A cluster analysis of reasons behind fear of birth among women in Sweden

BACKGROUND

Fear of birth is common and complex, caused by a variety of reasons. The aim was to investigate the prevalence of pre-established reasons in relation to fear, and to identify profiles of women based on their reported reasons behind fear of birth.

METHODS

A cross-sectional Swedish study of women with self-reported fear of birth who completed an online survey. Descriptive statistics, chi-square test, crude and adjusted odds ratios with 95% confidence intervals were used in the analysis of pre-established reasons in relation to self-reported severe fear. A Kappa-means cluster analysis was performed in order to group reasons, that were further investigated in relation to women's background variables.

RESULTS

A total of 1419 women completed the survey. The strongest reason behind fear of birth was to be forced to give birth vaginally. Four clusters were identified and labeled: minor complexity (reference group), relative minor complexity, relative major complexity, and major complexity. Cesarean section preference, previous mental health problems, being younger, primiparity, and exposure to domestic violence were factors related to cluster grouping.

CONCLUSIONS

Women with fear of birth have various reasons and diverse complexities behind their fear. Health care providers need to investigate these reasons and support pregnant women with childbirth fear, based on their needs.

High first trimester ferritin levels differ according to parity and are independently related to preterm birth: A prospective cohort study

INTRODUCTION

A considerable amount of neonatal morbidity and mortality worldwide is caused by preterm birth. To date, the underlying etiology of preterm birth has not been fully clarified. Previous studies demonstrate that inflammation is one of the pathological factors that might cause preterm birth, and that there is a difference between primiparous and multiparous women in immune response to pregnancy. The objective of this prospective cohort study was to investigate the role of two inflammatory markers, ferritin and C-reactive protein (CRP) and preterm birth, in first trimester women, stratified for parity. In addition, a possible association between high ferritin and CRP, and a possible association between high ferritin and CRP and preterm birth were assessed.

MATERIAL AND METHODS

A total of 2044 healthy, low-risk pregnant women from primary obstetric care in the Netherlands participated in this study. Their ferritin and CRP levels were evaluated at 12 weeks' gestation. Levels above the parity specific 95th percentile were defined as high. The main outcome of this study was to assess the presence of a possible association between parity specific high ferritin and CRP, and preterm birth. The secondary outcomes were the ferritin and CRP levels of women, stratified for parity, and the possible association between high ferritin and CRP levels. Logistic regression analysis was performed with preterm birth as a dependent variable and parity specific high ferritin and CRP as an independent variable, adjusting for age and history of preterm birth.

RESULTS

Ferritin levels decreased with increasing parity. Ferritin and CRP levels at 12 weeks' gestation were significantly higher in women with preterm birth. In primiparous women, high ferritin levels (OR: 2.5, CI: 1.14-5.38) and high CRP levels (OR: 5.0, CI: 2.61-9.94) were independently associated with preterm birth. In multiparous women, high ferritin levels (OR: 6.0, CI: 2.28-16.67) were independently associated with preterm birth while high CRP levels were not.

CONCLUSIONS

First trimester parity specific ferritin and CRP levels could play a part in predictive models for preterm birth, and further research for their additive role in preterm birth is needed.

Association of Parity with the Risks of Gestational Diabetes and Macrosomia: A Retrospective Cohort Study in Nanjing, China

BACKGROUND

After implementing the two-child policy, more Chinese women who had a previous delivery had their second child. Nevertheless, the impacts of parity on Gestational Diabetes (GDM) and macrosomia have not been fully confirmed. Therefore, we aimed to analyse the characteristics of pregnancy by parity and evaluate the association of parity with risks of GDM/macrosomia in a Chinese population.

METHODS

A total of 193,410 pregnant women (including 148,293 primiparae and 45,117 multiparae) with complete information were included. Univariate and multivariate logistic regression analyses were used to examine the association between parity and risks of GDM/macrosomia.

RESULTS

With the gradual implementation of the two-child policy, the proportion of multiparae increased rapidly and then decreased slightly. Multiparae were more likely to be older and have higher intrapartum BMI, as compared to primiparae (P < 0.001). Univariate regression analyses suggested that parity could increase the risks of GDM and macrosomia; while after adjustment, the association between parity and GDM risk disappeared, and the effects of parity on macrosomia risk and birth weight of babies were also weakened. Further, stratified analysis showed that parity only increased the risk of GDM in women over 30 years, and the effects of parity on macrosomia risk and birth weight were more pronounced among women over 30 years compared to women under 30 years.

CONCLUSION

Parity was not associated with GDM risk, but mildly associated with macrosomia risk. Particular attention should be paid to multiparae with advanced age to reduce the risks of GDM and macrosomia.

Nonreassuring fetal status during labor and offspring's childhood neurodevelopment at 3 years of age: The Japan Environment and Children's Study

OBJECTIVE

Although prior attempts have failed to identify the beneficial effects of intensive fetal monitoring on cerebral palsy, the association between nonreassuring fetal status (NRFS) during labor and the incidence of long-term neurodevelopmental delays in offspring remains unclear. This study aimed to evaluate this association using a nationwide birth cohort.

METHODS

Data from 72 869 women with singleton deliveries at and after 37 weeks of gestation from the Japan Environment and Children's Study (2011-2014) were analyzed. Multivariable logistic regression models were used to analyze the odds ratios (ORs) for neurodevelopmental delays using the Ages & Stages Questionnaire (Third Edition) in offspring aged 3 years.

RESULTS

The adjusted ORs for personal-social problems were 1.52 (95% confidence interval [CI], 1.06-2.16) for offspring delivered vaginally by nulliparous mothers and 1.51 (95% CI, 1.05-2.18) (for males, 1.70 [95% CI, 1.15-2.50]) for those delivered via cesarean section. No significant changes in adjusted ORs for neurodevelopmental delays were observed among participants without neonatal Apgar scores (ASs) <7 and without umbilical arterial pH (UmA-pH) <7.20.

CONCLUSION

NRFS during labor was associated with an increased incidence of personal-social problems in offspring aged 3 years. However, this association was not confirmed after excluding participants with neonatal ASs <7 and UmA-pH <7.20. The association between NRFS and offspring's neurodevelopmental delays might vary based on delivery settings, offspring sex, and short-term neonatal outcomes.

Influence of vaginal birth on lumbopelvic muscle mechanical properties on urinary incontinence

OBJECTIVE

To identify differences in the muscle mechanical properties of the pelvic floor (PF) and lumbar paravertebral (LP) muscles between young nulliparous and uni/multiparous women. Secondarily, specific behaviors, depending on the presence or absence or urinary incontinence (UI), were also researched.

DESIGN

Case-control study.

SETTING

Higher education institution.

PARTICIPANTS

One hundred young women participated, divided into two groups depending on whether they had vaginal birth (nulliparous or uni/multiparous). Each group included women with and without UI.

MAIN MEASURES

A muscle mechanical properties (tone, stiffness, decrement-inverse of elasticity-, and viscoelastic properties: relaxation and creep) assessment of the PF and LP muscles were performed with a hand-held tonometer.

RESULTS

Tone and stiffness of both sides of the PF presented group by UI interaction (p < 0.05), with uni/multiparous women with UI showing higher tone and stiffness compared to multiparous women without UI. In LP muscles, uni/multiparous women showed greater tone and stiffness on the right and left sides [-2.57 Hz (95% confidence interval -4.42,-0.72) and -79.74 N/m (-143.52,-15.97); -2.20 Hz (-3.82,-0.58) and -81.30 N/m (-140.66-,21.95), respectively], as well as a decrease in viscoelastic properties compared to nulliparous women [relaxation: 2.88 ms (0.31,5.44); creep: 0.15 (0.01,0.30); relaxation: 2.69 ms (0.13,5.25); creep: 0.14 (0,0.28), respectively].

CONCLUSIONS

Vaginal birth and UI have a differential influence on the muscle mechanical properties of the PF and LP muscles. The determination of muscle mechanical properties by externally applied hand-held tonometry improves the knowledge of the lumbopelvic status, with applicability in clinical and research fields.

Comparison of serum very low-density lipoprotein concentrations during transition in primiparous and multiparous cows

This study was carried out as an observational study in order to examine the difference of change in serum very low-density lipoprotein (VLDL) between primiparous and multiparous cows. Twenty-one clinically healthy cows (10 primiparous and 11 multiparous) were selected at 21 days prior to expected calving. Blood samples were collected in the morning (before feeding) on days -21, -7, 7, 21 and 56 days in milk (DIM). At 7 and 21 DIM, the serum non-esterified fatty acid concentration of multiparous cows was significantly higher than that of primiparous cows. The serum β-hydroxybutyrate concentration was also markedly higher in multiparous cows than in primiparous cows at 21 DIM. These results suggested that the degree of negative energy balance was greater in multiparous cows than in primiparous cows during this period. In both, serum VLDL concentrations decreased at over 7 DIM, increased at 21 DIM, and then decreased at 56 DIM. On the other hand, triglyceride and total protein concentrations of VLDL in multiparous cows were significantly lower than in primiparous cows at 21 DIM. This suggests that multiparous cows have poor triglyceride secretion from the liver and that they become more susceptible to hepatic lipidosis.

Impacts of ground ultra-low volume adulticide applications on Culex pipiens and Culex restuans (Diptera: Culicidae) abundance, age structure, and West Nile virus infection in Cook County, Illinois

Since the introduction of West Nile virus (WNV) to the United States over 20 years ago, thousands of cases of human disease and death have been reported. Yearly seasonal outbreaks continue to persist, and the city and suburbs of Chicago, Illinois, is considered a "hot spot" for WNV activity. To interrupt WNV transmission, ground ultra-low volume (ULV) adulticide applications are regularly used to reduce Culex pipiens L. and Culex restuans Theobold (Diptera: Culicidae) abundance and infection. The real-world effectiveness of adulticide applications has not been comprehensively assessed, and prior studies, including our own investigation, have yielded inconclusive or conflicting results. Therefore, we expanded our prior work and evaluated the effects of 5 sequential weekly truck-mounted ULV adulticide applications in large residential areas in the northern suburbs of Chicago, Illinois, in 2019 and 2020. Each day, Cx. pipiens and Cx. restuans host-seeking and gravid mosquitoes were collected to assess abundance, age structure, and WNV infection rates. Adulticide applications resulted in significant reductions of both host-seeking and gravid abundance on the night of treatment. The reduction in host-seeking mosquitoes was followed by a reduction in gravid mosquitoes trapped 3 and 4 days after adulticide application and an increase in the proportion of nulliparous mosquitoes. WNV infection rates were significantly reduced in treatment sites as compared to untreated sites when infection rates were higher in 2020. This large-scale study provides comprehensive evidence that ground ULV adulticide applications are an effective tool in an integrated mosquito management program for combating WNV vectors and infection risk.

