Sleep And Delivery Time 1.46
Sleep is related to various aspects of mental, cognitive and physical wellbeing in children and adults . There is abundant evidence of the adverse consequences of sleep problems on individuals including attention problems , neuropsychological problems , learning , emotional and behavioural problems [5, 6], daytime functioning and quality of life [7, 8]. The effects of maternal smoking during pregnancy have also been studied extensively, with exposed children being at greater risk of a range of adverse outcomes [9,10,11,12,13], some evident even in adulthood, for example nicotine dependence  and adverse effects on intelligence . More recently studies have suggested an association between prenatal maternal smoking and sleep problems in children [16,17,18,19]. If confirmed and the relationship persisted, this could potentially be an important mechanism contributing to adolescent and young adult sleep problems and their associated morbidity.
Sleep and delivery time 1.46
A cohort of 1,332 women was interviewed during early pregnancy. We ascertained psychiatric diagnosis status and collect information about sleep duration, daytime sleepiness, vital exhaustion and perceived stress. Logistic regression procedures were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs).
The baseline characteristics of the participants, along with the available data on sleep duration before pregnancy, are shown in Table 1. The characteristics of participants in the various sleep groups are also shown in Supplemental Table 1. The reported sleep duration was on average between 7 and 8 h, both before and during pregnancy. The participants tended to sleep longer and go to bed earlier during pregnancy than before pregnancy. Significant data points are summarized below and include risk ratios (RR) and 95% confidence intervals (CI) in the multivariable model, adjusted for maternal age at delivery, smoking habits, alcohol consumption, pre-pregnancy body mass index, gestational age at birth, parity, infertility treatment, and infant sex.
In this study, the participants tended to sleep longer and go to bed earlier during pregnancy than they did before pregnancy. In Japan, many women still stop working due to pregnancy or take maternity leave during late pregnancy. For that reason, sleep duration and bedtime might improve during pregnancy.
We used a log-binominal regression model to explore the association of maternal sleep with each outcome and to estimate the RRs of each outcome and 95% CIs. We initially adjusted for maternal age at delivery and then further adjusted for smoking habits (never smoked, ex-smokers who quit before pregnancy, smokers during early pregnancy), alcohol consumption (never drinkers, ex-drinkers who quit before pregnancy, drinkers during early pregnancy), pre-pregnancy BMI (
ImportanceThe well-being and development of children is strongly influenced by parents' physical and psychosocial health. Data from small, clinic-based studies suggest that sleep loss may be common in parents of children with atopic dermatitis (AD), but longitudinal population-based studies are lacking.ObjectivesTo compare sleep disturbances over time between mothers of children with and without AD and to determine whether these disturbances are associated with the child's disease severity and the child's sleep disturbances.Design, setting, and participantsIn the ongoing Avon Longitudinal Study of Parents and Children, all pregnant women residing in Avon, United Kingdom, with an expected delivery date between April 1, 1991, and December 31, 1992, were recruited. Analyses for this study, a secondary analysis of this cohort, were performed from September 2017 to September 2018. Mother-child pairs were followed up with a time-varying measure of child AD activity and severity and self-reported maternal sleep measures repeated at multiple time points between child ages 6 months and 11 years.Main outcomes and measuresTime-varying binary measures of maternal sleep duration (
IMPORTANCE: The well-being and development of children is strongly influenced by parents' physical and psychosocial health. Data from small, clinic-based studies suggest that sleep loss may be common in parents of children with atopic dermatitis (AD), but longitudinal population-based studies are lacking. OBJECTIVES: To compare sleep disturbances over time between mothers of children with and without AD and to determine whether these disturbances are associated with the child's disease severity and the child's sleep disturbances. DESIGN, SETTING, AND PARTICIPANTS: In the ongoing Avon Longitudinal Study of Parents and Children, all pregnant women residing in Avon, United Kingdom, with an expected delivery date between April 1, 1991, and December 31, 1992, were recruited. Analyses for this study, a secondary analysis of this cohort, were performed from September 2017 to September 2018. Mother-child pairs were followed up with a time-varying measure of child AD activity and severity and self-reported maternal sleep measures repeated at multiple time points between child ages 6 months and 11 years. MAIN OUTCOMES AND MEASURES: Time-varying binary measures of maternal sleep duration (
Therefore, screening for OSA by history should be done and sleep studies ordered as indicated. Obese women should be screened for OSA at the first prenatal visit. Women with suspected OSA due to reported snoring, excessive daytime sleepiness, witnessed apneas, or unexplained hypoxia should be referred to a sleep medicine specialist for evaluation and possible treatment. Refer to the Medscape article on sleep apnea for screening tools and further information.
