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Kinds of Trimester Terms modified by Trimester Selected AbstractsScreening Strategies for Group B Streptococcus in the Third Trimester of PregnancyJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 12 2002APRN-BC, FAANP, Lorna Schumann PhD Purpose To identify the best screening protocol to prevent neonatal group B streptococcal (GBS) sepsis through literature review. Data Sources Selected research articles, texts, and Internet sources. Conclusions Centers for Disease Control and Prevention (CDC), American Academy of Pediatrics (AAP), American College of Obstetricians and Gynecologists (ACOG), and American College of Nurse Midwives (ACNM) have issued guidelines describing methods to identify pregnant women at risk of intrapartum transmission of GBS to their babies. Studies have been conducted to discover the superiority of one prevention method over the other but no consensus has been reached. Implications for Practice Before widely used prevention methods, approximately 8,000 babies each year became infected with GBS; of those, 400 died and many survivors suffered life-long sequelae. Adoption of an appropriate protocol can prevent transmission of GBS from a colonized mother to her infant. Clinicians should implement either universal culture-based or risk factor-based screening guidelines for prenatal diagnosis and intrapartum prophylaxis of GBS disease. [source] Thrombophilic Gene Mutations and Recurrent Spontaneous Abortion: Prothrombin Mutation Increases the Risk in the First TrimesterAMERICAN JOURNAL OF REPRODUCTIVE IMMUNOLOGY, Issue 2 2001Rudolf Pihusch PROBLEM: Thrombophilic predisposition may be one of the underlying causes of recurrent spontaneous abortions (RSA). We studied the prevalence of five thrombophilic gene mutations in patients with RSA. METHOD OF STUDY: 102 patients with two or more consecutive abortions and 128 women without miscarriage were analyzed for factor V Leiden mutation (FVL), prothrombin G20210A mutation (PTM), C677T mutation in the 5,10-methylenetetrahydrofolate reductase (MTHFR) gene, glycoprotein IIIa (GPIIIa) C1565T polymorphism, and ,-fibrinogen G-455A polymorphism by polymerase chain reaction (PCR) techniques. RESULTS: No differences in the prevalence of FVL, MTHFR T/T, GPIIIa and ,-fibrinogen polymorphism were detected. Heterozygous PTM occurred more often in patients with RSA. This effect was significant in a subgroup with abortions exclusively in the first trimester (6.7% vs. 0.8%, P=0.027, OR 8.5). CONCLUSIONS: In contrast to the other mutations and polymorphisms, heterozygous PTM is more common in patients with abortions in the first trimester. This might reflect an influence of PTM on pathogenesis of early pregnancy loss. [source] Hyperthermia in utero due to maternal influenza is an environmental risk factor for schizophreniaCONGENITAL ANOMALIES, Issue 3 2007Marshall J. Edwards ABSTRACT A hypothesis is presented that the association between maternal influenza and other causes of fever during the second trimester of pregnancy and the subsequent development of schizophrenia in the child is due to the damage caused by hyperthermia to the developing amygdalohippocampal complex and associated structures in the fetal brain. Hyperthermia is a known cause of congenital defects of the central nervous system and other organs after sufficiently severe exposures during early organogenesis. The pathogenic mechanisms include death of actively dividing neuroblasts, disruption of cell migration and arborization and vascular damage. In experimental studies, hyperthermia during later stages of central nervous system development also caused damage to the developing brainstem that was associated with functional defects. This damage usually results in hypoplasia of the parts undergoing active development at the time of exposure. Recent studies have shown no evidence of direct invasion of the fetus by the influenza virus. Factors that might interact with hyperthermia include familial liability to schizophrenia, season of birth, maternal nutrition, severe stress and medications used to alleviate the symptoms of fevers. The time of the development of the fetal amygdalohippocampal complex and the changes found in its structure and associated areas of the brain are compatible with the known effects of hyperthermia. [source] Assessment of gestational age and neuromaturationDEVELOPMENTAL DISABILITIES RESEARCH REVIEW, Issue 1 2005Marilee C. Allen Abstract Neuromaturation is the functional development of the central nervous system (CNS). It is by its very nature a dynamic process, a continuous interaction between the genome and first the intrauterine environment, then the extrauterine environment. Understanding neuromaturation and being able to measure it is fundamental to infant neurodevelopmental assessment. Fetal and preterm neuromaturation has become easier to observe with the advent of prenatal ultrasonography and neonatal intensive care units. A number of measures of degree of fetal maturation have been developed and used to estimate gestational age (GA) at birth. The most reliable measures of GA are prenatal measures, especially from the first trimester. Postnatal GA measurements tend to be least accurate at the extremes of gestation, that is, in extremely preterm and post-term infants. Observations of measures of neuromaturation in infants born to mothers with pregnancy complications, including intrauterine growth restriction, multiple gestation, and chronic hypertension, have led to the discovery that stressed pregnancies may accelerate fetal pulmonary and CNS maturation. This acceleration of neuromaturation does not occur before 30 weeks' gestation and has a cost with respect to cognitive limitations manifested in childhood. The ability to measure fetal and preterm neuromaturation provides an assessment of neurodevelopmental progress that can be used to reassure parents or identify at risk infants who would benefit from limited comprehensive follow-up and early intervention services. In addition, measures of neuromaturation have the potential to provide insight into mechanisms of CNS injury and recovery, much-needed early feedback in intervention or treatment trials and a measure of early CNS function for research