A case-control study of hypocalcemia in high-risk neonates: racial,but no seasonal differences.

A role for vitamin D in the defense against falling serum calcium (Ca) concentrations following cord clamping has been suggested. Since race and season are known to affect vitamin D status, we theorized that black race and birth in winter are additional risk factors for neonatal hypocalcemia (NHC). We retrospectively studied 13,462 infants born at University Hospital (Cincinnati, OH) between January 1, 1984 and December 31, 1987. Serum Ca was measured at 24 hours of age routinely in infants with low birth weight (less than 2500 g), preterm delivery (less than 2500 g), preterm delivery (less than 37 weeks), neonatal asphyxia, and diabetic mothers. After exclusion of infants of diabetic mothers (to remove maternal diabetes as a major confounder) and infants with major congenital anomalies, 714 infants remained. In multiple regression analysis, low serum Ca values were significantly associated with low gestational age (p less than 0.01), low Apgar score (p less than 0.01), and white race (p less than 0.01) (R2 = 0.457). Season or month of birth was not significant. In pair-matched analysis controlling for factors other than season, season of birth did not affect serum Ca. In pair-matched analysis controlling for factors other than race, white race was once again a risk factor for hypocalcemia. Thus, low gestational age, low Apgar score, and white race, but not black race and delivery in winter, are risk factors for NHC. We speculate that in our climate and with the prevailing diet in pregnancy, vitamin D deficiency does not appear to play a role in NHC.(ABSTRACT TRUNCATED AT 250 WORDS)     

早产儿维生素D营养状况影响因素分析

目的 研究早产儿维生素D营养状况,并探讨相关影响因素.方法 回顾性分析2011年7月-2015年10月入住南京医科大学附属无锡妇幼保健院新生儿病房的早产儿血清25(OH)D水平,以及早产儿胎龄、性别、分娩方式、出生季节、出生体重,母亲年龄、职业、婚姻状况、体质指数、受孕方式、胎产次、妊娠期并发症(包括产前发热、妊娠期高血压、妊娠期糖尿病、妊娠期肝内胆汁淤积症、胎儿生长受限)及产前激素使用情况等潜在影响.纳入同期住院的97例足月儿作为对照病例.结果 早产儿组血清25(OH)D平均水平为(36.81±16.64)nmol/L,足月儿组血清25(OH)D平均水平为(40.49±12.75)nmol/L,早产儿组显著低于足月儿组(t=-2.45,P=0.02);早产儿组维生素D严重缺乏、缺乏、不足和充足的比例分别为26.00%、53.20%、16.40%、4.30%,足月儿分别为0、76.30%、21.60%和2.10%,差异有统计学意义(Z=-3.88,P<0.01).维生素D缺乏组早产儿母亲的年龄大于偏低组(t=2.15,P=0.03),缺乏组的母亲体质指数小于偏低组(t=7.74,P<0.01),缺乏组的血钙含量低于偏低组(t=-2.31,P=0.02).夏秋季节出生早产儿维生素D营养状况好于冬春季节(χ2=6.83,P=0.01).Logistic回归分析结果示:母亲年龄(OR=1.28,95%CI:1.19~1.37,P<0.01)、母亲BMI(OR=0.82,95%CI:0.75~0.89,P<0.01)、冬春季节出生(OR=0.57,95%CI:0.33~0.97,P=0.04)为早产儿维生素D缺乏的危险因素.结论 早产儿维生素D缺乏发生率较高;母亲年龄、体质指数及冬春季节出生是早产儿维生素D缺乏的危险因素.     

