Abstracts
African-Americans & Childbirth
African Americans (1)
Using a prospective comparative design, African American gravidae with and without genital tract infection were assessed with respect to dietary intakes, serum nutrient values, hematologic values, and pregnancy outcomes.
Intakes of ascorbic acid, vitamin A, protein, and iron were the dietary variables while levels of ascorbic acid, protein, albumin, globulin, and ferritin were the variables measured in serum.
Pregnancy outcome was defined on the basis of premature rupture of the membranes (PROM), and infant birth weight, birth length, gestational age, and head circumference.
Findings indicated no significant differences between the mean dietary intakes as well as serum values of the infected and non-infected women, and no difference in the incidence of PROM. However, non-infected women had a better mean hematologic profile than the infected gravidae during pregnancy. Also, for the non-infected group, there were significant relationships between head circumference and protein consumption and serum ferritin.
For the infected women, the relationship between the hemoglobin and hematocrit measurements obtained at the first prenatal visit and infant birth weight, birth length and head circumference were statistically significant.
Westney OE et al., Nutrition, genital tract infection, hematologic values, and premature rupture of membranes among African American Women. J Nutr, 1994 Jun, 124:6 Suppl, 987S-993S.
African Americans (2)
Investigated the effects of nutrition and other related factors on the outcome of pregnancy in nulliparous African American women 16-35 years old.
Biochemical variables such as, serum folate, vitamin B12, ascorbic acid, vitamin E, ferritin, selected minerals as well as complete blood count (CBC) and red cell folate were analyzed in the blood samples.
The concentrations of hematocrit, hemoglobin, white blood cells, red blood cells and vitamin B12 were below the reference non-pregnant ranges throughout gestation. Maternal concentrations of folate and vitamin E increased sequentially with increased gestational age. Serum ferritin, during the third trimester, declined to 58% of the first trimester concentration. Maternal levels of ferritin at delivery were one third of the values found in the infant (cord) sample. Cord levels of folate, ascorbic acid and vitamin B12 were higher than the concentrations in the maternal delivery samples.
Data suggest that major physiological changes, such as plasma volume expansion which alters blood chemistry and maternal to fetal transfer of nutrients, were similar to the findings of other investigators. In this population however, the findings for serum and whole blood folate are contrary to those reported by other researchers, and the sequential increase in the maternal concentration of the vitamin during pregnancy could be attributed to the use of vitamin supplements.
James H et al., Biochemical profile of African American women during three trimesters of pregnancy and at delivery. J Nutr, 1994 Jun, 124:6 Suppl, 943S-953S.
African Americans (3) - Preterm - High Risk
Determined the association of various demographic characteristics, medical risks, and prenatal interventions with birth outcomes of women in the South Carolina Medicaid High Risk Channeling Project.
Analyses of preterm delivery indicated that high-risk African American women were 60 % more likely to deliver a preterm baby than high-risk White women. The mean gestational age was 37.3 weeks for African American newborns and 38.2 weeks for White newborns.
Prenatal nutritional education had a significantly positive association with gestational duration.
Schulman ED: Preterm delivery among women in the South Carolina Medicaid High Risk Channeling Project. J Health Care Poor Underserved, 1995, 6:3, 352-67.
Childhood growth & Childbirth
The intrauterine environment plays a critical role in childhood growth.
Infants exposed to acute malnutrition in early pregnancy are more likely to be obese in later life.
Children exposed to hyperglycemia in utero are also more likely to develop insulin intolerance and obesity during childhood.
Animal experiments suggest that severe overnutrition or undernutrition during pregnancy may affect hypothalamic development, or pancreatic beta-cell development.
Cigarette smoking increases the risk of intrauterine growth retardation.
Alcohol ingestion during pregnancy leads to a syndromic decrease in childhood head circumference, stature, and weight.
The effects of cocaine are most likely multifactorial, since cocaine ingestion tends to covary with tobacco use, alcohol use, opiate use, and low socioeconomic status.
