Scientific basis for information on pregnancy
Pharmacological Interventions for Women with Decreased Fertility
Infertility treatment is often covered in the media for its painfulness and experiences, but it is not just a psychological problem, and the harmful effects of interventions are also a concern. This section introduces the evidence of pharmacological interventions in this context.
Studies
Nineteen studies were included, with a total of 1,937,880 participants.
In six eligible studies that included infertile women without a general population control group, exposure to ovarian stimulants was not associated with an increased risk of endometrial cancer. Fifteen eligible studies using the general population as a control group found an increased risk after exposure to ovarian stimulants.
Five eligible studies (92,849 participants) restricted to women with infertile fertility reported on exposure to clomiphene citrate.
The pooled studies showed a positive association.
Four studies found an increased risk of endometrial cancer in infertile women requiring clomiphene citrate compared to a general population control group.
These data do not tell us whether the association is due to the underlying condition requiring clomiphene or to the treatment itself. Using non-exposed, reproductively intact women as controls, exposure to gonadotropins was associated with an increased risk of endometrial cancer.
CONCLUSIONS.
The synthesis of the currently available evidence does not allow us to draw robust conclusions because the quality of the evidence is very low. Exposure to clomiphene citrate as an ovarian stimulant in women who have difficulty conceiving appears to be associated with an increased risk of endometrial cancer, especially in cycles with doses above 2000 mg (>7). This may be primarily due to potential risk factors in women who require treatment with clomiphene citrate, such as polycystic ovary syndrome, rather than exposure to the drug itself. The evidence for exposure to gonadotropins was inconclusive.
Skalkidou A, Sergentanis TN, Gialamas SP, Georgakis MK, Psaltopoulou T, Trivella M, Siristatidis CS, Evangelou E, Petridou E. Women treated with ovarian stimulants for infertility Risk of endometrial cancer in Cochrane Database of Systematic Reviews 2017, Issue 3. art. No.: CD010931. doi: 10.1002 / 14651858.CD010931.pub2.
Getting people to use contraception.
There is a study investigating interventions to reduce the risk of sexually transmitted infections and other diseases, rather than family planning.
The interventions are not that unusual, and are available to anyone with a scientific basis. But what are the results of the intervention itself?
The studies
We included 10 new studies, for a total of 25.
Five were conducted outside the United States.
Five, based on social cognitive theory, addressed the prevention of adolescent pregnancy and were one to two years in length.
The comparisons were usual care or education.
Adolescent mothers with a home-based curriculum had a second fewer births in two years. After 12 months of the school-based curriculum, the intervention group was more likely to report using an effective contraceptive method and to use a condom during their last sexual intercourse. Four of the nine studies used motivational interviewing (MI); in three studies, the comparison group received a handout.
The MI group reported more frequent effective use of contraception at 9 months.
Conclusion.
The overall quality of the results of the review was moderate; SCT-based trials focused on teens and offered many sessions; those using MI were a broader age range, but a special population; and the SCT-based trials focused on teenagers and offered many sessions. Sites with few resources need a program that can work in their settings and with regular clients. Reports could be clearer on how theory was used in the design and implementation of the program.
Lopez LM, Gray TW, Chen M, Torrey EE, Stockton LL. Theory-based interventions for contraception.Cochrane Database of Systematic Reviews 2016, Issue11. art. No.: CD007249. doi: 10.1002 / 14651858.CD007249.pub5.
Pregnancy and Aspirin.
It seems that aspirin is sometimes the drug of choice for treatment to improve pregnancy rates. However, no conclusions have been drawn about aspirin itself and its effect on pregnancy rates. However, there is no conclusion as to whether or not aspirin itself has any effect on pregnancy rates, so here is a study that investigates this issue.
The study
This search identified 13 trials with a total of 2653 participants with an average age of 35 years as eligible for inclusion in the review.
Ten studies used a dose of 100 mg per day and three studies used 80 mg aspirin.
In most of them, aspirin was started immediately after the start of downregulation, but the duration of treatment varied widely.
Eight studies provided a placebo for a control group.
There was no evidence of a difference between the aspirin group and the group that did not receive treatment or placebo in live birth rates.
In addition, clinical pregnancy rates were similar between the two groups.
Sensitivity analyses, excluding studies with a high risk of bias, did not change the effect estimates.