维生素D与早产儿呼吸窘迫综合征的临床分析

目的 分析早产儿血清维生素D[25-(OH)D₃]水平与早产儿呼吸窘迫综合征(RDS)发生的相关性,为早产儿RDS的治疗提供科学依据。方法 选取2018年9月-2019年3月在武汉大学人民医院新生儿科住院的131例RDS早产儿为实验组,29例非RDS早产儿为对照组。收集所有患儿一般临床资料(性别、分娩方式、母孕情况及Apgar 评分等)及血清25-(OH)D₃结果,分析25-(OH)D₃ 水平与RDS发生之间的关系。结果 RDS组25-(OH)D₃水平低于对照组,差异均有统计学意义(t=2.682,P＜0.05),且CPAP时间、吸氧时间、静脉营养天数、住院天数均明显高于对照组,差异均有统计学意义(t=2.969、2.380、2.571、1.999,P＜0.05)。Logistic 回归分析显示:维生素 D 缺乏是早产儿发生RDS 的危险因素(OR=0.050,95%CI:0.013~0.186,P＜0.05)。结论 早产儿更易发生维生素D缺乏,且维生素D缺乏可能是早产儿RDS发生的危险因素,预防维生素D缺乏有重大意义。     

维生素D水平与极低出生体重儿临床结局的相关性研究

目的分析出生时血清25-羟维生素D[25-(OH)D]水平对极低出生体重儿临床结局的影响,为早产儿相关疾病的预防和治疗提供新的方向。方法选取2019年9月-2020年9月在济宁医学院附属医院NICU住院治疗的105例极低出生体重儿为研究对象,根据出生24 h内血清25-(OH)D水平,将患儿分为维生素D严重缺乏组(A组)、维生素D缺乏组(B组)及维生素D正常组(对照组),对三组母婴一般资料、住院期间的治疗情况、合并症及临床转归进行比较。结果所有患儿出生时血清25-(OH)D平均值为(14.33±3.60)ng/ml,维生素D缺乏的发生率为79.1%。夏秋季节出生的患儿血清25-(OH)D明显高于冬春季节(t=2.71,P=0.01)。A组、B组患儿的出生体重、出生体重Z评分及1 min Apgar评分均较对照组低(F=0.86、 5.43、9.05,P<0.01)。母亲年龄越大,维生素D水平越低,差异有统计学意义(F=8.40,P<0.01)。A组、B组患儿住院时间、用氧时间、机械通气时间、无创通气时间均高于对照组,差异有统计学意义(F=19.65、7.45、15.97、4...     

新生儿骨矿代谢临床研究

目的 了解不同分类新生儿的骨矿代谢状况,并对比各项骨矿代谢指标在骨营养代谢异常中的诊断价值,为早期干预提供依据。方法 选取90例新生儿,其中足月儿62例、早产儿28例(极低出生体重儿12例,低出生体重儿16例)作为研究对象。检测血清骨钙素(OC)、β胶原分解片段(β-CTx)、血清钙(Ca²⁺)、25-羟胆骨化醇[25-(OH)D₃]及甲状旁腺素(PTH)浓度,并采用两组独立样本t检验及Pearson相关分析对检测结果进行统计学分析。结果 早产儿组血清β-CTx浓度高于足月儿组(P<0.05),血清Ca²⁺和PTH浓度低于足月儿组(P分别<0.01和<0.05);早产儿组血清OC水平与Ca²⁺、25-(OH)D₃呈正相关,血清β-CTx水平与Ca²⁺和25-(OH)D₃呈负相关;极低出生体重(VLBW)组血清OC与Ca²⁺浓度低于低出生体重(LBW)组(P均<0.05),血清β-CTx浓度高于LBW组(P<0.05); VLBW组血清OC水平与Ca²⁺、25-(OH)D₃呈正相关,血清β-CTx水平与Ca²⁺、25-(OH)D₃呈负相关;新生儿血清OC、Ca²⁺水平与胎龄、体重正相关,血清β-CTx水平与胎龄、体重负相关。结论 新生儿血清骨矿代谢指标水平主要受胎龄、体重因素的影响,早产儿易出现骨营养代谢异常,且胎龄越小(体重越轻)越易出现骨营养代谢异常,临床上应尽早发现并及时合理补充VitD和钙。     

