Objective This study aimed to describe the overall quantity and type of supplements and medications used during pregnancy in a low-risk cohort and to examine any racial/ethnic differences in intake. Study Design We used data from 2,164 racially/ethnically diverse, nonobese, and low-risk pregnant women participating without pre-pregnancy chronic conditions in a prospective cohort study at 12 sites across the United States. Medication data were self-reported as free text in enrollment, follow-up visit questionnaires, and abstracted from medical records at delivery. Supplements and medications data were mapped to their active ingredients and categorized into corresponding classes using the Slone Drug Dictionary. The total number and classes of supplements and medications consumed during pregnancy were calculated. Modified Poisson regression models were used to estimate the racial/ethnic differences in supplements and medications intake. All models were adjusted for maternal sociodemographic factors and study site. Results 98% of women took at least one supplement during pregnancy, with prenatal vitamins/multivitamins being most common. While only 31% reported taking no medications during pregnancy, 23% took one, 18% took two, and 28% took three or more. The percentage of women taking at least one medication during pregnancy was highest among non-Hispanic white women and lowest among Asians (84 vs. 55%, p < 0.001). All racial/ethnic groups reported taking the same top four medication classes including central nervous system agents, gastrointestinal drugs, anti-infective agents, and antihistamines. Compared with non-Hispanic white women, Hispanic (adjusted relative risk [aRR]: 0.84, 95% confidence interval [CI]: 0.71–0.98), and Asian women (aRR: 0.83, 95% CI: 0.70–0.98) were less likely to take central nervous system agents, as well as gastrointestinal drugs (Hispanics aRR: 0.79, 95% CI: 0.66–0.94; Asians aRR = 0.75, 95% CI: 0.63–0.90), and antihistamines (Hispanics aRR: 0.65, 95% CI: 0.47–0.92). Conclusion Supplement intake was nearly universal. Medication use was also common among this low-risk pregnancy cohort and differed by race/ethnicity. ClinicalTrials.gov Identifier NCT00912132. Key Points
Introduction Racial and ethnic differences in fetal growth and birth size in the USA have not been adequately explained by individual-level socioeconomic status (SES) factors. We explored whether differences may be partially explained by county-level indicators of SES. Methods We linked participant zip codes from the National Institute of Child Health and Human Development Fetal Growth Studies (2009–2013; n=1614) to county-level US census data to calculate a neighbourhood deprivation index, education isolation index and two indices of segregation: racial isolation and evenness. Using causal mediation methods, we evaluated the extent to which racial/ethnic differences in neonatal anthropometrics could be eliminated in a hypothetical setting where everyone lived in counties with high resource availability and racial/ethnic integration. Results Setting racial evenness to levels consistent with the highest diversity eliminated 79.9% of the difference in birth weight between non-Hispanic White and non-Hispanic Black and all the difference (106.3%) in birth weight between Hispanic and non-Hispanic White individuals. Setting racial evenness, racial isolation and education isolation to levels consistent with higher diversity and education was also associated with similar reductions in differences for other anthropometric measures. Conclusions Our findings suggest that, in a hypothetical scenario where everyone lived in counties with low deprivation or segregation, race/ethnic differences in neonatal anthropometry may substantially decrease or be eliminated. Our results also highlight the importance of considering community-level and structural factors in analyses of race/ethnic health disparities.
Abstract The objective of this study was to compare length of gestation, fetal growth, and birthweight by race/ethnicity and pregravid weight groups in twin pregnancies. Three thousand and thirty-six twin pregnancies of 28 weeks or more gestation were divided by race/ethnicity (White, Black and Hispanic), and pregravid body mass index (BMI) groups (less than 25.0 vs. 25.0 or more). Outcomes were modeled using multiple regression, controlling for confounders, with White non-Hispanic women as the reference group. Hispanic women had the highest average birthweight and the longest gestation, as well as the lowest proportions of low birthweight, very low birthweight, preterm and early preterm births of the 3 race/ethnicity groups. In the multivariate analyses, Hispanic women had significantly longer gestations (by 7.8 days) and faster rates of fetal growth midgestation (20 to 28 weeks, by 17.4 g/week) and late gestation (after 28 weeks, by 5.3 g/week), whereas Black women had significantly slower rates of fetal growth (by 5.7 g/week and by 4.5 g/week, respectively). These findings in twins reflect the racial and ethnic disparities previously shown in singletons, including the Hispanic paradox of longer gestations and higher rates of fetal growth.
Abstract Stress corrosion crack growth by slip-dissolution was considered from the standpoint of electrolyte resistance and/or dissolved metal ion concentration in the crack, using a trapezoidal mo...
Recent atom-probe tomography (APT) and ATEM studies of dealloyed layers in binary AgAu and ternary AgAuPt alloys showed the various ways in which more-noble elements enrich during dealloying, at the atomic scale (1). We have since extended this research in several directions – towards less expensive alloys, lean in more-noble elements, and towards the potential applications of such materials in gas sensing. In this presentation, we will start with a review of published and unpublished data from the APT study, which was done using alloys with 23 at% (Au + Pt). New information will then be shown for alloys with less than 6 at.% (Au + Pt). The dealloyed layers are very Ag-rich, and very interesting conflicts arise between enrichment of the more-noble element(s) on the ligament surfaces and the ultimate supply of those elements. For gas sensing applications, we take advantage of the effect of adsorption on ligament surfaces on electron scattering during conduction in the confined metal phase. Delicate impedance measurements at the milli-ohm level show that two kinds of environmental effect can be distinguished. Adsorption of water or other gases up to several molecular layers induce changes in the measured resistance of the metal phase, while thicker layers induce a double-layer charge separation leading to capacitive changes.
