157 lines
No EOL
17 KiB
HTML
157 lines
No EOL
17 KiB
HTML
<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN"
|
|
"http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
|
|
<html xmlns="http://www.w3.org/1999/xhtml">
|
|
<head>
|
|
<title>Research Activities, March 1999: Low Birthweight PORT publishes recent findings</title>
|
|
<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1" />
|
|
|
|
<!-- "metadata" -->
|
|
<meta name="Title" content="Research Activities, March 1999" />
|
|
<meta name="keywords" content="Agency for Health Care Policy and Research, Agency for Healthcare Research and Quality, AHRQ, AHCPR, AIDS/HIV, ambulatory care, benchmark, child, cost, elderly, health cost, healthcare cost, hospital, long-term care, managed care, markets, mental health, methodology, minority health, nursing, nursing homes, outcome research, out-of-pocket spending, patient care, primary, primary care, research, rural, spending, study, Translating Research Into Practice, TRIP" />
|
|
<meta name="description" content="Online newsletter summarizing published findings from AHRQ-funded studies, new AHRQ publications and products, and funding opportunities." />
|
|
<meta name="creator" content="Agency for Healthcare Research and Quality (AHRQ)" />
|
|
<meta name="language" content="English" />
|
|
<!-- end metadata -->
|
|
<link href="/includes/archive.css" rel="stylesheet" type="text/css" />
|
|
<link href="/includes/ahrqstyleprint_arch.css" rel="stylesheet" type="text/css" media="print" />
|
|
<script>
|
|
(function(i,s,o,g,r,a,m){i['GoogleAnalyticsObject']=r;i[r]=i[r]||function(){
|
|
(i[r].q=i[r].q||[]).push(arguments)},i[r].l=1*new Date();a=s.createElement(o),
|
|
m=s.getElementsByTagName(o)[0];a.async=1;a.src=g;m.parentNode.insertBefore(a,m)
|
|
})(window,document,'script','//www.google-analytics.com/analytics.js','ga');
|
|
|
|
ga('create', 'UA-75759936-1', 'auto');
|
|
ga(' set', 'anonymizeIp', true);
|
|
|
|
ga('send', 'pageview');
|
|
|
|
</script></head><body><!-- Google Tag Manager -->
|
|
<noscript><iframe src="//www.googletagmanager.com/ns.html?id=GTM-W4DST4"
|
|
height="0" width="0" style="display:none;visibility:hidden"></iframe></noscript>
|
|
<script>(function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':
|
|
new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],
|
|
j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src=
|
|
'//www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);
|
|
})(window,document,'script','dataLayer','GTM-W4DST4');</script>
|
|
<!-- End Google Tag Manager -->
|
|
<noscript>
|
|
Your browser doesn't support JavaScript. Please upgrade to a modern browser or enable JavaScript in your existing browser.
|
|
</noscript>
|
|
|
|
<!-- Page Header v2.0 -->
|
|
<a name="top" id="top"></a>
|
|
<!--Begin Banner CodeS-->
|
|
<div id="ahrqbanner">
|
|
<div class="hhsportion">
|
|
<a href="#h1" class="skipnav">Skip Navigation</a>
|
|
<a href="http://www.hhs.gov" title="U.S. Department of Health and Human Services">
|
|
<img src="/images/hhs_banner.gif" alt="U.S. Department of Health and Human Services" />
|
|
</a>
|
|
<a href="http://www.hhs.gov" title="www.hhs.gov" class="hhsright">
|
|
<img src="/images/hhs_link.gif" alt="www.hhs.gov" />
|
|
</a>
|
|
</div>
|
|
|
|
<div class="ahrqportion">
|
|
<a href="/" title="Archive: Agency for Healthcare Research Quality">
|
|
<img src="/images/ahrq_banner.gif" alt="Agency for Healthcare Research Quality" />
|
|
</a><form name="searchForm" method="get" action="https://search.ahrq.gov/search" id="banner_searchform">
|
|
<label for="search" style="z-index:-1;position:relative;margin-right:-65px; font-size:0px;">Search</label>
|
|
<input name="q" type="text" value=" Search Archive" size="11" onfocus="this.value='';" class="gotext" label="Search archive" id="search" />
|
|
<input type="hidden" name="entqr" value="0" />
|
|
<input type="hidden" name="output" value="xml_no_dtd" />
|
|
<input type="hidden" name="proxystylesheet" value="ARCHIVE_Front_End" />
|
|
<input type="hidden" name="client" value="ARCHIVE_Front_End" />
|
|
<input type="hidden" name="site" value="ARCHIVE_AHRQ_GOV" />
|
|
<input src="/images/topbn_GoButton.gif" class="gobtn" name="Submit" onclick="javascript:document.searchForm.submit();" type="image" alt="Search" />
|
|
</form>
|
|
