Obstetrics

ORLANDO, FLA. — Data have been conflicting on the role of calcium in gestational hypertension, but findings from a recent longitudinal study suggest it does not help prevent the condition, Yi Ning, M.D., of Harvard University, Boston, and colleagues reported in a poster at an international conference on women, heart disease, and stroke.

In the study, mean total calcium intake in 1,686 women was 1,310 mg/day in the first trimester, with most of that (85%) coming from foods. Gestational hypertension occurred in 118 of the women, and preeclampsia occurred in 61.

Adjustments were made for numerous variables, including maternal age, prepregnancy body mass index, race and ethnicity, income, parity, and smoking, as well as first measured systolic blood pressure and history of gestational hypertension or preeclampsia. No significant associations were found between the development of gestational hypertension or preeclampsia and the first-trimester intake of calcium.

The investigators also looked at intake of n-3 and n-6 polyunsaturated fatty acids and trans-fatty acids, and found no associations with gestational hypertension or preeclampsia. The same was true for second-trimester intake of the nutrients.

Participants completed food frequency questionnaires in both their first and second trimesters, and gestational hypertension and preeclampsia were identified using outpatient blood pressure and urine protein measurements, as well as delivery hospitalization diagnoses.

The findings support those of several other studies showing that calcium does not prevent gestational hypertension, according to Dr. Ning.

ORLANDO, FLA. — Data have been conflicting on the role of calcium in gestational hypertension, but findings from a recent longitudinal study suggest it does not help prevent the condition, Yi Ning, M.D., of Harvard University, Boston, and colleagues reported in a poster at an international conference on women, heart disease, and stroke.

In the study, mean total calcium intake in 1,686 women was 1,310 mg/day in the first trimester, with most of that (85%) coming from foods. Gestational hypertension occurred in 118 of the women, and preeclampsia occurred in 61.

Adjustments were made for numerous variables, including maternal age, prepregnancy body mass index, race and ethnicity, income, parity, and smoking, as well as first measured systolic blood pressure and history of gestational hypertension or preeclampsia. No significant associations were found between the development of gestational hypertension or preeclampsia and the first-trimester intake of calcium.

The investigators also looked at intake of n-3 and n-6 polyunsaturated fatty acids and trans-fatty acids, and found no associations with gestational hypertension or preeclampsia. The same was true for second-trimester intake of the nutrients.

Participants completed food frequency questionnaires in both their first and second trimesters, and gestational hypertension and preeclampsia were identified using outpatient blood pressure and urine protein measurements, as well as delivery hospitalization diagnoses.

The findings support those of several other studies showing that calcium does not prevent gestational hypertension, according to Dr. Ning.

ORLANDO, FLA. — Data have been conflicting on the role of calcium in gestational hypertension, but findings from a recent longitudinal study suggest it does not help prevent the condition, Yi Ning, M.D., of Harvard University, Boston, and colleagues reported in a poster at an international conference on women, heart disease, and stroke.

In the study, mean total calcium intake in 1,686 women was 1,310 mg/day in the first trimester, with most of that (85%) coming from foods. Gestational hypertension occurred in 118 of the women, and preeclampsia occurred in 61.

Adjustments were made for numerous variables, including maternal age, prepregnancy body mass index, race and ethnicity, income, parity, and smoking, as well as first measured systolic blood pressure and history of gestational hypertension or preeclampsia. No significant associations were found between the development of gestational hypertension or preeclampsia and the first-trimester intake of calcium.

The investigators also looked at intake of n-3 and n-6 polyunsaturated fatty acids and trans-fatty acids, and found no associations with gestational hypertension or preeclampsia. The same was true for second-trimester intake of the nutrients.

Participants completed food frequency questionnaires in both their first and second trimesters, and gestational hypertension and preeclampsia were identified using outpatient blood pressure and urine protein measurements, as well as delivery hospitalization diagnoses.

The findings support those of several other studies showing that calcium does not prevent gestational hypertension, according to Dr. Ning.

NEW ORLEANS — The risk of stroke among more than 8 million American women during the pre-, peri-, and postpartum periods was 34/100,000, a higher rate than previously calculated.

In addition, the risk of stroke rises with age. Women who were at least 40 years old had a 3.3-fold increased risk of stroke during pregnancy, delivery, and immediately after delivery, compared with women 15-19 years old, Cheryl D. Bushnell, M.D., reported at the 30th International Stroke Conference.

Women 35-39 years old had a 90% increased risk, compared with women younger than 20, said Dr. Bushnell, a neurologist at Duke University in Durham, N.C.

Although the stroke risk during pregnancy and delivery was higher than previous estimates of 4-26/100,000, there are currently no clear implications of what this finding means for monitoring and managing women during pregnancy and delivery, commented Andra H. James, M.D., an obstetrician at Duke and a coinvestigator on this study. Dr. James had no recommendations for changing current obstetric practice based on the new finding.

The researchers used data collected in the Nationwide Inpatient Sample during 2001-2002. This database, maintained by the Agency for Healthcare Research and Quality, is a 20% sample of all inpatients at about 1,000 community hospitals in the United States.

The database included records for more than 8 million women who were discharged with prepartum, delivery, or postpartum codes. In this group, 2,850 women had a stroke, a rate of 34.2 events/100,000 women, Dr. Bushnell said at the conference, sponsored by the American Stroke Association.

Besides age, race was a variable that affected women's stroke risk. African American women had a 70% increased risk, compared with white women. Clinical factors that boosted the risk of stroke were preeclampsia, postpartum infection, a blood transfusion, and any other comorbidity.

Of the 2,850 women with strokes, 117 died, for a mortality of 4.1%. and a rate of 1.4 stroke deaths per 100,000 deliveries. Given that the overall mortality rate during pregnancy and delivery in the United States is 10/100,000 deliveries, stroke accounts for 14% of all maternal deaths, Dr. Bushnell said.

