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Introduction: birth weight is a critical indicator of neonatal health and predicts future developmental outcomes. Despite its importance, there is a notable lack of research on the determinants of low birth weight (LBW) in southeast Gabon. This study aims to fill this gap by identifying factors contributing to LBW at the Centre Hospitalier Universitaire Amissa Bongo in Franceville. Methods: this retrospective analysis covered the period from February 2011 to May 2017, focusing on postpartum women and their infants. Data were analyzed using R software (version 4.3.2), employing both descriptive statistics and logistic regression. Statistical significance was determined at a p-value of less than 0.05. Results: among the 877 births analyzed, the prevalence of LBW was 8.4%. Bivariate analysis identified several factors associated with an increased risk of LBW, including, primigravida women (COR (95%CI) =0.59 (0.36-0.98), P = 0.036), primiparous women (COR (95%CI) =0.58 (0.36-0. 94), P = 0.024), women with a gestational age <37 weeks (COR (95%CI) =0.07 (0.04-0.11), P<0.001), women with ≤2 antenatal visits (COR (95%CI) =0.39 (0.18-0.93), P= 0.021), and women who underwent cesarean delivery (COR (95%CI) =0.46 (0.26-0.84), P = 0.008). However, multivariate analysis showed that only gestational age (AOR (95%CI) = 0.07 (0.04-0.11), P<0.001) and cesarean delivery (AOR (95%CI) = 0.48 (0.25-0.95), P = 0.03) were significantly associated with LBW. Conclusion: this study highlights the importance of gestational age and delivery method in the prevalence of LBW in southeast Gabon. These findings underscore the need for targeted interventions to address these risk factors, thereby improving neonatal health outcomes.

Asunto(s)

Edad Gestacional , Recién Nacido de Bajo Peso , Atención Prenatal , Humanos , Gabón/epidemiología , Femenino , Embarazo , Recién Nacido , Estudios Retrospectivos , Adulto , Factores de Riesgo , Adulto Joven , Prevalencia , Atención Prenatal/estadística & datos numéricos , Masculino , Peso al Nacer , Paridad , Adolescente

RESUMEN

Extending lactation length reduces the frequency of critical calving events for the cow and herewith reduces the frequency of periods with increased risk for health problems. Moreover, breeding is postponed until a moment later in lactation, which is associated with better conception rates and less days open after start of the breeding period in most studies. Potential risks of an extended lactation are that milk yield of cows at the end of the lactation may be too low which may lead to cows being overconditioned at the end of the extended lactation. Therefore, extending lactation length might not fit every cow. Individual cow characteristics like parity, milk yield level, or body condition determine the response of the cow to an extended lactation. These individual cow characteristics can be used in customized management strategies to optimize lactation length for individual cows. Customized lactation length for individual cows could limit the impact at herd level of disadvantages concerning milk losses and overconditioning and maintain benefits for improved cow health and fertility, reduced number of surplus calves and increased work satisfaction for the farmer. In conclusion, extending lactation length has interesting perspectives for health and fertility of high-producing dairy cows, although questions remain concerning management approaches to support lactation persistency of cows with an extended lactation, and consequences for calf health and development. Moreover, ongoing studies aim to develop decision support tools to select individual cows for a specific lactation length.

Asunto(s)

Industria Lechera , Fertilidad , Lactancia , Leche , Animales , Bovinos/fisiología , Femenino , Lactancia/fisiología , Fertilidad/fisiología , Embarazo , Factores de Tiempo , Cruzamiento , Paridad

RESUMEN

INTRODUCTION: Obstetrics research has predominantly focused on the management and identification of factors associated with labor dystocia. Despite these efforts, clinicians currently lack the necessary tools to effectively predict a woman's risk of experiencing labor dystocia. Therefore, the objective of this study was to create a predictive model for labor dystocia. MATERIAL AND METHODS: The study population included nulliparous women with a single baby in the cephalic presentation in spontaneous labor at term. With a cohort-based registry design utilizing data from the Copenhagen Pregnancy Cohort and the Danish Medical Birth Registry, we included women who had given birth from 2014 to 2020 at Copenhagen University Hospital-Rigshospitalet, Denmark. Logistic regression analysis, augmented by a super learner algorithm, was employed to construct the prediction model with candidate predictors pre-selected based on clinical reasoning and existing evidence. These predictors included maternal age, pre-pregnancy body mass index, height, gestational age, physical activity, self-reported medical condition, WHO-5 score, and fertility treatment. Model performance was evaluated using the area under the receiver operating characteristics curve (AUC) for discriminative capacity and Brier score for model calibration. RESULTS: A total of 12,445 women involving 5,525 events of labor dystocia (44%) were included. All candidate predictors were retained in the final model, which demonstrated discriminative ability with an AUC of 62.3% (95% CI:60.7-64.0) and Brier score of 0.24. CONCLUSIONS: Our model represents an initial advancement in the prediction of labor dystocia utilizing readily available information obtainable upon admission in active labor. As a next step further model development and external testing across other populations is warranted. With time a well-performing model may be a step towards facilitating risk stratification and the development of a user-friendly online tool for clinicians.

