Efficacy of telephone counseling for pregnant smokers: a randomized controlled trial

OBJECTIVE: Reducing tobacco use in pregnancy is a public health priority. Brief smoking counseling during prenatal care is effective but generates modest cessation rates. Telephone counseling is an effective smoking cessation method that could offer pregnant women convenient access to more intensive smoking cessation counseling. METHODS: The efficacy of proactive pregnancy-tailored telephone counseling for smoking cessation was compared with a "best-practice" brief-counseling control in a randomized controlled trial of 442 pregnant smokers referred by prenatal providers and a managed care plan. Trained counselors using cognitive-behavioral and motivational interviewing methods called intervention subjects throughout pregnancy and for 2 months postpartum (mean = 5 calls, mean total contact = 68 minutes). Controls received one 5-minute counseling call. RESULTS: Cotinine-validated 7-day tobacco abstinence rates in intervention and control groups were 10.0% and 7.5% at end of pregnancy (odds ratio [OR] 1.37, 95% confidence interval [CI] 0.69-2.70; number needed to treat = 40) and 6.7% versus 7.1% at 3 months postpartum (OR 0.93, 95% CI 0.44-1.99). The intervention increased end-of-pregnancy cessation rates among 201 light smokers (< 10 cigarettes/day at study enrollment) (intervention 19.1% versus control 8.4%; OR 2.58, 95% CI 1.1-6.1; number needed to treat = 9.3) and among 193 smokers who attempted to quit in pregnancy before enrollment (intervention 18.1% versus control 6.8%; OR 3.02, CI 1.15-7.94; number needed to treat = 8.8); 63% of the sample (n = 267) was in one of these subgroups. CONCLUSION: Proactive pregnancy-tailored telephone counseling did not outperform a brief "best practice" intervention among pregnant smokers. The intervention had efficacy in light smokers and in women who had attempted cessation earlier in pregnancy. Future studies should confirm whether telephone counseling benefits these groups of pregnant smokers. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, #NCT00181909. LEVEL OF EVIDENCE: I.     

Missed opportunities for chlamydia screening of young women in the United States

OBJECTIVE: To identify missed opportunities for chlamydia screening in ambulatory care offices. METHODS: We analyzed data from the 2005 National Ambulatory Medical Care Survey to estimate the number of visits to obstetrician-gynecologists and primary care physicians (family and general practitioners, internists, and pediatricians) for preventive care, pelvic examinations, Pap tests, and urinalyses for nonpregnant women aged 15-25 years, and the proportion of these visits at which chlamydia tests were not performed. RESULTS: Obstetrician-gynecologists provided care for nonpregnant women aged 15-25 years at 6.3 million office visits during 2005, and primary care physicians at 20.9 million visits. Although obstetrician-gynecologists conducted only 23.1% of visits made by young women, they conducted 68.8% of visits with pelvic examinations and 71.1% of visits with Pap tests. Primary care physicians conducted 77.5% of visits with urinalyses. Obstetrician-gynecologists did not perform a chlamydia test at 3.2 of 3.8 million (82.1%) visits with pelvic examinations and at 1.8 of 2.3 million (77.3%) visits with Pap tests. Primary care physicians did not perform a chlamydia test at 2.9 of 3.0 million (99.1%) visits with urinalyses. CONCLUSION: There are many missed opportunities for chlamydia testing of young women in ambulatory care visits - during pelvic examinations, Pap tests, and urinalyses. Effective and simple interventions are needed to increase targeted chlamydia screening of women by physicians. LEVEL OF EVIDENCE: III.     

A pilot study evaluating a telephone-based exercise intervention for pregnant and postpartum women

