Excessive gestational weight gain over multiple pregnancies and the prevalence of obesity at age 40.

OBJECTIVE: Although several studies have found an association between excessive gestational weight gain (GWG) and obesity later in life, to the best of our knowledge, no studies have explored the role of GWG events across the life course. DESIGN AND METHODS: We describe how the prevalence of midlife obesity (BMI⩾30 at age 40 or 41) among women varies by life course patterns of GWG (using 2009 IOM guidelines) in the USA's National Longitudinal Survey of Youth 1979 cohort. RESULTS: Among women who reported 1-3 births before age 40, the prevalence of midlife obesity increased with a rising number of excessive GWG events: from none (23.4%, n=875) to one (37.6%, n=707), from none (23.4%, n=875) to two (46.8%, n=427) and from none (23.4%, n=875) to three (54.6%, n=108), P<0.00005 for trend. Obesity prevalence was similar for the same number of excessive GWG events, regardless of parity. No clear pattern emerged for the sequencing of excessive GWG event(s) and later obesity. CONCLUSIONS: In our descriptive exploratory study, excessive GWG events appear to be associated with increased prevalence of obesity for parous women, suggesting the importance of preventive interventions regardless of timing of pregnancy-related weight changes over the life course.

Pharmacokinetics and safety of famciclovir in children with herpes simplex or varicella-zoster virus infection.

Two multicenter, open-label, single-arm, two-phase studies evaluated single-dose pharmacokinetics and single- and multiple-dose safety of a pediatric oral famciclovir formulation (prodrug of penciclovir) in children aged 1 to 12 years with suspicion or evidence of herpes simplex virus (HSV) or varicella-zoster virus (VZV) infection. Pooled pharmacokinetic data were generated after single doses in 51 participants (approximately 12.5 mg/kg of body weight [BW] for children weighing < 40 kg and 500 mg for children weighing > or = 40 kg). The average systemic exposure to penciclovir was similar (6- to 12-year-olds) or slightly lower (1- to < 6-year-olds) than that in adults receiving a 500-mg dose of famciclovir (historical data). The apparent clearance of penciclovir increased with BW in a nonlinear manner, proportional to BW(0.696). An eight-step weight-based dosing regimen was developed to optimize exposure in smaller children and was used in the 7-day multiple-dose safety phases of both studies, which enrolled 100 patients with confirmed/suspected viral infections. Twenty-six of 47 (55.3%) HSV-infected patients who received famciclovir twice a day and 24 of 53 (45.3%) VZV-infected patients who received famciclovir three times a day experienced at least one adverse event. Most adverse events were gastrointestinal in nature. Exploratory analysis following 7-day famciclovir dosing regimen showed resolution of symptoms in most children with active HSV (19/21 [90.5%]) or VZV disease (49/53 [92.5%]). Famciclovir formulation (sprinkle capsules in OraSweet) was acceptable to participants/caregivers. In summary, we present a weight-adjusted dosing schedule for children that achieves systemic exposures similar to those for adults given the 500-mg dose.

Effects of pimecrolimus cream 1% in the treatment of patients with atopic dermatitis who demonstrate a clinical insensitivity to topical corticosteroids: a randomized, multicentre vehicle-controlled trial.

BACKGROUND: Colonization with Staphylococcus aureus in atopic dermatitis (AD) is often associated with worsening of clinical symptoms. Staphylococcus aureus produces superantigens that contribute to cutaneous inflammation and corticosteroid (CS) resistance. OBJECTIVES: To investigate the relationship between CS insensitivity, S. aureus colonization and superantigen production in AD, and to explore the efficacy of pimecrolimus cream in CS-insensitive AD. METHODS: This was a randomized, double-blind, vehicle-controlled, multicentre, parallel-group study. Seventy-three patients with AD, aged 2-49 years, who had a documented clinical insensitivity to topical CS, were recruited. The primary efficacy parameters combined laboratory (including S. aureus colonization, superantigens) and clinical assessments [including Eczema Area and Severity Index (EASI), whole body Investigator's Global Assessment (IGA), pruritus assessment score, patient's assessment score of disease control]. RESULTS: An increase in S. aureus counts correlated with worsening of clinical score (week 6 vs. baseline) when assessed by IGA, pruritus severity and patient assessment. The presence of superantigens correlated with this worsening. During the 6-week double-blind phase, disease improvement in the pimecrolimus cream group was demonstrated by decreasing EASI scores compared with vehicle. Mean EASI scores for the head and neck showed greater improvement in the pimecrolimus cream group than in the vehicle group at all observed time points. CONCLUSIONS: In a cohort of patients with clinical insensitivity to CS there was a significant positive correlation between S. aureus and disease severity. Results suggest that for some of these patients, treatment with pimecrolimus cream 1% is useful, especially in the head/neck area.

