Hemodynamic and autonomic modifications during sleep stages in young hypotensive women

This study examined cardiovascular activity and autonomic involvement during sleep in essential hypotension. We compared young female hypotensives and normotensives using ambulatory blood pressure monitoring, impedance cardiography, and frequency-domain analysis of heart rate variability during a night of polysomnographic recording. Hypotensives, as compared to normotensives, exhibited lower blood pressure, reduced myocardial contractility and reduced sympathovagal balance across the whole night. Both groups exhibited a reduction in cardiovascular involvement from wake to sleep with similar cardiovascular activity during wake and REM. No group difference was observed in sleep architecture suggesting similar sleeping quality in hypotensives and normotensives. The lower blood pressure and reduced myocardial contractility associated with a lower sympathovagal balance in hypotensives, as compared to normotensives, suggest a night-time hypoactivation of the cardiovascular system supporting the hypothesis of impairment in autonomic control in essential hypotension.     

Hormones and cognitive functioning during late pregnancy and postpartum: a longitudinal study

This longitudinal study investigated the possible influence of estradiol (E?), progesterone (P), testosterone (T), cortisol (CORT), and prolactin (PRL) levels on cognitive functioning during late pregnancy and the early postpartum period. The performance of 55 pregnant women on a battery of neuropsychological tests, tested once during the third trimester of pregnancy and once during the early postpartum period, was compared with that of 21 nonpregnant controls matched for age and education. Women in the pregnancy group had significantly lower scores than the controls during both the pre- and postpartum visits on tasks of verbal recall and processing speed. CORT levels were significantly associated, in an inverted-U function, with verbal recall scores at both the pregnancy and at postpartum periods and with spatial abilities at postpartum only. During pregnancy, PRL levels were associated in both a linear and an inverted-U function with scores on tests of paragraph recall and in a linear function with scores on tests of executive function. At postpartum, E? and CORT were negatively associated in a linear fashion with attention scores. These findings provide new evidence that fluctuating hormone levels during late pregnancy and early postpartum may modulate selected cognitive abilities.     

Activity patterns and time allocation during pregnancy: a longitudinal study of British women

OBJECTIVE: Few studies provide data regarding the integrated everyday activities of Western pregnant women. The study aimed to quantify changes in the daily activity of women during pregnancy and to examine whether pregnancy has a differential impact on different activity domains. DESIGN: A prospective, longitudinal study of maternal time allocation and activity was carried out. METHODS: The time allocation patterns of 57 healthy nulliparous pregnant women were assessed at 16, 25, 34 and 38 weeks gestation by semi-structured interview. Mean total daily activity levels (DALs) were estimated according to the intensity and duration of each activity reported. Self-reported activity was sub-divided into occupational, recreational, domestic and nocturnal activity ratios. RESULTS: From 16 to 34 weeks gestation mean self-reported DAL declined significantly from 1.54 to 1.40 METS (Metabolic Equivalent TEE Score, where TEE is total energy expenditure) (p < 0.001). In the different activity domains, mean occupational activity ratio decreased (p < 0.002) whilst nocturnal activity ratio increased (p < 0.002) from 16 to 34 weeks. Mean recreational activity ratio decreased significantly between 25 and 38 weeks (p < 0.001) but no significant changes were observed in mean domestic activity ratio. CONCLUSIONS: Low-risk pregnancy has a differential impact on occupational, recreational and domestic domains. Economies in energy expenditure appear to be made in occupational and recreational activity while domestic activities are largely maintained during pregnancy. Changes in physical activity may be influenced more by the type of activity rather than the intensity of activity.     

