A randomised trial of low dose aspirin for primiparae in pregnancy. The Jamaica Low Dose Aspirin Study Group

OBJECTIVE: To investigate whether low dose aspirin medication given to primiparous women provides benefit in preventing pre-eclampsia or intrauterine growth retardation. DESIGN: Randomised double-blind controlled trial of low dose aspirin and placebo in pregnancy. POPULATION: Residents of the parishes of Kingston and St. Andrew, Jamaica; 6275 primiparae enrolled between 12 and 32 weeks of gestation. MAIN OUTCOME MEASURES: Hypertensive disorders of pregnancy (including pre-eclampsia and eclampsia), preterm delivery, and low birthweight. In addition, to assess whether enrollment early, rather than late had more beneficial effect. Possible adverse effects on the woman and her infant were monitored. RESULTS: Of enrolled primiparae, 97 percent were followed throughout pregnancy. There were no differences between those on aspirin and those on placebo in the development of hypertensive disorders (e.g. for a rise in diastolic pressure of 25 mmHg the odds ratio [OR] was 1.02 [95 percent CI 0.86-1.21]; for proteinuric pre-eclampsia OR 1.15 [95 percent CI 0.92-1.44]; eclampsia OR 0.82 [95 percent CI 0.44-1.53]; except for oedema which was significantly less prevalent in those on aspirin (OR 0.85 [95 percent CI 0.75-0.96]). Women on aspirin were no significantly less likely to deliver preterm (OR 0.93 [95 percent CI 0.79-1.09]) or have a larger fetus (mean birthweight difference 18 g [95 percent CI -9 to 45]). They were, however significantly more likely to suffer from bleeding disorders antenatally, intrapartum and postpartum: for postpartum haemorrhage OR 1.40 (95 percent CI 1.13-1.73). CONCLUSION: This trail shows that low dose aspirin has no consistent beneficial effect in primiparae(AU)

Urea kinetics in healthy women during normal pregnancy

Urea kinetics were measured in normal women aged 22-34 years at weeks 16, 24 and 32 on either their habitual protein intake (HABIT) or a controlled intake of 60 g protein/d (CONTROL), using primed-intermittent oral doses of [15N15N] urea and measurement of plateau enrichment in urinary urea over 18 h (ID) or a single oral dose of [15N15N] urea and measurement of enrichment of urea in urine over the following 48 h (SD). The intake of protein during HABIT-ID (80 g/d) was greater than that on HABIT-SD (71 g/d); urea production as a percentage of intake was significantly greater at week 16 for HABIT-ID than HABIT-SD, whereas urea hydrolysis at week 16 was greater for HABIT-SD than HABIT-ID and urea excretion at week 32 was greater for HABIT-ID than HABIT-SD . The combined results for HABIT-ID and HABIT-SD showed a significant reduction in urea production at week 32 compared with week 24. Urea excretion decreased significantly from week 16 to week 24 with no further decrease to week 32 and urea hydrolysis was significantly greater at week 24 than either week 16 or week 32. Compared with HABIT, on CONTROL there was a decrease in urea production at week 16, and urea excretion was significantly reduced at week 16. For all time periods urea production was closely related to the sum of intake plus hydrolysis. Hydrolysis was greatest at week 24 and closely related to urea production. There was a significantly inverse linear relationship overall for hydrolysis as a proportion of production and excretion as proportion of intake. The results show that on HABIT N is more effectively conserved in mid-pregnancy through an increase in urea hydrolysis and salvage, and during late pregnancy through a reduction in urea formation. Lowering protein intake at any stage of pregnancy increased the hydrolysis and salvage of urea. The staging of these changes was later than that in pregnancy in Jamaica.(AU)

Comparison of urinary 5-L-oxoproline (L-pyroglutamate) during normal pregnancy in women in England and Jamaica

Urinary 5-L-oxoproline was measured during normal pregnancies in Southampton, England and Kingston, Jamaica. The CV of 5-L-oxoproline excretion in urine, determined over 7 d in a non-pregnant woman and three pregnant women, was 10-36 percent. Compared with non-pregnant women, urinary 5-L-oxoproline increased three to four times from early pregnancy in women in Southampton, a highly significant difference, and remained elevated at similar levels during mid and late pregnancy. For women in Kingston, the excretion of 5-L-oxoproline was similar to that of Southampton women in the non-pregnant group and during early pregnancy. However, there was a progressive increase in the excretion of 5-L-oxoproline as pregnancy advanced and by late pregnancy excretion was from three to ten times greater than the average for the non-pregnant women. There was a significant difference between the women in Southampton and the women in Kingston during mid and late pregnancy, with women in Kingston excreting twice as much 5-l-oxoproline during late pregnancy. If the excretion of 5-L-oxoproline is a measure of glycine insufficiency, the results would indicate that in some pregnancies the ability of the mother to provide glycine for herself and the developing fetus is marginal or inadequate and the constraint appears more marked in Jamaica than in England.(AU)

