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Our understanding of the pathophysiologic processes leading to preterm premature rupture of membranes (PPROM) has grown tremendously in recent years. Evidence suggests that there may be a genetic susceptibility to PPROM and that genetic and environmental elements are important cofactors in its development. A number of risk-based protocols have been proposed in an attempt to identify those women at highest risk for PPROM. While we have made advances in the area of predicting PPROM, treatments based on current risk-based systems have failed to distinguish a specific, effective preventive therapy for PPROM. The concept that genetic factors increase susceptibility or decrease resistance to disease has stimulated new work in the field of PPROM. Several maternal and fetal gene polymorphisms have been identified that are associated with an increased risk for PPROM. Patients with 'susceptible' genotypes may also have clinical risk factors for PPROM resulting in a synergistic increase in the risk for PPROM, a so-called gene-environment interaction. The concept that these gene-environment interactions represent new targets for our efforts to prevent PPROM is explored.

Objective We sought to determine whether vitamins C and E could be delivered to the fetal-placental unit through maternal oral supplementation. Study design In a randomized, double-blind study, 20 women received a daily prenatal vitamin with or without 400 IU of vitamin E and 500 mg of vitamin C, starting at 35 weeks' gestation. At randomization, a nutritional questionnaire, plasma vitamin C and E and red blood cell (RBC) vitamin E levels were determined. At delivery, concentrations of maternal and fetal plasma vitamin C and E, maternal and fetal RBC vitamin E, amniotic fluid vitamin C, and chorioamnion vitamin E and tensile strength were determined. Results Maternal plasma vitamin E levels increased in the supplemented women but not in the control subjects. No changes in maternal vitamin C levels were noted. Maternal plasma vitamin C concentrations at delivery correlated closely with amniotic fluid vitamin C levels. Similarly, maternal plasma vitamin E levels at delivery correlated with the chorioamnion concentration of vitamin E. Conclusions Maternal plasma vitamin E levels are increased by oral supplementation. Maternal plasma vitamin C and E concentrations correlate with the concentration of vitamin C in the amniotic fluid and vitamin E in the chorioamnion, respectively.

Obese adult pregnant women have increased rates of maternal and neonatal complications. Our objective was to examine adverse obstetric outcomes in overweight adolescent women.In a retrospective case-control study of 4822 women who were19 years old, 3324 appropriate-weight subjects (body mass index, 18.5-24.9 kg/m2) and 1498 overweight subjects (body mass index,or = 25 kg/m2) were compared. Frequencies and odds ratios for adverse maternal or neonatal events were computed.Compared with appropriate-weight adolescents, primary cesarean delivery (odds ratio, 1.6; 95% CI, 1.4-1.9), failure to progress/cephalopelvic disproportion (odds ratio 1.6; 95% CI, 1.3-1.9), labor induction (odds ratio, 1.4; 95% CI, 1.3-1.7), pregnancy-induced hypertension (odds ratio, 1.8; 95% CI, 1.4-2.3), preeclampsia (odds ratio, 1.7; 95% CI, 1.2-2.4), and gestational diabetes mellitus (odds ratio, 3.0, 95% CI, 1.6-5.4) were significantly more common in overweight adolescents. Significant neonatal findings included an increased incidence of macrosomia (odds ratio, 1.6; 95% CI, 1.2-2.0) and a decreased incidence of low birth weight infants (odds ratio, 0.6; 95% CI, 0.4-0.8) and small for gestational age infants (odds ratio, 0.8; 95% CI, 0.7-1.0).Overweight adolescent women are at increased risk for adverse neonatal and perinatal outcomes. With rates of overweight increasing overall, overweight in the gravid adolescent is a pressing perinatal and public health concern.