Plasma extracellular superoxide dismutase activity in healthy pregnant women is not influenced by zinc supplementation.

We hypothesized that plasma extracellular superoxide dismutase (EC-SOD) activity reflects the zinc nutriture of healthy pregnant women. Sixty-three women were selected from 580 African-American women who participated in a clinical trial to evaluate the effect of prenatal zinc supplementation on pregnancy outcome. Half of the women received zinc (25 mg/d) and the other half was given a placebo from about 19 wk gestation to delivery. In the trial, a positive effect of zinc supplementation on birthweight was observed, indicating that the population as a whole had suboptimal zinc nutriture. Using plasma samples obtained during the trial, EC-SOD activities were measured and the values were compared with plasma zinc concentrations and plasma alkaline phosphatase activities. Plasma EC-SOD activities in our subjects were lower than previously published values for healthy adults in Korea. Although plasma EC-SOD activity may reflect severe zinc deficiency, it is not a sensitive marker for marginal deficiency status. Plasma EC-SOD activities did not prove to be a better indicator of zinc nutriture of pregnant women than either plasma zinc or plasma alkaline phosphatase activities.

Umbilical cord serum levels of thromboxane B2 in term infants of women who participated in a placebo-controlled trial of low-dose aspirin.

OBJECTIVE: Our aim was to quantify thromboxane B2 (TXB2) in umbilical cord serum of term infants of nulliparous, low-risk women who were randomly assigned to either placebo or low-dose (60 mg) aspirin (ASA) on a daily basis from 24 weeks' gestation through delivery as part of a randomized clinical trial for prevention of preeclampsia. METHODS: Umbilical cord sera from 230 singleton, term infants whose mothers were involved in our low-dose ASA trial were assayed for TXB2, the stable metabolite of thromboxane A2, without knowledge of treatment or outcome data. The data were related to assigned treatment group, longitudinal pattern of maternal serum TXB2 levels, and other maternal and newborn characteristics. The data also were analyzed according to whether or not maternal serum levels of TXB2 at 29-31, 34-36, and delivery were reduced > or =50% compared to values prior to initiation of the trial. RESULTS: Umbilical cord TXB2 levels (ng/ml, mean +/- SE) were significantly lower at term in the ASA group (36.1 +/- 3.3, n = 111) than in the placebo group (56.6 +/- 5.7, n = 119; P = 0.002). Umbilical cord TXB2 levels were correlated to those in maternal serum at delivery in the ASA group (r = 0.3441; P = 0.0005) but not in the placebo group (r = 0.0626; P = 0.53). Regardless of assigned treatment group, infants whose mothers had a > or =50% longitudinal reduction in serum TXB2 had lower umbilical cord TXB2 levels (39.2 +/- 3.6, n = 114) than infants whose mothers had <50% reductions in TXB2 (54.6 +/- 5.9, n = 116; P = 0.027). Birthweights of these infants correlated inversely (r = 0.1678, P = 0.017) with maternal serum TXB2 at delivery but not to umbilical cord TXB2 levels; the best correlation between birthweight and maternal serum TXB2 was noted in pregnancies assigned to receive placebo (r = -0.2558, P = 0.009). CONCLUSIONS: Umbilical cord serum levels of TXB2 1) are reduced in instances of long-term maternal ingestion of ASA, 2) correlate well with maternal serum levels of TXB2 at delivery when there is evidence for consistent maternal use of ASA, but 3) do not correlate with maternal serum TXB2 levels when there is no evidence for frequent maternal ingestion of cyclooxygenase inhibitors. These data suggest that the capacity for platelet production of TXA2 in fetal and maternal compartments are regulated independently. Finally, there is an inverse relationship between maternal serum TXB2 levels at delivery and birthweight of newborn infants that is most evident among the pregnancies assigned to placebo and also among pregnancies in which there was little evidence to suggest a pattern of cyclooxygenase inhibitor use during pregnancy.