Asunto(s)

Índice de Masa Corporal , Distocia , Edad Materna , Paridad , Humanos , Femenino , Embarazo , Distocia/epidemiología , Adulto , Factores de Riesgo , Dinamarca/epidemiología , Curva ROC , Inicio del Trabajo de Parto , Sistema de Registros , Edad Gestacional

RESUMEN

BACKGROUND: The exclusive breastfeeding rates is low in some countries. Low breastfeeding rates results in higher healthcare expenses and adverse health outcomes for individuals and society. Co-parenting is effective in promoting breastfeeding as it involves shared responsibility and collaboration between parents in raising children. However, the current breastfeeding co-parenting intervention programs exhibits significant variations in components, timing, and duration across studies. An evidence-based breastfeeding co-parenting intervention program is essential for enhancing breastfeeding-related outcomes. OBJECTIVE: To develop an evidence-based breastfeeding co-parenting intervention program for healthcare providers to guide parents with primiparas on breastfeeding. METHOD: To form an initial version of the intervention program, a systematic literature review was conducted to consolidate information on current intervention programs. Two rounds of Delphi method were followed to gather expert comments for the program modification to establish the formal version. RESULTS: Fourteen articles published between 1995 and 2022 were screened. Details of these researches, including starting and ending time, duration and specific contents, were integrated to developed the initial program. Then, six experts completed the two rounds consultation with a positive coefficient of 85.71%, coefficient judgment basis of 0.93, familiarity coefficient of 0.87, authority coefficient of 0.90 and the Kendall's W of 0.62. Finally, an evidence-based breastfeeding co-parenting intervention program was constructed in this study, consisting of breastfeeding co-parenting courses, individual counselling and a father's support group. CONCLUSION: This research developed a breastfeeding co-parenting intervention program for healthcare providers to guide primiparous parents to improve breastfeeding rates. Through a systematic literature review and Delphi method with good reliability, the program integrates breastfeeding courses, individual counseling, and a father's support group. Future research will focus on evaluating its impact and scalability to benefit maternal and infant health globally. TRIAL REGISTRATION: ChiCTR.org.cn (ChiCTR2300069648). Registration date: 2023-03-22.

Asunto(s)

Lactancia Materna , Responsabilidad Parental , Desarrollo de Programa , Humanos , Femenino , Embarazo , Técnica Delphi , Promoción de la Salud/métodos , Paridad , Masculino , Adulto

RESUMEN

OBJECTIVE: Childbirth is considered to be both beautiful and traumatic. Following a vaginal delivery, some women express discontent with the appearance of their genitalia on social media and/or websites. This study explored how some women perceived their genitalia, post childbirth. Three groups were compared: women with a vaginal delivery, those with a cesarean-section, and those who had never given birth. METHODS: After the study received approval from the institutional review board, 224 female participants living in Puerto Rico and aged 21 to 42 years completed a questionnaire about their genital self-image. RESULTS: Approximately 51% (n = 115) of the participants had never given birth; the others had given birth via C-section 23% (n = 51) or vaginally 26% (n = 58). In all 3 groups, 84% felt positive about their genitals, 79% expressed their satisfaction with the appearance of their genitals and 84%, with their size; 81% were not ashamed of their genitals. CONCLUSION: Logistic regression found no significant difference in genital self-perception between delivery groups or nulliparous women. The adjusted odds ratios for positive genital image varied slightly between delivery methods but were not statistically significant (ranging from 0.65 to 1.11 for vaginal deliveries, and 0.42 to 1.00 for C-sections; P > .05). This suggests that the method of delivery does not have a significant impact on women's genital self-perception. However, for the 21% with negative perceptions, targeted support is essential; for those struggling with their self-image after childbirth, our results can inform support services to address concerns.

Asunto(s)

Cesárea , Parto Obstétrico , Hispánicos o Latinos , Autoimagen , Humanos , Femenino , Puerto Rico , Adulto , Adulto Joven , Parto Obstétrico/psicología , Hispánicos o Latinos/estadística & datos numéricos , Encuestas y Cuestionarios , Cesárea/estadística & datos numéricos , Genitales Femeninos , Embarazo , Paridad , Imagen Corporal/psicología

RESUMEN

BACKGROUND: We aimed to determine the best-performing machine learning (ML)-based algorithm for predicting gestational diabetes mellitus (GDM) with sociodemographic and obstetrics features in the pre-conceptional period. METHODS: We collected the data of pregnant women who were admitted to the obstetric clinic in the first trimester. The maternal age, body mass index, gravida, parity, previous birth weight, smoking status, the first-visit venous plasma glucose level, the family history of diabetes mellitus, and the results of an oral glucose tolerance test of the patients were evaluated. The women were categorized into groups based on having and not having a GDM diagnosis and also as being nulliparous or primiparous. 7 common ML algorithms were employed to construct the predictive model. RESULTS: 97 mothers were included in the study. 19 and 26 nulliparous were with and without GDM, respectively. 29 and 23 primiparous were with and without GDM, respectively. It was found that the greatest feature importance variables were the venous plasma glucose level, maternal BMI, and the family history of diabetes mellitus. The eXtreme Gradient Boosting (XGB) Classifier had the best predictive value for the two models with the accuracy of 66.7% and 72.7%, respectively. DISCUSSION: The XGB classifier model constructed with maternal sociodemographic findings and the obstetric history could be used as an early prediction model for GDM especially in low-income countries.

