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Biomedical subjects

R L Goldenberg

Publications and source records attributed to R L Goldenberg.

283 records · Page 16Linked to original sources
PubMedDate not supplied

Plasma alkaline phosphatase and pregnancy outcome.

The objective was to determine the relationship between plasma alkaline phosphatase (AP) activity and birthweight (BWT) and preterm delivery (PTD). Five hundred eighty African-American women had plasma AP activities measured at various gestational ages (GA) with the results compared to a number of pregnancy outcomes. Plasma AP activity rose linearly during pregnancy from a mean of 39 U/L at 19 weeks to 130 U/L at delivery. In individual women, AP activities were consistently high or low as confirmed by correlation coefficients in adjacent time periods ranging from 0.63 to 0.87. AP at 19 weeks was not significantly associated with any outcome measure. However, at 26 weeks, AP in the highest quartile was associated with a 15.0% incidence of PTD < 37 weeks compared to 6.8% in the lower three quartiles (P = .004). For PTD < or = 32 weeks, the difference of PTD was 6.8 vs. 1.6% (P < .003). When women in the highest quartile of increase in AP from 19 to 26 weeks were compared to those in the lower quartiles, the rate of PTD < 37 weeks was 15.2 vs. 6.4% (P = .002), and the rate of PTD < or = 32 weeks was 6.1 vs. 1.7%, (P = .01). The mean BWT for the highest vs. the lower three quartiles in rate of increase was 3,058 vs. 3,288 g (P = .0005) and the mean GA was 38.1 vs. 39.2 weeks (P = .0001). Regression analyses adjusting for multiple confounders confirmed the association between high AP at 26 weeks and PTD < 37 weeks [OR (95% C.I.), 2.4 (1.2-4.8)] and PTD < or = 32 weeks [OR (95% C.I.), 3.7 (1.2-11.7)]. Similar results were found among women with a large increase in AP between 19 and 26 weeks. From these results we conclude that high or increasing AP activity at 26 weeks, but not 19 weeks, was significantly associated with subsequent PTD and a lower BWT.

Adult↗
PubMedDate not supplied

Umbilical cord serum levels of thromboxane B2 in term infants of women who participated in a placebo-controlled trial of low-dose aspirin.

OBJECTIVE: Our aim was to quantify thromboxane B2 (TXB2) in umbilical cord serum of term infants of nulliparous, low-risk women who were randomly assigned to either placebo or low-dose (60 mg) aspirin (ASA) on a daily basis from 24 weeks' gestation through delivery as part of a randomized clinical trial for prevention of preeclampsia. METHODS: Umbilical cord sera from 230 singleton, term infants whose mothers were involved in our low-dose ASA trial were assayed for TXB2, the stable metabolite of thromboxane A2, without knowledge of treatment or outcome data. The data were related to assigned treatment group, longitudinal pattern of maternal serum TXB2 levels, and other maternal and newborn characteristics. The data also were analyzed according to whether or not maternal serum levels of TXB2 at 29-31, 34-36, and delivery were reduced > or =50% compared to values prior to initiation of the trial. RESULTS: Umbilical cord TXB2 levels (ng/ml, mean +/- SE) were significantly lower at term in the ASA group (36.1 +/- 3.3, n = 111) than in the placebo group (56.6 +/- 5.7, n = 119; P = 0.002). Umbilical cord TXB2 levels were correlated to those in maternal serum at delivery in the ASA group (r = 0.3441; P = 0.0005) but not in the placebo group (r = 0.0626; P = 0.53). Regardless of assigned treatment group, infants whose mothers had a > or =50% longitudinal reduction in serum TXB2 had lower umbilical cord TXB2 levels (39.2 +/- 3.6, n = 114) than infants whose mothers had <50% reductions in TXB2 (54.6 +/- 5.9, n = 116; P = 0.027). Birthweights of these infants correlated inversely (r = 0.1678, P = 0.017) with maternal serum TXB2 at delivery but not to umbilical cord TXB2 levels; the best correlation between birthweight and maternal serum TXB2 was noted in pregnancies assigned to receive placebo (r = -0.2558, P = 0.009). CONCLUSIONS: Umbilical cord serum levels of TXB2 1) are reduced in instances of long-term maternal ingestion of ASA, 2) correlate well with maternal serum levels of TXB2 at delivery when there is evidence for consistent maternal use of ASA, but 3) do not correlate with maternal serum TXB2 levels when there is no evidence for frequent maternal ingestion of cyclooxygenase inhibitors. These data suggest that the capacity for platelet production of TXA2 in fetal and maternal compartments are regulated independently. Finally, there is an inverse relationship between maternal serum TXB2 levels at delivery and birthweight of newborn infants that is most evident among the pregnancies assigned to placebo and also among pregnancies in which there was little evidence to suggest a pattern of cyclooxygenase inhibitor use during pregnancy.

