摘要:

ObjectiveTo assess the relative influence of maternal body composition at late gestation on birth weight.MethodsMaternal body composition was estimated in 224 women near term using a deuterium dilution technique. Using a stepwise multiple linear regression analysis, we studied the association with birth weight of eight factors, including maternal fat-free mass and fat mass.ResultsMaternal fat-free-mass was the most important variable influencing birth weight (R2= .144,P< .001), followed by maternal fat mass (R2= .051,P< .001). Gestational age at delivery was the third strongest influence on birth weight (R2= .047,P< .001).ConclusionIn late pregnancy, fat-free mass was the most important maternal body component associated with birth weight. The implementation of longitudinal studies could shed more light on the influence of maternal body compotion on birth weight.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo examine associations between pregnancy weight gain outside and within ranges recommended by the Institute of Medicine and birth weight by both prepregnant body mass index (BMI) and race-ethnicity.MethodsMean birth weight and incidence of term low birth weight (LBW, less than 2500 g) and high birth weight (more than 4500 g) were compared across BMI-pregnancy weight gain-race-ethnicity strata. Subjects were 173,066 white, black, and Hispanic low-income pregnant women attending prenatal nutrition programs between 1990 and 1993.ResultsAmong low and average BMI women (all race-ethnicity groups), weight gain within Institute of Medicine ranges resulted in significant LBW reductions; further LBW reductions at gains beyond Institute of Medicine ranges were offset by increasing high birth weight risk. Among women of high and obese BMI, LBW trends were less pronounced; thus, the benefit of gaining within the Institute of Medicine range was less apparent. Although blacks in every BMI-weight gain category had lower mean birth weights than white women, gaining in the upper end of the Institute of Medicine ranges did not provide a consistent LBW reduction for black women; adjusted LBW odds ratios and 95% confidence intervals for gains in the upper relative to the lower half of the Institute of Medicine range were 1.3 (0.8, 2.1), 0.7 (0.5,1.03), 0.3 (0.2, 0.8), and 1.3 (0.7, 2.5) for black women of low, average, high, and obese BMI, respectively.ConclusionInstitute of Medicine pregnancy weight gain ranges recommended for low and average BMI women appear reasonable, but recommendations for high and obese BMI women require further evaluation. The recommendation that black women in all BMI groups strive for gains toward the upper ends of the ranges is not supported clearly by these data.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo evaluate the effectiveness of an intervention designed to enhance Medicaid prenatal care in improving birth outcomes of drug-using women infected with the human immunodeficiency virus (HIV).MethodsMedicaid and vital statistics records were linked for 353 HIV-infected drug-using women delivering in 1993 and 1994 while enrolled in New York State Medicaid. Of these, 68% were treated by providers participating in the Prenatal Care Assistance Program, designed to provide case management, improved continuity, referral services, and behavioral risk reduction counseling. In a series of logistic models, we estimated adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of low birth weight (less than 2500 g) and preterm delivery (before 37 weeks), comparing women using and not using the program.ResultsWomen using the Prenatal Care Assistance Program were significantly less likely, after adjustments were made for maternal characteristics, to have low birth weight infants and preterm deliveries (OR 0.52, 95% CI 0.31, 0.89; and OR 0.57, 95% CI 0.34, 0.97, respectively). Adding measures of greater adequacy and continuity of prenatal care to the models explained just over 20% of the Prenatal Care Assistance Program's protective effect. The addition of maternal high-risk behavior, HIV-focused care, and drug use treatment variables altered program effect estimates less profoundly (together accounting for 4 and 9% of the program's protection against low birth weight and preterm delivery, respectively).ConclusionThe Prenatal Care Assistance Program appeared to be successful in reducing the incidence of low birth weight and preterm delivery in this high-risk population. The program's success can be attributed, in part, to increased adequacy and continuity of prenatal care and, to a lesser extent, to more frequent receipt of special services and reduced maternal high-risk behaviors.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo test the effectiveness of a four-item prenatal-alcohol-use, self-administered screening questionnaire that asks about tolerance to alcohol, being annoyed by other's comments about drinking, attempts to cut down, and having a drink first thing in the morning (“eye-opener”) (T-ACE) in an ethnically and socioeconomically diverse sample.MethodsTwo hundred fifty T-ACE-positive and 100 T-ACE-negative women completed a comprehensive assessment of their alcohol use after initiating prenatal care at the Brigham and Women's Hospital in Boston, Massachusetts. This comprehensive assessment, which included the Alcohol Use Disorders Identification Test and the Short Michigan Alcoholism Screening Test as comparisons to the T-ACE, generated three criterion standards:Diagnostic and Statistical Manual of Mental Disorders, Third Ed., Revised(DSM-III-R), lifetime alcohol diagnoses, risk drinking (regularly having more than one fluid ounce of alcohol per drinking day before pregnancy), and current drinking.ResultsT-ACE-positive pregnant women were more likely than T-ACE-negative women to satisfy DSM-III-R criteria for lifetime alcohol diagnoses (40% versus 14%,P< .001) and risk drinking (39% versus 8%,P< .001) and to have current alcohol consumption (43% versus 13%,P< .001). In contrast, obstetric staff members documented only 33 (9%) women as using alcohol at any time, even though nearly all subjects (96%) were asked about drinking upon initiation of prenatal care.ConclusionThe T-ACE was the most sensitive screen for lifetime alcohol diagnoses, risk drinking, and current alcohol consumption. It outperformed obstetric staff assessment of any alcohol use by pregnant women enrolled in the study.