Maternal attitude toward pregnancy and the risk of neonatal death

OBJECTIVES: Reduced options for fertility control over the past decade have increased the rates of unwanted pregnancy. We evaluated whether a woman's negative attitude toward her pregnancy increased the risk of perinatal mortality, in a large, prospective cohort study. METHODS: The association between attitude toward the pregnancy and perinatal mortality was evaluated in a longitudinal cohort study of 8823 married, pregnant patients enrolled from 1959 to 1966 in the Child Health and Development Studies. RESULTS: Women who reported during the first trimester of prenatal care that the pregnancy was unwanted were more than two times more likely to deliver infants who died within the first 28 days of life than were women reporting accepted pregnancies. A positive attitude toward pregnancy was not associated with fetal death or post-neonatal death. CONCLUSIONS: These data, collected when induced abortions were illegal, may have important implications for the 1990s. If maternal attitude toward the pregnancy is associated with neonatal mortality and abortion laws change such that access is restricted, infant mortality may increase because a greater proportion of births will be unwanted.     

Maternal smoking during pregnancy and childhood cancer

The association between maternal smoking during pregnancy and childhood cancer was investigated using prospectively collected data from 54,795 liveborn children in the Collaborative Perinatal Project (1959-1966). Cases of cancer had a histologic diagnosis and/or a compatible clinical course. There were 51 children with cancer, for a cumulative incidence of cancer of 1.1 per 1,000 by 96 months of age. Maternal smoking was determined at each prenatal visit; 52% of mothers reported smoking at one or more visits. By age 8 years, cancer had occurred in 1.4 per 1,000 children whose mothers did not smoke during pregnancy, compared with 0.9 per 1,000 children whose mothers smoked (p = 0.15 by log rank test); the hazard ratio was 0.67 (95% confidence interval (CI) 0.38-1.17). There was no dose-response effect of smoking compared with nonsmokers (hazard ratio for one to 10 cigarettes/day = 0.45, more than 10 cigarettes/day = 0.83). The hazard ratio for leukemia among children whose mothers smoked was 0.82 (95% CI 0.31-2.11); the hazard ratio for cancers other than leukemia was 0.60 (95% CI 0.30-1.20). Adjustment did not change the hazard ratio substantially. Although the relatively small number of cases precluded extensive study of individual types of cancer, the authors conclude that maternal smoking during pregnancy is not associated with an increased risk of childhood cancer in this cohort.     

Varicella during pregnancy. Maternal and fetal effects

To determine the characteristics of maternal varicella at our institution, we reviewed all cases of primary varicella in pregnancy. Using a perinatal database that summarizes all obstetric admissions, we reviewed the medical records of women with varicella infections during pregnancy. Over a 5 1/2-year period, 31 pregnancies were affected by varicella infection among 11,753 deliveries. The mean age of those patients was 19.6 years, significantly different from our overall population of 25.3 years (P < .05). The racial composition of 35% Hispanic, 35% white, and 29% African American was different from that of our general population of 55% white, 38% African American, and 6% Hispanic (P = .023). The mean gestational age of the eruption of vesicles was 25 weeks. Of the 31 women, 7 had preterm labor within a week of their varicella, 3 delivered prematurely, and 3 infants had a birth weight of less than 2,700 grams. Respiratory symptoms developed in 6 women, and pneumonia developed in 4, 2 of whom required ventilatory support, 1 for 5 days, the other for 49 days. Eight women received acyclovir during gestation, and none suffered sequelae. In all, 6 infants had lesions and anomalies noted at birth, 5 possibly associated with varicella. Varicella infection is associated with a greater-than-expected level of both maternal and fetal morbidity. The fetal disease may occur due to maternal infection at any gestation and is most likely a spectrum of complications. The maternal disease appears to be worse in the latter half of pregnancy. Programs of prevention through vaccination must account for a possibly decreased level of immunity in different populations.     

