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CMAJ : Canadian Medical Association... Feb 2007Providing health care for a woman with a surrogate pregnancy involves unique challenges. Although the ethical debate surrounding surrogacy continues, Canada has banned... (Review)
Review
Providing health care for a woman with a surrogate pregnancy involves unique challenges. Although the ethical debate surrounding surrogacy continues, Canada has banned commercial, but not altruistic, surrogacy. In the event of a custody dispute between a surrogate mother and the individual(s) intending to parent the child, it is unclear how Canadian courts would rule. The prenatal health care provider must take extra care to protect the autonomy and privacy rights of the surrogate. There is limited evidence about the medical and psychological risks of surrogacy. Whether theoretical concerns about these risks are clinically relevant remains unknown. In the face of these uncertainties, the prenatal health care provider should have a low threshold for seeking obstetrical, social work, ethical and legal support.
Topics: Canada; Female; Humans; Infant Welfare; Infant, Newborn; Maternal Health Services; Maternal Welfare; Personal Autonomy; Policy Making; Practice Guidelines as Topic; Pregnancy; Surrogate Mothers
PubMed: 17296962
DOI: 10.1503/cmaj.060696 -
Philosophical Transactions of the Royal... Oct 2017Two of the most important human oncogenic viruses are hepatitis B virus (HBV) and human papillomavirus (HPV). HBV infection has been preventable by vaccination since... (Review)
Review
Two of the most important human oncogenic viruses are hepatitis B virus (HBV) and human papillomavirus (HPV). HBV infection has been preventable by vaccination since 1982; vaccination of neonates and infants is highly effective, resulting already in decreased rates of new infections, chronic liver disease and hepato-cellular carcinoma. Nonetheless, HBV remains a global public health problem with high rates of vertical transmission from mother to child in some regions. Prophylactic HPV vaccines composed of virus-like particles (VLPs) of the L1 capsid protein have been licensed since 2006/2007. These target infection by the oncogenic HPVs 16 and 18 (the cause of 70% of cervical cancers); a new vaccine licensed in 2014/2015 additionally targets HPVs 31, 33, 45, 52, 58. HPV vaccines are now included in the national immunization programmes in many countries, with young adolescent peri-pubertal girls the usual cohort for immunization. Population effectiveness in women is now being demonstrated in countries with high vaccine coverage with significant reductions in high-grade cervical intra-epithelial neoplasia (a surrogate for cervical cancer), genital warts and vaccine HPV type genoprevalence. Herd effects in young heterosexual men and older women are evident. Cancers caused by HBV and HPV should, in theory, be amenable to immunotherapies and various therapeutic vaccines for HPV in particular are in development and/or in clinical trial.This article is part of the themed issue 'Human oncogenic viruses'.
Topics: Cancer Vaccines; Hepatitis B; Hepatitis B Vaccines; Hepatitis B virus; Humans; Oncogenic Viruses; Papillomaviridae; Papillomavirus Infections; Papillomavirus Vaccines; Tumor Virus Infections
PubMed: 28893935
DOI: 10.1098/rstb.2016.0268 -
Journal of Assisted Reproduction and... Jun 2022Pregnancies conceived as contracted gestational carriers are a relatively new phenomenon for reproductive medicine. Since the intended parents control genetic screening...
OBJECTIVE
Pregnancies conceived as contracted gestational carriers are a relatively new phenomenon for reproductive medicine. Since the intended parents control genetic screening decisions, there may be differences in genetic decisions made for gestational carrier (GC) in vitro fertilization (IVF) pregnancies as compared to traditional non-gestational carrier IVF pregnancies. Our goal was to investigate the frequency and types of these genetic testing decisions.
METHODS
We performed a retrospective study of GC pregnancies counseled at a private maternal-fetal medicine practice between January 2006 and January 2021. Inclusion criteria were pregnancies that completed counseling with a certified genetic counselor and obtained high-resolution imaging. Controls were non-GC IVF pregnancies seen in the same period matched by parity, estimated delivery date (EDD), and the oocyte age utilized in conception. Statistical analysis included patient demographics, pre-implantation genetic testing (PGT-A) frequency and results, ultrasound imaging results, and the frequency with results of prenatal genetic screening (first or second-trimester serum screens), non-invasive prenatal testing (NIPT), or diagnostic testing (chorionic venous sampling (CVS) or amniocentesis).
