Search

Aims: An association between paternal age and type 1 diabetes (IDDM) among their offspring was recently reported as well as transgenerational responses in humans. This paper aims to assess the association of markers for prenatal exposures with IDDM. Methods: We analysed data from two birth cohorts in Great Britain on 5214 cohort members from the National Child Development Study (NCDS) and 6068 members of the 1970 British Birth Cohort Study (BCS70) with full information on IDDM and explanatory variables using multivariate logistic regression. Results: IDDM prevalence was 0.7% (95% CI 0.5–1.0%; n=38) in the NCDS and 0.4% (95% CI 0.3–0.6%; n=27) in the BCS70 cohort. Paternal age was not associated with IDDM possibly due to lack of sample power. Unexpectedly, a lowered prevalence of IDDM was observed among offspring of smoking fathers in both cohorts, with a combined odds ratio of 0.44 (95% CI 0.25–0.75). This association could not be explained by maternal smoking prior to, during or after pregnancy, number of siblings, parental social class, maternal and paternal age, or cohort. Maternal smoking in pregnancy did not alter the IDDM prevalence among offspring. Conclusions: This unexpected finding may be explained by germ-line mutations or other mechanisms associated with paternal smoking. This phenomenon should be investigated and these results should not be used as a justification for smoking. Paternal exposures may be important in determining IDDM risk. [ABSTRACT FROM AUTHOR]

Analyze the diagnostic and prognostic value of the sFlt-1/PlGF ratio in pregnant women with at least one sign/symptom of suspected/diagnosed pre-eclampsia. This retrospective observational study included 170 pregnant women with at least one sign/symptom of pre-eclampsia, who had sFlt-1/PlGF ratio values. The following information was evaluated: pregnant women's demographic data and clinical history; laboratory data (urine protein/creatinine ratio; sFlt-1/PlGF ratio); signs and symptoms presented; clinical outcome; fetal complications; data related to childbirth. Statistical analysis was performed by R Software Version 3.5.2. Among the 170 patients, 78 presented pre-eclampsia. The median sFlt-1/PlGF ratio was significantly higher [143.1 (2.2–2,927.1)] for women who presented pre-eclampsia than for women without pre-eclampsia [33.5 (0.8–400.2)]. The negative predictive value of sFlt-1/PlGF ratio <38 was 83.9 % (95 % CI, 71.7–92.4 %) and the positive predictive value of sFlt-1/PlGF ratio >85 or 110 (for late onset pre-eclampsia) was 76.4 % (95 % CI, 66.2–84.8 %). sFlt-1/PlGF >85 or 110 was associated with pre-eclampsia clinical development, fetal complications, shorter gestational age at birth, higher number of caesarean deliveries and lower birth weight. The sFlt-1/PlGF ratio, together with the standard diagnostic criteria, can be used to rule out pre-eclampsia, identify high-risk patients and predict the occurrence of adverse outcomes. [ABSTRACT FROM AUTHOR]

Maternal death is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management. Maternal mortality (MM) and morbidity are a public health issue, with scarce knowledge on their levels and causes in low-income (LIC) countries. The data on MM and morbidity should rely on population-based studies which are non-existent. Therefore, maternal mortality ratio (MMR) estimates are based mostly on the mathematical models. MMR declined from 430 per 100,000 live births (LB) in 1990 to 211 in 2017. Absolute numbers of maternal deaths were 585,000 in 1990, 514,500 in 1995 and less than 300,000 nowadays. Regardless of reduction, MM remains neglected tragedy especially in LIC. Millennium Development Goals (MDGs) declared reduction MMR by three quarters between 2000 and 2015, which failed. Target of Sustainable Development Goals (SDGs) was to decrease MMR to 70 per 100,000 LB. Based on the data from the country report on SDGs in 10 countries with the highest absolute number of maternal deaths it can be concluded that the progress has not been made in reaching the targeted MMR. To reduce MMR, inequalities in access to and quality of reproductive, maternal, and newborn health care services should be addressed, together with strengthening health systems to respond to the needs and priorities of women and girls, ensuring accountability to improve quality of care and equity. [ABSTRACT FROM AUTHOR]

Background: The pandemic caused by the new coronavirus SARS-CoV-2 (Covid-19) is quite a challenging experience for the world. At the moment of birth, the fetus is prepared to face the challenge of labor and the exposure to the outside world, meaning that labor and birth represent the first extrauterine major exposure to a complex microbiota. The vagina, which is a canal for reproduction, is by evolution separated (but not far) from the anus and urethra. Passing through the birthing canal is a mechanism for intergenerational transmission of vaginal and gut microorganisms for the vertical transmission of microbiota not only from our mothers and grandmothers but also from earlier ancestors. Methods: Many national and international instructions have been developed since the beginning of the Covid-19 outbreak in January 2020 in Wuhan in China. All of them pointed out hygiene measures, social distancing and avoidance of social contacts as the most important epidemiological preventive measures. Pregnancy and neonatal periods are considered as high risk for Covid-19 infection. Results: The instructions defined the care for pregnant women in the delivery room, during a hospital stay and after discharge. The controversial procedures in the care of Covid-19-suspected or -positive asymptomatic women in labor were: mode of delivery, companion during birth and labor, skin-to-skin contact, breastfeeding, and visits during a hospital stay. Conclusion: There is a hope that instruction on coping with the coronavirus (Covid-19) infection in pregnancy with all proposed interventions affecting mothers, babies and families, besides saving lives, are beneficial and efficient by exerting no harm. [ABSTRACT FROM AUTHOR]

