Body mass index-associated differences in response to ovulation induction with letrozole.

OBJECTIVE: To compare occurrence of pregnancy among obese (body mass index [BMI] ≥30) and nonobese (BMI <30), infertile women undergoing ovulation induction with the aromatase inhibitor letrozole followed by intrauterine insemination (IUI). DESIGN: Retrospective cohort study. SETTING: Academic reproductive endocrinology and infertility clinic. PATIENT(S): Ninety women with a variety of infertility diagnoses. INTERVENTION(S): Letrozole (5 mg) on menstrual cycle days 3-7, followed by intrauterine insemination (IUI). MAIN OUTCOME MEASURE(S): Occurrence of pregnancy and pregnancy outcomes. RESULT(S): Ninety women underwent 180 letrozole-IUI cycles. Conception of pregnancy occurred in 10.4% and 18.2% of the BMI <30 and BMI ≥30 groups, respectively. Using BMI as a continuous variable showed a pregnancy odds ratio of 1.093 (confidence interval 1.008-1.184) for each unit increase in BMI. Incidence of miscarriage, multiple births, number of mature follicles, and presence of LH surge were similar between groups. CONCLUSION(S): Our study of 90 women undergoing letrozole-IUI treatment showed greater likelihood of pregnancy in higher-BMI women, although the difference was not significant. Letrozole is an effective ovulation induction agent in higher-BMI women.

Metabolic effects of soy supplementation in postmenopausal Caucasian and African American women: a randomized, placebo-controlled trial.

OBJECTIVE: We sought to determine the effect of daily soy supplementation on abdominal fat, glucose metabolism, and circulating inflammatory markers and adipokines in obese, postmenopausal Caucasian and African American women. STUDY DESIGN: In a double-blinded controlled trial, 39 postmenopausal women were randomized to soy supplementation or to a casein placebo without isoflavones. In all, 33 completed the study and were analyzed. At baseline and at 3 months, glucose disposal and insulin secretion were measured using hyperglycemic clamps, body composition and body fat distribution were measured by computed tomographic scan and dual energy x-ray absorptiometry, and serum levels of C-reactive protein, interleukin-6, tumor necrosis factor-alpha, leptin, and adiponectin were measured by immunoassay. RESULTS: Soy supplementation reduced total and subcutaneous abdominal fat and interleukin-6. No difference between groups was noted for glucose metabolism, C-reactive protein, tumor necrosis factor-alpha, leptin, or adiponectin. CONCLUSION: Soy supplementation reduced abdominal fat in obese postmenopausal women. Caucasians primarily lost subcutaneous and total abdominal fat, and African Americans primarily lost total body fat.

Medication effects on midtrimester maternal serum screening.

OBJECTIVE: To determine whether medication classes are associated with alterations in concentrations of Quad screen analytes or the screen-positive rate. STUDY DESIGN: We conducted a retrospective cohort study of women with singleton gestations who received prenatal care and had a Quad screen performed in the University of Alabama at Birmingham system. Information on prescription medications was abstracted. Mean multiples of the medians for each analyte (alpha-fetoprotein, estriol, human chorionic gonadotropin, and inhibin A) and overall screening results were compared between those taking the class of medication and controls not taking any medications. RESULTS: There were 6206 women evaluated; 1337 took at least 1 prescription medicine and 4869 were controls. Mean analyte multiples of the medians were significantly different in women taking some medications compared with controls. Women taking certain medications had an increased screen-positive rate. CONCLUSION: Medications taken around the time of maternal serum screening are associated with alterations in individual analyte multiples of the medians, as well as the screen-positive rates.

Sphincter tears in primiparous women: is age a factor?

Anal sphincter tears during vaginal delivery may result in serious sequelae. We examined whether younger primiparous patients were at increased risk for sphincter tears during vaginal delivery. Data from an obstetric automated record were analyzed. Primiparous women delivering term infants (n = 5,937) were included to test for an association between age and sphincter tear rates. Three age groups were considered: young adolescents (≤ 16 years), older adolescents (17-20 years), and adults (≥ 21 years). No significant difference was found in tear rates among age cohorts (9.2%, 8.0%, and 9.6% respectively; p = 0.12). Logistic regression modeling revealed that young adolescents were not more likely to have sphincter tears compared to older cohorts. Younger adolescents may not be at increased risk of anal sphincter tears. Decisions regarding interventions to decrease sphincter tears during vaginal delivery should not be made on the basis of maternal age alone.

