Pregancy

_____________________________________________________________________________________ Resumo: Do ponto de vista imunológico, a gestação somente é possível porque uma intrincada rede imunorregulatória é disparada com o objetivo único de desenvolver um estado de tolerância materno-fetal e permit ir a imp lantação e manutenção do concepto até que haja condições de sobrevivência fora da cavidade uterina. O estudo dos mecanismos biológicos da gravidez contribui para au mentar os conhecimentos sobre tolerância imunológica s endo que diversos trabalhos demonstram a importância de aspectos imunes na gestação, fase esta que vai desde a implantação do embrião no útero materno e seu desenvolvimento até o final da gravidez. A forma co mo o sistema imunitário é modulado e o estudo dos sistemas de reconhecimento materno, inatos e adaptativos, que ocorrem durante a gravidez, permite co mpreender a sobrevivência do feto.Assim, faz-se necessário uma revisão abrangente do que há de mais atual na literatura visando discutir alguns dos mecanismos imunomoduladores presentes na interação materno-fetal, tais como a influência hormonal sobre o sistema imune materno, o reconhecimento das moléculas do Comp lexo Principal de Histocompatibilidade paterno que são expressas pelo embrião, as diversas citocinas liberadas no meio, o controle da ação direta das células NK uterinas e atividade das células T regulatórias. Palavras-chaves: Gestação, interação materno fetal e imunomodulação. Abstract: Fro m an immunological point of view, gestation is only possible because an intricate immunoregulatory network is triggered with the only purpose of developing a state of maternal-fetal tolerance and allowing the emb ryo's implantation and maintenance until there a re survival conditions outside the uterine cavity. The study of the biological mechanisms of pregnancy contributes to increase knowledge about immunological tolerance, wheren several studies demonstrate the importance of immunological aspects in pregnancy, period that covers since the imp lantation of the emb ryo in the mother's wo mb and its development until the end of the pregnancy. The way that the immune system is emodulated and the study of the maternal recognition, innate and adaptive, that occur during pregnancy, allows the comprehention of the fetus survival. Thus, an embracing review of what is most current in literature is necessary to discuss some of the immuno modulatory mechanisms present in the maternal-fetal interaction, such as a hormonal influence on the maternal immune system, recognition of the Principal Histocompatibility Co mplex molecules that are expressed by the embryo, such as various cytokines released in the environment, control of the direct action of the uterine Natural Killer cells and T regulatory cells activ ity. Keywords: Gestation, maternal fetal interaction and immuno modulation.

Planning for a Baby:  https://youtu.be/2iwLh6XCnq8

Pregnancy with IBD: https://youtu.be/br0kciD8xJk

Motherhood with IBD: https://youtu.be/TQjt8pnMv4I


Our aim is to provide an understanding of the experience of women with inflammatory bowel disease (IBD) who have made the transition to motherhood. A total of 22 mothers with IBD were recruited from around the United Kingdom. Semi-structured interviews were conducted and analyzed using thematic analysis. The central concept—Blurred Lines—offers a novel frame for understanding the transition to motherhood with IBD through identifying parallels between having IBD and becoming, and being, a mother. Parallels clustered into three main themes: Need for Readiness, Lifestyle Changes, and Monitoring Personal and Physical Development. Hence, women with IBD are in some ways well prepared for the challenges of motherhood even though, as a group, they tend to restrict their reproductive choices. We recommend health professionals initiate conversations about reproduction early and provide a multidisciplinary approach to pregnancy and IBD in which women have confidence that their ongoing treatment will be integrated successfully with their maternity care.

Background

Although most expectant women with severe fear of childbirth take pre-birth training sessions, the available literature does not provide substantial emphirical data on its impacts, especially in developing countries like Kenya.
Aim

The study aimed at exploring women’s experience from midwife-led integrated pre-birth training and its impact on the fear of childbirth.
Method

A qualitative interview was conducted using a thematic analysis. Thirty-three women who had experienced high and severe fear of childbirth, and had completed midwife-led integrated pre-birth training were interviewed one month after giving birth. The interviews were conducted in a maternal and child health clinic in Samburu, Kenya from December 2019 to January 2020. Collected data was analysed based on thematic analysis.
Results

The general theme ‘midwife-led integrated pre-birth training promoted constructive disposition and enhanced trust in the process of giving birth’ was validated by the interviewed participants. Their contributions covered three themes: ‘the significance of midwife-led pre-birth training’, ‘the role of efficient communication during pregnancy,’ and ‘adaptation to procedures for improved childbirth experience’.
Conclusions

In this study 85% (n = 29) of the participants revealed that midwife-led integrated pre-birth training enhanced their expectations for birth processes. They demonstrated readiness and preparedness for this process, which would lead to improved childbirth outcomes.

