Pregnancy and postnatal mental health

فَٱلۡحَٰمِلَٰتِ وِقۡرࣰ ا

and those that are heavily laden

and those that bear the clouds that bear moisture as a burden wiqran is the direct object of al-hāmilat ‘those that bear’;

بِسْمِ اللَّهِ الرَّحْمَٰنِ الرَّحِيمِ In the Name of Allah, the Most Gracious, the Most Merciful. وَالذَّارِيَاتِ ذَرْوًا - فَالْحَامِلَاتِ وِقْرًا - فَالْجَارِيَاتِ يُسْرًا - فَالْمُقَسِّمَاتِ أَمْرًا - إِنَّمَا تُوعَدُونَ لَصَادِقٌ - وَإِنَّ الدِّينَ لَوَاقِعٌ - وَالسَّمَاءِ ذَاتِ الْحُبُكِ - إِنَّكُمْ لَفِي قَوْلٍ مُخْتَلِفٍ - يُؤْفَكُ عَنْهُ مَنْ أُفِكَ - قُتِلَ الْخَرَّاصُونَ - الَّذِينَ هُمْ فِي غَمْرَةٍ سَاهُونَ - يَسْأَلُونَ أَيَّانَ يَوْمُ الدِّينِ - يَوْمَ هُمْ عَلَى النَّارِ يُفْتَنُونَ - ذُوقُوا فِتْنَتَكُمْ هَٰذَا الَّذِي كُنْتُمْ بِهِ تَسْتَعْجِلُونَ (1. By the scattering Dhariyat;)(2. And the laden Hamilat;)(3. And the steady Jariyat;)(4. And the distributors of command,)(5. Verily, that which you are promised is surely true.)(6. And verily, Ad-Din is sure to occur.)(7. By the heaven full of Hubuk,)(8. Certainly, you have different ideas.)(9. Turned aside therefrom is

حَدَّثَنِي إِسْحَاقُ بْنُ نَصْرٍ، حَدَّثَنَا أَبُو أُسَامَةَ، قَالَ حَدَّثَنِي بُرَيْدٌ، عَنْ أَبِي بُرْدَةَ، عَنْ أَبِي مُوسَى ـ رضى الله عنه ـ قَالَ وُلِدَ لِي غُلاَمٌ، فَأَتَيْتُ بِهِ النَّبِيَّ صلى الله عليه وسلم فَسَمَّاهُ إِبْرَاهِيمَ، فَحَنَّكَهُ بِتَمْرَةٍ، وَدَعَا لَهُ بِالْبَرَكَةِ وَدَفَعَهُ إِلَىَّ، وَكَانَ أَكْبَرَ وَلَدِ أَبِي مُوسَى‏.‏

Narrated Abu Musa:A son was born to me and I took him to the Prophet (ﷺ) who named him Ibrahim, did Tahnik for him with a date, invoked Allah to bless him and returned him to me. (The narrator added: That was Abu Musa's eldest son)

حَدَّثَنَا مُسَدَّدٌ، حَدَّثَنَا يَحْيَى، عَنْ هِشَامٍ، عَنْ أَبِيهِ، عَنْ عَائِشَةَ ـ رضى الله عنها ـ قَالَتْ أُتِيَ النَّبِيُّ صلى الله عليه وسلم بِصَبِيٍّ يُحَنِّكُهُ، فَبَالَ عَلَيْهِ، فَأَتْبَعَهُ الْمَاءَ‏.‏

Narrated `Aisha:A boy was brought to the Prophet (ﷺ) to do Tahnik for him, but the boy urinated on him, whereupon the Prophet had water poured on the place of urine

