Impact of maternal body mass index and gestational weight gain on pregnancy complications: an individual participant data meta-analysis of European, North American and Australian cohorts.

OBJECTIVE: To assess the separate and combined associations of maternal pre-pregnancy body mass index (BMI) and gestational weight gain with the risks of pregnancy complications and their population impact. DESIGN: Individual participant data meta-analysis of 39 cohorts. SETTING: Europe, North America, and Oceania. POPULATION: 265 270 births. METHODS: Information on maternal pre-pregnancy BMI, gestational weight gain, and pregnancy complications was obtained. Multilevel binary logistic regression models were used. MAIN OUTCOME MEASURES: Gestational hypertension, pre-eclampsia, gestational diabetes, preterm birth, small and large for gestational age at birth. RESULTS: Higher maternal pre-pregnancy BMI and gestational weight gain were, across their full ranges, associated with higher risks of gestational hypertensive disorders, gestational diabetes, and large for gestational age at birth. Preterm birth risk was higher at lower and higher BMI and weight gain. Compared with normal weight mothers with medium gestational weight gain, obese mothers with high gestational weight gain had the highest risk of any pregnancy complication (odds ratio 2.51, 95% CI 2.31- 2.74). We estimated that 23.9% of any pregnancy complication was attributable to maternal overweight/obesity and 31.6% of large for gestational age infants was attributable to excessive gestational weight gain. CONCLUSIONS: Maternal pre-pregnancy BMI and gestational weight gain are, across their full ranges, associated with risks of pregnancy complications. Obese mothers with high gestational weight gain are at the highest risk of pregnancy complications. Promoting a healthy pre-pregnancy BMI and gestational weight gain may reduce the burden of pregnancy complications and ultimately the risk of maternal and neonatal morbidity. TWEETABLE ABSTRACT: Promoting a healthy body mass index and gestational weight gain might reduce the population burden of pregnancy complications.

Maternal adverse childhood experiences, mental health, and child behaviour at age 3: The all our families community cohort study.

Links between adverse childhood experiences (ACEs) and threats to health and well-being later in life are well established. The current study extends those findings into younger populations of pregnant women and their children; investigating how ACEs relates to maternal postpartum well-being, coping, and parenting, as well as child outcomes. Participants included 1994 mothers and children from the All Our Families community-based cohort in Alberta, Canada, followed from pregnancy (from 2008 to 2011) until child age 3 years. The sample is representative of the pregnant population in an urban Canadian centre. Mothers completed questionnaires on ACEs, postpartum mental health, as well as parenting morale, efficacy, coping, and personality. Child outcomes included internalizing and externalizing behavior, as well as temperament. Approximately 62% of participants experienced at least one ACE; 25% experienced 3 or more ACEs. The presence of 3 or more ACEs was associated with postpartum smoking, binge drinking, depressive and anxiety symptoms, lower optimism and higher neuroticism, and lower reported parenting morale. In children, 3 or more maternal ACEs was associated with higher levels of internalizing (e.g., anxiety) and externalizing difficulties (aggression and hyperactivity), as well as temperament (surgency and negative affectivity). Cumulative maternal ACEs are associated with postpartum mental health and parenting morale, as well as maladaptive coping strategies. The demonstrated downstream consequences of maternal ACEs for child outcomes suggests that early intervention strategies and community resources to improve life course outcomes for parents and children are critical for breaking intergenerational continuities of risk.

Aerobic exercise for women during pregnancy.