Parity affects mammary development in late-pregnant swine

The goal of this project was to determine whether various measures of mammary development differed between gilts and multiparous sows at the end of gestation. During gestation, Yorkshire × Landrace gilts (n = 19) and sows (second and third gestations, n = 17) were fed one daily meal of a conventional corn-based diet, where the amount fed was based on body weight (BW) and backfat thickness (BF) at mating. On day 110 ± 1 of gestation, a jugular blood sample was obtained from all gilts and sows to measure insulin-like growth factor-1 (IGF-1), glucose, free fatty acids, and urea. On that same day, BW and BF were measured and animals were euthanized. Mammary glands from one side of the udder were dissected for compositional analyses. The fifth gland of the contralateral row of mammary glands was sampled for histology and immunohistochemical localization of Ki67. There was less total parenchyma (1,437.4 vs. 2,004.7 ± 127.1 g; P < 0.001) and total extraparenchymal tissue (1,691.0 vs. 2,407.0 ± 125.3 g; P < 0.001) in mammary glands of gilts compared to those from sows. When these values were expressed per kg BW (226.0 and 284.0 ± 2.7 kg for gilts and sows, respectively), parenchymal mass did not differ (P > 0.10), while extraparenchymal tissue weight tended to be less in gilts than sows (P = 0.07). All components within the parenchyma differed by parity (P < 0.001). Specifically, parenchymal tissue from gilts contained a greater proportion of fat and dry matter (DM), a lower proportion of protein, and lower concentrations of DNA (6.59 vs. 9.35 ± 0.53 mg/g DM) and RNA (7.76 vs. 12.33 ± 0.70 mg/g DM) than that from sows. On the other hand, the circumference of alveolar lumens was greater in gilts than sows (P < 0.001), while the percentage of epithelial cells that were positive for Ki67, a marker of cell proliferation, was greater in sows than gilts (P < 0.05). Circulating concentrations of IGF-1 were greater in gilts than in multiparous sows (45.0 vs. 27.3 ± 2.8 ng/mL, P < 0.001). None of the other blood variables were changed by parity. Results show a marked effect of parity on mammary gland development in swine. At the end of gestation, the mammary glands of gilts had less parenchyma with lower epithelial proliferation than glands from multiparous sows. These differences could alter the response of mammary tissue to various nutritional or endocrine signals. This information is crucial for the development of management strategies designed to maximize sow milk yield.

Associations of reproductive breast cancer risk factors with expression of stem cell markers in benign breast tissue

Background

We investigated the associations of reproductive factors known to influence breast cancer risk with the expression of breast stem cell markers CD44, CD24, and ALDH1A1 in benign breast biopsy samples.

Methods

We included 439 cancer-free women with biopsy-confirmed benign breast disease within the Nurses' Health Study (NHS) and NHSII. The data on reproductive and other breast cancer risk factors were obtained from biennial questionnaires. Immunohistochemistry (IHC) was performed on tissue microarrays. For each core, the IHC expression was assessed using a semi-automated platform and expressed as % of cells that stained positive for a specific marker out of the total cell count. Generalized linear regression was used to examine the associations of reproductive factors with a log-transformed expression of each marker (in epithelium and stroma), adjusted for other breast cancer risk factors.

Results

In multivariate analysis, the time between menarche and age at first birth was inversely associated with CD44 in epithelium (β per 5 years = -0.38, 95% CI -0.69; -0.06). Age at first birth and the time between menarche and age at first birth were inversely associated with ALDH1A1 (stroma: β per 5 years = -0.43, 95% CI -0.76; -0.10 and β = -0.47, 95% CI -0.79; -0.15, respectively; epithelium: β = -0.15, 95% CI -0.30; -0.01 and β = -0.17, 95% CI -0.30; -0.03, respectively). Time since last pregnancy was inversely associated with stromal ALDH1A1 (β per 5 years = -0.55, 95% CI -0.98; -0.11). No associations were found for CD24. The observed associations were similar in premenopausal women. In postmenopausal women, lifetime duration of breastfeeding was inversely associated with stromal ALDH1A1 expression (β for ≥24 vs. 0 to <1 months = -2.24, 95% CI 3.96; -0.51, p-trend = 0.01).

Conclusion

Early-life reproductive factors may influence CD44 and ALDH1A1 expression in benign breast tissue.

Menstrual health: Inequities in a cohort of menstruating people in the Brazilian southeastern region

OBJECTIVE

To assess menstrual hygiene management (MHM) and period poverty in a group of low- and medium-income menstruating people.

METHODS

A cross-sectional study was conducted at the University of Campinas, Brazil, from January to June 2022 with 535 participants aged 18-49. For data collection, we used the abbreviated version of the WHO Quality-of-Life questionnaire (WHOQOL-BREF) and a pre-tested questionnaire with items regarding MHM and period poverty.

RESULTS

We found an inverse relationship between the risk of no access to supplies to perform menstrual hygiene, which increased by 2.5% and each point less in the environmental domain of quality of life (QoL), and this risk increased by up to 3.1 times among participants who reported difficulty making ends meet. The risk of not having adequate conditions to perform menstrual hygiene at home increased by up to 2.6% for every one-point drop in the environmental domain of QoL. The risk of not having adequate conditions to perform menstrual hygiene outside the home increased by up to 1.3% for less points in the psychological domain of QoL, and 44.4% of those who indicated inadequate conditions for menstrual hygiene reported two or more childbirths.

CONCLUSIONS

Menstruating people who have an increased risk of lacking menstrual supplies and have an increased risk of inadequate conditions for MHM at home and outside the home, as well as those who have two or more deliveries and those having difficulties making ends meet, scored low on the QoL, especially in the environmental and psychological dimensions.

The gender composition of the members of the editorial board of toxicology journals: Assessment of gender equality

In many areas of medicine, gender equality has not yet been fully adopted despite recent developments. The inequality of gender in various areas of medicine is still debated. In this study, we analysed the gender composition of the editorial boards of toxicology journals in the Science Citation Index-Expanded (SCI-E) databases and the factors affecting this composition. The genders of the participants were determined by the data obtained from the official websites of the journals in September 2023. We analysed the journal metrics and publisher properties using Mann-Whitney U, Fisher's exact, Chi-square tests and Spearman's correlation coefficient. We used logistic regression analysis to reveal the independent factors related to gender parity. The representation rates of women were 28.62% on all editorial boards and 23.33% in editor-in-chief positions. The 'Neuroscience' (OR, 2.46 95%CI, 1.68-3.60, p < 0.001), 'Reproductive Biology'(OR, 2.05 95%CI, 1.22-3.42, p = 0.006) and 'Public, Environmental & Occupational Health'(OR, 1.49 95%CI, 1.18-1.88, p = 0.001) as a coverage category, the United States as a journal country (OR, 1.21, 95%CI, 1.04-1.40, p = 0.001), 5-year-IF≥3.6(OR, 1.54, 95%CI, 1.27-1.86, p < 0.001), 5-year H index≥29 (OR, 1.23, 95%CI, 1.01-1.49, p = 0.037) were the independent factors for gender parity. However, 'Oncology' (OR, 0.08 95%CI, 0.01-0.55, p = 0.011), 'Biochemistry, Molecular Biology' (OR, 0.62 95%CI, 0.44-0.86, p = 0.005) and 'Pharmacology & Pharmacy' (OR, 0.69 95%CI, 0.59-0.82, p < 0.001) as a coverage category, Japan as a publisher country (OR, 0.52 95%CI, 0.35-0.77, p = 0.001), and Switzerland as a journal country (OR, 0.61, 95%CI, 0.46-0.81, p = 0.001) were related to gender disparity. Greater endeavours are needed to reduce gender discrimination in toxicology. Toxicology authorities should continuously improve existing policies by optimising the analysis of objective information to eliminate barriers for toxicologists in terms of gender equality.

Prevention of obstetric anal sphincter injuries with perineal support and lateral episiotomy: A historical cohort study

INTRODUCTION

There are many risk factors for obstetric anal sphincter injury (OASIS) and the interaction between these risk factors is complex and understudied. The many observational studies that have shown a reduction of OASIS rates after implementation of perineal support have short follow-up time. We aimed to study the effect of integration of active perineal support and lateral episiotomy on OASIS rates over a 15-year period and to study interactions between risk factors known before delivery.

MATERIAL AND METHODS

We performed a historical cohort study over the periods 1999-2006 and 2007-2021 at Stavanger University Hospital, Norway. The main outcome was OASIS rates. Women without a previous cesarean section and a live singleton fetus in cephalic presentation at term were eligible. The department implemented in 2007 the Finnish concept of active perineal protection, which includes support of perineum, control of fetal expulsion, good communication with the mother and observation of perineal stretching. The practice of mediolateral episiotomy was replaced with lateral episiotomy when indicated. We analyzed the OASIS rates in groups with and without episiotomy stratified for delivery mode, fetal position at delivery and for parity, and adjusted for possible confounders (maternal age, gestational age, oxytocin augmentation and epidural analgesia).

RESULTS

We observed a long-lasting reduction in OASIS rates from 4.9% to 1.9% and an increase in episiotomy rates from 14.4% to 21.8%. Lateral episiotomy was associated with lower OASIS rates in nulliparous women with instrumental vaginal deliveries and occiput anterior (OA) position; 3.4% vs 10.1% (OR 0.31; 95% CI: 0.24-0.40) and 6.1 vs 13.9% (OR 0.40; 95% CI: 0.19-0.82) in women with occiput posterior (OP) position. Lateral episiotomy was also associated with lower OASIS rates in nulliparous women with spontaneous deliveries and OA position; 2.1% vs 3.2% (OR 0.62; 95% CI: 0.49-0.80). The possible confounders had little confounding effects on the risk of OASIS in groups with and without episiotomy.

