Abstract: Periodontal diseases are Gram-negative anaerobic infections that can occur in women of childbearing age (18 to 34 years). In the present investigation we sought to determine whether the prevalence of maternal periodontal infection could be associated with preterm low birth weight (PLBW), controlling for known risk factors and potential covariates. A case-control study of 124 pregnant or postpartum mothers was performed. PLBW cases were defined as a mother with a birth of less than 2,500 g and one or more of the following: gestational age <37 weeks, preterm labor (PTL), or premature rupture of membranes (PROM). Controls were normal birth weight infants (NBW). Assessments included a broad range of known obstetric risk factors, such as tobacco use, drug use, alcohol consumption, level of prenatal care, parity, genitourinary infections, and nutrition. Each subject received a periodontal examination to determine clinical attachment level. PLBW cases and primiparous PLBW cases (n = 93) had significantly worse periodontal disease than the respective NBW controls. Multivariate logistic regression models, controlling for other risk factors and covariates, demonstrated that periodontal disease is a statistically significant risk factor for PLBW with adjusted odds ratios of 7.9 and 7.5 for all PLBW cases and primiparous PLBW cases, respectively. These data indicate that periodontal diseases represent a previously unrecognized and clinically significant risk factor for preterm low birth weight as a consequence of either PTL or preterm PROM. J Periodontol 1996;67:1103-1113.

Abstract: Objective Physiological processes including neuroendocrine function have been proposed as mediators of the relationship between prenatal psychological state and pregnancy outcome; however, there are virtually no human studies that have systematically assessed such mechanisms. Neuroendocrine processes are significantly altered during pregnancy, and are characterized by the evolution of a transient neuroendocrine system, the placenta, and modifications in endocrine control mechanisms. Because these alterations have implications for neuroendocrine responsivity to exogenous conditions, the aim of the present study was to examine the cross-sectional association between prenatal psychosocial factors and stress-related neuroendocrine parameters during human pregnancy. Method Fifty-four adult women with a singleton, intrauterine pregnancy were recruited before 28 weeks of gestation. Maternal antecubital venous blood samples were withdrawn at 28 weeks of gestation for bioassays of adrenocorticotropin hormone (ACTH), beta-endorphin (beta E), and cortisol. Measures of prenatal stress, social support, and personality were collected using a two-part, self-report questionnaire administered at 28 and 30 weeks of gestation. Biomedical data were obtained from the medical record. Factors known to influence neuropeptide and hormone levels during pregnancy were controlled, including gestational age, circadian variation, and obstetric risk. Results In the present sample, prenatal psychosocial stress, social support, and personality variables were associated with neuroendocrine parameters in two primary ways. First, certain psychosocial factors were significantly associated with plasma levels of ACTH, beta E, and cortisol, and second, psychosocial factors were associated with a measure of disregulation of the normal relationship between two pro-opiomelanocortin (POMC) derivatives, ACTH and beta E. Furthermore, a combination of the maternal psychosocial and sociodemographic factors during pregnancy accounted for 36% of the variance in ACTH, 22% of the variance in the ACTH-beta E disregulation index, 13% of the variance in cortisol, and 3% of the variance in beta E. Conclusions The present findings are consistent with the premise that maternal-placental-fetal neuroendocrine parameters are significantly associated, both in magnitude and specificity, with features of maternal psychosocial functioning in pregnancy despite the systemic alterations associated with the endocrinology of pregnancy. These findings provide a basis for further investigations of the role of the neuroendocrine system as a putative mediating pathway between prenatal psychosocial factors and birth outcome, and possibly also as a mechanism linking features of the maternal psychosocial environment to fetal/infant brain development.

Abstract: The present study was designed to test the relation between stressful life events experienced during pregnancy and the risk of preterm delivery and shortened duration of pregnancy. We collected data prospectively in a general population sample, including repeated questionnaire measures of exposure to stressful life events during pregnancy. Between August 1989 and September 1991, 8,719 Danish-speaking women with singleton pregnancies attended antenatal care. Of these women, 5,873 (67%) completed all questionnaires. When indicating an event, the woman was asked to rate the amount of stress induced by this event. Measurement of gestational duration was primarily based on early ultrasound scan. When we evaluated life events independently of the individual's appraisal, we found no association with duration of gestation or risk of preterm delivery. In contrast, life events assessed by the subject as highly stressful were associated with shorter mean duration of gestation and increased risk of preterm delivery. This association was observed primarily with events experienced between the 16th and 30th week of gestation. Women who had one or more highly stressful life events had a risk of preterm delivery 1.76 times greater than those without stressful events (95% confidence interval = 1.15-2.71). We found no evidence for a buffering effect of social support.

