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PubMed1987

The St. Thomas's Hospital maternity case notes study: a randomised controlled trial to assess the effects of giving expectant mothers their own maternity case notes.

At an antenatal clinic in St. Thomas's Hospital, London, 246 expectant mothers were randomly allocated to hold either their own maternity case notes or the standard co-operation card. Information was collected on three occasions during their care on attitudes and health behaviour. Clinical outcomes were recorded and the effects of the two systems on clinic administration were observed. More of the notes group expressed satisfaction with most aspects of their care and delivery and significantly more of the notes group felt well informed and satisfied with their companion during labour. There were no differences in clinical outcomes between the two groups except that, for no identifiable systematic reason, there were more assisted deliveries among the notes group. A number of administrative advantages resulted from mothers holding their own notes and although initial reservations were found amongst professional staff interviewed at the start of the study, the results proved persuasive and the practice of giving mothers their own notes is now to be extended throughout the department.

Adult↗
PubMed1990

Ratio of fetal to maternal DNA is less than 1 in 5000 at different gestational ages in maternal blood.

Using Southern hybridization with the DNA probe pY3.4, we were not able to detect fetal DNA in blood of 36 pregnant women carrying male fetuses. Gestational ages ranged from 8-40 weeks of pregnancy. Using the same DNA probe, we were able to detect the male-specific signal in experimental dilution series down to 1/5000 on autoradiograms. We conclude that the ratio of fetal DNA in maternal circulation, in contrast to previous estimations, must be lower than 1/5000.

Autoradiography↗
PubMed1978

Effect of maternal dexamethasone therapy on the levels of oestrogens, progesterone and chorionic gonadotrophin in amniotic fluid and maternal serum.

Ten women were given dexamethasone intramuscularly in order to accelerate fetal lung maturation. Amniotic fluid and maternal serum were assayed for oestrone, oestradiol-17beta, oestriol, progesterone and chorionic gonadotrophin by specific radioimmunoassays before and after the treatment. No hormonal changes were observed in amniotic fluid. The serum levels of oestrogens 2 to 5 days after treatment were not significantly different from those before treatment, indicating that the previously reported suppression of oestrogen production by glucocorticoids disappears rapidly after treatment stops.

Amniocentesis↗
PubMed1993

Medical advice on maternal weight gain and actual weight gain. Results from the 1988 National Maternal and Infant Health Survey.

Weight gain advice showed a notable shift for white married mothers during the 1980s, with a large decline in reported advice of less than 22 pounds concomitant with a substantial increase in reported advice of 28 pounds or more. For black married mothers, there was little change in reported advice, except in the proportion of mothers who said they were advised to gain at least 35 pounds, which increased from 2 to 11%. It should be noted that it is not possible to corroborate the information on weight gain advice reported by mothers in 1980 or 1988 because of the lack of similar information from the providers of prenatal care. However, for the 1996 NMIHS, the feasibility of collecting such information from prenatal care providers will be examined. In view of the strong, positive relationship between maternal weight gain and birth weight, optimum weight gain advice for white and black mothers is critical. A recent nationwide survey of practicing dieticians found that 26% of the pregnant mothers they counseled believed that one shouldn't gain more than 20 pounds during pregnancy and that obese women didn't need to gain any weight at all. These beliefs were often culturally transmitted. Although only 12% of white mothers reported advice that did not meet the minimum standard in effect in 1988 and 19% reported advice that did not meet the minimum 1990 IOM guideline for their weight and height, a significantly higher proportion of black mothers reported advice of less than 22 pounds (33%) or the IOM minimum (34%). The far more frequent inappropriate advice reported by black than white mothers cannot be explained by differences in body mass index, age, education, parity, marital status, or site of care. Nevertheless, compliance with advice was almost the same for black and white mothers: More than 70% gained at least 22 pounds when this was the reported weight gain advice. It is thus entirely feasible that more appropriate advice for black women will result in significantly higher weight gains and improvement in infant birth weight and health.

Adolescent↗
PubMed1982

Delays in growth and biochemical development of rat brain caused by maternal methadone administration: are the alterations in synaptogenesis and cellular maturation independent of reduced maternal food intake?

