Prenatal care demand and its effects on birth outcomes by birth defect status in Argentina

Our objective was to identify determinants of prenatal care demand and evaluate the effects of this demand on low birth weight and preterm birth. Delay in initiating prenatal care was modeled as a function of pregnancy risk indicators, enabling factors, and regional characteristics. Conditional maximum likelihood (CML) estimation was used to model self-selection into prenatal care use when estimating its effectiveness. Birth registry data was collected post delivery on infants with and without common birth defects born in 1995-2002 in Argentina using a standard procedure. Several maternal health and fertility indicators had significant effects on prenatal care use. In the group without birth defects, prenatal care delay increased significantly LBW and preterm birth when accounting for self-selection using the CML model but not in the standard probit model. Prenatal care was found to be ineffective on average in the birth defect group. The self-selection of higher risk women into earlier initiation of prenatal care resulted in underestimation of prenatal care effectiveness when using a standard probit model with several covariates. Large improvements in birth outcomes are suggested with earlier initiation of prenatal care for pregnancies uncomplicated with birth defects in Argentina, implying large opportunity costs from the long waiting time observed in this sample (about 17 weeks on average). The suggested ineffectiveness for pregnancies complicated with common birth defects deserves further research.     

Prolactin responses to infant cues in men and women: effects of parental experience and recent infant contact

We used a longitudinal design to test whether parental experience differentially affects the development of prolactin responses to infant cues in men and women. Couples provided two blood samples at three tests, one test just before their babies were born, and two tests during the early postnatal period (n=21). Nine couples repeated the tests near the birth of their second babies. In the 30 min between the two samples, couples listened to recorded infant cries at the prenatal test and held their baby (fathers) or a doll (mothers) at the postnatal tests. Blood samples were analyzed for prolactin concentrations. Prolactin values were then related to sex and parity differences as well as to questionnaire data concerning emotional responses to infant cries and previous infant contact. We found that (1) prior to the birth of both the first and second babies, women's prolactin concentrations increased after exposure to infant stimuli, whereas men's prolactin concentrations decreased; postnatal sex differences varied with parity; (2) women's prolactin reactivity did not change significantly with parental experience; (3) the same men's prolactin concentrations decreased after holding their first newborns but increased after holding their second newborns; this change was not gradual or permanent; (4) men reporting concern after hearing recorded infant cries showed a different postnatal pattern of prolactin change after holding their babies than men not reporting concern; and (5) men who had little contact with their babies just prior to testing had a more positive prolactin response than men who had recently held their babies for longer periods. Although parental experience appears to affect men's prolactin responses, differences in reactivity were also related to patterns of recent infant contact and individual differences in responses to infant cues.     

What husbands in northern India know about reproductive health: correlates of knowledge about pregnancy and maternal and sexual health

Women in India suffer from a high incidence of reproductive disease, disability and death. Very little work has been done on men, but a much higher incidence of sexual experience outside marriage and sexually transmitted diseases (STDs) among males than previously expected for this population is now being documented. In north India, women are dependent on their husbands and other family members for health-related decisions. Therefore, the behaviour, knowledge and attitudes of men are integral to the reproductive health status of couples there. This study explores knowledge about three distinct areas of reproductive health among 6549 married men in five districts of the northern state of Uttar Pradesh, India. Factors contributing to men's knowledge in the areas of fertility, maternal health and STDs were investigated. Results showed that very few men had basic knowledge in any of these areas. The likelihood of reporting knowledge was associated with a set of determinants that differed in their magnitude and effect across the areas of reproductive health explored. In particular, men's belief about the ability of an individual to prevent pregnancy demonstrated an independent association with men's knowledge. After controlling for factors such as age, parity and educational and economic status, men who believed it not possible to prevent a pregnancy were less likely to know when during the menstrual cycle women would become pregnant and certain facts about STDs, but they were more likely to be able to name two or more symptoms of serious maternal health conditions. Possible explanations for this trend are discussed.     

Reproductive aspects in female rats exposed prenatally to hydrocortisone

We investigated the effects of hydrocortisone during the prenatal period and its later repercussion on reproductive aspects of female rats. Pregnant rats were treated (s.c.) with hydrocortisone acetate, at 1.5 mg/day on the 17th, 18th, and 19th days of pregnancy. Although the present study was not intended to identify mechanisms of toxicity, the treatment with hydrocortisone in the last period of pregnancy presented no signs of toxicity. The efficacy of the hydrocortisone in reducing the adrenal wet mass and plasma corticosterone levels immediately after delivery in both the treated mothers and in respective pups at birth may indicate impairment of the hypothalamus-pituitary-adrenal axis. In addition, the treatment with hydrocortisone did not interfere in the development of the female descendants until puberty. However, it affected the estrous cycle and fertility. Probably, the prenatal exposure to corticosteroids had altered at least partially the hypothalamus-pituitary-gonadal axis, resulting in the damages observed in adult life. These results indicate that the use of the hydrocortisone at a dose that apparently does not endanger the neonate led to undesirable effects in the adult reproductive phase, resulting in later deleterious alteration of the reproductive physiology in female rats.     

