Physical activity and aging research: opportunities abound.

Aging is associated with large between-subjects variability in motor function among older adults, which can compromise identifying the mechanisms for age-related reductions in motor performance. This variability is in part explained by differences among older adults in habitual physical activity. Quantifying and accounting for physical activity levels of the participants in aging studies will help differentiate those changes in motor function associated with biological aging rather than those induced by inactivity. Novelty: Quantification of physical activity levels in studies with older participants will help differentiate the effects of aging rather than physical inactivity.

Only women report increase in pain threshold following fatiguing contractions of the upper extremity.

PURPOSE: The perception of pain in response to a noxious stimulus can be markedly reduced following an acute bout of exercise [exercise-induced hypoalgesia (EIH)]. Sex differences in EIH frequently occur after exercise but may be confounded by the sex differences in muscle fatigue. The purpose was to determine if sex differences in pain relief occur after an exercise protocol when muscle fatigue is similar for both young and older men and women. METHODS: Pain perception of 33 men (15 young) and 31 women (19 young) was measured using a pressure pain stimulus on the left index finger before and after maximal velocity concentric contractions of knee extensors or elbow flexors (separate days). During the 2-min pressure pain test, participants verbally indicated the onset of pain (pain threshold) and reported pain intensity (0-10) every 20 s. RESULTS: Only women experienced an increase in pain threshold (30 ± 27 to 41 ± 32 s) following elbow flexor exercise (trial × sex: p = 0.03). Neither men nor women experienced an increase in pain threshold following knee extensor exercise, and pain ratings were unchanged after exercise with either limb (p > 0.05). The pain response to exercise was similar in young and older adults (trial × age: p > 0.05), despite older adults demonstrating greater fatigability than young adults for the elbow flexor and knee extensor exercise tasks. CONCLUSIONS: Under controlled conditions where muscle fatigue is similar, sex differences in EIH occur in young and older adults that is site specific (upper extremity). Only women experience EIH following acute single limb high-velocity contractions.

Sex differences in elite swimming with advanced age are less than marathon running.

The sex difference in marathon performance increases with finishing place and age of the runner but whether this occurs among swimmers is unknown. The purpose was to compare sex differences in swimming velocity across world record place (1st-10th), age group (25-89 years), and event distance. We also compared sex differences between freestyle swimming and marathon running. The world's top 10 swimming times of both sexes for World Championship freestyle stroke, backstroke, breaststroke, and butterfly events and the world's top 10 marathon times in 5-year age groups were obtained. Men were faster than women for freestyle (12.4 ± 4.2%), backstroke (12.8 ± 3.0%), and breaststroke (14.5 ± 3.2%), with the greatest sex differences for butterfly (16.7 ± 5.5%). The sex difference in swimming velocity increased across world record place for freestyle (P < 0.001), breaststroke, and butterfly for all age groups and distances (P < 0.001) because of a greater relative drop-off between first and 10th place for women. The sex difference in marathon running increased with the world record place and the sex difference for marathon running was greater than for swimming (P < 0.001). The sex difference in swimming increased with world record place and age, but was less than for marathon running. Collectively, these results suggest more depth in women's swimming than marathon running.

Sex differences in human fatigability: mechanisms and insight to physiological responses.

Sex-related differences in physiology and anatomy are responsible for profound differences in neuromuscular performance and fatigability between men and women. Women are usually less fatigable than men for similar intensity isometric fatiguing contractions. This sex difference in fatigability, however, is task specific because different neuromuscular sites will be stressed when the requirements of the task are altered, and the stress on these sites can differ for men and women. Task variables that can alter the sex difference in fatigability include the type, intensity and speed of contraction, the muscle group assessed and the environmental conditions. Physiological mechanisms that are responsible for sex-based differences in fatigability may include activation of the motor neurone pool from cortical and subcortical regions, synaptic inputs to the motor neurone pool via activation of metabolically sensitive small afferent fibres in the muscle, muscle perfusion and skeletal muscle metabolism and fibre type properties. Non-physiological factors such as the sex bias of studying more males than females in human and animal experiments can also mask a true understanding of the magnitude and mechanisms of sex-based differences in physiology and fatigability. Despite recent developments, there is a tremendous lack of understanding of sex differences in neuromuscular function and fatigability, the prevailing mechanisms and the functional consequences. This review emphasizes the need to understand sex-based differences in fatigability to shed light on the benefits and limitations that fatigability can exert for men and women during daily tasks, exercise performance, training and rehabilitation in both health and disease.

