Journal of Pregnancy The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. Antenatal Weight Management: Women’s Experiences, Behaviours, and Expectations of Weighing in Early Pregnancy Mon, 24 Oct 2016 12:28:43 +0000 The current emphasis on obstetric risk management helps to frame gestational weight gain as problematic and encourages intervention by healthcare professionals. However pregnant women have reported confusion, distrust, and negative effects associated with antenatal weight management interactions. The MAGIC study (MAnaging weiGht In pregnanCy) sought to examine women’s self-reported experiences of usual-care antenatal weight management in early pregnancy and consider these alongside weight monitoring behaviours and future expectations. 193 women (18 yrs+) were recruited from routine antenatal clinics at the Nottingham University Hospital NHS Trust. Self-reported gestation was 10–27 weeks, with 41.5% () between 12 and 14 and 43.0% () between 20 and 22 weeks. At recruitment 50.3% of participants () could be classified as overweight or obese. 69.4% of highest weight women (≥30 kg/m2) did not report receiving advice about weight, although they were significantly more likely compared to women with BMI < 30 kg/m2. The majority of women (regardless of BMI) did not express any barriers to being weighed and 40.8% reported weighing themselves at home. Women across the BMI categories expressed a desire for more engagement from healthcare professionals on the issue of bodyweight. Women are clearly not being served appropriately in the current situation which simultaneously problematizes and fails to offer constructive dialogue. J. A. Swift, J. Pearce, P. H. Jethwa, M. A. Taylor, A. Avery, S. Ellis, S. C. Langley-Evans, and S. McMullen Copyright © 2016 J. A. Swift et al. All rights reserved. Retracted: Antenatal Steroid Therapy for Fetal Lung Maturation and the Subsequent Risk of Childhood Asthma: A Longitudinal Analysis Wed, 12 Oct 2016 07:12:08 +0000 Journal of Pregnancy Copyright © 2016 Journal of Pregnancy. All rights reserved. The Impact of Maternal Obesity and Excessive Gestational Weight Gain on Maternal and Infant Outcomes in Maine: Analysis of Pregnancy Risk Assessment Monitoring System Results from 2000 to 2010 Thu, 22 Sep 2016 07:33:38 +0000 The objective of this study is to understand the relationships between prepregnancy obesity and excessive gestational weight gain (GWG) and adverse maternal and fetal outcomes. Pregnancy risk assessment monitoring system (PRAMS) data from Maine for 2000–2010 were used to determine associations between demographic, socioeconomic, and health behavioral variables and maternal and infant outcomes. Multivariate logistic regression analysis was performed on the independent variables of age, race, smoking, previous live births, marital status, education, BMI, income, rurality, alcohol use, and GWG. Dependent variables included maternal hypertension, premature birth, birth weight, infant admission to the intensive care unit (ICU), and length of hospital stay of the infant. Excessive prepregnancy BMI and excessive GWG independently predicted maternal hypertension. A high prepregnancy BMI increased the risk of the infant being born prematurely, having a longer hospital stay, and having an excessive birth weight. Excessive GWG predicted a longer infant hospital stay and excessive birth weight. A low pregnancy BMI and a lower than recommended GWG were also associated with poor outcomes: prematurity, low birth weight, and an increased risk of the infant admitted to ICU. These findings support the importance of preconception care that promotes achievement of a healthy weight to enhance optimal reproductive outcomes. Nancy Baugh, David E. Harris, AbouEl-Makarim Aboueissa, Cheryl Sarton, and Erika Lichter Copyright © 2016 Nancy Baugh et al. All rights reserved. Predictors of Gestational Weight Gain among White and Latina Women and Associations with Birth Weight Sun, 04 Sep 2016 09:37:17 +0000 This study examined racial/ethnic differences in gestational weight gain (GWG) predictors and association of first-trimester GWG to overall GWG among 271 White women and 300 Latina women. Rates of within-guideline GWG were higher among Latinas than among Whites (28.7% versus 24.4%, ). Adjusted odds of above-guideline GWG were higher among prepregnancy overweight (OR = 3.4, CI = 1.8–6.5) and obese (OR = 4.5, CI = 2.3–9.0) women than among healthy weight women and among women with above-guideline first-trimester GWG than among those with within-guideline first-trimester GWG (OR = 4.9, CI = 2.8–8.8). GWG was positively associated with neonate birth size (). Interventions targeting prepregnancy overweight or obese women and those with excessive first-trimester GWG are needed. Milagros C. Rosal, Monica L. Wang, Tiffany A. Moore Simas, Jamie S. Bodenlos, Sybil L. Crawford, Katherine Leung, and Heather Z. Sankey Copyright © 2016 Milagros C. Rosal et al. All rights reserved. Opinions and Practice of US-Based Obstetrician-Gynecologists regarding Vitamin D Screening and Supplementation of Pregnant Women Thu, 25 Aug 2016 10:03:41 +0000 Vitamin D deficiency/insufficiency is prevalent among pregnant women. Recommendations for adequate levels of circulating 25-hydroxyvitamin D and appropriate vitamin D supplementation during pregnancy differ between the Institute of Medicine and the Endocrine Society. Obstetrician-gynecologists must make clinical decisions in this environment of uncertain guidance. An online questionnaire regarding physician practice patterns for screening and supplementing pregnant women was administered to 225 randomly selected practicing obstetrician-gynecologists of whom 101 (45%) completed the questionnaire. A majority indicated that vitamin D insufficiency was a problem in their patient population (68.4%) and that most of their pregnant patients would benefit from vitamin D supplementation (66.3%). Half (52.5%) would recommend vitamin D supplementation during pregnancy to some patients, but only 16.8% to all. Only one in four (25.8%) routinely screen their pregnant patients for vitamin D status. Physicians who indicated that vitamin D status was a problem in their patient population were more likely to screen routinely (32.8% versus 9.7%, ) and believe their patients would benefit from supplementation (91.2% versus 16.1%, ). Opinion regarding supplementation levels and indicators of adequacy were split between the two competing recommendations, suggesting that clinical practice will likely remain variable across physicians, with uncertain public health consequences. Sara A. Mohamed, Ayman Al-Hendy, Jay Schulkin, and Michael L. Power Copyright © 2016 Sara A. Mohamed et al. All rights reserved. The Effect of the More Active MuMs in Stirling Trial on Body Composition and Psychological Well-Being among Postnatal Women Tue, 16 Aug 2016 09:05:55 +0000 Introduction. Physical activity is important for health and well-being; however, rates of postnatal physical activity can be low. This paper reports the secondary outcomes of a trial aimed at increasing physical activity among postnatal women. Methods. More Active MuMs in Stirling (MAMMiS) was a randomised controlled trial testing the effect of physical activity consultation and pram walking group intervention among inactive postnatal women. Data were collected on postnatal weight, body composition, general well-being, and fatigue. Participants were also interviewed regarding motivations and perceived benefits of participating in the trial. Results. There was no significant effect of the intervention on any weight/body composition outcome or on general well-being at three or six months of follow-up. There was a significant but inconsistent difference in fatigue between groups. Qualitative data highlighted a number of perceived benefits to weight, body composition, and particularly well-being (including improved fatigue) which were not borne out by objective data. Discussion. The MAMMiS study found no impact of the physical activity intervention on body composition and psychological well-being and indicates that further research is required to identify successful approaches to increase physical activity and improve health and well-being among postnatal women. Alyssa S. Lee, Rhona J. McInnes, Adrienne R. Hughes, Wendy Guthrie, and Ruth Jepson Copyright © 2016 Alyssa S. Lee et al. All rights reserved. Gestational Weight Gain: Results from the Delta Healthy Sprouts Comparative Impact Trial Tue, 09 Aug 2016 14:22:38 +0000 Introduction. Delta Healthy Sprouts trial was designed to test the comparative impact of two home visiting programs on weight status, dietary intake, and health behaviors of Southern African American women and their infants. Results pertaining to the primary outcome, gestational weight gain, are reported. Methods. Participants (), enrolled early in their second trimester of pregnancy, were randomly assigned to one of two treatment arms. Gestational weight gain, measured at six monthly home visits, was calculated by subtracting measured weight at each visit from self-reported prepregnancy weight. Weight gain was classified as under, within, or exceeding the Institute of Medicine recommendations based on prepregnancy body mass index. Chi-square tests and generalized linear mixed models were used to test for significant differences in percentages of participants within recommended weight gain ranges. Results. Differences in percentages of participants within the gestational weight gain guidelines were not significant between treatment arms across all visits. Conclusions. Enhancing the gestational nutrition and physical activity components of an existing home visiting program is feasible in a high risk population of primarily low income African American women. The impact of these enhancements on appropriate gestational weight gain is questionable given the more basic living needs of such women. This trial is registered with NCT01746394, registered 4 December 2012. Jessica L. Thomson, Lisa M. Tussing-Humphreys, Melissa H. Goodman, and Sarah E. Olender Copyright © 2016 Jessica L. Thomson et al. All rights reserved. Male Partner’s Involvement in HIV Counselling and Testing and Associated Factors among Partners of Pregnant Women in Gondar Town, Northwest Ethiopia Sun, 31 Jul 2016 17:03:57 +0000 Background. Despite the existence of several programmes promoting male involvement in HIV counselling and testing during their wife’s pregnancy as a part of PMTCT, few men have heeded the call. The aim of this study was to assess male partner’s involvement in HCT and its associated factors. Methods. This study was based on institution based cross-sectional study design that used systematic random sampling technique. A total of 416 partners were interviewed in the data collection. Multivariable logistic regression model was fitted to identify the independent predictors. Result. In this study, the prevalence of male involvement in HCT was found to be 40.1% (95% CI: 35.3%–44.7%). The independent predictors of male involvement were partners who were younger, were cohabitant, were with multigravida wives, were knowledgeable on route of mother-to-child transmission, and discussed HCT. Conclusion. The prevalence of male involvement in HCT was found to be suboptimal compared to similar studies in Ethiopia. There is a need of interventions on partners who are older, separated, and with lower gravidity wife. Awareness creation campaign should also be created on the route of mother-to-child transmission of HIV and on the importance of discussion with wife. Alemu Zenebe, Abebaw Gebeyehu, Lemma Derseh, and Kedir Y. Ahmed Copyright © 2016 Alemu Zenebe et al. All rights reserved. Pregnant Women in Louisiana Are Not Meeting Dietary Seafood Recommendations Mon, 18 Jul 2016 