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We examined the physiological and metabolic responses of 24 active late pregnant women to 40 min of vigorous (95% ventilatory threshold) steady-state treadmill exercise followed by a metabolic perturbation [oral glucose tolerance test (OGTT), 75 g] after exercise. Heart rate and respiratory measures were taken throughout exercise, and blood samples were collected during exercise and every 30 min during the 2-h OGTT. Values were compared with those for a group of physically active nonpregnant women ( n = 16) in the luteal phase of the menstrual cycle. Although late pregnant women were heavier, they performed the same work rate (182 vs. 208 W, P > 0.05), with the same oxygen pulse, but responded to the exercise with a blunted heart rate and relative oxygen consumption, with less carbon dioxide expired, possibly due to pregnancy-related adaptations in heart efficiency. Resting glucose concentrations were the same between groups, but by 40 min of exercise (3.8 ± 0.1 vs. 4.6 ± 0.1 mmol/l) and into 15 min of recovery (4.3 ± 0.2 vs. 5.0 ± 0.1 mmol/l), glucose concentrations were diminished in late pregnant women ( P ≤ 0.05, respectively). The pregnancy-induced delay of glucose uptake was seen in response to the postexercise OGTT compared with the nonpregnant women, but insulin sensitivity (ISI) remained (7.4 ± 0.9 vs. 9.7 ± 1.4 ISI, P > 0.05, respectively), with the preservation of the sensitivity of lipolysis inhibition of nonesterified free fatty acids to insulin. These adaptations may be fetoprotective, because our research suggests that 40 min of continuous treadmill exercise is well tolerated by physically active pregnant women. No adverse effects on birth outcome (3.53 ± 0.08 kg birth weight; 39.6 ± 0.33 wk gestational age) were observed.

Menstrual toxic shock syndrome (TSS) is a serious illness that afflicts women of premenopausal age worldwide and arises from vaginal infection by Staphylococcus aureus and concurrent production of toxic shock syndrome toxin-1 (TSST-1). Studies have illustrated the capacity of lactobacilli to reduce S. aureus virulence, including the capacity to suppress TSST-1. We hypothesized that an aberrant microbiota characteristic of pathogenic bacteria would induce the increased production of TSST-1 and that this might represent a risk factor for the development of TSS. A S. aureus TSST-1 reporter strain was grown in the presence of vaginal swab contents collected from women with a clinically healthy vaginal status, women with an intermediate status, and those diagnosed with bacterial vaginosis (BV). Bacterial supernatant challenge assays were also performed to test the effects of aerobic vaginitis (AV)-associated pathogens toward TSST-1 production. While clinical samples from healthy and BV women suppressed toxin production, in vitro studies demonstrated that Streptococcus agalactiae and Enterococcus spp. significantly induced TSST-1 production, while some Lactobacillus spp. suppressed it. The findings suggest that women colonized by S. aureus and with AV, but not BV, may be more susceptible to menstrual TSS and would most benefit from prophylactic treatment.

Considering the maternal risk for both short- and long-term disability imposed by activity restriction, it is of great concern that the antepartum symptoms of bed rest are still evident in the postpartum period. The benefits of bed-rest-exercise may alleviate or even prevent physiological distresses or deconditioning associated with activity restriction, thus, eliminating or stabilizing, factors that may augment existing complications. This is the first study to investigate the feasibility of incorporating a bed-rest exercise program in a specific hospitalized twin pregnancy case. The maternal physiological responses of heart rate, blood pressure and uterine contractions to a four week bed-rest resistance program were measured in a woman hospitalized due to complications during her twin pregnancy. A second participant (same diagnoses) was included as a control. The bed-rest-exercise reduced the degree of swelling in the lower extremities, promoted more energy during the day and a better night’s sleep. There were no significant differences in uterine contractions pre vs. post protocol and all babies were born healthy.

