Biomedical subjects
Publications and source records attributed to R L Goldenberg.
We compared pill counts with a biochemical measure of compliance in 283 women who participated in a randomized double-blind trial that evaluated the efficacy of low-dose aspirin in the prevention of preeclampsia. Subjects whose pill counts indicated a usage > 100% were less compliant than women with lower pill counts.
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OBJECTIVE: Our aim was to test the hypothesis that acetylsalicylate (aspirin) treatment reduces the incidence or severity of pregnancy-associated hypertension. STUDY DESIGN: Patients were nulliparous, healthy, and with a singleton gestation at between 20 and 22 weeks' gestation. A sample size of 600 patients was calculated on the basis of p < or = 0.05 and 90% power of observation. A 2-week placebo-controlled "run-in" was used to select compliant patients. Randomization occurred at 24 weeks, with 60 mg of aspirin or placebo treatment from randomization to delivery. RESULTS: Follow-up was maintained on 99% of the patients. The randomized patients had a 94% pill compliance index. At randomization, serum thromboxane medians were similar in both groups. Thromboxane B2 levels in the aspirin group decreased significantly from baseline at 29 to 31 weeks, 34 to 36 weeks, and at delivery as compared with an overall increase in the placebo group. Preeclampsia developed in five of 302 women (1.7%) who received aspirin versus 17 of 302 (5.6%) who received the placebo (p = 0.009). Preeclampsia was severe in one aspirin and in six placebo recipients (p = 0.06). CONCLUSION: Daily ingestion of 60 mg of aspirin beginning at 24 weeks' gestation significantly reduced the occurrence of preeclampsia.
OBJECTIVE: Our purpose was to determine if and when maternal risk factors and fetal sex have an impact on specific fetal anthropometric measurements assessed by ultrasonography. STUDY DESIGN: Serial ultrasonographic examinations were performed on 1205 fetuses of indigent multiparous women who ultimately gave birth at term. Femur length, abdominal circumference, and head circumference measurements were obtained at mean gestational ages of 18, 25, 31, and 36 weeks, and an estimated fetal weight was calculated. At birth the infant was weighted and head circumference, abdominal circumference, femur length, and crown-heel length measurements were made. Regression analyses were used to determine the effect on each measurement of maternal race, height, body mass index, hypertension, weight gain, smoking, previous low birth weight, and fetal sex. RESULTS: Acting through their effect on head circumference, abdominal circumference, and fetal length, each of the risk factors and female sex were shown to have a negative effect on fetal weight. The timing of the impact, its magnitude, and the specific anthropometric measurement affected were different for each of the risk factors. CONCLUSIONS: The impact of maternal risk factors and fetal sex on estimated fetal weight has been demonstrated to occur first in specific gestational age windows and is mediated through effects on specific fetal anthropometric measurements.
Serum concentrations of alpha-2-macroglobulin (alpha 2M) were measured in cord blood from neonates born in Alabama, USA and in Guatemala. Results indicate an inverse relationship between cord serum alpha 2M concentrations and birth weight of newborns in both locations. Infants with lower birth weight had higher cord serum alpha 2M concentrations as compared to those with higher birth weight. The results of the present study using cord serum are similar to those in our previous reports indicating an inverse relationship between maternal serum alpha 2M concentrations and birth weight. This distinctive and reproducible association between alpha 2M concentrations and fetal size in maternal as well as cord blood samples warrants further investigations to determine the mechanism of this relationship.
Serum albumin levels decrease during pregnancy while the concentration of most other maternal serum proteins of hepatic origin remain stable or increase. In a study of 289 women, most maternal characteristics such as race, age, smoking, a history of previous low birth-weight, infant sex and gestational age at delivery were not related to maternal serum albumin levels at 18 or 30 weeks' gestational age. The degree of maternal obesity significantly correlated with the concentration of albumin. There was a significant negative correlation in individual women between maternal serum levels of albumin and alpha-fetoprotein, with high levels of maternal serum alpha-fetoprotein predicting lower levels of albumin. We hypothesize that there may be a negative feedback effect of alpha-fetoprotein of fetal origin on the maternal production of albumin during pregnancy.
