correlation. The proportion of LF to total protein tended to decrease as lactation progressed. Protein, fat, dry matter, and energy content were significantly positively correlated with LF content (p < 0.001). Conclusion: Early breast milk tends to have a higher level of LF, and the change of LF concentration in breast milk is associated with the parity and body mass index of the mother.

A retrospective cohort study on the influencing factors for macrosomia in singleton pregnancies.

To explore the influencing factors of singletons with macrosomia, and to develop interventions for the prevention of macrosomia. A retrospective cohort study was conducted on 26,379 pregnant women who established the Maternal and Child Health Record and gave birth from January 1, 2019 to December 31, 2019 in a community health service center in Haidian district, Beijing. The study analyzed factors such as maternal age, ethnicity, education level, prepregnancy body mass index (BMI), parity, folic acid supplementation, gestational diabetes mellitus, gestational hyper, hypothyroidism in pregnancy (including subhypothyroidism), hyperthyroidism in pregnancy, and infant gender. Univariate analysis was performed using the χ2 test, and multivariate analysis was performed using non-conditional multivariate logistic regression analysis. Out of 26,379 live births, 5.8% (1522/26,379) were macrosomia and 94.2% (24,857/26,379) were non-macrosomia. Univariate analysis revealed that maternal age, prepregnancy BMI, education level, parity, hypothyroidism during pregnancy, and infant gender were identified as influencing factors for macrosomia (P < .05). Multivariate analysis showed that maternal age ≥ 35 years, education level of high school or below, pre-pregnancy BMI, hypothyroidism, male infant, and parity were all influencing factors for macrosomia (P < .05). Prepregnancy overweight or obesity, male infants, multiparity, and low education level are risk factors for macrosomia. Multiple factors can contribute to macrosomia, and therefore, maternal health care should be strengthened, and early interventions should be taken for the above-mentioned factors in the local area.

Behavioural variability, physical activity, rumination time, and milk characteristics of dairy cattle in response to regrouping.

In the commercial dairy industry worldwide, it is common practice to periodically regroup cows as part of their management strategy within housed systems. While this animal husbandry practice is intended to improve management efficiency, cows may experience social stress as a result of the social environment changes, which may have an impact on their behavioural patterns, performance, and welfare. We investigated whether regrouping altered dairy cows' behaviour and impacted their cortisol concentration (a physiological marker of stress), oxytocin, milk yield, and quality in a robotic milking system. Fifty-two lactating cows (17 primiparous; 35 multiparous) were moved in groups of 3-5 individuals into established pens of approximately 100 cows. Behaviour of the regrouped cows was directly observed continuously for 4 h/day across 4-time blocks (day-prior (d-1), day-of regrouping (d0), day-after (d + 1), and 6-days after (d + 6) regrouping). Cows were categorised as being with others, alone, or feeding every 2.5 min prior to the assessment of behavioural dynamics. Milk yield (MY) and composition, total daily activity, and rumination time (RUM) data were extracted from the Lely T4C management program (Lely Industries, Maassluis, the Netherlands), and milk samples were collected for cortisol and oxytocin concentration analyses; data were analysed using linear mixed-effect modelling. Primiparous cows were less likely to be interacting with others on d + 1 than d-1 compared with multiparous. However, average bout duration (minutes) between being alone and feeding activity states were similar on d-1, d + 1, and d + 6, for both primiparous and multiparous cows. A reduction in the average alone and feeding bout duration was observed on d0. Multiparous cows spent significantly more total time being alone on d0 compared to d-1. Neither regrouping nor parity statistically influenced milk DM content, energy, or cortisol concentration. Primiparous cows produced 3.80 ±â€¯2.42 kg (12.2%) less MY on d + 1 compared to their d-1, whereas multiparous cows did not change MY. A significant decrease of 0.2% fat was found in both parity groups following regrouping and remained low up to d + 6. Daily activity in both parity groups increased significantly and RUM reduced after regrouping. A significant decrease in oxytocin concentration was observed in all cows on d + 1. The results, specifically for primiparous cows, indicated a negative impact of regrouping on social interactions, due to changes in the social environment which may lead to short-term social instability. Multiparous cows may benefit from previous regrouping experiences.

Images in abnormal placenta: a rare case of "blood bag" formation in placenta membranacea.

