Showing papers on "Pregnancy published in 1991"

Correlations between antepartum maternal metabolism and intelligence of offspring.

Abstract: Background It is not clear to what extent maternal metabolism during pregnancy affects the cognitive and behavioral function of the offspring by altering brain development in utero. To investigate this question, we correlated measures of metabolism in pregnant diabetic and nondiabetic women with the intellectual development of their offspring. Methods The study included 223 pregnant women and their singleton offspring: 89 women had diabetes before pregnancy (pregestational diabetes mellitus), 99 had the onset of diabetes during pregnancy (gestational diabetes mellitus), and 35 had normal carbohydrate metabolism during their pregnancy. We correlated measures of maternal glucose and lipid metabolism (fasting plasma glucose levels, hemoglobin A1c levels, episodes of hypoglycemia, episodes of acetonuria, and plasma β-hydroxybutyrate and free fatty acid levels) with two measures of intellectual development in the offspring — the mental-development index of the Bayley Scales of Infant Development, give...

Maternal mortality surveillance, United States, 1979-1986.

Abstract: To understand further the epidemiology and causes of maternal death, the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, reviewed all identified maternal deaths in the United States, including Puerto Rico, for the period from 1979 through 1986. The maternal mortality ratio for the period was 9.1 deaths/100,000 live births. The ratios increased with age and were higher among women of black and other minority races than among white women for all age groups, particularly for women ages greater than or equal to 40 years. Unmarried women had a higher risk of death than married women. Women who had received any prenatal care had a lower risk of dying than women who had received no care (RR = 0.19, 95% confidence limits (CL) 0.15, 0.23). Women who received no prenatal care had a gestational age-adjusted risk of maternal death 5.7 times that of women receiving care defined as "adequate." The risk of maternal death increased with decreasing levels of education for all age groups, particularly among women ages greater than or equal to 35 years. The causes of death varied for different outcomes of pregnancy; pulmonary embolism was the leading cause of death following the delivery of a live birth. Future studies aimed at developing strategies to reduce the risk of maternal deaths in the United States should use enhanced surveillance and collect more information about each death, which would allow for better understanding of factors associated with maternal mortality.

Prevalence of back pain in pregnancy.

Abstract: The prevalence of back pain was studied in 855 pregnant women who were followed from the 12th week of pregnancy, every 2nd week, until childbirth. The 9-month period prevalence was 49%, with a point prevalence of 22-28% from the 12th week until delivery. Because 22% of the women had back pain at the

Spina Bifida in Infants of Women Treated with Carbamazepine during Pregnancy

Abstract: SHORTLY after Robert and Guibaud reported in 19821 an association between the use of valproic acid during pregnancy by women with seizure disorders and the occurrence of spina bifida in their offspring, carbamazepine was also implicated, on the basis of 12 cases of spina bifida among 60 infants with birth defects after exposure to carbamazepine in utero.2 , 3 Jones et al. recently reported the outcomes of pregnancy in a cohort of 56 women taking carbamazepine, on the basis of the data from the California Teratogen Registry.4 This study included a case of spina bifida. In follow-up correspondence, Jones et al. mentioned . . .

A multivariate analysis of risk factors for preeclampsia.

Abstract: Objective. —To determine, in a multivariate analysis, risk factors for preeclampsia that could be observed early in pregnancy and to establish whether these risk factors are different for nulliparas and multiparas. Design. —A case-control study of preeclampsia. Setting. —Women who gave birth at Northern California Kaiser Permanente Medical Centers in 1984 and 1985. Participants. —Preeclamptic cases (n =139) were determined from discharge diagnosis of severe preeclampsia and by confirmation of blood pressures and proteinuria from medical records. Controls (n = 132) were randomly selected women who had no discharge diagnosis of any hypertensive disorder of pregnancy and who had no evidence of hypertension or proteinuria from medical record review. Main Variables Examined. —Medical records were abstracted for information regarding maternal age, race, previous pregnancy history, family medical history, socioeconomic status, employment during pregnancy, body mass, and smoking and alcohol consumption. Results. —Multiple logistic regression analyses confirmed that case patients were more likely than control patients to be nulliparous (adjusted odds ratio [OR], 5.4; 95% confidence interval [CI], 2.8 to 10.3) and that preeclampsia in a previous pregnancy greatly increased the risk in a subsequent one (adjusted OR, 10.8; 95% CI, 1.2 to 29.1). However, regardless of parity, preeclamptic women were also more likely to be of high body mass (adjusted OR, 2.7; 95% CI, 1.2 to 6.2), to work during pregnancy (adjusted OR, 2.1; 95% CI, 1.1 to 4.4), and to have a family history of hypertension (adjusted OR, 1.7; 95% CI, 0.92 to 3.2). Having a previous history of a spontaneous abortion was protective but only in multiparous women (adjusted OR for multiparas, 0.09; 95% CI, 0.02 to 0.48). In contrast, being black was a significant risk for preeclampsia but only in nulliparous women (adjusted OR for nulliparas, 12.3; 95% CI, 1.6 to 100.8). Conclusions. —There are a number of risk factors for preeclampsia that may be determined early in a woman's pregnancy. Multiparas and nulliparas share certain risk factors but not others. A cohort investigation is needed to determine the ability of these risk factors to predict who develops preeclampsia. (JAMA. 1991;266:237-241)