Unexpected death during a brain scintigraphy

Brain scintigraphy was performed for differential diagnosis of suspected subdural hemorrhage in a 79-year-old woman. Planar pertechnetate (99mTcO4-) brain scan with AP, PA, lateral and vertex projections was planned. The procedure was started with AP-projection, continuing with lateral projections. After these images the patient was determined dead and the planned scannings were aborted. There was a clear difference in the intracranial uptake (choroid plexuses) in the lateral views as well as in the uptake in the venous sinuses. The findings in the AP view were normal and no signs of subdural hemorrhage were observed. The patient died during a routine nuclear medicine procedure, and cessation of intracranial circulation was observable on 99mTcO4- scans; the lack of uptake in cerebral sinuses confirmed the lack of intracerebral flow. In this rare case, brain death could be timed accurately using a static nuclear medicine procedure. Autopsy confirmed sudden brain circulatory disorders and general arteriosclerosis.     

Maternal smoking during pregnancy and psychiatric adjustment in late adolescence

Large-core (14g) needle biopsy (CNB) of the breast is a new diagnostic modality increasingly being used to evaluate patients with mammographic abnormalities. Two hundred twenty-four CNBs were performed on 198 patients. Surgical follow-up was available in 64 cases (28.6%). Overall concordance rate was 93.8% (60 of 64 cases). Of the four discordant cases, two were diagnosed as atypical ductal hyperplasia (ADH) on CNB; on excision, these cases showed cribriform ductal carcinoma in situ (DCIS); two remaining cases, diagnosed on CNB as ADH versus DCIS, showed invasive carcinoma (DCIS with invasive component and infiltrating cribriform carcinoma, respectively) on excisional biopsy. Malignancy, primary (52) or metastatic (5), was identified in 57 cases (25.4%); 47 of these patients underwent surgical excision, and the diagnosis was confirmed in all of these cases. Of 51 cases with radiographic evidence of microcalcifications, 48 (94%) had microcalcifications in the CNB: 30 (62.5%) were benign, 11 (22.9%) were malignant, and 7 (14.6%) were diagnosed as ADH. In the remaining three cases (1.3%), only benign breast tissue without microcalcifications was seen, and the lesion was considered to have been missed. Biopsy specimens were obtained from 173 lesions because of the presence of a mass: 125 (72.3%) were benign, 45 (26%) were malignant, and 3 (1.7%) were diagnosed as ADH. Follow-up was available in 118 patients with benign lesions: all were mammographically stable or decreased at 6 or 12 months; no follow-up was available for the remaining patients. CNB of the breast is a highly sensitive (96.9%) and specific (100%) technique for management of patients with mammographic abnormalities. The histologic findings should be correlated with the mammographic appearance, and an attempt should be made to achieve a specific diagnosis in all lesions, particularly masses. The diagnosis of ADH should always prompt excisional biopsy because of a high frequency of false-negative results caused by sampling errors or underestimation.     

A psychological case study of death during pregnancy.

A case presentation is made to elucidate the fact that evaluation of psychological status should include depth or projective material as well as surface or directly obtained information about the patient's personality. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Maternal recognition of pregnancy

Maternal recognition of pregnancy reflects the various ways in which the mother responds to the presence of a conceptus within her reproductive tract. A part of the biochemical information she senses may be irrelevant to pregnancy outcome, but some reflects the attempts by the conceptus to gain some measure of control over corpus luteum function, uterine blood supply, the mother's immune system, and other aspects of maternal physiology. Most probably as a result of ongoing genetic conflict between the mother and the conceptus, a bewildering range of placental structures and trophoblast signaling mechanisms are encountered in eutherian mammals despite the fact that the uterus and conceptus share a common interest, which is the successful outcome of the pregnancy. Here we review some of the ways that such mammals maintain luteal function in early pregnancy and briefly discuss the related topics of embryonic loss and maternal monitoring of conceptus fitness. We next address the view that the conceptus is an intruder, recognized as foreign by the mother, that likely survives by using strategies analogous to those employed by successful parasites. In this context, we describe the pregnancy-associated glycoproteins, multiple isoforms of which are released at the trophoblast-endometrial interface during pregnancy of ungulate species. These molecules, which are structurally related to pepsin, are proposed to bind and sequester antigenic peptides, thereby serving an immunoprotective role.     