Asunto(s)

Índice de Masa Corporal , Diabetes Gestacional , Prueba de Tolerancia a la Glucosa , Aprendizaje Automático , Humanos , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/sangre , Femenino , Embarazo , Adulto , Glucemia/análisis , Algoritmos , Primer Trimestre del Embarazo , Valor Predictivo de las Pruebas , Paridad , Factores de Riesgo , Adulto Joven

RESUMEN

In Lower-Middle-Income-Countries women are encouraged to present at a birthing facility for skilled care, but attending early can be associated with additional harm. Women admitted in latent labour are more likely to receive a cascade of unnecessary interventions compared with those attending a birthing facility during active labour. One reason that women present early is pain, with higher rates of admission among those who pain catastrophise. The aim of this study was to explore the prevalence of pain catastrophising in nulliparous women in Nepal and to identify predictors for pain catastrophising. A cross sectional study was conducted using a semi-structured survey. The survey was completed by 170 women (18-32 years) in one higher education institution in Kathmandu. The survey included the pain catastrophising scale (PCS), current and previous pain and information about period pain, sociodemographic variables of age, ethnicity, and religion. The prevalence of pain catastrophising reported at a cut off score of PCS≥20 was 55.9% and at a cut off score of PCS≥30 was 17.1%. All women with a PCS ≥30 reported having painful periods. Those with a PCS≥20 were four times [95%CI 1.93-8.42] more likely to report painful periods affecting their daily activities (p<0.001) and those with PCS≥30 three times [95%CI1.10-10.53] more likely (p<0.05). In both cases ethnicity and age were not associated. Women with higher PCS were less likely to take pain medication. A high prevalence of pain catastrophising was reported. It is important to understand how women's previous negative experiences of pain and pain catastrophising are perceived and if they are contributing to the rise in obstetric intervention, particularly caesarean births, in Nepal. We recommend repeating this study with a larger sample representing a more diverse population.

Asunto(s)

Catastrofización , Paridad , Parto , Humanos , Femenino , Adulto , Nepal/epidemiología , Prevalencia , Adolescente , Embarazo , Adulto Joven , Estudios Transversales , Catastrofización/psicología , Catastrofización/epidemiología , Parto/psicología , Encuestas y Cuestionarios , Dimensión del Dolor

RESUMEN

Large White and Meishan sows differ in maternal ability and early piglet growth. We investigated the relationships between 100 maternal traits, grouped into 11 blocks according to the biological function they describe and litter growth over three successive periods after birth (D0-D1, D1-D3 and D3-D7; D0 starting at the onset of farrowing), as a measure of sow investment in early piglet production. Within- and between-breed variation was exploited to cover a maximum of the variability existing in pig maternal populations. The objective was to quantify the contribution of maternal traits, including functional traits and behavioural traits, to early litter growth. Multivariate analyses were used to depict correlations among traits. A partial least square multiblock analysis allowed quantifying the effect of maternal traits on early growth traits. Partial triadic analyses highlighted how sow behaviour changed with days, and whether it resulted in changes in litter growth. Several behavioural traits (standing activity, reactivity to different stimuli, postural activity) and functional traits (body reserves, udder quality) at farrowing contributed substantially to litter growth from D0 to D7. Sow aggression towards piglets and time spent standing at D0 were unfavourably correlated to D1-D3 litter growth. Time spent lying with udder exposed at D0 was favourably correlated to D1-D3 litter growth. The farrowing duration was negatively correlated to D0-D1 and D1-D3 litter growth. Furthermore, D3-D7 litter growth was positively correlated to feed intake in the same period. Several behavioural traits and some functional traits influence early litter growth. The contribution of sow behaviour was greater in the critical period around farrowing than in later days.

