Preterm delivery risk in relation to maternal HIV infection, history of malaria and other infections among urban Zimbabwean women

OBJECTIVE

To examine preterm delivery risk in relation to maternal HIV infection, malaria history, and other infections among Zimbabwean women.

DESIGN

Hospital based, cross sectional study.

SETTING

Harare Maternity Hospital, Harare, Zimbabwe.

SUBJECTS

A convenient sample of 500 pregnant women.

MAIN OUTCOME MEASURE

Preterm delivery. THE STUDY FACTORS: Maternal socio-demographic information, and infectious disease history (during the year before pregnancy).

METHOD

Between July 1998 and March 1999 data were collected for a cross sectional study of pregnant women who delivered at the Harare Maternal Hospital. The association of maternal HIV infection, history of malaria, and other infections with preterm delivery were determined using multivariate analysis.

RESULTS

Overall, 497 women were studied, 444 (89.3%) delivered at term and 53 women (10.7%) delivered preterm. Women who delivered preterm were less likely to be HIV seropositive compared with others (odds ratio [OR] = 0.75. 95% confidence interval (CI): 0.38 to 21.48). Preterm delivery was associated with having tuberculosis infections in the year prior to the pregnancy (OR = 10.15, 95% CI: 1.15 to 89.87). Other infections associated with preterm delivery were malaria (OR = 2.39, 95% CI: 1.07 to 5.31), chest infections (OR = 2.63, 95% CI: 0.76 to 9.17), and Herpes (shingles) infection (OR = 2.58, 95% CI: 0.56 to 11.85). Overall, a positive history of any of the non-sexually transmitted infections (in aggregate) was associated with a 3.20 fold increase risk for preterm delivery (OR = 3.20. 95% CI: 1.59 to 6.43). Women with a history of infection and who did not use iron supplements during pregnancy, compared with women without such an history and who used iron supplements, experienced the highest risk for preterm delivery (OR = 8.34, 95% CI: 3.30 to 21.07).

CONCLUSION

Maternal non-STD infections, (i.e., tuberculosis, malaria, and chest infections) occurring in the year prior to pregnancy were associated with an increased risk of preterm delivery. The association of non-sexually transmitted infections and preterm delivery was particularly strong among women who did not use iron supplements during pregnancy.

Resolution of allergic airways inflammation but persistence of airway smooth muscle proliferation after repeated allergen exposures

BACKGROUND

Chronic inflammation in asthmatic airways can lead to characteristic airway smooth muscle (ASM) thickening and pathological changes within the airway wall.

OBJECTIVE

We investigated the long-term effects of repeated allergen exposure.

METHODS

Brown-Norway (BN) rats sensitized to ovalbumin (OVA) were exposed to OVA or saline aerosol every third day on six occasions and studied 24 h, 7 days and 35 days after the final exposure. We measured airway inflammation, ASM cell proliferation (by incorporation of bromodeoxyuridine; BrdU) and bronchial responsiveness to acetylcholine.

RESULTS

At 24 h, in OVA-exposed rats, we detected elevated OVA-specific serum IgE, increased numbers of macrophages, eosinophils, lymphocytes and neutrophils in the bronchoalveolar lavage (BAL) fluid and increased numbers of MBP+ (major basic protein) eosinophils and CD2+ T cells within the bronchial submucosa. This coincided with increased numbers of ASM cells expressing BrdU and with bronchial hyper-responsiveness (BHR). At 7 days, BHR was detected in OVA-exposed rats, coincident with increased numbers of macrophages and lymphocytes in BAL fluid together with increased numbers of CD2+ T cells within the bronchial submucosa. This coincided with increased numbers of ASM cells expressing BrdU. By day 35, the number of ASM cells expressing BrdU remained elevated in the absence of cellular infiltration and BHR.

CONCLUSION

Repeated OVA-challenge results in persistent ASM cell proliferation in the absence of bronchial inflammation and BHR, which lasts for at least 1 week following cessation of exposure.

