The effect of body mass index on three methods of fetal weight estimation

Objective To assess agreement between three methods of estimation of fetal weight and determine the influence of maternal obesity.
Design Prospective observational study.
Setting A tertiary referral teaching hospital.
Population Unselected women attending for induction of labour.
Method Maternal, clinical and ultrasonic estimations of fetal weight were made prior to induction of labour in 96 consenting women. The estimations of fetal weight were performed independently by the three methods.
Main outcome measure Bland and Altman plots to show limits of agreement, and intraclass correlation coefficients.
Results Variable levels of accuracy were obtained for maternal, clinical and ultrasound estimates of fetal weight. Ultrasound estimation of fetal weight performed equally best for women of high and low body mass index (BMI). For women of low BMI, the intraclass correlation coefficient (ICC) was 0.90 (95% CI 0.83–0.94) and 0.87 (95% CI 0.77–0.93) for women with high BMI. Despite this, the limits of agreement for ultrasound were in the order of −700 to +500 g. Both maternal and clinical estimation of fetal weight under-estimated true fetal weight in women with low BMI and over-estimated the true fetal weight in women with high BMI. The largest observed mean difference was obtained with clinical palpation in both low and high BMI women.
Conclusion The accuracy of ultrasound estimation of fetal weight was better than maternal and clinical estimation of fetal weight and was not influenced significantly by maternal BMI.     

Maternal depression and medication exposure during pregnancy: comparison of maternal retrospective recall to prospective documentation

Objective  Outcome investigations of prenatal maternal depression and psychotropic exposure rely extensively on maternal retrospective recall. This study compared postnatal recall to prospective documentation of illness and medication exposures.
Design  Prospective cohort and retrospective case–control studies.
Setting  Emory Women's Mental Health Program (prospective study) and Emory University Department of Psychology (retrospective study).
Sample  A total of 164 women who participated in both the prospective and retrospective studies.
Methods  Women with a history of mental illness were followed during pregnancy for prospective prenatal assessments of depression and medication exposures. At 6 months postpartum, some of these women also participated in a retrospective study during which they were asked to recall prenatal depression and medication use. Agreement between prospective and retrospective documentation of exposures was analysed.
Main outcome measures  Occurrence of maternal depression during pregnancy and maternal use of pharmacological agents during pregnancy.
Results  There was only moderate agreement ( k = 0.42) in prospective versus retrospective reporting of prenatal depression. Positive predictive value for recalling depression was 90.4%; however, negative predictive value for denying depression was only 53.8%. Participants accurately recalled psychotropic use but significantly underreported use of nonpsychotropic medications.
Conclusions  Studies using retrospective data collection may be susceptible to systematic recall bias with underreporting of maternal depression and use of nonpsychotropic agents during pregnancy.     

Induction of labour in nulliparous and multiparous women: a UK, multicentre, open-label study of intravaginal misoprostol in comparison with dinoprostone

Objective  To compare the efficacy and safety of a 25-microgram vaginal tablet of misoprostol (APL202) with dinoprostone (3-mg vaginal tablet) in cervical ripening and labour induction.
Design  A randomised, open-label, noninferiority, comparative study in two maternal populations.
Setting  Eighteen NHS study centres across the UK.
Population  Nulliparous or multiparous women with a singleton pregnancy eligible for induction of labour.
Methods  Women were randomised to receive either misoprostol, initially 25 micrograms (50 micrograms in nulliparous women with Bishop score ≤4) followed by 25 micrograms after 4 and 8 hours, or dinoprostone, initially 3 mg followed by 3 mg after 6 hours. Clinical noninferiority of misoprostol was defined as an absolute difference between treatments of no more than 10% for the primary outcome.
Main outcome measures  The number of vaginal deliveries achieved within 24 hours of labour induction. Maternal and fetal safety outcomes.
Results  A total of 626 women were randomised to misoprostol ( n = 318) or dinoprostone ( n = 308) treatment. The rate of vaginal deliveries achieved within 24 hours of induction did not significantly differ between the misoprostol and dinoprostone (43 versus 47%; 3.74% difference, 95% CI −3.58 to 11.05, respectively) treatment groups. The treatments were generally comparable for other secondary efficacy measures. Maternal and fetal adverse events were similarly distributed across the misoprostol and dinoprostone groups.
Conclusions  Low-dose misoprostol is efficacious in cervical ripening and labour induction and demonstrates a similar fetal and maternal safety profile to dinoprostone.     

