RESUMEN

BACKGROUND: PM2.5 is a complex mixture, with water-soluble inorganic ions (WSII), mainly NH4+, SO42-, and NO3-, constituting major components. Early-life PM2.5 exposure has been shown to induce adverse health consequence but it is difficult to determine whether such an effect occurs prenatally (preconception, gestational) or postnatally in human studies. METHODS: Four groups of C57BL/6 J mice were assigned to four exposure conditions: PM2.5 NO3-, PM2.5 SO42-, PM2.5 NH4+ and clean air, and exposure started at 4 weeks old. At 8 weeks old, mice bred within group. The exposure continued during gestation. After delivery, both the maternal and F1 mice (offspring) were kept in clean air without exposure to PM2.5. Respiratory function and pulmonary pathology were assessed in offspring mice at 8 weeks of age. In parallel, placenta tissue was collected for transcriptome profiling and mechanistic investigation. RESULTS: F1 mice in PM2.5 NH4+, SO42- and NO3- groups had 32.2 % (p=6.0e-10), 30.3 % (p=3.8e-10) and 16.9 % (p=5.7e-8) lower peak expiratory flow (PEF) than the clean air group. Importantly, the exposure-induced lung function decline was greater in male than female offspring. Moreover, exposure to PM2.5 WSII before conception and during gestation was linked to increased airway wall thickness and elevated pulmonary neutrophil and macrophage counts in the offspring mice. At the molecular level, the exposure significantly disrupted gene expression in the placenta, affecting crucial functional pathways related to sex hormone response and inflammation. CONCLUSIONS: PM2.5 WSII exposure during preconception and gestational period alone without post-natal exposure substantially impacted offspring's respiratory function as measured at adolescent age. Our results support the paradigm of fetal origin of environmentally associated chronic lung disease and highlight sex differences in susceptibility to air pollution exposure.

RESUMEN

PURPOSE: The purpose of this study was to conduct a pre-conception care program for women of childbearing age with inflammatory bowel disease (IBD) in Korea and verify its effects on self-efficacy for IBD management, IBD-related pregnancy knowledge, and IBD-related pregnancy anxiety. It also aimed to explore the changes in participants through the program. METHODS: A convergent mixed-methods study design was adopted. In the quantitative phase, 35 women (17 and 18 in the intervention and control group, respectively) participated. The intervention group attended a program that included small-group sessions and individual tele-coaching. To confirm the effects, data were collected before and one and four weeks after the intervention. In the qualitative stage, focus group interviews and tele-coaching were conducted with the intervention group. RESULTS: After the program ended, significant differences were observed over time between the intervention and control groups for self-efficacy for IBD management (Wald χ² = 4.41, p = .036), IBD-related pregnancy knowledge (Wald χ² = 13.80, p < .001) and IBD-related pregnancy anxiety (Wald χ² = 8.61, p = .003). Qualitative data analysis revealed the following themes: (1) improving confidence in IBD management and awareness for planned pregnancy; (2) improving IBD awareness related to pregnancy and childbirth; and (3) relieving anxiety about and actively facing pregnancy. CONCLUSION: This study is meaningful in that, to the best of our knowledge, it is the first to develop a pre-conception care program for women diagnosed with IBD and confirm its effectiveness. Furthermore, this program is expected to be suitable for patient counseling and education in clinical practice.

Asunto(s)

RESUMEN

BACKGROUND:  Understanding the intersection of epilepsy and pregnancy, including knowledge gaps and healthcare access for women with epilepsy (WWE), is critical. This study evaluated WWE knowledge gaps and information needs concerning epilepsy's impact on their sexual and reproductive health during pregnancy and examined healthcare system factors affecting their access to information, aiming to identify areas for improvement in educational and healthcare strategies to enhance health management for WWE. METHODS:  From July 2022 to June 2023, 111 WWE aged 18 to 40 years were recruited from the family medicine and internal medicine outpatient departments at Steve Biko Academic Hospital, Tembisa Tertiary Hospital (TTH), and Kalafong Hospital. Interviews assessed various aspects related to epilepsy in pregnancy and contraceptive use. RESULTS:  The study found strong links between WWE, their demographics, and their awareness of pregnancy-related epilepsy issues. Participants from TTH showed notably higher awareness (85.5%) of risks from epilepsy and AED during pregnancy (p  0.05). Age and education significantly influenced pregnancy planning and understanding of medication risks. Younger women (20-25 years) were more inclined towards future pregnancies, and those with more education were better informed about medication risks (p  0.05); and 68.5% had received counselling on AED and contraceptive interactions, yet only 16.2% knew AED could reduce contraceptive effectiveness. CONCLUSION:  The study reveals significant knowledge gaps in WWE regarding the impact of epilepsy and AED on pregnancy, suggesting tailored educational and counselling initiatives to improve WWE health outcomes and quality of life, advancing chronic disease management and public health objectives.Contribution: The study highlights substantial knowledge gaps in epilepsy during pregnancy among WWE, urging tailored counselling and information to empower informed decisions.

