Jami Star

HERBAL AND ALTERNATIVE MEDICINE USE DURING PREGNANCY: A CROSS-SECTIONAL SURVEY

Background: The use of herbal and alternative medical therapies has been increasing rapidly across the United States over the past 10 years. Women of reproductive age often are users of herbs. The use of herbal and alternative medical therapies among pregnant women is important but poorly studied to date. Objective: To determine the frequency of use of herbal and alternative medicine by women during pregnancy. Methods: Two hundred fifty pregnant women attending antepartum visits were prospectively enrolled in a cross-sectional survey about use of herbal and alternative medical therapies. Results: Two hundred forty-two women completed surveys (97%). Of the respondents, 9.1% reported use of herbal supplements during the current pregnancy, 7.5% using these agents at least weekly. The most commonly used herbs during pregnancy were garlic, aloe, chamomile, peppermint, ginger, echinacea, pumpkin seeds, and ginseng. Herb use during pregnancy was strongly associated with prior use of herbal supplements (25.6% versus 1.2%, P <0.001). There were trends toward greater use among white women (11.4% versus 6.1% in other racial groups) and in women with at least college-level education (10.1% versus 7.6% for high school or less). No association was found between herb use during pregnancy and age or income level. Alternative medical therapies were used by 13.3% of pregnant women. The therapies included aromatherapy, meditation/relaxation, chiropractic, yoga, acupressure, therapeutic touch, homeopathy, acupuncture, and reflexotherapy. Conclusion: Herbal and alternative medicine use is common among pregnant women. Pregnant women should be asked about their use of these therapies. Further research is needed to clarify the safety and effectiveness of these therapies during pregnancy.

Intrauterine therapy for homozygous alpha-thalassemia.

BACKGROUND Alpha-thalassemia is one of the most common genetic disorders in the world and is becoming more common in the United States with the increase in immigration of susceptible populations. This disease has been stated previously to be incompatible with extrauterine life. CASE A Filipino woman with a prior loss due to hemoglobin Barts underwent prenatal diagnosis that confirmed recurrence in the index pregnancy. Intravascular intrauterine exchange transfusions maintained appropriate fetal growth. A cesarean delivery yielded a 2190-g male infant with minor malformations. The postnatal course was characterized by mild respiratory insufficiency. Postnatal chronic transfusion therapy is underway pending consideration for bone marrow transplantation. CONCLUSION Antenatal diagnosis and therapy of homozygous alpha-thalassemia can prevent the prenatal consequences of hydrops and fetal death. New technologies such as stem cell transplantation may help to avert both prenatal and postnatal consequences.

Flow cytometric analysis of platelet activation throughout normal gestation

Objective To measure platelet activation in normal pregnancy, before and after stimulation with agonists, with a whole blood flow cytometric technique. Methods In a cross-sectional study, 5 mL of whole blood was collected from healthy volunteers (nine in the first trimester, ten in the second trimester, 35 in the third trimester, and 32 nonpregnant controls). Platelets were treated with an agonist (thrombin or U-46619, a thromboxane A2 analogue) or buffer and were exposed to saturating concentrations of monoclonal antibodies directed against platelet membrane glycoproteins (GPs): 7E3 (fibrinogen receptor GPIIb/IIIa), S12 (alpha granule marker P-selectin), and 6D1 (von Willebrand factor receptor GPIb). Mean fluorescence intensity was determined for 5000 platelets per sample by using a flow cytometer. Results In the absence of agonist, no significant difference between groups was found in antibody binding. At no stage of pregnancy were circulating activated platelets detected. Platelets from third-trimester subjects bound significantly less 7E3 than platelets of controls or of first- or second-trimester subjects after stimulation with high-dose thrombin (P < .05 for all comparisons). Down-regulation of 6D1 on platelets after stimulation with high-dose U-46619 was significantly greater in third-trimester gravidas than in controls or first-trimester subjects (P < .05). Conclusion Pregnancy does not increase the percentage of activated platelets in the circulation. Platelet reactivity is altered in the third trimester, as evidenced by decreased antibody binding to a fibrinogen receptor epitope and enhanced down-regulation of a von Willebrand factor receptor epitope.

Glucocorticoid-Associated Maternal Hyperglycemia: A Randomized Trial of Insulin Prophylaxis

OBJECTIVES To study the degree and timing of maternal hyperglycemia following betamethasone therapy in nondiabetic patients and establish a prophylactic dose of insulin. METHODS Forty-five patients receiving betamethasone 12 mg i.m. at 7 AM on two consecutive days were randomized to no insulin (n = 20), low-dose insulin (n = 18), and high-dose insulin (n = 7) protocols. Each treatment group received s.c. insulin at 7 AM on the 2 days of betamethasone therapy (20 units NPH/10 units regular, and 40 units NPH/20 units regular, respectively). Capillary plasma glucose measurements were obtained at fasting and 2 h after meals for 3 days. A multivariate normal regression model was used to estimate and compare mean glucose levels. RESULTS Eighty-five percent of patients who did not receive insulin exhibited hyperglycemia at levels previously associated with fetal acidosis. Significant differences in mean postprandial plasma glucose levels were found between the no-treatment and insulin groups on days 1 and 2. No significant differences were noted between groups on day 3. CONCLUSIONS Transient maternal hyperglycemia occurs in a consistent pattern in nondiabetic patients receiving betamethasone, which can be limited by the concurrent use of insulin. Further studies to assess fetal acidosis in this setting are warranted.

THE RELATIONSHIP BETWEEN SECOND‐TRIMESTER AMNIOTIC FLUID INSULIN AND GLUCOSE LEVELS AND SUBSEQUENT GESTATIONAL DIABETES

Associations between elevated amniotic fluid glucose and insulin levels in the second trimester and the subsequent development of gestational diabetes have been reported. We conducted a case–control study to determine which analyte best predicts future maternal glucose intolerance. Thirty‐nine women diagnosed with gestational diabetes (criteria of Carpenter and Coustan, Am. J. Obstet. Gynecol., 144,768, 1982) who had undergone genetic amniocentesis for advanced maternal age were matched with euglycaemic controls. Glucose and insulin concentrations were determined by analysis of stored amniotic fluid samples. No significant difference was detected between cases and controls for amniotic fluid glucose concentrations. Amniotic fluid insulin concentrations were significantly higher in cases (mean rank 4·44, P<0·01, using matched rank analysis of variance, where 1 is the lowest and 6 is the highest rank). After conversion to multiples of the median, 20 per cent of women with subsequent gestational diabetes were found to have amniotic fluid glucose levels at or above the 90th centile, while 35 per cent of cases had similarly elevated amniotic fluid insulin levels. We conclude that second‐trimester amniotic fluid insulin is a more sensitive predictor of impending glucose intolerance than amniotic fluid glucose, although neither is sufficiently powerful to use alone as a screening test.

Should women with human immunodeficiency virus be delivered by cesarean

Vertical transmission of human immunodeficiency virus (HIV) accounts for most new pediatric cases in the United States. With the routine use of zidovudine in the antepartum, intrapartum, and postnatal periods, transmission of HIV from mother to infant has decreased significantly during the past 5 years. Most transmission occurs during labor and delivery, so the effect of mode of delivery recently has been investigated. Several studies support cesarean to further reduce infection in newborns. However, those studies are limited by lack of data on concomitant effects of viral load and effects of combined antiretroviral therapy. There also might be increased operative morbidity in this population. Therefore, we suggest caution in establishing cesarean as a standard for delivery of HIV-infected women.