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Biomedical subjects

F R Witter

Publications and source records attributed to F R Witter.

At least 37 records · Page 2Linked to original sources
PubMed1995

Influence of maternal anthropometric status and birth weight on the risk of cesarean delivery.

OBJECTIVE: To determine whether greater weight gain during pregnancy is associated with an increased risk of cesarean delivery, and, if so, whether this effect is explained by the positive influence of weight gain on birth weight and if there is a threshold of pregnancy weight gain above which the risk of cesarean delivery is increased differentially. METHODS: We analyzed live births at Johns Hopkins Hospital for the period 1987-1989. A multiple logistic regression model was used to evaluate the risk of cesarean delivery, recorded in the hospital's perinatal data base. RESULTS: The study sample contained 4346 patients, 1086 of whom delivered by cesarean. Associated independently with an increased risk of cesarean delivery were the following: 1) greater weight gain during pregnancy, 2) older maternal age, 3) greater maternal prepregnant body mass index, 4) maternal height of 1.57 m or less, 5) the diagnosis of preeclampsia during current pregnancy, and 6) carrying a fetus weighing more than 3591 g at birth. An additional risk factor for cesarean delivery was a fetus less than 2847 g at birth, with the risk more marked the lower the gestational age. Maternal height of 1.73 m or more and a history of at least one previous viable pregnancy were associated independently with a decreased risk of cesarean delivery. CONCLUSION: The risk of cesarean delivery increases linearly with pregnancy weight gain, independent of birth weight. No specific threshold of weight gain can be determined above which the cesarean risk climbs more rapidly.

Adult↗
PubMed1995

Evaluation of preterm delivery in a systemic lupus erythematosus pregnancy clinic.

OBJECTIVE: To identify the primary etiology of preterm birth in women with systemic lupus erythematosus, analyzing prospective data collected on 66 pregnancies in 58 women followed-up at a lupus pregnancy center. METHODS: Hospital records were reviewed and subjects were interviewed for pregnancies delivered after 23 completed weeks' gestation in women cared for at the Hopkins Lupus Pregnancy Center. A control group consisted of all women delivered at the same hospital during 2 years of the study period. RESULTS: Preterm premature rupture of membranes (PROM) occurred in 13 of 33 (39%) pregnancies delivered at 24-36 weeks' gestation. In addition, term PROM also occurred with high incidence in ten of 33 (30.3%) pregnancies delivered after 36 weeks' gestation. The rate of PROM in study subjects differed from that in controls at 34-36 weeks' gestation and after 36 weeks. CONCLUSION: Premature rupture of membranes is more common in pregnancies occurring in women with systemic lupus erythematosus than in control pregnancies. Disease activity, prednisone use, and serologic studies are not predictive. Premature rupture of membranes is the major etiology of preterm birth in this cohort.

Case-Control Studies↗
PubMed1995

Modulation of alpha-interferon's antiviral and clinical effects by aspirin, acetaminophen, and prednisone in healthy volunteers.

The magnitude and duration of the antiviral and clinical effect of alpha-interferon was measured in healthy volunteers. A single 3 million unit intramuscular dose of interferon was given either alone (controls) or after 72 h of concomitant medications. These medications included either aspirin (650 mg every 4 h), acetaminophen (650 mg every 4 h), or prednisone (40 mg per day). Peripheral blood mononuclear cells were assayed for resistance to vesicular stomatitis virus infection and induction of 2'-5'-oligoadenylate synthetase activity as evidence of interferon's antiviral effect. Co-administration of acetaminophen increased both antiviral parameters by more than 70% (P < 0.05) and reduced symptoms after interferon dosing, compared to controls. Aspirin and prednisone did not demonstrate any significant differences from controls in antiviral effect. As a group, acetaminophen, aspirin, and prednisone reduced the clinical symptoms by 47% compared to controls (P = 0.03) after interferon dosing, although individual drug comparisons failed to reach statistical significance. Independent of treatment group, the changes in antiviral markers after interferon dosing correlated closely with each other (r = 0.72, P < 0.001), but neither correlated with symptoms or fever (r < 0.30, P > 0.05). Acetaminophen enhances the antiviral effects of a single intramuscular dose of alpha-interferon, considering the parameters measured in these healthy volunteers.

2',5'-Oligoadenylate Synthetase↗
PubMed1994

Are fathers prepared to encourage their partners to breast feed? A study about fathers' knowledge of breast feeding.

In order to study fathers' knowledge of breast feeding and its relationship with paternal factors, fathers of 92 breast feeding and 89 non-breast feeding newborns were compared. Paternal factors included previous children and the way they were fed, participation in prenatal care, attendance at prenatal classes, breast feeding information provided by health professionals, use of reading materials and interest in learning more about the subject. The results indicated that fathers had poor knowledge about breast feeding, especially those whose children were being bottle fed. After adjustments for confounders, fathers who had previous breast-fed child(ren), had attended prenatal classes and who received information about breast feeding from medical personnel had a significantly higher chance of having a better knowledge of breast feeding. It seems that fathers need to be better prepared to assume their new role as breast feeding supporters. Prenatal care was shown to be a good opportunity to improve fathers' knowledge of breast feeding.

