OBJECTIVE: A study was conducted to evaluate the safety and efficacy of 3 different doses of synthetic conjugated estrogens B, a new plant-derived 10-component conjugated estrogens product, for the treatment of menopausal vasomotor symptoms. METHODS: This was a randomized, double-blind, placebo-controlled trial. Highly symptomatic menopausal women (N = 281) received 12 weeks of a once-daily oral treatment with 0.3 mg, 0.625 mg, or 1.25 mg of 10-component synthetic conjugated estrogen or placebo. Patients recorded the daily frequency and severity of hot flushes. Statistical analyses compared results at weeks 4, 8, and 12 with baseline values. RESULTS: Statistically significant reductions (P < .05) in the frequency and severity of vasomotor symptoms were observed for all 3 dosage strengths of 10-component synthetic conjugated estrogen compared with placebo. The most commonly reported adverse events in all treatment groups were headaches. No difference in the incidence of treatment-related adverse events was seen between placebo and 10-component synthetic conjugated estrogen groups. CONCLUSION: The 0.3-mg, 0.625-mg and 1.25-mg dose strengths of 10-component synthetic conjugated estrogen significantly reduced the frequency and severity of vasomotor symptoms compared with placebo, and were well tolerated during this 12-week study. LEVEL OF EVIDENCE: I

OBJECTIVE:Our purpose was to determine the relation to infant birth weight of maternal fat and lean tissue during early and late pregnancy.DESIGN:Total and net maternal pregnancy weight, fat, and water were determined from measurements of total body water, body density, and bone mineral mass in 200 women, with the use of a multicompartment model for body fat estimation in early and late pregnancy. Regression modeling was used to determine the relation of maternal body composition to birth weight, with control for maternal age, height, parity, and race and for infant gestational age and sex.RESULTS:Maternal weight and body water at term were significantly associated with infant birth weight, but maternal body fat at term was not. These relations remained when maternal net values were used for weight, fat, and water to eliminate the contribution of the conceptus to these components.CONCLUSION:In well-nourished women delivering at term, maternal body fat near term does not contribute significantly to infant birth weight, but maternal body water does.

Anthropometric data from 200 pregnant women were used to estimate body fat at gestation weeks 14 and 37 and changes in body fat from week 14 to week 37 with four formulas from the literature. The resulting estimates were evaluated against the estimation of fat by a four-compartment model that determined fat from weight, total body water, bone mineral mass, and body density. The estimates of fat by existing anthropometric models were statistically different from those by the four-compartment model in both early and late pregnancy. Most importantly, the change in body fat estimated by the anthropometric models (all > 4 kg) was considerably higher than that estimated by the four-compartment model (3.3 kg). Two new anthropometric equations were developed, both of which used the four-compartment model as the reference method. The equation for predicting change in fat mass from week 14 to 37 of pregnancy was as follows: 0.77 (change in weight, kg)+ 0.07 (change in thigh skinfold thickness, mm)-6.13 (r2 = 0.73). The equation for determining fat (kg) at term was as follows: 0.40 (weight at week 37, kg)+ 0.16 (biceps skinfold thickness at week 37, mm) + 0.15 (thigh skinfold thickness at week 37, mm)-0.09 (wrist circumference at week 37. mm)+ 0.10 (prepregnancy weight.kg)-6.56 (r2 = 0.89). Both equations were derived on a randomly selected half of the total sample and validated on the remaining half. Both equations were found to be valid for use in studying pregnant women with different prepregnancy body mass indexes, different gestational weight gains, different ethnicities, and different socioeconomic status.

OBJECTIVE:To determine the fat deposited during pregnancy in women gaining according to recommendations of the Institute of Medicine and the relationship of weight gain to fat gain in women of different starting weights (classified by their body mass index). METHODS:A cohort study of healthy, nonsmoking women, 18-36 years of age, identified during prenatal visits at three hospital clinics and one birthing center in New York City. From a pool of 432 eligible volunteers who signed a consent form, body composition measurements were performed on 200 women at weeks 14 (+/-2) and 37+ of pregnancy, and bone mineral mass was measured at 2-4 weeks postpartum. Body fat was estimated with a model that used total body water, weight, and density and bone mineral mass. RESULTS:In women gaining as recommended by the Institute of Medicine, fat gains during pregnancy for women underweight, normal weight, overweight, or obese before pregnancy were 6.0 +/- 2.6 kg, 3.8 +/- 3.4 kg, 3.5 +/- 4.1 kg, and -0.6 +/- 4.6 kg, respectively. Higher weight gain increased fat gain. Body water gain was not different among the four prepregnancy weight groups. CONCLUSION:Recommended weight gain should not cause obesity in any weight group. Underweight women will normalize their body composition if they gain as recommended, whereas obese women will have little or no change in body fat. A majority of women do not gain as recommended during pregnancy.