Second-trimester plasma homocysteine levels and pregnancy-induced hypertension, preeclampsia, and intrauterine growth restriction.

OBJECTIVE: The purpose of this study was to determine whether second-trimester plasma homocysteine levels are elevated among women whose pregnancies are subsequently complicated by pregnancy-induced hypertension, preeclampsia, or intrauterine growth restriction. STUDY DESIGN: Women with normal but relatively low plasma zinc levels were randomly assigned to receive zinc supplementation or placebo from 19 weeks' gestation until delivery. Plasma homocysteine concentration and plasma and erythrocyte folate levels were determined for all available stored samples (zinc group, 231/294; placebo group, 206/286) at 26 and 37 weeks' gestation. Among all women with available samples, pregnancy-induced hypertension (n = 12) or preeclampsia (n = 4) developed in 16 women, and 22 pregnancies were complicated by intrauterine growth restriction. RESULTS: Mean homocysteine levels in women with pregnancy-induced hypertension and preeclampsia were similar to those of control subjects at 26 weeks' gestation but were significantly higher at 37 weeks' gestation. Homocysteine levels were similar between women with pregnancies complicated by intrauterine growth restriction and control subjects at both time points. CONCLUSION: Second-trimester plasma homocysteine concentrations do not predict the subsequent development of pregnancy-induced hypertension, preeclampsia, and intrauterine growth restriction.

Increased risk of preterm delivery with elevated maternal alpha-fetoprotein and plasma zinc levels in African-American women.

BACKGROUND: This study evaluated the relationship of maternal serum alpha-fetoprotein (MSAFP) and plasma zinc levels (PZn) to pregnancy outcome. METHODS: The subjects for this investigation consisted of 917 African-American women, who on registration for prenatal care between 7-22 weeks gestational age (GA), had PZn levels determined and also had MSAFP recorded in their charts. RESULTS: MSAFP levels greater than the 90th percentile significantly increased the risk of PTD (adjusted odds ratio or AOR=2.5, 95% C.I.=1.5-4.2) but not of IUGR. There was no significant relationship between maternal PZn level and PTD or IUGR. When subjects were stratified by MSAFP levels, in women with MSAFP greater than the 90th percentile, the AOR for PTD was 4.0 (95% C.I.=1.2-13.5) for women with PZn levels greater than the median vs. those with PZn equal to or less than the median. In women with MSAFP equal to or less than the 90th percentile, there was no such difference. Multiple regression analyses, using GA at birth as the dependent variable, indicated an interaction between MSAFP and PZn levels. CONCLUSION: In this population, the adverse pregnancy outcome associated with elevated MSAFP was seen only in women with PZn levels greater than the median. The reason for this association is not currently apparent.

Hydramnios prediction of adverse perinatal outcome.

OBJECTIVE: To determine whether hydramnios is associated with an increased risk of adverse perinatal outcomes. METHODS: Computerized records of all ultrasound examinations done at the University of Alabama at Birmingham from 1986 to 1996 (n = 40,065) were reviewed to identify 370 women with singleton pregnancies beyond 20 weeks' gestation and hydramnios diagnosed sonographically by amniotic fluid index of 25 cm or more, largest vertical pocket of 8 cm or more, or subjective impression. Controls were all women with singleton gestations with normal amniotic fluid volumes (n = 36,426). Obstetric outcomes were determined by cross-reference to our database. Cases with hydramnios were compared with controls for perinatal death, anomaly rate, fetal growth restriction (FGR), cesarean delivery, fetal aneuploidy, and maternal diabetes. Cases were sorted according to diabetes status, after which perinatal death, anomaly rate, FGR, cesarean delivery, and fetal aneuploidy were compared again. RESULTS: The incidence of hydramnios was 1%. The perinatal mortality rate in all women with hydramnios was 49 per 1000 births, compared with 14 per 1000 births in the control group (P < .001). Women with hydramnios had 25 times more anomalies than controls (8.4% versus 0.3%; P < .001), although the prevalence of fetal aneuploidy was not significantly different (one in 370 versus one in 3643; P = .10). The cesarean rate was three times higher in women with hydramnios compared with controls (47.0% versus 16.4%; P < .001). When hydramnios cases were divided according to diabetes status, all of the increased risk was in nondiabetic women: Perinatal mortality was 60 per 1000 in nondiabetic women versus 0 per 1000 in diabetic women (P = .03); the anomaly rate was 10.4% versus 0%, respectively (P = .005). CONCLUSION: Hydramnios indicated an increased risk of adverse perinatal outcomes, especially if not associated with diabetes. A comprehensive fetal evaluation, a workup to rule out maternal factors, and fetal surveillance are warranted; amniocentesis for fetal karyotype analysis might not be necessary.