Asunto(s)

RESUMEN

As scientific research progresses, there is an increasing understanding of the importance of paternal epigenetics in influencing the health and developmental path of offspring. Prior to conception, the environmental exposures and lifestyle choices of fathers can significantly influence the epigenetic state of sperm, including DNA methylation and histone changes, among other factors. These alterations in epigenetic patterns have the potential for transgenerational transmission potential and may exert profound effects on the biological characteristics of descendants. Paternal epigenetic changes not only affect the regulation of gene expression patterns in offspring but also increase the risk to certain diseases. It is crucial to comprehend the conditions that fathers are exposed to before conception and the potential outcomes of these conditions. This understanding is essential for assessing personal reproductive decisions and anticipating health risks for future generations. This review article systematically summarizes and analyzes current research findings regarding how paternal pre-pregnancy exposures influence offspring as well as elucidates underlying mechanisms, aiming to provide a comprehensive perspective for an enhanced understanding of the impact that paternal factors have on offspring health.

RESUMEN

Maternal adiposity (overweight or obesity) has been associated with adverse perinatal outcomes, although the potential risks of long-term neuropsychiatric and behavioral outcomes in the offspring remain unclear. Using the PRISMA guidelines, we searched PubMed, EMBASE, Scopus, and Web of Science to identify studies on maternal adiposity and offspring neuropsychiatric outcomes. Inverse variance-weighted random-effects meta-analyses were used to pool effect estimates with 95 % confidence intervals (95 % CIs) from adjusted odds ratios (OR) and hazard ratios (HR). Estimates were computed separately for preconception and pregnancy maternal overweight and obesity, with outcomes stratified by the type of neuropsychiatric outcome. In our meta-analyses of 42 epidemiological studies involving 3,680,937 mother-offspring pairs, we found increased risks of ADHD [OR=1.57, 95 % CI: 1.42-1.74], autism spectrum disorder [OR=1.42, 95 % CI: 1.22-1.65], conduct disorder [OR=1.16, 95 % CI: 1.00-1.35], Psychotic disorder [HR=1.61, 95 % CI: 1.41-1.83], externalizing behaviors [OR=1.30, 95 % CI: 1.07-1.56] and peer relationship problems [OR=1.25, 95 % CI: 1.04-1.27] in the offspring of preconception obese mothers. Similar increased risks were found in the offspring of preconception overweight mothers and those exposed to maternal adiposity during pregnancy. However, no association was found with offspring mood, anxiety, personality, eating, sleep disorders or prosocial problems. Preconception weight management may mitigate such adverse effects in the offspring.