Background: To become a mother represents, for many women, a challenging existential process. Women have to deal with countless changes and adaptations, which can be experienced as sources of imbalance but also as moments of personal enrichment.  Currently, this process is influenced by the medicalization of pregnancy and childbirth, which may have positive or negative consequences to the individual experiences of pregnancy and childbirth.Goals: This study aimed to deepen the understanding of the experience of pregnancy and expectations regarding childbirth in a group of women, in a context where pregnancy and childbirth are increasingly medicalized processes.Methods: In this qualitative study, we used semi-structured interviews to collect data regarding the experience of pregnancy and regarding expectations about childbirth in a sample of women (n = 37), recruited in health care centres or obstetric clinics by research assistants. The individual interviews took place at their homes...

The purpose of this study is to explore the experiences of Aeta mothers during pregnancy, childbirth and childrearing. This study was conducted on Kanawan, Morong, Bataan. A phenomenological design was utilized to achieve the objectives of the study. The participants of this study were selected using purposive sampling technique. A total of six Aeta mothers participated in the study and data were collected through semi-structured interview. Three major themes emerged during the interview with the Aeta mothers. The first theme is the integration of the traditional with current practices which refers to the adaptation of the current recommendations during pregnancy. The second theme which emerged is struggles of an Aeta mother which is described as the challenges of Aeta mothers brought about by their socioeconomic and demographic circumstances. The last theme which emerged is the Pride in their Indigenous Beliefs and Practices of Aeta Mothers which refers to the use of available technologies like herbal medicines and the belief of Aeta mothers in superstitions. This study reveals that the experiences of the Aeta mothers are products of modern and traditional practices. Moreover, a more pressing issue surfaced in the experiences of Aetas. The inequalities in health service delivery and the socioeconomic status are major problems of the Aeta community in Kanawan.

Phenomenologically grounded research on pregnancy is a thriving area of activity in feminist studies and related disciplines. But what has been largely omitted in this area of research is the experience of childbirth itself. This paper proposes a phenomenological analysis of childbirth inspired by the work of Merleau-Ponty. The paper proceeds from the conviction that the concept of anonymity can play a critical role in explicating the affective structure of childbirth. This is evident in at least two respects. First, the concept of anonymity gives structural specificity to the different levels of bodily existence at work in childbirth. Second, the concept of anonymity can play a powerful explanatory role in accounting for the sense of strangeness accompanying childbirth. To flesh these ideas out, I focus on two attributes of birth, sourced from first-person narratives of childbirth. The first aspect concerns the sense of leaving one's body behind during childbirth while the second aspect concerns the sense of strangeness accompanying the first encounter with the baby upon successful delivery. I take both of these aspects of childbirth seriously, treating them as being instructive not only of the uniqueness of childbirth but also revealing something important about bodily life more generally. Accordingly, the paper unfolds in three stages. First, I will critically explore the concept of anonymity in Merleau-Ponty; second, I will apply this concept to childbirth; finally, I will provide an outline of how childbirth sheds light on the broader nature of bodily life.

