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Concept: Abortion

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The rapid spread of Zika virus in the Americas and current outbreak of microcephaly in Brazil has raised attention to the possible deleterious effects that the virus may have on fetuses.

Concepts: Fertility, Abortion, São Paulo, German language, Americas, Latin America, Hydrops fetalis, Rh disease

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BACKGROUND: Estimation of maternal mortality is difficult in developing countries without complete vital registration. The indirect sisterhood method represents an alternative in places where there is high fertility and mortality rates. The objective of the current study was to estimate maternal mortality indices using the sisterhood method in a rural district in southwest Ethiopia. METHOD: We interviewed 8,870 adults, 15–49 years age, in 15 randomly selected rural villages of Bonke in Gamo Gofa. By constructing a retrospective cohort of women of reproductive age, we obtained sister units of risk exposure to maternal mortality, and calculated the lifetime risk of maternal mortality. Based on the total fertility for the rural Ethiopian population, the maternal mortality ratio was approximated. RESULTS: We analyzed 8503 of 8870 (96%) respondents (5262 [62%] men and 3241 ([38%] women). The 8503 respondents reported 22,473 sisters (average = 2.6 sisters for each respondent) who survived to reproductive age. Of the 2552 (11.4%) sisters who had died, 32% (819/2552) occurred during pregnancy and childbirth. This provided a lifetime risk of 10.2% from pregnancy and childbirth with a corresponding maternal mortality ratio of 1667 (95% confidence interval, 1564–1769) per 100,000 live births. The time period for this estimate was in 1998. Separate analysis for male and female respondents provided similar estimates. CONCLUSION: The impoverished rural area of Gamo Gofa had very high maternal mortality in 1998. This highlights the need for strengthening emergency obstetric care for the Bonke population and similar rural populations in Ethiopia.

Concepts: Pregnancy, Childbirth, Death, Demography, Population, Obstetrics, Abortion, Stillbirth

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BACKGROUND: Malaysia has relatively liberal abortion laws in that they permit abortions for both physical and mental health cases. However, abortion remains a taboo subject. The stagnating contraceptive prevalence rate combined with the plunging fertility rate suggests that abortion might be occurring clandestinely. This qualitative study aimed to explore the experiences of women and their needs with regard to abortion. METHODS: Women from diverse backgrounds were purposively selected from an urban family planning clinic in Penang, Malaysia based on inclusion criteria of being aged 21 and above and having experienced an induced abortion. A semi-structured interview guide consisting of open ended questions eliciting women’s experiences and needs with regard to abortion were utilized to facilitate the interviews. Audio recordings were transcribed verbatim and analyzed thematically. RESULTS: Thirty-one women, with ages ranging from 21–43 years (mean 30.16 +/-6.41), who had induced surgical/medical abortions were recruited from an urban family planning clinic. Ten women reported only to have had one previous abortion while the remaining had multiple abortions ranging from 2–8 times. The findings revealed that although women had abortions, nevertheless they faced problems in seeking for abortion information and services. They also had fears about the consequences and side effects of abortion and wish to receive more information on abortion. Women with post-abortion feelings ranged from no feelings to not wanting to think about the abortion, relief, feeling of sadness and loss. Abortion decisions were primarily theirs but would seek partner/husband’s agreement. In terms of the women’s needs for abortion, or if they wished for more information on abortion, pre and post abortion counseling and post-abortion follow up. CONCLUSIONS: The existing abortion laws in Malaysia should enable the government to provide abortion services within the law. Unfortunately, the study findings show that this is generally not so, most probably due to social stigma. There is an urgent need for the government to review its responsibility in providing accessible abortion services within the scope of the law and to look into the regulatory requirements for such services in Malaysia. This study also highlighted the need for educational efforts to make women aware of their reproductive rights and also to increase their reproductive knowledge pertaining to abortion. Besides the government, public education on abortion may also be improved by efforts from abortion providers, advocacy groups and related NGOs.

Concepts: Pregnancy, Birth control, Family planning, Human rights, Fertility, Abortion, History of abortion, Paternal rights and abortion