Food consumption of control pregnant and nursing rats was matched to that of methadone-treated dams and the patterns of growth and of biochemical development of the brain in the offspring were compared, using tyrosine hydroxylase activity as a marker for synaptogenesis of catecholamine neurons and the developmental pattern of ornithine decarboxylase activity as an index of delay of cellular maturation. Although body growth was slowed significantly, the degree of deficit was attenuated compared to previously reported experiments with non-pair-fed controls. Reduced brain weight and slowing of synaptogenesis also were evident in the methadone-exposed pups, and in this case, the effect was not attenuated with the use of pair-fed controls. Reduced brain weight and slowing of synaptogenesis also were evident in the methadone-exposed pups, and in this case, the effect was not attenuated with the use of pair-fed controls. Delays in the normal maturational decline of brain ornithine decarboxylase activity were prominent in the methadone group compared to offspring of pair-fed controls, just as reported previously in comparisons using non-pair-fed dams. These results indicate the part of the general growth deficit seen in perinatally-addicted pups is related to maternal undernutrition, but that delays in central synaptogenesis or in the pattern of biochemical maturation of the brain are relatively independent of the nutritional deficit.

Aging↗
PubMed1989

Breast milk antibodies to foods in relation to maternal diet, maternal atopy and the development of atopic disease in the baby.

Breast milk samples were collected from 152 women during the first week after delivery. The levels of IgG and IgA antibodies to beta-lactoglobulin, ovalbumin and gliadin were assessed with an enzyme-linked immunosorbent assay (ELISA). The breast milk antibody levels did not differ significantly between mothers on a strictly cow's milk and egg-free diet, and mothers taking these foods. Moreover, the colostral food antibody levels did not differ significantly between atopic and non-atopic mothers. Neither was there any correlation between the colostral antibody levels and the development of atopic disease in the baby. I conclude that maternal antigen avoidance during late pregnancy does not affect the food antibody levels in colostrum. High levels of food antibodies in a colostrum sample seem not to offer protection against food allergy in the child.

Animals↗
PubMed1995

Association between maternal antibodies to the external envelope glycoprotein and vertical transmission of human T-lymphotropic virus type I. Maternal anti-env antibodies correlate with protection in non-breast-fed children.

Vertical transmission of human T-lymphotropic virus type I (HTLV-I) depends primarily on breast-feeding; substitution of bottle-feeding has reduced the transmission rate from 20% in breast-fed children to 3% among bottle-fed. To determine the correlates of transmission for long breast-feeding (> or = 6 mo), short breast-feeding (< 6 mo), and bottle-feeding mothers, the antibody titers of transmitter (T) mothers and non-transmitter (nT) mothers were analyzed by using synthetic and recombinant epitopes representing the immunodominant epitopes of gag (Gag1a, r24), env (Env1/5, MTA1, RE3), and tax (Tax8/22-24) proteins. Seroreactivity to gag and tax epitopes was not significantly different except for anti-r24 antibody titer, which was significantly higher among T-mothers (geometric mean 134) when compared with nT-mothers (62) in the long-feeding group (P < 0.001). Profiles of antibody titers against env epitopes were different. Within the long-feeding group, Env1/5, MTA1, and RE3 titers were significantly higher among T-mothers (258, 1,476, and 738, respectively) when compared with nT-mothers (106, 279, and 320, respectively) (P < 0.01 for all three epitopes). In contrast, within the bottle-feeding group, antibody titers to Env1/5 (269) and RE3 (418) among nT-mothers were significantly higher than those among T-mothers (80 and 113, respectively) (P < 0.01). These data confirm that high-titered anti-HTLV-I antibodies in the long-feeding group correlate with milk-borne transmission of HTLV-I and, more importantly, imply that maternal anti-env antibodies may reduce the risk of non-milkborne infection.

Amino Acid Sequence↗
PubMed2003

Tolerance of the fetus by the maternal immune system: role of inflammatory mediators at the feto-maternal interface.

The adaptive immune system of placental mammals has evolved to tolerate the fetus. Rejection of the fetus by adaptive immune responses is therefore a rare event, with abortion being caused more frequently by inflammation in the placenta. This review will cover recent aspects of immune privilege and the innate immune system at the feto-maternal interface, citing examples of the role played by microbial infections in fetal demise.

Female↗
PubMed2004

WHO systematic review of maternal morbidity and mortality: the prevalence of severe acute maternal morbidity (near miss).

