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PubMed2005

Thyroid disorders associated with pregnancy: etiology, diagnosis, and management.

Pregnancy has an effect on thyroid economy with significant changes in iodine metabolism, serum thyroid binding proteins, and the development of maternal goiter especially in iodine-deficient areas. Pregnancy is also accompanied by immunologic changes, mainly characterized by a shift from a T helper-1 (Th1) lymphocyte to a Th2 lymphocyte state. Thyroid peroxidase antibodies are present in 10% of women at 14 weeks' gestation, and are associated with (i) an increased pregnancy failure (i.e. abortion), (ii) an increased incidence of gestational thyroid dysfunction, and (iii) a predisposition to postpartum thyroiditis. Thyroid function should be measured in women with severe hyperemesis gravidarum but not in every patient with nausea and vomiting during pregnancy. Graves hyperthyroidism during pregnancy is best managed with propylthiouracil administered throughout gestation. Thyroid-stimulating hormone-receptor antibody measurements at 36 weeks' gestation are predictive of transient neonatal hyperthyroidism, and should be checked even in previously treated patients receiving thyroxine. Postpartum exacerbation of hyperthyroidism is common, and should be evaluated in women with Graves disease not on treatment. Radioiodine therapy in pregnancy is absolutely contraindicated. Hypothyroidism (including subclinical hypothyroidism) occurs in about 2.5% of pregnancies, and may lead to obstetric and neonatal complications as well as being a cause of infertility. During the last few decades, evidence has been presented to underpin the critical importance of adequate fetal thyroid hormone levels in order to ensure normal central and peripheral nervous system maturation. In iodine-deficient and iodine-sufficient areas, low maternal circulating thyroxine levels have been associated with a significant decrement in child IQ and development. These data suggest the advisability of further evaluation for a screening program early in pregnancy to identify women with hypothyroxinemia, and the initiation of prompt treatment for its correction. Hypothyroidism in pregnancy is treated with a larger dose of thyroxine than in the nonpregnant state. Postpartum thyroid dysfunction (PPTD) occurs in 50% of women found to have thyroid peroxidase antibodies in early pregnancy. The hypothyroid phase of PPTD is symptomatic and requires thyroxine therapy. A high incidence (25-30%) of permanent hypothyroidism has been noted in these women. Women having transient PPTD with hypothyroidism should be monitored frequently, as there is a 50% chance of these patients developing hypothyroidism during the next 7 years.

Abortion, Spontaneous↗
PubMed2006

Survey of management practices on reproductive performance of dairy cattle on large US commercial farms.

A survey regarding general management, sire selection, reproductive management, inseminator training and technique, heat abatement, body condition scoring, facility design and grouping, nutrition, employee training and management, and animal health and bio-security was carried out from March to September of 2004 in 153 herds in the Alta Genetics (Watertown, WI) Advantage Progeny Testing Program. A total of 103 herds (67.3%) completed the survey. Herd size was 613 +/- 46 cows, with herds located in Wisconsin (26), California (12), New York (11), Minnesota (10), Michigan (7), Washington (6), Pennsylvania (6), Iowa (5), Idaho (5), Texas (4), Ohio (4), and other states (7). These farms sold 34.5 +/- 0.3 kg of milk/d per cow, with an annual culling rate of 34 +/- 1% and a calving interval of 13.8 +/- 0.1 mo. Cows were observed for estrus 2.8 +/- 0.3 times/d, for a duration of 27 +/- 4 min, but 78% of the respondents admitted that detection of estrus was not the employee's sole responsibility at that time. Managers tried to achieve pregnancy until 8.8 +/- 0.9 failed inseminations, 300 +/- 26 d postpartum, or milk yield <17.7 +/- 0.5 kg/d. Nonpregnant cows were culled at 326 +/- 36 d postpartum or milk yield <16.4 +/- 0.3 kg/ d. Mean durations of the voluntary waiting period were 52 +/- 1.3 and 53 +/- 1.4 d for primiparous and multiparous cows, respectively. Hormonal synchronization or timed artificial insemination programs were used in 87% of the herds, with 86% synchronizing first services, 77% resynchronizing repeat services, and 59% treating cystic, anestrous, or anovular cows. Finding good employees was identified as the greatest labor challenge, followed by training and supervising employees. Mastitis and hairy heel warts were noted as the greatest animal health concerns, followed by lameness, abortions, and death losses, whereas the greatest reproductive challenges were artificial insemination service rate, conception rate, twinning, and retained placenta or metritis. Results of this study can provide a useful benchmark or reference with regard to commonly used management practices on large commercial US dairy farms at the present time.