Determinants of postpartum sleep duration and sleep efficiency in minority women

Study ObjectivesTo examine demographic, psychosocial, and behavioral determinants of postpartum sleep duration and sleep efficiency among a cohort of black and Latina women.MethodsData were from 148 women (67% black, 32% Latina) at 5 months postpartum, recruited from an academic medical center in Philadelphia. Relevant demographic, psychosocial and behavioral predictors were assessed via questionnaire. Nocturnal sleep was objectively measured for 1 week using wrist actigraphy. Sleep duration was examined as a continuous variable and in categories (<7 versus ≥7 h per night); sleep efficiency was examined as a continuous variable. Independent multiple linear regression models were built to evaluate significant determinants of sleep.ResultsAdjusted models revealed that breastfeeding, having a bedtime after midnight, and being employed were associated with shorter sleep duration (–25–33 min, all p < 0.05). Multiparity, being unmarried, being employed, breastfeeding, having a bedtime after midnight, bedsharing, and responding to infant awakenings by getting up immediately rather than waiting a few minutes to see if the infant fell back asleep, were all significant determinants of sleeping <7 h per night (OR varying: 2.29–4.59, all p < 0.05). Bedsharing was the only variable identified from the multiple regression model that associated with poorer sleep efficiency (–3.8%, p < 0.05).ConclusionsFindings may inform interventions for improving postpartum sleep in socioeconomically disadvantaged, racial/ethnic minority postpartum women.     

A longitudinal study of cognitive performance during pregnancy and new motherhood

Summary This longitudinal study examined the popular belief that cognitive performance is impaired during pregnancy. Both self-report and objective test data on cognitive performance were collected on six occasions from three groups of women at three monthly intervals. Ten women who initially planned a pregnancy, 18 women initially in the first trimester of pregnancy, and 24 non pregnant controls completed the study. At each data collection participants reported their perceptions of current everyday memory, sleep, health, exercise, depression, anxiety and stress levels, and undertook a set of cognitive tests examining vocabulary, reasoning, short term memory, working memory, and semantic memory. A personality test was taken once. The planning group showed a significant increase in reported forgetting during pregnancy, and significantly more variability in sleep patterns than the control group over the test period. However, there were no other differences between groups on self-report or objective test results at any time phase. The personality factor of conscientiousness and level of reported anxiety were significant predictors of reported absentmindedness and forgetting on errands. The reported increase in forgetting in some pregnant women is possibly related to a complex interaction of personality and particular life situations. However, the precise nature of any objective change in memory performance during pregnancy is not yet clear.     

EEG sleep in primary depression. A longitudinal placebo study.

Characteristic EEG sleep changes in depression are highlighted by a sleep continuity disturbance, delta sleep reduction, and a shortened REM latency. Since these findings have been derived primarily from only a few baseline recordings, questions regarding their persistence and/or variability have not been previously addressed. As part of an extensive set of investigations of EEG sleep in depression, we examined nightly the sleep of 12 hospitalized, non-delusional, primary depressives who were involved in a program of active psychosocial treatment intervention and received only placebo during a 5-week study period. EEG sleep findings revealed a relative lack of change across time, particularly in those parameters reported to be associated with a primary or 'biologic' depressive episode. While some degree of clinical improvement was noted, the group failed to achieve a state of remission or even partial remission as determined by the Hamilton Rating Scale. It appears that the major sleep alterations associated with such disorders persist for up to at least 5 weeks in the absence of pharmacologic or other somatic intervention.     

A longitudinal follow-up study of young children's sleep patterns using a developmental classification system

Sixty-eight families participated in a longitudinal study that included video observations of sleep during the 1st year of life and annual follow-up phone interviews until the children were 4 years of age. Results revealed that approximately 19% of children have a sleep problem at 2 years of age, defined either by research criteria or parental report, and that sleep problems diminished over time. Approximately 25% of children were reported to be cosleeping at each follow-up interview, but only a third of the parents reported this behavior to be problematic. A subgroup of infants (33%), who were considered stable, non-self-soothers in the 1st year, were more likely to have a sleep onset problem and be cosleeping at the 2-year follow-up assessment.     

