Topical application of recombinant activated factor VII during cesarean delivery for placenta previa.

BACKGROUND: During cesarean delivery in patients with placenta previa, hemorrhaging after removal of the placenta is often challenging. In this condition, the extraordinarily high concentration of tissue factor at the placenta site may constitute a principle of treatment as it activates coagulation very effectively. The presumption, however, is that tissue factor is bound to activated factor VII. OBJECTIVE: We hypothesized that topical application of recombinant activated factor VII at the placenta site reduces bleeding without affecting intravascular coagulation. STUDY DESIGN: We included 5 cases with planned cesarean delivery for placenta previa. After removal of the placenta, the surgeon applied a swab soaked in recombinant activated factor VII containing saline (1 mg in 246 mL) to the placenta site for 2 minutes; this treatment was repeated once if the bleeding did not decrease sufficiently. We documented the treatment on video recordings and measured blood loss. Furthermore, we determined hemoglobin concentration, platelet count, international normalized ratio, activated partial thrombin time, fibrinogen (functional), factor VII:clot, and thrombin generation in peripheral blood prior to and 15 minutes after removal of the placenta. We also tested these blood coagulation variables in 5 women with cesarean delivery planned for other reasons. Mann-Whitney test was used for unpaired data. RESULTS: In all 5 cases, the uterotomy was closed under practically dry conditions and the median blood loss was 490 (range 300-800) mL. There were no adverse effects of recombinant activated factor VII and we did not measure factor VII to enter the circulation. Neither did we observe changes in thrombin generation, fibrinogen, activated partial thrombin time, international normalized ratio, and platelet count in the peripheral circulation (all P values >.20). CONCLUSION: This study indicates that in patients with placenta previa, topical recombinant activated factor VII may diminish bleeding from the placenta site without initiation of systemic coagulation.

Does internal podalic version of the non-vertex second twin still have a place in obstetrics? A Danish national retrospective cohort study.

OBJECTIVE: Investigate the rate of internal podalic version followed by breech extraction for a second non-vertex twin with the first delivered vaginally, and compare neonatal outcome with emergency cesarean section. DESIGN: Cohort study. SETTING: National Danish Registers. POPULATION: Twin pregnancies (1997-2012) with gestational age ≥34 weeks; first twin delivered vaginally, second by internal podalic version and breech extraction or cesarean section. METHODS: Data were collected from the Danish National Patient Register and the Danish National Birth Register. MAIN OUTCOME MEASURES: Rates of delivery mode, 5-min Apgar score, asphyxia, umbilical cord pH, admission to neonatal intensive care unit, treatment by mechanical ventilation, and experience level of obstetricians performing internal podalic version. RESULTS: 457 births were available for analysis: 39 cases of internal podalic version and breech extraction and 418 cesarean section cases for second twin. Compared with the cesarean section group, the internal podalic version group had lower rates of asphyxia. Apgar scores and umbilical cord pH levels were not significantly different, although with a tendency to be higher in the internal version than the cesarean section group, however, fewer cases needed mechanical ventilation. Thirty internal versions and breech extractions were performed by obstetricians with >5 years clinical experience and three by trainees. CONCLUSION: Cesarean sections for a second twin seem to have been frequent during the last 15 years while internal podalic version is a vanishing procedure. A slight tendency for better neonatal outcome was found in the internal podalic version and extraction group than cesarean section.

The Treatment of Obese Pregnant Women (TOP) study: a randomized controlled trial of the effect of physical activity intervention assessed by pedometer with or without dietary intervention in obese pregnant women.

