Recent research suggests that several of the major diseases of later life, including coronary heart disease, hypertension, and type 2 diabetes, originate in impaired intrauterine growth and development. These diseases may be consequences of "programming," whereby a stimulus or insult at a critical, sensitive period of early life has permanent effects on structure, physiology, and metabolism. Evidence that coronary heart disease, hypertension, and diabetes are programmed came from longitudinal studies of 25,000 UK men and women in which size at birth was related to the occurrence of the disease in middle age. People who were small or disproportionate (thin or short) at birth had high rates of coronary heart disease, high blood pressure, high cholesterol concentrations, and abnormal glucose-insulin metabolism. These relations were independent of the length of gestation, suggesting that cardiovascular disease is linked to fetal growth restriction rather than to premature birth. Replication of the UK findings has led to wide acceptance that low rates of fetal growth are associated with cardiovascular disease in later life. Impaired growth and development in utero seem to be widespread in the population, affecting many babies whose birth weights are within the normal range. Although the influences that impair fetal development and program adult cardiovascular disease remain to be defined, there are strong pointers to the importance of the fetal adaptations invoked when the maternoplacental nutrient supply fails to match the fetal nutrient demand.

Objective To determine how diet of the mother in pregnancy influences the blood pressure of the Design A follow up study of men and women born during 1948-1954 whose mothers had taken Setting Aberdeen, Scotland. Population Two hundred and fifty-three men and women born in Aberdeen Maternity Hospital. Main outcome measure Systolic and diastolic blood pressure. Results The relations between the diet of mothers and their offsprings' blood pressure were complex. When the mothers' intake of animal protein was less than 50g daily, a higher carbohydrate intake was associated with a higher blood pressure in the offspring (a 100 g increase in carbohydrate being associated with a 3 mmHg increase in systolic pressure (P = 0.02)). At daily animal protein intakes above 50 g, lower Carbohydrate intake was associated with higher blood pressure (a 100 g decrease in carbohydrate being associated with an 11 mmHg rise in systolic blood pressure (P = 0.004)). These increases in blood pressure were associated with decreased placental size. Conclusion Mothers' intakes of animal protein and carbohydrate in late pregnancy may influence their offsprings' adult blood pressure. This may be mediated through effects on placental growth.offspring in adult life.part in a survey of diet in late pregnancy.

A woman's life style choices before and during pregnancy have important implications for her unborn child, but information on behaviour can be unreliable when data are collected retrospectively. In particular there are no large longitudinal datasets that include information collected prospectively before pregnancy to allow accurate description of changes in behaviour into pregnancy. The Southampton Women's Survey is a longitudinal study of women in Southampton, UK, characterised when they were not pregnant and again during pregnancy. The objective of the analyses presented here is to describe the degree to which women comply with diet and life style recommendations before and during pregnancy, and changes between these time points. The analyses are based on 1490 women who delivered between 1998 and 2003 and who provided information before pregnancy and at 11 and 34 weeks' gestation. At each time point a trained research nurse ascertained smoking status and assessed food and drink consumption using a food frequency questionnaire. We derived the proportions of women who complied with recommendations not to smoke, to eat five portions of fruit and vegetables per day and to drink no more than four units of alcohol per week and 300 mg of caffeine per day. There was a notable reduction in smoking when women became pregnant: before pregnancy 27% of women smoked, whereas in early pregnancy 15% smoked. Similarly there were significant reductions in alcohol consumption and intake of caffeinated drinks: before pregnancy 54% of women drank more than four units of alcohol per week and 39% had estimated intakes of caffeine in drinks of>300 mg per day, whereas comparable figures for early pregnancy were 10% and 16% respectively. However, there was little change in fruit and vegetable intake; the percentages of women who did not achieve the recommendation to eat at least five portions of fruit and vegetables per week were 47% before pregnancy and 46% in early pregnancy. Younger women and those with fewer educational qualifications were less likely to comply with public health recommendations. Overall, 81% of women in early pregnancy complied with at least three of the recommendations. Although there is encouraging evidence of changed health behaviours in pregnancy, young women and those with few educational qualifications may particularly benefit from targeted health initiatives.

