Thelma E. Patrick

A randomized controlled trial of a smoking cessation intervention for pregnant adolescents

Background: The smoking prevalence rate among pregnant adolescents has been estimated at 59-62%, and 60-80% of these adolescents continue to smoke throughout their pregnancies. Objectives: The aim of this study was to evaluate the short- and long-term effects of smoking cessation strategies tailored to the pregnant adolescent to attain and maintain abstinence. The specific aim was to examine differences in short- and long-term smoking behaviors among three groups: Teen FreshStart (TFS), Teen FreshStart Plus Buddy (TFS-B), and Usual Care (UC) control. Methods: In this randomized controlled intervention study, a3-group (TFS, TFS-B, and UC) by 3-occasion (baseline, 8 weeks postrandomization, and 1-year following study entry) design was used. The study included 142 pregnant adolescents who were aged 14 to 19 years. Both self-reported smoking status collected on the Smoking History Questionnaire and saliva cotinine levels were used to identify smoking behaviors. Results: There were no significant differences among the three treatment groups at baseline in terms of the racial distribution, age, gestational age, age of menses initiation, number in family household, number of family members who smoked, or tobacco use. A significant difference between the UC group and the TFS-B group (p = .010) was seen in smoking behaviors measured 8 weeks following treatment initiation. At 1 year following study entry, however, there were no differences between the groups in smoking behaviors. Discussion: The TFS-B intervention was more effective in attaining short-term smoking cessation in the pregnant adolescent than TFS or UC. Findings suggest that the peer-enhanced programming had a limited effect but could not sustain the participant beyond postpartum (1 year following study entry). Future studies should include relapse prevention to sustain smoking abstinence into the postpartum period.

Homocysteine and Folic Acid Are Inversely Related in Black Women With Preeclampsia

Black women have an increased risk of preeclampsia compared with white women. Plasma homocysteine is increased in preeclampsia. Homocysteine concentrations are affected by nutritional deficiencies, particularly decreased folic acid and B12, leading to increased homocysteine. Previous studies have reported racial differences in nutritional intake including folic acid. Therefore, we investigated whether there were racial differences in plasma homocysteine, folic acid, and vitamin B12 among women with preeclampsia. We tested for an association between homocysteine and folic acid and B12, and we hypothesized an inverse relationship of homocysteine and folic acid in preeclampsia, more so in black women in whom preeclampsia developed. Black women with preeclampsia (n= 26) had elevated homocysteine concentrations (8.7±1.4 μmol/L) compared with black women with normal pregnancy (n= 52, 7.6±0.5 μmol/L), white women with preeclampsia (n= 34, 7.5±0.6 μmol/L), and white women with normal pregnancy (n= 48, 5.5±0.3 μmol/L). Folic acid concentrations were lower in black women (14.1±0.8 ng/mL) compared with white women (18.5±0.9 ng/mL, P < 0.01). However, plasma homocysteine was inversely related to folic acid only among black women with preeclampsia (r = −0.23, P = 0.01). These racial differences may have implications for the higher rates of preeclampsia in this group and may have long-term implications for future cardiovascular risk. Racial differences in diet, adherence to folic acid supplementation, or interactions of nutritional and maternal factors warrant further study by race and pregnancy status.

A Comparison of Circulating TNF Alpha in Obese and Lean Women With and Without Preeclampsia

Objectives: We hypothesized that TNF-α would be higher in obese versus lean women with preeclampsia. Methods: Total plasma TNF-α was measured in a nested case-control study of 123 nulliparous lean and obese control women and women with preeclampsia. Results: Adjusted mean TNF-α concentrations were 0.97 ± 0.11 (pg/mL ± SEM) in lean controls, 1.01 ± 0.10 in obese controls, 1.43 ± 0.11 in lean women with preeclampsia and 1.16 ± 0.11 in obese women with preeclampsia. Pregnancy outcome was the single predictor of TNF-α concentration in the general linear regression model (p = 0.04). Conclusion: TNF-α concentration was higher in preeclampsia compared with control subjects. Obesity was not associated with higher TNF-α concentrations in either preeclampsia or control subjects.

Current concepts in preeclampsia.

The purpose of this article is to review recent epidemiologic and pathophysiologic findings that advance the understanding of preeclampsia for the nurse in perinatal practice. Preeclampsia is different from other hypertensive disorders of pregnancy. Risk factors for preeclampsia and recent findings regarding normal and aberrant implantation are presented. Abnormal implantation and resulting poor placental perfusion may be the impetus for endothelial changes evidenced in preeclampsia; pathophysiology is described in relation to this event. The interaction of maternal factors, reduced placental perfusion, and endothelial cell dysfunction provides an explanation for the occurrence of preeclampsia and provides a basis for nursing practice and research. Implications for nursing care for women of childbearing age before, during, or after pregnancy may include (a) preconception or post-delivery counseling to reduce modifiable risk factors such as obesity, sedentary lifestyle, or high fat intake, (b) assessment of risk factors and increased surveillance when risk factors are present, and (c) surveillance of blood pressure changes of > 30 mmHg systolic or > 15 mmHg diastolic in advance of the third trimester of pregnancy.

Increased umbilical cellular fibronectin concentrations are associated with a decreased prevalence of growth restriction in preeclampsia.