BACKGROUND: Physiological responses of the fetus (especially increase in heart rate) to single, brief bouts of maternal exercise have been documented frequently. Many pregnant women wish to engage in aerobic exercise during pregnancy but are concerned about possible adverse effects on the outcome of pregnancy. OBJECTIVES: The objective of this review was to assess the effects of advising healthy pregnant women to engage in regular aerobic exercise (at least two to three times per week), or to increase or reduce the intensity, duration, or frequency of such exercise, on physical fitness, the course of labour and delivery, and the outcome of pregnancy. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (June 2005), MEDLINE (1966 to 2005 January Week 1), EMBASE (1980 to 2005 January Week 1), Conference Papers Index (earliest to 2005 January Week 1), contacted researchers in the field and searched reference lists of retrieved articles. SELECTION CRITERIA: Acceptably controlled trials of prescribed exercise programs in healthy pregnant women. DATA COLLECTION AND ANALYSIS: Both review authors independently assessed trial quality and extracted data. Study authors were contacted for additional information. MAIN RESULTS: Eleven trials involving 472 women were included. The trials were small and not of high methodologic quality. Five trials reported significant improvement in physical fitness in the exercise group, although inconsistencies in summary statistics and measures used to assess fitness prevented quantitative pooling of results. Seven trials reported on pregnancy outcomes. A pooled increased risk of preterm birth (relative risk 1.82, 95% confidence interval (CI) 0.35 to 9.57) with exercise, albeit statistically nonsignificant, does not cohere with the absence of effect on mean gestational age (weighted mean difference +0.3, 95% CI -0.2 to +0.9 weeks), while the results bearing on growth of the fetus are inconsistent. One small trial reported that physically fit women who increased the duration of exercise bouts in early pregnancy and then reduced that duration in later pregnancy gave birth to larger infants with larger placentas. AUTHORS' CONCLUSIONS: Regular aerobic exercise during pregnancy appears to improve (or maintain) physical fitness. Available data are insufficient to infer important risks or benefits for the mother or infant. Larger and better trials are needed before confident recommendations can be made about the benefits and risk of aerobic exercise in pregnancy.

Thomas Hastie Bryce (1862-1946)--a lesson in the power of observation.

Thomas Hastie Bryce was Regius Professor of Anatomy at the University of Glasgow from 1909 to 1935. In Anatomy, he is remembered as an embryologist and as an editor of the 11th edition of Quain's Elements of Anatomy. His most-lasting scientific contribution, however, was in archaeology where he defined the Clyde Group of Neolithic cairns in south-west Scotland. He showed that the Neolithic people of Arran were of short stature and were dolichocephalic, distinct from those of the Bronze Age. Also, Bryce was the first to appreciate the importance of pottery in analyzing the movement of ancient peoples across Europe, and defined Beacharra ware, a class of Neolithic pottery unique to the west of Scotland. As in anatomy, archaeological discoveries are made by study of morphology and relationships with careful attention to detail and a sound knowledge of the literature.

Course of the short gastric veins and their suitability for pancreatic islet transplantation.

Experience is being gained with pancreatectomy for patients with chronic pancreatitis suffering intractable pain. Transplantation of pancreatic islets isolated from the patient's own pancreas reduces the amount of injected insulin required, and research aims to develop treatments to make such patients independent of administered insulin. Claims have been made that the uppermost short gastric vein runs directly to the upper pole of the spleen in about 90% of subjects and that infusion of pancreatic islets by this route would allow them to settle in the spleen. This study investigates these claims. The findings suggest that the short gastric veins are inappropriate as a route of islet administration. Most short gastric veins, including the most superior, drain to tributaries of the splenic vein. Short gastric veins passing to the spleen itself without extra-splenic connections to the splenic vein and its tributaries are relatively rare. Only four examples in 12 specimens were found, and only two of these were the most superior short gastric vein. The short gastric veins run in the fat of the gastrosplenic ligament and are most readily visible as they leave the stomach. In our 12 dissecting room specimens, the short gastric veins ranged in number from 3-17, and in diameter from 0.5-4.5 mm (mean = 1.7 mm; SD = 0.7 mm). The four short gastric veins that drained directly to the spleen ranged in diameter from 0.5-1 mm, significantly narrower than those draining to the splenic vein or its tributaries and small for cannulation.

The chain saw--a Scottish invention.

The prototype of the chain saw familiar today in the timber industry was pioneered in the late 18th Century by two Scottish docors, John Aitken and James Jeffray, for symphysiotomy and excision of diseased bone respectively. The chain hand saw, a fine serrated link chain which cut on the concave side, was invented around 1783-1785. It was illustrated in Aitken's Principles of Midwifery or Puerperal Medicine (1785) and used by him in his dissecting room. Jeffray claimed to have conceived the idea of the chain saw independently about that time but it was 1790 before he was able to have it produced. In 1806, Jeffray published Cases of the Excision of Carious Joints by H. Park and P. F. Moreau with Observations by James Jeffray M.D.. In this communication he translated Moreau's paper of 1803. Park andMoreau described successful excision of diseased joints, particularly the knee and elbow. Jeffray explained that the chain saw would allow a smaller wound and protect the adjacent neurovascular bundle. While a heroic concept, symphysiotomy had too many complications for most obstetricians but Jeffray's ideas became accepted, especially after the development of anaesthetics. Mechanised versions of the chain saw were developed but in the later 19th Century, it was superseded in surgey by the Gigli twisted wire saw. For much of the 19th Century, however, the chain saw was a useful surgical instrument.