OBJECTIVE: This analysis was performed to present updated neonatal mortality data by age and birth weight for preterm newborns and to demonstrate the influence of plurality, ethnicity, and infant sex on mortality. STUDY DESIGN: Preterm birth weight and gestational age-specific mortality rates were compiled from the five centers that participated in the March of Dimes Multicenter Preterm Birth Prevention Project. In each center gestational age was assessed by standardized methods. A birth weight and gestational age-specific mortality chart for preterm births was created with live-birth data. RESULTS: In each birth weight group mortality decreased as the gestational age advanced; for each gestational age group heavier infants had less mortality. Female infants < 29 weeks survived better than male infants, and singletons < 29 weeks survived better than twins. Survival for black preterm newborns was better than that of whites but differences were not significant. Mortality for black term infants was significantly higher. The largest improvement in survival occurred between 25 and 26 weeks. At 30 weeks survival was > 90% and improved < 1% per week thereafter. CONCLUSIONS: When compared with rates in previous reports, mortality rates appear to have improved, especially at gestational ages < 29 weeks. These data may be useful in decision-making and in counseling patients at risk for preterm delivery.
OBJECTIVE: To determine gender-specific differences in anthropometric characteristics of full-term male and female infants. METHODS: Twelve hundred five term newborn infants were examined. All measures of length and skinfold thickness were performed in a standardized manner. RESULTS: After adjusting for confounding variables by regression analysis, we found that nearly all length and circumference measurements were significantly smaller in female infants than in male infants but that subcutaneous fat deposition in female infants was significantly increased. However, there was no difference in the ponderal index between male and female newborns, indicating that this measure does not correlate with newborn fat deposition across the sexes. CONCLUSIONS: Despite being shorter and having smaller circumferences, female infants have more subcutaneous fat than male infants. The ponderal index is not useful as a measure of fatness when the sexes are compared. We speculate that the greater subcutaneous fat deposition in female infants may be related to their better neonatal outcomes.
OBJECTIVE: To determine the relationship between measures of maternal protein nutriture and fetal size at birth. METHODS: We obtained serum samples at 18 and 30 weeks' gestation from 289 indigent multiparous women. The concentrations of albumin, prealbumin, and retinol-binding protein were correlated with birth weight, fetal growth retardation, and other measures of nutritional status. RESULTS: Serum albumin levels at 18 weeks correlated inversely with birth weight (P = .05). This negative correlation was explained by an inverse relationship between albumin concentration and maternal body mass index (BMI), and disappeared in a regression analysis adjusting for BMI. There was no significant correlation between albumin levels at 30 weeks and birth weight or between birth weight and the concentrations of the other two proteins at either gestational age. In individual subjects, the concentration of each protein correlated significantly with the concentration of the other proteins, and the levels at 18 weeks correlated with those at 30 weeks. CONCLUSION: Serum protein levels are not predictive of birth weight or growth retardation at birth, but do correlate significantly with a number of other measures of nutritional status.
OBJECTIVE: To evaluate the association between fetal loss in the second trimester and subsequent adverse birth outcomes. METHODS: We identified 95 women in our system who had a pregnancy loss at 13-24 weeks in the years 1985-1990 and tabulated the rates of preterm delivery, stillbirth, and neonatal death in the next pregnancy. We compared these outcomes to two groups: women who delivered at 25-36 weeks in their index pregnancy and those who delivered at term in their index pregnancy. RESULTS: Thirty-nine percent of women who had a pregnancy loss at 13-24 weeks in the index pregnancy had a preterm delivery in their next pregnancy, 5% had a stillbirth, and 6% had a neonatal death, with all outcomes worse than those found in the two control populations. Delivery at 19-22 weeks in the index pregnancy was associated with a 62% preterm delivery rate in the subsequent pregnancy. CONCLUSION: A second-trimester loss, especially one occurring at 19-22 weeks, is associated with a poor prognosis in the subsequent pregnancy.
