Variability and reliability of diastolic blood pressure during adolescence: the Philadelphia Blood Pressure Project.
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Adolescent↗
Biomedical subjects
M L Hediger
Publications and source records attributed to M L Hediger.
Letter: Failure to confirm anticonvulsant hypomagnesaemia.
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Epilepsy↗
[Saving straw? Necessary evil?].
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Chronic Disease↗
Point of diminishing returns: when does gestational weight gain cease benefiting birthweight and begin adding to maternal obesity?
This study is a reanalysis of the first scientific paper published by one of the authors, originally coauthored with Dr. Roy H. Petrie. In honor of Dr. Petrie, these data have been reanalyzed to re-evaluate the data using more sophisticated techniques and to expand on the original findings. This reanalysis examines the contribution of maternal weight gain to infant birthweight and retained maternal weight in the immediate postpartum period, and the effect of weight gains below, at, and above the Institute of Medicine (IOM) guidelines on both infant birthweight and retained maternal weight in the postpartum period. The study population included 487 term, uncomplicated, singleton pregnancies. Body mass index (BMI) was calculated for each woman, and categorized as underweight, normal weight, or overweight. Maternal retained weight was calculated as postpartum weight 2 days after delivery minus pregravid weight. Every kilogram of gestational weight gain increased birthweight by 44.9 g for underweight women, 22.9 g for normal weight women, and 11.9 g for overweight women. For every kilogram of retained weight, birthweight was increased by 35.6 g for underweight women, 15.9 g for normal-weight women, and 5.1 g for overweight women. Increasing weight gains from below to equal to IOM guidelines increased birthweight and maternal retained weight by 317 g (11%) (P < 0.01) and 5 kg (P < 0.01), respectively, for underweight women; 141 g (4.4%) (P < 0.02) and 6.2 kg (P < 0.01), respectively, for normal-weight women; and 200 g (6.4%) (NS) and 6.4 kg (P < 0.01), respectively, for overweight women. Increasing weight gains from equal to above the IOM guidelines increased birthweight and maternal retained weight by an additional 299 g (9.4%) (P < 0.02) and 7.3 kg (P < 0.01), respectively, for underweight women; an additional 196 g (5.9%) (P < 0.01) and 5.9 kg (P < 0.01), respectively, for normal weight women; and an additional 9 g (0.3%) (NS) and 8.3 kg (P < 0.01), respectively, for overweight women. These findings suggest that, beyond a certain level of weight gain, there is a point of diminishing returns (increase in birthweight) at the expense of increasing maternal postpartum obesity for the woman who has gained excessively.
Adult↗
Pregnancy in early adolescence: are there obstetric risks?
The purpose of this study was to determine if early adolescence imparts a significant obstetric risk in young primiparas relative to adult primiparas. The records of 239 young primiparas (< 16 years) and 148 older primiparas (18-29 years) were reviewed for demographic information, antepartum complications, mode of delivery, length of labor, episiotomy, lacerations, birthweight, and length of gestation. The young adolescents were shorter, had an earlier age at menarche, a lower pregravid body mass index, and a higher gestational weight gain. The young teens were less likely to smoke cigarettes but were more likely to be Medicaid recipients. The incidence of most antenatal complications (chronic hypertension, pregnancy-induced hypertension, placental abruption, placenta previa, premature rupture of the membranes, urinary tract infections, and anemia) were similar between the two groups. Preterm labor and contracted pelvis were more common among the young adolescent, while gestational diabetes was less common. The young primiparas were significantly (P < .05) less likely to have a Cesarean delivery and to lacerate with vaginal delivery. The length of labor and its stages were similar, as were overall birthweight and length of gestation. Thus, obstetric concerns regarding pregnancy in early adolescence may be unfounded. With the exception of an increased risk for preterm labor, it appears that pregnancy, labor, and delivery do not pose inordinate obstetric and medical risk to the very young adolescent primipara.
Adolescent↗
Does light pressure effleurage reduce pain and anxiety associated with genetic amniocentesis? A randomized clinical trial.
OBJECTIVE: To determine if light pressure effleurage (leg rubbing) during genetic amniocentesis reduces procedure-related pain and anxiety. METHODS: Two hundred women with singleton gestations undergoing genetic amniocentesis between 15-22 weeks recorded their level of anticipated pain and anxiety on a 10-cm linear visual analog scale prior to the amniocentesis. Subjects were then randomized to receive effleurage or no effleurage by the assisting nurse during the procedure. Subjects were blinded to the effleurage nature of the study. Following the amniocentesis, subjects repeated the pain and anxiety scoring. RESULTS: The two groups were similar with respect to subject and procedure characteristics, as well as anticipated pain or anxiety prior to amniocentesis. Postamniocentesis pain and anxiety scoring were similar in the two groups. The mean effleurage acceptance score was 8.3 +/- 1.8 (out of 10), and 90.2% of subjects reported that they would want effleurage with future amniocenteses. CONCLUSIONS: Although well accepted by women, light pressure effleurage during genetic amniocentesis does not reduce procedure-related pain or anxiety.
Adult↗
Low-level lead exposure in childhood influences neuropsychological performance.
Cumulative lead exposure in 193 inner-city black children was assessed by measuring lead concentrations in the primary and circumpulpal dentine of their deciduous teeth. Lead concentrations for these children were comparable to the concentrations reported in population studies of low-income children living in inner-city areas. Analysis of the children's neuropsychological test performance showed that elevated lead levels were associated with deficits in visual-motor functioning and perceptual integration, right-left orientation, and verbal abstraction; other verbal abilities and motor functioning were not affected. Possible alternative explanations for these findings were evaluated by examining the relationships between lead and maternal intelligence, family socioeconomic status, and perinatal indicators of neurological impairment. None of these relationships was significant. It was concluded that, even at levels usually regarded as asymptomatic, lead in the environment represents a hazard to inner-city children.
