Miriam E. Tucker

VIENNA — Decreased urinary placental growth factor at midgestation is strongly associated with the subsequent development of early-onset preeclampsia, S. Ananth Karumanchi, M.D., reported.

“Low urinary PlGF antedates the clinical diagnosis of preeclampsia and may serve as a screening test to predict who will develop early-onset disease,” Dr. Karumanchi said at the 14th World Congress of the International Society for the Study of Hypertension in Pregnancy.

The findings, published soon after the congress, come from a nested case-control study within the Calcium for Preeclampsia Prevention trial of healthy nulliparous women enrolled at five U.S. university medical centers during 1992–1995. Frozen serum and urine samples from 120 women with preeclampsia were compared with those of 120 matched normotensive controls (JAMA 2005;293:77–85).

In all the women, urinary PlGF levels increased during the first two trimesters, with a more rapid increase after 21–24 weeks and a peak at 29–33 weeks. However, those levels were significantly lower among the women who subsequently developed preeclampsia at weeks 25–28, 29–32, and 33–36. Differences were particularly large between the controls and the women who subsequently developed preeclampsia before 37 weeks or who had preeclampsia with a small-for-gestational age (SGA) infant.

Alterations in urinary PlGF levels at 21–32 weeks were also more pronounced in women who subsequently developed preeclampsia before 37 weeks (87 pg/mL) than among those who had onset of preeclampsia at term (223 pg/mL).

At 33–42 weeks, those levels were 22 vs. 118 pg/mL, lead author Richard J. Levine, M.D., of the National Institute of Child Health and Human Development, Bethesda, Md., and his associates reported in the published article.

The women were divided by quartiles of urinary PlGF obtained at 21–32 weeks' gestation and the results adjusted for gestational age at specimen collection, storage time, body mass index, and maternal age.

Compared with women in the upper three quartiles, the odds ratio was 22.5 for later development of preterm preeclampsia among the women with PlGF concentrations in the lowest quartile (less than 118 pg/mL). The association was even stronger when restricted to just morning urine specimens, with an odds ratio of 39.5.

For term preeclampsia, the adjusted odds ratios of lowest vs. the upper three quartiles of PlGF concentration were 2.2 at 21–32 weeks and 2.3 at 33–42 weeks' gestation. The data also suggested a strong association between low urinary PlGF and a substantially increased risk for preeclampsia with an SGA infant, but the numbers were too small to make a stable estimate, Dr. Levine and his associates noted.

Adjusting the results for urinary creatinine concentration did not change the strength of the associations, they said.

Previous data from this research group showed that increased circulating serum levels of the angiogenic factor soluble fms-like tyrosine kinase (sFlt-1) were predictive of subsequent preeclampsia (N. Engl. J. Med. 2004;350:672–83).

But because the sFlt-1 molecule is too large to be filtered into urine, the current study focused on PlGF, which binds to sFlt-1, as a more clinically feasible alternative. If a reliable dipstick assay could be developed for urine screening of all pregnant women for urine PlGF, then subsequent serum measurements of both PlGF and sFlt-1 could minimize false-positive results from urine testing, the researchers said.

At the congress, Dr. Karumanchi, a nephrologist at Beth Israel Deaconess Medical Center, Boston, said, “Obviously, this is a retrospective study done using specimens frozen for several years, and we don't know if it can be reproduced prospectively. Nevertheless, it does prove the hypothesis that angiogenic factors play a critical role in the pathogenesis of this syndrome.”

VIENNA — Decreased urinary placental growth factor at midgestation is strongly associated with the subsequent development of early-onset preeclampsia, S. Ananth Karumanchi, M.D., reported.

“Low urinary PlGF antedates the clinical diagnosis of preeclampsia and may serve as a screening test to predict who will develop early-onset disease,” Dr. Karumanchi said at the 14th World Congress of the International Society for the Study of Hypertension in Pregnancy.

The findings, published soon after the congress, come from a nested case-control study within the Calcium for Preeclampsia Prevention trial of healthy nulliparous women enrolled at five U.S. university medical centers during 1992–1995. Frozen serum and urine samples from 120 women with preeclampsia were compared with those of 120 matched normotensive controls (JAMA 2005;293:77–85).

In all the women, urinary PlGF levels increased during the first two trimesters, with a more rapid increase after 21–24 weeks and a peak at 29–33 weeks. However, those levels were significantly lower among the women who subsequently developed preeclampsia at weeks 25–28, 29–32, and 33–36. Differences were particularly large between the controls and the women who subsequently developed preeclampsia before 37 weeks or who had preeclampsia with a small-for-gestational age (SGA) infant.

Alterations in urinary PlGF levels at 21–32 weeks were also more pronounced in women who subsequently developed preeclampsia before 37 weeks (87 pg/mL) than among those who had onset of preeclampsia at term (223 pg/mL).

At 33–42 weeks, those levels were 22 vs. 118 pg/mL, lead author Richard J. Levine, M.D., of the National Institute of Child Health and Human Development, Bethesda, Md., and his associates reported in the published article.

The women were divided by quartiles of urinary PlGF obtained at 21–32 weeks' gestation and the results adjusted for gestational age at specimen collection, storage time, body mass index, and maternal age.

Compared with women in the upper three quartiles, the odds ratio was 22.5 for later development of preterm preeclampsia among the women with PlGF concentrations in the lowest quartile (less than 118 pg/mL). The association was even stronger when restricted to just morning urine specimens, with an odds ratio of 39.5.

For term preeclampsia, the adjusted odds ratios of lowest vs. the upper three quartiles of PlGF concentration were 2.2 at 21–32 weeks and 2.3 at 33–42 weeks' gestation. The data also suggested a strong association between low urinary PlGF and a substantially increased risk for preeclampsia with an SGA infant, but the numbers were too small to make a stable estimate, Dr. Levine and his associates noted.

Adjusting the results for urinary creatinine concentration did not change the strength of the associations, they said.

Previous data from this research group showed that increased circulating serum levels of the angiogenic factor soluble fms-like tyrosine kinase (sFlt-1) were predictive of subsequent preeclampsia (N. Engl. J. Med. 2004;350:672–83).

But because the sFlt-1 molecule is too large to be filtered into urine, the current study focused on PlGF, which binds to sFlt-1, as a more clinically feasible alternative. If a reliable dipstick assay could be developed for urine screening of all pregnant women for urine PlGF, then subsequent serum measurements of both PlGF and sFlt-1 could minimize false-positive results from urine testing, the researchers said.

At the congress, Dr. Karumanchi, a nephrologist at Beth Israel Deaconess Medical Center, Boston, said, “Obviously, this is a retrospective study done using specimens frozen for several years, and we don't know if it can be reproduced prospectively. Nevertheless, it does prove the hypothesis that angiogenic factors play a critical role in the pathogenesis of this syndrome.”

VIENNA — Decreased urinary placental growth factor at midgestation is strongly associated with the subsequent development of early-onset preeclampsia, S. Ananth Karumanchi, M.D., reported.

“Low urinary PlGF antedates the clinical diagnosis of preeclampsia and may serve as a screening test to predict who will develop early-onset disease,” Dr. Karumanchi said at the 14th World Congress of the International Society for the Study of Hypertension in Pregnancy.

The findings, published soon after the congress, come from a nested case-control study within the Calcium for Preeclampsia Prevention trial of healthy nulliparous women enrolled at five U.S. university medical centers during 1992–1995. Frozen serum and urine samples from 120 women with preeclampsia were compared with those of 120 matched normotensive controls (JAMA 2005;293:77–85).

In all the women, urinary PlGF levels increased during the first two trimesters, with a more rapid increase after 21–24 weeks and a peak at 29–33 weeks. However, those levels were significantly lower among the women who subsequently developed preeclampsia at weeks 25–28, 29–32, and 33–36. Differences were particularly large between the controls and the women who subsequently developed preeclampsia before 37 weeks or who had preeclampsia with a small-for-gestational age (SGA) infant.

Alterations in urinary PlGF levels at 21–32 weeks were also more pronounced in women who subsequently developed preeclampsia before 37 weeks (87 pg/mL) than among those who had onset of preeclampsia at term (223 pg/mL).

At 33–42 weeks, those levels were 22 vs. 118 pg/mL, lead author Richard J. Levine, M.D., of the National Institute of Child Health and Human Development, Bethesda, Md., and his associates reported in the published article.

