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Biomedical subjects

M Susser

Publications and source records attributed to M Susser.

At least 37 records · Page 2Linked to original sources
PubMed1998

Does risk factor epidemiology put epidemiology at risk? Peering into the future.

The multiple cause black box paradigm of the current risk factor era in epidemiology is growing less serviceable. This single level paradigm is likely to be displaced. The signs are that the growing strength of molecular epidemiology on the one side, and of a global epidemiology based on information systems on the other, will come to dominate epidemiology and segregate it into separate disciplines. At the same time, the links with public health interests grow weaker. A multilevel ecoepidemiology has the potential to bind these strands together.

Epidemiologic Methods↗
PubMed1998

Maternal leisure-time exercise and timely delivery.

OBJECTIVES: This study investigated whether, in a general obstetric population, exercise in pregnancy affects the timeliness of delivery. The hypothesis was that maternal exercise would not raise the risk of preterm birth. METHODS: A community cohort of 557 prenatal patients was followed up until the time of delivery. Data were collected on exercise in each trimester: none, low-moderate (< 1000 kcal [4184 kJ]/wk in energy expenditure), or heavy (> or = 1000 kcal/wk). Timely delivery was adopted as an outcome criterion. Thus, in the analysis, a term birth was treated as optimal and survival techniques were used to estimate risks for both preterm and postdates delivery. RESULTS: No association was found between low-moderate exercise and gestational length. Heavier exercise appeared to reduce, rather than raise, the risk of preterm birth. The adjusted relative risk among conditioned heavy exercisers was 0.11 (95% confidence interval = 0.02, 0.81). After term, conditioned heavy exercisers delivered faster than nonexercisers. CONCLUSIONS: The most important finding was the lack of evidence that vigorous maternal exercise is a risk factor for preterm delivery. A promising finding was that conditioned heavy exercisers have timely deliveries.

Adult↗
PubMed1998

Informed consent for HIV testing in a South African hospital: is it truly informed and truly voluntary?

OBJECTIVE: The purpose of this study was to assess informed consent to human immunodeficiency virus (HIV) testing in a perinatal HIV transmission study in a major referral hospital serving a largely Black population in South Africa. METHODS: First-time antenatal clinic attenders who were randomly selected from those enrolled in the perinatal HIV study (n = 56) answered questionnaires before and after counseling. RESULTS: Knowledge of HIV transmission and prevention, high at the outset, was little improved after counseling. The acceptance rate for HIV testing was high. Despite assurances that participation was voluntary, 88% of the women said they felt compelled to participate in the study. CONCLUSIONS: Informed consent in this setting was truly informed but not truly voluntary.

AIDS Serodiagnosis↗
PubMed1997

Major depressive disorder in the 6 months after miscarriage.

OBJECTIVE: To test a priori hypotheses that miscarrying women are at increased risk for a first or recurrent episode of major depressive disorder in the 6 months following loss and that this increased risk is greater for childless women, women with prior reproductive loss, and women aged 35 years or older; and to evaluate whether risk varies by time of gestation or by attitude toward the pregnancy. DESIGN: Cohort study. SETTING: The miscarriage cohort consisted of women attending a medical center for a spontaneous abortion (n=229); the comparison group was a population-based cohort of women drawn from the community (n=230). PARTICIPANTS: Miscarriage was defined as the involuntary termination of a nonviable intrauterine pregnancy before 28 completed weeks of gestation. Half of all participants were between 25 and 34 years of age; 40% were white and 35% Hispanic; 55% had more than a high school education. Participants constituted 60% of miscarrying women and 72% of community women who completed the first phase of this cohort study. MAIN OUTCOME MEASURE: Major depressive disorder was measured using the Diagnostic Interview Schedule. RESULTS: Risk for an episode of major depressive disorder among miscarrying women in the 6 months following loss was compared with the 6-month risk among community women who had not been pregnant in the preceding year. Among miscarrying women, 10.9% experienced an episode of major depressive disorder, compared with 4.3% of community women. The overall relative risk (RR) for an episode of major depressive disorder for miscarrying women was 2.5 (95% confidence interval [CI], 1.2-5.1) and was substantially higher for childless women (RR, 5.0; 95% CI, 1.7-14.4) than for women with children (RR, 1.3; 95% CI, 0.5-3.5) (P<.06). Among miscarrying women, 72% of cases of major depressive disorder began within the first month after loss; only 20% of community cases started during the comparable period. Among miscarrying women with a history of major depressive disorder, 54% experienced a recurrence. However, RR did not vary significantly by history of prior reproductive loss or by maternal age, nor did risk vary by time of gestation or attitude toward the pregnancy. CONCLUSIONS: Physicians should monitor miscarrying women in the first weeks after reproductive loss, particularly women who are childless or who have a history of major depressive disorder. Where appropriate, supportive counseling or psychopharmacologic treatment should be considered.

