MATERNITY CARE AS AN APPROACH TO MATERNAL AND CHILD HEALTH AND CRIPPLED CHILDREN'S SERVICES.
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Child↗
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Maternal and child health. Maternal mortality in the Americas.
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Adolescent↗
Maternal hypoglycemia during pregnancy in type 1 diabetes: maternal and fetal consequences.
There is strong evidence that the avoidance of hyperglycemia is essential inoptimizing pregnancy outcome in type 1 diabetes. The price to pay is a striking increase in severe hypoglycemia (SH), defined as episodes requiring help from another person. During type 1 diabetic pregnancy, occurrence rates of SH up to 15 times higher as in the intensively treated group of the Diabetes Control and Complications Trial (DCCT) are reported. Blood glucose (BG) treatment targets differ considerably between clinics; some authors advocate lower limits as low as 3.3 mmol/l. Improved glycemic control and/or recurrent hypoglycemia (i.e. BG <3.9 mmol/l) may result in impairment of glucose counterregulatory responses. Also, glucose counterregulation may be altered by pregnancy itself. Short-acting insulin analogs may help reduce hypoglycemia with preservation of good glycemic control, but their use during pregnancy has yet to be proven safe.Several clinical studies did not establish an association between maternal hypoglycemia and diabetic embryopathy. However, animal studies clearly indicate that hypoglycemia is potentially teratogenic during organogenesis. Increased rates of macrosomia continue to be observed despite near normal HbA(1c) levels. This may, at least in part, be the result of rebound hyperglycemia elicited by hypoglycemia. Exposure to hypoglycemia in utero may have long-term effects on offspring including neuropsychological defects. It is yet unclear to what extent the benefits of tight glycemic control balance with the increased risk of (severe) hypoglycemia during type 1 diabetic pregnancy. Efforts must be made to avoid low BG, i.e. <3.9 mmol/l, when tightening glycemic control.
Animals↗
The v-MFG test: investigating maternal, offspring and maternal-fetal genetic incompatibility effects on disease and viability.
The MFG test is a family-based association test that detects genetic effects contributing to disease in offspring, including offspring allelic effects, maternal allelic effects and MFG incompatibility effects. Like many other family-based association tests, it assumes that the offspring survival and the offspring-parent genotypes are conditionally independent provided the offspring is affected. However, when the putative disease-increasing locus can affect another competing phenotype, for example, offspring viability, the conditional independence assumption fails and these tests could lead to incorrect conclusions regarding the role of the gene in disease. We propose the v-MFG test to adjust for the genetic effects on one phenotype, e.g., viability, when testing the effects of that locus on another phenotype, e.g., disease. Using genotype data from nuclear families containing parents and at least one affected offspring, the v-MFG test models the distribution of family genotypes conditional on offspring phenotypes. It simultaneously estimates genetic effects on two phenotypes, viability and disease. Simulations show that the v-MFG test produces accurate genetic effect estimates on disease as well as on viability under several different scenarios. It generates accurate type-I error rates and provides adequate power with moderate sample sizes to detect genetic effects on disease risk when viability is reduced. We demonstrate the v-MFG test with HLA-DRB1 data from study participants with rheumatoid arthritis (RA) and their parents, we show that the v-MFG test successfully detects an MFG incompatibility effect on RA while simultaneously adjusting for a possible viability loss.
Alleles↗
Maternal uniparental heterodisomy for chromosome 2: detection through 'atypical' maternal AFP/hCG levels, with an update on a previous case.
We report a case of maternal uniparental disomy 2, detected through routine screening of placental karyotypes following the finding of 'atypical' AFP/hCG levels in the second trimester, with intrauterine growth retardation (IUGR) but otherwise normal outcome at term. Although the child remained small, subsequent early physical and mental development has also been normal. Additionally, we report long-term follow-up of an earlier case, again with relatively normal physical and mental development. The significance of atypical AFP/hCG results and the predictive value of prenatal testing for UPD2 in trisomy 2 confined placental mosaicism (CPM) cases are discussed.
Adult↗
Consensus workshop on the evaluation of maternal and developmental toxicity work group I report: end points of maternal and developmental toxicity.
It was concluded that this conference, sponsored by the EPA, has provided an opportunity to state current ideas regarding the utility of data from studies in developmental toxicology and that the deliberations have highlighted the need to consider fundamental relationships between maternal and developmental effects in a more comprehensive manner in the future.