<a href="https://www.ahrq.gov/" class="ahrqright">www.ahrq.gov</a>
|
|
</div><div class="ahrqlinks"><a href="https://www.ahrq.gov/">AHRQ Home—Live Site</a> | <a href="/">Archive Home</a> | <a href="/sitemap.htm">Site Map</a> <!-- | <img src="/images/envelope1.jpg" alt="" width="21" height="14" /><a href="https://subscriptions.ahrq.gov/service/multi_subscribe.html?code=USAHRQ">E-mail Updates</a> --></div>
|
|
</div>
|
|
<div id="PrintBanner">
|
|
<img src="/images/printbanner_arch.jpg" alt="Archive print banner" />
|
|
</div>
|
|
<a name="h1"></a>
|
|
<!-- End banner code -->
|
|
<!-- End of Page header -->
|
|
|
|
<!-- Content Body -->
|
|
<div id="mainContent">
|
|
<table width="100%" border="0" cellspacing="0" cellpadding="0" >
|
|
<tr valign="top">
|
|
<td width="70%">
|
|
<!-- Center Content section -->
|
|
<table width="100%" border="0" cellpadding="0" cellspacing="0" style="margin-left:10px; margin-right:10px;margin-top:5px" summary="This table gives the layout format of the bread crumb area and the center content area.">
|
|
<!--DWLayoutTable-->
|
|
<tr>
|
|
<td class="crumb_link"><div id="crumbContent">
|
|
<p><strong>You Are Here:</strong> <span class="crumb_link"><a href="/" class="crumb_link">AHRQ Archive Home</a> > <a href="/research/resarch.htm" class="crumb_link"><em>Research Activities</em> Archive</a> > <a href="." class="crumb_link">March 1999</a>
|
|
</span></p>
|
|
</div>
|
|
</td>
|
|
</tr>
|
|
<tr>
|
|
<td><h1><a name="h1" id="h1"></a> Outcomes/Effectiveness Research</h1>
|
|
</td>
|
|
</tr>
|
|
<tr>
|
|
<td><div id="centerContent"><div class="headnote">
|
|
<p>This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: <a href="https://info.ahrq.gov/">https://info.ahrq.gov</a>. Let us know the nature of the problem, the Web address of what you want, and your contact information. </p>
|
|
|
|
|
|
<p>Please go to <a href="https://www.ahrq.gov/">www.ahrq.gov</a> for current information.</p></div>
|
|
<a name="head1"></a><h2>Low Birthweight PORT publishes recent findings</h2>
|
|
<p>The Low Birthweight in Minority and High-Risk Women Patient Outcomes Research Team (PORT) was supported by the Agency for Health Care Policy and Research (PORT contract 290-92-0055) to examine the factors contributing to low birthweight, particularly among low-income black women who are at increased risk for delivering low birthweight babies. In addition, PORT researchers studied practices aimed at preventing low birthweight and its major sequelae. Led by Robert L. Goldenberg, M.D., of the University of Alabama at Birmingham, the researchers recently published three studies, as well as the PORT final report. All are summarized here.</p><p>
|
|
The first study demonstrates success with a five-step approach to increase doctors' use of corticosteroids, which are known to improve outcomes in preterm babies. The second study recommends that the routine screening of pregnant women for thrombocytopenia be discontinued. The third study concludes that maternal serum levels of metalloproteinase-9 do not appear to predict spontaneous preterm birth.</p><p>
|
|
<strong>Leviton, L.C., Goldenberg, R.L., Baker, C.S., and others (January 1999). "Methods to encourage the use of antenatal corticosteroid therapy for fetal maturation. A randomized controlled trial." <em>Journal of the American Medical Association</em> 281(1), 46-52.</strong></p><p>
|
|
A multipart intervention to improve the quality of care that physicians give to pregnant women has been successful and shows promise of decreasing infant mortality and disability in preterm infants. The goal of the intervention was to increase the appropriate use of corticosteroids, which when given prior to a preterm birth can reduce the risk of complications. According to Dr. Goldenberg and colleagues, this intervention resulted in a 33 percent increase in the use of corticosteroids.</p><p>
|
|
The study focused on minority and other high-risk women who tend to deliver preterm babies because of poor pregnancy weight gain, low prepregnancy weight, and other related lifestyle issues. Corticosteroid use is known to be one of the most effective ways to improve the outcomes of babies born preterm and reduce infant mortality and disability in preterm babies.</p><p>
|
|