Asunto(s)

Conducta Animal , Lactancia , Animales , Femenino , Lactancia/fisiología , Conducta Animal/fisiología , Porcinos/crecimiento & desarrollo , Embarazo , Paridad/fisiología , Tamaño de la Camada , Animales Recién Nacidos

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This study assesses the prevalence and determinants of inadequate (less than eight contacts) and late antenatal care (ANC) initiation (starting after 12 weeks) among mothers delivered at Gadarif Maternity Hospital in eastern Sudan. A hospital-based cross-sectional study was conducted at Gadarif Maternity Hospital. A questionnaire was used to collect sociodemographic, clinical, and obstetric data through face-to-face interviews. Seven hundred mothers were enrolled with the median (interquartile range) of mothers' age, and parity was 28(24-32) years and 3(2-5), respectively. Of these 700 mothers, 79.3 percent and 10.3 percent had inadequate and late ANC, respectively. In multivariable logistic regression analysis, being a housewife (adjusted odds ratio [AOR] 1.93, 95 percent CI 1.09, 3.43) was associated with inadequate ANC. High parity (AOR 1.27, 95 percent CI 1.07-1.52) was positively associated with late ANC initiation. There was no association between age, residence, education, preexisting medical disorder, and history of miscarriage) with inadequate or late ANC initiation In eastern Sudan, four out of five mothers did not comply with the World Health Organization's recommendation of a minimum of eight ANC contacts for positive pregnancy outcomes. This study is crucial for policy-makers to take further strategic actions to ensure adequate and early ANC initiation for all mothers in Sudan.

Asunto(s)

Madres , Paridad , Atención Prenatal , Humanos , Femenino , Estudios Transversales , Sudán/epidemiología , Adulto , Atención Prenatal/estadística & datos numéricos , Embarazo , Madres/estadística & datos numéricos , Adulto Joven , Encuestas y Cuestionarios , Factores Socioeconómicos , Aceptación de la Atención de Salud/estadística & datos numéricos , Factores Sociodemográficos , Modelos Logísticos , Prevalencia , Conocimientos, Actitudes y Práctica en Salud , Maternidades/estadística & datos numéricos

RESUMEN

OBJECTIVES: This study aims to describe patterns of beliefs about contraceptive-induced infertility and assess their relationship with current contraceptive use, including whether these relationships vary by parity and residence. DESIGN: We use data from Performance Monitoring for Action Ethiopia, a nationally representative, cross-sectional survey of 7491 women, aged 15-49, to assess agreement with the statement 'If I use family planning, I may have trouble getting pregnant next time I want to.' We used multilevel hierarchical models to identify the association between agreement and use of a hormonal method of contraception among 3882 sexually active, fecund women who wish to prevent pregnancy. We include interaction terms for parity and residence. RESULTS: 4 in 10 women disagreed (42.3%) and 2 in 10 strongly disagreed (20.7%) with the statement. Relative to women who strongly disagreed, women who disagreed and women who agreed had significantly lower odds of using a hormonal method of contraception (adjusted OR (aOR) 0.65, 95% CI 0.44 to 0.97 and 0.46, 95% CI 0.46, 95% CI 0.30 to 0.70). The effect of agreeing with the statement was strongest among high parity women (aOR 0.54, 95% CI 0.30 to 0.95). Greater agreement with the statement at the community-level use was associated with a reduction in the odds of using hormonal contraception but only among rural women. CONCLUSIONS: Efforts to address concerns around contraceptive-induced fertility impairment through the provision of comprehensive counselling and through community education or mass media campaigns are necessary, particularly among high-parity women and in rural communities. Interventions should acknowledge the possibility of delayed return to fertility for specific methods and attempt to address the root causes of concerns.

Asunto(s)

Conducta Anticonceptiva , Conocimientos, Actitudes y Práctica en Salud , Paridad , Humanos , Femenino , Etiopía/epidemiología , Adulto , Estudios Transversales , Adolescente , Adulto Joven , Persona de Mediana Edad , Conducta Anticonceptiva/estadística & datos numéricos , Embarazo , Población Rural/estadística & datos numéricos , Servicios de Planificación Familiar , Infertilidad/inducido químicamente , Agentes Anticonceptivos Hormonales/efectos adversos , Anticoncepción Hormonal/efectos adversos

RESUMEN

OBJECTIVE: Endogenous and exogenous hormonal factors have been associated with female breast, genital, and colorectal cancer risk. The aim of the present study is to conduct an evidence-based evaluation of the fraction of cancers attributable to and prevented by exogenous hormonal (i.e., combined oral contraceptives [COC] and combined estrogen-progestogen menopausal therapy [CEPMT]) and reproductive factors (i.e., parity and breastfeeding) in Italy. STUDY DESIGN: We calculated the population attributable and prevented fractions combining relative risks and prevalence of exposure in Italian women. Italian cancer incidence and mortality data were extracted from national sources and used to estimate the number of cancer cases and deaths attributable to reproductive factors and exogenous hormones in Italy in 2020. For long-term effects, a 20-year latency period was considered. RESULTS: COC were responsible for 4.4 % of breast and 10.9 % of cervical cancers in women aged 15-44, but also avoided 6.4 % of endometrial, 5.6 % of ovarian, and 2.9 % of colorectal cancers in women of all ages. Overall, COC use prevented 1174 cancer diagnoses and 577 cancer deaths. CEPMT caused 0.4 % of breast cancers at age 45-69. Low parity accounted for 8.1 %, 11.8 % and 15.5 % of breast, endometrial and ovarian cancers, respectively (6267 cases, 1796 deaths). Breastfeeding avoided 6.4 % of breast cancers (3775 cases, 897 deaths). CONCLUSIONS: Our analysis quantified the complex effects of hormonal and reproductive factors on cancer burden in Italian women.

