Date:
Jan 01, 2001

The chances that a premature baby will survive depends on the cause for the premature labor and the degree of development of the infant; the latter is ascertained by its gestational age (age in uterus) and/or birth weight. Since gestational age can sometimes be uncertain, birth weight is often used as an index of development.1

The National Center for Health Statistics, a government agency, has reported that the 1st month mortality rate (rate of death per 1,000 live births) in 1997 was:

A normal pregnancy lasts about 40 weeks (gestational age) and the usual weight for a full term infant is about 7+ lbs. Babies are considered premature if they are born before 37 weeks or are less than 5 lbs. in weight. 24-26 weeks of age is considered the gray zone for survival; death generally occurs before hospital discharge if the baby is less than 24 weeks gestational age.

The rate of prematurity has increased steadily in the past 15 years due to factors such as multiple births, often a result of fertility enhancement; multiple births is an important risk factor for prematurity. One in nine babies, about 436,000 a year, are born prematurely.

The brain, heart and lungs are particularly prone to delayed development or injury in prematures. A study published in the New England Journal of Medicine in August 2000 found that severe disability is common among children born extremely premature. It said that more than half of children born at 25 weeks or less (40 weeks being normal) had severely delayed development when evaluated at 30 months of age; about 10% had severe neuromotor disability (C.P.) and 7% were blind.

Comment:

Gestational age and birth weight of the infant are among the most important indices of determining the survival of an infant and the probability of survival. With the steadily increasing number of premature and low-birth weight infants being born in this country–and surviving because of the skills of the neonatal team, the occurrence of new cases of cerebral palsy is steadily increasing. Thus, prevention of prematurity has become one of the major research objectives of our Foundation. We are focusing on why does prematurity occur: what are the characteristics (biological, medical, social, etc.) of mothers at high risk of premature delivery? How can premature delivery be prevented? How to protect the premature infants brain from damage? Networking with the National Institute of Health, the Centers for Disease Control and Prevention and with the medical research community, our Foundation is giving priority attention to these questions.

As an aside, it must be remembered that 60% of children who have cerebral palsy were NOT premature. Some of the factors that lead to their brain injury are similar to those that are involved in brain injury in the premature infant; others are not. We are also working to sort these out.

1 Information derived from a number of sources including the NEJM, the National Center for Health Statistics, USA Today and previous Research Fact Sheets.

UCP Research & Educational Foundation, January 2001

Date:
Oct 01, 2000

There are a number of risk factors that increase the probability of an infant being born with cerebral palsy; four major risk factors are prematurity, low birth weight, maternal infection and multiple births (twins, triplets, etc). The May 1997 Research Fact Sheet provides information available about the relationship between multiple births and cerebral palsy.

However, there is now additional knowledge about the methods being used for fertility enhancement, a major factor in causing multiple births. Since multiple births (sometimes referred to as a “multiple pregnancy”) often occurs in women who have participated in a fertility enhancement procedure, more attention is now being given to approaches that reduce the risk of a high order multiple pregnancy (3 or more infants). There are 2 common methods of fertility enhancement in common use: 1) induction of ovarian egg production by hormone stimulation. This procedure usually results in the release of many eggs and thus the high probability of multiple births and (2) the fertilization and then the implantation of fertilized eggs into a woman’s uterus (in vitro fertilization); sometimes the fertilized eggs are permitted to develop to the next stage before they are implanted. The insertion of two or more fertilized eggs is usually done to increase the probability of a successful pregnancy occurring. Of the two procedures, the more common at this time is the induction of multiple egg production by the use of hormonal stimulation.

In a study of 3347 consecutive treatments involving 1494 infertile woman in which ovarian stimulation by hormones was used, 441 pregnancies occurred; this included 88 sets of twins, 22 triplets, 10 quadruplets, 5 quintuplets and 2 sextuplets.1 The number of eggs available to sperm and the level of a female sex hormone in the blood are indicators of the risk of a multiple pregnancy. The age of the woman involved was also significant as a predictor of the risk of a multiple pregnancy; younger women being at higher risk of a multiple pregnancy.

The authors suggest that the current guidelines being used by physicians as to whom and what method is to be used may no longer be adequate for reducing the occurrence of high order multiple pregnancies. One approach to reducing the risk would be to decrease the amount of ovarian stimulating hormone being used. The problem is it would also decrease the success rate of resulting pregnancies. The authors also suggest that increased consideration be given to use of in-vitro fertilization, implanting only two embryos (fertilized eggs) into the uterus. Using modern techniques, this could result in pregnancy in up to 60% of participating women.

