Pre- and post-natal development of the diaphragm

Animal models were used to examine properies of the diaphragm (the main respiratory muscle) before and after birth. The study revealed an insufficient blood supply to the fetus can result in structural and functional damage to the diaphragm. Damage was prevented when the mother was supplemented with creatine during pregnancy.

Transition to motherhood in type 1 diabetes : design of the pregnancy and postnatal well-being in transition questionnaires

Background : Life transitions are associated with high levels of stress affecting health behaviours among people with Type 1 diabetes. Transition to motherhood is a major transition with potential complications accelerated by pregnancy with risks of adverse childbirth outcomes and added anxiety and worries about pregnancy outcomes. Further, preparing and going through pregnancy requires vigilant attention to a diabetes management regimen and detailed planning of everyday activities with added stress on women. Psychological and social well-being during and after pregnancy are integral for good pregnancy outcomes for both mother and baby. The aim of this study is to establish the face and content validity of two novel measures assessing the well-being of women with type 1 diabetes in their transition to motherhood, 1) during pregnancy and 2) during the postnatal period.

Methods : The approach to the development of the Pregnancy and Postnatal Well-being in T1DM Transition questionnaires was based on a four-stage pre-testing process; systematic overview of literature, items development, piloting testing of questionnaire and refinement of questionnaire. The questionnaire was reviewed at every stage by expert clinicians, researchers and representatives from consumer groups. The cognitive debriefing approach confirmed relevance of issues and identified additional items.

Results : The literature review and interviews identified three main areas impacting on the women’s postnatal self-management; (1) psychological well-being; (2) social environment, (3) physical (maternal and fetal) well-being. The cognitive debriefing in pilot testing of the questionnaire identified that immediate postnatal period was difficult, particularly when the women were breastfeeding and felt depressed.

Conclusions : The questionnaires fill an important gap by systematically assessing the psychosocial needs of women with type 1 diabetes during pregnancy and in the immediate postnatal period. The questionnaires can be used in larger data collection to establish psychometric properties. The questionnaires potentially play a key role in prospective research to determine the self-management and psychological needs of women with type 1 diabetes transitioning to motherhood and to evaluate health education interventions.

The course of uveitis in pregnancy and postpartum

Aim
To examine the course of non-infectious uveitis during pregnancy.

Methods
This is a retrospective case series. The medical records of 47 subjects with a previous history of non-infectious uveitis pre-dating their pregnancy were reviewed. Uveitis activity during the periods 1 year before pregnancy, during pregnancy and 1 year postpartum, were recorded. Information on patient demographics, type of uveitis, medication use, sex of child and breastfeeding status were also collected. The main outcome measures were the events of flare-ups during the prepregnancy, pregnancy and postpartum periods.

Results
The rate of flare-up was 1.188 per person year prior to pregnancy, 0.540 per person year during pregnancy and 0.972 per person year in postpartum (p<0.001 for comparison between prepregnancy and pregnancy; p=0.009 for comparison between pregnancy and postpartum). Rates of flare-up only began to decrease in the second trimester. After delivery, rates of flare-up rebounded and within 6 months postpartum, flare-up rates were not significantly different from prepregnancy levels (p=0.306). Even so, 40% of subjects were found to have remained inactive within 1 year postpartum.

Conclusions
Uveitis activity decreased by mid-pregnancy, but returned to prepregnancy levels within 6 months postpartum. These findings may be used to adjust uveitis management during pregnancy and the postpartum period.

A comparison of maternal calcium and magnesium levels in pre-eclamptic and normotensive pregnancies: an observational case–control study

Objective : Supplementing pregnant women at high risk of developing pre-eclampsia with calcium may reduce the incidence of the disease. This study examines differences in serum and hair concentrations of calcium and magnesium between women with pre-eclamptic and normotensive pregnancies.Design : Observational case–control study.Setting : Two teaching hospitals in Cape Town, South Africa.PopulationWomen with pre-eclamptic (N = 96) or normotensive (N = 96) pregnancies, who delivered a single, live infant.MethodsDemographic and current pregnancy details were retrieved from clinical notes. Each participant completed a dietary questionnaire. Venous blood samples were taken from each participant to assess serum calcium and magnesium concentrations. Hair samples were obtained from all participants and calcium and magnesium levels were measured by inductively coupled plasma optical emission spectrometry (ICPOES).Main outcome measureHair and serum calcium and magnesium concentrations were compared between women with pre-eclamptic and normotensive pregnancies.ResultsDiet and socio-economic status in the two groups were similar. There was no significant difference in the hair calcium level between women with pre-eclamptic [1241 parts per million (ppm); range, 331–4654 ppm] and normotensive (1146 ppm; range, 480–4136 ppm) pregnancies (P = 0.5). Hair calcium levels in both groups were not affected by HIV infection.ConclusionWoman with pre-eclampsia showed no difference in chronic calcium status relative to normotensive women. This finding does not support the current belief that the mechanism by which calcium supplementation reduces the risk of developing pre-eclampsia is by correcting a nutritional deficiency.

Psychopharmacology and pregnancy : treatment efficacy, risks, and guidelines

 This book examines the role of psychopharmacological treatment in a range of disorders that may be encountered during pregnancy, including major depressive disorders, anxiety disorders, bipolar affective disorder, schizophrenia, eating disorders, and substance abuse. The natural history of each condition pre- and post-partum is analyzed, and the evidence for the efficacy of drug treatments, evaluated. Special attention is paid to the potential dangers of different treatment options for both mother and fetus, covering risks of malformation, pregnancy and obstetric risks, neonatal risks, and possible long-term consequences. The risks of not treating a particular condition are also analyzed. On the basis of the available evidence, management guidelines are provided that additionally take into account non-pharmacological options. Closing chapters consider the value of complementary and alternative medicine and ECT and explore future research directions.