The women were divided by quartiles of urinary PlGF obtained at 21–32 weeks' gestation and the results adjusted for gestational age at specimen collection, storage time, body mass index, and maternal age.

Compared with women in the upper three quartiles, the odds ratio was 22.5 for later development of preterm preeclampsia among the women with PlGF concentrations in the lowest quartile (less than 118 pg/mL). The association was even stronger when restricted to just morning urine specimens, with an odds ratio of 39.5.

For term preeclampsia, the adjusted odds ratios of lowest vs. the upper three quartiles of PlGF concentration were 2.2 at 21–32 weeks and 2.3 at 33–42 weeks' gestation. The data also suggested a strong association between low urinary PlGF and a substantially increased risk for preeclampsia with an SGA infant, but the numbers were too small to make a stable estimate, Dr. Levine and his associates noted.

Adjusting the results for urinary creatinine concentration did not change the strength of the associations, they said.

Previous data from this research group showed that increased circulating serum levels of the angiogenic factor soluble fms-like tyrosine kinase (sFlt-1) were predictive of subsequent preeclampsia (N. Engl. J. Med. 2004;350:672–83).

But because the sFlt-1 molecule is too large to be filtered into urine, the current study focused on PlGF, which binds to sFlt-1, as a more clinically feasible alternative. If a reliable dipstick assay could be developed for urine screening of all pregnant women for urine PlGF, then subsequent serum measurements of both PlGF and sFlt-1 could minimize false-positive results from urine testing, the researchers said.

At the congress, Dr. Karumanchi, a nephrologist at Beth Israel Deaconess Medical Center, Boston, said, “Obviously, this is a retrospective study done using specimens frozen for several years, and we don't know if it can be reproduced prospectively. Nevertheless, it does prove the hypothesis that angiogenic factors play a critical role in the pathogenesis of this syndrome.”

VIENNA — Prolonged prednisolone administration reduces the risk of HELLP exacerbations in women undergoing expectant management remote from term, Pieter van Runnard Heimel, M.D., said at the 14th World Congress of the International Society for the Study of Hypertension in Pregnancy.

Previous studies have demonstrated a beneficial effect of corticosteroids during expectant management in women with early-onset preeclampsia and HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. Most of these studies, however, have not looked at antepartum treatment for longer than 48 hours, said Dr. Heimel of the department of perinatology and gynecology at the University Medical Center, Utrecht, the Netherlands.

Of 31 women who developed HELLP syndrome before 30 weeks' gestation and were being managed expectantly, 15 were given 50 mg intravenous prednisolone twice daily, while the other 16 received intravenous placebo. The two groups did not differ in maternal age, blood pressure, or worst laboratory values.

Delivery was postponed for about a week in both groups, and the mean interval between entry and delivery—6.9 days with prednisolone versus 8.0 days with placebo—was not significantly different. However, HELLP exacerbations occurred in just 6 prednisone patients, compared with 13 in the placebo group, a significant 50% relative risk reduction.

The number needed to treat to prevent one recurrent exacerbation, 2.4, was also significant, Dr. Heimel reported at the meeting.

Time to recovery of normal lab values differed significantly for platelets (1.7 days with prednisone vs. 6.2 days for placebo), but not for liver enzyme levels. There were no significant differences in cesarean section rates (15 in the prednisone group and 14 in the placebo group) or in fetal or maternal indications for cesarean section.

There were three maternal complications—liver hematoma, liver rupture, and liver rupture/maternal death—all in the placebo group.

Mean gestational age and birth weight were not significantly different between the two groups.

Four perinatal deaths occurred in the placebo group; two were fetal demise, and two were in newborns within the first week of life. Three infants in the prednisolone group died within the first year of life.

Ten infants from each group were still alive at 24 months. Of those, two from the prednisolone group had head circumferences less than 2 standard deviations below normal, while three from the prednisolone group and four from the placebo group had other abnormalities, according to Dr. Heimel.

VIENNA — Prolonged prednisolone administration reduces the risk of HELLP exacerbations in women undergoing expectant management remote from term, Pieter van Runnard Heimel, M.D., said at the 14th World Congress of the International Society for the Study of Hypertension in Pregnancy.

Previous studies have demonstrated a beneficial effect of corticosteroids during expectant management in women with early-onset preeclampsia and HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. Most of these studies, however, have not looked at antepartum treatment for longer than 48 hours, said Dr. Heimel of the department of perinatology and gynecology at the University Medical Center, Utrecht, the Netherlands.

Of 31 women who developed HELLP syndrome before 30 weeks' gestation and were being managed expectantly, 15 were given 50 mg intravenous prednisolone twice daily, while the other 16 received intravenous placebo. The two groups did not differ in maternal age, blood pressure, or worst laboratory values.

Delivery was postponed for about a week in both groups, and the mean interval between entry and delivery—6.9 days with prednisolone versus 8.0 days with placebo—was not significantly different. However, HELLP exacerbations occurred in just 6 prednisone patients, compared with 13 in the placebo group, a significant 50% relative risk reduction.

The number needed to treat to prevent one recurrent exacerbation, 2.4, was also significant, Dr. Heimel reported at the meeting.

Time to recovery of normal lab values differed significantly for platelets (1.7 days with prednisone vs. 6.2 days for placebo), but not for liver enzyme levels. There were no significant differences in cesarean section rates (15 in the prednisone group and 14 in the placebo group) or in fetal or maternal indications for cesarean section.

There were three maternal complications—liver hematoma, liver rupture, and liver rupture/maternal death—all in the placebo group.

Mean gestational age and birth weight were not significantly different between the two groups.

Four perinatal deaths occurred in the placebo group; two were fetal demise, and two were in newborns within the first week of life. Three infants in the prednisolone group died within the first year of life.

Ten infants from each group were still alive at 24 months. Of those, two from the prednisolone group had head circumferences less than 2 standard deviations below normal, while three from the prednisolone group and four from the placebo group had other abnormalities, according to Dr. Heimel.

VIENNA — Prolonged prednisolone administration reduces the risk of HELLP exacerbations in women undergoing expectant management remote from term, Pieter van Runnard Heimel, M.D., said at the 14th World Congress of the International Society for the Study of Hypertension in Pregnancy.

Previous studies have demonstrated a beneficial effect of corticosteroids during expectant management in women with early-onset preeclampsia and HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. Most of these studies, however, have not looked at antepartum treatment for longer than 48 hours, said Dr. Heimel of the department of perinatology and gynecology at the University Medical Center, Utrecht, the Netherlands.

Of 31 women who developed HELLP syndrome before 30 weeks' gestation and were being managed expectantly, 15 were given 50 mg intravenous prednisolone twice daily, while the other 16 received intravenous placebo. The two groups did not differ in maternal age, blood pressure, or worst laboratory values.

Delivery was postponed for about a week in both groups, and the mean interval between entry and delivery—6.9 days with prednisolone versus 8.0 days with placebo—was not significantly different. However, HELLP exacerbations occurred in just 6 prednisone patients, compared with 13 in the placebo group, a significant 50% relative risk reduction.

The number needed to treat to prevent one recurrent exacerbation, 2.4, was also significant, Dr. Heimel reported at the meeting.

Time to recovery of normal lab values differed significantly for platelets (1.7 days with prednisone vs. 6.2 days for placebo), but not for liver enzyme levels. There were no significant differences in cesarean section rates (15 in the prednisone group and 14 in the placebo group) or in fetal or maternal indications for cesarean section.

There were three maternal complications—liver hematoma, liver rupture, and liver rupture/maternal death—all in the placebo group.

Mean gestational age and birth weight were not significantly different between the two groups.

Four perinatal deaths occurred in the placebo group; two were fetal demise, and two were in newborns within the first week of life. Three infants in the prednisolone group died within the first year of life.

Ten infants from each group were still alive at 24 months. Of those, two from the prednisolone group had head circumferences less than 2 standard deviations below normal, while three from the prednisolone group and four from the placebo group had other abnormalities, according to Dr. Heimel.

WASHINGTON — Oseltamivir's benefits aren't limited to treating and preventing influenza, Beth L. Nordstrom, Ph.D., reported in a poster presentation at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

Oseltamivir (Tamiflu) is indicated for the treatment of influenza in patients aged 1 year and older who have been symptomatic for no more than 2 days, and for prophylaxis of influenza in persons aged 13 years and older.