Syphilis, gonorrhoea, and drug abuse among pregnant women in Jefferson County, Alabama, US, 1980-94: monitoring trends through systematically collected health services data.

OBJECTIVE: To assess the association between self reported drug abuse and syphilis and gonorrhoea among pregnant women, Jefferson County, Alabama, United States, 1980-94. STUDY DESIGN: We analysed a prenatal care database and assessed the association of self reported drug use with seropositive syphilis and gonorrhoea using prevalence rates, multiple logistic regression models, and the Pearson correlation coefficient (r) for trends. RESULTS: Overall, 5.5% of the women acknowledged drug abuse, 1.4% had seropositive syphilis, and 4.8% had gonorrhoea. In a multivariate analysis, drug abuse was associated with syphilis (odds ratio 2.9, 95% confidence interval 1.6, 5.3) but not with gonorrhoea. Trends in the annual prevalence of drug abuse closely paralleled trends in the annual prevalence of syphilis, including simultaneous peaks in 1992 (drug abuse, 9.1%; syphilis, 3.2%). There was no such parallel trend between drug abuse and gonorrhoea. Annual prevalence of drug abuse correlated with the prevalence of syphilis (r = 0.89, p = 0.001) more than with the prevalence of gonorrhoea (r = 0.45, p = 0.201). CONCLUSION: Among pregnant women, an increase in drug abuse was closely associated with an epidemic of syphilis, but not of gonorrhoea. Systematically collected prenatal care data can usefully supplement surveillance of diseases and behavioural risk factors associated with them.

Elevated second-trimester amniotic fluid interleukin-6 levels predict preterm delivery.

OBJECTIVE: Our purpose was to determine whether early second-trimester amniotic fluid interleukin-6 levels predict delivery before 34 weeks' gestation. STUDY DESIGN: We used stored second-trimester amniotic fluid samples obtained from women undergoing genetic amniocentesis from 1988 to 1996. Interleukin-6 levels were measured by enzyme-linked immunosorbent assay in samples from every case known to result in delivery from 20 to 34 weeks' gestation (n = 290), and 290 matched controls delivering at > or =37 weeks. Fetal aneuploidies, anomalies, and all cases delivering within 30 days of the amniocentesis (which were thought to be possibly procedure related) were excluded. RESULTS: Interleukin-6 levels were higher in cases than controls (1.9 +/- 5.2 vs 1.0 +/- 2.4 ng/ml, p = 0.004). Cases were grouped according to whether the preterm delivery was indicated or spontaneous: The mean interleukin-6 levels were significantly higher than controls in the spontaneous group (1.6 +/- 3.2 vs 0.8 +/- 1.2 ng/ml, p = 0.01) but not in the indicated group (1.4 +/- 4.0 vs 0.8 +/- 1.2 ng/ml, p = 0.12). In all samples the interleukin-6 level was negatively correlated with the gestational age at delivery (R = -0.11633, p = 0.007). CONCLUSION: Elevated early second-trimester amniotic fluid interleukin-6 levels are associated with preterm delivery, confirming that in some women this indicator of very early intrauterine inflammation predicts birth before 34 weeks' gestation.