A population-based observational study of diabetes during pregnancy in Victoria, Australia, 1999-2008

Objectives: This paper reports secular trends in diabetes in pregnancy in Victoria, Australia and examines the effect of including or excluding women with pre-existing diabetes on gestational diabetes (GDM) prevalence estimates.

The effects of ethinylestradiol and progestins ("the pill") on cognitive function in pre-menopausal women

Oral contraceptives (OCs), often referred to as "the pill", are the most commonly employed form of reversible contraception. OCs are comprised of combined synthetic estrogen and progestin, which work to suppress ovulation and subsequently protect against pregnancy. To date, almost 200 million women have taken various formulations of OC, making it one of the most widely consumed classes of medication in the world. While a substantial body of literature has been dedicated to understanding the physical effects of OCs, much less is known about the long term consequences of OC use on brain anatomy and the associated cognitive effects. Accumulating evidence suggests that sex hormones may significantly affect human cognition. This phenomenon has been commonly studied in older populations, such as in post-menopausal women, while research in healthy, pre-menopausal women remains limited. The current review focused on the effects of OCs on human cognition, with the majority of studies comparing pre-menopausal OC users to naturally cycling women. Human neuroimaging data and animal studies are also described herein. Taken together, the published findings on OC use and human cognition are varied. Of those that do report positive results, OC users appear to have improved verbal memory, associative learning and spatial attention. We recommend future research to employ blinding procedures and randomised designs. Further, more detailed information pertaining to the specific generation and phasic type of OCs, as well as menstrual cycle phase of the OC non-users should be considered to help unmask the potential impact of OC use on human cognition.

Safety and efficacy of antenatal milk expressing for women with diabetes in pregnancy: protocol for a randomised controlled trial

Many maternity providers recommend that women with diabetes in pregnancy express and store breast milk in late pregnancy so breast milk is available after birth, given (1) infants of these women are at increased risk of hypoglycaemia in the first 24 h of life; and (2) the delay in lactogenesis II compared with women without diabetes that increases their infant's risk of receiving infant formula. The Diabetes and Antenatal Milk Expressing (DAME) trial will establish whether advising women with diabetes in pregnancy (pre-existing or gestational) to express breast milk from 36 weeks gestation increases the proportion of infants who require admission to special or neonatal intensive care units (SCN/NICU) compared with infants of women receiving standard care. Secondary outcomes include birth gestation, breastfeeding outcomes and economic impact.

Use of pregnancy counselling services in Australia 2007-2012

To assess the uptake of Medicare Benefit payments for non-directive pregnancy support counselling which commenced in November 2006.

A parent-based intervention to promote healthy eating and active behaviours in pre-school children: evaluation of the MEND 2-4 randomized controlled trial.

BACKGROUND: There is a paucity of studies evaluating targeted obesity prevention interventions in pre-school children. OBJECTIVES: We conducted a randomized controlled trial to evaluate the efficacy of a parent-based obesity prevention intervention for pre-schoolers - MEND (Mind, Exercise, Nutrition … Do It!) 2-4 on child diet, eating habits, physical activity/sedentary behaviours, and body mass index (BMI). METHODS: Parent-child dyads attended 10 weekly 90-min workshops relating to nutrition, physical activity and behaviours, including guided active play and healthy snack time. Assessments were conducted at baseline, immediately post-intervention, and 6 and 12 months post-intervention; child intake of vegetables, fruit, beverages, processed snack foods, fussiness, satiety responsiveness, physical activity, sedentary behaviour and neophobia were assessed via parent proxy report. Parent and child height and weight were measured. RESULTS: Two hundred one parent-child dyads were randomized to intervention (n = 104) and control (n = 97). Baseline mean child age was 2.7 (standard deviation [SD] 0.6) years, and child BMI-for-age z-score (World Health Organization) was 0.66 (SD 0.88). We found significant positive group effects for vegetable (P = 0.01) and snack food (P = 0.03) intake, and satiety responsiveness (P = 0.047) immediately post-intervention. At 12 months follow-up, intervention children exhibited less neophobia (P = 0.03) than controls. CONCLUSION: Future research should focus on additional strategies to support parents to continue positive behaviour change. ACTRN12610000200088.

‘I felt like I was watching porn’: the reality of preparing pre-service teachers to teach about sexual pleasure

Overwhelmingly, school-based sexuality education programmes focus on the prevention of infection, pregnancy and abuse, with little if any attention given to positive views of sexuality and rarely the inclusion of sex positive issues such as pleasure, intimacy and desire. This paper explores the experience of teaching about pleasure to pre-service health and physical education teachers as part of compulsory studies in a unit on sexuality education designed to prepare them to teach sexuality education in secondary schools. Drawing on the aims, theoretical framework, content and pedagogical structure of the unit, and data collected from 42, third-year pre-service teachers (PST) in Australia via surveys and student assessment, the paper provides some practical examples of what teaching about pleasure might look like in practice. It argues that with adequate preparation, a framework to celebrate sex and sexuality, a gender lens to examine normative discourses, and the opportunity for reflection, PST can develop the confidence, skill and willingness to include pedagogies of pleasure in their school-based work.

Repercussions of mild diabetes on pregnancy in Wistar rats and on the fetal development

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)