Now, new data suggest that oseltamivir also significantly reduces the risk of pneumonia in all age groups, and the rates of antibiotic use and hospitalization in the oldest and youngest patients, said Dr. Nordstrom, of Ingenix Epidemiology, Auburndale, Mass.

In a retrospective cohort study sponsored by Hoffman-La Roche, claims data from a large U.S. insurer containing a diagnosis of influenza were analyzed.

Among children aged 1–12 years, the proportion with a diagnosis of pneumonia was 0.7% among the 586 for whom oseltamivir was dispensed on the day of influenza diagnosis, compared with 2.5% of the 17,886 who did not receive oseltamivir, a 66% risk reduction.

In patients aged 13–59, pneumonia was diagnosed in 1.3% of the 10,649 who received the drug, compared with 2.1% of the 41,007 who did not—a reduction of 19%. In adults aged 60 and above, the difference was 1.7% of 463 with oseltamivir versus 8.8% of 3,298 without, a 59% drop.

Antibiotic use dropped with oseltamivir by 30% in the 1- to 12-year-olds, by 9% in the 13- to 59-year-olds, and by 14% in the 60-plus group. Hospitalizations were reduced by 71% with oseltamivir in the 1- to 12-year-olds, by 25% in 13- to 59-year-olds, and by 45% in the 60-plus patients.

WASHINGTON — Oseltamivir's benefits aren't limited to treating and preventing influenza, Beth L. Nordstrom, Ph.D., reported in a poster presentation at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

Oseltamivir (Tamiflu) is indicated for the treatment of influenza in patients aged 1 year and older who have been symptomatic for no more than 2 days, and for prophylaxis of influenza in persons aged 13 years and older.

Now, new data suggest that oseltamivir also significantly reduces the risk of pneumonia in all age groups, and the rates of antibiotic use and hospitalization in the oldest and youngest patients, said Dr. Nordstrom, of Ingenix Epidemiology, Auburndale, Mass.

In a retrospective cohort study sponsored by Hoffman-La Roche, claims data from a large U.S. insurer containing a diagnosis of influenza were analyzed.

Among children aged 1–12 years, the proportion with a diagnosis of pneumonia was 0.7% among the 586 for whom oseltamivir was dispensed on the day of influenza diagnosis, compared with 2.5% of the 17,886 who did not receive oseltamivir, a 66% risk reduction.

In patients aged 13–59, pneumonia was diagnosed in 1.3% of the 10,649 who received the drug, compared with 2.1% of the 41,007 who did not—a reduction of 19%. In adults aged 60 and above, the difference was 1.7% of 463 with oseltamivir versus 8.8% of 3,298 without, a 59% drop.

Antibiotic use dropped with oseltamivir by 30% in the 1- to 12-year-olds, by 9% in the 13- to 59-year-olds, and by 14% in the 60-plus group. Hospitalizations were reduced by 71% with oseltamivir in the 1- to 12-year-olds, by 25% in 13- to 59-year-olds, and by 45% in the 60-plus patients.

WASHINGTON — Oseltamivir's benefits aren't limited to treating and preventing influenza, Beth L. Nordstrom, Ph.D., reported in a poster presentation at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

Oseltamivir (Tamiflu) is indicated for the treatment of influenza in patients aged 1 year and older who have been symptomatic for no more than 2 days, and for prophylaxis of influenza in persons aged 13 years and older.

Now, new data suggest that oseltamivir also significantly reduces the risk of pneumonia in all age groups, and the rates of antibiotic use and hospitalization in the oldest and youngest patients, said Dr. Nordstrom, of Ingenix Epidemiology, Auburndale, Mass.

In a retrospective cohort study sponsored by Hoffman-La Roche, claims data from a large U.S. insurer containing a diagnosis of influenza were analyzed.

Among children aged 1–12 years, the proportion with a diagnosis of pneumonia was 0.7% among the 586 for whom oseltamivir was dispensed on the day of influenza diagnosis, compared with 2.5% of the 17,886 who did not receive oseltamivir, a 66% risk reduction.

In patients aged 13–59, pneumonia was diagnosed in 1.3% of the 10,649 who received the drug, compared with 2.1% of the 41,007 who did not—a reduction of 19%. In adults aged 60 and above, the difference was 1.7% of 463 with oseltamivir versus 8.8% of 3,298 without, a 59% drop.

Antibiotic use dropped with oseltamivir by 30% in the 1- to 12-year-olds, by 9% in the 13- to 59-year-olds, and by 14% in the 60-plus group. Hospitalizations were reduced by 71% with oseltamivir in the 1- to 12-year-olds, by 25% in 13- to 59-year-olds, and by 45% in the 60-plus patients.

WASHINGTON — Metronidazole is effective in the treatment of non-β-hemolytic streptococcal tonsillitis, Itzhak Brook, M.D., reported in a poster presentation at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

Although group A β-hemolytic streptococcus (GABHS) is one of the major causes of tonsillitis, other aerobic as well as anaerobic organisms have been isolated from both normal and inflamed tonsils. The exact role of these organisms is uncertain, and some are believed to be part of the normal oropharyngeal flora, said Dr. Brook, professor of pediatrics at Georgetown University, Washington.

The option of using metronidazole (250 mg every 12 hours for 10 days) was offered to 40 children (mean age 9 years) who presented with sore throat and massive tonsillar enlargement plus at least one of the following: anterior cervical adenitis, temperature higher than 38.3° C, and pharyngeal or tonsillar exudates or pharyngeal injection.

Rapid streptococcal antigen tests were negative in all the patients, and cultures of the tonsils showed no growth of β-hemolytic streptococci, including group A. None of the children had Epstein-Barr antibodies on immunofluorescence.

The 20 who chose metronidazole were similar to the 20 who did not with respect to age, race, sex, family size, current clinical findings, and previous antibiotics.

Compared with the children who remained untreated, those given metronidazole had significantly lower rates of fevers over 38° C after 1 day (11 vs. 17 children) and after 2 days (3 vs. 9 children), fewer sore throats after 1 day (12 vs. 19) and 2 days (9 vs. 16), and lower rates of tonsillar enlargement after 3 days (11 vs. 16) and 5 days (8 vs. 14). Pharyngeal injection at 2 days also was reduced with metronidazole, Dr. Brook reported at the conference, sponsored by the American Society for Microbiology.

Metronidazole was chosen for this study because it is effective against anaerobic bacteria but has virtually no activity against facultative and aerobic bacteria. These findings add to previous data suggesting a pathogenic role of anaerobes in the acute inflammatory process in the tonsils.

WASHINGTON — Metronidazole is effective in the treatment of non-β-hemolytic streptococcal tonsillitis, Itzhak Brook, M.D., reported in a poster presentation at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

Although group A β-hemolytic streptococcus (GABHS) is one of the major causes of tonsillitis, other aerobic as well as anaerobic organisms have been isolated from both normal and inflamed tonsils. The exact role of these organisms is uncertain, and some are believed to be part of the normal oropharyngeal flora, said Dr. Brook, professor of pediatrics at Georgetown University, Washington.

The option of using metronidazole (250 mg every 12 hours for 10 days) was offered to 40 children (mean age 9 years) who presented with sore throat and massive tonsillar enlargement plus at least one of the following: anterior cervical adenitis, temperature higher than 38.3° C, and pharyngeal or tonsillar exudates or pharyngeal injection.

Rapid streptococcal antigen tests were negative in all the patients, and cultures of the tonsils showed no growth of β-hemolytic streptococci, including group A. None of the children had Epstein-Barr antibodies on immunofluorescence.

The 20 who chose metronidazole were similar to the 20 who did not with respect to age, race, sex, family size, current clinical findings, and previous antibiotics.

Compared with the children who remained untreated, those given metronidazole had significantly lower rates of fevers over 38° C after 1 day (11 vs. 17 children) and after 2 days (3 vs. 9 children), fewer sore throats after 1 day (12 vs. 19) and 2 days (9 vs. 16), and lower rates of tonsillar enlargement after 3 days (11 vs. 16) and 5 days (8 vs. 14). Pharyngeal injection at 2 days also was reduced with metronidazole, Dr. Brook reported at the conference, sponsored by the American Society for Microbiology.