The most striking effects of the intrauterine environment on childhood growth are seen in children with intrauterine growth retardation. These children remain significantly lighter and shorter than their peers.
Efforts to reverse intrauterine growth retardation have been disappointing, and at times risky. However, caloric supplementation in undernourished populations may be of significant benefit. The use of growth hormone promises to reduce some of the height deficits; however, there is no evidence that it changes final height in children with intrauterine growth retardation.
Strauss RS: Effects of the intrauterine environment on childhood growth. Br Med Bull, 1997 Jan, 53:1, 81-95.
Fatty fish & Childbirth
Assessed the relationship between fatty fish intake, the main source of N-3 polyunsaturated fatty acids and maternal and fetal levels in erythrocytes at labor.
The study population was classified as follows:
superior intake group (SIG) (> 4 times fatty fish per month; 54.4 +/- 20.5 g/day),
medium intake group (MIG) (2-4 per month; 16.5 +/- 4 g/day) and
inferior intake group (IIG) (< 2 times per month; 4.3 +/- 4 g/day).
A minimum fatty fish intake of twice per month should be recommended (edible portion 85 g.) in order to reach the N-6/N-3 quotient usually proposed.
Sanjurjo P et al., Influence of fatty fish intake during pregnancy in the polyunsaturated fatty acids of erythrocyte phospholipids in the mother at labor and newborn infant. Acta Obstet Gynecol Scand, 1995 Sep, 74:8, 594-8.
Foods & Fluids?
Questions the routine practice of denying food and fluids to women in labor. Fasting in labor, an established practice throughout the United States since the 1940s, is now under careful scrutiny.
Many clinical practices, especially those that offer midwifery services, are currently instituting policies to allow and encourage eating and drinking in normal labor. To date, there have been no reported rises in maternal mortality with this policy change; neither have there been any reports of detrimental outcomes for mother or infant.
Ludka LM & Roberts CC: Eating and drinking in labor. A literature review. J Nurse Midwifery, 1993 Jul-Aug, 38:4, 199-207.
International catastrophes
It is of interest that, aside from starvation, the nutrition catastrophes of the past, including scurvy (vitamin C deficiency) resulting from lack of fresh vegetables and fruit and beriberi (vitamin B1 deficiency) from consumption of polished rice, are forgotten and only of interest as history.
The problems of vitamins were largely considered settled by the 1950s. With the appearance on the market of multiple-vitamin-and-mineral tablets, the public was also satisfied and considered the problem of deficiencies solved.
Now we are faced with unexpected nutrition problems primarily in the industrial West, which follow from the excess of dietary fats, the refining of grains to make white flour, and the alteration of other natural foods for general use. As we labor to understand and control these problems, new and unexpected "toxins," deficiencies, or excesses may develop.
Unsaturated vegetable oils and saturated animal fats are being reduced or eliminated. In their place, other components and compounds are being substituted for their taste and consistency, without adequate concern for their nutritional value or freedom from toxicity.
Swank RL: A prospective discussion of past international nutrition catastrophes--indications for the future. Nutrition, 1997 Apr, 13:4, 344-8.
Maternal underweight & Childbirth
Examined the differences in the pattern of weight gain according to trimesters of pregnancy for women who delivered term vs. preterm and analyzed the independent effect of prepregnancy weight status and rate of weight gain on delivering preterm.
80% of women identified themselves as being of Hispanic origin.
Women who delivered preterm had patterns of weight gain similar to women delivering term infants.
Underweight status (body mass index < 19.8 kg/m2) before pregnancy nearly doubled the likelihood of delivering preterm.
Inadequate weight gain in the third trimester defined as < 0.34, 0.35, 0.30 and 0.30 kg/wk for underweight, normal weight, overweight and obese women, respectively, increased the risk by a similar magnitude.
Preconceptional nutrition counseling and promotion of adequate weight gain during the third trimester of pregnancy should be components of public health programs designed to decrease the prevalence of preterm birth.
Siega-Riz AM et al., Maternal underweight status and inadequate rate of weight gain during the third trimester of pregnancy increases the risk of preterm delivery. J Nutr, 1996 Jan, 126:1, 146-53.
