Low dose acetylsalicylic acid in prevention of pregnancy-induced hypertension and intrauterine growth retardation in women with bilateral uterine artery notches

Objective To evaluate the efficacy of low-dose acetylsalicylic acid in the prevention of pregnancy-induced hypertension and intrauterine growth retardation in high-risk pregnancies as determined by transvaginal Doppler ultrasound study of the uterine arteries at 12 to 14 weeks of gestation.
Design Randomised, double blind and placebo-controlled trial.
Setting The Department of Obstetrics and Gynaecology, Tampere University Hospital, Finland.
Population One hundred and twenty pregnant women considered to be at high risk of pre-eclampsia or intrauterine growth retardation were screened by transvaginal Doppler ultrasound at 12 to 14 weeks of gestation.
Methods Ninety pregnant women with bilateral notches in the uterine arteries were randomised to receive acetylsalicyclic acid 0.5mg/kg/day (   n = 45  ) or placebo (   n = 45  ) from 12 to 14 weeks of gestation.
Main outcome measures Hypertensive disorders of pregnancy and intrauterine growth retardation.
Results Forty-three women on acetylsalicyclic acid and 43 on placebo were successfully followed up. The use of acetylsalicyclic acid was associated with a statistically significant reduction in the incidence of pregnancy-induced hypertension (  11.6% vs 37.2%, RR = 0.31, 95% CI 0.13–0.78  ) and pre-eclampsia (  4.7% vs 23.3%, RR = 0.2, 95% CI 0.05–0.86  ). The incidence of hypertension before 37 weeks of pregnancy was also significantly reduced (  2.3% vs 20.9%, RR = 0.22, 95% CI 0.05–0.97  ). The reduction in the incidence of intrauterine growth retardation (2.3% vs 7%) was not statistically significant. Acetylsalicyclic acid was not associated with excess risk of maternal or fetal bleeding.
Conclusion In women rated in Doppler velocimetry waveform analysis to be at high risk of pre-eclampsia, low-dose acetylsalicyclic acid reduces the incidence of pregnancy-induced hypertension and especially proteinuric pre-eclampsia.     

Does leisure time physical activity in early pregnancy protect against pre-eclampsia? Prospective cohort in Danish women

Objective  To examine the association between physical activity in early pregnancy and risk of pre-eclampsia.
Design  Prospective cohort.
Setting  Denmark.
Population  A total of 85 139 pregnant Danish women, recruited between 1996 and 2002.
Methods  The authors assessed leisure time physical activity in first trimester by a telephone interview and categorised women a priori into seven groups: 0 (reference), 1–44, 45–74, 75–149, 150–269, 270–419 and 420+ minutes/week. Pre-eclampsia diagnoses were extracted from the Danish National Patient Registry. A number of potential confounders were adjusted for by logistic regression.
Main outcome measures  Pre-eclampsia and severe pre-eclampsia.
Results  The two highest physical activity levels were associated with increased risk of severe pre-eclampsia compared with the nonexercising group, with adjusted odds ratios of 1.65 (95% CI: 1.11–2.43) and 1.78 (95% CI: 1.07–2.95), whereas more moderate levels of physical activity (1–270 minutes/week) had no statistically significant association with risk of pre-eclampsia (total n = 85 139).
Conclusions  We were unable to document a protective effect of leisure time physical activity against pre-eclampsia. Our data even suggest that leisure time physical activity exceeding 270 minutes/week in first trimester may increase risk of severe pre-eclampsia.     

