Preterm birth in the first pregnancy and risk of neonatal death in the second pregnancy: a propensity score-weighted matching approach.

The study purpose was to assess the relationship between various grades of preterm birth (moderate preterm: 33-36 weeks; severe preterm: 27-32 weeks; extreme preterm: ≤ 26 weeks) in the first pregnancy and neonatal mortality (death within 28 days of birth; early: 0-7 days; late: 8-28 days) in the second pregnancy. Using the Missouri maternally-linked dataset (1989-2005), a population-based, retrospective cohort analysis with propensity score-weighted matching was conducted on mothers with two consecutive singleton live births (n = 310,653 women). Women with a prior preterm birth were more likely to subsequently experience neonatal death. The odds increased in a dose-dependent pattern with ascending severity of the preterm event in the first pregnancy (moderate preterm: AOR = 1.32; 95% CI: 1.10-1.60; severe preterm: AOR = 2.62; 95% CI: 2.01-3.41; extreme preterm: AOR = 5.84; 95% CI: 4.28-7.97; p value for trend < 0.001). However, the pathway for the relationship between prior preterm birth and subsequent neonatal mortality may be the recurrence of preterm birth.

Maternal hepatitis B and hepatitis C infection and neonatal neurological outcomes.

To examine the associations between maternal hepatitis B (HBV) and hepatitis C (HCV) infection status and selected infant neurological outcomes diagnosed at birth, we conducted a population-based, retrospective cohort study on singleton live births in Florida from 1998 to 2009. Primary exposures included maternal HBV and HCV monoinfection. The neurological outcomes included brachial plexus injury, cephalhematoma, foetal distress, feeding difficulties, intraventricular h aemorrhage and neonatal seizures. Multivariable logistic regression models were used to generate odds ratios (OR) and 95% confidence intervals (CI) that were adjusted for socio-demographic characteristics, risky behaviours, pregnancy complications and pre-existing medical conditions, and timing of delivery. The risk of an adverse neurological outcome was higher in infants born to mothers with hepatitis viral infection (7.2% for HCV, 5.0% for HBV), compared with infants of hepatitis virus-free mothers (4.2%). After adjusting for potential confounders, women with HBV were twice as likely to have infants who suffered from brachial plexus injury (OR = 2.04, 95% CI = 1.15-3.60), while those with HCV had an elevated odds of having an infant with feeding difficulties (OR: 1.32, 95% CI = 1.06-1.64) and a borderline increased likelihood for neonatal seizures (OR = 1.74, 95% CI = 0.98-3.10). Additionally, HCV+ mothers had a 22% increased odds of having an infant with some type of adverse neurological outcome (OR: 1.22, 95% CI = 1.03-1.44). Our findings add to current understanding of the association between maternal HBV/HCV infections and infant neurological outcomes. Further research evaluating the role of maternal HBV and HCV infections (including viraemia, treatment) on pregnancy outcomes is warranted.

Interpregnancy BMI change and risk of primary caesarean delivery.

We conducted a retrospective study using Missouri maternally linked cohort files (1989-2005). We examined the association between interpregnancy body mass index (BMI) change and risk of primary caesarean delivery. BMI was classified as normal (18.5-24.9 kg/m(2)) or obese (≥30.0 kg/m(2)). Interpregnancy BMI change was defined using the following categories: normal-normal, normal-obese, obese-normal and obese-obese. Logistic regression models were used to generate adjusted odds ratios (OR) and 95% confidence intervals (CI) for the risk of primary caesarean delivery in the second pregnancy. Elevated risks for caesarean delivery in the second pregnancy were noted for normal weight mothers becoming obese (OR = 1.41, 95% CI 1.26-1.57) and obese mothers maintaining their obese status across both pregnancies (OR = 1.75, 95% CI 1.65-1.87). Women with a reduction in BMI (obese-normal) had a risk level for primary caesarean section that was comparable with that of women with normal BMI status in both pregnancies.

Intensive interventional maternity care reduces infant morbidity and hospital costs.