The excretion of 5-oxoproline in urine, as an index of glycine status, during normal pregnancy

The urinary excretion of 5-oxoproline, which may be used as an index of glycine status, was investigated in 30 normal pregnant women during different stages of pregnancy and in 18 non-pregnant female volunteers. During an 18-h study there was little variation in the 5-oxoproline/creatinine index,and a single sample gave a representative value. The excretion of 5-oxoproline/creatinine (umol/mmol) rose progressively as preqnancy advanced (non-pregnant mean 10, SD 5, first trimester mean 46, SD 12, second trimester mean 150, SD 180,and third trimester mean 280, SD 320) and by the third trimester was over 20 times greater than in non-pregnant women. The data suggest that as pregnancy advances the endogenous production of glycine may be insufficient to satisfy the increasing demands (Summary)

Maternal mortality in Jamaica

A confidential inquiry into all maternal deaths in Jamaica during 3 years (1981 to 1983) was carried out. 192 maternal deaths were identified by a variety of means. The maternal mortality rate of 10.8 per 10000 live births was considerably higher than the official rate of 4.8. The most common causes of death were hypertensive disease of pregnancy (10 percent), pulmonary embolus (8 percent), and sepsis (8 percent). Maternal mortality was closely related to both age and parity. The lowest rates were for women of para 2-4 aged 20-24 years and para 3-4 aged 25-29 years. The largest groups of avoidable factors were: non-use of and deficiencies in antenatal care; inadequacy in ensuring the delivery in hospital of women at high risk; and delays in taking action when signs of complications developed before, during, and after delivery.(AU)

Maternal respiratory function during pregnancy

Maternal respiratory function in the second (26) and third (76) trimesters of pregnancy was measured in 102 women and showed that: (i) Thirty-eight per cent and 36 percent of the women in second and third trimesters respectively had FEV1.0 percent<75 percent. MTT 0.7 sec. (ii) Nineteen per cent and 29 percent of the women in the second and third trimesters respectively had MTT>0.7 sec. (iii) Pregnancy superimposed on previous respiratory disorders such as bronchial asthma potentiated the compromisation of both central and peripheral airway function in the third trimester in that 41 percent had FEV<75 percent and 34 percent MTT>0.7 sec. It is concluded that normal pregnancy does not significantly affect central and peripheral airway function. However, pregnancy in the presence of upper or lower respiratory tract disease may influence respiratory function negatively. (AU)

Assessment of the nutritional status of pregnant women by weight for height and week of pregnancy - abstract

Assessment of the nutritional status of pregnant women by anthropometry presents obvious difficulties. The weight at a given stage depends on the woman's height, her pre-pregnant weight and the week of pregnancy. A reference table of weight for height by week of pregnancy has been devised, based on the premises that the average increment of weight during pregnancy is 20 percent of the pre-pregnant weight and that almost all the increment takes place linearly during the second and third trimesters of pregnancy. The table developed on theoretical grounds has been tested with retrospective data from Dominica. The preliminary results show a good correlation between the weight for height at different stages of pregnancy as a percentage of the reference table and the birth weight of the children. This type of reference table is, in our opinion, highly necessary as a simple tool to assess the nutritional status of pregnant women and, within limits, to "predict" the chances of delivering a low birth weight infant (AU)

Termination of hypertensive pregnancies with intra-amniotic urevert

Successful therapeutic abortion was achieved during the second trimester of pregnancy using intra-amniotic urevert and simultaneous intravenous syntocinon infusion in 19 patients with severe hypertension, severe pre-eclampsia or eclampsia. The mean induction-abortion interval was 24.25 hours, and side-effects were minimal (AU)

The significance of weight gains and losses during selected periods of pregnancy in Jamaican women

The weight gains between (i) the 20th and 30th weeks, and (ii) the 30th and 36th weeks of pregnancy in a series of 500 patients from the University College Hospital of the West Indies are presented. Although the average weight gains amongst patients who ultimately developed pre-eclampsia were slightly greater than those of the normal group, the actual weight gains ofindividual patients, both pre-eclamptic and normal demonstrated such a wide scatter that an excessive gain in any given patient over the periods studied had no useful prognostic significance. Patients who lost weight or failed to gain weight between (i) the 30th and 36th weeks, and (ii) the 36th and 40th weeks of pregnancy were also studied. Nearly all of them were delivered of healthy infants after the spontaneous onset of labour. There is no indication to induce premature labour solely on the grounds of failure to gain weight during the later weeks of pregnancy when all other findings are normal. Conclusions drawn from calculated average weight gains of groups of women over any selected periods of pregnancy must be used with caution in clinical practice, because the actual weight fluctuations in the individual pregnant patients in any group, normal or abnormal varies over such a wide range that average figures may be misleading if taken at their face value (AU)