Effects of supplementation of organic and inorganic combinations of copper, cobalt, manganese, and zinc above nutrient requirement levels on postpartum two-year-old cows.

The objective of this study was to determine whether a combination of Cu, Co, Mn, and Zn in an organic or inorganic form fed at higher than nutrient recommendations for 2-yr-old cows from calving to breeding would affect pregnancy rate, calving date, calf performance, and cow liver and serum mineral concentrations. Crossbred 2-yr-old cows were used after calving in 1994 (n = 127) and 1995 (n = 109). Cows were blocked by calving date to one of three treatments: 1) no supplemental minerals (CTL), 2) organic minerals (ORG), or 3) inorganic minerals (ING). Minerals were fed for the same daily intake for both organic and inorganic treatments: Cu (125 mg), Co (25 mg), Mn (200 mg), and Zn (360 mg). Cows were individually fed a mineral-protein supplement with grass hay from calving (February-March) to before breeding (May 15). Hay intakes were calculated using chromium oxide boluses to determine fecal output. Fecal excretion of minerals was calculated following trace element analysis of feces. Liver biopsies were obtained before calving, after calving (start of supplementation), at the end of supplementation, and in midsummer. Over 2 yr, more cows did not become pregnant (P < .01) in ORG (11/78) and ING (11/78) treatments than in CTL (0/80) treatments. A treatment x year interaction was found for day of conception. Cows in the ORG group conceived later (P < .01) than cows in the ING or CTL groups in 1994. In 1995, there was no difference (P > .10) in day of conception among groups. Liver Zn and Mn concentrations were not different (P > .10) and Cu concentrations increased (P < .01) for the ORG and ING groups. Cows in the ORG and ING groups had higher (P < .01) concentrations of Cu, Mn, and Zn in the feces than the CTL cows. Trace elements in the feces did not differ for ORG and ING groups. Results indicate that combinations of Cu, Co, Mn, and Zn fed at higher levels than are required reduced reproductive performance.

Absorption of dietary and supplemental folate in women with prior pregnancies with neural tube defects and controls.

BACKGROUND: The Public Health Service of the United States recommends that all women capable of childbearing consume .4 mg (400 microg) folic acid per day to decrease the risk of having a pregnancy affected by a neural tube defect such as spina bifida or anencephaly. Three strategies are available to women to achieve this goal: use of dietary supplements; use of fortified foods; and/or increased intake of naturally occurring folate from foods. Identification of the most effective vehicle for delivery of folate to all women is critical in order to prevent these devastating congenital defects. OBJECTIVE: To investigate the difference in response to an oral load of folate both from naturally occurring food sources and synthetic supplements among women with prior pregnancies affected by neural tube defects and controls. METHODS: We compared the absorption of test doses of 400 microg pteroylglutamic acid (unconjugated or synthetic folic acid found in supplements) and 400 microg pteroylpolyglutamic acid (conjugated or food folate) in 10 women with a history of neural tube defect affected pregnancies and eight controls with normal birth outcomes. The folate test dose was given as either 32 fluid ounces of orange juice or a folic acid single supplement pill. All participants received each test dose at separate clinic visits. The response to each test dose was measured by constructing an area under the curve (AUC) from the serum folate levels at 1, 2 and 3 hours post dose and applying a t-test to compare within and between cases and controls. We also compared red cell folate, vitamin B12, zinc and homocysteine between cases and controls. RESULTS: Within group comparisons showed that the area under the curve was significantly greater for the pteroylglutamic acid dose compared to the pteroylpolyglutamic acid dose for both cases and controls (p=0.02 and p=0.03, respectively). In a between group comparison, control women had a greater serum folate response to both forms of the vitamin compared to the case women, but the difference reached statistical significance only for the pteroylglutamic acid dose (p=0.02). Other measured nutrients differed between cases and controls, but did not reach statistical significance. CONCLUSION: We conclude that for all women synthetic folic acid as supplements or fortified foods may be the best way to increase acute folate levels in the blood, and thus delivery to the developing embryo. Further, since case women had a diminished response to both forms of the vitamin, and some case women had almost no response, we speculate that women with prior affected pregnancies may need a larger dose of folate to elicit a plasma response equivalent to the general population.