Effect of maternal adrenocorticotropin injections on the differentiation of sexual behavior of the offspring

Male and female rats were prenatally exposed to high levels of corticosteroids, by treatment of their mothers with ACTH, during the last third of pregnancy. In the females, treatment increased the ano-genital distance at birth, but no effect on sexual differentiation could be detected in the adult animals: They had normal cyclic reproductive function and female lordotic sexual behavior. The prenatal treatment demasculinized the males, who showed decreased ability for complete male copulatory behavior. The demasculinizing effect of prenatal corticosteroids was, however, particularly pronounced in certain litters, while not affecting others at all.     

Predation risk shapes the degree of placentation in natural populations of live‐bearing fish

The placenta is a complex life‐history trait that is ubiquitous across the tree of life. Theory proposes that the placenta evolves in response to high performance‐demanding conditions by shifting maternal investment from pre‐ to post‐fertilisation, thereby reducing a female’s reproductive burden during pregnancy. We test this hypothesis by studying populations of the fish species Poeciliopsis retropinna in Costa Rica. We found substantial variation in the degree of placentation among natural populations associated with predation risk: females from high predation populations had significantly higher degrees of placentation compared to low predation females, while number, size and quality of offspring at birth remained unaffected. Moreover, a higher degree of placentation correlated with a lower reproductive burden and hence likely an improved swimming performance during pregnancy. Our study advances an adaptive explanation for why the placenta evolves by arguing that an increased degree of placentation offers a selective advantage in high predation environments.     

Effects of Maternal Pregnancy Intention,Depressive Symptoms and Social Support on Risk of Low Birth Weight: A Prospective Study from Southwestern Ethiopia

Background

Low birth weight (LBW) is the principal risk factor for neonatal and infant mortality in developing countries. This study examines the effects of unwanted pregnancy, prenatal depression and social support on the risk of low birth weight in rural southwestern Ethiopia. We hypothesized that unwanted pregnancy and prenatal depression increase the risk of low birth weight, while social support mediates this association.

Methods

Data for the study comes from a prospective study in which women were followed from pregnancy through to delivery. Six hundred twenty two women were followed and 537 birth weights were measured within 72 hours. Multivariable log binomial regression was used to model the risk of low birth weight.

Results

The mean birth weight was 2989 grams (SD±504 grams), and the incidence of LBW was 17.88%. The mean birth weight of babies after unwanted pregnancy was 114 g lower compared to births from intended pregnancy. Similarly, mean birth weight for babies among women with symptoms of antenatal depression was 116 grams lower. Results of unadjusted log-binomial regression showed that unwanted pregnancy, prenatal depression and social support were associated with LBW. The relationship between antenatal depressive symptoms and LBW was mediated by the presence of social support, while the association between LBW and unwanted pregnancy remained after multivariable adjustment.

Conclusion

The incidence of low birth weight is high in the study area. Poverty, nonuse of antenatal care, low social support and unwanted pregnancy contribute to this high incidence of low birth weight. Hence, identifying women’s pregnancy intention during antenatal care visits, and providing appropriate counseling and social support will help improve birth outcomes.     

The 2nd:4th digit ratio,sexual dimorphism,population differences,and reproductive success: evidence for sexually antagonistic genes?