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo examine effects of maternal hypertension on spontaneous preterm birth (birth at less than 37 weeks' gestation) among black women.MethodsUsing hospital discharge summary records from the National Hospital Discharge Survey between 1988 and 1993, we conducted a case-control study to assess the risk of spontaneous preterm birth among black women with chronic hypertension preceding pregnancy and pregnancyinduced hypertension. Logistic regression was used to derive odds ratios (ORs) and 95% confidence intervals (CIs).ResultsPreterm births were almost two times more likely for women with pregnancy-induced hypertension (OR = 1.8; 95% CI, 1.5, 2.2), more than 1.5 times more likely for women with chronic hypertension preceding pregnancy (OR = 1.6; 95% CI, 1.3, 2.1), and more than four times more likely for women with pregnancy-aggravated hypertension (OR = 4.4; 95% CI, 2.9, 6.7) compared with normotensive women. Preterm births also were associated significantly with antepartum hemorrhage, poor fetal growth, marital status, and source of payment. The odds of preterm birth by mafernal hypertension were increased among women with chronic hypertension and genitourinary infection, whereas the odds of preterm birth were reduced among women with pregnancy-induced hypertension and genitourinary infection.ConclusionThese findings are important in demonstrating the relation between type of hypertension in pregnancy and preterm birth. The relationships between maternal hypertension and preterm birth need to be further investigated to provide some guidelines in the management of hypertension in pregnancy and assessment of prenatal care compliance for black women, particularly when genitourinary infection is present.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo review pregnancy outcomes when two or more ultrasound scans persistently fail to visualize the fetal stomach.MethodsA computerized ultrasound database was used to identify all fetuses in which two or more serial ultrasound examinations failed to visualize the fetal stomach. Sonographic images were reviewed retrospectively, with the reviewer blinded to outcome data, to confirm persistent nonvisualization. Pregnancy outcome data were obtained from hospital charts and physicians' office records. Fetal karyotypes, when performed, were obtained from amniotic fluid (AF) culture. The ultrasound findings then were compared with fetal karyotype results and pregnancy outcome data.ResultsOf 35,569 ultrasound scans performed during 1991-1996, 26 fetuses (0.07%) with persistently nonvisualized stomachs were identified. Structural defects were detected in 17 fetuses (65%), most often involving the cardiothoracic (n= 5), genitourinary (n= 4), and central nervous systems (n= 4). Karyotypes were obtained in 12 fetuses, and four of them were abnormal. Only five of 17 fetuses (29%) with a structural defect survived. In nine of 26 fetuses (35%) with persistently nonvisualized stomachs, no structural defect was identified. Each of these nine fetuses had abnormal AF volume in its surrounding sac, and the overall perinatal survival in fetuses without a structural defect was only 50%.ConclusionFetuses with persistently nonvisualized stomachs have an increased incidence of structural defects and AF abnormalities and are more likely to have a poor outcome. A detailed ultrasound examination and fetal karyotype analysis should be performed to evaluate fetuses with persistently nonvisualized stomachs.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo identify risk factors associated with poorer immediate neonatal outcomes among growth-restricted neonates.MethodsRecords of all 530 growth-restricted neonates born between January 1989 and February 1995 were reviewed. Outcomes included resuscitation measures, Apgar scores, and umbilical blood gas values. Neonates were assigned to one of six anesthetic groups, and outcomes were compared. Predictors of poorer outcomes were examined using logistic and linear regression.ResultsNeonates exposed to general anesthesia were more likely to be intubated (37.9% versus 4.1%,P< .001, Pearson χ2) and had lower mean 1- (4.0 versus 7.0) and 5-minute (6.5 versus 8.4) Apgar scores (P< .01, Scheffé) than those in all other anesthetic groups. They also had significantly lower umbilical artery (UA) pH values than neonates who received nalbuphine, epidural, or no anesthesia (7.21 versus 7.28, 7.26, 7.29, respectively;P< .01, Scheffé). Factors that significantly and independently predicted intubation among all neonates included exposure to general anesthesia (odds ratio [OR] 4.1; 95% confidence interval [CI] 1.9, 8.9) and lower infant weight (OR 10.1 per kg decrease; CI 5.1, 20). Factors predicting UA pH at most 7.15 included preeclampsia (OR 3.0; CI 1.5, 5.9) and older maternal age (OR 1.3 per 5 years; CI 1.02, 1.64); vertex delivery (OR 0.5; CI 0.2, 0.9) was protective. Factors predicting a 5-minute Apgar less than 7 were meconium (OR 1.5 per category going from none to terminal to light to heavy; CI 1.04, 2.3), general anesthesia (OR 6.9; CI 2.6, 18.2), lower infant weight (OR 16.5 per kg decrease; CI 7.8, 34.5), and vaginal breech delivery (OR 7.0; CI 1.8, 28.6); cesarean delivery (OR 0.2; CI 0.08, 0.66) was protective. Spontaneous vertex delivery raised the UA pH, and preeclampsia, amnioinfusion, breech delivery, and general anesthesia significantly and independently lowered the UA pH among all neonates. For infants delivered by cesarean, “fetal distress,” preeclampsia, previous spontaneous abortion, failed forceps use, and nalbuphine significantly and independently predicted lower UA pH.ConclusionRisk factors for poorer immediate neonatal outcomes among growth-restricted neonates include preeclampsia, fetal distress, breech delivery, forceps use, nalbuphine during labor, lower infant weight, and general anesthesia.