Primiparous Pregnancies Research Articles

Early pregnancy sex steroids during primiparous pregnancies and maternal breast cancer: a nested case\u2013control study in the Northern Sweden Maternity Cohort

BackgroundPregnancy and parity are associated with subsequent breast cancer risk. Experimental and epidemiologic data suggest a role for pregnancy sex steroid hormones.MethodsWe conducted a nested case–control study in the Northern Sweden Maternity Cohort (1975–2007). Eligible women had provided a blood sample in the first 20 weeks of gestation during a primiparous pregnancy leading to a term delivery. The current study includes 223 cases and 417 matched controls (matching factors: age at and date of blood collection). Estrogen receptor (ER) and progesterone receptor (PR) status was available for all cases; androgen receptor (AR) data were available for 41% of cases (n = 92). Sex steroids were quantified by high-performance liquid chromatography tandem mass spectrometry. Odds ratios (ORs) and 95% confidence intervals were estimated using conditional logistic regression.ResultsHigher concentrations of circulating progesterone in early pregnancy were inversely associated with ER+/PR+ breast cancer risk (ORlog2: 0.64 (0.41–1.00)). Higher testosterone was positively associated with ER+/PR+ disease risk (ORlog2: 1.57 (1.13–2.18)). Early pregnancy estrogens were not associated with risk, except for relatively high estradiol in the context of low progesterone (split at median, relative to low concentrations of both; OR: 1.87 (1.11–3.16)). None of the investigated hormones were associated with ER–/PR– disease, or with AR+ or AR+/ER+/PR+ disease.ConclusionsConsistent with experimental models, high progesterone in early pregnancy was associated with lower risk of ER+/PR+ breast cancer in the mother. High circulating testosterone in early pregnancy, which likely reflects nonpregnant premenopausal exposure, was associated with higher risk of ER+/PR+ disease.

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Objectives As inflammation has been associated with preeclampsia in cross-sectional analyses, we examined the relationship between inflammatory markers and preeclampsia in early pregnancy. Methods We conducted a nested case-control study of 409 preeclamptic women and 297 normotensive controls with primiparous singleton pregnancies enrolled in the Danish National Birth Cohort at a median gestation of 16 weeks. Preeclampsia was defined by blood pressure ⩾140/90 mmHg and proteinuria ⩾3 g/24 h. Inflammatory markers included interleukin (IL)-6, IL-6 receptor, IL-4, IL-4 receptor, IL-5, IL-12, IL-2, TNF-alpha, TNF-beta, TNF-receptor, IL-1beta IL-1alpha IL-8, IL-10, IFN-gamma, IL-18, macrophage migration inhibitory factor (MIF), macrophage inflammatory protein (MIP), transforming growth factor-beta (TGF), and RANTES. We examined associations between inflammatory markers dichotomized by the limit of detection (LOD) and preeclampsia using logistic regression to calculate odds ratios (OR) and 95% confidence intervals (CI). Models were adjusted for body mass index (BMI) and smoking. Results Women with IL-6 (OR 1.44, 95% CI 1.03–2.03) and TNF-alpha (OR 1.54, 95% CI 1.06–2.23) levels above the LOD have significantly increased risk of preeclampsia. IL-1beta levels above the LOD showed a decreased risk of preeclampsia (OR 0.55, 95% CI 0.3–1.01). Conclusions Elevated inflammatory markers in early pregnancy may be markers of subclinical disease and/or may be involved in pathogenesis. As these relationships are complex future studies should explore cytokine clusters in preeclampsia risk. Disclosures B.D. Taylor: None. G. Tang: None. R.B. Ness: None. J. Olsen: None. D.M. Hougaard: None. K. Skogstrand: None. J.M. Roberts: None. C. Haggerty: None.