Pregnancy outcomes following false-positive multiple marker screening tests.

Pregnancy outcomes in women with a false-positive midtrimester multiple marker screening test (MMST) were reviewed. A genetic database was used to identify all women > or = age 30 who had a MMST at 15-20 weeks of gestation, a targeted ultrasound, and amniocentesis, and complete pregnancy outcome data. All patients with an abnormal fetal ultrasound (US) or karyotype were excluded. The incidence of adverse outcomes (defined as fetal death, preterm delivery, or a birth weight less than the 10th percentile for gestational age), in those women with a positive MMST (risk of Down's syndrome > or = 1:190) was compared to the incidence of adverse outcomes in control women with negative MMST. Chi-square analysis and Fisher's exact tests were used for comparisons as appropriate. Complete data was available from 1135 women. Seventy-seven percent were over age 35. Two hundred and forty-six women (22%) had a positive multiple marker test. No significant differences in outcomes were discovered after comparisons to controls: fetal death 1 of 246 (0.4%) versus 12 of 889 (1.3%), p = 0.32; preterm delivery 32 of 246 (13.0%) versus 147 of 889 (16.5%), p = 0.17; birth weight less than the 10th percentile, 9 of 246 (3.7%) versus 30 of 889 (3.4%), p = 0.83. Our data suggest that women > or = age 30 with a false-positive MMST and a normal midtrimester obstetrical sonogram are not at an increased risk for adverse pregnancy outcomes in later gestation.

Pregnancy outcome and intelligence at age five years.

OBJECTIVE: Our purpose was to determine the influence of being small for gestational age at term and being preterm < 34 weeks on cognitive functioning at age 5 years. STUDY DESIGN: Five hundred forty-six children of black low-income mothers, nearly all at risk for being small for gestational age, followed up prenatally with early ultrasonographic gestational age dating, were classified as either term appropriate for gestational age, term small for gestational age, or preterm at < 34 weeks. At a mean of 5.5 +/- 0.5 years, a Wechsler Preschool and Primary Scale of Intelligence-Revised intelligence quotient test was administered. An intelligence quotient < 70 was used to define mental retardation. Univariate and multivariate analyses adjusted for maternal age, smoking, education and language skills, home environment, and child gender and preschool attendance were performed. RESULTS: Term small-for-gestational-age and preterm infants at < 34 weeks had 4 and 6 point intelligence quotient reductions compared with term appropriate-for-gestational-age infants. In the regression analyses these differences in intelligence quotient remained significant after confounders were adjusted. High maternal receptive language level (8 points), a positive home environment (5 points), and attendance at preschool (5 points) were each significantly associated with an increase in intelligence quotient. CONCLUSION: Both term small-for-gestational-age infants and those born at < 34 weeks had a significantly lower mean intelligence quotient, and small-for-gestational-age infants had an increased risk of mental retardation at age 5 years. Higher maternal language skills, a positive home environment, and attendance at preschool each were associated with an increase in the mean intelligence quotient of 5 to 7 points.

Effect of angiotensin-converting enzyme gene polymorphism on pregnancy outcome, enzyme activity, and zinc concentration.

OBJECTIVE: To evaluate the effect of angiotensin-converting enzyme (ACE) genotypes on pregnancy outcome, the incidence of pregnancy-induced hypertension, and changes in blood pressure (BP) during pregnancy; and the relationship between plasma ACE activities and plasma and erythrocyte zinc concentrations in each genotype. METHODS: The subjects (n = 191) were selected from 580 indigent African-American pregnant women who enrolled toward the end of a trial to evaluate the effect of zinc supplementation on pregnancy outcome. This selection resulted in 93 subjects who received zinc and 98 who received placebo. Sample size was calculated with a 0.50 correlation coefficient between plasma ACE activities and zinc levels and a power of 80%. This calculation indicated that the sample size in each ACE genotype should be more than 28. Angiotensin-converting enzyme genotypes were identified using polymerase chain reaction. Blood pressure, plasma ACE activities, and plasma and erythrocyte zinc concentrations were measured at each prenatal clinical visit. RESULTS: Pregnancy outcome, the incidence of pregnancy-induced hypertension, and BP were not different among the three ACE genotypes. There was no significant correlation between plasma ACE activities and zinc concentrations. Zinc supplementation did not have a significant effect on either plasma ACE activities or zinc concentrations, probably because of the small sample size in our study. CONCLUSION: There was no effect of ACE gene polymorphism on pregnancy outcome, the incidence of pregnancy-induced hypertension, or changes in BP during pregnancy. Among each ACE genotype, plasma ACE activities did not correlate significantly with plasma zinc concentrations.

