Eleanor L. Capeless

Neonatal morphometrics after endurance exercise during pregnancy

This study was designed to test the hypothesis that continuation of a regular running and/or aerobics program during late pregnancy at or above 50% of preconceptional levels limits fetal growth. Accordingly, detailed neonatal morphometric data were gathered in the offspring of two groups: 77 well-conditioned recreational runners and aerobic dancers who were delivered at term after continuing their exercise regimen at or above 50% of the preconceptional level throughout pregnancy and 55 matched controls. Daily exercise performance was quantitated before conception and throughout pregnancy. Significant reductions in birth weight (-310 gm), birth weight percentile (-20), ponderal index (-0.24), its percentile (-30), and the fetoplacental weight ratio (-0.7) were seen in the offspring of the exercise group whereas crown-heel length (51.4 cm) and head circumference (35.0) were similar in the two groups. Reductions in two-site skin-fold thickness (-1.5 mm), skin-fold percentile (-30), calculated percent body fat (-5.0%), and fat mass (-220 gm) in the offspring of the exercise group confirmed the asymmetric pattern of growth restriction and indicated that approximately 70% of the difference in birth weight could be explained by the difference in neonatal fat mass. In runners, the relative level of exercise performance in the last 5 months of pregnancy explained 40% of the variability in birth weight over an 1100 gm birth weight range. We conclude that continuation of a regular aerobic or running program at or above a minimal training level during late pregnancy results in an asymmetric pattern of growth restriction that primarily impacts on neonatal fat mass.

When do cardiovascular parameters return to their preconception values

Abstract To determine if the postpartum period is reflective of a womans cardiovascular status before pregnancy, we performed serial studies of 13 women before conception and at 6 and 12 weeks post partum. All pregnancies were singleton without hypertensive complications. Cardiac output, stroke volume, and end-diastolic volume were calculated with M-mode echocardiography from the left ventricular dimensions with subjects in the left lateral position. Systemic vascular resistance was calculated from cardiac output and simultaneous measurements of blood pressure. Stroke volume and end-diastolic volume remained consistently elevated over preconception values at 6 and 12 weeks. Systemic vascular resistance remained decreased, compared with baseline, at 12 weeks. Thus cardiovascular parameters had not returned to the preconception baseline, and previous studies that have used this time period for comparison have underestimated the contribution of stroke volume to the total change in cardiac output during pregnancy.

The changing glycemic response to exercise during pregnancy

This study was designed to test the hypothesis that pregnancy reverses the nonpregnant hyperglycemic response to sustained exercise. Serial data were obtained from 75 exercising women. Before pregnancy, exercise produced an intensity-dependent increase in blood glucose that averaged 1.5 mmol/L at high intensities. By the eighth week this response was blunted and blood glucose increased only when exercise intensity exceeded 80% of maximum. At 15 weeks this progressed and was not associated with a change in either the insulin or catecholamine response. By the twenty-third week exercise produced a decrease in blood glucose that was no longer related to exercise intensity. We conclude that the hypothesis is correct and speculate that the early change in the response is related to decreased hepatic glucose release coupled with increased glucose oxidation. In late pregnancy this is probably accentuated by fetoplacental demands.

Uterine artery Doppler velocimetry in the detection of adverse obstetric outcomes in women with unexplained elevated maternal serum α-fetoprotein levels

OBJECTIVE We hypothesized that in pregnancies complicated by unexplained elevations of maternal serum alpha-fetoprotein, second-trimester uterine artery Doppler findings would detect adverse obstetric outcomes. STUDY DESIGN One hundred three subjects with unexplained elevations of maternal serum alpha-fetoprotein had uterine artery Doppler velocimetry studies performed at the time of targeted ultrasonographic examination (17 to 22 weeks). A resistance index > 95th percentile or the presence of a uterine notch was considered abnormal. Adverse outcomes included preeclampsia, preterm birth, low birth weight, intrauterine growth restriction, abruptio placentae, and fetal death. Statistical analysis was performed by Student t test, chi 2 analysis, and stepwise logistic regression analysis. RESULTS An elevated uterine resistance index was associated with an increased relative risk for both preeclampsia (relative risk 41.82, 95% confidence interval 5.36 to 326.13) and low birth weight (relative risk 4.65, 95% confidence interval 1.90 to 11.39). A uterine artery notch was associated with an increased risk of preeclampsia (relative risk 52.22, 95% confidence interval 6.82 to 399.70), preterm birth (relative risk 3.21, 95% confidence interval 1.32 to 7.81), and low birth weight (relative risk 4.18, 95% confidence interval 1.64 to 10.66). When the presence of a uterine notch, vaginal bleeding, and level of maternal serum AFP were analyzed by stepwise logistic regression, the presence of a notch was found to be the only significant factor (odds ratio 6.95, 95% confidence interval 1.24 to 39.10) for the development of an adverse outcome. CONCLUSIONS Abnormal uterine artery Doppler findings are associated with an increased frequency of adverse obstetric outcomes in women with unexplained elevated maternal serum AFP levels. Abnormal Doppler findings demonstrated high sensitivity for the development of preeclampsia but were less sensitive in predicting other outcomes. The presence of a uterine artery notch is a better independent predictor of adverse outcome than are early vaginal bleeding or maternal serum AFP level.