Behavioral responses to artificial food colors.

Twenty-two young children, maintained on a diet that excluded certain foods, were challenged intermittently with a blend of seven artificial colors in a double-blind trial. Parents' observations provided the criteria of response. One child that responded mildly to the challenge and one that responded dramatically were detected. The latter, a 34-month-old female, showed a significant increase in aversive behaviors. These results further confirm previous controlled studies.

The accuracy of self-reported pregnancy-related weight: a systematic review.

Self-reported maternal weight is error-prone, and the context of pregnancy may impact error distributions. This systematic review summarizes error in self-reported weight across pregnancy and assesses implications for bias in associations between pregnancy-related weight and birth outcomes. We searched PubMed and Google Scholar through November 2015 for peer-reviewed articles reporting accuracy of self-reported, pregnancy-related weight at four time points: prepregnancy, delivery, over gestation and postpartum. Included studies compared maternal self-report to anthropometric measurement or medical report of weights. Sixty-two studies met inclusion criteria. We extracted data on magnitude of error and misclassification. We assessed impact of reporting error on bias in associations between pregnancy-related weight and birth outcomes. Women underreported prepregnancy (PPW: -2.94 to -0.29 kg) and delivery weight (DW: -1.28 to 0.07 kg), and over-reported gestational weight gain (GWG: 0.33 to 3 kg). Magnitude of error was small, ranged widely, and varied by prepregnancy weight class and race/ethnicity. Misclassification was moderate (PPW: 0-48.3%; DW: 39.0-49.0%; GWG: 16.7-59.1%), and overestimated some estimates of population prevalence. However, reporting error did not largely bias associations between pregnancy-related weight and birth outcomes. Although measured weight is preferable, self-report is a cost-effective and practical measurement approach. Future researchers should develop bias correction techniques for self-reported pregnancy-related weight.

Weight gain in pregnancy and child weight status from birth to adulthood in the United States.

BACKGROUND: High weight gain in pregnancy has been associated with child adiposity, but few studies have assessed the relationship across childhood or in racially/ethnically diverse populations. OBJECTIVES: The objectives of the study are to test if weight gain in pregnancy is associated with high birthweight and overweight/obesity in early, middle and late childhood and whether these associations differ by maternal race/ethnicity. METHODS: Mother-child dyads (n = 7539) were included from the National Longitudinal Survey of Youth 1979, a nationally representative cohort study in the USA (1979-2012). Log-binomial regression models were used to analyse associations between weight gain and the outcomes: high birthweight (>4000 g) and overweight/obesity at ages 2-5, 6-11 and 12-19 years. RESULTS: Excessive weight gain was positively associated, and inadequate weight gain was negatively associated with high birthweight after confounder adjustment (P < 0.05). Only excessive weight gain was associated with overweight in early, middle and late childhood. These associations were not significant in Hispanics or Blacks although racial/ethnic interaction was only significant ages 12-19 years (P = 0.03). CONCLUSIONS: Helping pregnant women gain weight within national recommendations may aid in preventing overweight and obesity across childhood, particularly for non-Hispanic White mothers.

Obstetric complications with GDM. Effects of maternal weight.