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BACKGROUND: Postpartum depression is a serious problem for women and their offspring. Micronutrient supplements are recommended for pregnant women because of their documented protective effects for the offspring, but their potential beneficial effects on maternal mental health are unknown. This study investigated the association between prenatal micronutrient supplementation and the risk for symptoms of postpartum depression in a longitudinal pregnancy cohort from the Alberta Pregnancy Outcomes and Nutrition (APrON) study. METHODS: Participants came from a cohort of the first 600 APrON women. Supplemental nutrient intake and symptoms of depression (measured with the Edinburgh Postnatal Depression Scale (EPDS)) were collected at each trimester and 12 weeks postpartum. RESULTS: Of the 475 participants who completed the EPDS at least twice in pregnancy and at 12 weeks postpartum, 416 (88%) scored <10 and 59 (12%) scored >=10, where an EPDS >=10 is considered to be “at least probable minor depression”. Mean nutrient intakes from supplements were higher in women with lower EPDS scores, particularly selenium (p = 0.0015) and omega-3s (p = 0.01). Bivariate analyses showed that several demographic and social/lifestyle variables were associated with EPDS >=10: not having been born in Canada (p = 0.01), greater number of chronic conditions (p = 0.05), greater number of stressful life events during this pregnancy (p = 0.02), and lower prenatal and postnatal support (p = 0.0043 and p = 0.0001, respectively). Adjusting for covariates and nutrients known to be associated with postpartum depression, logistic regression showed that having a prenatal EPDS >= 10 increased the odds of postpartum depressive symptoms (second and third trimester OR = 3.29, 95% CI = 1.55 - 7.01, p = 0.004 and OR = 4.26, 95% CI = 2.05 - 8.85, p < 0.0001, respectively), while prenatal supplemental selenium (per 10 mg, OR = 0.76, 95% CI = 0.74 - 0.78, p = 0.0019) and postnatal social support (OR = 0.87, 95% CI = 0.78 - 0.97, p = 0.0015) were protective. CONCLUSIONS: Multiple factors, including supplementary selenium intake, are associated with the risk of postpartum depressive symptoms. Future research on dietary supplementation in pregnancy with special attention to selenium intake is warranted.

Concepts: Pregnancy, Childbirth, Uterus, Obstetrics, Abortion, Bipolar disorder, Postpartum depression, Trimester

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It is known that sperm samples from recurrent pregnancy loss (RPL) couples have an increase in their sperm DNA fragmentation (SDF), but no studies have been performed in order to identify differences between single stranded SDF (ssSDF) and double stranded SDF (dsSDF) in these patients. This could be relevant because the type of DNA damage could have different effects. Semen samples were classified attending their clinical status: 25 fertile donors and 20 RPL patients with at least two unexplained first trimester miscarriages. SDF was analysed using alkaline and neutral Comet assay, SCD test and pulsed-field gel electrophoresis (PFGE), and ROC analysis including data from 105 more infertile patients (n = 150) was performed to establish predictive threshold values. SDF for alkaline and neutral Comet, and the SCD test was analysed in these categories of individuals. Data revealed the presence of two subgroups within fertile donors. The values obtained were 21.10±9.13, 23.35±10.45 and 12.31±4.31, respectively, for fertile donors with low values for both ssSDF and dsSDF; 27.86±12.64, 80.69±12.67 and 12.43±5.22, for fertile donors with low ssSDF and high dsSDF; and 33.61±15.50, 84.64±11.28 and 19.28±6.05, for unexplained RPL patients, also showing a low ssSDF and high dsSDF profile. This latter profile was seen in 85% of unexplained RPL and 33% of fertile donors, suggesting that it may be associated to a male risk factor for undergoing RPL. ROC analysis regarding recurrent miscarriage set the cut-off value at 77.50% of dsDNA SDF. PFGE for low ssSDF and high dsSDF profile samples and positive controls treated with DNase, to induce dsDNA breaks, showed a more intense band of about 48 kb, which fits the toroid model of DNA compaction in sperm, pointing out that some nuclease activity may be affecting their sperm DNA in RPL patients. This work identifies a very specific SDF profile related to the paternal risk of having RPL.

Concepts: DNA, Gene, Pregnancy, Genetics, Fertility, Abortion, Miscarriage, Habitual abortion

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BACKGROUND: Noninvasive prenatal detection of common fetal aneuploidies with cell-free DNA from maternal plasma has been achieved with high-throughput next-generation sequencing platforms. Turnaround times for previously tested platforms are still unsatisfactory for clinical applications, however, because of the time spent on sequencing. The development of semiconductor sequencing technology has provided a way to shorten overall run times. We studied the feasibility of using semiconductor sequencing technology for the noninvasive detection of fetal aneuploidy.METHODS: Maternal plasma DNA from 13 pregnant women, corresponding to 4 euploid, 6 trisomy 21 (T21), 2 trisomy 18 (T18), and 1 trisomy 13 (T13) pregnancies, were sequenced on the Ion Torrent Personal Genome Machine sequencer platform with 318 chips. The data were analyzed with the T statistic method after correcting for GC bias, and the T value was calculated as an indicator of fetal aneuploidy.RESULTS: We obtained a mean of 3 524 401 high-quality reads per sample, with an efficiency rate of 77.9%. All of the T21, T13, and T18 fetuses could be clearly distinguished from euploid fetuses, and the time spent on library preparation and sequencing was 24 h.CONCLUSIONS: Semiconductor sequencing represents a suitable technology for the noninvasive prenatal detection of fetal aneuploidy. With this platform, sequencing times can be substantially reduced; however, a further larger-scale study is needed to determine the imprecision of noninvasive fetal aneuploidy detection with this system.