Factors influencing plasma zinc levels in low-income pregnant women.

Plasma zinc (Zn) concentrations were measured in 4376 indigent women (86% African-American), at at mean (+/- SD) gestational age of 15 (+/- 7.8) wk to determine the relationship between various maternal characteristics and plasma Zn levels during pregnancy. Mean Plasma An levels were lower in African-American women than in Caucasian women, in multiparous women than in primiparous women, and in women with body weight > 69.9 kg than in those with body weight < or = 69.9 kg (p < or = 0.001 for each comparison). There were no significant differences related to maternal age, marital status, education, or smoking habit. Multiple regression analysis, including maternal prepregnancy weight, race, age, parity, smoking habit, education, and marital status indicated that race, parity, and pregnancy weight were significantly associated with maternal plasma Zn levels, adjusted for gestational age. Maternal race was the best predictor of plasma Zn concentrations among the population of pregnant women studied A significant proportion of variance in maternal plasma Zn levels. remained unexplained after taking into account various maternal characteristics. The reasons for lower plasma Zn levels in African-American women, compared to Caucasian women, during pregnancy are unknown.

Elevated amniotic fluid interleukin-6 levels at genetic amniocentesis predict subsequent pregnancy loss.

OBJECTIVE: Our purpose was to determine the proportion of pregnancy loss after genetic amniocentesis that is related to preexisting subclinical intrauterine inflammation. STUDY DESIGN: We accessed our bank of stored second-trimester amniotic fluid and maternal serum samples obtained from women undergoing genetic amniocentesis at our institution from 1988 to 1995 (N = 11,971). Interleukin-6 levels were measured by enzyme-linked immunosorbent assay in samples from every case resulting in spontaneous postprocedure loss (excluding fetal aneuploidy and anomalies) within 30 days after the procedure (n = 66) and from 66 normal control women delivered at term and matched for year of test, gestational age, maternal age, and indication for amniocentesis. RESULTS: Mean maternal serum interleukin-6 levels were the same in each group (0.02 +/- 0.07 ng/ml for cases and 0.06 +/- 0.25 ng/ml for controls, p = 0.45). Mean amniotic fluid interleukin-6 levels were higher in cases (4.0 +/- 13.1 ng/ml) than in controls (0.5 +/- 0.7 ng/ml, p = 0.04). The higher mean amniotic fluid interleukin-6 levels in the cases resulted from the inclusion of eight very high values (> or = 3 SD or > or = 2.5 ng/ml). When these samples were excluded, the means and range of values were the same in each group (0.4 +/- 0.4 ng/ml for cases and 0.5 +/- 0.7 ng/ml for controls, p = 0.58). Twelve percent (8/66) of the cases and 3% (2/66) of the controls had amniotic fluid interleukin-6 levels > or = 2.5 ng/ml (p = 0.048, odds ratio 4.1, 95% confidence interval 1.0 to 31.2). Although the overall correlation between maternal serum and amniotic fluid interleukin-6 levels was good (r = 0.50, p < 0.002), only one of the eight cases would have been identified by a maternal serum interleukin-6 level > or = 3 SD above the mean (> or = 0.8 ng/ml). CONCLUSION: Analysis of our complete unselected group of postamniocentesis pregnancy losses indicates that up to 12% may result from preexisting subclinical intrauterine inflammation. This inflammation is most likely localized and may not be identified by a maternal serum interleukin-6 level before the procedure.

