Many women aged 20-30 are postponing their first pregnancies until their mid 30s and beyond, which has resulted in compressed childbearing years and/or infertility. Little is known about the knowledge and understanding that Canadian women of advanced age (age 35-45) possess of their reproductive capacity. This phenomenological study sought to explore these women's knowledge and perception of their reproductive capacity in relation to the timing of first pregnancy. Research questions using the constructs of Ajzen's theory of planned behavior were developed to explore how the behavioral, normative, and control beliefs of women's childbearing behaviors were based on their perceptions of their reproductive capacity. A purposeful sample of 10 participants provided data in semistructured interviews about their lived experiences of being pregnant for the first time at an advanced age. Thematic analysis was used to analyze interview transcripts. Emergent themes derived from the data included being naïve about natural conception, use of fertility specialist, discussions of childbearing plans by family doctors, lacking energy to care for young children, and feeling judged by others. Results indicated inaccuracies in the women's factual knowledge in terms of the narrow window for fertility, chances of natural conception, the impact of long-term use of contraception, and the use of artificial reproductive technologies to compensate for age-related fertility decline. This study may promote positive social change by offering healthcare providers information that assists them in tailoring reproductive messages for patients that dispel misconceptions regarding women's reproductive potential, which may reduce the number of women experiencing involuntary childlessness and infertility

Yes / Evidence-based national guidelines recommend that women practise pelvic floor muscle exercises (PFMEs) during their first pregnancy in order to reduce the likelihood of becoming incontinent of urine. Adherence to these exercises during pregnancy is low, although little is known about the factors that influence some women to exercise during pregnancy while others do not. The aim of this study was to increase understanding of the motivating factors for, and barriers to, performing PFMEs during a first pregnancy using data gathered from four qualitative interviews. Analysis of the interview transcripts revealed four relevant themes: knowledge and understanding; experience of incontinence; attitude to incontinence; and cues to exercise. Having adequate knowledge of the PFMEs and the benefits of these exercises, knowing an incontinent woman of the same age and believing that the PFMEs would prevent incontinence, and having a regular cue to exercise prompted exercise adherence. Recommendations are made for practice and further research.

Abstract The purpose of this study was to evaluate extended first trimester screening for severe chromosomal disorders and adverse pregnancy outcomes in singleton pregnancies among the general population in Finland. Maternal serum biochemical markers, pregnancy associated plasma protein-A (PAPP-A) and free beta human chorionic gonadotropin (fβ-hCG), and fetal nuchal translucency (NT) thickness were measured during the gestational weeks 8+0–13+6. A computerized risk figure program was used to calculate an individual risk figure for chromosomal disorders. It was investigated whether the screening parameter, PAPP-A, is associated with adverse pregnancy outcomes. The prevalence of Down syndrome (DS) cases in Finland during the years 2002–2006 was 1:364 (N=795). The proportion of women aged 35 years or older increased from 5–10% in the years 1980–1990 to 19.1% during the study period. Most DS cases (61.1%) presented in that age group. The first trimester combined screening for Down syndrome yielded a detection rate (DR) of 81.9% for a 4.3% false positive rate (FPR). The performance was evaluated among 76949 voluntary women during the study period of 01.05.2002–31.12.2008. There were 188 cases of DS. The screening worked better among the older women. The number of invasive procedures needed to detect one case of DS was higher among the younger women. Adding specific algorithms for screening of other chromosomal abnormalities yielded DR of 74.0% for trisomy 18 (T18) and 54.5% for trisomy 13 (T13) with an additional increase of 0.3% FPR. For chromosomal abnormalities other than T18 and T13, the specific algorithms did not improve the screening performance. Low first trimester maternal serum levels of PAPP-A (≤0.30 MoM) were significantly associated with small for gestational age (SGA) newborns and stillbirths (SBs). The combined screening method for DS works well in practice and has been standardized in Finland. In screening for trisomies 18 and 13 a specific algorithm is reasonable. Low first trimester levels of PAPP-A could be used as an independent marker for pregnancies at high risk for SGA babies and SBs. / Tiivistelmä Tutkimuksen tarkoituksena oli arvioida laajennetun ensimmäisen raskauskolmanneksen kromosomipoikkeavuuksien seulonnan toimivuutta yksisikiöisissä raskauksissa suomalaisessa normaaliväestössä. Äidin seerumin biokemialliset merkkiaineet, raskauteen liittyvä valkuaisaine A (PAPP-A) ja raskaushormoni (fβ-hCG) sekä sikiön niskaturvotus mitattiin raskausviikoilla 8+0–13+6. Yksilöllinen riskiluku kromosomipoikkeavuuksille laskettiin käyttäen tietokoneen riskinlaskentaohjelmaa. Seulonnan merkkiaineen, PAPP-A:n, matalien pitoisuuksien yhteyttä epäsuotuisiin raskauden lopputuloksiin tutkittiin. Downin oireyhtymän esiintyvyys Suomessa oli 1:364 (N=795) vuosina 2002–2006. 35-vuotiaiden tai sitä vanhempien naisten osuus oli tutkimusaikana 19.1 %, mikä on huomattavasti suurempi kuin vuosien 1980–1990: 5–10 %. Näiden naisten sikiöiden joukosta löytyi suurin osa Down oireyhtymistä (61.1 %). Ensimmäisen raskauskolmanneksen yhdistelmäseulonnan toimivuutta tutkittiin aikana 01.05.2002–31.12.2008. Tutkimukseen osallistui 76 949 vapaaehtoista naista. Joukossa oli 188 Downin oireyhtymätapausta. Seulonnan herkkyys Downin oireyhtymälle oli 81.9 % ja tarkkuus 4.3 %. Seulonta toimi parhaiten vanhempien naisten joukossa. Niiden kajoavien toimenpiteiden määrä, jotka tarvittiin yhden Down-sikiön löytämiseksi, oli suurempi nuorten naisten joukossa. Tutkimuksessa Downin oireyhtymän algoritmiin lisättiin spesifiset algoritmit trisomioille 18 ja 13, jolloin saavutettiin 74.0 %:n herkkyys trisomialle 18 ja 54.5 %:n herkkyys trisomialle 13. Väärien positiivisten seulontatulosten määrä kasvoi 0.3  %:n verran. Seulonnan toimivuus muiden kromosomipoikkeavuuksien joukossa ei parantunut spesifisten algoritmien avulla. Lisäksi matalan PAPP-A-pitoisuuden yhteys pienipainoisuuten ja kuolleena syntyneisyyteen oli tilastollisesti merkittävä. Tutkimus osoitti, että esimmäisen raskauskolmanneksen yhdistelmäseulonta toimii hyvin käytännössä. Trisomioiden 18 ja 13 seulonnassa spesifisten algoritmien käyttö on järkevää. Matalaa ensimmäisen raskauskolmanneksen PAPP-A-arvoa voitaisiin käyttää itsenäisenä riskimerkkiaineena raskauksille, joissa pienipainoisuuden ja kuolleena syntymisen riski on kohonnut.