Pregnancy

Prenatal Issues-Iron

Eskeland B, Malterud K, Ulvik RJ, et al (Univ of Bergen, Norway; Haukeland Univ, Bergen, Norway)

Iron Supplementation in Pregnancy: Is Less Enough? A Randomized, Placebo Controlled Trial of Low Dose Iron Supplementation With and Without Heme Iron 

Acta Obstet Gynecol Scand 76: 822-828, 1997

     


27 mg of heme iron given from the 20th week of pregnancy prevented anemia. The control group not receiving it showed a drop in hemoglobin levels. 27 mg of elemental iron without the heme part was less effective but needs confirmation.

     


The authors do not advise high doses of iron the grounds that it makes hemoconcentration worse and interferes with zinc and magnesium absorption.

     

Neural Tube Defect

Shaw GM, Velie EM, Wasserman CR (March of Dimes Birth Defects Found, Emeryville, Calif)

Risk for Neural Tube Defect-Affected Pregnancies Among Women of Mexican Descent and White Women in California 

Am J Public Health 87: 1467-1471, 1997

     


Mexico-born Latina women showed a higher risk (a 2.4 odds ratio) compared to white women. Mexican women born in the US had the same ratio as their white counterparts. 

     


Diets containing folic acid have been preventive. Other nutritional deficiencies are possible.

     

Vomiting

Frigo P, Lang C, Reisenberger K, et al (Univ Hosp of Vienna)

Hyperemesis Gravidarum Associated With Helicobacter pylori Seropositivity 

Obstet Gynecol 91: 615-617, 1998

     


On the basis of serum IgG positivity in 90.5% of subjects of hyperemesis gravidarum compared to 46.5% in the controls, this has been suggested as a possible cause.

     


Presently available treatment for Helicobacter pylori cannot be used to prove the point. 

      

Diabetes

Naylor CD, for the Toronto Trihospital Gestational Diabetes Project Investigators (Sunnybrook Health Science Centre, North York, Ont, Canada; Univ of Toronto; Toronto Hosp; et al)

Selective Screening for Gestational Diabetes Mellitus 

N Engl J Med 337: 1591-1596, 1997

     


It is not practicable to examine all pregnant women for diabetes mellitus. 

      


Examination of patients for evaluation of those at risk is more logical. Race, age, body mass index, a family history and previous child births were used as a basis. Low risk groups were not for screening, but those with moderate to high chances would undergo the procedure.

     


Women with a plasma level of 130 mg/dl or high risk group with a level of 128 mg/dl need screening. This has discovered 81.2 per cent and 82.6 per cent to be detected yet allowing 34.7% not to undergo further testing.

    

Pregnancy Outcomes

Sampselle CM, Miller JM, Mims BL, et al (Univ of Michigan, Ann Arbor; Kent State Univ, Ohio)

Effect of Pelvic Muscle Exercise on Transient Incontinence During Pregnancy and After Birth 

Obstet Gynecol 91: 406-412, 1998

      


Pelvic muscle exercise in the non-pregnant has reduced urinary incontinence.

Vaginal and possibly cesarean delivery may lead to urinary incontinence. 

Pelvic exercises with results measured at 6 weeks and 6 months post partum showed greater pelvic muscle power in the exercising group.

      

The authors suggest pelvic muscle exercise for the primigravida especially those with muscle weakness.

     

Obesity 

Bianco AT, Smilen SW, Davis Y, et al (Mount Sinai Med Ctr, New York; New York Univ)

Pregnancy Outcome and Weight Gain Recommendations for the Morbidly Obese Woman 

Obstet Gynecol 91: 97-102, 1998

        


Morbid obesity affects both the mother and the child adversely; the effect on the neonate is more than the perinatal infant. 

        


The authors suggest that the morbidly obese do not weigh more than 25 pounds extra to avoid delivering large size babies as well as suffer medical maternal problems. 

        

Anxiety 

Sjogren B, Thomassen P (Karolinska Hosp, Stockholm; Sodersjukhuset, Stockholm)

Obstetric Outcome in 100 Women With Severe Anxiety Over Childbirth 

Acta Obstet Gynecol Scand 76: 948-952, 1997

       


Fear of delivery leads to cesarean section in 20% of pregnant women. With other psychosocial reasons the total increases to 68.

       


Psychologic treatment is cost effective and reduces surgery by 50%, hence is advised by the authors.