OBJECTIVE: The objective of the study was to assess physical activity intervention assessed by a pedometer with or without dietary intervention on gestational weight gain (GWG) in obese pregnant women by comparing with a control group. STUDY DESIGN: This study was a randomized controlled trial of 425 obese pregnant women comparing 3 groups: (1) PA plus D, physical activity and dietary intervention (n = 142); (2) PA, physical activity intervention (n = 142); and (3) C, a control group receiving standard care (n = 141). All participants routinely in gestational weeks 11-14 had an initial dietary counseling session and were advised to limit GWG to less than 5 kg. Physical activity intervention included encouragement to increase physical activity, aiming at a daily step count of 11,000, monitored by pedometer assessment on 7 consecutive days every 4 weeks. Dietary intervention included follow-up on a hypocaloric Mediterranean-style diet. Instruction was given by a dietician every 2 weeks. The primary outcome measure was GWG, and the secondary outcome measures were complications of pregnancy and delivery and neonatal outcome. RESULTS: The study was completed by 389 patients (92%). Median values of GWG (ranges) were lower in each of the intervention groups (PA plus D, 8.6 [-9.6 to 34.1] kg, and group PA, 9.4 [-3.4 to 28.2] kg) compared with the control group (10.9 [-4.4 to 28.7] kg [PA+D vs C]; P = .01; PA vs C; P = .042). No significant difference was found between the 2 intervention groups. In a multivariate analysis, physical activity intervention decreased GWG by a mean of 1.38 kg (P = .040). The Institute of Medicine's recommendations for GWG were more frequently followed in the intervention groups. CONCLUSION: Physical activity intervention assessed by pedometer with or without dietary follow-up reduced GWG compared with controls in obese pregnant women.

Pregnancy outcomes in a cohort of women with a preconception body mass index >50 kg/m².

We describe characteristics and risk factors regarding pregnancy outcome in women with a preconception body mass index (BMI) >50 kg/m² compared with women with BMI ≤50 kg/m² in a retrospective population cohort study in singleton pregnancies from the Danish Medical Birth Registry. Results were analyzed as relative risks by a two-proportion z-test. Women with preconception BMI >50 kg/m² smoked, developed gestational diabetes and pre-eclampsia, and needed induction of labor more frequently than mothers with BMI ≤50 kg/m². Examination of the case records showed that many attempted vaginal delivery without epidural analgesia, 21% needed an emergency cesarean section (compared with 12% among women with BMI ≤50 kg/m²), and 25% underwent general anesthesia in this context. Many neonates were macrosomic and 34% needed neonatal intensive care and early feeding compared with 6% of neonates from women with BMI ≤50 kg/m². Women with an extremely high preconception BMI develop more pregnancy complications and their neonates appear affected by this as well.

Acupuncture and/or sweeping of the fetal membranes before induction of labor: a prospective, randomized, controlled trial.

AIMS: To evaluate the efficacy of acupuncture, and sweeping of the fetal membranes, as methods for induction of labor. METHODS: Four hundred and seven pregnant women with normal singleton pregnancies and cephalic presentations were randomized at three delivery wards in Denmark at day 290 of gestation into groups of acupuncture, sweeping, acupuncture and sweeping and controls. The primary objective was to compare the proportion of women going into labor before induction of labor at 294 days in the four groups. The secondary objective was to compare the combined groups: with and without acupuncture, and with and without sweeping of the fetal membranes. The midwives, completing the forms for the trial at labor or induction, were blinded to group assessments. RESULTS: Four hundred and seventeen women were randomized. Ten were excluded after randomization. One hundred and four women were randomized to acupuncture, 103 to sweeping of the membranes, 100 to both acupuncture and sweeping, and 100 were randomized to the control group. Comparison of the four groups demonstrated no significant difference in the number of women achieving spontaneous labor before planned induction. No difference was demonstrated by comparing the combined groups treated with acupuncture with the groups not treated with acupuncture (P=0.76). However, significantly more women went into labor before planned induction (P=0.02) in the combined groups receiving sweeping, compared with the groups not treated with sweeping. CONCLUSIONS: Acupuncture at 41+ weeks of gestation did not reduce the need for induction. The study was of a sufficient size to demonstrate, in parallel, that sweeping of the fetal membranes significantly reduced the need of induction, sparing about 15% for formal induction of labor.

Maternal and perinatal complications by day of gestation after spontaneous labor at 40-42 weeks of gestation.