Serum ferritin and cobalamin in growth retarded fetuses

Objective To examine fetal and maternal serum cobalamin and ferritin concentrations in pregnancies complicated by fetal growth retardation.
Setting Harris Birthright Research Centre for Fetal Medicine, King's College Hospital Medical School, London.
Design Cross sectional study.
Subject Fetal blood samples obtained by cordocentesis from 20 growth retarded fetuses at 26 to 36 weeks of gestation. Maternal venous blood was also collected and serum ferritin and cobalamin concentrations were measured by radio-immunoassay in the fetal and maternal samples.
Results In the growth retarded group, the mean fetal serum concentration of cobalamin was higher than the normal mean for gestation (   t = 3.27  ,   P < 0.01  ), and this increase was significantly associated with fetal acidaemia (   r =−0.686  ,   P < 0.001  ) and erythroblastosis (   r = 0.731  ,   P < 0.001  ). In contrast, the fetal to maternal ferritin ratio was significantly reduced; there was a nonsignificant decrease in fetal serum and an increase in maternal serum ferritin concentration. There was an association between fetal serum ferritin concentration and erythrocyte count (   r =–0.612  ,   P < 0.01  ).
Conclusions In placental insufficiency, as in postnatal starvation and Kwashiorkor syndrome, uptake and storage of cobalamin by the fetal liver may be impaired. The decrease in fetal to maternal ratio of ferritin could be the consequence of impaired placental perfusion.     

Rate of rise in maternal plasma corticotrophin-releasing hormone and its relation to gestational length

Objective To assess the relationship between rate of increase in maternal plasma corticotrophin-releasing hormone and gestational length.
Design A prospective observational study.
Setting Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Hong Kong.
Methods Serial venous samples taken at four to six week intervals from 81 pregnant Chinese subjects were assayed for corticotrophin-releasing hormone concentrations. The investigators responsible for the laboratory assay were blinded to the obstetric outcome.
Results A total of 380 blood samples were taken. Each subject provided three to seven samples (  median =5  ). Seven of the 81 subjects had preterm delivery. Maternal corticotrophin-releasing hormone levels increased exponentially as gestation advanced. A negative correlation between the rate of rise of logarithmic equivalence of corticotrophin-releasing hormone concentrations (Ln-corticotrophin releasing hormone) per week and the gestational age at delivery was demonstrated (  r =−0.45, P <0.001  ). The rate of increase of Ln-corticotrophin releasing hormone concentrations per week was also significantly greater for those who delivered preterm before 37 weeks compared with those with uncomplicated term deliveries (  0.27 Vs 0.22, P = 0.018  ).
Conclusions The rate of increase in maternal plasma corticotrophin-releasing hormone is inversely proportional to gestational length. Results in a Chinese population confirm and extend results from previous caucasian populations. This study provides another piece of evidence on the close link between maternal plasma corticotrophin-releasing hormone and the timing of human parturition. As the hormone is synthesized by the placenta, it supports the suggestion that the human placenta has an important role in determining gestational length.     

The relationships between leptin and inflammatory cytokines in women with pre-eclampsia

Objective To compare maternal serum leptin concentration in women with pre-eclampsia and women with normal pregnancy, and to evaluate the relationships between leptin and several inflammatory cytokines.
Design Prospective clinical study.
Setting University Hospital of Puerto Real, Cadiz, Spain.
Sample Twenty-seven women with pre-eclampsia and 25 normotensive pregnant women.
Methods Maternal serum levels of TNF-α, TGF-β1, interleukin 6, and leptin were measured using a commercially available immunoassay.
Main outcome measures Maternal serum levels of leptin and its relationship to levels of TNF-α, TGF-β1 and interleukin 6.
Results Maternal serum leptin levels were higher in women with pre-eclampsia, but this difference was of borderline statistical significance (median 15.9ng/mL; interquartile range (5.4–31.9) vs 30.5ng/mL (13.9–64) (   P =0.05  ). The concentration of maternal serum leptin was correlated with pre-gestational and gestational body mass index (  r=0.45, P =0.03; r=0.44, P =0.04  ), TNF-α concentration (r=0.57, P =0.002) and interleukin-6 level (  r=0.46, P =0.02  ) in women with normal pregnancy. In women with pre-eclampsia, only a significant correlation between maternal serum leptin level and TNF-α concentration (  0.47, P =0.01  ) was found.
Conclusions The level of maternal serum leptin is increased and correlates positively with the level of TNF-α in women with pre-eclampsia. In women with a normal pregnancy leptin levels not only correlate with TNF-α, but also with IL-6 and body mass index.     