CONCLUSIONS

We observed a long-lasting reduction in OASIS rates after implementation of preventive procedures. Lateral episiotomy was associated with lower OASIS rates in nulliparous women with an instrumental delivery. Special attention should be paid to deliveries with persistent OP position.

Parity, mode of birth, and long-term gynecological health: A follow-up study of parous and nonparous women in the Australian Longitudinal Study on Women's Health cohort

BACKGROUND

Although gynecological health issues are common and cause considerable distress, little is known about their causes. We examined how birth history is associated with urinary incontinence (UI), severe period pain, heavy periods, and endometriosis.

METHODS

We studied 7700 women in the Australian Longitudinal Study on Women's Health with an average follow-up of 10.9 years after their last birth. Surveys every third year provided information about birth history and gynecological health. Logistic regression was used to estimate how parity, mode of birth, and vaginal tears were associated with gynecological health issues. Presented results are adjusted odds ratios (OR) with 95% confidence intervals.

RESULTS

UI was reported by 16%, heavy periods by 31%, severe period pain by 28%, and endometriosis by 4%. Compared with women with two children, nonparous women had less UI (OR 0.35 [0.26-0.47]) but tended to have more endometriosis (OR 1.70 [0.97-2.96]). Also, women with only one child had less UI (OR 0.77 [0.61-0.98]), but more severe period pain (OR 1.24 [1.01-1.51]). Women with 4+ children had more heavy periods (OR 1.42 [1.07-1.88]). Compared with women with vaginal birth(s) only, women with only cesarean sections or vaginal birth after cesarean section had less UI (ORs 0.44 [0.34-0.58] and 0.55 [0.40-0.76]), but more endometriosis (ORs 1.91 [1.16-3.16] and 2.31 [1.25-4.28]) and heavy periods (ORs 1.21 [1.00-1.46] and 1.35 [1.06-1.72]). Vaginal tear(s) did not increase UI after accounting for parity and birth mode.

CONCLUSION

While women with vaginal childbirth(s) reported more urinary incontinence, they had less menstrual complaints and endometriosis.

Consistency and Variability of the Human Milk Oligosaccharide Profile in Repeat Pregnancies

Human milk oligosaccharides (HMOs) are a set of complex carbohydrates and the third largest solid component of human milk, after lactose and lipids. To date, over 150 HMOs have been identified and the diversity of structures produced by lactating women is influenced by maternal genetics as well as other maternal, infant, and environmental factors. While the concentrations of individual HMOs have been shown to vary between individuals and throughout the course of lactation, the variability of HMO concentration profiles following different pregnancies occurring in the same woman is presently unknown. As such, the objective of this study was to compare HMO concentrations in human milk samples provided by the same women (n = 34) following repeat pregnancies. We leveraged existing human milk samples and metadata from the UC San Diego Human Milk Research Biorepository (HMB) and measured the concentrations of the 19 most abundant HMOs using high-performance liquid chromatography with fluorescence detection (HPLC-FL). By assessing dissimilarities in HMO concentration profiles, as well as concentration trends in individual structures between pregnancies of each participant, we discovered that HMO profiles largely follow a highly personalized and predictable trajectory following different pregnancies irrespective of non-genetic influences. In conclusion, this is the first study to assess the interactions between parity and time following delivery on variations in HMO compositions.

Association of Parity With Insulin Resistance Early in Pregnant Women: ECLIPSES Study

CONTEXT

Little is known about whether parity is associated with elevated early-pregnancy insulin resistance (IR), or whether overweight/obesity contributes to increasing the possible effect.

OBJECTIVE

We determined the associations between parity and glucose metabolism parameters in the first trimester of pregnancy in a Mediterranean pregnant population, and whether these associations are affected by overweight/obesity.

METHODS

A cross-sectional study was conducted of 264 healthy pregnant women from the ECLIPSES study who were recruited at 12 weeks of gestation. At baseline, details on socioeconomic status, obstetric history (including parity, ie, number of births), lifestyle factors, anthropometry, and blood samples were collected. Fasting serum glucose, insulin, and homeostasis model assessment of insulin resistance (HOMA-IR) index were assessed in the first trimester. Elevated IR was defined as the upper HOMA-IR tertile (≥1.58). Multivariable linear regression and Cox regression model with constant time were performed.

RESULTS

Parity ranged from 0 to 4. After multivariable adjustment, the insulin levels (β [% change]: 20.92; 95% CI, 4.08-37.71) and HOMA-IR index (β [% change]: 19.72; 95% CI, 2.43-40.49) were positively associated with parity. Additionally, multiparous women, as compared to nulliparous, were more likely to have higher HOMA-IR levels (primiparous [1 birth], β [% change[: 16.88; 95% CI, -1.00 to 37.99; multiparous [≥2 births), β [% change]: 32.18; 95% CI, 3.56-68.71), and an increased relative risk (RR) of an elevated IR (primiparous [1 birth], RR: 1.55; 95% CI, 1.03-2.36; multiparous (≥2 births), RR: 1.72; 95% CI, 1.05-2.83). The combination of multiparity and overweight/obesity conferred a 3.04-fold increase in the RR of elevated IR, which increased proportionally to the number of parities.

CONCLUSION

This study demonstrates that parity may have a negative effect on early-pregnancy IR and that maternal overweight/obesity appears to further aggravate this relationship.

Sickness absence and disability pension three years before and seven years after first childbirth: A Swedish population-based cohort study

AIMS

There is a widely held belief, in Sweden and internationally, that women with children are more likely to be on sickness absence (SA) than their nulliparous counterparts. However, empirical findings in the field are limited and inconsistent. We aimed to explore initially nulliparous women's patterns of SA and disability pension (DP) three years before and seven years after 2009, by later parity.

METHODS

We conducted a longitudinal cohort study of nulliparous women in Sweden on 31 December 2009 (N=426,918). We compared crude and standardized numbers of SA/DP net days in the three years before (Y-3 to Y-1) and the seven years (Y+1 to Y+7) after the date of the first birth in 2010 or 2 July 2010 in the following three groups: (1) women with no childbirth during the seven-year follow-up and an additional nine months (i.e. 7.8 years), (2) women with a first childbirth in 2010 and no additional childbirth during the next 7.8 years, and (3) women with their first childbirth in 2010 and minimum one more during the next 7.8 years.

RESULTS

Women remaining nulliparous had consistently more standardized mean SA/DP days than women giving birth. Compared with women with one birth, women with several births had similar mean numbers of standardized SA/DP days during Y-3 and Y-2, more during Y+1 to Y+3 and fewer during Y+4 to Y+7.

CONCLUSIONS

In contrast to the widely held societal belief, we found that in all years women who gave birth had fewer SA/DP days than those remaining nulliparous.

Association of parity with the prevalence of hypertension in Japan: The Tohoku Medical Megabank Community-based cohort study

This study investigated the association of parity with hypertension prevalence in Japanese women while considering a clinical history of hypertensive disorders of pregnancy (HDP) and menopausal status. This cross-sectional study included 30,530 Japanese women (6700 premenopausal; 23 830 postmenopausal). The association between parity and the prevalence of hypertension was evaluated using a multiple logistic regression model with possible confounders. In premenopausal women, no statistically significant association between parity and hypertension prevalence was found. When not adjusted for current body mass index (BMI), a linear graded association was observed between parity and the prevalence of hypertension in postmenopausal women. However, the association between parity and hypertension prevalence in postmenopausal women was attenuated after adjustment for current BMI. Both current BMI and a clinical history of HDP were significantly associated with a high risk of hypertension in both premenopausal and postmenopausal women. Our results also suggest that continuous surveillance and preventive measures for hypertension should be provided for women with HDP and high parity.

Association of hormonal and reproductive factors with differentiated thyroid cancer risk in women: a pooled prospective cohort analysis

BACKGROUND

The incidence of differentiated thyroid cancer (DTC) is higher in women than in men but whether sex steroid hormones contribute to this difference remains unclear. Studies of reproductive and hormonal factors and thyroid cancer risk have provided inconsistent results.

METHODS

Original data from 1 252 907 women in 16 cohorts in North America, Europe, Australia and Asia were combined to evaluate associations of DTC risk with reproductive and hormonal factors. Multivariable-adjusted Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% CIs.

RESULTS

During follow-up, 2142 women were diagnosed with DTC. Factors associated with higher risk of DTC included younger age at menarche (<10 vs 10-11 years; HR, 1.28; 95% CI, 1.00-1.64), younger (<40; HR, 1.31; 95% CI, 1.05-1.62) and older (≥55; HR, 1.33; 95% CI, 1.05-1.68) ages at menopause (vs 40-44 years), ever use of menopausal hormone therapy (HR, 1.16; 95% CI, 1.02-1.33) and previous hysterectomy (HR, 1.25; 95% CI, 1.13-1.39) or bilateral oophorectomy (HR, 1.14; 95% CI, 1.00-1.29). Factors associated with lower risk included longer-term use (≥5 vs <5 years) of oral contraceptives (HR, 0.86; 95% CI, 0.76-0.96) among those who ever used oral contraception and baseline post-menopausal status (HR, 0.82; 95% CI, 0.70-0.96). No associations were observed for parity, duration of menopausal hormone therapy use or lifetime number of reproductive years or ovulatory cycles.

CONCLUSIONS

Our study provides some evidence linking reproductive and hormonal factors with risk of DTC. Results should be interpreted cautiously considering the modest strength of the associations and potential for exposure misclassification and detection bias. Prospective studies of pre-diagnostic circulating sex steroid hormone measurements and DTC risk may provide additional insight.

Levator muscle avulsion and subsequent vaginal delivery: longitudinal 8-year follow-up

OBJECTIVES

The aim of this study is to assess the evolution of levator avulsion from 1 year to 8 years after first delivery in women with subsequent vaginal deliveries compared to women without subsequent vaginal deliveries. Further, we aim to assess whether women with full and partial avulsion 8 years after first delivery have larger levator hiatus area and more symptoms of pelvic organ prolapse compared to women with normal levator insertion.

