Early parenting – portraits from the lives of first-time parents

Objective: The study aimed to explore the experiences of first-time Maltese parents between pregnancy and the first six months in the postnatal period. Background: Parents’ interaction with their children appears to have an important and lasting effect on children’s cognitive and behavioural development. While both women and men anticipate equal involvement in child care, it is generally the woman who assumes primary responsibility when the new baby arrives. Methods: The qualitative paradigm was used to conduct the study by means of a semi-structured interview schedule. Data was collected at 28 weeks gestation, at 6 weeks postnatally and at 6 months postnatally. Twenty-six first-time parents (13 couples) participated in the study and were recruited by purposive sampling. Gender theory was used as the theoretical framework to guide this study. Interpretative phenomenological analysis was used during the analysing phase. Results: Two main super-ordinate themes were revealed from this study: ‘Pregnancy as a time of preparation’ and ‘The postnatal period as a time of critical change in the lifeworld of the couple’. Conclusion: Findings showed that competent and timely support by trained professionals could equip future couples for the art of parenting and could help parents to resolve challenges before they escalate into problems. This study encourages cross-cultural research on this topic so as to shed light on differences and similarities of contemporary early parenting challenges and outcomes.     

Examination of the association between male gender and preterm delivery

Objective

To examine possible reasons why a male fetus constitutes a risk factor for preterm delivery.

Study design

Retrospective study of deliveries from hospital database in a UK teaching hospital. The population comprised all deliveries >23 weeks over an 11-year period, excluding multiples, terminations and pregnancies with major abnormalities including indeterminate gender. Obstetric variables and outcomes were initially compared in male and female babies for preterm births in different gestation bands, extreme (<28 weeks), severe (29–32 weeks) and moderate (33–36 weeks). For each, the odds ratios with 95% confidence intervals for preterm delivery were calculated. Then, using binary logistic regression with adjusted odds ratios with 95% confidence intervals, putative causal pathways that might explain the male excess were tested.

Results

75,725 deliveries occurred, of which 4003 (5.3%) were preterm. Males delivered preterm more frequently (OR 1.13, 95% CI 1.06–1.20). This was due to spontaneous (OR 1.30, 95% CI 1.19–1.42) but not iatrogenic (OR 0.96, 95% CI 0.87–1.05) preterm birth. There was an increased risk of pre eclampsia among preterm females. Although males were larger, and male pregnancies were more frequently nulliparous and affected by some other obstetric complications (abruption, urinary tract infection), these did not account for their increased risk. Any effect of growth restriction could not be properly determined.

Conclusions

Being male carries an increased risk of spontaneous but not iatrogenic preterm birth. The reasons behind this remain obscure.     

Some considerations on sexuality and gender in the context of AIDS

Gender has become a major conceptual tool for understanding the evolving HIV pandemic globally. As such, it has provided a powerful way to see the structure of relations between men and women as central to various epidemics, and added weight to our understanding of HIV infection as not simply an individual experience of disease. Yet, as a concept, gender has its blind spots. This paper argues that there are four issues central to our understanding of how the HIV pandemic moves and develops that are not necessarily best understood through an analysis that uses gender alone, namely: women's vulnerability, men's culpability, young people's sexual interests and marginalized sexual cultures. The paper proposes using sexuality as a framework for analysing these issues and seeks to utilise developments in critical sexuality research to add to gender as a way to increase the capacity to respond to the HIV/AIDS crisis.     

Gender bias in the disposition of frozen embryos

Objective: To examine the gender differences found among couples when choosing the disposition of their frozen embryos.

Design: Retrospective chart review.

Setting: University affiliated in vitro fertilization (IVF) center.

Patients: Couples undergoing their first cycle of assisted reproductive technology (ART).

Intervention(s): None.

Main Outcome Measure(s): Choice of disposition of gametes and embryos.

Result(s): Gender bias is found when couples choose the dispositon of their frozen embryos, but not when they choose the disposition of their gametes.

Conclusion(s): Gender bias was found in couples who made decisions regarding the disposition of their frozen embryos.     

