Pregnancy Gestational Age Research Articles

Previous obstetric history and cervical legth in pregnancy

The cervical length is a predictor of premature delivery or abortion. In order to detect the risks of such complications, it is necessary to establish the factors affecting the length of the cervix. A transversal prospective study was carried out in a sample of 579 pregnant women with low risk, singleton pregnancies of various gestational ages. Cervical length was measured by transvaginal ultrasound as part of routine pregnancy monitoring. At the same time, data on previous first-trimester or mid-trimester abortions, as well as on premature deliveries and term deliveries, were collected and taken into consideration. The cervical length in primiparous women was not statistically significantly longer than in women with a previous pregnancy, except during the second trimester, (primiparous women: 33.8 mm, women with a previous pregnancy: 35.8 mm). Bearing in mind the empirical facts that the cervix in primiparous women, since intact, is significantly longer, the above mentioned findings cannot be easily explained. The cervix in women with a previous vaginal delivery was statistically significantly longer (35.6 mm) than in women with no vaginal delivery (34.09) (p = 0.011). In women with previous abortions of any kind, the cervical length was 34.2 mm. The cervical length in women without previous abortions was 34.7 mm, and there were no significant differences. Moreover, no statistically significant differences were established in women with or without previous abortions, regardless of the type. Taking into consideration the data from previous obstetric histories, the results of our study indicate that cervices of women.

Fetal lung development in pregnancies of diabetic women assessed by quantitative ultrasonic tissue characterization

This study was performed to compare quantitative ultrasonic tissue characterization of the fetal lung at different gestational ages in uncontrolled diabetic patients with that in normal uncomplicated pregnancies. A total of 44 women at 24-37 weeks' gestation with the diagnosis of diabetes in pregnancy were enrolled. Data were compared to those of the control group, which consisted of 140 women with uncomplicated pregnancies of the same gestational age. Longitudinal and transverse sections of the fetal thorax and upper abdomen were examined. A region of interest of constant size was defined and the tissue-specific gray scale was determined by using interactive software. Compared with normal pregnancies, fetal lungs of diabetic pregnancies have a higher echogenicity between 28 and 37 weeks of gestation. The lung mean gray values (MGV) only differed significantly between 30 and 31 weeks of gestation in the group with diabetes (P = 0.033) compared to the control group. The MGV of the liver in diabetic and normal pregnancies is similar during pregnancy, significant differences being found only at 30-31 weeks of gestation (P = 0.038). The lung-to-liver ratio in the control group showed a significant increase from 24 to 31 weeks and a slight non-significant decrease after 31 weeks. The ratio in the group with diabetes increased slightly up to week 33 and decreased slightly afterwards. Fetal lung MGV in uncontrolled diabetic pregnancies compared to that in uncomplicated pregnancies differs significantly only between 30 and 31 weeks of gestation.

Effect of vaginal metronidazole + miconazole treatment during pregnancy for gestational age and birth weight in a population-based study

The objective of the study was to check the effect of the combination of metronidazole and miconazole (M+M) for the prevention of sexually transmitted infections/disorders related preterm delivery/birth. Antiprotozoal vaginal metronidazole was not able to prevent preterm birth, while the antifungal topical miconazole use showed some reduction in preterm birth in our previous studies. The population-based large control (without any defects) data set of the Hungarian Case-Control Surveillance System of Congenital Abnormalities was used for the evaluation of the combination of M+M for birth outcomes. Of 38,151 controls, 846 (2.2%) had treatment with vaginal tablet of M+M for vaginal infections. The prevalence of preterm birth was 9.5% after this treatment compared with the 9.2% of preterm birth in the untreated group. Thus the combination of M+M was not able to reduce the preterm birth associated with vulvovaginal infections/disorders.

