Pregnancy and stroke

The risks of ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage are not increased in the 9 months of gestation except for a high risk in the 2 days prior and 1 day postpartum. The remaining 6 weeks postpartum also have an increased risk of ischemic stroke and intracerebral hemorrhage, though less than the peripartum period. Although there are some rare causes of stroke specific to pregnancy and the postpartum period, eclampsia, cardiomyopathy, postpartum cerebral venous thrombosis, and, possibly, paradoxical embolism warrant special consideration. The diagnostic and therapeutic approaches to stroke during pregnancy and the postpartum period are similar to the approaches in the nonpregnant woman with some minor modifications based on consideration of the welfare of the fetus. There is a theoretical risk of magnetic resonance imaging exposure during the first and second trimester but the benefit to the mother of obtaining the information may outweigh the risk. Available evidence suggests that low-dose aspirin (<150 mg/day) during the second and third trimesters is safe for both mother and fetus. Postpartum use of low-dose aspirin by breast-feeding mother is also safe for infant. While proper counseling is imperative, a history of pregnancy-related stroke should not be a contraindication for subsequent pregnancy.     

Compounding Vulnerability: Pregnancy and Schizophrenia

The predominant ethical framework for addressing reproductive decisions in the maternal–fetal relationship is respect for the woman's autonomy. However, when a pregnant schizophrenic woman lacks such autonomy, healthcare providers try to both protect her and respect her preferences. By delineating etic (objective) and emic (subjective) perspectives on vulnerability, I argue that options which balance both perspectives are preferable and that acting on etic perspectives to the exclusion of emic considerations is rarely justified. In negotiating perspectives, we balance the etic commitment to protect the vulnerable patient and her fetus from harm with the emic concern to empower a decisionally incapacitated woman. Equilibrium is best achieved by nurturing interdependent relationships that empower and protect the vulnerable woman. The analysis points to the need for better social support for mentally ill patients.     

Ethnicity and Social Support During Pregnancy

Data from two multi-ethnic prospective studies of African American, Latina, and non-Hispanic White pregnant women were used to examine the influence of contextual factors on social support processes during pregnancy. Multiple types of support (perceived support, received support, support satisfaction, network support) and sources of support (baby's father, family, friends) were assessed. The role of ethnicity in social support was examined after controlling for the contribution of related contextual factors (SES, marital status, age, parity, employment) to these processes. The impact of ethnicity and related contextual factors differed across sources of social support. Ethnic differences in support from family and friends, but not from the baby's father, emerged. However, marital status was a consistent predictor of support from the baby's father, and SES was a consistent predictor of support from friends. Overall, the findings of two studies suggest that although ethnicity is associated with support from friends and family, other contextual factors, such as marital status and SES, influence support processes during pregnancy.     

Stress Processes in Pregnancy and Preterm Birth

ABSTRACT— Preterm birth (PTB) is of epidemic proportions in the United States, particularly among African Americans. Its consequences range from risk of infant mortality to lifelong disease and disability. Stress is a contributor to preterm labor and delivery. This article summarizes research on stress as a risk factor for PTB. As is evident in considering the complex mechanisms, psychological science has much to contribute to addressing this important health issue.     

Drug Addiction During Pregnancy

ABSTRACT— Drug use during pregnancy is a significant risk factor for compromised child development. National statistics reveal that many pregnant women smoke tobacco (18%), drink alcohol (9.8%), and use illicit drugs (4%). Animal and clinical data show that prenatal alcohol and tobacco exposure have direct deleterious consequences on child development. Recent large multicenter studies have failed to show that prenatal cocaine or heroin exposure causes devastating child consequences when environmental variables are controlled. However, prenatal exposure to both licit and illicit drug use mostly occurs in the presence of environmental and contextual risk factors that together can impede healthy outcomes. Thus, treating these addiction disorders while addressing other lifestyle factors in a comprehensive way is critical.     

妊娠期睡眠障碍研究进展

妊娠期睡眠障碍指在妊娠期发生的睡眠形态和行为的紊乱,它已经成为影响孕妇生理、心理等问题的重要危险因素.本文主要从妊娠期睡眠障碍的概念、发生率、引起妊娠期睡眠障碍的原因、睡眠障碍对母亲、胎儿和妊娠结局的影响及睡眠障碍的干预措施等几个方面进行了综述.     