Obstetric complications recorded prospectively were assessed retrospectively in 150 women with gestational diabetes mellitus (GDM) and 305 control subjects matched for age, parity, and ethnicity. Intensive diet therapy and self-monitoring of capillary blood glucose were used to obtain postprandial euglycemia; 22% of GDM subjects required insulin. GDM and control subjects were grouped by body mass index to detect any influence of maternal prepregnancy weight on outcome. Polyhydramnios, preterm labor, and pyelonephritis were not more frequent in GDM, but hypertension without proteinuria (7.3 vs. 3.3%) and preeclampsia (8 vs. 3.9%) were more frequent in GDM. The frequency of hypertensive complications in GDM was not totally attributable to being overweight. Abnormalities of labor, birth trauma, and fetal macrosomia were not more common in GDM; 6.7% of the infants of mothers with GDM weighed greater than 4200 g at birth compared with 3.6% of control infants (NS), and 10% were large for gestational age and sex compared with 6.6% of control infants (NS). Despite this, cesarean delivery was more common in GDM (35.3 vs. 22%, P less than 0.01), mostly due to significantly more cesarean births without labor.

Pregnancy weight gain: still controversial.

During the 20th century, recommendations for maternal weight gain in pregnancy were controversial, ranging from rigid restriction to encouragement of ample gain. In 1990, the Institute of Medicine (IOM) recommended weight-gain ranges with the primary goal of improving infant birth weight. These guidelines were widely adopted but not universally accepted. Critics have argued that the IOM's recommendations are unlikely to improve perinatal outcomes and may actually increase the risk of negative consequences to both infants and mothers. We systematically reviewed studies that examined fetal and maternal outcomes according to the IOM's weight-gain recommendations in women with a normal prepregnancy weight. These studies showed that pregnancy weight gain within the IOM's recommended ranges is associated with the best outcome for both mothers and infants. However, weight gain in most pregnant women is not within the IOM's ranges. All of the studies reviewed were observational and there is a compelling need to conduct experimental studies to examine interventional strategies to improve maternal weight gain with the objective of optimizing health outcomes.

A prospective study of dietary intake and acquired immune deficiency syndrome in HIV-seropositive homosexual men.

We prospectively studied the relationship between dietary intake at baseline and the development of AIDS over 6 years in a population-based sample of 296 human immunodeficiency virus (HIV)-seropositive men. Nutrient intake was assessed before HIV serostatus was known. Subjects diagnosed with AIDS at baseline or during the 1st year were excluded. After adjustment for baseline CD4 T-lymphocyte count, HIV symptoms, and other risk factors, no nutrients were significantly associated with AIDS. However, when the continuous CD4 count and HIV symptom variables were replaced with a single binary health status variable, the hazard of AIDS decreased as consumption increased for all 11 micronutrients; this relationship was statistically significant for iron, vitamin E, and riboflavin and approached significance for vitamins C, thiamine, and niacin. Higher intake of all 11 micronutrients was associated with higher CD4 counts at baseline, and was significantly so for six of them. Daily multivitamin use was associated with a reduced hazard of AIDS [hazard ratio (HR) = 0.7; 95% confidence interval (CI) = 0.5, 1.0] and a significantly reduced risk for low CD4 counts at baseline (HR = 0.6, 95% CI = 0.4, 0.9). Additional studies are needed to determine whether dietary intake modifies the rate of developing AIDS in those who are HIV seropositive.

Effects of substance abuse on hallucination rates and treatment responses in chronic psychiatric patients.

BACKGROUND: Few data systematically document the effects of illicit drug exposure on psychotic illness. We examined the effect of substance abuse on rates and treatment responses of hallucinations in a chronic psychiatric population. METHOD: 113 cooperative patients consecutively admitted to a state psychiatric hospital were administered the Structured Clinical Diagnostic Interview for DSM-III-R, a Hallucination Interview, and an inventory of past and current substances of abuse. Demographic information was obtained on 104 of 108 patients who declined interview. Medication dosage was analyzed for one third of the interviewed sample; hospital records, nursing reports, contacts with relatives, and urine drug screens were used to confirm information from patient interviews. Hallucination rates and response were compared by diagnostic groups (chi-square). RESULTS: Noninterviewed patients had more frequent hospitalizations, more patients diagnosed with psychosis not otherwise specified or schizoaffective disorder, and fewer females with comorbid substance abuse than the study population. Among interviewed subjects, those with substance abuse and psychiatric illness had first admissions at an earlier age than patients with no substance abuse (p = .005). Schizophrenics experienced higher rates of visual (p = .04) and olfactory (p = .05) hallucinations when using illicit drugs. Substance abuse was associated with decreased treatment responsiveness of auditory (p < .03) and tactile (p < .004) hallucinations in schizophrenic or manic patients. Compared with nonparanoid patients, there was a trend for paranoid schizophrenics with substance abuse to experience more frequent visual (p = .09) and tactile (p = .06) and more refractory auditory (p = .08) hallucinations. No differences in medication dosages were found between patients with treatment-responsive and treatment-refractory hallucinations. CONCLUSIONS: Abused substances may interact selectively with primary psychiatric illness to increase rates and treatment resistance of specific hallucination modalities; etiologies are discussed.

