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Biomedical subjects

J A Read

Publications and source records attributed to J A Read.

At least 19 recordsLinked to original sources
PubMed1996

Prenatal maternal blood pressure response to stress predicts birth weight and gestational age: a preliminary study.

OBJECTIVE: The objective was to test the prospective association between prenatal maternal circulatory responses to a standardized psychologic challenge and birth outcome. STUDY DESIGN: We examined the relationship between blood pressure responses to a cognitive arithmetic stressor and birth outcome in 40 healthy primigravid women. Pregnant women between 18 and 37 years old were recruited from the University of Kentucky Prenatal Service Clinic for participation. All women performed an interactive arithmetic task while maternal heart rate and blood pressures were determined. Subsequent birth outcome parameters of birth weight and gestational age were obtained for prospective analyses. RESULTS: Results indicated that maternal systolic and diastolic blood pressures and heart rates were significantly increased during the arithmetic task (p < or = 0.01). Regression analyses suggested that women with larger diastolic blood pressure responses during stress had infants with lower birth weights (p < 0.01) and decreased gestational age (p < 0.05). CONCLUSIONS: This effect was specific to psychologic stress reactivity and was not related to maternal age, maternal race, baseline blood pressures, the trimester of stress testing, nor expired carbon monoxide. The relationship between maternal blood pressure response and birth outcome may reflect the transplacental impact of individual differences in systemic stress responsivity.

Adolescent↗
PubMed1995

Prevalence of low birth weight and preterm delivery in relation to the interval between pregnancies among white and black women.

BACKGROUND: The higher mortality rate among black infants than among white infants in the United States results largely from the greater frequency of low birth weight and prematurity among black infants. Higher rates of low birth weight and preterm delivery have been associated with shorter intervals between pregnancies. METHODS: We studied a racially mixed population of women in military families, who had access to free, high-quality health care. A total of 1992 white and black women had two consecutive, singleton pregnancies during the study period. We determined the outcome of the second of each pair of pregnancies and the length of time between the pregnancies. RESULTS: Short interpregnancy intervals (calculated from delivery to the next conception) were more frequent among black than among white women. A total of 7.7 percent of the 298 black women and 3.2 percent of the 1628 white women delivered premature, low-birth-weight infants (P < 0.001). Among the black women, an interpregnancy interval of less than nine months was associated with a significantly greater prevalence of preterm delivery and low birth weight in the neonates (11.6 percent, vs. 4.4 percent for longer interpregnancy intervals; P = 0.020). Among the white women, only intervals of less than three months between pregnancies were associated with a greater prevalence of prematurity and low birth weight in the infants (11.8 percent vs. 2.8 percent; P < 0.001). Of the black women, 46.3 percent had interpregnancy intervals of less than nine months; 4.2 percent of the white women had interpregnancy intervals of less than three months. CONCLUSIONS: A short interval between pregnancies is a risk factor for low birth weight and preterm delivery, and such intervals are more common among black than among white women. The relative frequency of intervals of less than nine months between pregnancies may be an important factor in the wide disparity in pregnancy outcomes between white and black women in the United States.

Adult↗
PubMed1995

Risk factors for preterm delivery in a healthy cohort.

To examine whether risk factors differed among subgroups of preterm (< 37 weeks of gestation) deliveries, we studied a cohort of 1,825 enlisted servicewomen who delivered from 1987 through 1990 at four U.S. Army medical centers. Preterm deliveries were classified by length of gestation (< 29 weeks, 29-32 weeks, 33-36 weeks) and clinical course [medical indication, idiopathic preterm labor, or preterm rupture of membranes (PROM)]. We abstracted medical records for information on age, race, army rank, marital status, gravidity, parity, the baby's sex, maternal prepregnancy height and weight, gestation at entry to prenatal care, alcohol drinking and smoking, time since and outcome of preceding pregnancy, surgery performed during pregnancy, anemia, and diagnoses of uterine abnormalities, sexually transmitted diseases, and urinary tract infections. We used proportional hazards analysis to evaluate associations for each subgroup of preterm delivery. The relative odds associated with a history of preterm delivery in the preceding pregnancy ranged from 3.1 for deliveries due to preterm labor or PROM to 6.2 for deliveries that occurred during 29-32 weeks; none of the other factors was consistently associated across the subgroups of preterm delivery. The paucity of associations is consistent with the conclusion of other investigators that most of the causes of preterm delivery are unknown.

