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Biomedical subjects

H L Minkoff

Publications and source records attributed to H L Minkoff.

At least 37 records · Page 2Linked to original sources
PubMed1992

The impact of human immunodeficiency virus serostatus on reproductive decisions of women.

Each year in the United States, several thousand women infected with the human immunodeficiency virus (HIV) become pregnant. The scope of the pediatric HIV epidemic will be determined by the reproductive decisions of these women. Although initial studies have not documented an effect of serostatus on reproductive choice, these studies have been limited to single-risk groups (eg, drug users) and have had small numbers of participants. We studied 108 HIV-seronegative women and 98 seropositive women through an index pregnancy and for an average of 1.5 years postpartum. Thirty-four of the seronegative women (31%) and 32 of the seropositive women (33%) learned their serostatus early enough in pregnancy to have the option to undergo abortion. One of the 34 seronegative women (2.9%) and six of the 32 seropositive women (18.8%) chose abortion (P less than .05). During follow-up, we found no significant differences in the numbers of pregnancies or live births between seropositive and seronegative women, or between drug-using and non-drug-using women. Among those who developed AIDS (N = 10), no live births occurred during followup. Although positive HIV status did correlate with the decision to terminate pregnancies, it did not correlate with subsequent fertility.

Abortion, Legal↗
PubMed1992

Pregnancy and women at risk for HIV infection.

Special issues of pregnant women with HIV, such as HIV disease in pregnancy, transmission during pregnancy, transmission through breast milk, the effect of HIV disease on pregnancy outcome, and strategies for preventing neonatal damage from HIV, are discussed. In addition, issues relevant to the care of women in general are presented, including gynecologic manifestations, prevention, and contraception.

Female↗
PubMed1991

The biologic and social consequences of perinatal cocaine use in an inner-city population: results of an anonymous cross-sectional study.

Cocaine use among pregnant women and reports of its adverse perinatal consequences have increased substantially over the past 10 years. However, most researchers have studied patients registered at drug treatment centers or have relied on voluntary participation by patients, either of which introduces the possibility of selection bias. To determine the frequency and consequences of prenatal cocaine use among an unselected inner-city obstetric population, we collected urine samples from parturient women at a municipal hospital and anonymously tested these specimens for metabolites of cocaine, marijuana, opiates, and methadone. Urine specimens, with linked obstetric data sheets, were available from a study population of 1111 patients, and pediatric data sheets were available for 846 mother-infant pairs. Cocaine metabolites were found in 11.5% of the urine samples collected, whereas metabolites of marijuana, opiates, and methadone, respectively, were present in 1.1%, 1.2%, and 0.3% of the specimens. Cocaine users were more likely than nonusers to have had no prenatal care (51% vs 8.8%; p less than 0.0001), to be American-born rather than Caribbean-born (71% vs 33%; p less than 0.001), and to have a higher parity (1.83 vs 1.14; p less than 0.0001). Infants of cocaine users had a lower mean gestational age (-0.93 weeks; p less than 0.01), a lower mean birth weight (2560 +/- 788 vs 3151 +/- 699 gm; p less than 0.001), and an increased probability of having an Apgar score of less than 7 at 5 minutes (12.5% vs 3.2%; p less than 0.0001). Multiple linear regression analysis that isolated confounding variables such as the presence or absence of prenatal care, maternal age and parity, and the use of cigarettes and alcohol did not substantially affect the differences described above. The effect of cigarette smoking on reducing fetal size was cumulative. In conclusion, cocaine is the most commonly used illicit drug among parturients in this community and is strongly associated with underutilization of prenatal care services. Infants of cocaine users are more likely to be preterm and depressed at birth and to have a low birth weight. Cocaine use, through the above-noted effects, increases the need for prenatal care while simultaneously decreasing the likelihood that it will be obtained.

Adult↗
PubMed1991

Preventing fetal damage from sexually transmitted diseases.

