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Biomedical subjects

M L Hediger

Publications and source records attributed to M L Hediger.

At least 19 recordsLinked to original sources
PubMed1995

Gestational weight gain, pregnancy outcome, and postpartum weight retention.

OBJECTIVE: To determine whether the risk of maternal overweight associated with an excessive rate of gestational gain needs to be balanced against the risks of impaired fetal growth associated with a low rate of gain. METHODS: Rate of gestational weight gain was measured prospectively in a sample of 274 young, low-income, and primarily minority women (12-29 years old) with pregravid body mass indices (BMI) in the normal range (19.8-26.0). We defined an excessive rate of gain between 20-36 weeks' gestation as one greater than 0.68 kg/week, and a low rate of gain as one less than 0.34 kg/week. Women were followed-up at 4-6 weeks and 6 months postpartum. RESULTS: Rate of measured gestational gain between 20-36 weeks' gestation was associated with total weight gain based on pregravid weight, with infant birth weight and gestation duration, and with maternal overweight (BMI greater than 26) and weight retention postpartum. Infant birth weight and gestation duration were significantly reduced for women with low rates of gain, and there was no significant difference between women with excessive and moderate gains. Despite little difference in pregravid BMI, women with excessive rates of gain retained more weight overall, attained a greater postpartum BMI, and had higher levels of subcutaneous fat and overweight. Maternal anthropometric status showed little change between 4-6 weeks and 6 months postpartum. CONCLUSION: Weight gained at an excessive rate by women with a pregravid BMI in the normal range does not greatly enhance fetal growth and gestation duration, contributing instead to postpartum maternal overweight.

Adolescent↗
PubMed1995

One-year changes in weight and fatness in girls during late adolescence.

OBJECTIVE: To document postmenarcheal growth and changes in weight and fatness in girls. DESIGN: Mixed longitudinal study to determine yearly growth increments. PARTICIPANTS: Six hundred sixty-eight postmenarcheal girls, initially ages 13 to 17 years, from two Philadelphia high schools. Overall, 61.4% of the girls were white, 15.7% black, 16.8% Puerto Rican Hispanic, and 6.1% of other ethnicities (non-Puerto Rican Hispanic or Asian). OUTCOME MEASURES: Height (in centimeters), weight (in kilograms), and triceps and subscapular skinfold thicknesses (in millimeters) were measured initially and after 1 year. The anthropometric measures were analyzed both cross-sectionally by age cohort and longitudinally. RESULTS: Viewed cross-sectionally by chronologic age groups and adjusted for ethnicity, gynecologic age, cigarette smoking, and late maturation (menarche > or = 14 years), there were no statistically significant trends with age in height, weight, body mass index (kilograms per m2), triceps, or subscapular skinfold thicknesses. Nevertheless, there were significant trends in velocity with increasing chronologic age. On the average, postmenarcheal girls gained about 6.5 kg (14.3 lb) during late adolescence from about 1.5 years after menarche to age 18 years. Height and triceps skinfolds showed significantly decreasing velocities, whereas there was a significant monotonic increase in velocity with age for skinfolds at the subscapular site. CONCLUSIONS: Even with normal weight gain during late adolescence in girls, there seems to be greater potential for fat deposition centrally. Thus, excessive weight gain during late adolescence may exacerbate the normal processes of fat deposition, leading to large gains in central fat, and thereby increasing the long-term risk for metabolic and cardiovascular diseases later in life.

Adipose Tissue↗
PubMed1992

Self-reported depression and negative pregnancy outcomes.

Studies addressing the association of depressive symptoms late in pregnancy with pregnancy outcome are lacking. We administered the revised Beck Depression Inventory (BDI) in the third trimester to 323 inner-city adolescents and 389 adults, who were mostly from U.S. minority groups (28.7% Puerto Rican, 61.8% black, 9.6% white). The BDI total score was regressed (as a continuous variable) on indicators of poor pregnancy outcome. There was no relationship of BDI scores with pregnancy outcome in the adolescents. However, among the adult gravidas the risk of a poor outcome rose 5-7% (p < 0.05) for each point the BDI total score increased. For the adults, at a cut-off score of 21 for the BDI, suggestive of clinical depression, the risk of delivering a low birth weight infant of < 2500 g was 3.97 (95% confidence interval [CI] 3.80-4.15); the risk for having a preterm delivery at < 37 completed weeks' gestation was 3.39 (95% CI 3.24-3.56); and their risk of having a small-for-gestational-age infant at < 10th percentile for standards was 3.02 (95% CI 2.88-3.17). Future research should address the physiological mechanisms associated with symptoms of depression that might contribute to an increased risk of poor outcomes and extend the findings to gravidas from different socioeconomic strata.