There was no evidence of a difference in ultrasound-confirmed multiple pregnancies between the groups.
The overall quality of the evidence ranged from very low to moderate. Limitations were inadequate reporting of study methods and suspected publication bias.
Conclusion.
Currently, there is no evidence to support the routine use of aspirin to improve pregnancy rates in the general IVF population. This is based on data from a randomized controlled trial. In this trial, there is no evidence of an effect of aspirin on women currently on ART, as there is no single outcome measure to show an effect of aspirin use. Furthermore, the current evidence does not rule out the possibility of adverse effects.
Siristatidis CS, Basios G, Pergialiotis V, Vogiatzi P. Aspirin for in vitro fertilization.Cochrane Database of Systematic Reviews 2016, Issue11. art. No.: CD004832 DOI: 10.1002 / 14651858.CD004832.pub4.
Nutrients to prevent miscarriage
In this article, I will talk about miscarriage prevention. I'm sure you've heard of it, but I've never heard of it. If we can prevent such an event, even if only a little.
That's why there was a research on a prevention plan that was being tested in terms of "nutritional management" that could be done on a daily basis.
What does the study say?
From a Cochrane review published in 2016.
It included a total of 40 trials (including 276,820 women and 278,413 pregnancies) assessing vitamin supplementation, starting before 20 weeks gestation and reporting at least one primary outcome that was eligible for review.
Eight trials were cluster-randomized, providing data on a total of 217,726 women and 219,267 pregnancies.
Vitamin C supplementation
There was no difference in the risk of total fetal loss.
(Risk ratio (RR) 1.14, 95% confidence interval (CI) 0.92-1.40, 7 trials, 18,949 women; high quality evidence)
compared with placebo or vitamin C groups.
among women who received other combinations of vitamin C.
There was no clear difference in the risk of total fetal loss or miscarriage among women who received other combinations of vitamin C compared to placebo or vitamin C groups.
Vitamin A supplementation
There was no difference in the risk of total fetal loss.
(RR 1.01, 95% CI 0.61 to 1.66, 3 trials, 1640 women; low quality evidence)
There was no evidence of a difference in the risk of total fetal loss or miscarriage among women who received other combinations of vitamin A compared with the placebo or vitamin A groups.
Comprehensive vitamin supplementation
There was evidence of a reduced risk of stillbirth among women who received multivitamins and iron and folic acid compared to the iron and folic acid only group.
(RR 0.92, 95% CI 0.85 to 0.99, 10 trials, 79,851 women; high quality evidence)
There was a lower rate of total fetal loss in women who received multivitamins without folic acid, but
(RR 0.49, 95% CI 0.34 to 0.70, 1 trial, 907 women)
With or without vitamin A
(RR 0.60, 95% CI 0.39 to 0.92, 1 trial, 1074 women)
However, caution should be exercised in interpretation because some studies included women receiving either vitamin A or placebo in the comparison group.
There was no evidence of a difference in the risk of total fetal loss or miscarriage among women who received other combinations of multivitamins compared to the placebo, folic acid, or vitamin A groups.
Folic Acid Supplementation
with or without multivitamins and/or iron, compared with women without folic acid.
There was no evidence of a difference in the risk of total fetal loss, premature birth or miscarriage, stillbirth, or congenital malformations among women who supplemented with folic acid.
Antioxidant vitamin supplementation
There was no evidence of a difference in preterm or late miscarriage among women who received antioxidants compared to the low antioxidant group
(RR 1.12, 95% CI 0.24 to 5.29, 1 trial, 110 women)
Results.
Taking vitamin supplements before or during the first trimester of pregnancy does not prevent women from experiencing miscarriage. However, there is evidence that women taking multivitamins, iron and folic acid had a reduced risk of stillbirth. There is not enough evidence to examine the effects of different combinations of vitamins on miscarriage and miscarriage-related outcomes.
Balogun OO, da Silva Lopes K, Ohta E, Takemoto Y, Rambold A, Takegata M, Mori R. Vitamin supplementation for miscarriage prevention. Cochrane Database of Systematic Reviews 2016, No. 5. Number: CD004073. doi: 10.1002 / 14651858.CD004073.pub4.