13:32:14 +0000 Background. The 2015–2020 Dietary Guidelines for Americans recommend that pregnant women and women of childbearing ages consume 8–12 oz. of seafood per week. Fish are the major dietary source of omega-3 long chain polyunsaturated fatty acids, which have benefits for the mother and fetus. Methods. In this observational study, we investigated dietary habits of pregnant women in Baton Rouge, Louisiana, USA, to determine if they achieve recommended seafood intake. A print survey, which included commonly consumed foods from protein sources (beef, chicken, pork, and fish), was completed by pregnant women at a single-day hospital convention for expecting families in October 2015. Women () chose from six predefined responses to answer how frequently they were consuming each food. Results. Chicken was consumed most frequently (75% of women), followed by beef (71%), pork (65%), and fish (22%), respectively. Consumption frequency for the most consumed fish (catfish, once per month) was similar to or lower than that of the least consumed beef, chicken, and pork foods. Consumption frequency for the most consumed chicken and beef foods was at least once per week. Conclusion. Our data indicate that pregnant women in Louisiana often consume protein sources other than fish and likely fail to meet dietary seafood recommendations. M. L. Drewery, A. V. Gaitán, C. Thaxton, W. Xu, and C. J. Lammi-Keefe Copyright © 2016 M. L. Drewery et al. All rights reserved. Clinician’s Attitudes to the Introduction of Routine Weighing in Pregnancy Thu, 30 Jun 2016 13:53:01 +0000 Background. Excessive gestational weight gain poses significant short- and long-term health risks to both mother and baby. Professional bodies and health services increasingly recommend greater attention be paid to weight gain in pregnancy. A large Australian tertiary maternity hospital plans to facilitate the (re)introduction of routine weighing of all women at every antenatal visit. Objective. To identify clinicians’ perspectives of barriers and enablers to routinely weighing pregnant women and variations in current practice, knowledge, and attitudes between different staff groups. Method. Forty-four maternity staff from three professional groups were interviewed in four focus groups. Staff included midwives; medical staff; and dietitians. Transcripts underwent qualitative content analysis to identify and examine barriers and enablers to the routine weighing of women throughout pregnancy. Results. While most staff supported routine weighing, various concerns were raised. Issues included access to resources and staff; the ability to provide appropriate counselling and evidence-based interventions; and the impact of weighing on patients and the therapeutic relationship. Conclusion. Many clinicians supported the practice of routine weighing in pregnancy, but barriers were also identified. Implementation strategies will be tailored to the discrete professional groups and will address identified gaps in knowledge, resources, and clinician skills and confidence. Tim Hasted, Helen Stapleton, Michael M. Beckmann, and Shelley A. Wilkinson Copyright © 2016 Tim Hasted et al. All rights reserved. Neighborhood-Level Poverty at Menarche and Prepregnancy Obesity in African-American Women Tue, 21 Jun 2016 00:00:00 +0000 Introduction. Menarche is a critical time point in a woman’s reproductive system development; exposures at menarche may influence maternal health. Living in a poorer neighborhood is associated with adult obesity; however, little is known if neighborhood factors at menarche are associated with prepregnancy obesity. Methods. We examined the association of neighborhood-level poverty at menarche with prepregnancy body mass index category in 144 pregnant African-American women. Address at menarche was geocoded to census tract (closest to year of menarche); neighborhood-level poverty was defined as the proportion of residents living under the federal poverty level. Cumulative logistic regression was used to examine the association of neighborhood-level poverty at menarche, in quartiles, with categorical prepregnancy BMI. Results. Before pregnancy, 59 (41%) women were obese. Compared to women in the lowest neighborhood-level poverty quartile, women in the highest quartile had 2.9 [1.2, 6.9] times higher odds of prepregnancy obesity; this was slightly attenuated after adjusting for age, marital status, education, and parity (odds ratio: 2.3 [0.9, 6.3]). Conclusions. Living in a higher poverty neighborhood at menarche is associated with prepregnancy obesity in African-American women. Future studies are needed to better understand the role of exposures in menarche on health in pregnancy. Andrea E. Cassidy-Bushrow, Rosalind M. Peters, Charlotte Burmeister, Lawrence F. Bielak, and Dayna A. Johnson Copyright © 2016 Andrea E. Cassidy-Bushrow et al. All rights reserved. A Qualitative Study to Examine Perceptions and Barriers to Appropriate Gestational Weight Gain among Participants in the Special Supplemental Nutrition Program for Women Infants and Children Program Wed, 15 Jun 2016 07:37:50 +0000 Women of reproductive age are particularly at risk of obesity because of excessive gestational weight gain (GWG) and postpartum weight retention, resulting in poor health outcomes for both mothers and infants. The purpose of this qualitative study was to examine perceptions and barriers to GWG among low-income women in the WIC program to inform the development of an intervention study. Eleven focus groups were conducted and stratified by ethnicity, and each group included women of varying age, parity, and prepregnancy BMI ranges. Participants reported receiving pressure from spouse and family members to “eat for two” among multiple barriers to appropriate weight gain during pregnancy. Participants were concerned about gaining too much weight but had minimal knowledge of weight gain