Change in pulse pressure during the preclinical phase of preeclampsia

OBJECTIVE: To measure and compare pulse pressure in early pregnancy between parturients who subsequently did or did not develop preeclampsia. STUDY DESIGN: Retrospective chart review of 44 parturients with preeclampsia and 187 controls without. The groups were compared for blood pressure indices before 15 weeks' gestation and other maternal variables. RESULTS: The preeclampsia group had a higher proportion of African Americans (23% vs. 9.6%, p = 0.005) and higher body mass index (26.2 +/- 7.1 SD vs. 24.0 +/- 4.9 kg/m2, p = 0.03). Before 15 weeks' gestation, women who later developed preeclampsia had higher systolic (114.3 +/- 11.6 vs. 107 +/- 12 mm Hg, p = 0.001), mean arterial (83.7 +/- 8.8 vs. 79.6 +/- 7.6 mm Hg, p = 0.002) and pulse (45.8 +/- 7.7 vs. 42.4 +/- 8.3 mm Hg, p = 0.001) pressure. On multivariable logistic regression analysis, only African American race (OR 3.1; 95% CI 1.13, 8.40; p = 0.028), and pulse pressure (OR 1.05; 95% CI 1.01, 1.1; p = 0.014) were independently associated with the development of preeclampsia. CONCLUSION: Primiparous women who later develop preeclampsia have an elevation in pulse, systolic and mean arterial pressure before 15 weeks.     

孕妇血清瘦素水平的测定

目的　探讨孕妇血清瘦素水平的变化及其与妊娠的关系。方法　采用放射免疫测定法 ,测定 2 5 1例孕妇 (观察组 )和 35例年龄、体重指数相近的正常非孕妇女 (对照组 )的血清瘦素水平 ,并将瘦素水平与孕妇的孕周、体重、体重指数、腹围、子宫底高度、血压等的关系进行了相关分析。结果　观察组瘦素水平为 (15 .1± 7.4) μg/L ,对照组瘦素水平为 (9.1± 4.9) μg/L ,两组比较 ,差异极有显著性 (P <0 .0 0 1)。相关分析显示 ,孕妇血清瘦素水平与其体重 (r =0 .5 2 9)、体重指数 (r =0 .5 5 1)、腹围 (r=0 .5 6 4)、子宫底高度 (r =0 .15 1)、收缩压 (r =0 .134 )、舒张压 (r=0 .2 5 1)均有相关性。妊娠期间 ,血清瘦素水平虽然逐渐上升 ,但直到孕 30周 ,统计学上尚无明显差异。结论　监测孕妇瘦素水平变化 ,对妊娠并发症 (如妊娠高血压综合征 )的临床观察可能有一定的意义     

Effect of exercise on blood pressure in pregnant women with a high risk of gestational hypertensive disorders

OBJECTIVE: To prospectively determine whether moderate exercise during pregnancy lowers blood pressure. STUDY DESIGN: A randomized, controlled trial with one test group and one control group. All subjects have a history of mild hypertension, gestational hypertensive disorders or a family history of hypertensive disorders. Subjects were recruited before 14 weeks' gestation. After four weeks of observation, the subjects were randomly assigned to either the exercise or control group. The exercise group visited the laboratory three times a week for 10 weeks (18-28 gestation weeks) to perform 30 minutes of exercise at Rating of Perceived Exertion level 13. RESULTS: A total of 16 pregnant women (mean age, 30 years) participated. The mean metabolic equivalent during exercise sessions was 4.7 (SD = 0.8). Blood pressure measurements were compared before and after the 10-week exercise period in the two groups. Systolic blood pressures did not change significantly, but diastolic blood pressure (DBP) in the exercise group decreased by 3.5 mm Hg, while that in the control group increased by 1.1 mm Hg. Thus, the pre-post change in DBP differed by 4.6 mm Hg between groups. Exercise treatment reduced the diastolic blood pressure to a near-significant level in the exercise group (t = 2.34, df = 7, P = .052). Percent body fat did not differ between the exercise and control groups either before or after exercise treatment. ANOVA revealed that pregnancy had a significant effect (F(1, 14) = 5.7, P = .03) on increasing the percentage of fat, but exercise treatment did not (F(1, 14) = .18, P = .68). Estimated energy expenditure in overall daily physical activities during the intervention did not differ between the two groups despite the inclusion of exercise. CONCLUSION: This study detected a strong trend that 10 weeks of moderate exercise lowered the diastolic blood pressure among pregnant women at risk of hypertensive disorders. The reductions were probably due to the effect of exercise itself, not to weight or overall daily physical activity levels.     

