Pregnancy in women with hemoglobinopathy has been associated with an increased risk of adverse pregnancy outcomes. We conducted a historical cohort study using Discharge Abstract Database for the fiscal year 1991-1992 through 2007-2008. We estimated the frequency of pregnant women with hemoglobinopathy and examined their associations with adverse pregnancy outcomes. Women with sickle cell disease are more likely to develop pre-eclampsia and preterm labor, and to undergo cesarean delivery than women with nutritional deficiency anemia, suggesting that there are other mechanisms beyond anemia that may be responsible for an increased risk of adverse pregnancy outcomes. The data suggested a synergistic effect of hemoglobinopathy and pre-eclampsia on preterm labor and cesarean delivery. Prediction models for pre-eclampsia, preterm labor and cesarean delivery were created and internally validated for women with hemoglobinopathy, with satisfactory discrimination and calibration.

Objective: Short interpregnancy interval (IPI), <18 months between pregnancies, is a potential cause of adverse delivery and birth outcomes, and may be a particular issue among those with other risks. Our goal was to examine IPI and delivery/infant complications in Tennessee. Methods: Birth certificate/vital records data included 101,912 women with a previous delivery. IPI groups (<6, 6-12, 12-18, 18-60 months) were compared on outcomes. Results: Thirty-nine percent of the deliveries had IPI <18 months, 9% were <6 months, rates 11% and 27% higher than nationally. Women with IPI <18 months were younger, lower educated with lower income, had higher BMIs, and were more likely to be unmarried, smokers, and have begun prenatal care later (p <.001). In adjusted analyses, IPI <18 months predicted elevated risk for precipitous labor, low-birth weight, preterm delivery, NICU admission, and infant mortality, with effects strongest for IPI <6 months. Finally, risks related to IPI <6 months were substantially higher for the lowest income women. Conclusions: Rates of less than optimal IPI were high in this population already experiencing significant maternal-child health disparities, with short IPI a particular risk factor for poor out-comes for the most disadvantaged women, suggesting yet another precursor for adverse birth outcomes in those already most at risk.

Maternal prenatal exposure to hurricanes and tornadoes could contribute to an increased risk for adverse birth outcomes. Little is known about the effects of Hurricane Katrina of August 2005, on pregnancy outcomes in Mississippi. Additionally, little is known about the influence of the April 2011 Alabama tornado disaster on births in that state. The purpose of this study was to bridge this knowledge gap by examining the relationship between maternal prenatal exposure to these storms and adverse infant health outcomes. The theoretical framework guiding this retrospective, cross-sectional study was the life course approach. Data for this investigation included 2,000 records drawn from the Linked Infant Births and Deaths registers. Chi-square and logistic regression analyses were performed. Results indicated hurricane exposure was not a predictor of preterm birth (OR = .723, 95% CI = [.452, 1.16]; p = 1.76) or low birth weight (OR = .608, 95% CI = [.329-1.13]; p = .113). However, an association was observed between tornado exposure and preterm birth (OR = 1.68, 95% CI = [1.19-2.39]; p = < 0.05) and low birthweight (OR = 1.91, 95% CI = [1.27-2.87]; p = < 0.05). Findings suggest pregnant women are vulnerable to natural disaster storms, and are at risk for adverse pregnancy outcomes. The implications for social change include informing preparedness efforts to reduce vulnerability to increased pregnancy risk factors and adverse birth outcomes, consequential to hurricane and tornado disasters.