AIM: To determine the prevalence of severe acute maternal morbidity (SAMM) worldwide (near miss). METHOD: Systematic review of all available data. The methodology followed a pre-defined protocol, an extensive search strategy of 10 electronic databases as well as other sources. Articles were evaluated according to specified inclusion criteria. Data were extracted using data extraction instrument which collects additional information on the quality of reporting including definitions and identification of cases. Data were entered into a specially constructed database and tabulated using SAS statistical management and analysis software. RESULTS: A total of 30 studies are included in the systematic review. Designs are mainly cross-sectional and 24 were conducted in hospital settings, mostly teaching hospitals. Fourteen studies report on a defined SAMM condition while the remainder use a response to an event such as admission to intensive care unit as a proxy for SAMM. Criteria for identification of cases vary widely across studies. Prevalences vary between 0.80% - 8.23% in studies that use disease-specific criteria while the range is 0.38% - 1.09% in the group that use organ-system based criteria and included unselected group of women. Rates are within the range of 0.01% and 2.99% in studies using management-based criteria. It is not possible to pool data together to provide summary estimates or comparisons between different settings due to variations in case-identification criteria. Nevertheless, there seems to be an inverse trend in prevalence with development status of a country. CONCLUSION: There is a clear need to set uniform criteria to classify patients as SAMM. This standardisation could be made for similar settings separately. An organ-system dysfunction/failure approach is the most epidemiologically sound as it is least open to bias, and thus could permit developing summary estimates.

Journal Article↗
PubMed1979

Interrelationships of circulating maternal steroid concentrations in third trimester pregnancies. III. Effect of intravenous cortisol infusion on maternal concentrations of estriol, 16 alpha-hydroxyprogesterone, 17 alpha-hydroxyprogesterone, progesterone, 20 alpha-dihydroprogesterone, delta 5-pregnenolone, delta5-pregnenolone sulfate, dehydroepiandrosterone sulfate, and cortisol.

The effect of a large dose (1000 mg) of iv cortisol-hemisuccinate on circulating steroid concentrations in five women, 28--34 weeks, gestational age, is reported. Maternal concentrations of estriol, 16 alpha-hydroxyprogesterone, 17 alpha-hydroxyprogesterone, progesterone, 20 alpha-dihydroprogesterone, delta 5-pregnenolone, delta 5-pregnenolone sulfate, dehydroepiandrosterone sulfate, and cortisol were measured by RIA before and at 8 and 12 h after iv cortisol infusions at 0 and 8 h. Data were evaluated by repeated measure analysis of variance. Estriol and 17 alpha-hydroxyprogesterone suppressed initially (P less than 0.05) and suppressed further with retreatment and increased treatment time (P less than 0.05). Dehydroepiandrosterone sulfate and progesterone suppressed initially (P less than 0.05) but did not suppress further with retreatment and increased treatment time (P greater than 0.05). delta 5-Pregnenolone and delta5-pregnenolone sulfate increased initially (P less than 0.05) but did not increase further (P greater than 0.05). Concentrations of 16 alpha-hydroxyprogesterone and 20 alpha-dihydroprogesterone were unchanged by cortisol infusion initially (P greater than 0.1) and with retreatment and increased treatment time (P greater than 0.1).

20-alpha-Dihydroprogesterone↗
PubMed1991

The effect of maternal oxygen administration on fetal and maternal blood flow values using Doppler ultrasonography.

Thirty-one pregnant women divided into three groups (AGA prepartum, SGA prepartum without distress, AGA in labor) were examined using Doppler ultrasonography before, during and after oxygen administration to mothers via a face mask. The aim of the study was to find out if there was any effect on the blood flow values in the fetal aorta, the umbilical artery, the fetal common carotid artery and the uterine arcuate arteries. The resistance index (RI) did not change in those vessels during maternal hyperoxygenation with one exception: in the group of SGA fetuses the RI in the fetal aorta increased significantly. Blood flow velocity and volume blood flow remained unchanged in the fetal aorta during oxygen administration.

Aorta↗
PubMed2002

Correlation of maternal serum fetuin/alpha2-HS-glycoprotein concentration with maternal insulin resistance and anthropometric parameters of neonates in normal pregnancy and gestational diabetes.

OBJECTIVE: Human fetuin/alpha(2)-HS-glycoprotein (AHSG) is a 49 kDa serum and tissue protein which is a natural inhibitor of insulin receptor signaling. We investigated serum AHSG levels during pregnancy and whether the protein is involved in insulin resistance observed in healthy pregnant women and patients with gestational diabetes. DESIGN: One hundred and four healthy pregnant women and 23 of their neonates, 30 patients with gestational diabetes and their neonates and 30 healthy age-matched non-pregnant females as a control group were investigated in a case-control cross-sectional study. METHODS: Serum AHSG was determined by radial immunodiffusion. RESULTS: We observed an increase of serum AHSG concentration in the second and third trimesters. Gestational diabetes patients had significantly higher AHSG levels than healthy pregnant women and non-pregnant controls. There was a highly significant positive correlation between serum AHSG concentration and indirect parameters of insulin resistance, i.e. tumor necrosis factor-alpha (TNF-alpha), leptin, C-peptide and C-peptide/blood glucose ratio. There was also a negative correlation between maternal AHSG, TNF-alpha, leptin levels and head circumference, body length and body weight of newborns. CONCLUSION: AHSG, TNF-alpha and leptin may contribute to insulin resistance during normal pregnancy and gestational diabetes. AHSG along with these cytokines may also negatively regulate neonatal skeletal development.