NEW ORLEANS — The risk of stroke among more than 8 million American women during the pre-, peri-, and postpartum periods was 34/100,000, a higher rate than previously calculated.

In addition, the risk of stroke rises with age. Women who were at least 40 years old had a 3.3-fold increased risk of stroke during pregnancy, delivery, and immediately after delivery, compared with women 15-19 years old, Cheryl D. Bushnell, M.D., reported at the 30th International Stroke Conference.

Women 35-39 years old had a 90% increased risk, compared with women younger than 20, said Dr. Bushnell, a neurologist at Duke University in Durham, N.C.

Although the stroke risk during pregnancy and delivery was higher than previous estimates of 4-26/100,000, there are currently no clear implications of what this finding means for monitoring and managing women during pregnancy and delivery, commented Andra H. James, M.D., an obstetrician at Duke and a coinvestigator on this study. Dr. James had no recommendations for changing current obstetric practice based on the new finding.

The researchers used data collected in the Nationwide Inpatient Sample during 2001-2002. This database, maintained by the Agency for Healthcare Research and Quality, is a 20% sample of all inpatients at about 1,000 community hospitals in the United States.

The database included records for more than 8 million women who were discharged with prepartum, delivery, or postpartum codes. In this group, 2,850 women had a stroke, a rate of 34.2 events/100,000 women, Dr. Bushnell said at the conference, sponsored by the American Stroke Association.

Besides age, race was a variable that affected women's stroke risk. African American women had a 70% increased risk, compared with white women. Clinical factors that boosted the risk of stroke were preeclampsia, postpartum infection, a blood transfusion, and any other comorbidity.

Of the 2,850 women with strokes, 117 died, for a mortality of 4.1%. and a rate of 1.4 stroke deaths per 100,000 deliveries. Given that the overall mortality rate during pregnancy and delivery in the United States is 10/100,000 deliveries, stroke accounts for 14% of all maternal deaths, Dr. Bushnell said.

NEW ORLEANS — The risk of stroke among more than 8 million American women during the pre-, peri-, and postpartum periods was 34/100,000, a higher rate than previously calculated.

In addition, the risk of stroke rises with age. Women who were at least 40 years old had a 3.3-fold increased risk of stroke during pregnancy, delivery, and immediately after delivery, compared with women 15-19 years old, Cheryl D. Bushnell, M.D., reported at the 30th International Stroke Conference.

Women 35-39 years old had a 90% increased risk, compared with women younger than 20, said Dr. Bushnell, a neurologist at Duke University in Durham, N.C.

Although the stroke risk during pregnancy and delivery was higher than previous estimates of 4-26/100,000, there are currently no clear implications of what this finding means for monitoring and managing women during pregnancy and delivery, commented Andra H. James, M.D., an obstetrician at Duke and a coinvestigator on this study. Dr. James had no recommendations for changing current obstetric practice based on the new finding.

The researchers used data collected in the Nationwide Inpatient Sample during 2001-2002. This database, maintained by the Agency for Healthcare Research and Quality, is a 20% sample of all inpatients at about 1,000 community hospitals in the United States.

The database included records for more than 8 million women who were discharged with prepartum, delivery, or postpartum codes. In this group, 2,850 women had a stroke, a rate of 34.2 events/100,000 women, Dr. Bushnell said at the conference, sponsored by the American Stroke Association.

Besides age, race was a variable that affected women's stroke risk. African American women had a 70% increased risk, compared with white women. Clinical factors that boosted the risk of stroke were preeclampsia, postpartum infection, a blood transfusion, and any other comorbidity.

Of the 2,850 women with strokes, 117 died, for a mortality of 4.1%. and a rate of 1.4 stroke deaths per 100,000 deliveries. Given that the overall mortality rate during pregnancy and delivery in the United States is 10/100,000 deliveries, stroke accounts for 14% of all maternal deaths, Dr. Bushnell said.

RENO, NEV. — Metformin controlled blood glucose levels as well as insulin in patients with class A2 gestational diabetes, and was not associated with any adverse maternal or neonatal outcomes, according to a randomized trial with 63 patients.

“We found that metformin appears to be an acceptable way to achieve glucose homeostasis in the A2 diabetes patient,” Christian Briery, M.D., said at the annual meeting of the Society for Maternal-Fetal Medicine.

The study enrolled pregnant patients who were at greater than 11 weeks' gestation but less than 35 weeks' gestation. The women received a starting dose of insulin of 0.7 U/kg daily, in three doses (31 patients) or 500 mg metformin twice daily (32 patients).

The patients were then monitored weekly to see that they achieved a postprandial blood glucose level of less than 120 mg/dL and a fasting glucose level of 60-90 mg/dL, said Dr. Briery of the University of Mississippi Medical Center, Jackson.

In blood glucose measurements taken by the patients at home, the mean fasting glucose level was 96.8 mg/dL in the insulin-treated patients versus 92.6 mg/dL in the metformin-treated group.

Similarly, the researcher reported that the mean postprandial glucose levels ranged in the insulin group from 104.4 mg/dL 2 hours after breakfast to 112.5 mg/dL 2 hours after lunch. The mean postprandial glucose levels in the metformin group ranged from 104.6 mg/dL 2 hours after breakfast to 108.1 mg/dL 2 hours after dinner.

The maternal and delivery measures considered included abdominal delivery, gestational age at delivery, shoulder dystocia, and postpartum hemorrhage.

There was no difference in those measures between the groups.

There was one intrauterine fetal death in the metformin group from a “cord problem” that was determined not to be related to treatment because the mother's glucose levels were consistently normal, Dr. Briery said.