Animals↗
Fetal cells in the maternal blood. Lack of response of fetal cells in maternal blood to mitogens and mixed leukocyte culture.
In an attempt to stimulate fetal cells in the maternal blood to mitotic division, peripheral blood lymphocytes were cultured from ten primiparous women and six multiparous women. In the case of the ten primiparous women, PWM was used to stimulate lymphocytes in 3- and 7-day cultures made at the 16th, 20th, 24th, and 28th week of gestation. Altogether, 10565 mitoses were analyzed after quinacrine staining of cells from five mothers who each subsequently gave birth to a male infant, and not a single XY mitosis was found. In the case of the multiparous women, lymphocyte cultures, with PHA or LPS as mitogen and MLC, were initiated between the 13th and 20th week of pregnancy. Four of the mothers were pregnant with a male child, and two with a female child. From cultures of each of the four mothers expecting a boy, a total of 9721 mitoses were analyzed after quinacrine staining, and not a single XY mitosis was found. However, one XY cell was found in the culture from one of the two women who delivered a girl. The XY mitosis probably originated from a pregnancy 8 months earlier which terminated in a male infant. In an attempt to culture and obtain good chromosome preparations from small numbers of cells, it was shown that a good mitotic response and good chromosome preparations could be obtained from as few as 6000 lymphocytes.
Cells, Cultured↗
Human mtDNA hypervariable regions, HVR I and II, hint at deep common maternal founder and subsequent maternal gene flow in Indian population groups.
We have analysed the hypervariable regions (HVR I and II) of human mitochondrial DNA (mtDNA) in individuals from Uttar Pradesh (UP), Bihar (BI) and Punjab (PUNJ), belonging to the Indo-European linguistic group, and from South India (SI), that have their linguistic roots in Dravidian language. Our analysis revealed the presence of known and novel mutations in both hypervariable regions in the studied population groups. Median joining network analyses based on mtDNA showed extensive overlap in mtDNA lineages despite the extensive cultural and linguistic diversity. MDS plot analysis based on Fst distances suggested increased maternal genetic proximity for the studied population groups compared with other world populations. Mismatch distribution curves, respective neighbour joining trees and other statistical analyses showed that there were significant expansions. The study revealed an ancient common ancestry for the studied population groups, most probably through common founder female lineage(s), and also indicated that human migrations occurred (maybe across and within the Indian subcontinent) even after the initial phase of female migration to India.
DNA, Mitochondrial↗
Fetal umbilical artery Doppler response to graded maternal aerobic exercise and subsequent maternal mean arterial blood pressure: predictive value for pregnancy-induced hypertension.
Predictive tests for the identification of women at high risk of the development of preeclampsia are critical to allow the most appropriate preventive measures. Preeclampsia is a vasospastic condition of pregnancy characterized by early and enhanced vascular reactivity to endogenous pressor agents. Exercise tolerance testing with cycle ergometry to induce hemodynamic response measured with duplex Doppler A/B ratio of the umbilical artery could unmask latent vascular pressor hypersensitivity. Our prospective cohort study was designed to test the efficacy of the American College of Obstetricians and Gynecologists exercise in pregnancy guidelines for the low-risk athletic, physically active, or sedentary patient. The pattern of fetal response to material exercise testing at 28 weeks' gestation was compared with subsequent maternal mean arterial blood pressure and the development of pregnancy-induced hypertension and preeclampsia. Doppler A/B ratio during the recovery period was assessed as below baseline (18) or elevated above resting baseline values (12). Third-trimester blood pressure pattern was assessed to be elevated in 11 patients, 10 of whom had elevated recovery A/B ratios. The Fisher exact test results were (p = 0.00002) positive predictive value, 83%; negative predictive value, 94%; sensitivity, 91%; and specificity, 89%. Preeclampsia developed in four patients; all had elevated recovery A/B ratios. Fisher exact test results were (p = 0.01806) positive predictive value, 33%; negative predictive value, 100%; sensitivity, 100%; and specificity, 69%.
Blood Pressure↗
Protein turnover in rat placenta: effects of maternal fasting and maternal protein restriction.