If pregnancy occurs before the recommended time frame for women who have had bariatric surgery, closer surveillance of maternal weight and nutritional status as well as serial monitoring of fetal growth will likely be beneficial. It is important to determine the type of bariatric surgery, restrictive (banding) or bypass (Roux-en-Y), because they may present different challenges during the pregnancy and at delivery.
Increasing BMI is associated with longer incision-to-delivery time, which may increase neonatal morbidity, particularly in emergency situations.  It is important not to wait until the last moment to transport the patient to the operating room, place an epidural catheter, etc, especially in the setting of morbid obesity and severe morbid obesity. The time and personnel it takes to move an obese patient (especially someone with a BMI of 40 kg/m2 or higher) to the operating room and position her can be far greater than for a non-obese individual. This factor needs to be considered as a provider evaluates fetal status and labor progression.
An appropriate dose of prophylactic antibiotics should be administered based on maternal weight. Some recommendations based on general surgical procedures would suggest a 2-g prophylactic cefazolin dose for women who weigh more than 80 kg (175 lb), with an increase to 3 g for those who weight more than 120 kg (265 lb).  Few studies have specifically addressed the question of weight-based dosing for antibiotic prophylaxis at the time of cesarean delivery. These have had mixed results. An additional suggested strategy is a second dose of antibiotics 4 hours after the first.
Danielle Hildreth is a registered nurse and certified personal trainer. She works full time in a labor and delivery unit, and her fitness background includes personal training, HIIT, yoga sculpt, and dance.
Building on the limited literature on web-based SSIs for chronic pain, we aim to evaluate a Zoom-delivered version of a previously developed and efficacious, skills-based, behavioral medicine SSI empowered relief (ER) [11,36]. Previously, our group conducted a three-arm randomized controlled trial conducted in 263 adults with chronic low back pain comparing in-person ER to a health education class or 8-week CBT . However, web-based delivery of ER has not been tested, particularly in mixed-etiology chronic pain, and the COVID-19 context underscores the importance of providing effective home-based chronic pain care. Extending this work to the digital platform, in this study, we conducted a parallel-group, randomized (1:1) comparative efficacy trial to assess the impact of a single-session videoconference-delivered ER group pain relief skills class versus waitlist control (WLC). We hypothesize that at 3 months posttreatment, (1) ER would be superior to WLC for reductions in pain catastrophizing, an index of pain coping; (2) ER would be superior to WLC for reductions in pain intensity, bothersomeness, and sleep disturbance; and (3) ER would be superior to WLC in reducing anxiety, depression, and physical function.
This study was a parallel-group, randomized, clinical trial comparing ER, a 2-hour single-session videoconference-delivered class, to a WLC. Enrolled participants (N=104) aged 18-80 years with mixed chronic pain etiology were randomized (1:1) to one of the two study arms. Participants completed outcome assessments at pretreatment, week 2, and 1, 2, and 3 months posttreatment. The primary outcome was pain catastrophizing levels at the 1-month follow-up , with pain intensity, pain, bothersomeness, and sleep disturbance as secondary outcomes. The tertiary outcomes included PROMIS (Patient-Reported Outcomes Measurement Information System) measures of anxiety, depression, and physical function at the 1-month follow-up time-point. We also report a more rigorous test of the durability of treatment effects at 3 months posttreatment as highlighted in the Results section. A crossover intervention class was offered to participants who were initially randomized to the WLC and was conducted in February 2021. Of 48 participants who were offered the treatment, 20 (42%) attended the crossover class at no cost, and no data were collected. This study was conducted between August 2020 and February 2021.
With respect to preliminary efficacy, time effects showed reductions in pain intensity and most pain-related indices, except for sleep disruption. ER demonstrated superior treatment effects on average pain intensity and pain-related catastrophizing, pain bothersomeness, and sleep disruption over the 3 months following treatment. The between-groups Cohen d effect sizes at 3-month posttreatment ranged from 0.60 to 0.91 for primary and secondary variables. For ER, pre- or posttreatment Cohen d effect sizes ranged from 0.37 to 0.89, demonstrating no clinical importance to moderate clinical importance for reducing pain-related catastrophizing, bothersomeness, and sleep disruption at the end of treatment. The treatment effect sizes across the primary and secondary outcomes suggested that a single-session, digital, skills-based intervention may have clinically meaningful effects on patient-reported outcomes. The durability of the treatment effects was demonstrated at the 3-month follow-up time-point. A greater proportion of participants in the ER group exceeded the thresholds for the clinical importance of effects at 3 months posttreatment. 041b061a72