Crohn's disease, pregnancy, and birth weight.

OBJECTIVE: Although there is general agreement that conception should be avoided when Crohn's disease is active, many questions remain unanswered for the woman with Crohn's disease in remission who becomes pregnant. METHODS: Sixty-five charts of women with Crohn's disease quiescent at the start of pregnancy were identified between January 1993 and December 1997. Each pregnancy was matched to a healthy control pregnancy by date, age, parity, smoking status, and gestational age +/- 1 wk, and comparisons were carried out using matched analyses. RESULTS: The two groups were similar in terms of maternal height, weight, and body mass index (BMI), in addition to the matched variables. The incidence of pregnancy complications was similar for most of the complications examined, whereas the incidence of poor maternal weight gain differed significantly between the groups (17/65 vs 2/65, p < 0.001). Flare-up of the Crohn's disease was seen in 13/65 (20%) of pregnancies. The greatest differences in neonatal outcomes were in terms of birth weight (3150+/-80 g vs 3500+/-60 g) and birth weight percentile (36.7%+/-.6% vs 57.5%+/-3.4%). Overall, there were 16 (24.6%) small for gestational age (SGA) births in the Crohn's group, compared with only one (1.5%) in the control group (p = 0.0007). Multivariate analysis was performed to identify factors predictive of SGA births in the Crohn's group. Ileal Crohn's disease was a statistically significant predictor (p = 0.035), whereas previous bowel resection trended toward statistical significance (p = 0.065). CONCLUSIONS: In view of the risk of low birth weight, all women with Crohn's disease who become pregnant should be followed carefully during the pregnancy, particularly those who have ileal disease or who have previously undergone bowel resection. Furthermore, smoking cessation needs to be aggressively pursued in these patients.

Early motor development of breech- and cephalic-presenting infants.

OBJECTIVE: This study was conducted to determine whether breech-presenting infants have a different pattern of early neuromotor development than cephalic-presenting infants--regardless of mode of delivery-thus explaining both the failure to assume cephalic version at the end of gestation and the higher rates of childhood motor impairments associated with breech presentation. METHODS: Ninety morphologically normal, term, breech-presenting singletons with birthweights greater than 2,500 g were paired with a similar cephalic-presenting infant, matched for gender and mode of delivery (n = 180; 100 delivered abdominally and 80 delivered vaginally). Data on neurological status (Neurological Assessment of the Preterm and Full-term Newborn Infant) and motor performance (Alberta Infant Motor Scale, Peabody Developmental Motor Scales, and age of walking) were collected prospectively over the first 18 months of life. This study was designed with a power of .80 to detect a "medium" effect size for motor development using the Alberta Infant Motor Scale. The data were analyzed using analysis of variance techniques. RESULTS: Breech-presenting infants had minor transient differences compared with cephalic-presenting infants. First, they had more open popliteal angles at birth (P < .001). Second, they had significantly lower motor scores at 6 weeks than the normative sample (P < .001). At 18 months, three infants were diagnosed with neurological problems, all of whom were delivered electively in the cesarean-breech group. CONCLUSION: As a group, breech-presenting infants do not have a persistent, inherently different pattern of motor development than cephalic-presenting infants. Mode of delivery did not explain the excess neuromotor impairment detected in the subgroup of breech infants.

Morbidity assessment index for newborns: a composite tool for measuring newborn health.

OBJECTIVE: The objective was to develop, validate, and recommend a scaling model for a discriminative obstetric outcome measure named the Morbidity Assessment Index for Newborns. The purpose of this tool is to allow comparison of obstetric therapeutic strategies on neonatal morbidity, particularly in the mild to moderate morbidity range. STUDY DESIGN: A list of 66 check-mark (yes or no) items of readily available clinical and laboratory data from the early neonatal period was compiled by a panel of obstetric and neonatal experts. These data were collected on 411 neonates born at >/=28 weeks' gestation and representing all grades of morbidity. Detailed psychometric testing included dimensionality testing and item analysis with the item response theory. The scores obtained with this new assessment tool were correlated with newborn and maternal disease conditions or events and with other measures of newborn morbidity. RESULTS: The Morbidity Assessment Index for Newborns is easy to apply in prospective or retrospective studies. Detailed psychometric evaluation resulted in modification of the list to 47 items, each item with a relative scale value according to severity of morbidity. The test was demonstrated to be a reliable and generalizable scaled index that performs optimally for the mild to moderate neonatal morbidity range. CONCLUSION: The Morbidity Assessment Index for Newborns is a validated outcome measurement scale of neonatal morbidity. This new tool may facilitate the conduct of obstetric clinical trials or epidemiologic population-based studies in obstetrics.