Gender specific intrapartum and neonatal outcomes for term babies

ObjectiveThe purpose of this study is to document the gender specific intrapartum and neonatal outcomes in term, singleton, appropriately grown babies. Study designDe-identified, routinely collected data of all women meeting inclusion criteria between 2001 and 2011 were examined (n=9223). Inclusion criteria were public (non-insured), primiparous women who had delivered singleton, appropriately grown babies at term. In this retrospective cohort study, we estimated 95% confidence intervals. Outcomes measured were maternal demographics, mode of delivery, birthweight, APGAR score, cord blood acidemia, respiratory distress, any resuscitation requirement, nursery admission and stillbirth rates. ResultsThe sex ratio of male babies was 1.05:1 (4718 males; 4505 females, p=0.85). Male babies were more likely to be delivered by instrumental (p=0.004) or caesarean (p<0.001). Birthweight was found to be a significant influencing factor on mode of delivery. Even after adjusting for birthweight, male babies were more likely to be delivered by instrumental delivery (OR 1.24, p<0.001), as well as by emergency caesarean for failure to progress (OR 1.24, p=0.04) and fetal distress (OR 1.38, p<0.001). Male babies, despite having greater birthweights than female babies (p<0.001), were more likely to have lower APGAR scores at 5min (p=0.004), require neonatal resuscitation (p<0.001), develop respiratory distress (p=0.005) and require nursery admission (p<0.001). No statistical difference between male and female babies was found for cord blood acidemia (p=0.58) or stillbirth (p=0.49). ConclusionThis large cohort study demonstrates that term, appropriately grown male babies in primiparous pregnancies fare more poorly in the intrapartum and neonatal periods than female babies. Even when birthweight was accounted for, male babies still required higher rates of intervention in the intrapartum and neonatal periods. This suggests gender may play an independent role in influencing pregnancy outcomes, although the underlying contributing physiology is not definitively established. The gender of the baby perhaps should be considered when counselling parents in the antepartum period.

Free β-human Chorionic Gonadotropin, Total Human Chorionic Gonadotropin and Maternal Risk of Breast Cancer

We investigated whether the free β-human chorionic gonadotropin (free β-hCG) would provide additional information to that provided by total hCG alone and thus be useful in future epidemiological studies relating hCG to maternal breast cancer risk. Cases (n = 159) and controls (n = 286) were a subset of our previous study within the Northern Sweden Maternity Cohort on total hCG during primiparous pregnancy and breast cancer risk. The associations between total hCG (hazard ratio: 0.79; 95% CI: 0.49-1.27), free β-hCG (hazard ratio: 0.85; 95% CI: 0.33-2.18) and maternal risk of breast cancer were very similar in all analyses and mutual adjustment for either one had minor effects on the risk estimates. In the absence of a reliable assay on intact hCG, total hCG alone can be used in epidemiological studies investigating hCG and breast cancer risk, as free β-hCG does not appear to provide any additional information.

Incidência de endometrite citológica e desempenho reprodutivo em vacas de corte Nelore

Avaliaram-se a incidência de endometrite citológica dos 29 aos 90 dias pós-parto e seus efeitos sobre o desempenho reprodutivo de vacas de corte Nelore submetidas a uma estação de monta (EM) de 90 dias. Foram utilizadas 49 matrizes Nelores, sem histórico de retenção de placenta, sem a presença de uma infecção uterina clínica, e com escore de condição corporal acima de 2,5. Realizou-se exame ultrassonográfico para avaliar a parede uterina e a atividade ovariana. O diagnóstico de endometrite citológica foi feito pela técnica de lavagem uterina, considerando-se caso de endometrite ≥5% de neutrófilos em cada lâmina. A incidência de endometrite citológica do rebanho foi de 22%, não diferindo entre as categorias analisadas (primíparas versus multíparas) (P&gt;0,05), a taxa de concepção à primeira inseminação também foi semelhante entre primíparas versus multíparas (P&gt;0,05), porém a taxa de gestação ao final da EM foi maior nas vacas multíparas (83,8%) quando comparadas às primíparas (50,0%) (P&lt;0,05). A presença ou ausência da endometrite citológica não influenciou a taxa de concepção (P&gt;0,05), tampouco a taxa de gestação ao final da EM (P&gt;0,05). Conclui-se que o uso da citologia endometrial não se justifica como ferramenta de diagnóstico em vacas de corte Nelore.

