Maternal adverse childhood experiences, mental health, and child behaviour at age 3: The all our families community cohort study.

Links between adverse childhood experiences (ACEs) and threats to health and well-being later in life are well established. The current study extends those findings into younger populations of pregnant women and their children; investigating how ACEs relates to maternal postpartum well-being, coping, and parenting, as well as child outcomes. Participants included 1994 mothers and children from the All Our Families community-based cohort in Alberta, Canada, followed from pregnancy (from 2008 to 2011) until child age 3 years. The sample is representative of the pregnant population in an urban Canadian centre. Mothers completed questionnaires on ACEs, postpartum mental health, as well as parenting morale, efficacy, coping, and personality. Child outcomes included internalizing and externalizing behavior, as well as temperament. Approximately 62% of participants experienced at least one ACE; 25% experienced 3 or more ACEs. The presence of 3 or more ACEs was associated with postpartum smoking, binge drinking, depressive and anxiety symptoms, lower optimism and higher neuroticism, and lower reported parenting morale. In children, 3 or more maternal ACEs was associated with higher levels of internalizing (e.g., anxiety) and externalizing difficulties (aggression and hyperactivity), as well as temperament (surgency and negative affectivity). Cumulative maternal ACEs are associated with postpartum mental health and parenting morale, as well as maladaptive coping strategies. The demonstrated downstream consequences of maternal ACEs for child outcomes suggests that early intervention strategies and community resources to improve life course outcomes for parents and children are critical for breaking intergenerational continuities of risk.

Impact of maternal body mass index and gestational weight gain on pregnancy complications: an individual participant data meta-analysis of European, North American and Australian cohorts.

OBJECTIVE: To assess the separate and combined associations of maternal pre-pregnancy body mass index (BMI) and gestational weight gain with the risks of pregnancy complications and their population impact. DESIGN: Individual participant data meta-analysis of 39 cohorts. SETTING: Europe, North America, and Oceania. POPULATION: 265 270 births. METHODS: Information on maternal pre-pregnancy BMI, gestational weight gain, and pregnancy complications was obtained. Multilevel binary logistic regression models were used. MAIN OUTCOME MEASURES: Gestational hypertension, pre-eclampsia, gestational diabetes, preterm birth, small and large for gestational age at birth. RESULTS: Higher maternal pre-pregnancy BMI and gestational weight gain were, across their full ranges, associated with higher risks of gestational hypertensive disorders, gestational diabetes, and large for gestational age at birth. Preterm birth risk was higher at lower and higher BMI and weight gain. Compared with normal weight mothers with medium gestational weight gain, obese mothers with high gestational weight gain had the highest risk of any pregnancy complication (odds ratio 2.51, 95% CI 2.31- 2.74). We estimated that 23.9% of any pregnancy complication was attributable to maternal overweight/obesity and 31.6% of large for gestational age infants was attributable to excessive gestational weight gain. CONCLUSIONS: Maternal pre-pregnancy BMI and gestational weight gain are, across their full ranges, associated with risks of pregnancy complications. Obese mothers with high gestational weight gain are at the highest risk of pregnancy complications. Promoting a healthy pre-pregnancy BMI and gestational weight gain may reduce the burden of pregnancy complications and ultimately the risk of maternal and neonatal morbidity. TWEETABLE ABSTRACT: Promoting a healthy body mass index and gestational weight gain might reduce the population burden of pregnancy complications.

Aerobic exercise for women during pregnancy.