The recurrence risk of severe de novo pre-eclampsia in singleton pregnancies: a population-based cohort

Objective  Previous studies have found recurrence risks of severe pre-eclampsia as high as 40%. Our objective was to determine both the recurrence risk of severe de novo pre-eclampsia and risk factors associated with it in a contemporaneous population.
Study design  Population-based retrospective cohort study.
Population  Women who had two or more singleton liveborn or stillborn hospital deliveries in Ontario, Canada between April 1994 and March 2002 and without a history of chronic hypertension
Methods  International Classification of Disease codes were used to identify patients in the Canadian Institute for Health Information Discharge Abstract Database.
Main outcome measures  The absolute and adjusted risks of recurrent severe de novo pre-eclampsia were determined.
Results  Between 1 April 1994 and 30 March 2002, there were 185 098 women with two or more singleton deliveries >20 weeks in the province of Ontario, Canada. There were 1954 women who had severe de novo pre-eclampsia in the index pregnancy, 133 of whom had recurrent severe pre-eclampsia, for a risk of recurrent severe pre-eclampsia of 6.8% (95% CI 5.7–7.9%). The risk of recurrent severe de novo pre-eclampsia was increased in women with pre-existing renal disease (adjusted OR 17.98, 95% CI 3.50–92.52) and those >35 years of age (adjusted OR 3.79, 95% CI 2.04–7.04, reference 20–25 years).
Conclusions  The recurrence risk of severe de novo pre-eclampsia in our population-based cohort study (6.8%) is lower than previously published reports in selected populations.     

Twin mothers, pregnancy hypertension and pre-eclampsia

Objective To estimate the maternal genetic contribution to the hypertensive diseases of pregnancy.
Design A cohort study of female twins with information on hypertensive diseases of pregnancy obtained by questionnaire screening, and verification of diagnosis from hospital or general practitioner records.
Setting A volunteer twin registry in the UK with recruitment through the media without reference to pregnancies or disease status.
Population Adult female, same-sex twin pairs who completed a pregnancy history questionnaire and consented to record inspection.
Main outcome measure Self-reported and hospital-validated diagnosis of non-proteinuric pregnancy hypertension and of pregnancy hypertension with proteinuria (pre-eclampsia).
Results Self-reported pre-eclampsia had a heritability of 0.221 and non-proteinuric hypertension of 0.198. However, none of the pairs who were self-reported as concordant for pre-eclampsia were confirmed from hospital records. Using hospital records, the heritability of pre-eclampsia was 0 and 0.375 for non-proteinuric hypertension. Using a model treating pre-eclampsia as a separate disease from non-proteinuric hypertension, and assuming that the next pair identified was both monozygotic and concordant for pre-eclampsia, the estimated heritability of pre-eclampsia remained 0 (95% CI 0–0.49). Using a threshold model in which non-proteinuric hypertension is treated as a mild form of pre-eclampsia, heritability is estimated at 0.247 (95% CI 0.23–4.454).
Conclusion Neither non-proteinuric hypertension nor pre-eclampsia are inherited in simple Mendelian fashion. The genetic contribution to multi-factorial inheritance is smaller than hitherto believed.     

World Health Organisation multicentre randomised trial of supplementation with vitamins C and E among pregnant women at high risk for pre-eclampsia in populations of low nutritional status from developing countries

Objective  To determine if vitamin C and E supplementation in high-risk pregnant women with low nutritional status reduces pre-eclampsia.
Design  Multicentred, randomised, controlled, double-blinded trial.
Setting  Antenatal care clinics and Hospitals in four countries.
Population  Pregnant women between 14 and 22 weeks' gestation.
Method  Randomised women received 1000 mg vitamin C and 400 iu of vitamin E or placebo daily until delivery.
Main outcome measures  Pre-eclampsia, low birthweight, small for gestational age and perinatal death.
Results  Six hundred and eighty-seven women were randomised to the vitamin group and 678 to the placebo group. Groups had similar gestational ages (18.1; SD 2.4 weeks), socio-economic, clinical and demographical characteristics and blood pressure at trial entry. Risk factors for eligibility were similar, except for multiple pregnancies: placebo group (14.7%), vitamins group (11.8%). Previous pre-eclampsia, or its complications, was the most common risk factor at entry (vitamins 41.6%, placebo 41.3%). Treatment compliance was 87% in the two groups and loss to follow-up was low (vitamins 2.0%, placebo 1.3%). Supplementation was not associated with a reduction of pre-eclampsia (RR: 1.0; 95% CI: 0.9–1.3), eclampsia (RR: 1.5; 95% CI: 0.3–8.9), gestational hypertension (RR: 1.2; 95% CI: 0.9–1.7), nor any other maternal outcome. Low birthweight (RR: 0.9; 95% CI: 0.8–1.1), small for gestational age (RR: 0.9; 95% CI: 0.8–1.1) and perinatal deaths (RR: 0.8; 95% CI: 0.6–1.2) were also unaffected.
Conclusion  Vitamins C and E at the doses used did not prevent pre-eclampsia in these high-risk women.     

