O objetivo deste estudo foi avaliar a influência da suplementação proteica no terço final da gestação de vacas Nelore e das bezerras em creep-feedingsobre o desempenho produtivo e reprodutivo de bezerras e novilhas. Para tanto, foi utilizado um arranjo fatorial (2X2), sendo o fator I a suplementação das vacas no terço final de gestação (n=350) e o fator II a suplementação das bezerras em creep-feeding (n=153). No terço final da gestação, as vacas foram suplementadas com 0,5 kg de farelo de soja, e as bezerras foram suplementadas em creep-feeding a partir dos 30 dias após o nascimento até a desmama, aos 6,38 meses de idade. O período experimental compreendeu do terço final da gestação até os 30 meses de idade. Não houve interação entre as estratégias de suplementação sobre o peso corporal (P=0,66) e ECC (P=0,58) das vacas, e sobre o peso corporal (P=0,62) e GMD (P=0,73) das bezerras dos 1,2 até 26,0 meses. Da mesma forma, não houve efeitoo da suplementação das vacas (P=0,98) e das bezerras em creep-feeding (P=0,78) sobre o peso das bezerras. Entretanto, a suplementação das vacas influenciou pontualmente o peso das novilhas aos 24,9 meses, sendo que as novilhas filhas de vacas suplementadas foram mais pesadas (P=0,040). A taxa de puberdade aos 12,5 (P=0,31) e 24,9 (P=0,75) meses e a taxa de prenhez aos 18,7 (P=0,86) e 26,0 (P=0,36) meses não foram influenciados por nenhuma das estratégias nutricionais. No entanto, houve interação entre a suplementação das vacas e das bezerras em creep-feeding sobre a taxa de prenhez aos 30 meses de idade, sendo que novilhas filhas de vacas suplementadas no terço final da gestação e que foram suplementadas em creep-feeding apresentaram maior taxa de prenhez (92%, P=0,019) quando comparadas com novilhas que receberam apenas um dos dois tipos de suplementação. A associação entre suplementação materna no terço final de gestação e a suplementação na fase de cria (creep-feeding) não impactaram sobre o peso corporal, GMD, taxa de puberdade das novilhas. / The objective of this study was to evaluate the influence of dam supplementation on least trimester of gestation of Nellore cows and creep-feeding supplementation on productive and reproductive performance of heifers. For this purpose, a factorial arrangement (2X2) was used, which the factor I was dam supplementation of cows in the least trimester of gestation (n = 350) and the factor II was creep-feeding supplementation (n = 153). Cows were supplemented with 0.5 kg of soybean meal by 90 days before partum, and the female calves were supplemented in creep-feeding from 30 days after birth until weaning at 6.38 months of age. The experimental period comprised the least trimester of gestation up to 30 months of age. There was no interaction between supplementations on body weight (P = 0.66) and BCS (P = 0.58) of cows, and on body weight (P = 0.62), and ADG (P = 0.73) of heifers from 1.2 to 26.0 months. In the same way, there was no effect of dam supplementation (P = 0.98), and creep-feeding (P = 0.78) on body weight of heifers. However, dam supplementation exerted punctual influence on body weight of heifers at 24.9 months of age, when heifers that dam were supplemented were heavier (P = 0.040). The reproductive parameters such puberty rate at 12.5 (P = .31) and 24.9 (P = 0.75) months and the pregnancy rate at 18.7 (P = 0.86) and 26.0 (P = 0.36) months were not influenced by any nutritional strategies. However, there was interaction between supplementations on the pregnancy rate at 30 months of age, which heifers from cows that received supplement on least trimester of gestation and were submitted to creep-feeding showed higher pregnancy rate (92%, P = 0.019) than heifers who received only one of two types of supplementation. The association between dam supplementation and creep-feeding did not affect body weight, ADG, and puberty onset in Nellore heifers.