أَخْبَرَنَا أَحْمَدُ بْنُ سُلَيْمَانَ، قَالَ حَدَّثَنَا أَبُو نُعَيْمٍ، قَالَ حَدَّثَنَا دَاوُدُ بْنُ قَيْسٍ، عَنْ عَمْرِو بْنِ شُعَيْبٍ، عَنْ أَبِيهِ، عَنْ جَدِّهِ، قَالَ سُئِلَ رَسُولُ اللَّهِ صلى الله عليه وسلم عَنِ الْعَقِيقَةِ فَقَالَ ‏"‏ لاَ يُحِبُّ اللَّهُ عَزَّ وَجَلَّ الْعُقُوقَ ‏"‏ ‏.‏ وَكَأَنَّهُ كَرِهَ الاِسْمَ قَالَ لِرَسُولِ اللَّهِ صلى الله عليه وسلم إِنَّمَا نَسْأَلُكَ أَحَدُنَا يُولَدُ لَهُ ‏.‏ قَالَ ‏"‏ مَنْ أَحَبَّ أَنْ يَنْسُكَ عَنْ وَلَدِهِ فَلْيَنْسُكْ عَنْهُ عَنِ الْغُلاَمِ شَاتَانِ مُكَافَأَتَانِ وَعَنِ الْجَارِيَةِ شَاةٌ ‏"‏ ‏.‏ قَالَ دَاوُدُ سَأَلْتُ زَيْدَ بْنَ أَسْلَمَ عَنِ الْمُكَافَأَتَانِ قَالَ الشَّاتَانِ الْمُشَبَّهَتَانِ تُذْبَحَانِ جَمِيعًا ‏.‏

It was narrated from 'Amr bin Shuaib, from his fahther, that his grandfather said:"The messenger of Allah was asked about the 'Aqiqah and he said: "Allah, the mighty and sublime, does not like Al-Uquq' as if he disliked the word (Al-Aqiqah). He said to the Messenger of Allah: 'But one of us may offer a sacrifice when a child is born to him.' He said: 'Whoever wants to offer a sacrifice for his child, let him do so, for a boy; two sheep, Mukafaatan, (of equal age), and for a girl, one.' (One of the narrators) Dawud said: 'I asked Ziad bin Aslam about the word Mukafaatan and he said: 'Two similar sheep that are slaughtered together

أَخْبَرَنَا الْحُسَيْنُ بْنُ حُرَيْثٍ، قَالَ حَدَّثَنَا الْفَضْلُ، عَنِ الْحُسَيْنِ بْنِ وَاقِدٍ، عَنْ عَبْدِ اللَّهِ بْنِ بُرَيْدَةَ، عَنْ أَبِيهِ، أَنَّ رَسُولَ اللَّهِ صلى الله عليه وسلم عَقَّ عَنِ الْحَسَنِ وَالْحُسَيْنِ ‏.‏

It was narrated from 'Abdullah bin Buraidah, from his father, that:the Messenger of Allah offered the 'Aqiqah for Al-Hasan and Al-Husain

حَدَّثَنَا أَحْمَدُ بْنُ مَنِيعٍ، حَدَّثَنَا إِسْمَاعِيلُ بْنُ إِبْرَاهِيمَ، حَدَّثَنَا عَلِيُّ بْنُ زَيْدٍ، عَنْ سَعِيدِ بْنِ الْمُسَيَّبِ، عَنْ عَلِيِّ بْنِ أَبِي طَالِبٍ، قَالَ قَالَ رَسُولُ اللَّهِ صلى الله عليه وسلم ‏ "‏ إِنَّ اللَّهَ حَرَّمَ مِنَ الرَّضَاعِ مَا حَرَّمَ مِنَ النَّسَبِ ‏"‏ ‏.‏ قَالَ وَفِي الْبَابِ عَنْ عَائِشَةَ وَابْنِ عَبَّاسٍ وَأُمِّ حَبِيبَةَ ‏.‏ قَالَ أَبُو عِيسَى حَدِيثُ عَلِيٍّ حَسَنٌ صَحِيحٌ ‏.‏

Ali (bin Abi Talib) narrated that The Messenger of Allah said:“Indeed Allah has made unlawful through suckling whatever He made unlawful through lineage.”

حَدَّثَنَا بُنْدَارٌ، حَدَّثَنَا يَحْيَى بْنُ سَعِيدٍ الْقَطَّانُ، حَدَّثَنَا مَالِكٌ، ح وَحَدَّثَنَا إِسْحَاقُ بْنُ مُوسَى الأَنْصَارِيُّ، قَالَ حَدَّثَنَا مَعْنٌ، قَالَ حَدَّثَنَا مَالِكٌ، عَنْ عَبْدِ اللَّهِ بْنِ دِينَارٍ، عَنْ سُلَيْمَانَ بْنِ يَسَارٍ، عَنْ عُرْوَةَ بْنِ الزُّبَيْرِ، عَنْ عَائِشَةَ، قَالَتْ قَالَ رَسُولُ اللَّهِ صلى الله عليه وسلم ‏ "‏ إِنَّ اللَّهَ حَرَّمَ مِنَ الرَّضَاعَةِ مَا حَرَّمَ مِنَ الْوِلاَدَةِ ‏"‏ ‏.‏ قَالَ أَبُو عِيسَى هَذَا حَدِيثٌ حَسَنٌ صَحِيحٌ ‏.‏ وَالْعَمَلُ عَلَى هَذَا عِنْدَ أَهْلِ الْعِلْمِ مِنْ أَصْحَابِ النَّبِيِّ صلى الله عليه وسلم وَغَيْرِهِمْ لاَ نَعْلَمُ بَيْنَهُمْ فِي ذَلِكَ اخْتِلاَفًا ‏.‏

