No abstract

Prevention Point Pittsburgh (PPP) is a public health advocacy organization that operates Allegheny County's only needle exchange program. In 2002, PPP implemented an Overdose Prevention Program (OPP) in response to an increase in heroin-related and opioid-related overdose fatalities in the region. In 2005, the OPP augmented overdose prevention and response trainings to include naloxone training and prescription. The objective of our study is to describe the experiences of 426 individuals who participated in the OPP between July 1, 2005, and December 31, 2008. Of these, 89 individuals reported administering naloxone in response to an overdose in a total of 249 separate overdose episodes. Of these 249 overdose episodes in which naloxone was administered, participants reported 96% were reversed. The data support findings from a growing body of research on similar programs in other cities. Community-based OPPs that equip drug users with skills to identify and respond to an overdose and prescribe naloxone can help users and their peers prevent and reverse potentially fatal overdoses without significant adverse consequences.

Pregnant women in methadone maintenance therapy may have poor nutrition during pregnancy. In 2006–2008, methadone treated pregnant women (n = 22) were recruited at an urban academic medical center and compared with non-drug using pregnant women (n = 119) at 20–35 weeks gestation. We measured adiposity using pre-pregnancy body mass index (BMI), dietary intake using a food frequency questionnaire, and micronutrient and essential fatty acid status using biomarkers. Methadone treated women had lower BMI, consumed more calories, had lower serum carotenoid concentrations and higher plasma homocysteine concentrations than controls. The study’s limitations and implications for future research are discussed.

Pre-pregnancy obesity is associated with adverse birth and pregnancy outcomes. Poor essential fatty acid and micronutrient status may contribute to this association. We assessed the association between pre-pregnancy body mass index (BMI) and micronutrient and essential fatty acid (EFA) status in mid-pregnancy. Women (n=129) provided non-fasting blood samples at ≤20 weeks gestation that were assayed for red blood cell EFA, plasma folate, plasma ascorbic acid, serum retinol, serum 25-hydroxyvitamin D, serum α-tocopherol, plasma homocysteine, serum soluble transferrin receptors, and serum carotenoids. Principal components analysis of these biomarker measures was used to construct three nutritional components: EFA, Micronutrient, and Carotenoid. Multivariable logistic regression was used to assess the independent effect of pre-pregnancy BMI on the likelihood of being in the lowest tertile of each nutritional component. After adjustment for parity, race/ethnicity, and age, obese pregnant women were 3.0 (95% CI: 1.1, 7.7) times as likely of being in the lowest tertile of the EFA component and 4.5 (95% CI: 1.7, 12.3) times as likely of being in the lowest tertile of the Carotenoid component as their lean counterparts. There was no association between obesity and Micronutrient component scores after confounder adjustment. Obese pregnant women may be vulnerable to having insufficient EFA and carotenoids concentrations, which may contribute to their elevated risk of adverse birth outcomes.

Objectives To estimate the effects of gestational weight gain (GWG), central adiposity and subcutaneous fat on maternal post-load glucose concentration. Methods Pregnant women [n = 413, 62% black, 57% with pregravid body mass index (BMI) ≥ 25] enrolled in a cohort study at <13 weeks gestation. GWG was abstracted from medical records. In a sub-sample of women (n = 214), waist circumference (WC), and biceps and triceps skinfold thicknesses were measured at enrollment. At 24–28 weeks gestation, post-load glucose concentration was measured using a 50-g 1-hour oral glucose tolerance test. Results After adjustment for pre-pregnancy BMI, age, parity, race/ethnicity, smoking, marital status, annual family income, education, family history of diabetes, and gestational age of GDM screening, each 0.3-kg/week increase in weight in the first trimester was associated with a 2.2 (95% CI: 0.1, 4.3)-mg/dl increase in glucose concentration. Each 8.6-mm increase in biceps skinfold thickness and each 11.7-mm increase in triceps skinfold thickness was associated with 4.3 (95% CI: 0.2, 8.5)-mg/dl increase in maternal glucose, independent of BMI and other confounders. Neither GWG in the second trimester nor WC at ≤ 13 weeks was significantly associated with glucose concentration after confounder adjustment. Conclusions Independent of pre-pregnancy BMI, high early pregnancy GWG and maternal subcutaneous body fat may be positively associated with maternal glucose concentrations at 24–28 weeks.