OBJECTIVE:We tested the hypothesis that survival is highest for infants born in the same weight range whether mothers are adolescent or adult, comparing the weights at which infants of these mothers achieve lowest neonatal mortality. METHODS:The relationship between birth weight and neonatal mortality was studied in births to 16.4 million women using the National Center for Health Statistics 1983-1987 national linked birth/infant death data sets. Neonatal mortality rates were calculated for 500 g birth weight categories. Births for maternal ages < or = 15 years, 16 years, and 17 to 18 years were compared with births to adults 19 to 34 years of age, whites and blacks considered separately. The birth weight categories associated with minimum neonatal mortality and the weight range corresponding with greatest survival were determined for each age and racial group. RESULTS:Minimum neonatal mortality rates occurred at the same birth weights (3500 to 4499 g white and 3000 to 3999 g black) whether mothers of the infants were adolescents or adults. The most favorable range of birth weight, in which survival was greatest, commenced at 3000 g for all mothers, terminating at 3999 g for most black adolescents and black adults, 4499 g for most white adolescents, and 4999 g for white adults. Of infants born to mothers < or = 16 years old, 33% were lighter and 1.5% were heavier than the favorable birth weight range. CONCLUSION:The birth weight categories with minimum neonatal mortality and the birth weight range in which neonatal survival was greatest were comparable for infants of adolescents and adults. Lower birth weights, occurring more frequently in births to teenage mothers, were associated with higher neonatal mortality. Assisting adolescent mothers to bear infants with birth weights in the range corresponding with low neonatal mortality is an appropriate goal of clinical management.

In July 1990, new guidelines for nutrition during pregnancy were published by the National Academy of Sciences. The Subcommittee on Weight Gain During Pregnancy revised the weight gain recommended for pregnancy. During the process of developing new recommendations, the subcommittee considered several factors that might help to determine the appropriate weight gain for an individual pregnant woman. Some of these factors include demographic and biological changes that might influence the effect of weight gain. Clinical issues that must be considered in implementing the weight gain recommendations include the importance of accurate weight and height measurement, categorizing the woman's weight for height, determining rate of gain at different times during pregnancy, and evaluating the significance of deviations from the expected weight gain pattern. A review of prior studies reveals that body composition changes. which might be important to consider in conjunction with weight changes, have not been well studied. Data are presented from a current study that indicates the problems encountered if traditional methods of body composition measurement are used during pregnancy.

Objective: To determine whether weight increases permanently as a result of pregnancy and to explore the determinants of postpartum weight retention.Data sources: Articles from the literature on obesity, parity, and gestational and postpartum weight changes were identified through a literature search.Methods of study selection: Studies from the last decade that examined weight changes related to pregnancy or parity in developed countries were selected if they provided adequate information to allow useful comparisons to other studies.Data extraction and synthesis: Average gestational and postpartum weight changes and their range of variation were noted. Studies emphasizing information related to weight change were used to identify alternative explanations for weight changes often credited to pregnancy. Explanations consistent with data from all of the different kinds of studies were developed by synthesis of the varied reports.Conclusions: Aging is a major determinant of weight increases associated with parity in cross-sectional studies. Average weight increments are generally less than 1.5 kg (3 lb) during a single reproductive cycle (before pregnancy to 1 year postpartum), but obese women tend to have larger weight changes (both increases and decreases) than lower-weight women. Under-reporting of pre-pregnancy weight, particularly by overweight women, probably contributes to overestimation of weight gain during pregnancy and estimated retained weight. A small number of women increase weight greatly during a reproductive cycle. The studies do not prove that this is the result of the pregnancy per se. Some women gain weight postpartum, suggesting that lifestyle factors can be significant determinants of weight gain during a reproductive cycle. Preventive efforts targeted to the postpartum visit could be useful.

This paper discusses the literature dealing with breast-feeding in women with human immunodeficiency virus (HIV) infection. This review is used to develop a background for a quantitative assessment of factors determining whether breast-feeding or bottle-feeding will result in a lower overall mortality in areas of different HIV prevalence. An algebraic formula is presented that enables calculation of the mortality that would result in any population if the following variables are known or capable of estimation: portion of childbearing women infected with HIV, portion of newborns infected with HIV at birth, relative mortality of breast-fed and bottle-fed infants that are not HIV infected, and transmissibility of HIV during breast-feeding. The information available for estimating these variables is incomplete. Nevertheless, boundaries can be set for each variable, based on information obtained locally or from the literature, to aid in objective evaluation of the risks of promoting bottle-feeding or breast-feeding in populations with different risk characteristics. Consideration of these factors indicates that the benefits of breast-feeding over bottle-feeding can substantially outweigh any putative risk of HIV transmission during breast-feeding unless the prevalence of HIV infection is quite high or the difference in mortality of breast-fed and bottle-fed infants is very low.