Animals↗
PubMed1989

Postpartum immunization with rubella virus vaccine and antibody response in breast-feeding infants.

Women who were susceptible to rubella, whether they had elected to breast-feed or formula-feed their infants, received immunization with subcutaneously administered rubella antibody 27/3 live, attenuated rubella virus vaccine in the postpartum period. The breast-fed or formula-fed infants of these mothers who had been immunized subsequently received active immunization with the rubella antibody 27/3 vaccine at 15 to 18 months of age. A second group of naturally immune women who were seropositive for rubella did not receive immunization after childbirth. However, infants of naturally immune mothers who did not receive immunization received immunization with the rubella vaccine and served as controls. Seroconversion for rubella antibody developed in over 94% of susceptible women who were seronegative for rubella after postpartum immunization. The infants of these mothers had no rubella antibody activity in the cord blood; however, 13% of such infants exhibited rubella antibody in serum at 6 months of age. On the other hand, 44% of breast-fed infants of naturally immune mothers (controls) demonstrated rubella antibody activity at 6 months of age. Subsequent immunization with rubella vaccine in breast-fed infants whose mothers had received postpartum immunization resulted in a serum antibody response that was similar to the response observed in the formula-fed infants or the infants of naturally immune mothers who had not received immunization. These data suggest that early neonatal exposure to the rubella virus in breast milk does not enhance or suppress subsequent responses to current programs of rubella vaccination in early childhood.

Antibodies, Viral↗
PubMed1975

[Human growth hormone and prolactin during pregnancy (author's transl)].

In order to know the secretory behaviors of human growth hormone (hGH) and human prolactin (hPRL) during pregnancy, the following studies were undertaken. Twenty three normal pregnant women of every period of gestation, eighteen women of postpartum and five nonpregnant subjects volunteered for this study. After fasting overnight, these volunteers were placed at complete bed rest, and a fasting antecubital venous blood sample was drawn at 8:00 a.m. Then L-arginine, 30 g, was infused intravenously over a 30 minute period, and venous blood samples were drawn at 30, 45, 60, 90, 120, minutes after infusion. Serum hGH level was detected by hGH radioimmunoassay Kit (Dainabot) and serum hPRL concentration was measured by double-antibody radioimmunoassay system (NIH-NIAMDD). In addition, serum hCS level was measured by hCS-Kobe double-antibody radioimmunoassay system in comparison with the secretory behaviors of hGH and hPRL. 1. Serum hGH, hPRL and hCS concentrations during pregnancy. HGH concentration remained almost unchanged through the course of pregnancy, but hPRL and hCS concentrations increased with the programs of pregnancy. 2. Serum hGH and hPRL concentrations in puerperium. HGH level did not change as compared to that of nonpregnant or pregnant women. HPRL concentration maintained high level in 1-3 postpartum weeks. 3. Effect of arginine on the concentrations of serum hGH, hPRL and hCS during pregnancy. The hGH response decreased, but that of hPRL increased along with the progress of pregnancy. During the arginine loading test there was no significant change in hCS concentration. 4. Effect of arginine on the concentrations of serum hGH and hPRL in puerperium. The HGH response was suppressed at the first week of the postpartum. The response of hPRL was lower than that of late pregnancy. To summarize, hGH and hPRL have some similar biological characters, but there was a difference in secretion pattern of the two hormones during pregnancy. Reserve function of hGH secretion was suppressed, but that of hPRL secretion increased along with the progress of pregnancy. And in the third trimester of pregnancy, the difference of the secretory behavior and secretory reserve function between hGH and hPRL was prominent.

