Differences In Maternal Demographics Research Articles

Anthropometric estimation of maternal body composition in late gestation

Objective: To construct a model to estimate maternal body composition in late gestation using anthropometric measurements. Methods: Twenty healthy pregnant women at 30 weeks’ gestation had estimates of body composition using hydrodensitometry, with corrections for residual lung volume, and total body water using H 2 18O (development group). Total body water was estimated from 18O abundances measured by gas-isotope-ratio mass spectrometry. Maternal age, height, weight, and seven skinfold sites were correlated with fat mass using stepwise regression analysis. The anthropometric model to estimate fat mass was then tested prospectively in a second group of 20 subjects and correlated with underwater weighing and total body water measurements (validation group). Statistical analysis used χ 2, paired t and Wilcoxon sign-rank tests. Results: There were no statistically significant differences in maternal demographics between groups. The fat mass of development group subjects using underwater weighing and total body water was 22.7 ± 7.6 kg. Using the development group, a model was derived that explained 91% of the variance in fat mass by underwater weighing and total body water using maternal weight and triceps, subscapular, and suprailiac skinfolds ( r 2 = 0.91, P < .001). When tested prospectively in the validation group, the correlation remained statistically significant ( r 2 = 0.89, P < .001). There was no statistically significant ( P = .88) difference between the anthropometric estimates of fat mass and underwater weighing and total body water measurements (95% confidence interval −2.476, 2.748 kg of fat mass). Conclusion: This anthropometric model can be used to predict maternal fat mass in late gestation.

Thoracic-Fluid Conductivity in Peripartum Women With Pulmonary Edema

In Brief Objective To measure the level of thoracic-fluid conductivity associated with pulmonary edema in peripartum women by noninvasive thoracic electrical bioimpedance. Methods Between March 1994 and August 1996, 134 women were selected for thoracic electrical bioimpedance monitoring. Among them, 12 had pulmonary edema, 33 had severe preeclampsia, 17 had mild preeclampsia, and 72 were in uncomplicated early labor. Each subject's highest thoracic-fluid conductivity measurement was related to her clinical presentation. The Kruskal-Wallis one-way analysis of variance was used to compare groups' means. A receiver operating characteristic curve was used to identify thoracic-fluid conductivity values associated with pulmonary edema. Results Pulmonary edema was associated with severe preeclampsia in ten cases, urosepsis in one case, and postoperative volume overload in one case. Other than gestational age, there were no significant differences in maternal demographics between groups. Thoracic-fluid conductivity values in women with pulmonary edema (80.6 ± 18.3 kohm−1) were significantly higher than those in women with severe preeclampsia (62.8 ± 16.3 kohm−1), mild preeclampsia (53.3 ± 11.2 kohm−1), or early labor (41.3 ± 6.7 kohm−1). Thoracic-fluid conductivity of at least 65 kohm−1 best identified pulmonary edema (sensitivity 83.3%; specificity 86.9%; positive predictive value 38.5%; negative predictive value 98.1%). Conclusion Preeclampsia was associated with increased thoracic-fluid conductivity stratified between mild and severe disease. Thoracic-fluid conductivity of at least 65 kohm−1 was strongly associated with peripartum pulmonary edema. Women with values above 65 kohm−1 might be candidates for medical intervention even without overt clinical symptoms. Thoracic-fluid conductivity of at least 65 kohm−1 measured by noninvasive thoracic electrical bioimpedance is associated with peripartum pulmonary edema.

Thoracic-fluid conductivity in peripartum women with pulmonary edema

Objective: To measure the level of thoracic-fluid conductivity associated with pulmonary edema in peripartum women by noninvasive thoracic electrical bioimpedance. Methods: Between March 1994 and August 1996, 134 women were selected for thoracic electrical bioimpedance monitoring. Among them, 12 had pulmonary edema, 33 had severe preeclampsia, 17 had mild preeclampsia, and 72 were in uncomplicated early labor. Each subject’s highest thoracic-fluid conductivity measurement was related to her clinical presentation. The Kruskal-Wallis one-way analysis of variance was used to compare groups’ means. A receiver operating characteristic curve was used to identify thoracic-fluid conductivity values associated with pulmonary edema. Results: Pulmonary edema was associated with severe preeclampsia in ten cases, urosepsis in one case, and postoperative volume overload in one case. Other than gestational age, there were no significant differences in maternal demographics between groups. Thoracic-fluid conductivity values in women with pulmonary edema (80.6 ± 18.3 kohm −1) were significantly higher than those in women with severe preeclampsia (62.8 ± 16.3 kohm −1), mild preeclampsia (53.3 ± 11.2 kohm −1), or early labor (41.3 ± 6.7 kohm −1). Thoracic-fluid conductivity of at least 65 kohm −1 best identified pulmonary edema (sensitivity 83.3%; specificity 86.9%; positive predictive value 38.5%; negative predictive value 98.1%). Conclusion: Preeclampsia was associated with increased thoracic-fluid conductivity stratified between mild and severe disease. Thoracic-fluid conductivity of at least 65 kohm −1 was strongly associated with peripartum pulmonary edema. Women with values above 65 kohm −1 might be candidates for medical intervention even without overt clinical symptoms.

