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Showing papers on "Pregnancy published in 1982"


Journal ArticleDOI
TL;DR: A unique group of preeclamptic/eClamptic patients with the finding of hemolysis, elevated liver enzymes, and a low platelet count is defined, termed the HELLP syndrome, which may occur when the usual clinical findings to diagnose severe preeclampsia are absent.

1,223 citations


Journal ArticleDOI
TL;DR: Investigation of cases of confirmed rubella infection at different stages of pregnancy and the findings in infected children being compared with those in children who had escaped infection found no defects attributable to rubella.

495 citations


Journal ArticleDOI
TL;DR: Maternal meals and glucose concentrations did not influence gross fetal body movements and fetuses demonstrated a peak in activity between 2100 and 0100 hours at 38 to 39 weeks' gestational age.

409 citations



Journal ArticleDOI
TL;DR: The number and size of live-born infants was much greater in mothers who had become acyanotic as a result of reparative surgery than in the still cyanotic women, whether or not they had had palliative surgery.
Abstract: In the state of Connecticut, 233 women with congenital heart defects were prospectively followed up through 482 pregnancies that resulted in 372 infants who were examined frequently during their first 3 years of life. Approximately half of the women had undergone cardiac surgery and they were compared with the women without operation. There was no maternal mortality, and no patient had infective endocarditis, brain abscess or a cerebrovascular accident. The proportion of pregnancies resulting in live births did not differ significantly in mothers with and without cardiac surgery; the average live birth rate was 77 percent in all. However, the number and size of live-born infants was much greater in mothers who had become acyanotic as a result of reparative surgery than in the still cyanotic women, whether or not they had had palliative surgery. In cyanotic women, placental size was abnormally large in relation to birth weight, which was abnormally low. When the mothers were classified according to cardiac function, there was a significant difference between the number of infants born alive to mothers in good to excellent status and the number born to mothers in fair to poor condition. The latter had a significant increase in interrupted pregnancies as well as in cardiovascular complications during pregnancy. The total group had a 16.1 percent incidence rate of infants with congenital heart disease. This rate was corrected to 14.2 percent by removal of seven mothers, two with Noonan's syndrome, one with hypertrophic cardiomyopathy and four with a family history of congenital heart defects.

320 citations


Journal ArticleDOI
01 Jan 1982-Diabetes
TL;DR: The data suggest that fetal malformations in the diabetic rat are attributable either to the hyperglycemia as such or to some accompanying metabolic consequence of insulin deficiency, and underscore the importance of a strict differentiation in the offspring of the diabetic rats between transient development retardations and true malformation.
Abstract: Intensive care of the pregnant mother with diabetes has dramatically decreased the incidence of diabetic fetopathy. The persistently high rate of fetal and neonatal mortality in diabetic pregnancies is nowadays mainly due to the increased incidence of serious congenital malformations. However, attempts to elucidate the precise teratogenic mechanisms have been sparse, presumably because of a lack of relevant animal models. In the present study we recorded the incidence and types of skeletal malformations in live offspring of normal rats and in rats made diabetic with the B-cytotoxic agent streptozotocin (SZ) at least 2 wk before conception. In some of the diabetic animals insulin treatment was begun 1 wk after the SZ injection and continued throughout pregnancy. In addition, the fetal development was followed by assessing the calcification of the skeleton on gestational days 20 and 22 with the aid of Alazarin Red S staining. Manifest diabetes in the pregnant rat induced a decrease in fetal weight and viability and marked retardation of skeletal maturation. In addition, about 20% of 135 viable fetuses showed skeletal malformations comprising either micrognathia or caudal dysgenesis. These defects were not found in 314 offspring of the control rats. Only two cases of caudal dysgenesis and none of micrognathia were detected among 233 offspring of the insulin-treated rats. The present data underscore the importance of a strict differentiation in the offspring of the diabetic rat between transient development retardations and true malformations. They also demonstrate that correction of the maternal glucose intolerance is crucial for preventing the fetus from developing skeletal malformations. Altogether the data suggest that fetal malformations in the diabetic rat are attributable either to the hyperglycemia as such or to some accompanying metabolic consequence of insulin deficiency.

314 citations


Journal ArticleDOI
TL;DR: A study of maternal immune responsiveness during pregnancy found that changes in disease activity and antibody production during pregnancy may account for changes in the survival of the fetus as an allograft.
Abstract: DECREASED maternal immune responsiveness during pregnancy may partly explain the survival of the fetus as an allograft. It may also account for changes in disease activity and antibody production i...