Noninvasive diagnosis of fetal anemia in RH-alloimmunized pregnancies by color Doppler

INTRODUCTION Fetal anemia is usually diagnosed by invasive procedures, such as amniocentesis and cordocentesis. As these procedures carry a substantial risk for pregnancy loss, a nonivasive method for diagnosing fetal anemia is needed. Doppler allows measurement of blood flow velocity in fetal vessels. In anemic fetuses increased velocities in medial cerebral artery (MCA) are registered. The aim of our study was to evaluate if there were changes in blood flow waveforms in anemic fetuses' MCA, and if these changes correlated with values of fetal hematological parameters. A clinical study evaluated 172 pregnancies of gestational age between 28 and 32 weeks, in which cordocentesis was performed due to maternal Rh-alloimmunization. During sonographic examination we evaluated blood flow velocities and pulsatility index (Pi) in MCA. We registered hematological parameters such as hemoglobin and hematocrit. Based on hemoglobin levels, all fetuses were divided into four groups: nonanemic (140 g/l); mild anemia (120-139.9 g/l); moderate anemia (100-119.9 g/l) and severe anemia requiring intrauterine transfusion (99.9 g/l). We compared mean systolic velocities and Pi between groups and studied the correlation between MCA mean systolic velocities and hemoglobin and hematocrit values. Statistical analysis was done using ANOVA test and parameter linear correlation. The difference was considered to be significant if p < 0. 05. Out of 172 fetuses, 60 (34.09%) were nonanemic, 56 (31.82%) showed mild anemia, 56 (31.82%) moderate anemia and 24 (13.64%) fetuses had severe anemia. Anemic fetuses had significantly higher MCA flow velocities compared to nonanemic fetuses. Values of Pi decreased in severe forms of fetal anemia, but the difference wasn't significant. Levels of hemoglobin and hematocrit showed inverse correlation with the values of MCA mean systolic velocities, while correlation with the values of Pi wasn't observed. Cerebral blood flow velocity in medial cerebral artery was assessed to diagnose fetal anemia. MCA mean systolic velocity is increased in anemic fetuses and correlates with the degree of anemia. The main advantage of this parameter is that advanced software programs are not necessary. We can conclude that in cases of Rh-alloimmunization in anemic fetuses increased MCA mean systolic velocities are registered. There is an inverse correlation between MCA mean systolic velocities and hemoglobin and hematocrit values. We suggest that measurements of MCA mean systolic velocities should be used in fetuses at risk for anemia and in selection of fetuses requiring invasive procedures.

Ethnicity and birth outcome: New Zealand trends 1980–2001: Part 2. Pregnancy outcomes for Maori women

While traditionally Maori perinatal mortality has been similar to that of other ethnic groups, rates of preterm birth, small for gestational age (SGA) and teenage pregnancy have remained high. To review current trends in preterm birth, SGA and teenage pregnancy for Maori during 1980-2001 and to highlight the major factors that have influenced Maori reproductive outcomes during this period. De-identified birth registration data from 1 189 120 singleton live births and 5775 stillbirths were analysed for 1980-2001. Outcomes of interest included preterm birth, SGA and late fetal death while explanatory variables included maternal ethnicity, age and NZ Deprivation Index decile. Trend analysis was undertaken for 1980-1994 and multivariate logistic regression was used to explore risk factors for 1996-2001. During 1980-1994, Maori women had the highest preterm birth rates of any ethnic group in New Zealand, but in relative terms, inequalities declined as a consequence of a non-significant 7% fall in rates being offset by a statistically significant 30% increase for the European/other ethnic group. Rates of SGA were also higher amongst Maori women but declined by 25% during the 1980-1994 period. In addition, Maori women experienced significant socioeconomic gradients in SGA, with risk for Maori women in the most deprived NZDep areas being double that of Maori living affluent areas. Paradoxically, while Maori women had high rates of teenage pregnancy, this did not confer additional risk for preterm birth or SGA during the 1996-2001 period. While high rates of teenage pregnancy amongst Maori women appear not to confer additional risk for preterm birth or SGA, the social consequences of early childbearing may well be significant. The persistence of elevated rates of preterm birth and large socioeconomic gradients in SGA amongst Maori suggest that broader social and policy interventions are necessary if Maori are to achieve optimal birth outcomes in the coming decades.