Aishah narrated that the Messenger of Allah said:“Indeed Allah has made unlawful through suckling whatever He made unlawful through birth.”

الخامسة أن تمتنع المرأة لتعززها ومبالغتها في النظافة والتحرز من الطلق والنفاس والرضاع وكان ذلك عادة نساء الخوارج لمبالغتهن في استعمال المياه حتى كن يقضين صلوات أيام الحيض ولا يدخلن الخلاء إلا عراة فهذه بدعة تخالف السنة فهي نية فاسدة واستأذنت واحدة منهن على عائشة رضي الله عنها لما قدمت البصرة فلم تأذن لها فيكون القصد هو الفاسد دون منع الولادة

لها حمل ووضع فهي دائما في حمل وولادة فإذا اذن لها ربها في الحمل احتبست الحرارة الطبيعية في داخلها واختبأت فيها ليكون فيها حملها في الوقت المقدر لها فيكون ذلك الوقت بمنزلة وقت العلوق ومبدأ تكوين النطف فتعمل المادة في اجوافها عملها وتهيئها للعلوق حتى إذا آن وقت الحمل دب فيها الماء فلانت اعطافها وتحركت للحمل وسرى الماء في افنانها وانتشرت فيها الحرارة والرطوبة حتى إذا آن وقت الولادة كسيت من سائر الملابس الفاخرة من النور والورق ما تتبخر فيه وتميس به وتفخر على العقيم فإذا ظهرت اولادها وبان للناظر حملها علم حينئذ كرمها وطيبها من لؤمها وبخلها فتولى تغذية ذلك الحمل من تولى غذاء الاجنحة في بطون امهاتها وكساها الاوراق وصانها من الحر والبرد فإذا تكامل الحمل وآن وقت الفطام تدلت اليك أفنانها كأنما تناولك ثمرة درها فإذا قابلتها رايت الافنان كأنها تلقاك بأولادها وتحييك وتكرمك بهم وتقدمهم اليك حتى كأن منا ولا يناولك إياهم بيده ولا سيما قطوف جنات النعيم الدانية التي يتناولها المؤمن قائما وقاعدا ومضطجعا وك

سمعت شيخ الإسلام ابن تيمية رحمه الله يذكر ذلك ويفسره بأن الولادة نوعان أحدهما هذه المعروفة والثانية ولادة القلب والروح وخروجهما من مشيمة النفس وظلمة الطبع

قال وهذه الولادة لما كانت بسبب الرسول كان كالأب للمؤمنين وقد قرأ أبي بن كعب رضي الله عنه @QB@ النبي أولى بالمؤمنين من أنفسهم @QE@ وهو أب لهم

وسمعت شيخ الإسلام ابن تيمية رحمه الله يقول هي ولادة الأرواح والقلوب من الأبدان وخروجها من عالم الطبيعة كما ولدت الأبدان من البدن وخرجت منه والولادة الأخرى هي الولادة المعروفة والله أعلم

الحادى عشر: فى آداب الولادة، وهى ستة:

Benefits of Physical Activity during Pregnancy and Postpartum: An Umbrella Review.: Purpose: This study aimed to summarize the evidence from the 2018 Physical Activity Guidelines Advisory Committee Scientific Report, including new evidence from an updated search of the effects of physical activity on maternal health during pregnancy and postpartum. Methods: An initial search was undertaken to identify systematic reviews and meta-analyses published between 2006 and 2016. An updated search then identified additional systematic reviews and meta-analyses published between January 2