BACKGROUND: Physiological responses of the fetus (especially increase in heart rate) to single, brief bouts of maternal exercise have been documented frequently. Many pregnant women wish to engage in aerobic exercise during pregnancy but are concerned about possible adverse effects on the outcome of pregnancy. OBJECTIVES: The objective of this review was to assess the effects of advising healthy pregnant women to engage in regular aerobic exercise (at least two to three times per week), or to increase or reduce the intensity, duration, or frequency of such exercise, on physical fitness, the course of labour and delivery, and the outcome of pregnancy. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (June 2005), MEDLINE (1966 to 2005 January Week 1), EMBASE (1980 to 2005 January Week 1), Conference Papers Index (earliest to 2005 January Week 1), contacted researchers in the field and searched reference lists of retrieved articles. SELECTION CRITERIA: Acceptably controlled trials of prescribed exercise programs in healthy pregnant women. DATA COLLECTION AND ANALYSIS: Both review authors independently assessed trial quality and extracted data. Study authors were contacted for additional information. MAIN RESULTS: Eleven trials involving 472 women were included. The trials were small and not of high methodologic quality. Five trials reported significant improvement in physical fitness in the exercise group, although inconsistencies in summary statistics and measures used to assess fitness prevented quantitative pooling of results. Seven trials reported on pregnancy outcomes. A pooled increased risk of preterm birth (relative risk 1.82, 95% confidence interval (CI) 0.35 to 9.57) with exercise, albeit statistically nonsignificant, does not cohere with the absence of effect on mean gestational age (weighted mean difference +0.3, 95% CI -0.2 to +0.9 weeks), while the results bearing on growth of the fetus are inconsistent. One small trial reported that physically fit women who increased the duration of exercise bouts in early pregnancy and then reduced that duration in later pregnancy gave birth to larger infants with larger placentas. AUTHORS' CONCLUSIONS: Regular aerobic exercise during pregnancy appears to improve (or maintain) physical fitness. Available data are insufficient to infer important risks or benefits for the mother or infant. Larger and better trials are needed before confident recommendations can be made about the benefits and risk of aerobic exercise in pregnancy.

Cellular responses to vasectomy.

A number of cell populations in the reproductive tract show a response to vasectomy. Some cell types show similar responses in man and all laboratory species, whereas others show marked species variations. This chapter describes these effects in a broadly chronological order and, in a general way, considers changes close to the site of vasectomy first and the longer term effects on the testis itself later. Following vasectomy, epididymal distension and sperm granuloma formation result from raised intraluminal pressure. The sperm granuloma is a dynamic structure and a site of much spermatozoal phagocytosis by its macrophage population. In many species, spermatozoa in the obstructed ducts are destroyed by intraluminal macrophages, and degradation products, rather than whole sperm, are absorbed by the epididymal epithelium. Humoral immunity against spermatozoal antigens following vasectomy is well established and there is evidence of modest T-lymphocyte activity. The role of lymphocytes in the reproductive tract epithelium and interstitium following vasectomy is poorly defined. In laboratory animals, there is evidence that pressure-mediated damage to the seminiferous epithelium can follow sperm granuloma formation and obstruction in the epididymal head. However, the contribution of lymphocytes and antisperm antibodies to testicular damage after vasectomy is far from clear. A number of studies have suggested that testicular changes may follow vasectomy in man but their validity and mechanism of occurrence require further study.

Is vasectomy harmful to health?

Since the late 1960s, vasectomy has been a popular and widely used form of contraceptive in Britain for couples who do not want to have any more children. However, throughout the past decade there has been considerable concern about the safety of this procedure. This paper reviews the current opinion on the possible health considerations associated with this operation and shows that the latest news is mostly reassuring.

