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Biomedical subjects

R L Goldenberg

Publications and source records attributed to R L Goldenberg.

At least 199 records · Page 11Linked to original sources
PubMed1992

Screening for hypertension in pregnancy.

The literature dealing with screening for hypertension in pregnancy was reviewed. No level of blood pressure or any other factor provides a guarantee of no risk for the development of preeclampsia. However, higher blood pressure in early pregnancy and a failure to decrease blood pressure in mid-pregnancy are both associated with the development of preeclampsia. The development of proteinuria, rather than the level of blood pressure, is the best predictor of poor pregnancy outcome. Multiparas, especially those with severe chronic hypertension who develop preeclampsia, are at greatest risk of poor pregnancy outcome.

Female↗
PubMed1992

Blood pressure, growth retardation, and preterm delivery.

The effect of various levels of both diastolic and systolic blood pressure at various times during pregnancy on the rates of intrauterine growth retardation (IUGR) and preterm delivery (PTD) were determined. Low systolic and diastolic pressures were associated with both IUGR and PTD, as were high pressures. Low pressures tended to be associated with spontaneous preterm deliveries, whereas high pressures were associated with more indicated preterm deliveries.

Blood Pressure Determination↗
PubMed1992

Maternal serum folate and zinc concentrations and their relationships to pregnancy outcome.

To evaluate the relationship between folate and zinc, and its effect on pregnancy outcome, maternal serum folate and zinc concentrations were determined at 18 and 30 wk gestation in a defined population of 285 pregnant women as part of a large-scale study to identify risk factors for fetal growth retardation (FGR). These results were correlated with birth weight and Apgar scores of newborn infants and with maternal infections during the perinatal period. A weak linear relationship was observed between maternal serum folate and zinc concentrations at 30 wk gestation. Folic acid supplementation had favorable effects on birth weight and Apgar scores of newborns, and reduced prevalence of FGR and maternal infections. No significant correlation was found between serum zinc concentration and birth weight of infants. The concept that folic acid supplementation has an adverse effect on maternal zinc nutriture and pregnancy outcome was not supported.

Adult↗
PubMed1992

Maternal demographic, situational and psychosocial factors and their relationship to enrollment in prenatal care: a review of the literature.

Whether or not a woman enrolls in prenatal care in a timely fashion is a major predictor of pregnancy outcome. In this review, we consider maternal demographic, situational and psychosocial factors which have been studied with relation to enrollment in prenatal care. Paying increased attention to some situational barriers such as problems with child care or transportation, and a number of psychosocial factors such as unplanned pregnancy and negative feelings about medical care, holds promise in achieving improved utilization of prenatal care.

Adolescent↗
PubMed1992

Serum folate and fetal growth retardation: a matter of compliance?

Serum folate levels were measured at 30 weeks' gestational age in 289 pregnant women, each of whom had been provided with folate supplementation at enrollment in prenatal care. There was a significant association between low serum folate levels and fetal growth retardation. High folate levels were most likely explained by recent folic acid intake. Therefore, we were concerned that the decreased fetal growth associated with low folate levels may have been related to a combination of psychological and behavioral characteristics for which low serum folate levels were only a surrogate measure. A profile of maternal psychosocial status was created, which included measures of depression, anxiety, self-esteem, mastery, stress, and social support. Poorer psychological scores were significantly related to lower serum folate levels. However, in women with both good and poor psychosocial scores, high folate levels were significantly associated with increased birth weight, a relationship that persisted even after adjusting for maternal race, body mass index, smoking, history of a low birth weight infant, and infant gender. Our findings suggest that women with good psychosocial scores are more likely to take folate, but that the use of folate itself is related to a lower risk of fetal growth retardation and increased birth weight.

Affective Symptoms↗
PubMed1992

The relationships among psychosocial profile, maternal size, and smoking in predicting fetal growth retardation.

OBJECTIVE: We explored the relationships among measures of psychosocial well-being, maternal size, and smoking in predicting infant size at birth. METHODS: Participants in this population-based cohort study were drawn from public health prenatal clinics in Jefferson County, Alabama during 1985-1988. Para 1 and 2 women were screened for 11 risk factors for low birth weight, including small stature, a previous low birth weight infant, and smoking. RESULTS: Poor scores on five of six psychosocial scales, as well as on a combined profile, were associated with a significantly higher relative risk of fetal growth retardation (FGR) only in thinner women, defined as having a body mass index less than the median (relative risk [RR] 2.11, 95% confidence interval [CI] 1.47, 3.04). A significant association between the psychosocial profile and birth weight was demonstrated for thin women in a multivariate analysis adjusting for gestational age, race, infant sex, and smoking (P = .0003). The relationship remained significant when hypertension, alcohol and drug use, and weight gain were added to the model (P = .003). In women with a body mass index above the median, a poor psychosocial profile showed little association with FGR (RR 1.20, 95% CI 0.73, 1.98) and did not have a significant association with birth weight. A poor profile had a greater association with FGR in non-smokers (RR 2.04, 95% CI 1.29, 3.22) than in smokers (RR 1.4, 95% CI 0.95, 2.06). CONCLUSIONS: Greater pre-pregnancy weight for height appears to protect against the adverse effects of a poor psychosocial profile in a population of poor, primarily black women. In thinner women, both smoking and a poor psychosocial profile were associated with a substantially increased rate of FGR, indicating a subgroup of women who may receive greater benefits from intervention programs.