Prior pregnancy outcome and the risk of intraamniotic infection in the following pregnancy.

OBJECTIVE: Our purpose was to determine whether the outcome of a prior pregnancy influenced the risk of intraamniotic infection in the following pregnancy. STUDY DESIGN: A case-control study was conducted at five King County, Washington, hospitals from 1990 through 1994. Cases (n = 585) of intraamniotic infection were identified by a medical record review for clinical signs of infection during labor and compared with controls (n = 575). Women were classified as having a spontaneous abortion or elective termination if the pregnancy had been diagnosed by a health care professional before 20 weeks and was verified by medical record review. Adjusted odds ratios and 95% confidence intervals were estimated using logistic regression. RESULTS: Women with spontaneous abortion (odds ratio = 4.3; 95% confidence interval 2.9 to 6.4) or elective termination (odds ratio = 4.0; 95% confidence interval 2.7 to 5.8) had an increased risk of intraamniotic infection. The increased risk was similar for women who did and did not have an earlier pregnancy carried beyond 20 weeks. CONCLUSIONS: Women who have had a spontaneous abortion or an elective termination have an increased risk of intraamniotic infection regardless of previous successful pregnancy outcome.

Maternal smoking during pregnancy and the risk of congenital urinary tract anomalies.

To study maternal smoking during pregnancy and the risk of congenital urinary tract anomalies, we interviewed mothers of 118 affected infants born to residents of western Washington State during 1990 and 1991 and mothers of 369 control infants randomly selected from those without birth defects delivered during those years in five hospitals in King County, Washington. Maternal smoking was associated with an increased risk of congenital urinary tract anomalies in offspring (adjusted odds ratio [OR] = 2.3; 95% confidence interval [CI] = 1.2, 4.5). This risk was higher among light smokers (1-1000 cigarettes during the pregnancy) (OR = 3.7; 95% CI = 1.7, 8.6) than among heavy smokers (OR = 1.4; 95% CI = 0.6, 3.3). Our results corroborate previous findings and support the hypothesis of a causal relation.

A population-based case-control study of risk factors for breech presentation.

OBJECTIVE: We evaluated relationships between breech presentation and infant, maternal, and pregnancy characteristics of singleton births. STUDY DESIGN: A population-based case-control study (3588 breech cases, 8183 controls) was conducted with data from the 1987 to 1988 Washington State birth certificate. RESULTS: Low birth weight, short gestational age, primiparity, and older maternal age were associated with increased risk of breech birth, and after we controlled for these factors, the following were also associated with breech birth: hydrocephalus, established maternal diabetes, congenital malformation of the infant, smoking during pregnancy, and late or no prenatal care. In addition, black and Filipino women had decreased risk of breech presentation compared with white women. CONCLUSION: Several different maternal and infant characteristics appear to increase risk of breech birth, suggesting that there may be several different biologic mechanisms leading to breech presentation.

A one nanosecond molecular dynamics simulation of the glucocorticoid receptor protein in complex with a glucocorticoid response element DNA sequence in a 10 Angstrom water layer.