Activation-induced cell death of human T-cell subsets is mediated by Fas and granzyme B but is independent of TNF-alpha

Human primary effector T cells were analyzed for their susceptibility to anti-CD3-induced activation-induced cell death (AICD). Th1 and Tc1 cells were more susceptible to AICD than their type 2 counterparts. Type 1 and type 2 subsets were also found to be differentially susceptible to CD95-mediated apoptosis, although cell-surface expression of CD95 and CD95L was at similar levels on all subsets. A role for CD95 in AICD was confirmed by the addition of anti-CD95L antibodies that partially abrogated AICD. Residual apoptosis could not be accounted for by TNF-alpha/TNFR interactions because although type 1 cells secreted more TNF-alpha than type 2 cells, the addition of TNFR:Fc fusion protein did not inhibit AICD. Instead, a reduction in AICD was observed in the presence of EGTA or concanamycin A. The inhibition of apoptosis by a granzyme B inhibitor z-AAD-CMK in Tc1 cells further indicated an involvement of the granule exocytosis mechanism in AICD.

Early Th1/Th2 cell polarization in the absence of IL-4 and IL-12: T cell receptor signaling regulates the response to cytokines in CD4 and CD8 T cells

Differentiation of developing T cells into the type 1 (IFN-gamma-producing) or type 2 (IL-4-producing) subsets is a central theme of immune regulation. The balance of IL-4 and IL-12 present during T cell activation has been considered the major influence on type 1 versus type 2 development. Here we show that CD4 T cells can become biased towards type 1 or type 2 phenotypes during their initial activation in the absence of IL-4 or IL-12. This type of regulation is dependent on the balance of MAPkinase, protein kinase C, and calcineurin signaling after TCR engagement. Later maturation of Th1 or Th2 effectors is dependent on IL-12 or IL-4. However Tc1 CD8 effector development is independent of IL-12, and Tc2 cell generation requires both appropriate TCR signals and IL-4 early in effector development. Using an altered peptide ligand to stimulate TCR transgenic T cells, we show that altered signaling regulates the numbers of CD8 cells capable of developing into Tc2 effectors, and also their responsiveness to IL-4. Together, the results support a two-stage model of differentiation in which intermediate cells biased towards the type 1 or type 2 pathways after activation, are subsequently matured in response to IL-12 or IL-4, respectively.

[Frequency of gastric lymphoma at 6 hospitals in Mexico City]

BACKGROUND

Gastric lymphoma has been traditionally considered a rare neoplasm that constitutes 1-5% of malignant gastric tumors. Two studies performed in Mexico in 1960 and 1966 found that only 1.9% and 1% of gastric neoplasms were lymphomas. Nevertheless, some studies made in the U.S. and in some European countries in recept decades have revealed an increase in the frequency of this neoplasm. A recent study made at two National Health Institutes in Mexico City (Instituto Nacional de Cancerología and Instituto Nacional de la Nutrición) revealed a remarkable increase in the frequency of gastric lymphoma (9.3% and 10.3%, respectively) in recent years.

AIM

To define whether there is an actual increase of lymphoma in our population and whether it includes other hospitals in Mexico City that provides attention to populations different from those who attend referral centers.

MATERIALS AND METHODS

Six hospitals in Mexico City were selected, including two National Health Institutes (Instituto Nacional de la Nutrición and Instituto Nacional de Cancerología), two private general hospitals used by patient with a high socioeconomic level (Hospital Español and Hospital Inglés), and two public general hospitals frequented by low-income patients (hospital Juárez and Hospital General de México). In each case, the gastric lymphomas diagnosed in each participant hospitals in the last 5 years were registered. For comparative purpose, diagnosed cases of gastric adenocarcinoma during the same period were also registered. Other types of gastric neoplasms were excluded from the study because they formed a very heterogeneous group and represented a minimal proportion of malignant gastric tumors. Age and sex of each patient were included for all lymphomas.