OBJECTIVE: The purpose of this study was to introduce an intensive interventional maternity care program, called the Temple Infant and Parent Support Services (TIPSS) program, and to determine whether comprehensive maternal and infant care would reduce the high rate of infant morbidity and mortality. METHODS: The TIPSS program was comprehensive, offering multidisciplinary services that were family focused and community based. Program services included community outreach, health education, as well as clinical care for the entire family. The effect of this program was evaluated among a very high-risk group of women who were recruited into care versus a control group of high-risk patients from the same neighborhood who voluntarily sought care at the Temple University School of Medicine. Outcome parameters evaluated included gestational age at delivery, birth weight, neonatal intensive care admission, infant death and cost of infant care. RESULTS: Among the TIPSS study group, 5.2% of infants were below 2500 g versus 11% in the control group (p < 0.05). Similarly, preterm deliveries occurred in 4.2% and 12% of the study and control groups, respectively (p < 0.005). Other significant differences observed included the number of prenatal visits (p < 0.001), maternal weight gain (p < 0.05) and admission to the neonatal intensive care unit (2% vs. 6.6%; p < 0.05). The reduced admission rate among neonates from the TIPSS program resulted in significant cost savings: $2849 for neonates in the study group versus $8499 for those in the control group. This corresponds to a $5560 savings per infant born to mothers cared for in the TIPSS study group. CONCLUSIONS: The Temple Infant and Parent Support Services program demonstrated that infant morbidity could be reduced when a comprehensive prenatal program was made available to indigent patients, even if there were multiple factors that placed the mother and her infant at high risk for complications.

Association between HIV-specific T helper responses and CTL activities in pediatric AIDS.

We examined the relationship between the profile of HIV-specific T helper (Th) cell responses, cytotoxic T lymphocyte (CTL) activity, HIV viral load, and CD4(+) T cell counts during longitudinal studies in children with perinatal HIV infection. Patients with AIDS demonstrated undetectable or low levels of HIV-specific Th and CTL activities, and exhibited almost exclusively Th0 type of responses with low IFN-gamma and IL-4 production. The levels of IL-2 expression in the envelope (env) peptide-stimulated peripheral blood mononuclear cells were increased in children with a slowly progressive disease, concomitant with higher numbers of CD45RO(+) memory T cells and increased proportions of Th1 clones. In these patients, high levels of env peptide-specific IL-2 expression correlated with increases in HIV-specific CTL responses, whereas a delay in the generation of HIV-specific CTL activity was associated with lower IL-2 production and elevated Th2 responses. Patients with slow disease progression produced higher levels of beta-chemokines than those detected in children with AIDS. These results suggest that an impaired development of HIV-specific cellular responses and inhibition of T cell differentiation during infancy are associated with fast disease progression. They also point to a protective role of noncytotoxic antiviral activity that might complement HIV-specific CTL responses in children with a slowly progressive disease.

Protective role of beta-chemokines associated with HIV-specific Th responses against perinatal HIV transmission.

To examine the protective role of cellular immunity in the vertical transmission of HIV, we analyzed HIV-specific IL-2 and CTL responses, as well as beta-chemokine expression in HIV-infected and uninfected infants of HIV+ mothers. Our results showed that HIV envelope (env) peptide-specific IL-2 responses associated with beta-chemokine production were detectable at birth in the majority of uninfected infants of HIV+ mothers. The responses falling to background before the infants were 1 yr old were rarely associated with HIV-specific CTL activity. Conversely, HIV-specific Th and CTL cellular responses were absent at birth in HIV-infected infants. Infants with AIDS-related symptoms exhibited undetectable or very low levels of HIV-specific cellular immunity during the first year of life, whereas those with a slowly progressive disease showed evidence of such immunity between their second and ninth month. The latter group of infected infants tested negative for plasma HIV RNA levels shortly after birth, suggesting lack of intrauterine exposure to HIV. The presence of HIV-specific Th responses at birth in uninfected newborns of HIV+ mothers, but absence of such activities in HIV-infected infants without evidence of intrauterine HIV infection, suggests that in utero development of HIV-specific Th responses associated with beta-chemokines could mediate nonlytic inhibition of infection during vertical transmission of HIV.

Management of hypoglycemia and diabetic ketoacidosis in pregnancy.

The article discusses the incidence and management of hypoglycemia and diabetic ketoacidosis (DKA) in pregnancy. Additional topics addressed are the incidence of hypoglycemia, pathophysiology, diagnosis and management of hypoglycemia in pregnancy, fetal monitoring with short- and long-term fetal sequelae, and prevention of hypoglycemic recurrences. Subsequently, attention is focused on the diagnosis and management of hyperglycemia and DKA in pregnancy.