Pregnancy and body image in Poland: Gender roles and self-esteem during the third trimester

Objectives: The study has two main objectives: (1) assessment of the perception of body image among a sample of women in their third trimester of pregnancy; and (2) examination of the relationship between body image, gender role orientation, gender role stress and self-esteem. Background: Body image has received much attention in the psychological literature, but little work has been conducted with pregnant women or outside of the United States. Research suggests that women experience both anxieties and positive emotions about their body image during pregnancy, which might be associated with their personal characteristics. Methods: 100 pregnant women were approached in seven different ‘Schools of Birth’ in Poland. Participants completed questionnaires assessing body image, feminine gender role stress, psychological masculinity–femininity and self-esteem during their third trimester of pregnancy. Results: Pregnant Polish women generally have a positive body image, which is positively associated with self-esteem. Feminine gender role stress was related to a negative body image, masculinity and androgyny positively correlated with body image. Structural equation modelling suggests that body image is a mediator between gender factors and self-esteem. Conclusion: Our findings underline the multidimensional nature of the body image and the importance of mediating factors in predicting the psychological outcomes of pregnancy.     

Midwifery Care for Transfeminine Individuals

This article focuses on the provision of gender‐affirming care and preventive care for transfeminine individuals—those assigned male at birth who identify as female or on the feminine spectrum. To meet the learning needs of health care providers less familiar with gender‐affirming care, this article begins with an overview of gender identity concepts. Initiation and management of feminizing gender‐affirming hormone therapy is then covered in detail, including common gender‐affirming medications and their adverse effects, diagnostic criteria, psychosocial evaluation, initial physical examination and laboratory work, and recommendations for follow‐up visits and laboratory monitoring. Lastly, the article briefly reviews health care of transfeminine individuals before and after surgical gender‐affirming interventions and details best practices for transfeminine preventive care.     

Male gender significantly increases risk of oxidative stress related congenital anomalies in the non-diabetic population

Objective.?Oxidative stress (OS) is an important mechanism of teratogenesis. Recent work suggests increased OS in males. We evaluated whether male gender increased the risk of cyanotic congenital heart defects (CCHD) whose development is linked to OS and other common congenital anomalies (CA) in non-diabetic pregnancies.

Methods.?CDC-National Center for Health Statistics data for 19 states in 2006 were reviewed. CCHD, anencephaly, spina bifida, congenial diaphragmatic hernia (CDH), omphalocele, gastroschisis, limb defects, cleft lip with or without cleft palate (CL/P) and isolated cleft palate were evaluated. Adjusted odds ratio (OR) (95% CI) were calculated for CA in males with females as the reference group.

Results.?Of 1,194, 581, cases analyzed after exclusions, 3037 (0.25%) had major CA. Males had elevated adjusted OR (95% CI) for CCHD: 1.198 (1.027, 1.397), CDH: 1.487 (1.078, 2.051), and CL/P: 1.431 (1.24, 1.651). There was a significant interaction between cigarette use and (male) fetal gender and also with maternal age in the CL/P group.

Conclusions.?In non-diabetic pregnancies, male gender appears to be an independent risk factor for some types of CA believed to be associated with OS. Cigarette smoking, a well recognized source of OS only increased the risk of CL/P in males.     

Endorsement of abortion: the differential impact of social perspective on women and men

Objective: The purpose of this study is to explore whether women’s and men’s endorsement of abortion is differentially influenced by perspective-taking. Methods: An experimental design was employed in which 145 university students (104 women, 41 men) were randomly assigned to one of two conditions and asked to make judgements regarding the advisability of abortion across diverse situations. Participants in the self-referent condition (n = 82; 56 women, 26 men) were asked to render judgements in reference to themselves, while those in the other-referent condition (n = 63; 48 women, 15 men) were asked to make judgements in reference to a generic ‘other’. Results: A significant interaction emerged between Sex and Referent Group. Specifically, referent-group membership had no impact on men’s endorsement of abortion, but did have a significant impact on women’s ratings whereby women were more endorsing of abortion for others than for themselves. Subsequent item analyses revealed that this pattern was evident for 6 of the 14 items. Conclusions: Given societal expectations regarding women’s and men’s appropriate parental roles, it is reasonable to speculate that gender differences would exist in the value attached to the parental role, and subsequently, in the choice made when the opportunity to become a parent versus termination of a pregnancy presents itself. Counsellors can use this information to maximise the extent to which they facilitate autonomous decision-making.     

