Background: Epidural anesthesia is commonly administered to laboring women. Some studies have suggested that epidural anesthesia might inhibit breast-feeding. This study explores the association between labor epidural anesthesia and early breast-feeding success.Methods: Standardized records of mother-baby dyads representing 115 consecutive healthy, fullterm, breast-feeding newborns delivered vaginally of mothers receiving epidural anesthesia were analyzed and compared with 116 newborns not exposed to maternal epidural anesthesia. Primary outcome was two successful breast-feeding encounters by 24 hours of age, as defined by a LATCH breast-feeding assessment score of 7 or more of 10 and a latch score of 2/2. Means were compared with the KruskalWallis test. Categorical data were compared using the Mantel-Haenszel chi-square test. Stratified analysis of potentially confounding variables was performed using Mantel-Haenszel weighted odd ratios (OR) and chi-square for evaluation of interaction.Results: Both epidural and nonepidural anesthesia groups were similar except maternal nulliparity was more common in the epidural anesthesia group. Two successful breast-feedings within 24 hours of age were achieved by 69.6% of mother-baby units that had had epidural anesthesia compared with 81.0% of mother-baby units that had not (odds ratio [OR] 0.53, P ‫؍‬ .04). These relations remained after stratification (weighted odds ratios in parenthesis) based on maternal age (0.52), parity (0.58), narcotics use in labor (0.49), and first breast-feeding within 1 hour (0.49). Babies of mothers who had had epidural anesthesia were significantly more likely to receive a bottle supplement while hospitalized (OR 2.63; P < .001) despite mothers exposed to epidural anesthesia showing a trend toward being more likely to attempt breast-feeding in the 1 hour (OR 1.66; P ‫؍‬ .06). Mothers who had epidural anesthesia and who did not breast-feed within 1 hour were at high risk for having their babies receive bottle supplementation (OR 6.27). Conclusions

Magnesium sulfate has been used for some time in the United States to prevent eclampsia. It dilates cerebral blood vessels and can reduce ischemia by preventing cerebral vasospasm. If eclampsia is in fact a result of cerebral ischemia, the calcium-channel blocker nimodipine, a specific cerebral vasodilator, would seem to be an ideal alternative treatment. Nimodipine can be given orally, has little toxicity, and lowers blood pressure. This unblinded trial randomized women with severe preeclampsia, for whom delivery had been decided on, to receive either 60 mg of nimodipine by mouth every 4 hours or a 6-g loading dose of magnesium sulfate followed by an infusion of 2 g per hour. An alternative was to administer 4 g at the outset to be followed by an infusion of 1 g per hour. Treatment continued for up to 24 hours antepartum. Participants were accessed from 14 centers in 8 countries. The 819 women randomized to receive nimodipine and the 831 given magnesium sulfate were comparable demographically and clinically, except for slightly higher baseline systolic blood pressure in the magnesium sulfate group. Mean arterial pressure fell by 8% on average within 1 hour of the start of treatment, and the reduction was maintained at 3 hours. Nimodipine-treated patients were significantly likelier to have a seizure than those given magnesium (2.6% vs. 0.8%). The crude relative risk of a seizure with nimodipine was 3.0. The majority of seizures in this group and all those in the magnesium sulfate group occurred in the antepartum period. The group difference in seizure risk was significant only in the postpartum period. Women given magnesium more often required hydralazine to control blood pressure and more frequently had postpartum bleeding. In addition, respiratory problems were more numerous in these patients. Rates of eclampsia were 1.4% in the nimodipine group and 0.5% in women given magnesium sulfate. This study shows that magnesium sulfate is a more effective means of preventing eclampsia in women with severe preeclampsia than is nimodipine. The findings suggest that eclampsia might be a result of cerebral overperfusion rather than decreased blood flow. ABSTRACTUsing caffeine while pregnant reportedly increases the risk of both spontaneous abortion and low birth weight. Caffeine augments catecholamine release from the renal medulla, possibly causing constriction of uteroplacental vessels and consequent fetal hypoxia. It also is possible that caffeine directly affects the fetal cardiovascular system, resulting in tachycardia and other arrhythmias. This prospective follow-up study sought information on coffee drinking from 18,478 women bearing singleton pregnancies. Participants completed questionnaires before their first antenatal visit, at approximately 16 weeks' gestation.The overall risk of stillbirth (defined as delivery of a dead fetus at 28 weeks' gestation or later) was 4.4 per 1000, and the risk of infant death during the first year of life was 4.0 per 1000. Stillbirths increased with the number of cups of coffee dr...