Predictors of maternal-origin microchimerism in young women in the Philippines.

OBJECTIVES: Microchimerism is the presence of a small quantity of cells or DNA from a genetically distinct individual. This phenomenon occurs with bidirectional maternal-fetal exchange during pregnancy. Microchimerism can persist for decades after delivery and have long-term health implications. However, little is known about why microchimerism is detectable at varying levels in different individuals. We examine the variability and the following potential determinants of maternal-origin microchimerism (MMc) in young women in the Philippines: gestational duration (in utero exposure to MMc), history of being breastfed (postpartum exposure to MMc), maternal telomere length (maternal cells' ability to replicate and persist), and participant's pregnancies in young adulthood (effect of adding fetal-origin microchimerism to preexisting MMc). MATERIALS AND METHODS: Data are from the Cebu Longitudinal Health and Nutrition Survey, a population-based study of infant feeding practices and long-term health outcomes. We quantified MMc using quantitative PCR (qPCR) in 89 female participants, ages 20-22, and analyzed these data using negative binomial regression. RESULTS: In a multivariate model including all predictors, being breastfed substantially predicted decreased MMc (detection rate ratio = 0.15, p = 0.007), and there was a trend of decreasing MMc in participants who had experienced more pregnancies (detection rate ratio = 0.55, p = 0.057). DISCUSSION: These results might be explained by breastfeeding having lasting impact on immune regulatory networks, thus reducing MMc persistence. MMc may also decrease in response to the introduction of fetal-origin microchimerism with pregnancies experienced in adulthood.

Global population variation in placental size and structure: Evidence from Cebu, Philippines.

INTRODUCTION: Placental morphology influences the intrauterine environment and fetal growth, which help set life-course health trajectories across generations. Little is known about placental characteristics in populations with chronic nutritional insufficiency where birth weights tend to be lower, and how these relationships between birth and placental weights vary across populations. METHODS: We collected weights and stereologically-determined villous mass and surface area of 21 placentas from offspring of women enrolled in a birth cohort study in metropolitan Cebu, Philippines, a low-income population. We identified 15 samples from other global populations ranging from low to high income that had similar data to ours to assess patterns of variation between birth and placental weights and microscopic characteristics. We ranked the population samples in order for each characteristic. RESULTS: Mean birth weight in Cebu was 3162 ±â€¯80 g (ranked 9/16) and placental weight was 454 ±â€¯32 g (ranked 12/16). Birth:placental weight ratio was 7.0 (ranked 3/16). Average villous surface area for Cebu placentas was 6.5 m2 (ranked 9/12); Birth weight:villous surface area was 0.048 g/m2 (ranked 4/12). DISCUSSION: Placentas from Cebu produced heavier neonates per units of placental weight and villous surface area than most other populations, despite lower villous surface areas and less complex surface-to-volume topography. This range of placental efficiency spurs questions about the mechanisms by which placental morphology optimizes efficiency in different environmental contexts during gestation. Placental variation both within and across populations is likely due to many intersecting environmental, metabolic, and (epi)genetic factors that will require additional research to clarify.

Regulation of inflammation during gestation and birth outcomes: Inflammatory cytokine balance predicts birth weight and length.

OBJECTIVES: The maternal environment during gestation influences offspring health at birth and throughout the life course. Recent research has demonstrated that endogenous immune processes such as dysregulated inflammation adversely impact birth outcomes, increasing the risk for preterm birth and restricted fetal growth. Prior analyses examining this association suggest a relationship between maternal C-reactive protein (CRP), a summary measure of inflammation, and offspring anthropometric outcomes. This study investigates pro- and anti-inflammatory cytokines, and their ratio, to gain deeper insight into the regulation of inflammation during pregnancy. METHODS: IL6, IL10, TNFɑ, and CRP were quantified in dried blood spots collected in the early third trimester (mean = 29.9 weeks) of 407 pregnancies in Metropolitan Cebu, Philippines. Relationships between these immune markers and offspring anthropometrics (birth weight, length, head circumference, and sum of skinfold thicknesses) were evaluated using multivariate regression analyses. Ratios of pro- to anti-inflammatory cytokines were generated. RESULTS: Higher maternal IL6 relative to IL10 was associated with reduced offspring weight and length at birth. Individual cytokines did not predict birth outcomes. CONCLUSIONS: Consistent with the idea that the relative balance of cytokines with pro- and anti-inflammatory effects is a key regulator of inflammation in pregnancy, the IL6:IL10 ratio, but neither cytokine on its own, predicted offspring birth outcomes. Our findings suggest that prior reports of association between CRP and fetal growth may reflect, in part, the balance between pro- and anti-inflammatory cytokines, and that the gestational environment is significantly shaped by cytokine imbalance.

The role of men in induced abortion decision making in an urban area of the Philippines.

OBJECTIVE: To understand beliefs about unintended pregnancy and abortion, and perceptions about male roles related to pregnancy decision-making among men in the Philippines. METHODS: Qualitative data were collected during in-depth interviews and focus group discussions with men in an urban area of the Philippines between October 2007 and July 2008. Interview participants were purposively sampled from a local survey based on their having reported being "afraid or troubled" or "afraid and planned to terminate" in response to a recent pregnancy. Focus group participants were selected from the same communities. Data were analyzed using the constant comparative method. RESULTS: In-depth interview data from 15 men-each interviewed twice-and five focus group discussions were included. Male interview participants reported feeling morally responsible for the pregnancy and as wanting to avoid the "sin" of induced abortion; however, they were concerned about being able to support a family financially. Participants expressed resentment towards partners who attempted or completed an induced abortion without their knowledge. In such cases, men would disparage their partner and cease interacting with them to avoid the "sin" of induced abortion. CONCLUSION: Participants described negative feelings towards women seeking induced abortions, and their own desire to avoid associated "sin". This highlights the effects of unintended pregnancy and induced abortion on young Filipino men, including their own experience of abortion stigma.

Old ideals and new realities: the changing context of young people's partnerships in Cebu, Philippines.

The Philippines has experienced rapid sociodemographic changes in recent years, with implications for young people. This study combines quantitative and qualitative data from Metro Cebu to assess the timing and predictors of young people's partnerships, as well as the context in which these partnerships are occurring. The majority of young people (54%) had premarital sex, though this pattern varied by gender. Wealthier, urban young men, and women with less education and lower reported religiosity, were more likely to have premarital sex. Engagement in risk behaviours was predictive of premarital sex for both males and females. The qualitative data contextualise the circumstances under which young people engage in sex and form partnerships and illustrate how sociocultural norms contribute to gender differences in partnership patterns. Given the 'new' realities of young Filipinos' lives, targeted efforts to support the transition to adulthood are needed to avert potentially adverse life events.

Perceptions and practices of illegal abortion among urban young adults in the Philippines: a qualitative study.

This study draws on in-depth interviews and focus group discussions with young adults in a metropolitan area of the Philippines to examine perceptions and practices of illegal abortion. Study participants indicated that unintended pregnancies are common and may be resolved through eventual acceptance or through self-induced injury or ingestion of substances to terminate the pregnancy. Despite the illegality of abortion and the restricted status of misoprostol, substantial knowledge and use of the drug exists. Discussions mirrored broader controversies associated with abortion in this setting. Abortion was generally thought to invoke gaba (bad karma), yet some noted its acceptability under certain circumstances. This study elucidates the complexities of pregnancy decisionmaking in this restrictive environment and the need for comprehensive and confidential reproductive health services for Filipino young adults.