PIP: Since the late 1960s, vasectomy has been a popular contraceptive option in Great Britain for couples who have achieved their desired family size. In recent years, however, considerable concern has been expressed about possible associations with cardiovascular disease and testicular and prostate cancer as well as long-term localized effects. This article reviewed the literature published during 1986-96 on these health concerns. Although vasectomized monkeys fed atherogenic diets appear to have a higher risk of peripheral artery disease, long-term studies of vasectomized men have failed to detect increased cardiovascular disease. No evidence has been found that vasectomy predisposes to testicular cancer or accelerates the growth of early testicular cancer. Studies demonstrating a 2-fold increase in the risk of prostate cancer after vasectomy were conducted in the US, where prostate cancer is common, and contained possible biases. European studies have not detected such an increased risk. Even if a relationship between vasectomy and prostate cancer is proven, further investigations would be required to determine if vasectomy causes prostate cancer through mechanisms such as hormonal changes, immunologic responses, or failure of growth inhibitors to reach the prostate due to obstruction of the reproductive tract, or whether vasectomized men are more exposed to the real causal agent. Moreover, even if the risk for vasectomized men in the UK is doubled, only 6/1000 men 65-74 years old would be expected to develop prostate cancer each year. The local effects of vasectomy on the reproductive tract are not fully determined. Distention of the epididymal duct occurs in most patients and granuloma formation is common. Vasectomy may also induce autoimmune orchitis. While many men develop structural changes in the reproductive tract after vasectomy, only a minority report discomfort. Although men considering vasectomy should be told that some studies have suggested a small increased risk of prostate cancer, they can be reassured that other health concerns are without foundation.

Vasectomy and the human testis.

PIP: Just as concerns that vasectomy might predispose its acceptors to cardiovascular disease have been largely discounted, Cole et al. have obtained results suggesting that vasectomy accelerates the growth of testicular tumors. Out of a cohort of over 3000 vasectomized men in Scotland, 8 developed testicular cancer within 4 years of the procedure. The expected number of cases would be 1.9. Earlier, Thornhill et al reported 3 cases of a rare mixed seminoma and malignant teratoma 8 weeks after vasectomy. Numerous studies have found abnormalities in testicular biopsy specimens from vasectomized men. These changes include degeneration of seminiferous epithelium, loss of germ cells such as spermatids, dilatation of testicular tubules, thickening of tubular walls, and interstitial fibrosis. More research is needed on factors (i.e., a history of orchitis or family history of autoimmune disease) that may predispose men to different forms of testicular change as well as the association between the formation of sperm granulomas and testicular abnormalities. Most important, however, is further investigation of the proposed association of vasectomy and accelerated tumor growth.^ieng

The life and times of James Jeffray, Regius Professor of Anatomy, University of Glasgow 1790-1848.

James Jeffray, Regius Professor of Anatomy at Glasgow University from 1790 -1848, worked at a time when the only legal support of material for dissection was the bodies of hanged criminals. The Napoleonic Wars created a large demand for anatomical teaching and Jeffray saw the height of the body-snatching era. At Glasgow University, Jeffray supervised the establishment of the Hunterian Museum, negotiated a separate Chair of Botany and was a prime mover in founding the Botanic Gardens. The fetal circulation was a special interest and he is remembered as the inventor of the chain saw, which he designed from a watch chain for use in excision of diseased joints in an effort to prevent amputation.

Glasgow resurrectionists.

The Napoleonic Wars and the colonial campaigns of the early 1800s created a great need for surgical training. Many of the cadavers used in Glasgow's schools of Anatomy were resurrected from local churchyards or imported from Ireland. In the 1820s, the activities of some resurrectionists showed gross insensitivity, with bodies being stolen before the funeral. In the early 1830s, cholera riots and the fear of "burking" led to the Anatomy Bill of 1832 receiving the Royal Assent.

The witch doctors of Scotland.

To investigate beliefs about healing in early modern Scotland, records of 61 witch trials were examined. Thirty-three were found to include healing in the charges. Seventeen described cures involving black magic, in which disease supposedly caused by the witch was removed or illness was transferred to another individual. Twenty-two included cures by white magic, i.e. herbal remedies and non-harmful magical rites. Most cases citing cures by black magic included charges of other black magic. However, several trials describing white magical cures make no mention of black magic. Most of the accused were probably implicated through confessions by other witches. Others may have had psychiatric problems and made fantastical statements. Some were antisocial individuals reported as witches by neighbours. Few were tried primarily for their healing activities.

Not modern-day body-snatching: the response of the public.