SAMMANFATTNING Bakgrund: Ätstörningar uppträder oftast hos kvinnor i reproduktiv ålder. Orsaker till ätstörning är svåridentifierade men sociala, psykologiska och biologiska processer verkar samverka. Ätstörningar kan vara svåra att behandla då många kvinnor är hemlighetsfulla kring sin ätstörning för att de skäms över sitt störda ätbeteende. Forskning tyder på att kvinnor med någon form av ätstörning löper risk för komplikationer under graviditeten och i samband med förlossningen samt vid övergång till moderskapet. Samtidigt som kvinnor med ätstörning ska hantera oro för fostrets/barnets välbefinnande försöker de hantera sin ätstörning, vilket kan göra dem sårbara. Det är betydelsefullt för mödravården att ha kännedom om hur ätstörningar påverkar graviditetsutfall för att kunna ge dessa kvinnor adekvat behandling och stötta dem på bästa sätt. Syfte: Att beskriva vilken effekt tidigare eller pågående ätstörning har på graviditetsutfall och övergång till moderskapet. Metod: En litteraturöversikt där sökning genomförts i databaserna Cinahl, Pubmed och PsycINFO. Tjugotvå vetenskapliga artiklar utgör resultatsammanställningen, varav sexton har kvantitativ ansats och sex kvalitativ ansats. Resultat: Pågående eller tidigare ätstörning hos gravida kvinnor påverkar kvinnans graviditet och graviditetsutfall genom ökad risk för depression och ångest under graviditeten och postnatalt samt för prematur födsel. Ätstörning ökar kvinnans sårbarhet under graviditeten och vid övergång till moderskapet på grund av hennes oro över viktuppgång och att inte bli eller vara en tillräckligt bra mamma. Pågående eller tidigare ätstörning hos mamman påverkar barnet genom ökad risk för låg födelsevikt och/eller SGA-barn. Kvinnor med ätstörning visar svårigheter i det interaktiva mönstret med barnet och har ofta svårt att känna igen barnets hunger och att kunna skilja på barnets hunger och dess behov av närhet. Kvinnor med ätstörning har ett ökat behov av stöd under graviditeten och postpartum. Motstridiga resultat framkom avseende prematur födsel, missfall, kejsarsnitt och instrumentell förlossning, inducerad förlossning, födelsevikt, SGA-barn, intrauterin tillväxthämning och Apgar-poäng. Slutsats: Denna litteraturöversikt visar att kvinnor med pågående eller tidigare ätstörning har högre risk för negativa utfall under graviditeten och perinatalt samt försämrade förutsättningar vid övergången till moderskapet. Flera studier visade på motstridiga resultat. Kliniska implikationer: Det är betydelsefullt att tidigt i graviditeten identifiera kvinnor med ätstörning för att kunna hindra eller lindra negativa utfall. Eftersom kvinnor med ätstörning ofta döljer sitt störda ätbeteende, försvåras identifieringen av dem. Ett enkelt verktyg som möjliggör screening av ätstörningar skulle möjligen underlätta upptäckten av ätstörning tidigt i en graviditet.