M.A. / The aim of this study was to ascertain which variables affect and influence women when making choices in unplanned pregnancy. In addition, to determine if there were any significant differences between the pregnancy and termination of pregnancy (TOP) group, indicating a specific profile for the respective group. Comparatively little research has been conducted on unplanned pregnancy and abortion within South Africa, as compared with international studies. Future longterm studies are recommended. The research conducted was of a quantitative quasi-experimental research design, wherein the researcher compared the following variables between the two groups: Biographic/demographic data, Personality Styles, perceived Family Environments and Coping Resources. Subjects were not randomly assigned, but selected by the nursing staff and researcher. Statistical analysis reflected that the two groups differed significantly on four variables. The majority of women in the TOP group were found to be the sole earners within their families. Conversely, women in the pregnancy group had more financial resources and lower levels of employment. A lack of sufficient finances was shown to be the strongest determining factor for those electing abortions. A compounding factor, were the nature of the relationships from where conception arose, 71% of the women who elected abortion described difficulties with the partnerin- conception. These included poor relationships due to excessive drinking, extramarital affairs, disinterest in the pregnancy, subsequent abandonment and divorce. Although the two groups had similar profiles in terms of the religious variable, many of the women who elected to remain pregnant, cited religion and/or their beliefs as the primary reason for continuing their pregnancies. In contrast, the TOP group reported a higher level of conflict within their family of origin, compared to the pregnancy group. IV No underlying pathology was found to exist in the group electing terminations, with both groups presenting similar personality styles. The two groups were also found to use comparable coping skills and resources. This research indicates, that most of the women experiencing an unplanned pregnancy based their decisions to abort on external variables; such as their relationships, financial position and religious beliefs. Studies indicate that these women are more likely to experience deleterious consequences, than those who make this decision based on their own personal needs. Many of these women made their decisions based on limitations not preference. This study may be considered to show important findings, as it reflects the need for effective pre- and post-abortion intervention/counselling services, which should be easily accessible to the public. The psychological well-being of the individual is critical for the overall well-being of the community, and ultimately therefore, society.

The number of adolescents who become pregnant each year has, for the past two decades, been a topic of serious concern among international education and health professionals. The Department of Education established a new policy that allows adolescents to pursue their studies during pregnancy. This policy frustrated parents and educators because it interfered with social norms and values. It also puts pregnant adolescents’ lives at risk (Mwamwenda, 1996: 206). The pregnant adolescent finds herself in the midst of a multifaceted crisis situation which is characterised by the emotional and physical reality of pregnancy. She also faces the interruption of normal physiological development, a possible change in educational and career pursuit as well as parental kinship support, an increase in medical risks during pregnancy, and the premature assumption of the adult role with its associated responsibilities. The shock of an unwanted pregnancy can be emotionally traumatic for the adolescent. Some receive emotional support from their close family members, others do not. In the absence of emotional support, the pregnant adolescent may experience increased anxiety and frustration, while others may develop depression. Together with middle-aged childbearing women, adolescents are viewed as a high risk maternity population. Complications such as high blood pressure, toxaemia, anemia and cardiac and other physiological conditions may develop, endangering the life of the adolescent (Bodak & Jensen, 1984: 938) The researcher’s curiosity about adolescent pregnancy was raised when she studied the statistics of adolescent pregnancy between 2000 and 2003, at the local clinic in Duduza. She realised that more adolescents are becoming pregnant every year. She decided to conduct research about adolescent pregnancy. The intention was to explore and describe the experience of adolescents during pregnancy at Duduza Location and to determine guidelines for educators, parents and health workers to support adolescents during pregnancy. She also intended to make recommendations for parents, educators and health workers on how pregnant adolescents can be supported. This research was aimed at describing and exploring the experiences of adolescents during pregnancy. This research was qualitative in nature. The sample was taken from pregnant adolescents in a township. Data gathering methods used in this research were individual interviews and observations. The observation for this study was conducted by the researcher at the local clinic and individual homes. A total of ten interviews were conducted and all of them were transcribed and edited. The participants had to comment on their experiences during pregnancy. These ten interviews formed the basis of this study to facilitate the attainment of the primary objectives which were to explore and describe the experiences of adolescents during pregnancy. The data from these interviews were analysed by using an open coding method. An independent coder did an analysis independent from the researcher. A consensus validation discussion was held with the independent coder on the analyses of the data. The detailed discussion of results obtained from the interviews and observations were presented in verbatim quotes, descriptive and reflective notes and illustration of emergent themes and categories. Rigor and adequacy were ensured by the data collected and the results obtained from the data analysis indicated convergence and saturation. The measures of trustworthiness, that is, credibility, transferability, dependability and confirmability, were applied throughout the study. Ethical considerations were addressed in the assent letters which were presented to the participants. Ethical considerations included the preserving of anonymity, confidentiality, and the ethical role of the researcher that had to be adhered to. The research results indicated that adolescent pregnancy has psychological effects on the adolescent and there is insufficient support from significant others when they find out that the adolescent girl is pregnant. The guidelines for parents, educators and health workers to support adolescents during pregnancy were formulated and recommendations discussed. / Prof. C.P.H. Myburgh