Birthweight and gestational age effects on motor and social development

The number of children at risk for delays in motor and social development (MSD) associated with preterm delivery and low birthweight is increasing, but such children are generally not seen as being in need of evaluation. The objective of these analyses was to determine whether there are independent effects of birthweight and gestational age on MSD and the magnitude of effects. Subjects were a representative sample of 4621 US-born singleton children, aged 2-47 months, examined in the third National Health and Nutrition Examination Survey (1988-94). MSD was assessed using an age-appropriate scale. Birthweight and gestational age were taken from birth certificates. Mexican-American and 'other' race/ethnicity (other than non-Hispanic white, non-Hispanic black or Mexican-American), low parental education level, older maternal age, higher birth order, low birthweight (LBW, <2500 g) and preterm delivery (<37 weeks) were all found to be associated with significant (P < 0.01) delays in MSD. Three per cent of the infants and children were preterm LBW and 2.2% term LBW (<2500 g, 37-44 weeks). Adjusting for socio-demographic factors, preterm LBW children had lower MSD scores (-1.5 +/- 0.3 points, P < 0.0001) through early childhood, as did term LBW children (0.8 +/- 0.4 points, P < 0.03). For females, LBW was the most important perinatal predictor of a lowered score (-0.9 +/- 0.3 points compared with normal birthweight, P < 0.04). For males, scores were additionally decreased by -0.1 +/- 0.03 points/week (P=0.001) of early delivery. LBW children had less muscle mass, but adjusting for muscularity did not diminish the effects of birth size on MSD. LBW status and preterm delivery are associated independently with small, but measurable, delays in MSD through early childhood and should be considered along with other known risk factors for development delays in determining the need for developmental evaluation.     

新生儿低钙血症危险因素分析

目的 分析新生儿低钙血症发病的危险因素,以期为临床诊疗提供理论依据。方法 将162例临床资料完整的患儿纳入研究,根据测定的血钙值将其分为低钙血症组(n=74)和非低钙血症组(n=88),以低钙血症是否发生为因变量,可能的影响因素为自变量,建立Logistic回归模型,采用SPSS17.0软件,进行非条件Logistic回归分析。结果 多因素非条件Logistic回归分析显示,孕周、出生体重、新生儿窒息、新生儿及母孕期维生素D缺乏和母孕期糖尿病与低血钙发生显著相关(P＜0.05),且提示孕周越小、出生体重越低、窒息发生、新生儿及母孕期维生素D缺乏和母孕期合并糖尿病的新生儿,出现低钙血症的危险性越大。29例出现肢体抽搐的患儿行振幅整合脑电图(aEEG)检查,其中aEEG异常的22例患儿低血钙纠正后复查aEEG均正常。结论 新生儿低钙血症的发病与患儿孕周、出生体重、新生儿窒息、新生儿及母孕期维生素D缺乏和母孕期糖尿病有密切的相关性。而且,短暂的新生儿低血钙可引起暂时的aEEG异常。     

Changing patterns of low birthweight and preterm birth in the United States, 1981-98

Low birthweight (LBW) and preterm birth are primary risk factors for infant morbidity and mortality in the US. With increasing multiple births and delayed childbearing, it is important to examine the separate contributions of these characteristics to the increases in LBW and preterm birth rates. US natality records from 1981, 1990 and 1998 were used to calculate LBW (% births <1500, 1500-2499, <2500 g) and preterm (% births <29, 29-32, 33-36, <37 weeks gestation) rates. Data were stratified by maternal race (black or white) and plurality (singleton vs. multiple birth). LBW and preterm rates among singletons were adjusted for maternal age to examine the influence of demographic shifts on LBW trends. From 1981 to 1998, LBW increased 12% among white infants, but remained relatively stable among black infants. During the same time, preterm birth increased 23% among white infants compared with 3% among black infants. For both black and white infants, the increase in LBW and preterm births was greater among multiple births than among singletons. Adjustment for maternal age did not reduce the temporal increase in LBW or preterm birth among singletons. Black infants continue to experience a markedly higher incidence of LBW and preterm birth, but the racial gap in these outcomes has narrowed slightly in recent years as a result of increasing LBW and preterm birth among white births. The differing trends for white and black infants are the consequence of a disparate trend in the incidence and outcome of multiple births coupled with increases in LBW and preterm birth among white singletons. Understanding the differential patterns in birth outcomes among white and black infants is necessary to develop effective interventions designed to decrease racial disparities in pregnancy outcome.     