We investigated protein/DNA interactions, using molecular dynamics simulations computed for one nanosecond, between a 10 Angstom water layer model of the glucocorticoid receptor (GR) DNA binding domain (DBD) amino acids and DNA of a glucocorticoid receptor response element (GRE) consisting of 29 nucleotide base pairs. Hydrogen bonding interactions were monitored. In addition, van der Waals and electrostatic interaction energies were calculated. Amino acids of the GR DBD DNA recognition helix formed both direct and water mediated hydrogen bonds at cognate codon-anticodon nucleotide base and backbone sites within the GRE DNA right major groove halfsite. Likewise amino acids in a beta strand structure adjacent to the DNA recognition helix formed both direct and water mediated hydrogen bonds at cognate codon-anticodon nucleotide base and backbone sites within both the GRE right and left major groove halfsites. In addition, amino acids within a predicted alpha helix located on the carboxyl terminus of the GR DBD interacted at codon-anticodon nucleotide sites on the DNA backbone of the GRE right major groove flanking nucleotides. These interactions together induced breakage of Watson-Crick nucleotide base pairing hydrogen bonds, resulting in significant structural changes and bending of the DNA into the protein.

Recent changes in delivery site of low-birth-weight infants in Washington: impact on birth weight-specific mortality.

OBJECTIVES: Our purpose was to ascertain whether the proportion of low-birth-weight infants delivered in Washington at tertiary hospitals changed between 1980 and 1991 and whether mortality differed by level of birth hospital. STUDY DESIGN: A retrospective cohort study was performed of 500 to 2499 gm infants born to Washington residents between 1980 and 1991 (n = 43,228). RESULTS: Overall, the percentage of low-birth-weight infants born at tertiary centers rose from 1980 to 1982 through 1986 to 1988 and subsequently declined significantly. Among infants weighing < 2000 gm nontertiary delivery was associated with greater potentially preventable mortality (500 to 999 gm, relative risk 1.5, 95% confidence interval 1.3 to 1.8; 1000 to 1499 gm, relative risk 2.1, 95% confidence interval 1.3 to 3.3; 1500 to 1999 gm, relative risk 1.6, 95% confidence interval 1.0 to 2.6). Nontertiary delivery of 2000 to 2499 gm infants was associated with lower overall mortality (relative risk 0.5, 95% confidence interval 0.3 to 0.8), but higher-risk deliveries in this birth weight range were apparently concentrated at tertiary hospitals. CONCLUSIONS: In light of the apparent benefit of tertiary center birth for infants weighing < 2000 gm, the possible erosion of effective regionalized perinatal care networks should be monitored closely.

Renal calcification: a complication of dexamethasone therapy in preterm infants with bronchopulmonary dysplasia.

We have previously reported a case study in which renal calcification formation may have been a complication of dexamethasone exposure in an infant with bronchopulmonary dsyplasia. To determine whether dexamethasone is associated with renal calcification formation, we conducted a prospective, nonrandomized study of 36 infants < 30 weeks' gestation and weighing < 1250 gm treated with dexamethasone because of bronchopulmonary dysplasia and compared them with a group not receiving dexamethasone. We identified seven infants in the dexamethasone group (n = 19) but no infant in the comparison group (n = 17) with renal calcifications at 2 months of age (p = 0.008). The urinary calcium excretion tended to be increased (15.5 +/- 16.6 vs 6.9 +/- 6.7 mg/kg/day ¿p = 0.05¿) and the calcium/creatinine ratio was significantly greater in the dexamethasone group (1.2 +/- 1.0 vs 0.6 +/- 0.4 ¿p = 0.02¿). Infants who received dexamethasone were significantly smaller 819.1 +/- 141.1 vs 954.6 +/- 141 gm ¿p = 0.008¿), were younger (26.2 +/- 1.7 vs 27.7 +/- 1.2 weeks ¿p = 0.004¿), received ventilator support longer (33.3 +/- 14.7 vs 12.1 +/- 14.7 days ¿p = 0.0001¿), and required more days of supplemental oxygen (54.3 +/- 9.7 vs 36.4 +/- 23.8 days ¿p = 0.009¿). We conclude that smaller, younger, and sicker infants are at the highest risk for the development of renal calcifications and that dexamethasone may be associated with increased urinary calcium excretion, which contributes to renal calcification formation.

Differential effects of plane of protein or energy nutrition on visceral organs and hormones in lambs.