Triglyceride hydrolase activities and expression of fatty acid binding proteins in the human placenta in pregnancies complicated by intrauterine growth restriction and diabetes.

Triglyceride (TG) hydrolases in the placental microvillous plasma membrane (MVM) release fatty acids from circulating lipoproteins and represent the critical initial step in transplacental fatty acid transfer. We investigated the activity of two TG hydrolases in MVM isolated from placentas of appropriately grown for gestational age pregnancies and pregnancies complicated by intrauterine growth restriction (IUGR), insulin-dependent diabetes mellitus (IDDM) or gestational diabetes mellitus (GDM). In addition, we measured protein expression of lipoprotein lipase (LPL) in MVM and two fatty acid binding proteins (L- and C-FABP) in placental homogenates. The TG hydrolase activities were assessed by measuring hydrolysis of (3)H-trioleic acid incorporated into intralipid micelles after incubation with MVM. The placenta-specific TG hydrolase activity (optimum at pH 6) did not differ in the patient groups studied. MVM LPL activity (optimum at pH 8) was reduced by 47% in preterm IUGR (n = 8, P < 0.05), compared with gestational age-matched controls. The LPL activity in placentas of IDDM pregnancies was increased by 39% (n = 8, P < 0.05), compared with controls. No significant differences were observed in cases of GDM. We found no alteration in protein expression of LPL or C-FABP. The expression of L-FABP was increased by 112% (n = 8, P < 0.05) in IDDM and 64% (n = 8, P < 0.05) in GDM. These results indicate that alterations in MVM LPL activity and expression of L-FABP may contribute to the altered lipid deposition and metabolism in IUGR and diabetic pregnancies.

Behavioral outcome including attention deficit hyperactivity disorder/hyperactivity disorder and minor neurological signs in perinatal high-risk newborns at 4-6 years of age with relation to risk factors.

Diagnostic problems with the criteria of attention deficit hyperactivity disorder (ADHD) in the Diagnostic Statistical Manual, 4th edn, have been identified. The aim of this study was to clarify whether the minor neurological signs test (MNT) the authors had previously reported was a predictor for the criteria of ADHD or hyperactivity disorder (HD) in perinatal risk children at 4-6 years of age and what kind of risk factors related to MNT. A total of 136 children discharged from neonatal intensive care units were examined at the age of 4-6 years by a developmental neuropediatrician using both MNT and diagnostic criteria of DSM-IV ADHD/ICD-10 (International Classification of Diseases, 10th edn) HD. SPSS base and professional were used for statistical analysis. On comparison of diagnostic criteria between ADHD (11.0%) and HD (27.5%), the incidence in the same subjects showed significant difference. MNT scores showed significant correlation with criteria of ADHD (P < 0.01) and HD (P < 0.05). Diagnostic validity of MNT for predicting ADHD was demonstrated with 78% sensitivity and 79% specificity. High positive rates on MNT did not show a significant difference between the very low birthweight (VLBW) and non-low birthweight (NLBW) groups. Behavioral outcome with relation to risk factors were analyzed using multiple regression analysis. Apgar 5 in the NLBW group and toxemia of pregnancy and small for gestational age (SGA) in VLBW group were highly correlated with behavioral outcome. Minor neurological signs test score was a significant predictor for criteria of ADHD and HD. High incidences of positive MNT were suspected in not only VLBW children but also NLBW children and Apgar 5 in NLBW children and toxemia of pregnancy and SGA in VLBW children influenced behavioral outcome.

Intraobserver and interobserver variation in the sonographic grading of placental maturity.