Arginine↗
PubMedDate not supplied

[Pregnancy, labor, and puerperium: concepts and practices of midwives in the state of Morelos].

In Mexico a combined type of care for the health-sickness phenomenon exists, where three systems interact: domestic, academic and traditional medicine. In relation to reproductive health, in the state of Morelos approximately 50 per cent of women in rural areas receive attention from traditional birth attendants, who make up one of the principal resources of traditional medicine. The goal of this study was to gather knowledge about and describe the concepts, resources and practices used by traditional birth attendants in their care during pregnancy, birth and puerperium; and likewise to determine their socio-demographic characteristics, their geographic distribution, their number and the level of training which they possess. A census based on three sources was carried out in which information about seven basic variables was sought. This information was completed with structured interviews with key informants which allowed the definition of a profile of the different types of traditional birth attendants according to the population they care for and the resources they use. The most relevant results indicate that 630 traditional birth attendants are distributed throughout the 32 municipalities of the state, with an average age of 52 years and 50 per cent having attended training courses. 17.5 per cent fall within the category of traditional birth attendant, 50 per cent are trained empiricists and 11.6 per cent are non-trained empiricists. The 20 per cent did not fit this typology. The strong social and cultural identification that exists between traditional birth attendants and their patients indicates the need to incorporate this valuable resource in rural reproductive health programs.

Adult↗
PubMed1998

Development of a progestin-based estrus synchronization program: II. Reproductive response of cows fed melengestrol acetate for 14 days with injections of progesterone and prostaglandin F2alpha.

We tested the efficacy of an estrus control system designed to provide optimal control of follicular development. In Exp. 1, postpartum cows (n = 133) and yearling heifers (n = 57) were fed either .5 mg x female(-1) x d(-1) of melengestrol acetate (MGA) or the carrier for MGA from d -13 to d 0 (d 0 = last day of MGA feeding). All females received 25 mg of PGF2alpha (i.m.) on d -13 and 0. On d -6, cows and heifers fed MGA were administered an i.m. injection of progesterone (200 mg; MGA/P4), and those fed the corn carrier (2XPGF2alpha) received no progesterone. Beginning on d 1, females were bred by AI from d 1 to at least d 5. During the estrus synchronization period (d 1 to d 5), more (P < .05) postpartum cows were observed in estrus (70.1 vs 42.4%), the timing of estrus was more (P < .05) precise, conception rate was similar, and pregnancy rate was higher (P < .05) in the MGA/P4 than in the 2XPGF2alpha treatment. More (P < .05) cows that were anestrous at the beginning of the breeding season were in estrus during the synchronization period in the MGA/P4 (55.8%) than in the 2XPGF2alpha (28.6%) treatment. In heifers, estrus was synchronized in over 90% of females, and neither conception nor pregnancy rate during the synchronization period differed between treatments. In Exp. 2, postpartum cows (n = 122) and heifers (n = 84) received treatments (MGA/P4 or 2XPGF2alpha) as described for Exp. 1 with one exception. In the MGA/ P4 treatment, progesterone was administered on d -7 rather than d -6. Females were bred by AI from d 1 to 5. The estrus response and conception rate during the synchronization period did not differ between treatments for either cows or heifers. We conclude that the progestin-based estrous synchronization system used in this study effectively synchronized an estrus of normal fertility in cyclic cows and induced a majority of anestrous cows to reinitiate estrous cycles.

Administration, Oral↗
PubMedDate not supplied

Preparing staff nurses to teach parents about newborn behavior.

