Impact of Adherence to a Standardized Oxytocin Induction Protocol on Obstetric and Neonatal Outcomes.

BACKGROUND: Oxytocin protocols are employed to induce uterine contractions and progressive cervical changes, but they are associated with adverse maternal and neonatal outcomes. The aim of this study was to determine whether compliance with a checklist-based protocol for oxytocin administration was associated with changes in neonatal and maternal outcomes. METHODS: A retrospective cohort study of 86,786 pregnant women undergoing term (> 37 weeks) induction of labor between January 2015 and December 2017 was performed. Systemwide training in the use of an oxytocin administration protocol was provided to obstetricians and nurses. Pre-use and in-use oxytocin checklists were incorporated into each unit's policies and procedures. Subsequently, charts were reviewed and individually audited by an obstetric nurse who scored each record based on the documentation of variables in an oxytocin administration protocol and ranked adherence as complete or absent. Primary outcomes were postpartum hemorrhage, neonatal ICU (NICU) admission, and delivery by cesarean section. Bivariate analyses (t-tests) were performed on adherent and nonadherent groups for comparison of selected demographic variables and the primary outcome variables. Logistic regression was completed on the primary outcome variable with eight covariates. RESULTS: Among patients with complete adherence to the oxytocin administration protocol, the rate of cesarean section in the unadjusted analysis was 16.20%, compared to 18.54% for those with incomplete adherence; the rates of postpartum hemorrhage were 2.64% vs. 3.14%, respectively, and the rates of NICU admission were 3.03% vs. 3.86%, respectively. In the multivariable logistic regression, complete protocol adherence was associated with significantly lower odds of postpartum hemorrhage (adjusted odds ratio [OR] 0.85, 95% confidence interval [CI] 0.76-0.94) but higher odds of Cesarean section (adjusted OR 1.07, 95% CI 1.01-1.13); the adjusted OR for NICU admission was 0.90, which did not reach statistical significance (95% CI 0.81-1.00). Among the covariates, nulliparity and elective induction were the strongest predictors of the primary outcomes of cesarean section, postpartum hemorrhage, and NICU admission. CONCLUSION: Adherence to the oxytocin administration protocol was associated with a decrease in postpartum hemorrhage but an increased risk of delivery by cesarean section.

Teen Pregnancy: Are Pregnancies following an Elective Termination Associated with Increased Risk for Adverse Perinatal Outcomes?

STUDY OBJECTIVE: The authors sought to determine whether pregnancies in adolescents following an abortion of pregnancy is associated with an elevated risk for adverse perinatal outcomes. METHODS: In a cohort study of all adolescent (younger than 18 years) deliveries over a 4-year period at 1 institution, we compared nulliparous women with a history of a prior abortion (cases) to those without a spontaneous loss or abortion of pregnancy (referent) for adverse perinatal outcomes, including preterm birth and fetal growth restriction. RESULTS: Of the 654 included nulliparous adolescent deliveries, 102 (16%) had an abortion before the index pregnancy. Compared with the referent group, adolescents with a history of a abortion were older (17.8 ± 0.8 vs 16.7 ± 1.2 years, P = .0001), enrolled earlier for prenatal care (14.4 ± 5.6 vs 17.2 ± 7.6 weeks, P = .0004), along with a higher incidence of African American race (95% vs 88%, P = .05). The groups did not differ with respect to other maternal demographics. Perinatal outcomes, including spontaneous preterm birth, abnormal placentation, birth weight, and gestational age at delivery, did not differ between the 2 groups. CONCLUSION: Compared with adolescent women who had just delivered and did not have a prior abortion, women who had just delivered and had a previous abortion were more likely to be older at the age of their first pregnancy and more likely to initiate early prenatal care. Thus, having a prior abortion may improve the health of a pregnancy though adverse outcomes do not differ between the 2 groups.

Second-Trimester Maternal Serum Paraxanthine, CYP1A2 Activity, and the Risk of Severe Preeclampsia.