Social Discounting and Cigarette Smoking During Pregnancy

In this study, we examined the association between social discounting and smoking status in a cohort of pregnant cigarette smokers (n = 91), quitters (n = 27), or never‐smokers (n = 30). The smokers and quitters were participants in clinical trials on smoking cessation and relapse prevention, whereas the never‐smokers were controls in a study on nicotine withdrawal during pregnancy. Social discounting was assessed using a paper‐and‐pencil task that assesses the amount of hypothetical money a person is willing to forgo in order to share with individuals in their social network ranging from the person who is emotionally closest to them to a mere acquaintance. The amount that women were willing to forgo in order to share decreased hyperbolically as a function of social distance, with smokers exhibiting steeper discounting functions (i.e., less generosity) than quitters or never‐smokers; discounting functions of quitters and never‐smokers did not differ significantly. In multivariate analyses controlling for potential sociodemographic and other confounds, social discounting remained a significant predictor of smoking status among smokers versus quitters. Overall, these results suggest that individual differences in social discounting may be a factor influencing the choices that women make about quitting smoking upon learning of a pregnancy. Copyright © 2011 John Wiley & Sons, Ltd.     

Pregnancy complications and neuropsychological outcomes: A review

Pregnancy complications elevate risk of associated adverse medical, socioenvironmental, and behavioral outcomes in children. These are likely to have a substantial impact on neuropsychological functioning and mental health across the child’s lifespan. Thus, an understanding of the complex relationships between pregnancy complications and neuropsychological outcomes is critical for both practitioners and researchers. This review summarizes prevalent pregnancy complications and the associated psychological and neuropsychological findings, highlighting methodological challenges that have restricted investigations of these outcomes and identifying opportune areas for future study.     

Pregnancy,Intimacy, and the Family Constitution

SUMMARY

The psychological effects of pregnancy and birth have a profound effect on the parents' relationship, especially on their experience of intimacy. The nature of the impact on the couple depends on the developmental stage of each parent and the couple's ability to adapt to new circumstances. Three developmental stages are described and the “family constitution” is presented as the body of goals, rules and roles that governs the behavior of the family and effectively managing the constitution is introduced and applied to two sets of circumstances related to pregnancy. Finally, the implications of the above concepts for therapists and counselors are delineated.     

Pregnancy reduction in Jewish law

10% of infertile women who become pregnant with the aid of hormonal stimulation become pregnant with multiple fetuses. 20% of mothers of triplets experience preeclampsia and 35% risk serious postpartum hemorrhage. Risk increases with the number of fetuses for venous stasis, varicose veins, phlebothrombosis, thrombophlebitis, and embolic phenomena. Risk increases proportionally with increased number of fetuses for fetal morbidity and mortality. Selective abortion is often used as a method of reducing risk to both the woman and the fetuses, thus increasing the chance that 1 or 2 fetuses will be born healthy. A related issue is the selective reduction of fetuses in multiple pregnancies that may have a genetic defect like Hurler's syndrome, microcephaly, Tay-Sachs disease, spina bifida, hemophilia A, or thalassemia major. In cases where 1 fetus in a set of twins is so inclined, the reduction of the defective fetus increased the success of the remaining co-twin. Selective reduction should not pose a problem for Jewish women since the procedure does not violate any Jewish legal or moral rules. In Jewish law an unborn fetus is not considered a person until it is born. Until the 40th day of pregnancy it is considered as 'mere fluid.' In order to stress the positive aspect of selective reduction it should be called "enhanced survival of multifetal pregnancies."     

异位妊娠临床诊疗中的策略与决策

通过异位妊娠的发病率,诊断及治疗中的注意事项,治疗方法的选择的分析,探讨异位妊娠的临床诊断及治疗的策略与决策。为了提高异位妊娠的诊断率、减少误诊率,需要建立合理的临床思维方法和科学的处理程序,为异位妊娠的临床诊断及治疗,提供科学的临床决策方法。     

Personality Factors Related to Black Teenage Pregnancy and Abortion

Forty-eight pregnant adolescents who applied for therapeutic abortions (TAs) were compared with 55 adolescents who planned to have their babies (Terms) and 67 adolescents who were not pregnant (Controls) on the California Psychological Inventory (CPI). All the subjects were single, Black, and aged 15 or 16. CPI results point to psychological differences with the Controls being most socialized, followed by the TAs, and then the Terms. Term girls seem to be experiencing a void and appear to be trying to fill it and assume an adult role by having a baby; the TAs do not seem to have these same needs. In addition, girls who became pregnant and described the relationship with the putative father as casual, appear on the CPI to have more daily problems, lack socialization, be less clear thinking, and have poor self-control. Pregnant girls who have good communication with their mothers showed no differences on the CPI from girls with poor communication with their mothers.     

孕激素在孕期治疗的利与弊

妊娠期间的内分泌变化是胎儿和胎盘发育的一个体现,尤其是孕激素在妊娠期和分娩期均发挥了重要的作用。但应注意孕期应用孕激素有利亦有弊,因此应从辩证的观点了解孕激素作为药物在临床治疗中的两重性,发挥其优点、克服其缺点,实现其治疗的最大效能。