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Interdisciplinary Nursing Research Nov 2022Preterm infants are at risk for severe infections due to their immature immune systems. Factors such as early life pain/stress experiences and feeding may influence...
BACKGROUND
Preterm infants are at risk for severe infections due to their immature immune systems. Factors such as early life pain/stress experiences and feeding may influence immune activation and maturation of immune systems. However, the underlying mechanism remains unclear. Fecal calprotectin (FCP) is a noninvasive surrogate biomarker of mucosal inflammation in the gastrointestinal tract and has been used in detecting intestinal inflammation in specific pediatric gastrointestinal disorders.
OBJECTIVE
To describe the longitudinal trajectory of FCP levels in preterm infants and investigate the contributing factors that are associated with FCP levels.
DESIGN
A longitudinal study design was used.
SETTINGS
Preterm infants were recruited from 2 neonatal intensive care units (NICU) of a children's medical center in the North-eastern US.
METHODS
Preterm infants were followed during their first 4 weeks of NICU hospitalization. Stool samples were collected twice per week to quantify the FCP levels. Cumulative pain/stress experiences and feeding types were measured daily. A linear mixed-effect model was used to examine the associations between FCP levels and demographic and clinical characteristics, cumulative pain/stress, and feeding over time.
RESULTS
Forty-nine preterm infants were included in the study. Infants' FCP levels varied largely with a mean of 268.7±261.3 µg/g and increased over time. Preterm infants experienced an average of 7.5±5.0 acute painful procedures and 15.3±20.8 hours of chronic painful procedures per day during their NICU stay. The mean percentage of mother's own milk increased from the first week (57.1±36.5%) to the fourth week (60.7±38.9%) after birth. Elevated FCP concentration was associated with acute and cumulative (chronic) pain/stress levels, mother's own milk, non-White race, and higher severity of illness score.
CONCLUSIONS
FCP levels were elevated in preterm infants with wide interindividual and intraindividual variations. Cumulative pain/stress during the NICU hospitalization, feeding, race, and health status may influence FCP concentrations in early life that may be associated with inflammatory gut processes.
PubMed: 36590866
DOI: 10.1097/NR9.0000000000000006 -
Human Reproduction (Oxford, England) Jun 2018What are the perspectives of adolescents conceived using surrogacy, egg or sperm donation regarding their conception and the third party involved?
STUDY QUESTION
What are the perspectives of adolescents conceived using surrogacy, egg or sperm donation regarding their conception and the third party involved?
SUMMARY ANSWER
The majority of adolescents described feeling indifferent about their conception, and yet simultaneously reported an interest in the third party involved, or were in contact with them.
WHAT IS KNOWN ALREADY
There is an assumption that children conceived through reproductive donation will feel negatively about their origins in adolescence. However, little is known about the views of adolescents who have been conceived through different types of reproductive donation.
STUDY DESIGN, SIZE, DURATION
Forty-four adolescents, all of whom had been told about their conception in childhood, participated in a semi-structured interview as part of the sixth phase of a longitudinal, multi-method, multi-informant study of assisted reproduction families in the UK.
PARTICIPANTS/MATERIALS, SETTING, METHODS
All adolescents were aged 14 years, had been conceived using surrogacy (n = 22), egg donation (n = 13) or sperm donation (n = 9) to heterosexual couples, and varied in terms of their information about, and contact with, the third party involved in their conception. Semi-structured interviews were conducted in participants' homes. Interviews were analysed qualitatively to determine adolescents' perceptions of their conception, and their thoughts and feelings about the surrogate or donor involved.
MAIN RESULTS AND THE ROLE OF CHANCE
Adolescents were found to feel positive (n = 7), indifferent (n = 32) or ambivalent (n = 5) about their conception. Amongst adolescents not in contact with the surrogate or donor, most were interested (n = 16) in the surrogate or donor, and others were ambivalent (n = 4), or not interested (n = 6) in them. Adolescents in contact with the surrogate or donor expressed positive (n = 14), ambivalent (n = 1) or negative (n = 1) feelings about them.
LIMITATIONS, REASONS FOR CAUTION
Of 56 adolescents invited to take part in the study, 47 consented to take part, giving a response rate of 84%. It was not possible to obtain information from adolescents who do not know about their conception.
WIDER IMPLICATIONS OF THE FINDINGS
The findings contradict the assumption that children conceived through reproductive donation will feel negatively about their origins in adolescence and suggest that it may be helpful to draw a distinction between adolescents' feelings about their conception in general, and their feelings about the surrogate or donor in particular.