Introduction: Exercise during pregnancy is associated with reduced rates of preeclampsia, gestational diabetes, anxiety, insomnia, and excessive weight gain. Continued exercise during the postpartum period is important for healthy weight loss and reduced anxiety. Unfortunately, pregnant and postpartum women are significantly less active than nonpregnant women. The purpose of this pilot study was to evaluate a telephone‐based exercise intervention designed for pregnant and postpartum women. Methods: Healthy women (N = 37) who were pregnant (16 weeks’ gestation or less) or postpartum (6 months or less) participated in a 3‐month, telephone‐based exercise intervention based on the transtheoretical model and social cognitive theory. Exercise was assessed by using the 7‐Day Physical Activity Recall Interview. Results: Pregnant participants significantly increased their exercise from a mean (standard deviation [SD]) of 60.47 (63.1) minutes per week at baseline to 132.9 (82.3) minutes at 3 months, F(1,13) = 9.96, P < .01. Postpartum participants significantly increased their exercise from a mean (SD) of 68.9 (63.5) minutes per week at baseline to 123.8 (48.8) minutes at 3 months, F(1,15) = 6.56, P < .05. Discussion: Participants responded positively to the intervention by significantly increasing their exercise levels. There is a need for a large, randomized controlled trial examining the efficacy of telephone‐based exercise interventions for pregnant and postpartum women.     

Vaccination and perinatal infection prevention practices among obstetrician-gynecologists

OBJECTIVE: To assist efforts to improve adult vaccination coverage by characterizing vaccination and infectious disease screening practices of obstetrician-gynecologists. METHODS: A written survey of demographics, attitudes, and practices was mailed to 1063 American College of Obstetricians and Gynecologists Fellows, including the Collaborative Ambulatory Research Network (n = 413) and 650 randomly sampled Fellows. RESULTS: Seventy-four percent of Collaborative Ambulatory Research Network members and 44% of nonmembers responded. A majority (Collaborative Ambulatory Research Network members: 60%; nonmembers: 49%) considered themselves primary care providers. Fewer than 60% routinely obtained patient vaccination or infection histories. Most screened prenatal patients for hepatitis B surface antigen (89%) and rubella immunoglobulin G antibody (85%). Sixty-four percent worked in practices that offered at least one vaccine; the most common were rubella (52%) and influenza (50%). Ten percent worked in practices that offered all major vaccines recommended for pregnant or postpartum women. Despite recommendations to provide influenza vaccine to pregnant women during influenza season, only 44% did so; among those who did not, 14% reported a belief that pregnant women do not need influenza vaccine. Provision of vaccine was associated with working in a multispecialty practice (adjusted odds ratio [OR] 2.6, 95% confidence interval [CI] 1.6, 4.1) and identifying as a primary care provider (adjusted OR 1.9; 95% CI 1.3, 2.7). The most common reasons for not offering vaccines were cost (44%) and a belief that vaccines should be provided elsewhere (41%). CONCLUSION: The high proportion of obstetrician-gynecologists who do not offer vaccines or screen for vaccine and infection histories suggests missed opportunities for prevention of maternal and neonatal infections.     

Endothelial precursor cells in the peripheral blood of pregnant women

OBJECTIVE: To determine whether primitive endothelial precursor cells are present in the peripheral blood of pregnant compared with nonpregnant subjects and whether these precursor cells are of fetal or maternal origin. METHODS: Peripheral blood mononuclear cells from 13 pregnant women in the second trimester and from ten nonpregnant women and men were cultured for 8-10 weeks under conditions that promoted endothelial cell development. Early outgrowth (1 week culture) and late outgrowth (4-6 weeks) colonies were observed, their endothelial nature was investigated, and fluorescence in situ hybridization was performed to determine the origin of the colonies from pregnant women's specimens. RESULTS: Peripheral blood mononuclear cell cultures from all pregnant women and all nonpregnant controls yielded early-outgrowth endothelial cells. Late-outgrowth endothelial cells were observed in 61.5% (eight of 13) of pregnant subjects, but in none of the ten nonpregnant controls (chi(2) test; P <.01). The adherent cells stained positively for von Willebrand factor and incorporated Dil-Ac-LDL, confirming their endothelial origin. Fluorescence in situ hybridization analysis showed only X chromosome-specific signals and no Y chromosome-specific signals in the cells from the late-outgrowth endothelial cells in all pregnant women carrying either a male (n = 5) or a female (n = 8) fetus. CONCLUSION: Primitive endothelial precursor cells are present in most pregnant women during the second trimester. These cells appear to be of maternal origin.     