Placenta membranacea is an uncommon placental anomaly. Here, we present the case of a 30-year-old primiparous woman admitted for thickened placenta and reduced amniotic fluid. A follow-up ultrasound, performed after 48 h, revealed that the placental parenchyma was thin and not adequately visualized, enclosing a substantial volume of flowing blood (150 mm), with an amniotic fluid index of 18 mm. An emergency cesarean section was promptly performed. Following fetal delivery, a substantial accumulation of dark red blood within the fetal membranes created a "blood bag", estimated at approximately 3000 ml. This observation aligned with the ultrasound findings, and both placental morphology and pathological results substantiated the diagnosis of placenta membranacea.

Comparison of serum very low-density lipoprotein concentrations during transition in primiparous and multiparous cows.

This study was carried out as an observational study in order to examine the difference of change in serum very low-density lipoprotein (VLDL) between primiparous and multiparous cows. Twenty-one clinically healthy cows (10 primiparous and 11 multiparous) were selected at 21 days prior to expected calving. Blood samples were collected in the morning (before feeding) on days -21, -7, 7, 21 and 56 days in milk (DIM). At 7 and 21 DIM, the serum non-esterified fatty acid concentration of multiparous cows was significantly higher than that of primiparous cows. The serum ß-hydroxybutyrate concentration was also markedly higher in multiparous cows than in primiparous cows at 21 DIM. These results suggested that the degree of negative energy balance was greater in multiparous cows than in primiparous cows during this period. In both, serum VLDL concentrations decreased at over 7 DIM, increased at 21 DIM, and then decreased at 56 DIM. On the other hand, triglyceride and total protein concentrations of VLDL in multiparous cows were significantly lower than in primiparous cows at 21 DIM. This suggests that multiparous cows have poor triglyceride secretion from the liver and that they become more susceptible to hepatic lipidosis.

Association of serum folic acid levels in response to fasting blood glucose in early pregnancy with the risk of gestational diabetes mellitus: A retrospective cohort study.

OBJECTIVE: With increasingly prevalent folic acid consumption in early pregnancy, concerns about its potentially negative effect on maternal metabolism have been raised. Recent findings regarding folic acid levels in the first trimester and the risk of gestational diabetes mellitus have been inconclusive. The aim of this study was to investigate the association of folic acid status in early pregnancy with gestational diabetes mellitus as well as examine whether glucose levels can be modulated by folic acid status during the same first trimester. METHODS: This was a retrospective cohort study based on 27 128 Chinese pregnant women who registered during their first prenatal visit from January 2015 to December 2019. Serum folic acid and fasting blood glucose concentrations were measured during the 9th to 13th gestational weeks. Binary logistic regression was applied to estimate the odds ratios of gestational diabetes mellitus by using the serum folic acid levels quartiles with adjustment for major confounders. To investigate the potential effect of modifying key risk factors for gestational diabetes mellitus, we established subgroups, in which analyses were stratified by age (<25, 25-29, 30-34, and ≥35 y), parity (nulliparous and parous), prepregnancy body mass index (< 18.5, 18.5-23.9, and ≥ 24 kg/m2), and family history of diabetes (yes and no). RESULTS: The positive association between maternal folate concentrations and fasting blood glucose was observed: the risk for hyperglycemia was higher in those in the middle (Q3) and higher (Q4) quartiles compared with those in Q1 and Q2. A higher risk for gestational diabetes mellitus was found in hyperglycemia of early pregnant women with high folate concentrations (Q3: odds ratio = 5.63; 95% CI, 4.56-6.95, and Q4: odds ratio = 5.57; 95% CI, 4.68-6.64) compared with normal fasting glucose mothers with folate concentrations in Q1 and Q2 after accounting for multiple covariables. Similar patterns were observed for different subgroups. Restricted cubic spline plots had a positive correlation of serum folic acid level with fasting blood glucose concentration as well as risk of gestational diabetes mellitus in a nonlinear pattern, with 32.5 nmol/L as the cutoff point for folic acid level. CONCLUSIONS: Our findings underscore the importance of maintaining an appropriate folic acid concentration for preserving a lower risk of gestational diabetes mellitus, especially in women with relatively higher blood glucose in early pregnancy. Additionally, folic acid concentration > 32.5 nmol/L may be considered a risk factor for gestational diabetes mellitus. This research suggested that folic acid levels should be monitored during the first trimester from the first prenatal checkup to prevent adverse effects of excessive folic acid intake.