Relationship between plasma glucose levels in glucose-intolerant women and newborn macrosomia.

The purpose of this study was to examine the relationship between newborn macrosomia and plasma glucose profile in both a "glucose challenge test (GCT)-positive oral glucose tolerance test (OGTT)-negative" group (n = 113) and a gestational diabetes mellitus (GDM) group (n = 50). We examined 1) plasma glucose concentrations following a positive screen 50-g GCT (n = 163), 2) glucose concentrations following a 100-g OGTT (n = 163), and 3) the average fasting (AF) and 2-hour postprandial (APP) plasma glucose concentrations in the treated GDM group (n = 46). It was a case-control study with macrosomia vs. non-macrosomia in the ratio of 1:4. Macrosomia was analyzed by both birthweight > 4,000 g and gender-specific birthweight > 90th percentile for gestational age criteria. The GCT and the OGTT were performed between 26 and 30 weeks of pregnancy. The results demonstrated no significant impact of plasma glucose values from GCT, OGTT, AF, or APP on macrosomia in both "GCT-positive OGTT-negative" and GDM (treated) groups. Further, the screening and diagnostic plasma glucose concentrations were not related to macrosomia in both "GCT-positive OGTT-negative" and GDM groups. We found a difference of 0.6 mmol/liter in the maternal AF and APP glucose concentrations between mothers of macrosomic versus non-macrosomic newborns in the treated (diet or diet+insulin) GDM group. The clinical relevance of this difference remains to be explored. Our study provides a different methodological and analytic perspective in examining macrosomia versus non-macrosomia in the "GCT-positive OGTT-negative" and the GDM groups using univariate and multivariate analyses.

Prenatal ultrasonographic diagnosis of dicephalus conjoined twins.

The authors report the prenatal diagnosis by ultrasonography of dicephalus dipus dibrachius conjoined twins (with two heads, one body, two legs and two arms) at 31 weeks' gestation. They discuss the types of conjoined twinning and their frequency of occurrence and the criteria for prenatal diagnosis, and they offer recommendations for management.

Success of a program of routine prenatal screening for hepatitis B surface antigen: the first 2 years.

Prenatal screening for hepatitis B surface antigen (HBsAg) restricted to women with defined risk factors for chronic hepatitis B virus (HBV) infection fails to identify many carriers. A centralized program of routine HBsAg screening for all pregnant women in Alberta was introduced in 1985. We collected and analysed data for the first 2 years of the program in Edmonton to determine the frequency of risk factors for HBsAg positivity, the proportion of multiparous HBsAg-positive women not identified in previous pregnancies, the efficiency and cost-effectiveness of providing immunoprophylaxis to infants at risk of HBV infection and the degree of success in inducing adequate protection. A total of 149 women (158 pregnancies) were found to be HBsAg positive. Risk factors were readily ascertainable for 85% of the women; the remaining 15% would not have been identified through risk-selective screening. The most common risk factors were Oriental ethnic origin, history of hepatitis, jaundice or multiple transfusions of blood or blood products, and occupational exposure to blood. Although 86% of the multiparous HBsAg-positive women had risk factors, only 7% had been identified in previous pregnancies. The Alberta program appears to be cost-effective. We conclude that only routine prenatal screening will identify all infants at risk of perinatal HBV infection and that a comprehensive public health program involving central laboratories, private physicians and public health staff can be highly effective and efficient in protecting infants against hepatitis B.