The AHCPR Low Birthweight PORT researchers used a five-step intervention to increase doctors' use of corticosteroids. The quality improvement program included enlisting local medical opinion leaders to encourage doctors to administer corticosteroids, lectures for doctors on corticosteroids, reminders in medical charts to use them, regular discussions with doctors on the various preterm scenarios, and ongoing feedback on their use of corticosteroids.</p><p>
|
|
Although a National Institutes of Health Consensus Conference and several medical societies have endorsed the use of corticosteroids to reduce the complications of preterm delivery, this treatment continues to be underused by the medical community. According to the researchers, the reasons for this low use include the fact that many obstetricians underestimate the benefits of corticosteroids, and hospital obstetrical practices for preterm labor do not always allow for the most optimal timing of corticosteroid administration.</p><p>
|
|
<strong>Rouse, D.J., Owen, J., and Goldenberg, R.L. (1998). "Routine maternal platelet count: An assessment of a technologically driven screening practice." American Journal of Obstetrics and Gynecology 179, pp. 573-576.</strong></p><p>
|
|
Routine screening of pregnant women for thrombocytopenia—or a low blood platelet count—a cause of bleeding disorders, should be discontinued. This practice fails to meet established pregnancy screening criteria. Also, it may actually be harmful because it may place unaffected fetuses of thrombocytopenic women and the women themselves at risk from invasive procedures. The researchers reviewed the literature to determine the potential for maternal thrombocytopenia screening to detect fetal thrombocytopenia and prevent fetal or neonatal mortality.</p><p>
|
|
Autoimmune thrombocytopenia occurs in about 2 in 1,000 pregnancies and is estimated to result in neonatal intracranial hemorrhage in about 2 in 100,000 births. Gestational thrombocytopenia, which occurs in 4 percent to 7 percent of pregnancies, is 40 to 70 times as prevalent in pregnancy as the autoimmune form, but it poses negligible risk to the fetus. What's more, maternal thrombocytopenia has been shown to be a relatively insensitive indicator of severe fetal thrombocytopenia. The positive predictive value of such a screening test, that is, its ability to predict an infant who will sustain an intracranial hemorrhage based on identifying mothers with the condition, is 0.1 percent, calculate the researchers.</p><p>
|
|
A maternal history of nongestational thrombocytopenia should identify nearly all of the about 2 in 1,000 women at presumed risk of delivering a severely thrombocytopenic infant. Also, women with gestational thrombocytopenia, which carries no risk to the fetus, may be diagnosed with autoimmune thrombocytopenia, and subjected needlessly to invasive diagnostic and therapeutic interventions such as cordocentesis and cesarean delivery. This screening test has an unacceptably high false-positive rate and is insensitive, that is, it fails to identify many at-risk fetuses, conclude the researchers.</p><p>
|
|
<strong>Tu, F.F., Goldenberg, R.L., Tamura, T., and others (1998). "Prenatal plasma matrix metalloproteinase-9 levels to predict spontaneous preterm birth." <em>Obstetrics and Gynecology</em> 92, pp. 446-449.</strong></p><p>
|
|
The ability to identify biomarkers that can predict the onset of preterm labor or premature rupture of membranes would be invaluable in designing a therapy to prevent these problems. The Low Birthweight PORT was hopeful that a zinc-dependent proteinase, plasma matrix metalloproteinase-9, might be such a marker. However, this study shows that although levels of this substance remain unchanged throughout pregnancy and then rise three-fold at the onset of spontaneous labor, levels obtained just prior to delivery do not appear to predict spontaneous preterm birth.</p><p>
|
|
The research team used an enzyme-linked immunosorbent assay to measure matrix metalloproteinase-9 levels in plasma samples from 35 nonpregnant women and in stored plasma samples obtained during a randomized trial of zinc supplementation in pregnant women. They then periodically sampled plasma levels of women who eventually delivered following spontaneous labor or premature rupture of membranes at 24 to 32 weeks, 33 to 36 weeks, and greater than 37 weeks.</p><p>