Objective assessment of bladder neck elevation and urethral compression at colposuspension

Objectives 1. To assess whether magnetic resonance imaging and intra-operative measurements are useful in assessing bladder neck elevation and urethral compression at colposuspension; 2. to see if intra-operative measurements could be a substitute for magnetic resonance scan measurements.
Design Prospective, observational study.
Setting Urogynaecology Unit, NHS Trust hospital.
Population Seventy-seven women undergoing colposuspension.
Methods Bladder neck elevation was assessed using magnetic resonance imaging and measuring the amount of suture bow-stringing intra-operatively. Urethral compression was assessed using magnetic resonance imaging and by two intra-operative measurements: the distance between the medial sutures (with a ruler) and the distance between the urethra and the pubic bone (using paired Hegar dilators).
Results The assessment of bladder neck elevation and compression against the pubic bone using magnetic resonance imaging was reliable (95% limits of agreement: −7.1mm to +7.1mm and −1.7mm to +3.8mm, correlation coefficient 0.92 and 0.87, respectively). The intra-operative assessment of urethral compression with a ruler was also reproducible at both paravaginal and pectineal sites (95% limits of agreement −2.6mm to +2mm and −2.1mm to +2.4mm, respectively; correlation coefficient 0.99 for both distances). Other intra-operative measurements of bladder neck elevation (suture bow-stringing) and urethral compression (Hegars) did not correlate with equivalent magnetic resonance scan measurements (  kappa =−0.046, P = 0.31  ;  kappa = 0.052, P = 0.41  , respectively).
Conclusions Measurements have been found that can reliably assess bladder neck elevation and urethral compression at colposuspension. These measurements should be suitable for investigating morbidity following colposuspension.     

Reference range of fetal cisterna magna volume by three-dimensional ultrasonography using the VOCAL method

Abstract

Objective: To determine reference values for the fetal cisterna magna volume by three-dimensional ultrasonography (3DUS) using the virtual organ computer-aided analysis (VOCAL) method.

Methods: A cross-sectional study was conducted with 224 healthy pregnant women between 17 and 29 completed weeks. Measurement of the fetal cisterna magna volume was performed in the standard axial plane of the transverse diameter of the cerebellum through the VOCAL method with a 30° angle. For the determination of reference values, polynomial regressions with adjustments by the coefficient of determination (R²) were held. The reliability and agreement were made by the intra-class correlation coefficient (ICC) and limits of agreement of the Bland-Altman graph.

Results: The average of the fetal cisterna magna volume ranged from 0.73?±?0.25 to 3.79?±?1.10?cm³ between 17 and 29 weeks, respectively. Correlation was observed between the fetal cisterna magna volume and the gestational age (GA), best represented by a quadratic equation: ?1.918+0.0284?×?GA + 0.0065?×?GA² (R^2?=?0.67). It was observed good reliability and intra-observer agreement, with ICC?=?0.92 and 95% limits of agreement (?49.7; 48.4). There was low inter-observer reliability and agreement, with ICC?=?0.58 and 95% limits of agreement (?114.0; 80.2).

Conclusion: Reference values for the fetal cisterna magna volume by 3DUS using the VOCAL method were determined and showed good agreement and intra-observer reliability.     