The ratio between the length of the 2nd and 4th digit (2D:4D) is sexually dimorphic, with mean male 2D:4D lower than mean female 2D:4D. It recently was suggested that 2D:4D is negatively correlated with prenatal testosterone and positively correlated with prenatal estrogen. It is argued that high prenatal testosterone and low estrogen (indicated by low 2D:4D) favors the male fetus and low prenatal testosterone and high estrogen (indicated by high 2D:4D) favors the female fetus. The patterns of expression of 2D:4D are interpreted in terms of sexually antagonistic genes.We report data on the following. (a) reproductive success and 2D:4D from England, Germany, Spain, Hungary (ethnic Hungarians and Gypsy subjects), Poland, and Jamaica (women only). Significant negative associations were found between 2D:4D in men and reproductive success in the English and Spanish samples and significant positive relationships between 2D:4D in women and reproductive success in the English, German, and Hungarian samples. The English sample also showed that married women had higher 2D:4D ratios than unmarried women, suggesting male choice for a correlate of high ratio in women, and that a female 2D:4D ratio greater than male 2D:4D predicted high reproductive success within couples. Comparison of 2D:4D ratios of 62 father:child pairs gave a significant positive relationship. This suggested that genes inherited from the father had some influence on the formation of the 2D:4D ratio. Waist:hip ratio in a sample of English and Jamaican women was negatively related to 2D:4D. (b) Sex and population differences in mean 2D:4D in samples from England, Germany, Spain, Hungary (including ethnic Hungarians and Gypsy subjects), Poland, Jamaica, Finland, and South Africa (a Zulu sample). Significant sex and population differences in mean 2D:4D were apparent.     

Coadaptation of prenatal and postnatal maternal effects

In a wide variety of species, a female's age of first reproduction influences offspring size and survival, suggesting that there exists an optimal timing of reproduction. Mothers in many species also influence offspring size and survival after birth through variation in parental care. We experimentally separated these effects in the burying beetle Nicrophorus vespilloides to test for coadaptation between prenatal and postnatal maternal effects associated with age at first reproduction. Females that reproduced early produced offspring with lower birth weight. The amount of parental care depended on the age of first reproduction of the caretaker, as did the extent of offspring begging. As predicted for a coadaptation of maternal effects, prenatal and postnatal effects were opposite for different-aged mothers, and larval weight gain and survival was greatest when the age of the caretaker and birth mother matched. Thus, prenatal effects intrinsically associated with age of first reproduction can be ameliorated by innate plasticity in postnatal care. A coadaptation of prenatal and postnatal maternal effects may evolve to allow variable timing of the first reproductive attempt. Such a coadaptation might be particularly valuable when females are constrained from reproducing at an optimal age, as, for example, in species that breed on scarce and unpredictable resources.     

女性生殖系统微生物群落及其与早产相关性研究进展

女性生殖系统微生物群落与女性生殖健康密切相关.阴道微生物的菌群变化伴随着多种阴道疾病的发生并可能通过宫颈感染子宫,孕期子宫内的炎症反应会导致胎儿早产(Preterm Birth,PTB),PTB被定义为妊娠满28周但不足37周所发生的分娩现象,PTB婴儿死亡率很高并面临着多种健康疾病,除了明确病原微生物的感染,PTB还...     

The medicalization of "nature" in the "artificial body": surrogate motherhood in Israel

In this article, I draw on anthropological and feminist scholarship on the body and the nature/culture divide as a framework for understanding the place of surrogate mothers in a conceptual ideology that connects motherhood with nature. I explore links between the medicalization of childbirth in Israel and the personal agency of surrogate mothers as relayed through interviews. Taking the patriarchal context of the Israeli surrogacy law of 1996 into consideration, I underscore surrogates' imaginative use of medical metaphors as tools for the subversion of surrogacy's threatening social connotations. By redefining the surrogate body as "artificial" and locating "nature" in the commissioning mother's body, surrogates adopt medical rhetoric to transform surrogacy from a transgressive act into an alternative route toward achieving normative Israeli national reproductive goals.     

Two different ethical notions of benefit sharing of genetic resources and their implications for global development

Nazi eugenics is one of the main historical events influencing current popular as well as scholarly discussions of reproductive genetics. This influence, however, is open to different interpretations and social constructions. Based on 44 open interviews with Israeli and German genetic counselors, conducted in 2000–2003, our findings suggest that while the majority of German counselors reflected on Nazi eugenics as setting moral limits for contemporary repro-genetics, many Israeli counselors detached their contemporary practice from the wrongdoings of the past. Correspondingly, German counselors were far more sensitive towards the disability critique of repro-genetics than their Israeli counterparts. We conclude with a discussion of these two opposite positions, suggesting that the comparison of German and Israeli professionals reveals a profound complexity and involvedness in coming to terms with the “eugenic” lessons of the Holocaust, on both sides. In Germany, potential benefits of repro-genetics might be rejected due to an emphasis on a more universalistic lesson of the Holocaust regarding the value of human life and dignity. In Israel, a more particularistic lesson of the Holocaust regarding national Jewish survival, combined with a lack of public debate regarding medicalization and geneticization, might have promoted the advent of unregulated commercially and consumer-driven repro-genetics.     