Remote prognosis of preeclampsia in women 25 years old and younger

Twenty-six primiparous women less than or equal to 25 years old who delivered between 1963 and 1978 and met the following criteria were studied: (1) The first obstetric visit was at less than or equal to 30 weeks' gestation with diastolic blood pressure less than or equal to 85 mm Hg; (2) diastolic blood pressure before delivery was greater than or equal to 95-mm Hg, rising at least 15 mm Hg; (3) 24-hour urine protein measured at least 1.0 gm; and (4) patients were enrolled in the Kaiser Health Plan in 1982. Each of the 26 patients was paired with a primiparous woman by year delivered, age, race (black versus nonblack), and weight +/- 1/3. In 23 pairs blood pressure follow-up was available in 1980 or thereafter, which was at least 3 1/2 years after delivery (average interval between delivery and follow-up = 10 years). Three in the preeclampsia group and two in the matched control group had hypertension, with diastolic blood pressure greater than or equal to 90 mm Hg. Mean systolic blood pressure (123.7 mm Hg) was 9.3 mm Hg higher in the preeclampsia group than in the matched controls (114.4 mm Hg), with a standard error of 4.15 mm Hg (p = 0.04). Mean diastolic blood pressure (77.0 mm Hg) was 2.9 mm Hg higher in the preeclampsia group than in the controls (74.1 mm Hg), with a standard error of 3.0 mm Hg (p = 0.345). We conclude that no significant difference in frequency of hypertension or diastolic blood pressure and a small but significant difference in systolic blood pressure is shown in follow-up between patients with preeclampsia and matched controls.     

The acute effects of ritodrine infusion on maternal metabolism: measurements of levels of glucose, insulin, glucagon, triglycerides, cholesterol, placental lactogen and chorionic gonadotropin.

Twenty-nine women in premature labor were randomly assigned to a ritodrine (N = 14) or placebo (N = 15) treatment group. Thirteen serial blood samples were drawn during the first 12 hours of therapy by intravenous drug infusion and they were analyzed for a variety of metabolic substances. There was a significant increase in the blood glucose level in the ritodrine group after one hour and this persisted for the 12 hours of intravenous drug treatment. Plasma insulin levels similarly did not increase in the placebo but significantly rose in the ritodrine group by 30 minutes, peaked at 2 1/2 hours, and remained elevated throughout the infusion. There were no significant differences between levels of plasma glucagon, cholesterol triglyceride, human placental lactogen, or human chorionic gonadotropin in the two treatment groups. Ritodrine caused significant maternal and fetal tachycardia. Its use in women with carbohydrate abnormalities should be monitored carefully. The increased glucose levels may lead to an increased fetal weight.     

The Variability of Fetal Lie, Presentation and Position During "Normal" Pregnancy

Summary: The fetal lie, presentation, and position was recorded serially from the 16th week of gestation until delivery in 100 pregnant women.
The incidence of these characteristics varied with gestation and parity, with stabilization of fetal lie occurring at the 22nd week in nulliparous patients, and at the 30th week in parous patients; the frequency of longitudinal lie rose from 63% at 16 weeks of gestation to 99% at 32 weeks of gestation.
Only 1 persistent breech presentation and 1 persistent transverse lie occurred in the 100 patients. The predominant position in the cephalic presentations was left occipital with a significantly higher incidence in the nullipara.
Considerable variability of lie, presentation, and position occurred in serial examinations, and late spontaneous version from breech to vertex occurred in 4 multiparous patients.     