Effect of gestational hypercholesterolaemia on omental vasoreactivity, placental enzyme activity and transplacental passage of normal and oxidised fatty acids

Objective  Maternal hypercholesterolaemia during pregnancy increases lipid peroxidation in mothers and fetuses and programs increased susceptibility to atherosclerosis later in life. The objective of this study was to elucidate the role of the placenta in mediating oxidative stress from mother to offspring.
Design  Comparison between normo- and hypercholesterolaemic mothers ( n = 36 each) and their children.
Setting  Obstetric wards, hospitals of the University of Naples and Regione Campania.
Population  Healthy primiparas delivering by caesarean section.
Methods  Biochemical measurements of oxidative stress and serum leptin in cord plasma and placenta, immunochemistry of placenta microvessels, and vasoreactivity studies were performed.
Main outcome measures  Oxidative status (i.e. lipid composition and content of oxidised fatty acids, activity of pro- and antioxidant enzymes, immunohistochemical presence of oxidation-specific epitopes) in maternal and cord blood and in placental tissue, as well as vascular reactivity in omental arteries.
Results  Hypercholesterolaemia during pregnancy was associated with extensive changes in fatty acid composition of both maternal and cord blood lipids, sufficient to alter vasoreactivity of omental vessels. Results also indicated that the placenta is not only subject to substantial oxidative stress, but that it may further increase fetal oxidative stress through changes of pro- and antioxidant enzyme activities.
Conclusions  The placenta plays an important role in both transmitting and enhancing pathogenic effects of gestational hypercholesterolaemia.     

Maternal anthropometrics are associated with fetal size in different periods of pregnancy and at birth. The Generation R Study

Objective  We aimed to examine the associations of maternal anthropometrics with fetal weight measured in different periods of pregnancy and with birth outcomes.
Design  Population-based birth cohort study.
Setting  Data of pregnant women and their children in Rotterdam, the Netherlands.
Population  In 8541 mothers, height, prepregnancy body mass index (BMI) and gestational weight gain were available.
Methods  Fetal growth was measured by ultrasound in mid- and late pregnancy. Regression analyses were used to assess the impact of maternal anthropometrics on fetal weight and birth outcomes.
Main outcome measures  Fetal weight and birth outcomes: weight (grams) and the risks of small (<5th percentile) and large (>95th percentile) size for gestational age at birth.
Results  Maternal BMI in pregnancy was positively associated with estimated fetal weight during pregnancy. The effect estimates increased with advancing gestational age. All maternal anthropometrics were positively associated with fetal size ( P -values for trend <0.01). Mothers with both their prepregnancy BMI and gestational weight gain quartile in the lowest and highest quartiles showed the highest risks of having a small and large size for gestational age child at birth, respectively. The effect of prepregnancy BMI was strongly modified by gestational weight gain.
Conclusions  Fetal growth is positively affected by maternal BMI during pregnancy. Maternal height, prepregnancy BMI and gestational weight gain are all associated with increased risks of small and large size for gestational age at birth in the offspring, with an increased effect when combined.     

Activin A, inhibin A, inhibin B and parturition: changes of maternal and cord serum levels according to the mode of delivery

Objective To evaluate whether activin A, inhibin A, and inhibin B levels in maternal and umbilical artery serum change according to the mode of delivery.
Design Maternal and cord blood specimens were collected at term after spontaneous labour and vaginal delivery, or elective caesarean section.
Setting Universities of Pisa, Turin, Naples and Udine.
Population Forty–two healthy pregnant women, at 39–40 weeks of gestation, divided into two subgroups: group 1 vaginal delivery (   n = 21  ), were delivered of 10 female and 11 male infants; group 2 elective caesarean section (   n = 21  ), were delivered of 11 female and 10 male infants.
Main outcome measures Serum activin A, inhibin A, inhibin B concentrations in maternal and umbilical cord blood.
Results At vaginal delivery, maternal serum inhibin A and inhibin B levels were lower and activin A levels higher than at elective caesarean section. Maternal levels of activin A, inhibin A and inhibin B were constantly higher than in umbilical arterial blood, independent of the mode of delivery. No significant difference was observed in umbilical arterial serum levels of the three proteins between the two modes of delivery. Umbilical arterial serum activin A and inhibin A concentrations did not show a significant difference between male and female infants in either vaginal or caesarean section, but male infants showed inhibin B levels significantly higher than female, independent of the mode of delivery.
Conclusions In the presence of active labour, the human placenta secretes larger amounts of activin A and lesser amounts of inhibin A and inhibin B into the maternal circulation. Inhibin–related proteins in the fetal circulation do not show differences according to the mode of delivery, suggesting that they have a different method of production or metabolic rate compared with maternal activin and inhibins.     

