Effect of maternal zinc supplementation on the cardiometabolic profile of Peruvian children: results from a randomized clinical trial.

Zinc is an essential micronutrient for the development of the fetal renal, cardiovascular and metabolic systems; however, there is limited evidence of its effects on the postnatal cardiometabolic function. In this study, we evaluated the effect of maternal zinc supplementation during pregnancy on the cardiometabolic profile of the offspring in childhood. A total of 242 pregnant women were randomly assigned to receive a daily supplement containing iron+folic acid with or without zinc. A follow-up study was conducted when children of participating mothers were 4.5 years of age to evaluate their cardiometabolic profile, including anthropometric measures of body size and composition, blood pressure, lipid profile and insulin resistance. No difference in measures of child cardiometabolic risk depending on whether mothers received supplemental zinc during pregnancy. Our results do not support the hypothesis that maternal zinc supplementation reduces the risk of offspring cardiometabolic disease.

The gestational foundation of sex differences in development and vulnerability.

Despite long-standing interest in the role of sex on human development, the functional consequences of fetal sex on early development are not well-understood. Here we explore the gestational origins of sex as a moderator of development. In accordance with the focus of this special issue, we examine evidence for a sex differential in vulnerability to prenatal and perinatal risks. Exposures evaluated include those present in the external environment (e.g., lead, pesticides), those introduced by maternal behaviors (e.g., alcohol, opioid use), and those resulting from an adverse intrauterine environment (e.g., preterm birth). We also provide current knowledge on the degree to which sex differences in fetal neurobehavioral development (i.e., cardiac and motor patterns) are present prior to birth. Also considered are contemporaneous and persistent sex of fetus effects on the pregnant woman. Converging evidence confirms that infant and early childhood developmental outcomes of male fetuses exposed to prenatal and perinatal adversities are more highly impaired than those of female fetuses. In certain circumstances, male fetuses are both more frequently exposed to early adversities and more affected by them when exposed than are female fetuses. The mechanisms through which biological sex imparts vulnerability or protection on the developing nervous system are largely unknown. We consider models that implicate variation in maturation, placental functioning, and the neuroendocrine milieu as potential contributors. Many studies use sex as a control variable, some analyze and report main effects for sex, but those that report interaction terms for sex are scarce. As a result, the true scope of sex differences in vulnerability is unknown.

Sympathomimetic amines effectively control pain for interstitial cystitis that had not responded to other therapies.

PURPOSE: To further investigate the efficacy of treatment of interstitial cystitis that had been refractory to standard treatment with sympathomimetic amines. METHODS: Dextroamphetamine sulfate sustained release capsules up to 30 mg per day were prescribed in women with refractory painful bladder syndrome/interstitial cystitis in six new cases. The patients were carefully evaluated for relief of symptoms. RESULTS: All six women found marked relief in their painful bladder syndrome in a rather short length of time. The benefit persisted as long as the therapy was maintained. Temporary cessation resulted in prompt return of symptoms, but resumption of sympathomimetic amines again allowed good relief of bladder pain and related symptoms. CONCLUSIONS: Because of very few side-effects and no drug dependence in the dosage used, sympathomimetic amines should be considered for first-line therapy.

Sex-specific associations of maternal prenatal testosterone levels with birth weight and weight gain in infancy.

Associations between maternal salivary testosterone at 36 weeks' gestation with birth weight and infant weight gain through 6 months of age were examined in a group of 49 healthy, pregnant women and their offspring. The diurnal decline of maternal testosterone was conserved in late pregnancy, and levels showed significant day-to-day stability. Elevated maternal morning testosterone level was associated with lower birth weight Z-scores adjusted for gestational age and sex, and greater infant weight gain between birth and 6 months. Although maternal testosterone levels did not differ by fetal sex, relations were sex-specific such that maternal testosterone had a significant impact on weight for male infants; among female infants associations were nonsignificant. Results highlight the opposing influence of maternal androgens during pregnancy on decreased growth in utero and accelerated postnatal weight gain.