The purpose of this project was to teach postpartum nurses about the many facets of newborn behavior and to help these nurses teach parents to recognize and respond to their newborn's cues, states, and behaviors. The Keys to Caregiving: Self-Instructional Video Series was used to accomplish this goal. Eighteen maternal-child nurses from a large metropolitan health sciences center completed the program. The average pre-test score was 80%; the average post-test score was 94%. Based on the pre- and post-test scores, the results demonstrate an improvement in nurses' knowledge about newborn behavior after completing the Keys to Caregiving program. The responses from staff nurses who completed the program were overwhelmingly positive.

Cues↗
PubMedDate not supplied

Nurse visitation for adolescent mothers: two-year infant health and maternal outcomes.

BACKGROUND: Children of adolescent mothers have higher rates of morbidity and unintentional injuries and hospitalizations during the first 5 years of life than do children of adult mothers. OBJECTIVE: The purpose of this study was to evaluate the 2-year postbirth infant health and maternal outcomes of an early intervention program (EIP) of home visitation by public health nurses (PHNs). METHODS: In a randomized controlled trial, a sample of predominantly Latina and African American adolescent mothers was followed from pregnancy through 2 years postpartum. The experimental group (EIP, n = 56) received preparation-for-motherhood classes plus intense home visitation by PHNs from pregnancy through 1 year postbirth; the control group (TPHNC, n = 45) received traditional public health nursing care (TPHNC). Health outcomes were determined based on medical record data; other measures evaluated selected maternal behaviors, social competence, and mother-child interactions. RESULTS: The total days of non-birth-related infant hospitalizations during the first 24 months was significantly lower in the EIP (143 days) than the TPHNC group (211 days) and episodes of hospitalization were fewer; more EIP than THHNC infants were never seen in the emergency room. The EIP mothers had 15% fewer repeat pregnancies in the first 2 years postbirth than TPHNC mothers. The TPHNC mothers significantly increased marijuana use over time, whereas EIP mothers did not. CONCLUSIONS: The EIP improved in selected areas of infant and maternal health, and these improvements were sustained for a period of 1 year following program termination. These findings have important implications for healthcare services.

Adolescent↗
PubMedDate not supplied

Postpartum patients' knowledge, risk perceptions, and behaviors pertaining to childhood injuries.

The purpose of this study was to assess postpartum patients' knowledge, risk perceptions, and behaviors pertaining to a variety of childhood injuries. Although the respondents did demonstrate some knowledge of injury prevention strategies, deficits were noted in the areas of burns, motor vehicle injuries, drownings, and falls, as well as in the concept that injuries, in some children, are unavoidable. Results showed that greater than 50% of mothers did not know the temperature of their hot water tank, 22.4% who had other children under the age of four did not use car safety seats with them, and only 43% of the mothers knew how to perform infant cardiopulmonary resuscitation. Recommendations for program development in parenting classes are included in addition to the roles of nurses and nurse-midwives in injury prevention program activities.

Accident Prevention↗
PubMedDate not supplied

[Neonatal cystic fibrosis screening program in the state of Paraná: evaluation 30 months after implementation].