Effectiveness of expressive writing therapy for postpartum women with psychological distress: Meta-analysis and narrative review.: Background: The increasing prevalence of psychological distress among mothers is outpacing the effectiveness of conventional coping methods like cognitive behavioral therapy. The efficacy of alternatives such as writing therapy for maternal psychological well-being remains uncertain due to a lack of extensive research and inconsistent findings. Objective: The aim of this study was to evaluate the effectiveness of expressive writing therapy in comparison to standard postpartum care for alleviatin

A systematic review of telephone support for women during pregnancy and the early postpartum period.: Objective: To assess the effects of telephone-based support on smoking, preterm birth, low birthweight, breastfeeding, and postpartum depression. Data sources: Cochrane Pregnancy and Childbirth Group trials register (March 2006), Cochrane Central Register of Controlled Trials (March 2006), Medline (1966-2006), EMBASE (1980-2006), and CINAHL (1982-2006). Secondary references were scanned and experts in the field were contacted. Study selection: All published, unpublished, and ongoing randomized c

Factors Influencing Paternal Postpartum Depression: A Systematic Review and Meta-Analysis.: Background: Postpartum period is a critical time that requires adjustments not only for mothers but also for fathers and may pose risk for depression. Studies show that the prevalence of paternal postpartum depression (PPD) is between 1.2% and 25.5%. PPD is an under-recognized public health issue and its reported influencing factors are still inconclusive. Objective: The purpose of this paper is to extend the literature by examining influencing factors that affect paternal PPD and describe the s

Impact of postpartum physical activity on maternal depression and anxiety: a systematic review and meta-analysis.: Objective: To examine the influence of postpartum exercise on maternal depression and anxiety. Design: Systematic review with random effects meta-analysis and meta-regression. Data sources: Online databases up to 12 January 2024, reference lists, recommended studies and hand searches. Eligibility criteria: Randomised controlled trials (RCTs) and non-randomised interventions of any publication date or language were included if they contained information on the Population (postpartum people), Inte

Associations between maternal psychological distress and mother-infant bonding: a systematic review and meta-analysis.: Purpose: Maternal psychological distress and mother-infant bonding problems each predict poorer offspring outcomes. They are also related to each other, yet the extensive literature reporting their association has not been meta-analysed. Methods: We searched MEDLINE, PsycINFO, CINAHL, Embase, ProQuest DTG, and OATD for English-language peer-reviewed and grey literature reporting an association between mother-infant bonding, and multiple indicators of maternal psychological distress. Results: We

Maternal Immune Activation and Neuropsychiatric Illness: A Translational Research Perspective.

Epidemiologic studies, including prospective birth cohort investigations, have implicated maternal immune activation in the etiology of neuropsychiatric disorders. Maternal infectious pathogens and inflammation are plausible risk factors for these outcomes and have been associated with schizophrenia, autism spectrum disorder, and bipolar disorder. Concurrent with epidemiologic research are animal models of prenatal immune activation, which have documented behavioral, neurochemical, neuroanatomic, and neurophysiologic disruptions that mirror phenotypes observed in these neuropsychiatric disorders. Epidemiologic studies of maternal immune activation offer the advantage of directly evaluating human populations but are limited in their ability to uncover pathogenic mechanisms. Animal models, on the other hand, are limited in their generalizability to psychiatric disorders but have made signi…

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The phenomenon of pregnancy - a psychological view.

Pregnancy is a very specific and complex period in a woman's life. The accompanying changes are observed not only on the biological/physiological plane but also in her psychological and social functioning. Altered psychological functioning can occur from the very beginning to the end of pregnancy, including the postpartum period. During pregnancy, visible changes occur in the body's appearance, as well as in femininity, affections, and sexuality, whereas the woman's position and role are gaining new qualities. To a greater or lesser degree, every expectant mother experiences psychological am-bivalence, frequent mood changes from exhaustion to exaltation, emotional disturbances, and/or mixed anxiety-depressive disorder. In addition, pregnancy causes a number of specific apprehensions concerning the course and outcome, which makes the woman particularly vulnerable and requires adequate tre…

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Obesity and pregnancy: mechanisms of short term and long term adverse consequences for mother and child.