Sexually transmitted disease screening by United States obstetricians and gynecologists

OBJECTIVE: To assess compliance with practice guidelines and to determine the extent of missed opportunities for sexually transmitted disease (STD) prevention by describing screening practices of a national sample of obstetricians and gynecologists and comparing them to the practices of other specialists. METHODS: Physicians (n = 7300) in five specialties that diagnose 85% of STDs in the United States were surveyed. Obstetrics and gynecology (n = 647) was one of the five specialties. Besides providing demographic and practice characteristics, respondents answered questions about who they screen (nonpregnant females, pregnant females) and for which bacterial STDs (syphilis, gonorrhea, chlamydia). RESULTS: Responding obstetricians and gynecologists were most likely to be non-Hispanic white (75%), male (66%), and in their 40s (mode 43 years old). They saw an average of 90 patients per week during 47 hours of direct patient care. Approximately 95% practiced in private settings. Almost all (96%) screened some patients for at least one STD. Obstetricians and gynecologists screened women more frequently than other specialties, but no specialty screened all women or all pregnant women. CONCLUSION: Obstetricians and gynecologists screen women for STDs at a higher rate than other specialties represented in this study. Consistent with published guidelines, most obstetricians and gynecologists in our survey screened pregnant women for chlamydia, gonorrhea, and syphilis. Nonetheless, only about half of obstetricians and gynecologists screened nonpregnant women for gonorrhea or chlamydia, and fewer screen nonpregnant women for syphilis.     

Pregnancy-related substance use in the United States during 1996-1998

OBJECTIVE: To provide a baseline estimate of the national prevalence of pregnancy-related illicit drug use and abstinence rates. METHODS: We analyzed data collected between 1996 and 1998 from the National Household Survey on Drug Abuse, a nationally representative sample survey of 22,303 noninstitutionalized women aged 18-44 years, of whom 1,249 were pregnant. RESULTS: During 1996-1998, 6.4% of nonpregnant women of childbearing age and 2.8% of pregnant women reported that they used illicit drugs. Of the women who used drugs, the relative proportion of women who abstained from illicit drugs after recognition of pregnancy increased from 28% during the first trimester of pregnancy to 93% by the third trimester. However, because of postpregnancy relapse, the net pregnancy-related reduction in illicit drug use at postpartum was only 24%. Marijuana accounted for three-fourths of illicit drug use, and cocaine accounted for one-tenth of illicit drug use. Of those who used illicit drugs, over half of pregnant and two-thirds of nonpregnant women also used cigarettes and alcohol. Among the sociodemographic subgroups, pregnant and nonpregnant women who were young (18-30 years) or unmarried, and pregnant women with less than high school education had the highest rates of illicit drug use. CONCLUSION: The continued burden of illicit drug use during pregnancy calls for policy efforts to enable primary care providers to identify and refer women who use substances to treatment and support services. Prevention of uptake of illicit drug use should be an integral part of public health programs for young women.     

Obstetricians' attitudes and opinions on sickness absence and benefits during pregnancy

BACKGROUND: In Sweden, sick leave is taken more frequently by pregnant women than by nonpregnant women. This led us to ask if the taking of sick leave during pregnancy could possibly be explained by attitudes to sickness absence held among obstetricians working in antenatal care. METHODS: All obstetricians (n = 45) engaged in public antenatal care and at work in May 2001 in seven hospitals in South Eastern Sweden were asked to anonymously respond to questions/statements concerning their work; 87% participated. The results were presented as percent (the median value) on a visual analog scale. RESULTS: In 60% of all contacts with pregnant women issues such as working conditions, sickness absence or benefit programs were discussed besides the actual pregnancy. In 46% the obstetricians stated that they could not exactly pinpoint a correct medical diagnosis motivating a sickness certificate asked for by the pregnant woman. As the majority of the obstetricians (74%) often did not like to conform to the pregnant women's wishes, unpleasant situations were not uncommon (56%). A conflict was experienced in the dual role that the obstetrician had as the patient's confidant on the one hand and as a representative or gatekeeper for the social security system on the other. Male and female obstetricians did not differ in their opinions on their handling of pregnant women with regard to taking sick leave but for one issue, back pain. CONCLUSIONS: The high degree of work dealing with sickness absence and social benefits at the Antenatal Care Centers seems to have a negative effect on the obstetrician's evaluation of their work environment. The obstetricians' opinion is that pregnant women are sick-listed too frequently, but obstetricians comply as a rule to the women's wishes in order to avoid conflict.     