Family networks in prenatal and postnatal health

This paper examines the effects of kin access on prenatal health practices, birth outcome, and postnatal health practice for infants born to black and white mothers ages 21 to 28 in the U.S. during 1984-86. The data used for this research were compiled from three sources: (1) The National Longitudinal Survey of Youth; (2) The Children of the National Longitudinal Survey of Youth; (3) special kin access data files, which were created specifically for this study. Logistic regression procedures are used to assess the effects of kin proximity, maternal grandmother proximity, and presence of the child's father on health practices (N = 1,030) and birth outcome (N = 1,385), controlling for the mother's educational attainment, work experience, poverty, presence of the child's father, and birth order of the child. We find no evidence supporting the notion that kin access positively affects the prenatal and postnatal health practices of young mothers. The results suggest that young mothers who reside with their mothers or other adult kin, and those who are in close proximity to them, are no more likely to seek prenatal care during the first trimester, or to avoid smoking or drinking during pregnancy. Mothers who live with a sexual partner or husband are, however, somewhat more likely to seek prenatal care and to avoid alcohol use during pregnancy. Closer kin access is associated with a lower probability of breastfeeding. These results suggest that it will not be adequate to rely on kin networks or kin assistance to improve the prospect of healthy birth outcomes.     

Father absence, parental care, and female reproductive development

This study examines female reproductive development from an evolutionary life history perspective. Retrospective data are for 10,847 U.S. women. Results indicate that timing of parental separation is associated with reproductive development and is not confounded with socioeconomic variables or phenotypic correlations with mothers' reproductive behavior. Divorce/separation between birth and 5 years predicted early menarche, first sexual intercourse, first pregnancy, and shorter duration of first marriage. Separation in adolescence was the strongest predictor of number of sex partners. Multiple changes in childhood caretaking environment were associated with early menarche, first sex, first pregnancy, greater number of sex partners, and shorter duration of marriage. Living with either the father or mother after separation had similar effect on reproductive development. Living with a stepfather showed a weak, but significant, association with reproductive development, however, duration of stepfather exposure was not a significant predictor of development. Difference in amount and quality of direct parental care (vs. indirect parental investment) in two- and single-parent households may be the primary factor linking family environment to reproductive development.     

Cystic fibrosis carrier population screening in the primary care setting.

To determine the receptivity of prenatal care providers and their patients to carrier testing for cystic fibrosis (CF), we offered free carrier screening, followed by genetic counseling of carriers, to all prenatal care providers in Rochester, NY, for all their female patients of reproductive age, pregnant or not. Of 124 prenatal care providers, only 37 elected to participate, but many of these offered screening only to pregnant women. The acceptance rate among pregnant women was approximately 57%. The most common reasons for accepting screening were to obtain reassurance (50.7%) and to avoid having a child with CF (27.8 %). The most common reasons for declining screening were not intending to terminate a pregnancy for CF (32.4%) and believing that the chance of having a CF child was very low (32.2%). Compared with decliners, acceptors were more likely to have no children, regarded having a child with CF as more serious, believed themselves more susceptible to having such a child, knew more about CF, would be more likely to terminate a pregnancy if the fetus were shown to have CF, and more strongly supported offering CF screening to women of reproductive age. Of 4,879 women on whom results were obtained, 124 were found to be carriers. Of these 124 carriers, the partners of 106 were tested. Of the five at-risk couples, four requested prenatal diagnosis and one requested neonatal diagnosis. No woman found to be a carrier whose partner tested negative requested prenatal diagnosis. Except for the imperfect knowledge of those testing negative, none of the adverse outcomes predicted for CF carrier testing in the general population were observed in this study.     

Effects of sympathetic denervation on follicular distribution,oestradiol and progesterone serum levels in prepubertal hemi-ovariectomized female guinea pig

The aim of this study was to determine the effects of maternal undernutrition during pregnancy on adult reproductive function in male and female offspring. Groups of ewes were fed rations providing either 100% (High, H) or 50% (Low, L) of estimated metabolisable energy (ME) requirements for pregnancy, from mating until day 95 of gestation, and thereafter were conventionally managed. At 20 months of age, LH and FSH profiles, and LH responses to exogenous GnRH were measured in male and female offspring and, in males, testicular responses to exogenous LH (as measured by testosterone concentrations) were also measured. Undernutrition had no effect on the mean birth weights of lambs of either sex, or on testicular size in male animals at either 6 weeks or 20 months of age. L males exhibited significantly higher FSH concentrations than H males (P < 0.05) but there were no differences with treatment in FSH profiles in females, basal LH profiles or gonadotrophin responses to GnRH in offspring of either sex, and no difference in basal testosterone concentrations or in the testosterone response to exogenous LH administration in males. Semen quality at 20 months of age was unaffected by pre-natal undernutrition but ovulation rate was significantly reduced in L compared to H female offspring (P < 0.05). It is concluded that pre-natal undernutrition had no effect on male reproductive development and adult function, but reduced ovulation rate in female progeny. This effect was not associated with a change in gonadotrophin profiles or pituitary responsiveness.     