Adolescent↗
PubMed1992

Young maternal age and parity. Influences on pregnancy outcome.

The influence of very young maternal age and parity on pregnancy outcome was examined in a cohort of nearly 900 adolescents and mature women from Camden, New Jersey. Young primigravid primiparas (aged 12 to 15 years) were compared with mature primigravid primiparas (18 to 29 years). Young multiparas (19 years or younger, with a first pregnancy at the age of 12 to 15 years) were compared with mature, multiparas (19 to 29 years old, with a first pregnancy at 18 years or older). After controlling for confounding factors, young primiparas were found to have a modest increase in preterm delivery, which was not statistically significant. However, low gynecologic age contributed disproportionately to the risk of preterm delivery in this group, with risk decreasing with each year from menarche (Cox's proportional hazard, 0.80; 95% confidence interval [CI], 0.68 to 0.94). Among multiparas, there were several statistical interactions associated with increased risk of small-for-gestational-age infants, including interactions between young age and low pre-pregnancy body mass (adjusted odds ratio [AOR], 5.74; 95% CI, 2.18 to 15.08), young age and a prior low-birth-weight infant (AOR, 10.58; 95% CI, 3.89 to 28.77), and young age and a prior preterm delivery (AOR, 5.52; 95% CI, 2.04 to 14.98). Thus, while chronologic age per se may not be a good predictor of pregnancy outcome, adolescents remain a high-risk group because of factors that are more common among them (e.g., biologic immaturity, inadequate prenatal care, poverty, minority status, low prepregnancy weight) and because factors associated with an early adolescent pregnancy, such as low gynecologic age, may continue to influence the outcome of subsequent pregnancies.

Adolescent↗
PubMed1992

Anemia vs iron deficiency: increased risk of preterm delivery in a prospective study.

Using criteria from the Centers for Disease Control, anemia and iron-deficiency anemia (anemia with serum ferritin concentrations less than 12 micrograms/L) were assessed in greater than 800 inner-city gravidas at entry to prenatal care. Iron-deficiency anemia was associated with significantly lower energy and iron intakes early in pregnancy and a lower mean corpuscular volume. The odds of low birth weight were tripled and of preterm delivery more than doubled with iron deficiency, but were not increased with anemia from other causes. When vaginal bleeding at or before entry to care accompanied anemia, the odds of a preterm delivery were increased fivefold for iron-deficiency anemia and doubled for other anemias. Inadequate pregnancy weight gain was more prevalent among those with iron-deficiency anemia and in those with anemias of other etiologies. The prevalence of iron-deficiency anemia (3.5%), however, was lower than anticipated for an inner-city, minority population in whom most anemias had been attributed clinically to iron deficiency.

Adolescent↗
PubMed1991

Maternal weight gain, diet and infant birth weight: correlations during adolescent pregnancy.

Inadequate weight gain during pregnancy is an important risk factor for low birth weight (LBW), but the contribution of diet to weight gain is uncertain. Pregnancy weight gains were examined at 4-week intervals from 12 to 36 weeks' gestation, as well as total gain for gestation, in a cohort of over 2000 young pregnant women, aged less than or equal to 18 at entry to prenatal care. The effect of diet was studied in a 15% random sample of the cohort, using a 24-hour dietary recall obtained at entry to prenatal care (averaging 17 weeks' gestation). As early as 16 weeks' gestation, gains below the lower limit of a clinical standard were associated with a decrement in birth weight at delivery of more than -85 g (p less than 0.01), and after 24 weeks of approximately -180 g (p less than 0.001). After adjusting for potential confounding variables, teenagers who went on to develop inadequate total weight gain for gestation had consumed 1878 kcal vs 2232 for teenagers with adequate total gain (p less than 0.05). There were significant deficits in protein (p less than 0.05) and carbohydrate intake (p less than 0.05) associated with inadequate gain. However, there was no direct effect of nutrient intake on birth weight, LBW, or preterm delivery. This suggests that the relationship between nutrient intake during pregnancy and birth weight may be indirect and moderated by weight gain during pregnancy.

Adolescent↗
PubMed1990

Nausea and vomiting during teenage pregnancy: effects on birth weight.