278 citations


Journal ArticleDOI
TL;DR: In the normal pregnancy groups, with increasing fetal gestational age from 28 to 32 weeks to 36 to 40 weeks there was an increase in the length of the active and quiet periods with fewer active-quiet cycles per hour.

274 citations


Journal ArticleDOI
19 Mar 1982-JAMA
TL;DR: Infected women were significantly younger than noninfected women, and significantly more often unmarried, supported by public assistance, and pregnant for the first time, among women followed up from 19 weeks' gestation until delivery, the mean duration of gestation was significantly shorter for those with antepartum chlamydial infection.
Abstract: In a prospective study of morbidity associated with Chlamydia trachomatis infections during pregnancy, we isolated C trachomatis from the endocervix of 18 (6.7%) of 268 women examined before 19 weeks' gestation. Infected women were significantly younger than noninfected women, and significantly more often unmarried, supported by public assistance, and pregnant for the first time. Among women followed up from 19 weeks' gestation until delivery, the mean duration of gestation was significantly shorter for those with antepartum chlamydial infection. Stillbirth or neonatal death occurred in six (33%) of the 18 pregnancies of infected women compared with eight (3.4%) of the 238 pregnancies of noninfected women followed up from the 19th week of gestation through delivery. Stillbirth or neonatal death occurred ten times more often among Chlamydia infected women than among uninfected controls matched for age, marital status, socioeconomic status, pregnancy order, and race. ( JAMA 1982;247:1585-1588)

264 citations


Journal ArticleDOI
TL;DR: A detailed review of the effects of in utero DES exposure is presented, including increased rates of spontaneous abortion, ectopic pregnancy, premature deliveries, and perinatal deaths, all contributing to an increase in overall adverse pregnancy outcome.

260 citations


Journal ArticleDOI
TL;DR: New findings in this study include a negative association between maternal marijuana use during pregnancy and fetal growth, and women who used marijuana during pregnancy were five times more likely to deliver infants with features considered compatible with the fetal alcohol syndrome.
Abstract: A study of 1,690 mother/child pairs at Boston City Hospital was conducted to assess the impact of maternal alcohol consumption on fetal development when confounding variables were controlled. Level of maternal drinking prior to pregnancy was associated with shorter duration of gestation. Lower maternal weight change, history of maternal illnesses, cigarette smoking, and marijuana use, however, were more consistently related to adverse fetal growth and development. New findings in this study include a negative association between maternal marijuana use during pregnancy and fetal growth. Also when confounding variables were controlled, women who used marijuana during pregnancy were five times more likely to deliver infants with features considered compatible with the fetal alcohol syndrome.

Journal ArticleDOI
TL;DR: There were no significant differences between the children in the treated and untreated groups in standing and supine blood pressures, or fourteen tests of ability, and methyldopa seems safe to use in pregnancy and is probably preferable to other drugs from the point of view of the neonate and child.

Journal ArticleDOI
TL;DR: In planning public health activities such as nutrition interventions for developing countries, the type of intrauterine growth retardation present in the target population should be considered in order to determine which type of intervention would be most appropriate, and establish its correct timing.
Abstract: Three different types of intrauterine growth retardation can be identified depending on the moment at which supplies to the fetus are diminished. When a reduction in sustenance occurs early in the first trimester of pregnancy, a well-proportioned but growth-retarded baby may be expected. When the negative factors develop around the 30th week of pregnancy, the result is a disproportionately growth-retarded infant. Both types of retardation can be illustrated using longitudinal uterine height and biparietal diameter values and by neonatal anthropometry. Epidemiological examples exist defining factors which produce these two kinds of retardation. The third type occurs when a reduction in food supplies takes place in the last month of pregnancy and causes a depletion of the fetal fat stored. Weight retardation is observed with little or no height impairment. In planning public health activities such as nutrition interventions for developing countries, the type of intrauterine growth retardation present in the target population should be considered in order to determine which type of intervention would be most appropriate, and establish its correct timing.

Journal ArticleDOI
TL;DR: It is concluded that PGI2 biosynthesis is increased during normal pregnancy, and that this increase is less in pregnancy-induced hypertension.



Journal ArticleDOI
TL;DR: There was a considerable variation in the time required for this hyperlipidaemia to decline after delivery; women who bottle‐fed their infants maintained an elevated serum triglyceride level for three times longer than those who breast‐feeding their infants.