Adult↗
PubMedDate not supplied

Factors influencing plasma zinc levels in low-income pregnant women.

Plasma zinc (Zn) concentrations were measured in 4376 indigent women (86% African-American), at at mean (+/- SD) gestational age of 15 (+/- 7.8) wk to determine the relationship between various maternal characteristics and plasma Zn levels during pregnancy. Mean Plasma An levels were lower in African-American women than in Caucasian women, in multiparous women than in primiparous women, and in women with body weight > 69.9 kg than in those with body weight < or = 69.9 kg (p < or = 0.001 for each comparison). There were no significant differences related to maternal age, marital status, education, or smoking habit. Multiple regression analysis, including maternal prepregnancy weight, race, age, parity, smoking habit, education, and marital status indicated that race, parity, and pregnancy weight were significantly associated with maternal plasma Zn levels, adjusted for gestational age. Maternal race was the best predictor of plasma Zn concentrations among the population of pregnant women studied A significant proportion of variance in maternal plasma Zn levels. remained unexplained after taking into account various maternal characteristics. The reasons for lower plasma Zn levels in African-American women, compared to Caucasian women, during pregnancy are unknown.

Adolescent↗
PubMedDate not supplied

Refrigeration of blood samples prior to separation is essential for the accurate determination of plasma or serum zinc concentrations.

An evaluation of refrigeration (7 degrees C) to prevent falsely high plasma or serum zinc concentrations owing to elapsed time between blood collection and centrifugation was performed. At room temperature (23 degrees C), both plasma and serum zinc concentrations increased significantly, if blood samples were stored uncentrifuged. Plasma zinc concentrations increased 6.3% at 1 h and 40.7% at 24 h, whereas serum zinc concentrations increased only 0.9% at 1 h and 12.5% at 24 h at room temperature. When blood samples were stored uncentrifuged in the refrigerator for up to 24 h, there were no significant increases in zinc concentrations in either plasma or serum. These findings suggest that plasma or serum separation should be performed immediately after blood drawing to obtain accurate zinc concentrations, and if this is not feasible, the samples should be immediately refrigerated and separation performed within eight hours.

Adult↗
PubMedDate not supplied

Catecholamine secretion in fetal adaptation to stress.

From the beginning of labor, the fetus must successfully adapt from intrauterine life to the stress of birth and, finally, to extrauterine life. The role of hormones known as catecholamines in this adaptive mechanism is described. An understanding of the physiology of catecholamine secretion will enhance the nursing care of mothers and their infants during this important transitional period.

Adaptation, Biological↗
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Evaluation of the impact of dissemination of smoking cessation methods on the low birthweight rate and on health care costs: achieving year 2000 objectives for the nation.