into the relationships between CNS structure and function. © 2005 Wiley-Liss, Inc. MRDD Research Reviews 2005;11:21,33. [source] Stroke in the developing brain and intractable epilepsy: effect of timing on hippocampal sclerosisDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 9 2003Waney Squier FRCP FRC Path A detailed study was made of the pathology of specimens removed by hemispherectomy for the treatment of intractable epilepsy in children with unilateral middle cerebral artery stroke. Neuropathological criteria were used to differentiate strokes that occurred in early intrauterine development (before 28 weeks gestational age) from those occurring in the last trimester, at birth, or after birth: 19 children had early strokes and 21 late. There was no difference in seizure history or occurrence of febrile convulsions in these two groups. Hippocampal tissue was available in 20 patients; pathology in the hippocampus, remote from the infarcted area, showed a marked difference between early-onset and late-onset groups. Hippocampal sclerosis was uncommon in children with early-onset strokes but developed in most of the children whose strokes were of later origin. However, hippocampal sclerosis was more closely related to a clinical history of a late initial precipitating insult irrespective of infarct timing. These findings demonstrate the changing vulnerability of the developing brain and show that hippocampal pathology is more closely related to the timing of an insult than seizure history or the occurrence of febrile convulsions. [source] Effects of iodine supplementation during pregnancy on child growth and development at school ageDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 2 2002Karen J O'Donnell MEd PhD Growth and development of 207 children (49% males; mean age 5.4 years [SD 0.2], range 4 to 7.3 years whose mothers received iodine during pregnancy, and children who received iodine first in their 2nd year, were examined in 1996; 192 children(49% males; mean age 6.5 years[SD 0.2], range 5.8 to 6.9 years) whose mothers received iodine while pregnant were seen in 1998. Children were from the southern part of China's Xinjiang Province which has the lowest levels of iodine in water and soil ever recorded. Head circumference but not height was improved for those who received iodine during pregnancy (compared with those receiving iodine at age 2) and for those supplemented before the end of the 2nd trimester (relative to those supplemented during the 3rd trimester). Iodine before the 3rd trimester predicted higher psychomotor test scores for children relative to those provided iodine later in pregnancy or at 2 years. Results from the test for cognitive development resulted in trend only differences between those children supplemented during pregnancy versus later. The results address the question of when maternal iodine supplements should begin in public health programs world wide. Findings may be relevant to the treatment of maternal and newborn thyroid deficiency in industrialized countries, particularly for those infants delivered before the end of the second trimester. [source] MR imaging methods for assessing fetal brain developmentDEVELOPMENTAL NEUROBIOLOGY, Issue 6 2008Mary Rutherford Abstract Fetal magnetic resonance imaging provides an ideal tool for investigating growth and development of the brain in vivo. Current imaging methods have been hampered by fetal motion but recent advances in image acquisition can produce high signal to noise, high resolution 3-dimensional datasets suitable for objective quantification by state of the art post acquisition computer programs. Continuing development of imaging techniques will allow a unique insight into the developing brain, more specifically process of cell migration, axonal pathway formation, and cortical maturation. Accurate quantification of these developmental processes in the normal fetus will allow us to identify subtle deviations from normal during the second and third trimester of pregnancy either in the compromised fetus or in infants born prematurely. © 2008 Wiley Periodicals, Inc. Develop Neurobiol, 2008 [source] Effects of excessive glucocorticoid receptor stimulation during early gestation on psychomotor and social behavior in the rat ,DEVELOPMENTAL PSYCHOBIOLOGY, Issue 2 2010Karine Kleinhaus Abstract Severe psychological stress in the first trimester of pregnancy increases the risk of schizophrenia in the offspring. To begin to investigate the role of glucocorticoid receptors in this association, we determined the effects of the glucocorticoid dexamethasone (2,mg/kg), administered to pregnant rats on gestation days 6,8, on maternal behaviors and schizophrenia-relevant behaviors in the offspring. Dams receiving dexamethasone exhibited increased milk ejection bouts during nursing. Offspring of dexamethasone-treated dams (DEX) showed decreased juvenile social play and a blunted acoustic startle reflex in adolescence and adulthood, effects that were predicted by frequency of milk ejections in the dams. DEX offspring also showed increased prepulse inhibition of startle and reduced amphetamine-induced motor activity, effects not correlated with maternal behavior. It is postulated that over-stimulation of receptors targeted by glucocorticoids in the placenta or other maternal tissues during early gestation can lead to psychomotor and social behavioral deficits in the offspring. Moreover, some of these deficits may be mediated by alterations in postnatal maternal behavior and physiology produced by early gestational exposure to excess glucocorticoids. © 2010 Wiley Periodicals, Inc. Dev Psychobiol 52:121,132, 2010 [source] Intra-individual variability in infancy: Structure, stability, and nutritional correlatesDEVELOPMENTAL PSYCHOBIOLOGY, Issue 3 2008Theodore D. Wachs Abstract Intra-individual variability (IIV) refers to relatively stable differences between individuals in the degree to which they show behavioral fluctuations over relatively short time periods. Using temperament as a conceptual framework the structure, stability, and biological roots of IIV were assessed over the first year of life. Biological roots were defined by maternal and infant nutrition. The sample was 249 Peruvian neonates, followed from the