OBJECTIVE: To measure the association between second-trimester maternal caffeine intake and caffeine metabolism through the CYP1A2 system and the risk of subsequent severe preeclampsia. METHODS: This was a nested case-control study of women who had undergone second-trimester screening for fetal aneuploidy and had banked serum available for analysis. The outcome of interest was severe preeclampsia, and exposures were serum paraxanthine (1,7-dimethylxanthine), measured through high-performance liquid chromatography, and CYP1A2 activity, assessed by paraxanthine/caffeine ratios. RESULTS: We identified 51 cases of severe preeclampsia from our population of 3,992 women (1.3%), of whom 33 had sufficient serum for analysis. These were compared with 99 healthy women. Median paraxanthine concentrations were not significantly higher in women in the control group than women in the case group (96.4 ng/mL compared with 38.0 ng/mL, P=.12), and higher serum paraxanthine was not associated with lower odds of severe preeclampsia (odds ratio [OR] 0.72, confidence interval [CI] 0.48-1.08). However, we found a significantly higher paraxanthine/caffeine ratio in women in the control group than women in the case group (0.37 compared with 0.23, P=.02) and a decreased risk of preeclampsia per every log standard deviation increase in paraxanthine/caffeine ratio (OR 0.53, 95% CI 0.31-0.90). CONCLUSION: Faster caffeine metabolism in the second trimester, assessed by paraxanthine/caffeine ratios, is associated with a reduced risk of subsequent severe preeclampsia. LEVEL OF EVIDENCE: II.

Estimating risk factors for spontaneous preterm delivery in teen pregnancies.

PURPOSE: Our aim was to estimate the perinatal risk factors associated with spontaneous preterm birth in the teenage parturient. METHODS: In a cohort study of all nulliparous teen (≤18-year old) deliveries over a 4-year period at one institution, we identified all cases of spontaneous preterm birth as defined by non-indicated delivery prior to 37 weeks of gestation. Analysis was performed using Fisher's exact, Student t test and logistic regression modeling. RESULTS: Of the 650 included teen deliveries, 88 (14 %) cases of spontaneous preterm birth were identified. Teenage mothers with spontaneous preterm birth had a significantly lower body mass index (BMI) (27.2 ± 6.4 vs. 31.0 ± 6.2, p = 0.0001) and had lower gestational weight gain (14.4 ± 6.6 vs. 11.2 ± 5.0 kg, p = 0.0001) than those mothers with uncomplicated term births. In fact, a normal prepregnancy BMI (<25 kg/m(2)) placed the teen at elevated risk for spontaneous preterm birth (OR 3.35, 95 % CI 1.98-5.64), while prepregnancy obesity (30-35 kg/m(2)) was protective (OR 0.26, 95 % CI 0.12-0.58). Controlling for potential confounders such as race, tobacco or illicit drug use, late prenatal care and sexually transmitted infections did not attenuate the above findings. CONCLUSIONS: Higher prepregnancy BMI, especially obesity, appears to be protective against spontaneous preterm birth in the nulliparous teen parturient. Further studies confirming this finding and investigation of potential underlying mechanisms of this association are warranted.

Do pregnant women with depression have a pro-inflammatory profile?

AIM: We tested the hypothesis that maternal depression is associated with a pro-inflammatory state in pregnancy. MATERIAL AND METHODS: In this nested case-control study, pro-inflammatory cytokine levels were compared between women with depression in pregnancy (n = 100) and a computer-generated referent group of healthy women known not to be depressed (n = 100). We only included cases with a documented Diagnostic and Statistical Manual of Mental Disorders depression diagnosis in the current pregnancy. Serum samples drawn at 11-14 weeks of gestation were analyzed for levels of tumor necrosis factor-alpha and interleukin-6 using high-sensitivity immunoassays. RESULTS: Maternal demographics were similar between the groups except for older age (34.1 vs 32.7 years, P = .05), and lower body mass index (27.3 vs 28.9 kg/m², P = 0.03) among the depressed subjects. Compared to control women, tumor necrosis factor-alpha (5.8 ± 3.4 vs 3.2 ± 2.8 pg/ml, P < 0.0001) and interleukin-6 (2.4 ± 3.8 vs 1.5 ± 1.4 pg/ml, P = 0.03) levels were higher among women with depression. The higher rate of inflammatory cytokines remained significant after controlling for potential confounders, including maternal age and body mass index. CONCLUSION: Women with depression may have higher levels of inflammatory markers in early pregnancy. Our findings support the hypothesis that inflammation may be a mediator in the association between maternal depression and adverse perinatal outcomes.