PL.15 Are Obstetricians Normal? Personal Birth Choices and Outcomes of South West Obstetricians and Gynaecologists; with Comparison to Regional and National Birth Statistics

ObjectivesPublication of NICE caesarean section guideline re-established debate about whether obstetricians fear childbirth. This study aimed: To determine personal choices of practising obstetricians on mode of delivery for themselves or...

Increased Placental Nutrient Transporter Expression at Midgestation after Maternal Growth Hormone Treatment in Pigs: A Placental Mechanism for Increased Fetal Growth1

Growth hormone (GH) is important in maternal adaptation to pregnancy, and maternal circulating GH concentrations are reduced in human growth-restricted pregnancies. In the pig, maternal GH treatment throughout early to mid pregnancy increases fetal growth, despite constraining effects of adolescent and primiparous pregnancy, high litter size, and restricted maternal nutrition. Because GH cannot cross the placenta and does not increase placental weight, we hypothesized that its effects on fetal growth might be via improved placental structure or function. We therefore investigated effects of maternal GH treatment in pigs on structural correlates of placental function and placental expression of nutrient transporters important to fetal growth. Multiparous (sows) and primiparous pregnant pigs (gilts) were treated with GH (~15 μg kg(-1) day(-1)) or vehicle from Days 25-50 of gestation (n = 7-8 per group, term ~115 days). Placentas were collected at Day 50 of gestation, and we measured structural correlates of function and expression of SLC2A1 (previously known as GLUT1) and SLC38A2 (previously known as SNAT2) nutrient transporters. Maternal GH treatment did not alter placental size or structure, increased protein expression of SLC2A1 in trophoblast (+35%; P = 0.037) and on its basal membrane (+44%; P = 0.011), and increased SLC38A2 protein expression in the basal (+44%; P = 0.001) but not the apical cytoplasm of trophoblast. Our findings suggest that maternal GH treatment increases fetal growth, in part, by enhancing placental nutrient transporter protein expression and hence fetal nutrient supply as well as trophoblast proliferation and differentiation and may have the potential to ameliorate intrauterine growth restriction.

983 Epidemiological Profile of the Service Plan for the High Risk in Maternal-Fetal Public Teaching Hospital

Background and objectiveTo know the epidemiological profile of health services maternal and child care is fundamental importance for the development of quality indicators that contribute to the quality of care...

Circulating estrogens and progesterone during primiparous pregnancies and risk of maternal breast cancer

Pregnancy reduces maternal risk of breast cancer in the long term, but the biological determinants of the protection are unknown. Animal experiments suggest that estrogens and progesterone could be involved, but direct human evidence is scant. A case-control study (536 cases and 1,049 controls) was nested within the Finnish Maternity Cohort. Eligible were primiparous women who delivered at term a singleton offspring before age 40. For each case, two individually matched controls by age (± 6 months) and date of sampling (± 3 months) were selected. Estradiol, estrone and progesterone in first-trimester serum were measured by high-performance liquid chromatography tandem mass spectrometry and sex-hormone binding globulin (SHBG) by immunoassay. Odds ratios (OR) and 95% confidence intervals (CI) were estimated through conditional logistic regression. In the whole study population there was no association of breast cancer with any of the studied hormones. In analyses stratified by age at diagnosis, however, estradiol concentrations were positively associated with risk of breast cancer before age 40 (upper quartile OR, 1.81; CI, 1.08-3.06), but inversely associated with risk in women who were diagnosed ≥ age 40 (upper quartile OR, 0.64; CI, 0.40-1.04), p(interaction) 0.004. Risk estimates for estrone mirrored those for estradiol but were less pronounced. Progesterone was not associated with risk of subsequent breast cancer. Our results provide initial evidence that concentrations of estrogens during the early parts of a primiparous pregnancy are associated with maternal risk of breast cancer and suggest that the effect may differ for tumors diagnosed before and after age 40.

