Showing papers on "Pregnancy published in 1997"

Incidence of fetal alcohol syndrome and prevalence of alcohol-related neurodevelopmental disorder

Abstract: We critique published incidences for fetal alcohol syndrome (FAS) and present new estimates of the incidence of FAS and the prevalence of alcohol-related neurodevelopmental disorder (ARND). We first review criteria necessary for valid estimation of FAS incidence. Estimates for three population-based studies that best meet these criteria are reported with adjustment for underascertainment of highly exposed cases. As a result, in 1975 in Seattle, the incidence of FAS can be estimated as at least 2.8/1000 live births, and for 1979-81 in Cleveland, approximately 4.6/1,000. In Roubaix, France (for data covering periods from 1977-1990), the rate is between 1.3 and 4.8/1,000, depending on the severity of effects used as diagnostic criteria. Utilizing the longitudinal neurobehavioral database of the Seattle study, we propose an operationalization of the Institute of Medicine's recent definition of ARND and estimate its prevalence in Seattle for the period 1975-1981. The combined rate of FAS and ARND is thus estimated to be at least 9.1/1,000. This conservative rate--nearly one in every 100 live births--confirms the perception of many health professionals that fetal alcohol exposure is a serious problem.

Trichomonas vaginalis associated with low birth weight and preterm delivery. The Vaginal Infections and Prematurity Study Group.

Abstract: Background:Several studies have suggested that pregnant women infected withTrichomonas vaginalismay be at increased risk of an adverse outcome.Goal:To evaluate prospectively the association betweenT. vaginalisand risk of adverse pregnancy outcome in a large cohort of ethnically diverse women.Study D

Maternal infection and cerebral palsy in infants of normal birth weight.

Abstract: Context. —Exposure to maternal or placental infection is related to risk of preterm birth and, in premature infants, of brain lesions predictive of cerebral palsy (CP). Few studies have investigated whether maternal infection is associated with risk of CP in children of normal birth weight. Objective. —To investigate maternal infection during the admission for delivery as a possible risk factor for CP in infants born weighing 2500 g or more. Design. —Population-based case-control study. Setting. —All hospitals in 4 northern California counties, 1983 through 1985. Participants. —A total of 46 children with disabling spastic CP who had no recognized prenatal brain lesions and 378 randomly selected control children weighing 2500 g or more at birth and surviving to age 3 years. Main Outcome Measures. —Disabling spastic CP and signs of neonatal morbidity. Results. —Maternal fever exceeding 38°C in labor was associated with increased risk of unexplained CP (odds ratio [OR], 9.3; 95% confidence interval [CI], 2.7-31.0), as was a clinical diagnosis of chorioamnionitis. One or more indicators of maternal infection were present in 2.9% of control children, 22% of children with CP (OR, 9.3; 95% CI, 3.7-23.0), and 37% of those with the spastic quadriplegic subtype of CP (OR, 19.0; 95% CI, 6.5-56.0). Newborns exposed to maternal infection, both cases and controls, had 5-minute Apgar scores below 6 more often than those unexposed. Among children with CP, those born to infected women were more often hypotensive, needed intubation, had neonatal seizures, and received a clinical diagnosis of hypoxic-ischemic encephalopathy. Conclusion. —Intrauterine exposure to maternal infection was associated with a marked increase in risk of CP in infants of normal birth weight. Maternal infection was also linked with low Apgar scores, other evidence of hypertension and need for resuscitation, and neonatal seizures—signs commonly attributed to birth asphyxia.

Nitric oxide and pregnancy

Abstract: This review will consider whether nitric oxide (NO) contributes to maternal systemic vasodilation during pregnancy, regulates uterine and fetoplacental blood flow, and is involved in uterine quiescence prior to parturition. Also, whether a deficiency of NO contributes to the hypertensive disorder of pregnancy, preeclampsia, will be considered. The biosynthesis of NO increases in gravid rats and sheep, but the status in normal human pregnancy and preeclampsia is controversial. NO contributes to maternal systemic vasodilation and reduced vascular reactivity during normal pregnancy; however, the relative contribution of NO is variable depending on the animal species, vascular bed, and vessel size. Impaired relaxation responses to acetylcholine, but not bradykinin or NO donors, are observed in small arteries from women with preeclampsia, suggesting a receptor or signal transduction defect, although NO may play little, if any, role here. Uterine arteries have increased endothelial nitric oxide synthase (NOS) activity, protein expression, and guanosine 3',5'-cyclic monophosphate production during pregnancy; however, whether these mediate uterine vasodilation during pregnancy remains to be established. NOS is expressed in the human placental syncytiotrophoblast and in the fetoplacental and umbilical vascular endothelium where basal production of NO contributes to low fetoplacental vascular resistance. Controversy exists over the status of placental NOS in preeclampsia, although an abnormality of umbilical NOS activity is likely. Finally, the uterus has NOS activity, which decreases at the end of gestation, and exogenous NO relaxes the myometrium, but whether endogenous NO contributes to uterine quiescence during pregnancy has yet to be confirmed.

