From pandemic to syndemic: microbiota, pregnancy, and environment at a crossroad.

Aim: SARS-CoV2 is the latest pandemic that have plagued the socio-health system as an epiphenomenon resulting from planetary resources abuse, crucial for biodiversity. The Anthropocene best defines the present epoch in which human activity irreversibly manipulates intricate and delicate geological and biological balances established over eons. The devastating ecological and socio-economic implications of COVID-19, underline the importance of updating the present pandemic framework to a syndemic. This paper stems from the need to suggest to scientists, doctors, and patients a mission that integrates responsibility from individual to collective health, from present to trans-generational, from human to the entire biotic network. Today's choices are crucial for the perspective on all levels: political, economic, and health as well as cultural.Methods: Research on PubMed and other specific web-sites journal was performed on the topic "Microbiota", "Covid-19", "Pandemic", "Zoonosis", "SARS-CoV-2", "Environmental Pollutants", "Epigenetics", "Fetal Programming", "Human Extinction". Data collected were analysed for an integrative model of interconnection between environment, pregnancy, SARS-CoV-2 infection, and microbiota. Moreover, systematic literature review allowed to summarise in a table information about the worst pandemics that afflicted the human species recently.Results: This paper offers a broad view of the current pandemic starting with pregnancy, the moment when a new life begins and the health trajectories of the unborn child are defined, which will inevitably have repercussions on his well-being. The fundamental role of the biodiversity-rich microbiota in avoiding the development of severe infectious diseases, is therefore highlighted. It is imperative to adjust the current reductionist paradigm based on mostly immediate symptom management towards a broader understanding of the spatial interconnection of ecological niches with human health and the impacts of today's choices on the future. Health and healthcare are elitist rather than egalitarian, therefore focusing on environmental health forces us to make a concerted and systemic effort that challenges political and economic barriers, which are biologically senseless. A healthy microbiota is essential to well-being, both by preventing chronic degenerative conditions, the infectiousness and pathogenicity of bacterial and viral diseases. SARS-CoV-2 should not be an exception. The human microbiota, forged by the first 1,000 days of life, is fundamental in shaping the health-disease trajectories, and by the everlasting exposome that is dramatically affected by the ecological disaster. Individual health is one world health whereas single and global well-being are interdependent in a space-time perspective.Conclusions: Is it not a convenient reductionism not to consider the COVID-19 emergency as a bio-social epiphenomenon of a far more devastating and multi-faceted crisis whose common denominator is the global biotic network loss of which humans are still part?

Cross-Cultural Adaptation and Validation of the Pregnancy Mobility Index for the Italian Population: A Cross-Sectional Study.

INTRODUCTION: Pregnancy is a specific condition that modifies the mobility of women. In this population, it seems important to use specific tools to properly assess them. The Pregnancy Mobility Index (PMI) was created in 2006 with the aim of assessing mobility in pregnant women. The goal of this study was to translate, adapt, and evaluate the statistical properties of the questionnaire in the Italian pregnant population. METHODS: The PMI underwent translation and transcultural adaptation. Reliability and concurrent validity, compared to the Oswestry Disability Index (ODI), was investigated on a sample of pregnant women. An ANOVA was performed to detect differences in the PMI score considering the Body Mass Index (BMI) and age of the sample. RESULTS: The PMI was forward translated, back translated, and transculturally adapted. A consensus meeting accepted the final version of the questionnaire. The PMI was given to 93 pregnant women. PMI showed excellent reliability for every item and the total score (Cronbach's alpha of 0.945). Concurrent validity compared with ODI items 2-9 was strong considering the total score, with r = 0.726, but moderate comparing the first item of the ODI and the total score of the PMI, r = 470, and considering the total score of both questionnaires (r = 0.683). The ANOVA showed statistical difference in pregnant women with lower BMI for every subscale and total score of PMI (p = 0.009) and for outdoor mobility considering age (p = 0.019). CONCLUSIONS: The PMI seems to be a valid and reliable tool to assess mobility in the pregnant population. Pregnant women with a lower BMI showed a greater mobility score in the PMI. In turn, younger pregnant women presented a lower mobility score compared to older pregnant women.

MYNd&CO (Mindfulness, Yoga, Nutrition, development & Coaching, and Osteopathy) randomized controlled trial for a positive psychophysical experience in pregnancy and after birth: a study protocol.

BACKGROUND AND AIM: The medicalisation of birth pathway may negatively impact on women's empowerment, enhancing distress even in cases of healthy pregnancies. We have built a program which is comprised of Mindfulness, Yoga, Nutrition, development & Counselling, Coaching, antenatal classes, and Osteopathic treatment (MYNd&CO). METHODS: This study is a randomized controlled trial involving low-risk pregnant women. They will be randomized to the experimental (MYNd&CO intervention plus standard care) or control group (standard care). The primary (general health and wellbeing, maternal distress) and secondary outcome measures (urinary incontinence, sexual problems, and physical wellbeing) will be assessed via questionnaires at baseline and 6 months after childbirth. The independent-samples t-test and Chi-square will be used to detect changes in the outcomes between intervention and control group. DISCUSSION: The trial is expected to increase knowledge about the effectiveness of a holistic approach in low-risk pregnant women, in terms of obstetrical and psychophysiological outcomes.

