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Background: We previously reported that supplementation with multivitamins (vitamin B complex, vitamin C, and vitamin E) at multiples of the Recommended Dietary Allowance (RDA) significantly decreased the risk of adverse pregnancy outcomes among HIV-infected women. The minimum dosage of multivitamins necessary for optimal benefits is unknown. Objective: We investigated the efficacy of multivitamin supplements at single compared with multiple RDAs on decreasing the risk of adverse pregnancy outcomes among HIV-infected women. Design: We conducted a double-blind, randomized controlled trial among 1129 HIV-infected pregnant women in Tanzania. Eligible women between 12 and 27 gestational weeks were randomly assigned to receive daily oral supplements of either single or multiple RDA multivitamins from enrollment until 6 wk after delivery. Results: Multivitamins at multiple and single doses of the RDA had similar effects on the risk of low birth weight (11.6% and 10.2%, respectively; P = 0.75). We found no difference between the 2 groups in the risk of preterm birth (19.3% and 18.4%, respectively; P = 0.73) or small-for-gestational-age (14.8% and 12.0%, respectively; P = 0.18). The mean birth weights were similar in the multiple RDA (3045 [+ or -] 549 g) and single RDA multivitamins group (3052 [+ or -] 534 g; P = 0.83). There were no significant differences between the 2 groups in the risk of fetal death (P = 0.99) or early infant death (P = 0.19). Conclusion: Multivitamin supplements at a single dose of the RDA may be as efficacious as multiple doses of the RDA in decreasing the risk of adverse pregnancy outcomes among HIV-infected women. This trial was registered at clinicaltrials.gov as NCT00197678. Am J Clin Nutr 2010;91:391-7. doi: 10.3945/ajcn.2009.28483.

Abstract Background: The health care system in Canada provides essential health services to all women irrespective of socioeconomic status. Our objective was to determine whether perinatal and infant outcomes varied [...]

A study is undertaken to quantify the frequency, clinical course, charges and outcomes of hyperemesis gravidarium. Hyperemesis occurs in 473 of 100,000 live births and is associated with significant charges while infants of mothers with hyperemesis have lower birth weights and the mothers are more likely to have infants that are small for gestational age.

Abstract Objective To compare the effects on pregnancy outcomes of changing partner between the first two births with having the same partner for both births. Design Prospective population study. Setting Norway. Participants 31 683 women who changed partner between their first two births and 456 458 women with the same partner for both births. Results After adjustment for maternal age and education, interval between births, and decade of birth, the risk of adverse pregnancy outcomes was higher for the second birth for women who changed partner between their first two births compared with those who had the same partner for both births: preterm birth (< 37 weeks; relative risk 2.0, 95% confidence interval 1.9 to 2.1), low birth weight (< 2500 g; 2.5, 2.3 to 2.6), and infant mortality (1.8, 1.6 to 2.1). For the first birth, the risk of these adverse pregnancy outcomes was only slightly higher for mothers who subsequently had a second birth with another partner. Conclusion Women who change partner between their first two births are at an increased risk of delivering a preterm, low birthweight baby with an increased risk of infant mortality compared with women who have the same partner for both births., Introduction A consequence of the increase in remarriages in Western societies is that a growing number of women are having children with different partners. The risk of adverse pregnancy outcomes […]

The authors have compared gestational trophoblastic disease incidence rates in New Mexico. Results desmonstrate that American Indians are at higher risk compared to other ethnic group in New Mexico.

Once a rare complication of pregnancy, the incidence of placenta accreta has continued to increase since the 1930s. An expert on the disorder outlines the best approach to diagnosis and [...]

The rate of hospitalization for pregnancy complications may have fallen from 1986 to 1992, but it is not clear whether overall prenatal health is improving. A recent trend to expand the definition of maternal illness to include accidents, drug overdoses, psychiatric problems and other conditions not directly associated with pregnancy may improve maternal health monitoring. Researchers reviewed hospitalization records for 1991 and 1992, and found that there were 18 hospitalizations for every 100 births, mostly for preterm labor. Hospitalization rates were much higher in black women.

The survival rate of triplets has increased recently but still exceeds that of single births, and the maternal complication rate remains high. Researchers retrospectively evaluated statistics of 57 triplet deliveries. The triplet mortality rate was 41 per 1000, which is lower than in previous years but is still higher than the 12.2 per 1000 rate of all births in Illinois in 1993. Preterm labor complicated 86% of triplet deliveries. Third-born infants were more likely to be small-for-gestational age than first- or second-born triplets. Cesarean delivery seemed to prevent a higher rate of newborn complications among third-born triplets. Complications rates were similar for triplets conceived spontaneously versus those conceived through reproductive assistance.

