摘要:

ObjectiveTo determine whether a high concentration of serum ferritin during the third trimester is a marker of subclinical maternal infection and very preterm delivery and is associated with maternal nutritional status.MethodsA total of 1162 gravidas was followed prospectively from entry to prenatal care (15.0 ± 4.9 completed weeks' gestation) in Camden, New Jersey, between 1985 and 1995. Multiple logistic regression and analysis of covariance were used to examine the influence of serum ferritin on the outcomes of interest.ResultsHigh concentrations of serum ferritin (at or above the 90th percentile) at week 28, but not at entry to prenatal care, increased risk of preterm and very preterm delivery, but the risk changed if the concentration of ferritin declined from entry. If the concentration declined as expected, high ferritin concentration had no influence on outcome. If the concentration increased, then high ferritin concentration at week 28 was associated with very preterm delivery (adjusted odds ratio [AOR] 8.77; 95% confidence interval [CI] 3.90, 19.72), preterm delivery (AOR 3.81; 95% CI 1.93, 7.52), low birth weight (AOR 5.15; 95% CI 2.47, 10.72), clinical chorio-amnionitis (AOR 2.56; 95% CI 1.01, 6.52), and symptoms of “flu” as an index of unmeasured infection (AOR 6.02; 95% CI 1.16, 31.17). Factors associated with failure of the ferritin concentration to decline included iron deficiency anemia earlier in pregnancy (AOR 3.98; 95% CI 1.17, 8.98) and lower levels of serum and red cell folate.ConclusionHigh serum ferritin concentration in the third trimester, resulting from a failure of ferritin to decline, is associated with very preterm delivery and markers of maternal infection. Iron deficiency anemia and other indicators reflecting poor maternal nutritional status earlier in pregnancy underlie this relationship.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo assess the effects of folate intake and pregnancy on plasma total homocyst(e)ine concentrations in women during the second trimester of pregnancy compared with young, healthy nonpregnant women.MethodsThe diet provided either 450 or 850 μg of folate per day. These levels are approximately the current (400 μg/day) and previous (800 μg/day) Recommended Dietary Allowances for folate in pregnant women. Folate was provided as both food folate (120 μg/day) and supplemental folic acid (either 330 or 730 μg/day) for a period of 12 weeks. Plasma homocyst(e)ine (sum of free and protein-bound homocysteine), serum folate, and erythrocyte folate concentrations were determined weekly.ResultsHomocyst(e)ine concentrations were lower in pregnant women during the second trimester of normal pregnancy than in nonpregnant controls, independent of dietary folate intake. The overall mean (± standard deviation) homocyst(e)ine concentration of the pregnant subjects (5.4 ± 1.4 μmol/L) was significantly lower than that observed in the nonpregnant control group (8.7 ± 1.7 μmol/L) (P< .0001). This difference in homocyst(e)ine concentrations remained constant throughout the 12 weeks of the investigation.ConclusionThe folate intakes in this investigation were adequate to maintain constant homocyst(e)ine concentrations in pregnant and nonpregnant women. The lower homocyst(e)ine concentrations observed in pregnant subjects compared with nonpregnant controls may be a physiologic response to pregnancy.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo determine if nonpregnant plasma volume is altered in women who are homozygous for the T 235 coding angiotensinogen allele, which predisposes women to an increased risk of preeclampsia.MethodsWe measured plasma volume by Evans blue dilution and analyzed it as a function of angiotensinogen genotype in 15 nulligravid women during midfollicular phase of 26 menstrual cycles. Eleven women were evaluated during two cycles, and four women were evaluated in one cycle. Fourteen women were white, and one was Asian. No subjects had illnesses or were taking medication. The range of body mass index (BMI [kg/m2]) was 20.2-31.0. Plasma volume (mL) was reported as plasma volume divided by BMI to control for variations in body sizes. Statistical analysis was performed by analysis of variance with post hoc testing using Fisher least significant difference test for multiple comparisons (P< .05 accepted for significance)ResultsAngiotensinogen genotype analysis showed five women homozygous for