Estimating risk factors and perinatal outcomes for gestational diabetes and impaired glucose tolerance in teen mothers.

BACKGROUND: Our objective was to identify potentially modifiable risk factors and outcomes for gestational diabetes and impaired glucose tolerance in a contemporary American teen population. METHODS: We conducted a retrospective cohort analysis of all teenage deliveries (≤18 years old) at one institution over a 4-year period with documented oral glucose tolerance testing. All cases of gestational diabetes and impaired glucose tolerance were identified using the Carpenter and Coustan diagnostic criteria and compared with teenage mothers with normal glucose tolerance testing. RESULTS: Of the 670 included teen deliveries, 668 were either African American or Hispanic/Latino; 31 (5%) were diagnosed with gestational diabetes (n = 5) or impaired glucose tolerance (n = 26). Higher maternal prepregnancy body mass index (34.3 ± 7.8 vs 30.3 ± 6.4, p = 0.001) and morbid obesity (body mass index ≥ 35 kg/m(2) , RR 2.0, 95% CI 1.1-3.6) were associated with gestational diabetes and impaired glucose tolerance. There was no association with weight gain above the Institute of Medicine recommended levels (RR 1.6, 95% CI 0.77-3.4). On postpregnancy follow up, three of the five (60%) teens with gestational diabetes and none of the 26 (0%) teens with impaired glucose tolerance were diagnosed with diabetes mellitus. CONCLUSIONS: Higher prepregnancy body mass index, especially morbid obesity, places the gravid teen at higher risk for development of gestational diabetes and impaired glucose tolerance in pregnancy. The potentially modifiable nature of these risk factors coupled with the emerging teen obesity epidemic underscores the need for increased public health focus on this problem.

Estimating risk factors for development of preeclampsia in teen mothers.

PURPOSE: Our objective was to identify potentially modifiable risk factors for preeclampsia in a contemporary American teen population. METHODS: We conducted a retrospective cohort analysis of all teenage deliveries (≤18 years old) at one institution over a 4-year-period. All cases of preeclampsia were identified using the National Working Group for Hypertension in Pregnancy diagnostic criteria and compared to normotensive teenage mothers. RESULTS: Of the 730 included teen deliveries, 65 (8.9 %) women developed preeclampsia and demonstrated a higher prepregnancy body mass index when compared with controls (32.9 ± 8.4 vs. 30.3 ± 6.1 kg/m(2), p = 0.002). Maternal obesity (body mass index ≥30 kg/m(2), RR 1.6, 95 % CI 1.0-2.8) and gestational weight gain above the Institute of Medicine recommended levels (RR 2.6, 95 % CI 1.5-4.4) were associated with higher risk for development of preeclampsia. When evaluating by severity or onset of disease, excessive weight gain in pregnancy was the strongest risk factor for mild (n = 58) or late onset (n = 54) preeclampsia (RR 2.5, 95 % CI 1.4-3.4). CONCLUSIONS: Maternal obesity and excessive gestational weight gain place the gravid teen at increased risk for preeclampsia. The modifiable nature of these risk factors permits the possibility of intervention and prevention.

Estimating the impact of pelvic immaturity and young maternal age on fetal malposition.