OBJECTIVE: To evaluate pregnancy outcome after spontaneous labor by day of gestation between 40(+0) and 41(+6) weeks of gestation. DESIGN: Evaluation of prospectively collected labor ward data. SETTING: University Hospital, Denmark. POPULATION: Unselected consecutive cohort of 14 678 spontaneously starting deliveries between 280 and 293 days of gestation during the years 2000-2006. METHODS: Data were registered in a computer program after each delivery by a midwife and the entries further evaluated by a specialist in obstetrics. Complication rates were compared using Fisher's exact test. MAIN OUTCOME MEASURES: Maternal complication rates for each gestation day, including cesarean delivery, maternal blood transfusion, episiotomy, operative vaginal delivery, third and fourth degree perineal lacerations and perinatal morbidity. RESULTS: The cesarean delivery rate increased from 6% on day 280 to 11% on day 293. Cesarean delivery increased from 40 to 41 weeks gestation (7.3 vs. 9.5%, p<0.005), as did maternal transfusion (0.5 vs. 1.2%, p<0.001) and cesarean section on the indication fetal distress (1.5 versus 2.4%, p<0.005), but perineal lacerations did not. Likewise, there was an increase in episiotomy rates (3.0 vs. 3.5%, p=0.08), operative vaginal delivery (5.8 vs. 6.5%, p=0.07) and admission to neonatal intensive care (1.4 versus 2.0%, p=0.009), but no increase in 5 minute Apgar scores <7 or low umbilical artery acid-base values. CONCLUSIONS: Deliveries starting spontaneously in an unselected cohort showed an increase in maternal complications, meconium-stained amniotic fluid and admission to the neonatal intensive care unit.

Anal incontinence in women with recurrent obstetric anal sphincter rupture: a case control study.

OBJECTIVES: To determine the risk of recurrent anal sphincter rupture (ASR), and compare the risk of anal incontinence (AI) after recurrent ASR, with that seen in women with previous ASR who deliver by caesarean section or vaginally without sustaining a recurrent ASR. METHODS: Women with recurrent ASR between January 2000 and June 2011 were identified at two delivery wards in Copenhagen. The women answered a questionnaire with a validated scoring system for AI (St. Mark`s score), and the results were compared with those obtained in two control groups: women with subsequent uncomplicated vaginal delivery or caesarean section. RESULTS: There were 93 437 vaginal deliveries. ASR occurred in 5.5% (n = 2851) of the nulliparous and 1.5% (n = 608) of the multiparous women. Recurrent ASR occurred in 8% (n = 49) of whom 50% reported symptoms of AI. We found no difference in the occurrence of AI between women with recurrent ASR, and those who delivered vaginally without repeat ASR (p = 0.37; OR = 2.0) or by caesarean section (p = 0.77; OR = 1.3). CONCLUSION: Women with a past history of ASR have an 8% risk of recurrence. AI affects half of the women with recurrent ASR. Larger studies are required to confirm our findings.

Intake of Sweets, Snacks and Soft Drinks Predicts Weight Gain in Obese Pregnant Women: Detailed Analysis of the Results of a Randomised Controlled Trial.

BACKGROUND: Lifestyle interventions targeting obese pregnant women often result in modest reduction in gestational weight gain, pregnancy complications and related risk factors. Examining adherence to the intervention can, however, provide valuable information on the importance of the different factors targeted. OBJECTIVE: To evaluate improvements and relevance of different dietary factors targeted with respect to gestational weight gain in a 3-arm Randomised Controlled Trial (n=342) among obese pregnant women with BMI≥30 kg/m2. METHODS: Randomisation 1:1:1 to either hypocaloric Mediterranean type of diet and physical activity intervention (D+PA); physical activity intervention alone (PA); or control (C). Diet was assessed at baseline (weeks 11-14) and endpoint (weeks 36-37) using a validated food frequency questionnaire. RESULTS: During the intervention women in the D+PA group significantly lowered their intakes of added sugars and saturated fat and increased their protein intake by ~1% of total energy compared to controls. Of these dietary variables only intakes of added sugar appeared to be related to GWG, while no association was observed for saturated fat or protein. Further analyses revealed that foods that contributed to intake of added sugars, including sweets, snacks, cakes, and soft drinks were strongly associated with weight gain, with women consuming sweets ≥2/day having 5.4 kg (95% CI 2.1-8.7) greater weight gain than those with a low (<1wk) intake. The results for soft drinks were more conflicting, as women with high weight gain tended to favour artificially sweetened soft drinks. CONCLUSION: In our sample of obese pregnant women, craving for sweets, snacks, and soft drinks strongly predicts GWG. Emphasis on reducing intakes of these foods may be more relevant for limiting gestational weight gain than encouraging strict compliance to more specific diets. TRIAL REGISTRATION: ClinicalTrials.gov NCT01345149.