goals during pregnancy. Receiving regular weight monitoring was reported, but participants had inconsistent discussions about weight gain with healthcare providers. Most were not aware of the IOM guidelines nor the fact that gestational weight gain goals differed by prepregnancy weight status. Results of these focus groups analyses informed the design of a pregnancy weight tracker and accompanying educational handout for use in an intervention study. These findings suggest an important opportunity for GWG education in all settings where pregnant women are seen. Loan Pham Kim, Maria Koleilat, and Shannon E. Whaley Copyright © 2016 Loan Pham Kim et al. All rights reserved. The Regional Centralization of Electronic Fetal Heart Rate Monitoring and Its Impact on Neonatal Acidemia and the Cesarean Birth Rate Thu, 09 Jun 2016 13:45:01 +0000 Objective. The improvement of the accuracy of fetal heart rate (FHR) pattern interpretation to improve perinatal outcomes remains an elusive challenge. We examined the impact of an FHR centralization system on the incidence of neonatal acidemia and cesarean births. Methods. We performed a regional, population-based, before-and-after study of 9,139 deliveries over a 3-year period. The chi-squared test was used for the statistical analysis. Results. The before-and-after study showed no difference in the rates of acidemia, cesarean births, or perinatal death in the whole population. A subgroup analysis using the 4 hospitals in which an FHR centralization system was continuously connected (compliant group) and 3 hospitals in which the FHR centralization system was connected on demand (noncompliant group) showed that the incidence acidemia was significantly decreased (from 0.47% to 0.11%) without a corresponding increase in the cesarean birth rate due to nonreassuring FHR patterns in the compliant group. Although there was no difference in the incidence of nonreassuring FHR patterns in the noncompliant group, the total cesarean birth rate was significantly higher than that in the compliant group. Conclusion. The continuous FHR centralization system, in which specialists help to interpret results and decide clinical actions, was beneficial in reducing the incidence of neonatal acidemia (pH < 7.1) without increasing the cesarean birth rate due to nonreassuring FHR patterns. Kaori Michikata, Hiroshi Sameshima, Hirotoshi Urabe, Syuichi Tokunaga, Yuki Kodama, and Tsuyomu Ikenoue Copyright © 2016 Kaori Michikata et al. All rights reserved. Obesity-Related Dietary Behaviors among Racially and Ethnically Diverse Pregnant and Postpartum Women Thu, 19 May 2016 14:16:36 +0000 Introduction. Obesity is common among reproductive age women and disproportionately impacts racial/ethnic minorities. Our objective was to assess racial/ethnic differences in obesity-related dietary behaviors among pregnant and postpartum women, to inform peripartum weight management interventions that target diverse populations. Methods. We conducted a cross-sectional survey of 212 Black (44%), Hispanic (31%), and White (25%) women, aged ≥ 18, pregnant or within one year postpartum, in hospital-based clinics in Baltimore, Maryland, in 2013. Outcomes were fast food or sugar-sweetened beverage intake once or more weekly. We used logistic regression to evaluate the association between race/ethnicity and obesity-related dietary behaviors, adjusting for sociodemographic factors. Results. In adjusted analyses, Black women had 2.4 increased odds of fast food intake once or more weekly compared to White women (CI = 1.08, 5.23). There were no racial/ethnic differences in the odds of sugar-sweetened beverage intake. Discussion. Compared with White or Hispanic women, Black women had 2-fold higher odds of fast food intake once or more weekly. Black women might benefit from targeted counseling and intervention to reduce fast food intake during and after pregnancy. Ashley Harris, Nymisha Chilukuri, Meredith West, Janice Henderson, Shari Lawson, Sarah Polk, David Levine, and Wendy L. Bennett Copyright © 2016 Ashley Harris et al. All rights reserved. Human Decidual Stromal Cells as a Component of the Implantation Niche and a Modulator of Maternal Immunity Thu, 28 Apr 2016 07:57:34 +0000 The human decidua is a specialized tissue characterized by embryo-receptive properties. It is formed during the secretory phase of menstrual cycle from uterine mucosa termed endometrium. The decidua is composed of glands, immune cells, blood and lymph vessels, and decidual stromal cells (DSCs). In the process of decidualization, which is controlled by oestrogen and progesterone, DSCs acquire specific functions related to recognition, selection, and acceptance of the allogeneic embryo, as well as to development of maternal immune tolerance. In this review we discuss the relationship between the decidualization of DSCs and pathological obstetrical and gynaecological conditions. Moreover, the critical influence of DSCs on local immune cells populations as well as their relationship to the onset and maintenance of immune tolerance is described. Kameliya Vinketova, Milena Mourdjeva, and Tsvetelina Oreshkova Copyright © 2016 Kameliya Vinketova et al. All rights reserved. A Low-Protein Diet Enhances Angiotensin II Production in the Lung of Pregnant Rats but Not Nonpregnant Rats Tue, 19 Apr 2016 12:50:59 +0000 Pulmonary angiotensin II production is enhanced in pregnant rats fed a low-protein (LP) diet. Here we assessed if LP diet induces elevations in angiotensin II production in nonpregnant rats and whether Ace expression and ACE activity in lungs are increased. Nonpregnant rats were fed a normal (CT) or LP diet for 8, 12, or 17 days and timed pregnant rats fed for 17 days from Day 3 of pregnancy. Plasma angiotensin II, expressions of Ace and Ace2, and activities of these proteins in lungs, kidneys, and plasma were measured. These parameters were compared among nonpregnant