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Biomedical subjects

R L Goldenberg

Publications and source records attributed to R L Goldenberg.

At least 73 records · Page 4Linked to original sources
PubMed1998

Choriodecidual inflammation: a potentially preventable cause of perinatal HIV-1 transmission?

The obstetric risk factors for perinatal transmission of HIV-1 include preterm birth, prolonged rupture of the chorioamniotic membranes, and clinical and histological bacterial chorioamnionitis. A chronic chorioamnionitis precedes many cases of preterm labour and spontaneous rupture of membranes, whereas an acute chorioamnionitis is more common after rupture of the membranes at term. Amniotic fluid cytokines are raised in the presence of term and preterm intrauterine bacterial infections, and various cytokines seem able to attract HIV-1-infected leucocytes into the amniotic cavity and to increase replication of HIV-1. We postulate that the association of preterm birth and prolonged rupture of membranes with perinatal transmission of HIV-1 may result from an associated chronic or acute bacterial chorioamnionitis marked by the migration of HIV-1-infected maternal leucocytes into the amniotic cavity. Antibiotic treatment could prevent this sequence of events.

Cesarean Section↗
PubMed1998

Relations of cigarette smoking and dietary antioxidants with placental calcification.

Associations between maternal cigarette smoking and accelerated placental maturation measured as tissue calcification have been reported. The authors sought to address whether intakes of the dietary antioxidants, vitamin C, alpha-tocopherol, and beta-carotene, were related to placental calcification of the maternal surface and villi in a cohort of smokers and nonsmokers at risk for delivering small-for-gestational age infants. Gross and histologic examination of placentas were used to determine calcification at the surface (n = 1,213) and villus sites (n = 730), respectively, in a prospective study of black and white women who delivered singleton births between December 1985 and October 1988 at the University of Alabama at Birmingham Hospital in Birmingham, Alabama. Controlling for race and gestational age, likelihood of surface and villus calcification increased as smoking levels increased. Significant reductions in villus calcification were related to alpha-tocopherol intake after controlling for smoking and gestation while intakes of beta-carotene and vitamin C were related to significant reductions in calcification for black but not white women. Surface calcification was not found to be related to antioxidant intake. The authors' findings confirm a pathologic relation between smoking and placental calcification and suggest that dietary antioxidants may reduce villus calcification.

Antioxidants↗
PubMed1998

Determinants of zinc intake in low-income black and white pregnant women.

A prospective study was conducted to evaluate and compare the determinants of dietary zinc intake in black and white low-income pregnant women. The study population consisted of 1298 low-income women (70% Black, 30% White) who received prenatal care at University Hospital at the University of Alabama in Birmingham from 1985 to 1989. Various maternal characteristics were evaluated at the first prenatal visit. Two 24 h recalls were obtained at 18 and 30 wk of gestation to calculate the intakes of dietary zinc and other nutrients. Student's t test, chi2, Pearson correlation coefficients, and multiple regression analyses were used to compare and evaluate the determinants of zinc and other nutrient intakes in Black and White subjects. The mean prepregnancy body mass index and the mean intake of zinc, energy, and all the other nutrients except calcium were significantly higher in Black than in White subjects. There was a significant correlation between zinc and energy intake (r = 0.69, p = 0.001). Age, marital status, parity, socioeconomic status, smoking, and alcohol intake were not significant predictors of zinc or other nutrient intakes. After adjusting for energy intake, race was the only significant predictor of dietary zinc intake. Race and energy intake explained 24% of the variation in zinc intake. Results of this study indicate that after adjusting for other covariates, race and energy intakes are the only predictors of zinc intake in low-income pregnant women.

Black or African American↗
PubMed1998

Plasma ferritin, premature rupture of membranes, and pregnancy outcome.