Bakgrund: Ätstörning är ett tillstånd som kännetecknas av problem med ätande, aptit och vikt. Ätstörningen kan föra med sig vissa psykiatriska tillstånd och de vanligaste är ångest, depression och personlighetsstörningar. I samband med graviditet sker förändringar som kvinnor måste anpassa sig till, bland annat viktuppgång. För kvinnor som har en pågående ätstörning eller dem med tidigare ätstörning kan anpassningsprocessen bli svårare och ätstörda beteenden från tidigare år kan komma tillbaka. Forskning visar att en del kvinnor med ätstörningar upprätthåller kompensatoriska beteenden i form av intensiv träning, restriktivt matintag, bruk av laxantia samt självframkallade kräkningar för att förhindra viktuppgång under graviditeten. Mörkertalet är stort när det gäller ätstörningar och det ses en tydlig tendens i undvikande av professionell hjälp.   Syfte: Att belysa ätstörningarnas påverkan på fostret och spädbarnet samt kvinnans fysiska och psykiska hälsa under och efter graviditet.   Metod: En litteraturöversikt där sökning av artiklar genomförts i databaserna CINAHL Complete, MEDLINE, PsycINFO och PubMed. Sjutton artiklar, publicerade 2007–2017, utgör studiens resultatdel varav fem artiklar av kvalitativ design och tolv av kvantitativ design.   Resultat: Ätstörning i samband med graviditet påverkar barnet genom ökad risk för låg födelsevikt, låg Apgar-poäng och spädbarnsdöd. En ätstörning påverkar kvinnan såväl fysiskt som psykiskt både innan och under en graviditet samt postpartum. Ätstörning har visat på fertilitetsproblem och upprepade missfall hos kvinnan. Under graviditet har kvinnor med ätstörning större risk för antepartumblödning och anemi samt komplikationer i samband med förlossning så som större behov av igångsättning och kejsarsnitt än vad kvinnor utan ätstörning har. Kvinnor med ätstörningar upplever i större omfattning känslor av självkritik och otillräcklighet som förälder då fokus ligger på den egna kroppen och inte på barnet. Ångest- och depressionssyndrom har visat sig vara vanligt förekommande under och efter graviditeten hos kvinnor med ätstörningar.   Slutsats: Denna litteraturöversikt visar att kvinnans ätstörning under en graviditet kan ha negativ påverkan på fostret och spädbarnet samt risk för ogynnsamma utfall vad gäller kvinnans fysiska och psykiska hälsa. / Background: Eating disorders are a condition characterized of problems by eating, a change in appetite and weight problems. Eating disorders can cause certain psychiatric conditions and the most common are anxiety, depression and personality disorders. During pregnancy, changes that women must adapt to includes increase in body weight. For women who have an ongoing eating disorder or those with a history of eating disorder, the adaptation process may be more difficult, and disrupting behaviours from previous years may come back. Research shows that some women with eating disorders maintain their compensatory behaviours in the form of intense training, food restriction, use of laxatives and self-induced vomiting to prevent increase of body weight during pregnancy. Estimated number of unknown cases of eating disorders are high, and there is a clear tendency to avoid seeking professional help.   Aim: The aim of this study was to highlight the effects of eating disorders on the fetus and the infant as well as the physical and mental health of women during and after pregnancy.   Methods: A literature review in which searches were conducted in the databases CINAHL Complete, MEDLINE, PsycINFO and PubMed. Seventeen scientific papers, published in 2007-2017, represent the result compilation, of which five articles have a qualitative approach and twelve have a quantitative approach.   Results: Eating disorders during pregnancy affects the child through increased risk of low birth weight, low Apgar scores and infant mortality. An eating disorder affects the woman both physically and mentally, before and during pregnancy and postpartum. Eating disorders have been shown to cause fertility problems and repeated miscarriages. During pregnancy, women with eating disorders have a greater risk of antepartum bleeding, anemia and complications such as greater need of initiation of childbirth and caesarean section than women without eating disorders. These women experience feelings of self-criticism and insufficiency as a parent since focus is on their own body and not on the child. Anxiety and depression syndromes are associated with women with eating disorders during pregnancy.   Conclusion: This literature review shows that women with eating disorders during pregnancy have a negative impact on the fetus and the infant, as well as a higher risk of unfavourable outcomes in the physical and mental health of the woman.

Maternal mortality, an example of poor maternal health outcomes, is widely accepted as an indicator of the overall health of a population. One of the Millennium Development Goals was reduction in maternal mortality by 3 quarters by 2015. These goals were not met in Nigeria and it is important to look at some of the reasons why. Education has been shown to have positive impact on pregnancy outcomes; however, the characteristics of pregnant women, their health literacy level, their usage of antenatal care services and how these impact pregnancy outcomes are yet to be analyzed in Lagos, Nigeria. Guided by the social cognitive theory and health belief model, the purpose of this cross-sectional quantitative study was to determine if there is a relationship between maternal health literacy, antenatal care visits, development of medical conditions during pregnancy, and pregnancy outcomes (measured by healthy or unhealthy baby) in Lagos, Nigeria. The research question for this study tested if there was a relationship between these variables. Lisa Chew's health literacy assessment tool was used in a sample of 130 women in Shomolu local government in Nigeria who met the inclusion criteria. Using binary logistic correlations, only problems developed during pregnancy is statistically significant with pregnancy outcomes (p < .05). The results suggested an increase in problems developed during pregnancy most likely will increase the chance of having negative pregnancy outcomes. Results from this study could promote positive social change by helping health professionals identify the characteristics of at-risk women during antenatal education sessions. The results could also help health professionals in the development of targeted antenatal care interventions.