Comment:

The emotional situation related to a successful pregnancy and the financial costs involved for each time a fertility enhancement procedure is used are two very important factors that need to be considered when deciding upon the method to be used for fertility enhancement. On the other hand, consideration also needs to be given to the emotional burden and high economic costs of multiple births which can require special neo-natal care; in addition, the increased probability in multiple births of one or more infants having developmental brain damage (e.g. cerebral palsy) must also be considered.

A consensus has not been reached on modern criteria that need to be established for the choice of fertility enhancement techniques in different groups of women (e.g. age groups). However, this study and others are providing the data necessary to review the present guidelines and how they need to be revised. The methods for achieving a successful pregnancy, which would result in a single full term birth, two at the most, needs to be reevaluated regularly as new knowledge about fertility enhancement methodologies become available.

1 Gleicher, N. et al. Reducing the Risk of High-Order Multiple Pregnancy After Ovarian Stimulation With Gonadotropins. NEJM 2000; 343:2-7

UCP Research & Educational Foundation, October 2000

Date:
Apr 01, 2000

Research Fact Sheets report primarily on research findings published in scientific journals. However, two books have recently been published of importance to issues of brain development in infancy and early childhood that warrant inclusion in the Research Fact Sheet series.

A view has been advanced in the behavioral and educational science literatures that by providing children during the first three years of life with an “enriched” educational and social environment, improved intelligence and better social performance will result. The biological evidence which is offered in support of this view is that during the first three years of life, the cells of the developing brain are aggressively making new connections (synapses) in response to stimuli in the environment; also, these cells are more receptive to stimuli at this early time than they are later in life. Therefore, it is suggested that enriching the input into the developing brain of all children during very early life gives it more opportunity to learn and be better prepared for the tasks of later life.

Dr. Alison Gopnick and her co-authors, all prominent development psychologists, support this view.1 They propose that learning things in the right sequence is of critical importance for the development of intelligence and social behavior. They believe that the first three years of life are crucial because what is learned during these early years provides the basis for future learning. The richer the early experience in a newly developing brain, the better prepared is brain cell organization for future learning. The authors support their position by evidence from the scientific literature that: during the first three years of life there is a large growth of new connections (synapses) in the developing brain, with a pruning of unused connections later in life — presumably because they are not being used; the developing brain is more receptive and responsive to new experiences (is more “plastic”); and different areas of developing brain can become more connection “dense” following stimulation. Therefore, they conclude that increasing the stimulation of the developing brain will have positive results, which benefits the potential of all children.

Dr. John T. Bruer disagrees with the conclusions drawn from these data.2 He takes issue with “the myth of the first three years”, proposing that the scientific evidence does not support it. For example: most of the studies have been done in animals in which a normal environment was compared to a deprived environment; a normal environment was not compared to an enriched environment. He points out that the reported differences in brain structure and performance were due to deprivation rather than to enrichment. Thus, he states that there is no evidence to support the proposal that enriching a normal environment will have a beneficial effect in animals. He further emphasizes that it is a broad leap to assume similar results in humans.

Dr. Mark H. Johnson, a British behavioral scientist, comments in a review of these books.3 He suggests that most developmental biologists and psychologists (both are experts on the developing brain) would agree that the state of available knowledge does not provide the basis for making social and educational policy at this time. Rigorous research still needs to be done before meaningful conclusions can be obtained. He emphasizes that techniques are now available for studying the workings of the human child’s brain and can tell us a great deal more about human learning. Finally, he points out that it is unlikely that the usual environment is an ideal environment for maximal learning when the brain has previously been damaged (e.g. CP). He concludes that early diagnosis and an early program of special instruction may be of special value for the brain damaged child; but there is no evidence this is true in children without brain damage.

Comment:

We still do not know whether enriching the environment above usual during the first years of life is of significance to a child with a developmental disability due to brain injury or brain dysfunction; however, there is also no evidence it is harmful. We are still in the situation of intuitively feeling that an increase in the opportunity for physical activity, sensory stimulation and assistive learning will have important positive results in maximizing the opportunity of a child with an injured brain to learn and adapt better. As Dr. Johnson points out, we now have the research tools to gather the information necessary to be able to rely on facts rather than on intuition.