Asunto(s)

Neoplasias de la Mama , Humanos , Femenino , Italia/epidemiología , Adulto , Persona de Mediana Edad , Adolescente , Anciano , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/prevención & control , Adulto Joven , Anticonceptivos Orales Combinados , Paridad , Lactancia Materna/estadística & datos numéricos , Neoplasias Endometriales/epidemiología , Neoplasias Endometriales/prevención & control , Neoplasias Colorrectales/epidemiología , Neoplasias Colorrectales/prevención & control , Incidencia , Neoplasias/epidemiología , Neoplasias/prevención & control , Terapia de Reemplazo de Estrógeno/estadística & datos numéricos , Neoplasias Ováricas/epidemiología , Neoplasias Ováricas/prevención & control , Factores de Riesgo , Embarazo , Neoplasias de los Genitales Femeninos/epidemiología , Neoplasias de los Genitales Femeninos/prevención & control

RESUMEN

Pregnancy and motherhood can have long-term effects on cognition and brain aging in both humans and rodents. Estrogens are related to cognitive function and neuroplasticity. Estrogens can improve cognition in postmenopausal women, but the evidence is mixed, partly due to differences in age of initiation, type of menopause, dose, formulation and route of administration. Additionally, past pregnancy influences brain aging and cognition as a younger age of first pregnancy in humans is associated with poorer aging outcomes. However, few animal studies have examined specific features of pregnancy history or the possible mechanisms underlying these changes. We examined whether maternal age at first pregnancy and estradiol differentially affected hippocampal neuroplasticity, inflammation, spatial reference cognition, and immediate early gene activation in response to spatial memory retrieval in middle-age. Thirteen-month-old rats (who were nulliparous (never mothered) or previously primiparous (had a litter) at three or seven months) received daily injections of estradiol (or vehicle) for sixteen days and were tested on the Morris Water Maze. An older age of first pregnancy was associated with impaired spatial memory but improved performance on reversal training, and increased number of new neurons in the ventral hippocampus. Estradiol decreased activation of new neurons in the dorsal hippocampus, regardless of parity history. Estradiol also decreased the production of anti-inflammatory cytokines based on age of first pregnancy. This work suggests that estradiol affects neuroplasticity and neuroinflammation in middle age, and that age of first pregnancy can have long lasting effects on hippocampus structure and function.

Asunto(s)

Estradiol , Hipocampo , Plasticidad Neuronal , Memoria Espacial , Animales , Femenino , Hipocampo/efectos de los fármacos , Hipocampo/metabolismo , Plasticidad Neuronal/efectos de los fármacos , Plasticidad Neuronal/fisiología , Embarazo , Memoria Espacial/efectos de los fármacos , Memoria Espacial/fisiología , Estradiol/farmacología , Ratas , Inflamación/metabolismo , Aprendizaje por Laberinto/efectos de los fármacos , Aprendizaje por Laberinto/fisiología , Envejecimiento/fisiología , Paridad/fisiología

RESUMEN

OBJECTIVE: To explore the effects of electric stimulation and biofeedback therapy in patients with postpartum pelvic organ prolapse and to identify factors that can affect therapeutic efficacy outcomes. METHOD: This retrospective study analysed clinical data about patients with postpartum pelvic organ prolapse. A total of 328 women with pelvic organ prolapse at 6 weeks postpartum were recruited from one tertiary hospitals in Sichuan province in China, between March 2019 and March 2022. The prognostic factors of therapeutic efficacy were analysed using logistic regression and decision tree model. RESULTS: Overall, 259 women showed clinical benefits from the treatment. The logistic regression model showed that parity, pelvic floor muscle training at home, and the pelvic organ prolapse quantitation stage before treatment were independent prognostic factors. The decision tree model showed that the pelvic organ prolapse quantitation stage before treatment was the main prognostic factor, followed by parity. There was no significant difference in the area under the receiver operating characteristic curve between the two models. CONCLUSION: Parity, pelvic floor muscle training at home, and the pelvic organ prolapse quantitation stage before treatment were important prognostic factors of electric stimulation and biofeedback therapy on postpartum pelvic organ prolapse.