Effects of type 1 diabetes, sprint training and sex on skeletal muscle sarcoplasmic reticulum Ca2+ uptake and Ca2+-ATPase activity.

Calcium cycling is integral to muscle performance during the rapid muscle contraction and relaxation of high-intensity exercise. Ca(2+) handling is altered by diabetes mellitus, but has not previously been investigated in human skeletal muscle. We investigated effects of high-intensity exercise and sprint training on skeletal muscle Ca(2+) regulation among men and women with type 1 diabetes (T1D, n = 8, 3F, 5M) and matched non-diabetic controls (CON, n = 8, 3F, 5M). Secondarily, we examined sex differences in Ca(2+) regulation. Subjects undertook 7 weeks of three times-weekly cycle sprint training. Before and after training, performance was measured, and blood and muscle were sampled at rest and after high-intensity exercise. In T1D, higher Ca(2+)-ATPase activity (+28%) and Ca(2+) uptake (+21%) than in CON were evident across both times and days (P < 0.05), but performance was similar. In T1D, resting Ca(2+)-ATPase activity correlated with work performed until exhaustion (r = 0.7, P < 0.01). Ca(2+)-ATPase activity, but not Ca(2+) uptake, was lower (-24%, P < 0.05) among the women across both times and days. Intense exercise did not alter Ca(2+)-ATPase activity in T1D or CON. However, sex differences were evident: Ca(2+)-ATPase was reduced with exercise among men but increased among women across both days (time × sex interaction, P < 0.05). Sprint training reduced Ca(2+)-ATPase (-8%, P < 0.05), but not Ca(2+) uptake, in T1D and CON. In summary, skeletal muscle Ca(2+) resequestration capacity was increased in T1D, but performance was not greater than CON. Sprint training reduced Ca(2+)-ATPase in T1D and CON. Sex differences in Ca(2+)-ATPase activity were evident and may be linked with fibre type proportion differences.

Theoretical prediction of induction period from transient pore evolvement in polyester-based microparticles.

A model was developed and compared to experimental results for prediction of the induction period during drug delivery from various compositions of biodegradable copolymer PLGA microparticles. The uniqueness of this model is that it considers transient pore evolvement and uses the kinetic parameters of polymer degradation, which are independent of experimental measurements of microparticle erosion, in its analysis. Delivery data from PLGA microparticles (50:50, 75:25, and 85:15) releasing ovalbumin (OVA, 46 kDa) and bovine serum albumin (BSA, 66 kDa) were determined and used as the model systems. Experimental measurements were carried out from 85 to 150 days depending on the PLGA characteristics. The predicted induction periods were approximately 45, 70, and 105 days for the release of both OVA and BSA from 50:50, 75:25, and 85:15 PLGA microparticles, respectively. Overall, these values were in very good agreement with experimentally estimated results.

Rotary culture enhances pre-osteoblast aggregation and mineralization.

Three-dimensional environments have been shown to enhance cell aggregation and osteoblast differentiation. Thus, we hypothesized that three-dimensional (3D) growth environments would enhance the mineralization rate of human embryonic palatal mesenchymal (HEPM) pre-osteoblasts. The objective of this study was to investigate the potential use of rotary cell culture systems (RCCS) as a means to enhance the osteogenic potential of pre-osteoblast cells. HEPM cells were cultured in a RCCS to create 3D enviroments. Tissue culture plastic (2D) cultures served as our control. 3D environments promoted three-dimensional aggregate formations. Increased calcium and phosphorus deposition was significantly enhanced three- to 18-fold (P < 0.001) in 3D cultures as compared with 2D environments. 3D cultures mineralized in 1 wk as compared with the 2D cultures, which took 4 wks, a decrease in time of nearly 75%. In conclusion, our studies demonstrated that 3D environments enhanced osteoblast cell aggregation and mineralization.

Activation varies among the knee extensor muscles during a submaximal fatiguing contraction in the seated and supine postures.