Modulation of somatotrophic and homeorhetic hormones, along with changes in visceral mass and metabolic activity, were measured in growing lambs restricted in energy (ER) or metabolizable protein (PR) to maintain BW for 7 wk and then repleted for 2 wk. Control lambs were fed an adequate diet for 9 wk. Serum IGF-I decreased more rapidly in PR, but both ER and PR were 70% of controls by wk 7 of restriction (P < .05) and increased above controls by d 14 of repletion. Somatotropin, increased by PR, returned to control levels upon repletion (P < .05). Insulin was decreased by PR (P < .02) but was transiently elevated above controls by repletion in ER and PR at d 2 (P < .01). Serum triiodothyronine, reduced to 70% of controls by PR and ER, returned to control levels after d 6 of repletion (P < .05). Thyroxine declined gradually to 65% of controls in ER and PR (P < .07) but did not respond to repletion. By wk 7 of restriction, liver mass in ER and PR was decreased to 50% of controls (P < .05). Return of liver mass, on an empty body weight basis, occurred by d 2 of repletion (P < .01). In vitro O2 consumption per gram of liver tissue was increased to 125% of controls by ER and PR (P < .05). Calculated whole liver O2 consumption in ER and PR was 68% of controls at wk 7 of restriction (P < .10). Protein restriction had a more immediate impact on hormones but not on visceral mass or activity compared with energy restriction. Elevated IGF-I levels, as observed in previously restricted lambs, may mediate compensatory growth in ruminants.

Risk factors for preeclampsia in twin pregnancies: a population-based cohort study.

OBJECTIVE: To evaluate in twin pregnancies the characteristics parity, race, smoking, and age, known to be risk factors for preeclampsia in non-twin pregnancies. METHODS: All twin pregnancies (3407) and approximately twice as many singletons (8287) were assembled using Washington state birth certificates from the period 1984-1988. RESULTS: In singleton pregnancies, preeclampsia was more common in women who were younger, black, poor, nulliparous, and nonsmokers. In twin pregnancies, similar associations were found, but were only statistically significant for age, race, and parity. There were no significant differences in the risk factors between twin and singleton women. Logistic regression showed that twin pregnancy carries a relative risk (RR) of 3.5 (95% confidence interval [CI] 3.0-4.2), nulliparity an RR of 4.0 (95% CI 3.3-4.8), and black race an RR of 1.8 (95% CI 1.2-2.6) for preeclampsia. In each case, this risk is independent of the other risk factors. CONCLUSION: Twin pregnancy carries nearly a fourfold increased risk of preeclampsia, independent of race and parity, and the risk of a nulliparous twin pregnancy is 14 times that of a parous singleton pregnancy. Risk factors in a singleton pregnancy act similarly in a twin pregnancy. Thus, any pathophysiologic model for preeclampsia needs to account for the risk twin pregnancy poses as well as other risk factors, such as parity and race.

Periconceptional multivitamin use in relation to the risk of congenital urinary tract anomalies.

To study the relation of maternal periconceptional vitamin use to the risk of a congenital urinary tract anomaly (CUTA), we conducted a case-control study using the Washington State Birth Defect Registry. We identified CUTA cases with no known chromosomal abnormality in seven counties in western Washington State occurring between January 1, 1990, and December 31, 1991. We randomly selected a sample, as controls, of all infants delivered in five large hospitals in King County who did not have a birth defect and who were born in the same year as the cases. About 55% of all infants in King County and a smaller proportion of infants in the other six counties are delivered in these five hospitals. We interviewed mothers of 118 cases and 369 controls to obtain information about their vitamin use during the pregnancy and during the year before the conception. After adjustment for maternal race, family income, county of maternal residence, and birth year, we found that women who used multivitamins during the first trimester had only 15% the risk of bearing a child with a CUTA compared with women who did not take vitamins [odds ratio (OR) = 0.15; 95% confidence interval (CI) = 0.05-0.43]. The reduction was smaller for use restricted to the second or third trimesters (OR = 0.31; 95% CI = 0.09-1.02). Among women who used vitamins during the first trimester, vitamin use before conception was not associated with any further reduction in the risk, nor did there appear to be an association with the amount or brand of vitamin used.(ABSTRACT TRUNCATED AT 250 WORDS)

A longitudinal study of maternal serum human chorionic gonadotropin levels during pregnancy.