Biochemical composition and variables of protein turnover were determined in rat placenta at 21 days gestation in control animals and in animals subjected to 72-h fasting and protein/calorie restriction (6 per cent protein) throughout gestation. Placental protein synthesis was determined following the injection of 'massive' amounts of 14C-phenylalanine intravenously to the pregnant rat. Protein content was reduced in placentas from rats that were fasted for 72 h and in those who were protein restricted throughout pregnancy. Placental RNA content was significantly reduced only in the protein-restricted animals. Fractional rates of protein synthesis were reduced in placentas from the protein-restricted animals (Ks = 17.9 +/- 0.8 per cent per day in controls versus 11.7 +/- 0.9 in protein restricted, P = 0.002), but not in fasted animals. Fractional protein breakdown was markedly enhanced in placentas following maternal fasting (Kd = 9.9 per cent per day in controls versus 26.0 per cent in fasted), but not affected by protein deprivation. These results mimic those previously reported for other fetal tissues under these experimental conditions.
Animals↗
Fetal and maternal aortic flow in two different maternal positions. An investigation with combined Doppler-velocimetry and ultrasonic multiple array.
To study aortic velocities in the fetus, a newly developed multirangegated Doppler velocimeter was combined with a commercial B-mode linear-array apparatus. Spectrum analysis of the Doppler shift signals was performed. The signals with the highest frequencies were selected for hard-copy, and integrated with a digitizer. In the first part of the study, the reproducibility of the method was established by serial measurements of aortic velocity in 7 near-term fetuses. It proved sufficient to evaluate 5 successive heart-cycles. The mean coefficient of variation was 5% (mean number of recordings evaluated 7.5). In the second part of the study, possible influence of aortocaval compression on fetal aortic velocity indicative of changes in fetal cardiac output, was investigated in 10 pregnant women with no symptoms of supine hypotension. Doppler monitoring of the material cardiac output from the suprasternal notch was added to the set-up described to study the supine reduction of cardiac output frequently described in pregnant women. No significant change was found either in the maternal or in the fetal circulation.
Aorta↗
The relationships between maternal HbA1, maternal size and fetoplacental size in Indian pregnancies.
A study of pregnant Punjabi, Indian women was carried out to establish whether or not there was a relationship between maternal HbA1 at term and birth weight of the baby. Measurements were made on the mother, placenta and baby. The regression of birth weight on placenta weight gave a correlation (r = 0.7, P less than 0.01, n = 59). No correlation was found between HbA1 and birth weight, birth weight corrected for placenta weight, or placenta weight. However, there was a weak but significant correlation between HbA1 and an adjusted placenta weight, expressed as a ratio Bwt'/Plwt', (r = 0.27, P less than 0.05, n = 56).
Anthropometry↗
The preterm prediction study: maternal stress is associated with spontaneous preterm birth at less than thirty-five weeks' gestation. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network.
OBJECTIVE: Our purpose was to determine whether various measures of poor psychosocial status in pregnancy are associated with spontaneous preterm birth, fetal growth restriction, or low birth weight. STUDY DESIGN: Anxiety, stress, self-esteem, mastery, and depression were assessed at 25 to 29 weeks in 2593 gravid women by use of a 28-item Likert scale. Scores for each psychosocial subscale were determined, and an overall psychosocial score was calculated. Scores were divided into quartiles, and the lowest quartile scores were used to define poor psychosocial status. The percent spontaneous preterm birth, low birth weight, and fetal growth restriction in women with low and high psychosocial scores were compared. Logistic regression analyses provided the odds ratios and 95% confidence intervals. RESULTS: Analyses revealed that stress was significantly associated with spontaneous preterm birth and with low birth weight with odds ratios of 1.16, p = 0.003, and 1.08, p = 0.02, respectively, for each point on the scale. A low score on the combined scale or on any subscale other than stress did not predict spontaneous preterm birth, fetal growth restriction, or low birth weight. After multivariate adjustment was performed for psychosocial status, substance use, and demographic traits, black race was the only variable significantly associated with spontaneous preterm birth, fetal growth restriction, and low birth weight; stress and low education were associated with spontaneous preterm birth and low birth weight. CONCLUSION: Stress was associated with spontaneous preterm birth and low birth weight even after adjustment for maternal demographic and behavioral characteristics. Black race continues to be a significant predictor of spontaneous preterm birth, fetal growth restriction, and low birth weight even after adjustment for stress, substance use, and other demographic factors.