Association between pregnancy-related complications and development of type 2 diabetes and hypertension in women: an umbrella review.

BACKGROUND: Despite many systematic reviews and meta-analyses examining the associations of pregnancy complications with risk of type 2 diabetes mellitus (T2DM) and hypertension, previous umbrella reviews have only examined a single pregnancy complication. Here we have synthesised evidence from systematic reviews and meta-analyses on the associations of a wide range of pregnancy-related complications with risk of developing T2DM and hypertension. METHODS: Medline, Embase and Cochrane Database of Systematic Reviews were searched from inception until 26 September 2022 for systematic reviews and meta-analysis examining the association between pregnancy complications and risk of T2DM and hypertension. Screening of articles, data extraction and quality appraisal (AMSTAR2) were conducted independently by two reviewers using Covidence software. Data were extracted for studies that examined the risk of T2DM and hypertension in pregnant women with the pregnancy complication compared to pregnant women without the pregnancy complication. Summary estimates of each review were presented using tables, forest plots and narrative synthesis and reported following Preferred Reporting Items for Overviews of Reviews (PRIOR) guidelines. RESULTS: Ten systematic reviews were included. Two pregnancy complications were identified. Gestational diabetes mellitus (GDM): One review showed GDM was associated with a 10-fold higher risk of T2DM at least 1 year after pregnancy (relative risk (RR) 9.51 (95% confidence interval (CI) 7.14 to 12.67) and although the association differed by ethnicity (white: RR 16.28 (95% CI 15.01 to 17.66), non-white: RR 10.38 (95% CI 4.61 to 23.39), mixed: RR 8.31 (95% CI 5.44 to 12.69)), the between subgroups difference were not statistically significant at 5% significance level. Another review showed GDM was associated with higher mean blood pressure at least 3 months postpartum (mean difference in systolic blood pressure: 2.57 (95% CI 1.74 to 3.40) mmHg and mean difference in diastolic blood pressure: 1.89 (95% CI 1.32 to 2.46) mmHg). Hypertensive disorders of pregnancy (HDP): Three reviews showed women with a history of HDP were 3 to 6 times more likely to develop hypertension at least 6 weeks after pregnancy compared to women without HDP (meta-analysis with largest number of studies: odds ratio (OR) 4.33 (3.51 to 5.33)) and one review reported a higher rate of T2DM after HDP (hazard ratio (HR) 2.24 (1.95 to 2.58)) at least a year after pregnancy. One of the three reviews and five other reviews reported women with a history of preeclampsia were 3 to 7 times more likely to develop hypertension at least 6 weeks postpartum (meta-analysis with the largest number of studies: OR 3.90 (3.16 to 4.82) with one of these reviews reporting the association was greatest in women from Asia (Asia: OR 7.54 (95% CI 2.49 to 22.81), Europe: OR 2.19 (95% CI 0.30 to 16.02), North and South America: OR 3.32 (95% CI 1.26 to 8.74)). CONCLUSIONS: GDM and HDP are associated with a greater risk of developing T2DM and hypertension. Common confounders adjusted for across the included studies in the reviews were maternal age, body mass index (BMI), socioeconomic status, smoking status, pre-pregnancy and current BMI, parity, family history of T2DM or cardiovascular disease, ethnicity, and time of delivery. Further research is needed to evaluate the value of embedding these pregnancy complications as part of assessment for future risk of T2DM and chronic hypertension.

Does parity order or cow antibody level influence the humoral immunity of calves for cattle anaplasmosis?