Maternal and fetal levels of methionine and homocysteine in early human pregnancy

Objective To investigate methionine metabolism during normal human embryonic development by measuring levels of methionine and total homocysteine in samples of maternal serum, extra-embryonic coelomic fluid, and amniotic fluid.
Design Cross-sectional observational study.
Setting Collaboration between St Bartholomew's Hospital, London, and the University Hospital of Nijmegen in The Netherlands.
Participants Twenty-three women with uncomplicated pregnancies between 8 and 12 weeks of gestation before surgical termination of an ultrasonographically normal fetus.
Methods Maternal serum samples were collected prior to surgery. Samples of extra-embryonic fluid and amniotic fluids were obtained by transvaginal ultrasound-guided coelocentesis and amniocentesis. Methionine was measured using an aminoacid analyser and total homocysteine by high performance liquid chromatography.
Results Levels of methionine were four times higher in extra-embryonic coelomic fluid and twice as high in amniotic fluid compared with maternal serum. In contrast, the total homocysteine concentrations were much lower in both extra-embryonic coelomic fluid and amniotic fluid than in maternal serum. All differences were significant (   P 0.01  ).
Conclusions The comparatively high concentrations of methionine in extra-embryonic coelomic fluid and amniotic fluid, and the concomitant low levels of total homocysteine in these fluids, suggest a role for methionine metabolism during early human pregnancy.     

A deficient maternal calcium intake during pregnancy increases blood pressure of the offspring in adult rats

Objective To assess in an animal model the effect of maternal dietary calcium intake during pregnancy on the blood pressure of offspring.
Design Randomised controlled trial.
Sample Ninety-eight 20-week-old female Wistar–Kyoto rats, giving birth to a total of 119 pups that were included in the follow up study.
Methods Rats were randomised to a calcium deficient diet, a diet with the recommended calcium levels, or a diet with calcium content much higher than the recommended levels. After one month on the experimental diet they were bred. After birth, systolic blood pressure in the offspring was measured monthly till 52 weeks of age.
Main outcome measures Blood pressure of the offspring.
Results The difference in blood pressure of the offspring between the normal and low maternal calcium group increased 0.49 mmHg per month (95% CI 0.18 to 0.84), 0.38 (0.07 to 0.68) between the low and high calcium group, and 0.12 (−0.20 to 0.43) between the normal and high calcium group. At the end of the follow up (52 weeks of age) blood pressure of the offspring in the deficient calcium group was 12.1 mmHg (95% CI 8.8 to 15.4,   P < 0.0001  ) higher than in the normal calcium group and 7.5 mmHg (95% CI 4.4 to 10.5,   P < 0.001  ) higher than the high calcium group. Blood pressure of the offspring in the high calcium group was 4.3 mmHg (95% CI 1.0 to 7.5,   P = 0.0l  ) higher than in the normal calcium group. In a multiple regression model maternal calcium intake during pregnancy was the strongest predictor of blood pressure of the offspring during adulthood.
Conclusions This experiment supports previous studies in humans suggesting a link between calcium intake during pregnancy and blood pressure in the offspring, and provides an animal model to explore the mechanisms involved in such association.     

Fetal age assessment based on ultrasound head biometry and the effect of maternal and fetal factors

BACKGROUND: Maternal height and weight have increased during the past 20 years, as has birthweight. The aim of the present study was to establish new reference charts for gestational age (GA) assessment using fetal biparietal diameter (BPD) and head circumference (HC), and to determine the effect of maternal and fetal factors on age assessment. METHODS: This was a prospective, cross-sectional study of 650 healthy women with regular menstrual periods and singleton uncomplicated pregnancies, recruited after written consent. BPD (outer-outer) and HC were measured at 10-24 weeks of gestation. We used regression analysis to construct mean curves and assess the effect of maternal and fetal factors on age assessment. RESULTS: BPD and HC were successfully measured in 642 participants. Using BPD and HC before 20 weeks, the new charts gave 3-8 days higher GA assessment than the charts presently in use, and <1 day difference compared to other recently established charts. Maternal age, multiparity, fetal gender, breech position and shape of fetal head affect GA estimation by 1-2 days when using BPD (p = 0.0001-0.02). Only maternal age and fetal gender affected GA estimation when using HC (相似文献   

