Thyroglobulin as a functional biomarker of iodine status in a cohort study of pregnant women in the United Kingdom

Background Though iodine deficiency in pregnancy is a matter of public-health concern, a functional measure of iodine status is lacking. The thyroid-specific protein, thyroglobulin (Tg), which reflects thyroid size, has shown promise as a functional measure in studies of children and adults, but data in pregnancy are sparse. In a cohort of mildly-to-moderately iodine-deficient pregnant women, we aimed to explore whether serum Tg is a sensitive functional biomarker of iodine status and to examine longitudinal change in Tg with gestational age. Method 230 pregnant women were recruited at an ante-natal clinic at 12 weeks of gestation to the Selenium in PRegnancy INTervention (SPRINT) study, in Oxford, UK. Repeated measures of urinary iodine-to-creatinine ratio, serum TSH and Tg at 12, 20, and 35 weeks of gestation were collected. Women were dichotomised by their iodine-to-creatinine ratio, (<150 or ≥150 μg/g) to group them broadly as iodine-deficient or iodine-sufficient. Women with thyroid antibodies were excluded; data and samples were available for 191 women. Results Median Tg concentration was 21, 19, and 23 μg/L in the first, second, and third trimesters, respectively. In a linear mixed model, controlling for confounders, Tg was higher in the <150 μg/g than in the ≥150 μg/g group (p<0.001) but there was no difference in TSH (p=0.27). Gestational week modified the effect of iodine status on TSH (p=0.01) and Tg (p=0.012); Tg did not increase with gestational week in the ≥150 μg/g group but did in the <150 μg/g group, and TSH increased more steeply in the <150 μg/g group. Conclusions Low iodine status (<150 μg/g) in pregnancy is associated with higher serum Tg, suggesting that the thyroid is hyper-stimulated by iodine deficiency, which causes it to enlarge. Tg is a more sensitive biomarker of iodine status in pregnancy than is TSH

Development of the Childbirth Perception Scale (CPS) : perception of delivery and the first postpartum week

Some caregivers suggest a more positive experience of childbirth when giving birth at home. Since properly developed instruments that assess women’s perception of delivery and the early postpartum are missing, the aim of the current study is to develop a Childbirth Perception Scale (CPS). Three focus groups with caregivers, pregnant women, and women who recently gave birth were conducted. Psychometric properties of 23 candidate items derived from the interviews were tested with explorative factor analysis (EFA) (N = 495). Confirmatory factor analysis (CFA) was performed in another sample of women (N = 483) and confirmed a 12-item CPS. The EFA in sample I suggested a two-component solution: a subscale ‘perception of delivery’ (six items) and a subscale ‘perception of the first postpartum week’ (six items). The CFA in sample II confirmed an adequate model fit and a good internal consistency (α = .82). Multivariate linear regression showed a positive effect of home delivery on perception of delivery in multiparous but not in primiparous women. The 12-item CPS with two dimensions (perception of delivery and perception of first postpartum week) has adequate psychometric properties. In multiparous women, home delivery showed to be independently related to more positive perception of delivery

Increased maternal TSH and decreased maternal FT4 are associated with a higher operative delivery rate in low-risk pregnancies:A prospective cohort study