Asunto(s)

Biorretroalimentación Psicológica , Terapia por Estimulación Eléctrica , Prolapso de Órgano Pélvico , Humanos , Femenino , Prolapso de Órgano Pélvico/terapia , Estudios Retrospectivos , Adulto , Pronóstico , Biorretroalimentación Psicológica/métodos , Terapia por Estimulación Eléctrica/métodos , Resultado del Tratamiento , Diafragma Pélvico/fisiopatología , Periodo Posparto , China , Paridad , Modelos Logísticos , Embarazo

RESUMEN

Importance: Few studies have investigated whether the associations between pregnancy-related factors and breast cancer (BC) risk differ by underlying BC susceptibility. Evidence regarding variation in BC risk is critical to understanding BC causes and for developing effective risk-based screening guidelines. Objective: To examine the association between pregnancy-related factors and BC risk, including modification by a of BC where scores are based on age and BC family history. Design, Setting, and Participants: This cohort study included participants from the prospective Family Study Cohort (ProF-SC), which includes the 6 sites of the Breast Cancer Family Registry (US, Canada, and Australia) and the Kathleen Cuningham Foundation Consortium (Australia). Analyses were performed in a cohort of women enrolled from 1992 to 2011 without any personal history of BC who were followed up through 2017 with a median (range) follow-up of 10 (1-23) years. Data were analyzed from March 1992 to March 2017. Exposures: Parity, number of full-term pregnancies (FTP), age at first FTP, years since last FTP, and breastfeeding. Main Outcomes and Measures: BC diagnoses were obtained through self-report or report by a first-degree relative and confirmed through pathology and data linkages. Cox proportional hazards regression models estimated hazard ratios (HR) and 95% CIs for each exposure, examining modification by PARS of BC. Differences were assessed by estrogen receptor (ER) subtype. Results: The study included 17 274 women (mean [SD] age, 46.7 [15.1] years; 791 African American or Black participants [4.6%], 1399 Hispanic or Latinx participants [8.2%], and 13 790 White participants [80.7%]) with 943 prospectively ascertained BC cases. Compared with nulliparous women, BC risk was higher after a recent pregnancy for those women with higher PARS (last FTP 0-5 years HR for interaction, 1.53; 95% CI, 1.13-2.07; P for interaction < .001). Associations between other exposures were limited to ER-negative disease. ER-negative BC was positively associated with increasing PARS and increasing years since last FTP (P for interaction < .001) with higher risk for recent pregnancy vs nulliparous women (last FTP 0-5 years HR for interaction, 1.54; 95% CI, 1.03-2.31). ER-negative BC was positively associated with increasing PARS and being aged 20 years or older vs less than 20 years at first FTP (P for interaction = .002) and inversely associated with multiparity vs nulliparity (P for interaction = .01). Conclusions and Relevance: In this cohort study of women with no prior BC diagnoses, associations between pregnancy-related factors and BC risk were modified by PARS, with greater associations observed for ER-negative BC.

Asunto(s)

Neoplasias de la Mama , Humanos , Femenino , Neoplasias de la Mama/genética , Neoplasias de la Mama/epidemiología , Embarazo , Adulto , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Australia/epidemiología , Canadá/epidemiología , Paridad , Estados Unidos/epidemiología , Sistema de Registros , Predisposición Genética a la Enfermedad , Estudios de Cohortes , Lactancia Materna/estadística & datos numéricos

RESUMEN

Short-chain fatty acids (SCFAs) produced in the rumen are key factors affecting dairy cows' energy balance (EB). This study aimed to quantitatively evaluate the effects of SCFAs production on EB in dairy cows. Primiparous dairy cows were divided into high non-esterified fatty acid (NEFA; group H) and low NEFA (group L) groups based on their blood NEFA levels at week 3 postpartum, which served as an indicator of EB. The amounts of SCFAs produced in the rumen, including acetate, propionate, and butyrate (SCFAsP), were calculated using the predicted rumen volume. Because there were no differences between the groups in SCFAsP/dry matter intake, whereas 4% fat-corrected milk (FCM)/SCFAsP was significantly higher in group H, it was suggested that more body fat was mobilized for milk production in group H. However, group L, which showed better EB, had propionate dominant and lower FCM/SCFAsP and milk energy/SCFAs energy at 3 and 7 weeks postpartum, indicating that group L had a better energy supply for milk production. These results suggest that SCFAsP produced by rumen fermentation and the composition of SCFAs in the rumen affect milk production and EB.

Asunto(s)

Metabolismo Energético , Ácidos Grasos no Esterificados , Ácidos Grasos Volátiles , Fermentación , Lactancia , Leche , Rumen , Animales , Rumen/metabolismo , Bovinos/metabolismo , Bovinos/fisiología , Femenino , Ácidos Grasos Volátiles/metabolismo , Lactancia/metabolismo , Lactancia/fisiología , Leche/metabolismo , Ácidos Grasos no Esterificados/metabolismo , Ácidos Grasos no Esterificados/sangre , Embarazo , Paridad , Periodo Posparto/metabolismo , Propionatos/metabolismo