Bacterial vaginosis (BV) is a common condition in women that represents an imbalance of the vaginal microflora, lactobacilli depletion, and excess growth of mainly anaerobic Gram-negative pathogens. Diagnosis is made using a series of tests or a Gram stain of a vaginal smear. Treatment with antibiotics is quite effective, but recurrences are common. A study of 55 vaginal samples from 11 postmenopausal women showed the presence of BV by the Gram stain-based Nugent scoring system, and polymerase chain reaction-denaturing gradient gel electrophoresis showed that Bacteroides or Prevotella species were the most common isolates recovered (24 of 25), with Escherichia coli, Staphylococcus aureus, and Streptococcus agalactiae also found in some samples. In one case, only Gardnerella vaginalis was found. These findings illustrate that BV remains common even among otherwise healthy women, but it is not caused solely by either Gardnerella or Mobiluncus. Use of a FemExam system (Cooper Surgical, Shelton, CT), based upon elevated pH and trimethylamine levels, to screen vaginal smears from 59 healthy women showed poor correlation with the Gram stain method. A randomized, placebo-controlled trial of these subjects showed that the lactobacilli-dominant microbiota was restored in subjects with BV but not in controls, following 2 months of daily oral intake of Lactobacillus rhamnosus GR-1 and Lactobacillus fermentum RC-14. These studies show that nucleic acid-based methods are effective at identifying bacteria responsible for BV. If such methods could be used to develop a commercially available, self-use kit, women would be much better placed to take control of their own health, for example, using medicinal food or dietary supplement products such as the clinically proven probiotic strains L. rhamnosus GR-1 and L. fermentum RC-14.

Many antibiotic monographs cite the induction of vaginal infections as a possible side effect. Invariably, this is believed to be due to Candida albicans, and empirical therapy is given. However, recent studies raise the question of the extent to which yeast do infect the host after antibiotic use. A double-blind, randomized, placebo-controlled study was undertaken on female patients to determine how many yeast infections occurred following 10 days antibiotic use. In addition, the study was designed to examine whether oral use of probiotic lactobacilli can reduce the risk of vaginal infection. Twenty four patients diagnosed with respiratory, oral or throat infections received one of several types of antibiotic for 10 days, and two capsules containing 10^9 dried Lactobacillus rhamnosus GR-1 and L. fermentum RC-14 from the day of commencement of antibiotic therapy for 21 days. The most commonly prescribed antibiotic was biaxin (clarithromycin). All but one patient had lactobacilli in the vagina upon entry to the study, and none developed yeast vaginitis or diarrhea during treatment or 20 days after completion of antibiotics. The mean Nugent score was higher in the placebo than the lactobacilli group (4.1 versus 2.4), and three cases of bacterial vaginosis arose (25% incidence compared to 0% in the lactobacilli group) in the placebo group (2 receiving cefuroxime, 1 on biaxin). The study suggested that current antibiotic use is not necessarily associated with either diarrhea or yeast infection, as is often surmised. Nevertheless, daily use of probiotics was safe and could potentially reduce the risk of patients developing bacterial vaginosis after antibiotic use.

We sequenced 16S rRNA genes from the vaginal swab contents of a postmenopausal woman with asymptomatic bacterial vaginosis (BV). Sequences from Atopobium vaginae were the most commonly detected. In a survey of 35 other postmenopausal women, this organism was detected in 44% with BV but not in any subjects deemed healthy.