Autism Spectrum Disorder from the Womb to Adulthood: Suggestions for a Paradigm Shift.

The wide spectrum of unique needs and strengths of Autism Spectrum Disorders (ASD) is a challenge for the worldwide healthcare system. With the plethora of information from research, a common thread is required to conceptualize an exhaustive pathogenetic paradigm. The epidemiological and clinical findings in ASD cannot be explained by the traditional linear genetic model, hence the need to move towards a more fluid conception, integrating genetics, environment, and epigenetics as a whole. The embryo-fetal period and the first two years of life (the so-called 'First 1000 Days') are the crucial time window for neurodevelopment. In particular, the interplay and the vicious loop between immune activation, gut dysbiosis, and mitochondrial impairment/oxidative stress significantly affects neurodevelopment during pregnancy and undermines the health of ASD people throughout life. Consequently, the most effective intervention in ASD is expected by primary prevention aimed at pregnancy and at early control of the main effector molecular pathways. We will reason here on a comprehensive and exhaustive pathogenetic paradigm in ASD, viewed not just as a theoretical issue, but as a tool to provide suggestions for effective preventive strategies and personalized, dynamic (from womb to adulthood), systemic, and interdisciplinary healthcare approach.

Carbon monoxide (CO) and nitric dioxide (NO2) exposure during fetal life: impact on neonatal and placental weight, a prospective study.

Objective: This prospective study aims to analyze how CO and NO2 exposure during pregnancy affects birth and placental weight as well as umbilical arterial pH.Study design: The population in study includes 3614 women born in Italy, living in Lombardia Region, consecutively admitted to the Clinica Mangiagalli for an elective cesarean section from January 2004 to December 2006. Outdoor air quality data was provided by the Department of the Regional Environmental Protection Agency and obtained by a network of fixed monitoring stations distributed in eight geographical areas across the region.Results: A positive association was found between birth weight and the concentration of CO to whom women were exposed during the last 10 d of pregnancy (mean change g + 28, 95% CI +1 to +55, p .04). Conversely, placental weight was not influenced by exposure to CO while a statistically significant weight reduction was related to an increase in NO2 exposure during the last trimester of pregnancy.Conclusion: Fetal weight was positively associated with an increased exposure to CO during the last 10 d of pregnancy. NO2 exposure was associated to a placental weight reduction. These findings underline the existence of a complex biological role of such pollutants, especially of CO, in cell oxygenation at a placental level.

Particulate matter (PM10) exposure, birth and fetal-placental weight and umbilical arterial pH: results from a prospective study.

OBJECTIVE: This prospective study aims to analyze the relation between particulate matter (PM10) exposure during pregnancy and birth weight (BW), placental weight (PW) and umbilical artery PH (UAPH). STUDY DESIGN: Population included 3614 women born in Italy, living in Lombardia Region, consecutively admitted to the Clinica Mangiagalli for an elective cesarean section from January 2004 through December 2006. Outdoor air quality data were provided by the Department of the Regional Environmental Protection Agency and obtained by a network of fixed monitoring stations representatively distributed in eight geographical areas. RESULTS AND CONCLUSION: Birth weight was negatively associated with exposure to PM10 concentration during the first trimester of pregnancy (mean change -22.2 g, 95%CI -8.7 to -35.7, p = 0.0013). Placental weight and umbilical artery PH were not associated with exposure to PM10 concentration. Fetal weight was negatively associated with exposure to PM10 concentration during the first trimester of pregnancy.

Intrauterine growth restriction is associated with changes in polyunsaturated fatty acid fetal-maternal relationships.

Fetuses with intrauterine growth restriction (IUGR) are at increased risk of death and disease during neonatal, pediatric, and adult life. Postnatal deficits in essential fatty acids have been associated with the neural and vascular complications of premature neonates. We studied whether fetal-maternal fatty acid relationships are already impaired in utero in IUGR fetuses. Fetal (F) and maternal (M) fatty acid profiles were determined in utero in 11 normal [appropriate for gestational age (AGA)] and in 10 IUGR fetuses by fetal blood sampling (FBS) between 19 and 39 wk. Total plasma fatty acid concentrations were significantly higher in M than in F of both AGA (M: 2.03 +/- 0.53 mg/mL; F: 0.64 +/- 0.29 mg/mL; p < 0.001) and IUGR (M: 2.16 +/- 0.59 mg/mL; F: 0.73 +/- 0.17 mg/mL; p < 0.001). The F/M ratio was significantly higher for linoleic acid (AGA: 0.36 +/- 0.09; IUGR: 0.52 +/- 0.12; p < 0.01) and significantly lower for the long-chain polyunsaturated fatty acid docosahexaenoic acid (AGA: 1.94 +/- 0.32; IUGR: 1.25 +/- 0.19; p < 0.05) and arachidonic acid (AGA: 2.35 +/- 0.35%; IUGR: 2.04 +/- 0.3%; p < 0.05) in IUGR compared with AGA pregnancies. The differences observed in the relative amounts but not in total plasma concentrations of fatty acid fetal-maternal relationships in pregnancies associated with IUGR could be related to inadequate transplacental supply as well as to a fetal lack of the enzymes necessary for elaboration of these metabolically relevant conditionally essential fatty acids. These differences might have a role in determining the biochemical environment leading to the neural and vascular complications associated with IUGR.