\u3cp\u3eBackground: The increasing number of operative deliveries is a topic of major concern in modern obstetrics. Maternal thyroid function is of known influence on many obstetric parameters. Our objective was to investigate a possible relation between maternal thyroid function, and operative deliveries. Secondary aim was to explore whether thyroid function was related to specific reasons for operative deliveries. Methods: In this prospective cohort study, low-risk Caucasian women, pregnant of a single cephalic fetus were included. Women with known auto-immune disease, a pre-labour Caesarean section, induction of labour, breech presentation or preterm delivery were excluded. In all trimesters of pregnancy the thyroid function was assessed. Differences in mean TSH and FT4 were assessed using t-test. Mean TSH and FT4 levels for operative deliveries were determined by one way ANOVA. Repeated measurement analyses were performed (ANOVA), adjusting for BMI, partiy, maternal age and gestational age at delivery. Results: In total 872 women were included, of which 699 (80.2%) had a spontaneous delivery. At 36weeks gestation women who had an operative delivery had a significantly higher mean TSH (1.63mIU/L versus 1.46mIU/L, p=0.025) and lower mean FT4 (12.9pmol/L versus 13.3pmol/L, p=0.007)) compared to women who had a spontaneous delivery. Mean TSH was significantly higher (p=0.026) and mean FT4 significantly lower (p=0.030) throughout pregnancy for women with an operative delivery due to failure to progress in second stage of labour, compared to women with a spontaneous delivery or operative delivery for other reasons. Conclusions: Increased TSH and decreased FT4 seem to be associated with more operative vaginal deliveries and Caesarean sections. After adjusting for several confounders the association remained for operative deliveries due to failure to progress in second stage of labour, possibly to be explained by less efficient uterine action.\u3c/p\u3

A new concept of maternity blues: Is there a subgroup of women with rapid cycling mood symptoms?

Background: Rapid cycling mood symptoms during the first postpartum week are an important aspect of maternity blues. The aim of this study is to identify women with these rapid cycling mood symptoms in the general population and to investigate possible risk factors of these symptoms. Methods: The Maternity Blues Scale (MBS) was validated in The Netherlands in 949 women at one week postpartum. Personal and family history of mood disorders and obstetric demographics were collected and the Edinburgh Postnatal Depression Scale (EPDS) was completed. A 16 item three factor NIBS solution was found: depression, negative arid positive affect. The latter two were used to define a rapid cycling mood symptoms group. Results: Using the 75th percentile cut-off, 20(2%) women reported high negative/high positive affect (rapid cycling mood group) and 65 (7%) women were depressed (EPDS >= 11). A previous episode of depression, major life events and instrumental delivery were independently related to depression (OR 3.5, 2.5 and 23, respectively) while only a history of depression in first-degree relatives was independently related to rapid cycling mood (OR 3.4, 95% CI 1.2-93). Limitations First, no syndromal diagnoses were obtained for depression and rapid cycling mood disorder. Second, history of depression was self-reported (not based on structural psychiatric interviews). Third, our study was not designed to study the longitudinal follow-up of women with rapid cycling mood symptoms. Conclusion the 16-item MBS could be useful in screening programs in detecting postpartum women at risk for (severe) mood disorders. Postpartum women with 'rapid cycling mood symptoms' can be identified with a possible more familiar form of mood disorder. (C) 2015 Elsevier B.V. All rights reserved

Antenatal mother–infant bonding scores are related to maternal reports of infant crying behaviour

Objective: To assess the relation between antenatal mother–infant bonding scores and maternal reports of infant crying behaviour.\u3cbr/\u3e\u3cbr/\u3eBackground: Crying is normal behaviour and it is important for parent–infant bonding. Even though bonding starts antenatally, the relation between antenatal bonding scores and infant crying behaviour has never been studied.\u3cbr/\u3e\u3cbr/\u3eMethod: A secondary analysis was performed on data that were gathered in a large prospective study within our region. Bonding was assessed using an antenatal bonding questionnaire at 32 weeks gestational age. The crying behaviour of infants was assessed with three questions at six weeks postpartum. Crying was termed excessive (EC+) when mothers perceived the crying to be ‘every day’, ‘often’ or ‘very often’, and with ‘crying episodes lasting more than 30 minutes’; in other words, when mothers scored high on all three questions. The relation between bonding and crying was examined using a multiple logistic regression analysis, including adjustment for relevant variables, especially maternal depression as measured with the Edinburgh Depression Scale.\u3cbr/\u3e\u3cbr/\u3eResults: In total, 894 women were included of whom 47 reported EC+ infants (5.3%). Antenatal bonding scores were significantly related to the reporting of crying behaviour, even after adjustment for relevant variables (p = 0.02). Each extra point on the bonding scale reduced the EC+ risk with 14% (OR = 0.86, 95% CI [0.76–0.97]).\u3cbr/\u3e\u3cbr/\u3eConclusion: Mothers with lower antenatal bonding scores were more likely to report an EC+ infant. Future research should further explore the concept of antenatal bonding, its relation with EC and risks associated with EC.\u3cbr/\u3e\u3cbr/\u3e\u3cbr/\u3eKeywords: Antenatal, mother–infant, bonding, crying, depressio