Adult↗
PubMed1994

Effect of breastfeeding support from different sources on mothers' decisions to breastfeed.

A cross-sectional study compared 100 breastfeeding and 100 non-breastfeeding new mothers in order to investigate the relationship between mothers' choice of breastfeeding and support from health professionals and lay people, taking into account potentially confounding sociodemographic influences. The importance of the male partners' opinion about breastfeeding was also examined. A favorable attitude of partners towards breastfeeding was the most important factor associated with breastfeeding (odds ratio = 32.8). Prenatal class attendance and breastfeeding support from lay people increased the odds of breastfeeding 2.7 and 3.3 times, respectively. Breastfeeding orientation provided by doctors, nurses, and nutritionists was not associated with the maternal decision to breastfeed. The results point toward the need for reevaluation of prenatal care interventions, inclusion of fathers in breastfeeding educational programs, and emphasis on community-based programs.

Adult↗
PubMed1993

Elevated circulating thrombomodulin in severe preeclampsia.

A relationship between serum thrombomodulin and preeclampsia was investigated. In women with severely preeclamptic pregnancies, serum thrombomodulin levels were found to be significantly elevated as compared with those of matched control subjects (p < 0.005). Serum thrombomodulin levels correlated positively with serum creatinine (r = 0.854, p < 0.0001) and uric acid levels (r = 0.784, p < 0.001).

Adult↗
PubMed1993

The ideal twin pregnancy: patterns of weight gain, discordancy, and length of gestation.

OBJECTIVE: Our purpose was to evaluate factors associated with the best intrauterine growth and lowest morbidity among twins ("ideal twin pregnancy"). STUDY DESIGN: A historic prospective study of 163 twin births was performed. Ten models were formulated with multiple regression and multivariate logistic regression. RESULTS: In the models of birth weight, gestations of 28 to 36 and 39 to 41 weeks, black race, > or = 15% discordancy, and smoking were all significant negative factors. The pattern of early low weight gain (< 0.85 pounds per week before 24 weeks) and late low weight gain (< 1.0 pound per week after 24 weeks) was negatively associated with all eight models of intrauterine growth. CONCLUSIONS: The best intrauterine growth and lowest morbidity is achieved earlier for twins than for singletons. Using length of stay and growth retardation criteria, nearly 70% of "ideal" twin pregnancies were between 35 and 38 weeks. In addition, poor weight gain and poor patterns of weight gain were associated with all measures of intrauterine growth and adverse pregnancy outcomes.

Baltimore↗
PubMed1993

A case-control study of maternal gestational weight gain and newborn birthweight and birthlength in twin pregnancies complicated by preeclampsia.

To evaluate the influence of rate of gestational weight gain on newborn birthweight and birthlength in twin gestations complicated by preeclampsia, 74 cases of preeclampsia in twin pregnancy were matched to 148 non-preeclamptic twin controls for maternal race, height, pregravid weight, age and length of gestation. Total weight gain was significantly higher for all cases versus controls and for mild cases versus controls. However, the rate of early weight gain was lower for severe cases and severe cases with thrombocytopenia compared to their controls. Mean birthweight and birthlength did not differ between cases and controls, although the proportion with birthlength below the 10th percentile was significantly higher among cases than controls. In addition, the proportion of birthweights and birthlengths < 10th percentile was significantly higher among cases than controls. These findings suggest that inadequate early weight gain in twin gestations complicated by preeclampsia results in retarded birthlength and birthweight. The implication of these findings are discussed.

Adult↗
PubMed1993

Clinical pharmacokinetics in the treatment of rheumatoid arthritis in pregnancy.

Rheumatoid arthritis is a relatively common problem in women of reproductive age. Pregnancy may affect all aspects of the pharmacokinetics of the drugs used in its treatment. The effects of pregnancy on the pharmacokinetics of drugs are, for the most part, not clinically significant. The pharmacokinetics of placental transfer and fetal safety have been specified for many drugs. Drugs used in rheumatoid arthritis can be classified into 3 classes: those with the greatest safety for the fetus, those that are unsafe for the fetus, and those for which there are insufficient data to determine the risk to the fetus.

Anti-Inflammatory Agents↗
PubMed1993

Perinatal mortality and intrauterine growth retardation.