RESULTS

A total of 879 malignant gastric neoplasms were included in our study. The relative percentage for gastric lymphoma by institution in descendent order was Hospital Español 25.4%; Instituto Nacional de la Nutrición 13.7%, Hospital Inglés 11.5%, Hospital General de México 8.5%, Instituto Nacional de Cancerología 6%, and Hospital Juárez 6%. Mean general frequency taking into account the six hospitals was 9.1%.

CONCLUSIONS

Frequency of gastric lymphomas in all analyzed institutions was higher than that reported in most series in the medical literature (1-5%) and that reported for the Mexican population in 1960 and 1966. The increase was most remarkable in hospitals attended by patients with high incomes (Hospital Español, Hospital Inglés), although the total number of neoplasms reported by these institutions was smaller than that reported by hospitals were by patients with lower incomes (Hospital Juárez, Instituto Nacional de Cancerología). The reason for this increase is unknown, but one might speculate that some strains of Helicobacter pylori, nutritional factors, and ethnic differences could be involved. Both gastroenterologists and pathologists must recognize the increase of this neoplasm because unlike gastric adenocarcinoma, gastric lymphoma is a curable disease in a high percentage of cases.

Different forms of heroin and their relationship to cook-up techniques: data on, and explanation of, use of lemon juice and other acids

Recent reports of the use of lemon juice in the preparation of heroin for injection have failed to recognize the importance of the different forms of heroin (in the form of the salt or the base) and the impact of this on the chemical manipulation required before injection. One hundred and four opiate addicts in London were interviewed about the forms of heroin (white, brown, etc) and their relationship to cook-up techniques (use of heat and acid). White heroin was typically prepared with water and heat; brown heroin was prepared with acid (citric acid or Vitamin C (ascorbic acid) or lemon juice) and heat; pharmaceutical heroin was prepared with water only (i.e. neither acid nor heat). On the last occasion of heroin use, brown heroin had been the form most commonly used, with over 90% of the sample using citric acid or vitamin C. Lemon juice was rarely used, and heat was almost universally applied in conjunction with lemon juice.

T cytotoxic 1 and T cytotoxic 2 CD8 T cells both inhibit IgE responses

BACKGROUND

It is well recognized that CD8 T cells inhibit IgE responses. In this study, we investigated the mechanism of CD8 T cell-mediated IgE suppression by comparing the capacity of T cytotoxic 1 (Tc1) and T cytotoxic 2 (Tc2) CD8 T cells to inhibit IgE responses to ovalbumin (OVA).

METHODS

Tc1 and Tc2 CD8 T cells were generated from OVA(257-264)-specific Vbeta5.2 T cell receptor (TcR) transgenic mice by stimulation with anti-CD3 and anti-CD28 under Tc1 and Tc2 polarizing conditions. Tc1 and Tc2 Vbeta5.2 TcR CD8 T cells (10(6)) were adoptively transferred to syngeneic mice, and following immunization with 100 micro of OVA/alum, serum IgE antibodies were measured by passive cutaneous anaphylaxis and expressed as the highest dilution that gave a detectable skin response.

RESULTS

Both Tc1 and Tc2 CD8 T cells from OT-I mice inhibited IgE.

CONCLUSION

Both Tc1 and Tc2 CD8 T cells promote Th1 immunity and inhibit IgE responses. This process appears to be independent of CD8 T cell-derived IFN-gamma, as both Tc2 (IFN-gamma-) and Tc1 (IFN-gamma+) CD8 T cells inhibited IgE.

Review article: molecular signals and genetic reprogramming in peripheral T-cell differentiation

Rearrangement of gene segments occurs in T lymphocytes during thymic development as the T-cell receptor (TCR) is first expressed, allowing T cells to become central regulators of antigen specificity in the acquired immune system. However, further development of T cells occurs after population of peripheral lymphoid tissues, which can result in T-cell expansion and differentiation into effectors of various immune function, or progression to memory T cells, anergic cells or death by apoptosis. This review focuses on more recent developments concerning the choices that peripheral T cells make between first encountering antigen through TCR recognition and death. These decisions are associated with a process of genetic reprogramming that alters the behaviour of cells so that immune responses are appropriately regulated.