Ten young men sustained an isometric contraction of the knee extensor muscles at 20% of the maximum voluntary contraction (MVC) torque on three separate occasions in a seated posture. Subjects performed an isometric knee extension contraction on a fourth occasion in a supine posture. The time to task failure for the seated posture was similar across sessions (291 +/- 84 s; P > 0.05), and the MVC torque was similarly reduced across sessions after the fatiguing contraction (42 +/- 12%). The rate of increase in electromyograph (EMG) activity (%MVC) and torque fluctuations during the fatiguing contractions were similar across sessions. However, the rate of increase in EMG differed among the knee extensor muscles: the rectus femoris began at a greater amplitude (31.5 +/- 11.0%) compared with the vastus lateralis and vastus medialis muscles (18.8 +/- 5.3%), but it ended at a similar value (45.4 +/- 3.1%). The time to task failure and increase in EMG activity were similar for the seated and supine tasks; however, the reduction in MVC torque was greater for the seated posture. These findings indicate that the time to task failure for the knee extensor muscles that have a common tendon insertion did not alter over repeat sessions as had been observed for the elbow flexor muscles (Hunter SK and Enoka RM. J Appl Physiol 94: 108-118, 2003).

Mathematical modeling of myoglobin facilitated transport of oxygen in devices containing myoglobin-expressing cells.

Low pO(2) is perhaps the most significant factor in artificial pancreas failure. In these environments, not only is the beta cell production of insulin reduced, but the cell death rate is also significantly higher. Mathematical models are developed to test the feasibility of facilitated oxygen transport in enhancing O(2) flux to genetically engineered cells in a bioartificial device such as a pancreas. For this device, it is proposed that beta cells be genetically engineered to express myoglobin throughout the cell. In addition, the significance of including myoglobin throughout the alginate matrix present to provide immuno-protection for the transplanted cells is considered. The mathematical analysis predicts that myoglobin facilitated oxygen transport has the potential of increasing the oxygen concentration at the centre of a cluster of cells (islet) with an effective radius of 100 microm by 50%. These theoretical models for myoglobin facilitated oxygen transport with homogeneous Michaelis-Menten consumption also indicate that including myoglobin in the alginate gel would beneficially improve the flux of oxygen to the transplanted cells.

Biodegradable microspheres containing group B Streptococcus vaccine: immune response in mice.

OBJECTIVE: This study seeks to show the feasibility of producing a group B Streptococcus (GBS) vaccine, which is capable of producing both a local IgA immune response at the mucosal surface where GBS is colonized and a humoral IgG response, which is capable of transplacental passive immunization. STUDY DESIGN: Inactivated GBS antigen was microencapsulated in poly (D, L-lactic-co-glycolic acid) (PLG) with a water-in-oil-in-water double emulsion technique. Immunostimulatory synthetic oligodeoxynucleotides containing cytidine-phosphate-guanosine (CpG) motifs were coencapsulated as a potent adjuvant. The ICR strain of mouse was used in these studies. Female mice with normal immune systems were immunized with the PLG microparticles containing GBS type III polysaccharide (GBS PS) vaccine and CpG adjuvant (PLG/GBS/CpG) via the oral, vaginal, or nasal routes or by the intramuscular or intraperitoneal routes. Booster doses were administered 4 weeks after the initial immunization. Vaginal washings and blood samples were obtained 3 weeks after the booster dose and examined for both IgG and secretory IgA (sIgA) GBS antibodies with the use of an enzyme-linked immunoabsorbent assay method. RESULTS: PLG/GBS/CpG microparticles elicited a significantly higher GBS antibody response when compared with nonencapsulated GBS antigen or PLG-encapsulated GBS PS vaccine without the addition of the CpG adjuvant. IgG and secretory IgA (sIgA) antibodies to GBS antigen were documented in both the vaginal washings and blood samples. CONCLUSION: Preliminary findings indicate that this novel PLG/GBS/CpG vaccine elicited both IgA and IgG antibody responses to the GBS PS antigen studied. This antibody response may provide both protection against maternal GBS colonization and passive transplacental immunization for the fetus and neonate.

Sex differences in the fatigability of arm muscles depends on absolute force during isometric contractions.