Body Mass Index↗
PubMed1992

The influence of previous low birth weight on birth weight, gestational age, and anthropometric measurements in the current pregnancy.

The effect of a previous low birth weight birth (less than 2750 g) was examined using a series of regression analyses. Effects on birth weight were partitioned into those associated with preterm delivery (128 g) and term delivery (178 g). Among term births, a mean difference of 107 g was associated with a previous birth of less than 2750 g, even after controlling for other risk factors including smoking, drug and alcohol use, maternal race, size, and hypertension. The pattern of measurements seen after a previous birth of less than 2750 g included significantly smaller head, chest, abdomen, arm, and thigh circumferences, but an insignificant impact on skinfold thicknesses and no significant effect on length measurements.

Anthropometry↗
PubMed1991

Gestational diabetes mellitus among African-American women.

Gestational diabetes mellitus (GDM) is associated with increased risk of poor outcomes for the pregnancy. It is a strong risk factor for subsequent diabetes. The epidemiology of GDM in African-American women is not well known. It has not been demonstrated that their risk factors are similar in character and weight to those among White women. There is considerable multicollinearity among GDM risk factors such as age, parity, obesity, hypertension, and family history of diabetes, and this needs to be sorted out. This review is based on the results of a nested case-control study to evaluate the frequency of, and the relationships of the known risk factors with, the onset of GDM among African-American women. All cases of GDM within a cohort of women seen at any of the county health department clinics in Jefferson County, Alabama from 1981 to 1987 were identified. The cohort represents approximately 63% of all African-American pregnancies in the county during the period. With few exceptions (5.1% based on fasting plasma glucose greater than or equal to 120 mg/dl), potential GDM cases (7.1%) were selected on the basis of a 2 h post 100 g carbohydrate meal screening plasma glucose measure at their second prenatal visit and again at 28-32 weeks greater than or equal to 115 mg/dl and diagnosed on the basis of the results of an oral glucose tolerance test (OGTT) using the criteria of O'Sullivan and Mahan. Women with any prior history of diabetes (even in pregnancy), 1.6%, were excluded. The frequency of the new diagnosis of GDM among African-American women in this pregnancy in the cohort was 2.5% of pregnancies and 3.4% of women, which is similar to the values reported in the other studies. Controls were selected from women with negative screening tests who delivered after a GDM subject. The results reported in this paper reflect 358 cases (86% of all eligible GDM cases identified) and 273 controls. Cases were significantly older (28.3 vs. 21.7 years), of higher gravidity (2.7 vs. 1.9), more obese (76.7 vs. 61.7 kg), gained weight more rapidly (0.34 vs. 0.28 kg/week), had more hypertension in this pregnancy (28.2 vs. 2.6%), and there was a higher proportion with a family history of diabetes (41.3 vs. 16.5%) (p less than 0.001 for all comparisons). Because there were significant correlations among the risk factors in both cases and controls, multivariable logistic regression analyses were performed.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1991

Contraceptive female sterilization in Alabama: a replication of the WHO study.

The prevalence of female sterilization for contraceptive purposes has grown rapidly throughout the world, and is especially high in the United States. Yet the psychosocial impact of female sterilization is incompletely understood. Much of the previous research has been retrospective and has lacked comparison groups of women using other methods. Better designed, prospective studies have been needed, and the World Health Organization's Collaborative Prospective Study of Female Sterilization was conducted to address this need. No evidence was found in the WHO study of a significant impact of tubal ligation compared to other contraceptive methods on mental health, menstruation, or sexual satisfaction. The present study, a replication of the WHO study, compared 323 Alabama women undergoing elective contraceptive sterilization with 318 women using other techniques to control fertility. In general, the results supported the WHO study conclusions. Although sterilization produced a small increase in menstrual distress in Alabama, there were no significant differences between sterilization and comparison women in mental health or sexual satisfaction.

Adult↗
PubMed1991

The relationship between maternal serum zinc levels during pregnancy and birthweight.

A retrospective follow-up study to ascertain the relationship between the level of serum zinc and its rate of change during gestation and birthweight was conducted in 476 women of lower socioeconomic status. Serum zinc concentrations measured at approximately 16 (early) and 32 weeks (later) in gestation were both found to be significant predictors of birthweight. Even after controlling for gestational age at birth and other determinants of birthweight, for each microgram/dl increase in serum zinc early and later in pregnancy, birthweight increased by 5.8 and 8.6 g, respectively. Furthermore, after adjustment for initial zinc levels both the total change (beta = -7.0, P = 0.0007) and the rate of change (beta = -60.8, P = 0.007) in serum zinc during pregnancy were inversely associated with birthweight, i.e., the larger the fall in serum zinc during pregnancy, the smaller the infant. Low serum zinc level (less than 60 micrograms/dl) late in pregnancy was associated with greater than a five-fold increase in the odds (OR = 5.8, 95% CI = 1.8, 16.4) of giving birth to a low birthweight infant. The results of this study suggest a threshold for maternal serum zinc below which the prevalence of low birthweight increases rapidly.