Comparison of antihypertensive efficacy and tolerability of losartan and extended-release felodipine in patients with mild to moderate hypertension.

Appropriate control of blood pressure has been shown to reduce morbidity and mortality in patients with hypertension. Losartan potassium, a selective antagonist of the angiotensin II type 1 (AT1) receptor, has been shown to lower blood pressure in patients with hypertension. The purpose of this study was to compare the efficacy and tolerability of losartan and extended-release (ER) felodipine in Taiwanese patients with mild to moderate hypertension. Patients with mild to moderate hypertension (sitting diastolic blood pressure, 95-115 mm Hg) were enrolled in this prospective, randomized, parallel study. Sitting blood pressure, heart rate, adverse reactions, and serum biochemistry values were assessed during 2 weeks of placebo and 12 weeks of active treatment. Each patient received 50 mg of losartan or 5 mg of felodipine ER once daily, and the dosage was adjusted to double the initial level at week 6 if necessary. Of the 44 patients randomly allocated to receive losartan (n = 23) or felodipine (n = 21) therapy, 37 completed the study; three patients in the losartan group and four in the felodipine group withdrew because of adverse experiences, or were lost to follow-up. The mean reductions in sitting diastolic blood pressure at 6 and 12 weeks were significant with both losartan (-8.6 and -11.38 mm Hg, respectively) and felodipine (-9.2 and -10.69 mm Hg, respectively), and did not differ significantly between the two groups. Both losartan and ER felodipine were well tolerated by patients. However, the ER felodipine group had a significantly higher rate of drug-related flushing than the losartan group (24% vs 0%, p = 0.022). The results indicate that once-daily administration of losartan is as effective and well tolerated as once-daily ER felodipine in blood pressure reduction.     

Magnesium supplementation during pregnancy: a double-blind randomized controlled clinical trial

Four hundred young normotensive primigravid women between 13 and 24 weeks' gestation were randomly allocated to one of two study groups. One group received placebo tablets and the other group received 365 mg of elemental magnesium daily (as magnesium aspartate hydrochloride). Three hundred seventy-four patients completed the study, 189 in the placebo group and 185 in the treatment group. There were no significant differences between the two groups regarding serum calcium, uric acid, or electrolyte levels. However, the magnesium-supplemented group had significantly higher magnesium levels at delivery (1.68 +/- 0.03 mg/dl vs. 1.56 +/- 0.03 mg/dl, p less than 0.01). There were no significant differences in either systolic or diastolic blood pressures between both groups either at time of enrollment or at subsequent gestational ages later during pregnancy. Analysis of variance for repeated measurements and Fisher's least significant difference testing indicated a significant increase (p less than 0.01) in blood pressure from the level at the time of enrollment to the level achieved at or beyond 37 weeks' gestation in each group. There were no significant differences between the two groups regarding any of the following parameters: incidences of preeclampsia, fetal growth retardation, preterm labor, birth weight, gestational age at delivery, or number of infants admitted to the special care unit. Magnesium supplementation during pregnancy did not improve pregnancy outcome in our population.     