RESUMEN

BACKGROUND: Despite increasing evidence of a strong correlation between air pollution and otitis media (OM), the impact of early-life ozone (O3) exposure on the development of OM in children remains uncertain. OBJECTIVES: To explore the connection between early-life O3 exposure and OM, and to identify the critical time period(s) during which O3 exposure significantly influences the development of OM in children. METHODS: We conducted a study involving 8689 children living in Changsha, China. Information regarding personal factors, health conditions, and the indoor environment was gathered using questionnaires. Personal exposure to outdoor O3 and other major pollutants at the place of residence during the periods before conception, prenatal periods, and after birth was calculated by applying the inverse distance weighted (IDW) method with data gathered from ten air quality monitoring stations. Multiple logistic regression analyses were employed to investigate the associations between O3 exposure and children's OM. RESULTS: After controlling for covariates and ambient temperature, exposure to O3 during the year preceding pregnancy was correlated with childhood lifetime OM, showing ORs (95 % CI) of 1.28 (1.01-1.64). O3 exposures in the 10th-12th, 7th-9th, and 4th-6th months before pregnancy were all linked to children's lifetime OM. Within the multi-window model, we detected that O3 exposure in the 10th to 12th month prior to pregnancy was significantly related to lifetime OM, showing ORs (95 % CI) of 1.28 (1.05-1.55). A significant link was discovered between childhood OM and O3 exposure after controlling for six other pollutants (SO2, PM2.5, NO2, PM2.5-10, CO, and PM10) during the 10th to 12th month prior to conception. Exposure to O3 during the 36th gestational week significantly raised the likelihood of childhood lifetime OM. There is a significant interaction between O3 and temperature exposure during the first trimester of pregnancy and one year before pregnancy on childhood lifetime OM. CONCLUSIONS: Preconceptional O3 exposure and its interaction with low temperature played critical roles in children's OM development, backing the hypothesis of "(pre) fetal origins of childhood OM".

RESUMEN

BACKGROUND: With the trend toward late marriages and late childbearing, cryopreservation of oocytes for fertility preservation is attracting attention as a method to counteract the declining birthrate. OBJECTIVES: To examine the impact of social oocyte cryopreservation on local communities by assessing the significance of government assistance for cryofreezing and capturing the participants' subsequent feelings regarding this assistance. DESIGN: Descriptive study. METHODS: A prospective study was conducted on city-dwelling women <35 years old attending monthly seminars on oocyte retrieval/cryopreservation to whom the study concept was explained. Egg collection and storage management costs were free for 3 years after the project completed, and subsequent actual storage costs were borne by the individuals. After oocyte retrieval, we conducted a questionnaire on oocyte cryopreservation and administrative assistance. RESULTS: Of the 62 seminar participants, 2 became pregnant naturally without oocyte retrieval. Oocytes were retrieved in 34 women (average age: 32.8 years, number of oocytes obtained: 8.3), among whom 4 subsequently became pregnant and gave birth through natural pregnancy or artificial insemination, and 1 became pregnant and gave birth using frozen oocytes. In a follow-up questionnaire given to these 34 subjects, all responded that they were glad to have oocyte cryopreservation, but 23 subjects (67.6%) answered that they could not perform cryopreservation without financial assistance. Twenty-five participants (73.5%) wanted to try to conceive without using frozen oocytes as a post-cryopreservation plan. CONCLUSIONS: As a countermeasure against the declining birthrate, oocyte cryopreservation and associated workshops that can provide the information and education needed to conduct this task in a "planned" manner may be useful in providing women with additional reproductive options. Financial assistance will also be required to offer this service to the women who need it.

Women benefit when egg freezing is subsidized by local municipalitiesWhy was the study done? To prospectively examine the significance of egg freezing in a society in which the declining birthrate is an issue, particularly with regard to those who wish to undergo egg freezing and their trends when it is supported by the government. What did the researchers do? This project was conducted as a three-year endowed course by a local city government. Participants were women aged 20 to 34 who lived in the city and were recruited through the city's newsletter and website. They then attended a fertility workshop that was held once a month. Participants who wished to freeze their eggs were offered one free egg retrieval and three years of frozen storage. Participants were also asked to complete a questionnaire about their progress three years after the project ended. What did the researchers find? Sixty-two women participated in the three-year project, of whom 34 chose to freeze their eggs. Those who did not plan to conceive early, and two conceived naturally. Of those who froze their eggs, only one gave birth using the frozen eggs, and seven conceived naturally or through fertility treatments without using frozen eggs, two of whom had two pregnancies, resulting in 10 children being born. What do the findings mean? Three years after the project ended, the findings suggested that egg freezing itself may not have had a significant effect on pregnancy and childbirth but that holding workshops on fertility may have acted as an incentive for women to become pregnant and give birth.