Plasma, urinary, and salivary 8-epi-prostaglandin f2alpha levels in normotensive and preeclamptic pregnancies

OBJECTIVE: Our purpose was to measure and compare plasma, urinary, and salivary concentrations of 8-epi-prostaglandin F(2alpha) (8-isoprostane) in women with normotensive pregnancies and the respective concentrations in pregnancies complicated by preeclampsia. STUDY DESIGN: Plasma, urinary, and salivary 8-isoprostane levels were measured in pregnant women with preeclampsia (n = 40), normotensive pregnant women (n = 20), and nonpregnant women (n = 10). One-way analysis of variance was used to determine significant differences. RESULTS: Plasma free 8-isoprostane concentrations were increased in women with severe preeclampsia (342 +/- 50 pg/mL), in comparison with nonpregnant women (129 +/- 17 pg/mL) and normotensive pregnant women (150 +/- 11 pg/mL; P =.003, and.0001, respectively). Urinary excretion of 8-isoprostane was slightly but not significantly decreased in preeclampsia (1200 +/- 227 pg/mL), in comparison with urinary excretion in nonpregnant women (1625 +/- 364 pg/mL) and normotensive pregnant women (2149 +/- 432 pg/mL). Salivary concentrations of 8-isoprostane were increased in normotensive women (496 +/- 113 pg/mL), in comparison with nonpregnant women (150 +/- 27 pg/mL) but were not related to preeclampsia (419 +/- 96 pg/mL; P 相似文献   

Postpartum contraceptive use among adolescent mothers

OBJECTIVE: To compare the incidence of repeat pregnancy and method continuation rate at 12 months postpartum in young women who chose either depot medroxyprogesterone acetate or oral contraceptives (OCs) as contraception. METHODS: We conducted a prospective cohort study of 122 postpartum women younger than 18 years of age who delivered between January 8, 1997 and December 31, 1997. Patients choosing depot medroxyprogesterone acetate (n = 76) and OCs (n = 46) were accrued for 12 months and were followed-up for a minimum of 12 months. Main outcome measures were median contraceptive method continuation and the incidence of repeat pregnancy at 12 months postpartum. RESULTS: There was no difference in mean age at delivery (P =.47), parity (P =.84), or gravidity (P =.78) between depot medroxyprogesterone acetate and OC users. At 12 months postpartum, 27.4% of OC users and 55.3% of depot medroxyprogesterone acetate users were still using contraception. Median time to contraceptive discontinuation was longer for those choosing depot medroxyprogesterone acetate compared with OCs (17.8 vs 7.4 months, respectively, P =.002). The overall incidence of repeat pregnancy at 12 months postpartum was 10.6%. Among OC and depot medroxyprogesterone acetate users, respectively, 24% and 2.6% became pregnant again, producing a relative risk (RR) of 9.09 (95% confidence interval [CI] 2.1, 39.2) for repeat pregnancy among OC users. The mean time to repeat pregnancy (this was reported instead of the median time whenever the pregnancy rate had not reached 50% at the end of the follow-up period) was longer for depot medroxyprogesterone acetate compared with OC users (17.1 months vs 13.2 months, respectively, P <.001). CONCLUSION: Adolescent mothers using depot medroxyprogesterone acetate injection for contraception have a higher method continuation rate and a lower incidence of repeat pregnancy at 12 months postpartum than those selecting OCs during the same period.     

The risk of folate and vitamin B(12) deficiencies associated with hyperhomocysteinemia among pregnant women

The purpose of this study was to compare the folate and vitamin B (12) levels in pregnant and nonpregnant women to evaluate the risk for hyperhomocysteinemia and for folate and vitamin B (12) deficiencies during pregnancy. Healthy pregnant women (n = 92; 24 to 28 gestational weeks; 18 to 39 years old) and nonpregnant women (n = 176; 18 to 39 years old) were sampled for serum levels of folate, vitamin B (12), and homocysteine. Pregnant women were less likely to have folate deficiency (8.0% versus 12.0%) but much more likely to have vitamin B (12) deficiency (46.1% versus 0.6%) than nonpregnant women. Those with lower dietary vitamin intakes were more likely to have vitamin B (12) deficiency. Serum folate and vitamin B (12) were negatively correlated with homocysteine among pregnant women. Pregnant women with folate deficiency were more likely to have hyperhomocysteinemia than those without folate deficiency. The vitamin B (12) level associated with hyperhomocysteinemia was lower in pregnant subjects than in nonpregnant subjects in this study, indicating that pregnant women require vitamin B (12) supplementation.     

