Objective To explore risk factors for postpartum weight retention at one year after delivery in predominantly low income women. Methods Data were collected from 774 women with complete height and weight information from participants in the NICHD Community Child Health Network, a national five-site, prospective cohort study. Participants were enrolled primarily in the hospitals immediately after delivery. Maternal interviews conducted at 1, 6, and 12 months postpartum identified risk factors for weight retention and included direct measurement of height and weight at 6 and 12 months. Logistic regression assessed the independent contribution of postpartum weight retention on obesity. Results Women had a mean prepregnancy weight of 161.5 lbs (BMI 27.7kg/m2). Women gained a mean of 32 lbs while pregnant and had a 1 year mean postpartum weight of 172.6 lbs (BMI 29.4kg/m2). Approximately 75% of women were heavier 1 year postpartum than they were prepregnancy, including 47.4% retaining over 10 lbs and 24.2% over 20 lbs. Women retaining at least 20 lbs were more often African American, younger, poor, less educated, or on pubic insurance. Race and socioeconomic disparities were associated with high pre-pregnancy BMI and excessive weight gain during pregnancy, associations which were attenuated by breastfeeding at 6 months and moderate exercise. Of the 39.8 with normal prepregnancy BMI, one third became overweight or obese 1 year postpartum. Conclusion Postpartum weight retention is a significant contributor to the risk for obesity 1 year postpartum, including for women of normal weight prepregnancy. Postpartum, potentially modifiable behaviors may lower the risk.

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Background and Objectives Labetalol is frequently prescribed for treatment of hypertension during pregnancy. However, the influence of pregnancy on labetalol pharmacokinetics is uncertain, with inconsistent findings reported by previous studies. This study examined the population pharmacokinetics of oral labetalol during and after pregnancy in women receiving labetalol for hypertension. Methods Data were collected from 57 women receiving the drug for hypertension from the 12th week of pregnancy through 12 weeks postpartum using a prospective, longitudinal design. A sparse sampling strategy guided collection of plasma samples. Samples were assayed for labetalol by high performance liquid chromatography. Estimation of population pharmacokinetic parameters and covariate effects was performed by nonlinear mixed effects modeling using NONMEM. Final population model was validated by bootstrap analysis and visual predictive check. Simulations were performed with the final model to evaluate the appropriate body weight to guide labetalol dosing. Results Lean body weight (LBW) and gestational age, i.e., weeks of pregnancy, were identified as significantly influencing oral clearance (CL/F) of labetalol, with CL/F ranging from 1.4-fold greater than postpartum values at 12 weeks gestational age to 1.6-fold greater at 40 weeks. Doses adjusted for LBW provide more consistent drug exposure than doses adjusted for total body weight. The apparent volumes of distribution for the central compartment and at steady-state were 1.9-fold higher during pregnancy. Conclusions Gestational age and LBW impact the pharmacokinetics of labetalol during pregnancy and have clinical implications for adjusting labetalol doses in these women.