METHODS

In this single center longitudinal study 195 initially primiparous women were included and underwent transperineal ultrasound 1 year and 8 years after first delivery. Muscle insertion was assessed by tomographic ultrasound imaging in the axial plane. Full levator avulsion was defined as abnormal muscle insertion in all three central slices. Partial levator avulsion was defined as abnormal muscle insertion in one but less than three central slices. Eight years after first delivery levator hiatus area was assessed at rest, during maximum pelvic floor muscle contraction, and maximum Valsalva maneuver. To assess symptoms of pelvic organ prolapse the vaginal symptoms module from the International Consultation on Incontinence Questionnaire was used.

RESULTS

At 1 year follow-up, 25 women (12.8%) showed signs of avulsion, 20 women fulfilled sonographic criteria for full avulsion and 5 women fulfilled sonographic criteria for partial avulsion. Eight years after first delivery, 35 (17.9%) women were diagnosed with avulsion, of them 25 women were diagnosed with full avulsion and 10 women were diagnosed with partial avulsion. No women with partial and full avulsion at 1 year improved on their avulsion status at 8-year follow-up. In the subsequent vaginal delivery group, 21 women (14%) were diagnosed with partial and full levator avulsion 1 year after first delivery, and 31 women (20.7%) were diagnosed with partial and full avulsion 8 years after first delivery. Of the 45 women without subsequent vaginal delivery, one woman with partial avulsion 1 year after first delivery was diagnosed as full avulsion at 8-year follow-up. All women with full avulsion at 1-year follow-up were diagnosed as full avulsion at 8 years regardless of subsequent vaginal delivery. At 8-year follow-up women with full avulsion had statistically significant larger levator hiatus area compared to women with normal muscle insertion. Vaginal symptoms scores ranged between 5.5 (SD 5.7) and 6.0 (SD 4.0) and vaginal symptom quality of life scores ranged between 0.9 (SD 1.4) and 1.5 (SD 2.2) and did not differ statistically significantly between women with normal muscle insertion and women with partial and full avulsion at 8-year follow-up.

CONCLUSION

More avulsions 8 years after first delivery compared to one year after first delivery were found in women with subsequent vaginal delivery. Except one primipara, none of the women without subsequent vaginal delivery changed on their levator status from 1 to 8 years after first delivery. Larger levator hiatus area was found in women with full avulsion compared to women with normal muscle insertion at 8-year follow-up. Vaginal symptoms scores were low and did not differ between women with normal muscle insertion, partial and full avulsion at 8-year follow-up. This article is protected by copyright. All rights reserved.

Impacts of Farrowing Pen Design, Season, and Sow Parity on Litter Performance and Piglet Mortality

Piglet mortality during lactation is a significant concern in swine production, influenced by complex interactions involving sow, piglet, environmental, and management factors. While crushing by the sow may be the ultimate cause of piglet mortality, there are many factors influencing the outcome, including parity, thermal stress, and animal housing systems. New farrowing systems are continuously being developed; however, it is difficult for producers to make decisions without any scientific basis. This study aimed to assess the impact of different farrowing pen layouts on piglet performance, considering parity and season. A total of 546 sows and 9123 piglets were monitored across 36 lactation cycles. Sows were randomly assigned to three farrowing pen layouts (standard, diagonal, and offset) in three rooms (20 sows by room). All farrowing pens had the same space allocations (2.7 m by 1.8 m and 2.1 m by 0.6 m for the sow area). The three types of farrowing pens were blocked by position within the room. Piglet performance traits (percent of stillborns, percent of mortality, percent of overlays, and average daily weight gain: ADG) and sows traits (health and parity) were monitored following US Meat Animal Research Center (USMARC) procedures. Results indicated that treatment, parity, and season influenced some piglet performance traits. The offset farrowing pen had a lower percent of stillborns compared to the standard. No significant differences were observed between the diagonal crate and the other treatments. When evaluating high mortality sow (>two piglets), the offset and standard treatments had a lower percent of overlays. Piglets from first-parity sows had lower ADG than those from higher-parity sows. A higher percent of overlays were observed in Autumn and Summer compared to Spring and Winter, and Summer had lower average daily weight gain than other seasons. The results suggest that modifying the layout (offset), with sows placed further away from the heating source, can reduce the percent of overlays in sows with high mortality (>2 piglets). In addition, the influence of season on the piglet production traits demonstrated the importance of proper management of the environment, even in systems with a certain level of climatic control.

Experiences of success and failure in childbirth

AIMS

To determine what kinds of birth-related experiences of success and failure are described by the participants, and whether there are differences according to fear of childbirth and parity. Studying these experiences is important for understanding the psychological mechanisms behind different childbirth experiences and their impact on maternal mental well-being.

METHODS

This was a longitudinal mixed methods study. Descriptions of the birth experiences of 113 Finnish participants were gathered in a survey at 4-8 weeks postpartum and analysed with content analysis. Fear of childbirth was determined antenatally with the Wijma Delivery Expectations scale (W-DEQ A).The number of success and failure expressions were compared between people with FOC and others and between primiparous and multiparous people.

RESULTS

The contents of the childbirth-related experiences of success and failure were categorised into 12 subcategories, organised under three higher-order categories that were named personal factors, course of childbirth, and support. The most typical expressions of success were in the categories of mode of birth, staff, and mental factors, and the most typical expressions of failure in the categories of staff and mental factors. Experiences of failure were more often expressed by primiparous than multiparous people, but there were no statistically significant differences by FOC. Expressions of success were equally common regardless of parity or FOC.

CONCLUSION

Postpartum people categorise aspects of their birth experiences in terms of success and failure. Primiparous people are more susceptible to experiencing failure at childbirth, but possible differences between people with FOC and other people warrant further investigation.

Evaluation of ultra-low volume treatments on Culex quinquefasciatus (Diptera: Culicidae) abundance and relative age by parity dissection

St. Tammany Parish Mosquito Abatement District relies on ultra-low volume (ULV) insecticides to manage adult Culex quinquefasciatus (Say 1823), the primary vector of West Nile virus in Louisiana, but abundance rarely declines post-treatment. Three field ULV applications each of adulticides containing deltamethrin, naled, or resmethrin were conducted from May through October 2022 to measure efficacy against free-flying Cx. quinquefasciatus. Female mosquitoes trapped before and after treatment were identified, counted, and age-graded by parity dissection. No insecticide applications reduced Cx. quinquefasciatus abundance, but trials with deltamethrin and naled significantly lowered average mosquito age in the area post-treatment. No trials with resmethrin reduced mosquito age, which corroborates laboratory susceptibility data indicating local resistance toward the pyrethroid. These trials establish parity dissections and relative age gradation as a means of measuring treatment success against Cx. quinquefasciatus.

The impact of age and parity on the experience of relief and regret in women who have undergone hysterectomy for benign disease: A cross sectional survey

OBJECTIVE

To investigate the impact of age and parity on the experience on relief and regret following elective hysterectomy for benign disease, and to explore the factors that impact relief and regret.

DESIGN

Retrospective cross-sectional survey of a cohort.

SETTING

Single-centre tertiary hospital in Melbourne, Australia.

POPULATION

Patients who underwent elective hysterectomy for benign indications from 01 January 2008 - 31 July 2015 (inclusive) with age <51 years at time of admission.

METHODS

Eligible participants completed a retrospective survey regarding their experience of relief and regret following hysterectomy.

MAIN OUTCOME MEASURES

Regret was defined as a positive response to "Do you regret the decision to have a hysterectomy?". Relief was defined as responding "agree/strongly agree" to "I feel relieved I had a hysterectomy".

RESULTS

268 of 1285 (21%) eligible participants completed the study questionnaire. Of these, 29 were aged <36 years at the time of hysterectomy. Seven percent (n=18/262) reported regretting having a hysterectomy and 88% (n=230/262) reported experiencing relief. We did not observe associations between age at hysterectomy and regret (aOR 0.93; 95% CI 0.85, 1.03), age at hysterectomy and relief (aOR 1.01; 95% CI 0.93, 1.09), nulliparity and regret (aOR 0.32; 95% CI 0.06, 1.59) or nulliparity and relief (aOR 2.37; 95% CI 0.75, 7.51). Desire for future pregnancy at the time of hysterectomy was more frequently reported in those who experienced regret vs no regret (46.7% vs 12.1%, OR: 6.33; 95% CI: 2.12, 18.90; p=0.001).

CONCLUSIONS

Age and parity are not associated with relief nor regret following elective hysterectomy for benign disease.

A Century of Change: Unraveling the Impact of Socioeconomic/Historical Milestones on Age at Menarche and Other Female Reproductive Factors in Japan

BACKGROUND

Reproductive factors such as age at menarche are known to be associated with disease risk, but data on trends in these factors in Japan are limited. In this study, we investigated secular trends in reproductive factors and explored their potential association with socioeconomic and historical events.

METHODS

We conducted a retrospective analysis of 62,005 Japanese women born between 1890 and 1991 using a survey conducted over 25 years. Trends in reproductive factors were analyzed using linear and joinpoint regression models, and their associations with major historical events involving Japan were evaluated.

RESULTS

We found that the age at menarche showed a significant downward trend (P-value<0.001) over the century. Three joinpoints were identified, in 1932 (15.23 years old), 1946 (13.48 years old), and 1959 (12.71 years old), which indicated that average age at menarche decreased by approximately 0.8% per year between 1932 and 1946, and then by 0.4% per year between 1946 and 1959, both of which were statistically significant. However, after 1959, age of menarche remained stable. Analyses of other reproductive factors found significant changes, including a decrease in parity and the number of babies breastfed, and an increase in age at first birth.

CONCLUSION

Age at menarche showed a long-term downward trend in Japan, with significant change points in annual percent change. Other factors showed secular changes in trends as well. These change points were observed at the same time as historical events, namely wars and economic development, suggesting that socioeconomic and environmental changes at the population level affect reproductive factors in females.