Intake of carbohydrates during pregnancy in obese women is associated with fat mass in the newborn offspring.

BACKGROUND: Transmission of obesity across generations is of concern. Offspring of obese women have short- and long-term increased morbidities. A high intake of carbohydrate during pregnancy combined with impaired glucose tolerance is postulated to result in high birth weight, which is linked to subsequent metabolic disease. OBJECTIVE: The objective was to examine the association between carbohydrate intake in obese pregnant women and their offspring's body composition. DESIGN: Secondary analyses were performed in an observational setting of 222 pregnant women with a pregestational BMI (in kg/m(2)) ≥30 participating in a randomized controlled trial. Diet was assessed at gestational weeks 11-14 and 36-37 by using a semiquantitative food-frequency questionnaire. Body composition in the offspring was assessed at birth by dual-energy X-ray absorptiometry. Relative fat mass (%) was the primary outcome. Absolute measures (total fat, abdominal fat, and lean body mass) were secondary outcomes. RESULTS: Mean ± SD weight and absolute and relative fat mass in the offspring at birth were 3769 ± 542 g, 436 ± 214 g, and 11% ± 4%, respectively. Maternal intake of digestible carbohydrates was associated with the offspring's relative fat mass in late (P-trend = 0.006) but not early (P-trend = 0.15) pregnancy. A comparison of mothers in the highest (median: 238 g/d) compared with the lowest (median: 188 g/d) quartile of digestible carbohydrate intake showed a mean adjusted higher value in the offspring's relative fat mass of 2.1% (95% CI: 0.6%, 3.7%), which corresponded in absolute terms to a 103-g (95% CI: 27, 179-g) higher fat mass. Abdominal fat mass was also higher. In a strata of women with well-controlled glucose (2-h glucose values ≤6.6 mmol/L), no association between carbohydrate intake and offspring fat mass was observed, but the associations became significant and increased in strength with higher intolerance (strata with 2-h glucose values between 6.7-7.7 and ≥7.8 mmol/L). CONCLUSION: In obese women, even those without gestational diabetes but with impaired glucose tolerance, a lower carbohydrate intake at moderate levels in late gestation is associated with a lower fat mass in their offspring at birth. The TOP study was registered at clinicaltrials.gov as NCT01345149.

A randomized controlled trial of the effect of fish oil supplementation in late pregnancy and early lactation on the n-3 fatty acid content in human breast milk.

The aim of this research was to investigate the effect of fish oil supplementation, in the third trimester of pregnancy and early lactation period of healthy pregnant Danish women. Forty-four pregnant women were randomly allocated to fish oil supplementation (1.3 g EPA and 0.9 g DHA per day) from week 30 of gestation (FO-group) or to a control regimen (olive oil or no oil; controls). The FO-group was randomly subdivided into women stopping fish oil supplementation at delivery IFO(pregn)], and women continuing supplementation for an additional 30 d [FO(pregn/lact)]. Thirty-six women agreed to collect milk samples at days 4, 16, and 30 postpartum. The FA composition of the milk samples was determined by GLC. At days 4, 16, and 30 in lactation, FO(pregn/lact) women (n = 12) had, respectively 2.3 (P = 0.001), 4.1 (P = 0.001), and 3.3 (P = 0.001) times higher mean contents of LCPUFA(n-3) in their breast milk compared with controls (n = 13), and 1.7 (P = 0.005), 2.8 (P = 0.001), and 2.8 (P = 0.001) times higher LCPUFA(n-3) contents, respectively, at these days compared with FO(pregn) women (n = 11). The latter group did not differ significantly from controls with regard to LCPUFA(n-3) content in the breast milk. Similar results were obtained when analyzing separately for effects on the milk content of DHA. Dietary supplementation with 2.7 g LCPUFA(n-3) per day from week 30 of gestation and onward more than tripled the LCPUFA(n-3) content in early breast milk; supplementation limited to pregnancy only was much less effective.

