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Small for gestational age (SGA) and fetal growth restriction (FGR)

Drs Zhang, Merialdi, Platt, and Kramer have provided readers of the American Journal of Obstetrics and Gynecology with a benchmark article, one that should be read and taken to heart by all who care for pregnant women and newborn infants. In this review, they shine a clarifying light on 3 decades of increasing confusion in the language and concepts that are used to describe fetuses and infants who are, or are suspected of being, small. Once upon a time, there were 3 categories that were defined by percentiles of growth that encompassed the entire population of newborn infants: (1) infants with birthweights <10th percentile, called small for gestational age (SGA); (2) infants with birthweights from 10th to 90th percentile, called appropriate for gestational age, and (3) infants with birthweights of >90th percentile, called large for gestational age (LGA).

A decrease in maternal plasma concentrations of sVEGFR-2 precedes the clinical diagnosis of preeclampsia

Objective: The aim of this study was to examine if maternal plasma concentrations of soluble vascular endothelial growth factor receptor (sVEGFR)-2 change prior to the diagnosis of preeclampsia.Study Design: A longitudinal study was conducted in normal pregnant women (n = 160) and patients with preeclampsia (n = 40). Blood samples were collected at 7 gestational age intervals from 6 weeks to term. Plasma concentrations of sVEGFR-2 were determined by enzyme-linked immunosorbent assay. Analysis was performed with cross-sectional and longitudinal (mixed effects model) approaches.Results: Mothers destined to develop preeclampsia have lower plasma sVEGFR-2 concentrations than those who will have a normal pregnancy (longitudinal approach; P < .05). Cross-sectional analysis suggested that the median plasma sVEGFR-2 concentration in women destined to develop preeclampsia was significantly lower than that in normal pregnant women from 28-31 weeks of gestation (P = .001) or 6-10 weeks prior to the diagnosis (P < .001).Conclusion: A lower maternal plasma sVEGFR-2 concentration precedes the development of preeclampsia, both term and preterm.

Differences in continence system between community-dwelling black and white women with and without urinary incontinence in the EPI study

Objective: We sought to compare continence system function of black and white women in a population-based sample.Study Design: As part of a cross-sectional population-based study, black and white women ages 35-64 years were invited to have pelvic floor testing to achieve prespecified groups of women with and without urinary incontinence. We analyzed data collected from 335 women classified as continent (n = 137) and stress (n = 102) and urge (n = 96) incontinent based on full bladder stress test and symptoms. Continence system functions were compared across racial and continence groups.Results: Comparing black to white women, maximal urethral closure pressure (MUCP) was 22% higher in blacks than whites (68.0 vs 55.8 cm H2O, P < .0001). White and black women with stress incontinence had MUCP 19% and 23% lower than continent women. MUCP in urge incontinent white women was as low as stress incontinent whites, but blacks with urge had normal urethral function.Conclusion: Black women have higher urethral closure pressures than white women. White women with urge incontinence, but not black women, have reduced MUCP.