Medicine and Health Sciences Commons^™

Gestational Trophoblastic Diseases: 1. Pathophysiology Of Hyperglycosylated Hcg, L. Cole, Donghai Dai, S. Butler, Kimberly Leslie, E. Kohorn

Kimberly K. Leslie

OBJECTIVE: Hyperglycosylated hCG (hCG-H) is a glycosylation variant of hCG produced by cytotrophoblast cells at implantation of pregnancy and in choriocarcinoma. We investigated the biological function of hCG-H in invasion in vitro and in vivo and the use of hCG-H antibodies in blocking tumorigenesis and cancer growth in vivo. METHODS AND RESULTS: hCG-H accounts for 43% to 100% of total hCG immunoreactivity in the culture fluid of choriocarcinoma cell lines and 100% in primary cultures of pregnancy cytotrophoblast cells. We investigated the action of hCG and hCG-H on isolated cytotrophoblast cell primary cultures and on 3 different lines of choriocarcinoma …

Chronic Intrauterine Infection And Inflammation In The Preterm Rabbit, Despite Antibiotic Therapy, R. Gibbs, J. Davies, R. Mcduffie, Kimberly Leslie, M. Sherman, C. Centretto, D. Wolf

Kimberly K. Leslie

OBJECTIVE: In a pregnant rabbit model using intracervical inoculation of Escherichia coli with delayed antibiotic therapy, we investigated the rate of positive cultures and histologic inflammation of maternal and fetal compartments and the concentration of tumor necrosis factor-alpha in the amniotic fluid for up to 5 days. STUDY DESIGN: New Zealand White rabbits at 70% gestation were inoculated intracervically with 10(3) - 10(4) colony-forming units of E coli per uterine horn. At varying intervals after inoculation (0.5 - 4.0 hours), antibiotic therapy was initiated with ampicillin-sulbactam. Primary outcomes were positive cultures and histologic inflammation score. Tumor necrosis factor-alpha levels in …

An Exploratory Study Of The Variables Impacting Preterm Birth Rates In New Mexico, K. Gwin, R. Schrader, K. Peters, A. Moreno, K. Thiel, Kimberly Leslie

Kimberly K. Leslie

BACKGROUND: Preterm birth (PTB) is a substantial health problem that accounts for significant infant morbidity and mortality and poses an economic burden to both individuals and the state of residence. The goal of this study was to identify maternal risk factors for PTB in New Mexico, a poor state with a unique ethnic background, in order to identify populations at increased risk that would benefit from intervention. METHODS: This was a cross-sectional retrospective exploratory analysis of 377,770 singleton live births in the state of New Mexico from 1991-2005. Gestational age of less than 37 weeks was defined as PTB. The …

Breast Cancer And Pregnancy, Kimberly Leslie, C. Lange

Kimberly K. Leslie

This article addresses a challenging diagnostic and treatment dilemma encountered in the care of pregnant women-breast cancer. The treatment of a breast cancer is significantly affected by an ongoing pregnancy and may result in an increased risk for a poor outcome in the mother. The definition, incidence, mechanism, diagnosis, and treatment of breast cancer associated with pregnancy and the normal physiologic and endocrine changes in the breast during pregnancy that contribute to the difficulty encountered by practitioners in diagnosing and treating the disorder are reviewed. The risks associated with pregnancy after breast cancer treatment and the effect of pregnancy on …

Chemotherapeutic Drugs In Pregnancy, Kimberly Leslie, C. Koil, W. Rayburn

Kimberly K. Leslie

Chemotherapy may be indicated for the treatment of cancer during pregnancy. The decision to use chemotherapy significantly impacts the pregnancy, and in turn the pregnancy may affect the treatment options available to patients with cancer. This review provides information about the effects of chemotherapeutic agents in pregnancy, taking into account both the mother and the fetus. For convenience, the agents are divided into categories based upon class and mechanism of action. These include alkylating agents, antimetabolites, nucleoside analogs, topoisomerase I inhibitors, topisomerase II inhibitors, vinca alkaloids, taxanes, and biologics such as signaling and growth factor blocking agents.

Chronic Hepatitis C In Pregnancy, E. Berkley, Kimberly Leslie, S. Arora, C. Qualls, J. Dunkelberg

Kimberly K. Leslie

OBJECTIVE: To estimate outcomes, to determine whether appropriate follow-up was performed for pregnant patients with hepatitis C virus (HCV), and to show that maternal and neonatal complications would be higher in the HCV-positive group. METHODS: We compared pregnant women from a drug dependence and treatment program who were HCV antibody-positive with those who were HCV antibody-negative using the University of New Mexico Perinatal Database. Maternal and neonatal outcomes were evaluated, including cholestasis of pregnancy, preterm birth, low birth weight, neonatal intensive care unit admissions, and neonatal methadone withdrawal. Variables were compared using Student t, Fisher exact, and chi(2) tests. RESULTS: …