早产儿脐血血清25羟维生素D与呼吸窘迫综合征的关联性研究

目的 探讨早产儿脐血血清25羟维生素D[25(OH)D] 水平与呼吸窘迫综合征(RDS)的关系,为RDS的临床预防提供新思路。方法 将2018年3月—2020年5月收治入复旦大学附属妇产科医院NICU的179例早产儿纳入分析,于出生时采集脐血,使用化学发光微粒子免疫检测法分析测定脐血血清25(OH)D水平。根据是否诊断RDS分为RDS组和对照组,将血清25(OH)D水平是否低于20 ng/ml分为维生素D减少组和充足组,并分别分析和比较两组各影响因素的差异。结果 25.1%早产儿脐血25(OH)D水平缺乏(<10 ng/ml)、42.5%不足(10~<20 ng/ml),32.4%正常(≥20 ng/ml)。RDS组脐血血清25(OH)D水平[(11.3±7.2) ng/ml]显著低于对照组[(15.88±8.4)nmol/L], t=3.469,P<0.01);RDS组脐血血清25(OH)D减少发生率为89.0%(121/136),显著高于对照组 [46.5%(20/43), χ²=35.221, P<0.01)]。通过单因素和多因素分析,新生儿胎龄≤32周和脐血血清25(OH)D<20 ng/ml是早产儿发生RDS的独立危险因素(OR=39.694, 5.696, P＜0.05)。结论 早产儿维生素D缺乏发生率高,低维生素D水平可能增加RDS发生率。     

Maternal and cord blood metal concentrations and low birth weight--a case-control study

There has been speculation on the possible role of trace metals in contributing to the occurrence of low birth weight, but few data are available for most metals. Twenty-five women giving birth to infants weighing between 1500 and 2500 g (cases) and 50 women giving birth to infants weighing more than 2500 g (controls) were studied. The cases and controls were matched for age +/- 4 years), race, and socioeconomic status. Cord blood and maternal blood collected at delivery were analyzed by atomic absorption spectrophotometry for calcium, magnesium, copper, lead, and iron. Significant differences between the mean blood metal concentrations of the low birth weight and control groups were found for calcium (P less than 0.001) and iron (P less than 0.05) in the maternal blood samples and for calcium (P less than 0.001) and iron (P less than 0.01) in the cord blood samples. All concentrations were lower in the low-birth weight group except for the maternal iron level. No significant differences between the low birth weight and control groups were found for copper, lead, and magnesium in either maternal or cord blood.     

Risk factors associated with low Apgar scores in a low-income population

Summary. The purpose of this study was to identify risk factors associated with Apgar scores of less than 7 in newborns scored at 5 minutes after birth. All newborns were delivered at Grady Memorial Hospital, Atlanta, Georgia, which primarily serves a low-income population. The data were obtained from the obstetric discharge records for 1985–89. In this case-control study, 939 newborns with Apgar scores of less than 7 were compared with 2817 new-borns with Apgar scores of 7 or higher. Low birthweight (< 2500 g) and short gestational age (< 37 weeks) were each significantly associated with low Apgar scores. Race was not a significant risk factor for low Apgar scores in this low socio-economic population. It is also demonstrated that maternal risk factors (pregnancy-induced hypertension, prolonged rupture of membranes), method of delivery (caesarean, repeat caesarean, vaginal birth after caesarean section) and male sex were significantly associated with Apgar scores of less than 7. As a result of the risks that were found to be associated with method of delivery, further study of the risks associated with caesarean delivery and of the relative advantage of a caesarean delivery versus vaginal delivery after a previous caesarean section is advocated.     