Objective: Cellular fibronectin (cFN), a marker of endothelial activation, is elevated in maternal and cord blood in preeclampsia. We tested whether maternal or fetal cFN is related to fetal growth restriction in preeclampsia, in the context of gestational age at delivery. Methods: Cellular fibronectin was measured in maternal and cord blood of 29 preeclamptic women and their infants delivered at Magee-Womens Hospital at 25-41 weeks of gestation. Relationships amog maternal and cord cFN, birth weight, birth weight percentile, and ponderal index were evaluated using Pearson correlation and regression analyses controlled for gestational age. Results: Cord cFN was not significantly related to maternal cFN (r = -.34, P = .08) or gestational age (r = -.32, P = .09). The relationship of maternal cFN to each index of infant size was not significant. By contrast, higher cord cFN predicted higher birth weight, birth weight percentile, and ponderal index (P < .05). Conclusion: Elevated maternal and cord cFN concentrations have been reported in pregnancy complicated by preeclampsia. This study assessed the relationship among maternal cFN, cord cFN, and indices of fetal growth in preeclampsia. Elevated cord cFN was associated with measures of better fetal growth.

Smoking Cessation Intervention for Pregnant, Minority, Adolescent Smokers

Historically, smoking has presented a serious health risk among Americans. Although the number of adult smokers in the U.S. has decreased in the last 20 years, American teens smoke in increasing numbers. In 1990, an estimated 8.5 million teens, or 42% of the adolescent population, were smokers. Unfortunately, these figures encompass adolescents who are pregnant, a group whose numbers are increasing each year and whose smoking jeopardizes their own health and the health of their infants. Pregnant teenagers who smoke present a double obstetrical risk. In addition to the detrimental effects on the fetus, teen mothers are at risk for toxemia, anemia and uterine dysfunction. Low birth weight and pregnancy-induced hypertension continue to be significant problems for pregnant adolescents who smoke. An additional risk factor for pregnant minority teens (African American) who smoke is a higher neonatal mortality rate which is seen in non-white mothers.

24-Hour Sleep Duration in Early Gestation is Associated with Increased Markers of Inflammation Among Women with a History of Preeclampsia

Background: Sleep duration, both short and long, is recognized as a potential contributor to adverse health conditions. This study evaluated whether long sleep duration in early gestation (15 weeks) was associated with increased circulating concentrations of inflammatory cytokines across pregnancy. Methods: Self-reported 24-hour sleep duration and blood samples were obtained concurrently at 15, 24 and 36 weeks gestation in 85 pregnant women with a history of preeclampsia. Plasma samples were assayed for the inflammatory cytokines IL-2, -6, -8, IFNγ, TNFα, GM-CSF and anti-inflammatory cytokines IL-4, -5, and -10 using Luminex technology. A ratio of pro-to-anti-inflammatory cytokines was calculated using multiples of the median (MOMs) for each relevant cytokine type to normalize the data for comparison. Data were analyzed using repeated measures mixed models. Results: Women with long sleep (≥ 9 hours) at 15 weeks gestation had higher IL-6 concentrations throughout gestation than women who were regular sleepers (p = .003). No other cytokine or the ratio of pro-to-inflammatory cytokines differed between groups. No interactions of group by time were significant. Conclusions: The tendency to sleep for more than 9 hours in early pregnancy may contribute to increased low-grade inflammation as evidenced by higher circulating concentrations of IL-6. This may initiate or augment pre-existing pathophysiology associated with adverse pregnancy outcomes. While, our data are preliminary, they direct further investigation to determine whether this association increases risk for adverse pregnancy outcomes.

Maternal and Fetal Leptin Correlate with Fetal Growth in Preeclampsia.|[dagger]| 1519

Serum leptin, the product of the obesity (ob) gene, correlates with adiposity and increases fat utilization. Leptin mRNA is present in the placenta, suggesting a role for leptin in fetal growth. Maternal serum leptin, triglyceride (trig) and free fatty acids (FFA) are elevated in healthy pregnancy, and are increased further in preeclampsia (PRE). Umbilical cord leptin levels correlate with birth weight, but not with maternal leptin levels in healthy pregnancy. Preeclampsia is associated with reduced perfusion of the placenta. We hypothesized that leptin production is increased in poorly perfused placenta in PRE and by increasing maternal fat utilization increases fuel availability to the fetus promoting fetal growth. Methods: Venous blood was obtained prepartum from 14 women with PRE and 15 healthy pregnant women (CNTL). Mixed arterio-venous blood was obtained from the umbilical cord of their infants at delivery. Plasma leptin concentration was measured by human antibody RIA. Lipids were measured by standard techniques. Data were analyzed using Mann-Whitney comparison of medians and Pearson correlation. Results: Median gestational age (38.1 v 37.7 wks), birth weight (BW, 3.1 v 3.2 kg), maternal leptin (52.8 v 26.7 ng/ml), cord leptin (3.7 v 5.6 ng/ml), maternal trig (263 v 239 mg/dl) and FFA (0.84 v 0.61 mmol/L) did not differ between PRE and CNTL, while BW%ile (29.3 v 59.7%) was significantly different at p=0.05. The correlation between maternal and cord leptin was highly significant in PRE (r=0.87, p=0.000) but not in CNTL(r=-0.16). Maternal trig did not correlate with leptin in PRE (r=-0.34) or CNTL (r=0.10). Maternal FFA correlated with leptin in CNTL (r=-0.72, p=0.003) but not PRE (r=-0.16). BW correlated with both maternal leptin (r=0.71, p=0.004) and cord leptin (r=0.67, p=0.012) in PRE. Only cord leptin was related to BW in CNTL (r=0.69, p=0.005). Conclusion: These data confirm the positive relationship between cord leptin and BW. We also found highly significant correlations of maternal leptin to cord leptin and to BW in preeclampsia which are not present in healthy pregnancy. Our hypothesis that maternal leptin increased in preeclampsia to increase fuel availability for the fetus is, however, not supported by these preliminary data.