Pregnant Women and Creatine
Creatine is a nutrient that is used for recovery from fatigue, as you may have heard if you like muscle training. If you are a muscle trainer, you may have heard of creatine. This is not the case, but there seems to be another expectation, so I will introduce the details.
The research is as follows
Creatine is an amino acid derivative, and when phosphorylated (phosphocreatine), it is involved in replenishing adenosine triphosphate (ATP) through the creatine kinase reaction. ATP is the source of energy for the human body to operate. Cells obtain creatine from diets rich in fish, meat, or dairy products, and by endogenous synthesis from the amino acids arginine, glycine, and methionine in a ratio of about 50:50.
Animal studies have shown that when creatine is given to the mother through the diet during pregnancy, it may provide neuroprotection to the fetus. It may be possible to evaluate whether maternally administered creatine during human pregnancy (when there is known, suspected, or possible fetal harm) provides neuroprotection to the fetus, and accordingly reduce the risk of adverse neurodevelopmental outcomes such as cerebral palsy and related disorders.
At this stage?
No randomized controlled trials have been identified for inclusion in this review, so we are unable to comment on the impact on practice. Evidence from animal studies supports a fetal neuroprotective role for creatine when administered to the mother during pregnancy, but there are no published trials evaluating creatine in pregnant women for fetal neuroprotection.
If creatine has been established to be safe for the mother and her fetus, research efforts should first be directed to randomized trials comparing creatine without intervention (ideally using placebo) or with alternative agents (including magnesium sulfate) for fetal neuroprotection (preterm infants) when appropriate. should be followed by studies comparing different regimens of creatine (dosage and duration of exposure).
Dickinson H, Bain E, Wilkinson D, Middleton P, Crowther CA, Walker DW. Creatine for pregnant women for fetal neuroprotection. Cochrane Database of Systematic Reviews 2014, No. 12. Number: CD010846. doi: 10.1002 / 14651858.CD010846.pub2.
Antioxidants against male infertility
There are many different treatments that can be considered to eliminate male infertility. In this article, we will discuss the results of a study on the effects of antioxidants on the body.
What is the content of the study?
The study included 61 studies on a total population of 6264 unfertilized males between the ages of 18 and 65.
18 different oral antioxidants were compared and combined.
Fertility: Antioxidants may lead to increased fertility.
The results assumed a baseline likelihood of birth after placebo or no treatment of 12% in the studies contributing to the analysis of birth rates.
The likelihood after the use of antioxidants is estimated to be between 14% and 26.
However, this result is based on only 124 births from 750 couples in seven relatively small studies. Clinical Pregnancy Rate: Antioxidants may increase and lead to clinical pregnancy rate. If the baseline probability of clinical pregnancy after placebo or no treatment is assumed to be 7%, then
suggest that the probability after antioxidant use is estimated to be between 12% and 26%. This result is based on 105 clinical pregnancies from 786 couples in 11 small studies.
Adverse Events
Miscarriage: Only three studies reported on this outcome, and the incidence was very low.
There was no difference in the rate of miscarriage between the antioxidant group and the placebo or no treatment group.
The findings suggest that in a population of expectant mothers with an expected miscarriage rate of 2%, there is a 1-13% risk of miscarriage after using antioxidants.
However, because the same interventions were compared in insufficient studies, no conclusions could be drawn from the comparison of antioxidants versus antioxidants.
Conclusion.
In this review, low-quality evidence from seven small randomized controlled trials suggests that antioxidant supplementation in men with low fertility may improve fertility in couples attending fertility clinics. Low-quality evidence suggests that it may also increase clinical pregnancy rates. Overall, there is no evidence of a higher risk of miscarriage, although antioxidants may cause milder gastrointestinal upset, but the evidence is of very low quality. For pregnant couples, overall, the current evidence is inconclusive based on the risk of significant bias due to underreporting of randomization methods, negligent reporting of live birth rates and clinical pregnancies, often unclear or high attrition. Inaccuracies are also more common due to low event rates and small overall sample sizes.
Smit RM, Mackenzie-Proctor R, Yazdani A, Stankiewicz MT, Jordan V, Showell MG. Antioxidants for male infertility. Cochrane Database of Systematic Reviews 2019, Issue 3 Number: CD007411. doi: 10.1002 / 14651858.CD007411.pub4.
Fallopian tube lavage for infertility treatment
The study
It included 13 studies involving 2914 women.