Concepts: Pregnancy, Infant, Embryo, Fetus, Uterus, Fertility, Abortion, Aneuploidy

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BACKGROUND: Significant racial disparities exist in the US unplanned pregnancy rate. We conducted a qualitative study using the theory of planned behavior as a framework to describe how low-income, African-American women approach family planning. STUDY DESIGN: Structured focus groups were held with adult, low-income, nonpregnant, African-American women in Connecticut. Data were collected using a standardized discussion guide, audio-taped and transcribed. Four independent researchers coded the transcripts using the constant comparative method. Codes were organized into overarching themes. RESULTS: Contraceptive knowledge was limited, with formal contraceptive education often occurring after sexual debut. Attitudes about contraception were overtly negative, with method effectiveness being judged by the presence of side effects. Family and friends strongly influence contraceptive decisions, while male partners are primarily seen as a barrier. Contraceptive pills are perceived as readily accessible, although compliance is considered a barrier. CONCLUSIONS: Contraception education should occur before sexual debut, should involve trusted family and community members and should positively frame issues in terms of achieving life goals.

Concepts: Scientific method, Pregnancy, Sexual intercourse, Family planning, Focus group, Combined oral contraceptive pill, Abortion, Qualitative research

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BACKGROUND: In the developing countries millions of women in the reproductive age who don’t use contraceptives prefer to postpone or limit their birth. This indicates their failure to take necessary decision to prevent and avoid unwanted pregnancy. METHODS: A community-based cross sectional household survey was conducted to investigate unmet need for family planning and associated factors and total demand for family planning in Kassala, Eastern Sudan between 1st May and 31st July 2012. RESULTS: A total of 812 married women were enrolled in this study. Their mean age and parity was 31.8 (7.3) and 3.4 (1.8) respectively. Ever use of contraception was 25.4% (206/812) and 26.2% (213/812) were currently using contraception. Unmet need for spacing was 15.1% while unmet need for limiting was 0.7%. The pregnant and amenorrheic women whose the pregnancy or birth was unwanted and mistimed were 105 (13%) and 130 (16%) respectively. Using Westoff model the total unmet need was estimated as 44.8%. The total demand for family planning was 71%.In logistic regression model, while age, age at marriage, parity, residence and experience of child death were not associated with total unmet need for family planning, women education < secondary level (OR=7.8; CI=5.6-10.9; P=0.00), husband education < secondary level (OR=1.9; CI=1.3-2.6, P = 0.00) and woman's occupation; housewife (OR=4.3; CI=2.5-7.2; P=0.00) were associated with the total unmet need. CONCLUSIONS: Unmet need for family planning in Eastern Sudan was significantly higher among women with less than secondary education. Also; it is influenced by couple's educational status and woman's occupation. The results of this study necessitate the need for the programme managers to take into account the concept of reproductive health education.

Concepts: Family, Pregnancy, Childbirth, Birth control, Marriage, Family planning, Abortion, Secondary education

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Sexual and reproductive health (SRH) is protected by the public authorities to ensure that people enjoy a free, satisfying, and safe sexual life. Despite the approval of the National Sexual and Reproductive Health Strategy in 2011, the progress achieved may be jeopardized by recent proposals for legislative changes affecting this area (abortion Law and 16/2012 Law) and by the impact of the current economic crisis. This article aims to describe the current situation of sexual and reproductive health in the Spanish population and to identify the potential impact of the economic crisis. To this end, we used the following information sources: the National Sexual Health Survey, the DAPHNE surveys, births and fetal deaths statistics from the Spanish National Institute of Statistics, the Registry of Voluntary Pregnancy Interruptions, reports from the National Epidemiology Center, and the National AIDS Registry. Sexual health and the availability of information are rated as good by the Spanish population. Among young people, schools and health services have become less important as information sources and the internet has become more important. Since the beginning of the crisis, contraceptive use and fertility have declined and maternity has been delayed. The economic crisis seems to have affected some indicators of sexual and reproductive health. However, the potential effects on other indicators should continue to be monitored because insufficient time may have passed for accurate determination of the full effect of the crisis.

Concepts: Pregnancy, Family planning, Health, Demography, Effect, Affect, Abortion, Sex education