OBJECTIVE: Fetal malposition, specifically occiput posterior and transverse (OP/OT), is associated with higher intra-partum morbidity. We tested the hypothesis that young maternal age and pelvic immaturity are risk factors for fetal malposition. METHODS: In a cohort study of all nulliparous teen (≤18 years) deliveries over a 4-year period at one institution, fetal head position at time of delivery was collected and correlated with maternal characteristics and outcome data. Using Risser staging observations, pelvic maturity age was set at 16, and accordingly, the women were divided into two groups (younger vs. older teens). Analysis was performed using Fisher's exact, student t test, and logistic regression modeling. RESULTS: Older teen mothers (16-18 years, n = 609) had higher rates of malposition (22 vs. 12 %, p = 0.02) when compared with younger teens (≤15 years, n = 98). Among all women with a malpositioned fetus, older teens had a higher body mass index (BMI: 32.6 ± 6.7 vs. 28.5 ± 3.5, p = 0.04) and subsequent need for cesarean delivery (69 vs. 33 %, p = 0.02) when compared with their younger counterparts. Although younger teens were more successful in having a vaginal delivery (67 %) with an OP/OT position, it was at the expense of a 25 % rate of severe perineal laceration (third/fourth degree). CONCLUSION: Obesity, and not young maternal age or pelvic immaturity, is associated with fetal malposition. The direct association with increasing pre-pregnancy BMI and the long-term impacts of the high rates of cesarean delivery in this young population underscores the need for more public health focus.

First-trimester maternal vitamin D status and risk for gestational diabetes (GDM) a nested case-control study.

BACKGROUND: Vitamin D deficiency may contribute to impaired glucose metabolism. There are sparse data regarding vitamin D and the development of gestational diabetes (GDM). The objective of this study was to assess if first-trimester vitamin D deficiency is more prevalent in women later diagnosed with GDM compared with women with uncomplicated pregnancies. METHODS: We conducted a nested case-control study of pregnant women who had previously given blood for routine genetic multiple marker screening and subsequently delivered at a tertiary hospital between November 2004 and July 2009. From an overall cohort of 4225 women, 60 cases of GDM were matched by race/ethnicity with 120 women delivering at term (≥37 weeks) with uncomplicated pregnancies. Banked maternal serum was used to measure maternal 25-hydroxyvitamin D [25(OH)D]. RESULTS: The prevalence of first-trimester maternal vitamin D deficiency (defined as 25(OH)D < 50 nmol/L) was comparable among women with GDM compared with controls (5/60 vs 8/120, p = 0.90). The median 25(OH)D level for all subjects was 89 nmol/L (interquartile range, 73-106 nmol/L). Seventy three percent (117/160) of the cohort had 25(OH)D levels ≥75 nmol/L. CONCLUSIONS: In a cohort of pregnant women with mostly sufficient levels of serum 25(OH)D, vitamin D deficiency was not associated with GDM. Further studies are warranted with larger cohorts, especially in populations with lower levels of vitamin D.

Midgestation maternal serum 25-hydroxyvitamin D level and soluble fms-like tyrosine kinase 1/placental growth factor ratio as predictors of severe preeclampsia.

Recent studies have shown that low serum 25-hydroxyvitamin D (25[OH]D) level is a risk factor for preeclampsia. The clinical significance of in vitro findings that vitamin D regulates vascular endothelial growth factor production is unclear. We sought to determine whether there is an association between midgestation serum 25(OH)D levels and angiogenic factor activity and to compare their predictive value for the development of severe preeclampsia. We conducted a nested case-control study of women with severe preeclampsia (n=41) versus women with uncomplicated term birth (n=123) who had second trimester genetic screening (15-20 weeks). Using banked frozen serum, we measured levels of 25(OH)D, vascular endothelial growth factor, soluble fms-like tyrosine kinase 1, and placental growth factor and compared their correlations and predictive values. We found no correlation between serum 25(OH)D and angiogenic factors levels. 25(OH)D alone was comparable to vascular endothelial growth factor and soluble fms-like tyrosine kinase 1/placental growth factor ratio as a predictive marker for severe preeclampsia. A composite of both 25(OH)D level and soluble fms-like tyrosine kinase 1/placental growth factor ratio was more predictive than either alone (area under curve: 0.83 versus 0.74 and 0.67, respectively). In conclusion, combining midpregnancy 25(OH)D level with soluble fms-like tyrosine kinase 1/placental growth factor ratio provides a better prediction for the development of severe preeclampsia.

