摘要:

ObjectiveTo determine the fat deposited during pregnancy in women gaining according to recommendations of the Institute of Medicine and the relationship of weight gain to fat gain in women of different starting weights (classified by their body mass index).MethodsA cohort study of healthy, nonsmoking women, 18–36 years of age, identified during prenatal visits at three hospital clinics and one birthing center in New York City. From a pool of 432 eligible volunteers who signed a consent form, body composition measurements were performed on 200 women at weeks 14 (−2) and 37+ of pregnancy, and bone mineral mass was measured at 2–4 weeks postpartum. Body fat was estimated with a model that used total body water, weight, and density and bone mineral mass.ResultsIn women gaining as recommended by the Institute of Medicine, fat gains during pregnancy for women underweight, normal weight, overweight, or obese before pregnancy were 6.0 ± 2.6 kg, 3.8 ± 3.4 kg, 3.5 ± 4.1 kg, and −0.6 ± 4.6 kg, respectively. Higher weight gain increased fat gain. Body water gain was not different among the four prepregnancy weight groups.ConclusionRecommended weight gain should not cause obesity in any weight group. Underweight women will normalize their body composition if they gain as recommended, whereas obese women will have little or no change in body fat. A majority of women do not gain as recommended during pregnancy.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo that end examine differences in birth weight among the term infants of black and white women with weight gains in the upper or lower half of recommended ranges.MethodsBirth weight (mean, low [at or below 2500 g], and suboptimal [2501–2999 g]) among term infants of 2219 black and 3966 white low-income women was compared with maternal prenatal weight gain classified according to four categories: below, within the lower or upper halves, and above the recommended ranges for pregravid body mass index (BMI) category (low, normal, high).ResultsAdjusted mean birth weights among the infants of women with prenatal weight gain in the upper versus lower half of the recommended ranges were higher among white women with normal BMI (3307 g upper half, 3199 g lower half,P= .0001) but not among black women with normal BMI (3180 g upper half, 3105 g lower half, not significant). Logistic regression analyses revealed that prenatal weight gain in the upper compared with the lower half of the recommended ranges was associated with a decreased adjusted odds ratio (OR) for low (but not suboptimal) birth weight among the infants of white women (OR 0.4, 95% confidence intervals [CI] 0.2,0.9) but not of black women (OR 1.2; 95% CI 0.4,3.3).ConclusionThese preliminary observations do not provide support for the presence of ethnic group-specific recommendations within guidelines for prenatal weight gain.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo evaluate the association between birth weight and birth order in grand grand multiparous women (ie, those who have had at least ten deliveries).MethodsThe longitudinal population consisted of 96 grand grand multiparous women with 1098 singleton deliveries. Two birth cohorts formed the cross-sectional reference populations: one from 1966 with 7564 deliveries and one from 1985–1986 with 5691 deliveries. In each population, birth weight was compared in four birth-order groups: first, second to fifth, sixth to ninth, and tenth to 12th born.ResultsThe birth weight increased with birth order in each population, especially in the longitudinal one. The association remained even after adjusting for gestational age, sex of the newborn, maternal diabetes mellitus, and body mass index. Children born tenth to 12th were 83 g (95% confidence interval [CI] 29, 137) heavier than those born sixth to ninth; these in turn were 29 g (95% CI −27, 85) heavier than children born second to fifth, and those born second to fifth were 169 g (95% CI 54, 283) heavier than first born infants. Further indirect adjustment for the secular trend decreased these contrasts somewhat.ConclusionBirth order is an independent determinant of birth weight even until the tenth delivery.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo compare the use of prenatal care, incidence of pregnancy complications, and neonatal outcomes among adolescent mothers with those among older mothers in a military population with equal access to a tertiary care center.MethodsWe reviewed the neonatal data base of a military tertiary care center for the period 1990–1996. All singleton births at least 20 weeks' estimated gestational age (EGA) or with birth weight at least 500 g were included. Maternal transfers were excluded. Mothers were divided into five age groups, with the ranges 13–17, 18–19, 20–24, 25–29, and 30 or more years. Prenatal care was assessed by the Kessner index. Data were analyzed by χ2test,ttest, Mann-WhitneyUtest, and logistic regression