RUCHAT, S.-M., M. H. DAVENPORT, I. GIROUX, M. HILLIER, A. BATADA, M. M. SOPPER, J. M. S. HAMMOND, and M. F. MOTTOLA. Nutrition and Exercise Reduce Excessive Weight Gain in Normal-Weight Pregnant Women. Med. Sci. Sports Exerc., Vol. 44, No. 8, pp. 1419–1426, 2012. Purpose: This study aimed to evaluate the effect of an exercise program of two different intensities, with nutritional control, on gestational weight gain (GWG), infant birth weight, and maternal weight retention at 2 months postpartum (2 mopp). Methods: Pregnant women (prepregnancy body mass index = 18.5–24.9 kgIm j2 ) were randomized at study entry (16–20 wk of gestation) to a low-intensity (LI, 30% HR reserve (HRR), n = 23) or moderate-intensity (MI, 70% HRR, n =2 6) exercise program, with nutritional control. The exercise program consisted of walking sessions three to four times per week, gradually increasing exercise time from 2 5t o 40 min per session. Forty-five normal -weight women who did not participate in any structured exercise program during pregnancy and had singleton births were used as a historical control group. Results :T otal GWG was higher in the control group (18.3 T 5.3 kg) compared with the LI (15.3 T 2.9 kg, P = 0.01) and MI (14.9 T 3.8 kg, P =0 .003) groups. During the intervention, GWG was similar in both intervention groups, with weekly rates of weight gain of 0.49 T 0.1 and 0.47 T 0.1 kgIwk j1 in the LI and MI groups, respectively. Excessive GWG during the intervention was prevented in 70% of the women in the LI group and 77% of those in the MI group. Excessive GWG occurred before the intervention began. At 2 mopp, 18% and 28% of the women in the LI and MI groups, respectively, retained e2.0 kg compared with only 7% of those in the control group. Infant birth weight was not different between the groups. Conclusions: Results suggest that a prenatal nutrition and exercise program regardless of exercise intensity, reduced excessive GWG and decreased weight retention at 2 mopp in women of normal weight before

This feasibility study investigated the response of maternal heart rate, blood pressure, and uterine contractions to a 30-min bed-rest exercise session (while listening to music) in hospitalized women with varying diagnoses of high-risk pregnancy. Eleven antenatal women who were hospitalized for activity restriction were assigned randomly to either a bed-rest exercise and music group (n = 6) or a bed-rest and music group (n = 5) that involved no exercise. The key findings were that there were no changes in maternal blood pressure or in the number of uterine contractions following the exercise intervention. A supervised bed-rest exercise intervention may, therefore, provide minimal risks and help alleviate the physiological effects of hospital activity restriction.

To study the feasibility of using electronic medical record (EMR) data from the Deliver Primary Healthcare Information (DELPHI) database to measure quality of care for patients with congestive heart failure (CHF) in primary care and to determine the percentage of patients with CHF receiving the recommended care.Items listed on the Ontario Ministry of Health and Long-Term Care Heart Failure Patient Care Flow Sheet (CHF flow sheet) were assessed and measured using EMRs of patients diagnosed with CHF between October 1, 2005, and September 30, 2008.Ten primary health care practices in southwestern Ontario.Four hundred eighty-eight patients who were considered to have CHF because at least 1 of the following was indicated in their EMRs: an International Classification of Diseases billing code for CHF (category 428), an International Classification of Primary Care diagnosis code for heart failure (ie, K77), or "CHF" reported on the problem list.Number of CHF flow sheet items that were measurable using EMR data from the DELPHI database. Percentage of patients with CHF receiving required quality-of-care items since the date of diagnosis.The DELPHI database contained information on 60 (65.9%) of the 91 items identified using the CHF flow sheet. The recommended tests and procedures were recorded infrequently: 55.5% of patients with CHF had chest radiographs; 32.6% had electrocardiograms; 32.2% had echocardiograms; 30.5% were prescribed angiotensin-converting enzyme inhibitors; 20.9% were prescribed β-blockers; and 15.8% were prescribed angiotensin II receptor blockers.Low frequencies of recommended care items for patients with CHF were recorded in the EMR. Physicians explained that CHF care was documented in areas of the EMR that contained patient identifiers, such as the encounter notes, and was therefore not part of the DELPHI database. Extractable information from the EMR does not provide a complete picture of the quality of care provided to patients with CHF.