Abstract: Transient neonatal hypothyroxinemia is very common in preterm infants. The literature on the effect of this hypothyroxinemia is, however, controversial, and large or long-term follow-up studies are not available. In a nationwide prospective follow-up study on very preterm and (or) very low birth weight infants (n = 717), we studied the relationship between thyroxine levels in the 1st wk of life and neurodevelopmental outcome at 5 y of age and school performance at 9 y of age. Thyroxine concentrations from filter paper eluates were determined in 717 infants: 32% had levels of more than 3 SD below the mean (<60 nmol/L). The percentage of infants with such low levels increased with decreasing gestational age. At the age of 5 y, 96% of survivors (n = 640) were available for extensive neurodevelopmental examination: 85 (13.3%) had a disability and 92 (14.3%) a handicap. At the age of 9 y, 83% of survivors (n = 552) answered a questionnaire on school performance: 300 (54.3%) were in mainstream education in a grade appropriate for age, 151 (27%) were in mainstream education with grade retention, and 101 (18.3%) were in special education. Both neurologic dysfunction at age 5 y and school failure at age 9 y were significantly related to lower neonatal thyroxine levels even after adjustment for other perinatal factors (odds ratio, 1.3) Whether this relationship is causal should be investigated. If a causal relationship exists, substitution therapy may at least partially prevent neurologic dysfunction and learning disabilities, both common sequelae of very preterm birth.

Abstract: In a non-selected population comprising 15,241 women, an evaluation was performed of the ultrasonic measurement of the biparietal diameter compared with a reliable last menstrual period as the basis for estimation of the day of delivery. In women with a reliable menstrual history and spontaneous onset of labor, the ultrasound estimate was the significantly better predictor of the day of delivery in 52% of cases, and the last menstrual period estimate was the better predictor in 46% of cases. The percentages of women who delivered within 7 days of the predicted day were 61 and 56% for the ultrasound and the last menstrual period estimations, respectively. There was a significantly narrower distribution of births according to the ultrasound estimate (p < 0.001). The proportion of estimated postterm births was 4% using the ultrasound method and 10% using the last menstrual period method (p < 0.001). Even when the difference between the methods in predicting the day of delivery was less than 7 days, the ultrasound method was better than the last menstrual period method. It is concluded that ultrasonic measurement of the biparietal diameter between 15 and 22 weeks of pregnancy is the best method for the estimation of the day of delivery and should be used as a routine procedure.

Abstract: BACKGROUND: Acute asthma during pregnancy is potentially dangerous to the fetus. The aim of this study was to investigate the effect of an acute attack of asthma during pregnancy on the course of pregnancy or delivery, or the health of the newborn infant, and to identify undertreatment as a possible cause of the exacerbations. METHODS: Five hundred and four pregnant asthmatic subjects were prospectively followed and treated. The data on 47 patients with an attack of asthma during pregnancy were compared with those of 457 asthmatics with no recorded acute exacerbation and with 237 healthy parturients. RESULTS: Of 504 asthmatics, 177 patients were not initially treated with inhaled corticosteroids. Of these, 17% had an acute attack compared with only 4% of the 257 patients who had been on inhaled anti-inflammatory treatment from the start of pregnancy. There were no differences between the groups as to length of gestation, length of the third stage of labour, or amount of haemorrhage after delivery. No differences were observed between pregnancies with and without an exacerbation with regard to relative birth weight, incidence of malformations, hypoglycaemia, or need for phototherapy for jaundice during the neonatal period. CONCLUSIONS: Patients with inadequate inhaled anti-inflammatory treatment during pregnancy run a higher risk of suffering an acute attack of asthma than those treated with an anti-inflammatory agent. However, if the acute attack of asthma is relatively mild and promptly treated, it does not have a serious effect on the pregnancy, delivery, or the health of the newborn infant.

Abstract: The aim of this study was to describe serum GH, IGF-I, and IGF binding protein (BP) 3 levels at birth and during the first 2 y of life in intrauterine growth-retarded (IUGR) children and to correlate these hormonal values with auxologic parameters noted during this period to investigate their predictive value on the postnatal growth pattern. Three hundred and seventeen children were included at birth and studied for auxologic and biologic parameters at birth, 3 and 30 d, and 3, 6, 12, 18, and 24 mo of age. At birth, when analyzed according to gestational age, serum GH levels were increased (p = 0.0001) and serum IGF-I and IGFBP3 levels were decreased (p = 0.0001) in IUGR as compared with normal neonates. When two cohorts were established at birth as a function of the ponderal index (PI) ( 3rd percentile), serum IGF-I and IGFBP3 levels were found to be significantly reduced in the case of low PI. All parameters were within normal limits at 1 mo of age and remained normal thereafter. During the first 3 mo of life, a positive correlation was found between IGF-I increment and weight gain (r = 0.28, p = 0.002). None of the biologic parameters at birth were predictive either of later growth or of short stature at 2 y of age. In conclusion, low serum IGF-I and IGFBP3 levels at birth were related to fetal malnutrition and were not predictive parameters for later growth.