Adolescent↗
PubMed1994

Antenatal hospitalization among enlisted servicewomen, 1987-1990.

OBJECTIVE: To describe the prevalence of, and indications for, antenatal hospitalization among women who delivered live and stillborn infants. METHODS: We reviewed the records of a cohort of 1825 black and white enlisted women who delivered from 1987-1990 at the four largest Army medical centers in the United States. Women with multiple gestations and those whose pregnancies ended before 20 weeks' gestation were excluded. Records of all women with preterm deliveries and a one-third sample of women with term deliveries were abstracted. RESULTS: Overall, 26.8 +/- 1.6% (mean +/- standard error) of the women were hospitalized antenatally. Of the estimated 702 antenatal hospitalizations, 44.0 +/- 3.4% were related to preterm labor, 10.3 +/- 1.9% to preeclampsia, 5.5 +/- 1.5% to hyperemesis, and 4.7 +/- 1.5% to urinary tract or kidney infection. The prevalence of hospitalization was lowest before 20 weeks (5.0 +/- 0.8%) and highest at 33-36 weeks (12.2 +/- 1.2%). Small and probably clinically insignificant differences between black and white women were noted in the overall prevalence of antenatal hospitalization and in the indications for hospitalization. CONCLUSION: As measured by hospitalization, severe antenatal morbidity is common in this population of healthy enlisted women.

Adolescent↗
PubMed1993

Preterm delivery among black and white enlisted women in the United States Army.

OBJECTIVE: To examine black-white differences in preterm delivery in a healthy population who had unrestricted access to prenatal care. METHODS: We conducted a retrospective cohort study of 842 black and 1026 white enlisted servicewomen who delivered a singleton infant of 20 or more weeks' gestation from July 1, 1987 through September 30, 1990 at four Army Medical Centers in the United States. Data were collected by reviewing maternal and newborn records. We used logistic and proportional hazards regression models to analyze outcomes defined by length of gestation, cause of preterm delivery, and jointly by length and cause. RESULTS: Black enlisted women had a cumulative probability of preterm delivery (13.5%) that was higher than that for white enlisted women (10.5%) (hazard ratio 1.31, 95% confidence interval [CI] 1.002-1.70). However, the ratio of black-to-white hazards was not uniform. Black-white differences were small and nonsignificant from 33-36 weeks' gestation, when most preterm deliveries occur. The differences were also small and nonsignificant for deliveries related to spontaneous rupture of membranes or idiopathic preterm labor, the most common causes of preterm delivery. The black-to-white hazard ratios were greatest for all deliveries before 33 weeks' gestation and for medically indicated preterm deliveries. CONCLUSIONS: Efforts to reduce black-white differences in preterm delivery must go beyond providing prenatal care and eliminating recreational drug use. Future studies should consider black-white differences in environments during the mother's own development and in psychosocial and physical stresses during pregnancy.

Adolescent↗
PubMed1992

Risk of chromosomal abnormalities in patients with idiopathic polyhydramnios.

This prospective investigation was designed to assess the incidence of chromosomal abnormalities in patients with idiopathic polyhydramnios. Polyhydramnios was defined as 25 cm or greater in total vertical height in all four quadrants (amniotic fluid index) in any nonreferral patient (ie, primary care population) undergoing sonographic examination with a singleton pregnancy, normal fetal anatomical survey, normal glucose screening, and negative antibody screen. During the 2-year period from May 1, 1988 through April 30, 1990, 5038 gravidas delivered at Madigan Army Hospital Center. Unexplained polyhydramnios was detected sonographically in 125 patients, an incidence of 2.5%. After obtaining informed written consent, amniocentesis was performed in all patients. Within this group (N = 125), four chromosomal abnormalities (incidence of 3.2%) were detected. There were two trisomy 18 and two trisomy 21 fetuses. None of the four patients had maternal serum alpha-fetoprotein screening performed. The incidence of aneuploidy in patients with idiopathic polyhydramnios (3.2%) is much higher than the reported incidence of major karyotype abnormalities in live births (0.59%). We conclude that fetal chromosomal analysis should be considered in all obstetric patients with sonographic evidence of idiopathic polyhydramnios.