Folate status of mothers during pregnancy and mental and psychomotor development of their children at five years of age.

OBJECTIVE: There are limited data relating folate nutritional status of mothers during pregnancy to mental and psychomotor development of their offspring. Using an existing data set from a study on the effect of prenatal zinc supplementation on child neurodevelopment, we evaluated the association between folate nutritional status of mothers during pregnancy and neurodevelopment of their children. METHODS: Maternal blood folate and total homocysteine (tHcy) concentrations were measured at 19, 26, and 37 weeks of gestation. At a mean of 5.3 years of age, 355 black children with low-socioeconomic background were given 6 tests: Differential Ability Scales, Visual and Auditory Sequential Memory, Knox Cube Test, Gross Motor Scale, and Grooved Pegboard. The scores of the tests between the 2 groups of mothers with poor versus adequate folate nutritional status classified by blood folate or tHcy concentrations were compared. RESULTS: There were no differences in the test scores of neurodevelopment between the 2 groups. CONCLUSION: Folate nutritional status of mothers in the later half of pregnancy assessed by plasma and erythrocyte folate and plasma tHcy concentrations had no impact on neurodevelopment of their children at age 5. It is unknown whether our findings in a low-socioeconomic population can be readily extrapolated to other populations.

Relationship between pre-pregnancy BMI and plasma zinc concentrations in early pregnancy.

We previously reported that pregnant women whose plasma Zn concentrations were below the 50th percentile tended to have high pre-pregnancy BMI (kg/m(2)) values. We therefore hypothesized that in pregnant women, plasma Zn concentrations are negatively correlated with BMI. We evaluated the association between BMI values and plasma Zn concentrations in 1474 women whose blood samples were obtained before 15 weeks of gestation. Their mean age was 22.7 years and mean gestational age at blood sampling was 10 weeks. The mean plasma Zn concentration and BMI were 11.6 micromol/l and 26.6 kg/m(2) respectively. Because plasma Zn concentrations decrease as gestational age increases, plasma Zn concentrations were standardized by Z-scores. Z-score distributions were compared among the quartiles of BMI. The highest BMI group had the lowest plasma Zn concentrations, whereas the lowest BMI group had the highest; the differences were significant between the BMI groups (P<0.0001). The interpretation of plasma Zn concentrations to assess Zn nutriture in pregnancy may be complicated not only by the well-established factor of gestational age at blood sampling, but also by a previously unrecognized factor, maternal BMI.

Effect of zinc supplementation of pregnant women on the mental and psychomotor development of their children at 5 y of age.

BACKGROUND: A negative effect of prenatal zinc deficiency on brain function has been well established in experimental animals, but this association in humans is controversial. OBJECTIVE: We evaluated the effect of prenatal zinc supplementation on the mental and psychomotor development of 355 children whose mothers participated in a double-blind trial of zinc supplementation that resulted in increased head circumference and birth weight. DESIGN: The children took 6 tests-the Differential Ability Scales, Visual Sequential Memory, Auditory Sequential Memory, Knox Cube, Gross Motor Scale, and Grooved Pegboard tests-at a mean age of 5.3 y. The scores were compared between the children of women who received a daily oral dose of 25 mg Zn during the second half of pregnancy and the children of women who received placebo. RESULTS: There were no differences in the test scores of neurologic development between the 2 groups. We analyzed the scores in 4 subgroups on the basis of maternal body mass index, because the increases in birth weight and head circumference due to the supplementation occurred only in the children of women with a body mass index (in kg/m(2)) < 26.0 in the original trial. No differences in the scores were found between these subgroups. CONCLUSIONS: Zinc supplementation of women in the latter half of pregnancy had no effect on the neurologic development of their children at age 5 y. It is not known whether our findings of no positive effect in the population with apparently inadequate zinc nutriture can be readily extrapolated to other populations.