Incidence of incisional hernia after cesarean delivery: a register-based cohort study.

OBJECTIVE: To estimate the incidence of incisional hernias requiring surgical repair after cesarean delivery over a 10-year period. METHODS: This population- and register-based cohort study identified all women in Denmark with no history of previous abdominal surgery who had a cesarean delivery between 1991 and 2000. The cohort was followed from their first until 10 years after their last cesarean delivery within the inclusion period or until the first of the following events: hernia repair, death, emigration, abdominal surgery, or cesarean delivery after the inclusion period. For women who had a hernia repair, hospital records regarding the surgery and previous cesarean deliveries were tracked and manually analyzed to validate the relationship between hernia repair and cesarean delivery. Data were analyzed with a competing risk analysis that included each cesarean delivery. RESULTS: We identified 57,564 women who had had 68,271 cesarean deliveries during the inclusion period. During follow-up, 134 of these women had a hernia requiring repair. Of these 68 (51% [95% CI 42-60%]) were in a midline incision although the transverse incision was the primary approach at cesarean delivery during the inclusion period. The cumulated incidence of a hernia repair within 10 years after a cesarean delivery was 0.197% (95% CI 0.164-0.234%). The risk of a hernia repair was higher during the first 3 years after a cesarean delivery, with an incidence after 3 years of 0.157% (95% CI 0.127-0.187%). CONCLUSIONS: The overall risk of an incisional hernia requiring surgical repair within 10 years after a cesarean delivery was 2 per 1000 deliveries in a population in which the transverse incision was the primary approach at cesarean delivery.

Midline versus transverse incision for cesarean delivery in low-income countries.

While transverse incision is the recommended entry technique for cesarean delivery in high-income countries, it is our experience that midline incision is still used routinely in many low-income settings. Accordingly, international guidelines lack uniformity on this matter. Although evidence is limited, the literature suggests important advantages of the transverse incision, with lower risk of long-term disabilities such as wound disruption and hernia. Also, potential extra time spent on this incision appears not to impact neonatal outcome. Therefore, we suggest that it is time for a change in guidelines for low-income settings in which resources are limited for treating complications that may be life threatening.

The effect of a preoperative single-dose methylprednisolone on postoperative pain after abdominal hysterectomy: a randomized controlled trial.

OBJECTIVE: Methylprednisolone has been shown to have analgesic effects after orthopedic surgery. The objective of this trial was to compare the effect of 125 mg methylprednisolone with placebo on postoperative pain after abdominal hysterectomy. STUDY DESIGN: In this randomized double-blinded placebo-controlled trial women scheduled for elective abdominal hysterectomy (n=59) were randomized to preoperatively receive either 125 mg methylprednisolone or saline intravenously. Primary outcome was postoperative pain measured on a 0.0-10.0 visual analog scale and assessed at rest and during mobilization repeatedly the first 24h and daily on the 2nd to 7th postoperative day. Secondary outcomes were postoperative use of opioids and antiemetics, vomiting, C-reactive protein levels, and time to mobilization and discharge. Repeated measures including the primary outcome were analyzed with linear mixed models. RESULTS: Forty-nine cases were analyzed (methylprednisolone n=25, placebo n=24). Pain scores were significantly higher in the methylprednisolone group compared to the placebo group during mobilization (0.79 [95% confidence intervals (CI) 0.07-1.50] P=0.03) but not at rest (0.55 [95% CI: -0.06 to 1.16] P=0.08). There was no difference between the methylprednisolone and placebo group regarding use of opioids (P=0.24) and antiemetics (P=0.14), number of vomits (P=0.26), and time to mobilization (P=0.24) and discharge (P=0.28). C-reactive protein levels were significantly higher in the placebo group (P=0.01). CONCLUSIONS: This trial showed no beneficial effect of methylprednisolone on postoperative pain after abdominal hysterectomy. Methylprednisolone significantly lowered postoperative CRP levels. CLINICAL TRIAL REGISTRATION: ClinicalTrial.gov: www.clinicaltrials.gov: NCT01106547.

Sharp compared with blunt fascial incision at cesarean delivery: a randomized controlled trial with each case as her own control.