Obstetric outcomes subsequent to intrauterine death in the first pregnancy

Objective  To compare obstetric outcomes in the pregnancy subsequent to intrauterine death with that following live birth in first pregnancy.
Design  Retrospective cohort study.
Setting  Grampian region of Scotland, UK.
Population  All women who had their first and second deliveries in Grampian between 1976 and 2006.
Methods  All women delivering for the first time between 1976 and 2002 had follow up until 2006 to study their next pregnancy. Those women who had an intrauterine death in their first pregnancy formed the exposed cohort, while those who had a live birth formed the unexposed cohort.
Main outcome measures  Maternal and neonatal outcomes in the second pregnancy, including pre-eclampsia, placental abruption, induction of labour, instrumental delivery, caesarean delivery, malpresentation, prematurity, low birthweight and stillbirth.
Results  The exposed cohort ( n = 364) was at increased risk of pre-eclampsia (OR 3.1, 95% CI 1.7–5.7); placental abruption (OR 9.4, 95% CI 4.5–19.7); induction of labour (OR 3.2, 95% CI 2.4–4.2); instrumental delivery (OR 2.0, 95% CI 1.4–3.0); elective (OR 3.1, 95% CI 2–4.8) and emergency caesarean deliveries (OR 2.1, 95% CI 1.5–3.0); and prematurity (OR 2.8, 95% CI 1.9–4.2), low birthweight (OR 2.8, 95% CI 1.7–4.5) and malpresentation (OR 2.8, 95% CI 2.0–3.9) of the infant as compared with the unexposed cohort ( n = 33 715). The adjusted odds ratio for stillbirth was 1.2 and 95% CI 0.4–3.4.
Conclusion  While the majority of women with a previous stillbirth have a live birth in the subsequent pregnancy, they are a high-risk group with an increased incidence of adverse maternal and neonatal outcomes.     

A randomised trial of low dose aspirin for primiparae in pregnancy

Objective To investigate whether low dose aspirin medication given to primiparous women provides benefit in preventing pre-eclampsia or intrauterine growth retardation.
Design Randomised double-blind controlled trial of low dose aspirin and placebo in pregnancy.
Population Residents of the parishes of Kingston and St Andrew, Jamaica; 6275 primiparae enrolled between 12 and 32 weeks of gestation.
Main outcome measures Hypertensive disorders of pregnancy (including pre-eclampsia and eclampsia), preterm delivery, and low birthweight. In addition, to assess whether enrolment early, rather than late had more beneficial effect. Possible adverse effects on the woman and her infant were monitored.
Results Of enrolled primiparae, 97% were followed throughout pregnancy. There were no differences between those on aspirin and those on placebo in the development of hypertensive disorders (e.g. for a rise in diastolic pressure of 25 mmHg the odds ratio [OR] was 1.02 [95% CI 0.86–1.211; for proteinuric pre-eclampsia OR 1.15 [95% CI 0.92–1.44]; eclampsia OR 0.82 [95% CI 0.44–1.531); except for oedema which was significantly less prevalent in those on aspirin (OR 0.85 [95% CI 0.75–0.961). Women on aspirin were not significantly less likely to deliver preterm (OR 0.93 [95% CI 0–79-1.091) or have a larger fetus (mean birthweight difference 18 g [95% CI -9 to 451). They were, however, significantly more likely to suffer from bleeding disorders antenatally, intrapartum and postpartum; for postpartum haemorrhage OR 1.40 (95% CI 1.13–1-73).
Conclusions This trial shows that low dose aspirin has no consistent beneficial effect in primiparae.     