Abstract: Objective : This study investigated the hypothesis that following a pregnancy loss, women have more mental health complaints than women who give birth to a living baby. Method : Mental health was assessed for 2,140 women during their first trimester of pregnancy through use of the Dutch version of the SCL-90. A total of 227 women who had lost their babies and 213 women who gave birth to a living baby were followed over a period of 18 months, during which their mental health was reassessed four times. Results : When mental health complaints at the beginning of pregnancy and reproductive loss history were taken into account, data analysis revealed that up to 6 months after their pregnancy loss, women showed greater depression, anxiety, and somatization than women who gave birth to living babies. Over time the mental health of women who had experienced a loss was found to improve and at 1 year was comparable to that of women who gave birth to living babies and to that of women in general. Conclusions : The majority of women are able to recover from pregnancy loss without psychiatric treatment in about 1 year. A pregnancy loss is nevertheless a stressful life event that can give rise to a marked deterioration in a woman's mental health, particularly in the first 6 months following loss.

Abstract: Objective: To investigate whether prenatal growth affects the risk of development of childhood onset insulin dependent (type I) diabetes mellitus. Design: Population based case-control study. Setting: Data from a nationwide childhood diabetes case register were linked with data from the nationwide Swedish Medical Birth Registry. Subjects: Data from a total of 4584 diabetic children born after 1973 and diagnosed with diabetes from 1978 to 1992 were studied. For each child with insulin dependent diabetes three control children were randomly selected from among all infants born in the same year and at the same hospital as the proband. Main outcome measures: Birth weight, gestation, maternal age and parity, number of previous spontaneous abortions, and sex specific birth weight by gestational week expressed as multiples of the standard deviation (SD). Results: There was a clear trend in the odds ratio for childhood onset diabetes according to SD of birth weight. The odds ratio (95% confidence interval) for small for gestational age after stratification for maternal age, parity, smoking habits, and maternal diabetes was 0.81 (0.65 to 0.99) and for large for gestational age after similar stratification was 1.20 (1.02 to 1.42). Conclusions: Intrauterine conditions that affect prenatal growth seem also to affect the risk of development of childhood diabetes in the way previously described for postnatal growth: a poor growth decreases and an excess growth increases the risk. The mechanism for this association is unclear. Key messages By linking two nationwide population based reg- isters the effect of intrauterine growth on the risk for childhood onset insulin dependent diabetes is estimated There was a clear trend in the risk for childhood onset diabetes according to differences in birth weight by gestational age expressed as multiples of SD from population means The adjusted odds ratio for babies who were small for gestational age was significantly decreased and for large for gestational age babies was significantly increased A poor intrauterine growth decreases and an excess growth increases the risk of development of childhood insulin dependent diabetes

Abstract: PURPOSE: To determine the effects of subchorionic hematoma size, gestational age, and maternal age on pregnancy outcome in patients with vaginal bleeding in the first trimester of pregnancy. MATERIALS AND METHODS: A retrospective review was performed with ultrasound images obtained in 516 patients with vaginal bleeding, a live fetus, and a subchorionic hematoma in the first trimester. Hematoma size was graded according to the percentage of the chorionic sac circumference elevated by the hematoma. Patients were also classified according to gestational age and maternal age. Logistic regression analysis was used to determine the effect of each variable on pregnancy outcome. RESULTS: The overall spontaneous abortion rate was 9.3% (48 of 516 patients). The rate nearly doubled when the separation was large (18.8%) compared with small and moderate hematomas (7.7% and 9.2%, respectively). A large separation was found to be associated with an almost three-fold increase in risk of spontaneous abortion. The spontane...

Abstract: OBJECTIVE To define the recurrence rate of gestational diabetes mellitus (GDM) in a subsequent pregnancy and to determine what factors could be predictive. RESEARCH DESIGN AND METHODS The subjects of the index pregnancy were 480 personally cared for women with GDM. One hundred women had had a subsequent pregnancy and had been tested for GDM. RESULTS The recurrence rate of GDM was 35% (95% CI, 25.5–44.5). An increase in weight between the two pregnancies and a higher maternal age and parity were risk associates for a recurrence. A recurrence of GDM was not associated with a higher glucose level, insulin use, or fetal birth weight in the index pregnancy. CONCLUSIONS GDM occurs in only one-third of subsequent pregnancies. Those women who had a recurrence of their GDM were older, more parous, and also had an increase in weight between the pregnancies.

