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Concept: Trimester

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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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Some studies suggest that prenatal infection increases risk of autism spectrum disorders (ASDs). This study was undertaken in a prospective cohort in Norway to examine whether we could find evidence to support an association of the prenatal occurrence of fever, a common manifestation of infection, with ASD risk. Prospective questionnaires provided maternal exposure data; case status was established from clinical assessments and registry linkages. In a large, prospectively ascertained cohort of pregnant mothers and their offspring, we examined infants born ⩾32 weeks for associations between fever exposure in each trimester and ASD risk using logistic regression. Maternal exposure to second-trimester fever was associated with increased ASD risk, adjusting for presence of fever in other trimesters and confounders (adjusted odds ratio (aOR), 1.40; 95% confidence interval, 1.09-1.79), with a similar, but nonsignificant, point estimate in the first trimester. Risk increased markedly with exposure to three or more fever episodes after 12 weeks' gestation (aOR, 3.12; 1.28-7.63). ASD risk appears to increase with maternal fever, particularly in the second trimester. Risk magnified dose dependently with exposure to multiple fevers after 12 weeks' gestation. Our findings support a role for gestational maternal infection and innate immune responses to infection in the pathogenesis of at least some cases of ASD.Molecular Psychiatry advance online publication, 13 June 2017; doi:10.1038/mp.2017.119.

Concepts: Immune system, Pregnancy, Infant, Embryo, Innate immune system, Autism, Fever, Trimester

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Pregnant women experience numerous physical alterations during pregnancy which may place them at an increased risk of falls. The purpose of this study was to examine ground reaction forces (GRFs) during staircase locomotion in pregnant and non-pregnant women. METHODS: Data were collected on 29 pregnant women in their second and third trimesters, and on 40 control women. Subjects walked at their freely chosen speeds during stair ascent and descent. A force plate imbedded in the second stair, but structurally independent of the staircase, was used to collect GRF data (1080Hz). A marker placed on the L3/L4 spinal segment was used to determine ascent and descent velocity from a motion-capture system. In the statistical analyses, trimester (control, second trimester, third trimester) and subject were the independent variables. Stance time and ascent/descent velocity were analyzed with an ANOVA. Mediolateral excursion of the COP during the step was analyzed with an ANCOVA. The GRFs were categorized into anterioposterior, mediolateral, and vertical forces. A two factor MANCOVA (subject, trimester) was performed on each GRF category. Mass and velocity served as covariates in each analysis (a=0.05). RESULTS: The mediolateral excursion of the COP during ascent was greater in the third trimester (p=0.04). The anterioposterior braking impulse was greater in both ascent (p=0.01) and descent (p=0.01) during pregnancy. The vertical GRF loading rate during descent was greater in pregnant women than in controls (p=0.04). CONCLUSION: These alterations are likely related to increased instability during stairway walking and could contribute to increased fall risk during pregnancy.

Concepts: Pregnancy, Childbirth, Force, Walking, Reaction, Ground reaction force, Trimester, Stairway