The balance of protein kinase C and calcium signaling directs T cell subset development

Development of naive T cells into type 1 (Th1, Tc1) or type 2 (Th2, Tc2) effector cells is thought to be under the control of cytokines. In this study, we show that when both IL-12 and IL-4 are present, murine and human T cell differentiation is regulated by the balance of protein kinase C (PKC) and calcium signaling within T cells. Although both biochemical signals were required for T cell activation via the TCR, altering the balance between them redirected type 1 cells to type 2 and vice versa. Stimulation of calcium signaling or inhibition of PKC favored type 1 differentiation, whereas stimulation of PKC or inhibition of calcineurin resulted in type 2 effectors. Altered peptide ligands induced distinct balances of PKC/calcium signaling and altered Tc1/Tc2 development in TCR-transgenic CD8 T cells. The data suggest novel strategies for manipulation of the immune response in vivo.

Identifying substance abusing delivering women: consequences for child maltreatment reports

OBJECTIVE

The major objective was to determine how and the extent to which SB2669, which requires the identification of substance abusing delivering women, affected the number of children reported for abuse or neglect in several California counties.

METHOD

A monthly time-series model from April 1988 to December 1995 was constructed. The idea underlying the model was that month-to-month changes in the number of child maltreatment reports was a response to the presence of SB2669 in addition to various demographic, social, and economic factors. By separately estimating each county's number of reports, it was assumed that SB2669 did not necessarily affect each county's reports by the same amount, perhaps partially because of different counties' implementation strategies or general policies. Our sampling size consisted of seven high prevalence counties.

RESULTS

The results suggest that the effects of SB2669 on the number of child maltreatment reports are mixed. On an aggregate level, all else constant, and at least for a few years after the passage of SB2669, SB2669 is associated with a decrease in child maltreatment reports in two of the participating counties. This decrease may be due to conscientious implementation of the legislation in these counties. This mixed finding is expected mainly because SB2669, although mandated, was never enforced. Moreover, from the process component of the study we learned that the implementation practices of this legislation vary substantially between and even within counties' hospitals.

CONCLUSIONS/FUTURE DIRECTIONS

A decrease in maltreatment reports in the presence of SB2669 is not necessarily the most desirable outcome in the light of what we know about the relationship between substance abuse and child maltreatment. Law makers need to rethink the purpose of the law and provide the necessary language, tools and training to ensure that the goals of identifying substance abusing mothers and their families are met. Provisions also need to be made that somehow enforce this legislation. These provisions could lessen county-level and hospital-level variability in implementing the law.

Human Tc1 and Tc2/Tc0 CD8 T-cell clones display distinct cell surface and functional phenotypes

It has recently become clear that distinct subsets of CD8 T cells, analogous to their CD4 counterparts, exist in rodents and humans. To examine functional differences between human CD8 T-cell subsets, we generated Tc1, Tc2, and Tc0 T-cell clones from the peripheral blood of healthy individuals. The majority of CD8 T-cell clones generated displayed a classic Tc1 phenotype, but 10% to 20% secreted interleukin (IL)-4 in addition to interferon-gamma (Tc0 phenotype). Generation of Tc2 clones was dependent on the use of anti-CD3 and anti-CD28 as the primary stimulus. The cytokine profiles of established clones remained susceptible to modification by the addition of IL-12 and IL-4. In addition, IL-12 enhanced and IL-4 inhibited the growth of Tc1 but not Tc2/0 CD8 T-cell clones. Significant functional differences were observed between the subsets. Tc2/0 clones expressed CD30 and CD40 ligand at a much higher level than Tc1 clones. Both Tc1 and Tc2/0 clones showed comparable cytotoxicity and produced similar levels of perforin and Fas L. However, Tc2 clones were much more resistant to activation-induced cell death and less susceptible to apoptosis by direct Fas ligation. Moreover, Tc1 and Tc2 clones had opposing effects on the development of CD4 effectors, promoting type 1 and type 2 responses, respectively. These data provide evidence for profound differences between human CD8 T-cell subsets that may be important in their functions as cytotoxic or immunoregulatory cells. (Blood. 2000;95:231-240)