Adult↗
Maternal epidural analgesia and rates of maternal antibiotic treatment in a low-risk nulliparous population.
BACKGROUND: Epidural analgesia is associated with an increased rate of fever in prospective randomized trials. While the evidence suggests that epidural fever is not infectious, epidural analgesia has been associated with increased rates of antibiotic use, the indications that prompt treatment have not been examined. METHODS: We analyzed 1235 nulliparous women with singleton term pregnancies presenting in labor with a temperature of < 99.5 degrees F. Antibiotic use during labor was categorized by indication. RESULTS: A total of 59.6% of women received epidural analgesia. The rate of antibiotic use was significantly higher in women receiving epidural analgesia (28 vs 10.8%). After adjusting for confounders using logistic regression, epidural analgesia was associated with a relative risk of 2.6 (95% CI 2.0, 3.4) for antibiotic treatment. The majority of the increased risk was due to significantly higher rates of antibiotic treatment for presumed chorioamnionitis (9.0 vs 0.4%) in the epidural analgesia group. CONCLUSION: Epidural-related fever results in excess maternal antibiotic treatment for presumed chorioamnionitis.
Adult↗
Maternal prenatal, infancy and concurrent predictors of maternal reports of child psychopathology.
RESEARCH on parent perceptions of infant temperament and child maladjustment has evolved from an initial interpretation of parent reports as objective, veridical descriptions of the child to an interpretation of parent reports as social perceptions that reflect both objective qualities of children and personality characteristics of parents (Bates 1983). Evidence that parents' descriptions reflect generalized behavior of their children is provided by modest correlations between parent and teacher reports of child behavior (Becker and Krug 1964; Glidewell et al. 1959; Rutter et al. 1970). Although limited agreement of parents and teachers in descriptions of child behavior might be interpreted as evidence of situational specificity of behavior (Mischel 1968), an alternative interpretation is that characteristics of parents influence their perceptions of child behavior. This longitudinal study tests hypotheses that maternal characteristics during pregnancy and infancy, prior to the development of stable child characteristics, predict mothers' reports of child psychopathology during the kindergarten year.
Child↗
Influence of other maternal variables on the relationship between maternal virus load and mother-to-infant transmission of human immunodeficiency virus type 1.
To assess the relationship between maternal human immunodeficiency virus (HIV) type 1 RNA level, other important covariates, and mother-to-infant (vertical) transmission of HIV-1, third trimester repository specimens from 160 HIV-1-seropositive women enrolled in the Mothers and Infants Cohort Study between 1986 and 1991 were assayed in batch for HIV-1 RNA. A significant association between peripheral blood HIV-1 RNA level and vertical transmission remained after controlling for CD4 cell level, duration of ruptured membranes, "hard" drug (cocaine and heroin) use, and frequency of sexual activity during pregnancy. However, the association was attenuated among women with advanced HIV infection and those with a high frequency of sexual activity during pregnancy. In these settings, interventions that target risk factors other than virus load may be particularly important for preventing vertical transmission of HIV-1.
Acquired Immunodeficiency Syndrome↗
Genetics of 51D-52A, a region containing several maternal-effect genes and two maternal-specific transcripts in Drosophila.
Two genomic clones exhibiting a maternal-specific pattern of expression map to cytological region 52A. To elucidate the function of these clones we have undertaken a mutagenesis of the cytological region 51D-52A. This paper presents the results of this screen and the preliminary analysis of female-sterile and lethal mutations isolated. A total of twelve complementation groups have been identified, four of which are defined exclusively by female-sterile alleles. Only one visible mutation was isolated, a recessive temperature-sensitive allele of Thickened-arista (Tarts). Several of the seven lethal loci display an embryonic lethal phase. Three of the four female-sterile loci affect chorion structure with one resulting in underamplification of the chorion genes, and two (possibly three) of the four female-steriles affect nuclear division/DNA replication. Thus it appears that this is a "developmentally important" region, possibly representing a clustering of genes involved in either DNA replication or nuclear division.
Alleles↗
Maternal Zinc Deficiency and Maternal and Child Health in Peru: The 2000 Avanelle Kirksey Lecture, Purdue University.
This article summarizes the findings of several research projects on maternal zinc deficiency in Peru.
Journal Article↗