In summary, there continues to be controversy whether “enriching” the environment above “normal” adds anything of significance for the developing brain of a young child with no evidence of developmental brain injury. However, many experts believe it is probable that a selective enriched environment could be of importance to brain development for a young child who does have developmental brain injury. However, we really do not know. Modern research tools offer the possibility for answering the question. The need is for research, not for more debate.

1 Gopnick A. et al. Minds, Brains and How Children Learn. Morrow; New York 1999.
2 Bruer, JT. The Myth of the First Three Years; A New Understanding of Early Brain Development and Lifelong Learning. Free Press; New York 1999.
3 Johnson, M.H. Into the Minds of Babes. Science 5438: 247

UCP Research & Educational Foundation, April 2000

In the first trimester (3 mos) of pregnancy, the fetus is completely dependent upon the mother for thyroid hormone. During the second and final trimesters of pregnancy, most fetuses are able to provide some thyroid hormone but also continue to rely upon their mothers for some hormone. Problems of brain development occur when either the mother is unable to provide for the fetus’ needs in the first trimester, or neither the mother nor the fetus can provide for fetal needs during the remainder of pregnancy. Another important issue is the availability of iodine to the mother since iodine is an important requirement to provide for proper thyroid production by both the mother and the developing fetus.

Should all pregnant women routinely be evaluated for thyroid function early in pregnancy? The thyroid status of a large group of pregnant women and their offsprings were evaluated by the authors.1 In those women with low levels of thyroid hormone, the authors show that hypothyroidism (low thyroid function) adversely affects the child’s performance on tests of intelligence, language, reading ability and motor performance. This can be true even when the mother is presenting no symptoms. As a result of their study, the authors suggest that an evaluation of the mother’s thyroid function should become routine early in pregnancy for all women.

In an editorial in the same journal (pages 601-602), Dr. Robert D. Utiger raises questions about the cost/benefit effects of routine examination of thyroid function in all pregnant women. He suggests instead that since iodine is essential for thyroid hormone production, an adequate supply of iodine needs to be made available to all pregnant women. This is particularly true in that a common source of iodine in the U.S. diet is iodized table salt. With efforts to decrease the use of table salt in order to prevent high blood pressure, the consumption of iodine may no longer be adequate — particularly for pregnant women. He suggests iodine needs to be added to other foods and be included in all vitamin products as the first step to prevent developmental brain damage due to maternal hypothyroidism. Thus, he proposes that before a national program of routine thyroid function in pregnant women is initiated, an increased supply of iodine be added to vitamin products used by pregnant women.

Comment:

It has been recognized for a very long time that an adequate supply of thyroid hormone is essential for normal brain development. This is true during the entire period of pregnancy but it is particularly true in the last half of pregnancy and in the early years of infant life. Modest thyroid hormone insufficiency leads to cognitive inadequacies (e.g. learning disabilities); a large insufficiency leads also to neurological deficits — spasticity, poor balance and deafness. In women at risk of a troubled pregnancy, a thorough thyroid function evaluation early in pregnancy would certainly seem prudent. Also, an available source of iodine within the diet or by dietary supplements (e.g. iodine fortified vitamins) should be routine. In addition, attention needs to be given to the thyroid hormone status of the newborn infant; and in selected cases to the infant several weeks after birth to make certain the infant’s thyroid gland continues to function properly.

There are no longer any questions about the absolute requirement of thyroid hormone for adequate brain development. Both pregnant women and their physicians need to recognize this on the “check list” of things to consider to foster normal development of the developing brain.

In summary, a controversy continues to exist about whether all pregnant women should have their thyroid function routinely evaluated early in pregnancy; or, should only women who are “at risk” of poor thyroid function be evaluated? In any case, most experts agree that routinely an iodine supplement is a good idea.

1Haddow J.E. et al. Maternal Thyroid Deficiency During Pregnancy and Subsequent Neuropsychological Development of the Child NEJM 1999; 341:549-555

© UCP Research & Educational Foundation, February 2000

Date:
Jul 01, 1999

Infants born with extremely low birth weights (less than 2 lbs.) are at risk of chronic lung disease, infection and death. A significant proportion of these disorders and deaths have been associated with a Vitamin A deficiency; however, “associated with” does not necessarily mean “due to”. Extremely low birth weight infants generally have a low store of Vitamin A at birth; also after birth, they have low amounts of Vitamin A in their feedings and a poor absorption of Vitamin A from their digestive tract.