Adolescent↗
Age at menarche based on recall information.
Censored likelihood methods which use recalled dates yield accurate estimates of the age at menarche in an urban population of black adolescent girls. The mean age at menarche is 12.44 (SE 0.08) years for a sample of 272 black adolescents in Philadelphia, PA. The methodology we describe is more efficient than logit or probit methods, which are not designed to utilize recall information. Alternative methods which use recall are biased if subject memory is influenced by length of time since menarche. Our methods also provide information on the nature of subject recall that may be useful in further analysis.
Adolescent↗
Fat distribution in children with cerebral palsy.
Triceps and subscapular skinfolds were measured on 95 North American children with cerebral palsy. Triceps fat was far more depleted than subscapular fat in comparison with population standards for sex, age and race. This truncal distribution of fat may be related to the high prevalence of under nutrition found in the sample.
Adipose Tissue↗
Effects of early maturation on fetal growth.
While the association of young maternal age with low birthweight (LBW) is well known, the contribution of early menarche to this association has never been studied. We examined the effects of early menarche (less than or equal to 11 years) on LBW and its two major underlying causes: pre-term delivery and smallness-for-gestational-age (SGA). Results represent a narrow chronological age range, 17-18 years, of a larger geographically based cohort of 2789 pregnant adolescents. Adjusted odds ratios (AOR) indicated that early menarche was significantly associated with an increased risk of LBW which was specific to SGA. The attributable risk of SGA with early menarche exceeded 20%. Early age at menarche is also correlated with an earlier onset of sexual activity, pregnancy, and childbearing. Consequently, adolescents with early menarche are over-represented in a sample limited to young gravidae or a sample that contains a stratum of young gravidae. This may have previously obscured the effects or early menarche on foetal growth and attributed them to a more frequently measured characteristic, young maternal age. Thus, effects of secular change in age at menarche may not be wholly benign. Improvements in maternal fertility and nutritional status appear to be offset by intrauterine growth retardation in the offspring.
Adolescent↗
Concurrent validity studies of blood pressure instrumentation. The Philadelphia Blood Pressure Project.
There is increasing evidence that blood pressure (BP) screening during adolescence may detect early evidence of hypertensive disease. Choice of instrumentation becomes important to maximize the accuracy and interpretive value of several serial readings. We therefore conducted two studies of adolescents, comparing auscultatory (Baumanometer and Random-zero), ultrasonic (Arteriosonde 1216), and infrasonic (Physiometrics SR-2) devices. These instruments were compared serially (Study 1) for older adolescents (n = 48). The Baumanometer, Arteriosonde 1216, and Physiometrics SR-2 were compared both serially and simultaneously (Study 2) for younger and older adolescents (n = 24). In both studies, the order of device presentation was completely counterbalanced. In Study 1, reliability estimates were high (r greater than 0.65), with the exception of the Arteriosonde 1216 diastolic readings, and the Physiometrics SR-2 yielded significantly lower mean diastolic BP readings than the other devices. Diastolic Phase V readings taken with the Random-zero were significantly higher when the Random-zero was presented at the end of the sequence of instrument presentation. This order of presentation effect is probably attributable to the need for overinflation when using the Random-zero device and may cause an overestimation of diastolic BP in the young. In Study 2, again the Arteriosonde 1216 did not perform reliably in recording diastolic BP. Further, the Physiometrics SR-2 device, although reliable, yielded diastolic readings significantly lower (p less than 0.001) than diastolic Phase IV readings taken both serially and simultaneously.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Blood pressure, growth and maturation from childhood through adolescence. Mixed longitudinal analyses of the Philadelphia Blood Pressure Project.
This paper presents data on the extent to which blood pressure (BP) and growth status at 7 years of age are associated with BP, growth, and maturity status during adolescence. Two samples of black adolescents, namely, a representative sample (n = 562) stratified by sex and age (11 to 15 years) and a sample (n = 256) with supine BP over one standard deviation above the mean at 7 years of age (High BP7), were selected from the Philadelphia Collaborative Perinatal Project (CPP) population and followed longitudinally for 3 years. When the subjects reached adolescence we again measured supine blood pressure, height, weight, and skeletal maturity. Analyses of the data collected at 7 years of age by the CPP indicated that weight and height are highly significantly associated with systolic blood pressure (SBP) and diastolic blood pressure (DBP) respectively. Accordingly, the SBP, DBP, weights, and heights of the representative sample at age 7 were divided into percentile groupings (< 15%, 15%-85%, > 85%). Using mixed longitudinal analyses during adolescence, we found that mean SBP tracked in males through age 15 and in females through age 13 based on the percentile groupings of SBP, height, and weight. Moreover, the weight percentile groupings provided the best discrimination of SBP at these ages. Skeletal age also tracked throughout early adolescence using these percentile groupings of 7-year heights and weights. In females only, diastolic phase 4 (DBP4) during adolescence was significantly associated with 7-year height percentile groupings. In comparing the representative and the High BP7 samples at each chronological age for BP, height, weight, and skeletal age at adolescence (ages 12 to 17 years), it was found that the High BP7 sample was, on the average, taller and heavier at age 7 and throughout early adolescence. At age 17 in males, however, there were no significant differences in BP, growth, or maturity status. In females, SBP of the High BP7 sample remained significantly higher, and there was a tendency for them to remain heavier through age 17. Hence BP variation is so closely associated with growth and maturation that these factors must be taken into account when assessing BP in childhood and adolescence.
Adolescent↗