techniques.ResultsIncluded in the study were 10,168 infants (344 aged 13–17, 893 aged 18–19, 3244 aged. 20–24, 3095 aged 25–29, and 2592 aged 30 or more years). There was a greater percentage of Hispanic mothers among adolescents aged 13–17 years (48.3%); this percentage decreased as maternal age increased (32.7% to 14.6%). The percentage of white mothers was greatest for mothers over 30 years old (72.1%), and this percentage decreased as maternal age decreased (70.3% to 35.8%). The percentage of black mothers remained relatively constant in all age groups (12.2–13.0%). There were significant differences in sponsor's rank distribution among groups; mothers 25–29 years old and over 30 years old had higher-paying ranks whereas both teenage groups were of predominantly lower-paying ranks. Gestational age at the first prenatal visit and overall use of prenatal care were significantly improved as maternal age increased for each successive age group. Older mothers had significantly higher rates for diabetes and abnormal fetal sonograms than younger mothers; younger mothers had increased rates for sexually transmitted disease, fetal growth restriction, and tobacco use. Multivariate analysis demonstrated that fetal complications, adequate prenatal care, black maternal race, and lower rank were significant independent risk factors for high-risk outcomes. Young maternal age was not an independent risk factor for prematurity or low birth weight.ConclusionAlthough adolescent mothers (13–17 years old) used prenatal care less than older mothers, there were no differences in the incidence of prematurity, low birth weight (LBW), or neonatal survival among this group of women cared for in a military tertiary health care setting. In this health care setting, risk for premature birth and LBW are related to complications of pregnancy, maternal race, and lower-paying rank.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo evaluate the seroprevalence of the rubeola (measles) antibody in several obstetric populations.MethodsIn this cross-sectional study, women presenting for prenatal care underwent measurement of antibodies to the rubeola virus. The study population presented for care at either an urban medical center (group I) or a suburban medical center (group II). These groups were divided further into those receiving care in a resident-supervised clinic (A) and those in a private-practice setting (B).ResultsA total of 768 women were tested. Seventy-five (9.8%) women had rubeola antibody titers less than or equal to 0.13 and were classified as seronegative. The lowest percentage of seronegative women (3.2%) was found at the urban resident-supervised clinic site. The highest percent-age of seronegative women (20.5%) was found in the suburban resident-supervised clinic site. Women classified as seronegative were younger, with a mean age of 25.0 years. No significant difference was observed based on gravidity, party, or care received in an urban versus suburban private-practice setting.ConclusionWe suggest that an appreciable number of women presenting for prenatal care may lack antibodies to the rubeola virus. In the interest of personal and public health, populations believed to be at risk may benefit from ongoing surveillance of immune status and appropriate vaccination. Additional study is necessary to define best those groups that would benefit from surveillance and vaccination.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine the seronegativity rate of varicella-zoster virus in a tertiary care obstetric population.MethodsAt their initial prenatal visit, all obstetric patients at Westchester County Medical Center have a varicella-zoster virus IgG antibody titer (Varicella Stat; Biowhit-taker, Inc., Walkersville, MD) performed. A value of 0.99 or greater units is positive. Patients were divided into three groups: seronegative, seropositive, and those with no test results. Mean maternal age was compared among groups using the unpaired two-tailed Studentttest, withP< .05 considered significant.ResultsFrom February 1, 1994, to May 30, 1996, 927 women had an initial prenatal visit. Ninety-nine patients were varicella-zoster virus antibody negative (seronegativity 11.6%, which is significantly higher than that reported in other studies); 755 were varicella-zoster virus antibody positive, and 73 had no results. The mean age of the seronegative patients was 27 years and of the seropositive patients 28 years, which was not significantly different.ConclusionVaricella-zoster virus seronegativity is higher in our obstetric population than generally is reported in adults. This may reflect the number of immigrants from tropical countries attending metropolitan hospitals. Mathematic models evaluating the impact of varicella-zoster virus vaccination and decisions regarding screening and postpartum vaccination must be based on accurate epidemiologic data, particularly in view of the effect of varicella-zoster virus on pregnant women, their fetuses, and their neonates.