Lack of prenatal care increases the rate of recurrent preterm delivery and health care costs when compared to university hospital-based prenatal care

Objective: To compare perinatal outcomes and total health care costs for patients with a previous history of preterm delivery (PTD) cared for in an inner-city university hospital house staff (HS) clinic vs pregnant patients who have not received any prenatal care (NPC). Study Design: We conducted a retrospective review of pregnant women with a history of PTD delivered at our institution between January 1994 and December 1996. Inclusion criteria were a history of at least one previous PTD. Prenatal care was given in a comprehensive setting in a teaching hospital. Exclusion criteria were infants with major malformations and multiple gestations. Data were obtained on maternal demographics and history of prenatal visits. Results: The study groups consisted of 96 HS and 53 NPC patients. There were no differences in maternal demographics, however, the number of prior preterm births was greater in the NPC group (1.59 vs 1.23, P = .003). The incidence of recurrent PTD (<34 weeks) was greater in the NPC group (49% vs 13%, P = <.001). The mean gestational age at time of delivery was decreased in the NPC group (33 weeks vs 37.2 weeks, P = <.001). The length of NICU stay was greater in the NPC group (15.6 vs 3.1 days, P = .001). The mean birth weight was less in the NPC group (2172 g vs 2786 g, P = <.001). The mean total mother-infant costs were significantly less in the HS group ($7,127 vs $18,047, P = .003). Even HS patients with only one prenatal visit had a significantly lower incidence of PTD (16% vs 75%, P = .04). Conclusions: Inner-city patients with a history of PTD who received even minimal prenatal care in a university HS clinic had a significantly lower incidence of recurrent PTD than those who had no prenatal care. Prenatal care also lowers total health care costs in women with a history of PTD. The coordinated multidisciplinary aspect of care provided at academic centers may have a positive impact on the problem of PTD.

Neonatal Predictors of Infection Status and Early Death Among 332 Infants at Risk of HIV-1 Infection Monitored Prospectively From Birth

Background and Methods. Differences in newborn outcome measures for human immunodeficiency virus (HIV)-1-infected and HIV-1-exposed but uninfected infants have been found in several studies, but not in others. Eighty-four infected and 248 uninfected children born to HIV-1-seropositive mothers followed prospectively in a multicenter, perinatal HIV-1 transmission cohort study were compared for differences in maternal demographics, health status, and newborn outcome measures, including delivery complications, physical examination findings, neonatal complications, and laboratory results. Results. Mothers of HIV-1-infected infants were more likely than those of uninfected infants to have acquired immunodeficiency syndrome (AIDS) diagnosed through 2 weeks postpartum (21% vs 11%, P = .04); the transmission rate for the 38 women with AIDS was 37% compared with 22% for the 245 women without AIDS. Two of 27 (7%) women receiving zidovudine during pregnancy had infected infants compared with 73 (27%) of 275 women who did not receive zidovudine (P = .033). Mean gestational age was significantly lower among HIV-1-infected (37 weeks) than among uninfected infants (38 weeks; P &amp;lt; .001). Infected infants had significantly higher rates of prematurity (gestational age less than 37 weeks) (33% vs 19%, P = .01) and extreme prematurity (gestational age less than 34 weeks) (18% vs 6%, P = .001) than uninfected infants. Infection was associated with lower birth weight (2533 g vs 2862 g, P &amp;lt; .001) and smaller head circumference (32.0 cm vs 33.1 cm, P = .001). HIV-1-infected infants were significantly more likely to be small for gestational age (26% vs 16%, P = .04) and low birth weight (less than 2500 g) (45% vs 29%, P = .006) than infants who were uninfected. Twenty-two (26%) HIV-1-infected children died during a median follow-up of 27.6 months (range 1.9 to 98.3 months). Prematurity was predictive of survival: by Kaplan-Meier, an estimated 55% (95% confidence interval, 31% to 72%) of preterm infected children survived to 24 months compared with 84% (95% confidence interval, 70% to 92%) of full-term infected children (P = .005). Conclusion. Infants born to women with AIDS are at higher risk for HIV-1 infection than are infants born to HIV-1-infected women with AIDS not yet diagnosed. Women receiving zidovudine appear less likely to transmit HIV-1 to their infants. Significantly higher rates of prematurity and intrauterine growth retardation were found among HIV-1-infected infants than among those in the uninfected, HIV-1-exposed control group. Prematurity was associated with shortened survival in HIV-1-infected infants. Measures of intrauterine growth and gestation appear to be important predictors of HIV-1 infection status for seropositive infants and of prognosis for the infected infant.