Hypertensive Disorders in Pregnancy.

Only 50 years ago obstetric care providers and women had many concerns regarding whether exercise during pregnancy created a harmful competition for substrate resources between the fetus and the mother. Animal and human research in the past 50 years, which includes acute and chronic aerobic exercise during pregnancy, has a reassuring margin of safety throughout gestation in women. Maternal physiology adapts to pregnancy changes involving the cardiorespiratory and glucometabolic alterations. Due to these changes, pregnant women have slight differences in response to acute exercise sessions. Chronic exposure to aerobic exercise before and during pregnancy is associated with numerous maternal and neonatal adaptations which may have short- and long-term benefits to maternal and child health. On the basis of the consistent evidence of safety of exercise during pregnancy, multiple nations and health care organizations, including the American College of Obstetrics and Gynecology, recommend moderate exercise for 20 to 30 minutes most days of the week. Despite the 15 to 20 years since the first recommendations were made, only 10% to 15% of pregnant women meet this recommendation. It seems there may be 2 foci for failure to achieve these exercise recommendations: patient specific and culturally driven and/or obstetric provider not recommending regular exercise due to lack of knowledge or motivation. This article addresses the provider knowledge by a review of the normal (at rest) physiologic adaptation to pregnancy. Then, we provide a detailed description of the type and intensity of controlled experiments that document the safety of exercise during pregnancy. The short- and long-term benefits are reviewed, including the safety in moderate-risk women.

https://journals.sagepub.com/doi/pdf/10.1177/1179562X17693224

Adaptation of Maternal-Fetal Physiology to Exercise in Pregnancy: The Basis of Guidelines for Physical Activity in Pregnancy.

Birth asphyxia is a significant global health problem, responsible for ~1.2 million neonatal deaths each year worldwide. Those who survive often suffer from a range of health issues including brain damage - manifesting as cerebral palsy (CP) - respiratory insufficiency, cardiovascular collapse and renal dysfunction, to name a few. Although the majority of research is directed towards reducing the brain injury that results from intrapartum birth asphyxia, the multi-organ injury observed in surviving neonates are of equal importance. Despite the advent of hypothermia therapy for the treatment of hypoxic-ischemic encephalopathy (HIE), treatment options following asphyxia at birth remain limited, particularly in low-resource settings where the incidence of birth asphyxia is highest. Furthermore, although cooling of the neonate results in improved neurological outcomes for a small proportion of treated infants, it does not provide any benefit to the other organ systems affected by asphyxia at birth. The aim of this review is to summarise the current knowledge of the multi-organ effects of intrapartum asphyxia, with particular reference to the findings from our laboratory using the precocial spiny mouse to model birth asphyxia. Furthermore, we reviewed the current treatments available for neonates who have undergone intrapartum asphyxia, and highlight the emergence of maternal dietary creatine supplementation as a preventative therapy, which has been shown to provide multi-organ protection from birth asphyxia-induced injury in our preclinical studies. This cheap and effective nutritional supplement may be the key to reducing birth asphyxia-induced death and disability, particularly in low-resource settings where current treatments are unavailable.

/pdf/understanding-the-full-spectrum-of-organ-injury-following-4069cet2v7.pdf

Understanding the Full Spectrum of Organ Injury Following Intrapartum Asphyxia.

Infection with Parvovirus B19 (B19V), Cytomegalovirus (CMV) and Herpes Simplex Virus-1/2 (HSV-1/2) may cause fetal loses including spontaneous abortion, intrauterine fetal death and non-immune hydrops fetalis. Few comprehensive studies have investigated first-trimester spontaneous abortions caused by virus infections in Chongqing, China. Our study intends to investigate the infection of B19V, CMV and HSV-1/2 in first-trimester spontaneous abortions and the corresponding immune response. 100 abortion patients aged from 17 to 47 years were included in our study. The plasma samples (100) were analyzed qualitatively for specific IgG/IgM for B19V, CMV and HSV-1/2 (Virion\Serion, Germany) according to the manufacturer’s recommendations. B19V, CMV and HSV-1/2 DNA were quantification by Real-Time PCR. No specimens were positive for B19V, CMV, and HSV-1/2 DNA. By serology, 30.0%, 95.0%, 92.0% of patients were positive for B19V, CMV and HSV-1/2 IgG respectively, while 2% and 1% for B19V and HSV-1/2 IgM. The low rate of virus DNA and a high proportion of CMV and HSV-1/2 IgG for most major of abortion patients in this study suggest that B19V, CMV and HSV-1/2 may not be the common factor leading to the spontaneous abortion of early pregnancy.

/pdf/infection-status-of-human-parvovirus-b19-cytomegalovirus-and-f3mjlu0lmm.pdf

Infection status of human parvovirus B19, cytomegalovirus and herpes simplex Virus-1/2 in women with first-trimester spontaneous abortions in Chongqing, China

The goal of this review is to define gestational age categories and discuss the epidemiology, complications, strategies for prevention, and management of late preterm infants. Late preterm (i.e., 34 to 36 weeks of gestation) birth is prevalent (8.0% of all live births in the USA in 2013) and is associated with increased infant mortality and morbidity. Although most late preterm births are medically indicated, elective early delivery plays a role. Policies limiting elective births at gestations less than 39 weeks and guidance for timing of indicated late preterm birth have reduced late preterm births. Late preterm neonates frequently require neonatal intensive care and should be monitored throughout life for developmental, educational, psychosocial, and medical morbidities. Prevention of late preterm births is key to reduction in mortality and morbidity. Continued prevention efforts and implementation of best practices may decrease acute and long-term complications of late preterm birth.

Optimizing Care and Outcomes for Late Preterm Neonates

Creasy and Resnik's maternal-fetal medicine : , Creasy and Resnik's maternal-fetal medicine : , کتابخانه دیجیتالی دانشگاه علوم پزشکی و خدمات درمانی شهید بهشتی

Creasy and Resnik's maternal-fetal medicine :

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Creasy and Resnik's maternal-fetal medicine :