Racial differences in hematocrit levels and the relationship between low and high hematocrit, intrauterine growth retardation, and preterm delivery were studied in a population of 17,149 low-income, iron- and folate-supplemented pregnant women. Hematocrit levels drawn during four gestational periods were considered. Evaluating pregnancy outcome in regard to hematocrit values at specific gestational ages eliminated the bias resulting in the previously reported association between a low hematocrit and preterm delivery in blacks. In contrast, in this study, in blacks, hematocrits of 27% to 30% were associated with lower but not significant reductions in the rates of intrauterine growth retardation and preterm delivery. Our major finding was that at 31 to 34 weeks, hematocrits > or = 40% were associated with significantly higher odds ratios for intrauterine growth retardation for both blacks and whites. These findings should prompt more attention to women who have high hematocrits in pregnancy while reducing concern for women of either race with low hematocrits.
OBJECTIVE: To examine the association of prenatal weight gain below, within, and above the Institute of Medicine guidelines with birth weight and fetal growth restriction (FGR) among low-income, high-risk black and white women. METHODS: Eight hundred three black and 365 white women were grouped by pregravid body mass index (BMI): low (below 19.8), normal (19.8-26), high (above 26-29), and very high (above 29). The impact of maternal weight gain on birth weight and race-specific FGR was determined while controlling for sociodemographic and reproductive variables and for time between last weight observation and delivery. RESULTS: One-third of both black and white women failed to achieve the Institute of Medicine minimum recommended gain for pregravid BMI. More women with low BMI gained less than the recommended weight as compared with those having normal, high, or very high BMI. Nonobese black women (BMI 29 or below) delivered fewer infants with FGR as weight gain increased from below the recommended range (17.9% FGR) to within (10.3% FGR) or above (3.8% FGR) the range; corresponding data for nonobese white women were 20.9, 19.1, and 10.5% FGR, respectively. Obese black women (BMI above 29) also delivered fewer infants with FGR (4.2%) when they exceeded the minimum gain (6 kg) than did white women (11.8%). When analysis of covariance was used to adjust mean birth weight, black women in each pregravid BMI category delivered increasingly larger infants (P < or = .01 for each category) as they met or exceeded the guidelines; among white women this trend was attenuated. CONCLUSION: These observations support the Institute of Medicine suggestion that black women strive for prenatal weight gain at the upper end of the recommended range for pregravid BMI.
Biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC) and femur length (FL) were compared by race and sex in 5,405 ultrasound examinations done on 2,831 women. Black fetuses had significantly longer FL than white fetuses; male fetuses had larger BPD, HC and AC than females. The differences in BPD, HC and AC correlated with the different birth weights observed between male and female infants, 3,253 vs. 3,153 g. The difference in birth weight between black and white infants, 3,152 vs. 3,331 g, did not correlate with differences in their respective BPD, HC and AC. Earlier delivery accounted for some but not all of the birth weight difference between black and white infants. Our data suggest that there may be differences in body length proportions (longer legs and shorter trunks in black infants) that are important factors in understanding the birth weight difference between black and white infants. Furthermore, fetal race and sex differences could account for some degree of error in the ultrasound estimation of gestational age.
OBJECTIVES: This study details the incidence, by gestational age and birth weight, of specific neonatal morbidities in singleton neonates without major congenital anomalies. STUDY DESIGN: Data were prospectively collected on all deliveries at five tertiary centers in the United States during the years 1983 through 1986. Pregnancies were meticulously dated and the gestational ages of the neonates at delivery were confirmed by Dubowitz score. RESULTS: The incidence of respiratory distress syndrome gradually decreases with increasing gestational age until 36 weeks. A marked decrease in the incidence of necrotizing enterocolitis, patent ductus arteriosus, intraventricular hemorrhage, and sepsis occurs after 32 completed weeks. The number of days of mechanical ventilation for respiratory distress syndrome and newborn stay in the tertiary care facility also were significantly reduced after 32 weeks. CONCLUSIONS: The incidence of both respiratory distress syndrome and patent ductus arteriosus is markedly decreased by both increasing gestational age and birth weight. The incidence of grade III and IV intraventricular hemorrhage, necrotizing enterocolitis, and sepsis virtually vanishes after 34 weeks. These data relating neonatal morbidities to gestational age are important to the obstetrician in the critical decision regarding the timing of delivery and to the parents, who can benefit from a realistic prediction of the neonatal course.
Maternal serum alpha-2-macroglobulin (alpha 2M) levels were measured at the time of delivery in 244 women in the central highlands of Guatemala. Significantly higher alpha 2M levels were found in thin women and in poor women. In multiple regression analysis controlling for gestational age, race, sex, maternal triceps skinfold thickness and socioeconomic status, high alpha 2M levels were significantly associated with decreased birthweight. These findings agree with those in a predominantly black population in the United States and extend the relationship between alpha 2M and decreased birthweight to a developing country.