At recent presentations on the history of anatomy in the West of Scotland, our group has been asked whether we would regard the revelations of 1999-2001 about organ retention as a modern form of body-snatching. We have compared newspaper reports of the Glasgow Herald from 1823 to 1832, the decade prior to the Anatomy Act of 1832, and the Herald, Sunday Herald and Evening Times from 1999 to 2001. Clearly body-snatchers appropriated whole corpses while the recent troubles concerned individual organs. Body-snatching was illegal while the crisis over organ retention arose from differing expectations between the medical profession and the public. Both practices caused huge public concern and distress to relatives. There are, however, interesting differences between the two sets of reports. The public had been aware of body-snatching for many years prior to the Anatomy Act, which regulated the supply of cadavers, whereas revelations about organ retention came as a shock. In the organ retention crisis, the parents of the children were more organised in supporting each other and in campaigning for change than were the public in the days of the resurrectionists.

The Bargarran witchcraft trial--a psychiatric reassessment.

In 1697, seven people were condemned at Paisley for using witchcraft to torment Christian Shaw, daughter of the laird of Bargarran. For seven months, Christian had bizarre seizures during which she claimed to see the Devil and her tormentors assaulting her. She also exhibited pica and said that the foreign material had been forced into her mouth by her invisible assailants. The notable Glasgow physician, Matthew Brisbane, was consulted and gave evidence at the trial; he could find no natural explanation for the pica. It is likely that Christian had a dissociative (conversion) disorder after being cursed by a servant. Christian recovered and later married the minister of Kilmaurs. After his untimely death, she established a highly successful spinning business which lead to the Paisley cotton industry.

The chain saw--a Scottish invention.

The prototype of the chain saw familiar today in the timber industry was pioneered in the late 18th Century by two Scottish docors, John Aitken and James Jeffray, for symphysiotomy and excision of diseased bone respectively. The chain hand saw, a fine serrated link chain which cut on the concave side, was invented around 1783-1785. It was illustrated in Aitken's Principles of Midwifery or Puerperal Medicine (1785) and used by him in his dissecting room. Jeffray claimed to have conceived the idea of the chain saw independently about that time but it was 1790 before he was able to have it produced. In 1806, Jeffray published Cases of the Excision of Carious Joints by H. Park and P. F. Moreau with Observations by James Jeffray M.D.. In this communication he translated Moreau's paper of 1803. Park andMoreau described successful excision of diseased joints, particularly the knee and elbow. Jeffray explained that the chain saw would allow a smaller wound and protect the adjacent neurovascular bundle. While a heroic concept, symphysiotomy had too many complications for most obstetricians but Jeffray's ideas became accepted, especially after the development of anaesthetics. Mechanised versions of the chain saw were developed but in the later 19th Century, it was superseded in surgey by the Gigli twisted wire saw. For much of the 19th Century, however, the chain saw was a useful surgical instrument.

"And afterwards your body to be given for public dissection": a history of the murderers dissected in Glasgow and the west of Scotland.

Between 1752 and 1832, the bodies of hanged murderers were dissected or gibbeted. During this period, 38 murderers were executed in the West of Scotland. The bodies of at least 23 were dissected in Glasgow. The stories of these murders are recounted. Insight is also given into the attitudes of the public and the anatomists to dissection of executed murderers.

Thomas Hastie Bryce (1862-1946)--a lesson in the power of observation.

Thomas Hastie Bryce was Regius Professor of Anatomy at the University of Glasgow from 1909 to 1935. In Anatomy, he is remembered as an embryologist and as an editor of the 11th edition of Quain's Elements of Anatomy. His most-lasting scientific contribution, however, was in archaeology where he defined the Clyde Group of Neolithic cairns in south-west Scotland. He showed that the Neolithic people of Arran were of short stature and were dolichocephalic, distinct from those of the Bronze Age. Also, Bryce was the first to appreciate the importance of pottery in analyzing the movement of ancient peoples across Europe, and defined Beacharra ware, a class of Neolithic pottery unique to the west of Scotland. As in anatomy, archaeological discoveries are made by study of morphology and relationships with careful attention to detail and a sound knowledge of the literature.