极低出生体重早产儿出生时及母亲维生素D缺乏与支气管肺发育不良关系的研究

目的 探讨极低出生体重儿出生时及母亲血液中25-羟基维生素D(25-OHD)的缺乏是否为导致早产儿后期发生支气管肺发育不良(BPD)的一个重要高危因素.方法 以郑州市儿童医院2014年3月至2015年6月收治的新生儿呼吸窘迫综合征并且体重≤1 500g的早产儿为研究对象,入院时留取静脉血(出生3天内)及从出生医院获取母亲分娩后静脉血标本,并进行25-OHD水平测定;按出生后28天后是否合并BPD分为BPD组及未BPD组.结果 80例早产儿有24例(30.00%)合并新生儿BPD,50例未合并BPD,死亡或自动出院6例.BPD组患儿机械通气时间、持续正压通气(CPAP)、总用氧时间、住院天数、PDA患儿数均明显高于非BPD组,差异均有统计学意义(t值分别为9.047、6.275、11.395、15.398,χ2=4.010,均P<0.05).BPD组患儿及母亲血清25-OHD明显低于非BPD组(t值分别为7.003、9.082,均P<0.05);所有BPD组患儿血中25-OHD均<10ng/mL,提示严重缺乏.Logistic回归分析显示出生时25-OHD血清水平是BPD的高危因素,母亲和新生儿血清中25-OHD每增加1ng/mL可能分别使BPD发生率降低24%(OR:0.76,95%CI:68~86,P<0.001)和39%(OR:0.61,95%CI:48~76,P<0.001).结论 通过研究证实极低出生体重早产儿出生时及母亲血清中25-OHD水平较低,是后期发生BPD的一个高危因素.然而仍需进一步研究早期补充足量维生素D是否可以预防BPD及后期其他肺部疾病的发生.     

Vitamin B6 nutriture during pregnancy and lactation. I. Vitamin B6 intake, levels of the vitamin in biological fluids, and condition of the infant at birth.

Vitamin B6 nutriture was assessed during pregnancy and lactation to determine possible relationships among vitamin B6 intake, levels of the vitamin in biological fluids and the condition of the infant at birth. Vitamin B6 levels were measured in maternal serum and in urine at 5 and 7 months gestation and at delivery, in cord serum and in milk at 3 and 14 days postpartum. Intake of vitamin B6, less than the Recommended Dietary Allowances (1974) for pregnancy and lactation, 2.5 mg/day, resulted in lower levels of the vitamin in maternal serum at delivery and in cord serum than higher intakes. Mothers whose infants had unsatisfactory Apgar scores at 1 min, (less than 7) had significantly low intakes of vitamin B6 and lower levels of the vitamin in both serum and milk than mothers whose infants had satisfactory scores, (greater than or equal to 7). At 5 months gestation, levels of vitamin B6 in maternal serum were significantly correlated with levels of the vitamin in cord serum and in milk at 14 days postpartum. This stage of gestation precedes the period of rapid growth of the central nervous system of the fetus, and is, therefore, a critical time for the assessment of maternal vitamin B6 nutriture.     

西安地区新生儿维生素D水平及影响因素分析

目的调查西安地区(北纬34°)新生儿维生素D水平,并分析其影响因素。方法选取2018年10月至2019年10月在西安交通大学第一附属医院新生儿科住院,生后48小时内入院且生命体征平稳的161例新生儿为研究对象。检测新生儿生后48小时内血清25-羟维生素D[25(OH)D]水平,并分析性别、胎龄、出生季节,母亲年龄、分娩方式、妊娠胎数,以及母亲孕晚期维生素D补充剂量对新生儿血清25(OH)D水平的影响。结果新生儿血清25(OH)D平均水平为12.20(9.10,17.30)ng/mL,维生素D缺乏、不足和充足的发生率分别为65.84%、15.53%和18.63%。单胎新生儿血清25(OH)D水平显著高于双胎新生儿(Z=-1.967,P<0.05)。秋季出生的新生儿血清25(OH)D水平显著高于春季出生的新生儿(H=-2.726,P<0.05)。与母亲孕晚期补充维生素D剂量<600IU/d相比,母亲孕晚期补充维生素D剂量≥600IU/d新生儿血清25(OH)D水平显著增高(Z=-3.968,P<0.05),维生素D缺乏发生率显著降低(χ^2=8.003,P<0.017)。经Logistic回归分析显示,母亲孕晚期补充维生素D剂量<600IU/d是新生儿维生素D缺乏的危险因素(OR=2.481,95%CI:1.023~6.008,P<0.001)。结论西安地区新生儿维生素D缺乏发生率较高;胎数、出生季节和母亲孕期维生素D补充剂量是新生儿维生素D水平的影响因素。     