The acquisition of herpes simplex virus during pregnancy

Abstract: Background The acquisition of genital herpes during pregnancy has been associated with spontaneous abortion, prematurity, and congenital and neonatal herpes. The frequency of seroconversion, maternal symptoms of the disease, and the timing of its greatest effect on the outcome of pregnancy have not been systematically studied. Methods We studied 7046 pregnant women whom serologic tests showed to be at risk for herpes simplex virus (HSV) infection. Serum samples obtained at the first prenatal visit, at approximately 16 and 24 weeks, and during labor were tested for antibodies to HSV types 1 and 2 (HSV-1 and HSV-2) by the Western blot assay, and the results were correlated with the occurrence of antenatal genital infections. Results Ninety-four of the women became seropositive for HSV; 34 of the 94 women (36 percent) had symptoms consistent with herpes infection. Women who were initially seronegative for both HSV-1 and HSV-2 had an estimated chance of seroconversion for either virus of 3.7 percent; those wh...

Effect of prenatal and infancy home visitation by nurses on pregnancy outcomes, childhood injuries, and repeated childbearing : a randomized controlled trial

Abstract: Context. —Interest in home-visitation services as a way of improving maternal and child outcomes has grown out of the favorable results of a trial in semirural New York. The findings have not been replicated in other populations. Objective. —To test the effect of prenatal and infancy home visits by nurses on pregnancy-induced hypertension, preterm delivery, and low birth weight; on children's injuries, immunizations, mental development, and behavioral problems; and on maternal life course. Design. —Randomized controlled trial. Setting. —Public system of obstetric care in Memphis, Tenn. Participants. —A total of 1139 primarily African-American women at less than 29 weeks' gestation, with no previous live births, and with at least 2 sociodemographic risk characteristics (unmarried, Intervention. —Nurses made an average of 7 (range, 0-18) home visits during pregnancy and 26 (range, 0-71) visits from birth to the children's second birthdays. Main Outcome Measures. —Pregnancy-induced hypertension, preterm delivery, low birth weight, children's injuries, ingestions, and immunizations abstracted from medical records; mothers' reports of children's behavioral problems; tests of children's mental development; mothers' reports of subsequent pregnancy, educational achievement, and labor-force participation; and use of welfare derived from state records. Main Results. —In contrast to counterparts assigned to the comparison condition, fewer women visited by nurses during pregnancy had pregnancy-induced hypertension (13% vs 20%; P =.009). During the first 2 years after delivery, women visited by nurses during pregnancy and the first 2 years of the child's life had fewer health care encounters for children in which injuries or ingestions were detected (0.43 vs 0.55; P =.05); days that children were hospitalized with injuries or ingestions (0.03 vs 0.16; P P =.006). There were no program effects on preterm delivery or low birth weight; children's immunization rates, mental development, or behavioral problems; or mothers' education and employment. Conclusion. —This program of home visitation by nurses can reduce pregnancyinduced hypertension, childhood injuries, and subsequent pregnancies among low-income women with no previous live births.

