Objective: Can gestational weight gain in obese women be restricted by 10-h dietary consultations and does this restriction impact the pregnancy-induced changes in glucose metabolism? Design: A randomized controlled trial with or without restriction of gestational weight gain to 6-7 kg by ten 1-h dietary consultations. Subjects: Fifty nondiabetic nonsmoking Caucasian obese pregnant women were randomized into intervention group (n ¼ 23, 2874 years, prepregnant body mass index (BMI) 3574 kg m À2 ) or control group (n ¼ 27, 3075 years, prepregnant BMI 3573 kg m À2 ). Measurements: The weight development was measured at inclusion (15 weeks), at 27 weeks, and 36 weeks of gestation. The dietary intakes were reported in the respective weeks by three 7-day weighed food records and blood samples for analyses of fasting s-insulin, s-leptin, b-glucose, and 2-h b-glucose after an oral glucose tolerance test were collected. Results: The women in the intervention group successfully limited their energy intake, and restricted the gestational weight gain to 6.6 kg vs a gain of 13.3 kg in the control group (P ¼ 0.002, 95% confidence interval (CI): 2.6-10.8 kg). Both s-insulin and s-leptin were reduced by 20% in the intervention group compared to the control group at week 27, mean difference: À16 pmol l À1 (P ¼ 0.04, 95% CI: À32 to À1) for insulin and À23 ng ml À1 (P ¼ 0.004, 95% CI: À39 to À8) for leptin. At 36 weeks of gestation, the s-insulin was further reduced by 23%, À25 pmol l À1 (À47 to À4, P ¼ 0.022) and the fasting b-glucose were reduced by 8% compared with the control group (À0.3 mmol l À1 , À0.6 to À0.0, P ¼ 0.03). Conclusions: Restriction of gestational weight gain in obese women is achievable and reduces the deterioration in the glucose metabolism.

The aim of the study was 1) to evaluate the association of maternal serum levels of placental GH and IGF-I with fetal growth, and 2) to establish reference data for placental GH, IGF-I, and IGF-binding protein-3 (IGFBP-3) in normal pregnancies based on longitudinal measurements. A prospective longitudinal study of 89 normal pregnant women was conducted. The women had, on the average, seven blood samples taken and three ultrasound examinations performed. All had normal umbilical artery pulsatility indexes during pregnancy and gave birth to singletons between 37 and 42 wk gestation with birth weights above -2 SD. Placental GH levels were detectable in all samples from as early as 5 wk gestation and increased significantly throughout pregnancy to approximately 37 wk when peak levels of 22 ng/ml (range, 4.64-69.22 ng/ml) were reached. Subsequently, placental GH levels decreased until birth. The change in placental GH during 24.5-37.5 wk gestation was positively associated with fetal growth rate (P = 0.027) and birth weight (P = 0.027). Gestational age at peak placental GH values (P = 0.007) was associated with pregnancy length. A positive association between the change in placental GH and the change in IGF-I levels throughout gestation was found in a multivariate analysis (r(2) = 0.42; P < 0.001). There was no association between placental GH and IGFBP-3 levels. The change in IGF-I throughout gestation (P = 0.039), but not placental GH, was significantly positively associated with placental weight at birth. We found a significant association between placental GH and fetal growth. In addition, we found a highly significant association between the increase in placental GH and the increase in IGF-I. The gestational age at peak placental GH levels was associated with pregnancy length.

The vast majority of Danish obstetricians and gynecologists would personally prefer vaginal delivery in uncomplicated pregnancies, but nearly 40% agree with the woman's right to request a cesarean section.