second trimester of pregnancy through the first 12 months of life. Maternal anthropometry, diet, iron status, and fetal growth were assessed prenatally. Neonatal anthropometry and iron status were assessed at birth. Degree of exclusive breastfeeding was assessed at 3 and 6 months, infant anthropometry was assessed at 3, 6, and 12 months, infant dietary intake was assessed at 6 and 12 months and infant iron status was tested at 12 months. Individual differences in IIV at 3, 6, and 12 months were derived from a residual standard deviation score based on infant behaviors measured using the Louisville Temperament Assessment Procedure. Principal components analysis indicated that individual differences in IIV were defined by two components at 3, 6, and 12 months. There was modest stability between IIV components assessed at 3 and 12 months. Reduced levels of IIV at 3 months were predicted by higher maternal weight and higher fetal weight gains in the first and second trimesters of pregnancy. Higher levels of IIV at 3 months were predicted by higher levels of maternal hemoglobin during pregnancy and higher levels of neonatal ferritin. © 2008 Wiley Periodicals, Inc. Dev Psychobiol 50: 217,231, 2008. [source] Sex differences in juvenile rhesus macaque (Macaca mulatta) agonistic screams: Life history differences and effects of prenatal androgensDEVELOPMENTAL PSYCHOBIOLOGY, Issue 4 2005Michelle L. Tomaszycki Abstract This study investigated sex differences in juvenile rhesus macaque (Macaca mulatta) vocal behavior during agonistic contexts, and the effects of prenatal androgens on these differences. A total of 59 subjects (5,8 per treatment group) received exogenous androgen (testosterone enanthate), an anti-androgen (flutamide) or vehicle injections (DMSO) for 30 or 35 days during the second (early) or third (late) trimester of pregnancy. An additional 19 unmanipulated controls were included in the analysis. Screams by juvenile males and females between the ages of 1 and 3 years were compared to the screams of adult female exemplars using a discriminant function analysis. Juvenile females produced more adult-female like screams than did juvenile males. Females exposed to androgen treatment late in gestation produced a more masculine pattern of screams. Flutamide treatment in males either early or late in gestation did not significantly affect scream production. Flutamide treatments in females late in gestation, however, masculinized scream production. Androgen treatments administered late in gestation hyper-masculinized male scream production. No sex differences in the contextual usage of screams emerged. These findings suggest that both life history differences and the early hormone environment contribute to sex differences in juvenile rhesus macaque vocal production. © 2005 Wiley Periodicals, Inc. Dev Psychobiol 47: 318,327, 2005. [source] Maternal exposure to first-trimester sunshine is associated with increased birth weight in human infantsDEVELOPMENTAL PSYCHOBIOLOGY, Issue 4 2004Karen Tustin Abstract Two alternative hypotheses have been generated to account for seasonal variation in the birth weight of human infants born in industrialized countries. First, it has been hypothesized that low ambient temperature during the second trimester of gestation decreases birth weight. Second, it has been hypothesized that exposure to bright sunshine during the first trimester increases birth weight. We tested these two hypotheses to determine which, if either, accounted for seasonal variation in birth weight of full-term infants. Birth weight data, collected over a 5-year period, were analyzed as a function of peak and trough sunshine and ambient temperature. Although there was no effect of ambient temperature during any trimester on birth weight, infants whose mothers were exposed to peak sunshine during their first trimester were born significantly heavier than infants whose mothers experienced trough levels of sunshine during the same trimester. Furthermore, infants whose mothers were exposed to trough levels of sunshine during their second and third trimesters were born significantly heavier than infants whose mothers were exposed to peak levels of sunshine during the same trimesters. We hypothesize that high levels of sunshine during early gestation may increase the level of insulin-like growth factor (IGF)-1, facilitating prenatal growth. © 2004 Wiley Periodicals, Inc. Dev Psychobiol 45: 221,230, 2004. [source] Fetal cyclic motor activity in diabetic pregnancies: Sensitivity to maternal blood glucoseDEVELOPMENTAL PSYCHOBIOLOGY, Issue 1 2003Steven S. Robertson Abstract Spontaneous fetal movement in the last third of human gestation is dominated by irregular oscillations on a scale of minutes (cyclic motility, CM). The core properties of these oscillations are stable during the third trimester of gestation in normal fetuses, but disrupted by poorly controlled maternal diabetes. Here we investigated whether fetal CM is linked to short-term instabilities in maternal glucose metabolism. The fetuses of 40 mothers with type I (n,=,28) or gestational (n,=,12) diabetes were studied one to six times between 27 and 40 postmenstrual weeks of gestation. Fetal movement and maternal blood glucose concentration were measured during two separate periods of fetal activity in each session. Fetal CM was quantified with spectral analysis. Early in the third trimester, changes in the rate of oscillation in fetal CM between the two periods of activity were inversely related to changes in maternal blood glucose levels. Fetal CM was unrelated to concurrent maternal blood glucose levels at any point in the third trimester. The pattern of results suggests that disruption of the temporal organization of spontaneous fetal motor activity in pregnancies complicated by maternal diabetes represents an acute response to fluctuations in the metabolic environment rather than an alteration of CM development. © 2003 Wiley Periodicals, Inc. Dev Psychobiol 42: 9,16, 2003. [source] Maturation of fetal responses to musicDEVELOPMENTAL SCIENCE, Issue 5 2004B.S. Kisilevsky Maturation of fetal response to music was characterized over the last trimester of pregnancy using a 5-minute piano recording of Brahms' Lullaby, played at an average of 95, 