OBJECTIVE: The objective of this study was to determine whether plasma ferritin levels predict maternal or neonatal outcomes in women with preterm rupture of membranes at <32 weeks' gestation. METHODS: Plasma from 223 women with premature rupture of membranes at <32 weeks' gestation who had participated in a randomized antibiotic trial were analyzed for ferritin at random assignment and at delivery, and the results were compared with the development of clinical chorioamnionitis, latency until delivery, neonatal sepsis, and a composite adverse neonatal outcome variable. RESULTS: The mean plasma ferritin level rose from 19.2 +/- 29.1 microgram/L on admission to 38.3 +/- 54.3 microgram/L at delivery, with a mean latency of 9.3 +/- 14.6 days. Plasma ferritin levels were significantly higher at both times in mothers whose infants acquired sepsis than in those whose infants did not, especially at delivery (68.5 +/- 96.3 microgram/L vs 32.5 +/- 40.5 microgram/L, P =.01), and neonatal sepsis was 2 to 3 times more common among women with plasma ferritin levels above the median than among those with levels below the median. CONCLUSIONS: Among women with premature rupture of membranes at <32 weeks' gestation, plasma ferritin levels were significantly associated with neonatal sepsis. These data suggest that higher plasma ferritin levels may serve as a marker of infection among women with premature rupture of membranes; however, the clinical utility of plasma ferritin levels in predicting neonatal outcome appears limited.

Adult↗
PubMed1998

Routine maternal platelet count: an assessment of a technologically driven screening practice.

Because automated blood cell counters are now widely used in many clinical settings, an assessment of hemoglobin concentration or hematocrit is invariably accompanied by a platelet count. Thus many asymptomatic pregnant women are being screened for thrombocytopenia. The objective of a good screening program is to reduce morbidity and mortality and thereby improve the quality of life; criteria for the evaluation of proposed or ongoing screening programs are well established. However, the screening of pregnant women for thrombocytopenia seems to have been both technologically mandated and passively accepted. Therefore we systematically evaluated the current de facto screening of asymptomatic pregnant patients for thrombocytopenia in the context of well-explained, desirable characteristics for a successful screening program. We conclude that screening for thrombocytopenia in pregnancy fails to meet established criteria, may actually be harmful (by placing unaffected fetuses of thrombocytopenic women, and the women themselves, at risk from invasive procedures), and should therefore be discontinued.

Cost-Benefit Analysis↗
PubMed1998

Elevated second-trimester amniotic fluid interleukin-6 levels predict preterm delivery.

OBJECTIVE: Our purpose was to determine whether early second-trimester amniotic fluid interleukin-6 levels predict delivery before 34 weeks' gestation. STUDY DESIGN: We used stored second-trimester amniotic fluid samples obtained from women undergoing genetic amniocentesis from 1988 to 1996. Interleukin-6 levels were measured by enzyme-linked immunosorbent assay in samples from every case known to result in delivery from 20 to 34 weeks' gestation (n = 290), and 290 matched controls delivering at > or =37 weeks. Fetal aneuploidies, anomalies, and all cases delivering within 30 days of the amniocentesis (which were thought to be possibly procedure related) were excluded. RESULTS: Interleukin-6 levels were higher in cases than controls (1.9 +/- 5.2 vs 1.0 +/- 2.4 ng/ml, p = 0.004). Cases were grouped according to whether the preterm delivery was indicated or spontaneous: The mean interleukin-6 levels were significantly higher than controls in the spontaneous group (1.6 +/- 3.2 vs 0.8 +/- 1.2 ng/ml, p = 0.01) but not in the indicated group (1.4 +/- 4.0 vs 0.8 +/- 1.2 ng/ml, p = 0.12). In all samples the interleukin-6 level was negatively correlated with the gestational age at delivery (R = -0.11633, p = 0.007). CONCLUSION: Elevated early second-trimester amniotic fluid interleukin-6 levels are associated with preterm delivery, confirming that in some women this indicator of very early intrauterine inflammation predicts birth before 34 weeks' gestation.

Adult↗
PubMed1998

The preterm prediction study: risk factors for indicated preterm births. Maternal-Fetal Medicine Units Network of the National Institute of Child Health and Human Development.