Asunto(s)

RESUMEN

Introduction: The prevalence of underweight in women of reproductive age (WRA) in South Asia remains unacceptably high. Underweight women suffer from lowered immunity, infertility, and a risk of developing non-communicable diseases. In pregnancy, undernutrition results in poor neonatal and maternal outcomes. We present the findings and the management strategy of undernutrition in the preconception and pregnancy phase intervention group in the WING study in low- to lower-middle-income neighborhoods of North India. Methods: We analyzed data from the Women and Infants Integrated Interventions for Growth Study (WINGS) intervention group. In this individually randomized factorial design trial, 13,500 women were enrolled from low to middle-income neighborhoods of Delhi: 6,722 women in the preconception group and 2,640 from the pregnancy group. Food supplements in the form of locally prepared snacks were given to provide necessary calories and protein requirements as per the Body mass index (BMI) during the preconception period and each trimester of pregnancy. The snacks (sweet or savory) and milk or egg as a source of high-quality protein were delivered at home, and intakes were observed. Individual tracking and close monthly monitoring were done for compliance, besides screening and treatment of infections. Results: The enrolled women's mean (SD) age was 24.2 (3.1) years. Approximately 35% of women had a height of < 150 cm, and 50% had schooling >12 years. 17% of women in preconception and 14 % in pregnancy intervention groups were Underweight. Approximately two-thirds of underweight women improved 9-12 months after management in the preconception group, and the same proportion improved 4 weeks after management during pregnancy. The proportion of women with inadequate weight gain (IWG) during pregnancy was higher in women who were underweight during preconception. Discussion: A comprehensive approach to managing undernutrition with high-quality energy-dense food supplementation substantially improved weight gain in women during preconception and pregnancy. Clinical trial registration: http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=19339%26EncHid=%26userName=societyforappliedstudies, identifier: Clinical Trial Registry India #CTRI/2017/06/008908.

Asunto(s)

RESUMEN

Background: Prior research has linked exposure to particulate matter with an aerodynamic diameter of ≤2.5 µm (PM2.5) with preterm birth (PTB). However, the modulating effect of preconception thyroid stimulating hormone (TSH) levels on the relationship between PM2.5 exposure and PTB has not been investigated. Objective: This study aimed to assess whether preconception TSH levels modulate the impact of PM2.5 exposure on PTB. Methods: This cohort study was conducted in Guangdong, China, as a part of the National Free Pre-Pregnancy Checkups Project. PM2.5 exposure was estimated by using the inverse distance weighting method. To investigate the moderating effects of TSH levels on trimester-specific PM2.5 exposure and PTB, we used the Cox proportional hazards model. Additionally, to identify the susceptible exposure windows for weekly specific PM2.5 exposure and PTB, we built distributed lag models incorporating Cox proportional hazards models. Results: A total of 633,516 women who delivered between January 1, 2014, to December 31, 2019, were included. In total, 34,081 (5.4%) of them had abnormal preconception TSH levels. During the entire pregnancy, each 10-µg/m3 increase in PM2.5 was linked to elevated risks of PTB (hazard ratio [HR] 1.559, 95% CI 1.390-1.748), early PTB (HR 1.559, 95% CI 1.227-1.980), and late PTB (HR 1.571, 95% CI 1.379-1.791) among women with abnormal TSH levels. For women with normal preconception TSH levels, PM2.5 exposure during the entire pregnancy was positively associated with the risk of PTB (HR 1.345, 95% CI 1.307-1.385), early PTB (HR 1.203, 95% CI 1.126-1.285), and late PTB (HR 1.386, 95% CI 1.342-1432). The critical susceptible exposure windows were the 3rd-13th and 28th-35th gestational weeks for women with abnormal preconception TSH levels, compared to the 1st-13th and 21st-35th gestational weeks for those with normal preconception TSH levels. Conclusions: PM2.5 exposure was linked with a higher PTB risk, particularly in women with abnormal preconception TSH levels. PM2.5 exposure appears to have a greater effect on pregnant women who are in the early or late stages of pregnancy.