Early labor assessment and support at home versus telephone triage: a randomized controlled trial

OBJECTIVE: To compare rates of cesarean delivery among women who were triaged by obstetric nurses, either by telephone or by means of home visits. METHODS: Healthy, nulliparous women in labor at term with uncomplicated pregnancies residing in the City of Vancouver, British Columbia, and suburbs between November 2001 and October 2004 were randomized when they sought advice about when to come to hospital. Women randomized to telephone triage (n=731) were provided with advice by telephone. Women randomized to a home visit (n=728) were triaged after a "hands-on" assessment in their homes. RESULTS: The relative risk (RR) for cesarean delivery among home-triaged women compared with those receiving only telephone support was 1.12 (95% confidence interval [CI] 0.94-1.32). The study was designed to have 80% power to detect a RR less than 0.78 or greater than 1.27 for cesarean delivery. Significantly fewer women in the home visit group were admitted to hospital with cervical dilatation at 3 cm or less (RR 0.85, 95% CI 0.76-0.94). Significantly more women in the home visit group managed their labor without a visit to hospital for assessment (RR 1.54, 95% CI 1.23-1.92). There were no statistically significant differences in use of narcotic analgesia, epidural analgesia, and augmentation of labor. Adverse neonatal outcomes were rare and did not differ between study groups. CONCLUSION: Early labor assessment and support at home versus support by telephone reduces the number of visits to hospital in latent phase labor but does not impact cesarean delivery rates among healthy nulliparous women. CLINICAL TRIAL REGISTRATION: ISRCTN, www.controlled-trials.com/isrctn, MCT-44153 LEVEL OF EVIDENCE: I.     

MEDICAID AND NON-MEDICAID PRENATAL CARE BY NURSE-MIDWIVES: Comparison of Risk,Time, Care Coordination,and Reimbursement

The purpose of the study was to compare high-risk pregnant women with medical assistance payment (HRMA) and those with private insurance payment (HRPI) on use of provider time, care coordination activities, and financial reimbursement. Comparisons were also conducted for the same factors between the high-risk and low-risk women (LRMA) that received medical assistance payment for their care. Total time spent by care providers in giving antepartum, intrapartum, and postpartum care was highest for the HRPI women. However, the two medical assistance groups started prenatal care significantly later and had fewer visits, and one-third did not return for their 6-weeks postpartum visit. The HRPI group also had a higher cesarean birth rate. Rates of care coordination activities such as calls, referrals, and consultations were significantly higher for the HRPI and HRMA women compared with those for the LRMA women. However, the HRMA women have limited financial and psychosocial resources that require additional provider management and referrals. Reimbursement rate was highest for the HRPI group in which approximately 73% of the total amount billed was collected compared with approximately 56% among medical assistance women. Recommendations for policy, practice, and further research are offered.     

Aspects of the normal psychology of pregnancy: the midtrimester.

In this study of nonpregnant women were compared with pregnant women. A set of feelings and attitudes along with questions relevant to the anatomy and physiology of parturition were the measures of comparison. The pregnant women and the nonpregnant women had almost identical feelings and attitudes. There were, however, three exceptions to this general condordance. They were: (1) the nonpregnant women's regard of pregnancy as a depressive and withdrawing experience, (2) a greater fear for the fetus among the nonpregnant women, and (3) higher scores on a pregnancy information inventory among the pregnant women.     