Overweight (body mass index [BMI] ≥25.0 to 29.9 kg·m−2) (41) and obesity (BMI ≥30.0 kg·m−2) (41) have been identified as major public health issues because the prevalence of obesity has been increasing worldwide at an alarming rate (13). Excess weight gain during gestation and failure to lose that weight after pregnancy are identifiable predictors of long-term obesity, cardiovascular disease, and type 2 diabetes (13,34). Over-weight (OW) mothers experiencing weight retention also start their next pregnancy with a higher early rate of weight gain (29). Excessive weight gain during pregnancy places women at higher risk for pregnancy-induced hypertension (32) and gestational diabetes mellitus (5). Total weight gain recommended for OW pregnant women is 7–11.5 kg (20), with a suggested weight gain in the first trimester of 0.91 kg (18). For obese (OB) women, the total weight gain during pregnancy recommended is at least 6 kg (20), with no upper limit of gain. Many researchers use 11.5 kg as the upper limit in assessing excessive weight gain for OB pregnant women because this is the same upper recommendation for OW women (6,12,36). Maternal weight gain and prepregnancy BMI have been positively correlated with birth weight (19). Maternal obesity is an independent risk factor for macrosomic infants (birth weight >4.0 kg) (4), perhaps imparting more risk for large babies than for glucose intolerance (19). Large babies are at greater risk for obesity later in life, together with related comorbidities, such as type 2 diabetes (30). Statistics shows that children of OB mothers are twice as likely to be large for gestational age at birth and that large for gestational age babies are more likely to be OB preschoolers (19). The direct influence of the fetal environment on lifelong health and the risk of chronic disease (8,30) cannot be ignored because it has been suggested that many intrauterine influences can be transmitted to the next generation nongenetically, and thus many of these modifiable undesired effects may be reversed and prevented (22). Pregnancy-related obesity can lead to a lifetime of unhealthy weight for the mother and her family. These concerns are reflected in the recent opinion statement from the American College of Obstetricians and Gynecologists on obesity during pregnancy, which recommends aggressive preventative management in all OW and OB women before conception, during pregnancy, and after delivery (3). This strong opinion reinforces the idea that a practical solution for obesity prevention in both mother and offspring may lie with the study of evidence-based interventions that are viable in the real world but conducted with scientific rigor (26) to promote long-term participation and effective knowledge translation. Unfortunately, there are very few studies reporting success in the prevention of excessive weight gain because of an intervention program specifically designed for OW or OB pregnant women. The purpose of the present study was to investigate the effects of a combined Nutrition and Exercise Lifestyle Intervention Program (NELIP) on pregnancy weight gain, birth weight, and weight retention early postpartum in OW and OB women. We defined excessive gestational weight gain on NELIP as >10.6 kg because we subtracted 0.91 kg (the recommended weight gain for first trimester) from the maximum total weight gain recommended (11.5 kg) for OW and OB women, which coincides with our intervention time frame during pregnancy. It was hypothesized that NELIP would prevent excessive pregnancy weight gain (≤10.6 kg) and minimize weight retention at 2 months postpartum. To determine whether OW women respond differently or similarly to OB women placed on the same intervention (NELIP), participants with a prepregnancy BMI of ≥25.0 to 29.9 kg·m−2 (OW) were compared with those women with a prepregnancy BMI of ≥30.0 kg·m−2 (OB). For comparative purposes, to form a matched historical cohort (MC) group, we collected hospital and birth record information at random from a large local perinatal database of women screened for chronic disease and delivering singleton births, who matched our intervention women by prepregnant BMI, maternal age, and parity during this same time frame.