Metronidazole was chosen for this study because it is effective against anaerobic bacteria but has virtually no activity against facultative and aerobic bacteria. These findings add to previous data suggesting a pathogenic role of anaerobes in the acute inflammatory process in the tonsils.

WASHINGTON — Metronidazole is effective in the treatment of non-β-hemolytic streptococcal tonsillitis, Itzhak Brook, M.D., reported in a poster presentation at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

Although group A β-hemolytic streptococcus (GABHS) is one of the major causes of tonsillitis, other aerobic as well as anaerobic organisms have been isolated from both normal and inflamed tonsils. The exact role of these organisms is uncertain, and some are believed to be part of the normal oropharyngeal flora, said Dr. Brook, professor of pediatrics at Georgetown University, Washington.

The option of using metronidazole (250 mg every 12 hours for 10 days) was offered to 40 children (mean age 9 years) who presented with sore throat and massive tonsillar enlargement plus at least one of the following: anterior cervical adenitis, temperature higher than 38.3° C, and pharyngeal or tonsillar exudates or pharyngeal injection.

Rapid streptococcal antigen tests were negative in all the patients, and cultures of the tonsils showed no growth of β-hemolytic streptococci, including group A. None of the children had Epstein-Barr antibodies on immunofluorescence.

The 20 who chose metronidazole were similar to the 20 who did not with respect to age, race, sex, family size, current clinical findings, and previous antibiotics.

Compared with the children who remained untreated, those given metronidazole had significantly lower rates of fevers over 38° C after 1 day (11 vs. 17 children) and after 2 days (3 vs. 9 children), fewer sore throats after 1 day (12 vs. 19) and 2 days (9 vs. 16), and lower rates of tonsillar enlargement after 3 days (11 vs. 16) and 5 days (8 vs. 14). Pharyngeal injection at 2 days also was reduced with metronidazole, Dr. Brook reported at the conference, sponsored by the American Society for Microbiology.

Metronidazole was chosen for this study because it is effective against anaerobic bacteria but has virtually no activity against facultative and aerobic bacteria. These findings add to previous data suggesting a pathogenic role of anaerobes in the acute inflammatory process in the tonsils.

PHILADELPHIA — The diabetes drug rosiglitazone appears to preserve cognitive function in patients with mild cognitive impairment and Alzheimer's disease, G. Stennis Watson, Ph.D., reported at the Ninth International Conference on Alzheimer's Disease and Related Disorders.

The finding, from a small randomized clinical trial funded by GlaxoSmithKline, suggest that “there may be a therapeutic window … a novel approach to treating cognitive dysfunction,” study coauthor Dr. Suzanne Craft said at a press briefing.

Twenty subjects with either mild cognitive impairment or Alzheimer's disease were randomized to receive 4 mg/day of rosiglitazone for 24 weeks, while another 10 subjects with similar degrees of cognitive impairment were randomized to receive placebo. Tests of cognition were performed at 2, 4, and 6 months, said Dr. Watson of the University of Washington, Seattle.

On the eight-word delayed recall part of the Buschke Selective Reminding Test, subjects on rosiglitazone remembered significantly more words than did the placebo subjects at 4 months (5.7 vs. 5.4) and 6 months (5.4 vs. 4.9), after adjustment for baseline performance. Similarly, the rosiglitazone group made fewer errors on the Stroop Color-Word Interference test, which measures selective attention. At 6 months, the rosiglitazone subjects made an average of 1.9 errors, compared with the expected 3.2 in the placebo group.

The effects are likely due to the drug's insulin-sensitizing and anti-inflammatory properties, and perhaps also to the amyloid-processing modulation action of rosiglitazone and other agents of the same class, Dr. Watson said at the conference, presented by the Alzheimer's Association.

PHILADELPHIA — The diabetes drug rosiglitazone appears to preserve cognitive function in patients with mild cognitive impairment and Alzheimer's disease, G. Stennis Watson, Ph.D., reported at the Ninth International Conference on Alzheimer's Disease and Related Disorders.

The finding, from a small randomized clinical trial funded by GlaxoSmithKline, suggest that “there may be a therapeutic window … a novel approach to treating cognitive dysfunction,” study coauthor Dr. Suzanne Craft said at a press briefing.

Twenty subjects with either mild cognitive impairment or Alzheimer's disease were randomized to receive 4 mg/day of rosiglitazone for 24 weeks, while another 10 subjects with similar degrees of cognitive impairment were randomized to receive placebo. Tests of cognition were performed at 2, 4, and 6 months, said Dr. Watson of the University of Washington, Seattle.

On the eight-word delayed recall part of the Buschke Selective Reminding Test, subjects on rosiglitazone remembered significantly more words than did the placebo subjects at 4 months (5.7 vs. 5.4) and 6 months (5.4 vs. 4.9), after adjustment for baseline performance. Similarly, the rosiglitazone group made fewer errors on the Stroop Color-Word Interference test, which measures selective attention. At 6 months, the rosiglitazone subjects made an average of 1.9 errors, compared with the expected 3.2 in the placebo group.

The effects are likely due to the drug's insulin-sensitizing and anti-inflammatory properties, and perhaps also to the amyloid-processing modulation action of rosiglitazone and other agents of the same class, Dr. Watson said at the conference, presented by the Alzheimer's Association.

PHILADELPHIA — The diabetes drug rosiglitazone appears to preserve cognitive function in patients with mild cognitive impairment and Alzheimer's disease, G. Stennis Watson, Ph.D., reported at the Ninth International Conference on Alzheimer's Disease and Related Disorders.

The finding, from a small randomized clinical trial funded by GlaxoSmithKline, suggest that “there may be a therapeutic window … a novel approach to treating cognitive dysfunction,” study coauthor Dr. Suzanne Craft said at a press briefing.

Twenty subjects with either mild cognitive impairment or Alzheimer's disease were randomized to receive 4 mg/day of rosiglitazone for 24 weeks, while another 10 subjects with similar degrees of cognitive impairment were randomized to receive placebo. Tests of cognition were performed at 2, 4, and 6 months, said Dr. Watson of the University of Washington, Seattle.

On the eight-word delayed recall part of the Buschke Selective Reminding Test, subjects on rosiglitazone remembered significantly more words than did the placebo subjects at 4 months (5.7 vs. 5.4) and 6 months (5.4 vs. 4.9), after adjustment for baseline performance. Similarly, the rosiglitazone group made fewer errors on the Stroop Color-Word Interference test, which measures selective attention. At 6 months, the rosiglitazone subjects made an average of 1.9 errors, compared with the expected 3.2 in the placebo group.

The effects are likely due to the drug's insulin-sensitizing and anti-inflammatory properties, and perhaps also to the amyloid-processing modulation action of rosiglitazone and other agents of the same class, Dr. Watson said at the conference, presented by the Alzheimer's Association.

VIENNA — Uterine artery velocimetry performed at 24 weeks' gestation is a useful tool for predicting recurrence of preeclampsia and other complications in women who had preeclampsia in a previous pregnancy, Tiziana Frusca, M.D., reported.

A normal uterine artery velocimetry (UAV) at 24 weeks suggests a preeclampsia recurrence risk of less than 1%, whereas an abnormal result suggests a one-in-four chance that the patient will become preeclamptic again, as well as an elevated risk of other complications.

“Knowing these patients are at very high risk, we can monitor them more closely,” Dr. Frusca said at the 14th World Congress of the International Society for the Study of Hypertension in Pregnancy.

Among 206 women with documented preeclampsia in a previous pregnancy, 39% had had severe or early-onset preeclampsia, 21% had chronic maternal disorders such as hypertension or autoimmune disorders, and 77% had been treated prophylactically with low-dose aspirin.

Preeclampsia recurred in 5.3% of subsequent pregnancies, whereas 12% (24) had hypertension without proteinuria, 14% (28) had intrauterine growth retardation (IUGR), and 1% (2) had placental abruption. Abnormal UAV—defined as a mean resistance index greater than 0.65 and/or the presence of bilateral notches—was identified in a total of 20% (41) of the women, while 80% (165) had normal UAV.

Complications were significantly more common among the women with abnormal UAV: hypertension without proteinuria (29% vs. 7%), IUGR (44% vs. 6%), and preeclampsia (24% vs. 0.6%), said Dr. Frusca of the department of ob.gyn. at the University of Brescia, Italy.