Tracking career satisfaction and perceptions of quality among US obstetricians and gynecologists

OBJECTIVE: To assess recent trends in professional satisfaction, perceptions of ability to provide high-quality care, and perceptions of ability to obtain needed services for patients in a national sample of obstetricians and gynecologists; to compare obstetrician-gynecologists with physicians in other specialties; and to identify demographic, professional, and practice characteristics associated with high career satisfaction. METHODS: We used data from the 1996-1997 (n=12,385; response rate, 65%) and 1998-1999 (n=12,280; response rate, 61%) waves of the nationally representative Community Tracking Study physicians' survey. The principal outcome measures were one item related to overall career satisfaction, six items measuring physicians' perceptions of their ability to provide high-quality care, and five items measuring physicians' perceptions of their ability to obtain needed services for patients. All results were weighted and adjusted to reflect the complex survey design. RESULTS: In 1996-1997, 34% of obstetrician-gynecologists (n=545) were very satisfied with their careers, and 24% were very or somewhat dissatisfied. Up to 45% perceived significant barriers to the delivery of high-quality care, and up to 58% were unable to "almost or almost always" obtain necessary services for patients. Results in 1998-1999 (n=484 obstetricians and gynecologists) were similar, except for a deterioration in perceived amount of time with patients and ability to obtain high-quality ancillary services. In comparison with primary care physicians, obstetrician-gynecologists were less satisfied (P=.001); in comparison with both primary care physicians and general surgeons, they had more problems delivering high-quality care (P<.001) and greater difficulties obtaining needed services for patients (P<.001). Controlling for selected demographic and professional characteristics, higher career satisfaction was associated with age greater than 65 years, practicing in small metropolitan areas and in academic settings, and having better perceptions of quality and ability to obtain services (P<.05). CONCLUSION: Although most obstetricians and gynecologists are satisfied with their careers, many are experiencing significant professional distress.     

Anergy during pregnancy

OBJECTIVE: This study was undertaken to determine whether the prevalence of anergy is higher among pregnant women than among nonpregnant women. STUDY DESIGN: Sixty human immunodeficiency virus-seronegative women (n = 30 pregnant, n = 30 nonpregnant) from the Duke University Medical Center (Durham, North Carolina) clinic were enrolled. Skin tests were performed with purified protein derivative of tuberculin, Candida antigen, mumps antigen, and tetanus toxoid. A power calculation was done to determine adequate sample size, and data were analyzed with the Fisher exact test and the t test. RESULTS: Three women in each group did not have a response to any of the antigens tested, for an anergy prevalence of 10%. Pregnant women were less likely to have a reaction to skin testing with tetanus toxoid than were nonpregnant women (10% vs 40%; P <.02). CONCLUSION: Human immunodeficiency virus-seronegative pregnant women did not appear to have a higher prevalence of anergy than that seen among comparable nonpregnant women. Human immunodeficiency virus-seronegative pregnant women who are being evaluated with the purified protein derivative of tuberculin skin test are therefore unlikely to need anergy skin testing just because they are pregnant.     

Women's exercise beliefs and behaviors during their pregnancy and postpartum

Limited research examines women's beliefs about the value of exercise and their actual exercise behaviors during pregnancy and postpartum. A retrospective study of 74 postpartum women was conducted to examine women's behavioral, normative, and control beliefs about exercising during pregnancy and postpartum and to determine their most salient beliefs. In addition, women's prepregnancy, pregnancy, and postpartum exercise behavior was examined. We found that 1) the most common exercise beliefs during pregnancy were that exercise improves mood and physical limitations (e.g., nausea) obstructed exercise participation; 2) the most common exercise beliefs during postpartum were that exercise controls weight gain and a lack of time obstructed exercise participation; 3) women's husband/partner and family members most strongly influenced their pregnancy and postpartum exercise behavior; and 4) women exercised more before they were pregnant than during pregnancy and postpartum. Researchers and health care professionals are encouraged to examine and understand women's beliefs about exercising during their pregnancy and postpartum and design their interventions accordingly, in an attempt to increase women's exercise behavior during their childbearing years.     