Adolescent↗
PubMed1991

Autoantibodies in black women with class A1 or class GB diabetes mellitus.

No marker except repeated fasting glucose determinations has proven useful to ascertain prospectively which women with gestational diabetes mellitus will remain euglycemic by diet modification or will require insulin therapy. We screened 183 black women with gestational diabetes mellitus to determine if the presence of islet cell, mitochondrial, nuclear, DNA, parietal cell, smooth muscle, thyroid microsomal, thyroid thyroglobulin autoantibodies, or rheumatoid factor predicted the need for insulin therapy to maintain euglycemia in women with gestational diabetes mellitus. One hundred forty-two women maintained normal fasting plasma glucose levels with dietary modifications and 41 required institution of split-dose insulin therapy. We found no significant differences in the prevalence of these autoantibodies in black women with Class GB versus Class A1 diabetes mellitus. We conclude that screening for autoantibodies in women with gestational diabetes mellitus is not useful in determining which patients will subsequently require insulin therapy during their pregnancies.

Antibodies, Antinuclear↗
PubMed1991

Histocompatibility antigen subtypes in black women with class A1 or class GB diabetes mellitus.

Insulin-dependent diabetes mellitus is associated with an increased frequency of certain histocompatibility antigens located on chromosome six, the most common types being B-8, B-15, DR-3, DR-4, and DR-7. We therefore theorized that screening for these subtypes may allow the identification of those women with gestational diabetes who will remain euglycemic on dietary modification (class A1) compared with those who will require insulin to achieve euglycemia (class GB). From 1982 to 1987, 228 black women with gestational diabetes were screened for the above histocompatibility antigens. As theorized, certain histocompatibility antigen subtypes were more common in women with class GB gestational diabetes mellitus; DR-2 (41.8% versus 23.7% p = 0.015), B-15 (p = 0.07), and DR-3 (p = 0.08). However, because of the low sensitivity (42%), specificity (75%), and positive predictive value (36%), this test is impractical in the clinical management of women with gestational diabetes mellitus.

Black People↗
PubMed1991

The relationship between maternal hematocrit and pregnancy outcome.

The relationship between maternal hematocrit and pregnancy outcome at various times in pregnancy was studied in 17,149 iron- and folate-supplemented pregnant women. On univariate analysis, early-pregnancy hematocrits below 37% were associated with preterm delivery. However, this relationship was not confirmed by multivariate analysis controlling for other risk factors. On both univariate and multivariate analyses, both early and later in pregnancy, hematocrits above 40% were associated with preterm delivery. In every gestational time period, at least part of the excess of preterm births was explained by an increase in indicated preterm deliveries. In both early and late pregnancy, and in both the univariate and multivariate analyses, only high hematocrits were associated with fetal growth retardation. The strongest association (odds ratio above 2) between high hematocrit and both fetal growth retardation and preterm delivery occurred with hematocrits at or above 43% at 31-34 weeks' gestation.

Female↗
PubMed1991

Maternal serum alpha 2-macroglobulin and fetal growth retardation.

Maternal serum alpha 2-macroglobulin levels were measured twice, at approximately 18 and 30 weeks' gestation, in 289 pregnant women who later delivered at or after 37 weeks. Levels were elevated as early as 18 weeks' gestation in women destined to have a growth-retarded infant, and this elevation persisted through 30 weeks' gestational age. Furthermore, levels were higher in white women than black, in smokers than in non-smokers, and in thin than in heavier women. When the effect of alpha 2-macroglobulin on birth weight was evaluated in a multiple regression analysis adjusting for gestational age, race, body size, smoking, fetal sex, and a history of a low birth weight infant, high alpha 2-macroglobulin levels were associated with a statistically significant decrease in birth weight. The effect was greater in women who smoked. This relationship did not appear to be associated with differences in serum zinc or hematocrit levels.

Adult↗
PubMed1991

Black-white differences in newborn anthropometric measurements.

The mean birth weight of black infants is consistently less than that of white infants. In 1518 low-income multiparous women, the mean difference in singleton births was 171 g, of which 38 g was partitioned to preterm births and another 35 g reflected lower gestational ages in term births. A series of regression analyses were used to determine the effect of black race on various newborn measurements in 1205 term newborns, adjusting for other known risk factors. In this model, black race accounted for a mean decrease of 148 g in weight and 0.52 cm in length. There were also significant decreases in mean head (0.44 cm), chest (0.66 cm), and abdominal (0.56 cm) circumferences. Arm and leg lengths were not different, but black arm circumferences (0.14 cm) were significantly larger. Triceps and thigh skin fold measurements were not statistically different, but black subscapular skin fold values were significantly smaller (0.17 mm). The ponderal index in blacks was significantly less than in whites. These data suggest that in this population, intrinsic and/or extrinsic factors associated with race account for most smaller black newborn measurements and for much of the racial difference in birth weight.

Alabama↗