Social support and pregnancy outcome

Article Abstract:

There is an association between strong social support and health status. It has been suggested that social support can be used to promote good health and improve the well-being of the mother and her fetus. The usefulness of social support in pregnancy was studied among 509 socially disadvantaged women. The women who received support received a minimum of three home visits by a midwife at the 14th, 20th and 28th week of pregnancy plus two phone contacts and another brief home visit in addition to standard prenatal care. The other women received routine prenatal care only. The midwives were instructed to give no clinical care but only to answer questions elicited by the mothers, make referrals and give practical information. All the women had a history of a low-birth-weight delivery (giving birth to an infant weighing less than 2,500 grams, or 5.5 pounds) and 41 percent smoked cigarettes. The women were given a questionnaire six weeks after delivery to determine the outcome of the pregnancy. The average birth weight of the infants born to mothers receiving the intervention was 1.3 ounces (38 grams) higher than the women who did not receive social support. Fewer low-birth-weight infants were born in the social-support group. The women who received social support were hospitalized less often during the pregnancy, had more spontaneous labors and deliveries, and were given less epidural anesthesia. Both groups had similar number of visits to the antenatal clinic. Although the same number of babies required resuscitation, the babies who were born to mothers who received support required less invasive methods to resuscitate them if they were not breathing, and less neonatal intensive care. The infants born to mothers who received support were healthier than the women who did not receive support. The women stated that the midwife's presence was the single most important factor influencing their positive pregnancy outcome. Social support can be a useful adjunct in improving the pregnancy outcome of disadvantaged low-income women. (Consumer Summary produced by Reliance Medical Information, Inc.)

Social aspects, Care and treatment, Methods, Prevention, Pregnant women, Prenatal care, Pregnancy, Complications of, Pregnancy complications

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What threat human parvovirus B19 to the fetus?

Article Abstract:

A newly discovered virus, parvovirus B19, may infect the fetus during pregnancy. The virus produces a range of symptoms in adults and, in some cases, their fetuses. A disease caused by this virus was observed in six Jamaican patients with sickle cell disease, who subsequently developed aplastic crisis, a blood disorder where all blood components fail to form. The most common manifestation of the parvovirus B19 is the childhood disease erythema infectiosum (fifth disease, or 'slapped face'). This is a contagious disease causing a rash which begins on the face (appearing as if the child had been slapped), and later spreads to the trunk and legs. The rash may or may not be preceded by fever and gastrointestinal upset. Joint pain may be involved when adults, especially women, are infected. Two women with documented parvovirus B19 infection during pregnancy are reported. One case resulted in fetal death, and the other developed hydrops fetalis, a severe fetal anemia. Normal pregnancy outcomes in infected women have also been reported; it is estimated that 80 percent of pregnant women who are infected have normal live births. Only one case has been reported were a congenital malformation was associated with the parvovirus. Similar mechanisms cause aplastic crisis in adults, and the anemia resulting in hydrops fetalis; both disorders involve a shortened red blood cell life span. Since the virus is infectious one week before the rash appears, quarantining patients with erythema infectiosum is not recommended. If parvovirus B19 infection is suspected during an aplastic crisis, quarantine is suggested. Blood tests for B19 are only available at a few laboratories, but should be performed on mothers with suspected infection. A test for alpha-fetoprotein in the mother's blood, which indicates fetal neurological complications, should also be performed, along with fetal ultrasonographic imaging. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Fetal pathology in human parvovirus B19 infection

Article Abstract:

The parvovirus B19 is known to cause erythema infectiosum (slapped face, or fifth disease) in children. It also can result in aplastic crisis (where blood cells fail to form) in adult patients with other blood disorders, such as sickle cell anemia. Parvovirus B19 infections may result in fetal death, miscarriage, or hydrops fetalis (severe fetal anemia). The outcome of pregnancies complicated by a parvovirus B19 infection was examined. There were nine women with confirmed or suspected B19 infection, and one possible infection. Out of a total of 10 pregnancies, two fetuses died during the first three months of pregnancy, and one was electively terminated. There were six apparently normal fetuses delivered at full term. The one fetus born at 37 weeks of pregnancy was small for its fetal age, and had many malformations. In two of the fetuses that died, autopsies found the B19 virus in cells other than the red blood cells. Eye abnormalities and swelling of fetal tissue were noted in the fetus that was terminated. Although the role of parvovirus B19 in fetal complications is unknown, interference with fetal organ development is suggested. (Consumer Summary produced by Reliance Medical Information, Inc.)

Maternal-fetal exchange, Physiological aspects

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