维生素D缺乏与早产儿缺氧缺血性脑病的相关性研究

目的 分析出生时维生素D水平与早产儿缺氧缺血性脑病(HIE)的相关性,为预防早产儿HIE提供依据。 方法 选择博罗县妇幼保健计划生育服务中心2018年6月—2020年6月诊断为HIE的早产儿25例(HIE组)和未发生HIE的早产儿138例(非HIE组),比较两组母亲和早产儿出生时血清25-(OH)D的水平,并对HIE的危险因素进行Logistic回归分析。 结果 与非HIE组比较,HIE组早产儿宫内窘迫发生率较高、1 min Apgar评分较低、机械通气时间较长,差异均有统计学意义(χ²=46.875,t=10.854、7.166,P＜0.01);HIE组母亲和早产儿出生时血清25-(OH)D水平明显低于非HIE组,差异有统计学意义(t=2.346、2.092,P＜0.05),HIE组早产儿出生时维生素D缺乏或不足的比例(64%)明显高于非HIE组(39.9%),差异有统计学意义(χ²=5.019,P＜0.05);两组母亲血清25-(OH)D水平与早产儿出生时25-(OH)D水平呈正相关(HIE组r=0.825,非HIE组r=0.682,P＜0.05)。Logistic 回归分析结果显示HIE的危险因素包括宫内窘迫(OR=1.137,95%CI:1.105～1.209)、1 min低Apgar评分(OR=1.170,95%CI:1.085～1.443)、机械通气时间(OR=1.431,95%CI:1.275～1.610)和低25-(OH)D水平(母亲OR=1.234,95%CI:1.010～1.511;早产儿OR=1.505,95%CI:1.191～1.899)。 结论 早产儿出生时维生素D缺乏或不足的比例达50.9%(83/163),母亲及早产儿出生时低维生素D水平是早产儿HIE发生的高危因素,应注重孕期和早产儿出生后的维生素D补充。     

Out-of-hospital births, U.S., 1978: birth weight and Apgar scores as measures of outcome

An examination of 1978 natality data for the United States disclosed that low birth weight was less common among 30,819 infants born out of hospital than among 3,294,101 infants born in hospital in that year. When controls were applied for birth attendant, infants' race, and mothers' education, age, nativity, and parity, the data revealed that white, well-educated women between 25 and 39 years of age, who were having their second babies and were attended by midwives out of hospital, were at least risk of bearing low birth weight infants. The incidence rate of low birth weight babies was lower for midwife-attended births in every category examined. For college-educated white women, for example, the incidence rate was 2.0 percent among those attended by midwives, 4.6 percent among those giving birth in hospital, and 3.6 percent among those whose out-of-hospital deliveries were attended by physicians. Apgar scores for babies born both in and out of hospital were also studied but, because of inconsistent reporting, were given less attention. Excellent (9-10) Apgar scores were more common among babies born out of hospital than among those born in hospital (63 percent compared with 49 percent), particularly for out-of-hospital births attended by physicians. At least with respect to birth weight and Apgar scores, the claim that out-of-hospital births are inherently more dangerous than hospital births receives no support from these data. The findings also suggest the need for further refinement of vital statistics categories to permit the analysis of distinctions between births attended by certified nurse-midwives and those attended by lay midwives, as well as differences between births at home and those in alternative birth centers.     