STUDY FUNDING/COMPETING INTEREST(S)
This study was funded by the Wellcome Trust [097857/Z/11/Z]. The authors have no conflicts of interest to declare.
Topics: Adolescent; Attitude; Disclosure; Female; Humans; Longitudinal Studies; Male; Parent-Child Relations; Psychology, Adolescent; Reproductive Techniques, Assisted; Surrogate Mothers; Tissue Donors
PubMed: 29701833
DOI: 10.1093/humrep/dey088 -
Cuadernos de Bioetica : Revista Oficial... 2018Ethical and bioethical problems, which are typical of the practice of surrogate motherhood, refer to its protagonists: the couple that orders it, due to its demand to...
Ethical and bioethical problems, which are typical of the practice of surrogate motherhood, refer to its protagonists: the couple that orders it, due to its demand to satisfy the desire of paternity and maternity and the promptness of having a female body to fulfill its aspirations; the expectant mother, and the physical and psychic repercussions coming from the role performed in the surrogacy contract, as well as the risks of manipulation and exploitation, related to her position; the baby and his right to grow counting on the certainty of his parental relationships and on the preservation of his emotional balance. The human and anthropological importance of these issues, along with the growing development of this practice in the world, has questioned our moral conscience. In this context, the expectant mother, the weakest and the most affected part among the parts involved in the surrogacy contract, demands a particular attention. In this sense, the aim of this work is to lead a phenomenological analysis of the different steps of the practice of surrogacy, from the first stage of collection and classification of the information referring to the candidates, to the stage of the insemination and of its consequences about to the private life of the expectant. On the other hand, this work tries to justify the existence of a parallelism, as for the exploitation of the female body, between the practice of surrogate motherhood and prostitution. Finally, the issue relating to the effective social emancipation of the surrogate women in poor countries, the real autonomy and the freedom of their decision, as well as the typical features of the desire of paternity of the ordering couple are dealt with. The carried out study has allowed to conclude that this practice always implies a degree of physical, psychic and moral exploitation of the expectant mother, which suggests its prohibition at global level.
Topics: Commodification; Contracts; Crime Victims; Developing Countries; Female; Freedom; Human Body; Human Rights; Humans; Infant, Newborn; Insemination, Artificial; Morals; Mother-Child Relations; Personal Autonomy; Pregnancy; Sex Work; Surrogate Mothers
PubMed: 29406763
DOI: No ID Found -
Indian Journal of Community Medicine :... Oct 2012Surrogacy refers to a contract in which a woman carries a pregnancy "for" another couple. Number of infertile couples from all over the World approach India where...
Surrogacy refers to a contract in which a woman carries a pregnancy "for" another couple. Number of infertile couples from all over the World approach India where commercial surrogacy is legal. Although this arrangement appears to be beneficial for all parties concerned,there are certain delicate issues which need to be addressed through carefully framed laws in order to protect the rights of the surrogate mother and the intended parents.
PubMed: 23293432
DOI: 10.4103/0970-0218.103466 -
World Journal of Experimental Medicine Mar 2024Gestational diabetes is typically diagnosed in the late second or third trimester of pregnancy. It is one of the most common metabolic disorders among expectant mothers,... (Review)
Review
Gestational diabetes is typically diagnosed in the late second or third trimester of pregnancy. It is one of the most common metabolic disorders among expectant mothers, with potential serious short- and long-term complications for both maternal and offspring health. C-peptide is secreted from pancreatic beta-cells into circulation in equimolar amounts with insulin. It is a useful biomarker to estimate the beta-cell function because it undergoes negligible hepatic clearance and consequently it has a longer half-life compared to insulin. Pregnancy induces increased insulin resistance due to physiological changes in hormonal and metabolic homeostasis. Inadequate compensation by islet beta-cells results in hyperglycemia. The standard oral glucose tolerance test at 24-28 wk of gestation sets the diagnosis. Accumulated evidence from prospective studies indicates a link between early pregnancy C-peptide levels and the risk of subsequent gestational diabetes. Elevated C-peptide levels and surrogate glycemic indices at the beginning of pregnancy could prompt appropriate strategies for secondary prevention.
PubMed: 38590302
DOI: 10.5493/wjem.v14.i1.89320 -
BMC Medical Ethics Feb 2017Professional guidelines have addressed ethical dilemmas posed by a few types of nontraditional procreative arrangements (e.g., gamete donations between family members),...