Both general anaesthesia and surgery elicits an acute stress response which activates the sympathomedullary and the hypothalamic-pituitary-adrenal (HPA) axis. The principal hormones secreted from these axes are the catecholamines, noradrenaline and adrenaline, and cortisol which readily mobilise free fatty acids (FFA’s) and glucose. Previous studies have shown that cortisol levels increase during surgery, (man: Ichikawa et al. 1971 and sheep: Jones 1990). Similarly plasma glucose and FFAs were reported to increase in response to this stress while insulin levels were suppressed. In this study, we evaluated the roles of adrenocorticotropic hormone (ACTH), cortisol and the catecholamines in the regulation of glucose, FFAs and insulin levels during anaesthesia and surgery. Mature merino ewes (n=3) were irnmunised against ACTH l-24 ovalbumin conjugate (0.5 mg) in Freund’s complete (primary) and incomplete (3 booster injections) adjuvant. Another 3 ewes received the adjuvant alone. All 6 ewes underwent surgery (catheterisation of the carotid artery) while under general anaesthesia. Venous blood samples from all ewes were taken from an indwelling jugular catheter prior to, during and after surgery. Plasma samples were analysed for cortisol and insulin by RIA, for glucose and FFAs by enzymic analysis and for noradrenaline and adrenaline by HPLC. There was no increase in noradrenaline or adrenaline levels in response to surgery in sheep either immunised (T) or not immunised (C) against ACTH. Plasma cortisol levels in the C group increased significantly (P c 0.01) in response to anaesthetic induction and surgery. In contrast, there was no increase in plasma cortisol for the T group. There was no significant difference in plasma FFAs and glucose. Plasma insulin levels increased, but not significantly in both groups following anaesthetic induction, declined during surgery in the C group but remained elevated in the T group.
Second-trimester labor induction is frequently complicated by significant morbidity. Although instrumental dilatation and evacuation is considered the safest method for second-trimester pregnancy termination, most younger physicians lack experience with this procedure. As a result, many physicians use vaginal prostaglandin suppositories for second trimester labor induction. Unfortunately, systemic side effects and in-complete abortion are common complications. We sought to compare the side effects and efficacy of intra-amniotic 15-methyl prostaglandin F2α (PGF2α) with intravaginal prostaglandin E2 (PGE2) for second-trimester labor induction. We compared outcomes in patients receiving intravaginal PGE2 (group A, N = 24) with intra-amniotic 15-methyl prostaglandin F2α (group B, N = 25) for midtrimester labor induction. Group A patients received intravaginal PGE2 20 mg every 3–4 hr, and group B patients received intra-amniotic 15-methyl PGF2α 2.5 mg. Eighty-eight percent of patients in group A successfully delivered by 24 hr, and all did by 36 hr. Eight patients in group A required surgical intervention due to incomplete abortion. Likewise, 96% and 100% of group B patients delivered within 24 and 36 hr, respectively. Only 1 patient in group B had an incomplete abortion. Significant gastrointestinal side effects were noted more often in group A than in group B patients (P < 0.001). The efficacy of intra-amniotic 15-methyl PGF2α for second trimester labor induction is confirmed in this study with significantly fewer systemic side effects and fewer cases requiring surgical intervention.
<p dir="ltr">Objective: Gestational diabetes mellitus (GDM) increases the risk of fetal overgrowth, as measured by two-dimensional (2D) ultrasonography. Whether fetal 3D soft tissue and organ volumes provide additional insight into fetal overgrowth is unknown. </p><p dir="ltr">Research Design & Methods: We prospectively evaluated longitudinal 3D fetal body composition and organ volumes in a diverse US singleton pregnancy cohort (2015-2019). Women were diagnosed with GDM, impaired glucose tolerance (IGT), or normal glucose tolerance (NGT). Up to five 3D ultrasound scans measured fetal body composition and organ volumes; trajectories were modeled using linear mixed models. Overall and weekly mean differences in fetal 3D trajectories were tested across glycemic status, adjusted for covariates.</p><p dir="ltr">Results: In this sample (N=2427), 5.2% of women had GDM and 3.0% had IGT. Fetuses of women who developed GDM, compared to NGT, had larger fractional arm and fractional fat arm volumes from 26-35 weeks, smaller fractional lean arm volume from 17-22 weeks, and larger abdominal area from 24-40 weeks. Fetuses of women with IGT had similar growth patterns, but manifested later in gestation and with larger magnitudes, and had larger fractional lean arm volume. No overall differences were observed among thigh or organ volumes across glycemic status.</p><p dir="ltr">Conclusions: Body composition differed in fetuses of GDM pregnancies, including larger arm and abdominal measures across the second and third trimesters. Patterns were similar in IGT pregnancies except occurred later in gestation and with larger magnitudes. Future research should explore how lifestyle and medication may alter fetal fat accumulation trajectories among hyperglycemic pregnancies. </p>
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