The effect of recurrent miscarriage and infertility on the risk of pre-eclampsia

Objective  Pre-eclampsia, recurrent miscarriage and infertility may all partly be caused by unsuccessful placentation early in pregnancy. If so, one will expect these disorders to be associated in population studies. The aim of the present investigation was to estimate the risk of pre-eclampsia in women with recurrent miscarriage and infertility.
Design  Cohort study.
Setting  The Norwegian Mother and Child Cohort Study (MoBa), a large population-based pregnancy cohort.
Sample  The sample consisted of 20 846 singleton pregnancies to nulliparous women participating in the MoBa, 1999–2005.
Methods  Information on miscarriage, infertility and potential confounders was self-reported in postal questionnaires, whereas the diagnosis of pre-eclampsia was retrieved from the Medical Birth Registry of Norway. Risk estimation and confounder control was performed with multiple logistic regression.
Main outcome measures  Pre-eclampsia according to history of miscarriage and infertility.
Results  An increased risk of pre-eclampsia, although not statistically significant, was found for women with recurrent miscarriages (adjusted OR 1.51, 95% CI 0.80–2.83). Women who had ever been treated for infertility also had increased risk (adjusted OR 1.29, 95% CI 1.05–1.60). When these two risk factors were combined, the adjusted odds ratio for pre-eclampsia was 2.40 (95% CI 1.11–5.18).
Conclusions  The study supports the hypothesis that infertility, recurrent miscarriage and pre-eclampsia share elements of the same aetiological factors.     

Magnesium sulphate in the treatment of eclampsia and pre-eclampsia: an overview of the evidence from randomised trials

Objective To evaluate the effectiveness of magnesium sulphate in the treatment of eclampsia and pre-eclampsia by a systematic quantitative overview of controlled clinical trials.
Design Online searching of the MEDLINE database between 1966 and 1995, and scanning of the bibliography of known primary studies and review articles on the use of magnesium sulphate in eclampsia and pre-eclampsia. Study selection, study quality assessment and data extraction were performed independently by two reviewers under masked conditions. Where possible outcome data from trials were pooled and summarised using the Mantel-Haenszel method.
Participants One thousand seven hundred and forty-three women with eclampsia and 2390 with pre-eclampsia included in nine randomised trials that evaluated the effects of magnesium sulphate.
Main outcome measures Seizure activity and maternal death.
Results In eclampsia, recurrence of seizures was less common with magnesium sulphate therapy compared with phenytoin (odds ratio [OR] 0.27, 95% CI 0.17.0.45,   P = 0.00  ) and diazepam (OR 0–41, 95% CI 0.30–0.57,   P = 0.00  ). As indicated by the point estimate, there was a trend towards a reduction in maternal mortality with magnesium sulphate in eclampsia (OR 0.51,95% CI 0.24–1.07,   P = 0.10  versus phenytoin; OR 0.78, 95% CI 0.41–1.45,   P = 0.52  versus diazepam). When used for seizure prophylaxis in pre-eclampsia, magnesium sulphate was found to be more effective than phenytoin (OR 0.15, 95% CI 0.03–0.72,   P = 0.01  ).
Conclusion Magnesium sulphate is a superior drug in preventing the recurrence of seizures in eclampsia and in seizure prophylaxis in pre-eclampsia.     