Abortion, Spontaneous↗
PubMed1997

Correlates of low thyroxine values at newborn screening among infants born before 32 weeks gestation.

We assessed the relation of perinatal factors to severe hypothyroxinemia of prematurity, defined as thyroxine value more than 2.6 standard deviations below the mean for newborns. The 365 survivors of birth before 32 weeks gestation were enrolled in a population-based study of the correlates of neonatal brain injury. In this historical cohort study, mothers were interviewed; perinatal data were abstracted from medical records and neonatal data were collected prospectively. Neonatal thyroxine screening values were retrieved from the New Jersey State Department of Health. Associated with severe hypothyroxinemia were: gestational age 23-27 weeks vs. 31 weeks (OR = 5.1, 95% CI 1.7, 15.2), later age at thyroxine test (OR = 1.6 per day, 95% CI 1.2, 2.1), fraction inspired oxygen at age 24 h > 40% (OR = 3.2, 95% CI 1.1, 8.8), mechanical ventilation (OR = 5.1, 95% CI 1.3, 19.4), diastolic blood pressure < 20 mmHg (OR = 2.3, 95% CI 1.2, 4.3), and > 12 years of maternal education (OR = 0.4, 95% CI 0.22, 1.0). Infants with severe hypothyroxinemia had higher mortality, more days of oxygen supplementation, ventilation and hospitalization and were 11 times more likely to require oxygen supplementation at the postnatal age equivalent to 36 weeks gestational age (odds ratio 10.6, 95% CI 2.3, 48.8). In preterm infants, neonatal thyroxine levels obtained at newborn screening in the first week of life may convey important prognostic information about mortality, morbidity, and the risk for bronchopulmonary dysplasia.

Congenital Hypothyroidism↗
PubMed1997

Do standing, lifting, climbing, or long hours of work during pregnancy have an effect on fetal growth?

We assessed prospectively the impact of length of the work week and job activity on fetal growth. Among 575 women who worked during pregnancy, neither prolonged standing, frequent lifting, or climbing at work, nor a high composite activity score showed an association with fetal growth, as measured by birthweight for gestational age. Long hours of work, however, did reduce fetal growth. Infants of women working long hours late in pregnancy showed decreases in gestation-adjusted birthweight of about 80 gm (95% confidence limits = -238, +74 gm), compared with women working 20 hours or less. When long hours (> 40 hours per week) were combined with job activity, the estimated reductions ranged up to 350 gm. At lower weights (< or = 3,000 gm), categorical analyses showed elevated odds ratios (1.1-1.8) for climbing, lifting, and long hours and for the combination of prolonged standing with a lengthy work week. These results indicate that long weeks of physically demanding work could lead to fetal growth reductions that may be clinically significant. Consistent with this suggestion, infants of women who worked part-time had the highest mean birthweights. Hours of work, not only job tasks, may be important for pregnant workers.

Adult↗
PubMed1997

Maternal receipt of magnesium sulfate does not seem to reduce the risk of neonatal white matter damage.

OBJECTIVE: To investigate whether in utero exposure to magnesium sulfate is associated with a lower incidence of cranial ultrasonographic abnormalities that predict cerebral palsy in infants who weigh less than 1501 g at birth. DESIGN: For a prospective study of the antecedents of cranial ultrasonographic abnormalities, we enrolled infants who weighed 500 to 1500 g when born at five institutions. Data were collected by interview of the mothers and review of medical records. Protocol cranial ultrasonograms were obtained as close as possible to postnatal days 1, 7, and 21. Abnormality on cranial ultrasound scans was determined by a consensus committee of three sonologists. RESULTS: Of the 1518 infants for whom we knew whether the mothers received magnesium sulfate, the first protocol cranial ultrasound scan was available for 1409 infants, the second for 1274 infants, and the third for 1050 infants. Forty-five percent of infants were exposed to magnesium sulfate before delivery. The major correlates of magnesium sulfate exposure were receipt of antenatal corticosteroids and a diagnosis of preeclampsia and/or pregnancy-induced hypertension. Maternal magnesium receipt was not associated with a reduced incidence of hypoechoic or hyperechoic images of white matter parenchyma, intraventricular hemorrhage, or ventriculomegaly, even when the sample was stratified by each of six potential confounders. When adjustment was made for gestational age, a measure of birth weight for gestational age, antenatal corticosteroid exposure, preeclampsia and pregnancy-induced hypertension, route of delivery, and the occurrence of any labor, the risk ratios for each cranial ultrasonographic abnormality associated with magnesium sulfate exposure hovered close to 1. CONCLUSION: Maternal receipt of magnesium sulfate does not seem to be associated with an appreciably reduced risk of cranial ultrasonographically defined neonatal white matter damage, intraventricular hemorrhage, or ventriculomegaly.