100, 105 or 110 dB (A). Within 30 seconds of the onset of the music, the youngest fetuses (28,32 weeks GA) showed a heart rate increase limited to the two highest dB levels; over gestation, the threshold level decreased and a response shift from acceleration to deceleration was observed for the lower dB levels, indicating attention to the stimulus. Over 5 minutes of music, fetuses older than 33 weeks GA showed a sustained increase in heart rate; body movement changes occurred at 35 weeks GA. These findings suggest a change in processing of complex sounds at around 33 weeks GA, with responding limited to the acoustic properties of the signal in younger fetuses but attention playing a role in older fetuses. [source] Severe hypoglycaemia during pregnancy in women with Type 1 diabetes is common and planning pregnancy does not decrease the riskDIABETIC MEDICINE, Issue 8 2009H. Robertson Abstract Aims, The aim of this study was to identify risk factors for severe hypoglycaemia (SH) in pregnancy in Type 1 diabetes, including associations with pregnancy planning and glycaemic control. Methods, Clinical data including details of the pregnancy and its outcome, glycaemic control, frequency of SH and evidence of pregnancy planning were collected prospectively as part of a national audit of 160 pregnancies in women with Type 1 diabetes. Results, An episode of SH was experienced by 29.4% of women at some point during the pregnancy, with the percentage of women experiencing SH decreasing from 21.9% in the first trimester to 18.1% in trimester 2 and 10.9% in trimester 3. Longer duration of diabetes was associated with increased frequency of SH during pregnancy (r = 0.191, P = 0.012). A greater fall in glycated haemoglobin (HbA1c) between pre-pregnancy and the first trimester was not associated with increased risk of SH in trimester 1. Planned pregnancies had better glycaemic control but higher risk of SH in trimester 1 (P = 0.047). Women with pre-pregnancy retinopathy and current smokers had an increased risk of SH in trimester 3 (P = 0.029, P = 0.033). Conclusions, SH is common during pregnancy and particularly in the first trimester. Planning pregnancy does not decrease the risk of SH. Improvements in glycaemic control at the start of pregnancy do not appear to increase the risk of SH. Education of women and their partners about the risks of SH and its management is essential when planning pregnancy. [source] First-trimester fetal heart rate in mothers with opioid addictionADDICTION, Issue 7 2010Maximilian Schmid ABSTRACT Aim To investigate the difference in fetal heart rate of opioid-dependent mothers compared to non-dependent mothers in the first trimester of pregnancy. Design The data of 74 consecutive singleton pregnancies of mothers enrolled in a maintenance programme for opioid-dependent women was matched to 74 non-exposed singleton pregnancies by maternal age, crown,rump length, smoking status, ethnic background and mode of conception. Measurement Fetal heart rate measured as part of first-trimester screening by Doppler ultrasound between 11+0 and 13+6 gestational weeks was compared retrospectively. Findings The mean fetal heart rate in opioid-dependent mothers was 156.0 beats per minute (standard deviation 7.3) compared to 159.6 (6.5) in controls. The difference in fetal heart rate was significant (P = 0.02). There was a significant difference in mean maternal body mass index (P = 0.01) but not in mean nuchal translucency (P = 0.3), gestational age (0.5), fetal gender (P = 0.3) and parity (P = 0.3) between both groups. Fifty-five per cent (41 of 74) of cases were taking methadone, 30% (22 of 74) buprenorphine and 15% (11 of 74) were taking slow-release morphines throughout the pregnancy. Conclusions In fetuses of opioid-dependent mothers a decreased fetal heart rate can already be observed between 11+0 and 13+6 gestational weeks. The effect of opioid intake needs to be taken into consideration when interpreting fetal heart rate in opioid-dependent mothers at first-trimester screening. [source] Evidence of a complex association between dose, pattern and timing of prenatal alcohol exposure and child behaviour problemsADDICTION, Issue 1 2010Colleen M. O'Leary ABSTRACT Background There is a lack of evidence regarding the effect of dose, pattern and timing of prenatal alcohol exposure and behaviour problems in children aged 2 years and older. Methods A 10% random sample of women delivering a live infant in Western Australia (1995,96) were invited to participate in an 8-year longitudinal survey (78% response rate n = 2224); 85% were followed-up at 2 years, 73% at 5 years and 61% at 8 years. Alcohol consumption was classified by combining the overall dose, dose per occasion and frequency to reflect realistic drinking patterns. Longitudinal analysis was conducted using generalized estimating equations (GEE) to investigate the association between child behaviour as measured by the Child Behaviour Checklist at 2, 5 and 8 years of age and prenatal alcohol exposure collected 3 months postpartum for each trimester separately, adjusting for a wide range of confounding factors. Results Low levels of prenatal alcohol were not associated with child behaviour problems. There were increased odds of internalizing behaviour problems following heavy alcohol exposure in the first trimester; anxiety/depression [adjusted odds ratio (aOR) 2.82; 95% confidence interval (CI) 1.07,7.43] and somatic complaints (aOR 2.74; 95% CI 1.47,5.12) and moderate levels of alcohol exposure increased the odds of anxiety/depression (aOR 2.24; 95% CI 1.16,4.34). Conclusions Prenatal alcohol exposure at moderate and higher levels increased the odds of child behaviour problems with the dose, pattern and timing of exposure affecting the type of behaviour problems expressed. Larger studies with more power are needed to confirm these findings. [source] Management issues for women with epilepsy,Focus on pregnancy (an evidence-based review): II.EPILEPSIA, Issue 5 2009Teratogenesis, perinatal outcomes Summary A committee assembled by the American Academy of Neurology (AAN) reassessed the evidence related to the care of women with epilepsy (WWE) during pregnancy, including antiepileptic drug (AED) teratogenicity and adverse perinatal outcomes. It is