Complications during pregnancy in women with epilepsy: population-based cohort study

Objective  To investigate whether women with epilepsy have an increased risk of complications during pregnancy and to explore the impact of antiepileptic drug (AED) use.
Design  Population-based cohort study.
Setting  Data from Medical Birth Registry of Norway based on all births in Norway 1999–2005.
Population  All births ( n  = 372 128) delivered in Norway, ensured through linkage with the National Population Registry run by Statistics Norway. All singleton births and the first child in multiple pregnancies were included, leaving 365 107 pregnancies for analyses.
Main outcome measures  Pre-eclampsia (mild and severe), gestational hypertension, eclampsia, vaginal bleeding (early and late) and preterm birth.
Results  We compared 2805 pregnancies in women with a current or past history of epilepsy (0.8%) and 362 302 pregnancies in women without a history of epilepsy. Women with epilepsy had an increased risk of mild pre-eclampsia, [odds ratio 1.3: 95% confidence interval (1.1–1.5)] and delivery before week 34 [1.2: (1.0–1.5)].
Antiepileptic drugs were used in 33.6% ( n  = 942) of the pregnant women with epilepsy. Compared to women without epilepsy, women with epilepsy and AED use had an increased risk of mild pre-eclampsia [1.8: (1.3–2.4)], gestational hypertension [1.5: (1.0–2.2)], vaginal bleeding late in pregnancy [1.9: (1.1–3.2)], and delivery before 34 weeks of gestation [1.5: (1.1–2.0)]. No significant increase in the risk of these complications was observed in women with epilepsy not using AED. These results remained unchanged after exclusion of multiple pregnancies.
Conclusion  Women with epilepsy have a low complication rate, but special attention should be paid to those using AED during pregnancy.     

Plasma P-selectin is elevated in the first trimester in women who subsequently develop pre-eclampsia

Objective To report plasma concentrations of the adhesion cell molecule P-selectin during pregnancy to determine the effect of subsequent development of hypertension and pre-eclampsia.
Design A longitudinal study.
Methods A longitudinal study involving 70 women followed up from early pregnancy; 20 who subsequently developed pre-eclampsia were compared with 24 who developed gestational hypertension and 26 normotensive women with normal obstetric outcome. The determination of citrate plasma soluble P-selectin levels throughout pregnancy was performed using a commercial quantitative sandwich immunoassay kit. The temporal course of plasma P-selectin in the three groups of subjects was analysed.
Results There was no significant difference in mean plasma P-selectin concentration between normotensive and gestational hypertensive subjects at any stage of pregnancy. Using a cutoff level of 60 ng/mL, P-selectin concentration at 10–14 weeks had a negative predictive value for pre-eclampsia of almost 99%. Mean plasma P-selectin concentrations were significantly elevated by 10–14 weeks in women who later developed pre-eclampsia (   P <0.001  ).
Conclusions Our data support an inflammatory model for pre-eclampsia whereby endothelial cell activation may be secondary to a primary inflammatory response. Plasma P-selectin has significant potential as a first trimester clinical marker of pre-eclampsia.     

A randomised study of misoprostol and gemeprost in combination with mifepristone for induction of abortion in the second trimester of pregnancy

Objective To compare the effectiveness of gemeprost and misoprostol as prostaglandins used in combination with mifepristone for induction of mid-trimester termination.
Design Randomised trial.
Setting Scottish teaching hospital.
Sample One hundred women undergoing abortion between 12 and 20 weeks.
Methods Each woman received 200 mg mifepristone and 36–48 hours later either 1 mg gemeprost vaginal pessary every 6 hours for 18 hours or  4 × 200 μg  misoprostol tablets vaginally followed by  2 × 200 μg  misoprostol tablets orally every 3 hours for 12 hours. Success was defined as the percentage of women aborted within 24 hours of the first administration of prostaglandin.
Main outcome measures Prostaglandin–abortion interval and side effects.
Results There were no significant differences in median prostaglandin–abortion interval between gemeprost (6.6 hours 95% CI 6.0–10.7) and misoprostol (6.1 hours 95% CI 5.5–7.5) (   P = 0.22  ). The cumulative abortion rates at 24 hours (96% vs 94%, respectively), the surgical evacuation rates (12% and 10%) and the incidence of vomiting, diarrhoea and pain were similar.
Conclusion Two hundred milligrammes of mifepristone followed 36–48 hours later by either vaginal gemeprost or misoprostol is a highly effective way of inducing abortion in the second trimester of pregnancy.     