OBJECTIVE: Preterm births occur for many different reasons. Most efforts to identify risk factors for preterm births either ignore cause and consider preterm births as a single entity or examine risk factors for spontaneous preterm births. We performed this study to examine risk factors for indicated preterm births, which constitute more than one quarter of all preterm births. STUDY DESIGN: The study included 2929 women evaluated at 24 weeks' gestation at 10 centers. Information was gathered about demographic factors, socioeconomic status, home and work environments, drug and alcohol use, and medical history. In addition vaginal samples were evaluated for fetal fibronectin and bacterial vaginosis and cervical length was measured by transvaginal ultrasonography. Associations with indicated preterm birth were evaluated by univariate tests and by multivariable analysis with logistic regression. RESULTS: Of the women studied at 24 weeks' gestation 15.3% were delivered of their infants at <37 weeks' gestation. Of these deliveries, 27.7% were indicated preterm births. Risk factors in the final multivariable model were, in order of decreasing odds ratios, mullerian duct abnormality (odds ratio 7.02), proteinuria at <24 weeks' gestation (odds ratio 5.85), history of chronic hypertension (odds ratio 4.06), history of previous indicated preterm birth (odds ratio 2.79), history of lung disease (odds ratio 2.52), previous spontaneous preterm birth (odds ratio 2.45), age >30 years (odds ratio 2.42), black ethnicity (odds ratio 1.56), and working during pregnancy (odds ratio 1.49). Alcohol use in pregnancy was actually associated with a lower risk of indicated preterm birth (odds ratio 0.35). CONCLUSION: The risk factors found in this analysis tend to be different from those associated with spontaneous preterm birth.

Adolescent↗
PubMed1998

The Preterm Prediction Study: recurrence risk of spontaneous preterm birth. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network.

OBJECTIVE: We sought to estimate the risk of spontaneous preterm birth in parous women by use of obstetric history, fetal fibronectin, and sonographic cervical length. STUDY DESIGN: The probability of spontaneous preterm birth before 35 weeks' gestation was estimated from a logistic regression model with data from 1282 parous women analyzed according to gestational age at the most recent prior delivery (prior preterm birth at 18 to 26 weeks, 27 to 31 weeks, 32 to 36 weeks, and > or = 37 weeks' gestation), fetal fibronectin status (positive = > or = 50 ng/dl), and cervical length by percentile groups (< or = 10th = < or = 25 nm, 10th to 50th = 26 to 35 mm, and > 50th = > 35 mm) measured at 22 to 24 weeks' gestation. Fibronectin and cervical length results were blinded for clinical care. RESULTS: Among fetal fibronectin positive women with a prior preterm birth, the estimated recurrence risk of preterm birth < 35 weeks' gestation was approximately 65% when the cervix was < or = 25 mm, 45% when the cervix was 26 to 35 mm, and 25% when the cervix was > 35 mm at 24 weeks' gestation. For fetal fibronectin negative women with a prior preterm birth, the recurrence risk was 25% when the cervix was < or = 25 mm, 14% when the cervix was 26 to 35 mm, and 7% when the cervix was > 35 mm. The risk of preterm birth was increased among women with a history of preterm delivery but was not influenced by the gestational age at delivery of the most recent preterm birth. CONCLUSION: The recurrence risk of spontaneous preterm birth varies widely according to fetal fibronectin and cervical length. Cervical length and fetal fibronectin results had distinct and significant effects on the recurrence risk of preterm birth. Predicted recurrence risk is increased by twofold to fourfold in women with a positive compared with a negative fetal fibronectin, and it increases as cervical length shortens in both fetal fibronectin-positive and fetal fibronectin-negative women. These data may be useful to care for women with a history of preterm birth and to design studies to prevent recurrent premature delivery.

Adult↗
PubMed1998

Serum leptin concentrations during pregnancy and their relationship to fetal growth.