There were no differences in outcome related to whether the prior preeclampsia had been early vs. late, whether the mother had any underlying chronic conditions, or whether she had been treated previously with low-dose aspirin.

These results suggest an overall preeclampsia recurrence risk of 1 in 19, which rises to 1 in 4 if the woman has an abnormal Doppler at 24 weeks. However, if the UAV is normal, the recurrence risk is only 1 in 165.

VIENNA — Uterine artery velocimetry performed at 24 weeks' gestation is a useful tool for predicting recurrence of preeclampsia and other complications in women who had preeclampsia in a previous pregnancy, Tiziana Frusca, M.D., reported.

A normal uterine artery velocimetry (UAV) at 24 weeks suggests a preeclampsia recurrence risk of less than 1%, whereas an abnormal result suggests a one-in-four chance that the patient will become preeclamptic again, as well as an elevated risk of other complications.

“Knowing these patients are at very high risk, we can monitor them more closely,” Dr. Frusca said at the 14th World Congress of the International Society for the Study of Hypertension in Pregnancy.

Among 206 women with documented preeclampsia in a previous pregnancy, 39% had had severe or early-onset preeclampsia, 21% had chronic maternal disorders such as hypertension or autoimmune disorders, and 77% had been treated prophylactically with low-dose aspirin.

Preeclampsia recurred in 5.3% of subsequent pregnancies, whereas 12% (24) had hypertension without proteinuria, 14% (28) had intrauterine growth retardation (IUGR), and 1% (2) had placental abruption. Abnormal UAV—defined as a mean resistance index greater than 0.65 and/or the presence of bilateral notches—was identified in a total of 20% (41) of the women, while 80% (165) had normal UAV.

Complications were significantly more common among the women with abnormal UAV: hypertension without proteinuria (29% vs. 7%), IUGR (44% vs. 6%), and preeclampsia (24% vs. 0.6%), said Dr. Frusca of the department of ob.gyn. at the University of Brescia, Italy.

There were no differences in outcome related to whether the prior preeclampsia had been early vs. late, whether the mother had any underlying chronic conditions, or whether she had been treated previously with low-dose aspirin.

These results suggest an overall preeclampsia recurrence risk of 1 in 19, which rises to 1 in 4 if the woman has an abnormal Doppler at 24 weeks. However, if the UAV is normal, the recurrence risk is only 1 in 165.

VIENNA — Uterine artery velocimetry performed at 24 weeks' gestation is a useful tool for predicting recurrence of preeclampsia and other complications in women who had preeclampsia in a previous pregnancy, Tiziana Frusca, M.D., reported.

A normal uterine artery velocimetry (UAV) at 24 weeks suggests a preeclampsia recurrence risk of less than 1%, whereas an abnormal result suggests a one-in-four chance that the patient will become preeclamptic again, as well as an elevated risk of other complications.

“Knowing these patients are at very high risk, we can monitor them more closely,” Dr. Frusca said at the 14th World Congress of the International Society for the Study of Hypertension in Pregnancy.

Among 206 women with documented preeclampsia in a previous pregnancy, 39% had had severe or early-onset preeclampsia, 21% had chronic maternal disorders such as hypertension or autoimmune disorders, and 77% had been treated prophylactically with low-dose aspirin.

Preeclampsia recurred in 5.3% of subsequent pregnancies, whereas 12% (24) had hypertension without proteinuria, 14% (28) had intrauterine growth retardation (IUGR), and 1% (2) had placental abruption. Abnormal UAV—defined as a mean resistance index greater than 0.65 and/or the presence of bilateral notches—was identified in a total of 20% (41) of the women, while 80% (165) had normal UAV.

Complications were significantly more common among the women with abnormal UAV: hypertension without proteinuria (29% vs. 7%), IUGR (44% vs. 6%), and preeclampsia (24% vs. 0.6%), said Dr. Frusca of the department of ob.gyn. at the University of Brescia, Italy.

There were no differences in outcome related to whether the prior preeclampsia had been early vs. late, whether the mother had any underlying chronic conditions, or whether she had been treated previously with low-dose aspirin.

These results suggest an overall preeclampsia recurrence risk of 1 in 19, which rises to 1 in 4 if the woman has an abnormal Doppler at 24 weeks. However, if the UAV is normal, the recurrence risk is only 1 in 165.

VIENNA — Obesity does not appear to increase the risk for progression to preeclampsia among women with mild gestational hypertension remote from term, John R. Barton, M.D., reported.

Among women with mild gestational hypertension, however, higher body mass index (BMI) is associated with higher birth weights and increased rates of cesarean delivery, Dr. Barton said in a poster presentation at the 14th World Congress of the International Society for the Study of Hypertension in Pregnancy.

A total of 365 women with mild gestational hypertension and normal BMI (20–25 kg/m2) were matched one-to-one for gestational age at diagnosis, race, and parity to 365 women who also had mild gestational hypertension but whose BMIs were 30 kg/m2 or greater. All had singleton pregnancies, said Dr. Barton of Central Baptist Hospital, Lexington, Ky.

Cesarean deliveries were significantly more common among the obese women (57% vs. 40%). However, the percentages who progressed to preeclampsia—41% in the obese group vs. 38% in the normal-weight group—were not significantly different between groups, nor were the percentages who developed severe hypertension, HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome, abruptio placentae, or eclampsia, Dr. Barton reported.

The majority of both obese and nonobese women delivered at 37 weeks or later, whereas the proportions delivered at sooner than 34 weeks—6.3% in the obese group vs. 9.9% of the normal weight women—were not significantly different.

Babies born to obese women had a significantly greater mean birth weight (3,033 g vs. 2,833 g), and a significantly smaller percentage of their babies weighed less than 2,500 g (24% vs. 32%). Perinatal deaths did not differ between the obese and nonobese groups.

This study differs from others that have found an association between obesity and the development of preeclampsia in that most of those data involved women who were originally normotensive, Dr. Barton noted.

These findings support previous recommendations for frequent antepartum monitoring of all women with hypertensive pregnancies, including twice-weekly fetal heart rate testing accompanied by weekly amniotic fluid volume estimation beginning at the time of diagnosis.

In addition, daily kick counts should be considered at the beginning of the third trimester. Abnormal nonstress tests or amniotic fluid elevations should be followed by a comprehensive maternal and fetal evaluation, he advised.

VIENNA — Obesity does not appear to increase the risk for progression to preeclampsia among women with mild gestational hypertension remote from term, John R. Barton, M.D., reported.

Among women with mild gestational hypertension, however, higher body mass index (BMI) is associated with higher birth weights and increased rates of cesarean delivery, Dr. Barton said in a poster presentation at the 14th World Congress of the International Society for the Study of Hypertension in Pregnancy.

A total of 365 women with mild gestational hypertension and normal BMI (20–25 kg/m2) were matched one-to-one for gestational age at diagnosis, race, and parity to 365 women who also had mild gestational hypertension but whose BMIs were 30 kg/m2 or greater. All had singleton pregnancies, said Dr. Barton of Central Baptist Hospital, Lexington, Ky.

Cesarean deliveries were significantly more common among the obese women (57% vs. 40%). However, the percentages who progressed to preeclampsia—41% in the obese group vs. 38% in the normal-weight group—were not significantly different between groups, nor were the percentages who developed severe hypertension, HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome, abruptio placentae, or eclampsia, Dr. Barton reported.

The majority of both obese and nonobese women delivered at 37 weeks or later, whereas the proportions delivered at sooner than 34 weeks—6.3% in the obese group vs. 9.9% of the normal weight women—were not significantly different.

Babies born to obese women had a significantly greater mean birth weight (3,033 g vs. 2,833 g), and a significantly smaller percentage of their babies weighed less than 2,500 g (24% vs. 32%). Perinatal deaths did not differ between the obese and nonobese groups.

This study differs from others that have found an association between obesity and the development of preeclampsia in that most of those data involved women who were originally normotensive, Dr. Barton noted.

These findings support previous recommendations for frequent antepartum monitoring of all women with hypertensive pregnancies, including twice-weekly fetal heart rate testing accompanied by weekly amniotic fluid volume estimation beginning at the time of diagnosis.

In addition, daily kick counts should be considered at the beginning of the third trimester. Abnormal nonstress tests or amniotic fluid elevations should be followed by a comprehensive maternal and fetal evaluation, he advised.