Vitamin and mineral status of women of childbearing potential.

Increasing data suggest a role for micronutrients in pregnancy outcome, and in some cases nutritional status must be adequate in the first weeks of pregnancy. We examined nationally representative survey data on women of childbearing age: the NHANES II data for serum measures of iron status and the CSFII four-day data for dietary measures of intake of protein, iron, zinc, folic acid, and vitamins A, C, and B6. For those nutrients, women below or near poverty had consistently lower levels, with median intakes below the RDA for all but protein (e.g., folic acid, 150 micrograms in contrast with the RDA of 180 for nonpregnant and 400 for pregnant women; for B6, 0.96 mg instead of 1.6 or 2.2). Even among women with incomes as high as three times the poverty level or more, large segments of the population had very low intakes. For example, the 25th percentile in that group was only 142 micrograms/day of folic acid, 4.6 alpha-tocopherol equivalents of vitamin E, 6.7 mg zinc, and 433 mg of calcium. Approximately 15% of women had low transferrin saturation.

Maternal weight gain pattern and birth weight.

OBJECTIVES: To determine the relationship between maternal weight gain pattern and birth weight. METHODS: All nonobese, white women delivered at the University of California, San Francisco, between 1980-1990 were eligible for this study. Our study group included 2994 uncomplicated pregnancies with complete data. All recorded prenatal weight gain measurements were used to estimate maternal trimester weight gain, pattern of gain (based on low versus not-low gain at each trimester), and total gain at delivery. Multiple linear regression analysis was used to assess the relationship between these weight gain measurements and fetal birth weight. RESULTS: After adjustment for seven covariates, each kilogram of maternal gain in the first, second, and third trimesters was associated with statistically significant increases in fetal birth weight of 18.0, 32.8, and 17.0 g, respectively. When compared with the pattern of gain that was not low in any trimester, patterns with low gain in the first and second trimesters or in the second and third trimesters were associated with significant decreases in birth weights of 133.0 and 88.5 g, but no important change in birth weight was seen for the group whose gains were low in the first and third trimesters. These findings were not due to differences in total weight gain, which averaged approximately 11 kg in these three pattern groups. CONCLUSION: The results suggest that specific patterns of maternal weight gain, particularly weight gain during the second trimester, are related to fetal birth weight.

Prenatal weight gain advice: an examination of the recent prenatal weight gain recommendations of the Institute of Medicine.

The Institute of Medicine (IOM) recently published new guidelines for maternal weight gain during pregnancy. Using data collected at Moffitt Hospital, University of California at San Francisco, we examined the associations between maternal weight gain outside the recommendations of the IOM and three pregnancy outcomes (small for gestational age [SGA] infants, large for gestational age [LGA] infants, and cesarean delivery). These analyses were repeated using population-specific weight gain ranges derived from a subgroup of women in this cohort with healthy pregnancy outcomes. The purpose of the study was to compare the national guidelines of the IOM with hospital standards. Both the recommendations of the IOM and the hospital ranges were associated with fewer SGA infants, LGA infants, and cesarean deliveries. The overall associations were similar for the population-derived and national ranges. Although the IOM ranges should be examined in other populations and with other birth outcomes, our results validated their recommendations. Maternal weight gain within the IOM recommendations reduced the risk of the outcomes studied; furthermore, these ranges performed as well as those derived from the target population.

Factors associated with the pattern of maternal weight gain during pregnancy.