Histological changes in radial forearm skin flaps in the oral cavity.

We reported previously that skin flaps transplanted to the oral cavity in reconstructive surgery for oral cancer frequently acquired the gross appearance of buccal mucosa. The changes were shown to be reactive in nature. The "changed" flaps generally had a heavier infiltration of leukocytes in the dermis and appeared to have thicker epithelium. The present study quantifies these parameters, as well as the numbers of intraepithelial leukocytes. The flaps that had acquired the gross appearance of oral mucosa had significantly thicker epithelium, larger numbers of dermal leukocytes, and more intraepidermal inflammatory cells per unit length than flaps that retained the gross appearance of thin skin. No correlation was found between these changes and radiotherapy.

Not modern-day body-snatching: the response of the public.

At recent presentations on the history of anatomy in the West of Scotland, our group has been asked whether we would regard the revelations of 1999-2001 about organ retention as a modern form of body-snatching. We have compared newspaper reports of the Glasgow Herald from 1823 to 1832, the decade prior to the Anatomy Act of 1832, and the Herald, Sunday Herald and Evening Times from 1999 to 2001. Clearly body-snatchers appropriated whole corpses while the recent troubles concerned individual organs. Body-snatching was illegal while the crisis over organ retention arose from differing expectations between the medical profession and the public. Both practices caused huge public concern and distress to relatives. There are, however, interesting differences between the two sets of reports. The public had been aware of body-snatching for many years prior to the Anatomy Act, which regulated the supply of cadavers, whereas revelations about organ retention came as a shock. In the organ retention crisis, the parents of the children were more organised in supporting each other and in campaigning for change than were the public in the days of the resurrectionists.

William Hunter's Gravid Uterus: the specimens and plates.

William Hunter's collection of anatomical specimens of the pregnant uterus forms one of the finest displays in the Anatomy Museum at the University of Glasgow. We were interested to know which specimens in the Museum matched the plates in Hunter's The Anatomy of the Human Gravid Uterus Exhibited in Figures (1774). In our investigation we were greatly assisted by Teacher's Catalogue of the Anatomical and Pathological Preparations of Dr William Hunter (1900). Thirteen specimens in the Museum and one from the pathological collection at the Royal Infirmary are represented in Hunter's book. The specimens can be recognized in 25 of its illustrations. A further three specimens may correspond to figures but we could not prove this. With one possible exception, all the specimens matching plates noted in Teacher's catalogue remain in the Museum and one believed missing in Marshall's (1970) revision of the catalogue has been found.

The mandibular canal of the edentulous jaw.

The morphology of the mandibular canal after loss of teeth has received little detailed attention. Improved documentation of this topic would allow better interpretation of dental radiographs and would enable those engaged in tooth implantation to better understand the nature of the tissue into which the prostheses are placed. In this study on mandibles from seven dissecting room cadavers panoramic radiographs usually showed the mandibular canal clearly, an incisive canal less so. The wall of the mandibular canal was similar in dentate and edentulous mandibles, and was highly perforated, as suggested by Cryer (Anderson et al., 1991). In edentulous specimens, it was composed mainly of cancellous bone with only occasional single osteons. The inferior alveolar nerve near the mandibular foramen was a large trunk, consisting of three to four nerve bundles with connective tissue sheaths. It became more loosely arranged toward the mental foramen. Medial to the mental foramen, the nerves were frequently in the form of small bundles in the marrow. Any incisive canal was ill-defined and neurovascular bundles, when present, ran through a labyrinth of intertrabecular spaces.

"And afterwards your body to be given for public dissection": a history of the murderers dissected in Glasgow and the west of Scotland.

Between 1752 and 1832, the bodies of hanged murderers were dissected or gibbeted. During this period, 38 murderers were executed in the West of Scotland. The bodies of at least 23 were dissected in Glasgow. The stories of these murders are recounted. Insight is also given into the attitudes of the public and the anatomists to dissection of executed murderers.

William Hunter's casts of the gravid uterus at the University of Glasgow.