Maternal and child health after assisted vaginal delivery: five-year follow up of a randomised controlled study comparing forceps and ventouse

Objective To undertake a five year follow up of a cohort of women and children delivered by forceps or vacuum extractor in a randomised controlled study.
Design Follow up of a randomised controlled trial.
Setting District general hospital in the West Midlands.
Population Follow up questionnaires were sent to 306 of the 313 women originally recruited at the North Staffordshire Hospital to a randomised controlled study comparing forceps and vacuum extractor for assisted delivery. Two hundred and twenty-eight women responded (74.5%) and all were included in the study; forceps (   n = 115  ) and vacuum extractor (   n = 113  ).
Main outcome measures Bowel and urinary dysfunction, child vision assessment, and child development.
Results Maternal adverse symptoms at long term follow up were relatively common. Urinary incontinence of various severity was reported by 47%, bowel habit urgency was reported by 44% (98/225), and loss of bowel control 'sometimes' or 'frequently' by 20% of women (46/226). No significant differences between instruments were found in terms of either bowel or urinary dysfunction. Overall, 13% (20/158) of children were noted to have visual problems. There was no significant difference in visual function between the two groups: ventouse 11/86 (12.8%), compared with forceps 9/72 (12.5%); odds ratio 0.97,95% CI 0.38–2.50. Of the 20 children with visual problems, a family history was known in 18, and 17/18 (94%) had a positive family history for visual problems. No significant differences in child development were found between the two groups.
Conclusions There is no evidence to suggest that at five years after delivery use of the ventouse or forceps has specific maternal or child benefits or side effects.     

The burden of caesarean section refusal in a developing country setting

Objective  To investigate the prevalence, aetiology and outcomes of caesarean section refusal in pregnant women.
Design  A prospective controlled study.
Setting  University of Nigeria Teaching Hospital and Aghaeze Hospital, Enugu, Nigeria.
Population  A total of 62 Nigerian women who declined elective caesarean section.
Method  Interviewer-administered questionnaires at the time of caesarean section refusal and postdelivery. The delivery outcomes of the subjects were compared with that of a matched control group of women who accepted caesarean section.
Main outcome measures  Prevalence, maternal reasons for caesarean section refusal and the resultant maternal and perinatal mortality.
Results  The prevalence of caesarean section refusal was 11.6% of all caesarean deliveries. Maternal reasons for refusing caesarean section include fear of death, economic reasons, desire to experience vaginal delivery and inadequate counselling. Outcomes were significantly worse among women who refused elective caesarean section than in the controls with a maternal mortality of 15% (versus 2%, P = 0.008) and a perinatal mortality of 34% (versus 5%, P < 0.001).
Conclusion  There is a high prevalence of caesarean section refusal in south-eastern Nigeria. Women declining caesareans have very poor maternal and perinatal outcomes and need extra support.     

Maternal mortality and serious maternal morbidity in Jehovah's witnesses in the Netherlands

Objective  To determine the risk of maternal mortality and serious maternal morbidity because of major obstetric haemorrhage in Jehovah's witnesses in the Netherlands.
Design  A retrospective study of case notes.
Setting  All tertiary care centres, general teaching hospitals and other general hospitals in the Netherlands.
Sample  All cases of maternal mortality in the Netherlands between 1983 and 2006 and all cases of serious maternal morbidity in the Netherlands between 2004 and 2006.
Methods  Study of case notes using two different nationwide enquiries over two different time periods.
Main outcome measures  Maternal mortality ratio (MMR) and risk of serious maternal mortality.
Results  The MMR for Jehovah's witnesses was 68 per 100 000 live births. We found a risk of 14 per 1000 for Jehovah's witnesses to experience serious maternal morbidity because of obstetric haemorrhage while the risk for the total pregnant population was 4.5 per 1000.
Conclusions  Women who are Jehovah's witnesses are at a six times increased risk for maternal death, at a 130 times increased risk for maternal death because of major obstetric haemorrhage and at a 3.1 times increased risk for serious maternal morbidity because of obstetric haemorrhage, compared to the general Dutch population.     

