Search

Maternal obesity affects offspring weight, body composition, and organ function, increasing diabetes and metabolic syndrome risk. We determined effects of maternal obesity and a high-energy diet on fetal pancreatic development. Sixty days prior to breeding, ewes were assigned to control [100% of National Research Council (NRC) recommendations] or obesogenic (OB; 150% NRC) diets. At 75 days gestation, OB ewes exhibited elevated insulin-to-glucose ratios at rest and during a glucose tolerance test, demonstrating insulin resistance compared with control ewes. In fetal studies, ewes ate their respective diets from 60 days before to 75 days after conception when animals were euthanized under general anesthesia. OB and control ewes increased in body weight by ~43% and ~6%, respectively, from diet initiation until necropsy. Although all organs were heavier in fetuses from OB ewes, only pancreatic weight increased as a percentage of fetal weight. Blood glucose, insulin, and cortisol were elevated in OB ewes and fetuses on day 75. Insulin-positive cells per unit pancreatic area were 50% greater in fetuses from OB ewes as a result of increased [beta]-cell mitoses rather than decreased programmed cell death. Lambs of OB ewes were born earlier but weighed the same as control lambs; however, their crown-to-rump length was reduced, and their fat mass was increased. We conclude that increased systemic insulin in fetuses from OB ewes results from increased glucose exposure and/or cortisol-induced accelerated fetal [beta]-cell maturation and may contribute to premature [beta]-cell function loss and predisposition to obesity and metabolic disease in offspring. sheep; fetal growth; pancreatic function

In the United Kingdom, the National Screening Programme for identification of hepatitits B virus (HBV) infection in pregnant women uses HBV e antigen (HBeAg) and antibody to HBeAg (anti-HBe) as [...]

The trends in HIV prevalence among childbearing women is analyzed through unlinked anonymous testing of newborns. It is found that a number of children born to an HIV-positive mother calls for continued efforts to prevent vertical transmission of the infection.

The predictors and extent of non-adherence to single-dose nevirapine are investigated to ensure the proper adherence for the prevention of mother-to-child transmission of HIV (pMTCT) programs to be effective. The results show that the place of birth and the poor health status of the newborn highly affect the nonadherence, which can be minimized by using nevirapine in the clinical protocols as well as the pMTCT programs.

A study is conducted to evaluate the acceptance of counseling and rapid HIV testing and to determine the associated risk factors for HIV infection in pregnant women in Baja California, Mexico. The results show a higher prevalence of such infections in Tijuana hospital as compared to the other areas and also demonstrate a wide acceptance of counseling among the pregnant women.

We studied HIV genetic diversity in a cohort of 127 pregnant, HIV-infected women who received prenatal care at Sainte-Justine Hospital in Montreal, Canada, between 1999 and 2003. Clade assignments were [...]

In the developing world, young women, pregnant women, and their infants and children frequently experience a cycle where undernutrition (macronutrient and micronutrient) and repeated infection, including parasitic infections, lead to adverse consequences that can continue from one generation to the next. Among parasitic infections, malaria and intestinal helminths coexist widely with micronutrient deficiencies and contribute importantly to anemia and this cycle of retarded growth and development. In somewhat more limited or focal geographic settings, other parasitic diseases (e.g., schistosomiasis, filariasis) contribute similarly to this cycle. It is undoubtedly much better to enter a pregnancy free of infection and nutritionally replete than the various alternatives. Existing intervention strategies for micronutrient support and for the control of common parasitic infections before or during pregnancy, particularly malaria and intestinal helminths, should be followed. However, further research to identify barriers and priority approaches to achieving this goal remain very important in resource-poor settings where targeted public health efforts are required. KEY WORDS: * pregnancy * malaria * anemia * intestinal helminths * parasitic diseases