Choroid plexus cysts do not affect fetal neurodevelopment.

OBJECTIVE: To determine whether an isolated finding of a choroid plexus cyst (CPC) during routine ultrasound is associated with altered fetal growth or development. STUDY DESIGN: Prospective, case-control study comparing 35 CPC cases to 67 controls. Neurobehavioral development assessment included 50 min long serial recordings of heart rate, motor activity and their interrelation at 24, 28, 32 and 36 weeks gestation. Growth measurement was based on three ultrasound evaluations of femur length, biparietal diameter, head circumference and abdominal circumference at initial exam, 28 and 36 weeks. RESULTS: Longitudinal analyses revealed no differences in fetal heart rate, variability or accelerations; the number or duration of fetal movements or total motor activity; nor fetal movement-fetal heart rate coupling. CPC cases had slightly smaller head and abdominal circumferences at 28 weeks, but these differences had disappeared by 36 weeks. CPC detection was more common when routine exams were conducted earlier (18.8 versus 19.5 weeks; P<0.01). CONCLUSION: Despite the presumption that CPCs with normal karyotypes are benign variants, little empirical support exists. These results indicate that CPCs detected by prenatal ultrasound do not pose or reveal a threat to fetal development.

Women's response to fetal choroid plexus cysts detected by prenatal ultrasound.

OBJECTIVES: To determine maternal responses to detection of a minor structural variant, the choroid plexus cyst (CPC), in their fetus on prenatal ultrasound. STUDY DESIGN: We interviewed 34 pregnant women with an isolated CPC detected on mid-pregnancy ultrasound about their objective experience at diagnosis, emotional response and subsequent reactions. Audiotaped, transcribed responses were evaluated by two independent raters and analyzed qualitatively and quantitatively. RESULTS: All women reported negative emotional responses including shock, distress, fear and decreased attachment, despite counseling by 82% of providers that the CPC was probably benign. Three women underwent amniocentesis purely for reassurance after CPC detection. Most (79%) sought information beyond what their physician provided, frequently on the internet. One half of women reported that intense negative responses were temporary. However, weeks after diagnosis, 62% continued to believe that the CPC presented some danger to their baby. CONCLUSIONS: Detection of CPC prenatally can evoke profound, negative maternal emotional responses despite accurate provider counseling. Practitioners should consider these responses when counseling parents about these and other structural variants of unclear functional significance.

Fetal growth in Peru: comparisons with international fetal size charts and implications for fetal growth assessment.

OBJECTIVES: To compare fetal biometry measurements obtained in a Peruvian population with reference fetal size charts obtained in Peruvian and non-Peruvian populations. METHODS: Fetal biometry measurements collected prospectively in 195 uncomplicated pregnancies were included in the presented analysis. At 20, 24, 28, 32, 36 and 38 weeks' gestation, fetal head circumference, abdominal circumference and femur diaphysis length were measured. Fetal biometry measurements were compared with fetal size charts obtained from another Peruvian and two non-Peruvian populations from North America and Europe. RESULTS: When compared with ultrasound-based reference fetal size charts obtained from North American and European populations, fetuses from the studied population appeared to grow more slowly with advancing gestational age. This trend was not observed when a Peruvian population, similar to the one studied here, was used as a reference. CONCLUSIONS: The results suggest that fetal growth in this Peruvian population may not be adequately assessed by using reference charts obtained from other populations and have implications for the use of growth standards in antenatal management.

Measuring the ups and downs of pregnancy stress.