Pregnancy complications among young (teenage) mothers may be limited to middle-school-age girls, aged 11 to 15. A study of 16,512 pregnancies of inner-city, first-time mothers revealed that high-school-age mothers (ages 16 to 19) and their babies did not fare any worse than those of young adult women aged 20 to 22. Middle-school-age mothers were more likely to give birth to preterm, very-low-birth-weight babies. High blood pressure was greater among middle-school-age mothers, but was thought to be related more to race than age. Vaginal deliveries were significantly higher among the school-age mothers, perhaps because they had smaller babies than the adult women. Use of oxytocin to augment labor rose significantly with maternal age. Pregnancy prevention and education should be targeted to the youngest pregnant girls and especially those socioeconomically disadvantaged.

Antibodies to the hepatitis C virus were found in 5.2% of 444 pregnant women receiving prenatal care at an inner-city clinic. In contrast, only 1.5% of 155 pregnant women seen in private practice tested positive for antibodies to hepatitis C. Clinic patients generally were younger than those seen in private practice. Slightly more than 82% of the clinic patients were black. Of the women seen in private practices, 36.3% were black and 60.3% were white. A total of 26 of the 599 tested were positive for antibodies to the hepatitis C virus. Three women also tested positive for HIV, the virus that causes AIDS. Two of these women also tested positive for antibodies to hepatitis C. The most significant risk factor associated with testing positive for antibodies to hepatitis C was substance abuse. However, if only women who were substance abusers were tested for hepatitis C, only 50% of the women who eventually tested positive would have been identified.

Women from different minority groups may have a higher risk of placenta previa than white women. Placenta previa is a placenta that develops in the lower portion of the uterus so that it covers or adjoins its opening. A study examined the incidence of placenta previa among women who delivered a live or stillborn infant in the hospital between 1979 and 1987. Approximately 0.5% of the deliveries each year were complicated by placenta previa. Its incidence rose among black women and women from other minority groups, but remained the same among white women. Black women and minority women had a higher risk of placenta previa than white women. Older women also had a higher risk than younger women. Women with placenta previa were more likely to have a cesarean section or to develop abruptio placenta. Abruptio placenta is premature detachment of the placenta.

OBJECTIVE: The purpose of our analysis was to provide a national overview of the magnitude of the public health burden associated with inpatient care for pregnancy complications. STUDY DESIGN: We analyzed data from the National Hospital Discharge Survey for 1986 and 1987. We calculated ratios of hospitalizations for pregnancy complications for every 100 hospitalizations involving a birth. Standard errors for these ratios were calculated with RATIOEST, and relative ratios with 95% confidence intervals were calculated for subgroups of interest. RESULTS: We found that for every 100 hospitalizations involving a birth, there were 22.2 nondelivery hospitalizations for pregnancy complications (14.6 antenatal complications, 7.6 pregnancy loss complications). These ratios were higher for black than for white women (relative ratio 1.4, 95% confidence interval 1.2 to 1.6). The effects of marital status, age, and insurance coverage differed between black and white women, and mean length of stay was longer for black than for white women. CONCLUSION: Hospitalization for pregnancy complications is far more common than is widely appreciated and is more frequent among black than white women. (Am J Obstet Gynecol 1992;166: 1339-44.)

Abruptio placentae is the premature detachment of a normally situated placenta. In severe cases, it can cause death of the fetus and sometimes even the mother. At one particular hospital, the rate of severe abruptio placentae decreased from 1 in 420 deliveries during the period 1956 through 1969 to 1 in 830 deliveries during the period 1974 through 1989. This study examined the factors associated with the decline in the rate of severe abruptio placentae. Patient records were reviewed to examine which factors that might be associated with abruptio placentae could be manipulated to further reduce the rate. Factors associated with the decline in the rate of abruptio placentae included a decline in high parity rates, that is, having given birth to many children, and a change in the racial composition of the hospital's patients. The number of Latin American women who delivered at the hospital had increased relative to the number of white and black women who delivered at the hospital. The rate of abruptio placentae is lowest among Latin American women and highest among black women. The reason for these racial differences is unknown. In both time periods, women who suffered from hypertension or who had previously suffered from abruptio placentae had a higher risk. Results indicated that even with reduced rates, severe abruptio placentae remained a prominent cause of fetal death. (Consumer Summary produced by Reliance Medical Information, Inc.)