The appearance of Grannum Grade III changes in the placenta at around 34-36 weeks is a predictor of adverse perinatal outcome, which may be reduced by reporting to the clinician. This has led to the suggestion that the placental grade should be noted during any third-trimester scan. There are no published data on the reproducibility of sonographic Grannum grading of the placenta; the objective of this study was to evaluate intra- and interobserver variation. Fifty-five placental images from normal and complicated pregnancies of several different gestational ages were collected between April and October 2001. Three fetal medicine consultants and three experienced sonographers graded the images as 0, I, II, III or ungradeable. They then regraded the same images, presented in a different order and with different codes, 4-6 weeks later. Observers were blinded to their previous grading and to each others'. Weighted kappa (kappa), with linear weights, was used to look for strength of agreement. There was good agreement between the two observations of each placental image for five observers (kappa = 0.61 to 0.90), and moderate agreement for one observer (kappa = 0.56). However, the kappa-values for comparisons between the 15 pairs of observers ranged from 0.24 to 0.69 with six values below 0.41, indicating only fair agreement. This was confirmed by the overall kappa-value of 0.24 between all six observers. The agreement between the observers for Grade III placenta was poor, with an overall kappa-value of 0.09. Although intraobserver agreement was generally good, interobserver agreement was only fair for all grades and poor for Grade III placenta. This may be an indication that Grannum grading is not reproducible or it may reflect a need for training in those performing grading. Such variation may limit the effectiveness of reporting Grannum grades in clinical practice.

Measurement of inhibin A and inhibin pro-αC in early human pregnancy and their role in the prediction of pregnancy outcome in patients with recurrent pregnancy loss

Objective To examine the temporal relationship among inhibin A, β-hCG, and pro-αC in early pregnancy and to determine whether the measurement of these hormones has any role in prediction of pregnancy outcome in patients with recurrent spontaneous miscarriage. Design Prospective descriptive study. Setting A tertiary referral center for recurrent miscarriage. Patient(s) Thirty-six pregnant women with previous history of recurrent spontaneous pregnancy loss. Intervention(s) Serial blood samples were collected prospectively at 6, 8, 10, and 12 weeks of gestation and were analyzed for inhibin A and inhibin pro-αc using a two-site enzyme-linked immunosorbent assay as well as for β-hCG using the microparticle enzyme immunoassay. Main outcome measure(s) Serum levels of inhibin A, inhibin pro-αc, and β-hCG. Result(s) The patients were allocated to two groups according to the pregnancy outcome: group 1 consisted of patients whose pregnancy continued beyond 20 weeks (control group); and group 2 consisted of patients who spontaneously aborted (aborted group). There was a significant difference in inhibin A concentrations between the control and aborted groups at 8, 10, and 12 weeks’ gestation. Significant differences in β-hCG concentrations between the two groups is evident only at 10 weeks’ gestation. There were no significant differences in inhibin pro-αc concentrations between the two groups at any gestational age. Assessment of the trend in the control group over the study period showed a significant increase in inhibin A and β-hCG but not inhibin pro-αc levels. Conclusion(s) Low serum levels of inhibin A at early gestational age in pregnancies destined to miscarry suggest a role for this glycoprotein as a marker for early pregnancy viability. Its measurement at the time of the first pregnancy test might be able to predict pregnancy outcome.