M 235, three women homozygous for T 235, and seven women who were heterozygous (MT 235). T 235 homozygotes had significantly lower plasma volume divided by BMI compared with women who were homozygous for M 235 and women who were heterozygous for MT 235 (mean 1 standard deviation [SD] [71.2 + 8.8, 86.6 + 5.2, 95.8 + 15.6, respectively,P< .05]). There was a tendency toward higher plasma volume in heterozygote MT 235 compared with homozygote M 235 carriers, but it was not statistically significant.ConclusionWe conclude that the homozygous T 235 coding angiotensinogen genotype is associated with reduced plasma volume in nulligravid women during the follicular phase of the menstrual cycle compared with M 235 homozygotes and heterozygotes. This association of the T 235 coding genotype might contribute to fetal growth restriction in preeclampsia.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo determine whether baseline characteristics during early pregnancy, proposed as potential risk factors for preeclampsia, show differences in prevalence and effects within distinct ethnic groups.MethodsIn a prospective cohort study of 2413 healthy nulliparous women from eight midwives' practices, we analyzed risk factors for preeclampsia (maternal age, body mass index, blood pressure at booking, smoking habit, and abortion history) in white, Mediterranean, Asian, and black women. In a univariate analysis, we estimated the relative risk of preeclampsia for the baseline variables and for ethnicity. In a multivariate analysis, we evaluated the simultaneous effect of the baseline variables in white (n= 1641) and black (n= 317) women.ResultsSignificant differences were found in the prevalence of the risk factors in different ethnic groups. In the univariate analysis, the relative risk (RR) of preeclampsia in black women was 2.4 (95% confidence interval [CI] 1.1, 5.6) compared with white women. In the multivariate analysis in white women, the adjusted RR of preeclampsia for a diastolic blood pressure at booking above 70 mmHg was 4.4 (CI 0.9, 20.8). Among black women, the adjusted RR of preeclampsia was increased for high maternal age (RR 1.2; CI 1.0, 1.4), but not for a diastolic blood pressure at booking above 70 mmHg (RR 0.8; CI 0.2, 3.9)ConclusionIn studies of risk factors for preeclampsia, black women should be analyzed separately from white women.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo measure the vascular endothelial receptor tyrosine kinase Tie, essential in the process of angiogenesis, in blood from healthy and preeclamptic pregnant women, in umbilical cord blood from both, and in blood from nonpregnant women.MethodsA total of 143 women participated in four arms of the study. Blood samples were collected from 54 healthy nonlaboring pregnant women (gestational weeks 14–41). Samples were collected immediately prepartum and postpartum from another 40 healthy women (15 delivered vaginally and 25 by cesarean) and 15 preeclamptic women (all delivered by cesarean). Arterial and venous cord samples were collected, when possible, from infants born by cesarean. Single blood samples were drawn from 34 nonpregnant controls. Of these, weekly samples from 11 were drawn during one menstrual cycle. A time-resolved fluoroimmunoassay was developed for the detection of the soluble extra-cellular domain of Tie.ResultsMaternal serum Tie levels decreased with advancing gestational age after 26 weeks (r= .6,P< .001). They were significantly higher in healthy women at term (median 233 ng/mL, range 152–414 ng/mL) compared with nonpregnant controls (median 173 ng/mL, range 107–333 ng/mL,P< .001) or with preeclamptic women at term (median 152 ng/mL, range 90–372 ng/mL,P< .05). This difference between healthy and preeclamptic women persisted on the first postpartum day (median 221 ng/mL, range 128–343 and median 152 ng/mL, range 90–372 ng/mL, respectively,P< .05). The highest levels of serum Tie receptor were observed in umbilical arterial and venous blood (median 240 ng/mL, range 174–474 ng/mL and median 340 ng/mL, range 245–690 ng/mL, respectively). In nonpregnant women, serum Tie levels did not vary with menstrual cycle.ConclusionThe high levels of the extracellular domain of Tie in healthy term maternal and cord blood may indicate a role for Tie in the vascular development of human fetuses and placentas.