CD8(+) T cell subsets and chronic obstructive pulmonary disease

COPD is a debilitating and progressive condition in which the airways become irreversibly obstructed and the lungs progressively damaged. Unlike asthma, we know little about the cells that initiate and drive this process. Research has shown that CD8(+) T cells are overrepresented in the lungs of patients with COPD and that they are inversely related to lung function. However, not all CD8(+) T cells are alike and subsets that make IFN-gamma but not IL-4 (Tc1), IL-4 but not IFN-gamma (Tc2) as well as those that make both (Tc0) have been described. This article focuses on the characteristics of CD8(+) T cell subsets and considers their potential contribution to chronic obstructive pulmonary disease (COPD). Kemeny DM, Vyas B, Vukmanovic-Stejic M, Thomas M, Noble A, Loh LC, O'Connor BJ. CD8(+) T cell subsets and chronic obstructive pulmonary disease.

IL-4 inhibits human CD8 T cell expression of the common IL-2 receptor gamma chain

Previous studies in both rats and humans have shown that interleukin (IL) 4 can suppress the generation of IL-2-producing CD8 T cells. In an attempt to elucidate the mechanism by which this suppression is brought about, we set out to investigate whether the IL-4 signal interferes with the IL-2 receptor system. It has already been reported that IL-2 can affect the expression of its own receptor and thus provide a means of controlling its own activities. In this study, we demonstrate that the IL-2 Ralpha- and the IL-2 Rgamma-chains are dramatically upregulated following stimulation of CD8 T cells, whereas lower levels of beta-chain are observed. IL-4 did not affect the expression of the alpha- or beta-chains, but was found to inhibit the generation of common gamma-chain-expressing cells. Moreover, CD4 T cells were found to express much lower levels of this subunit and appeared less sensitive to the effects of IL-4. We postulate that the differential expression of the gamma-chain subunit, in the presence and absence of IL-4, may provide a tool for identifying functionally distinct subpopulations of CD8 T cells.

Pharmacokinetic-pharmacodynamic relationships between pirarubicin exposure and hematotoxicity: clinical application using only one blood sample

The objective of the present study was to evaluate the relationship between the pharmacokinetic parameters of pirarubicin and of its metabolite doxorubicin measured in plasma and whole blood, and the hematologic toxicity of this drug, in order to evaluate the predictability of changes in white blood cells (WBC) by single measurement of drug concentrations. This pharmacokinetic-pharmacodynamic relationship was studied in a total of 45 patients with different tumor types treated by combined chemotherapy containing pirarubicin, administered as short infusion (10+/-2 min) at doses ranging from 50 to 90 mg. In 45 courses performed in 24 patients, we established the relationship between the half-product of pirarubicin level in whole blood at the end of the infusion and the duration of this infusion, which represents an estimate of the area under the time x concentration curve (AUC(PIRA,wb,ei) = C(PIRA,wb,ei) x duration of infusion/2), the age of the patients and the relative fall in WBC counts. These results allowed us to establish a predictive formula in order to anticipate the number of WBC that the patient will obtain about 12 days after treatment, at the nadir of the counting. WBCnadir = 0.032404 x Age + 2.005 + WBCinitial x e(-0.009316 x AUC(PIRA,wb,ei) + 4.202265), WBC being expressed as x 10(3) cells/microl and AUC(PIRA,wb,ei) in ng/ml x h. In a second step, the validation of the prediction was carried out in 43 courses from 21 patients treated in the same conditions, for which WBC(predicted nadir) was compared by linear regression to WBCcounted. We obtained a highly significant correlation: r = 0.656; p<0.0001). Therefore, we show in this paper that the hematological toxicity, especially the WBC nadir count, can be predicted from single-sample blood HPLC analysis. This rapid and easy prediction of leukopenia can help the clinician in anticipating important hematological toxicities and in deciding to start early prophylactic treatment with hematopoietic growth factors.