Glucose Metabolism in the Human Preterm and Term Placenta of IUGR Fetuses

Many fetuses suffering from intrauterine growth restriction (IUGR) are hypoglycaemic. However, the underlying mechanisms are not well established. An increased placental glucose consumption in IUGR could impair glucose transfer across the placenta. In this study we used two different approaches to investigate glucose metabolism in preterm and term placentae of IUGR fetuses. We determined activity and protein expression of the three rate-limiting glycolytic enzymes phosphofructo kinase (PFK), pyruvate kinase (PK) and hexokinase (HXK) in a cytoplasmic fraction of homogenates of placentae obtained from IUGR and appropriate for gestational age (AGA) pregnancies. Protein expression was assessed using Western blot and enzyme activities were determined in a spectrophotometer by measuring the rate of NADH oxidation (PFK and PK) or NADP reduction (HXK) in enzyme reactions coupled to the respective enzyme. To determine the distribution of the glycolytic enzymes immunocytochemistry was performed. We also measured glucose consumption and lactate production in fresh placental villous tissue using a perifusion system. The expression of PFK, PK and HXK as well as the activity of PK and HXK was unaltered in IUGR placentae. The activity of PFK on the other hand was 32 per cent lower in IUGR placentae ( n=24, P<0.05). Immunocytochemistry confirmed the distribution of the enzymes to the cytoplasm of the syncytiotrophoblast. Placental glucose consumption in IUGR [0.06±0.01 μmol/(min∗g), n=5] was not different from AGA [0.06±0.005 μmol/(min∗g), n=12], whereas lactate production was decreased by 28 per cent in IUGR. These results do not support the hypothesis of increased placental glucose consumption but suggest an altered glycolytic pathway in the IUGR placenta.

Unexpected fetal death during pregnancy—a problem of unrecognized fetal disorders during antenatal care?

Objective: To investigate the causes of ante partum fetal death (APFD) and to evaluate the diagnostic methods for prevention. Material and methods: A population-based retrospective study was conducted in 293 091 deliveries from 1996 to 2000 in the State of Hesse, Germany. The investigations focus on mortality of infants during pregnancy, separated between singletons of 37–42 weeks ( n=361) and 23–36 weeks ( n=550), and multiple births ( n=76). In 44 cases, the gestational age was unknown and in 19 cases lower than 23 weeks or greater than 43 weeks. In total 1006 cases remained and were subject for evaluation. Results: Perinatal mortality (PM) was 0.56%. APFD occurred in 1050 cases (0.3%), i.e. 63.5% of PM. Risk factors from the medical history during pregnancy could be identified in 515 cases (51.2%). Significant risk factors were social burden (odds ratio (OR) 58.3), diabetes mellitus (OR 5.4) and gestational diabetes (OR 2.1), psychological burden (OR 4.8), proteinuria (OR 2.8), maternal age (OR 1.7) and maternal smoking, depending on the number of cigarettes. The risk factors show a difference in significance, if related to the gestational age and multiple pregnancies. The contribution of malformations to APFD was 7.8%. There was however a number of unexpected fetal deaths with unidentified risk factors: n=415 (41.3%). In this group, fetal growth restriction was observed in 38.1%. Compared to control, APFD was three to five times higher in fetal growth retardation below the 10th percentile. Fetal death was closely related to fetal surveillance, i.e. the number of antenatal visits, ultrasound measurements, and fetal heart rate monitoring. Conclusion: Fetal ante partum fetal death can be reduced at least by 50%, if the available methods for fetal surveillance are employed aiming to detect indications of fetal oxygen deprivation at an early stage.

Longitudinal quantification of uterine artery blood volume flow changes during gestation in pregnancies complicated by intrauterine growth restriction