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OBJECTIVE: To describe the prevalence of iron depletion (ID), iron-deficiency anaemia (IDA) and risk of haemoconcentration during pregnancy and at delivery and to assess the influence of initial Fe stores and Fe supplementation on that prevalence. DESIGN: Longitudinal study. SETTING: Hospital Universitari Sant Joan de Reus (Catalonia, Spain). SUBJECTS: Two hundred and eighty-five pregnant women. Serum ferritin and Hb were measured in the first, second and third trimesters and at delivery. Women were classified according to initial Fe stores as ID or no ID (serum ferritin ≥12 μg/l) and according to Fe supplement use as supplemented or non-supplemented. RESULTS: Initial ID was 16·2 %. At delivery, 45·7 % had ID, 13·5 % IDA and 13·3 % had risk of haemoconcentration. Initial ID and non-supplemented groups had significantly higher prevalences of ID and IDA and lower risk of haemoconcentration at delivery than the other groups. In the multiple logistic models, no initial ID and Fe supplementation exerted a protective effect against ID at delivery (adjusted OR = 0·28; 95 % CI 0·13, 0·58 and adjusted OR = 0·39; 95 % CI 0·22, 0·69, respectively). Moderate Fe supplementation did not seem to clearly prevent IDA (adjusted OR = 0·91; 95 % CI 0·42, 1·96) or to enhance the haemoconcentration (adjusted OR = 1·42; 95 % CI 0·58, 3·50). CONCLUSIONS: The prevalence of ID and IDA was high in late pregnancy in healthy pregnant women, particularly in those with initial ID and/or those not taking supplements. Starting pregnancy with no ID and/or taking moderate Fe supplementation decreased the likelihood of ID at delivery. The risk of haemoconcentration was high at delivery, but did not seem to be promoted by Fe supplementation. Further research is necessary to determine the most appropriate nutritional advice for pregnant women.

Concepts: Pregnancy, Childbirth, Iron, Folic acid, Iron deficiency anemia, Human iron metabolism, Iron supplements, Trimester

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Postpartum depression affects a huge number of women and has detrimental consequences. Knowing the factors associated with postpartum depression during pregnancy can help its prevention. Although there is evidence surrounding behavioral or psychological predictors of postpartum depression, there is a lack of evidence of biological forecasters. The aim of this study was to analyze the sociodemographic, obstetric, and psychological variables along with hair cortisol levels during the first, second, and third trimesters of pregnancy that could predict postpartum depression symptoms. A sample of 44 pregnant women was assessed during 3 trimesters of pregnancy and the postpartum period using psychological questionnaires and hair cortisol levels. Participants were divided into 2 groups: a group with postpartum depression symptoms and a group with no postpartum depression symptoms. Results showed significant positive differences between groups in the first trimester regarding the Somatization subscale of the SCL-90-R (p < .05). In the second trimester, significant differences were found in the Somatization, Depression, Anxiety, and GSI subscales (p < .05). In the third trimester significant differences between both groups were found regarding pregnancy-specific stress. We found significant positive differences between groups regarding hair cortisol levels in the first and the third trimester. Hair cortisol levels could predict 21.7% of the variance of postpartum depression symptoms. In conclusion, our study provided evidence that psychopathological symptoms, pregnancy-specific stress, and hair cortisol levels can predict postpartum depression symptoms at different time-points during pregnancy. These findings can be applied in future studies and improve maternal care in clinical settings.

Concepts: Anxiety, Psychology, Pregnancy, Childbirth, Prediction, Obstetrics, Pregnancy test, Trimester

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Respiratory syncytial virus (RSV) causes significant morbidity and mortality in infants. We are developing an RSV fusion (F) protein nanoparticle vaccine for immunization of third trimester pregnant women to passively protect infants through transfer of RSV-specific maternal antibodies. The present trial was performed to assess the immunogenicity and safety of several formulations of RSV F vaccine in 1-dose or 2-dose schedules.

Concepts: Pregnancy, Childbirth, Infant, Fetus, Breastfeeding, Mother, Human respiratory syncytial virus, Trimester

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This study set out to compare the onset and duration of rocuronium-induced neuromuscular blockade in second trimester pregnant women and non-pregnant women receiving general anesthesia.

Concepts: Pregnancy, Childbirth, Trimester

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Pregnancy-related dreams are often found in pregnant women but also the number of negatively toned dreams seems to be increased in this challenging phase of a woman’s life.

Concepts: Pregnancy, Childbirth, Woman, Trimester

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While much has been written about postpartum smoking relapse prevention, few have examined changes in smoking behavior from pregnancy (3(rd) trimester) through 9 months postpartum among pregnant smokers, particularly for the large number of women who decrease tobacco consumption during pregnancy but do not quit altogether.

Concepts: Pregnancy, Childbirth, Tobacco, Nicotine, Number names, Trimester, Tobacco products