Maternal and neonatal outcomes of pregnancies complicated by asthma in an Australian population.

Objective: To determine if there are sex differences in risk and incidence of stillbirth, preterm delivery and small-for-gestational age (SGA) in pregnancies complicated by maternal asthma relative to a non-asthmatic population.

Study Design: Univariant and multiple regression analysis of the incidence of preterm delivery, SGA and stillbirth in singleton pregnancies complicated by asthma in Newcastle, NSW, Australia, from 1995 to 1999.

Results: Asthma complicated 12% of all singleton pregnancies.

Male sex and pre-existing diabetes are independent risk factors for stillbirth.

Aim: To determine whether the risk of stillbirth is associated with male fetal sex, fetal growth and maternal factors in an Australian population.

Methods: A retrospective secondary data analysis of 16 445 singleton births was performed using a tertiary referral centre obstetric database (1995-1999). Univariate and multiple logistic regression analyses were performed.

Process measures in an antenatal smoking cessation trial: another part of the picture.

Data on provider and patient compliance can be crucial in understanding the degree of a health education program's effectiveness, as well as in identifying areas where the program requires modification. However, such data are rarely systematically reported in randomized trials. This report assesses the degree to which doctors and midwives complied with intervention protocols in a hospital antenatal smoking cessation trial, and also examines the program's acceptability to patients.

A smoking cessation program at a public antenatal clinic.

Objectives: A randomized trial evaluated the impact of smoking cessation interventions on point prevalence and consecutive quit rates at an Australian public prenatal clinic.

Methods: Self-reports and urine cotinine tests confirmed patients' smoking status at the midpoint and end of pregnancy and 6 weeks postpartum.

Results: At all points, validated abstinence rates were significantly higher in the experimental group than in the control group.

Predictors of smoking in pregnancy and attitudes and knowledge of risks of pregnant smokers.

This study examined the prevalence and predictors of smoking by pregnant women attending a public antenatal clinic. The prevalence of smoking in this population (n = 2577) was found to be 38.0% (95% CI 36.

Continuity of care by a midwife team versus routine care during pregnancy and birth: a randomised trial.

Objective: To compare continuity of care from a midwife team with routine care from a variety of doctors and midwives.

Design: A stratified, randomised controlled trial.

Participants And Setting: 814 women attending the antenatal clinic of a tertiary referral, university hospital.

Smoking cessation in pregnancy: a survey of the medical and nursing directors of public antenatal clinics in Australia.

Smoking is a major cause of adverse pregnancy outcomes. However limited data are available documenting the perceptions of care providers in this area. This mail survey undertaken in 1992-1993 aimed to assess the smoking cessation practices of Australian public antenatal clinics.

Corticotrophin-releasing hormone and beta-endorphin in labour.

The objectives of this study were to determine whether the maternal plasma corticotrophin-releasing hormone (CRH) concentration influences the amount of uterine contractility induced by infused oxytocin during induction of labour, and secondly to assess changes in CRH and beta-endorphin in response to stress during labour. Serial plasma CRH and beta-endorphin measurements were made in 40 women undergoing induction of labour and correlated with uterine contractility, cervical dilatation, length of labour, analgesic usage and fetal distress. The plasma CRH concentration did not change throughout labour.

Plasma corticotropin-releasing hormone, beta-endorphin and cortisol inter-relationships during human pregnancy.

To investigate the dynamic relationships among corticotropin-releasing hormone (CRH), beta-endorphin (beta EP), cortisol and obstetric events during pregnancy, blood samples were collected from 193 women at 28 weeks, 38 weeks, during labour and on the second postnatal day. Cord blood at delivery was also obtained. We found that: (1) Maternal plasma CRH, beta EP and cortisol rose from 28 to 38 weeks.

Prolonged follicle stimulation decreases pregnancy rates after in vitro fertilization.

Ovarian stimulation with a GnRH-a and hMG for IVF treatment offers the potential to extend the period of follicle recruitment and growth free of the restriction imposed by a spontaneous midcycle LH surge. A randomized trial investigating the impact of extending follicle growth by 1 day resulted in a significantly reduced PR, despite an increase in the number of larger follicles (greater than or equal to 17 mm) at the time of hCG. The reason for a reduced PR was not related to the number of ova recovered or embryo quality.

Urinary corticotropin-releasing hormone immunoreactivity is elevated during human pregnancy.

Plasma corticotropin-releasing hormone immunoreactivity (CRH IR) rises with gestational age in women. In order to investigate the physiological changes of the hormone in pregnant women's urine, CRH IR was measured by radioimmunoassay in urine collected over a 24-hour period, a blood sample and a subsequent single collection of urine after the 24-hour collection (spot urine). Plasma CRH IR in pregnant subjects, 8682.