Influence of acid-base status at birth and Apgar scores on survival in 500-1000-g infants.

OBJECTIVE: To evaluate the influence of acid-base status at birth and Apgar scores on survival in very low birth weight infants. METHODS: We evaluated 1073 infants born alive and weighing 500-1000 g during 1979-1991; 658 had umbilical artery gas values examined. Apgar scores were assigned at 1 and 5 minutes after birth. Umbilical artery blood samples were collected at delivery for pH, carbon dioxide pressure (PCO2), and bicarbonate. Infants were grouped at 23-24, 25-26, 27-28, and 29 weeks or more. Using survival as the dependent variable, multiple logistic regression analyses were performed controlling for gestational age, birth weight, plurality, antenatal glucocorticoid use, mode of delivery, and year of birth, as well as for Apgar scores and cord blood gases. RESULTS: In every gestational age grouping, compared with infants with a pH lower than 7.05, survival was higher in infants with an umbilical artery pH of 7.05 or higher, significantly so at 27-28 weeks. There was no consistent relationship between umbilical artery PCO2 or bicarbonate and survival. However, with the exception of the 1-minute Apgar score at 23-24 weeks, the relationship of Apgar scores to survival was significant in all gestational age periods. Using multiple logistic regression analyses, the only significant relationships between any of the cord blood gases, Apgar scores, and mortality involved low 1-minute (odds ratio [OR] 2.7 [95% confidence interval (CI) 2.0-3.6]) and low 5-minute Apgar scores (OR 2.8 [95% CI 2.0-3.8]) and a bicarbonate less than 21 mEq/L (OR 1.6 [95% CI 1.1-2.4]). CONCLUSION: One- and 5-minute Apgar scores are better predictors of survival than umbilical artery blood gases in neonates weighing 500-1000 g at birth.

Reduced incidence of preterm delivery with metronidazole and erythromycin in women with bacterial vaginosis.

BACKGROUND: Pregnant women with bacterial vaginosis may be at increased risk for preterm delivery. We investigated whether treatment with metronidazole and erythromycin during the second trimester would lower the incidence of delivery before 37 weeks' gestation. METHODS: In 624 pregnant women at risk for delivering prematurely, vaginal and cervical cultures and other laboratory tests for bacterial vaginosis were performed at a mean of 22.9 weeks' gestation. We then performed a 2:1 double-blind randomization to treatment with metronidazole and erythromycin (433 women) or placebo (191 women). After treatment, the vaginal and cervical tests were repeated and a second course of treatment was given to women who had bacterial vaginosis at that time (a mean of 27.6 weeks' gestation). RESULTS: A total of 178 women (29 percent) delivered infants at less than 37 weeks' gestation. Eight women were lost to follow-up. In the remaining population, 110 of the 426 women assigned to metronidazole and erythromycin (26 percent) delivered prematurely, as compared with 68 of the 190 assigned to placebo (36 percent, P = 0.01). However, the association between the study treatment and lower rates of prematurity was observed only among the 258 women who had bacterial vaginosis (rate of preterm delivery, 31 percent with treatment vs. 49 percent with placebo; P = 0.006). Of the 358 women who did not have bacterial vaginosis when initially examined, 22 percent of those assigned to metronidazole and erythromycin and 25 percent of those assigned to placebo delivered prematurely (P = 0.55). The lower rate of preterm delivery among the women with bacterial vaginosis who were assigned to the study treatment was observed both in women at risk because of previous preterm delivery (preterm delivery in the treatment group, 39 percent; and in the placebo group, 57 percent; P = 0.02) and in women who weighed less than 50 kg before pregnancy (preterm delivery in the treatment group, 14 percent; and in the placebo group, 33 percent; P = 0.04). CONCLUSIONS: Treatment with metronidazole and erythromycin reduced rates of premature delivery in women with bacterial vaginosis and an increased risk for preterm delivery.