Maternal substance abuse during pregnancy. Policy implications in the United States

C3H10T1/2 cells are an established mesenchymal stem cell line which can differentiate into muscle, fat and cartilage cells when treated with azacytidine. Bone morphogenetic protein-2 (BMP-2) caused a dose dependent differentiation of these cells into fat, cartilage and bone cells-low concentrations favoring adipocytes and high concentrations chondrocytes and osteoblasts. The differentiated phenotypes were stable in the absence of BMP-2. Furthermore, the addition of other growth factors during the differentiation process altered the frequency of the differentiated colony formation. Transfection of the C3H10T1/2 cells with a BMP-2 cDNA also induced a phenotypic change from the parental fibroblast to adipocytes and osteoblasts. Our results in this model system indicate that a single protein factor can cause differentiation of a stem cell line to multiple phenotypes, that phenotypes induced can be regulated by factor concentration, and that other factors can also influence BMP-2 induced differentiation.     

Maternal smoking during pregnancy and the risk of conduct disorder in boys

(BACKGROUND): We studied the clinical efficacy of transurethral microwave thermotherapy (TUMT) using Endotherm UMW system (OLYMPUS). (METHODS): TUMT was performed in 28 patients with benign prostatic hyperplasia (BPH). Three patients of them were catheterized because of urinary retention. The treatment was performed in a single session for an hour. The urethral surface temperature was set at 39 degrees C, and the coolant flow of the urethral applicator (21 Fr balloon catheter) was set at 30 ml/min, to heat up the broad area of the prostate up to 45 degrees C. The clinical efficacy was evaluated by analyzing subjective responses, using the International Prostate Symptom Score (I-PSS) scale (S) and QOL score (L), and objective responses, using peak urinary flow rate (Qmax), average flow rate (Qave), residual urine volume and prostate volume following the treatment. (RESULTS): At 24 weeks after the treatment, significant improvement were observed in S score (41%), L score (37%), Qmax (53%) and Qave (62%). Although there was no significant decrease in residual urine and prostate volume. The three patients, with a catheter indwelled because of urinary retention, were all free of the catheter within 4 weeks after the treatment. During and after the treatment, no severe adverse effects, including transient urinary retention needed for indwelling a catheter, was detected. (CONCLUSION): A single session of TUMT by Endotherm UMW considered to be safe and useful for symptomatic BPH patients, even who are not indicated for transurethral resection of the prostate (TUR-P) because of underlying disorders.     

Maternal smoking during pregnancy, growth, and bone mass in prepubertal children

OBJECTIVES: A long-term follow-up study with nuclear magnetic resonance (NMR) imaging was undertaken to detect the morphological onset and to establish the early diagnosis in apical hypertrophic cardiomyopathy (HCM). BACKGROUND: A spadelike configuration on left ventriculogram (LVG) is regarded as a diagnostic criterion for the classical apical HCM. There also exists a segmented hypertrophy at the apical level without indicating the spadelike features (a nonspade configuration). To detect the hypertrophied myocardium of the nonspade configuration, circumferential scrutiny of the apex is required. Although both configurations can be underlying causes of giant negative T waves, etiological relationship between the two is not clarified. METHODS: The criteria for the spadelike configuration defined on left ventricular short-axis NMR images were as follows: (apical maximal thickness > or = 15 mm), (apical anterior thickness over basal anterior thickness > or = 1.3) and (apical posterior thickness over basal posterior thickness > or =1.3). Thirteen patients who had predominant hypertrophy (> or = 15 mm) at the apical level without the spadelike configuration underwent NMR imaging twice before and after 54+/-10 months' follow-up. RESULTS: Apical hypertrophy that had been confined to the lateral wall in four, the anterior-lateral wall in two, and the septal-anterior wall in one developed to become circumferential hypertrophy that fulfilled the criteria for the spadelike configuration after the follow-up period. CONCLUSIONS: The spadelike configuration can begin with the nonspade configuration and therefore, both can constitute a single disease entity of apical HCM. The early diagnosis of apical HCM can be achieved by identifying the hypertrophy frequently confined to the lateral wall at the apical level.     