highly probable that intrauterine first-trimester valproate (VPA) exposure has higher risk of major congenital malformations (MCMs) compared to carbamazepine (CBZ), and possibly compared to phenytoin (PHT) or lamotrigine (LTG). It is probable that VPA as part of polytherapy and possible that VPA as monotherapy contribute to the development of MCMs. AED polytherapy probably contributes to the development of MCMs and reduced cognitive outcomes compared to monotherapy. Intrauterine exposure to VPA monotherapy probably reduces cognitive outcomes and monotherapy exposure to PHT or phenobarbital (PB) possibly reduces cognitive outcomes. Neonates of WWE taking AEDs probably have an increased risk of being small for gestational age and possibly have an increased risk of a 1-minute Apgar score of <7. If possible, avoidance of VPA and AED polytherapy during the first trimester of pregnancy should be considered to decrease the risk of MCMs. If possible, avoidance of VPA and AED polytherapy throughout pregnancy should be considered and avoidance of PHT and PB throughout pregnancy may be considered to prevent reduced cognitive outcomes. [source] Changes in the Disposition of Oxcarbazepine and Its Metabolites during Pregnancy and the PuerperiumEPILEPSIA, Issue 3 2006Iolanda Mazzucchelli Summary:,Purpose: To determine potential changes in the plasma concentrations of oxcarbazepine (OXC) and its metabolites during pregnancy and puerperium. Methods: Five women receiving OXC monotherapy were followed prospectively during pregnancy and the puerperium. Four women were enrolled in the first trimester, and one woman, 2 weeks before delivery. Steady-state concentrations of OXC, its active R -(-)- and S -(+)-monohydroxy derivatives (MHD), and the additional metabolite carbamazepine-10,11- trans -dihydrodiol (DHD) were measured at regular intervals by an enantioselective HPLC assay. Results. In all samples, S -(+)-MHD was the most abundant compound in plasma and accounted almost entirely for the amount of active moiety (defined as the molar sum of OXC, R -(-)-MHD, and S -(+)-MHD) found in the circulation. The dose-normalized concentrations of active moiety decreased markedly during gestation and, in four of the five patients, increased strikingly after delivery. Plasma concentrations of S -(+)-MHD mirrored closely the levels of the active moiety. Plasma concentrations of the parent drug and other metabolites also tended to decrease during pregnancy and to increase after delivery. Conclusions: During treatment with OXC, S -(+)-MHD is by far the most abundant active compound in plasma. The concentration of this metabolite as well as the active moiety may decrease markedly during pregnancy and may increase severalfold after delivery. Because of these striking pharmacokinetic changes, the clinical response should be monitored closely in OXC-treated women throughout pregnancy and the puerperium. [source] Teratogenic Effects of Antiepileptic Drugs: Use of an International Database on Malformations and Drug Exposure (MADRE)EPILEPSIA, Issue 11 2000Carla Arpino Summary: Purpose: The study goal was to assess teratogenic effects of antiepileptic drugs (AEDs) through the use of a surveillance system (MADRE) of infants with malformations. Methods: Information on all malformed infants (1990,1996) with maternal first-trimester drug exposure was collected by the International Clearinghouse for Birth Defects and Monitoring Systems (ICBDMS). Cases were defined as infants presenting with a specific malformation, and controls were defined as infants presenting with any other birth defect. Exposure was defined by the use of AEDs during the first trimester of pregnancy. The association of AEDs with malformations was then estimated by calculating the odds ratios with 95% confidence intervals and testing their homogeneity among registries. Results: Among 8005 cases of malformations, 299 infants were exposed in utero to AEDs. Of those exposed to monotherapy, 65 were exposed to phenobarbital, 10 to methylphenobarbital, 80 to valproic acid, 46 to carbamazepine, 24 to phenytoin, and 16 to other AEDs. Associations were found for spina bifida with valproic acid. Infants exposed to phenobarbital and to methylphenobarbital showed an increased risk of oral clefts. Cardiac malformations were found to be associated with phenobarbital, methylphenobarbital, valproic acid, and carbamazepine. Hypospadias was associated with valproic acid. Porencephaly and other specified anomalies of brain, anomalies of face, coarctation of aorta, and limb reduction defects were found to be associated with valproic acid. Conclusions: Using the MADRE system, we confirmed known teratogenic effects of AEDs. We also found increased risks for malformations that had never been reported associated with AEDs or for which the association was suggested by case reports. [source] Pregnancy outcome in congenital dyserythropoietic anemia type IEUROPEAN JOURNAL OF HAEMATOLOGY, Issue 4 2008Hanna Shalev Abstract Objectives:, Congenital dyserythropoietic anemia type I (CDA I) is a rare inherited disease characterized by moderate to severe macrocytic anemia and abnormal erythroid precursors with nuclear chromatin bridges and spongy heterochromatin. Moderate to severe maternal anemia is a recognized independent risk factor for low birth weight (LBW) and complicated delivery. The aim of the study was to review the outcome of pregnancies in women with CDA I. Methods:, The clinical and laboratory records of 28 spontaneous pregnancies in six Bedouin women with CDA I were reviewed. The results were compared with findings from a retrospective review of a large population-based registry including all pregnancies in Bedouin women during the same 15-yr period. Results:, Eighteen pregnancies in women with CDA I (64%) were complicated. One pregnancy was aborted spontaneously in the first trimester and one resulted in a non-viable fetus (stillborn at 26 wk). Cesarean section (CS) was performed in 10 pregnancies (36%). Eleven of the 26 newborns (42%) had a LBW: six were born prematurely and five were small for gestational age. The odds ratio for CS in women with CDA I compared with healthy Bedouin women was 4.5 [95% confidence interval (CI) 1.2,10.3], and for a LBW infant, 5.5 (95% CI 2.4,12.3). Careful