Comparison of multiple-marker screening with amniocentesis for the detection of fetal aneuploidy in women > or = 35 years old.

OBJECTIVE: Our purpose was to compare the multiple-marker screening test with elective amniocentesis for the detection of fetal Down syndrome and other aneuploidies in women aged > or = 35. STUDY DESIGN: Our database included the multiple-marker screening test (maternal serum alpha-fetoprotein, human chorionic gonadotropin, unconjugated estriol, and maternal age) and genetic amniocentesis results from 1942 women aged > or = 35. A Down syndrome risk > or = 1:190 was considered screen positive. An algorithm to detect trisomy 18 was also used. RESULTS: The multiple-marker screening test Down syndrome screen-positive rate was 26.1% (507/1942). The Down syndrome detection rate was 75% (33/44); the trisomy 18 detection rate was 75% (3/4). However, the multiple-marker screening test detection rate for all aneuploidies was only 61%. Missed aneuploidies included trisomy 21, sex chromosome abnormalities, trisomy 13, trisomy 22, and trisomy 18. CONCLUSIONS: The multiple-marker screening test fails to detect approximately 39% of all fetal aneuploidies in women aged > or = 35. These data should be provided to women considering prenatal diagnosis so that they can make an informed decision regarding the multiple-marker screening test versus amniocentesis for advanced maternal age.

The effect of low-dose aspirin on pregnancies complicated by elevated human chorionic gonadotropin levels.

OBJECTIVE: Our purpose was to determine whether elevated second-trimester human chorionic gonadotropin levels identify women likely to benefit from low-dose aspirin therapy. STUDY DESIGN: We evaluated second-trimester human chorionic gonadotropin levels obtained from healthy nulliparous women before screening for participation in a double-blind randomized trial of aspirin therapy: 262 women took 60 mg of aspirin daily and 420 did not. RESULTS: Among women who did not take aspirin, those with human chorionic gonadotropin levels > or = 2.0 multiples of the median had a significantly lower mean birth weight (2859 vs 3159 gm, p = 0.04) than did those with normal human chorionic gonadotropin levels. All women who took aspirin had a higher mean birth weight than women who did not, but women with human chorionic gonadotropin levels > or = 2.0 multiples of the median had the greatest increase (416.2 gm higher in those with human chorionic gonadotropin levels > or = 2.0 multiples of the median, p = 0.02; 96 gm higher in those with human chorionic gonadotropin levels > or 2.0 multiples of the median, p = 0.04). Regression analysis suggested that the higher birth weight was partly explained by a higher gestational age at delivery and partly by increased weight independent of gestational age. CONCLUSIONS: Aspirin therapy increased birth weight in all women, especially in women with high human chorionic gonadotropin levels, partly by increasing gestational age at delivery. This observation needs to be confirmed by further studies.

The effect of zinc supplementation on pregnancy outcome.

OBJECTIVE: To evaluate whether zinc supplementation during pregnancy is associated with an increase in birth weight. DESIGN: A randomized double-blind placebo-controlled trial. SETTING: Outpatient clinic and delivery service at the University of Alabama at Birmingham. PATIENTS: Five hundred eighty medically indigent but otherwise healthy African-American pregnant women with plasma zinc levels below the median at enrollment in prenatal care, randomized at 19 weeks' gestational age. Women were subdivided by the population median body mass index of 26 kg/m2 into two groups for additional analyses. INTERVENTION: Women who were taking a non-zinc-containing prenatal multivitamin/mineral tablet were randomized to receive either a daily dose of 25 mg of zinc or a placebo until delivery. MAIN OUTCOME MEASURES: Birth weight, gestational age at birth, and head circumference at birth. RESULTS: In all women, infants in the zinc supplement group had a significantly greater birth weight (126 g, P = .03) and head circumference (0.4 cm, P = .02) than infants in the placebo group. In women with a body mass index less than 26 kg/m2, zinc supplementation was associated with a 248-g higher infant birth weight (P = .005) and a 0.7-cm larger infant head circumference (P = .007). Plasma zinc concentrations were significantly higher in the zinc supplement group. CONCLUSIONS: Daily zinc supplementation in women with relatively low plasma zinc concentrations in early pregnancy is associated with greater infant birth weights and head circumferences, with the effect occurring predominantly in women with a body mass index less than 26 kg/m2.