This double blind, randomized, placebo-controlled study was undertaken at 14 hospitals in the United Kingdom in asymptomatic women who were at high risk of preterm birth because of risk factors such as previous midtrimester pregnancy loss or preterm delivery, uterine abnormality, cervical surgery, or cerclage. The criterion for entry into the study was the presence of fetal fibronectin (fFN) in vaginal secretions in the second trimester of pregnancy. This factor appears to be more predictive of preterm birth than bacterial vaginosis or other putative biochemical markers. A total of 900 pregnancies were screened at 24 and 27 weeks gestation. Women with positive results were assigned to receive either oral metronidazole (400 mg 3 times a day) or a placebo for 1 week. The primary outcome was delivery before 30 weeks gestation, and secondary outcomes included delivery before 37 weeks.The study was stopped at an early stage when 21% of 53 women given metronidazole and 11% of 46 placebo recipients delivered before 30 weeks gestation. The risk ratio (RR) was 1.9, with an 85% confidence interval (CI) of 0.72-5.09. Preterm delivery (earlier than 37 weeks gestation) took place in 62% of women given metronidazole and in 39% of the placebo group (RR, 1.6; 95% CI, 1.05-2.4). The positive and negative predictive values of fFN for early preterm birth, estimated at 24 weeks gestation for the risk of delivery before 30 weeks, were 26% and 99%, respectively. The fFN reverted to negative in approximately half of the actively treated and placebo groups. Birth weights averaged 366 g lower for infants whose mothers received metronidazole, and 56% more infants in this group were smaller than 2.5 kg at birth compared with those who mothers received placebo. The proportions of low 1-and 5-minute Apgar scores were comparable in the metronidazole and placebo groups. This is the first prospective trial showing that metronidazole is not an effective means of preventing preterm delivery in high-risk women and that it may have adverse effects on the newborn infant. The investigators do not recommend the continued use of this drug with the intent of preventing preterm delivery. EDITORIAL COMMENT(In the second half of pregnancy, increased concentrations of cervical and vaginal fetal fibronectin reflect choriodecidual basement membrane disruption and may herald preterm birth. In some women, intrauterine infection may be responsible for the disruption (Lockwood CJ, et al. N Engl J Med 1991;325:669; Goldenburg RL, et al. Obstet Gynecol 1996;87:656). This begs the question, then, as to whether antibiotics might reduce the rate of preterm birth in women with positive OBSTETRICS Volume 61, Number 5 OBSTETRICAL AND GYNECOLOGICAL SURVEY ABSTRACTWhen the fetal head remains in an occipitoposterior position during labor, the woman experiences continued back pain and is at increased risk of requiring operative delivery. Neonatal morbidity also is more likely. Some practitioners have proposed using the hands-and-knees position in the hope that gravitational...

Objective-Randomised controlled trials are required to address causality in the reported associations between maternal influences and offspring adiposity. The aim of this study was to determine whether an antenatal lifestyle intervention in obese pregnant women associated with improved maternal diet and reduced gestational weight gain leads to a reduction in infant adiposity and sustained improvements in maternal lifestyle behaviours at 6 months postpartum.Subjects and Methods-We conducted a planned postnatal follow up of a randomised controlled trial (UPBEAT) of a complex behavioural intervention targeting maternal diet (glycemic load and saturated fat intake) and physical activity in 1555 obese pregnant women. The main outcome measure was infant adiposity, assessed by subscapular and triceps skinfold thicknesses. Maternal diet and physical activity, indices of the familial lifestyle environment, were assessed by questionnaire.Results-698 (45.9%) infants (342 intervention, 356 standard antenatal care) were followed up at mean age 5.92 months. There was no difference in triceps skinfold thickness z-scores between the intervention vs. standard care arms (difference -0.14 SD, 95% CI -0.38 to 0.10, p=0.246), but subscapular skinfold thickness z-score was 0.26 SD (-0.49 to -0.02; p=0.03) lower in the intervention arm. Maternal dietary glycemic load (-35.34; -48.0 to -22.67; p<0.001) and saturated fat intake (-1.93% energy; -2.64 to -1.22; p<0.001) were reduced in the intervention arm at 6 months postpartum. Causal mediation analysis suggested that lower infant subscapular skinfold thickness was mediated by changes in antenatal maternal diet and gestational weight gain rather than postnatal diet.Conclusion-This study provides evidence from follow-up of a randomised controlled trial that a maternal behavioural intervention in obese pregnant women has the potential to reduce infant adiposity and to produce a sustained improvement in maternal diet at 6 months postpartum.