Oil-soluble contrast media (OSCM) and no intervention
Findings showed that among women with infertility who had a 17% chance of being pregnant without the intervention
The results suggest that among infertile women with a 17% chance of conceiving without intervention, the rate increases from 29% to 55% with fallopian tube lavage with OSCM. Water-soluble contrast medium (WSCM) versus no intervention
There was no evidence of a difference between the groups.
No evidence of a difference between groups.
These studies were not pooled due to very high heterogeneity and there was no evidence of a difference between the groups in ongoing pregnancy rates.
OSCM and WSCM versus WSCM alone
There was no evidence of a difference in birth rates or ongoing pregnancies between the groups.
There was no evidence of a difference between any of the interventions in the incidence of adverse events, although such events were underreported in most studies.
Conclusion.
Evidence suggests that fallopian tube lavage with oil-soluble contrast media may increase the likelihood of pregnancy and delivery compared with no intervention. Findings of other comparisons were inconclusive due to inconsistencies and lack of statistical power. The evidence on adverse events was insufficient to reach firm conclusions. More robust randomized controlled trials are needed.
Mohiyedeen L, Hardiman A, Fitzgerald C, Hughes E, Mol BWJ, Johnson N, Watson A. Fallopian tube lavage for infertility. Cochrane Database of Systematic Reviews 2015, No. 5. Number: CD003718. doi: 10.1002 / 14651858.CD003718.pub4.
Interventions for unexplained infertility
What's so special about not being able to have children? There was a time in the past when people thought that it was, but with the development of the media and other factors, it has become a commonly recognized problem.
However, with the development of the media, it has become a common problem.
I would like to introduce some of the research that has been done on interventions for such treatment.
Study contents
We included 27 RCTs (4349 pairs) in this systematic review and 24 RCTs (3983 pairs) in the subsequent network meta-analysis.
Ten RCTs, including 2725 pairs, reported births.
There was insufficient evidence of differences between OS, IUI, OS-IUI, or IVF / ICSI and expectant management. Ovarian stimulation (OS), intrauterine insemination (IUI), OS-IUI, and in vitro fertilization (IVF) with or without intracytoplasmic sperm injection (ICSI)
This implies that assuming a 17% chance of delivery after prenatal care, the chances of following OS, IUI, OS-IUI, and IVF are 9% to 28%, 11% to 33%, and 15% to 37. OS-IUI and IVF / ICSI found an increase in fertility compared to expected management.
Eleven RCTs involving 2564 couples reported on multiple pregnancies.
Compared to expectant management / IUI, OS and OS-IUI increased the odds of multiple pregnancies. There was also insufficient evidence between IVF / ICSI and expected management / IUI.
The study results show that there is insufficient evidence of a difference between IVF / ICSI and OS-IUI for moderate / severe ovarian hyperstimulation syndrome (OHSS).
Conclusion.
There is insufficient evidence of a difference in fertility between pregnancy management and the other four interventions (OS, IUI, OS-IUI, and IVF / ICSI). Compared to pregnancy management / IUI, OS may increase the likelihood of multiple pregnancies and OS-IUI may increase the likelihood of multiple pregnancies.As is the evidence of differences in moderate or severe OHSS between IVF / ICSI and OS-IUI, the evidence for differences in pregnancy management between IVF / ICSI and multiple pregnancies is inadequate.
Wang R, Danhof NA, Tjon-Kon-Fat RI, Eijkemans MJC, Bossuyt PMM, Mochtar MH, van der Veen F, Bhattacharya S, Mol BWJ, van Wely M. . Cochrane Database of Systematic Reviews 2019, No. 9. Number: CD012692 DOI: 10.1002 / 14651858.CD012692.pub2.
An Intervention to Prevent and Treat Anxiety in Pregnant Women
The paper I'm going to introduce presents the results of an intervention on anxiety, which occurs in response to pregnancy and other women-specific events.
Perhaps the results are worth putting into practice! It may be a good idea.
What does the research say?
Evaluation of hypnotherapy (1 trial)
Images (5 trials)
Independence training (1 trial)
Yoga (1 trial)
Eight trials (556 participants) evaluating these were included.