SUMMARY Introduction: Urinary tract infections in pregnant women complicate the course of pregnancy. It is necessary to know not only the pathogen type but also to prescribe the safest antibiotics for adequate treatment of urinary tract infections. Materials and methods: The material for the study was urine. The study was conducted by a quantitative method. The identification of microorganisms was realized by MALDI-TOF, using mass-spectrometer Microflex (Bruker). Determination of the sensitivity of the isolated strains to antimicrobial agents was performed by disk methods in accordance with the recommendations of CLSI (2012). Statistical processing was performed using WhoNet 6.3 program. Results: The results of the research showed that the positive samples with a titer 10^6-10^8 CFU/ml were obtained in 87 pregnant women. E. coli were isolated in 55.17% cases. The most active antibacterial agents against E.coli were the drugs of fluoroquinolones group. All E. coli strains were susceptible to fosfomycin, trimethoprim, amikacin, isepamicin, netilmicin. High activity had nitrofurantoin (93.8%), ampicillin-sulbac-tam (97.3%), gentamicin and sisomicin (95.2%). 53.3% isolated E. coli strains were sensitive to ampicillin. Conclusion: The prevalence of urinary tract infections in pregnant women was 22.5%. E. coli was the most common causative agent of urinary tract infections in pregnant women. High antibacterial activity was registered in cephalosporins, fosfomycin, and nitrafurantoin.

Revision bibliografica de al literatura especializada sobre la relacion entre aborto y salud mental de la mujer, a la luz del Proyecto de Ley en discusion en Chile. Extracto del documento ad hoc a publicar por la Universidad de los Andes. NO DIVULGAR SIN EXPRESA AUTORIZACION DE LOS AUTORES

BACKGROUND: Malaria in pregnancy increases the risk of maternal anemia, abortion and low birth weight. Approximately 85.3 million pregnancies occur annually in areas with Plasmodium falciparum transmission. Pregnancy has been reported to alter the pharmacokinetic properties of many anti-malarial drugs. Reduced drug exposure increases the risk of treatment failure. The objective of this study was to evaluate the population pharmacokinetic properties of artemether and its active metabolite dihydroartemisinin in pregnant women with uncomplicated P. falciparum malaria in Uganda.
METHODS: Twenty-one women with uncomplicated P. falciparum malaria in the second and third trimesters of pregnancy received the fixed oral combination of 80 mg artemether and 480 mg lumefantrine twice daily for three days. Artemether and dihydroartemisinin plasma concentrations after the last dose administration were quantified using liquid chromatography coupled to tandem mass-spectroscopy. A simultaneous drug-metabolite population pharmacokinetic model for artemether and dihydroartemisinin was developed taking into account different disposition, absorption, error and covariate models. A separate modeling approach and a non-compartmental analysis (NCA) were also performed to enable a comparison with literature values and different modeling strategies.
RESULTS:
The treatment was well tolerated and there were no cases of recurrent malaria. A flexible absorption model with sequential zero-order and transit-compartment absorption followed by a simultaneous one-compartment disposition model for both artemether and dihydroartemisinin provided the best fit to the data. Artemether and dihydroartemisinin exposure was lower than that reported in non-pregnant populations. An approximately four-fold higher apparent volume of distribution for dihydroartemisinin was obtained by non-compartmental analysis and separate modeling compared to that from simultaneous modeling of the drug and metabolite. This highlights a potential pitfall when analyzing drug/metabolite data with traditional approaches.
CONCLUSION: The population pharmacokinetic properties of artemether and dihydroartemisinin, in pregnant women with uncomplicated P. falciparum malaria in Uganda, were described satisfactorily by a simultaneous drug-metabolite model without covariates. Concentrations of artemether and its metabolite dihydroartemisinin were relatively low in pregnancy compared to literature data. However, this should be interpreted with caution considered the limited literature available. Further studies in larger series are urgently needed for this vulnerable group.

A study chronicling the experiences of women with inflammatory bowel disease (IBD) during and after pregnancy found nurses and midwives were often unable to provide information and advice.

The qualitative research, led by the University of Leeds, is based on detailed interviews with 22 women who have both been diagnosed with the condition and have given birth to children.......