Initial Multicenter Experience With Double Nucleoside Therapy For Human Immunodeficiency Virus Infection During Pregnancy, Neal S. Silverman, D. Heather Watts, Joseph Hitti, D. M. Money, E. Livingston, J. Axelrod, J. M. Ernest, Douglas Robbins, M. M. Divito

Neal Silverman

OBJECTIVE: To study maternal and neonatal effects of combination nucleoside analog therapy administered to human immunodeficiency virus (HIV)-infected pregnant women for maternal indications. METHODS: A multicenter, prospective observational study was undertaken at six perinatal centers in the United States and Canada that supported regional referral programs for the treatment of HIV-infected pregnant women. Demographic, laboratory, and pregnancy outcome data were collected for 39 women whose antiretroviral treatment regimens were expanded to include more than one nucleoside analog for maternal indications. The 40 newborns were monitored at pediatric referral centers through at least three months of age to ascertain their HIV …

A Randomized Controlled Trial Investigating The Effects Of A Low-Glycemic Index Diet On Pregnancy Outcomes In Gestational Diabetes Mellitus, Jennie Brand-Miller, Jimmy Chun Yu Louie, Peter Petocz, Tania Markovic, Nimalie Perera, Deborah Foote, Glynis Ross

Jimmy Chun Yu Louie

OBJECTIVE: The prevalence of gestational diabetes mellitus (GDM) is rising. There is little evidence to demonstrate the effectiveness of one dietary therapy over another. We aimed to investigate the effect of a low-glycemic index (LGI) versus a conventional high-fiber diet on pregnancy outcomes, neonatal anthropometry, and maternal metabolic profile in GDM.RESEARCH DESIGN AND METHODS: Ninety-nine women (age 26-42 years; mean ± SD prepregnancy BMI 24 ± 5 kg/m²) diagnosed with GDM at 20-32 weeks' gestation were randomized to follow either an LGI (n = 50; target glycemic index [GI] ~50) or a high-fiber moderate-GI diet (HF) (n = 49; target …

Glycemic Index And Pregnancy: A Systematic Literature Review, Jimmy Chun Yu Louie, Jennie C. Brand-Miller, Tania P. Markovic, Glynis P. Ross, Robert G. Moses

Jimmy Chun Yu Louie

Background/Aim. Dietary glycemic index (GI) has received considerable research interest over the past 25 years although its application to pregnancy outcomes is more recent. This paper critically evaluates the current evidence regarding the effect of dietary GI on maternal and fetal nutrition. Methods. A systematic literature search using MEDLINE, EMBASE, CINAHL, Cochrane Library, SCOPUS, and ISI Web of Science, from 1980 through September 2010, was conducted. Results. Eight studies were included in the systematic review. Two interventional studies suggest that a low-GI diet can reduce the risk of large-for-gestational-age (LGA) infants in healthy pregnancies, but one epidemiological study reported an …

Maternal Concentrations Of Polyfluoroalkyl Compounds During Pregnancy And Fetal And Postnatal Growth In British Girls, Mildred Maisonet, Metrecia L. Terrell, Michael A. Mcgeehin, Krista Yorita Christensen, Adrianne Holmes, Antonia M. Calafat, Michele Marcus

Mildred Maisonet

Population-Based Placental Weight Ratio Distributions And Determinants Of Placental Weight Ratios, Erin M. Macdonald

Erin M Macdonald

The placental weight ratio (PWR) is a common proxy for the balance between fetal and placental growth, and is defined as the placental weight over the birth weight. The objectives were (1a) to establish PWR distributions by gestational age for the overall population and (1b) for small, average and large for gestational age infants (SGA, AGA, LGA) and (2) to determine what pregnancy related conditions were associated with the PWR. The data were obtained using a hospital based retrospective cohort. Nonparametric quantile regression was used for the first and multinomial logistic regression for the second objective. The results show how …

The Effect Of A Low Glycemic Index Diet During Pregnancy On Obstetric Outcomes, Robert G. Moses, M J. Luebcke, Warren S. Davis, K J. Coleman, Linda C. Tapsell, Peter Petocz, Jennie C. Brand-Miller

L. C. Tapsell

Abstract presented at The 2006 Annual Scientific Meeting of the Nutrition Society of Australia, 29 November - 2 December, Sydney, Australia

State Policies And Programs That Address The Needs Of Mentally Ill Mothers In The Public Sector, Joanne Nicholson, Jeffrey Geller, William Fisher, George Dion