The relationship of maternal weight status to birth weight was evaluated retrospectively for the first and second pregnancies of 72 younger (age 12-15 years at first conception) and 80 older (age 16-19 years at first conception) low-income adolescents (76% black, 24% white). Mean birth weight increased during the second pregnancies of both groups (277 g and 132 g, respectively). Multiple regression analysis (controlling for potentially confounding variables) indicated a positive relationship between second and third trimester rate of maternal weight gain (kg/week) and birth weight for younger adolescents during their second pregnancy (p = 0.014), and for older adolescents during their first pregnancy (p = 0.047). Mean birth weight increased with each increase in maternal weight-for-height (W/H) category near term from the lowest (< 100% of standard) to the highest (> or = 140% of standard), for both age groups during both pregnancies. Multiple regression analysis indicated that among older adolescents birth weight increased 4.2 +/- 2.0 g (X +/- SE) for each 1% increase in maternal W/H near term in their first pregnancy (p = 0.038) and 7.1 +/- 1.8 g for each 1% increase in maternal W/H near term in their second pregnancy (p = 0.0003). Among younger adolescents these relationships, while in the same direction, were not statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)
OBJECTIVE: Our objective was to determine if the low birth weight associated with unexplained elevations of midtrimester maternal serum alpha-fetoprotein levels is due to prematurity or to fetal growth retardation. STUDY DESIGN: Rates of preterm delivery and fetal growth retardation were analyzed according to incremental maternal serum alpha-fetoprotein levels in 5555 women, predominantly white, who were screened for neural tube defects (group 1) and 843 women, predominantly black, with risk factors for low birth weight (group 2). Statistical methods included chi 2, t tests, analysis of variance, and regression analysis. RESULTS: In both groups increasing levels of maternal serum alpha-fetoprotein are significantly associated with preterm delivery but not with fetal growth retardation. The preterm delivery rate increased in each group from 8% at levels less than 0.5 multiples of the median to 18.1% (p less than 0.001) at levels greater than or equal to 2.5 multiples of the median in group 1 and 28.1% (p = 0.01) in group 2. CONCLUSIONS: Women with unexplained elevations of maternal serum alpha-fetoprotein are at increased risk for preterm delivery but not fetal growth retardation. Because of the wide availability of maternal serum alpha-fetoprotein screening, women at increased risk for preterm delivery can be identified in the midtrimester of pregnancy.
OBJECTIVE: Our objective was to determine if the rate of periventricular-intraventricular hemorrhage is increased in the offspring of women who received a beta-sympathomimetic agent as part of the management of preterm labor. STUDY DESIGN: This retrospective study consists of 2827 women who were delivered of a singleton, live infant free of congenital neurologic anomalies between 25 and 36 completed weeks of gestation during a multicenter preterm birth prevention trial. The data were analyzed, adjusting for type of tocolytic agent, race, infant sex, gestational age, birth weight, health care center, route of delivery, indication for delivery, intrapartum fetal distress, respiratory distress syndrome, and neonatal sepsis. RESULTS: The overall incidence of periventricular-intraventricular hemorrhage in this population was 5.6%. In a univariate analysis in which no adjustment was made for potentially confounding variables, beta-sympathomimetic tocolysis was found to be associated with nearly a fourfold increase in the incidence of periventricular-intraventricular hemorrhage when compared with the use of either magnesium sulfate or no tocolytic agent. The results of a multivariate regression analysis revealed that beta-sympathomimetic agents were associated with a statistically significant increase in the overall incidence of periventricular-intraventricular hemorrhage (odds ratio 2.47, 95% confidence interval 1.34 to 4.56, p = 0.004) and a similar, but not significant, increase in the incidence of grades 3 and 4 periventricular-intraventricular hemorrhage (odds ratio 2.50, 95% confidence interval 0.96 to 6.48, p = 0.06). CONCLUSION: beta-Sympathomimetic tocolytic therapy may be associated with a more than twofold increase in the incidence of neonatal periventricular-intraventricular hemorrhage.