Asunto(s)

RESUMEN

INTRODUCTION: There is growing scientific and policy recognition that optimising health before a potential pregnancy (preconception health) improves reproductive outcomes and the lifelong health of future children. However, public awareness on this topic is low. We conducted a public consultation to develop language recommendations and identify and prioritise approaches to inform research and improve public awareness of preconception health. METHODS: A public consultation was undertaken with people of any gender aged 18-50 years living in the United Kingdom who were not currently expecting a child. Public contributors were recruited through patient and public involvement, community and support groups, an existing cohort study, and an LGBTQ+ charity. An initial round of online group discussions (February/March 2021) explored public contributors' knowledge of preconception health, their recommendations for appropriate language, and ideas about public health approaches. In a subsequent discussion round (May 2021), language recommendations were refined and suggested approaches prioritised. Discussions were summarised based on notes taken by two researchers. RESULTS: Fifty-four people joined the initial discussion round (66% women, 21% men, 13% nonbinary or transgender; 55% aged 18-30 years, 30% 31-40 years, 15% 41-50 years). Of these, 36 people (67%) participated in the subsequent round. Very few had heard the term 'preconception health', understood what it means, or why and for whom it is important. They recommended avoiding unfamiliar terms without further explanation (e.g., preconception health, medical terms), using language that is positive, encouraging and gender-sensitive where possible, and using messages that are specific, nonjudgmental and realistic. The phrases 'health and well-being during the childbearing years', 'health and well-being before pregnancy and parenthood' and 'planning for parenthood' resonated with most public contributors. School-based education, social media campaigns and the National Health Service emerged as priority approaches/settings for raising awareness. CONCLUSION: This public consultation produced recommendations from a diverse group of people of reproductive age in the United Kingdom to improve language and prioritise approaches that increase public understanding of preconception health in ways that are relevant and appropriate to them. This should begin in schools and will require adaptation of curricula, alongside co-development of public awareness campaigns and guidance for healthcare professionals. PATIENT OR PUBLIC CONTRIBUTION: This public consultation included a diverse group of members of the public. They were not involved in the original design of the project, but following the initial round of online group discussions, they contributed to the interpretation and refinement of the emerging concepts in a subsequent round of group meetings. After the consultation activity, public contributors formed a Public Advisory Group and have subsequently been involved in other studies on the same topic. Two public contributors (E.R. and F.F.) provided critical input in the preparation and revision of this manuscript and are co-authors of the paper.

Asunto(s)

RESUMEN

Established life course approaches suggest that health status in adulthood can be influenced by events that occurred during the prenatal developmental period. Yet, interventions such as diet and lifestyle changes performed during pregnancy have had a small impact on both maternal and offspring health outcomes. Currently, there is a growing body of literature that highlights the importance of maternal health before conception (months or years before pregnancy occurs) for the future health of offspring. While some studies have explored factors such as maternal body composition, nutrition, and lifestyle in this area, location-based environmental and socioeconomic exposures before conception may also contribute to future offspring health. In this line, the study of a patient's geographic history presents a promising avenue. To foster research in this direction, the integration of geospatial health, medical informatics and artificial intelligence techniques offers great potential. Importantly, novel sources of big health data sets such as electronic health records registered at the primary care level provide a unique framework due to its inherent longitudinal nature. Nonetheless, a number of privacy, ethical, and technical challenges need to be overcome for this kind of longitudinal analysis to mature and succeed. In the long-term, we support the vision of incorporating a patient's geographic history into her clinical history to equip clinicians with useful contextual information to explore.

Asunto(s)