Management of preterm premature rupture of membranes: a Lack of a national consensus

A questionnaire concerning the management of women with preterm premature rupture of membranes was sent to the members of the Society of Perinatal Obstetricians. Expectant management was recommended by 97% of the respondents. There was no consensus about the role and frequency of steroids, blood work, ultrasound examination, and fetal monitoring in the follow-up of these patients.

Labor induction with a prenatal diagnosis of fetal macrosomia

Since our institution has a low cesarean rate (14%), it was our hypothesis that the rate of cesarean delivery in patients who underwent induction for macrosomia would be similar to the cesarean rate in patients with similar birth weights who entered labor spontaneously. A retrospective analysis of cases seen from December 1993 to July 1995 revealed 53 nondiabetic patients who underwent induction for fetal macrosomia. These study patients were matched to the next nondiabetic patient delivering a child of equal or greater birth weight who entered labor spontaneously. Maternal demographics, labor characteristics, and neonatal outcome data were reviewed. There were no differences between the induction and spontaneous labor groups in maternal age, gestational age, rate of nulliparity, incidence of shoulder dystocia, Apgar scores, or vaginal birth after prior cesarean delivery. The cesarean delivery rate was higher in the induction group when compared to the spontaneous labor group (36% vs. 17%, P < 0.05) despite a lower birth weight in the induction group (4,102 +/- 374 g vs. 349 g, P < 0.05). Regional analgesia was administered more frequently in the induction group (38% vs. 53%, P < 0.05). An increased risk of cesarean delivery was observed in subjects undergoing induction for the indication of fetal macrosomia. These data support a plan of expectant management when fetal macrosomia is suspected.

Prenatal diagnosis of autosomal recessive polycystic kidneydisease: Variable outcome within one family

Autosomal recessive polycystic kidney disease is frequently diagnosed in utero by obstetric ultrasonography. We report a case in which there were varying outcomes of this disorder in three affected fetuses in a family. Recognition of variable expression within one family is important when parents are considering termination of a pregnancy with an affected fetus.

Fetomaternal bleeding as a cause of recurrent fetal morbidity and mortality

A woman had fetomaternal bleeding of unknown cause during at least three of five pregnancies. Each event was associated with significant fetal morbidity or mortality. Although fetomaternal bleeding has been reported as a cause of unexplained fetal death, its occurrence in subsequent pregnancies has not been described previously.

“Fetal Growth Charts”: Comparison of Cross-Sectional Ultrasound Examinations with Birth Weight

We examined the hypothesis that fetal growth curves derived from birth weight data deviate significantly from growth curves generated from cross-sectional ultrasound estimated fetal weight. Fetal growth curves created from birth weight data were compared with growth curves generated from ultrasound examinations collected cross-sectionally (350 observations each). Groups were distributed by gestational age between 26 and 39 weeks gestation (25 observations per week). Ultrasound examinations were performed for size/dates discrepancy. Menstrual age was confirmed by ultrasound in each case. One hundred ultrasound examinations performed for size/dates discrepancy (with dating confirmed) were prospectively evaluated to compare the distribution of fetal weight percentile between the two charts. Regression lines for the growth curves were significantly different (P < 0.001). For each gestational age between 26 and 35 weeks, the ultrasound estimated fetal weights demonstrated a higher mean fetal weight (P < 0.05)....

Successful pregnancy outcome in association with lipoatrophic diabetes mellitus

Lipoatrophic diabetes mellitus is a rare syndrome characterized by lipoatrophy and insulin-resistant diabetes mellitus. Partial lipodystrophy without clinical diabetes mellitus has been associated with intrauterine growth retardation and fetal death. We report successful pregnancy outcomes in two women with lipoatrophic diabetes mellitus.