Frank D. Johnstone

Neutrophil activation in pregnancy-induced hypertension

Summary. Human neutrophil elastase may be a major mediator of vascular damage and could contribute to the vascular damage seen in women with pregnancy‐induced hypertension (PTH). Elevated plasma levels of this substance will reflect neutrophil activation in vivo. To determine neutrophil activation in PIH, we studied 30 normal nonpregnant women, 32 women with normal pregnancies, 19 with mild/moderate PIH and 16 with severe PIH between 28 and 39 weeks gestation. Plasma neutrophil elastase was measured by radioimmuno‐assay. There was a significantly higher concentration of plasma neutrophil elastase in both mild/moderate and severe PIH than in normotensive pregnancies and this may contribute to the vascular lesion associated with PIH. Concentrations were also significantly higher in normal pregnancy than in non‐pregnant women which suggests that neutrophil activation and degranulation are increased in normal pregnancy.

Uptake and acceptability of antenatal HIV testing: randomised controlled trial of different methods of offering the test

Abstract Objective: To determine the uptake and acceptability of different methods of a universal offer of voluntary HIV testing to pregnant women. Design: Randomised controlled trial involving four combinations of written and verbal communication, followed by the direct offer of a test. The control group received no information and no direct offer of a test, although testing was available on request. Setting: Hospital antenatal clinic covering most of the population of the city of Edinburgh. Subjects: 3024 pregnant women booking at the clinic over a 10 month period. Main outcome measures: Uptake of HIV testing and womens knowledge, satisfaction, and anxiety. Results: Uptake rates were 6% for those in the control group and 35% for those directly offered the test. Neither the style of leaflet nor the length of discussion had an effect on uptake. Significant independent predictors of uptake were a direct test offer; the midwife seen; and being unmarried, previously tested, and younger age. Knowledge of the specific benefits of testing increased with the amount of information given, but neither satisfaction nor anxiety was affected by the type of offer. Conclusions: The universal offer of HIV testing is not intrusive and is acceptable to pregnant women. A policy of offering the HIV test to all women resulted in higher uptake and did not increase anxiety or dissatisfaction. Uptake depends more on the midwife than the method of offering the test. Low uptake rates and inadequate detection of HIV infection point to the need to assess a more routine approach to testing. Key messages HIV testing in pregnancy is beneficial, but uptake rates are not high Offering the test to women attending antenatal clinics increases uptake without increasing anxiety or dissatisfaction The extent of information given is not important in terms of whether women take the test and whether they find the procedure acceptable Uptake depends more on the midwife than the method of offering the test Low uptake rates and inadequate detection of HIV infection point to the need to assess a more routine approach to testing

Smoking during pregnancy: the dose dependence of birthweight deficits

Objective To assess whether a simple urine based estimate of relative daily nicotine intake could predict smoking related birthweight deficits more accurately than self‐reported cigarette consumption.

Antenatal HIV testing: assessment of a routine voluntary approach

Papers pp 16501656 The benefits of testing pregnant women for HIV are increasingly assured, particularly with regard to reducing vertical transmission.1 Yet uptake of antenatal HIV testing in Britain remains low.2 Our previous study examined an opt-in approach (women had to make an active choice to be tested).3 Some women were uncomfortable with this, feeling that it indicated high risk behaviour. We therefore assessed an approach based on similar requirements for information and consent but with a change in emphasis, in that testing was routine unless the woman declined. The testing programme was conducted during February to April 1998. Before their booking appointment, all women were sent a leaflet about blood tests to be conducted, including HIV testing. At the antenatal clinic they were offered an HIV test by midwives who had been trained to use a printed discussion protocol that emphasised the benefits and presented the test as routine, making it clear that the woman could decline. As with the other blood …

Does infection with HIV affect the outcome of pregnancy

Details are presented on the outcome of pregnancy in a group of Edinburgh women identified as positive for antibodies to HIV and in women who had a history of drug abuse or a partner known to be seropositive but who were themselves negative for HIV antibody. Pregnant women who had been tested for HIV up to June 1987 were identified. HIV state was known for 205 pregnant women. Most cases were determined during pregnancy, but in 23 (9 seropositive patients) it was determined retrospectively. Seropositivity was only found in women who had been intravenous drug users or whose partner was known seropositive. Of 50 women who were seropositive, 46 were intravenous drug users and 4 had seropositive partners. In 64 cases who were seronegative, 45 had used intravenous drugs since 1983, and 19 had a seropositive partner. These women tended to be young, unmarried, and smoked heavily. They usually lived in areas of Edinburgh with multiple deprivation. Both they and their partners were usually unemployed. In the seropositive group, spontaneous abortion showed an apparent increase, but this may be due to differences in ascertainment as the incidence in the seronegative group was low. Premature delivery, intrauterine growth retardation, and low birth weight were common compared with the total population, but seropositive and seronegative women did not differ from each other in these variables. Compared with rates in the total population of Edinburgh, the rates of prematurity and intrauterine growth retardation were increased more than 2-fold and the rate of low birthweight babies was increased nearly 4-fold, though the 1 twin pregnancy contributed to this. Adverse outcome was equally distributed between the seropositive and seronegative women, and there was no suggestion that infection with HIV itself had any effect. Although no evidence from this study shows that infection with HIV per se affects the outcome of pregnancy, none of these women showed symptomatic illness.

Clinical and ultrasound prediction of macrosomia in diabetic pregnancy

Objective To study prospectively the prediction power, at different gestations, of clinical and ultrasound measurements for fetal size in diabetic pregnancy.

Familial Trends in Low Birth Weight

The reproductive performance of sisters and sisters-in-law of 185 women who had delivered “light-for-dates” and “premature expulsion” low birth weight infants was studied. Percentile birth weights were compared taking into account length of gestation, fetal sex, and the height, weight, parity, and smoking habits of the mother. Sisters of women who had delivered light-for-dates babies had lighter babies than the general population, their sisters-in-law, or the sisters of women in the premature expulsion group. These other groups, however, had the expected distribution of percentile birth weights. Data on familial trends in smoking habits and unknown gestation are also presented. The results are consistent with the theory that the mothers own intrauterine experience affects her reproductive performance but could also be explained by shared family learning experience of as yet unidentified microsocial factors related to pregnancy performance.

Inverse changes in fetal insulin‐like growth factor (IGF)‐1 and IGF binding protein‐1 in association with higher birth weight in maternal diabetes

Objective  The insulin like growth factor (IGF) system plays a key role in regulating fetal growth, is metabolically regulated, and may influence development of increased birth weight in offspring of mothers with diabetes. We examined IGF‐1 and IGF binding protein‐1 (IGFBP‐1) concentrations in cord blood samples from offspring of mothers with gestational and type 2 diabetes.

The effect of introduction of umbilical Doppler recordings to obstetric practice

Objective To assess the effect on obstetric practice of clinician access to umbilical artery Doppler ultrasound results.

The effect of established and gestational diabetes on pregnancy outcome

Objective–To study thc prevalence and type of glucose intolerance in pregnancy and the effect of different types on perinatal mortality and fetal size.