Would supplemental administration of Vitamin A to extremely low birth weight infants needing respiratory assistance increase their rate of survival without chronic lung disease and reduce the risk of sepsis (infection)? Also, would there be any undesirable side effects of the Vitamin A administration?

The results of a carefully designed clinical trial of the intramuscular injection of 5000 IU of Vitamin A three times a week for four weeks was recently published.1 The study results indicated a reduction in the biochemical (blood) evidence of Vitamin A deficiency and a 6% reduction in the occurrence of chronic lung disease. There was no protection against death and only a marginal beneficial effect in protecting against sepsis. There was no evidence of complications due to Vitamin A injection.

Comment:

The extremely low-birth weight infant has a multitude of problems in staying alive and also in surviving without serious damage. Two organs at great risk of damage are the lungs and the brain. Chronic lung disease is a major problem in surviving infants who often require respiratory assist devices for periods after birth. A low blood level of Vitamin A is often found in these infants and is believed to be a factor in poor lung development. However, there has been concern about using injections of Vitamin A because of the potential undesirable effects of too much of the Vitamin being given by injection (Vitamin A is a fat soluble vitamin and poorly excreted in the urine. Thus, Vitamin A toxicity due to too much Vitamin A could be an important problem if injected rather than taken orally.)

This trial evaluated both issues: benefits and toxicity. It showed that there was some benefit to lung development of Vitamin A injections and the dosage schedule that was used had no injurious side effects. Although a 6 % improvement in outcome is desirable, it is disappointing that there wasn’t an even better positive result. On the other hand, it did help some infants and will now be considered for the care of the extremely low birth weight infant.

The proper care of the very low birth weight infant is still a major medical problem. Neonatal care has come a long way in the past 10 years but even modern incubators and nutritional and drug administration are still no real substitute for the uterus. The necessary nutritional, hormonal and other materials supplied by means of the placenta are still only marginally understood for administration by available feedings and injections. A larger and larger proportion of very low birth weight infants are now able to survive, but their organs (e.g. lung; brain) are at great risk of under-development and injury. Remember, low birth weight continues to be among the most important risk factors for cerebral palsy. It is estimated that about 1/3 of very low birth weight infants are brain damaged.

Research to provide better care for the low birth weight infant is very important and needs to be encouraged vigorously and supported; however, the most important breakthrough will occur when we are able to prevent premature birth of low birth weight babies–one of the major goals of the UCP Foundation research program.

1 Tyson JE et al. Vitamin A Supplementation for Extremely Low-Birth-Weight Infants. NEJM 1999 340:1962-68

© UCP Research & Educational Foundation, July 1999

Date:
Jun 01, 1999

The Foundation has reported previously that vaginal infection in the pregnant woman is an important factor that can lead to intrauterine infection. Also, that intrauterine infection may be important as a cause of premature labor. Finally, premature labor resulting in low birth weight infants is associated with the occurrence of cerebral palsy. Thus, vaginal infection might be a significant factor in the development of cerebral palsy.

Two studies have recently been published that address these issues:

Treatment of Vaginal Infection to Prevent Premature Delivery Dr. M. Klebanoff and his colleagues have published the results of a nationwide study [1] to learn whether treatment of a bacterial vaginal infection in pregnant women with no symptoms of illness, prevents premature delivery. The reason for the study is the belief that bacterial infection of the vagina is an important “risk factor” for premature delivery. Thus, would treatment of the infection prevent premature delivery? The answer from this study is “no”, it does not. Although the treatment (an antibiotic) did eliminate the vaginal infection, it did not prevent premature delivery. It was an excellent study. The only meaningful criticism is whether the treatment was started early enough in pregnancy to prevent the effects of infection as a contributor to premature labor.

Comment:

There is evidence of an association between the presence of non-symptomatic maternal vaginal infection and the occurrence of premature labor. However, is this a cause and effect relationship? Or are they unrelated? Or are both due to another factor common to both? One way of learning about this is to treat the infection and see if it has an effect on the occurrence of premature labor. These investigators did that and found it did not have an effect. This result raises the question does non-symptomatic infection of the vagina become important only when it is present with some other factor also present in pregnant women? To answer this question will take a study of a very large group of pregnant women. Research to answer that question is now being planned in Scandinavia.

