Pregnancy Outcome Measures Research Articles

Early measures of maternal alcohol misuse as predictors of adverse pregnancy outcomes.

Pregnancy outcome was studied in 531 obstetric outpatients with respect to maternal alcohol consumption prior to pregnancy recognition, (absolute alcohol per day prior to pregnancy, PPAA) and indications of problem drinking (IPD). Multiple regression was used to predict pregnancy outcome with PPAA and IPD, controlling for potentially confounding sociodemographic and health factors. PPAA predicted spontaneous abortion and lowered Apgar scores. The risk of spontaneous abortion increased an average of 25% for each additional ounce of absolute alcohol consumed per day (p less than 0.05). Adverse pregnancy outcomes related to intrauterine growth were more strongly related to IPD than PPAA, and IPD remained a significant predictor even after controlling for PPAA. The strongest association was with head circumference (p less than 0.01); logistic regression indicated that for each additional indication of problem drinking reported, risk of head circumference below the 10th percentile increased 2.77 times. Other pregnancy outcome measures negatively related to IPD were 5-min Apgar scores (p less than 0.05), birth weight (p less than 0.10), and 1-min Apgar scores (p less than 0.10). No significant curvilinear alcohol effects or interactions were observed. These findings highlight the potential clinical utility of PPAA and IPD in the early identification of women whose alcohol use puts their pregnancies at high risk.

The Medical and Psychosocial Impact of Comprehensive Care on Adolescent Pregnancy and Parenthood

To assess the medical and psychosocial effects of services provided by a comprehensive adolescent pregnancy and parenthood program, 125 adolescents who received care from a comprehensive program were compared with 135 adolescents who received care from community health providers. Few differences were found in pregnancy outcome measures. At 12 and 26 months after delivery, however, the intervention group scored significantly better on composite measures encompassing medical, psychosocial, and parenting events than did the comparison group, even after accounting for possible confounding factors. This suggests that comprehensive care has little effect on pregnancy outcomes for those adolescents who are already receiving prenatal and nutritional services, but does have a significant effect on events occurring during the first and second postpartum years.

The use of fetal biophysical profile improves pregnancy outcome in premature rupture of the membranes

A protocol using daily fetal biophysical assessment was applied in 73 consecutive patients with premature rupture of the membranes and no clinical signs of infection or labor. A persistently low biophysical score (7 or less on two examinations 2 hours apart) in the presence of a nonreactive nonstress test and absence of fetal breathing was used as an indication for delivery. Measures of pregnancy outcome included the presence of amnionitis or neonatal infection. The outcome of pregnancy in this group of patients was compared with the outcomes of two historic groups: one managed conservatively (control group) and the other managed with amniocentesis on admission to the hospital (amniocentesis group). Infection outcome, maternal as well as neonatal, and low 5-minute Apgar scores were significantly less in the study than in the control group. The frequency of neonatal sepsis was significantly less in the study than in the amniocentesis group. These data suggest that management of premature rupture of the membranes with daily fetal biophysical profiles improves pregnancy outcome by reducing the incidence of maternal and neonatal infection.

Social support in pregnancy: the 'soft' way to increase birthweight?

This paper examines the thesis that social support in pregnancy is capable of affecting birthweight as one easily measurable aspect of pregnancy outcome. The focus of the paper is on birthweight, since low birthweight is a relatively stable and important factor in social inequalities in perinatal health. The paper reviews the published literature on social support in pregnancy including simple observational and nonrandomized intervention studies and also randomized controlled trials of 'social' interventions. The methodological problems associated with some of these studies are discussed. However, it is concluded that there is considerable evidence to suggest that intervention programmes aimed at improving the 'social' side of antenatal care are capable of affecting birthweight and other 'hard' measures of pregnancy outcome. It is suggested that traditional professional approaches to pregnancy which divide the medical from the social perspective, have acted to prevent recognition of this evidence and its relevance to maternity care policy.

No effect of early antenatal care on classical measures of pregnancy outcome?

No effect of early antenatal care on classical measures of pregnancy outcome?

Low molecular weight heparin use in unexplained recurrent miscarriage.

Objective: The aim of the study was to investigate whether the use of low molecular weight heparin (LMWH) improve live birth rates when compared with control group in patients with unexplained recurrent miscarriages (URM). Methods: In this prospective observational study 150 women with a history of two or more previous unexplained first trimester pregnancy loss who received LMWH; either enoxaparin (n=50), tinzaparin (n=50) or nothing (n=50) were followed for the pregnancy outcome measures. Only the patients who have used standardized dosage of LMWH (4000 IU/day enoxaparin or 3500 IU/day tinzaparin ) were included to the study. The primary end point was the live birth rate and secondary end points were the side effects, late pregnancy complications and neonatal outcome in the study cohorts. Results: Live birth was achieved 85% of the LMWH group and 66% of the control group (p=0.007). According to the subgroup analysis; live birth rates did not differ significantly between the enoxaparin and tinzaparin group (84% and 86%, respectively). Maternal and neonatal side effects were not statistically significant among the study participants. Conclusion: Thromboprophylaxis with LMWH resulted in a improved live-birth rate in patient with 2 or more consecutive unexplained recurrent pregnancy loss. Nevertheless these findings need to be confirmed in larger randomized trials.