A nested case-control study of first-trimester maternal vitamin D status and risk for spontaneous preterm birth.

We assessed if first-trimester vitamin D deficiency is more prevalent in women who experienced a spontaneous preterm birth compared with women who delivered at term. We conducted a nested case-control study of pregnant women who had previously given blood for first-trimester combined screening for trisomy 21 and subsequently delivered at a tertiary hospital between November 2004 and July 2009. From an overall cohort of 4225 women, 40 cases of spontaneous preterm birth (≥ 23 (0/7) and ≤ 34 (6/7) weeks) were matched by race/ethnicity with 120 women delivering at term (≥ 37 (0/7) weeks) with uncomplicated pregnancies. Banked maternal serum was used to measure maternal 25-hydroxyvitamin D [25(OH)D]. The prevalence of first-trimester maternal vitamin D deficiency [25(OH)D < 50 nmol/L] was comparable among women who subsequently delivered preterm compared with controls (7.5% versus 6.7%, P = 0.90). The median 25(OH)D level for all subjects was 89 nmol/L (interquartile range, 73 to 106 nmol/L). Seventy-three percent (117/160) of the cohort had sufficient vitamin D levels [25(OH)D ≥ 75 nmol/L]. In a cohort of pregnant women with mostly sufficient levels of first-trimester serum 25(OH)D, vitamin D deficiency was not associated with spontaneous preterm birth.

Maternal depression and Epstein-Barr virus reactivation in early pregnancy.

OBJECTIVE: Recent evidence suggests a link between Epstein-Barr virus reactivation and chronic stress due to decreased cellular immune responses. Maternal depression complicates 10% to 20% of pregnancies and is accompanied by stress. We sought to estimate the association of Epstein-Barr virus reactivation with depression in pregnancy. METHODS: In this cohort study, prevalence of Epstein-Barr virus reactivation was compared between 100 pregnant women with depression before pregnancy and a computer-generated referent group of 100 healthy women not known to be depressed. We included only those women with documented Diagnostic and Statistical Manual of Mental Disorders depression diagnoses in the current pregnancy. Serum samples were analyzed for presence of Epstein-Barr virus viral capsid antigen, nuclear antigen, and early antigen antibodies. Epstein-Barr virus reactivation was defined by presence of viral capsid antigen or nuclear antigen immunoglobulin (Ig) G, along with early antigen IgG, viral capsid antigen IgM, or both early antigen IgG and viral capsid antigen IgM. RESULTS: Maternal demographics were similar between the groups except for older age (34.1 compared with 32.7 years, P=.05), and lower body mass index (27.3 compared with 28.9, P=.03) among the depressed individuals. Ninety-five percent of the women were seropositive for Epstein-Barr virus. Women with depression were more likely to have Epstein-Barr virus reactivation (48% compared with 30%, P=.01) when compared with referent participants. Epstein-Barr virus reactivation remained associated with maternal depression (adjusted odds ratio 1.97, 95% confidence interval 1.10-3.77, P=.03) after controlling for potential confounders. CONCLUSION: Women with depression have higher prevalence of Epstein-Barr virus reactivation, possibly due to increased stress. LEVEL OF EVIDENCE: II.

B cell acute lymphocytic leukemia in pregnancy.

Acute lymphocytic leukemia (ALL) is a rare occurrence in pregnancy and can be rapidly fatal if left untreated. The need for immediate treatment of ALL, coupled with the maternal-fetal risks from the chemotherapy regimen render a therapeutic dilemma in pregnant women with ALL. We report a case of ALL diagnosed in the 24th week of pregnancy to outline our management strategy, to demonstrate the feasibility of treatment with multi-agent chemotherapy, and to provide a review of the literature.

A nested case-control study of midgestation vitamin D deficiency and risk of severe preeclampsia.