follow-up was associated with significantly better fetal outcome (P = 0.05). Conclusions:, Pregnancies in women with CDA I are at high risk for delivery-related and outcome complications. To improve fetal outcome, women with CDA I should be carefully monitored during pregnancy. [source] Safety of rituximab therapy during the first trimester of pregnancy: a case historyEUROPEAN JOURNAL OF HAEMATOLOGY, Issue 4 2004Eva Kimby Abstract: The optimal treatment of non-Hodgkin's lymphoma (NHL) during pregnancy is currently undefined. The potential teratogenic effects of conventional chemotherapy preclude its use during the first trimester of pregnancy. We report the case of a pregnant woman with relapsed indolent follicular NHL who was treated with rituximab (unintentionally) during the first trimester. The treatment stabilised the disease. Following an uncomplicated pregnancy, a healthy child was born at full term and careful haematological and immunological monitoring has revealed no adverse effects resulting from exposure to rituximab. Data of using rituximab during pregnancy are scarce, but the present case shows that rituximab may be one option for treatment of NHL in early pregnancy. [source] A single institutional experience with 43 pregnancies in essential thrombocythemiaEUROPEAN JOURNAL OF HAEMATOLOGY, Issue 3 2001Curtis A. Wright Abstract: Objectives: We describe the periconception circumstances and outcome of 43 consecutive pregnancies in an unselected group of young women with essential thrombocythemia (ET). Patients and methods: We retrospectively studied 74 consecutive cases of young women with ET seen at our institution, among whom 43 pregnancies occurred in 20 patients. Results: Of the 43 pregnancies, 22 (51%) were successful (21 term and 1 preterm live births) and 21 (49%) ended in miscarriages (1 ectopic pregnancy, 2 elective abortions, 16 first-trimester spontaneous abortions, 1 stillbirth at 22 wk, and 1 abruptio placentae at 33 wk). Management of ET at the time of conception included either no specific therapy (16 cases) or the use of aspirin alone (24 cases), a cytoreductive agent (2 cases), or heparin (1 case). There were no significant differences with respect to platelet count or the effect of treatment with aspirin, either at the time of conception or during the first trimester, among cases of successful pregnancies (22), all miscarriages (21), or first-trimester spontaneous abortions (16). The findings were similar when the analysis was restricted to only first-time pregnancies. In patients with multiple pregnancies, the outcome of a subsequent pregnancy was not predicted by the outcome of the first. In general, in successful cases the last two trimesters were mostly uneventful, with healthy offspring being reported in all cases. Conclusions: Pregnant patients with ET have an increased risk of first-trimester abortion which is not predictable by preconception platelet count or aspirin therapy. In addition, our experience does not support the use of prophylactic platelet apheresis during delivery. [source] Effects of supra-physiological changes in human ovarian hormone levels on maximum force production of the first dorsal interosseus muscleEXPERIMENTAL PHYSIOLOGY, Issue 2 2005Kirsty Jayne Elliott The purpose of this study was to investigate the effects of supra-physiological changes in ovarian hormone levels on maximum force production in two conditions, one physiological (pregnancy) and one pseudo-physiological (in vitro fertilization (IVF) treatment). Forty IVF patients were tested at four distinct stages of treatment and 35 women were tested during each trimester of pregnancy and following parturition. Maximum voluntary isometric force per unit cross-sectional area of the first dorsal interosseus muscle was measured. Plasma concentrations of total and bioavailable oestradiol and testosterone were measured, in addition to the total concentrations of progesterone and human chorionic gonadotropin. Despite significant changes in the concentrations of total progesterone, 17,-oestradiol, bioavailable oestradiol and testosterone between phases, strength did not change significantly throughout IVF treatment (1.30 ± 0.29, 1.16 ± 0.38, 1.20 ± 0.29 and 1.26 ± 0.34 N mm,2, respectively, in the 4 phases of IVF treatment). Force production was significantly higher during the second trimester of pregnancy than following childbirth (1.33 ± 0.20 N mm,2 at week 12 of pregnancy, 1.51 ± 0.42 N mm,2 at week 20, 1.15 ± 0.26 N mm,2 at week 36 and 0.94 ± 0.31 N mm,2 at week 6 postnatal) but was not significantly correlated with any of the hormones measured. These data suggest that extreme changes in the concentrations of reproductive hormones do not affect the maximum force-generating capacity of young women. [source] Ginger as an antiemetic for women in the first trimester of pregnancy?FOCUS ON ALTERNATIVE AND COMPLEMENTARY THERAPIES AN EVIDENCE-BASED APPROACH, Issue 1 2003Article first published online: 14 JUN 2010 [source] Human fetal radial glia cells generate oligodendrocytes in vitroGLIA, Issue 5 2009Zhicheng Mo Abstract Limited knowledge about human oligodendrogenesis prompted us to explore the lineage relationship between cortical radial glia (RG) cells and oligodendrocytes (OLs) in the human fetal forebrain. RG cells were isolated from cortical ventricular/subventricular zone and their progeny was followed in vitro. One portion of RG cells differentiated into cells of OL lineage identified by cell-type specific antibodies, including platelet-derived growth factor receptor-alpha (PDGFR,), NG2, O4, myelin basic protein, and myelin oligodendrocyte glycoprotein. Moreover, using Cre Lox fate mapping (brain lipid binding protein-Cre/Floxed-yellow fluorescent protein) we established a direct link between RG cells and OL progenitors. In vitro generation of RG-derived O4+ OL progenitors was enhanced by addition of sonic hedgehog (SHH) and reduced by the SHH inhibitor, cyclopamine, suggesting the role of SHH signaling in this process. In summary, our in vitro experiments revealed that a portion of cortical RG cells isolated from human forebrain at the second trimester of gestation generates OL progenitors and this suggests a role of SHH in this process. © 2008 Wiley-Liss, Inc. [source] Lopinavir