Neonatal outcomes that were considered in the trial include birth weight, 5-minute Apgar score, respiratory distress syndrome, neonatal hypoglycemia, and neonatal ICU admission. Again, the researcher said there was no difference among the groups.

A previous study of metformin use during pregnancy looked specifically at patients who had polycystic ovary syndrome and who conceived while taking the drug. That investigation likewise found no indication of any adverse effects that might normally be associated with the agent.

RENO, NEV. — Metformin controlled blood glucose levels as well as insulin in patients with class A2 gestational diabetes, and was not associated with any adverse maternal or neonatal outcomes, according to a randomized trial with 63 patients.

“We found that metformin appears to be an acceptable way to achieve glucose homeostasis in the A2 diabetes patient,” Christian Briery, M.D., said at the annual meeting of the Society for Maternal-Fetal Medicine.

The study enrolled pregnant patients who were at greater than 11 weeks' gestation but less than 35 weeks' gestation. The women received a starting dose of insulin of 0.7 U/kg daily, in three doses (31 patients) or 500 mg metformin twice daily (32 patients).

The patients were then monitored weekly to see that they achieved a postprandial blood glucose level of less than 120 mg/dL and a fasting glucose level of 60-90 mg/dL, said Dr. Briery of the University of Mississippi Medical Center, Jackson.

In blood glucose measurements taken by the patients at home, the mean fasting glucose level was 96.8 mg/dL in the insulin-treated patients versus 92.6 mg/dL in the metformin-treated group.

Similarly, the researcher reported that the mean postprandial glucose levels ranged in the insulin group from 104.4 mg/dL 2 hours after breakfast to 112.5 mg/dL 2 hours after lunch. The mean postprandial glucose levels in the metformin group ranged from 104.6 mg/dL 2 hours after breakfast to 108.1 mg/dL 2 hours after dinner.

The maternal and delivery measures considered included abdominal delivery, gestational age at delivery, shoulder dystocia, and postpartum hemorrhage.

There was no difference in those measures between the groups.

There was one intrauterine fetal death in the metformin group from a “cord problem” that was determined not to be related to treatment because the mother's glucose levels were consistently normal, Dr. Briery said.

Neonatal outcomes that were considered in the trial include birth weight, 5-minute Apgar score, respiratory distress syndrome, neonatal hypoglycemia, and neonatal ICU admission. Again, the researcher said there was no difference among the groups.

A previous study of metformin use during pregnancy looked specifically at patients who had polycystic ovary syndrome and who conceived while taking the drug. That investigation likewise found no indication of any adverse effects that might normally be associated with the agent.

RENO, NEV. — Metformin controlled blood glucose levels as well as insulin in patients with class A2 gestational diabetes, and was not associated with any adverse maternal or neonatal outcomes, according to a randomized trial with 63 patients.

“We found that metformin appears to be an acceptable way to achieve glucose homeostasis in the A2 diabetes patient,” Christian Briery, M.D., said at the annual meeting of the Society for Maternal-Fetal Medicine.

The study enrolled pregnant patients who were at greater than 11 weeks' gestation but less than 35 weeks' gestation. The women received a starting dose of insulin of 0.7 U/kg daily, in three doses (31 patients) or 500 mg metformin twice daily (32 patients).

The patients were then monitored weekly to see that they achieved a postprandial blood glucose level of less than 120 mg/dL and a fasting glucose level of 60-90 mg/dL, said Dr. Briery of the University of Mississippi Medical Center, Jackson.

In blood glucose measurements taken by the patients at home, the mean fasting glucose level was 96.8 mg/dL in the insulin-treated patients versus 92.6 mg/dL in the metformin-treated group.

Similarly, the researcher reported that the mean postprandial glucose levels ranged in the insulin group from 104.4 mg/dL 2 hours after breakfast to 112.5 mg/dL 2 hours after lunch. The mean postprandial glucose levels in the metformin group ranged from 104.6 mg/dL 2 hours after breakfast to 108.1 mg/dL 2 hours after dinner.

The maternal and delivery measures considered included abdominal delivery, gestational age at delivery, shoulder dystocia, and postpartum hemorrhage.

There was no difference in those measures between the groups.

There was one intrauterine fetal death in the metformin group from a “cord problem” that was determined not to be related to treatment because the mother's glucose levels were consistently normal, Dr. Briery said.

Neonatal outcomes that were considered in the trial include birth weight, 5-minute Apgar score, respiratory distress syndrome, neonatal hypoglycemia, and neonatal ICU admission. Again, the researcher said there was no difference among the groups.

A previous study of metformin use during pregnancy looked specifically at patients who had polycystic ovary syndrome and who conceived while taking the drug. That investigation likewise found no indication of any adverse effects that might normally be associated with the agent.

RENO, NEV. — Middle cerebral artery Doppler ultrasonography has better sensitivity and specificity for detecting severe maternal red cell alloimmunization than amniotic fluid bilirubin values, Dick Oepkes, M.D., said at the annual meeting of the Society for Maternal-Fetal Medicine.

He and his associates conducted a study of 164 pregnancies, in which severe anemia occurred in 74. They found that ultrasonography can safely replace determination of the deflection of the optical density of amniotic fluid at 450 nm, said Dr. Oepkes, director of the fetal medicine section of the department of obstetrics at the Leiden University Medical Center, the Netherlands.

“The Doppler is clearly the superior technique,” he said. “The results of what we have found have confirmed what many people have directly implemented in their own centers already.”

The study's 164 pregnancies were in women who had serum antibody titers indicative of Rh positivity with antigen-positive fetuses. The women underwent amniocentesis and ultrasonography at the same time and then had fetal or cord blood sampling to confirm anemia, either at the time it was deemed necessary or at birth.