OBJECTIVE: To examine the pattern of maternal weight gain using maternal characteristics and pregnancy outcome. METHODS: We used maternal weight data measured prospectively from all deliveries between 1980-1990 at the University of California, San Francisco. Piecewise linear regression was used to estimate the rate of maternal weight gain in each trimester. Bivariate techniques were used to examine associations between maternal weight gain per trimester and maternal characteristics and pregnancy outcomes. We also used multiple regression analysis to examine the relationship between maternal characteristics and trimester weight gain. RESULTS: Weight data for at least one trimester were available for 10,418 women. The average rate of weight gain (kg/week) was lowest during the first trimester (0.169 +/- 0.268, n = 7587), peaked during the second trimester (0.563 +/- 0.236, n = 8000), and slowed slightly in the third trimester (0.518 +/- 0.234, n = 10,052). Maternal height, hypertension, cesarean delivery, and fetal size correlated positively with the rate of gain in each trimester, but pre-pregnancy body size, age, parity, smoking status, race-ethnicity, and diabetes were associated differently with gain, depending on which trimester was examined. The most important maternal predictors of weight gain per trimester were age and Asian race-ethnicity in the first trimester; pre-pregnancy body mass, parity, and height in the second; and hypertension, age, and parity in the third. CONCLUSION: Maternal weight gain per trimester is associated with a number of maternal characteristics and pregnancy outcomes, and these relationships vary according to which trimester is being examined.

Maternal weight gain in women with good pregnancy outcome.

The most liberal published guidelines for maternal weight gain at term suggest a range of 9-14 kg. In a cohort of 4674 women with good pregnancy outcomes who delivered at the University of California, San Francisco between 1980-1988, the lower end of the currently published weight gain range was relevant, but the upper limit of weight gain was higher. Good pregnancy outcome was defined as a vaginal birth between 37-42 weeks' gestation of a living, singleton infant of appropriate birth weight for gestational age without congenital anomalies, born to a mother who did not experience diabetes or hypertension during pregnancy. Ranges of 12-18 and 10-21 kg described 50 and 80% of the group, respectively. Mean weight gain was associated with maternal pre-pregnancy body mass, parity, and race, with the largest differences observed in overweight and obese women. The results reported here suggest that a wider range of maternal weight gain than is currently recommended is associated with good pregnancy outcome.

A critical review of the relationship between gestational weight gain and preterm delivery.

OBJECTIVE: To review the relationship between gestational weight gain and preterm delivery. DATA SOURCES: We identified published studies through Medline searches (for the period 1980-1996), and we reviewed bibliographies from published articles. METHODS OF STUDY SELECTION: We excluded non-English-language articles and articles that used total weight gain, unadjusted for gestational age. Thirteen articles were identified for review. TABULATION, INTEGRATION AND RESULTS: Eleven of the 13 studies reported a significant association between maternal weight gain and risk of preterm delivery, and most reported that inadequate rate of maternal weight gain was associated with an increased risk (approximately 50-100%) of preterm delivery. Studies examining pattern of gain noted that a low rate of gain during the latter part of pregnancy (but not early pregnancy) was associated with an increased risk of preterm delivery (also approximately 50-100%). The studies' findings were relatively consistent, despite the use of diverse samples, study designs, and analytic strategies. CONCLUSION: The evidence suggests that a lower rate of weight gain during pregnancy is associated with an increased risk of preterm delivery, and that a slow rate of gain during the latter part of pregnancy may be particularly important. To improve our understanding of the mechanisms of these relationships, future studies should examine pattern of gain; they should stratify analyses on the different subtypes of preterm delivery and provide more detailed descriptions of methods for assessing gestational duration.

Differences in postpartum weight retention between black and white mothers.