Objective. Despite dramatic reductions in perinatal human immunodeficiency virus (HIV) transmission in the United States, obstacles to perinatal HIV prevention that include lack of prenatal care; failure to test pregnant women for HIV before delivery; and lack of prenatal, intrapartum, or neonatal antiretroviral (ARV) use remain. The objective of this study was to describe trends in perinatal HIV prevention methods, perinatal transmission rates, and the contribution of missed opportunities for perinatal HIV prevention to perinatal HIV infection. Methods. We analyzed data obtained from infant medical records on 4755 HIV-exposed singleton deliveries in 1996-2000, from 6 US sites that participate in the Centers for Disease Control and Prevention's Pediatric Spectrum of HIV Disease Project. HIV-exposed deliveries refer to deliveries in which the mother was known to have HIV infection during the pregnancy. Results. Of the 4287 women with data on prenatal care, 92% had prenatal care. From 1996 to 2000, among the 3925 women with prenatal care, 92% had an HIV test before delivery; the use of prenatal zidovudine (ZDV) alone decreased from 71% to 9%, and the use of prenatal ZDV with other ARVs increased from 6% to 70%. Complete data on maternal and neonatal ARVs were available for 3284 deliveries. Perinatal HIV transmission was 3% in 1651 deliveries with prenatal ZDV in combination with other ARVs, intrapartum ZDV, and neonatal ZDV; 6% in 1111 deliveries with prenatal, intrapartum, and neonatal ZDV alone; 8% in 152 deliveries with intrapartum and neonatal ZDV alone; 14% of 73 deliveries with neonatal ZDV only started within 24 hours of birth; and 20% in 297 deliveries with no prenatal, intrapartum, and neonatal ARVs. Complete data on prenatal events were available in 328 HIV-infected and 3258 HIV-uninfected infants. A total of 56% of mothers of HIV-infected infants had missed opportunities for perinatal HIV prevention versus 16% of mothers of HIV-uninfected infants. Forty-four percent of the infected infants were born to mothers who had prenatal care, a prenatal HIV diagnosis, and documented prenatal ARV therapy. Seventeen percent of women with reported illicit drug use had no prenatal care versus 3% of women with no reported drug use. In a multivariate analysis, maternal illicit drug use was significantly associated with lack of prenatal care. In a multivariate analysis, year of infant birth and the combination of lack of maternal HIV testing before delivery and lack of prenatal antiretroviral therapies were significantly associated with perinatal HIV transmission. Conclusions. Missed opportunities for perinatal HIV prevention contributed to more than half of the cases of HIV-infected infants. Prenatal care and HIV testing before delivery are major opportunities for perinatal HIV prevention. Illicit drug use was highly associated with lack of prenatal care, and lack of HIV testing before delivery was highly associated with perinatal HIV transmission. Pediatrics 2003;111:1186-1191; perinatal HIV prevention, missed opportunities for perinatal HIV prevention, pediatric HIV infection., ABBREVIATIONS. HIV, human immunodeficiency virus; AIDS, acquired immunodeficiency syndrome; CDC, Centers for Disease Control and Prevention; ZDV, zidovudine; ARV, antiretroviral PSD, Pediatric Spectrum of Disease; OR, odds ratio; CI, confidence [...]