Severe anemia, which was confirmed in 74 neonates, was defined as a hemoglobin greater than or equal to 5 standard deviations from the mean for gestational age.

The sensitivity of the middle cerebral artery Doppler ultrasonography was 88%, and the specificity was 82%, yielding a positive predictive value of 80% and a negative predictive value of 89%.

In contrast, the amniotic fluid bilirubin (Delta-OD 450) values had a sensitivity of 76%, a specificity of 77%, a positive predictive value of 73%, and a negative predictive value of 80%.

The sensitivity of the Doppler was equally good, whether it was performed before or after 27 weeks' gestation, Dr. Oepkes explained.

Moreover, the study was conducted at 10 different institutions, and there was no great difference seen in the reliability of different ultrasonographers.

“We actually felt that this study was a pragmatic test that was done in the field so to speak,” Dr. Oepkes said.

RENO, NEV. — Middle cerebral artery Doppler ultrasonography has better sensitivity and specificity for detecting severe maternal red cell alloimmunization than amniotic fluid bilirubin values, Dick Oepkes, M.D., said at the annual meeting of the Society for Maternal-Fetal Medicine.

He and his associates conducted a study of 164 pregnancies, in which severe anemia occurred in 74. They found that ultrasonography can safely replace determination of the deflection of the optical density of amniotic fluid at 450 nm, said Dr. Oepkes, director of the fetal medicine section of the department of obstetrics at the Leiden University Medical Center, the Netherlands.

“The Doppler is clearly the superior technique,” he said. “The results of what we have found have confirmed what many people have directly implemented in their own centers already.”

The study's 164 pregnancies were in women who had serum antibody titers indicative of Rh positivity with antigen-positive fetuses. The women underwent amniocentesis and ultrasonography at the same time and then had fetal or cord blood sampling to confirm anemia, either at the time it was deemed necessary or at birth.

Severe anemia, which was confirmed in 74 neonates, was defined as a hemoglobin greater than or equal to 5 standard deviations from the mean for gestational age.

The sensitivity of the middle cerebral artery Doppler ultrasonography was 88%, and the specificity was 82%, yielding a positive predictive value of 80% and a negative predictive value of 89%.

In contrast, the amniotic fluid bilirubin (Delta-OD 450) values had a sensitivity of 76%, a specificity of 77%, a positive predictive value of 73%, and a negative predictive value of 80%.

The sensitivity of the Doppler was equally good, whether it was performed before or after 27 weeks' gestation, Dr. Oepkes explained.

Moreover, the study was conducted at 10 different institutions, and there was no great difference seen in the reliability of different ultrasonographers.

“We actually felt that this study was a pragmatic test that was done in the field so to speak,” Dr. Oepkes said.

RENO, NEV. — Middle cerebral artery Doppler ultrasonography has better sensitivity and specificity for detecting severe maternal red cell alloimmunization than amniotic fluid bilirubin values, Dick Oepkes, M.D., said at the annual meeting of the Society for Maternal-Fetal Medicine.

He and his associates conducted a study of 164 pregnancies, in which severe anemia occurred in 74. They found that ultrasonography can safely replace determination of the deflection of the optical density of amniotic fluid at 450 nm, said Dr. Oepkes, director of the fetal medicine section of the department of obstetrics at the Leiden University Medical Center, the Netherlands.

“The Doppler is clearly the superior technique,” he said. “The results of what we have found have confirmed what many people have directly implemented in their own centers already.”

The study's 164 pregnancies were in women who had serum antibody titers indicative of Rh positivity with antigen-positive fetuses. The women underwent amniocentesis and ultrasonography at the same time and then had fetal or cord blood sampling to confirm anemia, either at the time it was deemed necessary or at birth.

Severe anemia, which was confirmed in 74 neonates, was defined as a hemoglobin greater than or equal to 5 standard deviations from the mean for gestational age.

The sensitivity of the middle cerebral artery Doppler ultrasonography was 88%, and the specificity was 82%, yielding a positive predictive value of 80% and a negative predictive value of 89%.

In contrast, the amniotic fluid bilirubin (Delta-OD 450) values had a sensitivity of 76%, a specificity of 77%, a positive predictive value of 73%, and a negative predictive value of 80%.

The sensitivity of the Doppler was equally good, whether it was performed before or after 27 weeks' gestation, Dr. Oepkes explained.

Moreover, the study was conducted at 10 different institutions, and there was no great difference seen in the reliability of different ultrasonographers.

“We actually felt that this study was a pragmatic test that was done in the field so to speak,” Dr. Oepkes said.

RENO, NEV. — A single course of prenatal steroids given to hasten fetal lung maturity is effective for longer than 7 days, meaning there may be no need for a repeat, rescue dose, Alan M. Peaceman, M.D., said at the annual meeting of the Society for Maternal-Fetal Medicine.

In a review of 162 infants whose mothers had received a single, full course of prenatal steroids and who were born before 34 weeks' gestation, the only significant difference between those born within 7 days of the treatment and those born after 7 days was a greater need for ventilatory support.

“I think we need to reexamine our assumption that steroids lose their benefit after 7 days,” he said in an interview.

In 2000 a National Institutes of Health consensus panel recommended against the practice of repeat courses of prenatal steroids when a patient at risk for premature delivery did not deliver within 7 days of the treatment because of the possible risks associated with multiple courses.

It is not uncommon, however, for some physicians to use a single, repeat “rescue” course when delivery seems imminent and 7 days have elapsed, or for physicians to hold off giving the initial course until just before they think the patient will deliver, said Dr. Peaceman of the department of maternal-fetal medicine at Northwestern University, Chicago.

