The effects of female age on fecundity and pregnancy outcome

In industrialized countries worldwide, women are delaying childbearing for a variety of reasons, including pursuit of career, greater financial independence, improved and more accessible contraception and longer life expectancy. In terms of fertility and maternity, those aged ≥ 35 years are considered to be of advanced maternal age and there are usually marked reductions in both the fecundity rate for spontaneous conceptions and the success rates with assisted conception. These decreases are thought to be due mainly to oocyte ageing, and the established success of oocyte donation from younger individuals to older recipients supports this contention. For those who achieve a pregnancy at an advanced maternal age there is a greater likelihood of aneuploidy (assuming conception with the woman's own oocytes), hypertensive and other medical disorders, birth by Caesarean section and maternal mortality. However, most of the complications associated with advanced maternal age are caused by age-related confounding variables, and older premenopausal women in good health should not require special attention. The data on perinatal mortality rates are encouraging and in the absence of congenital abnormalities perinatal mortality is probably not much increased, if at all, in older mothers. Pregnancy is now possible for postmenopausal women with the application of oocyte donation, but these individuals have a significantly higher likelihood of cardiovascular ageing and should be considered at increased risk of vascular complications during pregnancy.     

The effects of female age on fecundity and pregnancy outcome

In industrialized countries worldwide, women are delaying childbearing for a variety of reasons, including pursuit of career, greater financial independence, improved and more accessible contraception and longer life expectancy. In terms of fertility and maternity, those aged > or = 35 years are considered to be of advanced maternal age and there are usually marked reductions in both the fecundity rate for spontaneous conceptions and the success rates with assisted conception. These decreases are thought to be due mainly to oocyte ageing, and the established success of oocyte donation from younger individuals to older recipients supports this contention. For those who achieve a pregnancy at an advanced maternal age there is a greater likelihood of aneuploidy (assuming conception with the woman's own oocytes), hypertensive and other medical disorders, birth by Caesarean section and maternal mortality. However, most of the complications associated with advanced maternal age are caused by age-related confounding variables, and older premenopausal women in good health should not require special attention. The data on perinatal mortality rates are encouraging and in the absence of congenital abnormalities perinatal mortality is probably not much increased, if at all, in older mothers. Pregnancy is now possible for postmenopausal women with the application of oocyte donation, but these individuals have a significantly higher likelihood of cardiovascular ageing and should be considered at increased risk of vascular complications during pregnancy.     

Extrauterine pregnancy. Critical review of the clinical diagnosis and early echography

A case of extrauterine pregnancy is reported. After a short review of the literature on the subject, personal experience of early diagnosis is reported and importance is attributed in IUD carriers to menstrual dysrhythmia and pelvic pain. For correct early diagnosis, such symptomatology must be integrated with laboratory tests and pelvic echography.     

Diet in pregnancy and the offspring's blood pressure 40 years later

Objective To determine how diet of the mother in pregnancy influences the blood pressure of the offspring in adult life.
Design A follow up study of men and women born during 1948–1954 whose mothers had taken part in a survey of diet in late pregnancy.
Setting Aberdeen, Scotland.
Population Two hundred and fifty-three men and women born in Aberdeen Maternity Hospital.
Main outcome measure Systolic and diastolic blood pressure.
Results The relations between the diet of mothers and their offsprings' blood pressure were complex. When the mothers' intake of animal protein was less than 50 g daily, a higher carbohydrate intake was associated with a higher blood pressure in the offspring (a 100 g increase in carbohydrate being associated with a 3 mmHg increase in systolic pressure (   P = 0.02  )). At daily animal protein intakes above 50 g, lower Carbohydrate intake was associated with higher blood pressure (a 100 g decrease in carbohydrate being associated with an 11 mmHg rise in systolic blood pressure (   P = 0.004  )). These increases in blood pressure were associated with decreased placental size.
Conclusion Mothers' intakes of animal protein and carbohydrate in late pregnancy may influence their offsprings' adult blood pressure. This may be mediated through effects on placental growth.     

Excess pregnancy weight gain and long-term obesity: one decade later

OBJECTIVE: To estimate the impact of excess pregnancy weight gain and failure to lose weight by 6 months postpartum on excess weight 8-10 years later. METHODS: Seven hundred ninety-five women were observed through pregnancy and 6 months postpartum to examine factors that affect weight loss. Weight was recorded 10 years later through a medical record review to examine the impact of retained weight on long-term obesity. Overall weight change at last follow-up and body mass index (BMI) were examined by pregnancy weight gain appropriateness according to the Institute of Medicine guidelines for weight gain during pregnancy. RESULTS: Of the original cohort, 540 women had a documented weight beyond 5 years (mean = 8.5 years). The average weight gain from prepregnancy to follow-up was 6.3 kg. There was no difference in weight gain by prepregnancy BMI. Women who gained less than the recommended amount during their pregnancy were 4.1 kg heavier at follow-up, those gaining the recommended amount were 6.5 kg heavier, and those gaining more than recommended were 8.4 kg heavier (P =.01). Women who lost all pregnancy weight by 6 months postpartum were 2.4 kg heavier at follow-up than women with retained weight, who weighed 8.3 kg more at follow-up (P =.01). Women who breast-fed and women who participated in aerobic exercise also had significantly lower weight gains. CONCLUSION: Excess weight gain and failure to lose weight after pregnancy are important and identifiable predictors of long-term obesity. Breast-feeding and exercise may be beneficial to control long-term weight.     

Backache in pregnancy: an obstetric physiotherapist's assessment and treatment notes

Backache experienced by pregnant women is still regarded by some, public and professionals alike, as an almost inevitable consequence of their state — an inconvenience to be borne with fortitude. However, much may be done to alleviate these symptoms when they present.Careful, thorough assessment of the problem is of paramount importance. Advice, general and tailored to the specific situation is given and a physical treatment plan mutually agreed with the patient.If the condition is not assessed and the necessary physical treatment not given, the woman may complain of backache over many years with the resultant cost to the Health Service of repeated consultations.     

Early pregnancy maternal urinary metabolomic profile and later insulin resistance and fetal adiposity

Objective: Our objective was to determine if early pregnancy urinary metabolomic profiles could predict fetal adiposity and macrosomia.

Methods: This is a prospective study of 50 healthy women in their second pregnancy. Fasting urine samples taken during early pregnancy were analyzed using NMR spectroscopy. Maternal glucose and insulin were measured in early pregnancy and at 28 weeks and the HOMA index for insulin resistance calculated. At 34 weeks ultrasound assessed fetal anthropometry including fetal anterior abdominal wall width (AAW). At delivery birth weight was recorded. Probabilistic principal component with covariates analysis (PPCCA), a novel extension of principal component analysis, which facilitates joint modeling of metabolomic data and additional covariate information, was employed to analyze the data.

Results: This analysis revealed that maternal HOMA and AAW significantly covaried with the ¹H NMR derived metabolomic profile of the urine. As such, in this cohort of healthy, non-diabetic women, early pregnancy urinary metabolomic profile differed significantly according to both maternal insulin resistance and fetal fat deposition in utero.

Conclusion: These findings hold potential for early pregnancy identification of those at risk of fetal macrosomia.