Objectives. To estimate race/ethnicity-specific prevalence of hepatitis B surface antigen (HBsAg) in pregnant urban women and to evaluate factors associated with maternal HBsAg testing. Methods. A multicenter, retrospective chart review was conducted of a racially/ethnically stratified random sample of maternal/infant charts of 10 523 women who gave birth to live infants during 1990-1993 in 4 urban areas in the United States. Data were collected on multiple variables, including demographic variables, HBsAg test dates and results, prenatal care type, and amount and source of payment. Results. HBsAg prevalence among white non-Hispanics was 0.60% (95% confidence interval [CI]: 0.22-0.98), black non-Hispanics 0.97% (95% CI: 0.48-1.47), Hispanics 0.14% (95% CI: 0.01-0.26), and Asians 5.79% (95% CI: 4.42-7.16). HBsAg testing rates increased from 56.6% in 1990 to 78.2% in 1993. Factors associated with not being tested varied by urban area, but in the combined area model, they were having no or private prenatal care (odds ratios: 18.75 and 5.07, respectively) and being black (odds ratios: 2.08). Only 20.9% (95% CI: 19.1%-22.8%) of those not tested prenatally were tested at delivery. The expected number of infants born to HBsAg-positive study-area women was 3327 using study prevalence rates, compared with 1761 using national rates. Conclusions. To help ensure that all urban infants who are born to HBsAg-positive women receive appropriate prophylaxis, health officials in urban areas should use urban-area prevalence rates to ascertain completeness of reporting maternal HBsAg positivity. Needed steps to increase maternal HBsAg testing rates include ensuring that more pregnant women receive prenatal care, promoting testing by private providers, educating providers about testing in all racial and ethnic groups, and reminding providers to test at delivery those women not tested prenatally. Pediatrics 2003;111:1192-1197; hepatitis B, hepatitis B surface antigen, infant, maternal, pregnancy, prevalence, vaccination., ABBREVIATIONS. HBsAg, hepatitis B surface antigen; HBV, hepatitis B virus; ESPHB, Enhanced Surveillance-Perinatal Hepatitis B Prevention; CI, confidence interval; CDC, Centers for Disease Control and Prevention; HBIG, hepatitis B immunoglobulin; [...]

Objective. To evaluate whether the risk for birth defects associated with maternal diabetes is attenuated by use of multivitamin supplements during the periconceptional period. Methods. In the population-based Atlanta Birth Defects Case-Control Study, we identified case infants who had nonsyndromic birth defects that were reported to be associated with diabetes (n = 3278) and were born during 1968-1980 to residents of metropolitan Atlanta. Controls were infants without birth defects (n = 3029). Maternal diabetes was defined as reported diabetes with onset before the date of birth of the index infant, and periconceptional use of multivitamins was defined as reported regular use of multivitamin supplements from 3 months before pregnancy through the first 3 months of pregnancy. Results. Offspring of mothers with diabetes had an increased risk for selected birth defects. However, the increased risk was limited to offspring of mothers who had diabetes and had not taken multivitamins during the periconceptional period (odds ratio: 3.93; 95% confidence interval: 1.79-8.63). Offspring of mothers who had diabetes and had taken multivitamins during the periconceptional period had no increased risk for birth defects (odds ratio: 0.15; 95% confidence interval: 0.00-1.99). Conclusions. Periconceptional use of multivitamin supplements may reduce the risk for birth defects among offspring of mothers with diabetes. Pediatrics 2003;111: 1146-1151; birth defects, congenital heart defects, central nervous system defects, diabetes, multivitamin supplements, prevention., ABBREVIATIONS. OR, odds ratio; CI, confidence interval. It is well established that offspring of mothers with diabetes are at increased risk for birth defects, (1-3) the most prevalent of which [...]