Joanne Nicholson

OBJECTIVE: The authors sought to determine whether state departments of mental health have specific policies and programs addressing the needs of mentally ill women served in the public sector who have preschool-age children. METHODS: A questionnaire was sent to the commissioner of mental health for each state and the District of Columbia. Questions addressed whether information was routinely collected on the parenting status of women who receive public-sector psychiatric services, whether services targeting mentally ill women with young children were available, and whether the state had policies concerning hospitalized women who are pregnant or who have young children. RESULTS: Sixteen …

"Sylvia Frumkin" Has A Baby: A Case Study For Policymakers, Joanne Nicholson, Jeffrey Geller, William Fisher

Joanne Nicholson

"Sylvia Frumkin" was a pseudonym given to a 32-year-old woman with chronic mental illness described by Susan Sheehan in her books Is There No Place on Earth for Me? This paper presents the case of "Gloria Morrison," a patient similar to Ms. Frumkin, who is also a mother. Issues raised by the case in three areas are discussed. Issues for the service delivery system include developing better assessment, prediction, and reduction of the risk that a parent's mental illness may pose to a child's safety and well-being; targeting supportive and educational interventions to relatives and foster parents caring for children …

Acculturation And Gestational Weight Gain In A Predominantly Puerto Rican Population, Alison Tovar, Lisa Chasan-Taber, Odilia I. Bermudez, Raymond R. Hyatt, Aviva Must

Lisa Chasan-Taber

Background Identifying risk factors that affect excess weight gain during pregnancy is critical, especially among women who are at a higher risk for obesity. The goal of this study was to determine if acculturation, a possible risk factor, was associated with gestational weight gain in a predominantly Puerto Rican population. Methods We utilized data from Proyecto Buena Salud, a prospective cohort study of Hispanic women in Western Massachusetts, United States. Height, weight and gestational age were abstracted from medical records among participants with full-term pregnancies (n=952). Gestational weight gain was calculated as the difference between delivery and prepregnancy weight. Acculturation …

Acculturation And Gestational Weight Gain In A Predominantly Puerto Rican Population, Alison Tovar, Lisa Chasan-Taber, Odilia I. Bermudez, Raymond R. Hyatt, Aviva Must

Alison Tovar

Background Identifying risk factors that affect excess weight gain during pregnancy is critical, especially among women who are at a higher risk for obesity. The goal of this study was to determine if acculturation, a possible risk factor, was associated with gestational weight gain in a predominantly Puerto Rican population. Methods We utilized data from Proyecto Buena Salud, a prospective cohort study of Hispanic women in Western Massachusetts, United States. Height, weight and gestational age were abstracted from medical records among participants with full-term pregnancies (n=952). Gestational weight gain was calculated as the difference between delivery and prepregnancy weight. Acculturation …

Improving Prenatal Education In A Health Center: A Pilot Study, Marcy Keddy Boucher, Hugh Silk, Judith A. Savageau, Katharine C. Barnard, Mary Flynn

Judith A. Savageau

Background: Currently, the timing and variety of health education topics that are covered during prenatal visits are decided upon by the individual physician caring for the patient. Consequently, some patients do not gain exposure to important subject matter that could potentially improve their satisfaction and pregnancy outcomes. Previously reported studies have found evidence that improved patient education may increase rates of breastfeeding (as well as duration), seat belt use during pregnancy, and decrease preterm low birth weight infants. In addition, one study has shown that when prenatal visits are targeted to specific objectives, the number of prenatal visits can …

Fatigue In Postpartum Women, Diane Gardner

Diane Huber

Childbirth and the responsibilities of parenting after birth require a great deal of energy. Fatigue in postpartum women is a concern for maternal-child nurses because of the impact on the health and parenting ability of the mother. To determine fatigue levels and types, 35 women who vaginally delivered were surveyed at 2 days, 2 weeks, and 6 weeks postpartum. This sample was found to be mildly fatigued, with situational and/or psychological fatigue. Nurses can intervene by assessing postpartum fatigue and using teaching/counseling methods for knowledge preparation and for clients at risk.

Excellence In Nursing: An Adolescent Parenting Program, Diane Gardner

Diane Huber

No abstract provided.

Early- And Late-Onset Group B Streptococcal Infections: Overview And Case Studies, Rebecca Siewert, D. Holida

Rebecca Siewert

Infants that are admitted and cared for in the neonatal intensive care unit are at risk for sepsis. Group B Streptococcus (GBS) is the most common cause of neonatal sepsis and meningitis. Group B Streptococcus is classified into early- and late-onset sepsis. With early onset, infants develop symptoms within 7 days of birth. With late onset, they develop symptoms between 7 days and 3 months of life. Prompt identification and treatment of suspected septic infants are crucial. Infants who develop early- or late-onset GBS sepsis are at risk for sequelae ranging from normal physiologic outcome to devastating long-term conditions and …

Psychometric Properties Of The Beginning Breastfeeding Survey, Pamela Mulder

Pamela J. Mulder

The Beginning Breastfeeding Survey is a reliable and valid measure of breastfeeding effectiveness during the postpartum hospitalization. Providing an accurate assessment of a mother's perception of breastfeeding effectiveness, the Beginning Breastfeeding Survey will guide targeted interventions to increase breastfeeding effectiveness and duration.

