Our study describes a cohort of women who had moderate-to-severe physical disabilities who historically have been discouraged from pregnancy. Women with physical disabilities experienced higher rates of preterm deliveries, low birthweight infants, and pregnancy complications. The pregnancy complications in most cases were not severe and were readily managed. Although it was common to experience functional changes during pregnancy, these changes had largely resolved by 6 weeks postpartum. Larger observational studies are needed to better understand the etiology and prevention of preterm labor and low-birthweight infants in this population, and, in particular, the role of maternal infections.
Perchlorate is a commonly occurring environmental toxicant that may be transported across the placental barrier by the sodium-iodide symporter (NIS), possibly resulting in both increased perchlorate exposure and decreased iodide uptake by the fetus. Therefore, we measured levels of three physiologically relevant NIS-inhibitors (perchlorate, nitrate and thiocyanate) and iodide in maternal and fetal fluids collected during cesarean-section surgeries on 150 U.S. women. Geometric means of perchlorate, thiocyanate and nitrate levels in maternal urine (2.90, 947 and 47900 µg/L, respectively) were similar to previously published results, while urinary iodide levels (1420 µg/L) were significantly higher (p<0.0001), likely because of prevalent prenatal vitamin use in the study population (74%). Thiocyanate levels were higher in the maternal serum, cord serum, and amniotic fluid of smokers compared to women with environmental tobacco smoke exposure and non-smokers (p-values of 0.0006, p=0.0011, and 0.0026, respectively). Perchlorate was detected in most samples: urine (100%), maternal serum (94%), cord serum (67%), and amniotic fluid (97%). Maternal urinary perchlorate levels were positively correlated with perchlorate levels in amniotic fluid (r=0.57), indicating that maternal urine perchlorate is an effective biomarker of fetal perchlorate exposure. Maternal serum perchlorate was generally higher than cord serum perchlorate (median ratio 2.4:1 for paired samples), and maternal urine perchlorate was always higher than fetal amniotic fluid perchlorate levels (mean ratio 22:1); conversely, iodide levels were typically higher in fetal fluids compared to maternal fluids. We found no evidence of either disproportionate perchlorate accumulation or lack of iodide in the fetal compartment. In this panel of healthy infants, we found no association between cord blood levels of these anions and newborn weight, length and head circumference.
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