Evidence of Intrauterine Infection Associated with Cerebral Palsy A second study addresses the question: is the presence of signs of inflammation in amniotic fluid (the fluid surrounding the fetus) associated with the occurrence of cerebral palsy? Dr. B.H. Yoon and his colleagues report[2] in a study of 104 newborns followed to the age of 3 that the evidence of signs of inflammation in the amniotic fluid is a significant finding in cerebral palsy. Comment: The results of this study are important in two ways: it helps identify an important process in pregnancy that is related to cerebral palsy (signs of inflammation found in the amniotic fluid); it also indicates that a method is available prior to delivery for evaluating the risk of the fetus developing cerebral palsy. It also raises the possibility of detecting inflammation early enough to treat the cause of the inflammation and prevent cerebral palsy. The practical problem is: whom to test? The testing procedure carries a small, but present risk. Testing every pregnant woman routinely would be impractical. Thus, the approach will probably be the identification of pregnant women at risk of having signs of inflammation in the amniotic fluid and testing those women. If the test is positive, then a detailed examination would be initiated to find the site and source of the inflammation and treat it. The objective of the treatment is both the health of the mother and the prevention of brain damage to the fetus. Remember, 70% of cerebral palsy is due to threats to the fetal brain prior to delivery. Early removal of the cause of inflammation should significantly lessen the probability of fetal brain damage. We now need to develop the criteria for periodic testing of high-risk pregnant women and learn whether early treatment of inflammation prevents developmental brain damage.

American Journal of Obstetrics and Gynecology 1999; 180:S2
American Journal of Obstetrics and Gynecology 1998:177:19

Date:
Sep 01, 1998

There is a steady increase in the survival rate of infants born very prematurely and who are discharged home before achieving full term age. A number of neurological evaluations are available to help identify full term infants and young children who either already show signs of or are suspect of developing a motor dysfunction such as cerebral palsy. However, similar examination of premature infants which reliably predicts future motor dysfunction has not been available. A recent study has been published by a team of Australian investigators that was designed to assess the usefulness of an observational neurological examination of premature infants in an intensive care neonatal nursery.

Because of the frailness of the premature infant and the confined environment in which the infant lives, observations were standardized that were reliable and practical under these conditions. The infants were tested in the neonatal nursery and then examined at age six to evaluate the efficacy of the observations for predicting motor dysfunction. The observations of the premature infants which were used are: course jitters; an asymmetrical neck reflex; stereotypical repetitive movements; and hypertonia. These were done under standardized conditions. The six month evaluation was a generally accepted evaluation of motor function. Of eleven (11) children who were diagnosed as having cerebral palsy, by age six, nine (9) had been recognized in the neonatal premature nursery as being suspect. Thus, the success of an early examination to predict cerebral palsy was very high (82%) utilizing this evaluation method.

Comment:

The need is obvious to be able to predict as early as possible with a reasonably high degree of certainty the future onset of the symptoms of cerebral palsy. Tests are available that are generally useful for full term infants and during the first two years of life. However, testing of the very premature infant has been less than satisfactory. The evaluation method developed by these authors appears to be useful in meeting this need. Having this information will provide the basis for giving priority to this group of infants to have focused assessments during early development and for being identified early for intervention services.

© UCP Research & Educational Foundation, September 1998

Date:
Mar 01, 1998

Severe and prolonged loss of oxygen (severe hypoxia) to the infant during delivery can cause or contribute to brain damage and to physical and cognitive difficulties.

When there is a modest loss of oxygen (mild hypoxia) for an extended period, the consequences are less understood. If the infant with a mild degree of oxygen deprivation demonstrates no evidence of brain damage at birth and/or during the first year of life, does that mean the child will not show evidence of brain damage as it grows older (e.g.: when he/she enters school)?

A pediatric research group in Canada has studied this question in full term infants (they used full term infants to avoid the complicating issue of prematurity).1 They compared the motor skills, cognitive developed memory and child behavior of two groups of children at age 4, and then again at 6-8 years of age. One group had experienced mild oxygen deprivation during delivery but no immediate evidence of brain damage; the other group had no bio-chemical or clinical evidence of hypoxia. The two groups were otherwise similar (“matched”).

When examined at 6-8 years of age, there were no differences in performance between the two groups. Mild hypoxia did not result in performance deficits or signs of developmental brain damage in full term infants when compared to the group which did not experience mild hypoxia.