Journal ArticleDOI
TL;DR: It is suggested that coffee consumption has a minimal effect, if any, on the outcome of pregnancy and there was no excess of malformations among coffee drinkers.
Abstract: We analyzed interview and medical-record data of 12,205 non-diabetic, non-asthmatic women to evaluate the relation between coffee consumption and adverse outcomes of pregnancy. Low birth weight and short gestation occurred more often among offspring of women who drank four or more cups of coffee a day and more often among the offspring of smokers. After controlling for smoking, other habits, demographic characteristics, and medical history by standardization and logistic regression, we found no relation between low birth weight or short gestation and heavy coffee consumption. Furthermore, there was no excess of malformations among coffee drinkers. These negative results suggest that coffee consumption has a minimal effect, if any, on the outcome of pregnancy.


Journal Article
TL;DR: Neither trial of labor nor duration of labor in patients with chorioamnionitis correlated with adverse neonatal outcome, however, the appearance of maternal fever prior to the onset of labor correlated more significantly with neonatal death and RDS in the newborn that did the development of maternal Fever in the intrapartum period.

Journal ArticleDOI
TL;DR: It is concluded that aspirin should be avoided during pregnancy because of the effects of maternal ingestion of acetylsalicylic acid (aspirin) within 10 days of delivery on maternal and neonatal hemostasis.
Abstract: In a case-control study, we evaluated the effects of maternal ingestion of acetylsalicylic acid (aspirin) within 10 days of delivery on maternal and neonatal hemostasis. Only one of 34 control maternal-neonatal pairs (3 per cent) had hemostatic abnormalities. In 10 pairs, when maternal aspirin ingestion occurred within five days of delivery, 6 of 10 mothers and 9 of the 10 infants had bleeding tendencies. Seven maternal-neonatal pairs in which aspirin was ingested 6 to 10 days before delivery were free of clinical bleeding. Among seven other mothers who ingested aspirin in the immediate post-partum period four of the seven (57 per cent) also had impaired hemostasis. Neonatal hemostatic abnormalities included numerous petechiae over the presenting part, hematuria, a cephalhematoma, subconjunctival hemorrhage, and bleeding from a circumcision. Maternal bleeding was confined to excessive intrapartum or post-partum blood loss. We conclude that aspirin should be avoided during pregnancy. If ingestion has occurred within five days of delivery, the neonate should be evaluated for the presence of bleeding.

Journal ArticleDOI
TL;DR: This study supports previous findings which suggest that increasing levels of progesterone and estradiol affect gastrointestinal function and therefore may contribute to gastrointestinal symptoms that often occur in pregnant women.
Abstract: In order to evaluate the possible effects of pregnancy-associated sex steroids on gastrointestinal function, we determined gastrointestinal transit times and sex steroid levels in 15 women during the third trimester of their pregnancies and again 4–6 weeks following delivery when gastrointestinal function had symptomatically returned to normal. Gastrointestinal transit time from ingestion of a liquid lactulose meal to its delivery to the cecum was determined by monitoring breath hydrogen concentrations at 10-min intervals. Gastrointestinal transit times were significantly prolonged in the third trimester of pregnancy, when progesterone and estradiol levels were increased, compared to the postpartum period. This study supports previous findings which suggest that increasing levels of progesterone and estradiol affect gastrointestinal function and therefore may contribute to gastrointestinal symptoms that often occur in pregnant women.

Journal ArticleDOI
TL;DR: The growth retardation was greatest when women were underweight pregravid and had a low pregnancy weight gain, when they were hypertensive, or when the work required standing, and the frequency of large placental infarcts progressively increased when women continued stand-up work into late gestation.
Abstract: In order to determine whether pregnancy outcome was altered when women were employed outside their homes, 7,722 pregnancies were analyzed. Gestations were not shortened but newborns of women who worked in the third trimester weighed 150 to 400 gm less than newborns of mothers who remained at home. The growth retardation was greatest when women were underweight pregravid and had a low pregnancy weight gain, when they were hypertensive, or when the work required standing. The growth retardation remained after the data were stratified by race, socioeconomic status, and other maternal factors that commonly influence fetal growth. The frequency of large placental infarcts progressively increased when women continued stand-up work into late gestation. Such infarcts reached a peak of 250/1,000 births after the 37th week of gestation in stand-up workers. Low uteroplacental blood flow is a likely explanation for both the fetal growth retardation and the large placental infarcts.

