PIDEMIOLOGICAL INVESTIGAtions from the United States and Europe demonstrate that higher intakes of n-3 long-chain polyunsaturated fatty acids (LCPUFA) from fish and seafood during pregnancy are associated with a reduced risk of depressive symptoms in the postnatal period, 1 as well as improved developmental outcomes in the offspring. 2,3 Of the n-3 LCPUFA, it is hypothesized that docosahexaenoic acid (DHA) may be responsible for the observed associations based on estimates of dietary requirements during pregnancy and the results of experimental animal studies. 4 However, n-3 LCPUFA intervention trials in human pregnancy have reported mixed results and have not been conclusive largely because of methodological limitations. Studies focused on perinatal mood have had open-label designs, small sample sizes, or large attrition, and most did not analyze by intention-to-treat. 5 Similarly, trials focused on the developmental outcomes of the children have made post-See also p 1717 and Patient Page.

Life history theory suggests that in risky and uncertain environments the optimal reproductive strategy is to reproduce early in order to maximize the probability of leaving any descendants at all. The fact that early menarche facilitates early reproduction provides an adaptationist rationale for our first two hypotheses: that women who experience more risky and uncertain environments early in life would have (1) earlier menarche and (2) earlier first births than women who experience less stress at an early age. Attachment theory and research provide the rationale for our second two hypotheses: that the subjective early experience of risky and uncertain environments (insecurity) is (3) part of an evolved mechanism for entraining alternative reproductive strategies contingent on environmental risk and uncertainty and (4) reflected in expected lifespan. Evidence from our pilot study of 100 women attending antenatal clinics at a large metropolitan hospital is consistent with all four hypotheses: Women reporting more troubled family relations early in life had earlier menarche, earlier first birth, were more likely to identify with insecure adult attachment styles, and expected shorter lifespans. Multivariate analyses show that early stress directly affected age at menarche and first birth, affected adult attachment in interaction with expected lifespan, but had no effect on expected lifespan, where its original effect was taken over by interactions between age at menarche and adult attachment as well as age at first birth and adult attachment. We discuss our results in terms of the need to combine evolutionary and developmental perspectives and the relation between early stress in general and father absence in particular.

Stillbirth occurs in about 1 of every 200 pregnancies. Suggestions have been made that it can be prevented through use of increased antenatal surveillance and intervention for risk factors such as advanced maternal age, but there is little supporting evidence for this practice.The aim of this retrospective study was to identify potential prepregnancy risk factors for antepartum stillbirth and to determine whether these risk factors are useful in identifying women at a significantly higher risk for stillbirth at term compared with those in the general population not deemed at increased risk of stillbirth. The study population included a cohort of 174,809 singleton births at Ն23 weeks of gestation delivered at 10 institutions in the United States between 2002 and 2008. Of these, 712 were antepartum stillbirths and 174,097 were live births. A subset of 155,629 singleton pregnancies was used to estimate the risk of term antepartum stillbirth. Multivariate analysis assessed the relationship between a potential risk factor and the occurrence of antepartum stillbirth, controlling for other risk factors.Compared with the live birth controls, factors independently associated with increased risk of antepartum stillbirth were African-American and Hispanic race, advanced maternal age (Ն35-39 years), nulliparity, prepregnancy body mass index Ն30, preexisting diabetes, chronic hypertension, smoking, and alcohol use. The risk of antepartum stillbirth increased in women with a history of cesarean delivery or preterm birth after adjustment for other risk factors. For term deliveries among women who were nonHispanic white, 25 to 29 years of age, normal weight, multiparous, and who had no chronic hypertension or preexisting diabetes, the baseline risk of term stillbirth was 0.8 per 1000. The adjusted risk of term stillbirth increased when the following individual factors were present: preexisting diabetes (3.

A four-step management plan adopted with obese women reduces the incidence of gestational diabetes.