OBJECTIVE: To test the hypothesis that maternal and cord serum leptin concentrations correlate with birth weight of infants. METHODS: Pregnant women (n = 135) of low socioeconomic status who delivered full-term infants were selected from more than 1500 women who participated in a study to identify factors related to fetal growth restriction (FGR). They were divided into two groups based on their infants being classified as having FGR (n = 66) or not (n = 69), and each group was divided further into three subgroups based on prepregnancy body mass index (BMI): less than 19.8, 19.8-28.9, and 29 or more. Sample estimations indicated that 20 subjects per subgroup would be adequate to detect 50% difference in leptin concentrations. RESULTS: Mean maternal serum leptin concentrations adjusted for BMI were highest at approximately 22-27 weeks' gestation (29.8 ng/mL) and declined thereafter until term (25.2 ng/mL). Leptin concentration and prepregnancy BMI correlated significantly. We found neither significant difference in leptin concentrations between the subjects with and without FGR infants nor significant correlation between maternal leptin concentrations and birth weight of infants. Mean cord serum leptin concentration (10.8 ng/mL) was lower than maternal concentrations and correlated significantly with birth weight (r = .61, P < .001). CONCLUSION: Our findings suggest that maternal leptin concentration during pregnancy is not an accurate indicator of fetal growth. Cord serum leptin concentrations were lower than maternal serum concentrations and correlated significantly with birth weight.

Adult↗
PubMed1998

Intrauterine viral infection at the time of second trimester genetic amniocentesis.

OBJECTIVE: To determine whether preexisting intrauterine viral infection is associated with postamniocentesis pregnancy loss. METHODS: We accessed our bank of second-trimester amniotic fluid (AF) samples obtained aseptically and stored at -20C from all 11,971 women who underwent genetic amniocentesis between 1988 and 1995. Samples were retrieved from every case of spontaneous pregnancy loss within 30 days of the amniocentesis (excluding aneuploidy and anomalies, n = 66). Sixty-six control samples were randomly chosen from subjects who delivered at term and were matched for year of test, gestational age, maternal age, and indication for amniocentesis. Investigators were blinded to the status of the samples, which were studied by polymerase chain reaction (PCR) for the presence of adenovirus, parvovirus, cytomegalovirus, Epstein-Barr virus, herpes simplex virus, enterovirus, influenza A virus, and beta-actin DNA. Results were compared with interleukin-6 (IL-6) levels previously measured by enzyme-linked immunosorbent assay in the same samples. RESULTS: Sixty-two study cases and 60 controls were sufficient for all PCR studies. Fourteen AF samples contained a single virus: five (8%) of 62 study cases and nine (15%) of 60 controls (P = .27). Adenovirus accounted for nine (64%) of 14 viruses identified: four of 62 cases and five of 60 controls (P = .74). Cytomegalovirus was not identified in any study cases but was found in three controls. The mean IL-6 levels in samples with and without virus were not significantly different (4.8+/-15.9 ng/mL with virus compared with 2.0+/-8.8 ng/mL without virus; P = .53). CONCLUSION: Presence of virus in second-trimester AF is not significantly associated with elevated IL-6 levels or with early postamniocentesis pregnancy loss.

Abortion, Spontaneous↗
PubMed1998

Prenatal plasma matrix metalloproteinase-9 levels to predict spontaneous preterm birth.

OBJECTIVE: Matrix metalloproteinase-9, a zinc-dependent proteinase, may be important in initiating labor or rupture of membranes. We determined plasma levels of this enzyme in nonpregnant and pregnant women and evaluated whether they predict spontaneous preterm delivery. METHODS: A sandwich enzyme-linked immunosorbent assay (ELISA) was used to measure matrix metalloproteinase-9 levels in plasma samples from 25 nonpregnant women (mean age 39+/-9 years) and in stored plasma samples obtained during a randomized trial of zinc supplementation in pregnancy. Women were selected who delivered following spontaneous labor or premature rupture of membranes at 24-32 weeks (n = 20), 33-36 weeks (n = 29), and greater than 37 weeks (n = 30). Plasma samples were obtained sequentially at 19, 26, 31, and 36 weeks if undelivered and at presentation for delivery. RESULTS: Plasma matrix metalloproteinase-9 levels for non-pregnant women averaged 18.6+/-11.2 (mean +/- standard deviation) ng/mL. Prenatal values averaged 298+/-227 ng/mL from 19 weeks until 36 weeks (not including presentation for delivery) and did not change significantly as the gestational age increased, regardless of whether women ultimately delivered at 24-32, 33-36, or after 37 weeks. Values obtained prior to, but within 1 week of, presentation for delivery (n = 7, 281+/-103 ng/mL) were not significantly different than those obtained earlier in pregnancy (n = 71, 309+/-307 ng/mL, [P = .60]). Plasma matrix metalloproteinase-9 levels for women in spontaneous labor were similar regardless of gestational age and were increased three-fold (852+/-301 ng/mL) compared with those drawn at each prenatal visit (for example, 26 week values = 285+/-144 ng/mL [P < .001]). CONCLUSION: Plasma matrix metalloproteinase-9 levels remain unchanged throughout pregnancy until the onset of spontaneous labor when there is a three-fold increase. Plasma matrix metalloproteinase-9 levels obtained prior to presentation for delivery do not appear to predict spontaneous preterm birth.