Impact of written information on women's use of postpartum services: a randomised controlled trial

BACKGROUND: This study evaluates the impact of providing women with written educational material on their satisfaction with care, and use of health services postpartum. METHODS: All women having a live birth at 4 private hospitals in Lebanon were eligible. The sample consisted of 187 women in the intervention and 191 in the control arms. An intervention booklet was developed following a qualitative study of women's information needs; placebo material was 2 leaflets about childproofing the house. Field workers administered a baseline questionnaire to recruit all eligible women, and conducted follow-up interviews 6-20 weeks postpartum at the women's residences. The written material was handed out to women just before discharge from hospital. At the baseline interview, interviewers and women were blinded to the nature of the written material. Outcome measures were a postpartum visit to a health professional after discharge and before the follow-up interview, and satisfaction with maternity care received during pregnancy, delivery and postpartum. RESULTS: Satisfaction with care during the postpartum period was 57.2% in the intervention and 38.9% in the control arm (p<0.001). Some 85% of women in the intervention arm had a postpartum visit compared to 55% in the control arm (p<0.001). CONCLUSION: In the context of high female literacy, the intervention is effective and requires few resources.     

Comparison of cerebral blood flow velocity as measured in preeclamptic, healthy pregnant, and nonpregnant women by transcranial Doppler sonography.

AIM: To test the hypothesis that the middle cerebral artery blood flow velocity (MCAV) is altered in preeclamptic pregnant women as compared with healthy pregnant and nonpregnant women. METHODS: Preeclamptic (n = 21) and healthy pregnant (n = 17) as well as healthy nonpregnant (n = 29) women underwent transcranial Doppler MCAV measurements. The mean MCAV values were compared between the different groups. Anova combined with Bonferroni correction was used for statistical analysis. RESULTS: The MCAV was significantly higher in nonpregnant women (mean +/- SE 73.0 +/- 2.12 cm/s) as compared with healthy pregnant women (67.0 +/- 1.8 cm/s, p = 0.0356). Preeclamptic women showed significantly higher MCAV values (83.5 +/- 2.1 cm/s) as compared with nonpregnant females (73.0 +/- 2.12 cm/s, p = 0.0014). Similar to nonpregnant women, healthy pregnant women showed lower MCAV values (67.0 +/- 1.8 cm/s) as compared with preeclamptic women (83.5 +/- 2.1 cm/s, p = 0.001). After Bonferroni correction the MCAV values in patients suffering from preeclampsia were still statistically significantly higher as compared with the two other groups. CONCLUSIONS: We detected increased resting MCAV values in pregnant women with preeclampsia. In our opinion, this finding refers to arteriolar dilation of the resistance vessels of the brain. Further studies are needed to prove altered vasoreactivity responses of the brain resistance arterioles in preeclampsia.     

Cell-derived microparticles and complement activation in preeclampsia versus normal pregnancy

BACKGROUND: Inflammation plays a major role in the vascular dysfunction seen in preeclampsia, and several studies suggest involvement of the complement system. OBJECTIVES: To investigate whether complement activation on the surface of microparticles is increased in plasma of preeclamptic patients versus healthy pregnant controls. METHODS: Microparticles from plasma of preeclamptic (n=10), healthy pregnant (n=10) and healthy nonpregnant (n=10) women were analyzed by flow cytometry for bound complement components (C1q, C4, C3) and complement activator molecules (C-reactive protein [CRP], serum amyloid P component [SAP], immunoglobulin [Ig]M, IgG). Fluid phase complement activation products and activator molecules were also determined. RESULTS: Levels of microparticles with bound complement components showed no increase in complement activation on the microparticle surface in preeclamptic women, in line with levels of fluid phase complement activation products. In healthy nonpregnant and pregnant women, bound CRP was associated with classical pathway activation on the microparticle surface, and in healthy pregnant women IgM and IgG molecules also contributed. In preeclamptic women, microparticles with bound SAP and those with IgG seemed to contribute to C1q binding without a clear association to further classical pathway activation. Furthermore, significantly increased levels of microparticles with bound CRP were present in preeclamptic compared with healthy pregnant women (median 178x10(6)/L versus 47x10(6)/L, P<0.01), but without concomitant increases in complement activation. CONCLUSIONS: We found no evidence of increased complement activation on the microparticle surface in preeclamptic women. Microparticles with bound CRP were significantly increased, but in contrast to healthy pregnant and nonpregnant women, this was not associated with increased classical pathway activation on the surface of the microparticles.