Despite substantial interest in the effects of stress on pregnancy, few instruments are available to measure pregnancy-specific stressors. Moreover, research has typically focused on the distressing, negative aspects of pregnancy. This report examines the reliability and validity of the Pregnancy Experience Scale (PES), a 41-item scale that measures pregnancy-specific daily hassles and uplifts. The PES was administered to two cohorts of low risk women at 24, 30, and 36 weeks (n = 52) or 32 and 38 weeks (n = 137). Women perceived their pregnancies to be significantly more intensely and frequently uplifting than hassling. Internal scale reliability was high (alpha = 0.91 to 0.95). Frequency and intensity scores for hassles and uplifts were stable over time (r's = 0.56 to 0.83) and patterns of convergent and discriminant validity emerged between the PES and existing measures of general affective intensity, daily stressors, depressive symptoms, and anxiety. These results indicate that (1) failure to measure pregnancy-specific stress will underestimate the degree to which pregnant women experience distress and (2) measurement of only the negative aspects of pregnancy will overestimate distress and fail to portray the degree to which women are psychologically elevated by their pregnancies. Measurement of hassles relative to uplifts may provide the most balanced assessment of pregnancy appraisal.

Cross-correlation of fetal cardiac and somatic activity as an indicator of antenatal neural development.

OBJECTIVE: In this study, we wanted to model the emergence of coupling between fetal cardiac and somatic activity in normal and at-risk fetuses. STUDY DESIGN: One hundred six fetuses of uncomplicated pregnancies were longitudinally monitored at 20, 24, 28, 32, 36, and 38 weeks of gestation by using a fetal actocardiograph and computerized data collection. Twenty-six fetuses of complicated pregnancies were also included. Statistical time series analysis techniques were used to examine the relation between fetal movement and fetal heart rate. RESULTS: A linear increase was found in the magnitude of the cross-correlation function between fetal movement and fetal heart rate as gestation advanced, with coalescence around a peak lag of 5 seconds by 32 weeks. Fetuses that delivered before term evidenced accelerated fetal movement and fetal heart rate coupling, whereas fetuses affected by deleterious conditions showed a decline in developmental trajectory. CONCLUSIONS: The cross-correlation between fetal cardiac and somatic activity is an indicator of neuroregulation in human fetuses.

In vitro fertilization and the family: quality of parenting, family functioning, and child psychosocial adjustment.

This study examined associations between homologous in vitro fertilization (IVF) and quality of parenting, family functioning, and emotional and behavioral adjustment of 3-7-year-old children. A cross-sectional survey was conducted in Taiwan with 54 IVF mother-child pairs and 59 mother-child pairs with children conceived naturally. IVF mothers reported a greater level of protectiveness toward their children than control mothers. Teachers, blind to condition, rated IVF mothers as displaying greater warmth but not overprotective or intrusive parenting behaviors toward their children. Teachers scored children of IVF as having fewer behavioral problems than control children. In contrast, IVF mothers reported less satisfaction with aspects of family functioning. Family composition moderated parenting stress: IVF mothers with only 1 child perceived less parenting stress than did those in the control group.

Antenatal origins of individual differences in heart rate.

This study examines prenatal-to-postnatal stability in heart rate and variability from mid-gestation through the first year of life. Fetal heart rate data were collected from 52 healthy fetuses at 24, 30, and 36 weeks gestation, and again at 2 weeks and 12 months of age. Fetal heart rate measures were stable during gestation and positively associated with neonatal and infant measures. Maternal pulse rate and oxygen saturation were moderately associated with fetal heart rate. Together, fetal cardiac (heart rate and variability) and maternal physiologic measures (blood pressure and oxygen saturation) explained 40 and 48% of the variance in heart rate and variability, respectively, at 1 year of age. These common measures of individual differences in autonomic function are enduring characteristics that originate during fetal development.

Baby and the brain: advances in child development.

As child morbidity and mortality declined during the twentieth century, a corresponding increase occurred in the relevance of child psychological well-being to public health. Evidence of this trend is the proliferation of programs intended to ameliorate conditions that place children in jeopardy of poor developmental outcome. Most recently, neurobiologic information on brain function and structure has been used to promote strategies for optimizing child development. This review will evaluate the current state of knowledge relating early child development to brain research and illustrate the potential misuse of this information. It will also suggest the following: (a) the extrapolation of neuroscience results to early academic and social enrichment programs obscures the magnitude of potential effects of these programs relative to the vast burden of risk imposed by poverty, and (b) an emphasis on intellectual functioning misses the most compelling evidence on the role of the early social environment in mediating establishment of neural networks that regulate a child's response to stress and capacity for self-control.