|
|
They found that plasma matrix metalloproteinase-9 levels averaged about 19 ng/mL from 19 weeks until 36 weeks and did not change significantly as the gestational age increased. This remained true regardless of whether women ultimately delivered at 24 to 32, 33 to 36, or after 37 weeks. Levels obtained prior to, but within 1 week of, presentation for delivery were not significantly different from those obtained earlier in pregnancy. Finally, levels for women in spontaneous labor were similar regardless of gestational age and were increased three-fold compared with those drawn at each prenatal visit.</p><p>
|
|
<strong><em>Low Birthweight in Minority and High-Risk Women Patient Outcomes Research Team. Final Report</em>. (AHCPR Publication No. 98-N005).</strong></p><p>
|
|
In this final report, the researchers provide detailed findings on topics such as bacterial vaginosis, preeclampsia and low-dose aspirin therapy, biochemical predictors of preterm birth, prevention-based findings, and neonatal intensive care. The report also includes an extensive cumulative bibliography. Key findings from the 5½-year PORT project are summarized for clinicians in a two-page clinical highlight which is available from the <a href="https://www.ahrq.gov/research/publications/order/order-research-activities.html">AHCPR Publication Clearinghouse</a> (AHCPR Publication No. 98-N005).</p><p>
|
|
A limited supply of free copies of the complete report (AHCPR Publication No. 99-N005) are available from AHCPR Publication Clearinghouse. Select to access online copies of the <a href="/clinic/lobrabs.htm">abstract</a>, <a href="/clinic/lobrbib1.htm">cumulative bibliography</a>, and the <a href="/clinic/lobrhigh.htm">clinical highlight</a>. </p>
|
|
|
|
<p class="size2"><a href=".">Return to Contents</a><br />
|
|
<a href="ra9.htm">Proceed to Next Article</a></p>
|
|
<div class="footnote">
|
|
<p> The information on this page is archived and provided for reference purposes only.</p></div>
|
|
<p> </p>
|
|
</div>
|
|
</td>
|
|
</tr>
|
|
</table>
|
|
<!-- End of Center Content section -->
|
|
</td>
|
|
</tr>
|
|
</table>
|
|
</div>
|
|
<!-- End of Content Body -->
|
|
<!-- Footer graphic 1.2-->
|
|
<table cellspacing="0" cellpadding="0" border="0" width="100%">
|
|
<tr>
|
|
<td width="125" background="/images/bottom_ahrq_bkg.jpg"><img src="/images/bottom_ahrq_1.jpg" width="125" alt="AHRQ" /></td>
|
|
<td width="100%" background="/images/bottom_ahrq_bkg.jpg" ><img src="/images/bottom_ahrq_bkg.jpg" width="10" height="34" alt="" /></td>
|
|
|
|
<td width="310" background="/images/bottom_ahrq_bkg.jpg"><img src="/images/bottom_ahrq_2.gif" alt="Advancing Excellence in Health Care" width="310" height="34" /></td>
|
|
</tr>
|
|
</table>
|
|
<!-- Footer links section -->
|
|
<div id="banner_Footer2"><p> <a href="https://www.ahrq.gov/">AHRQ Home</a> | <a href="https://info.ahrq.gov" class="footer_navlink">Questions?</a> | <a href="https://www.ahrq.gov/contact/index.html" class="footer_navlink">Contact AHRQ</a> | <a href="https://www.ahrq.gov/sitemap.html" class="footer_navlink">Site Map</a> | <a href="https://www.ahrq.gov/policy/electronic/accessibility/index.html" class="footer_navlink">Accessibility</a> | <a href="https://www.ahrq.gov/policy/electronic/privacy/index.html" class="footer_navlink">Privacy
|
|
Policy</a> | <a href="https://www.ahrq.gov/policy/foia/index.html" class="footer_navlink">Freedom of Information Act</a> | <a href="https://www.ahrq.gov/policy/electronic/disclaimers/index.html" class="footer_navlink">Disclaimers</a> | <a href="http://www.hhs.gov/open/recordsandreports/plainwritingact/index.html" class="footer_navlink">Plain Writing Act</a> <br />
|
|
|
|
<a href="http://www.hhs.gov" class="footer_navlink">U.S. Department of Health & Human Services</a> | <a href="http://www.whitehouse.gov" class="footer_navlink">The White House</a> | <a href="http://www.usa.gov" class="footer_navlink">USA.gov: The U.S. Government's Official Web Portal</a></p>
|
|
</div>
|
|
<div id="banner_Footeraddress"><p>Agency for Healthcare Research and Quality <img src="/images/bottom_dot.gif" alt="" /> 5600 Fishers Lane Rockville, MD 20857 <img src="/images/bottom_dot.gif" alt="" /> Telephone: (301) 427-1364</p></div>
|
|
|
|
<!-- End of Footer links section -->
|
|
</body>
|
|
</html> |