Development of a Pre- and Postnatal Bonding Scale (PPBS)

Objective: Bonding is a major topic in the field of developmental psychology, due to its importance in adequate childhood development. Studies investigating the relationship between pre- and postnatal bonding show moderate correlations. However, an important limitation is that no similar instruments were used to measure bonding pre- and post-natally. In the current study, a user-friendly questionnaire has been developed to assess maternal bonding during pregnancy and postpartum. Psychometric properties were also investigated. Methods: In a large unselected sample of 1050 pregnant women, 14 positive items, based on the literature, were used to construct a pre- and postnatal bonding scale (PPBS) questionnaire. The sample was randomly split into two equal sub-samples: group I was used for reliability and Exploratory Factor Analysis; group II for Confirmatory Factor Analysis (CFA). The bonding scale was assessed at 32 weeks pregnancy and at eight and 12 months postpartum. The Edinburgh Depression Scale (EDS) and the subscale Partner Involvement of the Tilburg Pregnancy Distress Scale (TPDS) were used to assess concurrent validity. Results: After CFA, a five-item bonding scale remained with excellent model fit (CFI: 0.97, TLI: 0.97, NFI: 0.98; RMSEA: 0.06 lower bound 0.03. Cronbach’s alpha’s at 32 weeks gestation and at eight and 12 months' postpartum were: 0.87, 0.80 and 0.79, respectively. Test-retest correlations of the PPBS at 32 weeks gestation and at eight and 12 months postpartum were high: 0.42 and 0.41 and 0.67 between eight and 12 months post-partum, respectively. At 32 weeks gestation, the PPBS correlated significantly with partner support (TPDS): 0.38 and depression (EDS): -0.24. Similar correlations with depression were found at eight and 12 months post-partum. Conclusion: The five-item PPBS seems to be a user-friendly self-rating scale with good psychometric properties and concurrent validity, both pre- and post-natally

Low concentrations of maternal thyroxin during early gestation:a risk factor of breech presentation?

\u3cp\u3eObjective: To evaluate the relation between breech position at term (&gt;37 weeks of gestation) and low maternal fT4 levels during gestation in women not suffering from overt thyroid dysfunction. Design: A prospective cohort study of pregnant women. Setting: Community-based study. Population/Sample: At random selected pregnant women of the general population. Methods: At antenatal booking, based on thyroid function assessed at 12 weeks of gestation in a large cohort of pregnant women, two groups of participants were defined: women with low fT4 levels - below the 10th centile (n = 135) and women with fT4 - between the 50th and 90th centiles at 12 weeks of gestation (n = 135). Women with clinical thyroid dysfunction (fT4 and TSH outside reference range) at 12 weeks of gestation were excluded. Maternal thyroid function (fT4 and TSH) was subsequently assessed at 24 and 32 weeks of gestation. Analysis refers to 204 women who met the inclusion and exclusion criteria and in whom all thyroid parameters were assessed. Main outcome measures: Fetal presentation (cephalic-breech) at delivery in women with term gestation (&gt;37 weeks of gestation) in relation to maternal thyroid function at 12, 24 and 34 weeks of gestation. Results: Breech presentation at term delivery was independently related to fT4 levels &lt;10th centile at 12 weeks of gestation (OR = 4.7, 95% CI 1.1-19 [but not to an fT4 level below the 10th centile at 24 and 32 weeks of gestation]) as well as primiparity (OR = 4.7, 95% CI 1.3-15). Conclusions: Women with hypothyroxinaemia (fT4 level at the lowest 10th centile) during early gestation but without overt thyroid function are at risk for fetal breech presentation at term (&gt;37 weeks of gestation).\u3c/p\u3