Anti-thyroid peroxidase antibodies during pregnancy and postpartum. Relation to postpartum thyroiditis

The frequency of autoantibodies to thyroid microsomes (MAb), thyroid peroxidase (TPOAb) and thyroglobulin (TgAb) was studied in 736 women during and after pregnancy. The aim was to study the relationship between TPO Ab and post-partum thyroid disease, and to compare their behaviour with MAb. Seventy-five (10%) were either MAb or TgAB positive, of whom 36 were sampled serially at 18, 30 and 36 weeks of pregnancy and 1, 6 and 12 months post partum. Twenty of the antibody negative mothers were selected at random for controls. Twelve of the 36 antibody positive mothers developed post-partum thyroid dysfunction (group 1), 24 did not (group 2) compared with none of the 20 controls (group 3). Six months post partum, TPO Ab titres rose overall in both groups 1 and 2, but only in those with measurable TPO Ab during the first trimester. A TPO Ab was less frequently positive than MAb, but the difference was not statistically significant. TPO Ab are not superior to MAb for predicting post partum thyroid disease in pregnant women.     

Mannose-binding lectin levels during pregnancy: a longitudinal study

BACKGROUND: Pregnancy is associated with changes in the immune system. Although previous studies have focussed mainly on adaptive immunity, there are indications that components of innate immunity, such as mannose-binding lectin (MBL), are associated with pregnancy outcome. Although this would suggest that pregnancy also involves adaptations in innate immunity, there are few studies in this area. Therefore, we aimed to determine whether MBL concentrations and the following steps in complement pathway activation are influenced by pregnancy. METHODS: MBL and Ficolin-2 concentrations, MBL-MBL-associated serine protease (MASP) complex activity, MBL pathway activity and classical complement pathway activity were determined by enzyme-linked immunosorbent assay (ELISA) in sera from pregnant women (n=32) during each trimester and post-partum. MBL genotyping was performed by PCR. RESULTS: During pregnancy, MBL concentrations increased to 140% [interquartile range (IQR) 116-181%, P < 0.0001]. This increase was already present at 12 weeks of pregnancy and was most pronounced in the high-production AA-genotype. Directly Post-partum MBL concentrations dropped to 57% of baseline (IQR 44-66%, P < 0.0001). Variations in MBL levels were reflected by similar changes in the following steps of complement activation, r > 0.93 (P < 0.01). Ficolin-2 levels and classical complement pathway activity were not similarly influenced by pregnancy. CONCLUSIONS: Pregnancy and the post-partum period profoundly influence MBL serum concentration and MBL complement pathway activity.     

A longitudinal study of pregnancy outcome following idiopathic recurrent miscarriage.

Recurrent miscarriage is a difficult clinical problem occurring in approximately 1-2% of fertile women. Following investigation, most cases fail to reveal an identifiable cause and are therefore classified as idiopathic. The aim of this study was to identify important gestational milestones for pregnancy success prediction in women following idiopathic recurrent miscarriage. A total of 325 consecutive patients with idiopathic recurrent miscarriage was involved in a prospective longitudinal observational study. Patients were identified from a miscarriage database of 716 patients. Preconceptual presentation and investigation excluded patients from the study sample with known associations of recurrent pregnancy loss, such as antiphosholipid syndrome, oligomenorrhoea, mid-trimester loss and other rare causes, e.g. abnormal parental karyotype. Following early presentation in a subsequent pregnancy, all patients followed a standard clinic protocol including fetal viability ultrasonography on a fortnightly basis throughout the first trimester. Kaplan-Meier curves were constructed for pregnancy outcome. Out of 325 idiopathic cases, 70% (n = 226) conceived, with a 75% success rate. Of 55 miscarriages, longitudinal assessment showed that six losses occurred following detection of fetal cardiac activity (3%). Data from this large study group have enabled accurate prediction of future pregnancy success and have established important gestational milestones for women with idiopathic recurrent miscarriage.     

