[Consequences for the newborn of alcohol consumption during pregnancy]

Prenatal ethanol exposure increases osteoarthritis susceptibility in female rat offspring by programming a low-functioning IGF-1 signaling pathway

Epidemiological evidence indicates that osteoarthritis (OA) and prenatal ethanol exposure (PEE) are both associated with low birth weight but possible causal interrelationships have not been investigated. To investigate the effects of PEE on the susceptibility to OA in adult rats that experienced intrauterine growth retardation (IUGR), and to explore potential intrauterine mechanisms, we established the rat model of IUGR by PEE and dexamethasone, and the female fetus and 24-week-old adult offspring subjected to strenuous running for 6 weeks were sacrificed. Knee joints were collected from fetuses and adult offspring for histochemistry, immunohistochemistry and qPCR assays. Histological analyses and the Mankin score revealed increased cartilage destruction and accelerated OA progression in adult offspring from the PEE group compared to the control group. Immunohistochemistry showed reduced expression of insulin-like growth factor-1 (IGF-1) signaling pathway components. Furthermore, fetuses in the PEE group experienced IUGR but exhibited a higher postnatal growth rate. The expression of many IGF-1 signaling components was downregulated, which coincided with reduced amounts of type II collagen in the epiphyseal cartilage of fetuses in the PEE group. These results suggest that PEE enhances the susceptibility to OA in female adult rat offspring by down-regulating IGF-1 signaling and retarding articular cartilage development.

[Non-drug psycho-active substance use and pregnancy]

BACKGROUND

The consumption of psycho-active substances (PAS) by pregnant women is in a growing increase around the world. It is a major problem of public health in some countries due to serious and negative consequences for children and society as well as for pregnant women. This problem has also increased among women in Morocco. However, it is still neglected and underrated in the absence of any official statistical data. This is the first study leading to a better profiling of pregnant women who may consume psycho-active substances during their pregnancy; it would permit better medical and psychosocial care of both women and children.

OBJECTIVES

To determine the prevalence and the factors associated with the psycho-active substances used by pregnant women and describe their socio-demographic characteristics.

METHODS AND PATIENTS

A trans-sectional study was carried out from September to October 2010, including pregnant women consulting at the obstetrical service of the provincial hospital Moulay Abdellah in the city of Salé. The study included women who were pregnant or had recently given birth, and not having any serious mental disorders that could have upset their cognitive abilities. The data was collected through a straight questionnaire of 25 items specifying the socio-demographic characteristics, data about pregnancy and habits of using psycho-active substances.

RESULTS

One hundred and fifty pregnant women were included in the study. The majority of them (83.2%) were aged 20 to 40 years old, 94.6% were married, 96% were unemployed and depended on their spouses for their financial resources and 80% had normal domestic relationships (from average to good quality). Among the women, 31.3% of them reported traumatic events in the past. The prevalence of psycho-active substance consumption by the pregnant women of our sample was 11.3%. The used substances were tobacco (9.3%) and cannabis (4%). These women were more likely to have a low level of education (47.1 vs 16.5). They were victims of abuse or neglect in their past (82.3 vs 24.9), and their relationships with their spouses were bad (70.6 vs 13.5) with a lack of desired pregnancy (47.1 vs 27.8) and poor follow-up (47.1 vs 3.8). The results show statistically significant differences.

CONCLUSION

Not only should decision-makers draw attention to the seriousness of the problem because of the relatively high rate of psycho-active substance consumption, but also they should increase obstetric team's awareness to look systematically for psycho-active substance use.

Using photovoice to examine community level barriers affecting maternal health in rural Wakiso district, Uganda

Uganda continues to have poor maternal health indicators including a high maternal mortality ratio. This paper explores community level barriers affecting maternal health in rural Wakiso district, Uganda. Using photovoice, a community-based participatory research approach, over a five-month period, ten young community members aged 18-29 years took photographs and analysed them, developing an understanding of the emerging issues and engaging in community dialogue on them. From the study, known health systems problems including inadequate transport, long distance to health facilities, long waiting times at facilities and poor quality of care were confirmed, but other aspects that needed to be addressed were also established. These included key gender-related determinants of maternal health, such as domestic violence, low contraceptive use and early teenage pregnancy, as well as problems of unclean water, poor sanitation and women's lack of income. Community members appreciated learning about the research findings precisely hence designing and implementing appropriate solutions to the problems identified because they could see photographs from their own local area. Photovoice's strength is in generating evidence by community members in ways that articulate their perspectives, support local action and allow direct communication with stakeholders.