BackgroundMaternal smoking during pregnancy is linked to reduced birth weight but the gestation at onset of this relationship is not certain. We present a systematic review of the literature describing associations between maternal smoking during pregnancy and ultrasound measurements of fetal size, together with an accompanying meta-analysis.MethodsStudies were selected from electronic databases (OVID, EMBASE and Google Scholar) that examined associations between maternal smoking or smoke exposure and antenatal fetal ultrasound measurements. Outcome measures were first, second or third trimester fetal measurements.ResultsThere were 284 abstracts identified, 16 papers were included in the review and the meta-analysis included data from eight populations. Maternal smoking was associated with reduced second trimester head size (mean reduction 0.09 standard deviation (SD) [95% CI 0.01, 0.16]) and femur length (0.06 [0.01, 0.10]) and reduced third trimester head size (0.18 SD [0.13, 0.23]), femur length (0.27 SD [0.21, 0.32]) and estimated fetal weight (0.18 SD [0.11, 0.24]). Higher maternal cigarette consumption was associated with a lower z score for head size in the second (mean difference 0.09 SD [0, 0.19]) and third (0.15 SD [0.03, 0.26]) trimesters compared to lower consumption. Fetal measurements were not reduced for those whose mothers quit before or after becoming pregnant compared to mothers who had never smoked.ConclusionsMaternal smoking during pregnancy is associated with reduced fetal measurements after the first trimester, particularly reduced head size and femur length. These effects may be attenuated if mothers quit or reduce cigarette consumption during pregnancy.

Objective-To examine the maternal influences which determine large placental weight anda high ratio of placental weight to birthweight. Thcsc arc known predictors of adult blood prcssurc. Design-Retrospective analysis of routinc obstctric and hacmatology department records for a large cohort of pregnant women. Setting-John Radcliffe Hospital, Oxford.

Objective To examine the extent to which women planning a pregnancy comply with recommendations for nutrition and lifestyle. Design Prospective cohort study. Setting Southampton, United Kingdom. Participants 12 445 non-pregnant women aged 20-34 recruited to the Southampton Women's Survey through general practices, 238 of whom became pregnant within three months of being interviewed. Main outcome measures Folic acid supplement intake, alcohol consumption, smoking, diet, and physical activity before pregnancy. Results The 238 women who became pregnant within three months of the interview were only marginally more likely to comply with recommendations for those planning a pregnancy than those who did not become pregnant in this period. Among those who became pregnant, 2.9% (95% confidence interval 1.2% to 6.0%) were taking 400 μg or more of folic acid supplements a day and drinking four or fewer units of alcohol a week, compared with 0.66% (0.52% to 0.82%) of those who did not become pregnant. 74% of those who became pregnant were nonsmokers compared with 69% of those who did not become pregnant (P=0.08). Women in both groups were equally likely to consume five or more portions of fruit and vegetables a day (53% in each group, P=1.0), but only 57% of those who became pregnant had taken any strenuous exercise in the past three months compared with 64% in those who did not become pregnant (P=0.03). Conclusion Only a small proportion of women planning a pregnancy follow the recommendations for nutrition and lifestyle. Greater publicity for the recommendations is needed, but as many pregnancies are unplanned, improved nutrition and lifestyles of women of childbearing age is also required.