rats or between nonpregnant and pregnant rats fed different diets. Major findings are as follows: (1) plasma angiotensin II levels were slightly higher in the LP than CT group on Days 8 and 12 in nonpregnant rats; (2) expression of Ace and Ace2 and abundance and activities of ACE and ACE2 in lungs, kidneys, and plasma of nonpregnant rats were unchanged by LP diet except for minor changes; (3) the abundance and activities of ACE in lungs of pregnant rats fed LP diet were greater than nonpregnant rats, while those of ACE2 were decreased. These results indicate that LP diet-induced increase in pulmonary angiotensin II production depends on pregnancy. Haijun Gao, Daren Tubianosa Tanchico, Uma Yallampalli, and Chandrasekhar Yallampalli Copyright © 2016 Haijun Gao et al. All rights reserved. Estimating HIV Incidence during Pregnancy and Knowledge of Prevention of Mother-to-Child Transmission with an Ad Hoc Analysis of Potential Cofactors Thu, 31 Mar 2016 09:53:40 +0000 Background. We determined the incidence of HIV seroconversion during the second and third trimesters of pregnancy and ad hoc potential cofactors associated with HIV seroconversion after having an HIV-negative result antenatally. We also studied knowledge of PMTCT among pregnant women in seven health facilities in Fako Division, South West Region, Cameroon. Method. During the period between September 12 and December 4, 2011, we recruited a cohort of 477 HIV-negative pregnant women by cluster sampling. Data collection was with a pretested interviewer-administered questionnaire. Sociodemographic information, knowledge of PMTCT, and methods of HIV prevention were obtained from the study population and we did Voluntary Counselling and Testing (VCT) for HIV. Results. The incidence rate of HIV seroconversion during pregnancy was 6.8/100 woman-years. Ninety percent of the participants did not use condoms throughout pregnancy but had a good knowledge of PMTCT of HIV. Only 31.9% of participants knew their HIV status before the booking visit and 33% did not know the HIV status of their partners. Conclusion. The incidence rate of HIV seroconversion in the Fako Division, Cameroon, was 6.8/100 woman-years. No risk factors associated with HIV seroconversion were identified among the study participants because of lack of power to do so. Thomas Obinchemti Egbe, Rose-Mary Asong Tazinya, Gregory Edie Halle-Ekane, Eta-Nkongho Egbe, and Eric Akum Achidi Copyright © 2016 Thomas Obinchemti Egbe et al. All rights reserved. Pregnancy and Birth Outcomes among Women with Idiopathic Thrombocytopenic Purpura Tue, 22 Mar 2016 11:53:03 +0000 Objective. To examine pregnancy and birth outcomes among women with idiopathic thrombocytopenic purpura (ITP) or chronic ITP (cITP) diagnosed before or during pregnancy. Methods. A linkage of mothers and babies within a large US health insurance database that combines enrollment data, pharmacy claims, and medical claims was carried out to identify pregnancies in women with ITP or cITP. Outcomes included preterm birth, elective and spontaneous loss, and major congenital anomalies. Results. Results suggest that women diagnosed with ITP or cITP prior to their estimated date of conception may be at higher risk for stillbirth, fetal loss, and premature delivery. Among 446 pregnancies in women with ITP, 346 resulted in live births. Women with cITP experienced more adverse outcomes than those with a pregnancy-related diagnosis of ITP. Although 7.8% of all live births had major congenital anomalies, the majority were isolated heart defects. Among deliveries in women with cITP, 15.2% of live births were preterm. Conclusions. The results of this study provide further evidence that cause and duration of maternal ITP are important determinants of the outcomes of pregnancy. Diego F. Wyszynski, Wendy J. Carman, Alan B. Cantor, John M. Graham Jr., Liza H. Kunz, Anne M. Slavotinek, Russell S. Kirby, and John Seeger Copyright © 2016 Diego F. Wyszynski et al. All rights reserved. Maternal-Cord Blood Vitamin D Correlations Vary by Maternal Levels Tue, 15 Mar 2016 09:48:21 +0000 Vitamin D levels of pregnant women and their neonates tend to be related; however, it is unknown whether there are any subgroups in which they are not related. 25-Hydroxyvitamin D [25(OH)D] was measured in prenatal maternal and child cord blood samples of participants ( pairs) in a birth cohort. Spearman correlations were examined within subgroups defined by prenatal and delivery factors. Cord blood as a percentage of prenatal 25(OH)D level was calculated and characteristics compared between those who did and did not have ≥25% and ≥50% of the maternal level and those who did and did not have a detectable 25(OH)D level. The correlation among Black children was lower than in White children. When the maternal 25(OH)D level was <15 ng/mL, the overall correlation was . Most children had a 25(OH)D cord blood level less than half of their mother’s; 15.4% had a level that was <25% of their mother’s. Winter birth and maternal level were associated with the level being less than 25%. Children with undetectable levels were more likely to be Black and less likely to be firstborn. These data suggest mothers may reduce their contribution to the fetus’s 25(OH)D supply once their own level becomes low. Ganesa Wegienka, Hareena Kaur, Roopina Sangha, and Andrea E. Cassidy-Bushrow Copyright © 2016 Ganesa Wegienka et al. All rights reserved. An Analysis of Behaviour Change Techniques Used in a Sample of Gestational Weight Management Trials Mon, 29 Feb 2016 12:51:53 +0000 Introduction. Maternal obesity and excessive gestational weight gain are associated with multiple adverse outcomes. There is a lack of clarity on the specific components of effective interventions to support pregnant women with gestational weight management. Method. All 44 studies within a preexisting review of lifestyle interventions, with