Prenatal SSRI alters the hormonal and behavioral responses to stress in female mice: Possible role for glucocorticoid resistance

Life time prevalence of major depression disorder (MDD) is higher in women compared to men especially during the period surrounding childbirth. Women suffering from MDD during pregnancy use antidepressant medications, particularly Selective Serotonin Reuptake Inhibitors (SSRI). These drugs readily cross the placental barrier and impact the developing fetal brain. The present study assessed the effects of prenatal exposure to fluoxetine (FLX), an SSRI antidepressant drug, on corticosterone and behavioral responses to stress in female mice. In young females, prenatal FLX significantly elevated corticosterone response to continuous stress. In adults, prenatal FLX augmented corticosterone response to acute stress and suppressed the response to continuous stress. Additionally, prenatal FLX significantly augmented stress-induced increase in locomotion and reduced anxiety- and depressive-like behaviors in adult, but not young mice. The dexamethasone suppression test revealed that prenatal FLX induced a state of glucocorticoid resistance in adult females, indicating that the negative feedback control of the hypothalamic-pituitary-adrenal axis response to stress was disrupted. These findings provide the first indication of altered hormonal and behavioral responses to continuous stress and suggest a role for the development of glucocorticoid resistance in these effects. According to these findings, prenatal environment may have implications for stress sensitivity and responsiveness to life challenges. Furthermore, this study may assist in understanding the limitations and precautions that should be taken in the use of SSRIs during pregnancy.     

High rates of pregnancy loss by subordinates leads to high reproductive skew in wild golden lion tamarins (Leontopithecus rosalia)

Across taxa, cooperative breeding has been associated with high reproductive skew. Cooperatively breeding golden lion tamarins (Leontopithecus rosalia) were long thought to have a monogynous mating system in which reproduction was limited to a single dominant female. Subordinates with few reproductive opportunities delayed dispersal and remained in the natal group to provide alloparental care to siblings, thus allowing dominant reproductive females to meet the energetic needs associated with high rates of reproduction and successful infant rearing. The goal of this study was to re-assess monogyny in wild golden lion tamarin groups based upon pregnancy diagnoses that used non-invasive enzyme immunoassay for progesterone and cortisol, combined with weekly data on individual weight gain, bi-annual physical examinations noting pregnancy and lactation status and daily behavioral observations. We established quantitative and qualitative criteria to detect and determine the timing of pregnancies that did not result in the birth of infants. Pregnancy polygyny occurred in 83% of golden lion tamarin groups studied. The loss of 64% of subordinate pregnancies compared to only 15% by dominant females limited reproductive success mainly to dominant females, thus maintaining high reproductive skew in female golden lion tamarins. Pregnancy loss by subordinate adults did not appear to result from dominant interference in subordinate hormonal mechanisms, but more likely resulted from subordinate abandonment of newborn infants to mitigate dominant aggression.     

Observations of a daytime birthing event in wild titi monkeys (Callicebus oenanthe): implications of the male parental role

Behaviors displayed during birth events, including prenatal, parturition, and postpartum periods, can give insight into caretaking roles in species in which the offspring is cared for by individuals other than the mother. Titi monkeys, genus Callicebus, exhibit a pair-bonded social system along with intense male care of offspring. Here, I report the first case of a birth seen in the wild in a group of Callicebus oenanthe, a little-known species in northern Peru, and describe infant care and development during the first few months after birth. Detailed behavior during the birth sequence as well as ad libitum data postpartum were recorded on nursing and infant care behaviors, including infant carrying, infant grooming, anogenital cleaning, protection, playing, and food sharing. In the 3 h preceding and during parturition, the male remained in contact with or in close proximity to the female (<1 m). The male licked and examined the newborn 3 min after parturition, carried the infant within 24 h after birth, was the main carrier of the infant, and was the predominant manual groomer of the infant during the first 4 months after birth. I argue that the male plays an integral role during the birth in order to establish his bond with the infant as well as reinforce infant care duties to the female and in predator vigilance. In light of various explanations for the exhibition of intense paternal care, I suggest that the male titi monkey provides infant care to release the female of these duties in order that she may spend more time foraging, thus potentially increasing the pair’s overall reproductive output.