Tyrimo tikslas - nustatyti psichologinės adaptacijos ir socialinių, demografinių bei sveikatos veiksnių sąsajas pogimdyminiu laikotarpiu. Tyrime dalyvavo 200 tiriamųjų. Tiriamųjų grupę sudarė pagimdžiusios moterys, gulinčios po gimdymo Vš.Į. Ukmergės ligoninės akušerijos skyriuje ir Kauno Vš.Į. 2-os klinikinės ligoninės filialo P.Mažylio gimdymo namuose. Siekiant nustatyti psichologinės adaptacijos ir socialinių, demografinių bei sveikatos veiksnių sąsajas pogimdyminiu laikotarpiu buvo naudoti šie klausimynai: „Savęs vertinimo klausimynas po gimdymo“, „Edinburgo pogimdyminės depresijos skalė“, „Spilbergerio C. D. Nerimo skalė“. Demografiniams, socialiniams ir sveikatos veiksniams nustatyti buvo naudojami Ž. Jankauskienės ir tyrimo autorės sudaryti klausimai. Tyrimo rezultatai parodė, kad moterų psichologinė adaptacija pogimdyminiu laikotarpiu yra susijusi su demografiniais rodikliais: vyresnio amžiaus moterys, ištekėjusios, turinčios aukštąjį išsilavinimą bei gyvenančios mieste yra geresnės psichologinės adaptacijos. Darbo ir vaikų turėjimas, didesnės pajamos, planuotas nėštumas, partnerio parama nėštumo metu, sveikatai palankus elgesys siejasi su geresne moterų psichologine adaptacija pogimdyminiu laikotarpiu. Šio tyrimo rezultatai parodė, kad nėštumo komplikacijos siejasi su blogesne psichologine adaptacija pogimdyminiu laikotarpiu. Gimdymo sužadinimas, gimdymo skausmo malšinimas yra susiję su moterų psichologine adaptacija pogimdyminiu laikotarpiu, tačiau natūralus... [toliau žr. visą tekstą] / The task of this study – to determine correlations between psychological adaptation, socio-demographic and health factors during postnatal period. The group of 200 women participated in this study. The group consisted of women after childbearing in Ukmergė hospital midwifery department and Kaunas 2nd hospital chapter, P.Mažylis midwifery house. Determining the correlations between psychological adaptation, socio-demographic and health factors was done by using The Postpartum self-evaluation questionnaire, Edinburgh Postnatal Depression Scale (EPDS), and Spielberger C.D. Stait Trait Anxiety Scale. Socio-demographic and health factors were determined using the questionnaire developed by Ž. Jankauskienė and the author of this study. The results of this study showed that psychological adaptation of women during the postnatal period is correlative with demographic factors: older, married and having a high school education women, living in bigger towns show better psychological adaptation. A better psychological adaptation is also correlated with having a job, children, bigger income, planned childbearing, help of the partner and healthy habits. The results of this study also shoved that complications during pregnancy correlate with poorer psychological adaptation during postnatal period. The stimulation of labour, using anesthetics during labour correlate with psychological adaptation during postnatal period. Natural childbirth, Cesarean section and childbirth with the help of... [to full text]

Doctor Pharmaceuticae - Dpharm / The use of efavirenz (EFV) in the first trimester of pregnancy remains controversial. In South Africa, the use of EFV-containing antiretroviral therapy (ART) as part of a Fixed Dose Combination (FDC) during the first trimester of pregnancy started in April, 2013. Literature to date has reported conflicting outcomes following the use of EFV-containing ART during the first trimester of pregnancy. The objectives of the study were to determine the prevalence of adverse pregnancy outcomes among HIV-positive pregnant women treated with EFV-containing ART and compare these results with those of pregnant women treated with NVP-containing ART and HIV-negative pregnant women in resource-limited settings. In addition, the study also aimed to determine the effect of the time of initiation of ART on the prevalence of adverse pregnancy outcomes.