The impact of fetal gender and ethnicity on the risk of spontaneous preterm delivery in women with symptoms of preterm labor

Objective: The objective of this study is to evaluate the relation among fetal gender, ethnicity, and preterm labor (PTL) and preterm delivery (PTD).

Methods: A secondary analysis was performed of a prospective cohort study including women with symptoms of PTL between 24 and 34 weeks. The proportion of women carrying a male or female fetus at the onset of PTL was calculated. Gestational age at delivery and risk of PTD of both fetal genders was compared and interaction of fetal gender and maternal ethnicity on the risk of PTD was evaluated.

Results: Of the 594 included women, 327 (55%) carried a male fetus. Median gestational age at delivery in women pregnant with a male fetus was 37 5/7 (IQR 34 4/7–39 1/7) weeks compared with 38 1/7 (IQR 36 0/7–39 5/7) weeks in women pregnant with a female fetus (p?=?0.032). The risk of PTD did not differ significantly. In Caucasians, we did find an increased risk of PTD before 37 weeks in women pregnant with a male fetus (OR 1.9 (95% CI 1.2–3.0)).

Conclusions: The majority of women with PTL are pregnant with a male fetus and these women deliver slightly earlier. Race seems to affect this disparity.     

Cassandra’s prophecy: medic or mother? Exploring the relevance of age-related fertility decline to women in medicine

This commentary presents a response to ‘Cassandra’s prophecy’ from the perspective of a final-year medical student, in an attempt to gauge the particular relevance of age-related fertility decline to female doctors. Women in the UK are increasingly trying to have children at an older age, with a resultant rise in the incidence of age-related fertility decline and obstetric problems. The literature suggests that the trend towards older motherhood is seen particularly among highly educated women, but that such women lack sufficient knowledge about how fertility and obstetric outcomes decline with age. Recent data indicate that female doctors have children significantly later than women in the general population, but are overall no more likely to remain childless. However, there is significant variation between different specialties; for instance, female surgeons have children significantly later and are more likely to be childless by age 35, as compared with both male surgeons and female doctors in other specialties. This commentary explores various explanations for and implications of these data, in the context of recent changes in NHS workforce gender demographics.     

Why sex matters: the biological mechanisms of cardiovascular disease

Cardiovascular disease (CVD) is the leading determinant of mortality and morbidity in women. However, a full understanding of the basic and clinical aspects of CVD in women is far from being accomplished. Sexual dimorphism in CVD has been reported both in humans and experimental animals. Menopause is a risk factor for CVD due to the reduction of endogenous estrogen, although the mechanisms underlying are poorly understood. Estrogens act through binding to vascular estrogen receptors and by non-genomic mechanisms. Advances in this field are essential to improve CVD diagnostic and clinical strategies in women, and to develop sex-specific prevention plans as much as female-oriented treatment algorithms. This paper reviews pathophysiology of CVD in women and its potential clinical implications. Particular emphasis is given to biochemical markers and to indicators of cardiovascular dysfunction and damage. Estimation of these parameters, central to cardiovascular pathophysiology, could represent a particularly relevant tool in female patients. More research is needed to identify women who will profit most of early intervention.     

Preserving the reproductive potential of transgender and intersex people

Background: The bodies of some transgender and intersex people have been mutilated and their minds subjected to immense distress. Their gender has often been determined by others. Loss of fertility used to be considered an inevitable consequence of treatment.

Objective: To review the issue of preserving the reproductive potential of transgender and intersex people.

Methods: A narrative review based on a wide-ranging search of the literature in multiple disciplines.

Results: Major technological advances have facilitated reproduction for transgender and intersex people in the last few years. A majority of trans-adults believe that fertility preservation should be offered to them. Deferment of surgery for intersex people is often best practice; gonadectomy in infancy closes off fertility options and determines a gender they may later regret.

Conclusions: Transgender and intersex people should be able to consent to or decline treatment, especially radical surgery, themselves. Preservation of reproductive potential and sexual function must be given a high priority. Treatment by multidisciplinary teams can provide a strong emphasis on mental health and well-being. Detailed information about options, an absence of any coercion and enough time are all needed in order to make complex, life-changing decisions.     