Current Therapy in Large Animal Theriogenology

Abstract: Equine Theriogenology: Reproductive Anatomy and Physiology of the Breeding Stallion. Examination of the Male Reproductive Tract: Evaluation of Potential Breeding Soundness. Infertility and Diseases of the Reproductive Tract. Surgical Correction of Abnormalities Affecting the Reproductive Organs of Stallions. Techniques for Artificial Insemination. Clinical Reproductive Anatomy and Physiology of the Mare. The Role of Photoperiod in Regulating Reproduction in the Mare: Basic and Practical Aspects. Clinical Examination of the Non-Pregnant Female Reproductive Tract. Control of the Estrous Cycle and Ovulation. Pregnancy Examination in the Mare. Abnormalities of Pregnancy. Retained Fetal Membranes. Management of Twin Pregnancy. Parturition and Dystocia. Abnormalities of Lactation. Immediate Care of the Post-Partum Mare and Foal. Infectious Diseases of the Puerperal Period. Irregularities of the Estrous Cycle and Ovulation in Mares. Non-Infectious Causes of Infertility in the Mare. Induced Abortion. Bacterial Causes of Infertility and Abortion. Equine Herpesvirus Infection. Equine Viral Arteritis. Fungal Abortion. Surgical Correction of Abnormalities of the Female Reproductive Organs. Embryo Transfer in Horses: Indications, Technique and Expected Outcomes. Section II: Bovine Theriogenology: Clinical Reproductive Anatomy and Physiology of the Bull. Evaluation of Potential Breeding Soundness. Diseases of the Reproductive System of the Bull. Surgical Correction of Abnormalities of the Reproductive Organs of Bulls and Preparation of Teaser Animals. Techniques for Artificial Insenination of Cattele with Frozen/Thawed Semen. Clinical Reproductive Physiology of the Cow. Reproductive Examination of the Non-Pregnant Cow. Estrous Detection. Clinical Management of Anestrous. Estrous Cycle Synchronization. Pregnancy Diagnosis. Induced Abortion. Pelvimetry. Parturition and Dystocia. Post Partum Care of the Cow and Calf. Metabolic Diseases of the Puerperal Period. Post-Partum Uterine Infections. Retained Placenta. Infertility Due to Abnomalities of the Ovaries. Bovine Venereal Diseases. Bacterial Causesof Bovine Infertility and Abortion. Viral Diseases of the Fetus. Protozoal Abortion in Cattle. Epizootic Bovine Abortion. Mycotic Bovine Abortion. Reproductive Toxicology. Dropsical Conditions Affecting Pregnancy. Effects of Environment on Bovine Reproduction. Effects of Nutrition on Reproduction in Dairy Cows. Effects of Nutrition on Reproduction in Beef Cows. Surgical Correction of Abnormalities of the Genital Organs of Cows. Reproductive Health Programs for Dairy Herds, Analysis of Records for Assessment of Reproductive Performance. Reproductive Health Programs for Beef Herds, Analysis of Records for Assessment of Reproductive Performance. Bovine Reproductive Biotechnology. Management of Reproduction in Dairy Herds Utilizing Bovine Somatotropin. Section III: Caprine Section: Clinical Reproductive Anatomy and Physiology of the Buck. Examination of the Reproductive Tract and Evaluation of Potential Breeding Soundness on the Buck. Infertility and Diseases of the Reproductive Organs of the Buck. Urogenital Surgery in Goats. Techniques for Artificial Insemination in the Goat. Clinical Reproductive Anatomy and Physiology of the Doe. Clinical Examination of the Female Reproductive Tract. Controlof the Estrous Cycle. Pregnancy Diagnosis in the Goat. Parturition and Dystocia in the Goat. Post-Partum Care of the Doe and Kid. Metabolic Diseases of the Puerperal Period. Periparturient Infection and Structural Abnormalities. Genetic Disordersif the Goat. Infectious Causes of Abortion. Noninfectious Prenatal Pregnancy Loss in the Doe. Noninfectious Infertility in the Doe. Sex Abnormalities in Goats. Induced Abortion and Parturition in the Goat. Reproductive Health Program. Reproductive Biotechnologies in the Goat. Section IV: Ovine Theriogenology: Applied Reproductive Physiology of the Ram. Breeding Soundness Evaluation and Surgical Sterilization of the Ram. Artificial Insemination of Sheep. Clinical Reproductive Physiology of Ewes. Genetic Improvement of Reproduction in Sheep. Breeding Strategies. Pregnancy Diagnosis. Abortion in Sheet. Diagnosis and Control. Lambing Management and Neonatal Care. Diseases of the Periparturient Ewe. Reproductive Health Management Programs. Embryo Transfer for Sheep. Applied Reproductive Physiology of the Boar. Reproductive Examination and Evaluation of the Boar. Infectious and Non-Infectious Causes of Infertility in Boars. Reproductive Surgeryin the Boar. Artificial Insemination in Swine. Breeding Systems and Mating Program Management. Applied Reproductive Anatomy and Physiology of the Sow. Clinical Examination of Female Reproductive Organs. Control of the Estrous Cycle in Swine. Diagnosis of Pregnancy. Infertility Associated with Abnormalities of the Estrous Cycle. Normal and Abnormal Parturition in Swine. Postpartum Care of the Dam and Neonates. Infectious Diseases of the Puerperal Period. Infectious (Non-Viral) Causes of Infertility and Abortion. Lactational Insufficiency Syndrome. Viral Causes of Infertility and Abortion. Non-Infectious Causes of Infertility and Abortion. Influence of Environment and Housing on Swine Reproduction. Reproductive Surgery in the Sow. Reproductive Health Programs for Swine Herds. Using Statistical Process Control to Investigate Reproductive Failure. Reproductive Biotechnology. Section VI: Llama Theriogenology: Reproductive Activity, Ejaculatory Patterns and Seminal Characteristicsof Male Llamas. Reproductive Evaluation of Infertility in the Male Llama. Reproductive Anatomy and Physiology of the Female Llama. Examinaton of the Female Reproductive Tract. Ovarian Function in Domesticated South American Camelids. Diagnosis of Pregnancy. Parturition in the Llama. Post-Partum Care of the Dam and Neonate. Infertility in Female Llamas. Reproductive Management Practices for Llamas. Reproductive Technologies in South American Camelids. Surgery to the Genitalia of Llamas.