OBJECTIVE: To determine if pregnant women with normal singletons will continue to have elevated serum human chorionic gonadotropin (hCG), given that they had an elevated serum hCG in the second trimester. METHODS: Nineteen women with second-trimester hCG levels > or = 2.0 multiples of the median, and 20 women with second-trimester hCG levels < 2.0 multiples of the median were the subjects of this investigation. All study participants had serum hCG levels repeated during the third trimester of pregnancy. We used a chi-square test and Student's t test for comparing categorical variables, and the means of continuous variables, respectively. RESULTS: Using the criterion of > or = 2.0 multiples of the median of the comparison group to define hCG elevation, women with elevated second-trimester hCG levels were women with normal second-trimester hCG levels (risk ratio = 3.9; 95% confidence interval 1.6-9.8; p < 0.001). Adjustment for potential confounders did not materially alter the association. CONCLUSION: Women with elevated hCG in the second trimester continued to have elevations in the third trimester. The persistence of elevated hCG levels in pregnancies uncomplicated by fetal anomalies should be evaluated as a clinical marker of adverse pregnancy outcomes.

Oral contraceptive use after conception in relation to the risk of congenital urinary tract anomalies.

The authors conducted a case-control study of the relation of OC use after conception to the occurrence of congenital urinary tract anomalies (CUTAs). Singleton CUTA cases with no known chromosomal abnormality from seven counties in western Washington State born during the period January 1, 1990-December 31, 1991 were identified through the Washington State Birth Defect Registry. Controls without birth defects were randomly selected from singleton births that occurred in the same year as the cases in five large hospitals in King County. Mothers of the 118 cases and 369 controls were interviewed to obtain their contraceptive history as well as other information. Mothers of nine cases (7.6%) and eight controls (2.2%) had taken OCs at some time during the pregnancy. After adjustment for birth year and county of maternal residence, OC use after conception was associated with an almost five-fold increased risk of having a baby with a CUTA [odds ratio (OR) = 4.8, 95 percent confidence interval (CI), 1.6-14.1] relative to no contraception at or after conception. Use of other contraceptive methods after conception was not related to the risk of CUTAs. OC use during the 3 or 6 months prior to the conception also was not associated with the risk of CUTAs. Further adjustment for sociodemographic factors, reproductive history, perinatal exposure to exogenous agents, and past OC use did not change the results, nor did restricting the analysis to residents of King County.(ABSTRACT TRUNCATED AT 250 WORDS)

PIP: A case-control study examined the relation of OC use after conception to the occurrence of congenital urinary tract anomalies (CUTAs). Singleton CUTA cases with no known chromosomal abnormality from 7 counties in western Washington state born during the period January 1, 1990-December 31, 1991 were identified through the Washington State Birth Defect Registry. Controls without birth defects were randomly selected from singleton births that occurred in the same year as the cases in 5 large hospitals in King County. Mothers of the 118 cases and 369 controls were interviewed to obtain their contraceptive history. Mothers of 9 cases (7.6%) and 8 controls (2.2%) had taken OCs at some time during the pregnancy. After adjustment for birth year and county of maternal residence, OC use after conception was associated with a 4.8-fold increased risk of having a baby with a CUTA [odds ratio (OR) = 4.8, 95% confidence interval (CI), 1.6-14.1) relative to no contraception at or after conception. The risk seemed to increase with increasing duration of OC use after their last menstruation: OR = 8.0 for women with longer than 4 weeks duration of use. Use of other contraceptive methods after conception was not related to the risk of CUTAs. OC use during the 3-6 months prior to conception was not associated with an increased risk of CUTAs in offspring relative to no OC use during the same period. Further adjustment for sociodemographic factors, reproductive history, perinatal exposure to exogenous agents, and past OC use did not change the results, nor did restricting the analysis to residents of King County. The cases exposed to prenatal OC use were slightly more likely to have megaloureter than were unexposed cases (4/9 vs. 27/109). These results are compatible with the hypothesis that oral contraceptive use after conception predisposes to the development of CUTAs in offspring; this hypothesis should be tested in other epidemiological studies of congenital malformations.

