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Structural equation modeling was used to examine the relationship of childhood trauma

This prospective study was an attempt to determine the frequency of viral hepatitis in general, and hepatitis E virus (HEV) in particular, in 62 pregnant women who had jaundice in the third trimester. Maternal serum was analyzed for markers of hepatitis A, B, C, and E viruses, and cord blood samples were tested for immunoglobulin M anti-HEV antibody by enzyme-linked immunosorbent assay. HEV-RNA was identified by the reverse transcriptase polymerase chain reaction technique.HEV infection was diagnosed in 45% of the 62 women. Nine of these women developed fulminant hepatic failure (FHF), defined as deep jaundice and hepatic encephalopathy developing within 4 weeks. Most HEV-positive women were primigravidas and presented at 32 to 34 weeks gestation. The largest number of cases occurred in July. Both fever and deeply colored urine were common signs of HEV infection. Serum levels of bilirubin, aspartate aminotransferase, and alanine aminotransferase were higher in women with FHF. HEV accounted for 37% of cases of acute viral hepatitis and 81% of cases of FHF. More than one fourth of women with HEV infection had obstetric complications, including premature rupture of membranes, intrauterine growth restriction, placenta previa, and retained placenta. Approximately two thirds of women with HEV infection had preterm deliveries. Only 5% were not delivered vaginally. Mortality for HEV-positive women was 27%. Vertical transmission was documented in 33% of 18 cases of HEV infection.One third of pregnant women with HEV in this study had severe hepatitis in the third trimester. HEV infection during pregnancy is associated with a high risk of both preterm labor and mortality. ABSTRACTOvarian tumors are reported in 1 of every 200 pregnancies and may cause serious problems such as torsion, infarction, and obstruction of vaginal delivery. These tumors have typically been removed by elective surgery, preferably in the second trimester. Because abdominal surgery significantly stresses both the mother and fetus, this study was planned to determine the optimal management of ovarian tumors in 89 pregnant women with tumors requiring surgery. Surgery was emergent because of torsion of the tumor in 36 cases (group A) and elective in 53 cases (group B).The 2 groups were similar in maternal age, parity, and gestational age at the time of surgery. Emergency surgery was done in the first, second, and third trimesters in 22, 5, and 9 women, respectively. Elective surgery was done in the second trimester in two thirds of cases and in the first trimester in the others. Mean birth weights were similar for the 2 groups, but preterm births were significantly more frequent in group A (22% vs. 4%). There was no group difference in gestational age at preterm delivery. Tumors were of comparable size in the 2 groups, and there was no difference in 8Obstetrical and Gynecological Survey ABSTRACTZinc deficiency in pregnancy probably is common all over the world but especially in developing countries and where women eat a diet based on cereals, vegetables, ...

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Maternal cocaine use during pregnancy can affect the infant directly through toxic effects or indirectly through cocaine's influence on maternal psychological status. We followed 160 cocaine exposed and 56 nonexposed infants and their mothers identified at birth through interview and/or urine screen. Although cocaine exposure defined the groups, infant exposure to alcohol, marijuana, and tobacco was allowed to vary. Infants were 99% African American and poor. All mothers completed the Brief Symptom Inventory (BSI) and infants were given the Bayley Scales of Mental (MDI) and Motor (PDI) Development at a mean corrected age of 17 ± 8 months. Both MDIs (94 ± 17 vs. 103 ± 16) and PDIs (101 ± 16 vs. 108 ± 12) were lower for cocaine exposed infants. Psychological distress was greater in cocaine using mothers. Hierarchical multiple regression was used to assess the relative effects of gestational age, maternal psychological distress, and cocaine and polydrug exposure on infant outcomes. Both psychological distress and cocaine and alcohol exposure predicted lower MDIs after controlling for prematurity. Neither psychological distress nor alcohol exposure predicted motor outcome, while cocaine had a significant effect. Tobacco and marijuana exposure were unrelated to outcome. These findings provide further support for direct effects of cocaine and alcohol on infant development, as well as highlight the need for studies to document maternal psychological factors, which may increase child risk for poorer outcomes.