Andrew S. Thagard

Evaluating effects of self-reported domestic physical activity on pregnancy and neonatal outcomes in "stay at home" military wives.

OBJECTIVE To determine if an association exists between daily physical activity, and pregnancy/neonatal outcomes in stay at home military wives. METHODS This is a prospective observational study of pregnant military wives who do not work outside the home. Participants completed a validated questionnaire of their daily activity from which the average energy expenditure per day (kcal/day) was calculated. Participants were grouped, according to their energy expenditure and assessed for antepartum, intrapartum, and neonatal outcomes. RESULTS There were 55 women (group 1) who expended ≤ 2,200 kcal/day, 77 expended 2,201 to 3,000 kcal/day, and 58 expended ≥ 3,001 kcal/day. Group 1 had the lowest maternal weight at first visit (p < 0.001) and delivery (p < 0.001) and highest percentage of primigravidas (p = 0.002). After adjusting for key maternal characteristics, women in group 1 were more likely to develop gestational diabetes. Although not significant, the women in group 1 had more intrauterine growth restriction and preterm labor whereas group 3 had a greater risk of antepartum hemorrhage. CONCLUSIONS Primigravida women of low weight not working are most likely to use the least energy compared to the heaviest women who use the most calories and are more likely to develop gestational diabetes.

Long-Term Impact of Intrauterine Neuroinflammation and Treatment with Magnesium Sulphate and Betamethasone: Sex-Specific Differences in a Preterm Labor Murine Model

Preterm infants are at significantly increased risk for lifelong neurodevelopmental disability with male offspring disproportionately affected. Corticosteroids (such as betamethasone) and magnesium sulphate (MgSO4) are administered to women in preterm labor to reduce neurologic morbidity. Despite widespread use of MgSO4 in clinical practice, its effects on adult offspring are not well known nor have sex-specific differences in therapeutic response been explored. The objective of our study was to examine the long-term effects of perinatal neuroinflammation and the effectiveness of prenatal MgSO4/betamethasone treatments between males and females in a murine model via histologic and expression analyses. Our results demonstrate that male but not female offspring exposed to intrauterine inflammation demonstrated impaired performance in neurodevelopmental testing in early life assessed via negative geotaxis, while those exposed to injury plus treatment fared better. Histologic analysis of adult male brains identified a significant reduction in hippocampal neural density in the injured group compared to controls. Evaluation of key neural markers via qRT-PCR demonstrated more profound differences in gene expression in adult males exposed to injury and treatment compared to female offspring, which largely showed resistance to injury. Prenatal treatment with MgSO4/betamethasone confers long-term benefits beyond cerebral palsy prevention with sex-specific differences in response.

The Role of Extremes in Interpregnancy Interval in Women at Increased Risk for Adverse Obstetric Outcomes Due to Health Disparities: A Literature Review

Background: The interpregnancy interval (IPI) defines the time between two consecutive gestations. In the general population, women with IPIs that fall outside the recommended 18-24 month range appear to be at modestly increased risk for adverse obstetric outcomes. Objective: The aim of this review was to assess the impact of extremes in IPI in populations with an increased baseline risk for adverse obstetric outcomes due to disparities in health and health care, including racial and ethnic groups, adolescents, and those of lower socioeconomic status. Methods: We conducted a MEDLINE/Pubmed literature search in February 2016. Identified articles were reviewed and assigned a level of evidence. Results: The 24 studies included in our final review were mainly retrospective with considerable heterogeneity in definitions and outcomes that prevented a quantitative meta-analysis. Conclusion: The results of our review suggest that at-risk populations may have an increased frequency of shortened IPIs though the impact appears to be moderate and inconsistent. There was insufficient evidence to draw meaningful conclusions regarding a prolonged IPI or the effect of interventions. Based on the current literature, under-served populations are more likely to have a shortened IPI which increased the incidence of prematurity and low birth weight in some groups though the effect on additional obstetric outcomes is difficult to assess

Observations of fetal brain activity via non‐invasive magnetoencephalography following administration of magnesium sulfate for neuroprotection in preterm labor

Cerebral palsy describes a complex, permanent, nonprogressive disorder of movement and posture that affects children born preterm at a disproportionate rate. Multiple randomized controlled trials summarized in meta-analyses demonstrate that administration of magnesium sulfate to women at risk of delivering preterm reduces the chance that their offspring will develop cerebral palsy with a number needed to treat of one in 46–56. Despite widespread clinical use, the precise means by which magnesium sulfate confers neuroprotection remains unknown. Potential mechanisms of action include antioxidant and/or anti-inflammatory effects, promoting hemodynamic stability, by preventing neuronal excitatory injury and by suppressing alterations in both the neuronal and nuclear membranes. If magnesium sulfate works in part by protecting neurons from damage from excessive excitatory neurotransmitters such as glutamate, differences in fetal brain activity pre and postmagnesium sulfate administration may be observed. While electroencephalography (EEG) can assess brain activity postnatally and has been used to predict developmental delay and cerebral palsy in infants born preterm, this technology cannot be applied in utero because of the inability of fetal electrocortical signals to be detected on the surface of the maternal abdomen with surface electrodes because of low signal strength. In contrast, magnetoencephalography (MEG) is a technique which is a homologue of EEG can non-invasively record fetal electrocortical signals over the maternal abdomen without being distorted. Therefore, MEG provides a noninvasive method to assess fetal brain activity. The objective of this study was to characterize the differences in fetal brain activity pre and post-magnesium sulfate administration in women diagnosed with preterm labor. This study was approved by the Institutional Review Board at the University of Arkansas for Medical Sciences. Eight women diagnosed with spontaneous preterm labor based on regular uterine contractions and a cervical dilation of at least 2 cm and 80% or less cervical dilation/effacement but with observed cervical change over time were enrolled. Fetal MEG was recorded using a non-invasive 151-channel Superconducting Quantum Interference Device (SQUID) called SARA housed in a magnetically shielded room to reduce the effects of environmental noise. A baseline 30-min fetal MEG was recorded for each patient. After the baseline recording, each patient received an intravenous four gram bolus of magnesium sulfate. Approximately 60min after the infusion, a second 30-min MEG was obtained. Interfering maternal and fetal heart-signal components were removed by applying an orthogonalprojection algorithm. The data from each sensor was partitioned into disjointed time windows of 2 s, and the power spectrum in each window was computed. The power spectral estimate was defined as the average of the spectra over all the time windows. Estimated spectrum was averaged over all the sensors. Any interference from the power-line was removed by using a notch filter. The resulting spectrum from each recording was divided into difference bands: delta (0.5–4Hz), theta (4–8Hz), alpha (8–13Hz) and beta (13–25Hz). In each band, relative power (RP) was defined as the ratio of the average power in that band to the average power in the range from 0.5 to 50Hz. The power in each of the frequency bands was compared for pre and post magnesium sulfate administration. Statistical analysis was determined via one-way ANOVA. Fetal MEG activity was successfully recorded in seven of the eight subjects with a gestational age ranging from 27 to