A meta-analysis of low dose aspirin for the prevention of intrauterine growth retardation

Objective To determine more precisely the effect of prophylactic low dose aspirin on intrauterine growth retardation and perinatal mortality.
Design Meta-analysis of 13 published randomised clinical trials.
Methods We searched 18 medical databases, including MEDLINE since 1964 and EMBASE since 1974, review articles and the references from each retrieved report to identify all studies evaluating the effect of aspirin in pregnancy and including both intrauterine growth retardation and perinatal mortality as outcome measures.
Results Among 13,234 women from 13 studies between 1985 and 1994, aspirin showed a significant reduction in intrauterine growth retardation (IUGR) (OR 0.82; 95% CI 0.72–0.93;   P = 0.003  ) and a nonsignificant reduction in perinatal mortality (OR 0.84; 95% CI 0.66–1.08;   P = 0.18  ). Subgroup analyses revealed that aspirin was effective at lower doses between 50 and 80 mg/day (IUGR: OR 0.87; 95% CI 0.76–0.99; mortality: OR 0.90, 95% CI 0.70–1.16), but that the preventive effect was greater at higher doses between 100 and 150 mg/day (IUGR: OR 0.36, 95% CI 0.22–0.59; mortality: OR 0.40, 95% CI 0.16–0.97) and among women entered before the 17th week of gestation (IUGR: OR 0.35, 95% CI 0.21–0.58; mortality: OR 0.43, 95% CI 0.17–1.06). We did not identify any specific subgroup of women most likely to benefit from aspirin treatment.
Conclusion The results of this meta-analysis showed that early aspirin treatment reduced the risk of intrauterine growth retardation. Low dose aspirin should not be used routinely in pregnant women until those most likely to benefit from aspirin treatment have been clearly identified.     

Primipaternity and duration of exposure to sperm antigens as risk factors for pre-eclampsia.

OBJECTIVE: To establish whether primipaternity and duration of unprotected sexual cohabitation is associated with an increased risk of pre-eclampsia. METHOD: At a tertiary referral center, the study had a case and control group of 60 multigravid women each, as well as a case and control group of 50 primigravid women each. Information was compiled by means of a confidential questionnaire. RESULT: After multiple logistic regression analysis using age, smoking, hypertension in previous pregnancies, change of paternity and duration of unprotected sexual cohabitation as predictors, the regression coefficients for change of paternity and sexual cohabitation of longer than 6 months in multigravid women were -0.4 (P = 0.15) and -1.4 (P = 0.03), respectively. CONCLUSION: Multigravid women with a period of unprotected sexual cohabitation of longer than 6 months had a decreased risk of pre-eclampsia. Primipaternity was not a significant risk factor for pre-eclampsia.     

The association of pre-eclampsia with the Duffy negative phenotype in women of West African descent

Objective To investigate whether pre-eclampsia in Curaçao is associated with the Duffy negative phenotype.
Design Retrospective study.
Setting
Population
Methods
Results Women with a history of pre-eclampsia had a higher Duffy negative phenotype frequency compared with women with a history of uncomplicated pregnancies (52.8 vs 27.3%, respectively; odds ratio 2.98; 95% CI 1.40–6.32;   P = 0.004  ).
Conclusions Pre-eclampsia is associated with the Duffy negative phenotype in women of West-African descent in the island of Curaçao.     