Nationwide dissemination of efficacious and cost-effective smoking cessation methods during the 1990s represents an important part of the solution to reducing the low birthweight (LBW) rate and associated health care costs. A minimum of 250,000 LBW births must be prevented during the 1990s to achieve the year 2000 LBW rate objective of 5% of total births. Annually 1,500 to 6,000 LBW births might be prevented between 1991 and 2000, and cumulatively 29,000 to 44,000, by dissemination of tested smoking cessation methods. Twelve to eighteen percent of the objective might be accomplished by dissemination. LBW births attributable to smoking might be reduced from the current 20% to 26% rate to a rate of 9% to 12% if the overall maternal smoking prevalence rate is reduced to 10% as projected in the Year 2000 Objectives. Smoking-attributable health care cost savings from dissemination would range from $22 million to $59 million.

Birth Rate↗
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Effects of very low birth weights on fetal and neonatal mortality rates in Alabama.

The relationship of births weighing less than 1,000 grams (g) to fetal and neonatal mortality rates, including changes over time, was studied. In Alabama during the period 1974-84, the percentage of reported births that weighed less than 500 g doubled, and the percentage of reported births weighing 500 to 999 g increased by about 10 percent. By the end of the study, while only 0.13 percent of reported births weighed less than 500 g, 24 percent of all stillbirths and 14 percent of all neonatal deaths were in this birth weight group. Similarly, in 1984, while only 0.62 percent of all births weighed 500 to 999 g, 23 percent of stillbirths and 42 percent of neonatal deaths were in this birth weight group. The data suggest that Alabama neonatal and fetal mortality rates declined more than was apparent in vital statistics data because of changes in reporting practices for very low birth weight newborns during the study period. Changes in vital statistics reporting are suggested to improve data reliability.

Alabama↗
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Lethal congenital anomalies as a cause of birth-weight-specific neonatal mortality.

The percentage of neonatal mortality caused by lethal congenital anomalies and the distribution of specific anomalies in various birth-weight groups are presented. State vital statistics data and autopsy-confirmed data from a single hospital are compared. Of neonates who died, less than 5% who were born weighing between 500 and 999 g died of a congenital anomaly, and nearly 45% who were born weighing more than 2,500 g died of a congenital anomaly. Most deaths associated with congenital anomalies in infants born weighing more than 2,500 g are cardiac in origin. Twenty-three percent of all neonatal deaths in Alabama are attributed to a lethal congenital anomaly. Use of these data to define limits to future improvements in neonatal mortality by standard medical care is discussed.

Abnormalities, Multiple↗
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Family planning: an essential component of prenatal care.

This nation's traditional approach to improving maternal and infant health has been prenatal care. But evidence is mounting that additional progress in reducing maternal and infant morbidity and mortality will depend, at least in part, on the care that a woman receives before she conceives. The studies reviewed in this paper indicate that increasing the interval between deliveries and preventing or delaying pregnancies among women at high risk could lower the rate of low birthweight (LBW). Since reducing the rate of unintended pregnancies would also reduce the number of pregnancies in women at high risk of LBW because of race, age, late or no prenatal care, and unhealthy behaviors, the prevention of unintended pregnancies would also reduce LBW. Unfortunately, prenatal care, as experienced by many women, devotes little attention to these family planning issues. Many women do not realize the importance of family planning to their own health and that of their children. Prenatal care providers should include instruction about the importance of pregnancy planning and encourage women to continue receiving health care between pregnancies. If the health of women and infants is to be improved, society must be willing to provide health services to women of reproductive age even when they are not pregnant.

Birth Intervals↗
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Employment-related stress and preterm delivery: a contextual examination.