Preconception care of diabetes. Glycemic control prevents congenital anomalies.

Abstract: To test the value of intensive management of diabetes before and during early pregnancy, 84 women recruited prior to conception were compared with 110 women who were already pregnant referred at 6 to 30 weeks' gestation. All underwent daily measurement of fasting and postprandial capillary blood glucose levels. Mean blood glucose levels during embryogenesis and organogenesis were within 3.3 to 7.8 mmol/L in 50% of preconception subjects and exceeded 10 mmol/L in 6.5%. One major congenital anomaly occurred in 84 infants (1.2%) of women treated before conception compared with 12 anomalies in 110 infants (10.9%) of mothers in the postconception group. Transient symptomatic hypoglycemia occurred during embryogenesis in 60% of women in the preconception group, with a median frequency of 2.7 episodes per week, but was not associated with excess malformations. We conclude that education and intensive management for glycemic control of diabetic women before and during early pregnancy will prevent excess rates of congenital anomalies in their infants.

Delaying childbearing: effect of age on fecundity and outcome of pregnancy.

Abstract: Objectives - To study the age of the start of the fall (critical age) in fecundity; the probability of a pregnancy leading to a healthy baby taking into account the age of the woman; and, combining these results, to determine the age dependent probability of getting a healthy baby. Design - Cohort study of all women who had entered a donor insemination programme. Setting - Two fertility clinics serving a large part of The Netherlands. Subjects - Of 1637 women attending for artificial insemination 751 fulfilled the selection criteria, being married to an azoospermic husband and nulliparous and never having received donor insemination before. Main ontcome measures - The number of cycles before pregnancy (a positive pregnancy test result) or stopping treatment; and result of the pregnancy (successful outcome). Results - Of the 751 women, 555 became pregnant and 461 had healthy babies. The fall in fecundity was estimated to start at around 31 years (critical age); after 12 cycles the probability of pregnancy in a woman aged >31 was 0.54 compared with 0.74 in a woman aged 20-31. After 24 cycles this difference had decreased (probability of conception 0.75 in women >31 and 0.85 in women 20-31). The probability of having a healthy baby also decreased - by 3.5% a year after the age of 30. Combining both these age effects, the chance of a woman aged 35 having a healthy baby was about half that of a woman aged 25. Conclusion - After the age of 31 the probability of conception falls rapidly, but this can be partly compensated for by continuing insemination for more cycles. In addition, the probability of an adverse pregnancy outcome starts to increase at about the same age. This study examined the age of the start of the fall (critical age) in fecundity, the probability of a pregnancy leading to a healthy baby taking into account the age of the women, and, by combining all of the results, the determination of the age-dependent probability of getting a healthy baby. 2 fertility clinics serving a large part of the Netherlands provided the 751 women who fulfilled the selection criteria. In this cohort study of all women who entered a donor insemination program, those who fulfilled the selection criteria were married to azoospermic husbands, were nulliparous, and never received donor insemination previously. Main outcome measures studied were the number of cycles prior to a pregnancy (positive pregnancy result) or the cessation of treatment and the result of the pregnancy (successful outcome). Of 751 women, 555 became pregnant and 461 had healthy babies. The drop in fecundity was estimated to begin at around age 31 (critical age); after 12 cycles, the probability of pregnancy in a woman age 31 was 0.54 compared with 0.74 in a woman age 20-31. After 24 cycles, this difference had decreased (probability of conception 0.75 in women 31 and 0.85 in women age 20-31). The probability of having a healthy baby also decreased, by 3.5% a year after the age of 30. Combining both of these age effects, the chance of a woman age 35 having a healthy baby was about 1.2 that of a woman age 25. After the age of 31, the probability of conception falls rapidly; however, this can be compensated for partly by continuing insemination for more cycles. In addition, the probability of an adverse pregnancy outcome begins to increase at about the same age.

Prospective investigation of postpartum depression: factors involved in onset and recovery.