Objective: To systematically review the literature focusing on obstetric and perinatal outcomes in women with previous or current eating disorders (EDs) and on the consequences of maternal EDs for
the offspring.
Methods: The study was performed following the systematic review and meta-analysis (PRISMA) statement. PubMed, SciELO, and Cochrane databases were searched for non-interventional studies published in English or Portuguese from January 1980 to December 2020. Risk of bias was assessed using the Methods guide for effectiveness and comparative effectiveness reviews (American Agency for Healthcare Research and Quality).
Results: The search yielded 441 records, and 30 articles were included. The psychiatric outcome associated with EDs in women was mainly perinatal depression. The most prevalent obstetric outcomes observed in women with EDs were vomiting, hyperemesis, bleeding, and anemia. Most studies found maternal anorexia nervosa and bulimia nervosa to be associated with low birth weight and slow fetal growth. Women with binge EDs delivered children with increased birth weight. Of the 30 studies included, methodological quality was good in seven, fair in eight, and poor in 15 studies.
Conclusion: A considerable body of evidence was reviewed to assess obstetric and perinatal outcomes in EDs. Acute and lifetime EDs, specially if severe, correlated with poor perinatal, obstetric, and neonatal outcomes. Obstetricians and general practitioners should be vigilant and screen for EDs during pregnancy.

Keywords: Eating disorders; anorexia nervosa; bulimia nervosa; pregnancy; perinatal; outcomes; risk factors; malnutrition

Maternal smoking during pregnancy (MSDP) continues to be a leading modifiable risk factor for perinatal complications and a range of neurodevelopmental and cardio-metabolic outcomes across the lifespan. Despite 40 years of intervention research less than one in five pregnant smokers who receive an intervention quit by delivery. Within this context, recognition of pregnancy is commonly associated with abrupt suspension or reduction of smoking in the absence of intervention, yet has not been investigated as a volitional target. The goal of this article is to provide the empirical foundation for a novel direction of research aimed at identifying malleable targets for intervention through the specification of behavior change mechanisms specific to pregnant women. To do so, we: (1) summarize progress on MSDP in the United States generated from conventional empirical approaches to health behavior change; (2) discuss the phenomenon of spontaneous change in the absence of intervention among pregnant smokers to illustrate the need for mechanistic specification of behavior change motivated by concern for fetal well-being; (3) summarize component processes in neurobiological models of parental and non-parental social behaviors as a conceptual framework for understanding change mechanisms during pregnancy; (4) discuss the evidence for the malleability of these processes to support their translational relevance for preventive interventions; and (5) propose a roadmap for validating the proposed change mechanism using an experimental medicine approach. A greater understanding of social and interpersonal processes that facilitate health behavior change among expectant mothers and how these processes differ interindividually could yield novel volitional targets for prenatal interventions. More broadly, explicating other-oriented mechanisms of behavior change during pregnancy could serve as a paradigm for understanding how social and interpersonal processes positively influence health behaviors across the lifespan.

Background: To become a mother represents, for many women, a challenging existential process. Women have to deal with countless changes and adaptations, which can be experienced as sources of imbalance but also as moments of personal enrichment. Currently, this process is influenced by the medicalization of pregnancy and childbirth, which may have positive or negative consequences to the individual experiences of pregnancy and childbirth. Goals: This study aimed to deepen the understanding of the experience of pregnancy and expectations regarding childbirth in a group of women, in a context where pregnancy and childbirth are increasingly medicalized processes. Methods: In this qualitative study, we used semi-structured interviews to collect data regarding the experience of pregnancy and regarding expectations about childbirth in a sample of women (n = 37), recruited in health care centres or obstetric clinics by research assistants. The individual interviews took place at their home...

ObjectivePre-pregnancy obesity has been associated with adverse birth outcomes. Poor essential fatty acid (EFA) and micronutrient status during pregnancy may contribute to these associations. We assessed the associations between pre-pregnancy BMI and nutritional patterns of maternal micronutrient and EFA status during mid-pregnancy.DesignA cross-sectional analysis from a prospective cohort study. Women provided non-fasting blood samples at ≤20 weeks’ gestation that were assayed for red cell EFA; plasma folate, homocysteine and ascorbic acid; and serum retinol, 25-hydroxyvitamin D, α-tocopherol, soluble transferrin receptors and carotenoids. These nutritional biomarkers were employed in a factor analysis and three patterns were derived: EFA, Micronutrients and Carotenoids.SettingThe Antidepressant Use During Pregnancy Study, Pittsburgh, PA, USA.SubjectsPregnant women (n 129).ResultsAfter adjustment for parity, race/ethnicity and age, obese pregnant women were 3·0 (95 % CI 1·1, 7·7) t...