The pattern of blood lead during pregnancy was investigated in a cohort of 195 women who, between October 1992 and February 1995, entered prenatal care at Magee-Womens Hospital in Pittsburgh, Pennsylvania, by week 13 of pregnancy. Blood was drawn as many as five times, once in each of the first two trimesters and a maximum of three times in the third trimester. Blood lead determinations were made by atomic absorption spectrophotometry. Potential sources or modifiers of lead exposure were collected by interviews, including sociodemographic, pregnancy history, occupational, and lifestyle data. Results confirmed a previously reported U-shaped curve in blood lead concentration during pregnancy as well as findings that blood lead levels increase with age, smoking, lower educational level, and African-American race and decrease with history of breastfeeding and higher intake of calcium. Additionally, interactions were found between time since last menstrual period and both maternal age and calcium. Specifically, older mothers showed steeper increases in blood lead concentrations during the latter half of pregnancy than did younger mothers, and intake of calcium had a protective effect only in the latter half of pregnancy, an effect that became stronger as pregnancy progressed. These findings provide further evidence that lead is mobilized from bone during the latter half of pregnancy and that calcium intake may prevent bone demineralization.

Research on stress tends to support an adverse effect on pregnancy outcomes, and suggests that the impact of these stressors is modified by social class and/or race. This study explicitly examined social factors such as experiences of discrimination, either racial or sexual, and neighbourhood crime as predictors of stress. We also examined cortisol and stress as predictors of blood pressure. A subsample of 94 African-American pregnant women, aged 18-39 years, who were enrolled in a longitudinal study of pregnancy and exposure to lead in the environment were used in this analysis. The women were patients at an obstetrics clinic at Magee Women's Hospital in Pittsburgh, PA, USA. Younger age, higher income, lower education and experiences of discrimination, both racial and sexual, were related to greater perceived stress; however, life events were not related to perceived stress. Higher income and urinary cortisol adjusted for creatinine were related to systolic blood pressure after the 36th week. As a body of evidence suggests that stress can have deleterious effects in both pregnant and non-pregnant women, future research should examine these forms of discrimination, especially racial discrimination, as a possible reason for the disparity in adverse pregnancy outcomes between African-American and white women.

African American women have a relatively high belief of the severity of sickle cell disease and benefits of genetic counseling but frequently do not appear to believe that they are at risk of having a child with the disease. This should be taken into account in the design of educational and counseling strategies.

Aims: To determine the factors that affect why some infants receive higher exposures relative to the mother's body burden than do others. Methods: A total of 159 mother-infant pairs from a cohort of women receiving prenatal care at MageeWomens Hospital in Pittsburgh, PA from 1992 to 1995 provided blood samples at delivery for lead determination. The difference between cord and maternal blood lead concentration (PbB) and a dichotomous variable indicator of higher cord than maternal PbB, were examined as indicators of relative transfer. Women were interviewed twice during the pregnancy about lifestyle, medical history, calcium nutrition, and physical activity. Results: Higher blood pressure was associated with relatively greater cord compared with maternal PbB, as was maternal alcohol use. Sickle cell trait and higher haemoglobin were associated with a lower cord relative to maternal blood lead PbB. No association was seen with smoking, physical exertion, or calcium consumption. Conclusion: While reduction in maternal exposure will reduce fetal exposure, it may also be possible to mitigate infant lead exposure by reducing transfer from the pregnant woman. Interventions aimed at reducing blood pressure and alcohol consumption during pregnancy may be useful in this regard. E xposure to lead causes developmental problems. Although postnatal and childhood exposure can have effects at low concentrations, 1 children who have been exposed to lead in utero may also suffer from deficits in development (such as intelligence, information processing, memory, and verbal skills), 2-7 growth, 8 9 and behaviour.10 11Because lead is incorporated into the bone matrix where it is retained for decades, 12 13 prenatal exposure to lead also contributes to an earlier and cumulatively greater body burden.14 15Maternal and infant blood lead levels (PbB) are highly correlated across a wide range of exposure levels, [16][17][18] so the most obvious sources of variation in fetal lead dose are those that affect the maternal PbB. Some sources of infant PbB reflect direct maternal exposure, such as occupational lead exposure, exposure to lead paint, or use of lead glazed ceramics.19 Since cigarette smoke contains lead, 20 21 smoking and passive smoking could fall into this category as well. 22Other factors associated with infant PbB may reflect a lifestyle associated with increased environmental exposure to lead. Maternal coffee consumption and alcohol use, 22 23 higher blood pressure, 24 25 and seasonal patterns 26-28 are such variables.For over 30 years, it has been recognised that lead freely crosses the placenta via diffusion.29 30 It has generally been assumed that there is no general enhancement or barrier to transfer. 31 However, factors besides the maternal lead exposure and PbB also appear to affect the concentration in fetal blood. Although maternal PbB is on average about 30% higher than the infant's, in most studies approximately one quarter of the infants have PbB higher than their mothers. [32][33][34][35][36] Rothenberg and co...

Aims To assess the effect of brief motivational enhancement intervention postpartum alcohol use. Design Single-blinded, randomized controlled effectiveness trial in which pregnant women were assigned to receive usual care or up to 5 face-to-face brief motivational enhancement sessions lasting 10–30 minutes each and occurring at study enrollment, 4 and 8 weeks after enrollment, 32 weeks of gestation, and 6 weeks postpartum. Setting Large, urban, obstetrics clinic. Participants Women who were ≥18 years old, < 20 weeks of gestation, and consumed alcohol during pregnancy. Of 3438 women screened, 330 eligible women were assigned to usual care (n=165) or intervention (n=165). Due to missing data, we analyzed 125 in the intervention group and 126 in the usual care group. Measurements The proportion of women with any alcohol use and the number of drinks per day, reported via follow-up telephone interviews at 4 and 8 weeks after enrollment, 32 weeks of gestation, and 6 weeks, 6 months, and 12 months postpartum. Findings In random effects models adjusted for confounders, the intervention group was less likely to use any alcohol (odds ratio 0.50; 95% confidence interval [CI], 0.23 – 1.09; P=0.08) and consumed fewer drinks per day (coefficient −0.11; 95% CI −0.23 − 0.01; P=0.07) than the usual care group in the postpartum period but these differences were non-significant. Missing data during the prenatal period prevented us from modeling prenatal alcohol use. Conclusions Brief motivational enhancement intervention delivered in an obstetrical outpatient setting did not conclusively decrease alcohol use during the postpartum period.