Objective To develop a rapid field assessment methodology to address the burden of malaria during pregnancy and the options for intervening within the existing antenatal care system in Kenya. Methods Surveys consisting of questionnaires, sampling of blood for parasitaemia and anaemia, and birth outcome assessment were conducted in antenatal clinics, delivery units, and in the community in Kisumu and Mombasa, Kenya. Findings The rates of maternal anaemia and severe anaemia, were, respectively, 79% and 8% in Kisumu, and 95% and 24% in Mombasa. The rates of placental parasitaemia were 27% and 24% and the rates of low birth weight were 18% and 24% in Kisumu and Mombasa, respectively. Women with placental parasitaemia had a higher incidence of low birth weight compared with women without placental parasitaemia in both Kisumu (28% vs 16%, P=0.004) and Mombasa (42% vs 20%, P=0.004). A total of 95% and 98% of women in Kisumu and Mombasa, respectively, reported attending an antenatal clinic during their previous pregnancy. Conclusion This methodology can be used by ministries of health to collect data for decision-making regarding malaria control during pregnancy; it can also provide a baseline measurement on which to evaluate subsequent interventions. Keywords Malaria, Falciparum/epidemiology/drug therapy; Pregnancy; Plasmodium falciparum/pathogenicity; Antimalarials/ therapeutic use; Anemia/etiology; Placenta/parasitology; Parasitemia; Cost of illness; Knowledge, attitudes, practice; Cluster analysis; Cross-sectional studies; Kenya (source: MeSH, NLM). Mots cles Paludisme plasmodium falciparum/epidemiologie/chimiotherapie; Grossesse; Plasmodium falciparum/pathogenicite; Antipaludique/usage therapeutique; Anemie/etiologie; Placenta/parasitologie; Parasitemie; Cout maladie; Prise decision; Connaissance, attitude, pratique; Sondage en grappes; Etude section efficace; Kenya (source: MESH, INSERM). Palabras clave Paludismo falciparum/epidemiologia/quimioterapia; Embarazo; Plasmodium falciparum/patogenicidad; Antimalaricos/uso terapeutico; Anemia/etiologia; Placenta/parasitologia; Parasitemia; Costo de la enfermedad; Toma de decisiones; Conocimientos, actitudes y practica; Analisis pot conglomerados; Estudios transversales; Kenya (fuente: DeCS, BIREME). [TEXT NOT REPRODUCIBLE IN ASCII], Introduction Infection of pregnant women with Plasmodium falciparum contributes to their children having a low birth weight, a major risk factor for neonatal and infant mortality (1). Malaria is one [...]

Research has been conducted on HIV counseling and testing guidelines set by U.S. Centers for Disease Control and Prevention. The description of these guidelines and their implications for the clinical practice and health policy are discussed .

Research has been conducted on voluntary counceling and testing for HIV among pregnant women in labor attending maternity ward in Rwanda . The factors related to refusal or acceptance of these counseling and testing factors have been investigated, and the results demonstrate that the information from this study is critical for vertical HIV transmission reduction in Rwanda.

Human immunodeficiency virus (HIV) infection affects body composition, but their relationship has not been studied in pregnant women. We conducted a cross-sectional study among 1669 women receiving antenatal care between 22 and 35 wk of gestation in Harare, Zimbabwe. The role of HIV-1 status and viral Ioad, malaria and elevated serum [[alpha].sub.1]-antichymotrypsin (ACT, an acute phase protein) in weight, body mass index (BMI), arm circumference (AC), triceps skinfold thickness (TSF), and arm muscle (AMA) and fat (AFA) area were assessed using multiple linear regression analysis. The mean (range) age was 24.4 (14-45) y and gestational age 29 (22-35) wk. HIV infection was present in 31.5% of the women, malaria parasitemia in 0.4% and 11.4% had serum ACT >0.4 g/L. There was no difference in any anthropometric variable between HIV-infected and uninfected women. However, women with viral loads (genome equivalents/mL) between 4 and 5 and >5 [log.sub.10] had 1.1 [95% confidence interval (CI): -0.3, 2.3] and 2.5 (95% CI: 0.1, 5.1) kg lower weights compared with uninfected women; this was explained by losses of both AFA and AMA. Malaria parasitemia was associated with 6 [cm.sup.2] (95% CI: 0.4; 11.8) or 25% lower AMA. Elevated serum ACT was a negative predictor of all anthropometric variables, i.e., levels between 0.3 and 0.4, 0.4 and 0.5 and >0.5 g/L were associated with 1, 2 and 6 kg lower mean body weights, respectively. Despite the limitations of a cross-sectional design, we conclude that arm fat and muscle areas, reflecting body fat and lean body mass, seem to be unaffected in the majority of HIV-infected pregnant women, but decline with increasing viral loads. The effects of viral load are not explained by elevated serum ACT, which is a strong independent predictor of all anthropometric variables. J. Nutr. 132: 3747-3753, 2002. KEY WORDS: * HIV-1 * malaria * acute phase * body composition, pregnancy

Research has been conducted on the predictors of plasma HIV-1 RNA viral load among HIV-1 seropositive pregnant women. Results demonstrate that prevention of malaria among the people living with HIV-1 should be given high priority.