Adult↗
PubMed1998

The effect of maternal magnesium sulfate treatment on neonatal morbidity in < or = 1000-gram infants.

We evaluated the effect of maternal magnesium sulfate treatment on selected neonatal outcomes in < or =1000-g infants. In a 1-year (1992-1993) observational study, the National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units collected outcome data for 799 infants whose birth weights were < or =1000 g. Only singleton infants, with a gestational age >20 weeks who were not the product of an induced abortion were included. Our analysis was further limited to those infants without major congenital anomalies, who were deemed potentially viable by the obstetrician, whose mother would have undergone a cesarean delivery for fetal indications, and who survived greater than 2 days. Outcomes were compared in infants whose mothers did and did not receive magnesium sulfate for labor tocolysis. Among the 124 women who did and the 184 who did not receive magnesium sulfate tocolytic therapy, the frequencies of grade III or IV intraventricular hemorrhage (16 vs. 20%, p = 0.34), seizure activity (7 vs. 10%, p = 0.35), grade III or IV retinopathy of prematurity (21 vs. 18% p = 0.59), abnormal neurological exam (28 vs. 28%, p = 0.91), intact survival to 120 days or to discharge (48 vs. 44%, p = 0.54), and infant mortality (23 vs. 31%, p = 0.10) were similar. Multiple logistic regression analysis was used to control for the effect of potential confounders (specifically, gestational age) and confirmed the lack of a significant association between maternal magnesium sulfate treatment for tocolysis and selected neonatal outcomes in this population of < or =1000-gram infants.

Adult↗
PubMed1998

Estimation of outcome and restriction of interventions in neonates.

OBJECTIVE: To learn whether pediatricians accurately estimate rates of survival and freedom from handicap in preterm infants and to learn whether their knowledge and attitude influence their choice of interventions that may enhance survival of extremely preterm infants. METHODS: Pediatricians practicing in Alabama were surveyed using a pretested questionnaire designed to identify pediatricians' knowledge regarding survival and handicap-free rates of infants born at gestational ages between 21 and 36 weeks. For infants born at each week of gestation, they were asked if they would provide specific therapeutic interventions. Survival and handicap-free rates were compared with published national rates. Pediatricians were divided into an optimist group and a pessimist group based on how their estimates of survival compared with national published data. The rates at which each group used therapeutic interventions were compared. RESULTS: The 159 (57%) responding pediatricians underestimated survival rates from 23 through 34 weeks' gestation and freedom from serious handicap from 23 through 36 weeks. Responses of the optimists approximated actual data whereas the pessimists underestimated neonatal outcome. Those pediatricians who underestimated neonatal outcome would intervene less often with invasive therapies, including mechanical ventilation, cardiopulmonary resuscitation, inotropes, and intravenous fluids, compared with those who accurately predicted outcome from 23 through 27 weeks' gestation. CONCLUSION: Pediatricians often underestimate neonatal outcome of preterm infants. Appropriate neonatal practice may be affected by this underestimation of the survival potential of preterm infants.

Alabama↗
PubMed1998

The preterm prediction study: the value of new vs standard risk factors in predicting early and all spontaneous preterm births. NICHD MFMU Network.