Obesity is the most common medical condition in women of reproductive age. Obesity during pregnancy has short term and long term adverse consequences for both mother and child. Obesity causes problems with infertility, and in early gestation it causes spontaneous pregnancy loss and congenital anomalies. Metabolically, obese women have increased insulin resistance in early pregnancy, which becomes manifest clinically in late gestation as glucose intolerance and fetal overgrowth. At term, the risk of cesarean delivery and wound complications is increased. Postpartum, obese women have an increased risk of venous thromboembolism, depression, and difficulty with breast feeding. Because 50-60% of overweight or obese women gain more than recommended by Institute of Medicine gestational weight guidelines, postpartum weight retention increases future cardiometabolic risks and prepregnancy obesity…

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Neurodevelopment: The Impact of Nutrition and Inflammation During Preconception and Pregnancy in Low-Resource Settings.

The rapid pace of fetal development by far exceeds any other stage of the life span, and thus, environmental influences can profoundly alter the developmental course. Stress during the prenatal period, including malnutrition and inflammation, impact maternal and fetal neurodevelopment with long-term consequences for physical and mental health of both the mother and her child. One primary consequence of maternal malnutrition, inflammation, and other sources of prenatal stress is a poor birth outcome, such as prematurity or growth restriction. These phenotypes are often used as indications of prenatal adversity. In fact, the original evidence supporting the fetal programming hypothesis came from studies documenting an association between birth phenotype and the development of subsequent physical and mental health problems. Fetal growth restriction in both term and preterm infants is associ…

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Does Insulin Explain the Relation between Maternal Obesity and Poor Lactation Outcomes? An Overview of the Literature.

It is well established that obese women are at increased risk of delayed lactogenesis and short breastfeeding duration, but the underlying causal contributors remain unclear. This review summarizes the literature examining the role of insulin in lactation outcomes. Maternal obesity is a strong risk factor for insulin resistance and prediabetes, but until recently a direct role for insulin in milk production had not been elucidated. Over the past 6 y, studies in both animal models and humans have shown insulin-sensitive gene expression to be dramatically upregulated specifically during the lactation cycle. Insulin is now considered to play a direct role in lactation, including essential roles in secretory differentiation, secretory activation, and mature milk production. At the same time, emerging clinical research suggests an important association between suboptimal glucose tolerance and…

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Programming of maternal and offspring disease: impact of growth restriction, fetal sex and transmission across generations.

Babies born small are at an increased risk of developing myriad adult diseases. While growth restriction increases disease risk in all individuals, often a second hit is required to unmask 'programmed' impairments in physiology. Programmed disease outcomes are demonstrated more commonly in male offspring compared with females, with these sex-specific outcomes partly attributed to different placenta-regulated growth strategies of the male and female fetus. Pregnancy is known to be a major risk factor for unmasking a number of conditions and can be considered a 'second hit' for women who were born small. As such, female offspring often develop impairments of physiology for the first time during pregnancy that present as pregnancy complications. Numerous maternal stressors can further increase the risk of developing a maternal complication during pregnancy. Importantly, these maternal compl…

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Developmental origins of health and disease--global public health implications.

The rapidly rising prevalence of non-communicable diseases (NCDs) represents a major challenge to public health and clinical medicine globally. NCDs are increasing rapidly in high-income countries, but even more rapidly in some low-middle-income countries with insufficient resources to meet the challenge. Whilst not identified in the Millennium Development Goals, there is much attention paid to NCDs in the discussions at many levels on the Sustainable Development Goals, as they underpin economic, social and environmental development in the post-2015 era. In this article, we discuss how a life-course approach to health, commencing of necessity in early development, can provide new opportunities for addressing this challenge. The approach can leverage human health capital throughout life and across generations. New insights into mechanisms, especially those processes by which the developme…

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Sleep-disordered breathing in pregnancy: a review of the physiology and potential role for positional therapy.

Background: Sleep disordered breathing (SDB) has been shown to be associated with negative clinical sequelae such as systemic hypertension and cardiovascular disease. It has been reported in the literature that approximately 53-56 % of patients with obstructive sleep apnea (OSA) have positional OSA, known as POSA. Potential treatment for sdb in pregnancy: These findings have led to a resurgence of positional therapy as an effective treatment for select patients with SDB. Pregnant patients can also be diagnosed with SDB, the negative consequences of which not only pertain to the patient but to the unborn fetus as well. Despite this, however, SDB is under-diagnosed in pregnant patients and research looking at SDB in pregnant patients and potential therapies are scarce. Conclusions: This article reviews the literature regarding the physiologic respiratory changes that occur during pregnancy…

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Chronic sleep loss during pregnancy as a determinant of stress: impact on pregnancy outcome.