Adolescent Parenting: Outcomes and Maternal Perceptions

Objective: To describe selected outcomes and maternal perceptions of adolescent parenting.
Design: Qualitative and quantitative methods, interview, and two standardized instruments were combined in this follow-up study of adolescents who received perinatal services between 1985 and 1988.
Setting: Data were collected in the mothers' homes.
Participants: Mothers who were randomly selected for an earlier chart outcome audit ( N = 98) and could be located ( n = 19).
Main outcome measures: Subsequent pregnancies; school completion; children's development, indicated by the Developmental Profile II (DPII); parental attitudes, indicated by the Adult-Adolescent Parenting Inventory (AAPI); and maternal perceptions.
Results: Responses revealed irregular use of contraceptives as one reason for the initial pregnancy and for subsequent unplanned pregnancies. Sixteen mothers completed high school, and 18 intend to complete postsecondary programs. The DPII indicated age-appropriate development of the children. AAPI scores for 84% of the mothers indicated nonnurturing attitudes. Mothers described family support, motherhood, and their children.
Conclusions: Research is needed with larger samples and to test interventions to promote regular use of contraception. Findings support the need for research-based programs to educate and promote the development of adolescent mothers and their children.     

Low birthweight and preterm birth rates 1 year before and after the Irish workplace smoking ban

Objective  It is well-established that maternal smoking has adverse birth outcomes (low birthweight, LBW, and preterm births). The comprehensive Irish workplace smoking ban was successfully introduced in March 2004. We examined LBW and preterm birth rates 1 year before and after the workplace smoking ban in Dublin.
Design  A cross-sectional observational study analysing routinely collected data using the Euroking K2 maternity system.
Setting  Coombe University Maternal Hospital.
Population  Only singleton live births were included for analyses (7593 and 7648, in 2003 and 2005, respectively).
Methods  Detailed gestational and clinical characteristics were collected and analysed using multivariable logistic regression analyses and subgroup analyses.
Main outcome measures  Maternal smoking rates, mean birthweights, and adjusted odds ratios (ORs) of LBW and preterm births in 2005 versus 2003.
Results  There was a 25% decreased risk of preterm births (OR, 0.75; 95% CI, 0.59–0.96), a 43% increased risk of LBW (OR, 1.43; 95% CI, 1.10–1.85), and a 12% fall in maternal smoking rates (from 23.4 to 20.6%) in 2005 relative to 2003. Such patterns were significantly maintained when specific subgroups were also analysed. Mean birthweights decreased in 2005, but were not significant ( P  = 0.99). There was a marginal increase in smoking cessation before pregnancy in 2005 ( P  = 0.047).
Conclusions  Significant declines in preterm births and in maternal smoking rates after the smoking ban are welcome signs. However, the increased LBW birth risks might reflect a secular trend, as observed in many industrialised nations, and merits further investigations.     

Maternal human parvovirus B19 infection and the risk of fetal death and low birthweight: a case–control study within 35 940 pregnant women

Objectives  To assess the association between maternal parvovirus B19 infection and fetal death, birthweight and length of gestation.
Design  Case–control study.
Setting  Population based.
Population  Cases were all 281 women with fetal death within a cohort of 35 940 pregnant woxmen in Norway. The control group consisted of a random sample of 957 women with a live born child.
Method  Information on pregnancy outcome was obtained from the Medical Birth Registry of Norway. First trimester serum samples were tested for antibodies against parvovirus B19 (IgM and IgG). In seronegative women, further serum was analysed to detect seroconversion during pregnancy.
Main outcome measures  Fetal death, length of gestation and birthweight.
Results  Two of 281 (0.7%) of the women who experienced fetal death and nine of 957 (0.9%) of the controls had presence of IgM antibodies, crude odds ratio 0.8; 95% CI (0.2–3.5). In initially, seronegative women, 3.1% (2/65) with fetal death and 2.6% (8/307) with a live birth seroconverted, crude odds ratio 1.2; 95% CI (0.2–5.7). Presence of maternal parvovirus-specific IgG or IgM antibodies in the first trimester, or seroconversion during pregnancy were not associated with lower birthweight or reduced length of gestation in live born children, but was associated with low birthweight in stillborn offspring.
Conclusion  Maternal parvovirus B19 infection was not associated with fetal death in our study. Very few cases of fetal death may be attributed to maternal parvovirus B19 infection.