Abstract: We examined the role of a number of psychosocial variables in the onset of postpartum depression and in recovery from depression that occurs during pregnancy. Women (N = 730) were recruited during pregnancy and were followed through 1 month postpartum. They were assessed on demographic variables and on measures of depressive symptomatology and diagnostic status, perceived stress, marital satisfaction, perceptions of their own parents, dysfunctional cognitions, and coping style. Onset of depression in the postpartum was predicted by the levels during pregnancy of depressive symptomatology and perceived maternal and paternal care during childhood. In contrast, recovery in the postpartum from depression during pregnancy was not predicted by the variables examined in this study. These results are discussed with reference to previous investigations that have examined depression that occurs outside the context of childbirth.

Effectiveness of routine ultrasonography in detecting fetal structural abnormalities in a low risk population.

Abstract: OBJECTIVE--To review the efficacy of routine prenatal ultrasonography for detecting fetal structural abnormalities. DESIGN--Retrospective study of the ultrasonographic findings and outcome of all pregnancies in women scanned in 1988-9. SETTING--Maternity ultrasonography department of a district general hospital. SUBJECTS--8785 fetuses. MAIN OUTCOME MEASURES--Correlation of prenatal ultrasonographic findings with outcome in the neonate. RESULTS--8733 babies were born during 1988-9, and 52 pregnancies were terminated after a fetal malformation was identified. 8432 (95%) of the fetuses were examined by ultrasonography in the second trimester. 130 fetuses (1.5%) were found to have an abnormality at birth or after termination of pregnancy, 125 of which had been examined in the second trimester. In 93 cases the abnormality was detected before 24 weeks (sensitivity 74.4%, 95% confidence interval to 66.7% to 82.1%. Two false positive diagnoses occurred, in both cases the pregnancies were not terminated and apparently normal infants were born. This gives a specificity of 99.98% (99.9% to 99.99%). The positive predictive value of ultrasonography in the second trimester was 97.9% (92.6% to 99.7%). Of the 125 abnormalities, 87 were lethal or severely disabling; 72 of the 87 were detected by the routine screening programme (sensitivity 82.8%, 73.2% to 90.0%). CONCLUSION--Routine fetal examination by ultrasonography in a low risk population detects many fetal structural abnormalities but can present several dilemmas in counselling.

Maternal Mortality: A Global Factbook

Abstract: 500000 women worldwide die each year from pregnancy related causes. Statistical data are provided for regions by country (those with >200000 population) on 1) basic indicators (population and rate of growth life expectancy fertility mortality); 2) social and economic measures (adult literacy by sex primary school enrollment by sex female mean age at first marriage gross national product (GNP) and calorie supply/capita daily); 3) health services (health expenditures as a percentage of GNP primary health care expenditure as a percentage of total health expenditure health facilities safe water adequate sanitary facilities and contraceptive prevalence rate); 4) community studies and data available by site; 5) hospital studies with data by site; 6) civil registration data or government estimates of maternal mortality and; 7) other sources of estimate. An annotated bibliography and data sources are included. The global picture reports on the nature and medical and nonmedical causes of maternal mortality coverage of maternity care and bibliography. The methods part focuses on definitions; rates and ratios; the reliability of official rates; community studies (household surveys sisterhood and indirect measures and reproductive age mortality surveys); health service records from hospitals and other sources of records; indirect indicators; and references. There is also an introductory section on definitions and explanations of the country profiles. 99% of maternal deaths occur in developing countries. The maternal mortality rate is highest for Asia particularly India Pakistan and Bangladesh (28% of the worlds births and 46% if the worlds maternal deaths). Africa has the next highest rate with 150000 women dying per year. Latin American maternal deaths amount to 34000/year. Pregnancy risks are highest in Africa. Historically this pattern is to be expected since even in the US maternal mortality was high in 1920 and high in England and Wales until 1935. The risk of dying at each pregnancy in a developing country is 1:140 while in Scandinavia it is 1:25000. The lifetime risk i s even higher or 1:23 with 6 pregnancies. 80% of deaths are related to anemia. Significant direct causes are hemorrhage puerperal sepsis hypertensive disorders obstructed labor and abortion. Indirect medical causes are anemia malaria and viral hepatitis. Nonmedical causes are limited access to care health service factors and social status.

Longitudinal assessment of changes in reproductive hormones during normal pregnancy.