OBJECTIVES: To present and analyze the results of the National Neonatal Cystic Fibrosis Screening Program in Paraná, 30 months after its implementation. METHODS: This is a descriptive study, with an analysis of the data from the screening of around 98% of all neonates in the period from September 2001 to April 2004, undertaken at the Neonatal Screening Program laboratory of the Fundação Ecumênica de Proteção ao Excepcional do Paraná. Blood samples for the Guthrie test were collected on hospital discharge, ideally between the second and sixth days postpartum, and filter papers were sent for immunoreactive trypsin assay by the immunofluorometric method. Children whose immunoreactive trypsin assay results were > or = 70 ng/ml for two distinct samples during the first 30 days of life, were referred for sweat conductivity testing by the Wescor method. In cases when the result was greater than 50 mMol/l quantitative chlorine and/or sodium in sweat was assayed (iontophoresis with pilocarpine). RESULTS: From a total of 456,982 tests, 4,028 (0.9%) children presented a first immunoreactive trypsin assay above the cutoff point set. Four hundred and seventy-eight of these (12.5%) also had a second blood sample assayed with immunoreactive trypsin above 70 ng/ml and 56 (11.7%) of these were referred to specialized clinics after their sweat conductivity test results were above 50 mMol/l and 48 (0.01% of the total number of children screened) had a diagnosis of cystic fibrosis confirmed. The incidence for the state of Paraná was 1:9,520, although some children have not yet been fully investigated. CONCLUSIONS: Neonatal screening for cystic fibrosis in the State of Paraná, in accordance with Health Ministry directives, was a pioneering initiative for Brazil. Many patients were diagnosed early, even asymptomatic ones, which is a challenge to improving prognosis with this fatal disease.

Biomarkers↗
PubMed2002

Vitamin A supplementation of women postpartum and of their infants at immunization alters breast milk retinol and infant vitamin A status.

Vitamin A supplementation of lactating mothers and of infants at the time of diphtheria-pertussis-tetanus (DPT) and oral polio vaccine (OPV) immunizations have both been suggested as measures to prevent deficiency among infants. This multicenter randomized, double-blind, placebo-controlled trial was conducted in Ghana, India and Peru to determine the effect of maternal vitamin A supplementation on breast milk retinol and of maternal and infant supplementation on infant vitamin A status. Mothers in the intervention group received 60 mg vitamin A (as retinol palmitate) at 18-42 d postpartum; their infants were given 7.5 mg three times, i.e., at 6, 10 and 14 wk of age with DPT and OPV immunizations. Mothers and infants in the comparison group received a placebo. Maternal supplementation resulted in higher breast milk retinol at 2 mo postpartum [difference in means 7.1, 95% confidence interval (CI), 3.4, 10.8 nmol/g fat] and lower proportion of mothers with breast milk retinol < or = 28 nmol/g fat (15.2 vs. 26.6%, 95% CI of difference -16.6, -4.1%). At 6 and 9 mo, maternal supplementation did not affect breast milk retinol or the proportion of mothers with low breast milk retinol. Vitamin A supplementation of the mothers and their infants reduced the proportion of infants with serum retinol < or = 0.7 micro mol/L (30.4 vs. 37%, 95% CI of difference -13.7, 0.6%) and that with low vitamin A stores as indicated by the modified relative dose response (MRDR) > 0.06 (44.2 vs. 52.9%, 95% CI of difference -16.6, -0.9%) at 6 mo. Supplementation had no effect at 9 mo. The beneficial effect of supplementation on breast milk retinol and infants' vitamin A status varied by site. It was greatest in India followed by Ghana and Peru. At the doses used, maternal supplementation improved breast milk retinol status at 2 mo (P < 0.001) and maternal and infant supplementation modestly increased (P = 0.03) infant vitamin A status at 6 mo of age. Additional strategies to improve vitamin A status of 6- to 9-mo-old infants must be considered.

Adult↗
PubMed1994

Use of milk progesterone and prostaglandin F2 alpha in a scheduled artificial insemination program.

We tested the efficacy of monitoring progesterone in dairy cows using a commercially available milk progesterone test as a determinant for administration of PGF2 alpha to induce estrus in cows before first AI. Holstein cows milked twice daily were assigned randomly for AI at their first estrus after d 42 postpartum (control) or to receive PGF2 alpha after a milk progesterone test. Milk progesterone was assessed in samples from the Monday morning milking in both groups of cows, but only those in the treatment received PGF2 alpha when milk progesterone tested high. Blood was collected before injection of PGF2 alpha on Monday afternoon to verify retrospectively the accuracy of the milk progesterone test. Agreement of serum concentrations of progesterone was 87% for high milk progesterone tests and 63% for low tests. Use of milk progesterone plus PGF2 alpha reduced days to first AI, calving intervals, rate of reproductive culling, and cost per pregnancy and increased the proportion of cows inseminated within 21 d of the beginning of breeding. As a management tool in an AI program, PGF2 alpha use is warranted and cost effective. However, the milk progesterone test is not justifiable unless the cost is significantly lower than the cost of a weekly injection of PGF2 alpha.