VIENNA — Obesity does not appear to increase the risk for progression to preeclampsia among women with mild gestational hypertension remote from term, John R. Barton, M.D., reported.

Among women with mild gestational hypertension, however, higher body mass index (BMI) is associated with higher birth weights and increased rates of cesarean delivery, Dr. Barton said in a poster presentation at the 14th World Congress of the International Society for the Study of Hypertension in Pregnancy.

A total of 365 women with mild gestational hypertension and normal BMI (20–25 kg/m2) were matched one-to-one for gestational age at diagnosis, race, and parity to 365 women who also had mild gestational hypertension but whose BMIs were 30 kg/m2 or greater. All had singleton pregnancies, said Dr. Barton of Central Baptist Hospital, Lexington, Ky.

Cesarean deliveries were significantly more common among the obese women (57% vs. 40%). However, the percentages who progressed to preeclampsia—41% in the obese group vs. 38% in the normal-weight group—were not significantly different between groups, nor were the percentages who developed severe hypertension, HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome, abruptio placentae, or eclampsia, Dr. Barton reported.

The majority of both obese and nonobese women delivered at 37 weeks or later, whereas the proportions delivered at sooner than 34 weeks—6.3% in the obese group vs. 9.9% of the normal weight women—were not significantly different.

Babies born to obese women had a significantly greater mean birth weight (3,033 g vs. 2,833 g), and a significantly smaller percentage of their babies weighed less than 2,500 g (24% vs. 32%). Perinatal deaths did not differ between the obese and nonobese groups.

This study differs from others that have found an association between obesity and the development of preeclampsia in that most of those data involved women who were originally normotensive, Dr. Barton noted.

These findings support previous recommendations for frequent antepartum monitoring of all women with hypertensive pregnancies, including twice-weekly fetal heart rate testing accompanied by weekly amniotic fluid volume estimation beginning at the time of diagnosis.

In addition, daily kick counts should be considered at the beginning of the third trimester. Abnormal nonstress tests or amniotic fluid elevations should be followed by a comprehensive maternal and fetal evaluation, he advised.

VIENNA — A high-fiber diet reduces the risk for preeclampsia in pregnant women, Michelle A. Williams, Sc.D., reported at the 14th World Congress of the International Society for the Study of Hypertension in Pregnancy.

There is a wide body of literature supporting the link between consumption of dietary fiber and reductions in blood pressure, as well as improvements in other cardiovascular risks, such as cholesterol and triglyceride concentrations, insulin sensitivity, and inflammation. Current dietary guidelines, therefore, recommend a diet containing at least five servings of fruits or vegetables daily and a total daily fiber intake of 20–30 g.

Now, similar findings from both a case-control study involving 511 women and a prospective cohort study of 875 women suggest that “current efforts to encourage populations to consume diets high in grains, fruits, and vegetables may also benefit pregnant women,” said Dr. Williams, professor of epidemiology at the University of Washington and associate director of the Center for Perinatal Studies at Swedish Medical Center, both in Seattle.

In the case-control study, 172 women with preeclampsia and 339 controls retrospectively completed questionnaires about their diets during pregnancy and in the 3 months before becoming pregnant.

The median daily consumption of carbohydrates was significantly lower in the preeclampsia group (216 g versus 253 g), as was fiber consumption (18 g versus. 19 g).

The women whose fiber intake placed them in the upper quartile of daily fiber consumption (more than 24 g) were 51% less likely to develop preeclampsia than were those in the lowest quartile (less than 13 g), after controlling for maternal age, parity, adiposity, income, and total caloric consumption.

Because of the potential limitations of this type of study design—including selection and recall bias—Dr. Williams and her colleagues followed this study with a larger prospective study in which the women were given a structured interview at 12 weeks' gestation in addition to the periconceptional dietary intake questionnaire.

Of the 875 women with singleton pregnancies, 62 had preeclampsia. Of those, 23 were among the lowest quartile for daily fiber consumption (less than 11.9 g), while 14 were in the highest quartile (more than 20.7 g). The women with preeclampsia accounted for approximately 10% of the total 222 women in the lowest fiber consumption quartile, compared with just 6% of the 218 in the highest quartile.

After adjustment for total daily calories, age, race or ethnicity, parity, prepregnancy body mass index, and daily vitamin C intake, the relative risk for preeclampsia was reduced by 70% among those whose fiber consumption was in the highest quartile, compared with those in the lowest. Even when a stricter definition of preeclampsia was used, resulting in the loss of 20 of the 62 women from the analysis, having the highest fiber consumption still cut the preeclampsia risk in half, Dr. Williams reported.

VIENNA — A high-fiber diet reduces the risk for preeclampsia in pregnant women, Michelle A. Williams, Sc.D., reported at the 14th World Congress of the International Society for the Study of Hypertension in Pregnancy.

There is a wide body of literature supporting the link between consumption of dietary fiber and reductions in blood pressure, as well as improvements in other cardiovascular risks, such as cholesterol and triglyceride concentrations, insulin sensitivity, and inflammation. Current dietary guidelines, therefore, recommend a diet containing at least five servings of fruits or vegetables daily and a total daily fiber intake of 20–30 g.

Now, similar findings from both a case-control study involving 511 women and a prospective cohort study of 875 women suggest that “current efforts to encourage populations to consume diets high in grains, fruits, and vegetables may also benefit pregnant women,” said Dr. Williams, professor of epidemiology at the University of Washington and associate director of the Center for Perinatal Studies at Swedish Medical Center, both in Seattle.

In the case-control study, 172 women with preeclampsia and 339 controls retrospectively completed questionnaires about their diets during pregnancy and in the 3 months before becoming pregnant.

The median daily consumption of carbohydrates was significantly lower in the preeclampsia group (216 g versus 253 g), as was fiber consumption (18 g versus. 19 g).

The women whose fiber intake placed them in the upper quartile of daily fiber consumption (more than 24 g) were 51% less likely to develop preeclampsia than were those in the lowest quartile (less than 13 g), after controlling for maternal age, parity, adiposity, income, and total caloric consumption.

Because of the potential limitations of this type of study design—including selection and recall bias—Dr. Williams and her colleagues followed this study with a larger prospective study in which the women were given a structured interview at 12 weeks' gestation in addition to the periconceptional dietary intake questionnaire.

Of the 875 women with singleton pregnancies, 62 had preeclampsia. Of those, 23 were among the lowest quartile for daily fiber consumption (less than 11.9 g), while 14 were in the highest quartile (more than 20.7 g). The women with preeclampsia accounted for approximately 10% of the total 222 women in the lowest fiber consumption quartile, compared with just 6% of the 218 in the highest quartile.

After adjustment for total daily calories, age, race or ethnicity, parity, prepregnancy body mass index, and daily vitamin C intake, the relative risk for preeclampsia was reduced by 70% among those whose fiber consumption was in the highest quartile, compared with those in the lowest. Even when a stricter definition of preeclampsia was used, resulting in the loss of 20 of the 62 women from the analysis, having the highest fiber consumption still cut the preeclampsia risk in half, Dr. Williams reported.

VIENNA — A high-fiber diet reduces the risk for preeclampsia in pregnant women, Michelle A. Williams, Sc.D., reported at the 14th World Congress of the International Society for the Study of Hypertension in Pregnancy.

There is a wide body of literature supporting the link between consumption of dietary fiber and reductions in blood pressure, as well as improvements in other cardiovascular risks, such as cholesterol and triglyceride concentrations, insulin sensitivity, and inflammation. Current dietary guidelines, therefore, recommend a diet containing at least five servings of fruits or vegetables daily and a total daily fiber intake of 20–30 g.

Now, similar findings from both a case-control study involving 511 women and a prospective cohort study of 875 women suggest that “current efforts to encourage populations to consume diets high in grains, fruits, and vegetables may also benefit pregnant women,” said Dr. Williams, professor of epidemiology at the University of Washington and associate director of the Center for Perinatal Studies at Swedish Medical Center, both in Seattle.

In the case-control study, 172 women with preeclampsia and 339 controls retrospectively completed questionnaires about their diets during pregnancy and in the 3 months before becoming pregnant.

The median daily consumption of carbohydrates was significantly lower in the preeclampsia group (216 g versus 253 g), as was fiber consumption (18 g versus. 19 g).

