Objective Is there there is a difference in indications for delivery, antepartum and neonatal characteristics in intermittent absent end diastolic velocity (iAEDV) compared to persistent absent or reversed end diastolic velocity (pA/REDV). Methods A retrospective study of 109 patients with iAEDV or pA/REDV from 19-39 weeks. The delivery indication was classified as maternal or fetal. The primary antepartum and maternal characteristic were age, parity, AMA, chronic hypertension, PEC, thrombophilia, lupus, diabetes, smoker, placenta previa, gestational age (GA) at diagnosis of IUGR and/or SGA, GA at diagnosis of elevated S/D, iAEDV or pA/REDV, GA at delivery, minimal/absent variability day of delivery, BPP ≤ 6 prior to delivery. The primary neonatal outcomes were birth weight, arterial cord pH, neonatal demise, necrotizing enterocolitis, intraventricular hemorrhage and length of stay in the NICU. Results Fetuses with iAEDV were diagnosed with an elevated S/D at a later GA (29.6 vs 27.5 weeks, P < 0.03), delivered at a later GA (31.6 vs 29.7 weeks, P < 0.01), had a higher birth weight (1336.6 vs 933g, P < 0.0004), were more likely to be delivered for maternal indications (42.9% vs 20.27%, P<0.01), had a higher cord arterial pH (7.28 vs 7.21, P<0.002) and were less likely to have an arterial pH at birth <7.2 (0% vs 34.1%, P < 0.002). Conclusions Although fetuses with iAEDV have an improved antenatal course as compared with pA/REDV, indications for delivery are more likely to be maternal and adverse outcome is common.

Abstract

Objective:

To estimate the effect of race on perinatal outcomes in obese women.

Methods:

Retrospective cohort study of birth records linked to hospital discharge data for all live born singleton infants ≥37 weeks gestation born to African-American or Caucasian Missouri residents from 2000-2006. We excluded major congenital anomalies and women with diabetes or chronic hypertension. Obesity was defined as pre-pregnancy body mass index ≥ 30 kg/m(2).

Results:

There were 312,412 births meeting study criteria. 27.1% (11,776) of African-American mothers and 19.1% (49,415) of Caucasian mothers were obese. There were no differences in cesarean delivery or preeclampsia between obese African- American and obese Caucasian women. Infants of obese African-American women were significantly less likely to be macrosomic (0.9% vs. 2.2%, adjusted odds ratio [aOR] 0.5, 95% confidence interval [CI] 0.4 0.6) and more likely to be low birth weight (3.4% vs. 1.8%, aOR 1.9, 95% CI 1.7, 2.2) compared to infants of obese Caucasian women. Compared to their normal weight peers, obese Caucasian women had a greater relative risk of developing preeclampsia (aOR 3.1, 95% CI 2.9, 3.2) than obese African-American women (aOR 2.1, 95% CI 1.9, 2.4).

Conclusion:

Racial disparities impact obesity-related maternal and neonatal complications of pregnancy.

Abstract

Objective.

The long-term prediction of delivery date with obstetric utrasound. Methods. The cervical length and the fetal vertebral, middle cerebral and umbilical resistance indices were measured in 317 pregnancies between 30 and 37 weeks. Subsequently, multivariate analysis was applied to calculate the best model for the prediction of delivery date.

Results.

The best model included the examinations of the cervical length and the middle cerebral artery resistance index. In comparison with estimated delivery date based on the last menstrual period, a small improvement was detected, particularly in earlier deliveries, however 34% of predictions still had an error of more than 5 days.

Conclusions.

Long-term sonographic prediction of delivery date depends mainly on the cervical length and improves the prediction of the estimated delivery date. However it is still too inaccurate for clinical use.

Abstract

Objective:

To test the hypothesis that preeclampsia is associated with higher incidence of early childhood caries in children aged between 3-5 years old.

Design:

An observational non concurrent cohort study

Setting:

Al-Hayat National Hospital, Khamees Mushyat, Saudi Arabic Kingdom Population: 200 children aged 3-5 years who fulfilled the inclusion criteria.

Methods:

A detailed dental examination was carried out for all children enrolled. We obtained all relevant obstetric data from mothers' and pediatric's medical records. Thirty cases were excluded due to missing data and therefore, only 170 children were considered for the statistical analysis. Results were tabulated and statistically analyzed. Main outcome measure: Early childhood caries

Results:

63 children (37%) out of 170 were affected with early childhood caries; 6 were delivered to preeclamptic and 57 to non preeclamptic mothers. Using logistic regression curve, early childhood caries was significantly associated with low birthweight, low Apgar score at 1st minute and with the pattern of infant feeding but not with preeclampsia. The relative risk for early childhood caries was 2.84 among low birthweight infants (95%CI: 1.47- 5.49), 1.95 among non breast fed children risk (95% CI: 1.11-4.20) and 2.64 among those delivered with an Apgar score less than 5 at 1 minute (95%CI:1.46- 4.77).

Conclusion:

Preecalampsia may not be associated with early childhood caries. A larger study and/or a study addressing the relation between preeclampsia and caries inducing lesions may provide more significant results.

Abstract

Objective:

To investigate the relationship between MBD and THOP.