Research has been conducted on adherence to HIV treatment regiments during pregnancy. The patterns of adherence to zidovudine during prenatal period have been investigated and the results demonstrate that the adherence to zidovudine taken during the last 3 weeks of pregnancy was low and declined the last 3 weks postpartum.

Research has been conducted on maternal HIV-1 genotype in MT-2 cells. The association of this genotype at or near delivery time with perinatal HIV-1 transmission has been investigated and the results demonstrate that the association of the nonsyncytium-inducing phenotype with transmission is stronger in women who has received azidothymidine during pregnancy.

The authors have evaluated zidovudine use guideline implementation in HIV-infected women and their newborns. Results demonstrate that zidovudine use by pregnant HIV-infected women and their infants has increased since the publication of 1994 guidelines in the United States.

Treating Trichomonas vaginalis infection in pregnant women will not necessarily prevent premature birth. In fact, in a study of 320 women who took an antibiotic for Trichomonas infection and 297 women who took a placebo, the premature birth rate was higher in the women who took the antibiotic.

Women with a history of peripartum cardiomyopathy who become pregnant have a high risk of heart failure and death. Peripartum cardiomyopathy is a heart disease that occurs during pregnancy or in the postpartum period. Most women recover partially or completely.

HTLV-1 infection does not have an adverse effect on pregnancy, according to a study of 6,754 pregnant women in Salvador, Bahia, Brazil. Fifty-seven of the women tested positive for HTLV-1, which is a retrovirus that is related to HIV.

Women who first test positive for HIV during their pregnancy are no more likely to transmit the virus to their baby than those who tested positive before their pregnancy. This was the conclusion of a study in Thailand before HIV-infected pregnant women were given AIDS drugs to prevent transmission.

Pregnant women who have tuberculosis in other parts of the body besides the lungs may have a higher risk of a poor pregnancy outcome. Tuberculosis in other parts of the body is called extrapulmonary tuberculosis. In a study of 33 pregnant women with extrapulmonary tuberculosis, 21 were much more likely to be hospitalized at some point during the pregnancy, more likely to have babies with low Apgar scores and more likely to have low-birth-weight babies.

We investigated the effect of supplementing women weekly with 7000 [[micro]gram] retinol equivalents as preformed vitamin A or [Beta]-carotene vs. a placebo, on the incidence of night blindness during pregnancy and the postpartum period in the rural plains of Nepal. Over a period of [approximately]3 y, [approximately]29,000 women of child-bearing age, living in 171 wards that were randomized to one of the three supplements, contributed 9932 first pregnancies. A prospective, weekly surveillance identified night blindness in pregnant women, verified further by detailed questioning about nighttime vision. After delivery, women were also interviewed at [approximately equal to]3 and [approximately equal to]6 mo postpartum to elicit a night blindness history over the preceding 3 mo. Vitamin A supplementation reduced the incidence of night blindness during pregnancy from 10.7% among controls to 6.7% (relative risk 0.62, 95% confidence interval: 0.45-0.85). [Beta]-Carotene supplementation had less of an effect (0.83, 0.63-1.11). Among women who took >95% of their vitamin A supplements during pregnancy, incidence of verified night blindness was reduced by 67%. Incidence (per 100 person-years) of night blindness during the first 3 mo postpartum was 11.3 in the control, 4.3 in the vitamin A and 8.7 in the [Beta]-carotene groups, yielding corresponding relative risks of 0.38 (0.26-0.55) and 0.77 (0.57-1.04). In the second 3 mo postpartum, both vitamin A and [Beta]-carotene reduced night blindness by [approximately]50%. Vitamin A intakes approaching a recommended amount for pregnancy markedly reduced but did not eliminate night blindness in Nepali women. Greater intakes of vitamin A than provided and/or other nutrients may be needed to prevent maternal night blindness in rural South Asia. KEY WORDS: night blindness pregnancy postpartum vitamin A [Beta]-carotene Nepal