Because of the small number of studies per intervention and the variety of outcome measures
Because of the small number of studies per intervention and the variety of outcome measures, we did not conduct a meta-analysis and report the results for each study separately. Compared to usual care, in one study (133 women), imaging had a positive impact on anxiety during labor and may reduce early and mid-trimester anxiety.
In another study, images were shown to have a positive impact on anxiety and depression immediately after delivery. Spontaneous training may be effective in reducing anxiety in women before delivery.
Conclusions.
Psychosomatic interventions may be helpful for anxiety in pregnant women. Based on individual studies, there is some but not strong evidence for the effectiveness of psychosomatic interventions for the management of anxiety during pregnancy. The main limitations of the study were the lack of blinding and insufficient details about the methods used for randomization.
Mark I, Toureche N, Ernst E, Hodnett ED, Blanchet C, Dodin S, Njoya MM. Psychosomatic interventions during pregnancy to prevent or treat anxiety in women. Cochrane Database of Systematic Reviews 2011, No. 7. Number: CD007559. doi: 10.1002 / 14651858.CD007559.pub2.
Countermeasures for nausea and vomiting in early pregnancy.
I feel like this is a women-only story, but my partner is aware of the results of this study. You may be able to help them gently.
What does the study say?
41 studies involving 5449 women.
Acupuncture stimulation
Acupuncture.
Ginger.
Chamomile
Lemon oil
Mint oil
Vitamin B6
Some antiemetics
We conclude from a number of interventions, including these.
Evidence on the efficacy of acupressure, auricular (ear) acupressure and acupuncture stimulation of P 6 points was limited.
Acupuncture (P 6 or traditional) did not show significant benefit to pregnant women.
The use of ginger products may be helpful to women, but evidence of efficacy was limited and inconsistent. Three recent studies support ginger over placebo.
There was only limited evidence from trials supporting the use of pharmacological substances, including vitamin B6.
Doxylamine - pyridoxime and other antiemetics to reduce mild or moderate nausea and vomiting. There was little information on adverse maternal and fetal outcomes and psychological, social or economic outcomes.
Conclusions.
Given the high prevalence of nausea and vomiting in early pregnancy, women and health professionals need clear guidance on effective and safe interventions based on systematically reviewed evidence. There is a lack of high quality evidence to support specific interventions.
Matthews A, Haas DM, Omatuna DP, Dowswell T. Nausea and vomiting in early pregnancy. Cochrane Database of Systematic Reviews 2015, No. 9. Number: CD007575. doi: 10.1002 / 14651858.CD007575.pub4.
Pregnancy and Abdominal Muscle Training
When a woman becomes pregnant, it becomes difficult for her to do the physical activities she could normally do, and there is a concern that her muscle strength will be reduced, so it is recommended that she continue physical activities such as training even after pregnancy.
In such a situation, there was a study investigating whether training that stimulates the rectus abdominis muscle group, if practiced before or during pregnancy, would have an effect during childbirth. The results of this study should help women consider whether they should do abdominal muscle training during pregnancy.
The study
A study was conducted to determine whether heterosexual pregnant women who claimed to have done regular abdominal strength training during the pre- and post-pregnancy periods had a reduced risk of cesarean section, instrumental vaginal delivery, and third- and fourth-degree perineal tears.
The study analyzed 36124 preterm pregnant women who participated in the Norwegian Mother and Child Cohort Study during the period 1999-2009 and answered questions about their main exposures.
Logistic regression analysis was used to evaluate the association between exposure and outcome before pregnancy and at 17 and 30 weeks of gestation. Among the participants, 66.9% reported abdominal strength training before pregnancy, which decreased to 31.2% by the 30th week of pregnancy. According to the results, there is no significant difference in the endpoints associated with childbirth, regardless of whether training was done or not.
Considerations
The question that needs to be considered in this study is whether the women in question are able to properly perform rectus abdominis muscle group training regardless of pregnancy?
Since the study was based on a questionnaire, would the conclusions be different if the intervention method was changed? There are some questions that need to be answered. The activity of the abdominal muscle group during childbirth is not well understood, and it is also unclear whether training is recommended for safety reasons. I've seen it stated that it is not recommended due to the risk to the mother and child, so these results may discourage people from trying it.
Even if the study design changes and the results are altered, it is unlikely that abdominal training will be recommended because women do not want to strain their abdomen during pregnancy. I think so. However, there is a concern that if some people start to do it even when they are pregnant, for reasons such as beauty, they might do it.