The STDs threaten the reproductive health of women in many ways, ranging from premature births through congenital infections and death. An understanding of the natural history of these diseases permits timely interventions which can mitigate the perinatal damage caused by these infections substantially. Ideally, primary prevention or safer sex will be adopted by sexually active women, thereby reducing the morbidity not only for their offspring but for themselves as well. Antiviral therapy is not yet available for minimizing any hazard of fetal exposure to HPV, HSV, HIV, and hepatitis B viral infections. Early antibiotic therapy should reduce the risk of congenital syphilis and any perinatal hazards associated with chlamydial and gonococcal infections.

Anti-Bacterial Agents↗
PubMed1990

Serious infections during pregnancy among women with advanced human immunodeficiency virus infection.

Fifty-six human immunodeficiency virus seropositive-women and 76 human immunodeficiency virus seronegative-women had known CD4 cell values and were followed up throughout pregnancy. The women with seronegative results and the 40 with seropositive results and CD4 (helper cell) counts consistently greater than 300 cells/mm3 had no serious infections during pregnancy. Among the 16 with seropositive results and counts that fell below 300 cells/mm3, three developed opportunistic infections, one had pneumonia, and one had a post-cesarean-section abscess. Human immunodeficiency virus seropositive-women with low CD4 counts are at markedly increased risk of serious infections during pregnancy. The consequences of this for fetal health, pregnancy management, maternal well-being, and human immunodeficiency virus testing policies are discussed.

Acquired Immunodeficiency Syndrome↗
PubMed1990

The relationship of cocaine use to syphilis and human immunodeficiency virus infections among inner city parturient women.

To study the relationship of cocaine use to syphilis and human immunodeficiency virus infections a blinded urine and serum survey was performed among parturient women at an inner city hospital. Discarded urine samples of 1206 parturient women were saved and given code numbers that were also assigned to data sheets containing nonidentifying information, including prenatal care status and syphilis serologic results. In the latter part of the study blood remaining after syphilis serologic tests were performed (n = 480) were tested for human immunodeficiency virus antibodies. Overall 12.9% of urine samples had cocaine derivatives, 1.4% opiates, 1.5% marijuana, 0.0% benzodiazepine, and 0.3% methadone. The prevalence of positive rapid plasma reagin tests was 18.7% among patients with positive urine toxicologic tests for cocaine and 2.41% for patients with negative urine tests (odds ratio = 9.3, 95% confidence interval 5.2 to 16.5, p less than 0.001). Fluorescent treponemal antibodies were also significantly more frequent among patients with positive urine samples. Four of 53 (7.6%) patients with positive urine toxicologic screens were human immunodeficiency virus antibody positive compared with six of 427 (1.4%) women with negative screens (odds ratio = 5.7, 95% confidence interval = 1.4 to 21.5, p = 0.019). Cocaine patients with positive cocaine screens and with syphilis or human immunodeficiency virus had prenatal care in 6 of 21 (28.6%) and 0 of 4 (0%) cases, respectively, while patients with negative cocaine screens and syphilis or human immunodeficiency virus had prenatal care in 13 of 18 (72.2%) and 5 of 6 (83.3%) cases, respectively (p = 0.010 and p = 0.048). Cocaine use appears to be associated with both the acquisition of human immunodeficiency virus and syphilis and the failure of infected individuals to utilize prenatal services.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Drug prophylaxis for human immunodeficiency virus-infected pregnant women: ethical considerations.

More than 5000 women infected with human immunodeficiency virus give birth annually in the United States. Many of these women are offered human immunodeficiency virus tests in prenatal settings. One of the incentives for them to be tested is access to medications that have been shown to prolong disease-free intervals in nonpregnant human immunodeficiency virus-infected individuals. However, the use of those medications during pregnancy has not been well studied and some have cautioned against their prenatal use. Thus consideration of these agents may be deferred by some clinicians until the postpartum period. In this article we argue that the availability of such agents should be disclosed to women who are seropositive for human immunodeficiency virus as part of the informed consent process.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Pregnancy outcomes among mothers infected with human immunodeficiency virus and uninfected control subjects.

