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      No birth-associated maternal mortality in Japanese macaques ( Macaca fuscata) despite giving birth to large-headed neonates

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          Significance

          A tight fit between the neonatal head and maternal pelvic dimensions is often associated with an increased maternal mortality risk in humans and some other primate species. Japanese macaques show a human-like tight feto-pelvic fit. Based on 27 y of data from a continuously monitored semi-free-ranging group of Japanese macaques, we found no birth-associated maternal mortality in macaques, which differs from the situation in many human populations.

          Abstract

          Human fetuses at term are large relative to the dimensions of the maternal birth canal, implying that their birth can be associated with difficulties. The tight passage through the human birth canal can lead to devastating outcomes if birth becomes obstructed, including maternal and fetal death. Although macaques have to accommodate similarly large fetuses, relative to their maternal birth canals, it was not known whether macaque mothers face birth difficulties similar to humans. Based on 27 y of demographic data from a semi-free-ranging, closely monitored population of Japanese macaques ( Macaca fuscata), we found no birth-associated mortality in macaques. This differs from the situation in many human populations. We suggest three nonmutually exclusive hypotheses to explain these observations. i) The macaque fetal skull is similarly flexible as the human fetal skull. ii) The macaque pelvis and connective tissue show greater flexibility during birth. iii) The interplay between macaque pelvic shape and birth dynamics is smoother and incurs fewer complications than in humans.

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          Most cited references88

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          Global causes of maternal death: a WHO systematic analysis.

          Data for the causes of maternal deaths are needed to inform policies to improve maternal health. We developed and analysed global, regional, and subregional estimates of the causes of maternal death during 2003-09, with a novel method, updating the previous WHO systematic review. We searched specialised and general bibliographic databases for articles published between between Jan 1, 2003, and Dec 31, 2012, for research data, with no language restrictions, and the WHO mortality database for vital registration data. On the basis of prespecified inclusion criteria, we analysed causes of maternal death from datasets. We aggregated country level estimates to report estimates of causes of death by Millennium Development Goal regions and worldwide, for main and subcauses of death categories with a Bayesian hierarchical model. We identified 23 eligible studies (published 2003-12). We included 417 datasets from 115 countries comprising 60 799 deaths in the analysis. About 73% (1 771 000 of 2 443 000) of all maternal deaths between 2003 and 2009 were due to direct obstetric causes and deaths due to indirect causes accounted for 27·5% (672 000, 95% UI 19·7-37·5) of all deaths. Haemorrhage accounted for 27·1% (661 000, 19·9-36·2), hypertensive disorders 14·0% (343 000, 11·1-17·4), and sepsis 10·7% (261 000, 5·9-18·6) of maternal deaths. The rest of deaths were due to abortion (7·9% [193 000], 4·7-13·2), embolism (3·2% [78 000], 1·8-5·5), and all other direct causes of death (9·6% [235 000], 6·5-14·3). Regional estimates varied substantially. Between 2003 and 2009, haemorrhage, hypertensive disorders, and sepsis were responsible for more than half of maternal deaths worldwide. More than a quarter of deaths were attributable to indirect causes. These analyses should inform the prioritisation of health policies, programmes, and funding to reduce maternal deaths at regional and global levels. Further efforts are needed to improve the availability and quality of data related to maternal mortality. © 2014 World Health Organization; licensee Elsevier. This is an Open Access article published without any waiver of WHO's privileges and immunities under international law, convention, or agreement. This article should not be reproduced for use in association with the promotion of commercial products, services, or any legal entity. There should be no suggestion that WHO endorses any specific organisation or products. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL.
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            Maternal mortality: who, when, where, and why.