Rise E, Bø K, Nystad W. Is there any association between abdominal strength training before and during pregnancy and delivery outcome? Mother and Child Cohort Study. Braz J Phys Ther. 2019;23(2):108-115. doi:10.1016/j.bjpt.2018.06.006
Supplements that don't solve male infertility.
A study conducted by the Eunice Kennedy Shriver National Institute of Child Health and Development (NICHD) found that dietary supplements containing zinc and folic acid, marketed as treatments for male infertility, may not improve pregnancy rates, sperm counts, or sperm function. So-called infertility supplements contain zinc and folic acid, zinc is a mineral essential for spermatogenesis, and previous studies of these nutrients as treatments for male infertility had produced conflicting results.
The study.
included 2,370 couples planning fertility treatment in four U.S. cities and their surrounding areas. Men were randomly assigned and distributed either a supplement containing 5 mg of folic acid and 30 mg of zinc, or a placebo.
Results.
There was no significant difference in birth outcomes between the two groups.
404 (34%) in the supplement group
416 (35%) in the placebo group.
Similarly, the groups did not differ across a variety of measures of sperm health, including sperm movement, shape, and total number.
However, the rate of sperm DNA fragmentation was higher in the supplement group (29.7 percent) compared to the placebo group (27.2 percent). The study suggested that higher rates of sperm DNA fragmentation were associated with infertility.
In addition, gastrointestinal symptoms were the main side effect of the supplement.
Supplement vs. placebo
Abdominal discomfort (6% vs. 3%)
Nausea (4% vs. 2%)
Vomiting (3% vs. 1%)
Schisterman EF, etal. Effect of folic acid and zinc supplementation in men on semen quality and fertility in couples undergoing fertility treatment: a randomized clinical trial. Journal of the American Medical Association. 2019.
Men's behavior in supporting their pregnant partners.
Increasing men's involvement in helping their partners stay healthy during pregnancy has been reported as one way to improve pregnant women's access to and use of health services, including birth preparation and preparing for complications. Men can play a meaningful role in providing pregnant women with the support they need to stay in better health.
In Rwanda, men play a variety of roles, resulting in diverse expectations and responsibilities to support women's health during this time of crisis. This study aimed to examine women's views, perspectives and experiences of men's involvement in maternal health and how this affects their access to and use of maternal health services.
Partner health during pregnancy.
Twenty-one interviews were conducted with pregnant and recently pregnant women in order to understand their views on men's involvement in promoting their health.
The interviews were conducted across five districts in Rwanda, in both rural and urban settings of the country, and data analysis was guided by a thematic analysis approach. A coding scheme was created and transcripts were coded in NVIVO™ software according to conceptual and practical topics that shaped the understanding of men's involvement in maternal care.
Results.
Three main themes emerged from the analysis process that categorized the specific roles men play in maternal health.
1) Facilitating access to maternal health services.
2) Support women's decisions and assist men to access health care as they decide.
3) Evaluate information from multiple sources to assist women in making informed decisions.
In conclusion, the study found that pregnant women experienced one of the above mentioned roles of men to help them make positive decisions and improve their health.
Tuyisenge, G., Crooks, V.A. & Berry, N.S. "He lets me go although he does not go with me": Rwandan women's perceptions of men's roles in maternal health. glob health res policy 6, 2 (2021). Available at: https://doi.org/10.1186/s41256-020-00185-w
Characteristics of a person who can love a fetus during pregnancy
The development of maternal prenatal attachment (MAA) is an important aspect of the transition to motherhood, and early identification of the risk of underdeveloped MAA offers the potential for preventive interventions targeting maternal mental health and the new mother-child relationship.
This study will investigate the relative importance of a broad set of psychosocial, pregnancy-related, and physiological factors measured in the first trimester of pregnancy on the MAA measured in the third trimester of pregnancy.
The study will.
A prospective study was conducted among pregnant women in general practice (GP) in Denmark, and data were obtained in the first and third trimesters from pregnancy health records and electronic questionnaires related to routine general practitioner prenatal care visits. The Maternal Antenatal Attachment Scale (MAAS) was used to assess maternal prenatal attachment, and the relative importance of potential determinants of maternal prenatal attachment was assessed by the relative contribution of each factor to the fit (R 2) calculated from a multivariable regression model.