Hypertensive disorders in pregnancy and intellectual abilities in the offspring in young adulthood: The Helsinki Birth Cohort Study

Background. Hypertensive disorders may affect the fetal developmental milieu and thus hint at mechanisms by which prenatal adversity associates with poorer intellectual ability in subsequent life.Aim. We tested if hypertensive disorders in pregnancy are associated with intellectual ability in the offspring in young adulthood and if any potential associations between hypertensive disorders and intellectual abilities differ according to length of gestation, birth-weight, parity, and childhood socio-economic background.Methods. Using mothers' blood pressure and urinary protein measurements at maternity clinics and birth hospitals, we defined normotensive or hypertensive pregnancies in mothers of 1,196 men who participated in the Helsinki Birth Cohort 1934–1944 Study. At age 20 years the men completed a test on intellectual abilities during compulsory military service.Results. Participants born after pregnancies complicated by hypertensive disorders scored lower on intellectual abilities compared to those born after normotensive pregnancies. The effects of hypertensive disorders were most obvious in men born preterm or after a primiparous pregnancy and in men of higher childhood socio-economic background.Conclusion. Hypertensive disorders in pregnancy are, albeit weakly, associated with lower intellectual abilities in the offspring. These findings are compatible with the concept of adverse fetal ‘programming’ by a suboptimal prenatal environment.

Giant hemorrhagic adrenal pseudocyst in a primiparous pregnancy: Report of a case

Adrenal cysts are rare and are usually discovered incidentally during diagnostic imaging, surgery, or autopsy. Most cystic lesions of the adrenal gland are nonfunctioning and become symptomatic when complicated by rupture, hemorrhage, or infection. A 40-year-old woman presented with a history of gradual-onset pain in her left flank region at 20 weeks' gestation. Ultrasound showed a 20-cm cystic mass in her left abdominal cavity. Pertinent laboratory tests were within normal limits. The patient underwent exploratory laparotomy, which revealed a 20 × 15-cm left adrenal cyst; thus, we performed left adrenalectomy with complete excision of the cyst. Histological examination confirmed a hemorrhagic adrenal pseudocyst. The patient had an uneventful postoperative course, and subsequent routine obstetric ultrasound examinations showed normal fetal activity and development until the pregnancy terminated with a stillbirth caused by pre-eclampsia at 34 weeks' gestation. To the best of our knowledge, this is only the 12th reported case of adrenal pseudocyst discovered during pregnancy. We analyze the clinicopathologic findings and discuss the possible association of pregnancy, with special reference to etiopathogenesis, presentation, diagnosis, and treatment.

Di-Nucleotide Repeat Polymorphisms of the Insulin-Like Growth Factor-1 Gene and Their Association with IGF-1, Insulin-Like Growth Factor-Binding Protein-1 and Birth Size in a Sri-Lankan Cohort

Background: Insulin-like growth factor (IGF)-I is implicated in fetal growth. Ethnic variations of IGF-1 have also been suggested. Di-nucleotide repeat polymorphisms of the IGF-1 gene or their association with IGF-1 levels and birth size have not been studied in Sri Lankans. Objectives: To describe IGF-1 di-nucleotide repeat polymorphisms and their association with IGF-1 and IGF-binding protein (IGFBP)-1 levels and birth size in a cohort of Sri Lankans. Methods: A cross-sectional study on 200 mother-newborn pairs was carried out. Maternal and cord blood levels of IGF-1 and IGFBP-1 were measured by enzyme-linked immunosorbent assay. Three di-nucleotide repeat polymorphisms of the IGF-1 gene [cytosine-adenine (CA) repeats in the promoter and 3′ regions and intron 2 cytosine-thymine (CT) repeat] were studied using PCR amplification and fragment analysis. Results:Cord blood IGFBP-1 levels correlated negatively with birth weight (p < 0.01) and crown-heel length (p < 0.05). Wild-type alleles of the CA repeat polymorphisms differed from those reported in other populations. Newborn and maternal intron 2 CT repeat polymorphism showed a significant effect on birth weight (p < 0.01 and p < 0.001, respectively), crown-heel length (p < 0.01) and head circumference (p < 0.01 and p < 0.05, respectively). Promoter region CA repeat polymorphism and intron 2 CT repeat polymorphism in the newborns were significantly (p < 0.05) associated with cord blood IGF-1 levels. Almost all these effects were limited to primiparous pregnancies. Conclusions: In Sri Lankans intron 2 CT repeat polymorphism of the IGF-1 gene appears to be a significant contributor to IGF-1 levels and birth size in primiparous pregnancies.