RESUMEN

The present study investigated factors associated with the incidence of stillbirth in young hyper-prolific sows within free farrowing systems in tropical environments. A total of 714 live-born and 54 stillborn piglets from 57 Landrace × Yorkshire sows, with an average parity of 2.7 ± 1.0 (range: 1 - 4), were comprehensively investigated. Reproductive variables of the sows, including gestation length, farrowing duration, the total number of piglets born per litter, and the birth order and status of each piglet, were recorded. Differences in the physiological characteristics of live-born and stillborn piglets, such as birth interval, cumulative birth interval, body weight at birth, crown-rump length, body mass index (BMI), ponderal index (PI), meconium staining score, and the percentage of piglets with a broken umbilical cord, were analysed. Piglets were divided into four groups based on the quartiles of birth order (Q1-Q4). On average, the duration of farrowing was 173.3 ± 85.9 min, and the total number of piglets born and number of piglets born alive-per litter were 14.1 ± 3.8 and 12.5 ± 3.5, respectively. The incidence of stillbirth was 6.7% (54/801 piglets). The higher percentages of stillbirths were detected in sows with large litter sizes (≥17 piglets, 10.9%) compared to those with small (≤13 piglets, 6.1%) and moderate (14 - 16 piglets, 2.8%) litter sizes (p < .001). The incidences of stillbirth in Q3 and Q4 of the litters were higher than in Q1 and Q2 (p < .001). Compared to live-born piglets, stillborn piglets had higher cumulative birth interval (103.0 ± 3.71 vs. 142.4 ± 9.35 min, p < .001), BMI (17.1 ± 0.15 vs. 18.4 ± 0.39 kg/m2, p = .002), PI (63.7 ± 0.59 vs. 70.8 ± 1.59 kg/m3, p < .001), meconium staining scores (1.78 ± 0.04 vs. 2.04 ± 0.10, p = .021), and the percentage of piglets born with a ruptured umbilical cord (45.2% vs. 66.0%, p = .004). An increase in the incidence of stillbirth was detected at 60, 120, 150, 180, and ≥ 210 min after the first piglet was born, compared to those born within the first 30 min of farrowing (p < .05). In conclusion, the study found that stillbirths in young, hyper-prolific sows were linked to several factors: large litter sizes (≥17 piglets per litter), prolonged cumulative birth intervals (142.4 min), elevated BMI of 18.4 kg/m2, high PI values of 70.8 kg/m3, increased meconium staining scores, and a higher occurrence of ruptured umbilical cords. To reduce the risk of stillbirth, particularly among piglets with high body indices born later in the birthing process, it is recommended to enhance farrowing supervision for young sows, starting at a cumulative birth interval of 60 min.

Asunto(s)

Mortinato , Animales , Mortinato/veterinaria , Mortinato/epidemiología , Femenino , Embarazo , Sus scrofa , Crianza de Animales Domésticos , Enfermedades de los Porcinos/epidemiología , Porcinos , Tamaño de la Camada , Incidencia , Clima Tropical , Paridad

RESUMEN

BACKGROUND AND OBJECTIVE: Episiotomy is one of the most commonly performed procedures in obstetrics. complications of episiotomy are pain, bleeding, infection, pain in the sitting position, and difficulty in taking care of the baby. This study aimed to investigate the effect of Camellia sinensis ointment on perineal pain and episiotomy wound healing in primiparous women. METHODS: This triple-blinded randomized clinical trial was conducted on 60 primiparous women who were referred to the maternity ward of Al-Hadi hospital in Shoushtar and Ganjovian hospital in Dezful, Iran, from 2020 to 2021. Participants were randomly assigned into two groups of intervention (Camellia sinensis extract ointment) and control (placebo) with a follow-up of 14 days. REEDA scale (redness, edema, ecchymosis, discharge, and approximation) was used to measure wound healing and the Visual Analog Scale (VAS) was used to measure the pain intensity. RESULTS: There was no significant difference between two groups before intervention in terms of sociodemographic characteristics, pain intensity, and episiotomy wound status. Scores of pain intensity and wound healing reduced on days 7, 10, and 14 post-intervention in the intervention group compared to placebo. There was a significant decrease between the groups of intervention and control in terms of the mean score of pain intensity (VAS scale) on day 10 (1.33 ± 0.71, 1.77 ± 0.93) and day 14 (0.73 ± 0.74, 1.13 ± 0.81) post-intervention (P < 0.05). Also, on day 14 post-intervention, there was a significant decrease between the groups of intervention and control in terms of the mean score of episiotomy wound healing (REEDA index) (0.53 ± 0.77, 1.77 ± 1.46) (P < 0.05). The GLM test was applied for repeated measures. REEDA index and VAS scale changed during different times (time-variable) (p < .001). But, the studied groups (group variable) and the studied groups (interaction effect of group * time) did not affect the changes in the REEDA index (p = .292, p = .306) and VAS scale (p = .47) during different times. CONCLUSION: Our study showed that Camellia sinensis extract ointment has a small effect on the healing process and pain reduction of episiotomy wounds. to confirm its effect, a study with a larger sample size should be conducted. TRIAL REGISTRATION: This trial was registered in the Iranian Registry of Clinical Trials on 04/10/2019 with the IRCT ID: IRCT20190804044428N1. Participants were enrolled between 11 April 2020 and 20 January 2021. URL of registry: https://en.irct.ir/trial/41326.