            The risk of a woman dying as a result of pregnancy or childbirth during her lifetime is about one in six in the poorest parts of the world compared with about one in 30 000 in Northern Europe. Such a discrepancy poses a huge challenge to meeting the fifth Millennium Development Goal to reduce maternal mortality by 75% between 1990 and 2015. Some developed and transitional countries have managed to reduce their maternal mortality during the past 25 years. Few of these, however, began with the very high rates that are now estimated for the poorest countries-in which further progress is jeopardised by weak health systems, continuing high fertility, and poor availability of data. Maternal deaths are clustered around labour, delivery, and the immediate postpartum period, with obstetric haemorrhage being the main medical cause of death. Local variation can be important, with unsafe abortion carrying huge risk in some populations, and HIV/AIDS becoming a leading cause of death where HIV-related mortaliy rates are high. Inequalities in the risk of maternal death exist everywhere. Targeting of interventions to the most vulnerable--rural populations and poor people--is essential if substantial progress is to be achieved by 2015.
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              International standards for fetal growth based on serial ultrasound measurements: the Fetal Growth Longitudinal Study of the INTERGROWTH-21st Project.

              In 2006, WHO produced international growth standards for infants and children up to age 5 years on the basis of recommendations from a WHO expert committee. Using the same methods and conceptual approach, the Fetal Growth Longitudinal Study (FGLS), part of the INTERGROWTH-21(st) Project, aimed to develop international growth and size standards for fetuses.
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                Author and article information

                Contributors
                Journal
                Proc Natl Acad Sci U S A
                Proc Natl Acad Sci U S A
                PNAS
                Proceedings of the National Academy of Sciences of the United States of America
                National Academy of Sciences
                0027-8424
                1091-6490
                7 October 2024
                15 October 2024
                7 October 2024
                : 121
                : 42
                : e2316189121
                Affiliations
                [1] aDepartment of Obstetrics and Gynecology, Division of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna , Vienna A-1090, Austria
                [2] bDepartment of Evolutionary Anthropology, University of Vienna , Vienna A-1030, Austria
                [3] cDepartment of Evolutionary Biology, Unit for Theoretical Biology, University of Vienna , Vienna A-1030, Austria
                [4] dKonrad Lorenz Institute for Evolution and Cognition Research , Klosterneuburg A-3400, Austria
                [5] eWildlife Research Center, Kyoto University , Inuyama 606-8501, Japan
                [6] fCenter for the Evolutionary Origins of Human Behavior, Kyoto University , Inuyama 484-8506, Japan
                [7] gDepartment of Behavioral and Cognitive Biology, University of Vienna , Vienna A-1030, Austria
                [8] hAustrian Research Center for Primatology , Ossiach A-9570, Austria
                Author notes
                1To whom correspondence may be addressed. Email: katharinaelisabeth.pink@ 123456gmail.com .

                Edited by Karen Rosenberg, University of Delaware, Newark, DE; received September 20, 2023; accepted August 15, 2024 by Editorial Board Member C. O. Lovejoy

                2K.E.P. and B.F. contributed equally to this work.

                Author information
                https://orcid.org/0000-0003-0381-8142
                https://orcid.org/0000-0002-4492-8906
                https://orcid.org/0000-0003-2115-7923
                https://orcid.org/0009-0008-0646-4742
                https://orcid.org/0000-0003-3629-1658
                https://orcid.org/0000-0003-4494-4970
                Article
                202316189
                10.1073/pnas.2316189121
                11494302
                39374390
                0109f317-e2f9-4282-b509-c2ed377b242f
                Copyright © 2024 the Author(s). Published by PNAS.

                This open access article is distributed under Creative Commons Attribution License 4.0 (CC BY).

                History
                : 20 September 2023
                : 15 August 2024
                Page count
                Pages: 8, Words: 5812
                Funding
                Funded by: Austrian Science Fund (FWF), FundRef 501100002428;
                Award ID: V-826
                Award Recipient : Barbara Fischer
                Categories
                research-article, Research Article
                anthro-bio, Anthropology
                from-the-cover, From the Cover
                402
                Biological Sciences
                Anthropology

                maternal mortality,primates,evolution of birth,feto-pelvic disproportion

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