Snyder v. American Association of Blood Banks: a re-examination of liability for medical practice guideline promulgators

Medical practice guidelines are playing an increasingly important role in both the medical and the legal context. As tools for the health practitioner, it is thought that medical practice guidelines may contribute to an increase in the quality of patient care and cost-effectiveness. In the legal setting, guidelines may improve the functioning of the medical malpractice system by creating more rational, predictable standards of care. The development and promulgation of medical practice guidelines, while increasing, are still evolving. A number of concerns, especially in the areas of physician autonomy, physician control, and ethics, as well as efficacy, need to be resolved. The use of such guidelines as the legal standard of care in malpractice cases evokes similar concerns, along with fears that the use of guidelines at trial may either lower the standard of care, or, conversely, raise the standard of care to levels that are difficult to meet. Adding to this controversy is the recent case of Snyder v. American Association of Blood Banks (1996), in which the New Jersey Supreme Court upheld a jury finding that the American Association of Blood Banks (AABB) was liable to a plaintiff who contracted AIDS from an HIV-tainted transfusion, for negligent failure to adopt guidelines requiring blood testing for surrogate markers. This opinion is significant as the first to find a duty of care running from a medical guideline promulgator to a third person, the injured patient. The opinion is examined in depth and within the context of other relevant case law. The impact the opinion will have is difficult to gauge. The somewhat unique facts of the case, as well as the court's unusually stinging critique of the defendant, AABB, and its motivations informing its response to the concerns about blood contamination, may limit its value as precedent. However, precedent does exist in analogous non-medical cases for promulgator liability. The pros and cons of promulgator liability are weighed. While closer regulation of guideline development and promulgation or promulgator immunity may be warranted, it is premature to consider either seriously until the impact of the Snyder opinion can be appreciated.

Suppression of immune responses by CD8 cells. I. Superantigen-activated CD8 cells induce unidirectional Fas-mediated apoptosis of antigen-activated CD4 cells

Stimulation of mature CD4 cells through the TCR induces cellular activation and expansion that are often followed by clonal elimination by a form of apoptosis termed activation-induced cell death. This process of CD4 cell apoptosis is generally thought to reflect clonal suicide and to be independent of other cell types. Here we show that during the response to the superantigen Staphylococcal enterotoxin A, activated CD8 cells, but not activated CD4 cells, suppress the CD4 proliferative response. Suppression by CD8 cells reflects their ability to induce CD4 cell apoptosis via ligation of Fas. Moreover, although activated CD8 cells that express Fas ligand and Fas eliminate CD4 cells through a Fas-dependent mechanism, they are themselves resistant to Fas-dependent apoptosis. These findings indicate a fundamental difference between the two major T cell subsets with regard to sensitivity to Fas-dependent apoptosis, expression of Fas ligand, and mediation of suppressive activity following immunization with superantigen.

Suppression of immune responses by CD8 cells. II. Qa-1 on activated B cells stimulates CD8 cell suppression of T helper 2 responses

We have investigated the role of MHC class I products and CD8 T cells in regulating Ab responses using beta2-microglobulin deficient (beta2m-/-) mice. Beta2m-/- mice produced stronger IgM and IgG responses than did control beta2m+/+ mice to both cellular and viral Ags. These Ab responses could be suppressed by infusion of activated B cells from beta2m+/+ mice. Further investigation showed that the beta2m-associated molecule on activated B cells that induced CD8 suppression was Qa-1 and that the Th2 component of CD4 cells was most affected by CD8-suppressive activity. Our findings suggest a novel pathway of Th inhibition in which B cell presentation of Qa-1-associated peptides stimulates CD8 suppressive activity.