RESUMEN

INTRODUCTION: Cortisol is a biological marker of stress, and its levels reflect the hypothalamic-pituitary-adrenal (HPA) axis response to stress over time. Saliva, blood, and urine cortisol reflect acute stress, whereas assessment of hair cortisol is a better reflection of chronic stress. There is limited information on hair cortisol concentration (HCC) in the perinatal period, particularly, in the preconception and postpartum periods. In addition to being a biomarker for stress, high levels of cortisol are typically associated with poor psychosocial outcomes, and adverse pregnancy outcomes. The objectives of this study were: (1) to measure HCC from six months preconception to six months postpartum; (2) to examine the relationship between HCC and demographic characteristics, depressive symptoms, and perceived stress in the first six months postpartum period; (3) and to assess the associations between HCC and systemic inflammatory markers in the first six months postpartum. METHODS: The analysis included 96 women from a longitudinal study with up to 3 study visits in the first six months postpartum. Blood and hair samples were collected at 1-2 months (PP1), 3-4 months (PP2), and 5-6 months (PP3) postpartum. We obtained sociodemographic information, depressive symptoms, and perceived stress scores at PP1-PP3. To quantify cortisol levels over time, 8 segments were derived corresponding to 6 (PC1) and 3 (PC2) months preconception as well as for each trimester (T1-T3) and postpartum (PP1-PP3). Eight cytokines (Granulocyte-macrophage colony-stimulating factor (GM-CSF), Interferon- gamma [IFN- γ], Interleukin [IL]-10, IL-2, IL-4, IL-6, IL-8, and Tumor necrosis factor-alpha (TNF- α) were measured in plasma in the postpartum samples. Univariate, bivariate, correlations, and linear mixed modelling were performed using SAS 9.4. Multiple testing correction was conducted for correlations using false discovery rate and a Q value of <0.05 was deemed significant. RESULTS: Median HCC varied over time peaking in the third trimester and declining in the postpartum. Significant differences were noted in median cortisol levels by race with Black/African American postpartum women experiencing higher levels at all timepoints. Significantly, higher median cortisol levels were also observed at PP1 and PP2 for mothers who reported their relationship status as single. Ethnicity, education, median age, depressive symptoms, and perceived stress were not associated with median cortisol levels. Pro-inflammatory cytokines IFN- γ (q= 0.01; r=-0.50) and IL-8 (q= 0.00; r=-0.55) showed correlations with HCC at PP1. CONCLUSION: HCC increased during pregnancy, peaking at T3 and declining PP consistent with previous work. Black/African American women and single women have significantly higher median cortisol levels in the postpartum period. The marked increase of HCC in Black women may be an important factor in understanding maternal health racial inequities. Future studies should investigate how the relationships between HCC, sociodemographics, and systemic cytokines impact perinatal outcomes.

Asunto(s)

RESUMEN

Angiotensin-converting enzyme inhibitors (ACE-Is) and angiotensin receptor blockers (ARBs) are not recommended during the second and third trimester because of the significant risk of congenital anomalies associated with their use. However, data are scarce, especially regarding their use in the first trimester and about the impact of stopping just before pregnancy. Our study illustrates the profile of the women who used ACE-Is or ARBs during pregnancy and evaluates the impact on perinatal outcomes. The Registry of Pregnancy and Cardiac Disease is a prospective, global registry of pregnancies in women with structural heart disease. Outcomes were compared between women who used ACE-Is or ARBs and those who did not. Multivariable regression analysis was performed to assess the effect of ACE-I or ARB use on the occurrence of congenital anomalies. ACE-Is (n = 35) and/or ARBs (n = 8) were used in 42 (0.7%) of the 5,739 Registry of Pregnancy and Cardiac Disease pregnancies. Women who used ACE-Is or ARBs more often came from a low-or-middle-income country (57% vs 40%, p = 0.021), had chronic hypertension (31% vs 6%, p <0.001), or a left ventricular ejection fraction <40% (33% vs 4%, p <0.001). In the multivariable analysis, ACE-I use during the first trimester was associated with an increased risk of congenital anomaly (odds ratio 3.2, 95% confidence interval 1.0 to 9.6). Therefore, ACE-Is should be avoided during pregnancy, also in the first trimester, because of a higher risk of congenital anomalies. However, there is no need to stop long before pregnancy. Preconception counseling is crucial to discuss the potential risks of these medications, to evaluate the clinical condition and, if possible, to change or stop the medication.

RESUMEN

AIM: The 2018 International Federation of Gynecology and Obstetrics abnormal uterine bleeding System-1 defines menstrual flow volume on a 3-point scale based on subjective assessment. However, the normal flow range has not been established, and it is unclear whether subjective assessment is accurate. We investigated the normal menstrual flow volume range in Japanese women and whether the actual measured menstrual flow volume agreed with the subjective evaluation. METHODS: We included female menstruating volunteers aged 18-49 years in this prospective observational study. Menstrual napkins were weighed before and after use for up to three cycles, and the values were recorded in an online diary. RESULTS: Overall, 211 participants were recruited. All items were completed by 167 participants, and 497 menstrual cycles were included in the analysis. The median total menstrual flow volume per cycle for 497 cycles was 56.7 g. The 5th-95th percentile values ranged from 15.7 to 166.4 g. The mean value was 77.6 ± 99.6 g, with no significant differences according to age group. In the 25 cycles corresponding to heavy flow, that is, above the 95th percentile of measured flow volume, 92% were underrated as "normal" by subjective evaluation, and only 8% were correctly rated as "heavy." CONCLUSIONS: Our results clarify the actual menstrual flow volume in the Japanese population; this will contribute toward making women aware of the normal range of menstrual flow volume, which may facilitate appropriate preconception care.