Perinatal mortality has decreased over the past 20 years, and the availability of prenatal care is now recognized as a factor in this improvement. Lupus anticoagulant and anticardiolipin antibodies do not appear to be useful screening tools for perinatal loss. Intrauterine growth retardation remains the second leading known cause of fetal death. Additionally, intrauterine growth retardation causes impaired development lasting into childhood, and the most vulnerable group are those born before 33 weeks' gestation. Newer approaches to the diagnosis and establishment of prognosis for fetuses with intrauterine growth retardation are also reviewed.

Cause of Death↗
PubMed1993

The role of fetal growth restriction and gestational age on length of hospital stay in twin infants.

OBJECTIVE: To evaluate the association between length of gestation and fetal growth restriction (FGR) and the role of FGR in neonatal morbidity as determined by length of hospital stay among newborn twins. METHODS: Using a race-, gender-, and gestational age-specific birth weight and length of hospital stay singleton standard, 490 twin infants were classified as FGR (at or below the tenth percentile) or non-FGR (above the tenth percentile). Length of stay and length-of-stay ratio (twin stay divided by the 50th percentile singleton stay) were calculated for each twin. Analysis included stepwise multiple regression for length of stay and length-of-stay ratio, and analysis of variance with main effects and second-order interactions for the length-of-stay measures using factors significant in the multiple regression models. RESULTS: For length of stay, significant factors in the multiple regression model included respiratory distress syndrome (RDS), gestation category, FGR, sepsis, time of birth (1979-1984 versus 1985-1989), and cesarean delivery. For length-of-stay ratio, significant factors included FGR, gestation category, sepsis, period of birth, cesarean delivery, and hyperbilirubinemia. The analysis of variance showed that RDS had the greatest effect on length of stay, whereas FGR had the greatest effect on length-of-stay ratio. For both dependent variables, the effect of FGR was magnified when compounded by significant neonatal complications (RDS, sepsis, hyperbilirubinemia) or gestation category. CONCLUSIONS: Fetal growth restriction is a major factor in the neonatal morbidity of twins. Early recognition of and interventions for FGR in twin gestations should be a primary goal for reducing both immediate and long-term adverse outcomes.

Birth Weight↗
PubMed1992

A randomized trial of prostaglandin E2 in a controlled-release vaginal pessary for cervical ripening at term.

OBJECTIVE: The purpose of this study was to determine if prostaglandin E2 in a controlled-release vaginal pessary can produce cervical ripening at term. STUDY DESIGN: This was a double-blind, randomized, placebo-controlled study conducted at a university center and involving 81 patients with 42 receiving active agent. Categoric data were analyzed by Pearson's chi 2 or logistic regression. Continuous variables were analyzed by analysis of variance and the F test. RESULTS: Prostaglandin E2 was significantly better than placebo at cervical ripening and at decreasing the time to rupture of membranes, the time to onset of labor, the need to give oxytocin, and the time to vaginal delivery. Multiparous women benefitted more than primiparous ones. The cesarean section rate decreased only for multiparous women. Uterine hyperstimulation occurred only with prostaglandin E2 and after the onset of labor. CONCLUSIONS: Prostaglandin E2, when administered in a controlled-release vaginal pessary, is affective in producing cervical ripening at term. This agent should be used on inpatients who are under continuous monitoring and it should be removed at the onset of labor.

Cervix Uteri↗
PubMed1991

The effect of maternal height on birth weight and birth length.

This retrospective study examined the gestational age at which differences were observed between birth weights and birth lengths of infants whose mothers differed by height. Infants whose gestational ages were between 24 and 42 weeks born to women 59-62 inches (150-157 cm) tall were compared to similar infants born to women 66-69 inches (168-175 cm) tall. Significant differences occurred in birth weight and birth length from 35 weeks onward. The infants of the shorter women were symmetrically smaller than the infants of the taller women as the infant ponderal indexes did not differ.

Birth Weight↗
PubMed1991

Gestational age-specific birthweights of twins versus singletons.

In order to more adequately characterize patterns of intrauterine growth retardation in twins, the mean birthweights of all nonanomalous white or black twins born between 24 and 41 weeks of gestation and surviving until discharge over an 11-year period (547 infants) and all similar singletons (19,072 infants) were compared by completed weeks of gestation. Between 24 and 35 weeks of gestation, the mean birthweights for the 547 twins and the 19,072 singletons were comparable and did not consistently differ statistically. From 36 to 41 weeks gestation, however, the difference became large, consistent, and statistically significant for each week at P less than 0.0001. This difference was present among all subgroups of twins, ie, in all males, females, blacks, and whites; it was still evident when the sample was further stratified by both race and sex (black males, white males, black females, white females). These data suggest a pattern of growth retardation in twins compared to singletons which is large, consistent, and statistically significant beginning at 36 weeks gestation. Clinically, these data also suggest the need for ultrasonic examination early in gestation (24-32 weeks) to document normal growth and to provide baseline data, and show the importance of such monitoring later in gestation, specifically after 36 weeks.

Baltimore↗