Anaplasmosis is a widely distributed vector-borne disease of cattle caused by the bacteria Anaplasma marginale, which may lead to severe losses in beef and dairy cattle production. Anecdotal information among farmers suggested that some cows may deliver calves more resilient to anaplasmosis. To investigate this, we tested two hypotheses: (i) whether the parity order or (ii) cow antibody levels may influence the humoral immunity of pre-weaning calves against cattle anaplasmosis. For this study, we sampled 170 cattle (Bos taurus taurus, Angus breed) on a farm in Southern Brazil, comprising 85 cows (50 multiparous and 35 primiparous) and their 85 calves (50 days old). Antibodies against A. marginale were investigated using iELISA. Eighty percent of the animals were considered seropositive (100% of the cows and 60% of the calves). There was no significant difference in seroprevalence between calves from primiparous and multiparous cows. However, calves from multiparous cows exhibited higher antibody levels. To address the second question, we classified cows based on their antibody levels to A. marginale (high or low). Calves from cows with high antibody levels also showed elevated antibody levels against A. marginale. Furthermore, calves from cows with high antibody levels had approximately four times greater odds of being seropositive for A. marginale at 50 days old than those born to mothers with low antibody levels. In conclusion, the calf's antibody level against A. marginale appears to be related to the cow's parity order and the mother's antibody level.

The influence of parity, body condition, litter size and carbetocin administration on colostrum production and immunoglobulin levels in highly productive sows within a tropical environment.

The aim of this study was to explore the factors contributing to colostrum production and the levels of colostrum immunoglobulins (IgG and IgA) in contemporary highly productive sows within a tropical climate. We focused on variables such as parity number, litter size, sow body condition score (BCS), the timing of sample collection following the commencement of farrowing and the use of carbetocin during the birthing process. A total of 100 colostrum samples were collected from a group of 50 Danish Landrace × Yorkshire crossbred sows. These samples were taken at two distinct time intervals: right after farrowing (0 h) and 6 h later. The colostrum samples were classified according to the sows' parity numbers, with 33 samples originating from primiparous sows and 67 from multiparous ones. Additionally, the number of live-born piglets were categorized into three groups: 7-13, 14-17 and ≥ 18 piglets per litter. Moreover, the samples were categorized based on the use of carbetocin during the birthing process, with 34 sows experiencing natural farrowing and 66 sows receiving carbetocin. The sow's BCS was assessed through visual evaluation and palpation. The piglet colostrum consumption and the amount of colostrum produced by the sows were determined. The concentrations of IgG and IgA were determined by using the enzyme-linked immunosorbent assay (ELISA) technique. On average, the colostrum production averaged 5.5 ± 1.7 kg, with IgG and IgA concentrations averaging 54.9 ± 24.6 mg/ml and 7.6 ± 3.5 mg/ml, respectively. Primiparous sows exhibited a significant 25.2% decrease in IgG concentration within 6 h of parturition (P < 0.05), whereas no such decline was observed in multiparous sows. Furthermore, multiparous sows displayed higher colostrum yields (6.2 ± 1.5 kg and 4.3 ± 1.5 kg, respectively, P < 0.001) and IgA concentrations compared to primiparous sows (8.3 ± 3.8 mg/ml and 6.3 ± 2.6 mg/ml, respectively, P = 0.002). Furthermore, a positive correlation was observed between IgA concentrations in colostrum and the sow's BCS at both the 0-h and 6-h post-farrowing time points (r = 0.425, P = 0.002 and r = 0.315, P = 0.031, respectively). The administration of carbetocin did not yield a significant impact on the concentrations of IgG and IgA in the sows' colostrum (P > 0.05). In conclusion, during the initial 6 h after birth, colostrum IgA levels remained stable, whereas there was a noticeable decline in IgG levels, particularly among primiparous sows. The production volume of colostrum and the concentration of IgA in sows within tropical conditions were influenced by both parity number and body condition score.

Evaluation of cesarean delivery rates and factors associated with cesarean delivery among women enrolled in a pregnancy cohort study at two tertiary hospitals in Thailand.