Results.
The sample consisted of 1328 women and 38.6% of the women were observed to have a low MAA. (Total MAAS ≤ 75) This was further reduced by self-rated poor health, low physical fitness, depression, increasing age, previous childbearing, and higher education, with perceived social support as the most important determinant.
In conclusion, women who are unable to experience psychological and physiological well-being, including social support, may have an underdeveloped MAA.
Ertmann, R.K., Bang, C.W., Kriegbaum, M. et al. What factors are most important for the development of the maternal-fetal relationship? A prospective study among pregnant women in Danish general practice. BMC Psychol 9, 2 (2021). Available at: https://doi.org/10.1186/s40359-020-00499-x
Mother-child bonding and attachment styles
The quality of the mother-child bond is related to the child's future, the literature assumes that the ability to form relationships is a relatively stable trait, and research studies suggest that maternal attachment styles in close adult relationships are related to the mother-child bond. The first year of parenthood is often stressful, and adult attachment styles may be related to parenting stress in the first year after birth. Since such stress may be negatively associated with mother-child bonding, this study will examine the association between maternal adult attachment style and mother-child bonding quality and whether this relationship is mediated by parenting stress.
The study.
comprised 168 women (mean age 31.0 years, SD 4.23 years) whose anxious and avoidant adult attachment dimensions were measured with the Experiences in Close Relationships questionnaire (ECR) between 31 and 41 weeks of gestation. Between 5 and 15 weeks after birth, mother-child bonding and parenting stress were measured with the Maternal Postnatal Attachment Scale (MPAS) and the Parenting Stress Index-Parental Domain (PSI-PD), respectively.
Results.
Both attachment-related avoidance and anxiety are significantly and negatively correlated with mother-child bonding. However, regression analysis showed that only attachment-related avoidance was a significant predictor of mother-child bonding when controlling for demographic variables and maternal mental health history. The relationship between adult attachment style and bonding is mediated by parenting stress, with higher scores of attachment avoidance and anxiety being associated with increased stress, which is associated with lower bonding quality.
In conclusion, people with an avoidant attachment style may have difficulties in bonding with their mothers and children, so it may be necessary to identify the style early and take action.
Nordahl, D., Rognmo, K., Bohne, A. et al. Adult attachment style and maternal-infant bonding: the indirect path of parenting stress. BMC Psychol 8, 58 ( 2020). Available at: https://doi.org/10.1186/s40359-020-00424-2
Leg cramps during pregnancy
What about studies?
The study presented here included five trials involving 352 women.
The trials were of moderate quality.
The only placebo-controlled trial of calcium treatment showed no evidence of benefit. Trials comparing sodium chloride to placebo (odds ratio 0.54, 95% confidence interval 0.23-1.29) and calcium to sodium chloride (odds ratio 1.23, 95% confidence interval 0.47-3.27) showed no evidence of benefit.
Placebo-controlled trials of multivitamins with mineral supplements (odds ratio 0.23, 95% confidence interval 0.05 to 1.01) and magnesium (odds ratio 0.18, 95% confidence interval 0.05 to 0.60) suggested some benefit. The evidence that calcium reduces cramping is weak and seems to depend on a placebo effect.
The evidence for sodium chloride is stronger, but the results of the sodium chloride trials may no longer be relevant because of dietary changes, including increased sodium intake in the general population.
It is impossible to recommend a multivitamin with mineral supplements because it is not clear which, if any, ingredients are helping. If a woman finds cramps bothersome during pregnancy, the best evidence is magnesium lactate or citrate, taken as 5mmol in the morning and 10mmol at night.
Conclusions.
Conclusively, magnesium lactate or citrate seems to be the way to go.
Since it is unclear what other supplements or other substances are working, the best way to proceed is magnesium or citrate. If your diet is based on fruits and vegetables, you can probably get enough of these. If you are pregnant and have no appetite problems, this is something you can consciously eat.
If you don't have an appetite and are thinking of taking supplements, I would recommend consulting with your doctor.
Young G, Jewell D. Interventions for leg cramps in pregnancy. Cochrane Database of Systematic Reviews 2002, No. 1. Number: CD000121. doi: 10.1002 / 14651858.CD000121.
