The association between women's work, working conditions, and adverse pregnancy outcomes: a review of the literature and directions for future research.
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Biomedical subjects
Publications and source records attributed to L Keith.
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To determine whether large gestational weight gains result in higher maternal body weight within two years post-partum, we administered an anonymous survey to 423 mothers of twins at the Annual Twinsday Festival in Twinsburg, Ohio, in 1989 and 1990. Data collected included pregravid and current weight, age and parity, gestational weight gain and length of gestation. Data were grouped by patient age (18-24 years, 25-34 years and 35-44 years), parity (primipara or multipara) and length of gestation as preterm (less than 37 weeks) and term (greater than or equal to 37 weeks). Statistical analysis included paired t-tests, unpaired t-tests and chi-square as appropriate. Except for multiparas in the oldest age category, the mean current weight was higher than pregravid weight for each age and age/parity category. Comparison across age categories showed in pattern of increasing pregravid weight with increasing age for the total study sample (all women) and for primiparas; among multiparas, this trend was not as evident. Our findings suggest that large weight gains in twin gestations do not result in higher maternal body weight within two years postpartum. Such gains are associated with better intrauterine growth and should be considered when formulating weight gain recommendations for twin gestations.
Monthly distribution of PIH (Pregnancy Induced Hypertension) was investigated in relation to the number of deliveries and nine specific cosmic and geomagnetic activity parameters during the years 1979-1983. PIH was observed in 3.165% of 19,843 deliveries. Significant (p less than 0.01) inverse correlation between the PIH index and monthly geomagnetic activity level was shown. Moderately significant (p less than 0.05) correlation with monthly maximal (noon hours) gamma-radiowave propagation was evident as was inverse correlation with this parameter in hours of minimal (early morning) propagation.
We examined the prevalence of marijuana use in a group of pregnant women using a qualitative, rapid urine screen to detect marijuana metabolites. Between July 1, 1987, and Aug 15, 1987, 322 consecutive patients underwent an anonymous urine toxicology screen at the time of admission to the labor-and-delivery unit. Patients were identified only by a consecutive number and by their age, race, marital status, gravidity, parity and obstetric service (clinic vs. private). The prevalence of positive urine toxicologic screens for marijuana was 19.9% among the study population (64 positive tests among 322 women screened). The prevalence was greater among the clinic patients than the private patients (52 of 161, or 32.3%, vs. 12 of 161, or 7.5%, respectively). The distribution of race and marital status among the marijuana-positive and -negative groups were also significantly different. Specifically, the proportions of black and single women were higher among the marijuana-positive group. Our findings suggest that marijuana use is common in our obstetric patients. The possible association between marijuana use during pregnancy and perinatal morbidity, as well as the unreliable nature of patient drug histories, may support the use of rapid, inexpensive screening techniques, especially if general screening is considered.
Sixty-seven women with primary addiction to cocaine were evaluated during their pregnancies by multiple ultrasound studies. Ultrasonic parameters included biparietal diameter, femur length, abdominal circumference, and head circumference. These values were compared with ultrasonic growth parameters in nonaddicted fetuses. Head and abdominal circumference data were used to evaluate the fetuses according to growth pattern. With this system of scoring, subtleties of asymmetric versus symmetric intrauterine growth retardation become apparent. In addition, birth weights of addicted infants were compared with birth weights of nonaddicted infants. The results suggest that, although statistically significant differences in birth weights cannot be demonstrated, abnormal growth of the addicted fetuses does occur. Addicted fetuses show a greater proportion of biparietal diameter and abdominal circumference values below the 50th and 25th percentiles than nonaddicted fetuses, and addicted fetuses more frequently exhibit intrauterine growth retardation patterns. These data suggest that it is fruitful to study these infants with near-normal size but with abnormal intrauterine growth patterns.
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Four used intrauterine contraceptive devices and two new control devices were studied by scanning electron microscopy. All intrauterine contraceptive devices were found to have surface deposits that differed not only from site to site on a given device but between devices. A finding of this study not previously described in the literature was the observation of a euhedral crystal rosette of an apatite mineral group [Ca5(PO4)3(F,Cl,OH)] on the Lippes Loop that had been in situ for 15 years.
The results of a multihospital study involving a total of 588 twin pairs born in Chicago in 1970-1975 are reported, with special respect to differences in mortality between first and second twins by time as well as by cause of death. Mortality was higher in second than in first twins and most commonly occurred after delivery and was the result of immaturity and of respiratory distress syndrome.
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A review of data from various large-scale studies reveals as much variation between studies as between devices. Many factors clearly unrelated to the IUD design undoubtedly influence their efficacy and continued use. Thus, the conclusions of the 1968 FDA report on effectiveness and utility still appear valid at this time. They are: A. "The Committee finds adequate scientific data attesting to the effectiveness and utility of the intrauterine devices." B. "The intrauterine devices are highly effective in preventing pregnancy, although they are not quite as reliable as the hormonal contraceptives if the latter are taken according to instructions." C. "The rate of continuation of use is similar to that of the oral contraceptives and is far higher than that of traditional methods, at least among the socially and economically deprived."
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