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The purpose of this study was to show that maternal folate status during pregnancy may be related to preterm birth.Women were recruited at 24 to 29 weeks' gestation from 1995 to 2000 into the Pregnancy, Infection, and Nutrition Study. Those who completed an interview and a food frequency questionnaire, or provided a blood sample for radioassay of serum (n = 2026) and red blood cell (n = 1034) folate were included.Mean daily dietary folate intake was 463 microg (SD +/- 248). Intake/=500 microg was associated with increased preterm delivery (RR = 1.8, 95% CI 1.4-2.6) controlling for total energy intake. Serum folate levels16.3 ng/mL and red blood cell folate levels/=626.6 ng/mL yielded adjusted risk ratios of 1.8 (95% CI 1.3-2.5) and 1.7 (95% CI 1.1-2.6), respectively. Patterns were similar for spontaneous and overall preterm birth.These results support the hypothesis that low folate levels during the second trimester of pregnancy are associated with an increased risk of preterm birth.

We sought to determine whether genetic variants associated with diabetes and obesity predict gestational weight gain.A total of 960 participants in the Pregnancy, Infection, and Nutrition cohorts were genotyped for 27 single-nucleotide polymorphisms (SNPs) associated with diabetes and obesity.Among Caucasian and African American women (n = 960), KCNQ1 risk allele carriage was directly associated with weight gain (P.01). In Bayesian hierarchical models among Caucasian women (n = 628), we found posterior odds ratios3 for inclusion of TCF2 and THADA SNPs in our models. Among African American women (n = 332), we found associations between risk allele carriage and weight gain for the THADA and INSIG2 SNPs. In Bayesian variable selection models, we found an interaction between the TSPAN8 risk allele and pregravid obesity, with lower weight gain among obese risk allele carriers.We found evidence that diabetes and obesity risk alleles interact with maternal pregravid body mass index to predict gestational weight gain.

Objective We sought to examine the association between narrowly defined subsets of maternal ethnicity and birth outcomes. Study Design We analyzed 1995–2003 New York City birth certificates linked to hospital discharge data for 949,210 singleton births to examine the multivariable associations between maternal ethnicity and preterm birth, subsets of spontaneous and medically indicated preterm birth, term small for gestational age, and term birthweight. Results Compared with non-Hispanic whites, Puerto Ricans had an elevated odds ratio (1.9; 95% confidence interval, 1.9–2.0) for delivering at 32–36 weeks (adjusted for nativity, maternal age, parity, education, tobacco use, prepregnancy weight, and birth year). We found an excess of adverse outcomes among most Latino groups. Outcomes also varied within regions, with North African infants nearly 100 g (adjusted) heavier than sub-Saharan African infants. Conclusion The considerable heterogeneity in risk of adverse perinatal outcomes is obscured in broad categorizations of maternal race/ethnicity and may help to formulate etiologic hypotheses.

Objective We sought to compare the outcomes of cervicoisthmic (CI) cerclage using traditional transabdominal (TA) approach vs the lesser used transvaginal (TV) approach. Study Design We conducted a retrospective cohort study of women who underwent placement of a CI cerclage. Results Before CI placement, the abdominal group had a total of 100 pregnancies that continued beyond the first trimester and had 27 (27%) surviving infants. After cerclage placement, there were 34 pregnancies and 24 (71%) surviving infants. Before cerclage placement, the vaginal group had a total of 90 pregnancies that continued beyond the first trimester and had 11 (12%) surviving infants. After cerclage placement, there were 29 pregnancies and 20 (69%) surviving infants. The vaginal cerclage group had a significantly shorter mean operative time of 33 vs 69 minutes, and shorter hospital stay of 0.5 vs 3.2 days. Conclusion Both TV and TA CI cerclage offers select patients with cervical insufficiency improved neonatal survival. The TV placement of a CI has less morbidity than the TA approach with a comparable neonatal survival.

The objective of the study was to compare Doppler ultrasound measurements of the fetal middle cerebral artery peak systolic velocity (MCA-PSV) obtained at a 0 degrees angle of insonation to assessment at 30 degrees and 30 degrees with angle correction.Patients between 14 and 36 weeks' gestation were enrolled (n = 66). MCA-PSV measurements were assessed at 0 degrees , 30 degrees , and 30 degrees with angle correction. The data were analyzed using a mixed model adjusted for gestational age. Pairwise comparisons of mean MCA-PSV measurements were made using the Tukey multiple comparison test.All measurements were obtained for 50 fetuses (76%). Mean MCA-PSV measurements were statistically different between 0 degrees vs 30 degrees (P = .03 to.001) but not between 0 degrees vs 30 degrees with angle correction (P = .34-.99) at each of the 5 gestational age groupings.Assessment of the MCA-PSV at 0 degrees and 30 degrees with angle correction provides comparable measurements during the second and third trimester of pregnancy.

Objective The purpose of this study was to identify potentially modifiable risk factors of placental injury that reflect maternal uteroplacental vascular compromise (UPVC) and acute and chronic placental inflammation. Study Design A prospective epidemiologic study was conducted. A total of 1270 placentas were characterized by gross and microscopic examination. Placental pathologic condition was coded for features of amniotic fluid infection syndrome (AFIS), chronic villitis, UPVC, and fetal vascular obstructive lesions. Odds ratios between UPVC, the acute and the chronic inflammatory lesions, and risk factors of interest were calculated. Results After adjustment for confounders, we found that women with a history of preterm birth had 1.60 times the odds of chronic inflammation (95% CI, 1.10, 2.55). Women with a previous elective termination had 3.28 times the odds of acute inflammation (95% CI, 1.89, 5.70). The odds of chronic villitis increased with parity; the odds of AFIS decreased with parity. Conclusion We have identified several predictors of UPVC, AFIS, and chronic villitis. Further studies are needed to examine whether interventions to alter UPVC, AFIS, and chronic villitis will lead to improved pregnancy outcomes.

Objective: The purpose of this study was to evaluate the accuracy of algorithms for the assignment of gestational age with the use of the last menstrual period and early ultrasound information. Study Design: Gestational age estimates that are based on last menstrual period, ultrasound scanning, or their combination were compared among women who attended prenatal care clinics in central North Carolina (n = 3655) by an evaluation of digit preference in the last menstrual period dates and a comparison of mean gestational age, preterm and postterm categories with the use of κ statistics, difference between actual and expected delivery date, and birth weight among subgroups with discrepant assignments. Results: Last menstrual period reports show digit preference, assign gestation 2.8 days longer on average than ultrasound scanning, yield substantially more postterm births (12.1% vs 3.4%), and predict delivery among term births less accurately. Misclassification of births as postterm was more common in younger women, those of nonoptimal prepregnancy body weight, cigarette smokers, and women who reported last menstrual period using preferred dates of the month. Conclusion: Last menstrual period estimates of the duration of gestation are subject to both random error and a systematic tendency to overstate the duration of gestation, most likely because of delayed ovulation. (Am J Obstet Gynecol 2002;187:1660-6.)