This study evaulated the effects of diet, weight gain (low = LWG, less than or equal to 15 lb; adequate greater than 15 lb), smoking, and stress on the pregnancy outcomes of 60 women. LWG mothers, compared to adequate weight gain, had lower calorie intakes, shorter gestations (0.5 wk, Dubowitz) smaller placentas (345 +/- 65 versus 373 +/- 75 g), and infants with lower birth weight 2640 +/- 329 versus 3192 +/- 307 g), ponderal indices (2.37 versus 2.62), and growth rates. Mothers who smoked had increased calorie intake, but showed no alterations in gestational age of infants or placenta weights. Infants of smokers weighed less than those of nonsmokers (2875 +/- 522 versus 309 +/- 511 g), but had a normal ponderal index. LWG or smoking were associated with impaired motor performance, visual habituation and orientation, and reflexes. Smoking adversely affected auditory habituation and orientation, and autonomic regulation. LWG and smoking have significant, but separate, detrimental effects on pregnancy outcome.

This study examined the roles of diet, cigarette smoking, and psychological stress in pregnancy weight gain. The 60 were selected by defined criteria to minimize variation in anthropometric, socioeconomic, and medical variables which also affect weight gain. To maximize variation in weight gain, subjects were also selected on the basis of low weight gain (less than or equal to 15 lb) and adequate weight gain (greater than 15 lb). Each weight gain group contained smokers and nonsmokers. Smokers consumed more calories than nonsmokers (2119 versus 1810 kcal/day, p less than 0.01). for nonsmokers, differences between the intakes of low weight gain (1617 kcal/day) and adequate weight gain (1905 kcal/day) women were significant (p less than 0.02) and calorie intake was correlated with weight gain (r=0.44 p, less than 0.02). Psychological stress negatively correlated with weight gain (r=0.37, p less than 0.01) but not with calorie intake. We conclude that low weight gain is associated with a lower food intake. In contrast, smoking and stress may cause low weight gain by reducing the utilization of calories for weight gain.

Maternal serum alpha-fetoprotein (MSAFP) was determined in patients 33 to 40 weeks pregnant, and the Iesults were analysed with consideration of the presence and quality of hypertensive disease that complicated many of the pregnancies. Patients with incompletely controlled hypertension had significantly higher MSAFP levels than control patients with pregnancies uncomplicated by any risk factor. MSAFP elevation was greatest in pre-eclampsia (301.6 k 147.6 kU/L, n = 35) >chronic hypertension with superimposed pre-eclampsia (240.4 f 74.7 kU/L, n = 30) > chronic hypertension (204.1 f 105.3 kU/L, n = 141). Each was significantly increased (P< 0.0001) over control pregnant patients' levels (104.3 f 38.8, n= 187). At each gestational week from 33 weeks to term, MSAFP of combined hypertensive women was significantly greater than corresponding control levels (P < 0.003 to < 0-Oool).The magnitude and time of onset of MSAFP increase may indicate severe fetal distress.

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