RESULTS
One hundred and ninety one gestational carrier pregnancies were identified and 167 met inclusion criteria. Gestational carrier pregnancies were significantly more likely to pursue PGT-A, PGT-A with NIPT, first-trimester screening, and second-trimester screening. There were no differences in rates of amniocentesis or CVS over controls.
CONCLUSIONS
Regarding genetic counseling and screening options, our series is the first to demonstrate that gestational carrier parents seek additional genetic counseling resources, even with reassuring PGT-A and ultrasound.
Topics: Aneuploidy; Female; Fertilization in Vitro; Genetic Counseling; Genetic Testing; Humans; Pregnancy; Preimplantation Diagnosis; Retrospective Studies; Surrogate Mothers
PubMed: 35377088
DOI: 10.1007/s10815-022-02483-3 -
Fertility and Sterility Apr 2023Intended parents engage with gestational carriers (GCs) to achieve their personal reproductive goals. All GCs have a right to be fully informed of the risks as well as...
Intended parents engage with gestational carriers (GCs) to achieve their personal reproductive goals. All GCs have a right to be fully informed of the risks as well as the contractual and legal aspects of the gestational-carrier process. The GCs have autonomy in making their own decisions regarding medical care and should be free from undue influences by the stakeholders involved. They should have free access to and receive psychological evaluation and counseling before, during, and after participating. In addition, GCs require separate independent legal counsel regarding the contract and arrangement. This document replaces the document of the same name, last published in 2018 (Fertil Steril 2018;110:1017-21).
Topics: Pregnancy; Female; Humans; Surrogate Mothers; Ethics Committees; Counseling; Reproductive Techniques, Assisted
PubMed: 36863967
DOI: 10.1016/j.fertnstert.2023.01.015 -
International Journal of Reproductive... Sep 2022The social and cultural challenges facing surrogate mothers have been explored in several studies. However, few studies have discussed the motivations of surrogate...
BACKGROUND
The social and cultural challenges facing surrogate mothers have been explored in several studies. However, few studies have discussed the motivations of surrogate mothers, their expressions and interpretations of their lived experiences, and their feelings of personal and spiritual satisfaction.
OBJECTIVE
This study aims to present the positive experiences of surrogate mothers from a phenomenological perspective.
MATERIALS AND METHODS
Using a phenomenological approach, this study was conducted from September 2020 to January 2021 in the city of Yazd, Iran. Participant observation and semi-structured interviews were used to collect the data among 12 participants with at least 1 experience of surrogate motherhood.
RESULTS
Our findings showed that, despite having had harsh physical and socio-cultural experiences such as fear of social labeling and stigma, participants felt a kind of inner satisfaction and a positive view of their actions. A core theme found in the study was mothers' satisfaction. The main categories included feminine self-sacrifice and positive rewards. Feminine self-sacrifice included 2 sub-categories: creating happiness and conveying motherly feelings, while positive rewards included good childbirth, family acceptance, and halal income.
CONCLUSION
This study showed that surrogate mothers experience conflicting feelings of inner satisfaction and social stigma during surrogacy. Some of those interviewed were willing to go through surrogacy again, but they feared social labeling and stigma, being misunderstood by others who are not fully informed about surrogacy, and being subjected to family and social disapproval.
PubMed: 36340669
DOI: 10.18502/ijrm.v20i9.12067 -
Fertility and Sterility Sep 2015Third-party reproduction has introduced a host of changing family constellations. Research has shown that children conceived through third-party reproduction are doing... (Review)
Review
Third-party reproduction has introduced a host of changing family constellations. Research has shown that children conceived through third-party reproduction are doing well psychologically and developmentally, but what about their parents? How have they coped with the transition to third-party reproduction? Has the experience impacted their marital stability or the quality of their parenting? This review will address parents of children conceived through oocyte donation, parents of children conceived through gestational surrogacy, and gay male parents of children conceived through oocyte donation and gestational surrogacy.