RESUMEN

The goal of this study was to assess the feasibility of using exome (ES) and genome sequencing (GS) in guiding preconception genetic screening (PCGS) for couples who are planning to conceive by creating a workflow for identifying risk alleles for autosomal recessive (AR) and X-linked (XL) disorders without the constraints of a predetermined, targeted gene panel. There were several limitations and challenges related to reporting and the technical aspects of ES and GS, which are listed in the discussion. We selected 150 couples from a cohort of families (trios) enrolled in a research protocol where the goal was to define the genetic etiology of disease in an affected child. Pre-existing, de-identified parental sequencing data were analyzed to define variants that would place the couple at risk of having a child affected by an AR or XL disorder. We identified 17 families who would be selected for counseling about risk alleles. We noted that only 3 of these at-risk couples would be identified if we limited ourselves to the current ACMG-recommended expanded carrier screening gene panel. ES and GS successfully identified couples who are at risk of having a child with a rare AR or XL disorder that would have been missed by the current recommended guidelines. Current limitations of this approach include ethical concerns, difficulties in reporting results including variant calling due to the rare nature of some of the variants, determining which disorders to report, as well as technical difficulties in detecting certain variants such as repeat expansions.

RESUMEN

Federal protections for abortion care in the United States ended in June 2022. For people with inflammatory bowel disease (IBD) who are capable of pregnancy, the implications of an unwanted or mistimed conception, particularly in the setting of active disease flares or teratogenic treatment, are precarious and geographically variable. Prioritizing evidence-based and person-centered counseling for preconception health and contraceptive care needs is important during health care visits and not limited to reproductive health providers. Development of multidisciplinary clinics or complex contraception clinics in high-volume IBD centers can support time-sensitive counseling and services for patients. This article reviews reproductive considerations for people with IBD, particularly in the setting of legislative restrictions in the post-Dobbs landscape.

RESUMEN

Despite major advances in infertility services, barriers to care as well as disparities in outcomes remain a significant problem. The cost of treatment, lack of or inadequate coverage, and location of infertility clinics are obvious contributors, however, advanced pathology, coexistent medical conditions, and lack of preconception care also contribute to delay in fertility particularly in underserved communities. Previous studies have discussed the role of trainee-run clinics in lower socioeconomic populations in providing low-cost infertility evaluation and management. This study uses a retrospective chart review to compare the etiology and duration of infertility in our patients to the general infertility patient population, to describe the coexistent medical pathologies within our population at initial presentation to infertility care, and to discuss how our clinic is addressing the gap in infertility care. PRECIS: Resident-run clinics offer a unique role in increasing access to care through preconception care and low-cost fertility treatment.

Asunto(s)

RESUMEN

Background: Perinatal outcomes are poor among migrant women in vulnerable situations, but little is known about their health preconception. We investigated preconception health inequalities between migrant women in vulnerable situations and non-migrant women. Methods: This national cross-sectional study used data from the NHS Maternity Services Data Set (MSDS) version 1.5, incorporating NHS maternity services in England. All 652,880 women with an antenatal booking appointment between 1/4/2018 and 31/3/2019 were included. Migration category data were available for 66.2 % (n = 432,022). Odds ratios were calculated comparing preconception indicators among probable migrants in vulnerable situations (English not their first language with complex social factors (CSF)), probable migrants not in vulnerable situations (English not their first language without CSF), probable non-migrants in vulnerable situations (English their first language with CSF) and probable non-migrants not in vulnerable situations (English their first language without CSF). CSF include recent migrants, asylum seekers, refugees, difficulty reading/speaking English; alcohol and/or drugs misuse; aged under 20; and/or experiencing domestic abuse. Findings: We identified 3.8 % (25,070 women) of the study population as probable migrants in vulnerable situations, 10.2 % (66,783 women) as probable migrants not in vulnerable situations, 5.6 % (36,433 women) as probable non-migrants in vulnerable situations, 46.5 % (303,737 women) as probable non-migrants not in vulnerable situations, and 33.8 % as having missing migration category data. Probable migrants in vulnerable situations (n = 25,070) had over twice the odds of not taking folic acid preconception compared to probable non-migrants not in vulnerable situations (odds ratio 2.15, 95 % confidence interval 2.06-2.25). They had increased odds of previous obstetric complications and being underweight, but lower odds of physical and mental health conditions (apart from diabetes and hepatitis b), smoking and overweight or obesity. Interpretation: Inequalities exist across many preconception indicators, highlighting opportunities to improve preconception health in this population to reduce health inequalities and improve perinatal and neonatal outcomes. Funding: Medical Research Council.