Women are capable of longer endurance times compared with men for contractions performed at low to moderate intensities. The purpose of the study was 1) to determine the relation between the absolute target force and endurance time for a submaximal isometric contraction and 2) to compare the pressor response and muscle activation patterns of men [26.3 +/- 1.1 (SE) yr] and women (27.5 +/- 2.3 yr) during a fatiguing contraction performed with the elbow flexor muscles. Maximal voluntary contraction (MVC) force was greater for men (393 +/- 23 vs. 177 +/- 7 N), which meant that the average target force (20% of MVC) was greater for men (79.7 +/- 6.5 vs. 36.7 +/- 2.0 N). The endurance time for the fatiguing contractions was 118% longer for women (1,806 +/- 239 vs. 829 +/- 94 s). The average of the rectified electromyogram (%MVC) for the elbow flexor muscles at exhaustion was similar for men (31 +/- 2%) and women (30 +/- 2%). In contrast, the heart rate and mean arterial pressure (MAP) were less at exhaustion for women (94 +/- 6 vs. 111 +/- 7 beats/min and 121 +/- 5 vs. 150 +/- 6 mmHg, respectively). The target force and change in MAP during the fatiguing contraction were exponentially related to endurance time (r(2) = 0.68 and r(2) = 0.64, respectively), whereas the change in MAP was linearly related to target force (r(2) = 0.51). The difference in fatigability of men and women when performing a submaximal contraction was related to the absolute contraction intensity and was limited by mechanisms that were distal to the activation of muscle.

Effect of 10-day cast immobilization on sarcoplasmic reticulum calcium regulation in humans.

This study investigated the effects of 10-day lower limb cast immobilization on sarcoplasmic reticulum (SR) Ca2+ regulation. Muscle biopsies were analysed in eight healthy females for maximal rates of SR Ca2+ release, Ca2+ uptake and Ca2+ ATPase activity at control, during immobilization at day 3 (IM 3), day 6 (IM 6) and day 10 (IM 10). Quadriceps muscle cross-sectional area (CSA) and 1-repetition maximum (1RM) leg extension strength were measured to determine the extent of muscle size and strength adaptations. Muscle CSA and strength decreased following 10 days of immobilization (11.8 and 41.6%, respectively, P < 0.01). A decrease in SR Ca2+ uptake rate (analysed per g wet wt) was found at IM 3 (13.2%, P=0.05), with a further decrease at IM 10 (19.8% from control, P < 0.01). At IM 10, a decrease in SR Ca2+ uptake rate (per mg protein) also occurred (19.9%, P < 0.01). Sarcoplasmic reticulum Ca2+ ATPase activity and rate of Ca2+ release were not altered with 10 days of immobilization. This study observed a decrease in SR Ca2+ uptake rate, muscular atrophy and strength loss over 10 days of immobilization in humans.

Leukemia in pregnancy and fetal response to multiagent chemotherapy.

BACKGROUND: Leukemia is rare in pregnancy and treatment with intensive, multiagent chemotherapy produces complete remission in most adults, but might have deleterious effects on fetuses. CASE: A 24-year-old gravida 3 para 2 presented at 24 weeks with pruritus, rash, pancytopenia, and hepatitis. A bone marrow biopsy found acute lymphocytic leukemia. She completed three cycles of intensive multiagent chemotherapy with transient oligohydramnios in each cycle. Although there was decreased fetal growth rate, umbilical artery Doppler scans were normal. She delivered a normal 2150-g male infant at 36 weeks. CONCLUSION: Pregnant women with newly diagnosed leukemia should not delay treatment, but multiagent chemotherapy might have transient effects on fetuses, most notably oligohydramnios. However, if fetal testing is normal, delivery might not be indicated.

Periodontal disease in pregnancy complicated by type 1 diabetes mellitus.

BACKGROUND: Systemic disease and hormonal changes have been implicated as complicating factors for periodontal disease. Diabetes has been identified as a risk factor for periodontal disease, and diabetics can experience periodontal destruction at an earlier age than non-diabetic individuals. Increased hormone levels during pregnancy can contribute to increased gingival inflammation. The purpose of this study was to examine the association of type 1 diabetes mellitus (DM) on the periodontal status of pregnant women. METHODS: Thirty-three (13 diabetic and 20 non-diabetic) subjects, 20 to 39 weeks gestation, participated in this study. The mean age of the diabetics and non-diabetics was 28.5 +/- 7.1 (SD) and 27.0 +/- 7.3 years, respectively. The following parameters were assessed at Ramfjord's reference teeth: plaque index (PI), gingival inflammation (GI), probing depth (PD), gingival margin (GM) location, and clinical attachment level (CAL). RESULTS: Diabetic subjects had significantly (P<0.001) higher PI (1.48 +/- 0.69) and GI (1.77 +/- 0.44) scores than non-diabetics (PI = 0.63 +/- 0.38; GI = 0.93 +/- 0.48). Mean PD for diabetics (2.95 +/- 0.69 mm) was significantly different (P<0.024) from that of non-diabetics (2.44 +/- 0.32 mm). Although mean GM location was coronal to the cemento-enamel junction (CEJ) in both groups, gingival margins were at a more apical position (P<0.001) in the diabetics (-0.20 +/- 1.24 mm) compared to non-diabetics (-1.76 +/- 0.53 mm). Mean CAL values also varied significantly (P<0.001) between diabetics (2.60 +/- 1.54 mm) and non-diabetics (0.68 +/- 0.65 mm). Significant differences were seen for GI (P<0.001), PD (P=0.005), GM location (P<0.001), and CAL (P<0.001) when assessing the effect of diabetes and controlling for plaque. When assessing the effect of plaque and controlling for diabetes, the only significant difference was GI (P=0.001). CONCLUSIONS: The results of this study demonstrate that periodontal inflammation and destruction are increased in pregnant diabetics as compared to non-diabetic pregnant patients. These findings may have implications for diabetic control and, hence, maternal and fetal outcomes in pregnant diabetic patients.