Chromosome Aberrations↗
PubMed1991

Reproducibility of the oral glucose tolerance test in pregnancy.

This prospective investigation evaluated the reproducibility of the 100 gm oral glucose tolerance test. Sixty-four obstetric patients with greater than or equal to 135 mg/dl on the 50 gm oral glucose screening test were scheduled for the 100 gm test. All patients repeated the oral glucose tolerance test in 1 to 2 weeks. Both tests included a preparatory diet, and testing conditions were identical. There were no significant differences in the mean test values at each testing interval when the entire study population was considered. Patients were then divided into four groups according to the outcome of the two tests. Forty-eight of 64 (75%) had normal results at each testing period (group 1); 11 of 64 (17%) had initially normal results and abnormal results on retest (group 2); 3 of 64 (5%) had initially abnormal results and normal results on retest (group 3); 2 of 64 (3%) had abnormal results at both testing phases (group 4). There were no significant differences between oral glucose tolerance test results within groups 1 and 4. However, significant differences occurred within groups 2 and 3 between the two tests. Group 2 patients had a greater frequency of an abnormal 1-hour value on the test than group 1 patients (p = 0.001). Overall, the reproducibility of the oral glucose tolerance test was 78% (50 of 64). We recommend the oral glucose tolerance test be repeated when the 1-hour value is abnormal or when the fasting blood sugar, 1-hour, and 2-hour values are near the upper end of the normal range.

Adult↗
PubMed1991

A simple method of separation of Pneumocystis carinii from rat lung.

Existing methods for purification of Pneumocystis carinii are unsatisfactory. Dialysis is a simple, non-stressful treatment which aided purification of organisms from rat cells. Yields were quantitated using a Petroff-Hausser chamber and nuclear staining. Following dialysis overnight, three times the yields of similar, undialysed preparations were obtained, with less than 0.2% contamination by lung cells. Overnight incubation at 4 degrees C also improved separation, but yields were only half those following dialysis. Dialysis is now used routinely in the preparation of pure Pneumocystis carinii suspensions.

Animals↗
PubMed1991

Screening for illicit drug use in a military obstetric population.

The purpose of our investigation was to determine the prevalence of illicit drug use within our socioeconomically heterogeneous obstetric population, in order to assess the need for institution of universal screening. Five hundred consecutive new obstetric registrants had urine collected for routine culture. Following removal of a small aliquot of urine for culture, the samples were sent to the Armed Forces Institute of Pathology, Division of Forensic Toxicology. Each specimen was screened for the presence of alcohol, cocaine metabolites, cannabinoids, opiates, and amphetamines using fluorescent polarization immunoassay techniques. All positive screening tests were confirmed by gas chromatography mass spectrometry. Thirty samples were either lost in processing or of insufficient quantity to test. Five of the 470 samples (1.06%) tested were positive. One subject was taking prescription narcotics, so the correlated prevalence was 0.85%. Three tested positive for tetrahydrocannabinol and two for opiates. Analysis of our data demonstrates that our obstetric population has a significantly lower prevalence of illicit drug use than other populations reported previously (P less than .01). We recommend that each institution providing obstetric services determine its specific prevalence of illicit drug use.

Cross-Sectional Studies↗
PubMed1991

The association of antiphospholipid antibodies with pregnancies complicated by fetal growth restriction.