Short sleep duration, poor sleep quality, and insomnia frequently characterize sleep in pregnancy during all three trimesters. We aimed: (i) to review the clinical evidence of the association between conditions of sleep loss during pregnancy and adverse pregnancy outcomes; and (ii) to discuss the potential pathophysiological mechanisms that may be involved. A systematic search of cross-sectional, longitudinal studies using Medline, Embase, and PsychINFO, and MeSH headings and key words for conditions of sleep loss such as 'insomnia', 'poor sleep quality', 'short sleep duration', and 'pregnancy outcome' was made for papers published between January 1, 1960 and July 2013. Twenty studies met inclusion criteria for sleep loss and pregnancy outcome: seven studies on prenatal depression, three on gestational diabetes, three on hypertension, pre-eclampsia/eclampsia, six on length of labor/type …

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Screening for substance abuse in women's health: a public health imperative.

Alcohol and drug use is a significant public health problem with particular implications for the health and safety of women. Women who abuse these substances are more likely to have untreated depression and anxiety and are at higher risk for intimate partner violence, homelessness, incarceration, infectious disease, and unplanned pregnancy. Substance abuse during pregnancy places both mother and fetus at risk for adverse perinatal outcomes. Data regarding the prevalence of substance abuse in women are conflicting and difficult to interpret. On the clinical level, strong arguments exist against routine urine drug testing and in favor of the use of validated instruments to screen women for drug and alcohol use both in primary women's health care and during pregnancy. A number of sex-specific screening tools are available for clinicians, some of which have also been validated for use during…

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Glucocorticoid excess and the developmental origins of disease: two decades of testing the hypothesis--2012 Curt Richter Award Winner.

Low birthweight, a marker of an adverse in utero environment, is associated with cardiometabolic disease and brain disorders in adulthood. The adaptive changes made by the fetus in response to the intra-uterine environment result in permanent changes in physiology, structure and metabolism, a phenomenon termed early life programming. One of the key hypotheses to explain programming, namely over exposure of the developing fetus to glucocorticoids, was proposed nearly two decades ago, following the observation that the fetus was protected from high glucocorticoid levels in the mother by the actions of the placental barrier enzyme, 11β-hydroxysteroid dehydrogenase, which converts active glucocorticoids into inactive products. Numerous mechanistic studies in animal models have been carried out to test this hypothesis using manipulations to increase maternal glucocorticoids. Overall, these ha…

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Methadone and buprenorphine for the management of opioid dependence in pregnancy.

This article provides an overview and discussion of the collective maternal, fetal and neonatal outcome research on women maintained on methadone or buprenorphine during pregnancy. Its focus is on an assessment of the comparative effectiveness of methadone and buprenorphine pharmacotherapy, with particular attention given to recent findings from the literature. Recommendations for clinical practice are outlined, and directions for future research are presented. Findings from comparative studies of methadone and buprenorphine underscore the efficacy of both medications in preventing relapse to illicit opioid use in the treatment of opioid-dependent pregnant patients, as well as the simplicity of induction onto methadone and patient retention while receiving such therapy. Fetal monitoring suggests that buprenorphine results in less fetal cardiac and movement suppression than does methadone…

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The implications of Ramadan fasting for human health and well-being.

Unlabelled: Islamic Ramadan is a 29-30 day fast in which food, fluids, medications, drugs and smoking are prohibited during the daylight hours which can be extended between 13 and 18 h · day(-1) depending on the geographical location and season. The majority of health-specific findings related to Ramadan fasting are mixed. The likely causes for these heterogeneous findings lie in the amount of daily time of fasting, number of subjects who smoke, take oral medications, and/or receive intravenous fluids, in the type of food and eating habits and in changes in lifestyle. During Ramadan fasting, glucose homeostasis is maintained by meals taken during night time before dawn and by liver glycogen stores. Changes in serum lipids are variable and depend on the quality and quantity of food intake, physical activity and exercise, and changes in body weight. Compliant, well-controlled type II diabe…

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Next steps in obesity prevention: altering early life systems to support healthy parents, infants, and toddlers.