Cartas al editor

Background: Medical complications in pregnancy can be a significant source of stress for pregnant women and their partners. Despite this, and evidence that anxiety is very common among perinatal women, little is known about the relationship between perinatal anxiety and medical complications in pregnancy. Purpose: The purpose of this research was to conduct a systematic review of the extant literature pertaining to medical complications of pregnancy and anxiety. Specific objectives were to (a) investigate differences in anxiety experience (symptoms and/or disorder) between women experiencing a medically complicated pregnancy and women experiencing a medically uncomplicated pregnancy, and (b) investigate the nature and scope of perinatal anxiety among women whose pregnancy is fraught with medical problems. Methods: The review was guided by the PRISMA reporting process. The electronic databases MEDLINE and PsycINFO were searched to identify studies that met the study inclusion criteria. Data were extracted and presented in a narrative form including tables and figures. An adapted form of the Newcastle-Ottawa Quality Assessment Scale for case-control and prevalence studies was used to perform a quality assessment review. Results: Twelve studies met the inclusion criteria. Findings indicated that anxiety symptom severity was greater among women experiencing a medically complicated pregnancy compared to those experiencing an uncomplicated pregnancy. The prevalence studies in which symptoms of anxiety were assessed at various times during pregnancy indicate that, among women experiencing a medically high-risk pregnancy, reported symptoms were most severe at initial assessment. Though an exact estimate cannot be provided due to methodological differences, these studies reported the prevalence rates of anxiety symptoms to range from 7.8% to 46.9%. The included studies that used DSM-IV criteria concluded that the risk may be most significant for two disorders: obsessive-compulsive disorder (OCD) and generalized anxiety disorder (GAD). Based on the overall quality of the available studies, the findings cannot be called as bias-free Conclusions: Women experiencing a medically complicated pregnancy appear to experience significantly more symptoms of anxiety compared to women experiencing a healthy pregnancy. / Graduate

Salmonella enterica species are intracellular bacteria causative agents of gastroenteritis and typhoid fever in humans. Pregnancy poses an increased risk of severe Salmonellosis in many mammalian species contributing to miscarriage and/or maternal illness. Previous studies indicated that Salmonella infection in pregnant mice caused rapid fetal and maternal death due to massive bacterial proliferation in the placenta. However, the susceptibility of human primary trophoblast cells (cTBCs) to Salmonella infection was not known. We hypothesized that human placental trophoblast cells are productively infected and provide a unique intracellular niche that permits uncontrolled Salmonella replication due to an ineffective maternal innate immune response to the virulent bacteria resulting in placental death. Firstly, we observed that S.Tm strains defective in the Salmonella pathogenicity island (SPI)-1 type III secretion system (TTSS) (S.Tm-ΔinvA) were unable to enter epithelial cells, but efficiently infected placental choriocarcinoma cell lines through scavenger receptor-mediated endocytosis. Next, we observed that S.Tm failed to grow vigorously in macrophages, but replicated rapidly within epithelial and placental trophoblast cells. Further examination of intracellular localization of S.Tm indicated that bacteria were arrested in early Rab5 expressing phagosomal vesicles within trophoblast cells, whereas phagosomal maturation progressed steadily in macrophages (with expression of lysosomal-associated membrane protein-1 (LAMP-1) and cathepsin D). Moreover, human primary cTBCs harboring S.Tm underwent rapid death of the cells. Infected cTBCs expressed phosphorylated-receptor-interacting serine/threonine-protein kinase (RIPK)-1 protein and phosphorylated-mixed lineage kinase domain-like (MLKL), suggesting induction of the necroptosis pathway of cell death. Furthermore, specific inhibition of necroptosis rescued S.Tm-induced death of cTBCs. Finally, S.Tm infected trophoblast cells produced interleukin (IL)-10, and signal transducer and activator of transcription (STAT)-3 signalling. This correlated to delayed phagosomal maturation which consequently facilitated intracellular pathogen proliferation. Overall, human trophoblast cells may act as reservoirs for S.Tm survival and may aid dissemination in the pregnant host.

Background Individually both migraine and post-traumatic stress disorder (PTSD) prevalence estimates are higher among women. However, there is limited data on the association of migraine and PTSD in women during pregnancy. Methods We examined the association between migraine and PTSD among women attending prenatal clinics in Peru. Migraine was characterized using the International Classification of Headache Disorders (ICHD)-III beta criteria. PTSD was assessed using the PTSD Checklist-Civilian Version (PCL-C). Multivariable logistic regression analyses were performed to estimate odds ratios (OR) and 95% confidence intervals (CI) after adjusting for confounders. Results Of the 2922 pregnant women included, 33.5% fulfilled criteria for any migraine (migraine 12.5%; probable migraine 21.0%) and 37.4% fulfilled PTSD criteria. Even when controlling for depression, women with any migraine had almost a 2-fold increased odds of PTSD (OR: 1.97; 95% CI: 1.64–2.37) as compared to women without migraine. Specifically, women with migraine alone (i.e. excluding probable migraine) had a 2.85-fold increased odds of PTSD (95% CI: 2.18–3.74), and women with probable migraine alone had a 1.61-fold increased odds of PTSD (95% CI: 1.30–1.99) as compared to those without migraine, even after controlling for depression. In those women with both migraine and comorbid depression, the odds of PTSD in all migraine categories were even further increased as compared to those women without migraine. Conclusion In a cohort of pregnant women, irrespective of the presence or absence of depression, the odds of PTSD is increased in those with migraine. Our findings suggest the importance of screening for PTSD, specifically in pregnant women with migraine.