Studies of employment-related stress as a risk factor for preterm delivery suggest that contextual factors unrelated to occupation, as well as work-related characteristics, must be examined in assessing this relationship. In this study, the relationship of work and contextual characteristics--assessed at midpregnancy and including scores on an occupational fatigue index--to preterm delivery was examined among 943 black and 425 white low-income multiparous women who were at risk for a poor pregnancy outcome. At 24 to 26 weeks gestational age, a 77-item questionnaire was self-administered to obtain detailed information on sociodemographic and contextual characteristics, home physical activities, and occupational characteristics. Questions in the occupational section of the questionnaire included most of those previously used by Mamelle and coworkers in 1984 and 1987 to construct an occupational fatigue index. The overall preterm delivery rate for black women was 14.0 percent and for white women, 9.6 percent. No relationships were observed between age, education, or marital status and preterm delivery, or between work status, hours per week, transportation, travel time, reliability of child care, or home physical activity and preterm delivery for either black women or white women. Black (but not white) women who continued to work at midpregnancy and who reported being able to take rest breaks when they felt tired had a lower preterm delivery rate (10.4 percent versus 21.9 percent; P = 0.031) compared with those who could or did not. Generally, scores for individual sources and levels of occupational fatigue, as well as total occupational fatigue index scores, were unrelated to preterm delivery in this relatively homogeneous group of low income high-risk women.

Adult↗
PubMedDate not supplied

The impact on infant birth weight and gestational age of cotinine-validated smoking reduction during pregnancy.

OBJECTIVE: To evaluate the impact of cotinine-confirmed smoking reduction during pregnancy on infant birth weight and gestational age at birth. DESIGN: Group analyses from a prospective, randomized smoking-cessation intervention trial using cotinine levels to assess smoking cessation and reduction. SETTING: Four maternity clinics of Jefferson County Health Department in Birmingham, Ala. PATIENTS: A total of 803 pregnant smokers and 474 never smokers with a fetal gestational age of 32 weeks or less at the first prenatal visit to a clinic. MAIN OUTCOME MEASURES: Infant birth weight and gestational age at birth. RESULTS: Infants who were born to women who quit smoking (quitters) had the highest mean birth weight (3371 +/- 581 g), followed by infants who were born to women who did not change smoking behavior (no changers) (3043 +/- 587 g). The mean infant birth weight of infants born to the quitters, adjusted by mother's age, race, height, weight at baseline, and gestational age at delivery was 241 g heavier than that among the no changers (P = .0008) and 167 g heavier than the reducers (P = .04). The adjusted mean infant birth weight of infants born to the reducers was 92 g heavier than that among the no changers (P = .08). White reducers with baseline cotinine levels greater than 100 ng/mL had infants who were 241 g heavier than did white no changers. A 220-g difference was also seen in black reducers with a baseline cotinine level of 100 ng/mL or less. Although smoking cessation increased infant gestational age at delivery by 1 week, smoking reduction had little effect. CONCLUSION: Cotinine-validated smoking reduction rates were positively associated with an increase in infant birth weight. While smoking cessation must continue to be the primary objective for pregnant smokers, specific intervention methods should also be directed toward smoking reduction for women who cannot quit.

Biomarkers↗
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Physician opinions of preterm infant outcome and their effect on antenatal corticosteroid use.

Our purpose was to compare physician opinions about the appropriate use of corticosteroids with physician perceptions of preterm infant outcome. A total of 409 obstetricians and family physicians who provide maternity care in Alabama were surveyed to determine whether (and how) their perceptions of preterm infant outcome influenced their decision to use antenatal corticosteroids. Results were compared with those of a similar survey of Alabama physicians conducted in 1979. A total of 85% of physicians in 1992 versus 61% in 1979 reported that situations existed in which they would prescribe antenatal corticosteroids (p < 0.001). In 1992 physicians who underestimated preterm infant survival began corticosteroid use at later gestational ages than those physicians who did not underestimate survival (p < 0.02). In addition, 54% of physicians who underestimated preterm infant survival reported giving corticosteroids between 23 and 28 weeks' gestational age versus 73% of physicians with more accurate perceptions (p < 0.03). We conclude that in 1992, compared within 1979, more Alabama physicians reported antenatal corticosteroid use. Use of this treatment was influenced by each physician's perceptions of the probable outcome of the preterm infant.

Alabama↗