Depressive symptoms in adulthood and intrauterine exposure to pre‐eclampsia: the Helsinki Birth Cohort Study

Please cite this paper as: Tuovinen S, Räikkönen K, Kajantie E, Pesonen A, Heinonen K, Osmond C, Barker D, Eriksson J. Depressive symptoms in adulthood and intrauterine exposure to pre‐eclampsia: the Helsinki Birth Cohort Study. BJOG 2010;117:1236–1242.Objective We studied whether pre‐eclampsia predicts depressive symptoms in offspring.Design Retrospective longitudinal cohort study.Setting Participants in the Helsinki Birth Cohort 1934–44 Study.Population We classed 788 women and men born at term after a normotensive, hypertensive or pre‐eclamptic pregnancy, by using the mother’s blood pressure and urinary protein measurements, at maternity clinics and birth hospitals.Methods Linear and logistic regression analyses. We made adjustments for the mother’s age and body mass index (BMI) at delivery, the participant’s body size at birth/length of gestation, sex and childhood socio‐economic status, age and educational attainment at testing.Main outcome measures Beck depression inventory (BDI) scores completed twice, at the ages of 60 and 63 years.Result Participants born after a primiparous pregnancy complicated by pre‐eclampsia had over 30% (P &lt; 0.04) higher depressive symptom scores in adulthood compared with those born after a primiparous normotensive pregnancy. We found no evidence of the association between pre‐eclampsia and depression among participants born after multiparous pregnancies. Gestational hypertension and depressive symptoms were not significantly associated. The models adjusting for mother’s age and BMI at delivery, the participant’s body size at birth/length of gestation, sex, childhood socio‐economic status, age and educational attainment at testing did not change the results.Conclusion Pre‐eclampsia is associated with later depressive symptoms in individuals born at term and after a primiparous pregnancy. These findings are compatible with the adverse fetal ‘programming’ by a suboptimal prenatal environment.

IGF-I during primiparous pregnancy and maternal risk of breast cancer

Previously, we reported that insulin-like growth factor (IGF)-I during early pregnancy is positively associated with maternal risk of breast cancer. To further explore this association, we designed a new study limited to women who donated a blood sample during their first pregnancy ending with childbirth. A case-control study was nested within the Northern Sweden Maternity Cohort in which repository since 1975, serum specimens remaining after early pregnancy screening for infectious diseases had been preserved. Study subjects were selected among women who donated a blood sample during the full-term pregnancy that led to the birth of their first child. Two hundred and forty-four women with invasive breast cancer were eligible. Two controls, matching the index case for age and date at blood donation were selected (n = 453). IGF-I was measured in serum samples on an Immulite 2000 analyzer. Conditional logistic regression was used to estimate odds ratios and 95% confidence intervals. A significant positive association of breast cancer with IGF-I was observed, with OR of 1.73 (95% CI: 1.14-2.63) for the top tertile, P < 0.009. Subgroup analyses did not indicate statistical heterogeneity of the association by ages at sampling and diagnosis or by lag time to cancer diagnosis, although somewhat stronger associations with risk were observed in women < or = age 25 at index pregnancy and for cases diagnosed within 15 years of blood donation. The results of the study add further evidence for an adverse effect of elevated IGF-I concentrations during early reproductive life on risk of breast cancer.