Humoral and cell-mediated immune responses to herpesvirus antigens during pregnancy—A longitudinal study

Humoral and cellular immune responses were studied during the second trimester, third trimester, and postpartum periods in 11 pregnant women and in nonpregnant control women. Complement fixing (CF) and indirect hemagglutinating antibody (IHA) titers for herpes simplex type 1 (HSV-1), herpes simplex type 2 (HSV-2), and cytomegalovirus (CMV) were determined. Cellular response was measured by [³H]thymidine uptake by stimulated lymphocytes. Phytohemagglutinin (PHA), HSV-1, HSV-2, and CMV antigens were used as stimulants. No differences in the mean titers of CF and IHA antibodies were found. The cellular response to PHA had a transient decrease (P<0.02) during the third trimester. The cellular response to CMV was significantly lower during the second and third trimesters. A diminished response to HSV-1 antigen was observed during the second and third trimesters; the cellular response to HSV-2, though reduced, was not significantly altered during pregnancy. These data indicate a suppression of cellular responses to various herpesviruses and PHA during pregnancy.     

Poor sleep quality increases symptoms of depression and anxiety in postpartum women

This study evaluated the relationship between sleep quality and symptoms of depression and anxiety in women studied in pregnancy and postpartum. Scores on standardized measures of sleep (PSQI) at 6 months postpartum, and symptoms of anxiety and depression (OASIS, the PHQ9, and EPDS) were assessed by structured interviews in 116 women in pregnancy and/or postpartum. Poor sleep quality was significantly associated with greater symptoms of depression and anxiety. Women who had significantly higher OASIS (anxiety) scores (β?=?.530, p?<?.001), PHQ9 (depression) scores (β?=?.496, p?<?.001), and EPDS (postpartum depression and anxiety) scores (β?=?.585, p?<?.001) also had elevated total PSQI scores after adjustment for covariates, including prenatal depression and anxiety scores. Though inferences about causality are not feasible, these results support emerging research showing sleep quality is a risk factor for negative maternal affect in the postpartum period. Assessment of maternal sleep hygiene is worth consideration as a component of identifying women at risk for postpartum depression and anxiety.     

Prevalence of suicidality during pregnancy and the postpartum

Summary This review examined the available prevalence estimates of suicidality (suicide deaths, attempts, and ideation including thoughts of self harm) in pregnancy and the postpartum. Studies that used defined community or clinic samples were identified through multiple electronic databases and contacts with primary authors. Definitions of and measurement of suicide deaths, intentional self-harming behavior, suicide attempts, and thoughts of death and self-harm were varied and are described with each study. While suicide deaths and attempts are lower during pregnancy and the postpartum than in the general population of women, when deaths do occur, suicides account for up to 20% of postpartum deaths. Self-harm ideation is more common than attempts or deaths, with thoughts of self-harm during pregnancy and the postpartum ranging from 5 to 14%. The risk for suicidality is significantly elevated among depressed women during the perinatal period, and suicide has been found to be the second or leading cause of death in this depressed population.     

Serum activin A and follistatin concentrations during human pregnancy: a cross-sectional and longitudinal study

Activin A, a dimer of the betaA-subunit of inhibin, has been shown to have multiple biological activities and sites of production. Follistatin is a high-affinity binding protein for activin, which neutralizes its activity. This study provides the first data, using a cross-sectional design, on the measurement of both these proteins in the maternal circulation of a large cohort of women (6-39 weeks of gestation, n = 2-20 women/time point) during normal pregnancies, and confirms that similar patterns are seen in nine women studied longitudinally during pregnancy. The concentrations of total activin A were measured using a specific two-site enzyme-linked immunosorbent assay (ELISA), and a new radioimmunoassay for measuring total follistatin in serum utilizing dissociating reagents to eliminate the interference of activin is described. At 38-39 weeks gestation, both activin A and follistatin concentrations rose to a peak (4.59 +/- 0.54 ng/ml and 72.7 +/- 3.31 ng/ml, respectively). The activin A and follistatin concentrations were highly correlated both in the cross-sectional study (P <0.0001) and in individual women in the longitudinal study (P <0.05-0.0001). Concentrations of follistatin showed a greater increase in the second trimester of pregnancy relative to activin A concentrations. The parallel increase in the secretion of these two proteins throughout pregnancy probably reflects feto-placental secretion.