BACKGROUND
Professional guidelines have addressed ethical dilemmas posed by a few types of nontraditional procreative arrangements (e.g., gamete donations between family members), but many questions arise regarding how providers view and make decisions about these and other such arrangements.
METHODS
Thirty-seven ART providers and 10 patients were interviewed in-depth for approximately 1 h each. Interviews were systematically analyzed.
RESULTS
Providers faced a range of challenges and ethical dilemmas concerning both the content and the process of decisions about requests for unconventional interfamilial and other reproductive combinations. Providers vary in how they respond - what they decide, who exactly decides (e.g., an ethics committee or not), and how - often undergoing complex decision-making processes. These combinations can involve creating or raising the child, and can shift over time - from initial ART treatment through to the child's birth. Patients' requests can vary from fully established to mere possibilities. Arrangements may also be unstable, fluid, or unexpected, posing challenges. Difficulties emerge concerning not only familial but social, combinations (e.g., between friends). These arrangements can involve blurry and confusing roles, questions about the welfare of the unborn child, and unanticipated and unfamiliar questions about how to weigh competing moral and scientific concerns - e.g., the autonomy of the individuals involved, and the potential risks and benefits. Clinicians may feel that these requests do not "smell right"; and at first respond with feelings of "yuck," and only later, carefully and explicitly consider the ethical principles involved. Proposed arrangements may, for instance, initially be felt to involve consanguineous individuals, but not in fact do so. Obtaining and verifying full and appropriate informed consent can be difficult, given implicit familial and/or cultural expectations and senses of duty. Social attitudes are changing, yet patients' views of these issues may also vary, based on their cultural backgrounds.
CONCLUSIONS
These data, the first to examine how clinicians make decisions about unconventional reproductive arrangements, highlight several critical ethical questions and ambiguities, and variations in clinicians' responses. While several professional guidelines exist, the current data highlight additional challenges, and have vital implications for improving future guidelines, practice, education and research.
TRIAL REGISTRATION
Not applicable.
Topics: Attitude of Health Personnel; Bioethical Issues; Child; Decision Making; Directed Tissue Donation; Family; Family Relations; Female; Fertilization in Vitro; Health Personnel; Humans; Informed Consent; Male; Morals; Parents; Surrogate Mothers
PubMed: 28245820
DOI: 10.1186/s12910-017-0177-x -
European Review For Medical and... Aug 2022Commercial surrogacy in Ukraine has been legal since 2002, and although no official figures are released, estimates point to several thousand births occurring yearly....
Commercial surrogacy in Ukraine has been legal since 2002, and although no official figures are released, estimates point to several thousand births occurring yearly. The country has long been regarded as one of the surrogacy capitals of the world, due to relatively affordable costs and effective targeted legislation making the surrogacy contracts enforceable. Would-be parents come from countries where surrogacy is banned or heavily restricted to start a family despite their infertility, a practice known as inter-country surrogacy. When a child is born through surrogacy, the surrogate mother forfeits her rights over the child, thus allowing the so-called "intended" or "commissioning" parents to be recognized as such on the Ukrainian birth certificate. Inter-country surrogacy has long been a highly controversial practice from an ethical and legal perspective, but the brutally destructive armed conflict erupted in the country over three months ago has laid bare all the pitfalls and deep flaws of such a system. Children born through surrogacy cannot be handed over to their intended parents, and surrogates risk legal issues and see their rights jeopardized by their choices even in a war setting, for instance if they decide to seek refuge abroad. The horrors of war thus risk victimizing the most vulnerable to an irreparable degree. An international effort is now more urgent than ever to seek a tenable balance between the desires of couples to achieve parenthood and the rights and freedom of often vulnerable women who risk exploitation and abuse and their children.
Topics: Armed Conflicts; Child; Family; Female; Humans; Pregnancy; Research; Surrogate Mothers; Ukraine
PubMed: 36066135
DOI: 10.26355/eurrev_202208_29497 -
International Journal of Environmental... Oct 2021(1) Background: Gestational surrogacy is the most common type of surrogacy today. Although technologically well-developed and legal in many countries, it challenges and...