A comparative analysis of gastrointestinal tract barrier function and immune markers in gilt vs. sow progeny at birth and weaning

Progeny born to primiparous sows (gilt progeny; GP) have lower birth, weaning and slaughter weights than sow progeny (SP). GP also have reduced gastrointestinal tract (GIT) development, as evidenced by lower organ weights. Therefore, the aim of this experiment was to quantify changes in GIT barrier function that occur in birth and weaning, representing two major challenges to the young piglet. The effects of parity (GP vs. SP) in GIT barrier integrity function were quantified at four timepoints: birth (~0 h), 24 h after birth (24 h), 1-d preweaning (PrW), and 1-d postweaning (PoW) in commercially reared piglets. Due to inherent differences between newborn and weanling pigs, the results were analyzed in two cohorts, birth (0 vs. 24 h, n = 31) and weaning (PrW vs. PoW, n = 40). Samples of the stomach, jejunum, ileum, and colon were excised after euthanasia and barrier integrity was quantified by measuring transepithelial resistance (TER), macromolecular permeability, the abundance of inflammatory proteins (IL-8, IL-1β, and TNF-α) and tight junction proteins (claudin-2 and -3). Papp was characterized using a dual tracer approach comprising 4 KDa fluorescein isothiocyanate (FD4) and 150 kDa tetramethyl rhodamine isothiocyanate (T150)-labeled dextrans. Characteristic effects of the initiation of feeding and weaning were observed on the GIT with the initiation of feeding, such as increasing TER and reducing Papp at 24 h, consistent with mucosal growth (P = 0.058) This was accompanied by increased cytokine abundance as evidenced by elevations in TNF-α and IL-1β. However, GP had increased IL-8 abundance (P = 0.011 and 0.063 for jejunum and ileum respectively) at birth than 24 h overall. In the weaning cohort, jejunal and ileal permeability to FD4 was higher in GP (P = 0.05 and 0.022, respectively) while only higher ileal T150 was observed in GP (P = 0.032). Ileal claudin-2 abundance tended to be higher in SP overall (P = 0.063), but GP ileal claudin-2 expression was upregulated weaning while no change was observed in SP (P = 0.043). Finally, other than a higher jejunal TNF-α abundance observed in SP (P = 0.016), no other effect of parity was observed on inflammatory markers in the weaning cohort. The results from this study indicate that the GIT of GP have poorer adaptation to early life events, with the response to weaning, being more challenging which is likely to contribute to poorer postweaning growth.

Previous pregnancies might mitigate cortical brain differences associated with surgical menopause

Surgical menopause causes a sharp drop in estrogen levels in middle-aged women, thus preventing the gradual physiological adaptation that is characteristic of the perimenopause. Previous studies suggest that surgical menopause might increase the risk of dementia later in life. In addition, the transition to motherhood entails long-lasting endocrine and neuronal adaptations. We compared differences in whole-brain cortical volume between women who reached menopause by surgery and a group of women who reached spontaneous non-surgical menopause and determined whether these cortical differences were influenced by previous childbearing. Using surface-based neuroimaging techniques, we investigated cortical volume differences in 201 middle-aged women (134 women who experienced non-surgical menopause, 78 of whom were parous women; and 67 women who experienced surgical menopause, 39 of whom were parous women). We found significant atrophy in the frontal and temporal regions in women who experienced surgical menopause. Nulliparous women with surgical menopause showed significant lower cortical volume in the left temporal gyrus extending to the medial temporal lobe cortex, as well as in the precuneus bilaterally compared to parous women with surgical menopause; whereas our results revealed no significant differences between parous women with surgical menopause and both parous and nulliparous women who reached a non-surgical menopause. Furthermore, in the surgical menopause group, we found a negative correlation between cortical volume and age at first pregnancy in the temporal lobe. Our study suggests that the long-term brain remodeling of parity may mitigate the neural impact of the sudden drop in estrogen levels that characterizes surgical menopause.

Relationship between placental location and fetal gender using ultrasonography: A prospective study from the Maternity and Children's Hospital, Najran, Saudi Arabia

The study was a prospective cross-sectional design and was carried out at the Maternity and Children's Hospital in Najran, Saudi Arabia on 142 pregnant women . The objective of the study was to establish, utilising ultrasound scan , whether there is any link between the site of the placenta and the gender of the fetus. A higher percentage of female fetuses were identified. The majority of placentas (73, 51.4%) were found to be anterior, of which 66 (46.5%) and 7 (4.9%) were present in female and male fetuses, respectively. 58 (40.8%) placentas were noted to be posterior, i.e. females, 10 (7.0%); males, 48 (33.8%). 10 (7.0%) placentas were high, a position which was equally prevalent in both genders, i.e. females, 5 (3.5%); males 5 (3.5%), and 1 (0.7%), in a male fetus, was low-lying. A significant correlation between placental site and the gender of the fetus was revealed by the chi-squared test (p < 0.05) the sensitivity of ultrasound in predication fetal gendar was 95.1%. The outcome reveals a noteworthy association between the position of the placenta and the gender of the fetus.

Changes in Gut Microbiota Associated with Parity in Large White Sows

As one of the most critical economic traits, the litter performance of sows is influenced by their parity. Some studies have indicated a connection between the gut microbiota and the litter performance of animals. In this study, we examined litter performance in 1363 records of different parities of Large White sows. We observed a marked decline in TNB (Total Number Born) and NBH (Number of Healthy Born) We observed a marked decline in TNB (Total Number Born) and NBH (Number of Healthy Born) among sows with parity 7 or higher. To gain a deeper understanding of the potential role of gut microbiota in this phenomenon, we conducted 16S rRNA amplicon sequencing of fecal DNA from 263 Large White sows at different parities and compared the changes in their gut microbiota with increasing parity. The results revealed that in comparison to sows with a parity from one to six, sows with a parity of seven or higher exhibited decreased alpha diversity in their gut microbiota. There was an increased proportion of pathogenic bacteria (such as Enterobacteriaceae, Streptococcus, and Escherichia-Shigella) and a reduced proportion of SCFA-producing families (such as Ruminococcaceae), indicating signs of inflammatory aging. The decline in sow function may be one of the primary reasons for the reduction in their litter performance.

Impact of preeclampsia and parity on sex-based discrepancies in subclinical carotid atherosclerosis in type 1 diabetes

CONTEXT

The excess risk of fatal and non-fatal cardiovascular events is roughly twice as high in women than in men with type 1 diabetes (T1D).

OBJECTIVE

To evaluate the impact of preeclampsia and parity on sex-based discrepancies in preclinical atherosclerosis and on the diagnostic performance of a cardiovascular risk scale.

DESIGN

Cross-sectional study.

SETTING

Single tertiary hospital.

PATIENTS

728 T1D (48.5% women) without cardiovascular disease and age ≥40 years, nephropathy, and/or ≥10 years of diabetes duration with another risk factor.

INTERVENTION

Standardized carotid ultrasonography.

MAIN OUTCOME MEASURES

Carotid plaque determined by ultrasonography and cardiovascular risk estimated according to the Steno T1 Risk Engine (Steno-Risk).

RESULTS

Nulliparous women and parous women without previous preeclampsia had a lower risk for carotid plaque than men (adjusted odds ratio [OR]: 0.48, 95% confidence interval [0.28-0.82]; adjusted OR: 0.51 [0.33-0.79], respectively), without differences in the preeclampsia group. The prevalence of carotid plaque increased as the estimated cardiovascular risk increased in all subgroups except for preeclampsia group. The area under the curve (AUC) of the Steno-Risk for identifying ≥2 carotid plaques was lower in the preeclampsia group (men: 0.7886, nulliparous women: 0.9026, women without preeclampsia: 0.8230, preeclampsia group: 0.7841; p between groups=0.042). Neither the addition of parity nor preeclampsia in the Steno-Risk led to a statistically significant increase in the AUC.

CONCLUSIONS

The risk for carotid plaque in women compared to men decreased as exposure to obstetric factors diminished. However, the addition of these factors did not improve the prediction of the Steno-Risk.

Parity of polaritons in a molecular aggregate coupled to a single-mode cavity

We investigated the parity of polaritons, particularly the parity of topological polariton states resulting from light fields, in a molecular aggregate with uniform and alternating excitation transfer interaction coupled to a single-mode cavity. We find that all polariton states are with even parity, in terms of parity conservation, and the even-parity edge states of the Su-Schrieffer-Heeger model with alternating excitation transfer interaction induce even-parity topological polariton states. Thus, the odd-parity edge states are almost unaffected. The original odd-parity edge state is then affected with respect to the parity non-conservation case, i.e., the occupation number of the edge states shifts from one edge to another. This result entails the preparation of edge states from the photonic excited states through an adiabatic process. .

Parity modulates impact of BMI and gestational weight gain on gut microbiota in human pregnancy

Dysregulation of maternal adaptations to pregnancy due to high pre-pregnancy BMI (pBMI) or excess gestational weight gain (GWG) is associated with worsened health outcomes for mothers and children. Whether the gut microbiome contributes to these adaptations is unclear. We longitudinally investigated the impact of pBMI and GWG on the pregnant gut microbiome. We show that the gut microbiota of participants with higher pBMI changed less over the course of pregnancy in primiparous but not multiparous participants. This suggests that previous pregnancies may have persistent impacts on maternal adaptations to pregnancy. This ecological memory appears to be passed on to the next generation, as parity modulated the impact of maternal GWG on the infant gut microbiome. This work supports a role of the gut microbiome in maternal adaptations to pregnancy and highlights the need for longitudinal sampling and accounting for parity as key considerations for studies of the microbiome in pregnancy and infants. Understanding how these factors contribute to and shape maternal health is essential for the development of interventions impacting the microbiome, including pre/probiotics.

