CE children report more symptoms of ODD and ADHD than nonexposed children. Adoptive or foster caregivers rated their CE children as having more behavioral problems than did maternal or relative caregivers of CE children or parents of NCE children. Although further studies are needed to understand the basis for the more negative ratings by adoptive or foster caregivers of their CE children, the self-report of CE children indicates a need for psychological interventions.

Persistent teratologic effects of CE on specific cognitive functions and additive effects of alcohol, lead, and marijuana exposure; IDA; and the home environment were identified. Documenting environmental factors in behavioral teratology studies is important, because in this sample, CE was associated with better home environment and lower environmental risk in a substantial number of children.

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Structural equation modeling was used to examine the relationship of childhood trauma

This prospective study was an attempt to determine the frequency of viral hepatitis in general, and hepatitis E virus (HEV) in particular, in 62 pregnant women who had jaundice in the third trimester. Maternal serum was analyzed for markers of hepatitis A, B, C, and E viruses, and cord blood samples were tested for immunoglobulin M anti-HEV antibody by enzyme-linked immunosorbent assay. HEV-RNA was identified by the reverse transcriptase polymerase chain reaction technique.HEV infection was diagnosed in 45% of the 62 women. Nine of these women developed fulminant hepatic failure (FHF), defined as deep jaundice and hepatic encephalopathy developing within 4 weeks. Most HEV-positive women were primigravidas and presented at 32 to 34 weeks gestation. The largest number of cases occurred in July. Both fever and deeply colored urine were common signs of HEV infection. Serum levels of bilirubin, aspartate aminotransferase, and alanine aminotransferase were higher in women with FHF. HEV accounted for 37% of cases of acute viral hepatitis and 81% of cases of FHF. More than one fourth of women with HEV infection had obstetric complications, including premature rupture of membranes, intrauterine growth restriction, placenta previa, and retained placenta. Approximately two thirds of women with HEV infection had preterm deliveries. Only 5% were not delivered vaginally. Mortality for HEV-positive women was 27%. Vertical transmission was documented in 33% of 18 cases of HEV infection.One third of pregnant women with HEV in this study had severe hepatitis in the third trimester. HEV infection during pregnancy is associated with a high risk of both preterm labor and mortality. ABSTRACTOvarian tumors are reported in 1 of every 200 pregnancies and may cause serious problems such as torsion, infarction, and obstruction of vaginal delivery. These tumors have typically been removed by elective surgery, preferably in the second trimester. Because abdominal surgery significantly stresses both the mother and fetus, this study was planned to determine the optimal management of ovarian tumors in 89 pregnant women with tumors requiring surgery. Surgery was emergent because of torsion of the tumor in 36 cases (group A) and elective in 53 cases (group B).The 2 groups were similar in maternal age, parity, and gestational age at the time of surgery. Emergency surgery was done in the first, second, and third trimesters in 22, 5, and 9 women, respectively. Elective surgery was done in the second trimester in two thirds of cases and in the first trimester in the others. Mean birth weights were similar for the 2 groups, but preterm births were significantly more frequent in group A (22% vs. 4%). There was no group difference in gestational age at preterm delivery. Tumors were of comparable size in the 2 groups, and there was no difference in 8Obstetrical and Gynecological Survey ABSTRACTZinc deficiency in pregnancy probably is common all over the world but especially in developing countries and where women eat a diet based on cereals, vegetables, ...

Background Children prenatally exposed to cocaine may be at increased risk for behavioral problems due to disruptions of monaminergically regulated arousal systems and/or environmental conditions. Objective To assess behavioral outcomes of cocaine (CE) and non-cocaine exposed (NCE) children, 4 through 10 years old, controlling for other prenatal drug exposures and environmental factors. Methods Low socioeconomic status (SES), primarily African-American children (n = 381 (193 (CE), 188 (NCE)) were recruited from birth. Generalized Estimating Equation (GEE) analyses were used to assess the predictive relationship of prenatal cocaine exposure to odds of caregiver reported clinically elevated behavioral problems at 4, 6, 9 and 10 years of age, controlling for confounders. Results Prenatal cocaine exposure was associated with increased rates of caregiver reported delinquency (OR=1.93, CI: 1.09-3.42, p<.02). A significant prenatal cocaine exposure by sex interaction was found for delinquency indicating that only females were affected (OR=3.57, CI: 1.67-7.60, p<.001). There was no effect of cocaine on increased odds of other CBCL subscales. Higher prenatal tobacco exposure was associated with increased odds of externalizing symptoms at 4, 9 and 10 years of age. For CE children, those in foster or adoptive care were rated as having more behavior problems than those in biologic mother or relative care. Greater caregiver psychological distress was associated with increased behavioral problems. There were no independent effects of elevated blood lead level on increased behavior problems after control for prenatal drug exposure and other environmental conditions. Conclusion Prenatal cocaine and tobacco exposure were associated with greater externalizing behavior after control for multiple prenatal drug exposures, other environmental and caregiving factors and lead exposure from 4 through 10 years of age. Greater caregiver psychological distress negatively affected caregiver ratings of all CBCL domains. Since cocaine and tobacco use during pregnancy and maternal psychological distress have the potential to be altered through prenatal educational, drug treatment and and mental health interventions, they warrant attention in efforts to reduce rates of problem behaviors in children.

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