The Beginning Breastfeeding Survey: Measuring Mothers' Perceptions Of Breastfeeding Effectiveness During The Postpartum Hospitalization, Pamela Mulder, T. Johnson

Pamela J. Mulder

No current breastfeeding assessment tool assesses the mother's perception of breastfeeding effectiveness during the early postpartum. Psychometric analysis of a new tool, the Beginning Breastfeeding Survey (BBS), in a multi-racial sample of 131 women revealed a coefficient alpha of .90. Factor analysis yielded three factors, (a) Maternal Breastfeeding Competence and Emotional Satisfaction, (b) Maternal Discomfort and Anxiety, and (c) Infant Breastfeeding Skill and Emotional Satisfaction. The BBS demonstrated discriminant validity in known group analyses and convergent validity with breastfeeding self-efficacy and postpartum fatigue. Future research will focus on improving the internal consistency reliability of the BBS and examining its ability …

Fetal Alcohol Syndrome: A Review And Case Presentation, E. Lindor, Ann Mccarthy, M. Mcrae

Ann Marie McCarthy

No abstract provided.

Candidate Genes For Nonsyndromic Cleft Lip And Palate And Maternal Cigarette Smoking And Alcohol Consumption: Evaluation Of Genotype-Environment Interactions From A Population-Based Case-Control Study Of Orofacial Clefts, P. Romitti, A. Lidral, R. Munger, Sandra Daack-Hirsch, T. Burns, J. Murray

Sandra Daack-Hirsch

Previous studies suggest that the relationship between genes and nonsyndromic cleft lip +/- cleft palate (CLP) or cleft palate only (CP) may be modified by the environment. Using data from a population-based case-control study, we examined allelic variants for three genes, i.e., transforming growth factor alpha (TGFA), transforming growth factor beta 3 (TGFB3), and Msh (Drosophila) homeobox homolog 1 (MSX1), and their interactions with two exposures during pregnancy (maternal cigarette smoking and alcohol consumption) as risk factors for CLP and CP. For each cleft phenotype, risk estimates associated with most allelic variants tended to be near unity. Risk estimates for …

Maternal Alcohol Use And Risk Of Orofacial Cleft Birth Defects, R. Munger, P. Romitti, Sandra Daack-Hirsch, T. Burns, J. Murray, J. Hanson

Sandra Daack-Hirsch

Maternal alcohol use during pregnancy is a known cause of birth defects associated with the fetal alcohol syndrome, but its role in more common, isolated, craniofacial birth defects is not well understood. A population-based, case-control study of orofacial clefts was conducted in Iowa using births during 1987-1991. Cases were identified by the Iowa Birth Defects Registry and classified as having a cleft lip with or without cleft palate (CLP) or cleft palate only (CP) and whether the cleft was isolated or occurred with other birth defects. Controls were selected from normal Iowa births. Maternal alcohol use during pregnancy was classified …

Feasibility And Efficacy Of A Physical Activity Intervention Among Pregnant Women: The Behaviors Affecting Baby And You (B.A.B.Y.) Study, Lisa Chasan-Taber, Marushka Silveira, Bess H. Marcus, Barry Braun, Edward Stanek, Glenn Markenson

Lisa Chasan-Taber

Background: Physical activity during pregnancy is associated with reduced risk of adverse maternal and fetal outcomes. However, the majority of pregnant women are inactive and interventions designed to increase exercise during pregnancy are sparse. We evaluated the feasibility and preliminary efficacy of an exercise intervention among a diverse sample of pregnant women. Methods: The B.A.B.Y. (Behaviors Affecting Baby and You) Study is conducted at a large tertiary care facility in Western Massachusetts. We randomized 110 prenatal care patients (60% Hispanic) to an individually tailored 12-week exercise intervention arm (n = 58) or to a health and wellness control arm (n …

A Longitudinal Study Of The Effect Of Pregnancy On Rising To Stand From A Chair, Wendy L. Gilleard, Jack Crosbie, Richard Smith

Wendy L Gilleard

Rising to stand from a chair becomes more difficult to perform as pregnancy progresses, which may lead to altered biomechanics affecting the musculoskeletal demands on the body segments. The kinematic and kinetic adaptations in the lower limbs and trunk as pregnancy progresses are unknown. Nine maternal subjects were investigated using an eight-camera motion analysis system and two force plates, four times throughout pregnancy and once post-birth during rising to stand. Twelve nulliparous female subjects were used to establish natural variation with retesting over the time period. The maternal subjects used temporal–spatial, kinematic and kinetic strategies to widen the base of …