Preinduction prostaglandin E2 gel prior to induction of labor in women with a previous cesarean section.

The objective of the study was to evaluate the efficacy and safety of preinduction cervical ripening with 0.5 mg of intracervical prostaglandin E2 (PGE2) gel in women with a previous cesarean section. A retrospective cohort study design was used to compare 117 women with one previous cesarean section (VBACS) with 354 nulliparas. Both groups received preinduction cervical ripening treatment with intracervical PGE2 gel. Student's t and chi 2 tests were used to evaluate group differences. Mantel-Haenszel summary risk ratios and 95% confidence intervals were examined in order to assess the relative risk of cesarian section delivery after adjusting for potential confounders. The mean numbers of PGE2 gel applications were 2.4 and 2.5 for VBACS and controls, respectively (p < 0.05). Thirty-nine percent of VBACS entered labor spontaneously as compared with 33% of nulliparas. Mean duration of ruptured membranes (8.2 vs. 12.1 h) and length of labor (20.1 vs. 28.5 h) were reduced among VBACS as compared with controls (p < 0.05). Overall, VBACS had a higher cesarean section rate as compared with controls (49.6 vs. 31.9%; adjusted relative risk = 1.6, 95% confidence interval 1.2-2.1). There were no differences in the occurrence of maternal and fetal morbidity. Overall, the efficacy and safety of 0.5 mg PGE2 gel administered for preinduction cervical ripening in VBACS is comparable to that observed in nulliparas.

Molecular dynamics simulations in solvent of the glucocorticoid receptor protein in complex with a glucocorticoid response element DNA sequence.

We investigated protein/DNA interactions, using molecular dynamics simulations computed in solvent, between the glucocorticoid receptor (GR) DNA binding domain (DBD) amino acids and DNA of a glucocorticoid receptor response element (GRE). We compared findings obtained from a fully solvated 80 Angstrom water droplet GR DBD/GRE model with those from a 10 Angstrom water layer GR DBD/GRE model. Hydrogen bonding interactions were monitored. In addition, van der Waals and electrostatic interaction energies were calculated. Molecular dynamics simulations from both models yielded similar findings; amino acids of the GR DBD DNA recognition helix formed both direct and water mediated hydrogen bonds at cognate codon/anticodon nucleotide base sites within the GRE right major groove halfsite. Likewise GR DBD amino acids in a beta strand structure adjacent to the DNA recognition helix formed both direct and water mediated hydrogen bonds at cognate codon/anticodon nucleotide base and backbone sites. We also investigated protein/DNA interactions with a 10 Angstrom water layer model consisting of the same GR DBD as above but with a predicted alpha helix attached to the carboxyl terminus of the GR DBD docked at the same GRE as above with additional flanking nucleotides. In this model, the interactions between amino acids of the DNA recognition helix and beta strand and nucleotides within the GRE right major groove halfsite were at cognate codon/anticodon nucleotide sites as found in the two models above. In addition, amino acids within the predicted alpha helix located on the carboxyl terminus of the GR DBD interacted at codon/anticodon nucleotide sites on the DNA backbone of the GRE flanking nucleotides. These interactions together induced breakage of Watson-Crick nucleotide base pairing hydrogen bonds, resulting in bending of the DNA, strand elongation and unwinding events similar to those described for helicases.