Treatment and control of gastrointestinal parasites.

Routine anthelmintic treatments are one of the most important components of an equine wellness program used by horse owners and veterinarians today. Thirteen different compounds are available in the United States in the treatment of gastrointestinal parasites, most of which are available over the counter. As a result, there is a decreased reliance on the veterinarian to perform routine tube dewormings. Therefore, the future of the veterinarian's role in the management of gastrointestinal parasites is likely to be in the consultation and design of parasite control programs. With this in mind, this article covers all of the equine anthelmintics and their clinical applications.

Fetal movement detection: comparison of the Toitu actograph with ultrasound from 20 weeks gestation.

OBJECTIVE: This study evaluates the validity of Doppler-detected fetal movement by a commercially available monitor and investigates whether characteristics of maternal body habitus and the intrauterine environment affect its performance. METHODS: Fetal movement was evaluated in normal pregnancies using both ultrasound visualization and a fetal actocardiograph (Toitu MT320; Tofa Medical Inc., Malvern, PA). Data were collected for 32 min on 34 fetuses stratified by gestational age (20-25 weeks; 28-32 weeks; 35-39 weeks). Fetal and maternal characteristics were recorded. Comparisons between ultrasound-detected trunk and limb movements and actograph records were conducted based both on 10-s time intervals and on detection of individual movements. RESULTS: Time-based comparisons indicated agreement between ultrasound and actograph 94.7% of the time; this association rose to 98% when movements of less than 1 s duration were excluded. Individual movements observed on ultrasound were detected by the actograph 91% of the time, and 97% of the time when brief, isolated movements were excluded. The overall kappa value for agreement was 0.88. The actograph was reliable in detecting periods of quiescence as well as activity. These findings did not vary by gestational age. The number of movements detected by the actograph, but not the single-transducer ultrasound, significantly increased over gestation. Maternal age, parity, weight, height, or body mass index were not consistently associated with actograph validity. Characteristics of the uterine environment, including placenta location, fetal presentation, and amniotic fluid volume also did not affect results. CONCLUSIONS: The Toitu actograph accurately detects fetal movement and quiescence from as early as 20 weeks gestation and has utility in both clinical and research settings. Actographs are most useful for providing objective and quantifiable measures of fetal activity level, including number and duration of movements, while visualization through ultrasound is necessary for studies of movement quality, source, or mechanics.

Effect of transportation and feed withdrawal on shedding of Salmonella typhimurium among experimentally infected pigs.

OBJECTIVE: To determine whether stress associated with transportation or feed withdrawal increased fecal shedding of Salmonella Typhimurium among pigs experimentally infected with the organism. ANIMALS: 86 healthy pigs. PROCEDURE: Pigs were challenge exposed with Salmonella Typhimurium at 4 weeks old and reared conventionally. When pigs reached market weight, they were assigned to groups and subjected to various combinations of transportation and feed withdrawal. Ileocecal contents were collected after slaughter and tested for Salmonella Typhimurium. RESULTS: Salmonella Typhimurium was not detected in feces collected from pigs just prior to slaughter. When feed was withheld for 24 hours prior to slaughter, the proportion of transported pigs with Salmonella Typhimurium in ileocecal contents at the time of slaughter was not significantly different from the proportion of nontransported pigs. However, when feed was not withheld prior to slaughter, the proportion of transported pigs with Salmonella Typhimurium in ileocecal contents at the time of slaughter was significantly higher than the proportion of nontransported pigs. CONCLUSIONS AND CLINICAL RELEVANCE: When carrier pigs remained on feed, transportation stress increased the proportion positive for Salmonella sp. On the basis of results reported here, it is suggested that producers withhold feed from pigs for 24 hours prior to transportation to a slaughter plant.