The evidence offered by his review of cases is not as definitive as that of a prospective trial, he said, but it does suggest one could give a single course at 24 weeks, as guidelines suggest.

“I'm not recommending anything,” Dr. Peaceman said in the interview. “But that is what the data are leaning toward: That there is no point in waiting” until closer to a patient's expected delivery date. Similarly, there is no need to give a repeat or “rescue” dose after 7 days if the patient still has not delivered.

In the reviewed cases, 84 of the 162 infants were born within 7 days of the treatment and 78 were delivered after 7 days. The groups did not differ in any of the assessed characteristics, including maternal age, route of delivery, and birth weight, Dr. Peaceman and coinvestigator William A. Grobman, M.D., also of the department, wrote in a poster that was presented at the meeting.

Respiratory support, defined as mechanical ventilation or continuous positive airway pressure use for greater than 24 hours, was needed by 63% of the infants delivered within 7 days, compared with 81% of the infants delivered after longer than 7 days.

None of the other outcomes considered, however, showed any statistically significant difference between groups. (See table.)

In a subanalysis, the researchers assessed data for those infants born at less then 30 weeks' gestation. There were still no significant differences between treatment groups other than respiratory support. Furthermore, the study observed no association between neonatal morbidity and the length of time beyond 7 days that passed before delivery.

RENO, NEV. — A single course of prenatal steroids given to hasten fetal lung maturity is effective for longer than 7 days, meaning there may be no need for a repeat, rescue dose, Alan M. Peaceman, M.D., said at the annual meeting of the Society for Maternal-Fetal Medicine.

In a review of 162 infants whose mothers had received a single, full course of prenatal steroids and who were born before 34 weeks' gestation, the only significant difference between those born within 7 days of the treatment and those born after 7 days was a greater need for ventilatory support.

“I think we need to reexamine our assumption that steroids lose their benefit after 7 days,” he said in an interview.

In 2000 a National Institutes of Health consensus panel recommended against the practice of repeat courses of prenatal steroids when a patient at risk for premature delivery did not deliver within 7 days of the treatment because of the possible risks associated with multiple courses.

It is not uncommon, however, for some physicians to use a single, repeat “rescue” course when delivery seems imminent and 7 days have elapsed, or for physicians to hold off giving the initial course until just before they think the patient will deliver, said Dr. Peaceman of the department of maternal-fetal medicine at Northwestern University, Chicago.

The evidence offered by his review of cases is not as definitive as that of a prospective trial, he said, but it does suggest one could give a single course at 24 weeks, as guidelines suggest.

“I'm not recommending anything,” Dr. Peaceman said in the interview. “But that is what the data are leaning toward: That there is no point in waiting” until closer to a patient's expected delivery date. Similarly, there is no need to give a repeat or “rescue” dose after 7 days if the patient still has not delivered.

In the reviewed cases, 84 of the 162 infants were born within 7 days of the treatment and 78 were delivered after 7 days. The groups did not differ in any of the assessed characteristics, including maternal age, route of delivery, and birth weight, Dr. Peaceman and coinvestigator William A. Grobman, M.D., also of the department, wrote in a poster that was presented at the meeting.

Respiratory support, defined as mechanical ventilation or continuous positive airway pressure use for greater than 24 hours, was needed by 63% of the infants delivered within 7 days, compared with 81% of the infants delivered after longer than 7 days.

None of the other outcomes considered, however, showed any statistically significant difference between groups. (See table.)

In a subanalysis, the researchers assessed data for those infants born at less then 30 weeks' gestation. There were still no significant differences between treatment groups other than respiratory support. Furthermore, the study observed no association between neonatal morbidity and the length of time beyond 7 days that passed before delivery.

RENO, NEV. — A single course of prenatal steroids given to hasten fetal lung maturity is effective for longer than 7 days, meaning there may be no need for a repeat, rescue dose, Alan M. Peaceman, M.D., said at the annual meeting of the Society for Maternal-Fetal Medicine.

In a review of 162 infants whose mothers had received a single, full course of prenatal steroids and who were born before 34 weeks' gestation, the only significant difference between those born within 7 days of the treatment and those born after 7 days was a greater need for ventilatory support.

“I think we need to reexamine our assumption that steroids lose their benefit after 7 days,” he said in an interview.

In 2000 a National Institutes of Health consensus panel recommended against the practice of repeat courses of prenatal steroids when a patient at risk for premature delivery did not deliver within 7 days of the treatment because of the possible risks associated with multiple courses.

It is not uncommon, however, for some physicians to use a single, repeat “rescue” course when delivery seems imminent and 7 days have elapsed, or for physicians to hold off giving the initial course until just before they think the patient will deliver, said Dr. Peaceman of the department of maternal-fetal medicine at Northwestern University, Chicago.

The evidence offered by his review of cases is not as definitive as that of a prospective trial, he said, but it does suggest one could give a single course at 24 weeks, as guidelines suggest.

“I'm not recommending anything,” Dr. Peaceman said in the interview. “But that is what the data are leaning toward: That there is no point in waiting” until closer to a patient's expected delivery date. Similarly, there is no need to give a repeat or “rescue” dose after 7 days if the patient still has not delivered.

In the reviewed cases, 84 of the 162 infants were born within 7 days of the treatment and 78 were delivered after 7 days. The groups did not differ in any of the assessed characteristics, including maternal age, route of delivery, and birth weight, Dr. Peaceman and coinvestigator William A. Grobman, M.D., also of the department, wrote in a poster that was presented at the meeting.

Respiratory support, defined as mechanical ventilation or continuous positive airway pressure use for greater than 24 hours, was needed by 63% of the infants delivered within 7 days, compared with 81% of the infants delivered after longer than 7 days.

None of the other outcomes considered, however, showed any statistically significant difference between groups. (See table.)