Between June 26, 1985, and Feb. 24, 1989, 101 seropositive pregnant women and 129 seronegative pregnant women from the same prenatal clinics in Brooklyn and the Bronx were recruited into a prospective study of human immunodeficiency virus infection in pregnant women and their offspring. This report details the course of pregnancy and short-term neonatal outcomes of 91 seropositive women and 126 seronegative women who gave birth during the study period. Seropositive mothers were significantly more likely to have sexually transmitted diseases (17.6% vs 7.1%, p = 0.017) and medical complications (43.0% vs 25%, p = 0.006) during pregnancy. No other obstetric complications (e. g., chorioamnionitis, endometritis, toxemia, or placental problems) were associated with serologic status. After controlling for confounding variables (drug use, tobacco use, age of mother, and clinic), we found that the mother's serologic status was not significantly associated with birth weight, gestational age, head circumference, or Apgar scores among live infants. For example, after adjustment on confounders we found that children born to seropositive mothers weighed about 7 gm more than children of seronegative mothers (95% confidence interval, -180 to 194 gm). We conclude that in this population human immunodeficiency virus infection has little demonstrable impact on the status at birth of live neonates.

Adult↗
PubMed1989

Mother-to-infant transmission of human immunodeficiency virus type 1: association with prematurity or low anti-gp120.

In a prospective study of pregnant women infected with human immunodeficiency virus type 1 (HIV-1) in Brooklyn, New York, USA, 16 (29%) of 55 evaluable infants were infected with HIV-1. 9 infants had paediatric acquired immunodeficiency syndrome, 6 had less severe clinical manifestations of HIV-1 infection, and 1 was symptom-free but was seropositive for HIV-1 beyond 15 months of age. The 10 infants born at 37 weeks of gestation or earlier were at higher risk of HIV-1 infection than infants born at 38 weeks of gestation or later (60% vs 22%) but the median age at appearance of disease was approximately 5 months in both groups. The HIV-1 transmission rate was not associated with predelivery levels of maternal T cells, anti-p24, or neutralising antibodies but it was higher, among full-term infants, for those with mothers in the lowest third of the distribution of anti-gp120 levels (53%). On immunoblot, transmitting mothers lacked a gp120 band but not other bands. Protection was not associated with antibody to recombinant peptides from the hypervariable region of the major neutralising gp120 epitope, and the anti-gp120 endpoint dilution titre was similar in transmitting and non-transmitting mothers. Mothers of uninfected full-term infants appear to confer immunological protection against HIV-1 infection of their offspring by way of a high-affinity antibody to a gp120 epitope, whose specificity has importance for vaccine development and possibly perinatal immunotherapy.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Vaginally administered cocaine overdose in a pregnant woman.

The deleterious effects of cocaine have been described in the adult population and in the neonate. Documentation of adverse effects in pregnant patients has been limited. We report the first known fatal vaginal administration of cocaine.

Administration, Intravaginal↗
PubMed1989

AIDS in obstetrics.

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Acquired Immunodeficiency Syndrome↗
PubMed1988

The case for routinely offering prenatal testing for human immunodeficiency virus.

Infections with human immunodeficiency virus are becoming increasingly common among women of reproductive age. The consequences of these infections on maternal and child health are substantial. Evidence has been published that suggests that testing only those women recognized as being at risk through physician-elicited, patient-volunteered testing programs will fail to identify substantial numbers of infected patients. This article develops the arguments that informing infected women of their serologic status is of critical importance and that in clinical practice identification of women with sexually transmitted diseases such as human immunodeficiency virus can only be accomplished with routine testing (with consent, confidentiality, and counseling).

Acquired Immunodeficiency Syndrome↗
PubMed1988

HIV in pregnancy.

Human immunodeficiency virus is becoming increasingly common among childbearing women. Through federally recommended testing programs, obstetricians will soon be identifying pregnant women in their practices who are HIV infected. Hence obstetricians must be prepared to face the social, ethical, and medical dilemmas brought on by HIV infection in pregnancy.

Acquired Immunodeficiency Syndrome↗