Pathways to Pregnancy and Parturition

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Anesthesia-related deaths during obstetric delivery in the United States, 1979-1990.

Abstract: BackgroundAnesthesia-related complications are the sixth leading cause of pregnancy-related death in the United States. This study reports characteristics of anesthesia-related deaths during obstetric delivery in the United States from 1979–1990.MethodsEach state reports deaths that occur within 1 y

Current methods of laboratory diagnosis of Chlamydia trachomatis infections.

Abstract: Infections caused by Chlamydia trachomatis are probably the most common sexually transmitted diseases in the United States. Commonly unrecognized and often inadequately treated, chlamydial infections can ascend the reproductive tract and cause pelvic inflammatory disease, which often results in the devastating consequences of infertility, ectopic pregnancy, or chronic pelvic pain. C. trachomatis infections are also known to increase the risk for human immunodeficiency virus infection. The obligate intracellular life cycle of C. trachomatis has traditionally required laboratory diagnostic tests that are technically demanding, labor-intensive, expensive, and difficult to access. In spite of these historical challenges, however, laboratory diagnosis of C. trachomatis has been a rapidly advancing area in which there is presently a wide array of commercial diagnostic technologies, costs, manufacturers. This review describes and compares the diagnostic methods for C. trachomatis infection that are currently approved for use in the United States, including the newest DNA amplification technologies which are yet to be licensed for commercial use. Issues to consider in selecting a test for purposes of screening versus diagnosis based on prevalence, performance, legal, social, and cost issues are also discussed.

Neurodevelopment of Children Exposed in Utero to Antidepressant Drugs

Abstract: Background Many women of reproductive age have depression, necessitating therapy with either a tricyclic antidepressant drug or a drug, such as fluoxetine, that inhibits the reuptake of serotonin. Whether these drugs affect fetal neurodevelopment is not known. Methods We studied the children of 80 mothers who had received a tricyclic antidepressant drug during pregnancy, 55 children whose mothers had received fluoxetine during pregnancy, and 84 children whose mothers had not been exposed during pregnancy to any agent known to affect the fetus adversely. The children's global IQ and language development were assessed between 16 and 86 months of postnatal age by age-appropriate Bayley Scales of Infant Development or the McCarthy Scales of Children's Abilities (for IQ) and the Reynell Developmental Language Scales. Results The mean (±SD) global IQ scores were 118±17 in the children of mothers who received a tricyclic antidepressant drug, 117±17 in those whose mothers received fluoxetine, and 115±14 in those ...

Trial of Calcium to Prevent Preeclampsia

Abstract: Background Previous trials have suggested that calcium supplementation during pregnancy may reduce the risk of preeclampsia. However, differences in study design and a low dietary calcium intake in the populations studied limit acceptance of the data. Methods We randomly assigned 4589 healthy nulliparous women who were 13 to 21 weeks pregnant to receive daily treatment with either 2 g of elemental calcium or placebo for the remainder of their pregnancies. Surveillance for preeclampsia was conducted by personnel unaware of treatment-group assignments, using standardized measurements of blood pressure and urinary protein excretion at uniformly scheduled prenatal visits, protocols for monitoring these measurements during the hospitalization for delivery, and reviews of medical records of unscheduled outpatient visits and all hospitalizations. Results Calcium supplementation did not significantly reduce the incidence or severity of preeclampsia or delay its onset. Preeclampsia occurred in 158 of the 2295 wome...