Aspirin (100 mg) used for prevention of pre-eclampsia in nulliparous women: the Essai Régional Aspirine Mère-Enfant study (Part 1)

Objective To reduce the incidence of pre-eclampsia in nulliparous women, in accordance with the suggestion of a recent meta-analysis that low dose aspirin might decrease this incidence by more than half if used early enough in and at a sufficient dose during pregnancy (more than 75 mg).
Design Multicentre randomised double-blinded placebo-controlled trial.
Setting Twenty eight centres in Northern of France and one in Belgium.
Population Three thousand and two hundred ninety-four nulliparous women recruited between 14 and 20 weeks.
Methods Randomisation to either 100 mg aspirin or placebo daily from inclusion through 34 weeks.
Main outcome measures Preeclampsia was defined as hypertension (≥140 and or 90 mmHg) associated with proteinuria (≥0.5 g/L).
Results The aspirin (   n = 1644  ) and placebo (   n = 1650  ) groups did not differ significantly in the mothers' incidence of pre-eclampsia (28 of 1632 [1.7%] vs 26 of 1637 [1.6%]; relative risk, RR, 1.08, 95% CI 0.64–1.83), hypertension, HELLP syndrome or placental abruption, or in the children's incidence of perinatal deaths or birthweight below the 10th centile. The incidence of babies with birthweight below the third centile was significantly higher in the aspirin group, with no explanation. The incidence of maternal side effects was higher in the aspirin group, principally because of a significantly higher rate of haemorrhage.
Conclusions Aspirin at a dose of 100 mg does not reduce the incidence of pre-eclampsia in nulliparous women. Aspirin (100 mg) is associated with an increase in bleeding complications.     

Induced abortion and risk of small-for-gestational-age birth

Objective  To investigate the possibility of an association between previous induced abortion and subsequent birth of a small-for-gestational-age (SGA) infant.
Design  Case–control study.
Setting  General and university hospitals.
Methods  Cases were 555 women who delivered SGA babies. Controls were 1966 women who gave birth at term (>37 weeks of gestation) to healthy infants of normal weight on randomly selected days at the hospital where cases had been identified. All women in the case and control categories were interviewed on the obstetric wards by one of a team of six interviewers. During the interviews, information was obtained regarding general socio-demographic factors, personal characteristics and habits, gynaecological and obstetric history, general anamnesis, family history of obstetric and gynaecological diseases, and the age of the father of the child. Further information on current pregnancy and delivery was also collected. We used conditional multiple logistic regression (with age as the matching variable), with maximum likelihood fitting, to obtain odds ratios and their corresponding 95% CIs. Included in the regression equations were terms for education, plus terms significantly associated in this data set with the risk of SGA birth (smoking in pregnancy, history of SGA, gestational hypertension and parity).
Population  Women admitted to a general and a university hospital.
Results  No significant increase in the risk of SGA birth was observed in women with a previous induced abortion [odds ratio (OR) 1.0; 95% CI 0.6–1.7]. The OR for SGA birth was 1.2 (95% CI 0.7–2.1) for preterm and 1.0 (95% CI 0.7–1.4) for term SGA births.
Conclusion  This study found no association between risk of SGA birth and induced abortion.     

Effects of interpregnancy interval and outcome of the preceding pregnancy on pregnancy outcomes in Matlab, Bangladesh