The Hunterian Collection at the University of Glasgow possesses 11 plaster casts showing the pregnant uterus. Three correspond to Plates I, IV, and VI of Hunter's The Anatomy of the Gravid Uterus Exhibited in Figures (1774), progressive stages of dissection of the same specimen. A further three casts show consecutive stages of dissection of a uterus containing a fetus presenting by the breech. The other specimens show a normal pregnancy at about 6 months, a normal full-term uterus with the fetal head becoming engaged, a breech presentation with placenta previa and the umbilical cord around the fetal neck, and an obstructed labor with distended bladder and colon. The 10 on display show realistic coloring and are mounted on black wooden stands. An 11th specimen, amateurishly painted, is not on display. The casts differ in their style; some show only the abdomen, pelvis, perineum, and thighs, others show the full torso. They also differ in the amount of detail shown. The first three casts show the cut femur and muscles at the transected ends of the thighs, also shown in some of the plates in the Gravid Uterus. Although these features enhance the artistic impact of both the engravings and the casts, the authors are unconvinced that Hunter deliberately used them to achieve this, as has been claimed.

Cellular responses to vasectomy.

A number of cell populations in the reproductive tract show a response to vasectomy. Some cell types show similar responses in man and all laboratory species, whereas others show marked species variations. This chapter describes these effects in a broadly chronological order and, in a general way, considers changes close to the site of vasectomy first and the longer term effects on the testis itself later. Following vasectomy, epididymal distension and sperm granuloma formation result from raised intraluminal pressure. The sperm granuloma is a dynamic structure and a site of much spermatozoal phagocytosis by its macrophage population. In many species, spermatozoa in the obstructed ducts are destroyed by intraluminal macrophages, and degradation products, rather than whole sperm, are absorbed by the epididymal epithelium. Humoral immunity against spermatozoal antigens following vasectomy is well established and there is evidence of modest T-lymphocyte activity. The role of lymphocytes in the reproductive tract epithelium and interstitium following vasectomy is poorly defined. In laboratory animals, there is evidence that pressure-mediated damage to the seminiferous epithelium can follow sperm granuloma formation and obstruction in the epididymal head. However, the contribution of lymphocytes and antisperm antibodies to testicular damage after vasectomy is far from clear. A number of studies have suggested that testicular changes may follow vasectomy in man but their validity and mechanism of occurrence require further study.

Macrophages of the sperm granuloma 3 months after vasectomy in the Albino Swiss rat.

This study documents the appearance and arrangement of the macrophages of the sperm granuloma 3 months after vasectomy in the Albino Swiss rat. We found, as have others, that the macrophages form a distinct layer in the granuloma wall, external to the central mass of extravasated spermatozoa. Those closest to the spermatozoa showed much phagocytosis. Many had two, three, or more nuclei. The largest macrophages, giant cells of the foreign body and Langhans types, were generally farther from the sperm mass, but retained evidence of phagocytic activity in the form of sperm fragments. Macrophages, either mono- or multinucleate, frequently showed numerous surface microridges that interdigitated with those of neighboring cells. The microridges varied in length, but were of uniform thickness and cytoplasmic content and were rarely branched. Monocytes were frequently observed, indicating continuing significant recruitment of cells of the macrophage series to the granuloma. We also noted mononucleate cells in the connective tissue external to the macrophage layer. Their cytology suggested they were macrophages, but they showed much less phagocytic activity than those of the main macrophage layer and had distinctive aggregations of moderately electron-dense droplets.

Effect of vasectomy on the seminiferous tubule boundary zone in the Albino Swiss rat.

The boundary zone of a seminiferous tubule consists of the basement membrane of the seminiferous epithelium, its myoid cells, and their basal laminae. This study examines the boundary zones of seminiferous tubules in healthy and degenerated testes following long-term, left-sided vasectomy in the rat and compares them to those of sham-operated controls and adult rats exposed in utero to the antiandrogen, flutamide. Degenerated tubular profiles showed similar changes, irrespective of whether the degeneration was ipsilateral or bilateral. In transverse tubular profiles, the basal laminae of the seminiferous epithelium and the myoid cells became more undulating, that of seminiferous epithelium showing complex folding. The collagen layer of the boundary zone, which lies between the basal laminae of the seminiferous epithelium and the myoid cells, thickened and its fibers became irregularly orientated. Rather than being flattened as in controls, the region of the myoid cell near the nucleus and the nucleus itself developed triangular profiles in the transversely sectioned tubules. Similar features were also seen in the degenerated tubules of rats exposed to flutamide. The changes in the boundary zone are not specific for vasectomy and probably reflect reduction in the cross-sectional area of tubular profiles and possibly in their length. We also noted occasional leukocytes infiltrating the boundary zone; they may have increased in number in those tubules that showed degeneration following vasectomy.