(1) Background: Gestational surrogacy is the most common type of surrogacy today. Although technologically well-developed and legal in many countries, it challenges and even contradicts the basic traditional concepts of family, motherhood, and gender roles. In the present study, we examined the types of stigma coping strategies surrogate mothers discussed in an online support group in post-Soviet Russia. (2) Method: We conducted a qualitative thematic analysis of 15,602 posts on a Russian-language online support group for surrogate mothers. (3) Findings: group members discussed four types of coping strategies: stigma internalization, stigma avoidance, group identification, and stigma challenging. Nevertheless, these strategies varied across the surrogate motherhood stages. Group members advised each other on specific strategies to use to cope with the state of discreditable (invisible) stigma (i.e., during the first few months of their pregnancies), with different strategies for when the pregnancies became visible and they risked becoming discredited people. Furthermore, group members disclosed that they used these strategies even when they returned to their previous family and work routines. Theoretically, our findings challenge Goffman's classic theoretical dichotomy and coping research concerning discreditable (invisible) and discredited (visible) stigma. (4) Conclusion: Our findings indicate that surrogate mothers anticipate experiencing stigma and therefore plan for it by discussing potential coping strategies in the online group. Moreover, any intervention designed to cater to the needs of surrogate mothers must, therefore, take into consideration the social needs of their entire family.
Topics: Adaptation, Psychological; Female; Humans; Language; Mothers; Pregnancy; Russia; Social Stigma; Spouses; Surrogate Mothers
PubMed: 34769841
DOI: 10.3390/ijerph182111325 -
Indian Journal of Medical Ethics 2010New legislation can be oppressive for a significant population depending upon the politics of its drafters. The current upsurge of the surrogacy trade in India, and the...
New legislation can be oppressive for a significant population depending upon the politics of its drafters. The current upsurge of the surrogacy trade in India, and the label of a "win-win" situation that it has acquired, points towards an unfettered commercialisation of assisted reproductive technology and the practice of surrogacy that is blinding its middle class users as well as providers, policy makers and law makers, and charging an imagination that is already caught up in spiralling consumerism. This paper analyses the Draft Assisted Reproductive Technology (Regulation) Bill and Rules, 2008, in the Indian socioeconomic context. It identifies the interests of the affected women, and examines the contradictions of the proposed Bill with their interests, as well as with current health and population policies, confining itself to the handling of surrogacy and not the entire content of the Bill. The bases of the analytical perspective used are: the context of poverty and the health needs of the Indian population; the need to locate surrogacy services within the overall public health service context and its epidemiological basis; the need to restrain direct human experimentation for the advancement of any technology; the use of safer methods; and, finally, the rights of surrogate mothers and their babies, in India, as opposed to the compulsion or dynamics of the medical market and reproductive tourism.
Topics: Commerce; Female; Human Rights; Humans; India; Infant, Newborn; Politics; Pregnancy; Public Policy; Reproductive Techniques, Assisted; Surrogate Mothers
PubMed: 22106569
DOI: 10.20529/IJME.2010.079 -
Reproductive Health Feb 2019Gestational surrogacy is one of the options for women whom pregnancy is contraindicated. Despite of increasing demand for gestational surrogacy, its various aspects are...
BACKGROUND
Gestational surrogacy is one of the options for women whom pregnancy is contraindicated. Despite of increasing demand for gestational surrogacy, its various aspects are controversial. The unique nature of surrogacy causes surrogate mothers to face a variety of problems such as, ethical confusion, psychological disturbance and reproductive health matters. Therefore, it is necessary to develop a comprehensive care program for reproductive and sexual health providing specific care at prenatal and pregnancy as well as delivery and postpartum period in socio- cultural context of Iran.
METHODS
This research is an exploratory study with the qualitative-quantitative sequencing design (mixed) that is consisted of three sequential phases. In the first phase, following a qualitative approach, the researcher will explain needs of reproductive and sexual health in surrogate mothers. In the second phase, a primary reproductive and sexual health care program is designed for surrogate mothers in which, in addition to using the qualitative study results, related papers and texts will be also used. In the third phase of the study, reproductive and sexual health care program will be evaluated by RAND method (RAM).
DISCUSSION
The results of this mixed method study are expected to lead to the development of a reproductive and sexual health care program meeting the needs of surrogate mothers and are in accordance with the cultural conditions of the research community, ultimately leading to improvement in reproductive and sexual health of surrogate mothers.
Topics: Clinical Protocols; Culture; Female; Humans; Iran; Program Evaluation; Qualitative Research; Reproductive Health; Reproductive Health Services; Research Design; Surrogate Mothers
PubMed: 30808381
DOI: 10.1186/s12978-019-0687-8