Maternal psychological distress, prenatal cortisol, and fetal weight.

OBJECTIVE: The objective of this study was to examine the effects of maternal psychological distress on estimated fetal weight during midgestation and explore the maternal hypothalamic-pituitary axis and sympathoadrenal dysregulation as potential risk factors for these effects. METHODS: Fetal ultrasound biometry measurements and maternal sociodemographic characteristics, emotional distress symptoms, and first morning urine samples were collected during a clinical ultrasound examination for a cross-sectional sample of 98 women who were between 16 and 29 weeks pregnant. Fetal weight was estimated from ultrasound biometry measurements; maternal emotional distress was assessed using the daily hassles (stress), Center for Epidemiologic Studies-Depression (depression), and State-Trait Anxiety Inventory (anxiety) scales; and urine samples were assayed for cortisol and norepinephrine levels. RESULTS: Correlation analyses revealed that both maternal psychological (daily hassles, depression, and anxiety) and biochemical (cortisol and norepinephrine) variables were negatively related to fetal biometry measurements and estimated fetal weight. A structural equation model further revealed that when the independent variance of maternal sociodemographic, psychological distress, and biochemistry measures were accounted for, prenatal cortisol was the only significant predictor of fetal weight. CONCLUSIONS: Women exhibiting psychological distress during pregnancy exhibit elevated cortisol levels during midgestation that are in turn related to lower fetal weight.

Outcome of pregnancies among Hispanics: revisiting the epidemiologic paradox.

OBJECTIVE: To evaluate the outcome of pregnancies among Hispanics in a tertiary care hospital in Miami, Florida. STUDY DESIGN: Retrospective study of all women who delivered in our institution over an 11-year period. Outcome variables were stratified by race/ethnicity groups: Hispanics, non-Hispanic blacks and non-Hispanic whites. Variables included rates of low birth weight (LBW), preterm delivery (PTD) and other selected pregnancy outcomes. RESULTS: Thirty-five percent were of Hispanic origin, mainly of Caribbean, Central American and South American origin. Hispanics had the lowest rate of LBW (9%) when compared to blacks, non-Hispanics (18%) and white non-Hispanics (11%) (p < 0.0001). Hispanic women were less likely to deliver prematurely, at < 37 weeks (adjusted odds ratio [AOR] 0.68, 95% CI 0.65-0.91, p < 0.0001), < 32 weeks (AOR 0.57, 95% CI 0.52-0.63, p < 0.0001) and < 28 weeks (AOR 0.66, 95% CI 0.51-0.65, p < 0.0001). Hispanic women were less likely to have preterm premature rupture of membranes (AOR 0.66, 95% CI 0.58-0.75, p < 0.0001). CONCLUSION: Hispanics have the lowest PTD and LBW rates when compared to non-Hispanic whites and blacks.

Prenatal maternal biochemistry predicts neonatal biochemistry.

Depressed (n = 45) and nondepressed (n = 47) mothers were recruited prenatally at an ultrasound clinic. Their urine samples were assayed for cortisol, catecholamines (norepinephrine, epinephrine, dopamine) and serotonin. Their urines were assayed again at the neonatal period, and their newborns' urines were also assayed at that time. The depressed versus the nondepressed mothers showed significantly higher cortisol and norepinephrine and significantly lower dopamine levels across the pre- and postnatal assessments. At the postnatal assessment all levels had decreased except the serotonin levels for both groups. Regression analyses on the mother's postnatal biochemistry with the prenatal biochemistry entered as predictor variables showed highly significant, specific relationships between each of the catecholamines, cortisol, and serotonin. The newborn's biochemistry (except for epinephrine) was higher than the maternal biochemistry. Regression analyses on the neonatal biochemistry with the mother's prenatal biochemistry entered as predictor variables also suggested highly significant, specific relationships. The continuity between the mother's and the newborn's neurotransmitter/ neurohormone profiles and data showing that elevated norepinephrine and cortisol predict to low birthweight and prematurity, respectively, highlight the importance of assessing these levels during pregnancy.

Maternal toxicity with continuous nevirapine in pregnancy: results from PACTG 1022.

OBJECTIVE: To compare the safety of nelfinavir and nevirapine-based antiretroviral treatment in HIV-1-infected pregnant women. METHODS: In Pediatric AIDS Clinical Trials Group Protocol 1022, 38 antiretroviral-naive pregnant women at 10-30 weeks' gestation were randomized to nelfinavir or nevirapine with zidovudine plus lamivudine. The study was suspended because of greater than expected toxicity and changes in nevirapine prescribing information. The incidence of treatment-limiting hepatic or cutaneous toxicity was compared between groups for all subjects and for the subset with CD4 cell counts greater than 250 cells/microL at study entry. RESULTS: Toxicity was seen in 1 (5%) of 21 subjects randomized to nelfinavir and 5 (29%) of 17 subjects randomized to nevirapine (P = 0.07). Within the nevirapine group, 1 subject developed fulminant hepatic failure and died, and another developed Stevens-Johnson syndrome. The one adverse event associated with nelfinavir occurred in a subject with a CD4 cell count less than 250 cells/microL. All 5 events among subjects with a CD4 cell count greater than 250 cells/microL were associated with nevirapine (P = 0.04). CONCLUSIONS: Continuous nevirapine may be associated with increased toxicity among HIV-1-infected pregnant women with CD4 cell counts greater than 250 cells/microL, as has been observed in non-pregnant women.

The impact of race/ethnicity on mother-to-child HIV transmission in the United States in Pediatric AIDS Clinical Trials Group Protocol 316.

The present analysis was designed to determine whether race/ethnicity was independently associated with mother-to-child HIV-1 transmission risk in subjects enrolled in a trial of 2-dose intra-partum nevirapine in combination with standard antiretroviral therapy and to determine what factors, including race/ethnicity, predicted maternal viral suppression at the time of delivery. Women enrolled in Pediatric AIDS Clinical Trials Group (PACTG) 316 from sites in the United States and Puerto Rico were included. Distribution of selected maternal disease and treatment characteristics was assessed by race/ethnicity category. Logistic regression models were fit to evaluate possible association of factors with HIV transmission and with viral load at delivery. Variables associated with the outcome at P < 0.05 level were retained in the final models. Of 1052 women randomized at PACTG sites, 891 were included in the present analysis: 572 (64%) were black; 206 (23%) were Hispanic; and 113 (13%) were white. All women who had infected infants were black or Hispanic (11/572 and 3/206, respectively), whereas none of the women identified as white had an infected infant (0/113). This difference was not statistically significant (P = 0.54). White women had higher entry CD4 cell counts and lower HIV-1 RNA at delivery than women of other races/ethnicities. Black and Hispanic women were more likely than white women to start therapy during their current pregnancy but did not initiate prenatal care later. In bivariate models that included antiretroviral type and variables that had values of P < or = 0.25 in univariate analysis, time of antiretroviral initiation, time of prenatal care initiation, and race/ethnicity each retained significance in predicting viral suppression at delivery. Race/ethnicity remained predictive of viral suppression at delivery in a multivariate model incorporating all of these variables (P = 0.01). Higher HIV-1 RNA and lower CD4 cell counts in women identified as black or Hispanic have significant implications for the health of these women and their newborns. Race/ethnicity is significant in predicting viral suppression at the time of delivery.