CONTEXT: Vitamin D may be important in the pathogenesis of severe preeclampsia. Given the few effective preventive strategies for severe preeclampsia, studies establishing this link are needed so that effective interventions can be developed. OBJECTIVE: Our objective was to assess whether midgestation vitamin D deficiency is associated with development of severe preeclampsia. DESIGN AND SETTING: We conducted a nested case-control study of pregnant women who had previously given blood for routine genetic multiple marker screening and subsequently delivered at a tertiary hospital between January 2004 and November 2008. PATIENTS: Participants included women with singleton pregnancies in the absence of any chronic medical illnesses. From an overall cohort of 3992 women, 51 cases of severe preeclampsia were matched by race/ethnicity with 204 women delivering at term with uncomplicated pregnancies. Banked maternal serum was used to measure maternal 25-hydroxyvitamin D [25(OH)D]. MAIN OUTCOME MEASURE: The main outcome was severe preeclampsia. RESULTS: Midgestation maternal 25(OH)D concentration was lower in women who subsequently developed severe preeclampsia compared with controls [median (interquartile range), 75 (47-107) nmol/liter vs. 98 (68-113) nmol/liter; P = 0.01]. Midgestation maternal 25(OH)D of less than 50 nmol/liter was associated with an almost 4-fold odds of severe preeclampsia (unadjusted odds ratio, 3.63; 95% confidence interval, 1.52-8.65) compared with midgestation levels of at least 75 nmol/liter. Adjustment for known confounders strengthened the observed association (adjusted odds ratio, 5.41; 95% confidence interval, 2.02-14.52). CONCLUSION: Maternal midgestation vitamin D deficiency was associated with increased risk of severe preeclampsia. Vitamin D deficiency may be a modifiable risk factor for severe preeclampsia.

Association of midgestation paraoxonase 1 activity and pregnancies complicated by preterm birth.

OBJECTIVE: The objective of the study was to determine whether an association exists between low paraoxonase 1 activity and dyslipidemia at midgestation and preterm birth. STUDY DESIGN: We conducted a case-control study of 30 women with preterm birth and 90 women with uncomplicated term deliveries. Maternal serum collected at 15-20 weeks was used to measure lipid concentrations and paraoxonase 1 activity using 2 substrates: paraoxon and phenylacetate (arylesterase activity). RESULTS: The groups did not differ with respect to maternal demographics. Paraoxonase 1 activity (paraoxon) was significantly lower in women delivering preterm compared with controls (12.9 +/- 6.1 vs 16.6 +/- 7.7 dA/min; P = .02). Arylesterase activity and serum lipid concentrations were similar between women with preterm birth and controls. CONCLUSION: Midgestation paraoxonase 1 activity is lower in women who later experience spontaneous preterm birth compared with women who have term deliveries. Prospective studies are needed to determine the significance of paraoxonase 1 in the pathogenesis of preterm birth.

Prevalence of Epstein-Barr virus reactivation in pregnancy.

Recent evidence suggests a link between Epstein-Barr virus (EBV) reactivation and chronic stress in nonpregnant adults, possibly due to decreased cellular immune response. Our objective was to determine the prevalence of EBV seropositivity in a diverse cohort of pregnant women and whether maternal demographic characteristics were associated with EBV reactivation. In this cross-sectional study, we evaluated midpregnancy serum specimens from 64 healthy pregnant women for presence of EBV viral capsid antigen, EBV nuclear antigen, and EBV early antigen. The subjects were reported as EBV seronegative, EBV seropositive with reactivation, and EBV seropositive without reactivation. The maternal demographics of the seropositive women with EBV reactivation were compared with their nonreactivated counterparts. Chi-square and Student T test were used for statistical analysis. In our pregnant cohort, 63 (98%) of the 64 women were EBV seropositive. Among these seropositive women, 22 (35%) women demonstrated EBV reactivation in pregnancy. EBV reactivation was not associated with maternal age, race, parity, or insurance type. In our diverse pregnant cohort, 98% of women analyzed were EBV seropositive with 35% demonstrating EBV reactivation in the pregnancy by the second trimester. The pathophysiology and clinical implications of EBV reactivation during pregnancy need further study.

The effect of excess weight gain in teenage pregnancies.