Animals↗
PubMed2002

Benefits of infant massage for mothers with postnatal depression.

Infant massage by the mother has been popular in many cultures, especially India, and is growing in popularity in the West. Mothers with postnatal depression often have problems interacting with their infants. A small controlled study has shown that attending a massage class can help such mothers relate better to their babies. The mechanisms by which this is achieved are not clear but may include learning to understand their babies' cues and the release of oxytocin.

Curriculum↗
PubMed2004

Improved thymic function in exclusively breastfed infants is associated with higher interleukin 7 concentrations in their mothers' breast milk.

BACKGROUND: In rural Gambians, the season of birth strongly predicts adult mortality. Those born during the harvest season have longer life spans than do those born during the hungry season, and the deaths associated with infectious diseases suggest permanent early-life influences on immunity. Thymic measurements showed significantly smaller thymuses in infants born during the hungry season than in those born during the harvest season. The differences were greatest at 8 wk of age, a time when all infants were exclusively breastfed, which suggests the involvement of breast milk factors. OBJECTIVE: This study tested whether thymic size differences reflect thymic output and ascertained whether thymic output is associated with breast milk interleukin 7 (IL-7) concentrations. DESIGN: We studied thymic size and output in a prospective cohort of 138 Gambian infants born in either the hungry or the harvest season by measuring signal-joint T cell receptor-rearrangement excision circles (sjTRECs) at birth and at 8 wk of age. IL-7 concentrations in breast milk were measured by using an enzyme-linked immunosorbent assay. RESULTS: By age 8 wk, those born in the hungry season had significantly lower sjTREC counts than did those born in the harvest season (0.97 and 2.12 sjTRECs/100 T cells, respectively; P = 0.006). At 1 wk postpartum, the breast milk of mothers of infants born in the hungry season had significantly lower IL-7 than did that of mothers of infants born in the harvest season (79 and 100 pg/mL, respectively; P = 0.02). The findings were similar at 8 wk postpartum. CONCLUSION: These data show a plausible pathway linking external seasonal insults to mothers with thymic development in their infants, which suggests possible implications for long-term programming of immunity.

Breast Feeding↗
PubMedDate not supplied

Black non-Hispanic mothers' perceptions about the promotion of infant-feeding methods by nurses and physicians.

OBJECTIVE: To describe reports of low-income Black non-Hispanic women about the promotion of infant-feeding methods by nurses and physicians. DESIGN: Ethnographic research conducted over 18 months with interviewing and participant observation of informants. SETTING: The study took place in a Special Supplemental Nutrition Program for Women, Infants, and Children clinic and neighborhood in the New York metropolitan area. PARTICIPANTS: 130 Black non-Hispanic mothers enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children were general informants. From this group, 11 primiparous key informants were selected for close follow-up during pregnancy and the 1st postpartum year. MAIN OUTCOME MEASURES: Audiotaped interviews and field notes were analyzed for mothers' descriptions of infant-feeding education and support from nurses and physicians. FINDINGS: The informants reported limited breastfeeding education and support during pregnancy, childbirth stay in neonatal intensive care unit, postpartum, and recovery in the community. They also expressed trust/distrust concerns and varying degrees of anxiety about the ways they were treated by nurses and physicians. CONCLUSIONS: To decrease disparities in breastfeeding, this research suggests that health care professionals should focus their efforts on the development of trusting relationships and continuity of care along with clear, consistent breastfeeding education and support.

Adult↗