Prenatal care and infant birth outcomes among Medicaid recipients

Infant morbidity due to low birth weight and preterm births results in emotional suffering and significant direct and indirect costs. African American infants continue to have worse birth outcomes than white infants. This study examines relationships between newborn hospital costs, maternal risk factors, and prenatal care in Medicaid recipients in an impoverished rural county in South Carolina. Medicaid African American mothers gave birth to fewer preterm infants than did non-Medicaid African American mothers. No differences in the rates of preterm infants were noted between white and African American mothers in the Medicaid group. Access to Medicaid services may have contributed to this reduction in disparities due to race. Early initiation of prenatal care compared with later initiation did not improve birth outcomes. Infants born to mothers who initiated prenatal care early had increased morbidity with increased utilization of hospital services, suggesting that high-risk mothers are entering prenatal care earlier.     

扬州市早产儿血清钙、磷、碱性磷酸酶以及维生素D水平状况分析

目的 探索不同出生孕周、体重和出生季节的早产儿其血清钙(calcium,Ca),磷(phosphorus,P),碱性磷酸酶(alka-line phosphatase,ALP)以及维生素D(vitamin D,VD)水平的情况.方法 选取扬州市妇幼保健院新生儿科2018年6月-2019年7月出生的早产儿共计488例作为...     

The effect of a preterm birth prevention program in 17 rural and three urban counties in northwest North Carolina.

The results of a program of low birthweight prevention in 17 rural (20,727 births) and three urban counties (15,561 births) for calendar years 1985 and 1986 are described. Records for women in the program were matched with birth certificate data by computer. Rural and urban women in and out of the program were compared by race on the following risk factors: age less than 18 years, unmarried, education less than 12 years, Medicaid recipient, not WIC recipient, inadequate prenatal care, and previous fetal or live born death. Adjusting for these risk factors, logistic regression was used to estimate program effects on low birthweight (LBW), very low birthweight (VLBW), and preterm low birthweight (PLBW) among rural women. There was a statistically significant difference (p less than or equal to 0.01) favoring women in the program for very low birthweight and preterm low birthweight in white women, and low birthweight and preterm low birthweight in nonwhite women. The differences in rural areas exceed those in urban areas for all but one mean, very low birthweight births among white women.     

Diminished and erratic absorption of ergocalciferol in adult cystic fibrosis patients

BACKGROUND: Osteoporosis diminishes the quality of life in adults with cystic fibrosis (CF). Vitamin D deficiency resulting from malabsorption may be a factor in the etiology of low bone mineral density (BMD) in patients with CF. OBJECTIVE: Absorption of oral ergocalciferol (vitamin D2) and the consequent response of 25-hydroxyvitamin D in 10 adults with CF and exocrine pancreatic insufficiency was compared with that of 10 healthy control subjects. DESIGN: In this pharmacokinetic study, CF patients and control subjects were pair-matched on age, sex, and race. Each subject consumed 2500 microg oral vitamin D2 with a meal. The CF group also took pancreatic enzymes that provided > or = 80000 U lipase. Blood samples were obtained at baseline and at 5, 10, 24, 30, and 36 h after vitamin D2 consumption to measure serum vitamin D2 and 25-hydroxyvitamin D concentrations. RESULTS: Vitamin D2 concentrations in all subjects were near zero at baseline. CF patients absorbed less than one-half the amount of oral vitamin D2 that was absorbed by control subjects (P < 0.001). Absorption by the CF patients varied greatly; 2 patients absorbed virtually no vitamin D2. The rise in 25-hydroxyvitamin D in response to vitamin D2 absorption was significantly lower over time in the CF group than in the control group (P = 0.0012). CONCLUSIONS: Vitamin D2 absorption was significantly lower in CF patients than in control subjects. These results may help explain the etiology of vitamin D deficiency in CF patients, which may contribute to their low BMD.