Sex hormone-binding globulin in gestational diabetes

BACKGROUND: Insulin is an important regulator of serum sex hormone-binding globulin (SHBG) concentration which works by inhibiting its production in hepatocytes. Low SHBG level is associated with increased insulin resistance and hyperinsulinemia. Our purpose was to compare maternal serum SHBG level between normal and gestational diabetic pregnant women and to study the relationships between SHBG, SHBG/insulin and SHBG/glucose ratio and several endocrine, metabolic and clinical parameters. METHODS: Serum SHBG concentrations were measured in 34 women with gestational diabetes and in 32 matched controls. Glucose, insulin, C-peptide, fructosamine, beta-HCG, cholesterol, triglycerides, HDL cholesterol, LDL cholesterol, apolipoprotein A, apolipoprotein B, total and free T4, total and free estriol, T3 and IGF-1 were measured. Insulin sensitivity was estimated using the short insulin tolerance test. RESULTS: SHBG, SHBG/insulinemia ratio and SHBG/glucose ratio were significantly lower in the diabetic group (309.54 +/- 112.22 vs 460.54 +/- 144.54, p = 0.00001), (33.55 +/- 16.62 vs 72.56 +/- 66.50, p = 0.0006 using log-transformed values), (5.88 +/- 1.87 vs 3.39 +/- 1.23, p < 0.00001). SHBG was negatively correlated with insulinemia (r = -0.40, p = 0.001), C-peptide (r = -0.41, p = 0.001), glycemia (r = -0.27, p = 0.02), diastolic blood pressure (r = -0.41, p = 0.001) and beta-HCG (r = -0.41, p = 0.001) and positively correlated with LDL-c (r = 0.25, p = 0.04) and apolipoprotein B (r = 0.33, p = 0.007). CONCLUSIONS: SHBG concentrations are lower in gestational diabetic pregnant women and are related to insulin levels but not to peripheral insulin sensitivity. Since insulinemia was similar in normal and gestational diabetic pregnant women, we speculate that gestational diabetes is characterized by a higher peripheral insulin resistance, a fasting normal insulinemia and a higher hepatic insulin sensitivity, at least in other actions than on carbohydrate metabolism. The role of sex steroids, T4 and IGF-1 in regulating SHBG appears to be limited during pregnancy.     

Insulin-like growth factor 1 and its binding protein 1 during normal and diabetic pregnancies.

Investigations of circulating insulin-like growth factor 1, hPL, and infant size during pregnancy in normal and insulin-dependent diabetic women have yielded conflicting results and have not been analyzed longitudinally. We studied serial changes in maternal serum insulin-like growth factor 1 levels (measured by radioimmunoassay after acid ethanol extraction) throughout pregnancy in 22 normal women and in 38 with insulin-dependent diabetes. The diabetic women had significantly lower serum insulin-like growth factor 1 concentrations than normal women throughout pregnancy and after delivery, although the rates of change in both groups of women were similar. Within-patient analysis showed a significant decrease in serum insulin-like growth factor 1 between 6-12 weeks' gestation and a significant increase between 24-32 weeks, followed by a significant decrease from 36 weeks' gestation to 12 weeks after delivery. Incremental changes in insulin-like growth factor 1 between 24-32 weeks' gestation correlated significantly with incremental changes in hPL (r = 0.40; P less than .001) and with birth weight (r = 0.37; P less than .01), but not with ultrasound measurements of fetal growth. The correlation of increments in insulin-like growth factor 1 and birth weight became nonsignificant when the association of hPL with both insulin-like growth factor 1 and birth weight was taken into account. Neither insulin-like growth factor binding protein 1 (placental protein 12) nor its ratio to insulin-like growth factor 1 showed any association with infant size. The physiologic changes in maternal serum insulin-like growth factor 1 in pregnant diabetic women do not appear related to the increased birth weight of their infants.     

Pregnancy and severe chronic hypertension: maternal outcome.