Methods:

124 infants, born in Marmara University Hospital with a gestational age ≤ 34 weeks, were enrolled. Clinical features were recorded. Serum TSH, free T4, total T4, calcium, phosphorus and total Alkaline Phosphatase (ALP) levels were determined in the first and third postnatal weeks. MBD was defined as a phosphorus level < 4.5 mg/dl and/or ALP >900 IU/L. THOP was defined as a serum free and/or total thyroxine level lower than -1 SD for gestational age at the 7(th) postnatal day. Result: THOP was diagnosed in nineteen (15,3 %) patients. MBD was diagnosed in 52 (41,9 %) at the 3(rd) month. Low birth weight, low gestational age and prolonged parenteral nutrition were associated with MBD. Multivariate analysis documented a significant relationship solely between MBD and gestational age.

Conclusion:

The risk of MBD does not increase significantly in babies with THOP.

Aim:

To evaluate the effectiveness of emergency cervical cerclage and its effect on the mode of delivery. Patients and

Methods:

Between April 2007 and July 2011 patients attending MH Diyarbakir Obstetrics and Gynecology Hospital and MH Seferihisar State Necat Hepkon Hospital who underwent emergency cervical cerclage (ECC) were included in this retrospective analysis.

Results:

At the time of ECC, the mean gestational age, cervical length and cervical dilatation were 21.4±2.2 weeks, 4.3±0.8 cm and 11±2.4 mm, respectively. The average time between the procedure and birth was 13.8±4.9 weeks and this period was sufficient to maintain a viable pregnancy (p<0.05). In this study, 12 patients (60%) were delivered vaginally and 8 (40%) patients delivered with CS (40%). the difference was statistically insignificant (p: 0.371). Regarding the gestational age at time of delivery, 55% of patients delivered at 36 weeks, 70% at 32 weeks, and 80% of them delivered at 28 weeks. The total live birth rate was 90%.

Conclusion:

ECC provides satisfactory time for the fetus to gain sufficient viability. Pregnancies with emergency cerclage show no difference in terms of birth method, whether cesarean or vaginal birth, and delivery type does not appears to be linked to ECC.

Abstract Mothers of infants in the neonatal intensive care unit (NICU) have very low breastfeeding rates and these high-respiratory-risk (HRR) NICU infants may benefit from breastfeeding through decreased risk for respiratory illnesses. This population's increased risk for maternal depression and high rates (22%) of maternal smoking may negatively affect breastfeeding.

Objective:

This exploratory study investigated associations of breastfeeding with depressive symptoms and maternal smoking in mothers of HRR NICU infants (i.e., presence of one household smoker and birth weight <1500g or mechanical ventilation >12 hours).

Methods:

Breastfeeding, depression, and smoking data were collected from 104 mothers in the NICU following delivery.

Results:

Fifty-five (52.9%) mothers reported breastfeeding, 39 (37.5%) had a Center for Epidemiological Studies Depression Scale (CES-D) score (>16) suggestive of depression, and 36 (34.6%) reported smoking. Mothers with CES-D scores >16 were less likely to breastfeed compared to those with scores <16 (38.5% vs. 61.5%; p=0.02). Breastfeeding and smoking were not significantly associated (p<0.10). Mothers of HRR infants with significant depressive symptoms who smoke have significantly lower breastfeeding rates (21%) than mothers who are not depressed and do not smoke (65%).

Conclusions:

Interventions to improve breastfeeding initiation and continuation that target depression and smoking are necessary.

Abstract Objetives: To find the best early predictor model for fetal growth and large for gestational age (LGA) infants considering clinical, ultrasonographic and biochemical variables.

Methods:

In 2,097 singleton pregnancies at first trimester, we evaluated maternal characteristics, PAPP-A and ß-HCG proteins, fetal nuchal translucency thickness and uterine artery pulsatility index (UtA-PI). At second trimester fetal ultrasound biometry and UtA-PI were then measured. The relationships between birth weight and LGA and maternal characteristics, first and second trimester variables, and all variables combined, were studied. The performance of screening was determined by receiver operating characteristic curves analysis.

Results:

Stepwise regression analysis showed that in the prediction of birthweight percentile there were significant contributions from all maternal factors, PAPP-A and Ut-A PI in the first trimester, and fetal biometric variables in the second trimester. Maternal charateristics combined with PAPP-A, β-hCG, fetal NT and uterine artery PI identified 30.2 % LGA (FPR 10%.). The combined model reached a sensitivity of 41.2% (FPR 10%) and 56.2% (FPR 20%).

Conclusions:

Sensitivity of the screening for LGA improves significantly after addition of second trimester ultrasound measurements to first trimester variables and maternal characteristics.

Abstract

Objective:

To examine the correlation in genes expressed in paired umbilical cord blood (UCB) and newborn blood (NB).

Methods:

Total mRNA and mRNA of three gene sets (inflammatory, hypoxia, and thyroidal response) was assessed using microarray in UCB and NB spotted on Guthrie cards from 7 mother/infant pairs.

Results:

The average gene expression correlation between paired UCB and NB samples was 0.941 when all expressed genes were considered, and 0.949 for three selected gene sets.

Conclusion:

The high correlation of UCB and NB gene expression suggest that either source may be useful for examining gene expression in the perinatal period.