Bacteria & Childbirth
Premature Birth and Vaginal Bacteria
There is an association between preterm delivery and the presence of large numbers of Bacteroides bacteria in the vagina and cervix of pregnant women.
Out of 211 women, 139 of these or 66% delivered preterm. It was found that in cervical and vaginal samples women with high concentrations of lactobacillus had lower rates of preterm delivery. Those that had high concentrations of Bacteroides bivius or B. fragilis had higher rates of preterm delivery.
Though a causal relationship has not been found, if this is proven to be true, then antibiotics may be of benefit in the prevention of preterm delivery.
"Vaginal Bacteria Implicated in Premature Births", Infectious Disease News, August 8, 1991;19.
Magnesium & Childbirth
Premature Labor and Low Magnesium
Serum magnesium levels were significantly lower in females undergoing premature labor than pregnant or nonpregnant healthy females. The hypomagnesemia was present in addition to other predisposing factors for prematurity, including antepartum eclampsia, hemorrhage, multiple pregnancy, previous history of abortion, or premature delivery. Hypomagnesemia contributes to the onset of spontaneous labor before term.
"Serum Magnesium Level in Pregnancy", Goel, Meenakshi, et al, Indian Veterinary Medical Journal, June 1991;15:83-87.
Preterm Labor, Magnesium Sulfate and Ritodrine
Tocolytic agents have been used to help prevent preterm labor. These include betasympathomimetics, magnesium sulfate, calcium channel blockers and antiprostaglandins combined therapy. There has been a concern that there are excessively high complication rates using ritodrine hydrochloride and magnesium sulfate together. Improved the number of patients delivering after 36 weeks, and decreased the stay in the neonatal intensive care unit per infant 3 versus 15.5 days. They can be used safely and efficaciously.
"Safety and Efficacy of Combined Ritodrine and Magnesium Sulfate For Preterm Labor: A Method For Reduction of Complications", Coleman, Fred H., MD, American Journal of Perinatology, October 1990;7(4):366-369.
Vitamin A & Childbirth
Vitamin A and Progesterone
It has been reported that vitamin A doses in excess of 10,000 I.U. can be teratogenic in early pregnancy. The Teratogology Society recommends taking no more than 8000 I.U./d during pregnancy. In this study 6000 I.U. per day was used which is within safe limits. This supplementation of vitamin A was beneficial in that it increased maternal and fetal vitamin A levels as well as progesterone levels.
"Effect of Vitamin A Supplementation on Plasma Progesterone and Estradiol Levels During Pregnancy", Panth, Meena, et al, International Journal of Vitamin and Nutrition Research, 1991;61: 17-19.
Vitamin D & Childbirth
Vitamin D and Birth Weight
Birth weight and weight of the placenta, its protein, DNA and RNA weights were significantly higher in the supplemented group. The safety and administration of recommended pharmacologic doses during the third trimester of pregnancy are safe.
"Effect of Pharmacologic Doses of Vitamin D During Pregnancy on Placental Protein Status and Birth Weight", Kaur, Jasbinder, et al, Nutrition Research, 1991;11:1077-1081.
Pain & Childbirth
Warm Water Bath and Pain
Warm water immersion is a safe, effective way of decreasing women's labor pain. The stimulation for breath is not birth itself but exposure to air. Although blood pressure does not appear to drop below normal in the water, warm water may lower blood pressure as much as 30 to 40 points in the mothers. Most individuals around the world give birth either kneeling or squatting but not lying on their backs with their legs up in the air as in the United States. This is the most painful position for giving birth.
"Warm Bath Can Ease Birth Pain", Family Practice News, May 15-31, 1991;1,61.
Zinc & Childbirth
Zinc Deficiency and Toxicity
Zinc is important in DNA replication, RNA transcription, and prostaglandin synthesis among other metabolic processes.