OBJECTIVES: This study was undertaken to determine the relationship between fetal fibronectin, short cervix, bacterial vaginosis, other traditional risk factors, and spontaneous preterm birth. METHODS: From 1992 through 1994, 2929 women were screened at the gestational age 22 to 24 weeks. RESULTS: The odds ratios for spontaneous preterm birth were highest for fetal fibronectin, followed by a short cervix and history of preterm birth. These factors, as well as bacterial vaginosis, were more strongly associated with early than with late spontaneous preterm birth. Bacterial vaginosis was more common--and a stronger predictor of spontaneous preterm birth--in Black women, while body mass index less than 19.8 was a stronger predictor in non-Black women. This analysis suggests a pathway leading from Black race through bacterial vaginosis and fetal fibronectin to spontaneous preterm birth. Prior preterm birth is associated with spontaneous preterm birth through a short cervix. CONCLUSIONS: Fetal fibronectin and a short cervix are stronger predictors of spontaneous preterm birth than traditional risk factors. Bacterial vaginosis was found more often in Black than in non-Black women and accounted for 40% of the attributable risk for spontaneous preterm birth at less than 32 weeks.

Cervix Uteri↗
PubMed1998

The impact of short interpregnancy intervals on pregnancy outcomes in a low-income population.

OBJECTIVES: The objective of this study was to determine whether the length of the interval between pregnancies was associated with either preterm birth or intrauterine growth retardation in a low-income, largely Black population. METHODS: The study population consisted of 4400 women who had received prenatal care in county clinics and had two consecutive singleton births between 1980 and 1990. RESULTS: Interpregnancy intervals were positively associated with age and negatively associated with the trimester in which care was initiated in the second pregnancy. Whites had shorter intervals than non-Whites. The percentage of preterm births increased as the length of the interpregnancy interval decreased, but only for women who had not had a previous preterm birth. The association between interval and preterm birth was maintained when other factors associated with preterm birth were controlled. There was no significant relationship between intrauterine growth retardation and interpregnancy interval. CONCLUSIONS: Women, particularly those who are poor and young, should be advised of the potential harm to their infants of short interpregnancy intervals.

Adolescent↗
PubMed1998

Practice variation in the use of interventions in high-risk obstetrics.

OBJECTIVE: To assess the relationship between clinical, demographic, and site-of-care factors and the use of tocolysis and corticosteroid therapy in the treatment of premature labor. DATA SOURCE: Secondary clinical and demographic data collected for the five-center March of Dimes Prematurity Prevention clinical trial, 1983-1986. STUDY DESIGN: We used logistic regression analysis in assessing the clinical, patient, and care site factors associated with the use of tocolysis and corticosteroid therapy during episodes of premature labor occurring to women enrolled in the trial. The two interventions were not subject to control in the trial, but were provided according to customary practice at the care site. DATA EXTRACTION: A total of 4,625 episodes of labor occurring before 37 weeks gestation were identified from either preterm labor or preterm delivery records recorded for the 33,792 women enrolled in the trial. PRINCIPAL FINDINGS: The use of tocolysis, an intervention that attempts to control premature labor contractions and that was widely used in high-risk obstetrics, varied almost exclusively by clinical factors. The use of corticosteroid therapy, a little used but effective intervention that reduces respiratory complications in premature infants, varied significantly by site of care and was used less frequently across sites and clinical conditions for minority group patients. CONCLUSION: This study confirms the premise that practice variation on the basis of nonclinical factors occurs more commonly for interventions where there is more uncertainty about clinical indications and effectiveness. The study also identifies another area of clinical care in which the use of aggressive and relatively uncertain interventions is provided less frequently to minority group patients.

Adrenal Cortex Hormones↗
PubMed1998

Neurodevelopmental outcome of small-for-gestational-age infants.

Despite many methodological difficulties, studies evaluating the relationship between being small for gestational age (SGA) at birth and various measures of adverse neurologic outcome generally show significant associations. Nevertheless, cerebral palsy is rarely found in SGA infants. Minimal neurologic dysfunction is more commonly seen in males and lower socioeconomic SGA children, and is often associated with attention deficits, hyperactivity, clumsiness, and poor school performance. Vision and hearing are generally not disturbed in SGA infants.

Attention Deficit Disorder with Hyperactivity↗