MEDICAL NEWS TIPS

February 1997
Listed below are story ideas from the Johns Hopkins Medical Institutions. To pursue any of these stories, call the contact person listed.

ACADEMIC MEDICAL CENTERS MAY PROVIDE BETTER PRENATAL CARE

Inner-city women who develop diabetes during pregnancy are more likely to deliver healthy babies if they receive prenatal care from university clinics than from health maintenance organizations, a Johns Hopkins study suggests. The costs of prenatal care were about the same in both groups.

"More intensive monitoring of fetal growth and maternal blood-sugar control at the university clinic appeared to contribute to better fetal outcomes in women with pregnancies complicated by gestational diabetes mellitus," says Jessica Bienstock, M.D., lead author and an instructor in gynecology/obstetrics.

Researchers studied 85 women receiving care at Hopkins and 115 women who belonged to a managed care system between 1990 and 1996. Results show the Hopkins group had significantly more sonograms than the HMO patients, a greater percentage of patients who were frequently seen during their pregnancy, and a lower rate of third trimester fetal deaths (zero versus 5 percent).

For media inquiries only, contact John Cramer at (410)955-1534 or jcramer@welchlink.welch.jhu.edu.

MOTHERS' WEIGHT GAIN PLAYS CRUCIAL ROLE IN TWIN PREGNANCIES

Twins born to women who do not gain sufficient weight during weeks 20-28 of pregnancy may be at increased risk of being born prematurely and underweight, according to a study by Johns Hopkins and the universities of Michigan and Miami.

"Nutritional support during this important period of gestation may be particularly beneficial for women pregnant with twins," says Frank Witter, M.D., a co-author and an associate professor of gynecology/obstetrics at Hopkins.

Results of the study of 212 twin pregnancies show birthweight increased by nearly two ounces for each pound of maternal weight gain between weeks 20-28 of pregnancy, but only by about a third of an ounce for each pound of maternal weight gain between conception and 20 weeks and after 28 weeks.

In women with preeclampsia, each pound of maternal gain after 28 weeks reduced birthweight by two-thirds of an ounce. Smoking reduced birthweight by 2.6 ounces per week after 28 weeks. Sixteen percent of the women were underweight, 52 percent were normal weight and 32 percent were overweight. Twenty-five percent of the pregnancies were complicated by preeclampsia.

For media inquiries only, contact John Cramer at (410)955-1534 or jcramer@welchlink.welch.jhu.edu.

PREGNANT WOMEN WITH PRE-EXISTING HEART DISEASE MAY DELIVER SAFELY

Contrary to common medical opinion, women who have a heart disease called dilated cardiomyopathy before becoming pregnant may not be at high risk of sudden heart failure, a study including a Johns Hopkins researcher suggests.

But women who develop peripartum cardiomyopathy -- a higher-risk type of heart disease that occurs late in pregnancy or the first few months after delivery -- may have an increased risk of death, the results show.

Cardiomyopathy is any disease of the heart muscle that reduces its pumping ability. In dilated cardiomyopathy, heart muscle cell metabolism is abnormal for an unknown reason. Peripartum cardiomyopathy, like other types of cardiomyopathy, may be metabolic, infectious, nutritional, toxic, autoimmune, degenerative or of unknown cause.

Researchers compared 26 women, ages 15 to 45, with peripartum cardiomyopathy with 11 women with pre-existing dilated cardiomyopathy. Results show the peripartum cardiomyopathy group fared significantly worse, with three women dying and four undergoing heart transplants. In the pre-existing cardiomyopathy group, there were no deaths and no significant decline in heart function except for one woman who had a heart transplant after the pregnancy was terminated for genetic reasons. The babies born to both groups did well.

"Women with pre-existing dilated cardiomyopathy have traditionally been advised not to become pregnant or not to carry pregnancies to term, but this is largely based on studies of peripartum cardiomyopathy," says Urania Magriples, M.D., an assistant professor of gynecology/obstetrics at Hopkins who was the study's senior author while at Yale. "Peripartum cardiomyopathy is a sudden, rapidly evolving blow to the woman, but women with stable dilated cardiomyopathy generally do well in pregnancy."

For media inquiries only, contact John Cramer at (410)955-1534 or jcramer@welchlink.welch.jhu.edu.

HITTING VIRAL "HOMES" MAY HELP RESEARCHERS STOP INFECTIONS

Wade Gibson, Ph.D., inspects the "homes" of viruses--shells of protein that the viruses build for themselves when they're getting ready to infect new cells.

By poking and probing these homes as they take shape, Gibson, a Hopkins professor of pharmacology and molecular sciences, looks for weak spots where new drugs might be able to damage or block the building process and halt the spread of infection.

Gibson's group discovered assemblin, a protein used by cytomegalovirus (CMV) to put together its shell. CMV is a member of the herpes virus family and an important cause of human disease.

"CMV uses assemblin to put together a scaffold for building its protein shell," explains Gibson. "It also uses assemblin to cut the scaffold up and pull it out of the completed shell; this gives it room to put in the genetic material of the virus. If we can block the assembly or the cutting-up action, the virus would be stopped."

Gibson and his colleagues recently learned that CMV's version of assemblin has a unique structure. "This means there's a good chance scientists can develop a drug that will block CMV assemblin without side effects on any important human proteins," he explains.

For media inquiries only, contact Michael Purdy (410) 955-8725 or mpurdy@welchlink.welch.jhu.edu.

SECOND TRIAL OF NEW RAGWEED ALLERGY VACCINE ENCOURAGING

A new ragweed allergy vaccine can provide significant relief from the miseries of hayfever and can do it more quickly and with fewer injections than allergy shots, according to a new multicenter trial led by Johns Hopkins researchers.

Traditional allergy shots are water-based extracts of whole pollens, animal dander or dust--the materials a patient is allergic to, or allergens. In contrast, the vaccine, developed by Immulogic Pharmaceutical Corp., only contains specific parts of the allergen selected for their ability to favorably stimulate the immune system.

Unlike traditional ragweed shots, which have to start in January, injections of the vaccine don't have to start until July, a few weeks before the season starts. Two to four injections are given over two or three weeks, with injections ending two to three weeks before ragweed season.

"We've shown evidence of some clinical activity for the vaccine in a previous study in the 1995 ragweed season," says Peter Creticos, M.D., an associate professor of medicine and leader of several clinical trials of the vaccine. "This study, conducted during the 1996 ragweed season, conclusively shows relevant benefit for the patient, with a 31% reduction in symptoms and a 54% reduction in the need for supplemental medication versus the control group," he explains.

Further studies will examine whether fewer doses or lower doses of the vaccines create even greater benefits.

For media inquiries only, contact Michael Purdy (410) 955-8725 or mpurdy@welchlink.welch.jhu.edu.


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