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo identify risk factors associated with low postpartum hematocrits after vaginal delivery and to define lower risk categories of patients for whom routine determination of hematocrit may not be necessary.MethodsThis case-control study was designed to identify risk factors for discharge hematocrit below 27% in nonanemic patients after a vaginal delivery using the University of California, San Francisco, Perinatal Database. Multivariate statistics were used to determine the most significant risk factors. Lower risk subpopulations were analyzed to determine their rate of low discharge hematocrits.ResultsRisk factors associated with odds ratios greater than 1.5 for discharge hematocrit less than 27% included estimated blood loss greater than 500 mL, placenta previa, abruption, prolonged third stage, preeclampsia, prior post-partum hemorrhage, and prior cesarean delivery. Estimated blood loss > 500 mL was the most significant risk factor for discharge hematocrit less than 27% (odds ratio 4.5, 95% confidence interval 3.8, 5.4). A population without statistically significant risk factors was identified; this group had a 1.4% risk of discharge hematocrit less than 27%.ConclusionRoutine postpartum hematocrits are unnecessary in clinically stable patients with an estimated blood loss of less than 500 mL.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo estimate the risk for cerebral palsy in preterm infants in relation to the presence of meconium in the amniotic fluid (AF).MethodsA cohort study was conducted of 404 consecutive preterm infants delivered between 24 and 33 weeks' gestation at a single institution. Sociodemographic and clinical data were collected at birth. The diagnosis of cerebral palsy was made at 2 years' corrected age. Politomous logistic regression models were used to evaluate the odds for cerebral palsy while adjusting for potential confounders.ResultsThe overall prevalence of cerebral palsy among survivors was 11.6% (40/345). The cerebral palsy rate was 41.2% (7/17) among infants who were meconium-stained at birth and 10% (33/328) among those who were not (P= .006 by Fisher exact test). After adjustment for potential confounders (gestational age and fetal gender), the odds ratio of cerebral palsy among infants delivered to women with meconium-stained AF was 6.9 (95% confidence interval 2.32, 20.81,P= .001) relative to those delivered to women with clear AF.ConclusionThe results of the present study support the view that the presence of meconium in the AF is a gestational age-independent risk factor for cerebral palsy among preterm infants.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo evaluate the amniotic fluid (AF) volume in normal singleton pregnancies from 15 to 40 weeks.MethodsThis prospective study evaluated the AF volume in singleton pregnancies undergoing amniocentesis for genetic assessment of fetal karyotype, preterm labor, or fetal lung maturity. Amniotic fluid volume was determined using a dye dilution technique. To assess the relationship between AF volume and estimated gestational age, a nonlinear regression model was applied.ResultsOne hundred forty-four normal singleton pregnancies had AF volume evaluated. There was wide variability in the measured AF volumes with a significant (P< .01) increase in AF volume as a function of gestational age. Growth curve modeling estimated that AF volume continued to increase until 40 weeks' gestation. Analyses of the observed AF volume indicated that AF volume nearly doubled after 30 weeks' gestation.ConclusionIn contrast to other reports indicating that maximal AF volume in singleton gestations is expected early in the third trimester, we observed the attainment of maximal AF volume near term.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine the relationship between the change in amniotic fluid index (AFI) and the volume of fluid removed at amnioreduction.MethodsIn a prospective study of 20 twin and 19 singleton pregnancies undergoing amnioreduction for severe polyhydramnios, AFI was measured immediately before and after the procedure and was correlated with the volume of fluid withdrawn.ResultsA significant linear relationship was found between AFI change and the volume drained in all pregnancies (Y= −4.2X;R2= 0.49;P= .002). This relationship was similar in singleton and twin pregnancies. However, there was a significant absolute difference in AFI change between singleton and twin pregnancies of 7.9 cm (95% confidence interval 0.41, 15.2;P= .04).ConclusionThese findings support the use of the four-quadrant AFI as a semiquantitative index of amniotic fluid volume. This relationship can be used to predict the drain-age volume required to achieve a target AFI with amnioreduction and thus avoid repeated AFI measurements during the procedure itself.

ISSN:0029-7844    

出版商:OVID    

年代:1997

数据来源: OVID