Observations on multiple sperm granulomas in the rat epididymis following vasectomy.

Seven epididymides of long-term vasectomized rats showing multiple sperm granulomas were studied in serial histological sections. Despite the presence of the multiple granulomas, only two rats showed continuity of the epididymal duct with the central sperm mass of a granuloma. A further three specimens showed breaks in the epididymal epithelium at sites of local distension in the epididymal tail. Granulomas in the epididymal body seem to receive spermatozoa only transiently. The spermatozoa at the center of granulomas in continuity with the epididymal duct showed evenly distributed sperm heads. A number of others showed clumping of spermatozoa, attributed to stagnation of flow and fluid resorption. In many granulomas, folds in the macrophage layer with a connective tissue core rich in lymphocytes and plasma cells projected into the central sperm mass. We conclude that the sperm granuloma is a dynamic structure that shows changes with age and that the sperm granuloma closest to the testis must not be assumed to be the one that is draining the spermatozoa.

Degenerated tubules in the guinea pig testis after long-term vasectomy or sham operation.

The testes of eight unilaterally vasectomized and six sham-operated Dunkin Hartley guinea pigs were examined 3 years after operation by wax and resin histology and transmission electron microscopy. Degenerated tubules are reported that were common on the side of vasectomy but also found in the contralateral testes and in the controls. A central accumulation of macrophages, rich in phagocytosed debris including spermatozoal fragments, was surrounded by attenuated Sertoli cells, a markedly thickened basement membrane and myoid cells. At some sites macrophages impinged directly on the basement membrane. They probably represented highly degenerated seminiferous tubules. The study suggests that the response to injury of seminiferous tubules may show species variations. Macrophages did not feature in the degenerated seminiferous tubules we reported following vasectomy in the rat. However, the rat showed striking changes in the morphology of the basal laminae and myoid cells which did not occur in the guinea pig. Pathological changes have been reported in the human testis following vasectomy but their etiology is unclear. Studies in the guinea pig are enhancing understanding of the mechanisms and features of testicular damage.

Effect of long-term vasectomy on seminiferous tubules in the guinea pig.

The little previous work on the influence of vasectomy on the guinea pig testis has given controversial results. One group reports that the guinea pig suffers autoimmune orchitis while others claim damage may be mechanical. To clarify the issue, this study compares the morphology of seminiferous tubules 3 years after left unilateral vasectomy (8 guinea pigs) and control sham operation (6 animals). Grossly, left and right testes following left-sided vasectomy were similar to controls and not significantly different in weight. On histology, left and right experimental testes and the control material showed various degrees of seminiferous tubular degeneration, including intraepithelial vesicle formation, loss of germ cells and intraluminal macrophages. Although vesicle formation was striking in most testes, quantitative analysis indicated that it was more frequent in the ipsilateral testis following unilateral vasectomy. It seems that vasectomy had exacerbated an age-related phenomenon. Lymphocytic infiltration was seen in five of the left testes following vasectomy, in two of the corresponding right testes, but in none of the controls. Two vasectomized left testes, however, showed atrophic changes but no lymphocytic invasion. The results suggest that autoimmune orchitis follows vasectomy but that it may not be the primary cause of degeneration. Attempts to gain positive evidence for mechanical damage, however, were inconclusive.

James Jeffray: observations on the heart and on the peculiarities of the foetus.

James Jeffray, Regius Professor of Anatomy in the University of Glasgow (1790-1848), published his lectures on the heart as a monograph entitled Observations on the Heart and on the Peculiarities of the Foetus (Jeffray, 1835), in which he considered controversies about the adult heart, such as the arrangement of the coronary vessels and the function of the aortic and pulmonary sinuses, and about the fetal circulation. His sources were the works of Senac, Lower, Vieussens, Eustachius, Mery, Haller, Winslow, and Sabatier which were available from the Hunterian bequest. Jeffray supplemented his own material with Hunterian specimens for the illustrations. He supported the theory that blood from the superior and inferior venae cavae crossed in the right atrium, that from the superior cava being destined for the right ventricle and from the inferior passing through the foramen ovale to the left atrium. He also held that the valve of the inferior vena cava directed the bloodflow from that vessel to the foramen ovale. These views conflicted with those of John Bell (1763-1820), a successful Edinburgh anatomist and surgeon whose opinions are attacked several times in the publication. Regarding the placenta, Jeffray may have been deliberately vague about whether the fetal and maternal circulations are continuous or separate, an issue resolved by William Hunter in the previous century.