protein binding in HIV-1-infected pregnant womenHIV MEDICINE, Issue 4 2010FT Aweeka Background Pregnancy may alter protein binding (PB) of highly bound protease inhibitors due to changes in plasma concentrations of albumin and ,-1 acid glycoprotein (AAG). Small changes in PB can greatly impact the fraction of drug unbound (FU) exerting pharmacological effect. We report lopinavir (LPV) PB during third trimester (antepartum, AP) compared to ,1.7 weeks postpartum (PP) to determine if FU changes compensate for reduced total concentrations reported previously. Methods P1026s enrolled women receiving LPV/ritonavir, soft gel capsules 400/100 mg or 533/133 mg twice daily. LPV FU, albumin and AAG were determined AP and PP. Results AP/PP samples were available from 29/25 women respectively with all but one woman receiving the same dose AP/PP. LPV FU was increased 18% AP vs. PP (mean 0.96±0.16% AP vs. 0.82±0.21% PP, P=0.001). Mean protein concentrations were reduced AP (AAG=477 mg/L; albumin=3.28 mg/dL) vs. PP (AAG=1007 mg/L; albumin=3.85 mg/dL) (P<0.0001 for each comparison). AAG concentration correlated with LPV binding. Total LPV concentration did not correlate with LPV FU AP or PP. However, higher LPV concentration PP was associated with reduced PB and higher FU after adjustment for AAG. Conclusions LPV FU was higher and AAG lower AP vs. PP. The 18% increase in LPV FU AP is smaller than the reduction in total LPV concentration reported previously and is not of sufficient magnitude to eliminate the need for an increased dose during pregnancy. [source] Pregnancy, but not the allergic status, influences spontaneous and induced interleukin-1, (IL-1,), IL-6, IL-10 and IL-12 responsesIMMUNOLOGY, Issue 1 2006Petra Amoudruz Summary In this study, we investigated how pregnancy influences cytokine production in response to stimulation of the innate and the adaptive immune system, respectively. Peripheral blood mononuclear cells (PBMCs) from allergic (n = 44) and non-allergic (n = 36) women were collected at three time-points: during the third trimester, at delivery and at a non-pregnant state 2 years after delivery. The production of interleukin-1, (IL-1,), IL-6, IL-10 and IL-12 was measured by enzyme-linked immunosorbent assay (ELISA) or enzyme-linked immunospot assay (ELISPOT). The spontaneous cytokine production, and the response following stimulation with agents that primarily activate the adaptive part of the immune system [phytohaemagglutinin (PHA), allergen extracts from cat and birch], or lipopolysaccharide (LPS) that activate innate immunity was measured in vitro. There was a significantly higher spontaneous in vitro production of IL-1,, IL-6 and IL-10 by PBMCs during pregnancy than 2 years after pregnancy, and this was not affected by the allergic status of the women. Conversely, in PHA-stimulated cell cultures there was a lower production of IL-10 and IL-12 during pregnancy than 2 years after pregnancy. LPS-induced IL-6 levels were significantly lower in PBMCs obtained during pregnancy than at 2 years after pregnancy. In addition, we made the interesting observation that in allergic women total immunoglobulin E (IgE) levels were significantly lower 2 years after pregnancy compared to the levels during pregnancy. Taken together, our results indicate that while atopic allergy in women does not have a substantial effect on cytokine production, pregnancy has an obvious effect on the immune system in terms of cytokine production as well as on the total IgE levels. [source] Prenatal Maternal Anxiety and Depression Predict Negative Behavioral Reactivity in InfancyINFANCY, Issue 3 2004Elysia Poggi Davis The effects of maternal antenatal and postnatal anxiety and depression on infant negative behavioral reactivity were examined in a sample of 22 mother-infant pairs. Maternal anxiety and depression were assessed by standardized measures during the third trimester of pregnancy and postpartum. Infant negative behavioral responses to novelty were assessed using a previously validated measure at 4 months of age. Maternal anxiety and depression during the prenatal, but not the postnatal period, were related to infant negative behavioral reactivity to novelty. These data illustrate that prenatal maternal psychological state can exert persisting influences on human infant behavior. [source] Understanding the "ghosts in the nursery" of pregnant women experiencing domestic violence: Prenatal maternal representations and histories of childhood maltreatment,INFANT MENTAL HEALTH JOURNAL, Issue 4 2010Johanna C. Malone Selma Fraiberg and colleagues (1975) conceptualized the "ghosts in the nursery" as experiences from a mother's past that influenced her ability to form a warm and attuned relationship with her child. Contemporary infant mental health interventions often ask the mother to reflect on her own history of attachment relationships to gain insight into as well as to strengthen her developing relationship with her child. This study investigated the association between a mother's history of childhood maltreatment (CM) and her subsequent prenatal maternal representation during the third trimester of pregnancy. Controlling for domestic violence (DV), distorted prenatal representations were associated with higher rates of self-reported childhood physical neglect. In addition, DV moderated the relationship between representations and CM, such that women who were exposed to DV during pregnancy and had distorted prenatal representations were least likely to report childhood physical and sexual abuse. Implications are discussed in relation to infant mental health interventions which rely on a parent's ability to psychologically access and reflect on childhood histories to more sensitively parent her own child. Selma Fraiberg y colegas (1975) definió el concepto de "fantasmas en el cuarto de los niños" como experiencias del pasado de las madres que ejercen influencia en la habilidad de ella para formarse una cálida y afinada relación con su infante. A menudo, las intervenciones contemporáneas de la salud mental infantil les piden a las madres que reflexionen sobre su propia historia de relaciones afectivas con el fin de lograr un mejor conocimiento y al mismo tiempo hacer más fuerte la relación que están desarrollando con