Antigen-specific CD8+ T cells inhibit IgE responses and interleukin-4 production by CD4+ T cells

There is a growing body of evidence which suggests that CD8+ T cells play an important part in regulating the IgE response to non-replicating antigens. In this study we have systematically investigated their role in the regulation of IgE and of CD4+ T cell responses to ovalbumin (OVA) by CD8+ T cell depletion in vivo. Following intraperitoneal immunization with alum-precipitated OVA, OVA-specific T cell responses were detected in the spleen and depletion of CD8+ T cells in vitro significantly enhanced the proliferative response to OVA. Depletion of CD8+ T cells in vivo 7 days after immunization failed to enhance IgE production, while depletion of CD8+ T cells on days 12-18 greatly enhanced the IgE response, which rose to 26 micrograms/ml following a second injection of anti-CD8 on day 35 and remained in excess of 1 microgram/ml over 300 days afterwards. Reconstitution on day 21 of rats CD8-depleted on day 12 with purified CD8+ T cells from animals immunized on day 12 completely inhibited the IgE response. This effect was antigen specific; CD8+ T cells from OVA-primed animals had little effect on the IgE response of bovine serum albumin immunized rats. In vivo, CD8+ T cell depletion decreased interferon (IFN)-gamma production but enhanced interleukin (IL)-4 production by OVA-stimulated splenic CD4+ T cells. Furthermore, CD8+ T cell depletion and addition of anti-IFN-gamma antibody enhanced IgE production in vitro in an IL-4-supplemented mixed lymphocyte reaction. These data clearly show that antigen-specific CD8+ T cells inhibit IgE in the immune response to non-replicating antigens. The data indicate two possible mechanisms: first, CD8+ T cells have direct inhibitory effects on switching to IgE in B cells and second, they inhibit OVA-specific IL-4 production but enhance IFN-gamma production by CD4+ T cells.

Effects of age on perinatal substance abuse among whites and African Americans

This descriptive study assessed age effects on perinatal use of alcohol, marijuana, and cocaine among African-American and white women. Data were derived from the California Perinatal Exposure Study, relying on a statistical probability sample n = 29,494) of women who underwent anonymous urine toxicology screening in birthing hospitals. The central hypothesis was that there would be no difference in age effects on drug use among white and African-American women. Marital status and payment source were used as risk factors in order to create detailed age-risk profiles for both racial-ethnic groups. Logistic regression analyses were used and findings indicated that cocaine use peaked in early adulthood for whites and in mid-adulthood for African-Americans who had higher prevalence levels with the same or fewer risk factors as whites. Over one third of African-American women in their mid-thirties who were not married and who had publicly assisted births tested positive for cocaine. In contrast, high risk whites had higher marijuana prevalence levels than African-American women, and prevalence increased with age. Alcohol prevalence increased with age for African-American and white women who were publicly assisted, but decreased with age for all others. Findings for alcohol and marijuana generally followed the same risk-adjusted patterns for African American and white women but with different prevalence levels; however, cocaine use had a unique pattern with higher prevalence among African-American women in mid-adulthood regardless of risk level.

The relationship between shoe size and mode of delivery

This study investigates whether a woman with a small shoe size has a higher chance of being delivered by cesarean section. Data on shoe size and mode of delivery were collected by chart review and telephone survey from clients of a freestanding birth center. Purposive sampling was done to include all women transferred and delivered by cesarean section for CPD or FTP, and an equivalent number of women who had a normal spontaneous vaginal delivery. Data on twenty two first time mothers who were delivered by cesarean section and twenty three who delivered vaginally were compared. This study did not find any relationship between small shoe size and cesarean section delivery.

Prenatal substance abuse in California: findings from the Perinatal Substance Exposure Study

This article reports the overall statewide findings of an epidemiological study that included 29,494 pregnant women who had been admitted for delivery in more than 200 hospitals in California and who were tested for alcohol and other drugs via blind urine toxicology screens. Results were matched to demographic data. The article includes analysis and discussion of four major variables: race/ethnic group differences, acculturation, source of payment for birth, and prenatal care status. Regional results are also discussed. The authors emphasize the high rate of alcohol use and self-reported tobacco use in comparison to relatively low rates of illicit drug use. Alcohol use rates were fairly stable, while use of illicit drugs and tobacco tended to vary according to social and demographic variables. The findings establish the need for both broad-based and targeted prevention and intervention programs to better disseminate the risks involved in drinking alcohol, smoking tobacco, and using drugs during pregnancy.