The women whose fiber intake placed them in the upper quartile of daily fiber consumption (more than 24 g) were 51% less likely to develop preeclampsia than were those in the lowest quartile (less than 13 g), after controlling for maternal age, parity, adiposity, income, and total caloric consumption.

Because of the potential limitations of this type of study design—including selection and recall bias—Dr. Williams and her colleagues followed this study with a larger prospective study in which the women were given a structured interview at 12 weeks' gestation in addition to the periconceptional dietary intake questionnaire.

Of the 875 women with singleton pregnancies, 62 had preeclampsia. Of those, 23 were among the lowest quartile for daily fiber consumption (less than 11.9 g), while 14 were in the highest quartile (more than 20.7 g). The women with preeclampsia accounted for approximately 10% of the total 222 women in the lowest fiber consumption quartile, compared with just 6% of the 218 in the highest quartile.

After adjustment for total daily calories, age, race or ethnicity, parity, prepregnancy body mass index, and daily vitamin C intake, the relative risk for preeclampsia was reduced by 70% among those whose fiber consumption was in the highest quartile, compared with those in the lowest. Even when a stricter definition of preeclampsia was used, resulting in the loss of 20 of the 62 women from the analysis, having the highest fiber consumption still cut the preeclampsia risk in half, Dr. Williams reported.

VIENNA — Both increasing severity and recurrence of gestational hypertension increase a woman's chances of developing ischemic heart disease later in life, Anna-Karin Wikström, M.D., said at the 14th World Congress of the International Society for the Study of Hypertension in Pregnancy.

Long-term measures to prevent hypertension should be undertaken in women who experience severe or recurrent hypertension during pregnancy, said Dr. Wikström of Uppsala University, Stockholm.

Data from three Swedish medical databases were analyzed for more than 400,000 women with first births since 1973 and for more than 200,000 who gave birth to two infants between 1973 and 1982. Only singleton births were included. Women with chronic hypertension and/or diabetes were excluded.

After adjustment for maternal age, socioeconomic status, and hospital category, the relative risk of developing ischemic heart disease (IHD) after 19–28 years' follow-up was 1.6 for the women who had gestational hypertension without proteinuria in their first pregnancies, compared with those who did not have hypertension in their first pregnancies. Among women with preeclampsia the relative risk was 1.9, and among those with severe preeclampsia it was 2.8. All the between-group differences were statistically significant, she said.

In the group with two children, the women who had any degree of hypertensive disease during their first pregnancy but not during the second had a 1.9 relative risk of IHD, compared with those who did not have hypertension in either pregnancy.

The relative risk of IHD for women with hypertension in the second pregnancy but not the first was 2.4, and for those with hypertension in both pregnancies, 2.8. The difference between the first-pregnancy and both-pregnancy groups was statistically significant, she noted.

While sharing this information with all gestational hypertension patients might create unnecessary anxiety, it “could be considered in women with a history of severe or recurrent preeclampsia,” Dr. Wikström said.

VIENNA — Both increasing severity and recurrence of gestational hypertension increase a woman's chances of developing ischemic heart disease later in life, Anna-Karin Wikström, M.D., said at the 14th World Congress of the International Society for the Study of Hypertension in Pregnancy.

Long-term measures to prevent hypertension should be undertaken in women who experience severe or recurrent hypertension during pregnancy, said Dr. Wikström of Uppsala University, Stockholm.

Data from three Swedish medical databases were analyzed for more than 400,000 women with first births since 1973 and for more than 200,000 who gave birth to two infants between 1973 and 1982. Only singleton births were included. Women with chronic hypertension and/or diabetes were excluded.

After adjustment for maternal age, socioeconomic status, and hospital category, the relative risk of developing ischemic heart disease (IHD) after 19–28 years' follow-up was 1.6 for the women who had gestational hypertension without proteinuria in their first pregnancies, compared with those who did not have hypertension in their first pregnancies. Among women with preeclampsia the relative risk was 1.9, and among those with severe preeclampsia it was 2.8. All the between-group differences were statistically significant, she said.

In the group with two children, the women who had any degree of hypertensive disease during their first pregnancy but not during the second had a 1.9 relative risk of IHD, compared with those who did not have hypertension in either pregnancy.

The relative risk of IHD for women with hypertension in the second pregnancy but not the first was 2.4, and for those with hypertension in both pregnancies, 2.8. The difference between the first-pregnancy and both-pregnancy groups was statistically significant, she noted.

While sharing this information with all gestational hypertension patients might create unnecessary anxiety, it “could be considered in women with a history of severe or recurrent preeclampsia,” Dr. Wikström said.

VIENNA — Both increasing severity and recurrence of gestational hypertension increase a woman's chances of developing ischemic heart disease later in life, Anna-Karin Wikström, M.D., said at the 14th World Congress of the International Society for the Study of Hypertension in Pregnancy.

Long-term measures to prevent hypertension should be undertaken in women who experience severe or recurrent hypertension during pregnancy, said Dr. Wikström of Uppsala University, Stockholm.

Data from three Swedish medical databases were analyzed for more than 400,000 women with first births since 1973 and for more than 200,000 who gave birth to two infants between 1973 and 1982. Only singleton births were included. Women with chronic hypertension and/or diabetes were excluded.

After adjustment for maternal age, socioeconomic status, and hospital category, the relative risk of developing ischemic heart disease (IHD) after 19–28 years' follow-up was 1.6 for the women who had gestational hypertension without proteinuria in their first pregnancies, compared with those who did not have hypertension in their first pregnancies. Among women with preeclampsia the relative risk was 1.9, and among those with severe preeclampsia it was 2.8. All the between-group differences were statistically significant, she said.

In the group with two children, the women who had any degree of hypertensive disease during their first pregnancy but not during the second had a 1.9 relative risk of IHD, compared with those who did not have hypertension in either pregnancy.

The relative risk of IHD for women with hypertension in the second pregnancy but not the first was 2.4, and for those with hypertension in both pregnancies, 2.8. The difference between the first-pregnancy and both-pregnancy groups was statistically significant, she noted.

While sharing this information with all gestational hypertension patients might create unnecessary anxiety, it “could be considered in women with a history of severe or recurrent preeclampsia,” Dr. Wikström said.

VIENNA — The use of low-molecular-weight heparin together with low-dose aspirin can improve pregnancy outcomes in women who previously had preeclampsia and low-birth-weight infants, Sergio Ferrazzani, M.D., reported.

Women with preeclampsia and low-birth-weight infants in their first pregnancy have double the recurrence rate of preeclampsia in their second pregnancy, compared with those who did not have preeclampsia previously. Infants of those subsequent pregnancies are at increased risk for fetal growth restriction and low birth weight. Data suggest that preeclampsia and fetal growth restriction might share one or more pathophysiologic mechanisms, noted Dr. Ferrazzani of the Catholic University of the Sacred Heart, Rome.

An electronic database search of records from his hospital's high-risk pregnancy ward yielded data on 54 women with previous preeclampsia associated with low birth weight and/or intrauterine growth retardation who were negative for antiphospholipid antibody. The women had not been treated with aspirin during a previous pregnancy, he said at the 14th World Congress of the International Society for the Study of Hypertension in Pregnancy.

Of those 54 women, 23 gave birth during 1990–1996, when hospital policy called for thromboprophylaxis with low-dose (100 mg/day) aspirin alone (ASA); the 31 women who delivered during 1997–2003 were treated with the same daily dose of aspirin plus low-molecular-weight heparin (4,000 units subcutaneous enoxaparin).

Aspirin was prescribed from the 22nd day of the menstrual cycle and was discontinued after 36 weeks' gestation. The low-molecular-weight heparin (LMWH) was prescribed after results of a positive pregnancy test were received, and was continued until delivery.

The women were similar with regard to demographic and anthropomorphic characteristics. About 20% of the women in each group had chronic hypertension, and almost as many (17% in the ASA alone group and 19% in the ASA-LMWH group) had more than one previous pregnancy complicated by preeclampsia.

Gestational age at delivery of the treated pregnancy was higher in both groups, compared with the women's first pregnancies, but the improvement was greater for those in the ASA-LMWH group. The increase was 32.1 vs. 34.8 weeks for women treated with ASA alone, compared with 30.9 vs. 36.4 weeks for women treated with ASA-LMWH.