Smoking, Drinking, and Drug Use in Young Adulthood: The Impacts of New Freedoms and New Responsibilities

Abstract: Why do some young adults substantially change their patterns of smoking, drinking, or illicit drug use after graduating from high school? In this book, the authors show that leaving high school and leaving home create new freedoms that are linked to increases in the use of cigarettes, alcohol, marijuana, and cocaine. They also show that marriage, pregnancy, and parenthood create new responsibilities that are linked to decreases in drug use. The research is based on more than 33,000 young people followed from high school through young adulthood by the nationwide Monitoring the Future project. Every two years, participants reported on their drug use, as well as their schooling, employment, military service, living arrangements, marriages, pregnancies, parenthood, and even their divorces. The unique qualities of this research--large nationally representative samples, follow-ups extending up to 14 years beyond high school, and multiple approaches to analysis and data presentation--allowed the examination of several important influences simultaneously, while retaining much of the rich detail encountered in the real world. On the whole, the results are encouraging, suggesting that the potentials for change and improvement during the transition to adulthood are as important as the detrimental effects of problem behavior in adolescence. This research is a "must" read for anyone concerned with how new freedoms and responsibilities impact adolescents, young adults, and the use of licit and illicit drugs.

Outcomes of pregnancy in insulin dependent diabetic women: results of a five year population cohort study

Abstract: Objective: To monitor pregnancies in women with pre-existent insulin dependent diabetes for pregnancy loss, congenital malformations, and fetal growth in a geographically defined area of north west England. Design: Population cohort study. Setting: 10 maternity units in Cheshire, Lancashire, and Merseyside which had no regional guidelines for the management of pregnancy in diabetic women. Subjects: 462 pregnancies in 355 women with insulin dependent diabetes from the 10 centres over five years (1990-4 inclusive). Main outcome measures: Numbers and rates of miscarriages, stillbirths, and neonatal and postneonatal deaths; prevalence of congenital malformations; birth weight in relation to gestational age. Results: Among 462 pregnancies, 351 (76%) resulted in a liveborn infant, 78 (17%) aborted spontaneously, nine (2%) resulted in stillbirth, and 24 (5%) were terminated. Of the terminations, nine were for congenital malformation. The stillbirth rate was 25.0/1000 total births (95% confidence interval 8.9 to 41.1) compared with a population rate of 5.0/1000, and infant mortality was 19.9/1000 live births (5.3 to 34.6) compared with 6.8/1000. The prevalence of congenital malformations was 94.0/1000 live births (63.5 to 124.5) compared with 9.7/1000 in the general population. When corrected for gestational age, mean birth weight in the sample was 1.3 standard deviations greater than that of infants of non-diabetic mothers. Infants with congenital malformations weighed less than those without. Conclusion: In an unselected population the infants of women with pre-existent insulin dependent diabetes mellitus have a 10-fold greater risk of a congenital malformation and a fivefold greater risk of being stillborn than infants in the general population. Further improvements in the management of pregnancy in diabetic women are needed if target of the St Vincent declaration of 1989 is to be met. Key messages Infants of women with established insulin dependent diabetes mellitus have 10 times the population risk of congenital malformations and five times the stillbirth rate Excess mortality among infants of women with pre-existent insulin dependent diabetes mellitus is predominantly due to congenital malformations The birth prevalence of congenital malformations can be reduced by good periconceptional glycaemic control, but the challenge remains to implement this on a population basis Macrosomia remains a problem among infants of women with established insulin dependent diabetes mellitus

Culture and selection of viable blastocysts: a feasible proposition for human IVF?

Abstract: In human in-vitro fertilization (IVF) embryos are routinely transferred to the uterus on day 2 or day 3 of development. Resultant implantation and pregnancy rates are disappointingly low, with only approximately 10% of embryos transferred leading to a live birth. The ability to culture embryos to the blastocyst stage should help to resolve this problem by synchronizing the embryo with the female reproductive tract, and by identifying those embryos with little developmental potential. Co-culture has offered a possible means of producing blastocysts capable of high implantation rates. However, recent developments in the field of embryo physiology and metabolism have led to the formulation of new sequential serum-free culture media capable of supporting the development of viable blastocysts in several mammalian species, including the human. It is therefore proposed that blastocyst transfer should be considered for routine use in human IVF. The high viability of blastocysts cultured in the appropriate sequential media means that fewer embryos are required for transfer to achieve a pregnancy, culminating in fewer multiple births. Furthermore, the development of suitable non-invasive tests of embryo viability should further increase the overall success of human IVF by the ability to select before transfer those blastocysts most able to establish a pregnancy.

