José M Belizán

Cigarette smoking during pregnancy and risk of preeclampsia: a systematic review.

In this systematic review of the existing evidence regarding the relationship between cigarette smoking during pregnancy and preeclampsia, studies were found through searches of MEDLINE (1966-October 31, 1998), Embase, Popline, CINAHL, Lilacs, bibliographies of identified studies, and proceedings of meetings on preeclampsia, and also through contact with relevant researchers. No language restrictions were imposed. Only cohort and case-control studies dealing with the relationship between cigarette smoking and preeclampsia were considered. Assessment of methodologic quality and data extraction of each study were carried out by 2 authors working independently. Typical relative risks and odds ratios with 95% confidence intervals were calculated for cohort and case-control studies, respectively, with both fixed and random effects models. Twenty-eight cohort studies and 7 case-control studies including a total of 833,714 women were included. All cohort studies reported an inverse association between cigarette smoking during pregnancy and incidence of preeclampsia (typical relative risk, 0.68; 95% confidence interval, 0.67-0.69). The findings were similar for case-control studies (typical odds ratio, 0.68; 95% confidence interval, 0.57-0.81). An inverse dose-response relationship was also found. Pooled data from cohort and case-control studies showed a lower risk of preeclampsia associated with cigarette smoking during pregnancy.

Maternal morbidity and mortality associated with multiple gestations

Objective To test the hypothesis that women with multiple gestations are at increased risk of adverse maternal outcomes. Methods We studied the association between multiple gestation and frequency of adverse maternal outcomes in 885,338 pregnancies recorded in the Perinatal Information System database of the Latin American Center for Perinatology and Human Development, Montevideo, Uruguay, between 1985 and 1997. Relative risks (RRs) were adjusted for 14 potential confounding factors through multiple logistic regression models. Results There were 15,484 multiple gestations. Among parous women, multiple gestation was associated with a twofold increase in risk of death compared with singleton gestations [adjusted RR 2.1; 95% confidence interval (CI) 1.1, 3.9]. Compared with singleton gestations, women with multiple gestations had adjusted RRs of 3.0 (95% CI, 2.9, 3.3) for eclampsia, 2.2 (95% CI, 1.9, 2.5) for preeclampsia, and 2.0 (95% CI, 1.9, 2.0) for postpartum hemorrhage. Likewise, there was significant association between multiple gestation and increased incidence of preterm labor, anemia, urinary tract infection, puerperal endometritis, and cesarean delivery. The incidences of premature rupture of membranes, third-trimester bleeding, and gestational diabetes mellitus were not statistically different for singleton and multiple gestations. Conclusion Multiple gestation increases the risk of significant maternal morbidity and mortality.

Nutrient Involvement in Preeclampsia

Preeclampsia is a pregnancy-specific condition that increases maternal and infant mortality and morbidity. It is diagnosed by new-onset increased blood pressure and proteinuria during gestation; for many years these markers were the sole targets for study. More recently, increased attention to the multisystemic nature of the syndrome with involvement of almost all organs, activation of coagulation and increased sensitivity to pressor agents has expanded understanding of the disorder. The epidemiology of preeclampsia, being more common in poor women, long ago suggested that nutrients might be involved in the disorder. Numerous conflicting hypotheses were advanced but the testing of these hypotheses has either been done poorly or not at all. Review of the available data indicates very few studies that provide useful insights. In many studies the syndrome is poorly defined and in most studies nutritional data (questionnaires or biomarkers) are obtained on women with the clinical syndrome. In overtly preeclamptic women it is impossible to decipher cause from effect. Nonetheless, current concepts of the genesis of preeclampsia that include endothelial dysfunction, inflammatory activation, oxidative stress and predisposing maternal factors provide targets for well-designed nutritional investigation. In this review the current concepts of the pathogenesis of preeclampsia are reviewed and available data are assessed in light of these concepts. Targets for nutritional investigation based on the current knowledge of pathophysiology are suggested.

Episiotomy rates in primiparous women in Latin America: hospital based descriptive study.

Current scientific evidence shows that routine episiotomy is not justified: it has no benefit for mother or infant, increases the need for perineal suturing and the risk of complications to the healing process at seven days post partum, produces unnecessary pain and discomfort, and has potentially harmful long term effects.1 2 3 We report rates of episiotomy in primiparous women in Latin American hospitals according to characteristics of hospitals and caregivers. We conducted a hospital based descriptive study based on data routinely collected in a perinatal information system.4 We analysed data from 122 hospitals in 16 Latin American countries that had reported 416 852 deliveries between 1995 and 1998. We selected hospitals reporting more than 35 spontaneous vaginal deliveries in primiparous women, which is the sample size required to …

A deficient maternal calcium intake during pregnancy increases blood pressure of the offspring in adult rats.

Objective To assess in an animal model the effect of maternal dietary calcium intake during pregnancy on the blood pressure of offspring.

Effect of oral clindamycin on late miscarriage and preterm delivery

The small sample size and the lack of power might explain these findings although also possible is that the intervention has no beneficial effects on perinatal outcomes or at least no great effects in very preterm deliveries which is the subgroup that most contributes to neonatal mortality in developed countries. The Kaplan-Meier curve shows that the reduction in preterm birth rates achieved is concentrated in bigger babies with a gestational age of 33–37 weeks. Although this decrease has mimimum effect on mortality rates in the developed world it could have a great effect in developing countries. Ugwumadu and colleagues do not discuss these issues which we believe are especially important when considering the implications of their results for practice and research. (excerpt)