Similarly, the proportion of women with small-for-gestational-age fetuses, which was 100% among all the first pregnancies, dropped to just 35% with ASA treatment alone and to 16% with ASA-LMWH treatment. Both groups showed a birth weight improvement, but the ASA-LWMH group's increase was nearly double that of the group treated with ASA alone (1,372 g vs. 2,017 g in the ASA group and 1,197 g vs. 2,600 g in the ASA-LMWH group).

In both groups, there were six intrauterine deaths among the first pregnancies and none in the treated pregnancies. Neonatal deaths dropped from 6 to 3 with ASA and from 11 to 1 with ASA-LMWH. Only the ASA-LMWH drop was statistically significant, he noted.

Preeclampsia (in 100% of all the first pregnancies) occurred in 30% of the subsequent ASA-treated pregnancies, compared with just 3% of pregnancies treated with both ASA and LMWH.

Among the 11 patients with chronic hypertension, the mean gestational age at delivery and the mean birth weight were also significantly greater among the infants of the 6 patients from the ASA-LMWH group, compared with those of the 5 ASA patients, Dr. Ferrazzani added.

None of the women treated with ASA-LMWH developed heparin-induced thrombocytopenia or thrombotic episodes, and there was no clinical evidence of heparin-induced osteoporosis. Mild bruising at the injection site—which was considered to be confirmatory of self-administration of the anticoagulant—was the only complication noted with heparin therapy, he said.

VIENNA — The use of low-molecular-weight heparin together with low-dose aspirin can improve pregnancy outcomes in women who previously had preeclampsia and low-birth-weight infants, Sergio Ferrazzani, M.D., reported.

Women with preeclampsia and low-birth-weight infants in their first pregnancy have double the recurrence rate of preeclampsia in their second pregnancy, compared with those who did not have preeclampsia previously. Infants of those subsequent pregnancies are at increased risk for fetal growth restriction and low birth weight. Data suggest that preeclampsia and fetal growth restriction might share one or more pathophysiologic mechanisms, noted Dr. Ferrazzani of the Catholic University of the Sacred Heart, Rome.

An electronic database search of records from his hospital's high-risk pregnancy ward yielded data on 54 women with previous preeclampsia associated with low birth weight and/or intrauterine growth retardation who were negative for antiphospholipid antibody. The women had not been treated with aspirin during a previous pregnancy, he said at the 14th World Congress of the International Society for the Study of Hypertension in Pregnancy.

Of those 54 women, 23 gave birth during 1990–1996, when hospital policy called for thromboprophylaxis with low-dose (100 mg/day) aspirin alone (ASA); the 31 women who delivered during 1997–2003 were treated with the same daily dose of aspirin plus low-molecular-weight heparin (4,000 units subcutaneous enoxaparin).

Aspirin was prescribed from the 22nd day of the menstrual cycle and was discontinued after 36 weeks' gestation. The low-molecular-weight heparin (LMWH) was prescribed after results of a positive pregnancy test were received, and was continued until delivery.

The women were similar with regard to demographic and anthropomorphic characteristics. About 20% of the women in each group had chronic hypertension, and almost as many (17% in the ASA alone group and 19% in the ASA-LMWH group) had more than one previous pregnancy complicated by preeclampsia.

Gestational age at delivery of the treated pregnancy was higher in both groups, compared with the women's first pregnancies, but the improvement was greater for those in the ASA-LMWH group. The increase was 32.1 vs. 34.8 weeks for women treated with ASA alone, compared with 30.9 vs. 36.4 weeks for women treated with ASA-LMWH.

Similarly, the proportion of women with small-for-gestational-age fetuses, which was 100% among all the first pregnancies, dropped to just 35% with ASA treatment alone and to 16% with ASA-LMWH treatment. Both groups showed a birth weight improvement, but the ASA-LWMH group's increase was nearly double that of the group treated with ASA alone (1,372 g vs. 2,017 g in the ASA group and 1,197 g vs. 2,600 g in the ASA-LMWH group).

In both groups, there were six intrauterine deaths among the first pregnancies and none in the treated pregnancies. Neonatal deaths dropped from 6 to 3 with ASA and from 11 to 1 with ASA-LMWH. Only the ASA-LMWH drop was statistically significant, he noted.

Preeclampsia (in 100% of all the first pregnancies) occurred in 30% of the subsequent ASA-treated pregnancies, compared with just 3% of pregnancies treated with both ASA and LMWH.

Among the 11 patients with chronic hypertension, the mean gestational age at delivery and the mean birth weight were also significantly greater among the infants of the 6 patients from the ASA-LMWH group, compared with those of the 5 ASA patients, Dr. Ferrazzani added.

None of the women treated with ASA-LMWH developed heparin-induced thrombocytopenia or thrombotic episodes, and there was no clinical evidence of heparin-induced osteoporosis. Mild bruising at the injection site—which was considered to be confirmatory of self-administration of the anticoagulant—was the only complication noted with heparin therapy, he said.

VIENNA — The use of low-molecular-weight heparin together with low-dose aspirin can improve pregnancy outcomes in women who previously had preeclampsia and low-birth-weight infants, Sergio Ferrazzani, M.D., reported.

Women with preeclampsia and low-birth-weight infants in their first pregnancy have double the recurrence rate of preeclampsia in their second pregnancy, compared with those who did not have preeclampsia previously. Infants of those subsequent pregnancies are at increased risk for fetal growth restriction and low birth weight. Data suggest that preeclampsia and fetal growth restriction might share one or more pathophysiologic mechanisms, noted Dr. Ferrazzani of the Catholic University of the Sacred Heart, Rome.

An electronic database search of records from his hospital's high-risk pregnancy ward yielded data on 54 women with previous preeclampsia associated with low birth weight and/or intrauterine growth retardation who were negative for antiphospholipid antibody. The women had not been treated with aspirin during a previous pregnancy, he said at the 14th World Congress of the International Society for the Study of Hypertension in Pregnancy.

Of those 54 women, 23 gave birth during 1990–1996, when hospital policy called for thromboprophylaxis with low-dose (100 mg/day) aspirin alone (ASA); the 31 women who delivered during 1997–2003 were treated with the same daily dose of aspirin plus low-molecular-weight heparin (4,000 units subcutaneous enoxaparin).

Aspirin was prescribed from the 22nd day of the menstrual cycle and was discontinued after 36 weeks' gestation. The low-molecular-weight heparin (LMWH) was prescribed after results of a positive pregnancy test were received, and was continued until delivery.

The women were similar with regard to demographic and anthropomorphic characteristics. About 20% of the women in each group had chronic hypertension, and almost as many (17% in the ASA alone group and 19% in the ASA-LMWH group) had more than one previous pregnancy complicated by preeclampsia.

Gestational age at delivery of the treated pregnancy was higher in both groups, compared with the women's first pregnancies, but the improvement was greater for those in the ASA-LMWH group. The increase was 32.1 vs. 34.8 weeks for women treated with ASA alone, compared with 30.9 vs. 36.4 weeks for women treated with ASA-LMWH.

Similarly, the proportion of women with small-for-gestational-age fetuses, which was 100% among all the first pregnancies, dropped to just 35% with ASA treatment alone and to 16% with ASA-LMWH treatment. Both groups showed a birth weight improvement, but the ASA-LWMH group's increase was nearly double that of the group treated with ASA alone (1,372 g vs. 2,017 g in the ASA group and 1,197 g vs. 2,600 g in the ASA-LMWH group).

In both groups, there were six intrauterine deaths among the first pregnancies and none in the treated pregnancies. Neonatal deaths dropped from 6 to 3 with ASA and from 11 to 1 with ASA-LMWH. Only the ASA-LMWH drop was statistically significant, he noted.

Preeclampsia (in 100% of all the first pregnancies) occurred in 30% of the subsequent ASA-treated pregnancies, compared with just 3% of pregnancies treated with both ASA and LMWH.

Among the 11 patients with chronic hypertension, the mean gestational age at delivery and the mean birth weight were also significantly greater among the infants of the 6 patients from the ASA-LMWH group, compared with those of the 5 ASA patients, Dr. Ferrazzani added.

None of the women treated with ASA-LMWH developed heparin-induced thrombocytopenia or thrombotic episodes, and there was no clinical evidence of heparin-induced osteoporosis. Mild bruising at the injection site—which was considered to be confirmatory of self-administration of the anticoagulant—was the only complication noted with heparin therapy, he said.