Antibiotic Therapy for Reduction of Infant Morbidity After Preterm Premature Rupture of the Membranes: A Randomized Controlled Trial

Abstract: Context. —Intrauterine infection is thought to be one cause of preterm premature rupture of the membranes (PPROM). Antibiotic therapy has been shown to prolong pregnancy, but the effect on infant morbidity has been inconsistent. Objective. —To determine if antibiotic treatment during expectant management of PPROM will reduce infant morbidity. Design. —Randomized, double-blind, placebo-controlled trial. Setting. —University hospitals of the National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Patients. —A total of 614 of 804 eligible gravidas with PPROM between 24 weeks' and 0 days' and 32 weeks' and 0 days' gestation who were considered candidates for pregnancy prolongation and had not received corticosteroids for fetal maturation or antibiotic treatment within 1 week of randomization. Intervention. —Interavenous ampicillin (2-g dose every 6 hours) and erythromycin (250-mg dose every 6 hours) for 48 hours followed by oral amoxicillin (250-mg dose every 8 hours) and erythromycin base (333-mg dose every 8 hours) for 5 days vs a matching placebo regimen. Group B streptococcus (GBS) carriers were identified and treated. Tocolysis and corticosteroids were prohibited after randomization. Main Outcome Measures. —The composite primary outcome included pregnancies complicated by at least one of the following: fetal or infant death, respiratory distress, severe intraventricular hemorrhage, stage 2 or 3 necrotizing enterocolitis, or sepsis within 72 hours of birth. These perinatal morbidities were also evaluated individually and pregnancy prolongation was assessed. Results. —In the total study population, the primary outcome (44.1% vs 52.9%;P=.04), respiratory distress (40.5% vs 48.7%;P=.04), and necrotizing enterocolitis (2.3% vs 5.8%;P=.03) were less frequent with antibiotics. In the GBS-negative cohort, the antibiotic group had less frequent primary outcome (44.5% vs 54.5%;P=.03), respiratory distress (40.8% vs 50.6%;P=.03), overall sepsis (8.4% vs 15.6%;P=.01), pneumonia (2.9% vs 7.0%;P=.04), and other morbidities. Among GBS-negative women, significant pregnancy prolongation was seen with antibiotics (P Conclusions. —We recommend that women with expectantly managed PPROM remote from term receive antibiotics to reduce infant morbidity.

Cardiovascular Function Before, During, and After the First and Subsequent Pregnancies

Abstract: This study was designed to test the hypothesis that the vascular remodeling of pregnancy begins early, persists for at least 1 year after delivery, and is accentuated by a second pregnancy. Serial estimates of heart rate, arterial pressure, left ventricular volumes, cardiac output, and calculated peripheral resistance were obtained before pregnancy, every 8 weeks during pregnancy, and 12, 24, and 52 weeks postpartum in 15 nulliparous and 15 parous women using electrocardiography, automated manometry, and M-mode ultrasound. During pregnancy, body weight increased 14.5 ± 1.8 kg and returned to prepregnancy values 1 year postpartum. Heart rate peaked at term 15 ± 1 beat/min above prepregnancy levels (57 ± 1 beat/min). Mean arterial pressure reached its nadir (−6 ± 1 mm Hg) at 16 weeks, returning to baseline at term. The increases in left ventricular volumes and cardiac output (2.2 ± 0.2 L/min) peaked at 24 weeks as did the 500 ± 29 dynes·cm·s −5 decrease in peripheral resistance, and their magnitude was significantly greater in the parous women. Postpartum they gradually returned toward baseline but remained significantly different from prepregnancy values in both groups at 1 year. We conclude that cardiovascular adaptations to the initial pregnancy begin early, persist postpartum, and appear to be enhanced by a subsequent pregnancy. We speculate that persistence of these changes may lower cardiovascular risk in later life.

