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The predictors of birthweight (scBWT) in normal pregnancy are well established. The objectives of this study were to characterize and determine predictors of scBWT among women diagnosed with scGDM. A cohort of 436 scGDM full-term pregnancies (followed 1978-1989) were examined using data abstracted from the Royal Victoria Hospital Antenatal Diabetic Clinic charts and McGill Obstetric and Neonatal Database. Women were treated with insulin and/or diet. Dietary treatment (mean 2047 kcal/d) significantly decreased the rate of weight gain and mean fasting plasma glucose (scFPG). Regression analysis identified several predictors of scBWT (mean 3520 g): prepregnancy body mass, height, smoking, pre-diagnostic rate of weight gain, scFPG, gestational age, infant gender, and length of treatment. Stratification by body mass indicated that among non-obese women with scGDM, scFPG and length of treatment were not significant predictors of scBWT. In conclusion, since women with normal pregravid mass and prediagnostic weight gain are at lower risk of high scBWT, these require consideration, in addition to plasma glucose criteria, when treating scGDM.

Background: Preliminary observations suggest that aberrations in maternal central hemodynamics and uterine artery Doppler velocimetry reflect the severity of hypertensive disorders of pregnancy. In addition, the precise changes of cardiac output in normal pregnancy, particularly in the third trimester, have remained controversial. Aims and Objective: To measure concomitantly Doppler echocardiographic maternal central hemodynamics and uterine artery Doppler velocimetry and evaluate their association with adverse feto-neonatal outcome in hypertensive pregnant women. To evaluate cardiac output longitudinally in the latter half of pregnancy in normal healthy women. Design and Setting: Prospective study conducted at the Obstetric Unit, King Edward VIII Hospital, Durban, South Africa. Study sample: forty (40) pregnant hypertensives without any prior therapy and a further group of pre-eclamptic women (n=22) treated with stat dose sodium gardinal and alpha-methyldopa were studied. Results: i) A trend to a higher cardiac output was seen in the hypertensives compared to the normotensives. Hypertensive women were of larger stature; there was no difference in cardiac index. Fetal birthweight correlated poorly with cardiac index in pre-eclamptic women (r =0.21). A better correlation was seen with uterine artery resistance index (r = - 0.65) and systemic vascular resistance index (r = -0.49). Critical values for cardiac index and systemic vascular resistance index to predict poor adverse feto-neonatal outcome with good predictive values were not identified. ii) Pre-eclamptics treated with stat dose of sodium gardinal and/or methyldopa prior to echocardiography had a significantly lower systemic vascular resistance index and uterine artery resistance index compared to the untreated group. The lower systemic vascular resistance index in this treated cohort occurred from a combination of non-significant lower blood pressure and higher cardiac index. iii) Compared to normotensive women, untreated pre-eclamptics had a significantly lower heart rate (p< 0.001), a higher stroke index (p=0.018) and no difference in resultant cardiac index (p=0.452). iv) In gestational apoteinuric hypertensives presenting after 34 weeks gestation, maternal hemodynamics and uterine artery resistance index did not help define a higher risk group. v) In chronic hypertensives pregnancies, left ventricular hypertrophy correlated with severity of blood pressure. Higher risk chronic hypertensives were better selected by proteinuria than maternal central hemodynamics or uterine artery resistance index. vi) In normal pregnancy, maternal cardiac output peaked in early to mid third trimester and was maintained till term. Significant correlations were observed among maternal cardiac output, maternal body surface area and fetal birth weight. Discussion: i) This study shows that cardiac index and systemic vascular resistance index measured in the latter part of the second and third trimesters in hypertensive pregnant women were not associated with adverse fetal outcome. Large variations in cardiac index values were observed that restricted detection of satisfactory critical values for cardiac index and systemic vascular resistance index to predict adverse outcome. ii) An improved correlation of uterine artery resistance index with maternal hemodynamics and fetal birthweight in pre-eclampsia supports the hypothesis that poor placentation does not allow for a normal increase in uterine blood flow. iii) The poor correlation between uterine artery resistance index and maternal central hemodynamics, does not support the hypothesis that elevated cardiac output in hypertensive pregnancies (hyperdynamic disease model) occurs as a compensatory response to maintain adequate perfusion in a utero-placental bed with high resistance that did not decrease. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2004.