Mood changes, obstetric experience and alterations in plasma cortisol, beta-endorphin and corticotrophin releasing hormone during pregnancy and the puerperium.

The relationships between mood change, obstetric experience and alterations in plasma cortisol, beta-endorphin (beta-EP) and corticotrophin-releasing hormone (CRH) were examined in a prospective study of 97 primiparous Australian women. Psychological measures were administered between the 28th week of pregnancy and the 3rd postnatal month, including the Profile of Mood States (POMS) and the Montgomery Asberg Depressive Rating Scale (MADRS). Blood samples were collected for cortisol, beta-EP and CRH assay on most of these occasions and during labour.

A randomized trial of laparoscopy and transvaginal ultrasound-directed oocyte pickup for in vitro fertilization.

Ninety-four (94) couples undergoing IVF for the usual spectrum of clinical reasons and who were suitable for either laparoscopic or vaginal ovum pickup (OPU) were randomly assigned at the commencement of 166 treatment cycles to one of two OPU procedures. Both patient and clinician were informed of the allocation. If either wished to change this, then that cycle was eliminated from the trial.

Postnatal disappearance of the pregnancy-associated reduced sensitivity of plasma cortisol to feedback inhibition.

We recently observed that the characteristic insensitivity of the pituitary-adrenal system in women to feedback inhibition during pregnancy persists for at least four days postnatally. We therefore examined women during the first five weeks after delivery to assess when the sensitivity of plasma cortisol to glucocorticoid inhibition returns to normal. Dexamethasone (DEXA, 1 mg) was ingested at 11 pm by normal healthy women, once between the 3rd and 27th postnatal days, and again on day 35.

The nonsuppressibility of plasma cortisol persists after pregnancy.

To determine if normal balance is restored to the hypothalamic-pituitary-adrenal axis after pregnancy, we compared the dexamethasone suppressibility of plasma cortisol in women four days after delivery of their infant, with that of nonpregnant women. Plasma concentrations of cortisol before dexamethasone administration were similar in the post-partum women and in women taking oestrogen contraceptives, but both were higher than in normally cycling women. After dexamethasone, plasma cortisol in the post-partum women was significantly higher than in both oestrogen-taking and normally cycling nonpregnant women.

Demographic and personality characteristics of couples undergoing in vitro fertilisation.

Two hundred and fifty-eight (258) couples requesting in vitro fertilisation (IVF) were interviewed by a social worker prior to commencing treatment. At the time of admission to hospital 147 women and 134 men completed a questionnaire which incorporated the Eysenck Personality Inventory and the Spielberger State-Trait Anxiety Inventory. Forty-three women conceived and 26 couples (14.

Post-partum psychoses and the dexamethasone suppression test.

The hypothesis that post-partum psychoses are predominantly mixed affective disorders was tested by administering the dexamethasone suppression test (DST) to seven puerperal psychotics, six puerperal depressives and comparison groups of non-puerperal psychotic and depressed women. The hypothesis received support from the finding that two-third of the puerperal patients had positive DSTs versus one-third of similar non-puerperal patients. An 80% rate of positive DSTs in 19 normal women 5 days post-partum, however, suggested this was an invalid interpretation of this finding, particularly as the majority of these tests returned to normal when repeated several weeks later.

An examination of the proposed roles of placental lactogen in the ewe by means of antibody neutralization.

The physiological role of placental lactogen (PL; chorionic somatomammotrophin) in the ewe has been investigated by infusion of ewes (n = 3) on day 131 of pregnancy with sufficient ovine PL (oPL) antibody to neutralize circulating oPL for at least 12 h. Effectiveness of the antibody neutralization was defined both in vitro and in vivo according to rigorous criteria. Control ewes (n = 3) were infused simultaneously with an equivalent amount of pooled goat gamma globulin.

Insulin-like growth factor receptor in fetal lamb liver: characterization and developmental changes.

Multiplication-stimulating activity (MSA), an insulin-like growth factor (IGF) (rat IGF II), binds to extracts of many tissues from fetal lambs. We now report the presence of high concentrations of a glycoprotein receptor with a high affinity for MSA-II in microsomes prepared from fetal lamb liver. The binding of radiolabeled MSA-II is inhibited by IGF but not by insulin, human, and ovine GH, ovine PRL, ovine placental lactogen, and mouse epidermal growth factor.

Peripartum concentrations of beta endorphin and cortisol and maternal mood states.

Nineteen women were studied before, during and after labour by assessment of their mood using a variety of psychological tests and by measurement of their plasma concentrations of beta-endorphin and cortisol. Beta-endorphin and cortisol concentrations rose markedly during labour and were influenced by the type of analgesia used. A deterioration in cognitive performance between days 2 and 4 postpartum correlated positively with the fall in beta-endorphin concentrations from those in labour to those on the fourth day postpartum.