Group B streptococci causing neonatal bloodstream infection: antimicrobial susceptibility and serotyping results from SENTRY centers in the Western Hemisphere.

OBJECTIVE: Group B streptococcal infection is a common cause of neonatal sepsis. Surveillance of antimicrobial susceptibility and serotype frequencies of invasive group B streptococci is important to ensure the effectiveness of therapeutic regimens and to guide vaccine development. STUDY DESIGN: Prospective surveillance of neonatal bloodstream infection was performed at all Western Hemisphere sites participating in the SENTRY Program. From January 1997 through December 1999, a total of 122 isolates of bloodstream infections with group B streptococci were collected and sent to the University of Iowa for antimicrobial susceptibility testing and serotyping. RESULTS: No isolates were resistant to penicillin. More than 25% of isolates from US hospitals and 14% of isolates from Canadian hospitals were erythromycin resistant. Seven percent of isolates from the United States and Canada were resistant to clindamycin. No clindamycin or erythromycin resistance was found among isolates from Latin America. Clindamycin and erythromycin resistance was most frequent among serotype V strains. CONCLUSIONS: No emerging resistance to penicillin was noted among bloodstream infection isolates of group B streptococci from a broad geographic area; erythromycin and clindamycin resistance was found in the United States and Canada and appeared most frequently among serotype V strains.

Relationships among age-associated strength changes and physical activity level, limb dominance, and muscle group in women.

This study investigated the magnitude and rate of age-associated strength reductions in Australian independent urban-dwelling women and the relationship to muscle groups, limb dominance, and physical activity level. Independent urban-dwelling women aged 20 to 89 years (N = 217) performed maximal voluntary contractions with the dominant and nondominant knee extensors, plantar flexors, and handgrip. Anthropometric measurements were made and questionnaire responses used to obtain current physical activity levels. Trend analysis within analysis of variance and regression analysis on strength was performed. Limb muscle strength was found to be associated with increased age, muscle group, limb dominance, and activity. Self-reported physical activity levels declined with age but women who were more physically active for their age group were stronger in all muscle groups and had more lean body mass and lean thigh and leg cross-sectional area than relatively inactive women. Slopes of the linear reductions of maximal voluntary strength of the knee extensors, plantar flexors, and handgrip with age were significantly different (p < .05) at 9.3%, 7.4%, and 6.2% per decade, respectively. The limb muscle strength of healthy Australian independent and urban-dwelling women aged 20 to 89 years was found to be associated with age and three aspects of disuse: muscle group, relative levels of physical activity, and limb dominance.

Present and future perspectives on the use of free or encapsulated pancreatic islet cell transplantation as a treatment of pregnancy complicated by type 1 diabetes.

Pregnancies complicated by insulin-dependent diabetes mellitus (IDDM) pose significant health risks to both the mother and her developing fetus. Congenital malformations in the offspring of diabetic mothers have an incidence which is 2-5 times that seen in the background. Euglycemia in the first trimester of pregnancy can reduce this incidence, but achieving euglycemia with conventional exogenous insulin therapy is both costly and difficult. Even with intense insulin dosage adjustments, the blood glucose profile of the diabetic pregnant patient does not mimic that seen in nondiabetic patients. Both the difficulties and inadequacies of conventional therapy for IDDM-complicated pregnancy provide a stimulus for research to develop improved therapeutic modalities. Islet transplantation holds great promise as a treatment for pregnancies complicated by IDDM. This article reviews the current status of islet transplantation including the use of immunomodulation and immunoisolation techniques and their potential use for the treatment of IDDM pregnancies.

In vivo biocompatibility evaluation of Cibacron blue-agarose.