OBJECTIVE: To compare patient preference for either sharp incision with scissors or blunt manual cleavage of the fascia at cesarean delivery in a randomized controlled trial in which each woman was her own control. STUDY DESIGN: Women undergoing primary cesarean delivery (n=34) were randomized to side distribution of sharp or blunt incision of the fascia (sharp right and blunt left or blunt right and sharp left) and followed three months postoperatively. The primary outcome was patient preference for the right or left side of the scar 3 months postoperatively and modeled by polytomous logistic regression. The secondary outcome was difference in pain between the two sides measured on a 0.0-10.0 numerical rating scale at 1, 3, and 7 days and 1 and 3 months postoperatively. Pain scores were analyzed with a Wilcoxon signed rank test. RESULTS: 28 cases were analyzed and no significant difference was found in preference after three months. Nine women preferred the sharp (32%, 95% CI 16-52%) and 7 the blunt side (25%, 95% CI 11-45%) (P=0.804). Pain scores did not differ significantly between the two sides at any time postoperatively either at rest or during mobilization. CONCLUSION: No significant difference was found in patient preference with regard to sharp or blunt incision of the fascia, nor was there a significant difference in postoperative pain scores. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov: www.clinicaltrials.org;NCT01297725.

Subcuticular suture compared with staples for skin closure after cesarean delivery: a randomized controlled trial.

OBJECTIVE: To compare subcuticular sutures with staples for skin closure after cesarean delivery in a randomized trial in which each woman was her own control. METHODS: Women undergoing cesarean delivery (primary, n=32; repeat, n=31) were randomized to side distribution of skin closure methods with one side of the skin incision closed with staples and the other side closed with subcuticular suture. The primary outcome was the overall preferred side of the scar 6 months postoperatively. Additional outcomes were women's preferred method of closure and cosmetically preferred side of the scar, difference in objective cosmetic scores (assessed by two plastic surgeons), and pain between the two sides of the scar and infection rate. RESULTS: Significantly more women preferred the stapled side, both overall (odds ratio [OR] 2.55; 95% confidence interval [CI] 1.18-5.52) and cosmetically (OR 2.67; 95% CI 1.24-5.74), and reported staples as their preferred technique (OR 2.00; 95% CI 1.10-3.64). There were no significant differences in pain scores at any time. One plastic surgeon preferred the stapled side (OR 2.8; 95% CI 1.01-7.78) and scored it significantly higher on a cosmetic visual analog scale (P=.031); the other found no significant difference. There were four (6.8%) cases of infection-three on the sutured side and one bilateral. CONCLUSION: Staples were preferred to subcuticular suture for skin closure by women after cesarean delivery. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov; www.clinicaltrials.gov; NCT01217567. LEVEL OF EVIDENCE: : I.

Inflammatory markers in the second trimester prior to clinical onset of preeclampsia, intrauterine growth restriction, and spontaneous preterm birth.

Low-grade inflammation has been associated with pregnancy complications including preeclampsia (PE), intrauterine growth restriction (IUGR), and spontaneous preterm birth (SPB). In an unmatched, nested case-control study, we assessed the possible predictive association of maternal C-reactive protein (CRP), interferon-γ-inducible protein 10 (IP-10), and soluble urokinase plasminogen activator receptor (suPAR) in second trimester plasma samples in relation to later development of PE (n = 29), IUGR (n = 53), and SPB (n = 9). Inflammatory marker levels in these groups were compared to normotensive healthy pregnant controls (n = 127). We found no statistically significant difference in CRP, IP-10, or suPAR in second trimester plasma samples from pregnant women with later PE, IUGR, and SPB when compared to normotensive healthy controls. Second trimester plasma samples of CRP, IP-10, and suPAR cannot be used as a prognostic marker for PE, IUGR, and SPB.

Fish oil intake compared with olive oil intake in late pregnancy and asthma in the offspring: 16 y of registry-based follow-up from a randomized controlled trial.