Abstract: Objective. —To clarify the optimal estimated date of delivery for multifetal pregnancies. Design, Subjects, and Setting. —A retrospective study of all 88 936 infants born of multifetal pregnancies and all 6 020 542 infants born of singleton pregnancies that occurred at 26 weeks or more of gestation between 1989 and 1993 in Japan. Main Outcome Measure. —Incidence of stillbirth and early neonatal death according to gestational age at delivery. Results. —The mean±SD duration of pregnancy was 37.0±2.7 weeks for multifetal pregnancies and 39.6±1.6 weeks for singleton pregnancies. In multifetal pregnancies, the incidence of stillbirth and of early neonatal death gradually declined until 37 to 38 weeks' gestation and then increased. These parameters in singleton pregnancies declined until 39 weeks' gestation before increasing. The lowest incidence of perinatal death (stillbirth plus early neonatal death) seen at 38 weeks' gestation in multifetal pregnancies corresponded to that seen at 43 weeks' gestation in singleton pregnancies (10.5 vs 9.7 per 1000 infants). The risk of perinatal death was more than 6 times as high for fetuses of multifetal pregnancies born at 37 weeks or later than for singleton fetuses born at 40 weeks or later (relative risk, 6.6; 95% confidence interval, 6.1-7.1). Conclusion. —Fetuses of multifetal pregnancies are at an increased risk of death after reaching the normative gestational age for singleton pregnancies. Limiting the estimated date of delivery to 37 to 38 weeks may be appropriate in multifetal pregnancies. ( JAMA . 1996;275:1432-1434)

Abstract: The relations between pre- and perinatal risk factors and asthma were investigated using a case-control study of 262 African-American children aged 4-9 years, both asthmatic and nonasthmatic, all of whom resided in a poor urban area and received health care at a local hospital-based clinic. Risk factors were ascertained through review of obstetric, perinatal, and pediatric records. Asthmatic children had significantly lower birth weights and gestational ages than nonasthmatic children and were more likely to have required oxygen supplementation and positive pressure ventilation after birth than nonasthmatics (p < 0.05). The mothers of asthmatic children were more likely to have smoked during pregnancy (50% vs. 27%), to have gained less weight during pregnancy (26.3 pounds (11.9 kg) vs. 34.5 pounds (15.7 kg)), and to have had no prenatal care (12% vs. 2% ) than mothers of nonasthmatic children. Multiple logistic regression demonstrated that the strongest independent predictors of asthma were maternal history of asthma (adjusted odds ratio (OR) = 9,7), lack of prenatal care (OR = 4.7), history of bronchiolitis (OR = 4.7), positive pressure ventilation at birth (OR = 3.3), low maternal weight gain (<20 pounds (<9 kg)) (OR = 3.4), and maternal smoking during pregnancy (OR = 2.8). These data suggest that pre- and perinatal exposures may increase susceptibility to asthma in inner city children.

Abstract: Mares with complicated pregnancies (illness, problems at parturition or delivery of an abnormal foal, n = 30) were scanned transabdominally from 298 days gestation to term in order to measure fetal size, evaluate fetal well-being and characterise the intrauterine environment. The results of the last scan obtained prior to parturition were compared to normal data obtained from fetuses of comparable gestational age to develop a biophysical profile specific for the equine fetus. Twelve mares produced a normal foal (positive outcome) and 18 mares delivered 19 abnormal foals (negative outcome). Both fetuses that were inactive throughout the entire scan and 4 of 5 fetuses with heart rate abnormalities were abnormal at birth. Three of 4 fetuses surrounded by decreased allantoic fluid quantities had a negative outcome. All mares with large anechoic spaces between the uterus and placenta (n = 3) and/or thickened uteroplacental units (n = 5) delivered abnormal foals. There was a significant correlation between fetal aortic diameter and neonatal foal weight in these complicated pregnancies (P<0.0001, r = 0.85). Fetal aortic diameters were predicted from maternal weight and 6 fetuses had smaller than predicted aortic diameters, all with negative outcomes. A biophysical profile of the equine fetus from 298 days gestational age to term was developed that included 6 factors related to pregnancy outcome: fetal heart rate, fetal aortic diameter, maximal fetal fluid depths, uteroplacental contact, uteroplacental thickness and fetal activity. The profile proved informative about fetal well-being, perinatal morbidity and perinatal mortality. A low score was a definite indication of an impending negative outcome; however, a high score was not assurance of a positive outcome. The utility of such a biophysical profile and future directions for research are discussed.