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To investigate the effect of race, body mass index (BMI), and weight gain on blood pressure in pregnancy and postpartum.Secondary analysis of pregnant women aged 14 to 25 who received prenatal care at a university-affiliated public clinic in New Haven, Connecticut and delivered singleton term infants (n = 418). Longitudinal multivariate analysis was used to evaluate blood pressure trajectories from pregnancy through 12 weeks postpartum.Obese and overweight women had significantly higher blood pressure readings as compared with women with normal BMI (all p0.05). African American women who had high pregnancy weight gain had the greatest increase in mean arterial and diastolic blood pressures in pregnancy and postpartum.Blood pressure trajectories in pregnancy and postpartum are significantly affected by race, BMI, and weight gain. Given the young age of this cohort, targeted efforts must be made for postpartum weight reduction to reduce cardiovascular risk.

Women with dilated cardiomyopathies (DCM) have traditionally been advised not to attempt to carry pregnancies. This is largely based on data derived from studies of the course of peripartum cardiomyopathy (PPCM) and it is not clear that this extrapolation is appropriate. Our objective was to compare maternal and obstetric outcomes of pregnancies in women with preexisting DCM to women with PPCM. A 10-year retrospective comparative cohort study was undertaken of women between the ages of 15 and 40 discharged from two university medical centers with the diagnosis of cardiomyopathy (CM). Patients were included in the study if CM was diagnosed prior to pregnancy (DCM group) or if CM developed during pregnancy or within 5 months postpartum (PPCM group), and follow-up data was available. Thirty-one subjects were included in the study. Twenty-three women with the diagnosis of PPCM were compared with 8 women with DCM of other etiologies. There were no significant differences in maternal age, race, parity, tobacco or other substance use, or other risk factors between the two groups. Maternal outcomes in the PPCM group were significantly worse than in the DCM group, with three maternal deaths and four women undergoing heart transplants (p = 0.05). In the DCM group, one woman with a prepregnancy ejection fraction of 16% underwent transplantation after termination of pregnancy for genetic indications. None of the other women in the DCM group had a significant decline in cardiac status. Infant outcomes in both groups were uniformly good. PPCM represents an acute, evolving insult to the pregnant or postpartum woman. The prognosis of this condition should not be used for counseling women with DCM considering pregnancy. Women with stable DCM may do well during pregnancy without significant deterioration in their cardiac status.

The objective of this study is to determine whether risk factor (RF) screening can be used instead of routine third-trimester testing for gonorrhea and chlamydia in a clinic setting. We performed prospective analysis of women entering prenatal care over a 10-month period. Patients included received combined gonorrhea and chlamydia screening by DNA probe at the first prenatal visit and in the third trimester. RF examined included age

We investigated body mass index (BMI) and weight gain among pregnant women (ages 14 to 25) and assessed the relationship of BMI and weight gain on birth outcomes. We performed a secondary analysis of 841 women enrolled in a randomized controlled trial receiving prenatal care in two university-affiliated clinics. Almost half the patients were overweight or obese. An average of 32.3 ± 23.6 pounds was gained in pregnancy with only 25.3% gaining the recommended weight and over half overgaining. Weight gain had a significant relationship to birth weight. Multivariate analysis showed that prepregnancy BMI but not weight gain was a significant predictor of cesarean delivery (odds ratio [OR] 1.91, confidence interval [CI] 1.24 to 2.69, p < 0.0001). When large-for-gestational-age infants were removed from the analysis, there was still a significant effect of BMI on cesarean delivery (OR 1.76, CI 1.17 to 2.66, p = 0.007) but not of weight gain (OR 1.45, CI 0.94 to 2.17, p = 0.093). Prepregnancy BMI is a more significant predictor of cesarean delivery than pregnancy weight gain in young women.

The object of this study was to investigate the prevalence of Hepatitis C virus (HCV) by second-generation testing and to determine the effectiveness of risk factor-guided screening. We performed a prospective study of HCV exposure determined by second-generation enzyme-linked immunoadsorbent assay (ELISA) and confirmed by radioimmunoblot assay (RIBA). Risk factors (RF) were interpreted by univariate and multivariate analyses. Eight hundred eighty-six consecutive patients were tested for HCV over a 1-year period; 34 women tested positive for HCV and 32 were confirmed by RIBA (prevalence 3.6%). Forty-nine percent of women had at least one RF. Age, intravenous drug use, history of hepatitis strongly correlated with HCV (p

The object of this study was to investigate the relationship of thrombomodulin (TM) and glycosylated hemoglobin (HbA 1 C) in pregnant diabetics and to determine clinical correlates. We performed a prospective cohort study of 53 patients: 25 women with insulin-dependent diabetes (group 1) and 28 with gestational diabetes group 2). Group 1 underwent monthly determinations of HbA 1 C and TM. Group 2 underwent determination at 36 weeks of gestation. There was a significant difference in HbA 1 C between groups 1 and 2 (p = 0.0005), but there was no difference in TM. There was no correlation between TM and HbA 1 C. TM levels correlated positively with serum creatinine (r = 0.46, p = 0.002), proteinuria (r = 0.48, p = 0.007), and duration of diabetes (r = 0.41, p = 0.042). TM was significantly higher in diabetics of advanced White Classification (p = 0.008). With good control, TM does not appear to be elevated in a diabetic pregnancy. TM may be a marker of endothelial damage that correlates more with duration of diabetes and renal disease than with HbA 1 C, which reflects short-term control.