Abstract: The concentrations of hormones measured in serum from maternal blood change dramatically during pregnancy. While the relative contributions of sex steroids shift from maternal ovaries and adrenals to the fetoplacental unit, other maternal tissues such as pituitary and liver respond to increasing concentrations of estrogen and secrete increasing amounts of prolactin and sex-hormone-binding globulin. To determine longitudinal changes in circulating maternal hormones, we collected blood from 60 women on three occasions during their pregnancies. We observed a 1.7-fold increase in testosterone concentration in serum; concentrations of sex-hormone-binding globulin in serum rose 5.6-fold. The major increase (6.8-fold) in estradiol in serum occurred within the first 16 weeks, followed by a further 4.8-fold increase by term. Mean concentrations of progesterone, 17-hydroxyprogesterone, and androstenedione in serum increased 11.9-, 3-, and 1.3-fold, respectively, whereas concentrations of dehydroepiandrosterone sulfate (DHEAS) fell by 50%. Mean serum prolactin concentrations increased 3.8-fold during the first trimester and by a similar amount during the final 24 weeks of pregnancy. We used these data, obtained from a cohort of women with uncomplicated pregnancies, to construct reference intervals for hormones in maternal serum.

A new cause of female pseudohermaphroditism: placental aromatase deficiency.

Abstract: A description is presented of the first documented case of placental aromatase deficiency. The deficiency caused maternal virilization during pregnancy and pseudohermaphroditism of the female fetus. A 24-yr-old primigravida showed progressive virilization during the third trimester. Urinary excretion of estrogen was less than 14 μmol/day between 35–38 weeks of pregnancy, although nonstress tests showed reactive patterns and serum levels of human placental lactogen were above 460 nmol/L. Maternal serum levels of estrogens were low, and those of androgens were high in the third trimester. A dehydroepiandrosterone sulfate loading test induced a marked increase in maternal serum levels of androgens, whereas no such increase was observed in estrogens. The woman delivered vaginally a live full-term infant who exhibited female pseudohermaphroditism. Cord serum levels of estrogens were extremely low, while those of androgens were high. The aromatase activity of the placenta, determined by the conversion of [7-3H]...

Maternal and fetal influences on blood pressure.

Abstract: To study maternal and fetal influences on blood pressure in childhood 405 children aged 4 years who were born and still resident in the Salisbury health district were visited at home for blood pressure and growth measurements. Information on the pregnancy, delivery, and baby was abstracted from the routine obstetric notes. Similar to recent findings in adults, the child's systolic pressure was inversely related to birth weight and positively related to placental weight. Systolic pressure at 4 years increased by 1.2 mm Hg for every SD decrease in the ratio of head circumference to length at birth, and by 1.1 mm Hg for every SD decrease in ponderal index at birth. Mothers whose haemoglobin concentrations fell below 100g/l during pregnancy had children whose systolic pressures were on average 2.9 mm Hg higher than the children of mothers with higher haemoglobin concentrations. Patterns of placental weight, birth weight, head circumference, and length that are associated with high blood pressure in adults are also associated with higher blood pressure in 4 year old children. Identification of the intrauterine influences that lead to these patterns of fetal growth could lead to the primary prevention of hypertension.

Calcium supplementation to prevent hypertensive disorders of pregnancy.

Abstract: Background. Calcium supplementation has been reported to reduce blood pressure in pregnant and nonpregnant women. We undertook this prospective study to determine the effect of calcium supplementation on the incidence of hypertensive disorders of pregnancy (gestational hypertension and preeclampsia) and to determine the value of urinary calcium levels as a predictor of the response. Methods. We studied 1194 nulliparous women who were in the 20th week of gestation at the beginning of the study. The women were randomly assigned to receive 2 g per day of elemental calcium in the form of calcium carbonate (593 women) or placebo (601 women). Urinary excretion of calcium and creatinine was measured before calcium supplementation was begun. The women were followed to the end of their pregnancies, and the incidence of hypertensive disorders of pregnancy was determined. Results. The rates of hypertensive disorders of pregnancy were lower in the calcium group than in the placebo group (9.8 percent vs. 14.8...

Prognosis of pregnancy-associated breast cancer.

Abstract: The survival of patients with pregnancy-associated (PA) breast cancer is difficult to predict for two reasons: The combination is very rare, and the natural history of breast cancer that is not associated with pregnancy is intricate and varies among individuals. Valid data collection and analysis is problematic given that studies gather patients over many years. The charts of 56 women with Stages I, II, and III breast cancer, who were pregnant or within 1 year postpartum at the time of breast cancer diagnosis between 1960 and 1980, were analyzed. Patients with PA breast cancer were compared to nonpregnant women of comparable ages, who were treated at the same hospital, by the same physicians, and during the same period. Four patients were lost before 5-year follow-up, and one patient before 10-year follow-up. These five patients had distant metastases at the time they were lost to follow-up, and are considered to have died within that time. Across stages, patients with PA breast cancer have survival not significantly different from those patients with non-pregnancy-associated (non-PA) breast cancer.