OBJECTIVE: To determine the maternal outcome associated with severe chronic hypertension during the second half of pregnancy. METHODS: An analysis of data obtained of women with severe chronic hypertension (> or = 160/110 mm Hg) and > or = 20 weeks' gestation who were hospitalized and delivered during a 5-year period. The pregnancy outcome data were collected retrospectively from medical records. Each patient was observed closely throughout hospitalization with intensive monitoring of the clinical status of both mother and fetus. Antihypertensive drugs were used for systolic or diastolic blood pressure > or = 160 and > or = 110 mm Hg, respectively. Women with superimposed preeclampsia received magnesium sulfate. The main outcome measures were peak of blood pressure, superimposed preeclampsia, and major maternal complications. RESULTS: Of 154 women studied, 111 (72%) had pregestational chronic hypertension, and 120 (78%) developed superimposed preeclampsia. The mean weeks' gestation was 34.5 +/- 4.6. Overall, 110 (71.4%) pregnancies were delivered by cesarean section. Maternal age and parity were significantly higher among women who had pregestational chronic hypertension than those who had chronic hypertension diagnosed during the first half of pregnancy. Abruptio placentae (8.4%), HELLP syndrome (8.4%), acute renal insufficiency (3.9%), pulmonary edema (1.3%), and postpartum hypertensive encephalopathy (1.3%) were the most frequent maternal complications. There were no maternal deaths, disseminated intravascular coagulation, or eclampsia. CONCLUSION: Three-quarters of women with severe chronic hypertension in the second half of pregnancy developed superimposed preeclampsia. Intensive monitoring of the clinical status of the mother was associated with low maternal morbidity and the absence of maternal deaths. Pregestational chronic hypertension does not change the maternal prognosis.     

Management of women with one abnormal oral glucose tolerance test value reduces adverse outcome in pregnancy

In this study we sought to test the hypothesis that treatment of women with one abnormal oral glucose tolerance test value will result in reduction of adverse outcome. One hundred twenty-six women with one abnormal oral glucose tolerance test value and 146 women in the control group (normal oral glucose tolerance test values) participated in a prospective study during the third trimester of pregnancy. The subjects with one abnormal test result were randomized into treated (group 1) and untreated groups (group II). Group 1 subjects were treated with a strict diabetic protocol to maintain tight glycemic control by means of diet and insulin therapy. Group 2 subjects tested their capillary blood glucose for a baseline period. The study revealed that the level of glycemic control was similar before initiation of therapy (mean capillary blood glucose 118 +/- 14 vs. 119 +/- 15 mg/dl, p = NS) for groups 1 and 2, respectively. There was a significant difference in mean capillary blood glucose (95 +/- 10 vs. 119 +/- 15 mg/dl, p less than 0.0001), preprandial, and postprandial determinations between the treated and untreated groups. The overall incidence of neonatal metabolic complications (4% vs. 14%, p less than 0.05) and large infants (6% vs. 24%, p less than 0.03) was significantly lower in the treated group. Comparison between the control (normal oral glucose tolerance test) and the untreated groups showed a significantly higher incidence of large infants and metabolic complications. No difference was found between the normal and treated groups. Thus we conclude that treatment of individuals with one abnormal oral glucose tolerance test value will result in significant reduction in adverse outcome in pregnancy.     

The effect of hospitalisation on ambulatory blood pressure in pregnancy

METHODS: Twenty-four-hour ambulatory blood pressure monitoring was performed on 40 women (20 hypertensive, 20 normotensive) on a hospitalised and non-hospitalised day. Mean blood pressure differences were calculated for the awake, sleeping and 24-hour periods on both days. RESULTS: Mean heart rate was higher at home (1.79, p = 0.04) than in hospital, but there were no significant differences in mean systolic (1.30 mmHg, p = 0.06), diastolic (0.78 mmHg, p = 0.21) or mean arterial blood pressure (0.81 mmHg, p = 0.19) between the hospitalised and non hospitalised day for the group overall. Nevertheless, the range of individual responses was wide (-8.5 mmHg to 15.4 mmHg mean arterial blood pressure). Hypertensive women receiving antihypertensive therapy had significantly greater differences in mean arterial blood pressure between the hospital and non-hospital day when compared to the rest of the group (5.8 mmHg, compared to 3.3 mm Hg, p = 0.02). CONCLUSIONS: Although hospitalisation does not significantly lower blood pressure in pregnant women as a group, women receiving antihypertensive therapy demonstrate significant differences in blood pressure between hospital and home. Based on conventional blood pressure measurements alone, these women may be at risk of either under treatment, or over treatment, of blood pressure.     