In a subanalysis, the researchers assessed data for those infants born at less then 30 weeks' gestation. There were still no significant differences between treatment groups other than respiratory support. Furthermore, the study observed no association between neonatal morbidity and the length of time beyond 7 days that passed before delivery.

RENO, NEV. — Women who've had three spontaneous abortions before a current pregnancy have almost a 50% higher risk of carrying a fetus with aneuploidy than those who've never had a miscarriage, according to a large review of women who had undergone amniocentesis.

The aneuploidy rate becomes almost 2% in women who have had three pregnancy losses, Katherine Bianco, M.D., and associates wrote in a poster presentation at the annual meeting of the Society for Maternal-Fetal Medicine.

The study reviewed fetal karyotype analyses from 46,939 women who had been seen at a single prenatal diagnostic referral center between 1983 and 2003, 80% of whom were 35 years old or older, said Dr. Bianco of the department of obstetrics and gynecology at the University of California, San Francisco.

According to those records, women who could identify one previous spontaneous abortion were found to have fetuses with trisomy 13, 18, or 21 at a rate of 1.45%, compared with a rate of 1.10% for those who had not previously had a spontaneous abortion. Women who had two prior losses had a rate of 1.56%. Those with three prior losses had a rate of 1.70%, and a 2.18% rate of any aneuploidy.

RENO, NEV. — Women who've had three spontaneous abortions before a current pregnancy have almost a 50% higher risk of carrying a fetus with aneuploidy than those who've never had a miscarriage, according to a large review of women who had undergone amniocentesis.

The aneuploidy rate becomes almost 2% in women who have had three pregnancy losses, Katherine Bianco, M.D., and associates wrote in a poster presentation at the annual meeting of the Society for Maternal-Fetal Medicine.

The study reviewed fetal karyotype analyses from 46,939 women who had been seen at a single prenatal diagnostic referral center between 1983 and 2003, 80% of whom were 35 years old or older, said Dr. Bianco of the department of obstetrics and gynecology at the University of California, San Francisco.

According to those records, women who could identify one previous spontaneous abortion were found to have fetuses with trisomy 13, 18, or 21 at a rate of 1.45%, compared with a rate of 1.10% for those who had not previously had a spontaneous abortion. Women who had two prior losses had a rate of 1.56%. Those with three prior losses had a rate of 1.70%, and a 2.18% rate of any aneuploidy.

RENO, NEV. — Women who've had three spontaneous abortions before a current pregnancy have almost a 50% higher risk of carrying a fetus with aneuploidy than those who've never had a miscarriage, according to a large review of women who had undergone amniocentesis.

The aneuploidy rate becomes almost 2% in women who have had three pregnancy losses, Katherine Bianco, M.D., and associates wrote in a poster presentation at the annual meeting of the Society for Maternal-Fetal Medicine.

The study reviewed fetal karyotype analyses from 46,939 women who had been seen at a single prenatal diagnostic referral center between 1983 and 2003, 80% of whom were 35 years old or older, said Dr. Bianco of the department of obstetrics and gynecology at the University of California, San Francisco.

According to those records, women who could identify one previous spontaneous abortion were found to have fetuses with trisomy 13, 18, or 21 at a rate of 1.45%, compared with a rate of 1.10% for those who had not previously had a spontaneous abortion. Women who had two prior losses had a rate of 1.56%. Those with three prior losses had a rate of 1.70%, and a 2.18% rate of any aneuploidy.

RENO, NEV. — Fetuses with hypoplastic left heart syndrome and normal chromosomes are unlikely to die in utero, according to a retrospective study of 176 fetuses diagnosed prenatally with the disorder.

Of these fetuses, which were diagnosed over a 12-year period, 133 were live born, 32 underwent therapeutic abortion, and 3 died in utero. The outcome for eight of the fetuses is unknown, Rebecca H. Allen, M.D., and her associates wrote in a poster presentation at the annual meeting of the Society for Maternal-Fetal Medicine.

Of the 3 fetuses that died in utero, 1 had trisomy 13, 1 had trisomy 18, and 1 was not karyotyped. Both of the fetuses with abnormal karyotypes had other anomalies detected by ultrasound. The third had no anomalies, but was one of triplets. Only 2 of the 133 live-born fetuses had abnormal karyotypes; 29 had other anomalies.

Parents of fetuses with hypoplastic left heart syndrome are sometimes offered interventional procedures, and fetal death occasionally follows. It's unknown whether such procedures contribute to intrauterine death.

“This finding does not argue against prenatal cardiac interventional procedures,” Dr. Allen of Brigham and Women's Hospital, Boston, said in an interview, stating that the study was designed to examine the natural history of the syndrome.

The study emphasizes “the need for karyotype in the evaluation of a fetus with hypoplastic left heart syndrome. A fetus with normal chromosomes and an isolated hypoplastic left heart lesion is a potentially good candidate for in utero cardiac intervention,” she said.

This fetus has hypoplastic left heart syndrome. This sonogram shows a very small left ventricle (LV) and an enlarged right ventricle (RV). The right atrium (RA) and left atrium (LA) also are indicated. Courtesy Dr. Rebecca H. Allen

RENO, NEV. — Fetuses with hypoplastic left heart syndrome and normal chromosomes are unlikely to die in utero, according to a retrospective study of 176 fetuses diagnosed prenatally with the disorder.

Of these fetuses, which were diagnosed over a 12-year period, 133 were live born, 32 underwent therapeutic abortion, and 3 died in utero. The outcome for eight of the fetuses is unknown, Rebecca H. Allen, M.D., and her associates wrote in a poster presentation at the annual meeting of the Society for Maternal-Fetal Medicine.