a potential to impact on maternal weight outcomes, were considered for content analysis. Interventions were classified using Behaviour Change Technique (BCT) taxonomy clusters to explore which categories of BCT were used in interventions and their effectiveness in managing gestational weight gain. Results. The most commonly used BCTs were within the categories of “feedback and monitoring,” “shaping knowledge,” “goals and planning,” “repetition and substitution,” “antecedents,” and “comparison of behaviours.” For diet and mixed interventions “feedback and monitoring,” “shaping knowledge,” and “goals and planning” appeared the most successful BCT categories. Conclusions. Poor reporting within studies in defining the BCTs used, in clarifying the differences in processes between intervention and control groups, and in differentiating between the intervention and research processes made BCT classification difficult. Future studies should elaborate more clearly on the behaviour change techniques used and report them accurately to allow a better understanding of the effective ingredients for lifestyle interventions during pregnancy. H. Soltani, M. A. Arden, A. M. S. Duxbury, and F. J. Fair Copyright © 2016 H. Soltani et al. All rights reserved. Baird-Pattinson Aetiological Classification and Phases of Delay Contributing to Stillbirths in a Nigerian Tertiary Hospital Thu, 14 Jan 2016 15:58:25 +0000 Purpose. This study aims to identify triggers of stillbirth in the study setting and to make suggestions to reduce the prevalence. Method. A three-year retrospective case-control study of stillbirths at Ekiti State University Teaching Hospital. Results. The stillbirth rate was 33 per 1000 births. Based on Baird-Pattinson classification of the primary obstetric causes of stillbirth, adverse intrapartum events, hypertensive diseases, and unexplained intrapartum fetal deaths were topmost causes of stillbirths. In comparison with the controls, other identified predictors of SB were grand multiparity (), delays in seeking medical care and/or in receiving treatment (), wrong initial diagnosis (), inadequate intrapartum monitoring (), and inappropriate clinical management (). Conclusion. Stillbirth rate remains high in our setting. Elimination of obstacles to accessing care, effective management of hypertensive disorders in pregnancy, updated health facilities, improved dedication to duty, and retraining of health workers will reduce the prevalence. Jacob Olumuyiwa Awoleke and Abiodun Idowu Adanikin Copyright © 2016 Jacob Olumuyiwa Awoleke and Abiodun Idowu Adanikin. All rights reserved. Beliefs, Barriers, and Preferences of European Overweight Women to Adopt a Healthier Lifestyle in Pregnancy to Minimize Risk of Developing Gestational Diabetes Mellitus: An Explorative Study Thu, 14 Jan 2016 07:02:25 +0000 Introduction. We explored beliefs, perceived barriers, and preferences regarding lifestyle changes among overweight European pregnant women to help inform the development of future lifestyle interventions in the prevention of gestational diabetes mellitus. Methods. An explorative mixed methods, two-staged study was conducted to gather information from pregnant European women (BMI 25 kg/m2). In three European countries 21 interviews were conducted, followed by 71 questionnaires in six other European countries. Content analysis and descriptive and chi-square statistics were applied (). Results. Women preferred to obtain detailed information about their personal risk. The health of their baby was a major motivating factor. Perceived barriers for physical activity included pregnancy-specific issues such as tiredness and experiencing physical complaints. Insufficient time was a barrier more frequently reported by women with children. Abstaining from snacking was identified as a challenge for the majority of women, especially for those without children. Women preferred to obtain support from their partner, as well as health professionals and valued flexible lifestyle programs. Conclusions. Healthcare professionals need to inform overweight pregnant women about their personal risk, discuss lifestyle modification, and assist in weight management. Lifestyle programs should be tailored to the individual, taking into account barriers experienced by overweight first-time mothers and multipara women. Judith G. M. Jelsma, Karen M. van Leeuwen, Nicolette Oostdam, Christopher Bunn, David Simmons, Gernot Desoye, Rosa Corcoy, Juan M. Adelantado, Alexandra Kautzky-Willer, Jürgen Harreiter, Frans Andre van Assche, Roland Devlieger, Dirk Timmerman, David Hill, Peter Damm, Elisabeth R. Mathiesen, Ewa Wender-Ozegowska, Agnieszka Zawiejska, Pablo Rebollo, Annunziata Lapolla, Maria G. Dalfrà, Stefano del Prato, Alessandra Bertolotto, Fidelma Dunne, Dorte M. Jensen, Lise Lotte T. Andersen, Frank J. Snoek, and Mireille N. M. van Poppel Copyright © 2016 Judith G. M. Jelsma et al. All rights reserved. Australian Pregnant Women’s Awareness of Gestational Weight Gain and Dietary Guidelines: Opportunity for Action Wed, 06 Jan 2016 09:25:53 +0000 Background. Excessive gestational weight gain (GWG) can negatively impact on maternal and foetal health. Guidelines based on Institute of Medicine (IOM) encourage managing GWG by following healthy eating recommendations and increasing physical activity. This study investigated pregnant women’s knowledge of their optimal GWG and recommended dietary approaches for GWG management. Method. English-speaking pregnant women were recruited from five hospitals in New South Wales (Australia) and an online link. Prepregnancy Body Mass Index (BMI) was calculated from self-reported height and prepregnancy weight. Participants identified their recommended GWG. A survey assessed practical dietary knowledge and asked about broad dietary recommendations to prevent excessive GWG. Chi square and logistic regression analyses were used. Results. pregnant