The association of antiphospholipid antibodies with fetal growth restriction is often cited, but the published evidence for this is based on few patients and comes primarily from patient histories, not study groups. In this prospective study, we evaluated a subgroup of our population with fetuses whose estimated weights at ultrasound were at or below the tenth percentile for gestational age. Plasma and serum testing was performed to determine the presence of antiphospholipid antibodies, specifically lupus anticoagulant and anticardiolipin antibodies, respectively. From March 1990 through March 1991, 55 women were followed for suspected fetal growth restriction. Intensive monitoring of the fetal condition and modification of the mother's activity were recommended, resulting in 100% compliance. Despite this, 37 newborns were confirmed by birth weight to be at or below the tenth percentile, and all were below the 45th percentile. Fifteen of 55 women (27%) were positive for anticardiolipin antibodies, as were nine of 37 (24%) with correctly diagnosed fetal growth restriction. Five of 15 women whose newborns had ponderal indexes below the tenth percentile tested positive for anticardiolipin antibodies. None of the women had a positive lupus anticoagulant test. The prevalence of anticardiolipin antibodies in this study group was significantly higher than in our general population. We conclude that there is a statistically significant association between the presence of circulating maternal anticardiolipin antibodies and fetal growth restriction.

Autoantibodies↗
PubMed1991

Use of a standard preparatory diet for the oral glucose tolerance test. Is it necessary?

A prospective investigation was performed to evaluate the necessity of a diet containing greater than or equal to 150 g/d of carbohydrate for three days before the oral glucose tolerance test (OGTT). Thirty-seven obstetric patients who had a value of greater than or equal to 135 mg/dL on the one-hour, 50-g oral glucose screening test underwent a subsequent OGTT. The patients were alternately assigned to one of two groups. Nineteen of 37 (51%) were asked to precede the OGTT with a three-day diet containing greater than 150 g/d of carbohydrate. Those patients were then asked not to alter their normal dietary pattern and to repeat the OGTT in one to two weeks (group I). Eighteen of 37 (49%) followed the testing scheme in reverse order (group II). There were no significant differences in mean fasting or in one-, two- or three-hour plasma glucose values at either testing period between groups I and II. There were no significant differences between groups I and II in the number of patients who had an abnormal OGTT at the initial or repeat testing period. Dietary preparation for the OGTT is not necessary, and patients can be scheduled for the test when convenient.

Adult↗
PubMed1990

Vaginal breech delivery: a five-year prospective evaluation of a protocol using computed tomographic pelvimetry.

In 1983 a protocol was established at our institution that used computed tomographic pelvimetry to evaluate patients presenting with a singleton term frank breech fetus for an attempt at vaginal delivery. The criteria for a trial of labor were singleton fetus, term gestation (37 to 42 weeks' gestation from the first day of the last menstrual period), frank breech presentation, estimated fetal weight 2000 to 4000 gm, non-extended fetal head, and adequate computed tomographic pelvimetry. Two digital radiographs and a tomographic cross-section were taken of each patient, i.e., an anteroposterior view, a lateral view, and an axial section through the femoral head at the level of the fovea capitalis. Adequate pelvimetry was defined as: anteroposterior diameter of the inlet greater than or equal to 10.0 cm, transverse diameter of the inlet greater than or equal to 11.5 cm, transverse (interspinous) diameter of the midpelvis greater than or equal to 9.5 cm, and posterior sagittal diameter of the midpelvis greater than or equal to 4.0 cm. The purpose of this prospective analysis was to determine the obstetric and perinatal outcome of those breech fetuses that were evaluated with these criteria during the study period of January 1984 through July 1989. During this period the incidence of breech deliveries at our institution was 2.71% (394/14,542). Of these 394 breech deliveries, 122 patients underwent computed tomographic pelvimetry. Eighty-five patients had adequate pelvimetry, fulfilling the protocol criteria, and formed the study group. Eighty-one percent (69/85) of the study group had successful vaginal deliveries (group 1). Nineteen percent (16/85) required cesarean delivery after a trial of labor (group 2) (10 with fetal distress and six with arrested labor disorders). Of the 37 patients who had inadequate computed tomographic pelvimetry and underwent cesarean delivery without a trial of labor (group 3), 54% (20/37) had an extended fetal head, 21.6% (8/37) had an inadequate transverse diameter of the inlet, 13.5% (5/37) had an inadequate midpelvic posterior sagittal measurement, and 10.8% (4/37) had an inadequate interspinous diameter. Perinatal outcome including Apgar scores, cord gases, length of hospital stay, neonatal complications, was evaluated. No difference in infant complications was noted between the group delivered vaginally and the groups delivered abdominally. The only maternal complications in our study group were chorioamnionitis, endomyometritis, and postpartum anemia. There were no significant differences in the incidence of chorioamnionitis among the three groups of patients.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1990

Reduced concentrations of IgG antibodies to Pneumocystis carinii in HIV-infected patients during active Pneumocystis carinii infection and the possibility of passive immunisation.