There is an urgent need for effective, sustainable child obesity prevention strategies. Progress toward this goal requires strengthening current approaches to add a component that addresses pregnancy onward. Altering early-life systems that promote intergenerational transmission of obesity holds promise for interrupting the continuing cycle of the obesity epidemic. A 2011 Institute of Medicine (IOM) report emphasizes the need for interventions early in life to prevent obesity. A 2010 IOM report called for addressing gaps in existing obesity research evidence by using a systems perspective, simultaneously addressing interacting obesity promoting factors in multiple sectors and at multiple societal levels. A review of evidence from basic science, prevention, and systems research supports an approach that (1) begins at the earliest stages of development, and (2) uses a systems framework to …

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Omega 3 fatty acids, gestation and pregnancy outcomes.

Pregnancy is associated with a reduction in maternal serum docosahexaenoic acid (DHA, 22:6 n-3) percentage and its possible depletion in the maternal store. Since the synthesis of long chain polyunsaturated fatty acids (LCPUFA) in the fetus and placenta is low, both the maternal LCPUFA status and placental function are critical for their supply to the fetus. Maternal supplementation with DHA up to 1 g/d or 2·7 g n-3 LCPUFA did not have any harmful effect. DHA supplementation in large studies slightly the enhanced length of gestation (by about 2 days), which may increase the birth weight by about 50 g at delivery. However no advice can be given on their general using to avoid preterm deliveries in low or high risk pregnancies. Several studies, but not all, reported improvements of the offspring in some neurodevelopmental tests as a result of DHA supplementation during gestation, or, at le…

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The next generation of disease risk: are the effects of prenatal nutrition transmitted across generations? Evidence from animal and human studies.

Suboptimal intrauterine conditions, including poor nutrition, during critical periods of growth may lead to lifelong changes in the body's organs and tissues, thus providing a physiological basis for adult-onset disease. Remarkably, recent evidence suggests that the long-term consequences of adverse conditions during early development may not be limited to one generation, but may lead to poor health in the generations to follow, even if these individuals develop in normal conditions themselves. For example, the diet of a pregnant mother may affect the development and disease risk of her children and even her grandchildren. There is limited evidence for this in humans since studies of multiple generations are difficult to maintain. However, recent animal models have been generated to investigate this phenomenon and will be instrumental in the future for assessing the underlying mechanisms…

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Obesity and women's health: an evidence-based review.

Obesity negatively impacts the health of women in many ways. Being overweight or obese increases the relative risk of diabetes and coronary artery disease in women. Women who are obese have a higher risk of low back pain and knee osteoarthritis. Obesity negatively affects both contraception and fertility as well. Maternal obesity is linked with higher rates of cesarean section as well as higher rates of high-risk obstetrical conditions such as diabetes and hypertension. Pregnancy outcomes are negatively affected by maternal obesity (increased risk of neonatal mortality and malformations). Maternal obesity is associated with a decreased intention to breastfeed, decreased initiation of breastfeeding, and decreased duration of breastfeeding. There seems to be an association between obesity and depression in women, though cultural factors may influence this association. Obese women are at hi…

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The London Position Statement of the World Congress of Gastroenterology on Biological Therapy for IBD with the European Crohn's and Colitis Organisation: pregnancy and pediatrics.

Women with inflammatory bowel disease (IBD) have similar rates of fertility to the general population, but have an increased rate of adverse pregnancy outcomes compared with the general population, which may be worsened by disease activity. Infertility is increased in those undergoing ileal pouch-anal anastomosis. Anti-tumor necrosis factor therapy in pregnancy is considered to be low risk and compatible with use during conception in men and women and during pregnancy in at least the first two trimesters. Infliximab (IFX) and certolizumab pegol are also compatible with breastfeeding, but safety data for adalimumab (ADA) are awaited. The safety of natalizumab during pregnancy is unknown. For children with Crohn's disease (CD), IFX is effective at inducing and maintaining remission. Episodic therapy is not as effective as scheduled infusions. Disease duration in children does not appear to…

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Hungry in the womb: what are the consequences? Lessons from the Dutch famine.

An increasing body of evidence suggests that poor nutrition at the very beginning of life - even before birth - leads to large and long term negative consequences for both mental and physical health. This paper reviews the evidence from studies on the Dutch famine, which investigated the effects of prenatal undernutrition on later health. The effects of famine appeared to depend on its timing during gestation, and the organs and tissues undergoing critical periods of development at that time. Early gestation appeared to be the most vulnerable period. People who were conceived during the famine were at increased risk of schizophrenia and depression, they had a more atherogenic plasma lipid profile, were more responsive to stress and had a doubled rate of coronary heart disease. Also, they performed worse on cognitive tasks which may be a sign of accelerated ageing. People exposed during a…

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Cocaine addiction in mothers: potential effects on maternal care and infant development.

