Elevated maternal serum alpha-fetoprotein with oligohydramnios: ultrasound evaluation and outcome.

Nineteen pregnancies evaluated for elevated maternal serum alpha-fetoprotein levels were found to have moderate to severe oligohydramnios. There were no survivors among six fetuses with ultrasound-diagnosed urinary tract anomalies. We followed 11 of the remaining 13 pregnancies with serial ultrasound examinations. When the second ultrasound examination demonstrated severely decreased amniotic fluid, the outcome was always poor (intrauterine death, perinatal death, or fetal deformations). Of the five cases in which the second ultrasound showed normal to moderately decreased fluid, there were four surviving infants. When no primary malformations are seen on the initial ultrasound examination, serial ultrasound evaluations of amniotic fluid volume help predict the pregnancy outcome.

Hypothyroidism complicating pregnancy.

Hypothyroidism rarely complicates pregnancy because most affected women are anovulatory. In this report, we describe 28 complicated pregnancies cared for over a ten-year period at Parkland Memorial Hospital. In the group of 16 pregnancies in 14 overtly hypothyroid women, maternal complications were common and included anemia (31%), preeclampsia (44%), placental abruption (19%), postpartum hemorrhage (19%), and cardiac dysfunction. Perinatal morbidity and mortality were also high mainly because of placental abruption, and reflected frequent low birth weight (31%) and fetal death (12%). In a group of 12 women with subclinical hypothyroidism, these complications were less impressive. We speculate that overt thyroid deficiency is associated with adverse pregnancy outcome related to preeclampsia and placental abruption. Thyroxine replacement probably improves these outcomes even if subclinical hypothyroidism persists.

The role of early post-implantation beta-HCG levels in the outcome of pregnancies following in-vitro fertilization.

Daily plasma beta-HCG levels from days 11 to 18 after ovum retrieval (OR) were evaluated in a group of 73 women who became pregnant following in-vitro fertilization and embryo replacement (IVF-ER). The 47 patients who had a normal ongoing pregnancy could be distinguished from the 26 patients with a pathological pregnancy (pre-clinical abortion, clinical abortion and tubal pregnancy) by the mean daily beta-HCG levels, their mean daily increase and the intercept and slope of the beta-HCG regression analysis. The mean daily beta-HCG levels of the normal pregnancies were significantly higher than: (i) pre-clinical abortions on days 12-18 after OR; (ii) clinical abortions on days 12-16; and (iii) tubal pregnancies on days 12-17. Using quadratic discriminant analysis, normal and pathological pregnancies could also be distinguished by their absolute beta-HCG levels on day 13 after OR with 27.6 mIU/ml being the cut-off point. Our results indicate that the outcome of pregnancy following IVF-ER could be predicted with a high degree of probability by monitoring daily beta-HCG levels within the first 2 weeks following OR.

Routine screening for gestational diabetes in white, black, and Mexican-American teenagers.

This study assesses the frequency of gestational diabetes in a multiethnic teenage pregnancy clinic. One hundred thirty-seven women age 12-18 years were screened with a 1-hour 50-gm glucola test at 24-34 weeks gestation. Screening tests were positive in 5.8% of these teenagers, of whom half were obese. Gestational diabetes was documented in two primiparas (1.4%). Maternal weight gain was excessive in 54%, and 8.7% of the total group had macrosomic infants. We conclude that gestational diabetes should be screened for in all young pregnant women with the screening test recommended by the Second International Workshop-Conference on Gestational Diabetes.

The implications of hypozincemia in pregnancy.

Leukocyte zinc levels were significantly higher in normal pregnant women than in normal controls (p less than 0.001). There were inverse correlations between plasma zinc and leukocyte zinc (r = -0.76, p less than 0.001) and between plasma zinc and placental zinc (r = -0.88, p less than 0.0001) in normal pregnancies. When compared with infants borne by some pre-eclamptic subjects, there were significant increases in cord plasma zinc of infants borne by normal pregnant subjects (p less than 0.001). Plasma zinc concentrations were lower in normal pregnant subjects and in pre-eclamptics who gave birth to infants with normal birthweight than in pre-eclamptics who delivered infants with lower birthweight (p less than 0.005). When compared with normal pregnant women and pre-eclamptics who gave birth to infants with normal birthweight, total plasma estrogens were decreased in pre-eclamptics who delivered infants with lower birthweights (p less than 0.001). The data from this study suggest that in human pregnancy, zinc and estrogens compete for common binding sites on the plasma proteins and zinc plays an important role in the course and eventual outcome of human pregnancy.