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo determine if labor activates the fetal fibrinolytic system.MethodsA total of 59 umbilical venous blood samples were collecting following vaginal delivery at term (n= 20), cesarean delivery following labor at term (n= 12), vaginal delivery before term (n= 18), and cesarean delivery without labor (n= 9). D-dimer concentrations, a sensitive marker of fibrinolysis, were measured by enzyme-linked immunosorbent assay, and compared between groups by Kruskel-Wallis and Mann WhitneyUtests, with significance defined asP< .05.ResultsThere were no significant differences in median D-dimer concentrations between newborns delivered vaginally or by cesarean after term labor or preterm labor. There were significant differences in median umbilical venous D-dimer concentrations in subjects delivered vaginally or by cesarean after term or preterm labor compared with term subjects without labor delivered by cesarean (427, 773, and 326 versus 87 ng/mL,P= .01)ConclusionElevation of umbilical plasma D-dimer concentrations in laboring patients suggests activation of fetal fibrinolysis before delivery.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo examine trends in alcohol use among pregnant women in the United States and to characterize pregnant women who use alcohol, with an emphasis on frequent use (at least five drinks per occasion or at least seven drinks per week)MethodsWe used the Behavioral Risk Factor Surveillance System data from 1988 through 1995 to obtain the percentage of pregnant women who used alcohol. We used multiple logistic models to identify subgroups of pregnant women who are at increased risk for alcohol use.ResultsOverall, 14.6% (869 of 5983) of pregnant women consumed alcohol and 2.1% (133 of 5983) consumed alcohol frequently. Among pregnant women, alcohol use decreased from 22.5% (95% confidence interval [CI] 20.8, 23.9) in 1988 to 9.5% (95% CI 7.9, 11.8) in 1992 and then increased to 15.3% (95% CI 13.1, 17.2) by 1995. Among pregnant women, frequent alcohol use decreased from 3.9% (95% CI 2.4, 5.2) in 1988 to 0.9% (95% CI 0.4, 1.6) in 1991 and then increased to 3.5% (95% CI 2.0, 5.1) by 1995. Pregnant women who were at high risk for alcohol use were college educated, unmarried, employed, or students, had annual household incomes of more than $50,000, or were smokers. Pregnant women who were at high risk for frequent alcohol use were more likely to be unmarried, or smokers.ConclusionThe increasing prevalence of alcohol use among pregnant women calls for increased ascertainment of alcohol use among preconceptional and pregnant women. Brief interventions by clinicians, increased referral to alcohol treatment programs, and increased use of contraception by women of reproductive age who are problem drinkers should be considered as means of preventing alcohol-exposed pregnancies.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo examine the effect of prenatal care with and without drug rehabilitation on perinatal outcome in cocaine-using women.MethodsCocaine-exposed pregnancies of 905 human immunodeficiency virus (HIV)-negative women were frequency matched (ratio 6:1) and compared with 150 nonusers. Cocaine subgroups consisted of 278 women who received prenatal care and drug rehabilitation (“comprehensive care”), 206 women who received prenatal care only, and 421 who received neither. Maternal and fetal complications, drug screening, and attendance were recorded. Pregnancy rates and HIV seroconversion were determined over the year following delivery.ResultsThe groups were similar in age, race, education and poverty level. Linear trends of increasing incidence of maternal complications were seen across the four groups. Comparing nonusers with cocaine users, the odds ratios, with 95% confidence intervals were: 28.0 (4.2, 103.2) for both anemia and weight under 100 lb; 2.4 (1.8, 5.0) for urinary tract infections; 15 (4.6, 36.1) for syphilis; and 11.2 (4.0, 35.8) for other sexually transmitted diseases. Perinatal outcome measures were similar for nonusers and “comprehensive care” groups but significantly worse for the other two groups. Four maternal deaths and two myocardial infarctions occurred with no care. Positive toxicology at delivery was 1.5 and 4.3 times more likely for the two groups without drug treatment, than for “comprehensive care.” Congenital anomalies and HIV seroconversion increased in cocaine users. Repeat pregnancy was less likely and more often drug free with “comprehensive care.”Conclusion“Comprehensive care” of the cocaine-using gravida increases the likelihood of carrying to term, having fewer complications, being drug free at delivery, and having fewer exposed repeat pregnancies.