To quantify and compare longitudinal uterine artery volume flow changes in appropriate for gestational age (AGA) pregnancies and those complicated by intrauterine growth restriction (IUGR). Serial longitudinal study. Large UK Teaching Hospital Obstetrics and Gynaecology Department and Institute of Anatomy, RWTH Aachen, Germany. Pregnant women with accurately dated singleton pregnancies. Quantified uterine volume flow was prospectively measured by colour power angiography in (a) 32 women with abnormal uterine artery Doppler velocimetry at 20 and 24 weeks of gestation and with risk factors for IUGR (IUGR group) and (b) 25 women with normal uterine artery Doppler velocimetry and no risk factors for IUGR (AGA group) between 20 and 38 weeks of gestation. Values obtained from each gestation were compared using unpaired t test. Gestational age at delivery, birthweight and total quantified volume flow (mL/min) per gestation in IUGR and AGA pregnancies. Twenty of the 32 women recruited into the IUGR group and 18 of the 25 controls fulfilled the criteria for inclusion in the analyses. The mean birthweight [SD] and gestational age [SD] at delivery in the IUGR and AGA groups were 2634 [277] versus 3429 [349] g and 39.5 [1.2] and 41.1 [2.3] weeks, respectively. The diameter of the proximal uterine artery just after it crosses the external iliac artery was smaller in the IUGR group from as early as 20 weeks of gestation but this difference only became statistically significant from 24 weeks of gestation and widened as pregnancy advanced. The quantified volume flow in the IUGR group was significantly less than that in the AGA throughout the study period (287 [117] versus 328 [159] mL/min at 20 weeks (P < 0.05), 334 [169] versus 538 [181] mL/min at 24 weeks [P < 0.004] and 534 [332] versus 830 [284] mL/min at 38 weeks of gestation [P < 0.002]). Volume flow in the IUGR group was 12.5% and 36.7% less than that in the AGA group at 20 and 28 weeks of gestation, respectively. Proximal uterine artery diameter and quantified volume flow change with gestation and show significant differences between AGA pregnancies and those complicated by IUGR. These changes occur early and become more marked as pregnancy advances. Early use of these measurements may identify pregnancies at risk of complications.

Longitudinal quantification of uterine artery blood volume flow changes during gestation in pregnancies complicated by intrauterine growth restriction

Objective To quantify and compare longitudinal uterine artery volume flow changes in appropriate for gestational age (AGA) pregnancies and those complicated by intrauterine growth restriction (IUGR). Design Serial longitudinal study. Setting Large UK Teaching Hospital Obstetrics and Gynaecology Department and Institute of Anatomy, RWTH Aachen, Germany. Population Pregnant women with accurately dated singleton pregnancies. Methods Quantified uterine volume flow was prospectively measured by colour power angiography in (a) 32 women with abnormal uterine artery Doppler velocimetry at 20 and 24 weeks of gestation and with risk factors for IUGR (IUGR group) and (b) 25 women with normal uterine artery Doppler velocimetry and no risk factors for IUGR (AGA group) between 20 and 38 weeks of gestation. Values obtained from each gestation were compared using unpaired t test. Main outcome measures Gestational age at delivery, birthweight and total quantified volume flow (mL/min) per gestation in IUGR and AGA pregnancies. Results Twenty of the 32 women recruited into the IUGR group and 18 of the 25 controls fulfilled the criteria for inclusion in the analyses. The mean birthweight [SD] and gestational age [SD] at delivery in the IUGR and AGA groups were 2634 [277] versus 3429 [349] g and 39.5 [1.2] and 41.1 [2.3] weeks, respectively. The diameter of the proximal uterine artery just after it crosses the external iliac artery was smaller in the IUGR group from as early as 20 weeks of gestation but this difference only became statistically significant from 24 weeks of gestation and widened as pregnancy advanced. The quantified volume flow in the IUGR group was significantly less than that in the AGA throughout the study period (287 [117] versus 328 [159] mL/min at 20 weeks ( P < 0.05), 334 [169] versus 538 [181] mL/min at 24 weeks [ P < 0.004] and 534 [332] versus 830 [284] mL/min at 38 weeks of gestation [ P < 0.002]). Volume flow in the IUGR group was 12.5% and 36.7% less than that in the AGA group at 20 and 28 weeks of gestation, respectively. Conclusion Proximal uterine artery diameter and quantified volume flow change with gestation and show significant differences between AGA pregnancies and those complicated by IUGR. These changes occur early and become more marked as pregnancy advances. Early use of these measurements may identify pregnancies at risk of complications.

Intra-observer and interobserver variation in the ultrasonographic grading of placental maturity

The appearance of Grannum Grade (GG) 3 changes in the placenta around 34–36 weeks is a predictor of adverse perinatal outcome which may be reduced by reporting GG to the clinician. This has led to the suggestion GG to be reported during any third trimester scan. There are no published data on the reproducibility of GG. We therefore set out to evaluate intra- and interobserver variation in GG. Fifty-five placental images from normal and complicated pregnancies of different gestational age were collected between April and October 2001. Three fetal medicine consultants and three experienced ultrasonographers graded the images as 0, 1, 2, 3 or ungradeable; 4–6 weeks later they regraded the same images, presented in a different order and with different codes. Observers were blinded to their previous grading and to each other. All the data were analysed using the package Stata version 7.0 (Stata Corporation, Texas). Weighted kappa (κ), with linear weights, was used to look for strength of agreement. There was good agreement between the two observations of each placental image for five observers (κ 0.61–0.89) and moderate agreement for one (κ 0.55). However, the κ values for comparisons between the 15 pairs of observer ranged from 0.23 to 0.69 with six values below 0.41, indicating only fair agreement. This is confirmed by the overall κ value of 0.24 between all six observers.

Rh-prophylaxis in early abortion

Rh-prophylaxis in early abortion

The role of maternal reproductive history in the aetiology of neural tube defects

The contribution of environmental factors to the aetiology of neural tube defects (NTD) has been stressed over recent years and many different risk factors have been proposed. We evaluated the reproductive history of 113 NTD cases to investigate the possible role of maternal age, gestational age, sex, parity and previous pregnancy. Our results show that parity and previous spontaneous abortion can be considered as risk factors for NTD and that an accurate evaluation of reproductive history can be useful for genetic counselling. The known benefits of periconceptional intervention in reducing the incidence of NTD in high risk populations, together with our results, means that mothers with a positive reproductive history for spontaneous abortion and for multiparity are ideal subjects for folic acid periconceptional management.

Serum activin A, inhibin A, and follistatin concentrations in preeclampsia or small for gestational age pregnancies

OBJECTIVE: To determine whether maternal serum activin A, inhibin A, and follistatin concentrations in idiopathic small for gestational age (SGA) pregnancies are similar to those in normal pregnancies or elevated as in preeclampsia.METHODS: Maternal serum activin A, inhibin A, and follistatin concentrations were determined in 1) nulliparous women with idiopathic SGA (birth weight <10th percentile; n = 18), preeclampsia (systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg plus proteinuria ≥2+ or >0.3 g/24h; n = 22), and normotensive controls, matched for gestational age at sampling (n = 22), and 2) a longitudinal series of samples collected at five intervals throughout pregnancy from nulliparous women with idiopathic SGA (n = 19), preeclampsia (n = 22), preeclampsia plus SGA (n = 15), or who had uncomplicated pregnancies (n = 20).RESULTS: Serum concentrations of activin A and inhibin A were similar in idiopathic SGA pregnancies to controls. In preeclampsia, activin A and inhibin A levels were markedly increased compared with controls or women with idiopathic SGA (P < .001), particularly in those with early-onset disease. Follistatin concentrations were only modestly (<twofold) elevated in preeclampsia (P < .001). In the longitudinal study, serum activin A or inhibin A concentrations were increased in women who later developed preeclampsia, whereas in women with idiopathic SGA pregnancy, a small overall increase in activin A levels was observed.CONCLUSIONS: In contrast to women with preeclampsia, normotensive women with SGA pregnancies do not have markedly elevated circulating levels of activin A and inhibin A. These data support the hypothesis that increased serum activin A concentrations in preeclampsia may be a manifestation of maternal disease rather than just a marker of abnormal placentation.