BACKGROUND: Evidence suggests that asthma is rooted in the intrauterine environment and that intake of marine n-3 polyunsaturated fatty acids (n-3 PUFAs) in pregnancy may have immunomodulatory effects on the child. OBJECTIVE: Our aim was to examine whether increasing maternal intake of n-3 PUFAs in pregnancy may affect offspring risk of asthma. DESIGN: In 1990, a population-based sample of 533 women with normal pregnancies were randomly assigned 2:1:1 to receive four 1-g gelatin capsules/d with fish oil providing 2.7 g n-3 PUFAs (n = 266); four 1-g, similar-looking capsules/d with olive oil (n = 136); or no oil capsules (n = 131). Women were recruited and randomly assigned around gestation week 30 and asked to take capsules until delivery. Among 531 live-born children, 528 were identified in registries and 523 were still alive by August 2006. Diagnoses from the International Coding of Diseases version 10 were extracted from a mandatory registry that recorded diagnoses reported from hospital contacts. RESULTS: During the 16 y that passed since childbirth, 19 children from the fish oil and olive oil groups had received an asthma-related diagnosis; 10 had received the diagnosis allergic asthma. The hazard rate of asthma was reduced by 63% (95% CI: 8%, 85%; P = 0.03), whereas the hazard rate of allergic asthma was reduced by 87% (95% CI: 40%, 97%; P = 0.01) in the fish oil compared with the olive oil group. CONCLUSION: Under the assumption that intake of olive oil in the dose provided here was inert, our results support that increasing n-3 PUFAs in late pregnancy may carry an important prophylactic potential in relation to offspring asthma.

The roles of long-chain polyunsaturated fatty acids in pregnancy, lactation and infancy: review of current knowledge and consensus recommendations.

This paper reviews current knowledge on the role of the long-chain polyunsaturated fatty acids (LC-PUFA), docosahexaenoic acid (DHA, C22:6n-3) and arachidonic acid (AA, 20:4n-6), in maternal and term infant nutrition as well as infant development. Consensus recommendations and practice guidelines for health-care providers supported by the World Association of Perinatal Medicine, the Early Nutrition Academy, and the Child Health Foundation are provided. The fetus and neonate should receive LC-PUFA in amounts sufficient to support optimal visual and cognitive development. Moreover, the consumption of oils rich in n-3 LC-PUFA during pregnancy reduces the risk for early premature birth. Pregnant and lactating women should aim to achieve an average daily intake of at least 200 mg DHA. For healthy term infants, we recommend and fully endorse breastfeeding, which supplies preformed LC-PUFA, as the preferred method of feeding. When breastfeeding is not possible, we recommend use of an infant formula providing DHA at levels between 0.2 and 0.5 weight percent of total fat, and with the minimum amount of AA equivalent to the contents of DHA. Dietary LC-PUFA supply should continue after the first six months of life, but currently there is not sufficient information for quantitative recommendations.

Use of alcohol and illicit drugs among pregnant Danish women, 1998.

AIMS: In 1999 the Danish National Board of Health adjusted its recommendation concerning alcohol in pregnancy: "Avoid alcohol in pregnancy if possible; If you drink, drink no more than 1 drink per day; do not drink every day". In this paper frequency and pattern of alcohol consumption and the use of illicit drugs during early pregnancy among pregnant Danish women are described. METHODS: From October to December 1998, 432 Danish-speaking pregnant women referred to the Midwife Centre in Aarhus, Denmark, for routine antenatal care were interviewed at their first visit at 15-16 weeks of gestation. The women were interviewed about average alcohol intake before pregnancy, binge drinking (intake of > or =5 drinks on a single occasion), and the use of illicit drugs in pregnancy. They subsequently filled in a two week diary on current alcohol intake. RESULTS: Nearly 90% of the women reduced their alcohol intake when they became pregnant. A total of 92% of women reported a maximum intake of three drinks/week, and only 1% exceeded the recommendations of average alcohol intake of six drinks/week. Nevertheless, 25% exceeded the recommended maximum daily intake of one drink in the second trimester, and 40% of the women reported at least one binge episode since conception. Binge drinkers tended to be smokers and primiparous women. CONCLUSIONS: Consumption peaks were a major problem in the first and second trimester. Midwives and doctors should pay special attention to binge drinking when inquiring about alcohol consumption and providing information on alcohol to pregnant women.