Time Trends in Human Fecundability in Sweden

Trends in biologic fertility are elusive. Possible negative trends in male reproductive health are still debated, and their effect on human fertility might be negligible. Time-to-pregnancy (TTP) is a functional measure of couple fecundability. We analyzed data on TTP among 832,000 primiparous women 20 years of age and older in the nationwide Swedish Medical Birth Registry from 1983 through 2002. This age restriction led to an exclusion of 10% of primiparous pregnancies. Subfertility (TTP > or =1 year) was analyzed as a function of maternal age, calendar time at initiation of attempt, and birth cohort-taking into account the truncation problems that are inherent in birth-based retrospective sampling. Subfertility generally decreased over successive birth cohorts. When studied as a period effect, a transient increase in subfertility was seen in the early 1990s. Subfertility increased with age, except that for women in their late 1930s, an apparent decrease was observed, particularly among the early cohorts. We found decreasing subfertility over time. We speculate that these patterns might be related to a Sweden-specific decrease over time in sexually transmitted diseases, to changes in sexual behavior induced by socioeconomic conditions, or to broader biologic or educational trends.

Étude des facteurs de risques obstétricaux dans le suivi de 365 grossesses primipares adolescentes à l’île de la Réunion

Analysis of obstetrical risk factors in teenage primiparous pregnancies in Reunion Island (4% of total births).Retrospective study, between 2001 and 2002, comparing primiparous adolescents (13-17 years, n = 365), with primiparous controls (18-29 years, n = 2050). The analysis included demographical factors, maternal medical histories, prenatal follow-up, obstetrical risk factors, delivery modes and neonatal characteristics.Adolescents attended on average 8 prenatal consultations, however 4% had poor prenatal care (less than 3 visits, OR 4.2, P < 0.001 vs controls). They presented less gestational diabetes, but there were no differences concerning pre-existing hypertension, hypertensive disorders of pregnancy, medical reasons of hospitalisation between the two groups. Mode of delivery was more favorable in adolescents (half rate of caesarean sections, shorter duration of membrane ruptures). Nevertheless, adolescents presented a higher risk of severe prematurity (<32 Weeks gestation, incidence 3.6% vs 1.6%, OR 2.3, p = 0.008).With optimal prenatal care (more than 90% of our cohort), primiparous adolescents present globally a favorable course of their pregnancies and have better deliveries than their young (18-29 years) counterparts. However, there is a significant risk of severe prematurity requiring special care for these pregnancies.

Association between a variant of the glutathione S-transferase P1 gene (GSTP1) and hypertension in pregnancy in Japanese: interaction with parity, age, and genetic factors.

Hypertension in pregnancy (HP), including preeclampsia (PE), is known to be a multifactorial disease. Recently, an Ile105Val variant of the glutathione S-transferase P1 gene ( GSTP1) was shown to be associated with PE in The Netherlands. We therefore performed an association study of the Ile105Val variant comparing 131 patients with HP and 327 normal pregnant controls in Japan. We analyzed the data in the context of other risk factors before pregnancy. The frequency of the Ile/Val+Val/Val genotype of the GSTP1 was not significantly different between the HP (26%) patients and the controls (28%). However, in primiparous patients, the frequency was significantly different in elderly pregnancy (63% in severe HP vs. 18% in controls; P < 0.05), in the subgroup with the MM+MT genotypes of the angiotensinogen gene (50% in severe HP vs. 26% in controls; P < 0.05), and in the subgroup with the GA+AA genotypes of the endothelial nitric oxide synthase gene (42% in severe HP vs. 13% in controls; P < 0.05). These results suggest that this variant of the GSTP1 may play a role in the manifestation of HP together with other independently and/or synergistically acting factors, particularly in primiparous pregnancy.

Size at birth and early childhood growth in relation to maternal smoking, parity and infant breast-feeding: longitudinal birth cohort study and analysis.