Health status and timing of onset of prenatal care: is there an association among low-income women?

We examined medical obstetric conditions predating pregnancy and current symptoms as predictors of the timing of the start of prenatal care among low-income women in Snohomish County, Washington. The investigation was a cross-sectional survey with retrospective record review. Subjects were 473 women who sought care through the community health center network, which was the only provider of prenatal care for low-income women in the county at the time of the study. Women with a history of two or more medical or obstetric conditions were more likely than those without such histories to seek prenatal care early in pregnancy. Women who, in the current pregnancy, had few physical symptoms were more likely to delay seeking prenatal care than symptomatic women. Among this relatively homogeneous group, sociodemographic characteristics were not associated with the timing of entry into prenatal care. The findings help to explain the patterns of prenatal care use of certain groups, and suggest avenues for intervention to improve use among low-income women.

Maternal serum CA 125 levels in the diagnosis of abruptio placentae.

OBJECTIVE: To evaluate measurements of maternal serum CA 125 for the diagnosis of abruptio placentae. METHODS: This investigation was conducted at Swedish Medical Center/Seattle from December 1991 through April 1992. During the study period, we identified 21 consecutive patients with a clinical diagnosis of abruptio placentae. In addition, we enrolled two groups of patients whose pregnancies were not complicated by placental abruption (28 preterm controls and 53 term controls). RESULTS: Mean maternal serum levels of CA 125 were significantly higher among women with abruptio placentae (40.6 +/- 29.6 U/mL) than among preterm controls (26.6 +/- 17.2 U/mL) or term controls (22.0 +/- 11.4 U/mL). Using a positive threshold of 35 U/mL, the sensitivity and specificity of maternal serum CA 125 for abruptio placentae were 42.9% (95% confidence interval [CI] 21.7-64.1) and 92.5% (95% CI 85.4-99.6), respectively. CONCLUSIONS: These findings support an earlier report documenting higher mean maternal serum levels of CA 125 among women with pregnancies complicated by abruptio placentae than in control subjects. However, measurement of maternal serum CA 125 does not appear to be a useful marker for the diagnosis of abruptio placentae. At present, clinical diagnosis of abruptio placentae, with the aid of ultrasonography to rule out other causes of late gestational hemorrhage, should be considered the most sensitive and specific method of detecting this pregnancy complication.

Elevated second-trimester human chorionic gonadotropin and subsequent pregnancy-induced hypertension.

OBJECTIVE: Pregnancy-induced hypertension is believed to be a disorder of the vascular endothelium, possibly focused in the placenta. Markers such as cellular fibronectin appear early in patients in whom pregnancy-induced hypertension develops. We hypothesized that patients with elevated second-trimester levels of human chorionic gonadotropin would have an increased risk for pregnancy-induced hypertension. STUDY DESIGN: We conducted a cohort study, using a database of patients undergoing second-trimester serum screening for Down syndrome and who were delivered at our institution between January 1990 and August 1991. We included all 180 women with human chorionic gonadotropin levels > or = 2.0 multiples of the median. A sequential sample of 369 women with levels < 2.0 multiples of the median served as the referent group. Standard American College of Obstetricians and Gynecologists definitions of pregnancy-induced hypertension and proteinuria were used. RESULTS: Patients with elevated human chorionic gonadotropin levels were at increased risk for pregnancy-induced hypertension (risk ratio 1.7, 95% confidence interval 1.2 to 2.4) and proteinuric pregnancy-induced hypertension (risk ratio 5.1, 95% confidence interval 1.6 to 16.2). Adjusting for potential confounding factors did not alter these associations. CONCLUSIONS: Patients with elevated human chorionic gonadotropin appear to be at higher risk of pregnancy-induced hypertension and proteinuric pregnancy-induced hypertension. Second-trimester human chorionic gonadotropin levels should be further investigated as a potential marker for pregnancy-induced hypertension.