Allele mining in prolactin receptor gene and its association with some economic traits in Egyptian goat breeds

The objectives of the current study were to identify polymorphism in the prolactin receptor (PRLR) gene among three Egyptian goat breeds (Zaraibi, Damascus, and Barki) and to investigate the association between PRLR genotype, parity, season of kidding, and litter size factors with milk yield and reproductive traits of Zaraibi goats. One hundred and ninety blood samples were collected for DNA extraction, with 110 from Zaraibi, 40 from Barki, and 40 from Damascus breeds. Three genotypes, CC, CT and TT, for the prolactin receptor gene were identified in the 190 DNA samples using restriction fragment length polymorphism and were confirmed by direct sequencing technique. Milk yield during suckling and lactation periods in addition to age at first conception, gestation length, and litter size were determined in 110 Zaraibi goats. The Zaraibi goats recorded the highest heterozygosity (0.495) and the effective number of alleles (1.972). The g.62130C > T SNP showed a significant association (p < 0.01) with suckling, lactation, and total milk yield of Zaraibi goats with the highest values recorded at the third parity. Age at the first conception and gestation length traits were significantly influenced by the kidding season (p < 0.05) with younger age in autumn and shorter length in spring seasons. Milk yield during the suckling period was significantly (p < 0.01) higher in the case of triplets' litter size. The current study showed that litter size and parity played an important role in the amount of Zaraibi goats' milk yield. The g.62130C > T SNP of the PRLR gene may be a useful marker for assisted selection programs to improve goat milk yield during suckling and lactation periods with the heterozygous genotype CT recording the highest values.

Caesarean sections before and during the COVID-19 pandemic in western Sydney, Australia

BACKGROUND

To determine the changes in emergency and elective caesarean section (CS) rates since the COVID-19 pandemic, identify the groups most affected, and examine changes in the factors associated with CS rates, and reasons for CS.

METHODS

We conducted a retrospective cohort study using routinely collected data of 22,346 births from before the pandemic (January 2018-February 2020) and 18,597 births during the pandemic (March 2020-December 2021). Data were analysed using multinominal logistic regression.

RESULTS

The CS rate increased by 4.1% (from 30.1% to 34.2%), reflecting increases of 2.3% in emergency CS (from 11.5% to 13.8%) and 1.7% in elective CS (from 18.7% to 20.4%). Large groups with notable increases were women who were nulliparous (7.2% increase), from South Asia (6.0%), obese (5.2%) and giving birth at a small hospital (6.1%). Compared to pre-pandemic, the relative risk of an emergency CS versus a vaginal delivery increased 1.36 times (adjusted relative risk ratio (aRRR) = 1.36; 95% CI = 1.27, 1.45) and the risk of having an elective CS increased 1.11 times (aRRR = 1.11; 95% CI = 1.04, 1.20). Factors associated with both emergency and elective CS were age, region of birth, reproductive history, body mass index, hypertension, diabetes, mode of antenatal care and hospital. Socio-Economic Indexes for Areas and antenatal care were only associated with elective CS. Baby gender was only associated with emergency CS. Preterm gestation at delivery was associated with reduced emergency but increased elective CS. Foetal compromise was the most common indication for emergency CS (43.2%) and increased the most (8.0%). Previous CS was the most common indication for elective CS (61.5%) and reduced the most (1.9%).

CONCLUSIONS

Both emergency and elective CS rates increased significantly during the pandemic, with the former increasing at a higher rate. The persistent upward trend of CS rates, exacerbated by increasing proportions of nulliparous women undergoing CSs, is concerning.

Impact of parity on pelvic floor morphology and function: A retrospective study

To analyze the effect of parity on pelvic floor morphology and function during the postpartum period. A total of 971 participants, who attended the Fujian Maternity and Child Health Hospital (Fuzhou, China) between December 2019 and August 2021, were included. All participants were assessed using the modified Oxford scale (MOS), pelvic floor surface electromyography, and 3-dimensional pelvic floor ultrasound to assess pelvic floor morphology and function. Multivariate analysis revealed no differences among primipara, deuteripara, and tertipara in pre-baseline rest, phasic contraction, endurance contraction, post-baseline rest, and MOS, except for tonic contraction (P = .020), the amplitude of which was lower in primipara than in deuteripara in post hoc comparison (P = .008). Differences in bladder neck presentation and bladder neck descent were statistically significant in multivariate analysis (P = .002, P = .001, respectively), with the value of bladder neck presentation in primiparas being greater than that of deuteriparas and tertipara (P = .002, P = .008, respectively), and the value of bladder neck descent was lower than that of deuteripara and tertipara in further post hoc comparisons (P = .002, P = .003, respectively). Functional impairment was not statistically associated with parity according to the MOS score or surface electromyography. However, parity was significantly correlated with descent of the bladder neck, and most of the effects appeared to occur during the first delivery.

Frequency and Outcome of Pregnant Females Presenting With Thrombocytopenia at a Tertiary Care Hospital

BACKGROUND

Platelet-related problems are more frequently discovered in women during pregnancy because screening is carried out as part of the initial clinic examination using automated blood counts. This study was done to find out the frequency and outcomes of pregnant females presenting with thrombocytopenia at a tertiary care hospital.

METHODOLOGY

This cross-sectional study was conducted at the Department of Obstetrics and Gynecology, Jinnah Hospital, Lahore, Pakistan, from April 2023 to September 2023. This study involved 280 pregnant women presenting in the third trimester. Blood examination was acquired, and a platelet count less than 150x109/L was labeled as thrombocytopenia. Outcome variables were frequency of thrombocytopenia, while post-delivery, frequency of placental abruption, preterm delivery, stillbirth, need for blood transfusion, and poor Apgar score were noted and compared among women with and without thrombocytopenia.

RESULTS

In a total of 280 pregnant females, the mean age and gestational age at the time of presentation were 29.34±4.38 years and 31.30±2.87 weeks, respectively. The mean BMI of the females was 27.97±4.72 kg/m2. Thrombocytopenia was noted in 34 females (12.1%). Placental abruption, preterm delivery, need for blood transfusion, stillbirth, and poor Apgar score were observed in 1.4%, 4.3%, 8.2%, 1.1%, and 2.1% cases, respectively. Placental abruption (11.8% vs. 0.0%; p<0.001), preterm delivery (29.4% vs. 0.8%; p<0.001), need of blood transfusion (35.3% vs. 4.5%; p<0.001), stillbirth (8.8% vs. 0.0%; p<0.001), and poor Apgar score (17.6% vs. 0.0%; p<0.001) were all significantly higher among pregnant women with thrombocytopenia as compared to those with a normal platelet count.

CONCLUSION

The frequency of thrombocytopenia was 12.1% among pregnant females. The frequency of placental abruption, preterm delivery, need for blood transfusion, stillbirth, and poor Apgar score were all significantly higher among pregnant women with thrombocytopenia as compared to those with a normal platelet count, irrespective of the patient's age, parity, and BMI.

Predicting intention and maintenance of breastfeeding up to 2-years after birth in primiparous and multiparous women

OBJECTIVES

Breastfeeding up to 2-years has been associated with short and long-term health benefits for both newborns and mothers. However, few women breastfeed up to 2-years after birth. This study extends previous research on the theory of planned behaviour (TPB) examining the predictors of intention and maintenance of breastfeeding up to 2-years in both primiparous and multiparous women.

DESIGN

155 pregnant women participated in this longitudinal study.

METHODS

Expectant mothers completed a questionnaire and then 2-years after the child's birth were asked to report breastfeeding behaviour. Interactions among parity and TPB constructs were examined.

RESULTS

Attitudes, descriptive and injunctive norms, and perceived behavioural control (PBC) explained 58% of the variance in mothers' intention to breastfeed. Attitudes were the strongest predictor, followed by PBC, descriptive norms and parity. A significant interaction was found between parity and PBC, showing that PBC was only a significant predictor of intention to breastfeed at 2-years in multiparous women. Intentions predicted breastfeeding behaviour at 2-years.

CONCLUSION

Promoting intentions may be a useful way to increase breastfeeding duration to 2-years and targeting attitudes and norms may be one way to increase intentions. Further, targeting PBC may also be useful to increase intentions, but only in multiparous women.

Cellular and molecular signatures of motherhood in the adult and ageing rat brain

Pregnancy is marked by robust changes, including brain changes to volume, structure, connectivity and neuroplasticity. Although some brain changes are restricted to pregnancy and the postpartum, others are long-lasting. Few studies have examined possible mechanisms of these changes or the effects of multiple pregnancies. We characterized various cellular and molecular signatures of parity (nulliparous, primiparous, biparous) in the rat hippocampus. We investigated density of neural stems cells (Sox2), microglia (Iba-1) and levels of a synaptic protein (PSD-95), cell signalling pathways, neuroinflammation, and the tryptophan-kynurenine (TRP-KYN) pathway, one week after weaning their pups from the last pregnancy (age of dam: seven months) and in middle-age (age of dam: 13 months). Parity increased PSD-95 levels in both age groups and prevented the age-related decrease in neural stem cell density observed in nulliparous rats. Biparity increased cell signalling phosphoproteins (pp70S6K, S6RP) and number of microglia in the dentate gyrus, regardless of age. Parity resulted in transient changes to the TRP-KYN system. Thus, previous parity has lasting effects on synaptic plasticity with fewer lasting effects on inflammation and cell signalling phosphoproteins in the whole hippocampus.

Nonverbal face-to-face interactions in macaques and humans: A translational pilot study

Human and nonhuman primate mother-infant dyads engage in face-to-face interactions critical for optimal infant development. In semi-free-ranging rhesus macaques (Macaca mulatta), maternal primiparity and infant sex influence the expression of nonverbal face-to-face mother-infant interactions. However, whether similar patterns of variation exist in laboratory-housed macaques or human mothers is not well understood. Comparing both species would yield information regarding the translational validity of macaques to humans in this important social/developmental domain. In this pilot study, we first compared semi-free-ranging (n = 39) and laboratory-housed (n = 20) macaques, finding that laboratory-housed dyads, first-time mothers, and mothers of sons engaged in higher rates of face-to-face interactions regardless of housing. After translating the nonhuman primate coding scheme for use in a small but diverse group of human mother-infant dyads (N = 27; 44.4% African American, 18.5% American Indian, 7.4% Asian/Asian American, and 29.6% White), we found that, like macaques, human mothers of sons engaged in more face-to-face interactions; however, experienced (vs. first-time) mothers engaged in more interactions. Macaques and humans also engaged in species-specific interactions with their infants. We conclude that components of caregiver-infant nonverbal face-to-face interactions are translatable across human and nonhuman primate species and represent an exciting avenue for future caregiving work.

