High maternal serum alpha-fetoprotein (AFP) levels during pregnancy may be instrumental in reducing the subsequent risk of breast cancer. This hypothesis was tested in a nested case-control study using stored frozen sera accrued between 1959 and 1966 by the University of California at Berkeley Child Health and Development Studies (CHDS) group from a cohort of pregnant women. Cases with histologically confirmed breast cancer were identified from California Cancer Registry files covering their date of enrollment in the CHDS until 1994. Controls were selected from the CHDS cohort by using randomized recruitment. Third-trimester maternal serum AFP levels were analyzed by using both a radioimmunoassay and an immunoenzymatic method. After controlling for multiple confounders in logistic regression models, the authors found an inverse association between high levels of maternal serum AFP (top quartile) during the index pregnancy and the risk of breast cancer. The protective effect of high levels of maternal serum AFP varied by age at first full-term pregnancy (age 20 years or less: odds ratio (OR) = 0.43, 95% confidence interval (CI) 0.28-0.65; age 21-23 years: OR = 0.62, 95% CI 0.41-0.92). After age 27 years, the estimated risk exceeded unity (OR = 1.67, 95% CI 1.14-2.45). These study findings suggest that some of the protection against breast cancer conferred by early first full-term pregnancy may result from high levels of maternal serum AFP. After age 27 years, a high maternal serum AFP level is not protective and may increase risk.

OBJECTIVE:Epidural analgesia is associated with a four-to five-fold increase in noninfectious maternal fever in nulliparous women. Fever prophylaxis may safely reduce both unnecessary neonatal sepsis evaluations and the potential effect of fever on the fetus. STUDY DESIGN:We performed a randomized double-blind placebo-controlled study. Immediately after epidural placement, full-term nulliparas with a temperature of <99.51F received acetaminophen 650 mg or placebo, per rectum, every 4 hours. Tympanic membrane temperatures were measured hourly. Our power to detect an effect of acetaminophen treatment on maternal temperature over time was 90%. RESULTS:In all, 21 subjects were randomized to each arm. Treatment with acetaminophen did not impact maternal temperature curves. Fever >100.41F was identical in the acetaminophen and placebo groups (23.8%, p ¼ 1.0). Neonatal surveillance blood cultures did not reveal occult infection. CONCLUSIONS:Acetaminophen prophylaxis prevented neither maternal hyperthermia nor fever secondary to epidural analgesia, suggesting that the mechanism underlying fever does not include centrally mediated perturbations of maternal thermoregulation.

In a large screening population the Access system measured consistently higher PSA than the Centaur system. These findings provide a basis for interpreting PSA results obtained from 2 commonly used clinical assays.

To test the hypothesis that high calcium intake protects against preeclampsia, the relation between milk intake and preeclampsia was examined in a cohort of 9,291 pregnant women (7,104 white women and 2,187 black women) selected from the Child Health and Development Study population assembled by the University of California, Berkeley, during 1959-1966. Exposure was based on glasses of milk per day with and without calcium supplements. Data from both white and black women displayed a U-shaped distribution of preeclampsia risk in relation to milk and milk plus supplement intake. Logistic regression analysis showed that women who drank two glasses of milk per day had the lowest risk (reference category). The relative risk (RR) for those drinking one glass of milk per day was similarly low (RR = 1.2; 95 percent confidence interval (CI) 0.7-2.0), but risk for those drinking less than one glass of milk per day was substantially higher (RR = 1.9; 95 percent CI 1.2-2.9). Women drinking three or more glasses of milk per day also showed increased risk (RR = 2.0; 95 percent CI 1.2-3.4) as did those drinking four or more glasses per day (RR = 1.8; 95 percent CI 1.1-3.0). The increased risk associated with low milk intake is consistent with studies showing reduced blood pressure with increased calcium intake. The increased risk with high milk intake has not been demonstrated previously.