RESUMEN

Optimizing the overall health of individuals prior to pregnancy can improve both pregnancy and lifelong health outcomes. Despite extremely high financial expenditure on birth in the United States, maternal and infant mortality rates continue to rise. Moreover, significant racial and ethnic disparities persist in perinatal health outcomes. Preconception care, or health care provided before or between pregnancies, has the capacity to meet these challenges. Preconception care can be integrated into every health care visit, including visits with primary care, reproductive health, and mental health care clinicians. Increasing awareness among clinicians of the benefits of preconception care and equipping them with innovative strategies to implement this care into practice, the number of people receiving optimal care could be increased. Recent innovations in preconception care include group care, health applications (apps), reminders in electronic health records, social marketing campaigns, social media movements, community-based partnerships, health care policy and access, and improving public and clinician education on preconception health topics. Ultimately, improving preconception health is best done in partnership between the consumer and clinician. Midwives, whose care is person-centered and partnership-focused, are well positioned to champion the innovation and implementation of equitable preconception care. The purpose of this State of the Science review, therefore, is to synthesize the literature on recent evidence-based innovations that may be used to improve preconception health and counseling.

RESUMEN

BACKGROUND: Globally, the HIV pandemic makes preconception care even more crucial due to the additional risks for sexual and vertical transmission of HIV. However, there is limited evidence on the utilization of preconception care among high-risk women in Ethiopia. The purpose of this research is to assess preconception care utilization and associated factors among HIV-positive women of reproductive age who attend ART clinics in public hospitals in the Hadiya zone of Southern Ethiopia in 2023. METHODS: A cross-sectional study design employing a mixed methods approach was used among 297 study participants from July 1-Semptember 1, 2022. Data were collected by pretested structured questionnaires. The data were analyzed by SPSS statistical software version 25. Logistic regression, Adjusted Odds Ratio (AOR) with a 95% confidence interval was computed, and variables with a p-value < 0.05 were considered statistically significant. Qualitative data were analyzed using open code version 4.03. RESULTS: This study revealed that 19.9% (95%Cl: 15.4, 24.2) of study participants use preconception care. Women's autonomy (AOR = 3.65; 95% CI: 1.14, 11.68;P = 0.03), knowledge of PCC (AOR = 3.05; 95% CI: 1.13, 8.22; P = 0.001), getting family/husband support (AOR = 4.06; 95% CI: 1.56, 10.53;P = 0.022), discussions with healthcare providers (AOR = 5.60; 95% CI: 2.26, 13.90;P = 0.002), availability of room for PCC (AOR = 3.77; 95% CI: 1.38, 10.31;P = 0.009), getting all laboratory services (AOR = 4.19; 95% CI: 1.61, 10.94; P = 0.002), and history of medical problems (AOR = 2.94; 95% CI: 11.01, 8.62;P = 0.036) were significantly associated with PCC use. CONCLUSION: The level of PCC use in the current study area is low. Women's autonomy, knowledge of PCC, obtaining support from family or husband, engaging in discussions with healthcare providers, having access to a PCC room, access to all laboratory services, and having a history of medical problems are significantly associated with PCC use. Our findings suggest integrating PCC into routine HIV care, boosting women's autonomy, and integrating family support with healthcare providers.

Asunto(s)