Age at Natural Menopause and Influencing Factors in Women Attending the Gynecological Outpatient Clinic at a Tertiary Care Hospital

Background

Menopause is the irreversible cessation of menstruation that results from the lack of ovarian follicular function and is diagnosed after 12 consecutive months of amenorrhea without reasonable cause. This study aims to determine the average age at natural menopause and identify its associated factors among Somali women.

Methods

This is a cross-sectional study conducted at the Mogadishu Somalia Türkiye Recep Tayyip Erdogan research and training hospital's Obstetrics and Gynecology outpatient clinic between June 1 and July 1, 2023. Data was collected from subjects during the data collection period using face-to-face interviews with structured questionnaires consisting of sociodemographic, lifestyle, dietary, and reproductive characteristics. A multivariate logistic regression analysis was conducted to find the association between menopause age and target variables.

Results

Out of the 188 participants recruited for the study, the median age of menopause was 45.00 (95% CI = 44.50-45.62), and 48.9% had either premature or early menopause. The majority (53.7%) of the participants had a minimum of eight children. In Spearman's rank correlation analysis, we found a significantly positive correlation between menopausal age and age at first (p<0.01), last childbirth (p<0.01), number of parities (p<0.05), and age at marriage (p<0.05). In multivariate logistic regression, we found that the odds of developing premature or early menopause among unemployed women were 59% lower than those of employed women (AOR = 0.41, 95% CI = 0.18-0.93).

Conclusion

In this study, we established that the age of natural menopause was lower than the findings reported by previous authors. We also found that employment status, education, history of contraceptive use, BMI, age at first and last childbirth, and parity were associated with age at natural menopause, suggesting that social, lifestyle, and reproductive factors may have an impact on menopausal age.

The association between parity and hypertension: a cross-sectional, community-based study

Background

The available data on the association between parity and hypertension are inconclusive. This study was conducted to investigate the prevalence of hypertension and its association with parity among adult Sudanese women.

Methods

A multi-stage sampling survey was conducted in four villages in the River Nile State in Sudan between July and September 2022. The World Health Organization's three-level stepwise questionnaire was used to gather the participants' sociodemographic characteristics (age, sex, marital status, parity, educational level, occupation, obstetric history, family history of hypertension, weight and height). Regression analyses were performed.

Results

A total of 408 women were recruited. The median [measured in terms of interquartile range (IQR)] age was 45.0 years (33.0-55.7 years). A linear regression analysis revealed a significant association between parity and diastolic blood pressure (coefficient, 0.60; P = 0.011). The prevalence of hypertension (55.9%) increased with parity and ranged from 43.7% to 74.9%. In the multivariate analyses, increasing age (adjusted odds ratio [AOR], 1.03; 95% confidence interval [CI], 1.02-1.05), increasing parity (AOR, 1.09; 95% CI, 1.01-1.19), family history of hypertension (AOR, 1.79; 95% CI, 1.15-2.77), and increasing body mass index (AOR, 1.09; 95% CI, 1.05-1.13) were associated with hypertension. In women of ages ≥ 50 years, increasing parity was significantly associated with hypertension (AOR, 1.15; 95% CI, 1.2-1.29). Para > 5 (AOR, 2.73; 95% CI, 1.11-6.73) was associated with hypertension.

Conclusion

A high prevalence of hypertension was found among Sudanese women, and that parity at 5 or more is linked to hypertension.

Parity and Risk of Dementia in Women: The Atherosclerosis Risk in Communities Study

Objective: Reproductive factors, including parity, may contribute to dementia risk, due to hormonal, physiological, social, and demographic factors. We hypothesized that higher parity would be associated with increased dementia risk. Materials and Methods: We utilized data from the Atherosclerosis Risk in Communities (ARIC) community-based cohort study. Participants were recruited in 1987-1989 and followed through 2017. Participants, all born between 1921 and 1945, were from four U.S. communities in Forsyth County, NC; Jackson, MS; Minneapolis, MN; and Washington County, MD. We included all female participants seen at ARIC visit three or five for whom parity and dementia outcomes were available (N = 7,921). The primary exposure was self-reported number of live births. Our primary outcome was dementia, diagnosed via neurocognitive assessments, informant interviews, and expert adjudication. We created Cox proportional hazards models to evaluate the association between parity and incident dementia, adjusting for demographic factors, education level, apolipoprotein E allele status, and vascular risk factors. We tested for interactions by race and birth cohort. Results: The adjusted hazard ratio was 0.82 (95% confidence intervals [CI] 0.69-0.99) for dementia in women with 0-1 births and 0.85 (95% CI 0.72-0.99) for women with 5+ births, compared to women with 2 births (reference group). This association was present in women born from 1924 to 1934, but not in women born in 1935 or later (p-interaction <0.001). Conclusion: We found an inverted U-shaped association of parity with dementia risk. This effect was modified by birth cohort, suggesting that the association may depend on demographic and sociocultural factors.

Ultra-low volume (ULV) adulticide treatment impacts age structure of Culex species (Diptera: Culicidae) in a West Nile virus hotspot

West Nile virus (WNV) invaded the continental United States over 20 years ago and continues to cause yearly seasonal outbreaks of human and veterinary disease. In the suburbs of Chicago, Illinois, ultra-low volume (ULV) truck-mounted adulticide spraying frequently is performed to reduce populations of Culex restuans Theobald and Cx. pipiens L. mosquitoes (Diptera: Culicidae) in an effort to lower the risk of WNV transmission. The effectiveness of this control method has not been rigorously evaluated, and evidence for Culex population reduction after ULV adulticide spraying has been inconclusive. Therefore, we evaluated the results of 5 sequential weekly truck-mounted adulticide applications of Zenivex® E20 (etofenprox) in 2 paired sites located in Cook County, IL, during the summer of 2018. Mosquito population abundance, age structure, and WNV infection prevalence were monitored and compared between paired treatment and nearby control sites. Adulticide treatment did not result in consistent short-term or long-term reductions in target WNV vector Culex abundance. However, there was a significant increase in the proportion of nulliparous females in the treated sites compared to control sites and a decrease in Cx. pipiens WNV infection rates at one of the treated sites. This evidence that ULV adulticide spraying altered the age structure and WNV infection prevalence in a vector population has important implications for WNV transmission risk management. Our findings also underscore the importance of measuring these important indicators in addition to abundance metrics when evaluating the efficacy of control methods.

The Association between Grand Multiparity and Adverse Neonatal Outcomes: A Retrospective Cohort Study from Ha'il, Saudi Arabia

Inconsistent evidence exists regarding the association of grand multiparity with adverse neonatal outcomes. This study aims to compare specific adverse outcomes in grand multiparas (those with five or more births at twenty or more weeks of gestation, regardless of fetal outcome) compared to those with lower parity (those with less than five births at twenty or more weeks of gestation, regardless of fetal outcome). A retrospective cohort study was undertaken at the Maternity and Children Hospital in Ha'il region, Saudi Arabia. After calculating the required sample size, data were collected from consenting participants with a viable singleton delivery. Socio-demographic variables, select maternal characteristics, and adverse neonatal outcomes (admission to the neonatal intensive care unit, low birth weight, prematurity, and APGAR score less than 7 in the first 5 min) were compared between grand multiparas and women with lower parity. Two hundred ninety-four participants were recruited (ninety-eight grand multiparas and one hundred ninety-six of lower parity). There was a statistically significant difference between the two groups in relation to age, level of education, body mass index, and the occurrence of gestational diabetes. Out of the studied adverse neonatal outcomes after the adjustment for maternal age between the two groups, no statistically significant difference in the adverse neonatal outcomes was found between the two groups. Grand multiparity does not incur an additional risk of adverse neonatal outcomes compared to women of lower parity. Furthermore, increasing maternal age and comorbid conditions might have a more detrimental effect on neonatal outcomes than grand multiparity per se.

Effects of Parity and Postpartum Depression on Mother-Infant Bonding in the First Month Postpartum: A Retrospective Study

Objective This study aimed to examine the relationship between parity, postpartum depression (PPD), and mother-infant bonding (MIB) failure in the first month postpartum. Methods The study included 1,509 Japanese patients (748 primiparous and 761 multiparous). MIB was assessed using the Mother-to-Infant Bonding Scale Japanese version (MIBS-J), which was translated in 2012, and its subscales, including lack of affection (LA) and anger and rejection (AR). Postpartum depression (PPD) was assessed using the Japanese version of the Edinburgh Postnatal Depression Scale (EPDS) and its subscales, including anxiety (ANX), anhedonia (ANH), and depression (DEP). Multiple regression analyses using interaction terms were performed to examine the association of parity with the MIBS-J and EPDS. Results Parity was significantly associated with AR. ANX and ANH were strongly associated with LA, and ANX and DEP were strongly associated with AR. The interaction term "parity×EPDS total" was significantly associated with MIBS-J total, LA, and AR scores. Conclusions Primiparas and mothers with high ANX had more negative emotions toward their children during the first month postpartum, and mothers with high ANX or ANH had less interest in their children.

Adverse obstetric and perinatal outcomes of patients with history of recurrent miscarriage: a retrospective cohort study

OBJECTIVE

To examine the associations between a history of recurrent miscarriage (RM) and adverse obstetric and perinatal outcomes in the subsequent pregnancy that progressed beyond 24 weeks.

DESIGN

Retrospective cohort study.

SETTING

A large tertiary maternity hospital.

PATIENT(S)

All women who booked for antenatal care and delivery between January 2014 and August 2021 were recorded. The study was limited to women with a singleton pregnancy, and to avoid intraperson correlation, we selected the first record of delivery from each mother in the study, leaving 108,792 deliveries for analysis. Obstetric and perinatal outcomes were compared among 1994 women (1.83%) with a history of ≥2 miscarriages (RM), 11,477 women (10.55%) with a history of 1 miscarriage, and 95,321 women (87.62%) with no history of miscarriage, respectively.

INTERVENTION(S)

Women with a history of ≥2 miscarriages or RM.