Fetal birth weight of less than 5.5 pounds (2,500 grams), termed low birth weight (LBW), is the leading cause of fetal and infant death in the US. Since the LBW rate has not changed, the decrease in infant mortality seen over the years is better explained by the increase in survival of LBW infants. Although efforts to reduce the incidence of LBW were made by improving the health status of pregnant women, the number of very low birth weight infants has increased. Newer, more effective approaches to prevent LBW must be found. It is already known that women who are of low socioeconomic status, unemployed, uninsured, with limited food and prenatal care resources are at risk for LBW pregnancies. Other known risk factors include race (blacks are two times more likely to have LBW infants), previous LBW pregnancies, young age, poor nutrition and lack of prenatal care. A variety of interventions providing social, medical and behavioral support have been instituted to reduce LBW. Prevention strategies should improve the understanding of the pathophysiology of LBW on the cellular level. Access to prenatal care can be improved by lifting current financial barriers to health care. Research should be aimed at investigating the mechanisms involved in preterm labor, which causes the early delivery of low birth weight infants. Controlled studies should be performed to test potential interventions. Integrating the efforts of multidisciplinary research teams will reduce information fragmentation and improve strategies for the prevention of LBW. (Consumer Summary produced by Reliance Medical Information, Inc.)

A crucial component of safe motherhood is postnatal care. Postnatal care is important for mothers for treatment of complications arising from delivery, especially for births that occur at home. The study utilizes Bangladesh Demographic and Health Survey (BDHS), 2004 data to identify the more important factors affecting postnatal care of mothers in the urban and rural areas. Descriptive and multivariate logistic regression methods were employed in analyzing data. Findings reveal that there exist strong urban-rural differentials in receiving postnatal care (PNC) from medically trained providers among urban and rural mothers. We found that urban illiterate mothers receive two times more postnatal care from medically trained providers than rural illiterate mothers. But receiving PNC from medically trained providers among highly educated mothers is almost same both in the urban and rural area. Receiving PNC from medically trained providers increases with improving the economic condition of mothers both in the urban and rural area. Urban mothers receive more PNC (77 per cent) from medically trained providers as against their rural counterparts (58.6 per cent) who can tell about their pregnancy complications. Regarding knowledge of potentially life-threatening conditions during or after delivery is found very low among the rural women. Finally in the logistic regression analysis we have found receiving ANC and delivery assistance from medically trained providers, type of toilet facilities and told about pregnancy complications have net significant effect on receiving PNC from medically trained providers. Keywords: PNC | ANC | Medically trained providers | Pregnancy complications and Logistic regression analysis., Introduction The postnatal period (the time just after delivery and through the first six weeks of life) is especially critical for newborns and mothers. Both mothers and their newborns are [...]

Keywords: Among the congenital heart diseases causing intra cardiac R-L shunts | Tetrology of Fallot (TOF) is the most common syndrome. It is characterized by presence of ventricular septal defect [...]

There is disagreement regarding a causal relationship between generalized osteoporosis and pregnancy. There has been an increasing number of reports of older pregnant women who develop severe groin pain with associated osteopenia or demineralization of the bones of the hip. Typically the pain develops gradually during the third trimester of pregnancy; there is rapid improvement following delivery and bone mineralization returns to normal. Cases are presented of two 31-year-old pregnant women, each of whom developed transient osteoporosis of the hip during pregnancy, with associated fractures that were the result of weakened bone tissue. One patient was admitted to the hospital at 30 weeks gestation and was found to have a healing fracture of the rim of the pubic bone; she was treated with bed rest and traction, and was required to avoid weight-bearing until after delivery. One month after delivery the pain was gone. The second patient developed a painless limp during her fifth month of pregnancy, which was followed by groin and thigh pain. No X-rays were taken because of the pregnancy. After delivery X-rays revealed advanced osteopenia (decreased amount of bone tissue) and displaced fracture of the hip. Surgery was performed to stabilize the fracture, and the patient eventually began walking normally. Chemical or hormonal factors related to pregnancy may act as the stimulus for the local shift in the mineral content of the bone; this transient osteoporosis may have complex causes. Care should be taken in such cases, because a painful osteoporotic hip may be at risk for fracture during vaginal delivery, due to the flexed contracted position of the lower extremities. (Consumer Summary produced by Reliance Medical Information, Inc.)

Maternal deaths due to haemorrhage have doubled in the United Kingdom since the last report from the Confidential Enquiry into Maternal Deaths, which covered 1985-7. The inquiry's latest report, covering […]

RANCHO MIRAGE, CALIF. -- More than a quarter of all pregnancies were complicated by at least one major medical condition in a large, cross-sectional cohort study representing the vast majority [...]