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo evaluate the effects of smoking cessation before or early in pregnancy on maternal airway function and birth weight.MethodsMeasurements of forced expiratory spirometry including forced vital capacity, forced expiratory volume in 1 second, forced expiratory flow rates between 0.2 and 1.2 L, 25% and 75%, and 75% and 85%, and instantaneous flows at lung volumes of 25%, 50%, and 75% were carried out by a wedge bellow spirometer in 40 pregnant exsmokers and were compared with those of 175 nonsmoking and 97 currently smoking pregnant women. Spirometric testing was conducted at a mean (± SD) gestational age of 21.5 ± 7.0 weeks. In exsmokers, the average lifetime cigarette consumption was 17.1 ± 8.1/day for a mean duration of 9.7 ± 3.9 years, similar to that observed in current smokers. The median duration of smoking abstinence was 20 weeks before study spirometry.ResultsAll spirometric measurements in exsmokers were similar to those of nonsmokers and were significantly higher than those of current smokers. Spirometric measurements for nonsmokers, current smokers, and exsmokers were respectively: forced expiratory volume in 1 second (3.36 ± 0.39, 3.09 ± 0.45, and 3.35 ± 0.32 L); forced expiratory flow rate between 25% and 75% (ie, mid-expiratory phase) (3.85 ± 0.69, 3.21 ± 0.76, and 3.86 ± 0.66 L/sec); forced expiratory flow rate between 75% and 85% (ie end-expiratory phase) (1.39 ± 0.35, 1.03 ± 0.35, and 1.41 ± 0.39 L/sec); instantaneous flow at lung volume of 50% (4.35 ± 0.82, 3.76 ± 0.89 and 4.36 ± 0.68 L/sec); and instantaneous flow at lung volume of 25% (1.91 ± 0.47, 1.47 ± 0.49, and 1.92 ± 0.46 L/sec). Mean gestational age at delivery was similar among the three groups (277 ± 11, 274 ± 12, and 274 ± 11 days for nonsmokers, current smokers, and exsmokers, respectively). The mean birth weight of babies born to exsmokers (3408 ± 511 g) was similar to that of babies born to nonsmokers (3469 ± 461 g), but was significantly greater than that of babies born to smoking pregnant women (3189 ± 485 g;P< .001)ConclusionSmoking cessation either before or at an early stage of pregnancy is associated with early, reversible increments of maternal airway function and mean birth weights that are higher than among women who continue smoking.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo evaluate the role of thyroid hormones in maintaining early pregnancy and to examine the association between thyroid physiological functions and immunological parameters.MethodsForty-five pregnant women with a clinical diagnosis of threatened abortion and a live fetus and 30 normal pregnant women were included in the study. Blood samples were taken on admission to the hospital. The patients were divided retrospectively into two groups on the basis of outcome: 1) 31 women who did not miscarry (positive outcome) and 2) 14 women who miscarried (negative outcome). Plasma TSH, free triiodothyronine (fT3), free thyroxine (fT4), hCG, immunoglobulin (Ig) G and IgM concentrations and blood counts were determined in each patient.ResultsHuman chorionic gonadotropin was significantly higher in women who did not abort (39.4 ± 16.9 IU/mL) than in women who miscarried (17.6 ± 14.8 IU/mL,P< .001). Free thyroxine but not fT3 was lower in patients with negative outcome (1.25 ± 0.26 ng/mL compared with 1.98 ± 0.22 ng/mL,P< .001) and IgG and IgM plasma levels were higher (780 ± 500 ng/mL compared with 470 ± 300 ng/mL and 930 ± 400 ng/mL compared with 650 ± 280 ng/mL, respectively,P< .05). Plasma TSH levels were higher in patients with negative outcomes (1.72 ± 0.84 mIU/mL compared to 1.01 ± 0.41 mIU/mL,P< .001). Plasma concentrations of hCG and thyroid hormones were significantly correlated with peripheral blood lymphocyte and neutrophil counts only in the group of women who aborted.ConclusionOur results indicate that maternal immune response, trophoblast function, and maternal thyroid function are somehow correlated. The presence of low concentrations of hCG and fT4 and high levels of TSH and gamma globulins in women with threatened abortion suggests a negative outcome for the pregnancy.

ISSN:0029-7844    

出版商:OVID    

年代:1998

数据来源: OVID