women completed the surveys; 49% entered pregnancy overweight (25.2%) or obese (23.6%); and knowledge of recommended GWG was lacking. Prepregnancy BMI was a significant predictor of GWG recommendation knowledge (). Pregnant women were highly knowledgeable about broad dietary recommendations but had poor knowledge of detailed recommendations. Conclusions. Limited knowledge of IOM’s GWG guidelines and of specific dietary recommendations for pregnancy should be addressed by health care providers and education initiatives to assist the high number of women who enter pregnancy overweight or obese. Khlood Bookari, Heather Yeatman, and Moira Williamson Copyright © 2016 Khlood Bookari et al. All rights reserved. Physiologic Course of Female Reproductive Function: A Molecular Look into the Prologue of Life Tue, 01 Dec 2015 09:31:36 +0000 The genetic, endocrine, and metabolic mechanisms underlying female reproduction are numerous and sophisticated, displaying complex functional evolution throughout a woman’s lifetime. This vital course may be systematized in three subsequent stages: prenatal development of ovaries and germ cells up until in utero arrest of follicular growth and the ensuing interim suspension of gonadal function; onset of reproductive maturity through puberty, with reinitiation of both gonadal and adrenal activity; and adult functionality of the ovarian cycle which permits ovulation, a key event in female fertility, and dictates concurrent modifications in the endometrium and other ovarian hormone-sensitive tissues. Indeed, the ultimate goal of this physiologic progression is to achieve ovulation and offer an adequate environment for the installation of gestation, the consummation of female fertility. Strict regulation of these processes is important, as disruptions at any point in this evolution may equate a myriad of endocrine-metabolic disturbances for women and adverse consequences on offspring both during pregnancy and postpartum. This review offers a summary of pivotal aspects concerning the physiologic course of female reproductive function. Joselyn Rojas, Mervin Chávez-Castillo, Luis Carlos Olivar, María Calvo, José Mejías, Milagros Rojas, Jessenia Morillo, and Valmore Bermúdez Copyright © 2015 Joselyn Rojas et al. All rights reserved. Implementation of the International Association of Diabetes and Pregnancy Study Groups Criteria: Not Always a Cause for Concern Mon, 30 Nov 2015 13:55:57 +0000 Background. Controversy surrounds the decision to adopt the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria for the diagnosis of gestational diabetes mellitus (GDM) as fears that disease prevalence rates will soar have been raised. Aims. To investigate the prevalence of pregnancy complicated with GDM before and after the introduction of the IADPSG 2010 diagnostic criteria. Materials and Methods. A prospective audit of all women who delivered from July 1, 2010, to June 30, 2014, in a predefined geographic region within the North Metropolitan Health Service of Western Australia. Women were diagnosed with GDM according to Australian Diabetes in Pregnancy Society (ADIPS 1991) criteria until December 31, 2011, and by the IADPSG 2010 criteria after this date. Incidence of GDM and predefined pregnancy outcomes were audited. Results. Of 10,296 women, antenatal oral glucose tolerance test (OGTT) results and follow-up data were obtained for 10,103 women (98%), of whom 349 (3.5%) were diagnosed with GDM. The rate of GDM utilising ADIPS criteria was 3.4% and the rate of utilising IADPSG criteria was 3.5% (). Conclusion. IADPSG diagnostic criteria did not significantly increase the incidence of GDM in this low prevalence region. Pooja Sibartie and Julie Quinlivan Copyright © 2015 Pooja Sibartie and Julie Quinlivan. All rights reserved. Early Detection of Fetal Malformation, a Long Distance Yet to Cover! Present Status and Potential of First Trimester Ultrasonography in Detection of Fetal Congenital Malformation in a Developing Country: Experience at a Tertiary Care Centre in India Mon, 23 Nov 2015 12:55:28 +0000 Background. Early detection of malformation is tremendously improved with improvement in imaging technology. Yet in a developing country like India majority of pregnant women are not privileged to get timely diagnosis. Aims and Objectives. To assess the present status and potential of first trimester ultrasonography in detection of fetal congenital structural malformations. Methodology. This was a retrospective observational study conducted at Sanjay Gandhi Postgraduate Institute of Medical Sciences. All pregnant women had anomaly scan and women with fetal structural malformations were included. Results. Out of 4080 pregnant women undergoing ultrasound, 312 (7.6%) had fetal structural malformation. Out of 139 patients who were diagnosed after 20 weeks, 47 (33.8%) had fetal structural anomalies which could have been diagnosed before 12 weeks and 92 (66.1%) had fetal malformations which could have been diagnosed between 12 and 20 weeks. Conclusion. The first trimester ultrasonography could have identified 50% of major structural defects compared to 1.6% in the present scenario. This focuses on the immense need of the hour to gear up for early diagnosis and timely intervention in the field of prenatal detection of congenital malformation. Namrata Kashyap, Mandakini Pradhan, Neeta Singh, and Sangeeta Yadav Copyright © 2015 Namrata Kashyap et al. All rights reserved. AngiomiRs: Potential Biomarkers of Pregnancy’s Vascular Pathologies Tue, 13 Oct 2015 14:52:50 +0000 In recent years, microRNAs (miRNAs) have been the focus of research for their role in posttranscriptional regulation and as potential biomarkers of risk for disease development. Their identification in specific physiological processes, like angiogenesis, a key pathway in placental vascular development in pregnancy, suggests an important role of