Early pregnancy nausea and vomiting (NVP) has been reported to be a favorable risk factor for pregnancy outcome. We studied nausea and vomiting in 239 randomly selected teens from a geographic-based cohort of nearly 2800 pregnant adolescents from Camden County, New Jersey. Early (first trimester) NVP was reported by 20.9%, and an additional 17.6% reported that their NVP persisted into the second or third trimester (late NVP). After adjusting for confounding factors (length of gestation, maternal age, ethnicity, prepregnant body mass index, weight gain, and smoking), we found that early NVP alone did not significantly affect birth weight. Late NVP, however, was associated with a significant decrement in birth weight (-256.5 +/- 108.0 g, p less than 0.05). Further, the effect of late NVP was greater when maternal weight gain was inadequate. Teenagers with continued NVP are more likely to be nutritionally stressed during the course of their pregnancy.

Adolescent↗
PubMed1990

Maternal growth during pregnancy and decreased infant birth weight.

We used stature and measurement of knee height to measure continued maternal growth during adolescent pregnancy in a sample of young gravidas (primigravidas and multiparas) and mature pregnant control subjects. Growth during pregnancy has been masked by a tendency of all gravidas to shrink while pregnant (approximately 0.5 cm over 6 mo of observation). Consequently, growth of many adolescent gravidas has not been clinically apparent. There was no effect on maternal growth during a first pregnancy in adolescence but this may be a result of the relatively good prepregnant nutrition status of the young gravidas in developed countries. Maternal growth during pregnancy, however, is associated with significantly decreased (-282 g, p less than 0.05) birth weight for infants when maternal growth continues during a subsequent adolescent pregnancy. This observation is consistent with the hypothesized competition between the metabolic demands of the growing adolescent mother and the nutrient needs of her developing fetus.

Adolescent↗
PubMed1990

Rate and amount of weight gain during adolescent pregnancy: associations with maternal weight-for-height and birth weight.

This study presents information on the course and rates of weight gain and the associations among weight gain, prepregnancy weight-for-height, and infant birth weight, based on a total sample of 1419 uncomplicated term deliveries to adolescents. The distribution of cumulative weight gain indicates that for adolescents not only is the median gain at term (14.2-15.5 kg) significantly in excess of that reported for adults, but also weight-gain velocity is greater from the beginning of pregnancy. Although the contributions of prepregnancy weight-for-height and weight gain to birth weight may be independent, they are not necessarily additive. Birth weight does not appear improved for the infants of overweight adolescents except when weight gain is low (less than 11.1-12.3 kg at term), and, for Puerto Rican and black adolescents, birth weight is not further improved at any maternal prepregnancy body mass index (weight-for-height) with excessive weight gains (greater than 17.9-19.3 kg at term).

Adolescent↗
PubMed1990

Weight gain during pregnancy in adolescence: predictive ability of early weight gain.

Pregnancy weight gains were examined at 4-week intervals from 12-36 weeks' gestation and total gain assessed at delivery in a cohort of 2008 pregnant women aged 18 or less at entry to prenatal care. As early as 12 weeks' gestation, there was a significant association between the amount of weight gained and infant birth weight measured at the time of delivery. At 16 weeks' gestation, gains below the 25th percentile were associated with an increased risk of low birth weight (LBW) (adjusted odds ratio 1.56; 95% confidence interval 1.01-2.43), and by 20 weeks' gestation, the risk of LBW was doubled (adjusted odds ratio 2.00; 95% confidence interval 1.34-2.99). Also at 16 weeks, there was a doubling in the risk of excessive fetal size or macrosomia (adjusted odds ratio 2.31; 95% confidence interval 1.31-4.10) associated with maternal weight gain above the 75th percentile. These results suggest that an increased risk of certain poor pregnancy outcomes is detectable late in the first or early in the second trimester. Consequently, weight gain monitoring may be important early in pregnancy.

Adolescent↗
PubMed1989

Association between low gynaecological age and preterm birth.

Low gynaecological age, defined as conception within 2 completed years of menarche, was examined for its association with preterm birth, using data from a geographically based cohort of over 1700 young primigravidae aged 18 or younger at start of prenatal care. After stratifying by chronological age and controlling for confounding variables, low gynaecological age was associated with almost double the risk of preterm delivery whether estimated from the mother's last menstrual period (adjusted odds ratio (AOR) = 1.77, 95% CI 1.19-2.64) or using the obstetric estimate of gestation (AOR = 2.10, 95% CI 1.36-3.25). Low gynaecological age was also associated with an increase in risk of low birthweight (LBW) (AOR = 1.70, 95% CI 1.01-2.88), but not of small-for-gestational-age babies (AOR = 0.94, 95% CI 0.49-1.81). Thus low gynaecological age may be an important addition to assessment systems to detect women at risk of preterm labour and delivery.