There is remarkably wide variation in rates of infancy growth, however, its regulation is not well understood. We examined the relationship between maternal smoking, parity, and breast- or bottle-feeding to size at birth and childhood growth between 0 and 5 y in a large representative birth cohort. A total of 1,335 normal infants had weight, length/height, and head circumference measured at birth and on up to 10 occasions to 5 y old. Multilevel modeling (MLwiN) was used to analyze longitudinal growth data. Infants of maternal smokers were symmetrically small at birth (p < 0.0005) compared with infants of nonsmokers, however, showed complete catch-up growth over the first 12 mo. In contrast, infants of primiparous pregnancies were thin at birth (p < 0.0005), showed dramatic catch-up growth, and were heavier and taller than infants of nonprimiparous pregnancies from 12 mo onwards. Breast-fed infants were similar in size at birth than bottle-fed infants, but grew more slowly during infancy. Among infants who showed catch-up growth, males caught up more rapidly than females (p = 0.002). In conclusion, early postnatal growth rates are strongly influenced by a drive to compensate for antenatal restraint or enhancement of fetal growth by maternal-uterine factors. The mechanisms that signal catch-up or catch-down growth are unknown but may involve programming of appetite. The importance of nutrition on early childhood growth is emphasized by the marked difference in growth rates between breast- and bottle-fed infants. The sequence of fetal growth restraint and postnatal catch-up growth may predispose to obesity risk in this contemporary population.

Size at Birth and Early Childhood Growth in Relation to Maternal Smoking, Parity and Infant Breast-Feeding: Longitudinal Birth Cohort Study and Analysis

There is remarkably wide variation in rates of infancy growth, however, its regulation is not well understood. We examined the relationship between maternal smoking, parity, and breast- or bottle-feeding to size at birth and childhood growth between 0 and 5 y in a large representative birth cohort. A total of 1335 normal infants had weight, length/height, and head circumference measured at birth and on up to 10 occasions to 5 y old. Multilevel modeling (MLwiN) was used to analyze longitudinal growth data. Infants of maternal smokers were symmetrically small at birth (p < 0.0005) compared with infants of nonsmokers, however, showed complete catch-up growth over the first 12 mo. In contrast, infants of primiparous pregnancies were thin at birth (p < 0.0005), showed dramatic catch-up growth, and were heavier and taller than infants of nonprimiparous pregnancies from 12 mo onwards. Breast-fed infants were similar in size at birth than bottle-fed infants, but grew more slowly during infancy. Among infants who showed catch-up growth, males caught up more rapidly than females (p = 0.002). In conclusion, early postnatal growth rates are strongly influenced by a drive to compensate for antenatal restraint or enhancement of fetal growth by maternal-uterine factors. The mechanisms that signal catch-up or catch-down growth are unknown but may involve programming of appetite. The importance of nutrition on early childhood growth is emphasized by the marked difference in growth rates between breast- and bottle-fed infants. The sequence of fetal growth restraint and postnatal catch-up growth may predispose to obesity risk in this contemporary population.

Elevated Maternal Serum hCG in the Second Trimester Increases Prematurity Rate and Need for Neonatal Intensive Care in Primiparous Preeclamptic Pregnancies

Objective. This study was designed to investigate the association between the serum concentrations of maternal second trimester human chorionic gonadotropin (hCG) and the severity of preeclampsia.Methods. At Kuopio University Hospital, a total of 487 preeclamptic primiparas had undergone maternal serum screening for Down's syndrome between January 1993 and December 1998. Of these, 37 women had unexplained elevated serum hCG concentrations [>2.5 multiples of the median (MoM)], whereas the remaining 450 preeclamptic women had normal hCG results. Pregnancy characteristics and outcome measures in these groups were evaluated using logistic regression.Results. Elevated midtrimester hCG concentrations were associated with higher rates of low-birth-weight infants, preterm delivery, and need for neonatal intensive care. The adjusted odds ratios was 2.11 [95% confidence interval (CI): 1.03–4.32], 2.08 (95% CI: 1.10–4.30), and 2.27 (95% CI: 1.14–4.51), respectively.Conclusions. In primiparous preeclamptic pregnancies, an elevated maternal serum hCG concentration is a marker of early-onset and severe disease with significant maternal and perinatal morbidity. This finding, in turn, reinforces the association between elevated hCG concentrations and placental damage in early pregnancy. Elevated maternal serum hCG levels identify a subgroup of preeclamptic patients who deserve more intensive observation.