First Nations Peoples' perceptions, knowledge and beliefs regarding stillbirth prevention and bereavement practices: A mixed methods systematic review

BACKGROUND

First Nations Peoples endure disproportionate rates of stillbirth compared with non-First Nations Peoples. Previous interventions have aimed at reducing stillbirth in First Nations Peoples and providing better bereavement care without necessarily understanding the perceptions, knowledge and beliefs that could influence the design of the intervention and implementation.

AIM

The aim of this review was to understand the perceptions, knowledge and beliefs about stillbirth prevention and bereavement of First Nations Peoples from the US, Canada, Aotearoa/New Zealand, and Australia.

METHODS

This review was conducted in accordance with the JBI methodology for a convergent integrated mixed method systematic review. This review was overseen by an advisory board of Aboriginal Elders, researchers, and clinicians. A search of eight databases (PubMed, MEDLINE, PsycInfo, CINAHL, Embase, Emcare, Dissertations and Theses and Indigenous Health InfoNet) and grey literature was conducted. All studies were screened, extracted, and appraised for quality by two reviewers and results were categorised, and narratively summarised.

RESULTS

Ten studies were included within this review. Their findings were summarised into four categories: safeguarding baby, traditional practices of birthing and grieving, bereavement photography and post-mortem examination. The results indicate a diversity of perceptions, knowledge and beliefs primarily around smoking cessation and bereavement practices after stillbirth. However, there was a paucity of research available.

CONCLUSIONS

Further research is needed to understand the perceptions, knowledge and beliefs about stillbirth among First Nations Peoples. Without research within this area, interventions to prevent stillbirth and support bereaved parents and their communities after stillbirth may face barriers to implementation.

Pregnancy Loss in Relation to the Risks of Female-Specific Cancers in a Population-Based Cohort and Mendelian Randomization Study - China, 2004-2017

What is already known about this topic?

Limited evidence exists regarding the relationship between pregnancy loss and female-specific cancers within the Chinese population from prospective cohort studies.

What is added by this report?

Terminations were associated with a 13% lower risk of endometrial cancer, whereas stillbirths were related to an 18% higher risk of cervical cancer. Rural residents with a history of pregnancy loss experienced a 19% and 38% increased risk of breast and cervical cancers, respectively, compared to their urban counterparts. Moreover, a positive graded relationship between live births and pregnancy loss on cervical cancer was observed.

What are the implications for public health practice?

This study has significant implications for identifying women at an increased risk for breast and genital cancers and contributes to the development of effective public health strategies for female cancer prevention. Future research on reproductive history, particularly in rural areas, should be given priority in efforts to improve female cancer screening and early detection.

The role of DNA hydroxymethylation and TET enzymes in placental development and pregnancy outcome

The placenta is a temporary organ that is essential for supporting mammalian embryo and fetal development. Understanding the molecular mechanisms underlying trophoblast differentiation and placental function may contribute to improving the diagnosis and treatment of obstetric complications. Epigenetics plays a significant role in the regulation of gene expression, particularly at imprinted genes, which are fundamental in the control of placental development. The Ten-Eleven-Translocation enzymes are part of the epigenetic machinery, converting 5-methylcytosine (5mC) into 5-hydroxymethylcytosine (5hmC). DNA hydroxymethylation is thought to act as an intermediate in the DNA demethylation mechanism and potentially be a stable and functionally relevant epigenetic mark on its own. The role of DNA hydroxymethylation during differentiation and development of the placenta is not fully understood but increasing knowledge in this field will help to evaluate its potential role in pregnancy complications. This review focuses on DNA hydroxymethylation and its epigenetic regulators in human and mouse placental development and function. Additionally, we address 5hmC in the context of genomic imprinting mechanism and in pregnancy complications, such as intrauterine growth restriction, preeclampsia and pregnancy loss. The cumulative findings show that DNA hydroxymethylation might be important for the control of gene expression in the placenta and suggest a dynamic role in the differentiation of trophoblast cell types during gestation.

The Intersect of Pregnancy Loss, Trauma, and Spirituality: A Dyadic Perspective

OBJECTIVES

Pregnancy loss and trauma are unexpected yet frequent occurrences for females in the United States, however little research exists on the role of pregnancy loss and trauma with both partners in couple relationships. The purpose of this study was to use dyadic analyses to better understand the role of trauma, spirituality, and pregnancy loss in the context of the couple relationship.

METHOD

Drawn from a secondary data set, the dyadic sample included survey responses from (n = 97) matched, pregnant heterosexual couples. Couples responded to questions related to traumatic experiences, previous pregnancy history, relationship satisfaction, and spirituality. Actor-partner independence models were conducted to explore pregnancy loss, trauma, and spirituality on relationship satisfaction.

RESULTS

Female partner's experience of trauma and loss predicted relationship satisfaction, but the male partner's experience did not. In addition, spirituality moderated the effects of loss and trauma for female partners but not for male partners.

CONCLUSION

The outcomes from this study punctuated the importance of learning about relational dynamics (e.g., pregnancy and interpersonal traumas) through dyadic samples and analyses. Implications include research and clinical recommendations to incorporate biopsychosocial-spiritual metrics into research designs with diverse samples and dyads.

Association of Tumor Necrosis Factor-α (TNF-α) -308G>A and -238G>A Polymorphisms with Recurrent Pregnancy Loss Risk: A Meta-Analysis

Background

Multiple studies have been carried out examining the association of tumor necrosis factor-α gene (TNF-α) promoter region polymorphisms with recurrent pregnancy loss (RPL) risk. However, the results remain controversial and incomplete. Hence, we performed a meta-analysis to evaluate the association of the TNF-α -308G>A and -238G>A polymorphisms with RPL risk.

Materials and Methods

In this meta-analysis, a comprehensive search of PubMed, Web of Knowledge and EMBASE was performed to identify relevant studies published until December 1, 2017. The associations were assessed by odds ratio (OR) and its corresponding 95% confidence interval (CI).

Results

A total of 29 case-control studies, comprising 20 studies on TNF-α -308G>A (3,461 cases and 3,895 controls) and nine studies on TNF-α -238G>A (2,589 cases and 2,664 controls), were included in the meta-analysis. Overall, we found TNF-α -308G>A to be associated with an increase in RPL risk under the homozygote (OR=1.716, 95% CI: 1.210-2.433, P=0.002) and the recessive (OR=1.554, 95% CI: 1.100-2.196, P=0.012) models. TNF-α -238G>A was also significantly associated with increased risk of RPL under the allele model (OR=1.554, 95% CI: 1.100-2.196, P=0.012). Stratified analysis revealed a more significant association between theTNF-α -308G>A polymorphism and increased RPL risk in Asians under the homozygote (OR=2.190, 95% CI: 1.465-3.274, P≤0.001), the dominant (OR=1.642, 95% CI: 1.269-2.125, P≤0.001) and the recessive (OR=1.456, 95% CI: 1.039-2.040, P=0.029) models, but not in Caucasians. A non-significant association was, however, identified between TNF-α -238G>A and RPL risk based on ethnicity. Moreover, TNF-α -308G>A and -238G>A polymorphisms were significantly associated with increased risk of RPL in high quality studies and polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) subgroups.

Conclusion

The present meta-analysis demonstrates that TNF-α -308G>A and -238G>A polymorphisms are associated with an increased risk of RPL.