Objective  To estimate the effects on pregnancy outcomes of the duration of the preceding interpregnancy interval (IPI) and type of pregnancy outcome that began the interval.
Design  Observational population-based study.
Setting  The Maternal Child Health–Family Planning (MCH–FP) area of Matlab, Bangladesh.
Population  A total of 66 759 pregnancy outcomes that occurred between 1982 and 2002.
Methods Bivariate tabulations and multinomial logistic regression analysis.
Main outcome measures  Pregnancy outcomes (live birth, stillbirth, miscarriage [spontaneous fetal loss prior to 28 weeks], and induced abortion).
Results  When socio-economic and demographic covariates are controlled, of the IPIs that began with a live birth, those <6 months in duration were associated with a 7.5-fold increase in the odds of an induced abortion (95% CI 6.0–9.4), a 3.3-fold increase in the odds of a miscarriage (95% CI 2.8–3.9), and a 1.6-fold increase in the odds of a stillbirth (95% CI 1.2–2.1) compared with 27- to 50-month IPIs. IPIs of 6–14 months were associated with increased odds of induced abortion (2.0, 95% CI 1.5–2.6). IPIs ≥ 75 months were associated with increased odds of all three types of non-live-birth (NLB) outcomes but were not as risky as very short intervals. IPIs that began with a NLB were generally more likely to end with the same type of NLB.
Conclusions  Women whose pregnancies are between 15 and 75 months after a preceding pregnancy outcome (regardless of its type) have a lower likelihood of fetal loss than those with shorter or longer IPIs. Those with a preceding NLB outcome deserve special attention in counselling and monitoring.     

Maternal serum activin A levels in association with intrauterine fetal growth restriction

Objective To assess maternal serum activin A as a potential marker of fetal growth restriction.
Design A cohort study.
Setting A maternal–fetal medicine unit, university teaching hospital.
Population Fifty-seven women with a small fetus (less than 10th centile for gestation) referred for assessment of fetal size by ultrasound biometry.
Methods At the time of presentation for fetal biometry, maternal blood was collected for activin A measurement. The case records of each woman were independently reviewed after delivery and the pregnancy grouped into one of three groups: constitutionally small fetus, intrauterine growth restricted (IUGR) fetus or IUGR fetus and maternal pre-eclampsia (IUGR–pre-eclampsia). Activin A levels in the three groups were compared.
Main outcome measures Maternal serum activin A levels.
Results Sixteen of the 57 pregnancies were classified as constitutionally small, 17 as IUGR and 24 as IUGR–pre-eclampsia. Expressed as multiples of a normal median (MoMs), the median (95% CI) activin A level in the constitutionally small pregnancies was 1.12 (0.72–1.39) MoMs significantly lower than the level in both the IUGR pregnancies, 3.00 (1.84–4.11) MoMs, and the IUGR–pre-eclampsia pregnancies, 7.96 (5.73–10.62) MoMs (   P = 0.002 and 0.0001 for IUGR vs constitutionally small and IUGR–pre-eclampsia vs constitutionally small, respectively  ).
Conclusions Maternal serum activin A may be useful in the assessment of the small for gestational age fetus.     

Prediction of fetal birthweight in Taiwanese women with pre-eclampsia and gestational hypertension using an equation based on maternal characteristics

Aim:  The purpose of the present study was to develop a method for predicting the birthweight of newborns in women with pre-eclampsia and gestational hypertension based on maternal characteristics and pregnancy-related factors.
Methods:  A total of 661 consecutive pregnant women with pre-eclampsia and gestational hypertension who delivered at Chang Gung Memorial Hospital from 1994 to 2003 were included in the analysis. Multivariate regression formulas (Models I and II) were derived from maternal characteristics to predict low infant birthweight. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated and tested for these formulas.
Results:  The Model I formula was as follows:

Using a cut-off value of 2210 g, the equation predicts the occurrence of a low birthweight baby with 90.9% sensitivity. If higher specificity is required, increasing the cut-off value to 2488 g yields a specificity of 95.2%. Receiver operating characteristic (ROC) curve analysis revealed an area under the curve of 93.7 (95% confidence interval [CI], 0.88 to 0.99) for low birthweight baby prediction in Model I.
Conclusion:  The results suggest that these regression formulas based on maternal characteristics may accurately predict low birthweight babies in pregnant women with pre-eclampsia and gestational hypertension. The cut-off values were determined and cross-validated by ROC curve analysis.