Circulating leptin in women: a longitudinal study in the menstrual cycle and during pregnancy

Abstract: OBJECTIVE To investigate whether leptin is linked to reproduction, circulating levels were measured longitudinally throughout spontaneous menstrual cycles and during pregnancy in normal women. DESIGN Longitudinal blood samples were collected from normal volunteers, either during regular menstrual cycles or during successful singleton pregnancies. PATIENTS Six healthy, regularly cycling, women volunteers (31.5 ± 3.0 years old, BMI = 21.6 + 0.5) were recruited for serial venous blood sampling throughout one complete menstrual cycle. In addition, five healthy, women (31.8 ± 1.2 years old, pre-pregnant BMI = 30.0 ± 3.1) provided serial venous blood samples throughout one complete singleton pregnancy. MEASUREMENTS Circulating venous oestradiol, progesterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), leptin and (pregnant group only) human chorionic gonadotrophin (hCG). RESULTS In spontaneously cycling women, changes in circulating leptin levels were associated with menstrual phase (P < 0.001) and correlated with progesterone levels (P < 0.05). Peak leptin concentrations were recorded during the luteal phase (P < 0.01), coincident with maximal progesterone levels (P < 0.05). Leptin concentrations were elevated throughout gestation (P < 0.05), and especially during the second trimester (P < 0.05). Post-partum, circulating leptin levels fell sharply to below pre-pregnant values. Leptin correlated with oestradiol (P < 0.05) and human chorionic gonadotrophin (hCG, P < 0.01) levels during pregnancy. First trimester (P < 0.05) and postpartum (P < 0.05) oestradiol concentrations and post-partum hCG levels exhibited the greatest correlation with circulating leptin. CONCLUSIONS We conclude that the relationship between body mass index and circulating leptin varies during the course of spontaneous cycles in women, the best correlation occurring during the luteal phase when progesterone and leptin concentrations are highest. This, together with the correlation between circulating oestradiol, hCG and leptin levels during pregnancy, strongly suggests a dynamic relationship between leptin and reproductive events in women.

Effects on birth weight and perinatal mortality of maternal dietary supplements in rural Gambia: 5 year randomised controlled trial .

Abstract: Objective: To test the efficacy in terms of birth weight and infant survival of a diet supplement programme in pregnant African women through a primary healthcare system. Design: 5 year controlled trial of all pregnant women in 28 villages randomised to daily supplementation with high energy groundnut biscuits (4.3MJ/day) for about 20 weeks before delivery (intervention) or after delivery (control). Setting: Rural Gambia. Subjects: Chronically undernourished women (twin bearers excluded), yielding 2047 singleton live births and 35 stillbirths. Main outcome measures: Birth weight; prevalence of low birth weight ( Results: Supplementation increased weight gain in pregnancy and significantly increased birth weight, particularly during the nutritionally debilitating hungry season (June to October). Weight gain increased by 201 g (P Conclusion: Prenatal dietary supplementation reduced retardation in intrauterine growth when effectively targeted at genuinely at-risk mothers. This was associated with a substantial reduction in the prevalence of stillbirths and in early neonatal mortality. The intervention can be successfully delivered through a primary healthcare system. Key messages In developing countries chronic maternal undernutrition is a prime contributor to the birth of over 25 million low birthweight babies annually and to high rates of neonatal mortality. An absence of well designed field trials has created uncertainty about the potential efficacy of maternal feeding programmes This large scale randomised controlled trial shows that dietary supplementation in pregnancy can be highly effective in reducing the proportion of low birthweight babies and perinatal mortality Incorporating supplementary feeding into a rural primary healthcare system is feasible Late pregnancy is the period most amenable to intervention

Risk factors for pregnancy associated venous thromboembolism

Abstract: In an attempt to reduce the incidence of pregnancy associated venous thromboembolism (PA-VTE), some researchers have advocated screening of all women for the factor V(Leiden) mutation during early pregnancy. We have conducted a large retrospective study (over 72,000 deliveries) to determine if this would be useful. Sixty-two objectively confirmed venous thrombotic events (51 DVT, 11 PE) were recorded at two maternity units in the UK. The incidence of DVT was 0.71 per 1000 deliveries (95% CI 0.5-0.9) with 0.50 occurring in the antenatal period (95% CI 0.34-0.66) and 0.21 in the puerperium (95% CI 0.11-0.31). The incidence of PE was 0.15 per 1000 deliveries (95% CI 0.06-0.24), 0.07 antenatal (95% CI 0.01-0.13) and 0.08 in the puerperium (95% CI 0.02-0.14). Of these 62, 50 attended for follow-up and thrombophilia screening. 28% of all episodes of PA-VTE had no clinical risk factor for thrombosis or an identifiable thrombophilic abnormality. Deficiency of antithrombin was identified in 12% of individuals (95% CI 3-21) and the factor V(Leiden) mutation in 8% (95% CI 0.5-15.5). Based on estimates of the prevalence of the factor V(Leiden) mutation in the population, we estimate that the thrombotic risk for a woman during pregnancy or the puerperium with the defect is approximately 1 in 400-500. This figure would not lend support to the idea of random screening for the mutation in early pregnancy.