Adolescent↗
PubMed1989

Patterns of weight gain in adolescent pregnancy: effects on birth weight and preterm delivery.

Early weight gain adequacy may be a particular problem among adolescent gravidas because of their tendency to poor prepregnant nutritional status, nutritionally poor diets during pregnancy, and body image concerns, but it is not known whether irregular patterns of weight gain during adolescent pregnancy are associated with birth weight and length of gestation. We studied weight gain during pregnancy and pregnancy outcome in a cohort of 1790 teenage gravidas from Camden, New Jersey. We found that early inadequate weight gain (less than 4.3 kg by 24 weeks' gestation) was associated with a significantly increased risk of having a small for gestational age infant (adjusted odds ratio 1.88; 95% confidence interval 1.08-3.27), even when later gains brought the cumulative total weight gain to within adult standards. Late inadequate gains (less than 400 g/week) were associated significantly with preterm delivery (before 37 completed weeks' gestation), whether or not the total gain was adequate for gestation (adjusted odds ratio 1.69; 95% confidence interval 1.12-2.55). These results suggest that supplementation, intervention, or prenatal care protocols for adolescents that do not focus on balanced weight gain during adolescent pregnancy may reduce preterm delivery but may not significantly affect the incidence of intrauterine growth retardation.

Adolescent↗
PubMed1986

Blood pressure, body fat, and dehydroepiandrosterone sulfate variation in adolescence.

Several significant interrelations among variation in blood pressure, body fat, and adrenal androgen levels, as assessed by serum dehydroepiandrosterone sulfate concentrations, were found in black male and female adolescents, aged 12 to 16 years. In girls, high levels of dehydroepiandrosterone sulfate were associated with significantly higher levels of blood pressure (alpha = 0.05), even after adjusting for the significant association between increased levels of dehydroepiandrosterone sulfate and body fat. The increased body fat (i.e., body mass index) found with higher levels of dehydroepiandrosterone sulfate in girls was related to significantly greater (alpha = 0.05) accumulations of fat in the upper trunk, as opposed to the limb. In boys, high levels of serum dehydroepiandrosterone sulfate, low body mass index, and significantly higher blood pressure were interrelated (alpha = 0.05). In addition to the interaction of increased body mass index or body fat and increased levels of dehydroepiandrosterone sulfate in association with higher blood pressure, high levels of the adrenal androgen, even in boys with low body mass index, were associated independently with relatively higher blood pressure. Body proportion analyses for these boys indicated that they were tall and thin, in contrast to the other boys with low body mass index, who were generally short and thin.

Adipose Tissue↗
PubMed1985

Pulse rate, blood pressure and body composition in black adolescents: the Philadelphia Blood Pressure Project.

Patterns of pulse rate, blood pressure (BP), and body size and composition are investigated in a black urban sample of over 600 adolescents (aged 12-17) in Philadelphia as part of the Philadelphia Blood Pressure Project. Supine and seated pulse rates decline after the age of 13 in both males and females, and females have significantly higher pulse rates than males, ranging from 1.6 to 4.7 beats/30 sec higher depending upon chronological age and position. Seated pulse rates are consistently higher than supine in both sexes ranging from 1.3 to 2.9 beats/30 sec depending upon chronological age. Pulse rate and both systolic blood pressure (SBP) and diastolic phase IV blood pressure (DBP) show a positive association throughout adolescence for females (r = 0.16 SBP, r = 0.24 DBP) but not for males (r = -0.06 SBP, r = 0.06 DBP). Females in the highest diastolic IV blood pressure stratum (greater than 85%) maintain higher pulse rates throughout adolescence, while males with the highest DBP have higher pulse rates in early adolescence (ages 12-14) but lower pulse rates in later adolescence (ages 16 and 17). Females with the highest DBP also show consistently higher measures of relative fatness (triceps skinfolds) throughout adolescence. Males with the highest DBP have greater triceps skinfolds in early adolescence and lower triceps in later adolescence, a pattern similar to that shown for pulse rate. For DBP, triceps is significantly and positively associated with pulse rate in the upper DBP percentile group (p less than 0.05). Thus, females with the highest blood pressure during adolescence are characterized by higher pulse rate and greater fatness. Males show this same pattern in early adolescence; whereas, in contrast, the older adolescent males in our sample with the highest DBP are characterized by lower pulse rates, relatively decreased fatness, and increased muscularity. Our findings suggest that, at least in some older black male adolescents, a higher DBP may reflect a decrease in cardiac output as indicated by a lower pulse rate, or an increase in peripheral vascular resistance, possibly associated with relatively decreased fatness and increased muscle mass for size.

Adolescent↗