This study investigated the biocompatibility of Cibacron blue-agarose as a biomaterial for microencapsulation. Cibacron blue-agarose is known to have an affinity for albumin under certain pH conditions and in the proper steric environment. Thus it was postulated that the material's high affinity for host albumin might reduce a secondary immune response and reduce the fibrotic overgrowth that often accompanies transplanted foreign materials. In vivo tests were performed using the Lewis rat model. Both Cibacron blue-agarose and plain agarose disks were prepared, with some disks from each group being pre-exposed to sera from Lewis rats. The disks were transplanted into the peritoneal cavities of Lewis rats. After 115 days the disks were excised. Fibrotic overgrowth was analyzed using light microscopy, and a blind study was used to measure the average growth thickness on each disk. The results demonstrated that all disks developed some fibrotic encapsulation and that the presence of Cibacron blue was not significant in reducing fibrotic overgrowth (p = 0.62). Agarose disks pre-exposed to sera had significantly less average overgrowth than any other group (p = 0. 06).

Human skeletal sarcoplasmic reticulum Ca2+ uptake and muscle function with aging and strength training.

This study investigated the adaptations of skeletal muscle sarcoplasmic reticulum (SR) Ca2+ uptake, relaxation, and fiber types in young (YW) and elderly women (EW) to high-resistance training. Seventeen YW (18-32 yr) and 11 EW (64-79 yr) were assessed for 1) electrically evoked relaxation time and rate of the quadriceps femoris; and 2) maximal rates of SR Ca2+ uptake and Ca2+-ATPase activity and relative fiber-type areas, analyzed from muscle biopsies of the vastus lateralis. EW had significantly slower relaxation rates and times, decreased SR Ca2+ uptake and Ca2+-ATPase activity, and a larger relative type I fiber area than did YW. A subgroup of 9 young (YWT) and 10 elderly women (EWT) performed 12 wk of high-resistance training (8 repetition maximum) of the quadriceps and underwent identical testing procedures pre- and posttraining. EWT significantly increased their SR Ca2+ uptake and Ca2+-ATPase activity in response to training but showed no alterations in speed of relaxation or relative fiber-type areas. In YWT none of the variables was altered after resistance training. These findings suggest that 1) a reduced SR Ca2+ uptake in skeletal muscle of elderly women was partially reversed with resistance training and 2) SR Ca2+ uptake in the vastus lateralis was not the rate-limiting mechanism for the slowing of relaxation measured from electrically evoked quadriceps muscle of elderly women.

Perinatal management of women with immune thrombocytopenic purpura: survey of United States perinatologists.

OBJECTIVE: The aim of the study was to determine how perinatologists in the United States manage the care of women with immune thrombocytopenic purpura with respect to mode of delivery. STUDY DESIGN: US members of the Society of Perinatal Obstetricians were surveyed with a 4-question questionnaire. Two mailings were sent. Questions 1 and 2 asked for a response regarding the perinatal management of delivery for women with chronic immune thrombocytopenic purpura and new-onset disease. The options were cordocentesis or fetal scalp blood sampling and cesarean delivery if the platelet count was <50,000 cells/microL, cesarean delivery if the maternal platelet count was <50,000 cells/microL, cesarean delivery of all women with immune thrombocytopenic purpura, and trial of labor without determining fetal platelet count. The third question asked for an opinion on whether cesarean delivery was protective against intracranial hemorrhage in cases of immune thrombocytopenic purpura. The fourth question asked whether the practitioner was in academic or private practice or both. RESULTS: Among the 1596 perinatologists surveyed, there were 940 informative responses (58.9%). Most would allow a trial of labor for women with chronic (59.0%) or new-onset (66.6%) immune thrombocytopenic purpura. In cases of chronic immune thrombocytopenic purpura, 31.0% of those responding would perform an invasive procedure to determine fetal platelet count, followed by cesarean delivery if this count was <50, 000 cells/microL. In cases of new-onset immune thrombocytopenic purpura, 25.4% would do so. Of the respondents, 11.8% reportedly considered cesarean delivery protective against intracranial hemorrhage, whereas 56.6% did not and 31.6% were unsure. CONCLUSIONS: The management of women with immune thrombocytopenic purpura remains controversial in the United States. Approximately two thirds of perinatologists would allow a trial of labor without a procedure to determine fetal platelet count. Most physicians surveyed did not consider cesarean delivery to be protective against intracranial hemorrhage.