Zinc deficiency is noted to cause dysfunctioning of male gonads and associated organs. Since zinc is important in protein synthesis, it is important in the growth of the gonads which contain very rapidly dividing cells. Zinc deficiency has been associated with acrosomal deformities and structural changes in the spermatozoa tail.
In females zinc deficiency's effects are varying in function and can cause teratological and genetic abnormalities. Some symptoms of zinc toxicity include excessive sweating, blurred vision, hypothermia, diarrhea, gastric spasms and pulmonary manifestations.
Heightened levels of calcium can inhibit zinc absorption producing zinc toxicity in certain cases. Zinc also has an antagonistic relationship with copper and interacts with lead and iron.
"Effects of Zinc Deficiency and Toxicity on Reproductive Organs, Pregnancy and Lactation: A Review", Bedwal, R.S., et al, Trace Elements in Medicine, 1991;8(2):89-100.
Prostaglandins & Childbirth
Investigated differences in maternal plasma and trophoblast prostaglandin metabolism associated with preterm births. Tissue prostaglandins (PGs) E2 and F2 alpha and the stable plasma PGF2 alpha metabolite, 13,14-dihydro-15-keto-PGF2 alpha, were measured in preterm (< 37 weeks) and term (< or = 37 weeks) births.
Amnion PGE2 in preterm (106.1 +/- 15.7 ng/g wet weight tissue; x +/- SEM; n = 37) was lower than in term (176.6 +/- 22.7 ng/g wet weight; x +/- SEM; n = 34, P < 0.02). Placenta PGE2 was lower in preterm (34.7 +/- 19.7 ng/g wet weight; x +/- SEM) than in term (103.3 +/- 28.0 ng/g wet weight; x +/- SEM, P < 0.04).
Preterm PGF2 alpha was consistently lower in the amnion (106.8 +/- 17.5 ng/g wet weight) and placenta (102.5 +/- 8.7 ng/g wet weight) than in term amnion (188.2 +/- 24.8 ng/g wet weight; P < 0.01) and placenta (128.9 +/- 7.8 ng/g wet weight; P < 0.03).
Findings suggest qualitative and quantitative differences in maternal and trophoblast eicosanoid metabolism between term and preterm parturition.
Reece MS et al., Prostaglandins in selected reproductive tissues in preterm and full-term gestations. Prostaglandins Leukot Essent Fatty Acids, 1996 Nov, 55:5, 303-7.
Serum ferritin & Childbirth
Identified biochemical indices for iron and protein nutriture as well as acute-phase reactants as predictors of preterm delivery.
Concentrations of iron, ferritin, transferrin, transferrin saturation, and transferrin receptor were measured as indices of iron status. The concentrations of acute-phase reactants, including C-reactive protein, alpha-2-macroglobulin, beta-2-microglobulin and ceruloplasmin, were also measured, along with albumin, prealbumin, retinol-binding protein, copper, and zinc.
Serum ferritin concentrations were negatively correlated with gestational age at birth. For subjects having serum ferritin levels above the median compared with those below, the odds ratio of having an early spontaneous preterm delivery was 3.
Elevated serum ferritin levels during the second trimester are predictive of early spontaneous preterm delivery, possibly because these reflect an acute-phase reaction to subclinical infections that are closely associated with premature delivery.
Tamura T et al., Serum ferritin: a predictor of early spontaneous preterm delivery. Obstet Gynecol, 1996 Mar, 87:3, 360-5.
High risk & Preterm Childbirth
Preterm - High Risk - African American
Determined the association of various demographic characteristics, medical risks, and prenatal interventions with birth outcomes of women in the South Carolina Medicaid High Risk Channeling Project.
Analyses of preterm delivery indicated that high-risk African American women were 60 % more likely to deliver a preterm baby than high-risk White women. The mean gestational age was 37.3 weeks for African American newborns and 38.2 weeks for White newborns.
Prenatal nutritional education had a significantly positive association with gestational duration.
Schulman ED: Preterm delivery among women in the South Carolina Medicaid High Risk Channeling Project. J Health Care Poor Underserved, 1995, 6:3, 352-67.
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