Of the 3 fetuses that died in utero, 1 had trisomy 13, 1 had trisomy 18, and 1 was not karyotyped. Both of the fetuses with abnormal karyotypes had other anomalies detected by ultrasound. The third had no anomalies, but was one of triplets. Only 2 of the 133 live-born fetuses had abnormal karyotypes; 29 had other anomalies.

Parents of fetuses with hypoplastic left heart syndrome are sometimes offered interventional procedures, and fetal death occasionally follows. It's unknown whether such procedures contribute to intrauterine death.

“This finding does not argue against prenatal cardiac interventional procedures,” Dr. Allen of Brigham and Women's Hospital, Boston, said in an interview, stating that the study was designed to examine the natural history of the syndrome.

The study emphasizes “the need for karyotype in the evaluation of a fetus with hypoplastic left heart syndrome. A fetus with normal chromosomes and an isolated hypoplastic left heart lesion is a potentially good candidate for in utero cardiac intervention,” she said.

This fetus has hypoplastic left heart syndrome. This sonogram shows a very small left ventricle (LV) and an enlarged right ventricle (RV). The right atrium (RA) and left atrium (LA) also are indicated. Courtesy Dr. Rebecca H. Allen

RENO, NEV. — Fetuses with hypoplastic left heart syndrome and normal chromosomes are unlikely to die in utero, according to a retrospective study of 176 fetuses diagnosed prenatally with the disorder.

Of these fetuses, which were diagnosed over a 12-year period, 133 were live born, 32 underwent therapeutic abortion, and 3 died in utero. The outcome for eight of the fetuses is unknown, Rebecca H. Allen, M.D., and her associates wrote in a poster presentation at the annual meeting of the Society for Maternal-Fetal Medicine.

Of the 3 fetuses that died in utero, 1 had trisomy 13, 1 had trisomy 18, and 1 was not karyotyped. Both of the fetuses with abnormal karyotypes had other anomalies detected by ultrasound. The third had no anomalies, but was one of triplets. Only 2 of the 133 live-born fetuses had abnormal karyotypes; 29 had other anomalies.

Parents of fetuses with hypoplastic left heart syndrome are sometimes offered interventional procedures, and fetal death occasionally follows. It's unknown whether such procedures contribute to intrauterine death.

“This finding does not argue against prenatal cardiac interventional procedures,” Dr. Allen of Brigham and Women's Hospital, Boston, said in an interview, stating that the study was designed to examine the natural history of the syndrome.

The study emphasizes “the need for karyotype in the evaluation of a fetus with hypoplastic left heart syndrome. A fetus with normal chromosomes and an isolated hypoplastic left heart lesion is a potentially good candidate for in utero cardiac intervention,” she said.

This fetus has hypoplastic left heart syndrome. This sonogram shows a very small left ventricle (LV) and an enlarged right ventricle (RV). The right atrium (RA) and left atrium (LA) also are indicated. Courtesy Dr. Rebecca H. Allen

Prenatal exposure to combustion-related air pollution may cause chromosomal abnormalities in fetal tissue, according to a study of 60 New York City newborns.

In other populations, such abnormalities have been linked to an increased risk of leukemia and other cancers, said Kirsti A. Bocskay of the department of environmental health sciences at Columbia University, New York, and her colleagues.

The investigators monitored exposure to polycyclic aromatic hydrocarbons (PAHs)—found in emissions from vehicles, residential heating, power generation, and tobacco smoke—among nonsmoking African American and Dominican mothers in three low-income neighborhoods.

The mothers filled out questionnaires and wore air monitors for 48 hours in the third trimester. Chromosomal abnormalities were measured in umbilical cord blood at delivery.

The investigators found 4.7 chromosome abnormalities per 1,000 white blood cells in newborns from mothers with low exposure to PAHs and 7.2 abnormalities per 1,000 white blood cells in newborns from mothers with high exposure to PAHs.

The study finds a significant association between prenatal exposure to airborne carcinogenic PAHs and stable aberrations in cord blood at the relatively low environmental concentrations in New York, the researchers said (Cancer Epidemiol. Biomarkers Prev. 2005;14:506-11).

Prenatal exposure to combustion-related air pollution may cause chromosomal abnormalities in fetal tissue, according to a study of 60 New York City newborns.

In other populations, such abnormalities have been linked to an increased risk of leukemia and other cancers, said Kirsti A. Bocskay of the department of environmental health sciences at Columbia University, New York, and her colleagues.

The investigators monitored exposure to polycyclic aromatic hydrocarbons (PAHs)—found in emissions from vehicles, residential heating, power generation, and tobacco smoke—among nonsmoking African American and Dominican mothers in three low-income neighborhoods.

The mothers filled out questionnaires and wore air monitors for 48 hours in the third trimester. Chromosomal abnormalities were measured in umbilical cord blood at delivery.

The investigators found 4.7 chromosome abnormalities per 1,000 white blood cells in newborns from mothers with low exposure to PAHs and 7.2 abnormalities per 1,000 white blood cells in newborns from mothers with high exposure to PAHs.

The study finds a significant association between prenatal exposure to airborne carcinogenic PAHs and stable aberrations in cord blood at the relatively low environmental concentrations in New York, the researchers said (Cancer Epidemiol. Biomarkers Prev. 2005;14:506-11).

Prenatal exposure to combustion-related air pollution may cause chromosomal abnormalities in fetal tissue, according to a study of 60 New York City newborns.

In other populations, such abnormalities have been linked to an increased risk of leukemia and other cancers, said Kirsti A. Bocskay of the department of environmental health sciences at Columbia University, New York, and her colleagues.

The investigators monitored exposure to polycyclic aromatic hydrocarbons (PAHs)—found in emissions from vehicles, residential heating, power generation, and tobacco smoke—among nonsmoking African American and Dominican mothers in three low-income neighborhoods.