Blood Glucose↗
PubMed1991

Maternal and fetal atrial natriuretic peptide levels, maternal plasma renin activity, angiotensin II, prostacyclin and thromboxane A2 levels in normal and preeclamptic pregnancies.

To clarify the possible role of elevated atrial natriuretic peptide (ANP) in the pathophysiology of preeclampsia, we measured ANP, renin activity (PRA), angiotensin II (Ang II), TXB2 (a stable metabolite of TXA2) and 6-keto-PGF1 alpha (a stable end product of PGI2) concentrations in the plasma of 19 normal pregnant women and 35 severe preeclamptic patients at term. Plasma ANP levels in the preeclamptic patients (n = 35, 71.5 +/- 3.8 pg/ml, mean +/- S.E.) and also umbilical plasma ANP (n = 35, 83.0 +/- 4.2 pg/ml) were significantly (p less than 0.01) higher than those of normal pregnant women plasma (n = 19, 58.7 +/- 3.7 pg/ml) and umbilical plasma (n = 19, 47.6 +/- 4.7 pg/ml). There was a significant (p less than 0.01) positive correlation between maternal ANP levels and fetal ANP levels (n = 54, r = 0.44). Plasma PRA and 6-keto-PGF1 alpha levels in preeclampsia were significantly (p less than 0.05) lower than those of normal pregnancy. The ratio of 6-keto-PGF1 alpha/TXB2 in preeclampsia was significantly (p less than 0.01) lower than that of normal pregnancy as we reported previously. There was no significant correlation between plasma ANP level and plasma PRA, Ang II, plasma TXB2 and 6-keto-PGF1 alpha concentrations. Moreover there was no significant correlation between plasma ANP level and the severity of preeclampsia. These data suggest the possibility of a transplacental crossing of ANP secreted by feto-placental unit, which might be, at least in part, responsible for the high ANP levels observed in preeclampsia. The ANP in preeclampsia is not related directly to hypertension, but it may play a substantial role in the regulation or normalization of blood volume and vascular reactivity.

6-Ketoprostaglandin F1 alpha↗
PubMed1999

Genetic relationships among direct and maternal components of milk yield and maternal weaning gain in a multibreed beef herd.

Data spanning 1980 to 1993 from a multibreed beef herd including primarily eight breeds (Angus, Charolais, Gelbvieh, Hereford, Maine-Anjou, Pinzgauer, Simmental, and Tarentaise) were used to obtain 2,207 records on 200-d weaning gain (WG) and 1,826 records on 200-d milk yield (MY), obtained by machine milking after oxytocin injection. Estimates of (co)variances for the two traits (WG and MY) were obtained with REML with breed of calf, breed of cow, and heterotic effects modeled for the two traits. Animal effects of calf (CalfWG, CalfMY) and cow (CowWG, CowMY) contributions to each trait were modeled including 2,926 animals. The permanent environmental effect of the cow was modeled for MY, with 693 levels. Estimates of breed differences were generally similar to literature estimates. Simmental, Charolais, and Maine-Anjou were highest for CalfWG, and Tarentaise, Simmental, Gelbvieh, and Maine-Anjou were highest for CowMY. Heterosis was estimated at 8.00, 2.58, 4.05, and 5.50% of the mean for CalfWG, CowWG, CalfMY, and CowMy, respectively. Variance attributable to repeated records on CowMy represented 9% of phenotypic variance. Heritabilities estimated were .22 and .24 for CalfWG and CowWG and .04 and .35 for CalfMY and CowMY. Genetic correlations estimated between CalfWG and CowWG and between CalfMY and CowMY were -.35 and -.64, respectively. A genetic correlation between CowWG and CowMY of .76 indicates that maternal weaning gain evaluations are a good predictor of a cow's potential for milk yield.

Analysis of Variance↗
PubMed1976

Correlation of maternal physical fitness during pregnancy with maternal and fetal pH and lactic acid at delivery.