Should the definition of preeclampsia include a rise in diastolic blood pressure of >/=15 mm Hg to a level <90 mm Hg in association with proteinuria?

OBJECTIVE: This study was undertaken to compare baseline characteristics and pregnancy outcomes between normotensive women who did and those who did not have a rise in diastolic blood pressure of >/=15 mm Hg in association with proteinuria. STUDY DESIGN: We studied 4302 healthy nulliparous women from the Calcium for Preeclampsia Prevention trial who were delivered at >/=20 weeks' gestation. We selected as the study group normotensive women who developed proteinuria within 7 days of a rise in diastolic blood pressure of >/=15 mm Hg with respect to baseline on 2 occasions 4 to 168 hours apart. Baseline blood pressure was the mean of measurements at 2 clinic visits before 22 weeks' gestation. Other normotensive women used for comparison were those who did not develop gestational hypertension or a rise in diastolic blood pressure of >/=15 mm Hg in association with proteinuria. RESULTS: Except for greater weight (P <.001), body mass index (P <.001), and systolic blood pressure (P =.05) the baseline characteristics of the 82 women with a rise in diastolic blood pressure of >/=15 mm Hg in association with proteinuria did not differ significantly from those of the other normotensive women. Although they had a greater rate of weight gain (P <.005), larger babies (P =.06), and a 2-fold increase in abdominal delivery (P <.001), there was little other evidence of adverse pregnancy outcomes among these women. CONCLUSION: During normotensive pregnancy a rise in diastolic blood pressure of >/=15 mm Hg in association with proteinuria appears to be benign and is not a useful clinical construct.     

High incidence of respiratory distress syndrome (RDS) in infants born to mothers with placenta previa

OBJECTIVE: To evaluate the incidence of respiratory distress syndrome (RDS) in infants born to mothers with placenta previa and to assess the risk factors for RDS. METHODS: Ninety-nine pregnant women with placenta previa who delivered by cesarean section at 30-35 weeks of gestation were compared retrospectively with 102 pregnant women matched for week of gestation and birth year, who underwent elective cesarean section. Maternal characteristics, neonatal outcome, and incidence of RDS were analyzed. Umbilical cord blood samples were collected at delivery and were used to determine cortisol, epinephrine, and norepinephrine levels. Student's t-test, the chi-square test, and Fisher's exact test were used for statistical comparisons. P < 0.05 was considered significant. The Mann-Whitney U test was used for comparison of continuous variables. RESULTS: Preeclampsia, histological chorioamnionitis, and premature rupture of membranes were significantly lower in the placenta previa group (placenta previa: 2.0% vs. control: 14.7%, P < 0.01; 14.1% vs. 30.1%, P < 0.01; 7.1% vs. 17.6%, P < 0.05, respectively). The incidence of RDS was significantly higher in the placenta previa group than in the control group (29.3% vs. 6.9%, P < 0.0001). The cortisol level in umbilical cord blood in the placenta previa group was lower than in the control group (median 7.3, range 4.4-14.9 microg/dl vs. median 10.6, range 4.9-30.3 microg/dl, P < 0.05). There were no significant differences in epinephrine or norepinephrine levels between the two groups. CONCLUSIONS: The incidence of RDS in infants delivered at 30-35 weeks' gestation by cesarean section was significantly higher in mothers with placenta previa than in women without placenta previa. This may reflect decreased fetal stress since the cord blood cortisol levels were found to be lower in women with placenta previa.     