OBJECTIVE: To determine whether the overall retention of weight gained during pregnancy and the factors affecting postpartum weight retention differ by race. METHODS: Data from the 1988 National Maternal and Infant Health Survey were analyzed to examine postpartum weight retention of 20 lb or more among 990 black and 1129 white women who began pregnancy with normal weight for height. The impact of various maternal characteristics on both weight retention and the association between weight retention and race was tested by multivariate methods. RESULTS: Black mothers were twice as likely to retain at least 20 lb than white mothers (adjusted odds ratio 2.20, 95% confidence interval 1.50-3.22). This black-white difference did not differ substantially by socioeconomic status. However, many factors affecting postpartum weight retention differed by maternal race. For example, whereas unmarried status was associated with weight retention among white mothers, high parity was associated with weight retention among black mothers. Low socioeconomic status and high prenatal weight gain were associated with an increased risk of weight retention for both black and white mothers. CONCLUSION: These data suggest that population-specific strategies may be needed to help mothers return to their pre-pregnancy weight.

Maternal weight gain and preterm delivery.

This study examined the relationship between maternal weight gain and preterm delivery in 2163 women who participated in the Prenatal Nutrition Project at the University of California, San Diego between 1978-1986. Multivariate analysis of the data indicated that the risk of spontaneous preterm birth increased 60% in women with a low rate of weight gain (less than 0.27 kg/week) compared with those with an average rate (0.27-0.52 kg/week). Women with a low rate of gain were more than twice as likely to experience a preterm delivery as those with a high gain (higher than 0.52 kg/week); the odds ratio was 2.54 and 95% confidence interval was 1.49, 4.88. This difference in weight gain appeared after 20 weeks' gestation.

Inocoterone and acne. The effect of a topical antiandrogen: results of a multicenter clinical trial.

BACKGROUND AND METHODS: Because acne is androgen dependent, antiandrogen therapy might improve the condition. Inocoterone acetate (RU 882) is a nonsteroidal antiandrogen that binds to the androgen receptor and has antiandrogenic activity in animal models. To test its topical effect on acne, 126 male subjects with facial acne completed a 16-week, multi-center, double-blind study in which the twice-daily application of a 10% solution of inocoterone was compared with vehicle solution. Baseline and monthly examinations included acne lesion counts and general and endocrine laboratory tests. RESULTS: Inflammatory papules and pustules showed greater reduction in the inocoterone-treated subjects than in the subjects treated with vehicle. This difference achieved statistical significance by week 12 (24% reduction vs 10%) and week 16 (26% reduction vs 13%) and, with longitudinal analysis, throughout the course of the study. Global assessments and changes in comedo counts and sebum excretion rates were not significantly different between the groups. No serious adverse reactions were encountered. CONCLUSIONS: In this double-blind study of 126 male subjects with acne, a topical solution of the antiandrogen inocoterone, compared with vehicle, produced a modest but statistically significant reduction in the number of inflammatory acne lesions.

Preterm birth among African American and white women: a multilevel analysis of socioeconomic characteristics and cigarette smoking.

STUDY OBJECTIVE: Research shows that neighbourhood socioeconomic factors are associated with preterm delivery. This study examined whether cigarette smoking and individual socioeconomic factors modify the effects of neighbourhood factors on preterm delivery. DESIGN: Case-control study. SETTING: Moffit Hospital in San Francisco, California. PARTICIPANTS: 417 African American and 1244 white women, including all preterm and a random selection of term deliveries 1980-1990, excluding non-singleton pregnancies, congenital anomolies, induced deliveries, and women transported for special care. US census data from 1980 and 1990 were used to characterise the women's neighbourhoods, defined as census tracts. RESULTS: Cigarette smoking increased the risk of preterm delivery among both African American (OR=1.77, 95% confidence intervals (CI) (1.12 to 2.79)) and white women (OR=1.25, 95% CI (1.01 to 1.55)). However, cigarette smoking did not attenuate or modify the association of neighbourhood factors with preterm delivery. Among African American women, having public insurance modified the relation between neighbourhood unemployment and preterm delivery; among women without public insurance, the risk of preterm delivery was low in areas with low unemployment and high in areas with high unemployment, while among women with public insurance the risk of preterm delivery was highest at low levels of neighbourhood unemployment. CONCLUSIONS: Cigarette smoking was associated with preterm delivery, especially among African Americans. Adverse neighbourhood conditions had an influence on preterm delivery beyond that of cigarette smoking. The effects of some neighbourhood characteristics were different depending on individual socioeconomic status. Examining socioeconomic and behavioural/biological risk factors together may increase understanding of the complex causes of preterm delivery.