Maternal cocaine addiction is a significant public health issue particularly affecting children, with high rates of reported abuse, neglect, and foster care placement. This review examines both preclinical and clinical evidence for how cocaine abuse may affect maternal care and infant development, exploring brain, behavioral, and neuroendocrine mechanisms. There is evidence that cocaine affects infant development both directly, via in utero exposure, and indirectly via alterations in maternal care. Two neural systems known to play an important role in both maternal care and cocaine addiction are the oxytocin and dopamine systems, mediating social and reward-related behaviors and stress reactivity. These same neural mechanisms may also be involved in the infant's development of vulnerability to addiction. Understanding the neuroendocrine pathways involved in maternal behavior and addictio…

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Risk, theory, social and medical models: a critical analysis of the concept of risk in maternity care.

Background: there is an on-going debate about perceptions of risk and risk management in maternity care. Objectives: to provide a critical analysis of the risk concept, its development in modern society in general and UK maternity services in particular. Through the associated theory, we explore the origins of the current preoccupation with risk. Using Pickstone's historical phases of modern health care, the paper explores the way maternity services changed from a social to a medical model over the twentieth century and suggests that the risk agenda was part of this process. Key conclusions: current UK maternity services policy which promotes normality contends that effective risk management screens women suitable for birth in community maternity units (CMUs) or home birth: however, although current policy advocates a return to this more social model, policy implementation is slow in pra…

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Medical follow up after bariatric surgery: nutritional and drug issues. General recommendations for the prevention and treatment of nutritional deficiencies.

This review is an update of the long-term follow-up of nutritional and metabolic issues following bariatric surgery, and also discusses the most recent guidelines for the three most common procedures: adjustable gastric bands (AGB); sleeve gastrectomy (SG); and roux-en-Y gastric bypass (GBP). The risk of nutritional deficiencies depends on the percentage of weight loss and the type of surgical procedure performed. Purely restrictive procedures (AGB, SG), for example, can induce digestive symptoms, food intolerance or maladaptative eating behaviours due to pre- or postsurgical eating disorders. GBP also has a minor malabsorptive component. Iron deficiency is common with the three types of bariatric surgery, especially in menstruating women, and GBP is also associated with an increased risk of calcium, vitamin D and vitamin B12 deficiencies. Rare deficiencies can lead to serious complicati…

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Fetal origins of mental health: evidence and mechanisms.

The concept of fetal programming states that changes in the fetal environment during sensitive periods of organ development may cause long-lasting changes in the structure and functioning of these organs later in life and influence the risk for chronic diseases such as coronary heart disease and type 2 diabetes. Fetal growth is a summary marker of the fetal environment and is reflected by relatively easy-to-obtain measures of size at birth such as birth weight. In the last two decades, a body of evidence emerged linking fetal growth with behavioural and mental health outcomes later in life. Cognitive functioning and behavioural problems in childhood, in particular inattention/hyperactivity, have been shown to be inversely related to fetal growth. Although results are mixed, risk for personality disorders and schizophrenia seems to be linked with fetal growth and adversity, while the evid…

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Women's mental health: depression and anxiety.

Sex ratios for selected mental disorders such as major depressive disorder and anxiety disorder are much higher in women than men. Anxiety disorders constitute the most prevalent mental disorder in adults, and affect twice as many women as men. Depression and anxiety exist comorbidly and along with other mental disorders. This article focuses on depression and anxiety in women, and other conditions comorbid with depression or anxiety: cardiac disease, obesity, vitamin D deficiency, and irritable bowel syndrome.

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Treatment of opioid-dependent pregnant women: clinical and research issues.

This article addresses common questions that clinicians face when treating pregnant women with opioid dependence. Guidance, based on both research evidence and the collective clinical experience of the authors, which include investigators in the Maternal Opioid Treatment: Human Experimental Research (MOTHER) project, is provided to aid clinical decision making. The MOTHER project is a double-blind, double-dummy, flexible-dosing, parallel-group clinical trial examining the comparative safety and efficacy of methadone and buprenorphine for the treatment of opioid dependence in pregnant women and their neonates. The article begins with a discussion of appropriate assessment during pregnancy and then addresses clinical management stages including maintenance medication selection, induction, and stabilization; opioid agonist medication management before, during, and after delivery; pain manag…

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