Nigeria is one of the countries with the highest Under-5 Mortality rates (U5M) estimated at 117 deaths/1000 live births. Despite public health control initiatives, no significant improvement in U5M has been demonstrated. The purpose of the study was to determine whether history of Adverse Pregnancy Outcomes (APO) and maternal socioeconomic factors could predict the death of children before their fifth birthday, using the life course health development and fetal programming theories. The study population was women in their reproductive age (15- 49 years). The study was a secondary data analysis of the datasets obtained from three Nigeria Demographic and Health Surveys (2003, 2008, and 2013). Complex samples multivariate logistic regression was used to determine the associations among variables. The results showed that lower education level (p < 0.001), lower income level (p <0.05), rural residential setting (p< 0.01), and lower socioeconomic status index (p < 0.001) of women were statistically significant predictors of U5M. APO was not statistically associated with U5M (p > 0.05). This concludes that children of women with low socioeconomic factors and status index could be at higher risk of death within the first 5 years of their lives, and women with history of APO stand no greater risk of losing their under-5 children. The study would contribute to positive social change among women in Nigeria through early identification of women whose children may be at risk of U5M and provision of evidence-based advocacy to urge increased government and public attention to women and child welfare.

Disinfection by-products (DBPs) are a major group of water contaminants and their role in causing adverse health outcomes, including adverse pregnancy outcomes, endocrine disruption, respiratory related adverse health outcomes and cancer has been subject to extensive epidemiological and toxicological research and review. Determination of safe exposure to DBPs, particularly within drinking water supplies, has been a topic of extensive debate, with a wide range of acceptable levels set across the industrialized world. The focus of the research in this thesis was on two of the main health outcomes associated with DBP exposure, namely adverse pregnancy outcomes and asthma related symptoms. To assess adverse pregnancy outcomes in Perth, an extensive classification quantification of the major DBPs in Perth drinking water was conducted. A registrybased prevalence study was carried out to assess birth defects in relation to high, medium and low DBP areas (defined by the water sampling and analysis). It was found that women living in high THM areas are 22% (odds ratio (OR) 1.22, 95% confidence interval (95% CI) 1.01-1.48) more likely of having a baby with any birth defect. High exposure was also strongly associated with an increased risk of having a baby with a cardiovascular defect (62% increased risk). Low birth weight and prematurity were also assessed; however these outcomes were not associated with an increased risk through an increase in exposure. Following on from this analysis, a population risk assessment model was developed for DBPs in high exposure environments. This involved a three step process: (i) Firstly a questionnaire-based validation and reliability study was used to assess water consumption patterns of a population of pregnant women in Perth. (ii) Secondly a prediction model for teratogenic burden of DBPs in Perth was developed, related to the exposure patterns of the population of pregnant women involved in the validation and reliability study. (iii) Finally, combining the information collected in (i) and (ii), along with the regression slope estimates for birth weight from the prevalence study (defined in Section 2.2.1), a dose-response model for THMs and birth weight was developed. Predictive simulations for birth weights at given THM levels were then conducted. It was estimated that pregnant women in Perth are exposed to between 0.3 – 4.10 µg/day ingested TTHM, and of this, the more toxic brominated forms accounted for between 0.27 – 3.69 µg/day. Based on a dose-response model used, birthweights calculated for the ‘hypothetical’ exposures ranged from 3403.2g for the highest exposure to 3503.5g in the lowest exposure, which is a difference of over 100g. Although the resulting reduction in birth weight is not extreme, there is still a significant reduction in birth weight present as exposure to TTHMs increases. This is the first doseresponse model to be developed to assess an adverse pregnancy outcome based on pregnant women exposure data, and will be a useful tool for assessing varying exposures throughout not only Australia but also throughout the industrialised world, where DBP exposure is highly prevalent.