Asunto(s)

Camellia sinensis , Episiotomía , Pomadas , Perineo , Cicatrización de Heridas , Humanos , Femenino , Episiotomía/efectos adversos , Adulto , Cicatrización de Heridas/efectos de los fármacos , Perineo/lesiones , Embarazo , Camellia sinensis/química , Adulto Joven , Extractos Vegetales/farmacología , Extractos Vegetales/administración & dosificación , Extractos Vegetales/uso terapéutico , Dimensión del Dolor , Paridad , Dolor Postoperatorio/tratamiento farmacológico , Dolor/tratamiento farmacológico , Irán

RESUMEN

OBJECTIVE: To determine risk factors and to develop a risk prediction score for intrapartum cesarean delivery (CD) in women over 40 years old. STUDY DESIGN: A retrospective cohort study, in a single university-affiliated tertiary medical center. All women aged 40 years or more who planned a trial of labor between 2012 and 2022. Women who opted for an elective CD and those with non-viable fetuses were excluded. Maternal and neonatal characteristics of women who delivered vaginally were compared to those who underwent an intrapartum CD. Risk factors were examined using univariate and multivariate analysis. A score was developed to predict the need for intrapartum CD. We assessed a receiver operating characteristic curve to evaluate the performance of our model. MAIN OUTCOME MEASURE: An unplanned intrapartum cesarean section. RESULTS: During the study period, 122,583 women delivered at our center, of whom 6122 (4.9 %) aged 40 years or more attempted a trial of labor. Of them, 428 (7 %) underwent intrapartum CD. Several independent risk factors were identified, including nulliparity, regional anesthesia, induction of labor, use of antibiotics during labor, multiple gestation, previous cesarean delivery, and the presence of gestational diabetes or preeclampsia. A risk score model, employing a cut-off of 7, demonstrated successful prediction of intrapartum CD, with an area under the curve of 0.86. CONCLUSION: The score model for intrapartum CD can be used by caregivers to offer a more informed consultation to women aged 40 years or more deciding on the mode of delivery.

Asunto(s)

Cesárea , Esfuerzo de Parto , Humanos , Femenino , Estudios Retrospectivos , Embarazo , Cesárea/estadística & datos numéricos , Adulto , Factores de Riesgo , Curva ROC , Medición de Riesgo/métodos , Trabajo de Parto Inducido , Persona de Mediana Edad , Paridad

RESUMEN

BACKGROUND: Although research interest in fear of childbirth has increased, interventions targeting especially multiparas with fear of childbirth have been overlooked, although untreated fear can cause serious adverse effects on the mother and the whole family. Thus MOTIVE (Multiparas overcoming Childbirth Fear Through Intervention and Empowerment), an intervention for pregnant multiparas with fear of childbirth, was designed. METHODS: This is a protocol of a single-arm non-randomized feasibility study of the MOTIVE trial with a mixed-methods design. The primary aim of the intervention is to assist pregnant multiparas with fear of childbirth, with the desired outcome to alleviate fear. MOTIVE consists of four group sessions (2 h each); three during pregnancy and one after giving birth and in addition of a phone call after birth. The intervention is provided by a midwife and a psychiatric nurse at the maternity hospital. Quantitative data will be gathered via self-report questionnaires at three time points, at baseline, at 4 weeks post-baseline and post-intervention. Qualitative data will be gathered by diaries, open-ended questions from post-intervention questionnaires, and individual interviews. The target is to assemble four groups of four multiparas over a 12-month period. DISCUSSION: The findings will provide insights into the feasibility and acceptability of the intervention and will inform revisions to it. The results will guide the development of a definitive, larger-scale trial evaluation to further examine the efficacy of the refined intervention.

Asunto(s)

Miedo , Estudios de Factibilidad , Parto , Humanos , Femenino , Embarazo , Parto/psicología , Partería/métodos , Paridad , Adulto , Mujeres Embarazadas/psicología , Empoderamiento , Encuestas y Cuestionarios

RESUMEN

The purpose of this study was to investigate the associations between multilevel racism and gestational age at birth among nulliparous women. We conducted a secondary analysis of data of the nuMoM2b Study (2010-2013) to examine the associations between individual- and structural-level experiences of racism and discrimination and gestational age at birth among nulliparous women (n = 9148) at eight sites across the U.S. Measures included the individual Experiences of Discrimination (EOD) scale and the Index of Concentration at the Extremes (ICE) to measure structural racism. After adjustment, we observed a significant individual and structural racism interaction on gestational length (p = 0.012). In subgroup analyses, we found that among those with high EOD scores, women who were from households concentrated in the more privileged group had significantly longer gestations (ß = 1.27, 95% CI: 0.48, 2.06). Women who reported higher EOD scores and more economic privilege had longer gestations, demonstrating the moderating effect of ICE as a measure of structural racism. In conclusion, ICE may represent a modifiable factor in the prevention of adverse birth outcomes in nulliparas.

Asunto(s)

Edad Gestacional , Racismo , Humanos , Femenino , Embarazo , Adulto , Paridad , Estados Unidos , Resultado del Embarazo/etnología , Resultado del Embarazo/epidemiología , Adulto Joven , Factores Socioeconómicos