A comparison of the bioequivalence of 0.5% fenbendazole top dress pellets or 10% fenbendazole oral suspension against a spectrum of equine parasites.

A controlled test was conducted to assess the efficacy bioequivalence of a single dose of 0.5% fenbendazole (FBZ) top dress pellets to a 10% FBZ suspension formulation (Panacur suspension 10%, Hoechst Roussel Vet). Thirty horses with naturally-acquired parasite infections, in replicates of three, were used. Strongyle egg per gram counts were not significantly different (P>0.1) between groups pretreatment, but FBZ treated groups were significantly different from the control group post-treatment. At necropsy, which occurred seven to nine days post-treatment, two methods of nematode recovery were compared to assess whether a small aliquot can be used in a control test to determine efficacy against large as well as small strongyles. Both post mortem worm recovery techniques revealed similar efficacies of both formulations (>95%) against small and large strongyles, but large differences in the number of worms recovered. Six species of small strongyles comprised 96% of all the small strongyles recovered: Coronocyclus coronatus, Cylicocyclus insigne, Cylicostephanus longibursatus, Cylicocyclus brevicapsulatus, Cylicocyclus nassatus, and Cyathostomum catinatum. The results of this study demonstrated therapeutic bioequivalence between FBZ formulations and also the need to sample at least a 10% aliquot to accurately estimate number of large strongyles. No adverse reactions to treatment were detected.

Persistent activity of doramectin and ivermectin against Ascaris suum in experimentally infected pigs.

A study was conducted to investigate the persistent nematocidal activity of two avermectins against experimentally-induced infections of Ascaris suum in swine. Seventy-two nematode-free cross-bred pigs of similar bodyweight were randomly allotted to nine treatment groups of eight pigs each. Eight of the groups were treated with injectable solutions containing 300 microg of doramectin/kg (IM) or 300 microg of ivermectin/kg (SC) either 0 (same day), 7, 14, or 21 days prior to an oral challenge of 50000 embryonated A. suum eggs. The ninth group (control) was challenged in parallel without any avermectin treatment. At 41 or 42 days after challenge, pigs were euthanatized and adult and larval stages of A. suum were collected from the gastrointestinal tract of each pig and counted. Both avermectins significantly (P < 0.0002) reduced nematode counts when given on the day of challenge (0 days prior), and the efficacy was 100% and 97.5% for doramectin and ivermectin, respectively. Doramectin given 7 days prior to challenge significantly (P < 0.0001) reduced nematode counts, and the efficacy was 98.4%. For all other avermectin-treatment groups, nematode counts were not significantly reduced compared to those in control pigs. These data indicated that anthelmintic activity of ivermectin against A. suum persisted for less than 7 days and the activity of doramectin persisted for more than 7, but less than 14 days.

Adding zinc to prenatal iron and folate tablets improves fetal neurobehavioral development.

OBJECTIVE: Our objective was to examine whether improvement in maternal zinc status during pregnancy is positively associated with fetal neurobehavioral development in a Peruvian population. STUDY DESIGN: We electronically monitored, at 32 and 36 weeks' gestation, 55 fetuses whose mothers were randomly assigned to receive, during pregnancy, a daily supplement containing 60 mg iron and 250 microg folate, with or without 15 mg zinc. Fetal heart rate and movement patterns were quantified in 55 and 34 fetuses, respectively, as indexes of neurobehavioral development. RESULTS: Fetuses of mothers who received zinc supplementation showed fewer episodes of minimal fetal heart rate variability, increased fetal heart rate range, an increased number of accelerations, an increased number of movement bouts, an increased amount of time spent moving, and an increased number of large movements. Differences by supplementation type increased with gestational age and were statistically significant at 36 weeks' gestation (P <.05). CONCLUSION: Improving maternal zinc status through prenatal supplementation may improve fetal neurobehavioral development.