P regnancy-induced hypertension (PIH) or pregnancyaggravated hypertension (PAH) occurs in B7% of pregnant women, but whether medical treatment for mildto-moderate gestational hypertension is necessary is controversial. Knowledge of the long-term effects of prenatal exposure to antihypertensive medications is necessary so that risks to the infant can be weighed against benefits to the mother. This historical cohort study examined the functional development of children whose mothers were treated with labetalol or methyldopa or received no antihypertensive medication (bed rest only) for mildto-moderate gestational hypertension.The children studied were born at 12 Dutch hospitals (7 teaching hospitals, 5 general hospitals) whose mothers agreed to participate in the study. The mothers of these children had received prenatally either labetalol or methyldopa, or were treated only with bed rest for gestational hypertension. Functional development was measured at ages 4 to 10 year using standard tests that assessed IQ, concentration, memory, motor development, and behavior. Linear regression and the Pearson w 2 tests were used to compare the 3 groups.A total of 4000 hospital records were reviewed, from which data on 355 mother-child pairs were extracted; 99 were treated with labetalol, 101 with methyldopa, and 155 with bed rest. Of these 355 women, 275 agreed to allow their children to participate. Ultimately, 203 children met eligibility criteria, and 202 underwent testing. Pregnancy characteristics were determined from the patients' hospital records. Compared with the medication groups, the bedrest only patients had a later onset of hypertension, more often had PIH rather than PAH, and were less likely to receive any other drugs for their disorder. Nearly 20% of women in the labetalol and methyldopa groups received phenobarbital during the pregnancy. Infants in the bed-rest group were less likely than those in the medication groups to be born very preterm, but were more likely to be small for gestational age. The groups did not differ significantly for modes of delivery and the presence of other pregnancy complications. Treatment in the methyldopa group began earlier in the pregnancy compared to women in the labetalol group, and women receiving methyldopa more frequently received other medical treatments for PIH/PAH.There was a trend towards better gross motor development for children in the labetalol and bed-rest groups compared to youngsters in the methyldopa group, but this was not statistically significant. More children in the labetalol group had attention deficit hyperactivity disorder compared to children whose mothers received methyldopa or were only on bed rest during the pregnancy. Children in the methyldopa group were more likely to have sleeping problems as reported by their parents than children in the labetalol or bed-rest groups. Other aspects of functional development were not found to differ among the three groups.In this historical cohort study, prenatal exposure to labetalol was associated with an inc...

Vitamin B12 is important for infant growth and supplementation to lactating mothers could increase intakes to exclusively breastfed (EBF) infants in areas where maternal diet is poor in B12. HIV+ mothers in the Breastfeeding, Antiretrovirals, and Nutrition study were randomized to receive a lipid‐based nutrient supplement (LNS), containing the RDA for B12 (2.6μg), or no LNS. We examined the relationships among maternal and infant plasma (MP, IP) and breastmilk (BM) concentrations of B12 in a sub‐sample (n=521) at 2 or 6 wk (baseline) and 24 wk. At baseline MP B12 was positively correlated with BM (r=0.36) and IP (r=0.42), and IP and BM B12 were correlated (r=0.32) (all p<0.001). At 24 wk the relationships remained significant: MP B12 with BM (r=0.42) and IP (r=0.32), and IP with BM (r=0.29). At baseline there were no differences between LNS and no LNS in MP, BM or IP B12 concentrations. At 24 wk MP and BM B12 were higher in the LNS vs. no LNS group (p<0.005).However IP B12 was not increased by LNS despite strong correlation among IP, BM and MP. IP B12 is likely explained by maternal status in pregnancy. Maternal supplementation with 1 RDA of B12 was insufficient to improve IP concentrations through breast milk in this population, suggesting that higher levels of supplementation may be necessary.Grant Funding Source: CDC (U48‐DP000059–01); Bill & Melinda Gates Foundation (OPP53107); Carolina Population Center (NICHD 5 R24 HD050924); USDA, ARS‐WHNRC.

Little is known about inflammation in young infants. We assessed C‐reactive protein (CRP) in exclusively breastfed (EBF) infants (n=537) born to HIV‐infected Malawian women in the Breastfeeding, Antiretrovirals and Nutrition Study (BAN). BAN mothers were randomized to receive a lipid‐based nutrient supplement (LNS), meeting nutritional needs of lactation, or no LNS and to a maternal, infant or no antiretroviral (ARV) regimen, with counseling for EBF to 24 weeks. Maternal and infant CRP levels were measured at 2 (n=366) or 6 (n=170) weeks, and 24 weeks. Infant CRP was elevated early (geometric mean at 2 weeks= 4.4 mg/L) but declined to 1.6 mg/L at 24 weeks, while maternal CRP increased from 0.65 to 1.82 mg/L. In linear regression models, log infant CRP at 6 weeks was significantly positively related to concurrently measured maternal BMI and CRP and inversely related to maternal CD4>500, but unrelated to treatment arm or infant BMI, sex, or infections. At 24 weeks, infant CRP was significantly related to infant infection and higher maternal BMI. Logistic regression comparing low to medium or high inflammation also showed that inflammation in young, EBF infants is driven mainly by maternal factors. By 24 weeks, while maternal factors still predicted infant CRP, infant infections became an important contributor to elevated CRP. Support: CDC U48‐DP000059‐01, Bill & Melinda Gates Foundation OPP53107, CPC R24 HD050924.