Comment:

It has been suggested that while mild oxygen deprivation during delivery does not usually result in immediate loss of brain function, there might be a modest loss of function as the child matures. This study indicates that this is probably not true. Brain injured children can certainly demonstrate difficulties in motor performance or in cognitive abilities for the first time at school age even though there was no overt evidence of such during infancy or early childhood; however, these difficulties are probably not due primarily to mild hypoxia during the birthing process. The causes for delayed evidence of difficulties probably occurred during infancy or childhood, sometimes because of a pre-existing sensitivity to brain injury due to intrauterine factors.

1 Handley-Derry, M., et al. Intrapartum Fetal Asphyxia and the Occurrence of Minor Deficits in 4 and 8 Year Old Children. Developmental Medicine and Child Neurology (1997); 39: 508-511.

© UCP Research & Educational Foundation, March 1998

Date:
Jan 01, 1998

Should women taking medication for depression discontinue the medication during pregnancy in order to protect the developing fetus?

Between 8-20% of women are reported to have depression at some time during their lives. It occurs most often during childbearing years and often requires drug therapy. The drugs commonly used for the treatment of depression cross the placenta and enter the circulation of the fetus. The fetal brain develops throughout pregnancy but is believed to be most vulnerable to drug-induced malformation during the first trimester.

Thus the dilemma: maternal well being may require the continuation of anti-depressant drug therapy during pregnancy. What effect will continuation of anti-depressant drugs have on fetal brain development?

A research study done in Canada explored this question.1 The investigators found that two commonly used anti-depressant drugs taken by the mother had no detrimental effects on their children’s intelligence, language or behavioral development as measured during preschool years.

Comment:

All substances used by a pregnant woman must be assumed to enter the circulation of the developing fetus: food; liquid; alcohol; tobacco; drugs; etc. In general, all authorities agree that non-food substances other than physician recommended vitamin supplements should be avoided. However, pregnant women do have illnesses that require medications for the maintenance of their physical and mental health. In all instances, the use of these medications taken during pregnancy need to be carefully monitored by the woman’s physician. In the use of selected anti-depressants, the present study indicates they have no recognized ill-effect on the developing fetal brain and can be continued. It must be emphasized that the present study only investigated the effects of two common types of anti-depressants. The results cannot be broadened to include effects of other medications.

1 Nulman, I.et al. Neurodevelopment of Children in Utero to Antidepressant Drugs. NEJM 336:4; 458-262

© UCP Research & Educational Foundation, January 1998

Date:
Dec 01, 1997

Pre-eclampsia is a serious problem complicating pregnancy, particularly in the second trimester. It is a major reason for prenatal care since it can cause serious illness and even death of the mother as well as premature birth and disorders of the infant.

Pre-eclampsia can develop without warning. It’s symptoms are dangerously high blood pressure and protein in the urine. If it is not treated promptly it can progress to eclampsia which is characterized by convulsions, kidney failure and can cause death. Early recognition and treatment of pre-eclampsia is essential to prevent eclampsia and protect the life of the mother and the fetus. A study reported in the April 1997 issue of the Journal of Clinical Investigation by Dr. Susan Fisher and colleagues at the University of California in San Francisco, provides important information about the biology of pre-eclampsia. The study demonstrates that pre-eclampsia is the result of a defect in the placenta, the critical interface between the mother and fetus. It is caused by a failure of cells of the placenta to invade the uterus wall deeply enough to permit the necessary exchange of blood and blood constituents between the mother and the fetus.

At this time there are still no effective methods for preventing pre-eclampsia. Risk factors include a genetic component, pregnancy with twins, pre-existing high blood pressure, diabetes and having had pre-eclampsia previously. It occurs most frequently during first pregnancies and in women under age 20 or over age 35.

The occurrence of cerebral palsy in infants whose mothers have pre-eclampsia is lower than in the general population of pregnancies. The reason(s) is unknown but may be related to the effect of the treatment of the pre-eclamptic mother (often includes magnesium sulfate).

Pre-eclampsia is one of the most serious problems of pregnancy. It must be diagnosed promptly and treated in order to prevent eclampsia. Now that the biology of pre-eclampsia is becoming more clear, the development of an early test and treatment of the cause rather than the effects is closer at hand.

© UCP Research & Educational Foundation, December 1997