The mothers filled out questionnaires and wore air monitors for 48 hours in the third trimester. Chromosomal abnormalities were measured in umbilical cord blood at delivery.

The investigators found 4.7 chromosome abnormalities per 1,000 white blood cells in newborns from mothers with low exposure to PAHs and 7.2 abnormalities per 1,000 white blood cells in newborns from mothers with high exposure to PAHs.

The study finds a significant association between prenatal exposure to airborne carcinogenic PAHs and stable aberrations in cord blood at the relatively low environmental concentrations in New York, the researchers said (Cancer Epidemiol. Biomarkers Prev. 2005;14:506-11).

KEVIN FOLEY, RESEARCH/ANGIE RIES, DESIGN

KEVIN FOLEY, RESEARCH/ANGIE RIES, DESIGN

KEVIN FOLEY, RESEARCH/ANGIE RIES, DESIGN

RENO, NEV. — Preterm twins conceived through assisted reproductive techniques are more likely than twins conceived naturally to have respiratory distress syndrome and patent ductus arteriosus at delivery, investigators reported in a poster presentation at the annual meeting of the Society for Maternal-Fetal Medicine.

Nils Stenman, M.D., of the University of Pennsylvania, Philadelphia, and his colleagues compared neonatal outcomes of 238 preterm twins conceived using assisted reproductive techniques (ART) with those of 718 preterm twins that were naturally conceived. All twins were born at 24-35 weeks' gestation at one hospital over a 5-year period.

Mean birth weight and mean gestational age at delivery were the same for both groups of twins, as were rates of sepsis, necrotizing enterocolitis, intraventricular hemorrhage rates, and neonatal mortality.

However, the ART-conceived twins had a higher incidence of respiratory distress syndrome (70% versus 45%) and patent ductus arteriosus (63% versus 38%).

Mothers of the ART-conceived twins were more likely to be older, nulliparous, and white. However, there is no explanation for why the ART-conceived neonates would have a higher incidence of respiratory distress syndrome or patent ductus arteriosus, the researchers said.

A recent metaanalysis of studies of neonatal outcome in ART concluded that while singleton neonates conceived with ART tend to be born earlier and with lower birth weight and have worse outcomes, the same is not true for twins (BMJ [online] 2004;328:261). The studies in the analysis tended not to look as specifically at different neonatal outcomes in preterm twins as did the current study, or they looked at different outcomes, Dr. Stenman and colleagues said.

The neonatal mortality in the current study was 2% for both groups of twins.

RENO, NEV. — Preterm twins conceived through assisted reproductive techniques are more likely than twins conceived naturally to have respiratory distress syndrome and patent ductus arteriosus at delivery, investigators reported in a poster presentation at the annual meeting of the Society for Maternal-Fetal Medicine.

Nils Stenman, M.D., of the University of Pennsylvania, Philadelphia, and his colleagues compared neonatal outcomes of 238 preterm twins conceived using assisted reproductive techniques (ART) with those of 718 preterm twins that were naturally conceived. All twins were born at 24-35 weeks' gestation at one hospital over a 5-year period.

Mean birth weight and mean gestational age at delivery were the same for both groups of twins, as were rates of sepsis, necrotizing enterocolitis, intraventricular hemorrhage rates, and neonatal mortality.

However, the ART-conceived twins had a higher incidence of respiratory distress syndrome (70% versus 45%) and patent ductus arteriosus (63% versus 38%).

Mothers of the ART-conceived twins were more likely to be older, nulliparous, and white. However, there is no explanation for why the ART-conceived neonates would have a higher incidence of respiratory distress syndrome or patent ductus arteriosus, the researchers said.

A recent metaanalysis of studies of neonatal outcome in ART concluded that while singleton neonates conceived with ART tend to be born earlier and with lower birth weight and have worse outcomes, the same is not true for twins (BMJ [online] 2004;328:261). The studies in the analysis tended not to look as specifically at different neonatal outcomes in preterm twins as did the current study, or they looked at different outcomes, Dr. Stenman and colleagues said.

The neonatal mortality in the current study was 2% for both groups of twins.

RENO, NEV. — Preterm twins conceived through assisted reproductive techniques are more likely than twins conceived naturally to have respiratory distress syndrome and patent ductus arteriosus at delivery, investigators reported in a poster presentation at the annual meeting of the Society for Maternal-Fetal Medicine.

Nils Stenman, M.D., of the University of Pennsylvania, Philadelphia, and his colleagues compared neonatal outcomes of 238 preterm twins conceived using assisted reproductive techniques (ART) with those of 718 preterm twins that were naturally conceived. All twins were born at 24-35 weeks' gestation at one hospital over a 5-year period.

Mean birth weight and mean gestational age at delivery were the same for both groups of twins, as were rates of sepsis, necrotizing enterocolitis, intraventricular hemorrhage rates, and neonatal mortality.

However, the ART-conceived twins had a higher incidence of respiratory distress syndrome (70% versus 45%) and patent ductus arteriosus (63% versus 38%).

Mothers of the ART-conceived twins were more likely to be older, nulliparous, and white. However, there is no explanation for why the ART-conceived neonates would have a higher incidence of respiratory distress syndrome or patent ductus arteriosus, the researchers said.

A recent metaanalysis of studies of neonatal outcome in ART concluded that while singleton neonates conceived with ART tend to be born earlier and with lower birth weight and have worse outcomes, the same is not true for twins (BMJ [online] 2004;328:261). The studies in the analysis tended not to look as specifically at different neonatal outcomes in preterm twins as did the current study, or they looked at different outcomes, Dr. Stenman and colleagues said.

The neonatal mortality in the current study was 2% for both groups of twins.