MAIN OUTCOME MEASURE(S)

Obstetric complications included gestational diabetes mellitus, preeclampsia (subclassified as preterm and term preeclampsia), placenta previa, placenta accreta, and fetal distress. Perinatal outcomes included emergency cesarean section, elective cesarean section, induction, postpartum hemorrhage, preterm birth, stillbirth, Apgar score <7 at 5 minutes, neonatal asphyxia, neonatal sex, congenital; malformation, low birth weight, and neonatal death.

RESULT(S)

After adjusting for relevant confounders, there was an increased risk of adverse obstetric and perinatal outcomes in a subsequent pregnancy for women with a history of RM, specifically for placental dysfunction disorders: preterm preeclampsia (risk ratio [RR] = 1.58; 95% confidence interval [CI], 1.03-2.32), preterm birth (RR = 1.34; 95% CI, 1.15-1.54)], and abnormal placentation, that is placenta previa (RR = 1.78; 95% CI, 1.36-2.28), and placenta accreta (RR = 4.19; 95% CI, 2.75-6.13).

CONCLUSION(S)

Significant associations existed between a history of RM and the occurrence of adverse obstetric and perinatal outcomes including placental dysfunction disorders and abnormal placentation. These findings may contribute to the early detection and appropriate intervention for placenta-associated diseases in women with a history of RM, with the goal of avoiding or reducing the associated detrimental effects.

Characteristics Associated with Pelvic Floor Disorders among Female Canadian Armed Forces Members

OBJECTIVES

Urinary incontinence (UI) and pelvic organ prolapse (POP) are prevalent pelvic floor disorders (PFDs) among the female population. In the military environment, being a non-commissioned member (NCM), and physically demanding occupations are factors associated with higher PFD risk. This study seeks to characterize the profile of female Canadian Armed Forces (CAF) members reporting symptoms of UI and/or POP.

METHODS

Present CAF members (18-65 years) responded to an online survey. Only current members were included in the analysis. Symptoms of UI and POP were collected. Multivariate logistic regressions analyzed the relationships between PFD symptoms and associated characteristics.

RESULTS

765 active members responded to female-specific questions. The prevalence of self-reported POP and UI symptoms were 14.5% and 57.0%, respectively, with 10.6% of respondents reporting both. Advanced age (adjusted odds ratio [aOR]: 1.062, CI 1.038-1.087), a body mass index (BMI) categorized as obese (aOR: 1.909, [1.183-3.081]), parity ≥1 (e.g., aOR for 1: 2.420, [1.352-4.334]) and NCMs (aOR: 1.662, [1.144-2.414]) were factors associated with urine leakage. Parity of ≥2 (aOR: 2.351, [1.370-4.037]) compared to nulliparous and having a perception of a physically demanding job (aOR: 1.933, [1.186-3.148]) were associated with experiencing POP symptoms. Parity of ≥2 increased the odds of reporting both PFD symptoms (aOR: 5.709, [2.650-12.297]).

CONCLUSION

Parity was associated with greater odds of experiencing symptoms of UI and POP. Higher age, higher BMI, and being an NCM were associated with more symptoms of UI, and the perception of having a physically demanding role increased the likelihood of reporting POP symptoms.

Maternal and Perinatal Outcome in Patients With Eclampsia: A Study Done at a Tertiary Care Centre

Background One of the leading causes contributing to morbidity and mortality globally is attributed to eclampsia. Hence, it is vital to comprehensively review each female having eclampsia and to evaluate the factors that govern the outcomes in females with eclampsia. Aim To decode the fetal and maternal outcomes in subjects having eclampsia and to evaluate various factors that govern the outcomes. Methods This retrospective cohort and epidemiological study commenced at the Department of Obstetrics and Gynaecology, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, in January 2016 till April 2017, and included females that either developed eclampsia in hospital stay duration or presented with pre-existing eclampsia. In included females, various fetal and maternal parameters were assessed along with the outcome of pregnancy. The institutional data records and the database were also used to determine the prevalence and incidence of eclampsia. Baseline maternal parameters were recorded from the already-existing institute data. These included the gestational age (in years), socioeconomic status, educational attainment, parity, gravidity, and the number of weeks of gestation present at the time of delivery. Antenatal care data assessed were blood pressure recordings, any proteinuria documented in the data, and the number of antenatal visits by the subjects. Statistical analysis was performed to assess both parameters. Results  In the current investigation, there were 0.34% eclampsia cases among females visiting the institution for deliveries. Incidences of stillbirth were seen in 19.04% and 8% of study participants, respectively. We found 9.52% (n=4) of female infants to have perished from eclampsia. Preterm births, a delayed start to the treatment, and insufficient care were all linked to poor foetal and mother outcomes. The longer the period between the beginning of a fit and delivery, the greater the likelihood of unfavourable results. Seizure onset before or after birth, parity, or subject age had no impact on mother or foetal health. The p-value for statistical significance was kept at 0.05. Conclusion Most of the research participant women, had intrapartum eclampsia, postpartum eclampsia, and antepartum eclampsia, based on the time of the convulsions in relation to the labor. It was highlighted that there was no conclusive evidence linking the date of the fit's beginning to unfavourable results or an elevated risk of complications. Neonatal mortality and stillbirth were observed with vaginal delivery in eclampsia cases. Outcomes in eclampsia can be improved by early treatment initiation, timely and appropriate referral, early disease recognition, and appropriate antenatal care.

Altitude Modifies the Effect of Parity on Birth Weight/Length Ratio: A Study Comprising 2,057,702 Newborns between 1984 and 2020 in Austria

(1) Background: Lower birth weight among newborns in higher altitudes has been well documented in previous literature. Several possible causes for this phenomenon have been investigated, including biophysiological adaptation, epigenetic or genetic mechanisms or lifestyle changes. This is the first study to show the effect modification of altitude and parity on the birth weight length ratio (BWLR) in women resident in moderate altitudes compared to a low sea level.; (2) Methods: This population-based study obtained data on altitude (0-300, 300-500, 500-700,700-900, >900 m), parity (1, 2, …, 7, 8/9), birth weight and length on all births in Austria between 1984 and 2020 from birth certificates provided by Statistics Austria. The BWLR was calculated, and the effect of moderate altitude and parity was estimated using multivariable linear mixed models adjusting for predefined variables. Sub-group regression analyses were conducted by altitude group. (3) Results: Data on 2,057,702 newborns from 1,280,272 mothers were analyzed. The effect of parity on BWLR, as indicated by the difference of BWLR between the first- and second-born infants, ranged between 1.87 to 2.09 g per centimeter across all altitude groups. Our analyses found that the effect of parity on BWLR diminished from parity three onwards at altitude 0-300, whilst the effect of parity on BWLR continued to increase at higher than 300 m and was most notable in the highest altitude group >900 m. (4) Conclusions: Findings from our study indicated that the negative effect of increasing altitude on BWLR was deprived for newborns of higher parity. It shows that the residential altitude can modify the effect of parity on BWLR.

Tracking behavioral changes of confined sows from the first mating to the third parity

The occurrence pattern of stereotypic behavior in high-parity confined sows is still unclear. We continually observed the behavioral changes in activity-restricted sows from the first mating to the end of the third parity. The results showed that the second- or third-parity weaned sows exhibited more vacuum chewing and total oral behavior than the first-parity sows. The vacuum chewing of sows in the second and third pregnancies was significantly more than that of the first-pregnancy sows at each stage of pregnancy, and the total oral behavior changed similarly. The sitting of sows in the second and third pregnancies was significantly more than that of the first-pregnancy sows in the early stage of pregnancy, whereas sitting behavior in the third pregnancy was significantly more than that in the middle stages of the first and second pregnancies. Vacuum chewing or sitting was positively correlated with confinement duration. In summary, vacuum chewing and sitting behaviors in sows confined from the first mating were significantly affected by parity. From the late stage of the first pregnancy to the middle stage of the second pregnancy is the key period of stereotypic behavior development for low-parity sows.

Cost of Serum Versus Skin Allergy Testing Among Medicare Fee-for-Service Beneficiaries in the United States

Background: Testing for allergic sensitization can be achieved similarly via skin or serum specific immunoglobulin E (sIgE) testing, although the costs of each method differ. Objective: This study compared cost and utilization of allergy testing utilizing skin vs sIgE testing and whether equal access (parity) to both testing methods affects overall allergy testing costs among Medicare fee-for-service beneficiaries in the United States. Methods: Allergy test utilization and payment data were analyzed using 100% 2019 Medicare fee-for-service claims data. Beneficiaries with any sIgE test, skin prick test, or intradermal skin test associated with ICD-10 codes of allergic rhinitis, asthma, and food allergy were included. Aggregate and per-beneficiary testing cost, number of allergens tested, and number of allergy-related specialist visits incurred were estimated by the testing patterns of sIgE only, skin prick only, intradermal only, skin prick and intradermal, and sIgE plus prick and/or intradermal. Medicare Administrative Contractors (MACs) with parity for all allergy tests and those which restricted sIgE testing were compared. Multivariate linear regression was performed on the association between testing patterns and each cost and utilization measure, controlling for parity, age, sex, race/ethnicity, and dual-eligible status. Results: We analyzed 270 831 patients and 327 263 allergy-related claims. Total payment for all allergy tests was $71 380 866, including $15 903 954 for sIgE tests, $42 223 930 for skin prick tests, and $13 252 982 for intradermal tests. Beneficiaries receiving sIgE tests had only 1.8 fewer allergist visits than those with skin prick tests only (0.8 vs 2.6). Cost of testing per beneficiary was also lower in sIgE testing only compared with skin prick tests only ($161 vs $247). Multivariable regression results showed per-beneficiary payments for allergy testing were on average $22 lower in MACs with parity compared with MACs without parity. Discussion: Serum specific IgE testing is associated with lower costs and fewer allergy specialist visits compared with skin testing. Insurance coverage with parity toward sIgE and skin testing is associated with lower overall costs of allergy testing. Conclusion: Among Medicare fee-for-service beneficiaries in the United States, sIgE testing may be more cost effective compared with skin testing in the management of allergic disease.