The relationship between Pneumocystis carinii antibody concentrations and acute Pneumocystis infection was investigated by testing sequential samples of serum from HIV antibody-positive patients with respiratory symptoms and HIV-negative immunocompromised patients by means of an indirect immunofluorescence assay for specific IgG antibodies to P. carinii. Loss of circulating antibody at the time of active Pneumocystis infection was observed in five patients with proven infection. Three others showed recovery of antibody coinciding with treatment and clinical recovery from infection. Concentrations of specific IgG antibody against P. carinii were measured in 40 blood donors and in six different batches of an intravenous immunoglobulin (IV Ig) preparation. Titres greater than 128 were found in the IV Ig batches examined. The use of IV Ig, either alone or in conjunction with other therapeutic agents, should therefore be considered in patients suffering from acute infection with P. carinii.

Antibodies, Fungal↗
PubMed1989

Reliability of fetal buttock blood sampling in assessing the acid-base balance of the breech fetus.

This prospective investigation was undertaken to compare fetal buttock capillary blood pH and umbilical artery and vein pH in fetuses presenting by the breech. The study group comprised ten term patients with singleton fetuses in the frank breech presentation who met established criteria for vaginal breech delivery. All patients had a normal labor pattern. Eight fetuses had a normal fetal heart rate tracing and two had severe variable decelerations during the second stage of labor. We obtained capillary blood for pH measurement from the fetal buttock within 15 minutes of delivery. Immediately after delivery, we collected arterial and venous blood samples from the umbilical cord for measurement of pH. In all fetuses, there was a highly significant correlation between fetal buttock capillary blood pH and umbilical artery pH (r = 0.96; P less than .001) and umbilical vein pH (r = 0.88; P less than .001). We conclude that measurement of pH in capillary blood obtained from the fetal buttock provides accurate assessment of the acid-base status of the breech fetus.

Blood Specimen Collection↗
PubMed1989

Randomized comparison of oral terbutaline and ritodrine for preventing recurrent preterm labor.

We compared oral ritodrine and terbutaline for the prevention of recurrent preterm labor. Women between 20 and 35 weeks' gestation who successfully completed a course of intravenous tocolysis were eligible for inclusion. One hundred two patients were randomized to oral ritodrine (20 mg every four hours) or oral terbutaline (5 mg every four hours). The groups showed no significant differences with respect to recognized risk factors for preterm labor or prognostic factors for the failure of tocolysis. Initial treatment failures occurred more frequently in the ritodrine group (nine vs. two, P = .0527). There were no statistically significant differences in the treatment results or frequency of side effects. We conclude that ritodrine appears to be less effective than terbutaline upon the initiation of oral therapy and that oral ritodrine and terbutaline are equivalent in safety and efficacy when used on a long-term basis for preventing recurrent preterm labor.

Administration, Oral↗
PubMed1988

Outcome of trial of labor in patients with a single previous low transverse cesarean section for dystocia.

The purpose of this prospective investigation was to evaluate the outcome of trial of labor in women with a history of a single low transverse cesarean section for dystocia in comparison with the outcome in women with a history of cesarean delivery for a reason other than dystocia. During the study period, 89 of 131 patients (68%) with a history of dystocia had a successful trial of labor, compared with 78 of 96 women (81%) who had cesarean delivery for a reason other than dystocia (P less than .025). Within the former group, 79% of women who originally had surgery while still in the latent phase of labor had a successful trial of labor, compared with 61% (.05 less than P less than .10) of patients who had an arrest of dilation in the active phase of labor and 65% (not significant) of those who had an arrest of descent. The only serious complication among study patients was a single instance of uterine scar dehiscence (0.5%). We conclude that approximately two-thirds of patients with a previous cesarean delivery for dystocia will have a successful trial of labor. Of these women, those individuals whose initial operation was performed in the latent phase of labor appear to have the best prognosis for subsequent vaginal delivery.

Abdomen↗