Pregnant Nepalese women suffering from night blindness find it difficult to work at night due to their condition. The disease is an additional burden, besides the economic and social ones, that these women have to carry. Night blindness, aside from being a nutritional and health status indicator, affects the economic well-being of these women and their families. This illness is caused by vitamin A deficiency and affects women who have good vision during daytime. Almost 10% to 20% of rural Nepalese women develop the disease during their pregnancy.

Tularemia is a bacterial zoonotic disease caused by a gram-negative coccobacillus, Francisella tularensis; the most virulent subspecies, tularensis (type A), is found in North America, but subspecies holarctica (type B) [...]

Systemic lupus erythematosus (SLE), an autoimmune disease which occurs with 90% greater frequency in women than in men, can have profound effects for the mother and the child, whether born or unborn, when it occurs in a pregnant woman. It requires individual case management. SLE occurs usually between the second and fourth decades of life . It is a multisystem disease and so it has numerous effects, but it is no longer a contraindication for pregnancy. Successful pregnancies are possible despite SLE in the mother.

The incidence of syphilis among women delivering babies at the Boston City Hospital appeared to increase from 1951 to 1991. Blood samples from 647 women admitted for delivery were tested for syphilis in 1991. These results were compared with those from 1,005 women tested after delivery in 1951. In the earlier study 2.4% of the women tested positive for syphilis either before or during pregnancy. In the 1991 study, 3.9% of the women tested positive for syphilis during pregnancy or delivery. In the 1991 study women who tested positive were more likely to be infected with other sexually transmitted diseases and more likely to use illicit drugs. No cases of congenital syphilis were diagnosed in either study., Objective. To examine the incidence and epidemiologic correlates of congenital syphilis at an inner-city Boston hospital, and draw comparisons with the situation at the same hospital 40 years ago. Design. Chart review and comparison with data collected in 1951. Setting. Maternity and pediatric services at Boston City Hospital. Methods. A study conducted in 1951 on the maternity service of Boston City Hospital in which demographic data were collected on all women admitted in labor over a 5-month period was replicated. Serologic testing for syphilis was carried out on these women, and the demographic and medical correlates of positive maternal syphilis serology were examined. This study was repeated exactly 40 years later, using the cord blood screening for syphilis done routinely at delivery and a review of prenatal records. Results. From a group made up largely of married white women in 1951, the study population shifted in 1991 to a group made up mostly of minority women, with 75% unmarried. In 1951, 24 patients were diagnosed with syphilis either before or during the pregnancy, giving a prevalence rate of 2.4%. In 1991, 25 of 647 women were diagnosed with syphilis, for a prevalence rate of 3.9%. The women with positive cord blood serologies had a higher rate of other sexually transmitted diseases and substance abuse. No symptomatic cases of congenital syphilis were seen in 1951 or in 1991, although at least 11 of the 26 infants born to mothers with positive serologies in 1991 received intravenous penicillin therapy. Conclusions. The continued prevalence of diagnosed syphilis in women at delivery reflects an inner-city epidemic of congenital syphilis that is tied to substance abuse, human immunodeficiency virus, and changing social patterns, as well to older problems of serologic screening, prenatal care, treatment failures, and maternal reinfection. It is essential that screening programs be maintained and improved in this high-risk population, and that infants born to mothers with positive serologies receive full and adequate treatment if there is any doubt at all about their infection status. Pediatrics 1994;94: 24-28; syphilis, congenital; serologic tests, prenatal screening, epidemiology, history.