Excess weight gain in pregnancy, as defined by the Institute of Medicine (IOM), has been linked to adverse obstetrical outcomes. However, this relationship has not been examined in the younger maternal population. Our aim was to study excess weight gain in our inner-city teenage population. In this retrospective cohort study, we reviewed all nulliparous teenage deliveries between 2000 and 2004. The groups were divided by IOM criteria into "underweight" (body mass index [BMI] <20 kg/m(2); n = 58), "normal" (BMI, 20 to 26.0 kg/m(2); n = 255), "overweight" (BMI, 26.1 to 29.0 kg/m(2); n = 54), and "obese" (BMI > 29.0 kg/m(2); n = 89). The groups were then compared according to normal (control, n = 257) and excess weight gain (n = 199). Frequencies and odds ratios (ORs) for adverse outcomes were calculated. Excess weight gain was associated with an increased risk for cesarean delivery (OR 1.96, 95% confidence interval [CI], 1.28 to 3.01) and postpartum fever (OR, 2.46; 95% CI, 1.13 to 5.35). Significant neonatal findings included higher birthweight (3199 g versus 2864 g; p < 0.0001) and increased risk of macrosomia (OR, 8.18; 95% CI, 2.02 to 32.99) in the excess weight gain group. We concluded that excess weight gain places teen mothers at increased risk for cesarean delivery, postpartum febrile morbidity, and macrosomia. Interventions aimed at optimal weight gain in teen pregnancies are warranted.

Association of midgestational paraoxonase 1 activity with pregnancies complicated by preeclampsia.

The antioxidant enzyme paraoxonase 1 is a marker of oxidative stress and has been implicated in the pathogenesis of preeclampsia. Our objective was to determine if an association exists between low paraoxonase 1 activity at midgestation and the development of preeclampsia. We conducted a case-control study of 50 women with preeclampsia and 101 women with uncomplicated term deliveries. Maternal serum collected at 15 to 20 weeks was used to measure paraoxonase 1 activity using two substrates: paraoxon and phenylacetate (arylesterase activity). The groups did not differ with respect to maternal demographics. Paraoxonase 1 activity (paraoxon) was significantly higher in women with preeclampsia compared with controls (19.4 +/- 9.4 versus 15.6 +/- 8.0 change in absorbance per minute (dA/min), P = 0.009). When stratified by disease severity, paraoxonase 1 activity (paraoxon) was highest in women with severe preeclampsia (21.6 +/- 9.1 versus 15.6 +/- 8.0 dA/min, P = 0.002). We observed a trend toward higher arylesterase activity in women with preeclampsia compared with controls (0.343 +/- 0.07 versus 0.323 +/- 0.06 dA/min, P = 0.06). Midgestational paraoxonase 1 activity is higher in women with preeclampsia before clinical signs of the disease are present. Prospective studies are needed to determine the significance of paraoxonase 1 in the pathogenesis of preeclampsia.

Obstetric and newborn infant outcomes in human immunodeficiency virus-infected women who receive highly active antiretroviral therapy.

OBJECTIVE: Our aim was to examine perinatal outcomes in women who are infected with human immunodeficiency virus (HIV) and who receive highly active antiretroviral therapy compared with the general population. STUDY DESIGN: In this retrospective cohort study, we compared 151 HIV-positive and 302 HIV-negative women. We defined highly active antiretroviral therapy as concomitant use of at least 3 antiretroviral drugs. We calculated frequencies and odds ratios for adverse pregnancy outcomes. RESULTS: Compared with control subjects, smoking (odds ratio, 4.62; 95% confidence interval [CI], 2.58-8.27), drug abuse (odds ratio, 5.48; 95% CI, 2.21-13.59), and spontaneous preterm birth (adjusted odds ratio, 2.27; 95% CI, 1.22-4.25) were more common among HIV-positive women. HIV-positive women were more likely to deliver a small-for-gestational-age infant, but this was due to higher tobacco and cocaine use. Neonatal outcomes were otherwise similar. CONCLUSION: HIV-positive women are at increased risk for preterm birth and lower birthweight infants; therefore, antenatal surveillance should include fetal growth assessment. Highly active antiretroviral therapy use does not increase maternal complications.