A comparison of no medication versus methyldopa or labetalol in chronic hypertension during pregnancy

Three hundred women with mild chronic hypertension at 6 to 13 weeks' gestation were randomly allocated to receive either methyldopa or labetalol or be in the control group. Thirty-seven women (12%) were excluded for various reasons. Of the remaining 263 patients, 90 received no drug, 87 received methyldopa, and 86 received labetalol. All 263 were followed throughout pregnancy with serial renal function tests and serial assessment of fetal status. There were no differences among the three groups in mean systolic or diastolic blood pressures, mean gestational age, or initial laboratory findings at time of entry. Patients treated with medications had significantly lower (p less than 0.0001) systolic and diastolic blood pressures throughout gestation compared with the no-medication group. Among the control group there was a spontaneously significant lowering (p less than 0.0001) of both systolic and diastolic blood pressures at 14 to 26 weeks' gestation. However, there were no differences among the three groups regarding the incidences of either superimposed preeclampsia (15.6%, 18.4%, and 16.3%, respectively), abruptio placentae (2.2%, 1.1%, and 2.3%, respectively), or preterm delivery (10%, 12.5%, and 11.6%, respectively). In addition, there were no differences among the groups regarding gestational age at delivery, birth weight, incidence of fetal growth retardation, or neonatal head circumference. There was one midtrimester loss in the methyldopa group and one stillbirth in each of the other groups. We conclude that treatment of maternal blood pressure in mild chronic hypertension during pregnancy did not improve perinatal outcome.     

Placental lactogen,progesterone, total estriol and prolactin plasma levels in pregnant women with insulin-dependent diabetes mellitus

Fifteen insulin-dependent diabetic (White's class B-C) and 10 healthy pregnant women were examined from the 12th to the 36th wk. Every 4 wk, a blood sample was drawn to determine total estriol, progesterone, placental lactogen and prolactin.Throughout the pregnancy, total estriol and progesterone in diabetic and non-diabetic women are very similar. On the contrary, the PRL levels are constantly lower in diabetic pregnant women, even though the difference is statistically significant only for the 24th wk determination. The hPL level is instead significantly lower in diabetic pregnant women at the 12th, 20th, 24th, 32nd and 36th wk. A negative correlation exists between the hPL value and the mean blood glucose level, performed the same day as the hormonal test. This correlation is statistically significant at the 12th, 16th, 20th, 28th and 36th wk. No significant difference is found between the two groups examined for the delivery week, the placental weight, the birth weight and the fetal body weight index.To conclude, while estriol and progesterone are not affected by the higher variability of glucose levels during pregnancy in diabetics, compared to normals, hPL and perhaps also PRL may be influenced by the mild hyperglycemia consequent to diabetes.     

The Alabama Preterm Birth Study: diffuse decidual leukocytoclastic necrosis of the decidua basalis, a placental lesion associated with preeclampsia, indicated preterm birth and decreased fetal growth.

OBJECTIVE: Laminar necrosis, a band-like distribution of coagulative necrosis, has been reported at the choriodecidual interface of the free membranes of placentas of women with various adverse neonatal outcomes. Our goal in this study was to evaluate the frequency of an equivalent feature in the decidua basalis, diffuse decidual leukocytoclastic necrosis (DDLN), a diffuse coagulative necrosis admixed with karyorrhectic debris, in preterm births <32 weeks, and to determine its association with various obstetric conditions, markers of placental inflammation, and newborn outcome. STUDY DESIGN: Four hundred and forty-six mother/infant dyads who delivered between 23 and 32 weeks gestational age (GA) had their medical records abstracted, a variety of placental and cord blood cultures performed, cord interleukin-6 (IL-6) levels determined, and the placentas evaluated histologically by a single pathologist (OFP). RESULTS: Women with DDLN (27%) were significantly more likely than other women to have preeclampsia (57.6 vs. 24.8%, p < 0.0001), an indicated preterm birth in this pregnancy (61.9 vs. 26.4%, p < 0.0001), and a prior indicated preterm birth (12.7 vs. 4.1%, p = 0.001), but were not more likely to have an abruption, diabetes, to smoke or be Black. Among DDLN-positive vs. DDLN-negative women, birth weight was significantly lower (1,069 +/- 373 vs. 1,171 +/- 389 g, p = 0.014), despite the GAs being similar (28.6 +/- 2.2 vs. 28.6 +/- 2.3 weeks, p = NS). Women with DDLN were less likely to have a positive placental culture for any organism (50.0 vs. 61.3%p = 0.03), Ureaplasma urealyticum and Mycoplasma hominis in either the placenta or cord blood (29.7 vs. 42.1%, p = 0.02), or an elevated cord blood IL-6 (21.5 vs. 32.9%, p = 0.059). They also were less likely to have acute inflammation of the membranes (27.4 vs. 56.4%, p < 0.0001), chorionic plate (17.0 vs. 48.6%, p < 0.0001) or cord (15.7 vs. 36.6%, p < 0.0001). Decidual necrosis in the free membranes also occurred more frequently in the presence vs. absence of DDLN (25.2 vs. 9.2%, p < 0.0001). Infants whose placentas had DDLN were significantly less likely to have neonatal systemic inflammatory response syndrome (20.7 vs. 35.2%, p = 0.004), but were not significantly different for other neonatal outcomes including respiratory distress syndrome, intraventricular hemorrhage or death. CONCLUSION: DDLN of the decidua basalis is relatively common in placentas of 23-32 week newborns, and, when present, is inversely associated with inflammatory maternal and newborn conditions and positively associated with preeclampsia, indicated preterm birth, and lower birth weight. The positive correlation of DDLN with obstetrical and neonatal conditions associated with underperfusion of the placental bed, suggests that DDLN may be a marker of vascular compromise.     