Journal ArticleDOI
TL;DR: The combined evidence suggests that the menstruating interval is associated with a reduction of fecundity which is less complete than it is during the phase of lactational amenorrhea.
Abstract: This discussion describes the methods which have been used to investigate lactational infertility and examines how different breastfeeding patterns influence human birth intervals. Lactational infertility can be measured in 3 different ways: by the duration of the interbirth interval; by the duration of lactational amenorrhea; and by the return of ovulation. The ultimate test of fertility is pregnancy. Several reports have demonstrated that breastfeeding increases the interval between pregnancies. For example 2 studies compared the time to next conception in nursing and nonnursing mothers from Alaskan Eskimo and rural Indian populations. Despite the wide differences in climate and culture the conception rates were similar in the 2 populations and conception occurred sooner in the nonlactating than lactating mothers. Despite clear evidence that breastfeeding is associated with prolonged interbirth intervals it cannot be assumed that breastfeeding per se is directly responsible for this effect. In many cultures and particularly in Africa sexual taboos are imposed on nursing mothers and reduced frequency of intercourse could explain at least partially the fertility inhibiting effect of breastfeeding. The return of menstruation postpartum has been used in many studies as an indirect index of resumed ovulation. This is a convenient method because it is easy to measure and can be applied to large populations. Many studies have shown that duration of postpartum amenorrhea is longer in breastfeeding than nonnursing mothers. In nonnursing mothers the duration of postpartum amenorrhea averages about 3 months. Among nursing mothers it may last for more than 2 years. Most studies which have attempted to define the timing of ovulation after childbirth have used endometrial biopsy. As an alternative the use of plasma or urinary steroid concentrations provides objective evidence of ovulation and enables a quantitative estimate of menstrual cycle adequacy. The interbirth consists of 3 phases: lactational amenorrhea; the menstrual interval (the interval between the return of postpartum menstruation and next conception); and the length of gestation itself. Only the period of gestation is relatively fixed. Thus it is important to consider the timing and frequency of ovulations during lactational amenorrhea and during the menstruating interval. The combined evidence suggests that the menstruating interval is associated with a reduction of fecundity which is less complete than it is during the phase of lactational amenorrhea. Suckling is a major variable in the control of postpartum ovulation yet relatively few studies have attempted to measure the suckling stimulus. A study of Konner and Worthman (1980) of ]Kung hunter gatherers suggested that very frequent suckling exerts a profound inhibitory effect upon reproduction. The early and regular use of supplementary food will have a detrimental effect on the contraceptive effect of breastfeeding. Malnutrition and age are additional factors that have been suggested as an influence on lactational infertility. For individual mothers breastfeeding cannot be relied upon as a guarantee against pregnancy. Its main importance as a contraceptive method is in developing countries.

Journal ArticleDOI
TL;DR: Graves' disease is aggravated in early pregnancy and after delivery and ameliorates in the latter half of pregnancy, and postpartum relapse of persistent hyperthyroidism could be predicted from an early increase in the FT4 index during pregnancy.
Abstract: The effect of pregnancy on the clinical course of Graves' disease was examined by studies on 41 pregnancies in 35 patients with Graves' disease, who were considered to be in a state of remission or near remission and were not receiving antithyroid drugs, during and after delivery. Eighteen of the 41 cases (44%) showed transient increases in the serum free T4 index (FT4 index) during weeks 10--15 of pregnancy, but normal thyroid function in the second and third trimesters. Similar transient increases in the serum free T3 index (FT3 index) were observed in early pregnancy in these patients. These early increases in the FT4 and FT3 indexes were specific to Graves' disease and were not observed in Hashimoto's disease. Two to 4 months postpartum, 32 cases (78%) developed various degrees of thyrotoxicosis, which was divided into 3 types: 1) persistent thyrotoxicosis with high radioactive iodine (RAIU) (10 cases), 2) transient thyrotoxicosis with normal or high RAIU) (10 cases), and 3) destruction-induced thyrotoxicosis with low RAIU (12 cases). An increase in the FT4 index in early pregnancy was significantly (P less than 0.001) associated with relapse of stimulation-induced thyrotoxicosis of either the persistent or transient type. Patients who developed destruction-induced thyrotoxicosis after delivery had significantly higher titers of antithyroid microsomal antibodies (P less than 0.001) and a longer euthyroid period before pregnancy (P less than 0.01) than patients who had recurrent persistent thyrotoxicosis. These data indicate that Graves' disease is aggravated in early pregnancy and after delivery and ameliorates in the latter half of pregnancy. Postpartum relapse of persistent hyperthyroidism could be predicted from an early increase in the FT4 index during pregnancy.

Journal ArticleDOI
TL;DR: In this paper, the characteristics of 26 patients with presumptive premature ovarian failure have been examined and the initial diagnosis was based on any single serum FSH concentration of greater than 40 mIU/ml in karyotypically normal women under 35 years of age with irregular menses or amenorrhea.