Effects of maternal smoking during pregnancy and a family history of asthma on respiratory function in newborn infants

Abstract: Summary Introduction Infants of mothers who smoke have reduced respiratory function and are more likely to develop wheezing. Little evidence is available on the effect of inutero cigarette-smoke exposure as opposed to postnatal exposure to environmental tobacco smoke. We used a previously validated non-invasive method to measure the time to peak tidal expiratory flow (tPTEF) as a proportion of expiratory time (tE) in newborn infants soon after birth to examine the effects of a family history of asthma and in-utero cigarette-smoke exposure on the infants' respiratory function. Methods We collected respiratory-function data from 500 healthy infants of mothers taking part in the Western Australia Pregnancy Cohort Study. During behaviourally defined quiet sleep, measurements were obtained a median of 58 h (range 26–159) after the infants were born. We used uncalibrated inductance plethysmography. The uncalibrated volume signal was differentiated to flow and used to calculate respiratory rate, total inspiratory time, tE, and tPTEF. Mothers answered questionnaires on demographic, medical, and pregnancy characteristics, including smoking history. Serum cotinine measurements were available to validate self-reported smoking history in a subset of mothers (238). Results Data suitable for analysis were obtained from 461 infants. In multivariate regression analysis, lower values of tPTEF/tE were independently associated with respiratory rate (β coefficient per 10 breaths/min 0·018 [SE 0·005], p 10 cigarettes daily; ? coefficient -0·049 [0·022], p Conculsion In-utero smoke exposure, a family history of asthma, and maternal hypertension during pregnancy are associated with reduced respiratory function after birth. We speculate that these factors adversely affect lung development in utero.

Association between air pollution and low birth weight: a community-based study.

Abstract: The relationship between maternal exposure to air pollution during periods of pregnancy (entire and specific periods) and birth weight was investigated in a well-defined cohort. Between 1988 and 1991, all pregnant women living in four residential areas of Beijing were registered and followed from early pregnancy until delivery. Information on individual mothers and infants was collected. Daily air pollution data were obtained independently. The sample for analysis included 74,671 first-parity live births were gestational age 37-44 weeks. Multiple linear regression and logistic regression were used to estimate the effects of air pollution on birth weight and low birth weight (< 2,500 g), adjusting for gestational age, residence, year of birth, maternal age, and infant gender. There was a significant exposure-response relationship between maternal exposures to sulfur dioxide (SO2) and total suspended particles (TSP) during the third trimester of pregnancy and infant birth weight. The adjusted odds ratio for low birth weight was 1.11 (95% CI, 1.06-1.16) for each 100 micrograms/m3 increase in SO2 and 1.10 (95% CI, 1.05-1.14) for each 100 micrograms/m3 increase in TSP. The estimated reduction in birth weight was 7.3 g and 6.9 g for each 100 micrograms/m3 increase in SO2 and in TSP, respectively. The birth weight distribution of the high-exposure group was more skewed toward the left tail (i.e., with higher proportion of births < 2,500 g) than that of the low-exposure group. Although the effects of other unmeasured risk factors cannot be excluded with certainty, our data suggests that TSP and SO2, or a more complex pollution mixture associated with these pollutants, contribute to an excess risk of low birth weight in the Beijing population.

Prednisone and aspirin in women with autoantibodies and unexplained recurrent fetal loss.

Abstract: Background Recurrent fetal loss has been well described in women with antiphospholipid antibodies. Such women also often have other autoantibodies commonly found in patients with systemic lupus erythematosus. Treating them with prednisone and aspirin may reduce the risk of fetal loss. Methods We screened 773 nonpregnant women who had the unexplained loss of at least two fetuses for antinuclear, anti-DNA, antilymphocyte, and anticardiolipin antibodies and for the lupus anticoagulant. Of 385 women with at least one autoantibody, 202 who later became pregnant were randomly assigned in equal numbers to receive either prednisone (0.5 to 0.8 mg per kilogram of body weight per day) and aspirin (100 mg per day) or placebo for the duration of the pregnancy. The women were stratified according to age (18 to 34 years or 35 to 39 years) and the week of gestation at which the previous fetal losses had occurred ( 12 weeks). The primary outcome measure was a successful pregnancy. Results Live infants were born to...