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Using information available in the medical and sports medicine literature, a pilot program of exercise for pregnant women was designed for implementation at the local YMCA. The exercises consisted of 1) calisthenics and stretching exercises performed for 20 to 30 minutes and 2) a similar time period of aerobic exercise at no more than 70 percent predicted maximum pulse. Each of these was conducted formally three times weekly with participants urged to perform the exercises on their own at additional times. A group of nine women was followed from 14-16 weeks gestation through delivery and for 6 weeks postpartum and was matched with a group of four nonexercising controls. Both groups were tested by predicted maximum oxygen uptake during bicycle ergometer testing. To date, 37 women have participated and delivered with no untoward side effects in either mothers or offspring. In addition, considerable subjective benefits were stated by participants. Objective quantification of these benefits requires greater numbers of participants and controls, a longer period of time (estimate 3 years) to complete data collection, and more vigorous data collection in terms of reproducibility and meeting the schedule desired.

This study investigated the impact of perinatal complications on the developing child and the relationship of those complications to the development of autism in an individual. The biological mothers of autistic children (N = 183) completed the Maternal Perinatal Scale, a maternal selfreport which surveys complications of pregnancy and medical conditions of the mother. Archival data on normals (N = 209), obtained during previous perinatal investigations, was utilized as a control group.Previous research in this area has been limited, with no definitive conclusions. All previous investigators have declined to state that events identified in previous research were definitely related to the development of autism.An overall multivariate test was performed to determine if significant differences existed between the autistic and normal subjects. Following this exploration of the data, previously identified complications were entered into a stepwise discriminant analysis in the order of theirtheoretical importance to determine the extent of their contribution to autism. Following this analysis, medical conditions of the mothers (items 27-47 as included on the MPS) were entered into the stepwise analysis to determine their contribution, if any, to autism in the sample.The results of this analysis revealed that the two groups differed significantly on three of the ten factors of the MPS. The overall multivariate test was highly significant and revealed that the groups differed on Factor 2 (Gestational Age), Factor 4 (Maternal Morphology), and Factor 8 (Intrauterine Stress). Moreover, five of the six previously identified items were found to be significant. These were: prescriptions raken during pregnancy, length of labor, viral infection,, abnormal presentation at delivery, and low birthweight. Three of the maternal medical conditions examined were also highly significant and contributed to separation between groups. These were: urinary infection, high temperatures, and depression. These were items which have not been identified in previous investigations.Based on discriminant analysis of the 10 factors of the MPS, 65% of the cases were correctly grouped. The MPS would be a useful clinical tool in identification of those children who are at risk for development of autism. / Department of Educational Psychology

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The relationship between the preauricular sulcus and pitting on the dorsal aspect of the pubic corpus in association with pregnancy and parturition has aroused considerable interest since the early 1970's. The major limitation of much of the discussion is that it has been based on data derived from skeletal samples with either unknown or uncertain obstetric histories. The excavation of the crypts beneath Christ Church, Spitalfields between 1984 and 1986 produced 968 skeletons, 387 of which were recovered in association with securely associated, legible coffin plates. Of the 138 adult females in this sample the parity status of 94 has been reconstructed from historical documentation. Such obstetric factors as parity status, number of births, age at first and last births and birth spacing have been examined in relation to the presence or absence of the preauricular sulcus, its type and size, pubic pitting, sacral scarring and the extension of the pubic tubercle. The results suggest that the preauricular sulcus and sacral scarring are independent of obstetric events and that although the small numbers of females with more than one pubic pit or an extended pubic tubercle had born children, the absence of these features is associated with both parous and nulliparous females. Unlike previous studies, both localised cortical resorption and tubercle extension were evaluated as a component part of the obstetric pelvis. The more capacious pelvis proved to be associated with wider and longer preauricular sulci and with the presence of pubic pitting. In order to facilitate comparative studies the Christ Church females are described as part of the sample from which they are derived. Their environmental and cultural backgrounds are discussed.

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