A cardiovascular in vitro model was used to examine the influence of peripheral resistance on the Doppler blood-velocity waveforms. In the study the velocity indices were determined as a function of peripheral resistance either with the flow kept constant (the perfusion pressure varied) or with the pressure constant (the flow varied). The peak velocity (Vpeak) is normally accepted as a simple expression of the stroke volume. However, in this study Vpeak did increase with resistance when the stroke volume was constant. Rising slope (RS) is said to correlate with heart contractility, but in this study such a relation was not found. Pulsatility index (PI) and A/B ratio (A/B) are normally considered to reflect peripheral resistance. PI was found to be a flow- and pressure-independent proportional expression of peripheral resistance. A/B also increased with resistance but this relationship is more uncertain. The results of this in vitro study support the clinical use of PI as a flow- and pressure-independent estimate of peripheral resistance. The relation of RS and Vpeak to heart contractility and stroke volume, respectively, is found to be dependent also on resistance, blood flow, and pressure.

The relationship between peripheral resistance and the Doppler blood velocity indices--pulsatility index (PI), A/B ratio, resistance index (RI), and the minimum velocity (Vmin)--was evaluated in the brachial arteries of five young women. All the indices showed a very good correlation with resistance (r greater than 94%); the regression line for both PI and A/B were linear, whereas the relationships between resistance and RI, and resistance and Vmin, were best described by a logarithmic and by power function, respectively. Although the women were carefully selected to be as alike as possible, there were significant differences in the individual slopes of the regression lines.

[1] After three decades of research on the correlation between sea level and various proxies, there has been very little quantification of the first-order influence of sea level change on nutrient inventory, marine productivity, and burial of organic carbon. We present a model aimed at quantifying the burial of organic carbon as a function of sea level rise. The biogeochemical model explicitly considers the mean surface area distribution of the Earth as a function of elevation. Also included is dissolved inorganic phosphate (DIP) liberated from coastal sediments during transgression. We quantify how sea level rise of magnitudes inferred for the mid-Cretaceous influences the phosphorus cycle and burial of organic carbon. The burial efficiency is greater on the shelf. Therefore, in the model, the larger shelf area under high sea level results in more efficient burial of marine organic carbon for a given DIP concentration and associated new production of organic matter (NP). With a Late Cretaceous model shelf area the residence time of DIP decreases by 60% relative to the present-day reference. Thus, in the final steady state, DIP and NP in the open ocean are reduced compared to today when the biologically reactive phosphorus (P reac ) fluxes to the ocean from land are held constant. The lower new production reduces the oxygen demand for respiration and results in a significant oxygenation of the global ocean. Finally, the global organic carbon burial decreases by 30% relative to today in the model. This decrease results from feedbacks between the flux of organic carbon to the seafloor and the ratio of organic carbon to P reac in buried sediments. In contrast, during sea level rise, coastal erosion may increase the P reac flux to the ocean by up to $20% relative to today and cause a temporary increase in DIP concentration in the ocean. The resulting increase in organic carbon burial is equivalent to a carbon isotope event of +0.5 to 1%. Larger carbon isotope events can be triggered by sea level rise only when the ocean is sufficiently close to anoxia in the oxygen minimum zone just prior to the sea level rise.

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Three methods of episiotomy repair were randomly assigned after 900 consecutive deliveries. The three procedures were: (1) continuous No. 00-plain catgut in the vagina; No. 00-plain catgut interrupted stiches in the perineal muscles and fascia, and No. 00-nylon interrupted stiches in the skin. (2) The same technique as in (l), but with No. 0-polyglycolic acid (Dexon) in all layers. (3) The suture material as in (2), but used with a subcuticular technique. The women treated with method 3 reported statistically significant less pain and disabilities in the early puerperium. Three months after delivery 262 women (33%) still had perineal complaints which could be directly related to the episiotomy in 25% (8% of total number). The group treated with method 3 had the best long-term results and we conclude that the subcuticular technique using polyglycolic acid should be the method of choice.in all layers, one single needle-mounted suture is sufficient for the entire episiotomy and the suture does not need to 'be removed. This method gave the best results in the early puerperium and also in the long term. This method is now the standard procedure in our department and we regard it as the method of choice for episiotomy repair.