Renal function in the newborn. Newborn creatinine related to birth weight, maturity and maternal creatinine

The maternal and newborn renal function in 84 normal pregnant women delivering at term was investigated. There was no difference between maternal and newborn plasma concentrations of urea (3.9 +/- 1.0 vs. 3.9 +/- 1.2 mmol/l) and creatinine (65.8 +/- 13.3 vs. 65.3 +/- 11.6 mumols/l). The plasma sodium and potassium concentrations were significantly higher in the newborn (139.6 +/- 4.1 vs. 136.8 +/- 5.1 mmol/l, p less than 0.001, and 5.1 +/- 1.3 vs. 4.2 +/- 0.9 mmol/l, p less than 0.001, respectively). Significant correlations were found between newborn sodium (p less than 0.02) and potassium (p = 0.0001) with maternal potassium concentrations, newborn urea with maternal urea concentrations (p = 0.0001), and newborn creatinine with maternal creatinine concentrations (p = 0.0001), gestation of delivery (p less than 0.05) and birth weight (p = 0.025).     

Uterine artery Doppler velocimetry in patients with idiopathic hydramnios.

OBJECTIVE: To evaluate the role of overdistended uterus on the uterine artery (UA) blood flow velocimetry by comparing UA Doppler in patients with idiopathic hydramnios to patients with normal amniotic fluid (AF) volume. METHODS: Pulsatility index (PI) of both UAs was determined prospectively between 26 and 41 weeks of gestation in 72 consecutive pregnant women with singleton pregnancies and idiopathic hydramnios and in 72 pregnant women with normal AF volume. Hydramnios was defined as an AF index (AFI) above 24 cm. A normal amount of AF was defined as an AFI of 6-24 cm. Patients with known fetal structural or chromosomal anomalies and those with diabetes mellitus were excluded. RESULTS: No significant differences were observed between the groups with regard to maternal age, gravidity, and gestational age at examination. Gestational age at delivery and accordingly birth weight were significantly lower in patients with hydramnios compared to those with a normal AFI (34.9 +/- 2.1 vs. 39.1 +/- 1.2, p < 0.001; 2,508 +/- 399 vs. 2,995 +/- 420, p < 0.001, respectively). No significant differences were noted between right UA PI (0.73 +/- 0.3 in the hydramnios group vs. 0.71 +/- 0.2 in the control group; p = 0.091) and left UA PI (0.91 +/- 0.3 in the hydramnios group vs. 0.84 +/- 0.3 in the control group; p = 0.131) of both groups. CONCLUSION: UA velocimetry in patients with idiopathic hydramnios was not significantly different from those with a normal AF volume.