The aim of the study was to investigate gene expression profiles of post-menopausal women receiving Premarin estrogen replacement therapy (ERT), compared to controls, and to examine any correlations between the bacterial vaginosis (BV) status of the subjects. Based upon an expected finding of a 50-60% difference between gene expression of host antimicrobials with alpha=0.05 (2-sided), beta=0.20 the calculation of 7 subjects per group, led to a sample size of 10 subjects receiving Premarin estrogen replacement therapy and 10 healthy, age-matched controls. Vaginal samples were collected at a single timepoint and processed for RNA recovery and Affymetrix array analysis, as well as Nugent scoring and denaturing gradient gel electrophoresis to identify bacteria. Lactobacillus iners was the most commonly detected species in the normal flora and this was confirmed with L. iners-specific PCR method. Vaginal swabs from 6 Premarin and 8 control vaginal samples provided a non-invasive means to analyze human gene expression. There was no significant up-regulation of cancer-associated gene expression in subject receiving Premarin ERT, but some evidence that the potentially protective innate immunity was reduced in patients with BV. Of those with a normal flora, there was a 2-fold down-regulation of carcinoma associated forkhead box A1 gene expression. BV was associated with 7-fold down-regulation of host antimicrobial colony stimulating factor, -9.83-fold for IL-1alpha, -8.33 for IL-1beta and -3.63 for IL-6. This is the first study to use gene arrays to correlate changes in host expression response to estrogen replacement therapy and BV.

w c m r t ( p h aiting lists for medical care are associated with motional distress (Hamilton, Hamilton & Mayo, 996; Leddy, Kaldenbert & Becker, 2003) as well as hysical suffering (Mahon, Bourne, Rorabeck, Feeny, titt, & Webster-Bogaert 2002; Sampalis, Boukas, iberman, Reid, Dupuis, 2001; Screeche-Powell & wen, 2003; Walsh, Bruce, Bennington, & Ravi, 2002). or women, being placed on a waiting list for tubal igation may also lead to an increased risk of uninended pregnancy. This is an objective failure of health ervices to meet women’s health and reproductive eeds, and in fact, increases their health risks. The incidence of pregnancy for women who coneive while waiting for tubal ligation is underestiated. Published studies only report women pregant on the day of their procedure, excluding women ho become pregnant while waiting either for consulation or tubal ligation. Reported incidences of pregancy on the day of tubal ligation range from 1.4–17 in ,000 women (Chi & Feldblum, 1981; Chi, Siemens, hampion, Gates & Cilenti, 1987; Lipscomb, Spellman Ling, 1993; Loffer & Pent, 1980; Trias, Anderson, jeda & Oberle, 1987). One group from the Netherands had a pregnancy rate of 32–45 per 1,000 women, ith a waiting time for tubal ligation of 2 years Arntzen & Skjeldestad, 1991). Harms of prolonged waiting time for tubal ligation nclude not only those related to contraceptive failure nd unintended pregnancy, but also harms secondary

Objectives: A study was conducted to use new molecular technologies to identify the vaginal bacterial species of postmenopausal women under oral estrogen therapy (Premarin-conjugated equine estrogen, CEE). Study design: Nineteen postmenopausal women under CEE treatment were recruited and their vaginal flora were analyzed during 3 months, using polymerase chain reaction in combination with denaturing gradient gel electrophoresis (DGGE) and sequencing of DNA fragments. Results: Sixty-eight percent of the women presented with a ‘Normal’ Nugent score at the first sampling time (d0). All the subjects had bacterial species detected in their vaginal flora. Lactobacillus species were detected in all samples. Moreover, 53% of the women had lactobacilli exclusively at d0. Two Lactobacillus species were dominant, and were recovered from the majority of samples ( L. iners and L. crispatus ). Forty-four percent of the samples also contained other bacterial species, which were potential urogenital pathogens. Candida albicans was detected in 26% of the subjects. The vaginal flora of the women under CEE treatment were different from that of postmenopausal women not receiving hormone therapy, but very similar to premenopausal women. Conclusions: The present study indicates that one benefit from hormone replacement therapy (HRT) is the restoration of a lactobacilli vaginal flora associated with a protective effect against urogenital infections.