The relationship of maternal attitude toward weight gain to weight gain during pregnancy and low birth weight.

OBJECTIVE: To evaluate the relationships between maternal attitude toward weight gain, actual weight gain, and infant birth weight. METHODS: Maternal attitude toward weight gain during pregnancy was assessed in 1000 women, using an 18-item questionnaire administered at a mean of 20 weeks' gestation. Composite scores were compared with pregnancy weight gain, maternal body mass index (BMI), and infant birth weight. RESULTS: In the total population, the attitude score was not significantly related to pregnancy weight gain (r = -0.05, P = .08) and was negatively associated with birth weight (r = -0.09, P < .004). Maternal body size as measured by BMI was strongly associated with both weight gain and birth weight. Obese women (BMI greater than 26.6) tended to have negative attitudes and had the lowest mean weight gain (10.2 kg), but had the heaviest babies (3400 g). Thin women (BMI less than 19.6) had significantly higher attitude scores and a higher mean weight gain (14.1 kg) than did obese women. A significantly larger proportion of thin women achieved recommended gains when compared with larger women, but had the lightest babies (3114 g). Within the group of thin women, after adjustment for smoking, race, and gestational age at delivery, attitude scores were not significantly associated with either weight gain or birth weight. CONCLUSION: Maternal attitude regarding weight gain is strongly influenced by pre-pregnancy body size; thin women tend to have positive attitudes and obese women tend to have negative attitudes about weight gain. Within BMI groups, a positive attitude does not predict appropriate weight gain or birth weight. These findings may explain in part why nutritional counseling programs tend to be associated with only minimal increases in birth weight.

Predicting low Apgar scores of infants weighing less than 1000 grams: the effect of corticosteroids.

OBJECTIVE: To evaluate maternal and neonatal factors that predict low Apgar scores in newborns weighing less than 1000 g. METHODS: From a data set of all live-born infants who were delivered between 1979-1991 and who weighed 1000 g or less, we reviewed the records of 837 neonates born at 24-28 weeks' gestation. Potential risk factors were evaluated for associations with a 1-minute Apgar score of 3 or less and a 5-minute Apgar score of 6 or less. Analyses used chi 2 test and multiple logistic regression. RESULTS: The prevalence of 1-minute Apgar scores of 3 or less decreased from 65.9% at 24 weeks to 38.2% at 28 weeks, and the prevalence of 5-minute Apgar scores of 6 or less decreased from 83.3% at 24 weeks to 51.2% at 28 weeks. As the birth weight increased from 500-599 g to 900-1000 g, 1-minute Apgar scores of 3 or less decreased from 77.0% to 39.6%, and 5-minute Apgar scores of 6 or less decreased from 89.2% to 56.4%. Aside from gestational age and birth weight, corticosteroid use was the strongest predictor of Apgar scores above 3 at 1 minute and above 6 at 5 minutes. Male and nonvertex-presenting infants had an increased likelihood of low Apgar scores, as did infants with cord blood pH less than 7.05 or bicarbonate value less than 17 mEq/L. CONCLUSION: Neonates at very low gestational ages and birth weights are more likely than larger or more mature infants to have low Apgar scores. Males, nonvertex-presenting infants, and those who are acidotic at birth also have an increased prevalence of low scores. Infants born to mothers treated with antenatal corticosteroids are less likely to have low Apgar scores. This finding indicates that antenatal corticosteroids may benefit the newborn at birth, before respiratory distress syndrome becomes apparent.