Vasectomy review: sequelae in the human epididymis and ductus deferens.

Following vasectomy, spermatogenesis continues, the human epididymis and ductus deferens may distend and leak, and the extravasated spermatozoa stimulate formation of a sperm granuloma. Granulomas may occur at 60% of vasectomy sites and are usually asymptomatic and relieve intraluminal pressure. About 3-5% of patients experience pain. Intraluminal phagocytosis may explain why some reproductive tracts become depleted of spermatozoa. Distension of the epididymis is common after vasectomy and may lead to granuloma formation there. Up to 6% of patients have symptoms, but many with epididymal changes have no discomfort. Most episodes of painful epididymitis and granulomas resolve with conservative treatment, but < 1% require vasectomy reversal or, if this is ineffective, excision of the epididymis and obstructed ductus deferens.

James Jeffray: observations on the heart and on the peculiarities of the foetus.

James Jeffray, Regius Professor of Anatomy in the University of Glasgow (1790-1848), published his lectures on the heart as a monograph entitled Observations on the Heart and on the Peculiarities of the Foetus (Jeffray, 1835), in which he considered controversies about the adult heart, such as the arrangement of the coronary vessels and the function of the aortic and pulmonary sinuses, and about the fetal circulation. His sources were the works of Senac, Lower, Vieussens, Eustachius, Mery, Haller, Winslow, and Sabatier which were available from the Hunterian bequest. Jeffray supplemented his own material with Hunterian specimens for the illustrations. He supported the theory that blood from the superior and inferior venae cavae crossed in the right atrium, that from the superior cava being destined for the right ventricle and from the inferior passing through the foramen ovale to the left atrium. He also held that the valve of the inferior vena cava directed the bloodflow from that vessel to the foramen ovale. These views conflicted with those of John Bell (1763-1820), a successful Edinburgh anatomist and surgeon whose opinions are attacked several times in the publication. Regarding the placenta, Jeffray may have been deliberately vague about whether the fetal and maternal circulations are continuous or separate, an issue resolved by William Hunter in the previous century.

Immune response following vasectomy in the rat: a study of the stimulation of the regional lymph node.

Following vasectomy, sperm granulomas are generally believed to be important sites of access of spermatozoal antigens to the immune system. This study tests the validity of that assumption by grafting tissues from a sperm granuloma to an ectopic site (the scrotal skin) and studying the effect on the regional (inguinal) lymph node. Xiphoid cartilage provided the graft material in control animals. The experimental lymph nodes showed significant increases in weight and in the number of sectional profiles of cortical nodules indicating that they were stimulated by the presence of the granuloma tissue. To investigate the mechanism of lymph node stimulation further, a group of rats underwent unilateral vasectomy followed after 7 wk by ipsilateral orchidectomy. Three months after the initial operation the histological features of the regional (left renal) lymph node of the epididymis and granuloma were compared with corresponding nodes from rats 3 months following unilateral vasectomy only and following sham operation. The results indicate that continuous sperm production is required to sustain activity of the regional lymph nodes despite the continued presence of spermatozoa in the sperm granuloma.

The lymphatic drainage of the epididymis and of the ductus deferens of the rat, with reference to the immune response to vasectomy.

The lymphatic drainage of the testis, epididymis and ductus deferens was determined in unoperated and in unilaterally vasectomised Albino Swiss rats. In the vasectomised animals, the lymphatic drainage of epididymal and vasal sperm granulomas was also investigated. The normal epididymis, and sperm granulomas which develop in it after vasectomy, drain to the regional testicular lymph node via the inferior epididymal trunk; vasectomy does not interfere with this route. There is a lymphatic watershed within the middle one third of the scrotal ductus deferens; lymph may drain caudally, to enter the inferior epididymal trunk and/or rostrally to the iliac node. Lymphatics draining granulomas at the vasectomy site, may, therefore, be interrupted by vasectomy. This would contribute to, but does not fully explain, the variable immune response of the regional testicular node following vasectomy.