Early first-trimester crown-rump length measurements in male and female singleton fetuses in IVF pregnancies

Objectives: The generally higher birth-weight of male newborns compared to female newborns is attributed mainly to intrauterine exposure to testosterone. We aimed to determine if crown-rump length (CRL) differs between male and female fetuses early in the first trimester. Methods: A retrospective cohort study of 333 women with nondiabetic singleton IVF pregnancies attending a single university-affiliated tertiary medical center in 2000–2007 who underwent CRL measurement before 50 days of pregnancy (date of measurement minus oocyte retrieval date plus 14 days). Data on pregnancy outcome, including fetal sex, were collected by routine follow-up telephone interview and combined with the delivery data. Results: There were 169 female and 164 male fetuses according to the reported fetal sex at delivery. Most of the CRL measurements (68.7%) were performed at an actual gestational age of 43–45 days. On linear regression analysis, male fetal sex was a significant (p = 0.011) predictor of larger CRL: CRL (mm) = –23.851 + GA (days) × 0.621 + 0.334 × Sex (F = 1, M = 2), R² = 0.512, p <0.001. A general linear model, adjusted for gestational age (40–50 days), revealed that mean CRL was significantly higher in male than in female fetuses (4.58?±?0.09?mm, [95% CI: 4.3–4.7] vs 4.24?±?0.09?mm [4.0–4.4]; p < 0.001). Conclusions: Male fetuses are larger than female fetuses in the early first trimester. Given that gonadal differentiation has not yet occurred, still unidentified nonhormonal factors are apparently responsible for this difference.     

Influence of gravidity and foetal gender on the value of screening variables in the first trimester of pregnancy

Objectives

Combined screening for chromosome abnormalities in the first trimester of pregnancy is based on maternal age, nuchal translucency (NT) and biochemical markers (PAPP-A and free β-hCG). We sought to assess the value of the variables used in the combined screening strategy taking into account maternal gravidity and foetal gender.

Study design

Between July 1999 and December 2009, a total of 21,193 singleton pregnancies were screened for aneuploidy in the first trimester, in the Hospital Clínico San Carlos (Madrid, Spain). In the original database foetal gender data were available in 4370 euploid cases, and there were 2343 women with at least two consecutive pregnancies. We conducted a retrospective assessment of ultrasound and biochemical markers taking into account foetal gender and maternal gravidity, and evaluated the effect on the performance of screening, in terms of detection rates and false positive rates. Information on pregnancy outcome was obtained from the hospital's intranet medical records or by contacting the patient by telephone postpartum. Karyotype was ascertained by amniocentesis or chorionic villus sampling, and euploid status was assumed in newborns with normal phenotype. Student's t-tests (paired or unpaired as appropriate) were applied to the data, and the Bland–Altmann method was applied in evaluating individual differences in markers between successive gestations.

Results

PAPP-A decreased significantly between the first and the second pregnancy (p < 0.01). PAPP-A and free β-hCG values were significantly higher (p = 0.04 and p < 0.01 respectively) and NT was lower (p = 0.02) in pregnancies with a female foetus.

Conclusions

Correlations between the biochemical variables in relation to gravidity and foetal gender can introduce a bias in the calculated risk of chromosome abnormalities. Differences in NT measurements with respect to foetal gender do not seem to be of clinical importance. NT is independent of gravidity so routine use of NT compensates for the influence of these maternal–foetal variables on the values of biochemical parameters. Hence, the bias in overall combined screening is small.     

Obstetrician gender and the likelihood of performing a maternal request for a cesarean delivery

Objective

To examine the relationship between obstetrician gender and the likelihood of maternal request for cesarean section (CS) within different healthcare institutions (medical centers, regional hospitals, district hospitals, and obstetric and gynecology clinics).

Study design

Five years of population-based data from Taiwan covering 857,920 singleton deliveries without a clinical indication for a CS were subjected to a multiple logistic regression to examine the association between obstetrician gender and the likelihood of maternal request for a CS.

Results

After adjusting for physician and institutional characteristics, it was found that male obstetricians were more likely to perform a requested CS than female obstetricians in district hospitals (OR = 1.53) and clinics (OR = 2.26), while obstetrician gender had no discernible associations with the likelihood of a CS upon maternal request in medical centers and regional hospitals.

Conclusions

While obstetrician gender had the greatest association with delivery mode decisions in the lowest obstetric care units, those associations were diluted in higher-level healthcare institutions.