Topics: Adaptation, Psychological; Counseling; Donor Selection; Emotions; Female; Fertility; Humans; Infertility; Male; Mental Health; Oocyte Donation; Parent-Child Relations; Parents; Patient Care Team; Pregnancy; Reproductive Techniques, Assisted; Surrogate Mothers; Tissue Donors
PubMed: 26232745
DOI: 10.1016/j.fertnstert.2015.07.1128 -
Indian Journal of Pediatrics May 2022While a Cochrane review (2016) showed that kangaroo mother care (KMC) initiated after clinical stabilization reduces mortality by 40%, evidence of the effect of... (Review)
Review
While a Cochrane review (2016) showed that kangaroo mother care (KMC) initiated after clinical stabilization reduces mortality by 40%, evidence of the effect of initiating KMC immediately after birth without waiting for babies to become stable was unavailable until recently. This research gap was addressed by a multicountry, randomized, controlled trial co-ordinated by WHO. This trial was conducted in five hospitals in Ghana, India, Malawi, Nigeria, and Tanzania. Implementation of this trial led to development of the "mother-newborn care unit (MNCU)." Mother-newborn care unit or mother-newborn intensive care unit (M-NICU) is a facility where sick and small newborns are cared with their mothers 24 × 7 with all facilities of level II newborn care and provision for postnatal care to mothers. The mother is not a mere visitor, but she has her bed inside the special newborn care unit (SNCU)/newborn intensive care unit (NICU) and as a resident of MNCU, becomes an active caregiver and is involved in continuum of neonatal care. The study results show that intervention babies in MNCU had 25% less mortality at 28 d of life, 35% less incidence of hypothermia, and 18% less suspected sepsis as compared to control babies cared in conventional NICU. World Health Organization is in the process of reviewing the current recommendations on care of preterm or LBW newborns considering new evidence that has become available. However, it would require national policy change to permit mother and surrogate in SNCU/NICU 24 × 7, making the concept of zero-separation a reality.
Topics: Child; Female; Humans; India; Infant, Low Birth Weight; Infant, Newborn; Intensive Care Units, Neonatal; Kangaroo-Mother Care Method; Mothers; Randomized Controlled Trials as Topic
PubMed: 35244878
DOI: 10.1007/s12098-022-04145-9 -
International Journal of Molecular... Oct 2022Developmental instability (DI) is thought to be inversely related to a capacity of an organism to buffer its development against random genetic and environmental...
Developmental instability (DI) is thought to be inversely related to a capacity of an organism to buffer its development against random genetic and environmental perturbations. DI is represented by a trait's inter- and intra-individual variabilities. The inter-individual variability (inversely referred to as canalization) indicates the capability of organisms to reproduce a trait from individual to individual. The intra-individual variability reflects an organism's capability to stabilize a trait internally under the same conditions, and, for symmetric traits, it is expressed as fluctuating asymmetry (FA). When representing a trait as a random variable conditioned on environmental fluctuations, it is clear that, in statistical terms, the DI partitions into "extrinsic" (canalization) and "intrinsic" (FA) components of a trait's variance/noise. We established a simple statistical framework to dissect both parts of a symmetric trait variance/noise using a PCA (principal component analysis) projection of the left/right measurements on eigenvectors followed by GAMLSS (generalized additive models for location scale and shape) modeling of eigenvalues. The first eigenvalue represents "extrinsic" and the second-"intrinsic" DI components. We applied this framework to investigate the impact of mother-fetus major histocompatibility complex (MHC)-mediated immune cross-talk on gene expression noise and developmental stability. We showed that "intrinsic" gene noise for the entire transcriptional landscape could be estimated from a small subset of randomly selected genes. Using a diagnostic set of genes, we found that allogeneic MHC combinations tended to decrease "extrinsic" and "intrinsic" gene noise in C57BL/6J embryos developing in the surrogate NOD-SCID and BALB/c mothers. The "intrinsic" gene noise was negatively correlated with growth (embryonic mass) and the levels of placental growth factor (PLGF), but not vascular endothelial growth factor (VEGF). However, it was positively associated with phenotypic growth instability and noise in PLGF. In mammals, the mother-fetus MHC interaction plays a significant role in development, contributing to the fitness of the offspring. Our results demonstrate that a positive impact of distant MHC combinations on embryonic growth could be mediated by the reduction of "intrinsic" gene noise followed by the developmental stabilization of growth.