BACKGROUND: Cesarean delivery rates have increased globally resulting in a public health concern. We estimate rates of cesarean deliveries among Thai women using the World Health Organization (WHO) Robson Classification system and compare rates by Robson group to the Robson guideline for acceptable rates to identify groups that might benefit most from interventions for rate reduction. METHODS: In 2017 and 2018, we established cohorts of pregnant women aged ≥ 18 years seeking prenatal care at two tertiary Thai hospitals and followed them until 6-8 weeks postpartum. Three in-person interviews (enrollment, end of pregnancy, and postpartum) were conducted using structured questionnaires to obtain demographic characteristics, health history, and delivery information. Cesarean delivery indication was classified based on core obstetric variables (parity, previous cesarean delivery, number of fetuses, fetal presentation, gestational week, and onset of labor) assigned to 10 groups according to the Robson Classification. Logistic regression was used to identify factors associated with cesarean delivery among nulliparous women with singleton, cephalic, term pregnancies. RESULTS: Of 2,137 participants, 970 (45%) had cesarean deliveries. The median maternal age at delivery was 29 years (interquartile range, 25-35); 271 (13%) participants had existing medical conditions; and 446 (21%) had pregnancy complications. The cesarean delivery rate varied by Robson group. Multiparous women with > 1 previous uterine scar, with a single cephalic pregnancy, ≥ 37 weeks gestation (group 5) contributed the most (14%) to the overall cesarean rate, whereas those with a single pregnancy with a transverse or oblique lie, including women with previous uterine scars (group 9) contributed the least (< 1%). Factors independently associated with cesarean delivery included age ≥ 25 years, pre-pregnancy obesity, new/worsen medical condition during pregnancy, fetal distress, abnormal labor, infant size for gestational age ≥ 50th percentiles, and self-pay for delivery fees. Women with existing blood conditions were less likely to have cesarean delivery. CONCLUSIONS: Almost one in two pregnancies among women in our cohorts resulted in cesarean deliveries. Compared to WHO guidelines, cesarean delivery rates were elevated in selected Robson groups indicating that tailored interventions to minimize non-clinically indicated cesarean delivery for specific groups of pregnancies may be warranted.

The effect of the training provided to primiparous pregnant women based on the model on pregnancy risk perception and health literacy.

The purpose of this study was to assess the impact of health education based on the health belief model (HBM) on the perception of risk in pregnancy and health literacy in primiparous pregnant women to maintain and improve their health. The study was carried out with 82 pregnant women who were in the second trimester. The number of samples was calculated using the G-Power program version 3.1.7. The number of samples was found 44 for the education group and 44 for the control group with a confidence interval of 95 percent, a margin of error of 5 percent, a large Cohen d effect size value (0.5), and a power of 80 percent. Randomization was performed using the envelope method to determine the interventional and control groups. The training prepared in line with the SIM was presented to the participants in the education group. 2 sessions per week, a total of 4 times. "Personal Information Form," Health Literacy Scale (HLS), and Perception of Pregnancy Risk Questionnaire (PPRQ) were used as data collection tools. The mean of the risk perception of the pregnant toward the baby posttest score was 9.95 ± 13.30 in the education group, and 23.35 ± 21.41 in the control group (p = .001). The mean health literacy scale posttest score was 103.52 ± 19.77 in the education group and 93.5 ± 19.02 in the control group, and it was found to be statistically significantly higher in the health literacy education group than in the control group (p = .027). This study found that educating pregnant women using the health belief model reduces their risk perception and boosts their degree of health literacy.

"Social support and stressful life events: risk factors for antenatal depression in nulliparous and multiparous women".

Nulliparous (pregnant women who are giving birth for the first time) and multiparous (women who have multiple children) may have different concerns, which may be associated with risk of antenatal depression. This study aims to examine the role of social support and stressful life events as risk factors for antenatal depression in nulliparous and multiparous women. The sample included 1,524 pregnant women recruited from an obstetrics setting at the end of the first trimester of pregnancy from two Spanish tertiary-care public hospitals. The sample completed the Patient Health Questionnaire (PHQ-9), and the "social support" and "stressful life events" subscales of the Postpartum Depression Predictor Inventory-Revised (PDPI-R). Nulliparous women reported a lower prevalence of depressive symptoms (15.6 percent) compared to multiparous mothers (20.1 percent). In both groups, marriage/partner problems (NP: ß = 0.178, p < .01 vs MP: ß = 0.164, p < .01) and a perceived lack of instrumental support from friends (NP: ß = -0.154, p < .01 vs MP: ß = -0.154, p < .01) were significant risk factors for antenatal depression. However, nulliparous women have more risk factors such as unemployment (ß = 0.096, p < .05), job change (ß = 0.127, p < .01), financial problems (ß = 0.145, p < .01) and lack of instrumental support from partner (ß = -0187, p < .01). For multiparous women, moving (ß = 0.080, p < .05) and lack of instrumental support from family (ß = -0.151, p < .01) were risk factors. These results suggest the critical need for screening and designing preventive interventions adapted and taking into consideration parity to provide more effective health care during pregnancy.