The physical fitness of 120 healthy primigravidae was determined two weeks before term using first the standardized three-stage submaximal work test on the following day the voluntarily maximal pulse-conducted work test on a bicycle ergometer. After the first test the level of lactic acid in the capillary circulation of 115 mothers was examined. Immediately after delivery the pH and the level of lactic acid in the maternal artery, umbilical vein and umbilical artery were determined. The level of lactic acid after the work test was negatively correlated with the physical performance of the mother. The level of lactic acid in the mother after the work test and the levels of lactic acid in the umbilical vessels were positively correlated. The mean pH value in physically fit women after delivery was almost significantly higher than in the women of below average performance. The pH level in the umbilical artery was also almost significantly higher in the mothers with above average performance. The physically fit women appear to work more during delivery than the less fit mothers, as the level of lactic acid after the delivery was as high as or higher than in mothers with a physical performance below average. The physical fitness of six mothers, who delivered an asphyxiated baby, was almost significantly lower than the performance of the mothers. Five mothers with an exceptionally high pH after delivery had a significantly higher performance than the other mothers.

Adult↗
PubMed1992

Elevated maternal serum alpha-fetoprotein levels and maternal risk factors. Their association with pregnancy complications.

Maternal serum alpha-fetoprotein (MS-AFP) screening programs identify a population of pregnant women with elevated MS-AFP values. When the levels are unassociated with a fetal anomaly, those women have a high incidence of pregnancy complications. Such patients were compared to a population with normal MS-AFP values to determine the incidence of historical risk factors and to ascertain if their presence affected the rate of pregnancy complications. A total of 358 patients were followed prospectively, 23 with elevated MS-AFP levels and 335 with normal levels (control group). Historical risk factors were more frequent in the patients with elevated MS-AFP levels. There was a fourfold increase in the rate of pregnancy complications when a patient had both risk factors and elevated MS-AFP levels as compared with elevated MS-AFP levels alone. In the control group, patients with known risk factors experienced twice the incidence of pregnancy complications as did patients with no risk factors. Using multiple logistic regression analysis, elevated MS-AFP levels were shown to be an independent variable in the risk assessment. The results of this study have wide application in the counseling and follow-up of patients identified by MS-AFP screening programs.

Female↗
PubMed1991

[Effect of maternal postural change on maternal hemodynamics in late pregnancy--supine hypertension].

The purpose of this investigation was to ascertain the effect of postural change in late pregnant women from the left lateral recumbent position to the supine position on their blood circulation. Patients in whom the blood pressure at the right upper limb in the supine position increased by at least 20mmHg or more (diastolic and/or systolic pressure) were classified as the supine hypertensive group. Patients in whom the blood pressure of the right upper limb decreased by at least 20mmHg or more were classified as the supine hypotensive group. And other patients were classified as the no blood pressure change group. The results were as follows. 1. The incidence of supine hypertension was 48% in primigravidas and 38% in multigravidas. Supine hypertension was especially common in PIH (pregnancy induced hypertension) complicated women (75%). 2. Maternal cardiac function: With postural change from the left lateral recumbent position to the supine position, CO (cardiac output) decreased and SVR (systemic vascular resistance) was increased in both the supine hypertensive and the no blood pressure change groups by the thermodilution method (n = 14). CVP (central venous pressure) and PCWP (pulmonary capillary wedge pressure) shows different pattern of change in the supine hypertensive group and the no blood pressure change group. In the former group, CVP was decreased by 45 +/- 16% and PCWP was increased by 21 +/- 9% in the supine position compared with in the left lateral recumbent position. However, in the latter group, CVP decreased by 87 +/- 69% and PCWP decreased by 53 +/- 46% as the result of the same postural change.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Output↗
PubMed1990

[Bacterial infection in the newborn by maternal-fetal contamination: oral antibiotic treatment of the colonized newborn. Prospective study at a maternity unit].

It is not yet known how important bacterial colonisation of the newborn is but in most maternity units this, when it occurs, is treated by parenteral antibiotic therapy. We have, in a prospective study, given antibiotics orally (amoxycillin or clavulanic acid-amoxycillin) in neonates who were colonised by bacteria, and have studied their clinical progress in the first month of life, using a questionnaire to be filled in by the parents. There were 119 neonates treated in 19 months and of these 87.4% of the parents replied to the questionnaires. The children did well in every case. A pharmacokinetic study showed that 76% of the amoxycillin given by mouth was absorbed. It seems, therefore, to us to be useful to give antibiotic treatment by mouth in these neonates.

Administration, Oral↗