Journal ArticleDOI
TL;DR: A higher incidence of mildly low birth weight in children born to schizophrenics is associated with developmental abnormalities at one year, and a large number of results which involve the schizophrenic fathers are reported.
Abstract: A twenty‐year study was begun in Denmark in 1962 of the differential effects of pregnancy and delivery complications on children of schizophrenic parents, on children of normal parents, and on children of parents with nonschizophrenic psychiatric disorders. This paper studies these children and their parents in 1971 utilizing data on pregnancy, delivery, and the physical and neurological examinations of the children at birth and at one year of age. Results include (1) a higher incidence of mildly low birth weight in children born to schizophrenics, also associated with developmental abnormalities at one year, (2) a higher incidence of infant females suffering from the effects of pregnancy complications, particularly where the schizophrenic parent was the father, and (3) a large number of results which involve the schizophrenic fathers.

Journal ArticleDOI
TL;DR: It is proposed that hormones produced during pregnancy down regulate the local maternal immune response against paternal foreign transplantation antigens present on the fetus and trophoblast, thereby allowing the fetus to elude graft rejection.
Abstract: We propose that hormones produced during pregnancy down regulate the local maternal immune response against paternal foreign transplantation antigens present on the fetus and trophoblast, thereby allowing the fetus to elude graft rejection. Progesterone, in concentrations produced locally at the placental maternal interface, is the key hormone in this process. It has demonstrable immunosuppressive properties including: 1) anti-inflammatory and graft-sparing effects when administered locally in animals; 2) inhibition of human and murine lymphocyte activation and the generation of killer T lymphocytes; 3) restriction of human monocyte-macrophage oxygen radical production and oxygen consumption, and 4) effects on cellular ingress into the uterus. Although some of these properties are shared with other sex steroids, and with glucocorticoids, it is the selective high concentration of progesterone in the placenta that affords immunosuppression. Whether these effects require participation of classic hormone receptor mechanisms is uncertain. We do not exclude other progesterone actions such as induction of specific uterine proteins that have essential immunosuppressive actions, especially in early pregnancy. Indeed, our main focus for further research is directed toward uterine rather than systemic effects of progesterone and other hormones.

Journal ArticleDOI
19 Mar 1982-JAMA
TL;DR: The data suggest that the intake of bromocriptine during pregnancy is not associated with an increased risk to the fetus.
Abstract: Information was collected on the outcome of 1,410 pregnancies in 1,335 women to whom bromocriptine mesylate (Parlodel) had been given, primarily in the early weeks of pregnancy. These pregnancies resulted in 197 early terminations (14%) (including 25 induced abortions [1.8%]) and in 1,213 births (86%). The incidence rate of spontaneous abortions (11.1%), extrauterine pregnancies (0.9%), and minor (2.5%) and major (1.0%) malformations is comparable with that quoted for normal populations, and the incidence of twin pregnancies (1.8%) is slightly but not significantly raised, if correction is made for concomitant therapy with other agents inducing ovulation. The data suggest that the intake of bromocriptine during pregnancy is not associated with an increased risk to the fetus. ( JAMA 1982;247:1589-1591)

Journal ArticleDOI
TL;DR: Chorion biopsy was performed in 165 cases at 6–12 weeks of pregnancy, following an ultrasonic or embryo‐fetoscopic chorion frondosum localization, and pregnancies resulted in the timely delivery of full‐term healthy infants.
Abstract: Chorion biopsy was performed in 165 cases at 6–12 weeks of pregnancy, following an ultrasonic or embryo-fetoscopic chorion frondosum localization. One hundred patients had their biopsies taken immediately before induced abortion. In 39 cases abortion was carried out 5–10 days after biopsy. In 26 pregnant patients biopsy was performed for genetic reasons. Fetal sex was determined in ‘native’ smears from biopsy specimens for cytological investigation, using X- and Y-chromatin assays. Fetal sex diagnosis proved correct in all the cases. In 40 observations, the origin of the biopsy specimen was histologically checked. In 16 biopsy specimens, a number of enzymes were simultaneously assayed: β-D-ghcosidase, β-D-galacto-sidase, β-D-hexosaminidase, β-D-glucuronidase, α-L-fucosidase, β-D-mannosidase, sphingo-myelinase and arylsulphatase A. The levels of the above enzymes were compared to those observed in tissue cultures of amniotic cells obtained through amniocentesis at 16–18 weeks of pregnancy. The amniotic sac remained intact in all cases of chorion biopsy. If the pregnancy was maintained after the biopsy, no spontaneous abortions were recorded, and pregnancies resulted in the timely delivery of full-term healthy infants. Therefore, the method described is a valuable means of diagnosing inherited disorders, with promising applications in prenatal medicine.