Abstract The aim of the present study was to evaluate the efficacy of the first trimester screening for Down syndrome (DS) in an unselected low-risk Finnish population. The study involved 4,617 women who attended screening between the 8th and 14th weeks of pregnancy in 1998-2000. They gave a blood sample for the measurement of pregnancy associated plasma protein A (PAPP-A) and free beta human chorionic gonadotrophin (β-hCG). Of these women, 3,178 also had an ultrasound examination for the measurement of fetal nuchal translucency (NT). The risk figure for every screened woman was calculated using a computerized risk figure program. The risk 1 in 250 was used as a cut-off. The subgroup of screen positives comprised 5.8% of the study group. There were 16 DS cases. The combined method (maternal age, NT and the biochemical markers) detected 77% of the affected pregnancies. NT combined with maternal age gave a detection rate of 69%. Serum markers without NT combined with maternal age found 75% of the Down's. In 49 consecutive singleton in-vitro-fertilization pregnancies, the β-hCG value was more often elevated compared to spontaneous pregnancies, increasing the false positive rate. In 67 twin pregnancies, the serum marker levels were approximately double those in singletons. Smoking reduced PAPP-A by 20% making the smokers more likely to get a positive screening result. To determine the impact of the screening on the live born incidence of DS, two historical populations were compared. The first group was screened by second trimester serum samples (β-hCG and AFP) and the second group by first trimester ultrasound examination. When detection rates were at the same level, the second trimester screening reduced the number of live born Down's children more effectively. In conclusion, the first trimester combined method (maternal age, NT, β-hCG and PAPP-A) for Down syndrome screening is efficient in an unselected low risk population. The biochemical screening is not recommended in IVF-pregnancies.

4 pp. / Before they may even know they are pregnant; women’s bodies and their level of folate play a critical role in preventing certain birth defects, specifically neural tube defects (NTDs). NTDs are birth defects in the brain, spinal cord, or spine. Considered ‘one of the most important public health discoveries of this century’ is that daily supplemental folic acid taken before becoming pregnant significantly reduces the risk of NTDs (1). In 1998, the United States made sweeping efforts that fortified cereal grains with folic acid to ensure all Americans consume adequate amounts of this vitamin. So what exactly is folate? What are the functions of this vitamin? What foods have high levels of folate and what is the recommended daily intake? This article will answer these questions and will go on to explain folic acid fortification and the impact fortification has had on the incidence of NTDs in Arizona.

Magister Scientiae (Medical Bioscience) - MSc(MBS) / Increased levels of oestrogen and progesterone during pregnancy may lead to periodontal disease. The anaerobic Gram-negative bacteria called red complex (Porphyromonas gingivalis, Tannerella forsythensis and Treponema denticola) are frequently associated with periodontal disease. Periodontopathogens produce toxins and enzymes which can enter the bloodstream and cross the placenta to harm the foetus. The response of the mother’s immune system to infection by these periodontopathogens, brings about the release of inflammatory mediators which may trigger preterm labour or result in low birth-weight infants. The purpose of this study was to examine the prevalence of red complex, using BANA and PCR in subginginval plaque samples from pregnant women. Subgingival plaque samples were obtained from pregnant women between the ages of 17 to 45 years attending a Mitchells Plain ante-natal clinic. Plaque samples were analyzed by the enzymatic BANA-test for detection of the presence of red complex and DNA was extracted and analyzed using 16 rDNA-Polymerase Chain Reaction (PCR). Seventy-nine percent of pregnant women showed gingival index scores of ≥ 1 of which 74.24% harboured by at least one of the members of the red complex. P.gingivalis was the most prevalent of the three members of the red complex. Findings of this study confirmed a need for dental preventive measures in pregnant women and microbial monitoring of suspected periodontopathogenes. This could be achieved by joint cooperation between Maternity Obstetric Units (MOU), Dentistry and oral microbiology departments. The results of this study revealed that although PCR is more sensitive than BANA in detecting members of the red complex, BANA showed a better association with the indices used to diagnose periodontal disease. / South Africa