Topics: Mice; Animals; Female; Humans; Placenta Growth Factor; Mothers; Endothelial Growth Factors; Vascular Endothelial Growth Factor A; Phenotype; Mice, Inbred BALB C; Mice, Inbred C57BL; Mice, SCID; Fetus; Gene Expression; Mammals
PubMed: 36293324
DOI: 10.3390/ijms232012467 -
CMAJ : Canadian Medical Association... Apr 2022
Topics: COVID-19; Female; Humans; Influenza A Virus, H1N1 Subtype; Influenza, Human; Pandemics; Pregnancy
PubMed: 35379661
DOI: 10.1503/cmaj.211069 -
Fertility and Sterility Feb 2018To provide an evidence-based assessment of metabolic syndrome, hypertension, and hyperlipidemia in first-degree relatives of women with polycystic ovary syndrome (PCOS). (Meta-Analysis)
Meta-Analysis Review
Metabolic syndrome, hypertension, and hyperlipidemia in mothers, fathers, sisters, and brothers of women with polycystic ovary syndrome: a systematic review and meta-analysis.
OBJECTIVE
To provide an evidence-based assessment of metabolic syndrome, hypertension, and hyperlipidemia in first-degree relatives of women with polycystic ovary syndrome (PCOS).
DESIGN
Systematic review and meta-analysis.
SETTING
Not applicable.
PATIENT(S)
Mothers, fathers, sisters, and brothers of women with and without PCOS.
INTERVENTION(S)
An electronic-based search with the use of PubMed from 1960 to June 2015 and cross-checked references of relevant articles.
MAIN OUTCOME MEASURE(S)
Metabolic syndrome, hypertension and dyslipidemia, and surrogate markers, including systolic blood pressure (BP), diastolic BP, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides.
RESULT(S)
Fourteen of 3,346 studies were included in the meta-analysis. Prevalence of the following was significantly increased in relatives of women with PCOS: metabolic syndrome (risk ratio [RR] 1.78 [95% confidence interval 1.37, 2.30] in mothers, 1.43 [1.12, 1.81] in fathers, and 1.50 [1.12, 2.00] in sisters), hypertension (RR 1.93 [1.58, 2.35] in fathers, 2.92 [1.92, 4.45] in sisters), and dyslipidemia (RR 3.86 [2.54, 5.85] in brothers and 1.29 [1.11, 1.50] in fathers). Moreover, systolic BP (mothers, sisters, and brothers), total cholesterol (mothers and sisters), low-density lipoprotein cholesterol (sisters), and triglycerides (mothers and sisters) were significantly higher in first-degree relatives of PCOS probands than in controls.
CONCLUSION(S)
Our results show evidence of clustering for metabolic syndrome, hypertension, and dyslipidemia in mothers, fathers, sisters, and brothers of women with PCOS.
SYSTEMATIC REVIEW REGISTRATION NUMBER
PROSPERO 2016 CRD42016048557.
Topics: Adolescent; Adult; Chi-Square Distribution; Cluster Analysis; Evidence-Based Medicine; Family; Female; Genetic Predisposition to Disease; Heredity; Humans; Hyperlipidemias; Hypertension; Male; Metabolic Syndrome; Middle Aged; Odds Ratio; Pedigree; Phenotype; Polycystic Ovary Syndrome; Prevalence; Risk Assessment; Risk Factors; Young Adult
PubMed: 29331234
DOI: 10.1016/j.fertnstert.2017.10.018