OBJECTIVE -We investigated the association between functional health literacy and markers of pregnancy preparedness in women with pregestational diabetes.RESEARCH DESIGN AND METHODS -English-and Spanish-speaking pregnant women with pregestational diabetes were recruited. Women completed the Test of Functional Health Literacy in Adults (TOFHLA) short form and a questionnaire. A TOFHLA score of Յ30 was defined as low functional health literacy.RESULTS -Of 74 women participating in the study, 16 (22%) were classified as having low functional health literacy. Compared with women with adequate health literacy, those with low health literacy were significantly more likely to have an unplanned pregnancy (P ϭ 0.02) and significantly less likely to have either discussed pregnancy ahead of time with an endocrinologist or obstetrician (P ϭ 0.01) or taken folic acid (P ϭ 0.001).CONCLUSIONS -The results of this study suggest that low functional health literacy among women with pregestational diabetes is associated with several factors that may adversely impact birth outcomes. Diabetes Care 27:331-334, 2004A pproximately 19,000 pregnancies in the U.S. occur annually in women with pregestational diabetes. Although this represents a small proportion of total births, pregnancies in women with diabetes are important because of the potential for adverse outcomes, including spontaneous abortions, stillbirths, congenital anomalies, and the requirement for neonatal intensive care (1). The risk of these outcomes may be minimized with preconceptional planning. Specifically, periconceptional folic acid supplementation and good glycemic control before pregnancy have been shown to reduce these risks to a level only slightly higher than that of the baseline population (2-11).Many women with diabetes unfortunately fail to receive preconceptional counseling or to achieve good glucose control before pregnancy. Health care providers have attempted to determine the barriers to ideal diabetes care. Diabetes is a chronic disease that can be very confusing and frustrating for patients. Many patients may not understand their disease, the information their health care providers give them, or the importance of tight glucose control. Studies in nonpregnant diabetic subjects have confirmed the relationship between low socioeconomic status, low literacy, and poorer glycemic control with a higher risk of complications (12-15). Two studies (16,17) specifically evaluating functional health literacy in nonpregnant diabetic patients found very high rates of inadequate and marginal health literacy at 50 to 75%.Functional health literacy has not been studied in pregnant women with diabetes. We therefore performed a pilot study evaluating the association between low functional health literacy in women with pregestational diabetes and markers for adverse pregnancy outcome. RESEARCH DESIGN AND METHODS -Pregnant patients withpregestational diabetes, class B or higher, either type 1 or type 2, were prospectively recruited from three sites: two universitybased clini...

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Objective. To determine the intraobserver and interobserver variability in calculating three-dimensional fetal brain volumes and to examine the relationship between these volumes and biparietal diameter and head circumference measurements and estimated gestational age. Methods. Eighty-five subjects between 16 and 40 completed weeks' gestation participated in the Institutional Review Board-approved study. Fetal head images were obtained axially and stored on a magnetic optical disk. The fetal brain volumes were calculated in triplicate by each of 2 observers using 8 to 10 coronal cuts. The coefficient of variation was determined for both physicians. Pearson correlations and linear regression were used to evaluate the relationship between three-dimensional head volume and standard biparietal diameter and head circumference measurements and estimated gestational age. Results. The coefficients of variation were low for both investigators, at 2.04% and 2.44%. The correlations between fetal brain volumes and biparietal diameter, head circumference, and estimated gestational age were all highly significant (P < .001). The linear regression of brain volumes with estimated gestational age was also highly significant (P < .001). Conclusions. Three-dimensional fetal brain volume measurements had excellent intraobserver and interobserver reliability. The volumes correlated very well with standard biparietal diameter and head circumference measurements. These volumes can also be used to determine estimated gestational age. Key words: fetal brain volumes; three-dimensional ultrasonography; estimated gestational age; biparietal diameter; head circumference. Abbreviations BPD, biparietal diameter; EGA, estimated gestational age; HC, head circumference; 3D, three-dimensional; 2D, two-dimensional hree-dimensional (3D) ultrasonography improves imaging of the fetal brain. Images of the corpus callosum, septum pellucidum, third and fourth ventricles, and other anatomic structures are easily obtainable compared with standard two-dimensional (2D) ultrasonography.1 With 3D ultrasonography, it is possible to examine all 3 orthogonal planes and to scan the fetal head through parallel sections. There is also a marker dot that is in the same position in all views that enables precise evaluation of anatomic and pathologic characteristics. 2-4Three-dimensional ultrasonography also enables volume calculation. Studies have shown that 3D ultrasonographic in vitro volume estimation is accurate. 5,6 To date, volumes of the placenta and fetal liver have been used to diagnose fetal growth restriction. 7,8 Volumes of the fetal thigh, abdomen, and upper arm have been integrated into formulas for birth weight prediction. [9][10][11][12] Although the fetal brain has been studied extensively for anatomic structure by 3D ultrasonography, brain volumes have not been previously evaluated.

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