miRNAs that regulate angiogenesis (angiomiRs). Many complications of pregnancy have in common placental vascular alterations, involving an imbalance in the angiogenesis process in the development of conditions such as preeclampsia, intrauterine growth restriction, and gestational diabetes, complications with the highest rates of morbimortality in pregnancy. Many studies have identified angiomiRs with differential expression profiles in each of these diseases; however, this evidence requires further studies focused on evaluating their potential as biomarkers of risk for the angiomiRs detected, to establish correlations between placental tissue and serum/plasma expression profiles. Therefore, the objective of this review is to highlight the best angiomiRs detected in placental tissue and serum/plasma in each of these three pathologies to show the current data available for potential biomarkers and to propose future research strategies on this topic. Laura María Rodríguez Santa, Laura Yuriko González Teshima, Jose Vicente Forero Forero, and Andres Orlando Castillo Giraldo Copyright © 2015 Laura María Rodríguez Santa et al. All rights reserved. Naegele Forceps Delivery and Association between Morbidity and the Number of Forceps Traction Applications: A Retrospective Study Thu, 03 Sep 2015 07:01:03 +0000 Objective. To present the method of Naegele forceps delivery clinically practiced by the lead author, its success rate, and morbidity and to evaluate the relationship between morbidity and the number of forceps traction applications. Methods. Naegele forceps delivery was performed when the fetal head reached station +2 cm, the forceps were applied in the maternal pelvic application, and traction was slowly and gently performed. In the past two years, Naegele forceps delivery was attempted by the lead author in 87 cases, which were retrospectively reviewed. Results. The numbers of traction applications were one in 64.7% of cases, two in 24.7%, and three or more in 10.7%. The success rate was 100%. No severe morbidity was observed in mothers or neonates. Neonatal facial injury occurred most commonly in cases with fetal head malrotation, elevated numbers of traction applications, and maternal complications. Umbilical artery acidemia most commonly occurred in cases with nonreassuring fetal status. The significant crude odds ratio for three or more traction applications was 20 in cases with malrotation. Conclusion. Naegele forceps delivery has a high success rate, but multiple traction applications will sometimes be required, particularly in cases with malrotation. Malrotation and elevated numbers of traction applications may lead to neonatal head damage. Naoki Matsumoto, Toshifumi Takenaka, Nobuyuki Ikeda, Satoshi Yazaki, and Yuichi Sato Copyright © 2015 Naoki Matsumoto et al. All rights reserved. Forceps, Actual Use, and Potential Cesarean Section Prevention: Study in a Selected Mexican Population Mon, 24 Aug 2015 07:36:09 +0000 Objective. Assessment of the frequency of complications observed with various forceps and operative vaginal delivery (OVD) techniques performed at the ABC Medical Center (Mexico City) to evaluate their safety, bearing in mind the importance of decreasing our country’s high cesarean section incidence. Methods. We reviewed 5,375 deliveries performed between the years 2007 and 2012, only 146 were delivered by OVD.  Results. Only 1.0% of the cases had a serious, life-threatening situation (uterine rupture). The Simpson forceps was the most favored instrument (46%) due to its simplicity of use, effectiveness, and familiarity. Prophylactic use was the most common indication (30.8%) and significant complications observed were vaginal lacerations (), relative risk (RR) of 3.4 (95% confidence interval [CI]: 1.15–10.04), and fourth degree perineal tear (), RR of 3.4 (95% CI: 1.15–10.04). Conclusions. Forceps use and other OVD techniques are a safe alternative to be considered, diminishing C-section incidence and its complications. Rodrigo Ayala-Yáñez, Paulette Bayona-Soriano, Arturo Hernández-Jimenez, Alejandra Contreras-Rendón, Paulina Chabat-Manzanera, and Roberto Nevarez-Bernal Copyright © 2015 Rodrigo Ayala-Yáñez et al. All rights reserved. Impaired Fertility Associated with Subclinical Hypothyroidism and Thyroid Autoimmunity: The Danish General Suburban Population Study Mon, 17 Aug 2015 14:10:32 +0000 Introduction. The aim of this study was to estimate the significance of TSH, thyroid peroxidase antibody (TPOAb), and mild (subclinical) hypothyroidism in women from The Danish General Suburban Population Study (GESUS) on the number of children born, the number of pregnancies, and the number of spontaneous abortions. Methods. Retrospective cross sectional study of 11254 women participating in GESUS. Data included biochemical measurements and a self-administrated questionnaire. Results. 6.7% had mild (subclinical) hypothyroidism and 9.4% prevalent hypothyroidism. In women with mild hypothyroidism TPOAb was significantly elevated and age at first child was older compared to controls. TSH and TPOAb were negatively linearly associated with the number of children born and the number of pregnancies in the full cohort in age-adjusted and multiadjusted models. TSH or TPOAb was not associated with spontaneous abortions. Mild (subclinical) hypothyroidism was associated with a risk of not having children and a risk of not getting pregnant in age-adjusted and multiadjusted models. Prevalent hypothyroidism was not associated with the number of children born, the number of pregnancies, or spontaneous abortions. Conclusion. Impaired fertility is associated with TSH, TPOAb, and mild (subclinical) hypothyroidism in a Danish population of women. Anne-Dorthe Feldthusen, Palle L. Pedersen, Jacob Larsen, Tina Toft Kristensen, Christina Ellervik, and Jan Kvetny Copyright © 2015 Anne-Dorthe Feldthusen et al. All rights reserved.