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo establish fetal growth nomograms for twin gestations, categorized by placental chorionicity, and to compare them with those of published singleton and twin nomograms.MethodsComputerized data files of live births of all twins delivered between January 1990 and October 1996 at Saint Peter's Medical Center were used. Birth weight curves corresponding to the fifth, tenth, 50th, 90th, and 95th percentiles were derived separately for twins with monochorionic and dichorionic placentation. We generated the curves by applying the method of generalized estimating equations, after adjusting for the potential intracluster correlation due to twinning. The curves were then smoothed on the basis of nonparametric restricted cubic splines to derive (smoothed) birth weight percentiles. We then compared our twin birth weight nomogram to six previously published singleton and two twin nomograms published previously for predicting small for gestational age infants (defined as birth weight below the tenth percentile).ResultsAmong 1302 twin fetuses, 272 (21%) were monochorionic. Twins from monochorionic gestations weighed, on average, 66.1 g (standard deviation 28.4 g,P= .02) less than twins from dichorionic gestations after correcting for gestational age. Twin curves based on parity (nulliparity versus multiparity) were not different from each other. Analyses indicate that all previously published singleton nomograms approximate twin growth reasonably well between 32 and 34 weeks, but they underestimate twin growth at earlier gestational ages (between 25 and 32 weeks) and overestimate twin growth beyond 34 weeks' gestation. Similarly, a comparison of previously published twin nomograms with those of ours indicates that the growth standards in our population were similar to those in other published twin nomograms.ConclusionWe recommend that future epidemiologic and clinical studies use twin nomograms to identify growthrestricted twin fetuses. Moreover, because fetal growth is influenced by placental chorionicity, we recommend that fetal growth assessment in twin gestations consider placental chorionicity, whenever the information is available.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveAlthough retroplacental hemorrhage is a major cause of fetal death, its etiology often remains obscure. In some reports, cocaine use by pregnant women has been associated with retroplacental hemorrhage and clinical abruptio placentae. This study was designed to assess the occurrence of chorionic villus hemorrhage, an entity shown recently to be associated with retroplacental hemorrhage, in the placentas of cocaine users.MethodsTwenty-nine placentas from cocaine users and 15 placentas from drug-free controls, as determined by questionnaire and urine toxicology screen, were examined prospectively, and pathological findings documented. The prevalence of retroplacental hemorrhage, chorionic villus hemorrhage, edema, chorioamnionitis, funisitis, infarction, fetal vessel thrombosis, and intervillus hemorrhage was examined in the two groups.ResultsChorioamnionitis was the most frequent finding in both groups (58% of cocaine users, 66% of controls). Edema of moderate severity or greater was found only in the cocaine-using group (17%). The prevalence of chorionic villus hemorrhage among women using cocaine also was 17%.ConclusionCocaine use during pregnancy may be associated with chorionic villus hemorrhage and villus edema, even in the absence of clinical abruptio placentae. The relationship between abnormal placental morphology and adverse perinatal outcomes remains to be determined.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo determine whether a difference in the behavioral and physiologic response to circumcision can be demonstrated between neonates undergoing the procedure with ring block and those receiving no anesthesia.MethodsForty healthy male newborns were assigned randomly to receive either ring block or no anesthesia. Indices of perceived pain including crying time, behavioral state, oxygen saturation, and heart and respiratory rates were recorded at baseline and at intervals during the circumcision. Infants were reassessed 2 minutes and 2 hours postoperatively.ResultsInfants receiving ring block cried less than did controls (P< .001). Anesthetized infants had smaller increases in heart rate (P< .005) and demonstrated less arousal (P< .005) during each operative interval. For all operative intervals combined, anesthetized infants had a smaller decrease in oxygen saturation (P< .001) and a smaller increase in respiratory rate (P= .005) than did controls. Two minutes postoperatively, anesthetized infants had returned to their baseline behavioral state, whereas controls remained significantly more aroused (P< .005). Two hours postoperatively, there were no significant differences in any variables between the groups, nor between each group and its baseline. There were no complications related to anesthesia administration.ConclusionNeonatal circumcision causes behavioral and physiologic changes consistent with the perception of pain. Ring block is an effective method of anesthesia for this procedure.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID