Longitudinal Study Of Pregnant Women Research Articles

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OBJECTIVES/SPECIFIC AIMS: (1) Characterize the prevalence and initial pharmacological management of chronic pain syndromes during pregnancy in a women’s mental health program. (2) Describe the severity and qualitative characteristics of chronic pain during pregnancy and the acute postpartum period. (3) Compare obstetrical and neonatal outcomes between pregnant women with and without chronic pain syndromes. METHODS/STUDY POPULATION: A chart review was conducted to identify all pregnant women who presented for an initial evaluation to the Women’s Mental Health Program (WMHP) at the University of Arkansas for Medical Sciences from July 2013 to June 2016. We excluded respondents <18 years of age or who did not consent to having their information used for research purposes. Demographic information, past and current medical histories, and medication history were obtained from written and electronic medical records. Chronic pain complaints and medication history are presented as counts and percentages. In an ongoing prospective, longitudinal study of pregnant women with chronic pain, women are enrolled before 20 weeks gestation and followed throughout pregnancy and the first 3 months postpartum. Study visits occur at 4-week intervals; and pain characteristics, analgesic exposures, other medications, and depressive measures are collected. Obstetrical and neonatal outcomes are obtained following delivery. Subjects will be compared based on pain types (ie, neuropathic pain, non-neuropathic pain, and controls) and treatment exposures (eg, +/− opioids). Primary outcome measures include visual analog scale (VAS). Secondary outcome measures include other pain and depression assessments. Data will be analyzed using SAS 9.4. A p-value of<0.05 was considered statistically significant. RESULTS/ANTICIPATED RESULTS: (1) Chronic pain conditions were reported by 28.2% (44/156) of the initial referrals to the WMHP. (2) 95.5% of respondents with chronic pain were taking at least 1 medication, and 59.5% were taking 2 or more medications. Mean number of medications used were 2.6±2.1.3. The most common medications reported were acetaminophen (43.2%), opioids (43.2%), and sedative/hypnotics (36.4%). Non-pharmacological therapy (eg, physical therapy and transcutaneous electrical nerve stimulation) was reported by 20.5% of respondents. (4) We anticipate that measures of pain severity will increase in pregnancy, peak in the third trimester, and decline in the postpartum period. (5) We foresee that the prospective results will confirm the chart review as indicated by a higher rate of medication exposures during pregnancy, including non-analgesic medications in the women with chronic pain syndromes. (6) We expect women with chronic pain syndromes to have a higher rate of obstetrical complications, specifically pre-term delivery and operative delivery. (7) Finally, we anticipate that chronic pain syndromes and management will result in a higher rate of neonatal complications, specifically neonatal intensive care unit admission, neonatal respiratory problems, and small for gestational age infants. DISCUSSION/SIGNIFICANCE OF IMPACT: Chronic pain syndromes are prevalent in more than one-quarter of pregnant women in our study with the majority of women using pharmacological agents to manage their condition. This prevalence is greater or equal to than other common obstetrical conditions, such as gestational diabetes or preterm delivery. The novel prospective data will be germane to the clinical care of pregnant women with chronic pain disorders. Clinical practice will be better informed by our data regarding the potential impact of chronic pain and its management on pregnancy course and perinatal outcomes. These data will provide the initial foundation for the development of treatment guidelines for the management of chronic pain syndromes during the perinatal period.

Spot urine protein measurements in normotensive pregnancies, pregnancies with isolated proteinuria and preeclampsia

We performed a prospective, longitudinal study of pregnant women presenting to their first obstetrics visits to characterize the changes in spot urine protein-to-creatinine (UPCR) and albumin-to-creatinine ratios (UACR) in normotensive pregnancies, as well as identify clinical characteristics associated with isolated proteinuria and preeclampsia. We measured spot urinary albumin, protein, and creatinine at the first prenatal visit, end of the second trimester, and at delivery. In the normotensive pregnancies (n = 142), we found that from the beginning of pregnancy to delivery, UACR increased by a median [interquartile range (IQR)] of 14.7 mg/g Cr (3.74-51.8) and UPCR by 60 mg/g Cr (30-130) (P < 0.001 for both changes). Isolated proteinuria (defined as UPCR > 300 mg/g Cr in the absence of hypertension) was identified in 19/142 (13.4%) normotensive pregnancies. Increases in systolic and diastolic blood pressure from early pregnancy to delivery and increases in UACR from early to midpregnancy were associated with isolated proteinuria at delivery. Twelve women developed preeclampsia. Nulliparity, early, and midpregnancy diastolic blood pressures were strongly associated with the development of preeclampsia, but early changes in UACR were not. In conclusion, women who develop isolated proteinuria at delivery have a larger increase in blood pressure than women without proteinuria and have a "microalbuminuric" phase earlier in gestation, unlike women who develop preeclampsia. These findings suggest a different mechanism of urine protein excretion in women with isolated proteinuria as compared with women with preeclampsia, where proteinuria has a more abrupt onset.

Cannabis Use and Quality of Life of Adolescents and Young Adults: Findings from an Australian Birth Cohort

Cannabis is generally used to enhance mood (quality of life), but it is not known whether it has this effect in the medium to longer term. Little is currently known about the temporal sequence between cannabis use and the quality of life (QOL). Data are taken from a prospective longitudinal study of pregnant women recruited at their first antenatal visit in Brisbane, Australia. Offspring data from the follow-ups with 14-year-olds and 21-year-olds are used here. Indicators of QOL, happiness, and satisfaction at 14 years are considered as predictors of subsequent cannabis use. The association between cannabis use and QOL at 21 years, adjusting for prior QOL (14 years), is also examined. Socio-demographic characteristics were included as potential confounders relevant to QOL assessments. In this cohort, lower QOL in the early teenage years predicted subsequent onset of cannabis use in young adulthood. After adjustment for socio-demographic characteristics and for QOL pre-cannabis use, participants who used cannabis more frequently had a lower QOL at the 21-years follow-up. Frequent use of cannabis does not appear to enhance the user’s QOL and appears to be associated with a reduced QOL into young adulthood.

Early child care and obesity at 12 months of age in the Danish National Birth Cohort.

Background/ObjectivesEvidence suggests that the child care environment may be more obesogenic than the family home, and previous studies have found that child care use may be associated with obesity in children. Few studies, however, have focused on child care during infancy, which may be an especially vulnerable period. This study examined child care use in infancy and weight status at 12 months of age in a country where paid maternity leave is common and early child care is not as prevalent as in other developed countries.Subjects/MethodsWe studied 27821 children born to mothers participating in the Danish National Birth Cohort (DNBC), a longitudinal study of pregnant women enrolled between 1997 and 2002, who were also included in the Childcare Database, a national record of child care use in Denmark. The exposure was days in child care from birth to 12 months. The outcomes were sex-specific body mass index (BMI) z-score and overweight/obesity (BMI ≥85th percentile based on the World Health Organization classification) at 12 months. We conducted multivariable linear and logistic regression analyses examining child care use and weight outcomes.ResultsA total of 17721 (63.7%) children attended child care during their first year of life. After adjustment for potential confounders, a 30-day increment of child care was associated with a modestly higher BMI z-score at 12 months (0.03 units; 95% CI: 0.01, 0.05; p=0.003). Similarly, child care use was associated with increased odds of being overweight/obese at 12 months of age (OR 1.05; 95% CI: 1.01, 1.10; p=0.047).ConclusionsChild care in the first year of life was associated with slightly higher weight at 12 months, suggesting that child care settings may be important targets for obesity prevention in infancy.

Quantifying circulating hypoxia-induced RNA transcripts in maternal blood to determine in uterofetal hypoxic status

BackgroundHypoxia in utero can lead to stillbirth and severe perinatal injury. While current prenatal tests can identify fetuses that are hypoxic, none can determine the severity of hypoxia/acidemia. We hypothesized a hypoxic/acidemic fetus would up-regulate and release hypoxia-induced mRNA from the fetoplacental unit into the maternal circulation, where they can be sampled and quantified. Furthermore, we hypothesized the abundance of hypoxia induced mRNA in the maternal circulation would correlate with severity of fetal hypoxia/acidemia in utero. We therefore examined whether abundance of hypoxia-induced mRNA in the maternal circulation correlates with the degree of fetal hypoxia in utero.MethodsWe performed a prospective study of two cohorts: 1) longitudinal study of pregnant women undergoing an induction of labor (labor induces acute fetal hypoxia) and 2) pregnancies complicated by severe preterm growth restriction (chronic fetal hypoxia). For each cohort, we correlated hypoxia induced mRNA in the maternal blood with degree of fetal hypoxia during its final moments in utero, evidenced by umbilical artery pH or lactate levels obtained at birth. Gestational tissues and maternal bloods were sampled and mRNAs quantified by microarray and RT-PCR.ResultsHypoxia-induced mRNAs in maternal blood rose across labor, an event that induces acute fetal hypoxia. They exhibited a precipitous increase across the second stage of labor, a particularly hypoxic event. Importantly, a hypoxia gene score (sum of the relative expression of four hypoxia-induced genes) strongly correlated with fetal acidemia at birth. Hypoxia-induced mRNAs were also increased in the blood of women carrying severely growth restricted preterm fetuses, a condition of chronic fetal hypoxia. The hypoxia gene score correlated with the severity of ultrasound Doppler velocimetry abnormalities in fetal vessels. Importantly, the hypoxia gene score (derived from mRNA abundance in maternal blood) was significantly correlated with the degree of fetal acidemia at birth in this growth restriction cohort.ConclusionsAbundance of mRNAs coding hypoxia-induced genes circulating in maternal blood strongly correlates with degree of fetal hypoxia/acidemia. Measuring hypoxia-induced mRNA in maternal blood may form the basis of a novel non-invasive test to clinically determine the degree of fetal hypoxia/acidemia while in utero.

Is Vitamin D Binding Protein a Novel Predictor of Labour?

Vitamin D binding protein (VDBP) has previously been identified in the amniotic fluid and cervicovaginal fluid (CVF) of pregnant women. The biological functions of VDBP include acting as a carrier protein for vitamin D metabolites, the clearance of actin that is released during tissue injury and the augmentation of the pro-inflammatory response. This longitudinal observational study was conducted on 221 healthy pregnant women who spontaneously laboured and delivered either at term or preterm. Serial CVF samples were collected and VDBP was measured by ELISA. Binary logistic regression analysis was performed to assess the utility of VDBP as a predictor of labour. VDBP in the CVF did not change between 20 and 35 weeks' gestation. VDBP measured in-labour was significantly increased 4.2 to 7.4-fold compared to 4–7, 8–14 and 15–28 days before labour (P<0.05). VDBP concentration was 4.3-fold significantly higher at 0–3 days compared to 15–28 days pre-labour (P<0.05). The efficacy of VDBP to predict spontaneous labour onset within 3 days provided a positive and negative predictive value of 82.8% and 95.3% respectively (area under receiver operator characteristic curve = 0.974). This longitudinal study of pregnant women suggests that VDBP in the CVF may be a useful predictor of labour.

Postnatal depression, maternal bonding failure, and negative attitudes towards pregnancy: a longitudinal study of pregnant women in Japan

Postnatal depression and bonding failure after childbirth are major mental health issues. We investigated 99 pregnant women on three occasions (late in pregnancy and 5 days and 1 month postnatally). Anxiety during pregnancy predicted postnatal depression and bonding failure, whereas negative attitudes towards pregnancy predicted bonding failure. The effect of negative attitudes towards pregnancy on postnatal depression was possibly mediated by bonding failure. Postnatal depression and bonding failure are correlated with different risk factors and run rather independently over the course of the puerperium. Postnatal depression may be predicted by bonding failure.

Evaluation of Fetal Liver Volume by Tridimensional Ultrasound in Women With Gestational Diabetes Mellitus

ObjectiveTo evaluate the effect of gestational diabetes mellitus (GDM) on fetal liver growth during the third trimester. MethodsWe performed a longitudinal study of pregnant women recruited at the time of GDM screening (24 to 28 weeks of gestation), with follow-up visits at 32 weeks, 36 weeks, and delivery. Women with GDM were followed with nutritional recommendations and insulin when necessary according to the Canadian Diabetes Association guidelines. Fetal liver volume was evaluated using 3-D ultrasound at each antenatal visit, and fetal liver growth was compared between women with and without GDM. ResultsTwenty-seven women were recruited, 10 with normal glucose tolerance (NGT) and 17 with confirmed GDM, five who required insulin and 12 who were treated by diet only. We found no difference in fetal liver volume between groups at any of the three visits, and median birth weight was also similar between groups On the other hand, we found a strong correlation between fetal liver volume at 36 weeks’ gestation and birth weight (ρ = 0.61, P < 0.001). ConclusionsIn our preliminary study, we found that fetal liver volume could be a strong predictor of infant birth weight independent of GDM status This suggests that fetal liver volume of offspring of women with NGT is similar to that of offspring of women with GDM treated following recommended targets. Larger studies are required.

Vitamin D insufficiency and skeletal development in utero

Over the last 10 years, our perception of what constitutes normal vitamin D status has undergone a substantial revision. Prior to this, suboptimal vitamin D was defined at a very basic level by the presence or absence of associated bone disease (i.e., rickets in children and osteomalacia in adults). As a consequence, vitamin D deficiency was determined by serum concentrations of 25-hydroxyvitamin D (25-OHD) of less than 25 nM (10 ng/mL), and anything higher was “normal.” However, this has changed with the observation that several parameters of calcium homeostasis continue to correlate with serum levels of 25-OHD up to concentrations as high as approximately 80 nM (32 ng/mL).(1,2) The implication is that optimal vitamin D status is achieved only at 25-OHD concentrations above this; anything less is suboptimal or “insufficient.” Based on these revised parameters, it has been concluded that vitamin D insufficiency is a global phenomenon, with an estimated 1 billion people worldwide having suboptimal levels of 25-OHD.(3) Some groups appear to be at greater risk of vitamin D insufficiency than others, notably pregnant women.(4–8) In a study carried out in Pittsburgh, PA, Bodnar and colleagues showed that 74% to 95% of pregnant black women and 46% to 62% of pregnant white women were vitamin D insufficient.(5) Notably, during early pregnancy, almost 45% of the African-American mothers had 25-OHD levels that were less than 37.5 nM.(5) A key question arising from these epidemiologic data concerns the physiologic impact of vitamin D insufficiency during pregnancy. In the current issue of the Journal, Mahon and colleagues have addressed this through a prospective longitudinal study of pregnant women in which they have characterized the impact of maternal vitamin D status on in utero measures of fetal skeletal development.(9)

Maternal smoking, demographic and lifestyle factors in relation to daughter's age at menarche

A previous study suggested a younger age at menarche (AAM) among daughters of heavy prenatal smokers, especially among non-Whites. The present study was designed to evaluate that association in another population and to examine other factors that may be related to AAM. We analysed data from the Collaborative Perinatal Project, a nationwide longitudinal study of pregnant women and their children conducted in 1959-66. At three sites, with a predominance of Black participants (80%), AAM was ascertained in the offspring when they were young adults. We included data on 1556 daughters who had a mean AAM of 12.7 years (standard deviation 1.8). Amount smoked by the mothers was obtained from a baseline interview and subsequent prenatal visits. Regression models were run including maternal smoking and other covariates, for only the prenatal period, as well as in models with some childhood characteristics. In the prenatal factor model, younger mean AAM in daughters was found with maternal characteristics of earlier AAM, being married, and of lower parity. Examining childhood variables, earlier AAM was found among girls with few or no siblings or with higher socio-economic status. Unlike our previous findings, mean AAM was later in daughters of heavy smokers (20+ cigarettes/day), with a delay of 0.31 years [95% confidence interval (CI) 0.008, 0.61], or about 3.7 months in the prenatal model, and 0.34 years [95% CI -0.02, 0.66] in the model with childhood variables included. The pattern was consistent by race. A number of prenatal and childhood factors related to AAM were identified that should be considered when examining exogenous exposures in relation to pubertal onset.

Stress and Blood Pressure During Pregnancy: Racial Differences and Associations With Birthweight

To extend findings that African American women report greater stress during pregnancy, have higher blood pressure (BP), and are twice as likely to have low birthweight infants relative to white women. This study examines a) racial differences in associations between stress and BP during pregnancy, and b) the combined effects of stress and BP on infant birthweight in a sample of 170 African American and white women. A prospective, longitudinal study of pregnant women was conducted in which measures of BP, stress, and other relevant variables were collected. Multiple measures of systolic and diastolic BP were taken at each of three points during pregnancy (18-20, 24-26, and 30-32 weeks gestation). Both systolic blood pressure (SBP) and diastolic blood pressure (DBP) were positively associated with stress in pregnant African American women and not in pregnant white women. In analyses of birthweight, there were no main effects of BP or stress. However, a significant interaction demonstrated that, when stress was high, DBP was negatively associated with birthweight and a combination of high stress and high DBP predicted the lowest birthweight in the sample. Furthermore, African American women were twice as likely as white women to have a combination of high stress and high DBP. Racial differences in relationships between stress and BP, and the interactive effect of stress and DBP on birthweight together suggest that a high stress-high BP profile may pose a risk for lower birthweight among African American women, in particular, and possibly for all pregnant women.

Perceptions of effective advice in pregnancy – The case of activity

Summary Objectives The paper uses qualitative and quantitative data arising from a longitudinal study of pregnant women to examine women’s responses to advice provided about changing their behaviour during pregnancy. Design A longitudinal study over nine months involving a semi-structured questionnaire and interview schedule together with a range of psychological measures and activity measurement using actimetry. The purpose of the main study was to explore maternal daily activity in low-risk pregnancy. Participants 57 women volunteers aged (mean age 26.3 years) with low-risk pregnancy, recruited via an East Midlands City Centre teaching hospital antenatal clinic. Results Data on advice suggest that 1) response to advice is extremely varied and that reduction in activity is not always welcome; 2) factors affecting women’s responses to advice include the importance they attach to an active lifestyle in pregnancy. Conclusions The paper highlights the inherent difficulties of providing effective advice during the short period of pregnancy; the need for clear and consistent messages to be provided by all health professionals involved in antenatal care as well as the difficulty of changing cultural expectations of pregnancy-appropriate behaviours.

Serum concentrations of human chorionic gonadotrophin and immunoreactive inhibin in early pregnancy and recurrent miscarriage: a longitudinal study.

Serum concentrations of immunoreactive inhibin (ir-inhibin) and human chorionic gonadotrophin (HCG) have been measured during the first trimester in a longitudinal study of pregnant women attending a recurrent miscarriage clinic. In 30 singleton pregnancies (Group 1) that continued successfully to term, the median concentration of ir-inhibin initially declined from 1,140 pg/mL at week 4-5 then rose back to comparable values between weeks 7 and 10 but to decline again to reach the significantly lower level of 840 pg/mL (p < 0.01) at week 15-16. Serum levels of HCG showed the classical profile of normal pregnancy reaching a median peak value of 65,600 IU/L (1st IRP) at week 8-9. In 7 pregnancies that miscarried but earlier had evidence on ultrasound of an active fetal heart, HCG levels in the first 9 weeks were consistently below the 10th percentile for Group 1 pregnancies (p < 0.001). Levels of ir-inhibin were also suppressed but to a lesser extent. In 6 of 7 a fetal pregnancies, HCG levels during the first 9 weeks were again markedly subnormal. The levels of ir-inhibin varied between high normal and subnormal. In none of the pregnancy groups was a correlation found between ir-inhibin and HCG concentrations. In a single pregnancy with an anencephalic fetus, while levels of ir-inhibin and HCG were not depressed, peak values were not reached until week 12. The study shows that the level of ir-inhibin in the maternal serum in early pregnancy is of little value as a prognostic indicator of pregnancy outcome. It confirms that a subnormal HCG level is a useful predictor of early pregnancy failure.

The National WIC Evaluation: evaluation of the Special Supplemental Food Program for Women, Infants, and Children. IV. Study methodology and sample characteristics in the longitudinal study of pregnant women, the study of children, and the food expenditures study

The longitudinal study of pregnant women enrolled a national probability sample of 5,205 women first certified for WIC and 1,358 comparable low-income pregnant women in 174 WIC clinics located in 58 areas in the contiguous 48 states and in 55 prenatal clinics without WIC programs in counties with low program coverage. The women completed 24-h dietary recalls, histories of food expenditures, health care utilization, health and sociodemographic status, and anthropometric assessment. At late-pregnancy follow-up 3,967 WIC and 1043 control women were interviewed and 853 WIC and 762 control women completed 1-wk food expenditure diaries. Birth outcome was abstracted (from hospital records) for 3,863 WIC and 1058 control women. Anthropometry, dietary intake, health, and use of health services were related to WIC among 2,619 random low-income preschoolers. Psychological development was assessed in 526 children aged 4 and 5 y. Control women had higher income, education, and employment status; therefore, WIC program benefits probably were underestimated.

The National WIC Evaluation: evaluation of the Special Supplemental Food Program for Women, Infants, and Children. V. Longitudinal study of pregnant women

The major associations with the Special Supplemental Food Program for Women, Infants, and Children (WIC) in pregnancy were increased intake of protein, iron, calcium, and vitamin C (four of five targeted nutrients) and of energy, magnesium, phosphorus, thiamin, riboflavin, niacin, vitamin B-6, and vitamin B-12; reversal of low weight gain in early pregnancy; smaller fat stores in late pregnancy; reduced frequency of premature rupture of the uterine membranes; larger infant head circumference with no effect on birth weight and length; increased birth weight and head circumference with better program quality; and lower fetal mortality of appreciable but not significant magnitude. Incremental energy intake was comparable to that in most small-scale supplementation trials. There was no evidence of effects on frequency of prenatal care, use of alcohol or tobacco, the intention to breast-feed, or the rate of breast-feeding. Maternal alcohol intake was associated with depressed infant head circumference, over and above effects on birth weight and length.

A simple assessment of the risk of low birth weight to select women for nutritional intervention

There is growing evidence that the high prevalence of low-birth-weight (LBW) babies, a characteristic of many poor societies, can be significantly reduced through nutritional intervention programs. In order to increase the efficiency of these programs, pregnant women at risk of delivering LBW babies must be identified. Several risk scales have been extensively used in urban populations of developed countries. However, these indicators are of little use in poor communities, since most of them require expensive laboratory techniques, a long interview, at least two visits to a health center, and a precise estimation of gestational age. The present paper proposes several risk indicators of LBW, appropriate for use in areas with inadequate health resources. In a four-year longitudinal study of pregnant women from poor rural villages in Guatemala, mothers of LBW babies were found to be typically small in stature and head circumference. In addition, their houses tended to be of relatively poor quality. The proportion of LBW babies found among women at risk, as defined by these indicators, was significantly lower among women with similar characteristics receiving adequate food supplementation during pregnancy. Categories of high risk were based on maternal height, head circumference, and house quality. It is concluded that use of these categories will increase the efficiency of these programs without decreasing significantly their effectiveness.

Rubella in the Collaborative Perinatal Research Study

A LONGITUDINAL study of pregnant women at 11 university hospitals throughout the United States provided the unique opportunity to analyze the epidemiology of rubella and to determine the effects on the children born to these women. A total of 6,161 gravida women were under observation during the epidemic which occurred in the United States during the first six months of 1964. Extensive clinical data were obtained for all pregnant patients and their children. Special protocols were instituted to provide detailed information on rubella. Serial serum specimens were taken throughout the pregnancies, and these were subsequently tested for antibody to rubella. Information on the epidemiology of rubella in the pregnant women who were observed in January through June 1964, and additional women studied in 1966 and January 1969 is presented in this report. Data from longitudinal surveillance of the children of the 1964 pregnancies for a period of three years are