sus hijos. Este estudio investigó la asociación entre la historia de una madre que tuvo una niñez llena de maltratos (CM) y su subsiguiente representación maternal prenatal durante el tercer trimestre del embarazo. Considerando por medio del experimento de control la variable de la violencia doméstica, (DV), las representaciones prenatales distorsionadas se asociaron con puntajes más altos de la auto-reportada negligencia física en la niñez. Es más, la violencia doméstica (DV) sirvió para moderar la relación entre las representaciones y el maltrato en la niñez (CM), a tal punto de que las mujeres que habían estado expuestas a la violencia doméstica (DV) durante el embarazo y tenían representaciones prenatales distorsionadas fueron las menos propensas a reportar el abuso físico y sexual en la niñez. Se discuten las implicaciones en relación con las intervenciones de la salud mental infantil que dependen de la habilidad de la madre de acceder a y reflexionar sobre sus historias de la niñez, sicológicamente, con el fin de criar a su propio infante con una mayor sensibilidad. Selma Fraiberg et collègues (1975) conceptualisa les "fantômes dans la crèche" en tant qu'expériences d'un passé de la mère qui ont influencé sa capacité à former une relation chaleureuse et sensible avec son enfant. Les interventions contemporaines de santé mentale du nourrisson demandent souvent à la mère de faire un effort de réflexion sur sa propre histoire de relations d'attachement afin d'arriver à mieux connaître sa relation qui se développe avec son enfant, et aussi de la renforcer. Cette étude s'est penchée sur l'association entre l'histoire de maltraitance durant l'enfance de la mère (abrégé CM en anglais) et sa représentation maternelle prénatale ultérieure durant le troisième trimestre de la grossesse. Avec un contrôle pour la violence conjugale (abrégée DV en anglais), les représentations prénatales déformées étaient liées à des taux plus élevés de négligence physique durant l'enfance auto-rapportées. De plus, la violence conjugale (DV) modérait la relation entre les représentations et la maltraitance durant l'enfance (CM), d'une telle manière que les femmes qui ont été exposées à la violence conjugale (DV) durant la grossesse et qui faisaient preuve de représentations prénatales déformées étaient les moins à même de signaler une maltraitance physique et des abus sexuels. Les implications sont discutées en relation aux interventions de santé mentale du nourrisson qui reposent que la capacité d'un parent à accéder psychologiquement aux histoires de son enfance et à y réfléchir de fa,on à élever son propre enfant de plus sensiblement. Selma Fraiberg und Kollegen (1975) konzeptualisiert die "Gespenster im Kinderzimmer", als Erfahrungen aus der Vergangenheit der Mutter, die ihre Fähigkeit, eine warme und angemessene Beziehung zu ihrem Kind aufzubauen. Zeitgemäße Interventionen der seelische Gesundheit von Kleinkindern fragen Mütter oft nach ihrer eigenen Geschichte von Bindungsbeziehungen, um einen Einblick zu bekommen, damit die sich entwickelnde Beziehung zu ihrem Kind gestärkt werden kann. Die vorliegende Studie untersuchte den Zusammenhang zwischen mütterlichen Misshandlungserfahrungen (CM) und deren späteren Schilderungen im dritten Trimenon ihrer eigenen Schwangerschaft. Maßgeblich für häusliche Gewalt (DV) war eine verzerrte Darstellung, die mit einer höheren Rate von selbst berichteter körperlicher Verwahrlosung assoziiert war. Darüber hinaus beeinflusste DV die Beziehung zwischen den Vorstellungen und den CM, so dass Frauen, die während der Schwangerschaft DV ausgesetzt waren, und verzerrten Darstellungen hatten mit großer Wahrscheinlichkeit von körperlichen und sexuellen Missbrauch berichteten. Die Auswirkungen werden in Bezug auf Interventionen der psychischen Gesundheit von Kindern diskutiert, die die elterliche Fähigkeit, psychologische Zusammenhänge zu verstehen und darüber hinaus zu Reflexion über die eigenen Kindheitsgeschichten anregen, damit die Eltern sensibler auf ihr eigenes Kind reagieren können. [source] Caregiving behavior and interactions of prenatally depressed mothers (antidepressant-treated and non-antidepressant-treated) during newborn acute pain,INFANT MENTAL HEALTH JOURNAL, Issue 4 2009Fay F. Warnock This exploratory study aimed to examine time-based measures of the behaviors and interactions of prenatally depressed serotonin reuptake inhibitors (SRI)-medicated mothers to their infant's pain (n = 10) by comparing them with similar measures obtained from prenatally depressed nonmedicated mothers and their infants (n = 10), and nondepressed mothers and their infants (n = 10). During the second trimester of their pregnancy, the 30 study mothers were assessed for depression and anxiety, with no further measures of maternal mood taken. Maternal and infant interactions were continuously videorecorded while the infant underwent a scheduled heel lance for routine blood screening that occurred when study infants were between the ages of 24 and 60 hr. Maternal behavior and infant cry, for all 30 cases, were coded second-by-second for the full duration of each infant's heel lance using a reliable coding system and analyzed using odds ratio and regression analyses. Infants exposed to prenatal SRIs and depressed maternal mood were more likely to have lower Apgar scores and to exhibit weak and absent cry. Even when duration of the heel lance was controlled for, women with depression during the second trimester were more likely to exhibit depressed behavior at 2 days' postpartum despite sustained SRI antidepressant treatment. Both groups of prenatally depressed mothers were more likely to exhibit diminished response to their infants' pain cue although nonmedicated mothers' expressions of depressed behavior were more similar to healthy controls. Comprehensive understanding is essential to optimize the clinical care of mothers and their infants in this complex setting. This study contributes preliminary new findings that warrant prospective and longitudinal studies to clarify further the impacts of prenatal SRI and maternal mental mood (e.g., chronic depression and anxiety) effects on the mother,infant interaction and infant pain and stress reactivity. [source] | |||||||||||||||||||||||||||||||||||||