Maternal B lymphocytes specific for paternal histocompatibility antigens are partially deleted during pregnancy

Although genetically different from its mother, a mammalian fetus bearing paternal alloantigens is normally not rejected. To investigate one of the many possible mechanisms involved in this important biologic phenomenon, we analyzed the consequences of fetal alloantigen recognition on maternal B lymphocytes. We used transgenic mice expressing a unique B cell receptor with a relatively high affinity for the MHC class I molecule H-2Kk on most B lymphocytes. We provide the first evidence for an alloantigen-specific B cell deletion in the spleens and bone marrow of transgenic mothers bearing H-2Kk-positive fetuses. This highly reproducible deletion affects < or =80% of Id-bearing B cells, starts at midpregnancy, and is only observed until term. Such a specific maternal B cell deletion could contribute to the success of the fetal allograft.     

Maternal iodine status and thyroid volume during pregnancy: correlation with neonatal iodine intake

Differences in pregnancy-associated alterations in thyroid volume and urinary iodine (UI) excretion have been attributed to geographical variations in dietary iodine intake. In this study, ultrasound-measured thyroid volume and UI excretion were assessed during the 3 trimesters of pregnancy, at delivery, and at 6 weeks postpartum. Urine specimens also were obtained from mothers and both breast- and formula-feeding infants at 3 days after delivery. Thyroid volume showed a significant increase (maximum 47.0%), compared with nonpregnant control values over the 3 trimesters of pregnancy, which occurred as early as the first trimester and was paralleled by increased UI excretion, followed in turn by a precipitous fall at delivery. UI excretion in breast-feeding neonates (100 +/- 6.8 micrograms/L) was significantly higher than in their mothers (76 +/- 5.6 micrograms/L; p < 0.01) but was significantly lower (43 +/- 3.5 micrograms/L) in formula-fed infants. The results suggest that in an area of moderate dietary iodine intake, UI loss during pregnancy may result in maternal thyroid enlargement. The ability of the breast to transport iodine compensates for this loss in breast-fed infants, but this protection may be lost in formula feeding.     

Maternal drug use during pregnancy: Are preterm and full-term infants affected differently?

This study examined whether preterm infants are more vulnerable to the effects of prenatal drug exposure than are full-term infants. The sample of 235 low-income African American mothers and their infants included 119 cocaine-polydrug users, 19 alcohol-only users, and 97 nonusers; 148 infants were full term and 87 were preterm. Direct effects of exposure on birth weight, birth length, ponderal index, and irritability were moderated by length of gestation: Fetal growth deficits were more extreme in later-born infants, whereas increases in irritability were more extreme in earlier born infants. Effects of exposure on cardiorespiratory reactivity to a neonatal exam were not moderated by length of gestation. In general, effects of exposure occurred for both cocaine-polydrug and alcohol-only users and so could not be unambiguously attributed to either of these drugs alone. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Maternal instinct in women with complicated pregnancy

Using an Ussing chamber, both the posterior epithelial membrane and cultured epithelial cell monolayers from canine trachea were used for measurements of potential difference (PD) and short circuit current (SCC). Conductance (G) was calculated as the ratio SCC/PD. Adenosine (10(-5) to 10(-3) M) failed to produce any significant increases in PD and SCC. ATP (10(-6) to 10(-4) M) produced a significant transient increase in SCC in a dose-dependent fashion, reaching a peak value within 3 min after stimulation. Isoproterenol (ISOP) at 10(-8) M itself did not significantly alter the SCC value. In both the epithelial membrane and cultured epithelial cells treated with amiloride, however, pretreatment with 10(-8) M ISOP significantly augmented the ATP-induced SCC rise, whereas G did not significantly change. These findings indicate that beta-adrenergic stimulation augments Cl- secretion induced by P2-receptor stimulation in airway epithelial cells.     

From death concepts to brain death diagnostic criteria

The authors present considerations about death and brain death concepts, as well the legal aspects for its diagnosis in Brazil. They also present the UNICAMP Protocol for the Diagnosis of Brain Death, revised and according with the current law, with standard techniques for the diagnostic exam. They emphasize the importance of a mature ethical position for this frequent and challenging situation.