Prenatal diagnosis of major congenital malformations.

Congenital malformations affect approximately 2-3% of all live births every year. Several of these are associated with in-utero fetal demise or may account for significant neonatal morbidity and mortality. Therefore, it is important that, when possible, congenital anomalies are diagnosed during the antenatal period to allow adequate counseling of the mother and to permit preparation of the neonatal care team to optimize the outcome. The role of ultrasound in perinatal medicine has expanded over the past two decades. Previously, B-mode sonography allowed for the detection of multiple gestations, fetal biometry, and basic antenatal diagnosis of congenital anomalies. The technology has since rapidly advanced to the point that even subtle abnormalities are amenable to antenatal diagnosis. Perinatal medicine has advanced concurrently with these technological breakthroughs, and as a result, the possibilities for in-utero therapy and potential surgery have markedly improved. This article reviews the types and incidences of the various anomalies that are detectable by antenatal ultrasonography using a systematic approach; highlights the prenatal diagnostic and therapeutic strategies; discusses the obstetrics and medical management of pregnancies complicated by these conditions, and presents the neonatal prognosis and the recurrence risks for subsequent pregnancies.

Reliability and validity of the Ego and Discomfort Anxiety Inventory.

This article reports significant test-retest reliability scores for the Ego and Discomfort Anxiety Inventory. Positive significant correlations with the Fear of Negative Evaluation Scale supported the construct validity of the Ego Anxiety Scale. Positive significant correlations with the Costello-Comrey Anxiety Scale supported the construct validity of the Discomfort Anxiety Scale. The sample included 28 graduate social work students in a research methods class and 28 undergraduate students in an introductory social work class at Michigan State University.

Development of the ego and discomfort anxiety inventory: initial validity and reliability.

This article reports on four studies regarding the development, reliability, and validity of scales to measure two forms of anxiety, ego anxiety and discomfort anxiety. In the first study 140 undergraduates completed fourteen items related to ego anxiety and discomfort anxiety, as well as the Self-esteem Scale, the IPAT Anxiety Scale, and the Hopelessness Scale. Principal component analyses produced two factors, each with five items that showed differentiation between ego anxiety and discomfort anxiety. Guttman scales were developed from the items in the two factors. The resulting Ego Anxiety Scale had a coefficient of reproducibility of .94, a coefficient of scalability of .67 and estimated scale reliability of .84. The Discomfort Anxiety Scale had a coefficient of reproducibility of .91, a coefficient of scalability of .65 and estimated scale reliability of .83. Significant relationships were found between the scores on the two anxiety scales and scores on the Self-esteem Scale and the IPAT. Correlations between scores on the new anxiety scales and scores on the Hopelessness Scale were not significant. In the second study, undergraduates completed the Ego and Discomfort Anxiety Scales, the Self-esteem Scale, the IPAT Anxiety Scale, and the Hopelessness Scale. The reliability of the Ego Anxiety Scale (0.77) and the Discomfort Anxiety Scale (0.85) was estimated using Cronbach's alpha measure. t tests for scores of independent samples for students in Studies I and II were completed for scores on the Ego and Discomfort Anxiety Scales, Self-esteem Scale, IPAT Anxiety Scale, and Hopelessness Scale. None of these test comparisons were significant. The data from Studies I and II were pooled to provide tentative normative data for the Ego and Discomfort Anxiety Scales. The third study explored the reliability and validity of the new scales, testing 79 undergraduates who completed the Ego and Discomfort Anxiety Scales, the Fear of Negative Evaluation Scale, and the Problem Solving Inventory. The reliability coefficients of the Ego Anxiety Scale and Discomfort Anxiety Scale were 0.75 and 0.82, respectively. The differences between the combined scores of subjects in Studies I and II and the scores of subjects in the third study on the Ego and the Discomfort Anxiety Scale were not significant. A significant positive correlation, however, was found between scores on the Ego Anxiety Scale and scores on the Fear of Negative Evaluation Scale.(ABSTRACT TRUNCATED AT 400 WORDS)

Acute myocardial infarction associated with prostaglandin E2.

Prostaglandin E2 is rarely associated with serious maternal side effects when used for second-trimester pregnancy termination. Acute myocardial infarction complicating therapeutic pregnancy termination with prostaglandin E2 in a patient with chronic glomerulosclerosis and severe hypertension is reported.