The onset of individual human life has fascinated thinkers of all cultures and epochs, and the history of their ideas may enlighten an unsettled debate. Aristotle attributed three different souls to the subsequent developmental stages. The last, the rational soul, was associated with the formed fetus, and entailed fetal movements. With some modifications, the concept of delayed ensoulment – at 30, 42, 60, or 90 days after conception – was adopted by several Christian Church Fathers and remained valid throughout the Middle Ages. The concept of immediate ensoulment at fertilization originated in the 15th century and became Catholic dogma in 1869. During the Enlightenment, philosophers began to replace the rational soul with the term personhood, basing the latter on self-consciousness. Biological reality suggests that personhood accrues slowly, not at a specific date during gestation. Requirements for personhood are present in the embryo, but not in the preembryo before implantation: anatomic substrate; no more totipotent cells; decreased rate of spontaneous loss. However, biological facts alone cannot determine the embryo's moral status. Societies must negotiate and decide the degree of protection of unborn humans. In the 21st century, fertilization, implantation, extrauterine viability and birth have become the most widely accepted landmarks of change in ontological status. [ABSTRACT FROM AUTHOR]

Introduction: The objective of this study was to evaluate the underlying causes of neonatal mortality (NNM) in midwife-attended home births and compare them to hospital births attended by a midwife or a physician in the United States (US). Methods: A retrospective cohort study of the Centers for Disease Control (CDC) linked birth/infant death data set (linked files) for 2008 through 2012 of singleton, term ( ≥ 37 weeks) births and normal newborn weights ( ≥ 2500 grams). Results: Midwife-attended home births had the highest rate of neonatal deaths [122/95,657 neonatal mortality (NNM) 12.75/10,000; relative risk (RR): 3.6, 95% confidence interval (CI) 3-4.4], followed by hospital physician births (8695/14,447,355 NNM 6.02/10,000; RR: 1.7 95% CI 1.6-1.9) and hospital midwife births (480/1,363,199 NNM 3.52/10,000 RR: 1). Among midwife-assisted home births, underlying causes attributed to labor and delivery caused 39.3% (48/122) of neonatal deaths (RR: 13.4; 95% CI 9-19.9) followed by 29.5% due to congenital anomalies (RR: 2.5; 95% CI 1.8-3.6), and 12.3% due to infections (RR: 4.5; 95% CI 2.5-8.1). Comment: There are significantly increased risks of neonatal deaths among midwife-attended home births associated with three underlying causes: labor and delivery issues, infections, and fetal malformations. This analysis of the causes of neonatal death in planned home birth shows that it is consistently riskier for newborns to deliver at home than at the hospital. Physicians, midwives, and other health care providers have a professional responsibility to share information about the clinical benefits and risks of clinical management. [ABSTRACT FROM AUTHOR]

Aims: There is a rapid rise in the male-to-female sex ratio at birth in Hong Kong, which coincides with the influx of Mainland Chinese mothers crossing the border to give birth in Hong Kong. Our objective is to explore the sex ratio patterns among Hong Kong Chinese and Mainland Chinese. Methods: Analysis of the statistics from Hong Kong public hospitals from 2003 to 2007. Results: For the 194,602 babies studied, 140,962 (72.4%) were eligible (Hong Kong Chinese) and 52,741 (27.1%) were non-eligible (Mainland Chinese). The overall sex ratio at birth (defined as males per 1000 females) was 1088; 1078 for eligible and 1116 for non-eligible. For eligible persons, the sex ratios were 1060 for parity 0, 1073 for parity 1 and 1184 for parity 2 or above. For non-eligible persons, the sex ratios were 1047 for parity 0, 1149 for parity 1 and 1745 for parity 2 or above. Non-eligible persons of parity 1 or above were more likely to have sons than eligible persons of same parity (P<0.000). Conclusion: We believe that the rapid rise of sex ratio in Hong Kong can be partly explained by the influx of Mainland Chinese who may have practiced sex selection more than Hong Kong Chinese. [ABSTRACT FROM AUTHOR]

Aim: To compare the perinatal outcome of grand multi-parous women (giving birth for the fifth to ninth time) and pauciparous (parity 2 to 4) women in the region of Flanders, Belgium.Methods: Population-based, retrospective, age-matched study.Results: 2832 grand multiparous women were compared with 2832 pauciparous women. In univariate analysis grand multiparous women showed more transverse lie, macrosomia, and fetal death and had less frequently epidural analgesia and episiotomy. Logistic regression demonstrated that grand multiparity was a significant factor contributing to fetal death and macrosomia.Conclusion: Grand multiparity is associated with fetal death and macrsomia in the region of Flanders, Belgium. [ABSTRACT FROM AUTHOR]

Aims: This study compares neonatal and maternal morbidity and mortality between waterbirths and landbirths (spontaneous singleton births in cephalic presentation, vacuum extractions are excluded). Methods: In this observational study covering nine years, standardized questionnaires were used to document 9,518 spontaneous singleton cephalic presentation births, of which 3,617 were waterbirths and 5,901 landbirths. Results: Landbirths show higher rates of episiotomies as well as third and fourth degree perineal lacerations. Waterbirths show a higher rate of births without injuries, first and seconddegree perineal lacerations, vaginal and labial tears. After a waterbirth, there is an average loss of 5.26 g/l blood; this is significantly less than landbirths where there is an 8.08 g/l blood loss on average. In 69.7% waterbirths required no analgesic, compared to 58.0% for landbirths. Water and landbirths do not differ with respect to maternal and neonatal infections. After landbirths, there was a higher rate of newborn complications with subsequent transfer to an external NICU. During the study, there were neither maternal nor neonatal deaths related to spontaneous labor. Conclusions: Waterbirths are associated with low risks for both mother and child when obstetrical guidelines are followed. [ABSTRACT FROM AUTHOR]