Adrenal Cortex Hormones↗
PubMed1997

Magnesium sulfate in labor and risk of neonatal brain lesions and cerebral palsy in low birth weight infants. The Neonatal Brain Hemorrhage Study Analysis Group.

OBJECTIVES: We tested the hypothesis that administration of magnesium sulfate in labor protects against the development of neonatal brain lesions and cerebral palsy (CP) in low birth weight infants. METHODS: Magnesium exposure was ascertained in a population-based cohort of 1105 infants weighing 2000 g or less through review of medical records of maternal magnesium sulfate administration and, where available, elevated maternal serum magnesium levels. Neonatal germinal matrix/intraventricular hemorrhage and parenchymal brain lesions were ascertained by a prospective, timed ultrasound scanning protocol in the first week of life. CP was ascertained at 2 years of age by clinical examination in 80% of survivors and by interview and medical record review in another 6% and was classified as disabling or nondisabling. RESULTS: No significant reduction in risk of nondisabling CP (adjusted odds ratio [OR], 1.00; 95% confidence interval [CI], 0.53 to 1.88) or disabling CP [DCP] (adjusted OR, 0.63; 95% CI, 0.32 to 1.24) CP with magnesium exposure was found in a logistic regression model that controlled for gestational age, fetal growth, gender, multiple birth status, mode of delivery, amnionitis, and hypertensive disorders. In a small subset of infants, those with onset of parenchymal lesions at 7 days of age or later (n = 29), magnesium exposure was associated with a significantly reduced risk of DCP (OR, 0.10; 95% CI, 0.02 to 0.65). Magnesium sulfate exposure was not associated with germinal matrix/intraventricular hemorrhage (adjusted OR, 0.89; 95% CI, 0.64 to 1.25) or with parenchymal brain lesions (adjusted OR, 0.83; 95% CI, 0.53 to 1.30). CONCLUSIONS: The hypothesis that magnesium sulfate use reduces the risk of neonatal brain lesions or CP in low birth weight infants was not statistically supported in this study, although a modest reduction in risk of DCP cannot be excluded. The data further suggest that magnesium exposure may be associated with reduction in risk of CP in low birth weight infants who have late-onset brain lesions, but this unpredicted observation requires confirmation in another data set.

Adult↗
PubMed1997

Thyroxine values from newborn screening of 919 infants born before 29 weeks' gestation.

OBJECTIVES: Severe transient hypothyroxinemia in premature infants is associated with cerebral palsy and mental retardation: this study assessed its prevalence in very premature infants. METHODS: Congenital hypothyroidism screening programs in three states provided thyroxine values for 919 newborn infants younger than 29 weeks who were enrolled in a multicenter study. RESULTS: Thyroxine values were lower than 4.0 micrograms/dL in 21% of survivors and increased each week by 0.6 microgram/dL (95% confidence interval [CI] = 0.4, 0.7). At tests done 1 to 2 days after birth, levels were 2.5 micrograms/dL higher (95% CI = 1.8, 3.3) than at tests done at 8 to 14 days. In New York, levels were 1.0 microgram/dL higher (95% CI = 0.3, 1.6) than elsewhere. The levels of infants who died were 1.3 micrograms/dL lower (95% CI = 0.6, 2.0) than those of survivors. CONCLUSIONS: Severe transient hypothyroxinemia is common in very premature infants and deserves further study.

Gestational Age↗
PubMed1997

Cocaine use during pregnancy: sensitive detection by hair assay.

OBJECTIVES: This paper compares the sensitivity of two tests of cocaine use, interview and urine test, with that of a radioimmunoassay of hair. METHODS: Interviews and hair samples were provided by 397 obstetric patients in one New York City hospital; urine samples were obtained in 377. Of these patients, 241 were receiving prenatal care (were registered) and 156 delivered without prenatal care (were unregistered). The 241 registered patients were derived from 400, comprising all reporting use of cocaine ever ("ever-users"), all reporting use by the father but not themselves ("lifestylers"), and a sample of women who were neither ever-users nor lifestylers. The 156 unregistered patients were derived from 352 women interviewed at delivery, unselected for reported use. RESULTS: Thirty-two percent reported ever using cocaine, 45% of these within 6 months before interview. Urine tests were positive in 20%, hair tests in 59%. The estimated sensitivity of the hair test (92%) was 3.1 times higher than that of the urine test (95% confidence interval [CI] = 2.5, 3.8) and 4 times higher than that of reported use in the past 6 months (95% CI = 3.2, 5.0). CONCLUSIONS: Self-report and urine tests alone miss most of cocaine users during pregnancy. Hair tests greatly improve detection and thus can enhance evaluations of the effects of prenatal cocaine use on fetal and child development.

Cocaine↗