The barriers that prevent women from obtaining prenatal care were studied in a multiethnic, primarily indigent urban population. Two thousand nine hundred eighty-seven women were delivered at the University of Miami/Jackson Memorial Medical Center from January 15 to April 10, 1988. Of these women, 227 (7.6%) did not access any prenatal care. These women formed the study group. The results indicated that the main barriers were systematic (35.5%), patient-related (35.5%), and financial (29%). Ethnic group, marital status, and education influenced access to prenatal care, whereas age did not appear to do so. Although low birth weight rates were higher in the study group, it was apparent that cultural behavior influenced birth weight, whether or not prenatal care was obtained.

Adolescent↗

PubMedDate not supplied

Blood pressure in infant twins: birth to 6 months of age.

To describe the time course of the early development genetic variance for blood pressure, a cohort of twins is being followed from birth to 1 year of age. The present interim report describes systolic and diastolic blood pressure measurements for 102 twin pairs (39 monozygotic (MZ) and 63 dizygotic (DZ) in the newborn period and at 1, 3 and 6 months of age. Mean values for both systolic and diastolic blood pressure were similar regardless of race, sex, zygosity, or chorionicity. Statistically significant genetic variance was detected for systolic blood pressure at 6 months of age but not for diastolic blood pressure at any data point. The data are consistent with the hypothesis that genetic factors that determine within-family similarities of blood pressure may be detected early in life, and support the need for further investigation of both genetic and environmental determinants of blood pressure in young populations.

Blood Pressure↗

PubMedDate not supplied

Blood glucose control during pregnancy.

Pregnant diabetic women represent a unique category of patient in whom diabetic control is most desirable, since even minor degrees of hyperglycemia have adverse effects on the conceptus. In 18 insulin-dependent pregnant diabetic women (White Class B, N = 4; C, N = 5; D, N = 7; and R, N =2), we have utilized a therapeutic program consisting of intensive patient education, a multiple-component insulin regimen (two to four injections daily), careful dietary control, and meticulous balancing of food, activity, and insulin dosage, monitoring such balance with patient-determined blood glucose measurements four to seven times daily using the Dextrostix/Eyetone system. Our goals for blood glucose management have been to attain fasting levels of 60-90 mg/dl, preprandial levels less than 105 mg/dl, and postprandial levels less than 120 mg/dl, in the absence of significant hypoglycemia. We have been able to attain these goals for most of the period of monitoring in the majority of these patients, while in the others we have achieved marked improvement in diabetic control, although we did not consistently attain our goals. Despite this, there was not infrequent neonatal morbidity, including a 33% frequency of macrosomia, an 11% frequency of significant hypoglycemia, and a 22% frequency of congenital malformation. Nevertheless, all infants survived and are generally healthy, whereas only 38% of 21 previous pregnancies in these same women have eventuated in living offspring. Thus, although further refinement is clearly indicated, it appears that our approach has resulted in improved pregnancy outcome. Patient self-monitoring of blood glucose is a procedure that is relatively simple, practical, acceptable to patients, and facilitates the attainment of glycemic control.

Adult↗

PubMedDate not supplied

Home blood glucose monitoring as an aid in diabetes management.

Home blood glucose monitoring, using Dextrostix and an Eyetone meter, has been utilized in several subcategories of patients with insulin-dependent diabetes mellitus. These include pregnant patients, anephric patients, patients undergoing weight reduction, patients with altered renal threshold for glucose reabsorption, and patients in whom diabetic regulation is difficult. Patients monitored home blood glucose continually (on a daily basis), intermittently, or only for particular problems or symptoms. Such monitoring can be practically accomplished in a manner acceptable to patients. Motivation, compliance with protocol, and an understanding of the objectives of the program are essential on the part of the patient. Home blood glucose monitoring, however, can provide an insight diabetes regulation that cannot be attained in any other way and can greatly facilitate regulation of diabetes. Such home blood glucose monitoring may increase the likelihood of achievement of a degree of control approximating euglycemia.

Adolescent↗