Pregnancy and the erythrocyte sedimentation rate

Objectives To determine the range of erythrocyte sedimentation rate values obtained in healthy pregnant women. To examine the effect of gestational age and haemoglobin concentration on erythrocyte sedimentation rate. Setting Queen Charlotte's Hospital, London, UK. Design Cross sectional descriptive study. Population Healthy pregnant women attending for routine outpatient antenatal visits at Queen Charlotte's Hospital in London. Methods Erythrocyte sedimentation rate was determined by the Westergren method, haemoglobin concentration by automated cell counter and gestational age by ultrasonography. The median and 95% reference range was determined for erythrocyte sedimentation rate values obtained. Linear regression analysis was used to determine the influence of haemoglobin concentration and gestational age on erythrocyte sedimentation rate. Results For 1019 women examined, the range of erythrocyte sedimentation rate values obtained was 4–112 mm/h. Gestational age and haemoglobin concentration both significantly influenced erythrocyte sedimentation rate. ( P<0.0001). For non-anaemic women the 95% reference range rose from 18–48 mm/h in the first half of pregnancy to 30–70 mm/h in the second half of pregnancy. For anaemic women the corresponding reference ranges were 21–62 mm/h and 40–95 mm/h, respectively. Conclusion For the correct interpretation of erythrocyte sedimentation rate values obtained during pregnancy gestational age and haemoglobin concentration must be taken into account.

Pregnancy and the erythrocyte sedimentation rate

To determine the range of erythrocyte sedimentation rate values obtained in healthy pregnant women. To examine the effect of gestational age and haemoglobin concentration on erythrocyte sedimentation rate. Queen Charlotte's Hospital, London, UK. Cross sectional descriptive study. Population Healthy pregnant women attending for routine outpatient antenatal visits at Queen Charlotte's Hospital in London. Erythrocyte sedimentation rate was determined by the Westergren method, haemoglobin concentration by automated cell counter and gestational age by ultrasonography. The median and 95% reference range was determined for erythrocyte sedimentation rate values obtained. Linear regression analysis was used to determine the influence of haemoglobin concentration and gestational age on erythrocyte sedimentation rate. For 1,019 women examined, the range of erythrocyte sedimentation rate values obtained was 4-112 mm/ h. Gestational age and haemoglobin concentration both significantly influenced erythrocyte sedimentation rate. (P < 0.0001). For non-anaemic women the 95% reference range rose from 18-48 mm/h in the first half of pregnancy to 30-70 mm/h in the second half of pregnancy. For anaemic women the corresponding reference ranges were 21-62 mm/h and 40-95 mm/h, respectively. For the correct interpretation of erythrocyte sedimentation rate values obtained during pregnancy gestational age and haemoglobin concentration must be taken into account.

Placental transport of leucine, phenylalanine, glycine, and proline in intrauterine growth-restricted pregnancies.

L-[1-13C]Leucine, [1-13C]glycine, L-[1-13C]phenylalanine, and L-[1-13C]proline were infused as a bolus into the maternal circulation of seven appropriate for gestational age at 30.3 +/- 3.0 wk and 7 intrauterine growth-restricted pregnancies at 26.5 +/- 1.0 wk gestation to investigate placental transport in vivo. Umbilical venous samples were obtained at the time of in utero fetal blood sampling at 450 +/- 74 sec from the bolus injection. In normal pregnancies the fetal/maternal (F/M) enrichment ratios for leucine (0.76 +/- 0.06) and phenylalanine (0.77 +/- 0.06) were higher (P < 0.01) than the F/M ratios for glycine (0.18 +/- 0.04) and proline (0.22 +/- 0.02). This suggests that these two essential amino acids rapidly cross the placenta in vivo. Compared with the essentials, both glycine and proline had significantly lower F/M enrichment ratios, which were not different from each other. The results support the hypothesis that amino acids with high affinity for exchange transporters cross the placenta most rapidly. In intrauterine growth-restricted pregnancies, the F/M enrichment ratio was significantly lower (P < 0.01) for L-[1-13C]leucine (0.76 +/- 0.06 vs. 0.48 +/- 0.07) and for L-[1-13C]phenylalanine (0.77 +/- 0.06 vs. 0.46 +/- 0.07) compared with appropriate for gestational age pregnancies reflecting impaired transplacental flux. The F/M enrichment ratio did not differ for [1-13C]glycine (0.18 +/- 0.04 vs. 0.17 +/- 0.03), and L-[1-13C]proline (0.22 +/- 0.02 vs. 0.18 +/- 0.04).